[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Engrossed Amendment House (EAH)]
In the House of Representatives, U. S.,
September 18, 1995.
Resolved, That the bill from the Senate (S. 641) entitled ``An Act to
reauthorize the Ryan White CARE Act of 1990, and for other purposes'', do pass
with the following
AMENDMENTS:
Strike out all after the enacting clause, and insert:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ryan White CARE Act Amendments of
1995''.
SEC. 2. REFERENCES.
Whenever in this Act an amendment is expressed in terms of an
amendment to a section or other provision, the reference shall be
considered to be made to that section or other provision of the Public
Health Service Act (42 U.S.C. 201 et seq.).
TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES
SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS.
(a) Number of Cases; Delayed Applicability.--Effective October 1,
1996, section 2601(a) (42 U.S.C. 300ff-11) is amended--
(1) by striking ``subject to subsection (b)'' and inserting
``subject to subsections (b) through (d)''; and
(2) by striking ``metropolitan area'' and all that follows
and inserting the following: ``metropolitan area for which
there has been reported to the Director of the Centers for
Disease Control and Prevention a cumulative total of more than
2,000 cases of acquired immune deficiency syndrome for the most
recent period of five calendar years for which such data are
available.''.
(b) Other Provisions Regarding Eligibility.--Section 2601 (42
U.S.C. 300ff-11) is amended by adding at the end thereof the following
subsections:
``(c) Requirements Regarding Population.--
``(1) Number of individuals.--
``(A) In general.--Except as provided in
subparagraph (B), the Secretary may not make a grant
under this section for a metropolitan area unless the
area has a population of 500,000 or more individuals.
``(B) Limitation.--Subparagraph (A) does not apply
to any metropolitan area that was an eligible area
under this part for fiscal year 1995 or any prior
fiscal year.
``(2) Geographic boundaries.--For purposes of eligibility
under this part, the boundaries of each metropolitan area are
the boundaries that were in effect for the area for fiscal year
1994.
``(d) Continued Status as Eligible Area.--Notwithstanding any other
provision of this section, a metropolitan area that was an eligible
area under this part for fiscal year 1996 is an eligible area for
fiscal year 1997 and each subsequent fiscal year.''.
(c) Conforming Amendment Regarding Definition of Eligible Area.--
Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by striking ``The
term'' and all that follows and inserting the following: ``The term
`eligible area' means a metropolitan area meeting the requirements of
section 2601 that are applicable to the area.''.
SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.
(a) Establishment.--Section 2602(b)(1) (42 U.S.C. 300ff-12(b)(1))
is amended--
(1) in subparagraph (A), by inserting before the semicolon
the following: ``, including federally qualified health
centers'';
(2) in subparagraph (D), by inserting before the semicolon
the following: ``and providers of services regarding substance
abuse'';
(3) in subparagraph (G), by inserting before the semicolon
the following: ``and historically underserved groups and
subpopulations'';
(4) in subparagraph (I), by inserting before the semicolon
the following: ``, including the State medicaid agency and the
agency administering the program under part B'';
(5) in subparagraph (J), by striking ``and'' after the
semicolon;
(6) by striking subparagraph (K); and
(7) by adding at the end the following subparagraphs:
``(K) grantees under section 2671, or, if none are
operating in the area, representatives of organizations
in the area with a history of serving children, youth,
women, and families living with HIV; and
``(L) grantees under other HIV-related Federal
programs.''.
(b) Duties.--Section 2602(b)(3) (42 U.S.C. 300ff-12(b)(3)) is
amended--
(1) by striking ``The planning'' in the matter preceding
subparagraph (A) and all that follows through the semicolon at
the end of subparagraph (A) and inserting the following: ``The
planning council under paragraph (1) shall carry out the
following:
``(A) Establish priorities for the allocation of
funds within the eligible area based on the following
factors:
``(i) Documented needs of the HIV-infected
population.
``(ii) Cost and outcome effectiveness of
proposed strategies and interventions, to the
extent that such data are reasonably available.
``(iii) Priorities of the HIV-infected
communities for which the services are
intended.
``(iv) Availability of other governmental
and nongovernmental resources.'';
(2) in subparagraph (B)--
(A) by striking ``develop'' and inserting
``Develop''; and
(B) by striking ``; and'' and inserting a period;
(3) in subparagraph (C)--
(A) by striking ``assess'' and inserting
``Assess'';
(B) by striking ``rapidly''; and
(C) by inserting before the period the following:
``, and assess the effectiveness, either directly or
through contractual arrangements, of the services
offered in meeting the identified needs''; and
(4) by adding at the end the following subparagraphs:
``(D) Participate in the development of the
statewide coordinated statement of need initiated by
the State health department (where it has been so
initiated).
``(E) Obtain input on community needs through
conducting public meetings.''.
(c) General Provisions.--Section 2602(b) (42 U.S.C. 300ff-12(b)) is
amended by adding at the end the following paragraph:
``(4) General provisions.--
``(A) Composition of council.--The planning council
under paragraph (1) shall (in addition to requirements
under such paragraph) reflect in its composition the
demographics of the epidemic in the eligible area
involved, with particular consideration given to
disproportionately affected and historically
underserved groups and subpopulations. Nominations for
membership on the council shall be identified through
an open process, and candidates shall be selected based
on locally delineated and publicized criteria. Such
criteria shall include a conflict-of-interest standard
for each nominee.
``(B) Conflicts of interest.--
``(i) The planning council under paragraph
(1) may not be directly involved in the
administration of a grant under section
2601(a). With respect to compliance with the
preceding sentence, the planning council may
not designate (or otherwise be involved in the
selection of) particular entities as recipients
of any of the amounts provided in the grant.
``(ii) An individual may serve on the
planning council under paragraph (1) only if
the individual agrees to comply with the
following:
``(I) If the individual has a
financial interest in an entity, and
such entity is seeking amounts from a
grant under section 2601(a), the
individual will not, with respect to
the purpose for which the entity seeks
such amounts, participate (directly or
in an advisory capacity) in the process
of selecting entities to receive such
amounts for such purpose.
``(II) In the case of a public or
private entity of which the individual
is an employee, or a public or private
organization of which the individual is
a member, the individual will not
participate (directly or in an advisory
capacity) in the process of making any
decision that relates to the
expenditure of a grant under section
2601(a) for such entity or organization
or that otherwise directly affects the
entity or organization.''.
SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.
