[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 641 Engrossed in Senate (ES)]

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
104th CONGRESS
  1st Session
                                 S. 641

_______________________________________________________________________

                                 AN ACT


 
To reauthorize the Ryan White CARE Act of 1990, and for other purposes.
    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Reauthorization Act 
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 a section or other provision of title XXVI of 
the Public Health Service Act (42 U.S.C. 300ff-11 et seq.).

SEC. 3. GENERAL AMENDMENTS.

    (a) Establishment of Grant Program.--Section 2601 (42 U.S.C. 300ff-
11) is amended--
            (1) in subsection (a)--
                    (A) by striking ``March 31 of the most recent 
                fiscal year'' and inserting ``March 31, 1995, and 
                December 31 of the most recent calendar year 
                thereafter''; and
                    (B) by striking ``fiscal year--'' and all that 
                follows through the period and inserting ``fiscal year, 
                there has been reported to and confirmed by, for the 5-
                year period prior to the fiscal year for which the 
                grant is being made, the Director of the Centers for 
                Disease Control and Prevention a cumulative total of 
                more than 2,000 cases of acquired immune deficiency 
                syndrome.''; and
            (2) by adding at the end thereof the following new 
        subsections:
    ``(c) Population of Eligible Areas.--The Secretary may not make a 
grant to an eligible area under subsection (a) after the date of 
enactment of this subsection unless the area has a population of at 
least 500,000 individuals, except that this subsection shall not apply 
to areas that are eligible as of March 31, 1994. For purposes of 
eligibility under this title, the boundaries of each metropolitan area 
shall be those in effect in fiscal year 1994.
    ``(d) Continued Funding.--A metropolitan area that has received a 
grant under this section for the fiscal year in which this subsection 
is enacted, shall be eligible to receive such a grant in subsequent 
fiscal years.''.
    (b) Emergency Relief for Areas With Substantial Need for 
Services.--
            (1) HIV health services planning council.--Subsection (b) 
        of section 2602 (42 U.S.C. 300ff-12(b)) is amended--
                    (A) in paragraph (1)--
                            (i) by striking ``include'' and all that 
                        follows through the end thereof, and inserting 
                        ``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.''; and
                            (ii) by adding at the end thereof the 
                        following new sentences: ``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) in paragraph (2), by adding at the end thereof 
                the following new subparagraph:
                    ``(C) Chairperson.--A planning council may not be 
                chaired solely by an employee of the grantee.'';
                    (C) in paragraph (3)--
                            (i) in subparagraph (A), by striking 
                        ``area;'' and inserting ``area based on the--
                            ``(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, 
                        (either demonstrated or probable);
                            ``(iii) priorities of the HIV-infected 
                        communities for whom the services are intended; 
                        and
                            ``(iv) availability of other governmental 
                        and nongovernmental resources;'';
                            (ii) by striking ``and'' at the end of 
                        subparagraph (B);
                            (iii) by striking the period at the end of 
                        subparagraph (C) and inserting ``, and at the 
                        discretion of the planning council, assess the 
                        effectiveness, either directly or through 
                        contractual arrangements, of the services 
                        offered in meeting the identified needs; ''; 
                        and
                            (iv) by adding at the end thereof the 
                        following new subparagraphs:
                    ``(D) participate in the development of the 
                Statewide coordinated statement of need initiated by 
                the State health department;
                    ``(E) establish operating procedures which include 
                specific policies for resolving disputes, responding to 
                grievances, and minimizing and managing conflict-of-
                interests; and
                    ``(F) establish methods for obtaining input on 
                community needs and priorities which may include public 
                meetings, conducting focus groups, and convening ad-hoc 
                panels.'';
                    (D) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively; and
                    (E) by inserting after paragraph (1), the following 
                new paragraph:
            ``(2) Representation.--The HIV health services planning 
        council shall include representatives of--
                    ``(A) health care providers, including federally 
                qualified health centers;
                    ``(B) community-based organizations serving 
                affected populations and AIDS service organizations;
                    ``(C) social service providers;
                    ``(D) mental health and substance abuse providers;
                    ``(E) local public health agencies;
                    ``(F) hospital planning agencies or health care 
                planning agencies;
                    ``(G) affected communities, including people with 
                HIV disease or AIDS and historically underserved groups 
                and subpopulations;
                    ``(H) nonelected community leaders;
                    ``(I) State government (including the State 
                medicaid agency and the agency administering the 
                program under part B);
                    ``(J) grantees under subpart II of part C;
                    ``(K) grantees under section 2671, or, if none are 
                operating in the area, representatives of organizations 
                with a history of serving children, youth, women, and 
                families living with HIV and operating in the area; and
                    ``(L) grantees under other Federal HIV programs.''.