(a) Formula Grants Based on Relative Need of Areas.--Section
2603(a) (42 U.S.C. 300ff-13(a)) is amended--
(1) in paragraph (1)--
(A) in the second sentence, by inserting ``,
subject to paragraph (4)'' before the period; and
(B) by adding at the end the following sentence:
``Grants under this paragraph for a fiscal year shall
be disbursed not later than 60 days after the date on
which amounts appropriated under section 2677 become
available for the fiscal year, subject to any waivers
under section 2605(d).'';
(2) in paragraph (2), by amending the paragraph to read as
follows:
``(2) Allocations.--Of the amount available under section
2677 for a fiscal year for making grants under section
2601(a)--
``(A) the Secretary shall reserve 50 percent for
making grants under paragraph (1) in amounts determined
in accordance with paragraph (3); and
``(B) the Secretary shall, after compliance with
subparagraph (A), reserve such funds as may be
necessary to carry out paragraph (4).''; and
(3) by adding at the end the following paragraph:
``(4) Maximum reduction in grant.--In the case of any
eligible area for which a grant under paragraph (1) was made
for fiscal year 1995, the Secretary, in making grants under
such paragraph for the area for the fiscal years 1996 through
2000, shall (subject to the extent of the amount available
under section 2677 for the fiscal year involved for making
grants under section 2601(a)) ensure that the amounts of the
grants do not, relative to such grant for the area for fiscal
year 1995, constitute a reduction of more than the following,
as applicable to the fiscal year involved:
``(A) 1 percent, in the case of fiscal year 1996.
``(B) 2 percent, in the case of fiscal year 1997.
``(C) 3 percent, in the case of fiscal year 1998.
``(D) 4 percent, in the case of fiscal year 1999.
``(E) 5 percent, in the case of fiscal year
2000.''.
(b) Supplemental Grants.--Section 2603(b) (42 U.S.C. 300ff-13(b))
is amended--
(1) in paragraph (1)--
(A) in the matter preceding subparagraph (A), by
striking ``Not later than'' and all that follows
through ``section 2605(b)--'' and inserting the
following: ``After allocating in accordance with
subsection (a) the amounts available under section 2677
for grants under section 2601(a) for a fiscal year, the
Secretary, in carrying out section 2601(a), shall from
the remaining amounts make grants to eligible areas
described in this paragraph. Such grants shall be
disbursed not later than 150 days after the date on
which amounts appropriated under section 2677 become
available for the fiscal year. An eligible area
described in this paragraph is an eligible area whose
application under section 2605(b)--'';
(B) in subparagraph (D), by striking ``and'' after
the semicolon;
(C) in subparagraph (E), by striking the period at
the end and inserting ``; and''; and
(D) by adding at the end thereof the following
subparagraph:
``(F) demonstrates the manner in which the proposed
services are consistent with the local needs assessment
and the statewide coordinated statement of need.''; and
(2)(A) by redesignating paragraphs (2) through (4) as
paragraphs (3) through (5), respectively; and
(B) by inserting after paragraph (1) the following
paragraph:
``(2) Priority.--
``(A) Severe need.--In determining severe need in
accordance with paragraph (1)(B), the Secretary shall
give priority consideration in awarding grants under
this subsection to eligible areas that (in addition to
complying with paragraph (1)) demonstrate a more severe
need based on the prevalence in the eligible area of--
``(i) sexually transmitted diseases,
substance abuse, tuberculosis, severe mental
illness, or other conditions determined
relevant by the Secretary, which significantly
affect the impact of HIV disease;
``(ii) subpopulations with HIV disease that
were previously unknown in such area; or
``(iii) homelessness.
``(B) Prevalence.--In determining prevalence of
conditions under subparagraph (A), the Secretary shall
use data on the prevalence of the conditions described
in such subparagraph among individuals with HIV disease
(except that, in the case of an eligible area for which
such data are not available, the Secretary shall use
data on the prevalences of the conditions in the
general population of such area).''.
(c) Additional Requirements for Grants.--Section 2603 (42 U.S.C.
300ff-13) is amended by adding at the end the following subsection:
``(c) Compliance With Priorities of HIV Planning Council.--
Notwithstanding any other provision of this part, the Secretary, in
carrying out section 2601(a), may not make any grant under subsection
(a) or (b) to an eligible area unless the application submitted by such
area under section 2605 for the grant involved demonstrates that the
grants made under subsections (a) and (b) to the area for the preceding
fiscal year (if any) were expended in accordance with the priorities
applicable to such year that were established, pursuant to section
2602(b)(3)(A), by the planning council serving the area.''.
SEC. 104. USE OF AMOUNTS.
Section 2604 (42 U.S.C. 300ff-14) is amended--
(1) in subsection (b)--
(A) in paragraph (1)(A), by striking ``including
case management and comprehensive treatment services,
for individuals'' and inserting the following:
``including HIV-related comprehensive treatment
services (including treatment education and measures
for the prevention and treatment of opportunistic
infections), case management, and substance abuse
treatment and mental health treatment, for
individuals'';
(B) in paragraph (2)(A)--
(i) by inserting after ``nonprofit private
entities,'' the following: ``or private for-
profit entities if such entities are the only
available provider of quality HIV care in the
area,'' ; and
(ii) by striking ``and homeless health
centers'' and inserting ``homeless health
centers, substance abuse treatment programs,
and mental health programs''; and
(C) by adding at the end the following paragraph:
``(3) Priority for women, infants and children.--For the
purpose of providing health and support services to infants,
children, and women with HIV disease, the chief elected
official of an eligible area shall use, of the grants made for
the area under section 2601(a) for a fiscal year, not less than
the percentage constituted by the ratio of the population in
such area of infants, children, and women with acquired immune
deficiency syndrome to the general population in such area of
individuals with such syndrome, or 15 percent, whichever is
less. In expending the funds reserved under the preceding
sentence for a fiscal year, the chief elected official shall
give priority to providing, for pregnant women, measures to
prevent the perinatal transmission of HIV.''; and
(2) in subsection (e), by adding at the end thereof the
following sentence: ``In the case of entities to which such
officer allocates amounts received by the officer under the
grant, the officer shall ensure that, of the aggregate amount
so allocated, the total of the expenditures by such entities
for administrative expenses does not exceed 10 percent (without
regard to whether particular entities expend more than 10
percent for such expenses).''.
SEC. 105. APPLICATION.
Section 2605 (42 U.S.C. 300ff-15) is amended--
(1) in subsection (a)--
(A) in paragraph (1)(B), by striking ``1-year
period'' and all that follows through ``eligible area''
and inserting ``preceding fiscal year'';
(B) in paragraph (4), by striking ``and'' at the
end thereof;
(C) in paragraph (5), by striking the period at the
end thereof and inserting ``; and''; and
(D) by adding at the end thereof the following
paragraph:
``(6) that the applicant will participate in the process
for the statewide coordinated statement of need (where it has
been initiated by the State), and will ensure that the services
provided under the comprehensive plan are consistent with such
statement.'';
(2) in subsection (b)--
(A) in the subsection heading, by striking
``Additional''; and
(B) in the matter preceding paragraph (1), by
striking ``additional'';
(3) by redesignating subsections (c) and (d) as subsections
(d) and (e), respectively; and
(4) by inserting after subsection (b), the following
subsection:
``(c) Single Application.--Upon the request of the chief elected
official of an eligible area, the Secretary may authorize the official
to submit a single application through which the official
simultaneously requests a grant pursuant to subsection (a) of section
2603 and a grant pursuant to subsection (b) of such section. The
Secretary may establish such criteria for carrying out this subsection
as the Secretary determines to be appropriate.''.
SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.
Section 2606 (42 U.S.C. 300ff-16) is amended--
(1) by inserting before ``The Administrator'' the
following: ``(a) In General.--'';
(2) by striking ``may, beginning'' and all that follows
through ``title,'' and inserting ``(referred to in this section
as the `Administrator') shall''; and
(3) by adding at the end the following subsection:
``(b) Planning Grants Regarding Initial Eligibility for Grants.--
``(1) Advance payments on first-year formula grants.--With
respect to a fiscal year (referred to in this subsection as the
`planning year'), if a metropolitan area has not previously
received a grant under section 2601 and the Administrator
reasonably projects that the area will be eligible for such a
grant for the subsequent fiscal year, the Administrator may
make a grant for the planning year for the purpose of assisting
the area in preparing for the responsibilities of the area in
carrying out activities under this part.
``(2) Requirements.--
``(A) In general.--A grant under paragraph (1) for
a planning year shall be made directly to the chief
elected official of the city or urban county that
administers the public health agency to which section
2602(a)(1) is projected to apply for purposes of such
paragraph. The grant may not be made in an amount
exceeding $75,000.
``(B) Offsetting reduction in first formula
grant.--In the case of a metropolitan area that has
received a grant under paragraph (1) for a planning
year, the first grant made pursuant to section 2603(a)
for such area shall be reduced by an amount equal to
the amount of the grant under such paragraph for the
planning year. With respect to amounts resulting from
reductions under the preceding sentence for a fiscal
year, the Secretary shall use such amounts to make
grants under section 2603(a) for the fiscal year,
subject to ensuring that none of such amounts are
provided to any metropolitan area for which such a
reduction was made for the fiscal year.
``(3) Funding.--Of the amounts available under section 2677
for a fiscal year for carrying out this part, the Administrator
may reserve not more than 1 percent for making grants under
paragraph (1).''.
TITLE II--CARE GRANT PROGRAM
SEC. 201. GENERAL USE OF GRANTS.
Section 2612 (42 U.S.C. 300ff-22) is amended to read as follows:
``SEC. 2612. GENERAL USE OF GRANTS.
``(a) In General.--A State may use amounts provided under grants
made under this part for the following:
``(1) To provide the services described in section
2604(b)(1) for individuals with HIV disease.
``(2) To provide to such individuals treatments that in
accordance with section 2616 have been determined to prolong
life or prevent serious deterioration of health.
``(3) To provide home- and community-based care services
for such individuals in accordance with section 2614.
``(4) To provide assistance to assure the continuity of
health insurance coverage for such individuals in accordance
with section 2615.
``(5) To establish and operate consortia under section 2613
within areas most affected by HIV disease, which consortia
shall be designed to provide a comprehensive continuum of care
to individuals and families with such disease in accordance
with such section.
``(b) Priority for Women, Infants and Children.--For the purpose of
providing health and support services to infants, children, and women
with HIV disease, a State shall use, of the funds allocated under this
part to the State for a fiscal year, not less than the percentage
constituted by the ratio of the population in the State of infants,
children, and women with acquired immune deficiency syndrome to the
general population in the State of individuals with such syndrome, or
15 percent, whichever is less. In expending the funds reserved under
the preceding sentence for a fiscal year, the State shall give priority
to providing, for pregnant women, measures to prevent the perinatal
transmission of HIV.''.
SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.
Section 2613 (42 U.S.C. 300ff-23) is amended--
(1) in subsection (a)--
(A) in paragraph (1), by inserting ``(or private
for-profit providers or organizations if such entities
are the only available providers of quality HIV care in
the area)'' after ``nonprofit private,''; and
(B) in paragraph (2)(A)--
(i) by inserting ``substance abuse
treatment, mental health treatment,'' after
``nursing,''; and
(ii) by inserting after ``monitoring,'' the
following: ``measures for the prevention and
treatment of opportunistic infections,
treatment education for patients (provided in
the context of health care delivery),''; and
(2) in subsection (c)(2)--
(A) in clause (ii) of subparagraph (A), by striking
``and'' after the semicolon;
(B) in subparagraph (B), by striking the period at
the end and inserting ``; and''; and
(C) by adding after subparagraph (B) the following
subparagraph:
``(C) grantees under section 2671, or, if none are
operating in the area, representatives in the area of
organizations with a history of serving children,
youth, women, and families living with HIV.''.
SEC. 203. PROVISION OF TREATMENTS.
Section 2616(a) (42 U.S.C. 300ff-26(a)) is amended--
(1) by striking ``may use amounts'' and inserting ``shall
use a portion of the amounts'';
(2) by striking ``section 2612(a)(4)'' and inserting
``section 2612(a)(2)''; and
(3) by inserting before the period the following: ``,
including measures for the prevention and treatment of
opportunistic infections''.
SEC. 204. ADDITIONAL REQUIREMENTS FOR GRANTS.
(a) Findings.--The Congress finds as follows:
(1) Research studies have demonstrated that administration
of antiviral medication during pregnancy can significantly
reduce the transmission of the human immunodeficiency virus
(commonly known as HIV) from an infected mother to her baby.
(2) The Centers for Disease Control and Prevention have
recommended that all pregnant women receive HIV counseling;
voluntary, confidential HIV testing; and appropriate medical
treatment (including antiviral therapy) and support services.
(3) The provision of such testing without access to such
counseling, treatment, and services will not improve the health
of the woman or the child.
(4) The provision of such counseling, testing, treatment,
and services can reduce the number of pediatric cases of
acquired immune deficiency syndrome, can improve access to and
provision of medical care for the woman, and can provide
opportunities for counseling to reduce transmission among
adults.
(5) The provision of such counseling, testing, treatment,
and services can reduce the overall cost of pediatric cases of
acquired immune deficiency syndrome.