            (2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-
        13) is amended--
                    (A) in subsection (a)(2), by striking ``Not later 
                than--'' and all that follows through ``the Secretary 
                shall'' and inserting the following: ``Not later than 
                60 days after an appropriation becomes available to 
                carry out this part for each of the fiscal years 1996 
                through 2000, the Secretary shall''; and
                    (B) in subsection (b)
                            (i) in paragraph (1)--
                                    (I) by striking ``and'' at the end 
                                of subparagraph (D);
                                    (II) by striking the period at the 
                                end of subparagraph (E) and inserting a 
                                semicolon; and
                                    (III) by adding at the end thereof 
                                the following new subparagraphs:
                    ``(F) demonstrates the inclusiveness of the 
                planning council membership, with particular emphasis 
                on affected communities and individuals with HIV 
                disease; and
                    ``(G) demonstrates the manner in which the proposed 
                services are consistent with the local needs assessment 
                and the Statewide coordinated statement of need.''; and
                            (ii) by redesignating paragraphs (2), (3), 
                        and (4) as paragraphs (3), (4), and (5), 
                        respectively; and
                            (iii) by inserting after paragraph (1), the 
                        following new 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 section to any qualified applicant that 
                demonstrates an ability to spend funds efficiently and 
                demonstrates a more severe need based on prevalence 
                of--
                            ``(i) sexually transmitted diseases, 
                        substance abuse, tuberculosis, severe mental 
                        illness, or other diseases determined relevant 
                        by the Secretary, which significantly affect 
                        the impact of HIV disease in affected 
                        individuals and communities;
                            ``(ii) AIDS in individuals, and 
                        subpopulations, previously unknown in the 
                        eligible metropolitan area; or
                            ``(iii) homelessness.
                    ``(B) Prevalence.--In determining prevalence of 
                diseases under subparagraph (A), the Secretary shall 
                use data on the prevalence of the illnesses described 
                in such subparagraph in HIV-infected individuals unless 
                such data is not available nationally. Where such data 
                is not nationally available, the Secretary may use the 
                prevalence (with respect to such illnesses) in the 
                general population.''.
            (3) Distribution of funds.--
                    (A) In general.--Section 2603(a)(2) (42 U.S.C. 
                300ff-13(a)(2)) (as amended by paragraph (2)) is 
                further amended--
                            (i) by inserting ``, in accordance with 
                        paragraph (3)'' before the period; and
                            (ii) by adding at the end thereof the 
                        following new sentence: ``The Secretary shall 
                        reserve an additional percentage of the amount 
                        appropriated under section 2677 for a fiscal 
                        year for grants under part A to make grants to 
                        eligible areas under section 2601(a) in 
                        accordance with paragraph (4).''.
                    (B) Increase in grant.--Section 2603(a) (42 U.S.C. 
                300ff-13(a)) is amended by adding at the end thereof 
                the following new paragraph:
            ``(4) Increase in grant.--With respect to an eligible area 
        under section 2601(a), the Secretary shall increase the amount 
        of a grant under paragraph (2) for a fiscal year to ensure that 
        such eligible area receives not less than--
                    ``(A) with respect to fiscal year 1996, 98 percent;
                    ``(B) with respect to fiscal year 1997, 97 percent;
                    ``(C) with respect to fiscal year 1998, 95.5 
                percent;
                    ``(D) with respect to fiscal year 1999, 94 percent; 
                and
                    ``(E) with respect to fiscal year 2000, 92.5 
                percent;
        of the amount allocated for fiscal year 1995 to such entity 
        under this subsection.''.