(6) The cancellation or limitation of health insurance or
other health coverage on the basis of HIV status should be
impermissible under applicable law. Such cancellation or
limitation could result in disincentives for appropriate
counseling, testing, treatment, and services.
(7) For the reasons specified in paragraphs (1) through
(6)--
(A) mandatory counseling and voluntary testing of
pregnant women should be the standard of care; and
(B) the relevant medical organizations as well as
public health officials should issue guidelines making
such counseling and testing the standard of care.
(b) Additional Requirements for Grants.--Part B (42 U.S.C. 300ff-21
et seq.) is amended--
(1) in section 2611, by adding at the end the following
sentence: ``The authority of the Secretary to provide grants
under this part is subject to section 2673D (relating to the
testing of pregnant women and newborn infants).''; and
(2) by inserting after section 2616 the following section:
``SEC. 2616A. REQUIREMENT REGARDING HEALTH INSURANCE.
``(a) In General.--Subject to subsection (c), the Secretary shall
not make a grant under this part to a State unless the State has in
effect a statute or regulations regulating insurance that imposes the
following requirements:
``(1) That, if health insurance is in effect for an
individual, the insurer involved may not (without the consent
of the individual) discontinue the insurance, or alter the
terms of the insurance (except as provided in paragraph (3)),
solely on the basis that the individual is infected with HIV
disease or solely on the basis that the individual has been
tested for the disease.
``(2) That paragraph (1) does not apply to an individual
who, in applying for the health insurance involved, knowingly
misrepresented any of the following:
``(A) The HIV status of the individual.
``(B) Facts regarding whether the individual has
been tested for HIV disease.
``(C) Facts regarding whether the individual has
engaged in any behavior that places the individual at
risk for the disease.
``(3) That paragraph (1) does not apply to any reasonable
alteration in the terms of health insurance for an individual
with HIV disease that would have been made if the individual
had a serious disease other than HIV disease.
``(b) Regulation of Health Insurance.--A statute or regulation
shall be deemed to regulate insurance for purposes of this section only
to the extent that it is treated as regulating insurance for purposes
of section 514(b)(2) of the Employee Retirement Income Security Act of
1974.
``(c) Applicability of Requirement.--
``(1) In general.--Except as provided in paragraph (2),
this section applies upon the expiration of the 120-day period
beginning on the date of the enactment of the Ryan White CARE
Act Amendments of 1995.
``(2) Delayed applicability for certain states.--In the
case of the State involved, if the Secretary determines that a
requirement of this section cannot be implemented in the State
without the enactment of State legislation, then such
requirement applies to the State on and after the first day of
the first calendar quarter that begins after the close of the
first regular session of the State legislature that begins
after the date of the enactment of the Ryan White CARE Act
Amendments of 1995. For purposes of the preceding sentence, in
the case of a State that has a 2-year legislative session, each
year of such session is deemed to be a separate regular session
of the State legislature.''.
(c) Testing of Newborns; Prenatal Testing.--Part D (42 U.S.C.
300ff-71 et seq.) is amended by inserting before section 2674 the
following sections:
``SEC. 2673C. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS; PROGRAM OF
GRANTS.
``(a) Program of Grants.--The Secretary may make grants to States
described in subsection (b) for the following purposes:
``(1) Making available to pregnant women appropriate
counseling on HIV disease.
``(2) Making available to such women testing for such
disease.
``(3) Testing newborn infants for such disease.
``(4) In the case of newborn infants who test positive for
such disease, making available counseling on such disease to
the parents or other legal guardians of the infant.
``(5) Collecting data on the number of pregnant women and
newborn infants in the State who have undergone testing for
such disease.
``(b) Eligible States.--Subject to subsection (c), a State referred
to in subsection (a) is a State that has in effect, in statute or
through regulations, the following requirements:
``(1) In the case of newborn infants who are born in the
State and whose biological mothers have not undergone prenatal
testing for HIV disease, that each such infant undergo testing
for such disease.
``(2) That the results of such testing of a newborn infant
be promptly disclosed in accordance with the following, as
applicable to the infant involved:
``(A) To the biological mother of the infant
(without regard to whether she is the legal guardian of
the infant).
``(B) If the State is the legal guardian of the
infant:
``(i) To the appropriate official of the
State agency with responsibility for the care
of the infant.
``(ii) To the appropriate official of each
authorized agency providing assistance in the
placement of the infant.
``(iii) If the authorized agency is giving
significant consideration to approving an
individual as a foster parent of the infant, to
the prospective foster parent.
``(iv) If the authorized agency is giving
significant consideration to approving an
individual as an adoptive parent of the infant,
to the prospective adoptive parent.
``(C) If neither the biological mother nor the
State is the legal guardian of the infant, to another
legal guardian of the infant.
``(3) That, in the case of prenatal testing for HIV disease
that is conducted in the State, the results of such testing be
promptly disclosed to the pregnant woman involved.
``(4) That, in disclosing the test results to an individual
under paragraph (2) or (3), appropriate counseling on the human
immunodeficiency virus be made available to the individual
(except in the case of a disclosure to an official of a State
or an authorized agency).
``(c) Limitation Regarding Availability of Grant Funds.--With
respect to an activity described in any of paragraphs (1) through (4)
of subsection (b), the requirement established by a State under such
subsection that the activity be carried out applies for purposes of
this section only to the extent that the following sources of funds are
available for carrying out the activity:
``(1) Federal funds provided to the State in grants under
subsection (a).
``(2) Funds that the State or private entities have elected
to provide, including through entering into contracts under
which health benefits are provided. This section does not
require any entity to expend non-Federal funds.
``(d) Definitions.--For purposes of this section, the term
`authorized agency', with respect to the placement of a child
(including an infant) for whom a State is a legal guardian, means an
entity licensed or otherwise approved by the State to assist in such
placement.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there is authorized to be appropriated $10,000,000
for each of the fiscal years 1996 through 2000.
``SEC. 2673D. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS; CONTINGENT
REQUIREMENT REGARDING STATE GRANTS UNDER PART B.
``(a) Determination by Secretary.--During the first 30 days
following the expiration of the 2-year period beginning on the date of
the enactment of the Ryan White CARE Act Amendments of 1995, the
Secretary shall publish in the Federal Register a determination of
whether it has become a routine practice in the provision of health
care in the United States to carry out each of the activities described
in paragraphs (1) through (4) of section 2673C(b). In making the
determination, the Secretary shall consult with the States and with
other public or private entities that have knowledge or expertise
relevant to the determination.
``(b) Contingent Applicability.--
``(1) In general.--If the determination published in the
Federal Register under subsection (a) is that (for purposes of
such subsection) the activities involved have become routine
practices, paragraph (2) applies on and after the expiration of
the 18-month period beginning on the date on which the
determination is so published.
``(2) Requirement.--Subject to subsection (c), the
Secretary shall not make a grant under part B to a State unless
the State meets not less than one of the following
requirements:
``(A) The State has in effect, in statute or
through regulations, the requirements specified in
paragraphs (1) through (4) of section 2673C(b).
``(B) The State demonstrates that, of the newborn
infants born in the State during the most recent 1-year
period for which the data are available, the HIV
antibody status of 95 percent of the infants is known.
``(c) Limitation Regarding Availability of Funds.--With respect to
an activity described in any of paragraphs (1) through (4) of section
2673C(b), the requirements established by a State under subsection
(b)(2)(A) that the activity be carried out applies for purposes of this
section only to the extent that the following sources of funds are
available for carrying out the activity:
``(1) Federal funds provided to the State in grants under
part B.
``(2) Federal funds provided to the State in grants under
section 2673C.
``(3) Funds that the State or private entities have elected
to provide, including through entering into contracts under
which health benefits are provided. This section does not
require any entity to expend non-Federal funds.''.
SEC. 205. STATE APPLICATION.
Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)) is amended--
(1) in subparagraph (A), by striking ``and'' after the
semicolon;
(2) in subparagraph (B), by striking ``and'' after the
semicolon; and
(3) by adding at the end thereof the following
subparagraphs:
``(C) a description of the activities carried out
by the State under section 2616; and
``(D) a description of how the allocation and
utilization of resources are consistent with a
statewide coordinated statement of need, developed in
partnership with other grantees in the State that
receive funding under this title and after consultation
with individuals receiving services under this part.''.
SEC. 206. ALLOCATION OF ASSISTANCE BY STATES; PLANNING, EVALUATION, AND
ADMINISTRATION.
Section 2618(c) (42 U.S.C. 300ff-28(c)) is amended--
(1) by striking paragraph (1);
(2) by redesignating paragraphs (2) through (5) as
paragraphs (1) through (4), respectively; and
(3) in paragraph (3) (as so redesignated), by adding at the
end the following sentences: ``In the case of entities to which
the State allocates amounts received by the State under the
grant (including consortia under section 2613), the State shall
ensure that, of the aggregate amount so allocated, the total of
the expenditures by such entities for administrative expenses
does not exceed 10 percent (without regard to whether
particular entities expend more than 10 percent for such
expenses).''.
SEC. 207. TECHNICAL ASSISTANCE.
Section 2619 (42 U.S.C. 300ff-29) is amended by inserting before
the period the following: ``, including technical assistance for the
development and implementation of statewide coordinated statements of
need''.
TITLE III--EARLY INTERVENTION SERVICES
SEC. 301. ESTABLISHMENT OF PROGRAM.
Section 2651(b) (42 U.S.C. 300ff-51(b)) is amended--
(1) in paragraph (1), by inserting before the period the
following: ``, and unless the applicant agrees to expend not
less than 50 percent of the grant for such services that are
specified in subparagraphs (B) through (E) of such paragraph'';
and
(2) in paragraph (4), by inserting after ``nonprofit
private entities'' the following: ``(or private for-profit
entities, if such entities are the only available providers of
quality HIV care in the area)''.
SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.
Section 2652(b)(1)(B) (42 U.S.C. 300ff-52(b)(1)(B)) is amended by
inserting after ``nonprofit private entity'' the following: ``(or a
private for-profit entity, if such an entity is the only available
provider of quality HIV care in the area)''.
SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND DEVELOPMENT GRANTS.
Section 2654 (42 U.S.C. 300ff-54) is amended by adding at the end
thereof the following subsection:
``(c) Planning and Development Grants.--
``(1) In general.--The Secretary may provide planning
grants, in an amount not to exceed $50,000 for each such grant,
to public and nonprofit private entities for the purpose of
enabling such entities to provide early intervention services.
``(2) Requirement.--The Secretary may award a grant to an
entity under paragraph (1) only if the Secretary determines
that the entity will use such grant to assist the entity in
qualifying for a grant under section 2651.
``(3) Preference.--In awarding grants under paragraph (1),
the Secretary shall give preference to entities that provide
HIV primary care services in rural or underserved communities.
``(4) Limitation.--Not to exceed 1 percent of the amount
appropriated for a fiscal year under section 2655 may be used
to carry out this section.''.
SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.
Section 2664(a)(1) (42 U.S.C. 300ff-64(a)(1)) is amended--
(1) in subparagraph (A), by striking ``and'' after the
semicolon; and
(2) by adding at the end the following subparagraph:
``(C) evidence that the proposed program is
consistent with the statewide coordinated statement of
need and that the applicant will participate in the
ongoing revision of such statement of need.''.
SEC. 305. AUTHORIZATION OF APPROPRIATIONS.
Section 2655 (42 U.S.C. 300ff-55) is amended by striking
``$75,000,000'' and all that follows and inserting ``such sums as may
be necessary for each of the fiscal years 1996 through 2000.''.
TITLE IV--GENERAL PROVISIONS
SEC. 401. COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN,
INFANTS, AND CHILDREN.
(a) In General.--Section 2671 (42 U.S.C. 300ff-71) is amended--
(1) in subsection (a), by amending the subsection to read
as follows:
``(a) In General.--
``(1) Program of grants.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration and in consultation with the Director of the
National Institutes of Health, shall make grants to public and
nonprofit private entities that provide primary care (directly
or through contracts) for the purpose of--
``(A) providing through such entities, in
accordance with this section, opportunities for women,
infants, and children to be participants in research of
potential clinical benefit to individuals with HIV
disease; and
``(B) providing to women, infants, and children
health care on an outpatient basis.
``(2) Provisions regarding participation in research.--With
respect to the projects of research with which an applicant
under paragraph (1) is concerned, the Secretary may not make a
grant under such paragraph to the applicant unless the
following conditions are met:
``(A) The applicant agrees to make reasonable
efforts--
``(i) to identify which of the patients of
the applicant are women, infants, and children
who would be appropriate participants in the
projects; and
``(ii) to offer women, infants, and
children the opportunity to so participate (as
appropriate), including the provision of
services under subsection (f).
``(B) The applicant agrees that the applicant, and
the projects of research, will comply with accepted
standards of protection for human subjects (including
the provision of written informed consent) who
participate as subjects in clinical research.