            (4) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is 
        amended--
                    (A) in subsection (b)(1)(A)--
                            (i) by inserting ``, substance abuse 
                        treatment and mental health treatment,'' after 
                        ``case management''; and
                            (ii) by inserting ``which shall include 
                        treatment education and prophylactic treatment 
                        for opportunistic infections,'' after 
                        ``treatment services,'';
                    (B) in subsection (b)(2)(A)--
                            (i) by inserting ``, or private for-profit 
                        entities if such entities are the only 
                        available provider of quality HIV care in the 
                        area,'' after ``nonprofit private entities,''; 
                        and
                            (ii) by striking ``and homeless health 
                        centers'' and inserting ``homeless health 
                        centers, substance abuse treatment programs, 
                        and mental health programs''; and
                    (C) in subsection (e)--
                            (i) in the subsection heading, by striking 
                        ``and Planning;
                            (ii) by striking ``The chief'' and 
                        inserting:
            ``(1) In general.--The chief'';
                            (iii) by striking ``accounting, reporting, 
                        and program oversight functions'';
                            (iv) by adding at the end thereof the 
                        following new sentence: ``An entity (including 
                        subcontractors) receiving an allocation from 
                        the grant awarded to the chief executive 
                        officer under this part shall not use in excess 
                        of 12.5 percent of amounts received under such 
                        allocation for administration.''; and
                            (v) by adding at the end thereof the 
                        following new paragraphs:
            ``(2) Administrative activities.--For the purposes of 
        paragraph (1), amounts may be used for administrative 
        activities that include--
                    ``(A) routine grant administration and monitoring 
                activities, including the development of applications 
                for part A funds, the receipt and disbursal of program 
                funds, the development and establishment of 
                reimbursement and accounting systems, the preparation 
                of routine programmatic and financial reports, and 
                compliance with grant conditions and audit 
                requirements; and
                    ``(B) all activities associated with the grantee's 
                contract award procedures, including the development of 
                requests for proposals, contract proposal review 
                activities, negotiation and awarding of contracts, 
                monitoring of contracts through telephone consultation, 
                written documentation or onsite visits, reporting on 
                contracts, and funding reallocation activities.''.
            ``(3) Subcontractor administrative costs.--For the purposes 
        of this subsection, subcontractor administrative activities 
        include--
                    ``(A) usual and recognized overhead, including 
                established indirect rates for agencies;
                    ``(B) management oversight of specific programs 
                funded under this title; and
                    ``(C) other types of program support such as 
                quality assurance, quality control, and related 
                activities.''.
            (5) Application.--Section 2605 (42 U.S.C. 300ff-15) is 
        amended--
                    (A) in subsection (a)--
                            (i) in the matter preceding paragraph (1), 
                        by inserting ``, in accordance with subsection 
                        (c) regarding a single application and grant 
                        award,'' after ``application'';
                            (ii) in paragraph (1)(B), by striking ``1-
                        year period'' and all that follows through 
                        ``eligible area'' and inserting ``preceding 
                        fiscal year'';
                            (iii) in paragraph (4), by striking ``and'' 
                        at the end thereof;
                            (iv) in paragraph (5), by striking the 
                        period at the end thereof and inserting ``; 
                        and''; and
                            (v) by adding at the end thereof the 
                        following new paragraph:
            ``(6) that the applicant has participated, or will agree to 
        participate, in the Statewide coordinated statement of need 
        process where it has been initiated by the State, and ensure 
        that the services provided under the comprehensive plan are 
        consistent with the Statewide coordinated statement of need.'';
                    (B) in subsection (b)--
                            (i) in the subsection heading, by striking 
                        ``Additional'';
                            (ii) in the matter preceding paragraph (1), 
                        by striking ``additional application'' and 
                        inserting ``application, in accordance with 
                        subsection (c) regarding a single application 
                        and grant award,'';
                            (iii) in paragraph (3), by striking ``and'' 
                        at the end thereof; and
                            (iv) in paragraph (4), by striking the 
                        period and inserting ``; and'';
                    (C) by redesignating subsections (c) and (d) as 
                subsections (d) and (e), respectively; and
                    (D) by inserting after subsection (b), the 
                following new subsection:
    ``(c) Single Application and Grant Award.--
            ``(1) Application.--The Secretary may phase in the use of a 
        single application that meets the requirements of subsections 
        (a) and (b) of section 2603 with respect to an eligible area 
        that desires to receive grants under section 2603 for a fiscal 
        year.
            ``(2) Grant award.--The Secretary may phase in the awarding 
        of a single grant to an eligible area that submits an approved 
        application under paragraph (1) for a fiscal year.''.