``(C) For the third or subsequent fiscal year for
which a grant under such paragraph is sought by the
applicant, the Secretary has determined that--
``(i) a significant number of women,
infants, and children who are patients of the
applicant are participating in the projects
(except to the extent this clause is waived
under subsection (k)); and
``(ii) the applicant, and the projects of
research, have complied with the standards
referred to in subparagraph (B).
``(3) Prohibition.--Receipt of services by a patient shall
not be conditioned upon the consent of the patient to
participate in research.
``(4) Consideration by secretary of certain
circumstances.--In administering the requirement of paragraph
(2)(C)(i), the Secretary shall take into account circumstances
in which a grantee under paragraph (1) is temporarily unable to
comply with the requirement for reasons beyond the control of
the grantee, and shall in such circumstances provide to the
grantee a reasonable period of opportunity in which to
reestablish compliance with the requirement.'';
(2) in subsection (c), by amending the subsection to read
as follows:
``(c) Provisions Regarding Conduct of Research.--With respect to
eligibility for a grant under subsection (a):
``(1) A project of research for which subjects are sought
pursuant to such subsection may be conducted by the applicant
for the grant, or by an entity with which the applicant has
made arrangements for purposes of the grant. The grant may not
be expended for the conduct of any project of research.
``(2) The grant may not be made unless the Secretary makes
the following determinations:
``(A) The applicant or other entity (as the case
may be under paragraph (1)) is appropriately qualified
to conduct the project of research. An entity shall be
considered to be so qualified if any research protocol
of the entity has been recommended for funding under
this Act pursuant to technical and scientific peer
review through the National Institutes of Health.
``(B) The project of research is being conducted in
accordance with a research protocol to which the
Secretary gives priority regarding the prevention and
treatment of HIV disease in women, infants, and
children. After consultation with public and private
entities that conduct such research, and with providers
of services under this section and recipients of such
services, the Secretary shall establish a list of such
protocols that are appropriate for purposes of this
section. The Secretary may give priority under this
subparagraph to a research protocol that is not on such
list.'';
(3) by striking subsection (i);
(4) by redesignating subsections (g) and (h) as subsections
(h) and (i), respectively;
(5) by inserting after subsection (f) the following
subsection:
``(g) Additional Provisions.--The Secretary may not make a grant
under subsection (a) unless the applicant for the grant agrees as
follows:
``(1) The applicant will coordinate activities under the
grant with other providers of health care services under this
Act, and under title V of the Social Security Act.
``(2) The applicant will participate in the statewide
coordinated statement of need under part B (where it has been
initiated by the State) and in revisions of such statement.'';
(6) by redesignating subsection (j) as subsection (m); and
(7) by inserting before subsection (m) (as so redesignated)
the following subsections:
``(j) Coordination With National Institutes of Health.--The
Secretary shall develop and implement a plan that provides for the
coordination of the activities of the National Institutes of Health
with the activities carried out under this section. In carrying out the
preceding sentence, the Secretary shall ensure that projects of
research conducted or supported by such Institutes are made aware of
applicants and grantees under this section, shall require that the
projects, as appropriate, enter into arrangements for purposes of this
section, and shall require that each project entering into such an
arrangement inform the applicant or grantee under this section of the
needs of the project for the participation of women, infants, and
children.
``(k) Temporary Waiver Regarding Significant Participation.--
``(1) In general.--In the case of an applicant under
subsection (a) who received a grant under this section for
fiscal year 1995, the Secretary may, subject to paragraph (2),
provide to the applicant a waiver of the requirement of
subsection (a)(2)(C)(i) if the Secretary determines that the
applicant is making reasonable progress toward meeting the
requirement.
``(2) Termination of authority for waivers.--The Secretary
may not provide any waiver under paragraph (1) on or after
October 1, 1998. Any such waiver provided prior to such date
terminates on such date, or on such earlier date as the
Secretary may specify.
``(l) Training and Technical Assistance.--Of the amounts
appropriated under subsection (m) for a fiscal year, the Secretary may
use not more than five percent to provide training and technical
assistance to assist applicants and grantees under subsection (a) in
complying with the requirements of this section.''.
(b) Conforming Amendments.--Section 2671 (42 U.S.C. 300ff-71) is
amended--
(1) in the heading for the section, by striking
``demonstration'' and all that follows and inserting
``coordinated services and access to research for women,
infants, and children.'';
(2) in subsection (b), by striking ``pediatric patients and
pregnant women'' and inserting ``women, infants, and
children''; and
(3) in each of subsections (d) through (f), by striking
``pediatric'', each place such term appears.
(c) Authorization of Appropriations.--Section 2671 (42 U.S.C.
300ff-71) is amended in subsection (m) (as redesignated by subsection
(a)(6)) by striking ``there are'' and all that follows and inserting
the following: ``there are authorized to be appropriated such sums as
may be necessary for each of the fiscal years 1996 through 2000.''.
SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.
(a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71 et seq.)
is amended by inserting after section 2673 the following section:
``SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL SIGNIFICANCE.
``(a) In General.--The Secretary shall make grants to public and
nonprofit private entities (including community-based organizations and
Indian tribes and tribal organizations) for the purpose of carrying out
demonstration projects that provide for the care and treatment of
individuals with HIV disease, and that--
``(1) assess the effectiveness of particular models for the
care and treatment of individuals with such disease;
``(2) are of an innovative nature; and
``(3) have the potential to be replicated in similar
localities, or nationally.
``(b) Certain Projects.--Demonstration projects under subsection
(a) shall include the development and assessment of innovative models
for the delivery of HIV services that are designed--
``(1) to address the needs of special populations
(including individuals and families with HIV disease living in
rural communities, adolescents with HIV disease, Native
American individuals and families with HIV disease, homeless
individuals and families with HIV disease, hemophiliacs with
HIV disease, and incarcerated individuals with HIV disease);
and
``(2) to ensure the ongoing availability of services for
Native American communities to enable such communities to care
for Native Americans with HIV disease.
``(c) Coordination.--The Secretary may not make a grant under this
section unless the applicant submits evidence that the proposed program
is consistent with the applicable statewide coordinated statement of
need under part B, and the applicant agrees to participate in the
ongoing revision process of such statement of need (where it has been
initiated by the State).
``(d) Replication.--The Secretary shall make information concerning
successful models developed under this section available to grantees
under this title for the purpose of coordination, replication, and
integration.
``(e) Funding; Allocation of Amounts.--
``(1) In general.--Of the amounts available under this
title for a fiscal year for each program specified in paragraph
(2), the Secretary shall reserve 3 percent for making grants
under subsection (a).
``(2) Relevant programs.--The programs referred to in
subsection (a) are the program under part A, the program under
part B, the program under part C, the program under section
2671, the program under section 2672, and the program under
section 2673.''.
(b) Striking of Related Provision.--Section 2618 (42 U.S.C. 300ff-
28) is amended by striking subsection (a).
SEC. 403. SPECIAL TRAINING PROJECTS.
(a) Transfer of Program.--The Public Health Service Act (42 U.S.C.
201 et seq.) is amended--
(1) by transferring section 776 from the current placement
of the section;
(2) by redesignating the section as section 2673B; and
(3) by inserting the section after section 2673A (as added
by section 402(a)).
(b) Modifications.--Section 2673B (as transferred and redesignated
by subsection (a)) is amended--
(1) in subsection (a)(1)--
(A) by striking subparagraphs (B) and (C);
(B) by redesignating subparagraphs (A) and (D) as
subparagraphs (B) and (C), respectively;
(C) by inserting before subparagraph (B) (as so
redesignated) the following subparagraph:
``(A) to train health personnel, including
practitioners in programs under this title and other
community providers, in the diagnosis, treatment, and
prevention of HIV disease, including the prevention of
the perinatal transmission of the disease and including
measures for the prevention and treatment of
opportunistic infections;'';
(D) in subparagraph (B) (as so redesignated), by
adding ``and'' after the semicolon; and
(E) in subparagraph (C) (as so redesignated), by
striking ``curricula and'';
(2) by striking subsection (c) and redesignating subsection
(d) as subsection (c); and
(3) in subsection (c) (as so redesignated)--
(A) in paragraph (1)--
(i) by striking ``is authorized'' and
inserting ``are authorized''; and
(ii) by inserting before the period the
following: ``, and such sums as may be
necessary for each of the fiscal years 1996
through 2000''; and
(B) in paragraph (2)--
(i) by striking ``is authorized'' and
inserting ``are authorized''; and
(ii) by inserting before the period the
following: ``, and such sums as may be
necessary for each of the fiscal years 1996
through 2000''.
SEC. 404. EVALUATIONS AND REPORTS.
Section 2674 (42 U.S.C. 300ff-74) is amended--
(1) in subsection (b)--
(A) in the matter preceding paragraph (1), by
striking ``not later than 1 year'' and all that follows
through ``title,'' and inserting the following: ``not
later than October 1, 1996,'';
(B) by striking paragraphs (1) through (3) and
inserting the following paragraph:
``(1) evaluating the programs carried out under this title;
and''; and
(C) by redesignating paragraph (4) as paragraph
(2); and
(2) by adding at the end the following subsection:
``(d) Allocation of Funds.--The Secretary shall carry out this
section with amounts available under section 241. Such amounts are in
addition to any other amounts that are available to the Secretary for
such purpose.''.
SEC. 405. COORDINATION OF PROGRAM.
Section 2675 of the Public Health Service Act (42 U.S.C. 300ff-75)
is amended by adding at the end the following subsection:
``(d) Annual Report.--Not later than October 1, 1996, and annually
thereafter, the Secretary shall submit to the appropriate committees of
the Congress a report concerning coordination efforts under this title
at the Federal, State, and local levels, including a statement of
whether and to what extent there exist Federal barriers to integrating
HIV-related programs.''.
TITLE V--ADDITIONAL PROVISIONS
SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.
Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) is
amended to read as follows:
``(3) Amount of grant.--
``(A) In general.--Subject to the extent of amounts
made available in appropriations Acts, a grant made for
purposes of this paragraph to an eligible area shall be
made in an amount equal to the product of--
``(i) an amount equal to the amount
available for distribution under paragraph (2)
for the fiscal year involved; and
``(ii) the percentage constituted by the
ratio of the distribution factor for the
eligible area to the sum of the respective
distribution factors for all eligible areas.
``(B) Distribution factor.--For purposes of
subparagraph (A)(ii), the term `distribution factor'
means the product of--
``(i) an amount equal to the estimated
number of living cases of acquired immune
deficiency syndrome in the eligible area
involved, as determined under subparagraph (C);
and
``(ii) the cost index for the eligible area
involved, as determined under subparagraph (D).
``(C) Estimate of living cases.--The amount
determined in this subparagraph is an amount equal to
the product of--
``(i) the number of cases of acquired
immune deficiency syndrome in the eligible area
during each year in the most recent 120-month
period for which data are available with
respect to all eligible areas, as indicated by
the number of such cases reported to and
confirmed by the Director of the Centers for
Disease Control and Prevention for each year
during such period; and
``(ii) with respect to--
``(I) the first year during such
period, .06;
``(II) the second year during such
period, .06;
``(III) the third year during such
period, .08;
``(IV) the fourth year during such
period, .10;
``(V) the fifth year during such
period, .16;
``(VI) the sixth year during such
period, .16;
``(VII) the seventh year during
such period, .24;
``(VIII) the eighth year during
such period, .40;
``(IX) the ninth year during such
period, .57; and
``(X) the tenth year during such
period, .88.
``(D) Cost index.--The amount determined in this
subparagraph is an amount equal to the sum of--
``(i) the product of--
``(I) the average hospital wage
index reported by hospitals in the
eligible area involved under section
1886(d)(3)(E) of the Social Security
Act for the 3-year period immediately
preceding the year for which the grant
is being awarded; and
``(II) .70; and
``(ii) .30.
``(E) Unexpended funds.--The Secretary may, in
determining the amount of a grant for a fiscal year
under this paragraph, adjust the grant amount to
reflect the amount of unexpended and uncanceled grant
funds remaining at the end of the most recent fiscal
year for which the amount of such funds can be
determined using the required financial status report.
The amount of any such unexpended funds shall be
determined using the financial status report of the
grantee.
``(F) Puerto rico, virgin islands, guam.--For
purposes of subparagraph (D), the cost index for an
eligible area within Puerto Rico, the Virgin Islands,
or Guam shall be 1.0.''.
SEC. 502. AMOUNT OF CARE GRANTS.
Section 2618 (42 U.S.C. 300ff-28), as amended by section 402(b), is
amended by striking subsection (b) and inserting the following
subsections:
``(a) Amount of Grant.--
``(1) In general.--Subject to subsection (b) (relating to
minimum grants), the amount of a grant under this part for a
State for a fiscal year shall be the sum of--
``(A) the amount determined for the State under
paragraph (2); and
``(B) the amount determined for the State under
paragraph (4) (if applicable).
``(2) Principal formula grants.--For purposes of paragraph
(1)(A), the amount determined under this paragraph for a State
for a fiscal year shall be the product of--
``(A) the amount available under section 2677 for
carrying out this part, less the reservation of funds
made in paragraph (4)(A) and less any other applicable
reservation of funds authorized or required in this Act
(which amount is subject to subsection (b)); and
``(B) the percentage constituted by the ratio of--
``(i) the distribution factor for the
State; to
``(ii) the sum of the distribution factors
for all States.
``(3) Distribution factor for principal formula grants.--
For purposes of paragraph (2)(B), the term `distribution
factor' means the following, as applicable:
``(A) In the case of each of the 50 States, the
District of Columbia, and the Commonwealth of Puerto
Rico, the product of--
``(i) the number of cases of acquired
immune deficiency syndrome in the State, as
indicated by the number of cases reported to
and confirmed by the Secretary for the 2 most
recent fiscal years for which such data are
available; and
``(ii) the cube root of the ratio (based on
the most recent available data) of--
``(I) the average per capita income
of individuals in the United States
(including the territories); to
``(II) the average per capita
income of individuals in the State.
``(B) In the case of a territory of the United
States (other than the Commonwealth of Puerto Rico),
the number of additional cases of such syndrome in the
specific territory, as indicated by the number of cases
reported to and confirmed by the Secretary for the 2
most recent fiscal years for which such data is
available.
``(4) Supplemental amounts for certain states.--For
purposes of paragraph (1)(B), an amount shall be determined
under this paragraph for each State that does not contain any
metropolitan area whose chief elected official received a grant
under part A for fiscal year 1996. The amount determined under
this paragraph for such a State for a fiscal year shall be the
product of--
``(A) an amount equal to 7 percent of the amount
available under section 2677 for carrying out this part
for the fiscal year (subject to subsection (b)); and
``(B) the percentage constituted by the ratio of--
``(i) the number of cases of acquired
immune deficiency syndrome in the State (as
determined under paragraph (3)(A)(i)); to
``(ii) the sum of the respective numbers
determined under clause (i) for each State to
which this paragraph applies.
``(5) Definitions.--For purposes of this subsection and
subsection (b):
``(A) The term `State' means each of the 50 States,
the District of Columbia, and the territories of the
United States.
``(B) The term `territory of the United States'
means each of the Virgin Islands, Guam, American Samoa,
the Commonwealth of the Northern Mariana Islands, the
Commonwealth of Puerto Rico, and the Republic of the
Marshall Islands.
``(b) Minimum Amount of Grant.--
``(1) In general.--Subject to the extent of the amounts
specified in paragraphs (2)(A) and (4)(A) of subsection (a), a
grant under this part for a State for a fiscal year shall be
the greater of--
``(A) the amount determined for the State under
subsection (a); and
``(B) the amount applicable under paragraph (2) to
the State.
``(2) Applicable amount.--For purposes of paragraph (1)(B),
the amount applicable under this paragraph for a fiscal year is
the following:
``(A) In the case of the 50 States, the District of
Columbia, and the Commonwealth of Puerto Rico--
``(i) $100,000, if it has less than 90
cases of acquired immune deficiency syndrome
(as determined under subsection (a)(3)(A)(i));
and
``(ii) $250,000, if it has 90 or more such
cases (as so determined).
``(B) In the case of each of the territories of the
United States (other than the Commonwealth of Puerto
Rico), $0.0.''.
SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.
(a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71) is
amended by adding at the end thereof the following section:
``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.
``(a) In General.--For the purpose of carrying out parts A and B,
there are authorized to be appropriated such sums as may be necessary
for each of the fiscal years 1996 through 2000. Subject to section
2673A and to subsection (b), of the amount appropriated under this
section for a fiscal year, the Secretary shall make available 64
percent of such amount to carry out part A and 36 percent of such
amount to carry out part B.
``(b) Development of Methodology.--With respect to each of the
fiscal years 1997 through 2000, the Secretary may develop and implement
a methodology for adjusting the percentages referred to in subsection
(a).''.
(b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
(c) Conforming Amendments.--Section 2605(d)(1) (as redesignated by
section 105(3)), is amended by striking ``2608'' and inserting
``2677''.
SEC. 504. ADDITIONAL PROVISIONS.
(a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) is
amended by inserting ``funeral-service practitioners,'' after
``emergency medical technicians,''.
(b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 300d(a))
is amended in the matter preceding paragraph (1) by striking ``The
Secretary,'' and all that follows through ``shall,'' and inserting
``The Secretary shall,''.
(c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 et seq.)
is amended--
(1) in section 2601(a), by inserting ``section'' before
``2604'';
(2) in section 2603(b)(4)(B), by striking ``an expedited
grants'' and inserting ``an expedited grant'';
(3) in section 2617(b)(3)(B)(iv), by inserting ``section''
before ``2615'';
(4) in section 2618(b)(1)(B), by striking ``paragraph 3''
and inserting ``paragraph (3)'';
(5) in section 2647--
(A) in subsection (a)(1), by inserting ``to''
before ``HIV'';
(B) in subsection (c), by striking ``section 2601''
and inserting ``section 2641''; and
(C) in subsection (d)--
(i) in the matter preceding paragraph (1),
by striking ``section 2601'' and inserting
``section 2641''; and
(ii) in paragraph (1), by striking ``has in
place'' and inserting ``will have in place'';
(6) in section 2648--
(A) by converting the heading for the section to
boldface type; and
(B) by redesignating the second subsection (g) as
subsection (h);
(7) in section 2649--
(A) in subsection (b)(1), by striking ``subsection
(a) of''; and
(B) in subsection (c)(1), by striking ``this
subsection'' and inserting ``subsection'';
(8) in section 2651--
(A) in subsection (b)(3)(B), by striking
``facility'' and inserting ``facilities''; and
(B) in subsection (c), by striking ``exist'' and
inserting ``exists'';
(9) in section 2676--
(A) in paragraph (2), by striking ``section'' and
all that follows through ``by the'' and inserting
``section 2686 by the''; and
(B) in paragraph (10), by striking ``673(a)'' and
inserting ``673(2)'';
(10) in part E, by converting the headings for subparts I
and II to Roman typeface; and
(11) in section 2684(b), in the matter preceding paragraph
(1), by striking ``section 2682(d)(2)'' and inserting ``section
2683(d)(2)''.
TITLE VI--EFFECTIVE DATE
SEC. 601. EFFECTIVE DATE.
Except as provided in section 101(a), this Act takes effect October
1, 1995.
Amend the title so as to read: ``An Act to amend the Public Health
Service Act to revise and extend programs established pursuant to the
Ryan White Comprehensive AIDS Resources Emergency Act of 1990.''.
Attest:
Clerk.
104th CONGRESS
1st Session
S. 641
_______________________________________________________________________
AMENDMENTS