            (6) Technical assistance.--Section 2606 (42 U.S.C. 300ff-
        16) is amended--
                    (A) by striking ``may'' and inserting ``shall'';
                    (B) by inserting after ``technical assistance'' the 
                following: ``, including peer based assistance to 
                assist newly eligible metropolitan areas in the 
                establishment of HIV health services planning councils 
                and,''; and
                    (C) by adding at the end thereof the following new 
                sentences: ``The Administrator may make planning grants 
                available to metropolitan areas, in an amount not to 
                exceed $75,000 for any metropolitan area, projected to 
                be eligible for funding under section 2601 in the 
                following fiscal year. Such grant amounts shall be 
                deducted from the first year formula award to eligible 
                areas accepting such grants. Not to exceed 1 percent of 
                the amount appropriated for a fiscal year under section 
                2677 for grants under part A may be used to carry out 
                this section.''.
    (b) Care Grant Program.--
            (1) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) 
        is amended--
                    (A) in subsection (a)--
                            (i) 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
                            (ii) in paragraph (2)(A)--
                                    (I) by inserting ``substance abuse 
                                treatment, mental health treatment,'' 
                                after ``nursing,''; and
                                    (II) by inserting ``prophylactic 
                                treatment for opportunistic infections, 
                                treatment education to take place in 
                                the context of health care delivery,'' 
                                after ``monitoring,'';
                    (B) in subsection (c)--
                            (i) in subparagraph (C) of paragraph (1), 
                        by inserting before ``care'' ``and youth 
                        centered''; and
                            (ii) in paragraph (2)--
                                    (I) in clause (ii) of subparagraph 
                                (A), by striking ``served; and'' and 
                                inserting ``served;'';
                                    (II) in subparagraph (B), by 
                                striking the period at the end; and
                                    (III) by adding after subparagraph 
                                (B), the following new subparagraphs:
                    ``(C) grantees under section 2671 and 
                representatives of organizations with a history of 
                serving children, youth, women, and families with HIV 
                and operating in the community to be served; and
                    ``(D) representatives of community-based providers 
                that are necessary to provide the full continuum of 
                HIV-related health care services, which are available 
                within the geographic area to be served.''; and
                    (C) in subsection (d), to read as follows:
    ``(d) Definition.--As used in this part, the terms `family centered 
care' and `youth centered care' mean the system of services described 
in this section that is targeted specifically to the special needs of 
infants, children (including those orphaned by the AIDS epidemic), 
youth, women, and families. Family centered and youth centered care 
shall be based on a partnership among parents, extended family members, 
children and youth, professionals, and the community designed to ensure 
an integrated, coordinated, culturally sensitive, and community-based 
continuum of care.''.
            (2) Provision of treatments.--Section 2616 (42 U.S.C. 
        300ff-26) is amended by striking subsection (c) and inserting 
        the following new subsections:
    ``(c) Standards for Treatment Programs.--In carrying out this 
section, the Secretary shall--
            ``(1) review the current status of State drug reimbursement 
        programs and assess barriers to the expended availability of 
        prophylactic treatments for opportunistic infections (including 
        active tuberculosis); and
            ``(2) establish, in consultation with States, providers, 
        and affected communities, a recommended minimum formulary of 
        pharmaceutical drug therapies approved by the Food and Drug 
        Administration.
In carrying out paragraph (2), the Secretary shall identify those 
treatments in the recommended minimum formulary that are for the 
prevention of opportunistic infections (including the prevention of 
active tuberculosis).
    ``(d) State Duties.--
            ``(1) In general.--In implementing subsection (a), States 
        shall document the progress made in making treatments described 
        in subsection (c)(2) available to individuals eligible for 
        assistance under this section, and to develop plans to 
        implement fully the recommended minimum formulary of 
        pharmaceutical drug therapies approved by the Food and Drug 
        Administration.
            ``(2) Other mechanisms for providing treatments.--In 
        meeting the standards of the recommended minimum formulary 
        developed under subsection (c), a State may identify other 
        mechanisms such as consortia and public programs for providing 
        such treatments to individuals with HIV.''.
            (3) State application.--Section 2617(b) (42 U.S.C. 300ff-
        27(b)) is amended--
                    (A) in paragraph (2)--
                            (i) in subparagraph (A), by striking 
                        ``and'' at the end thereof; and
                            (ii) by adding at the end thereof the 
                        following new subparagraph:
                    ``(C) a description of how the allocation and 
                utilization of resources are consistent with the 
                Statewide coordinated statement of need (including 
                traditionally underserved populations and 
                subpopulations) developed in partnership with other 
                grantees in the State that receive funding under this 
                title;'';
                    (B) by redesignating paragraph (3) as paragraph 
                (4);
                    (C) by inserting after paragraph (2), the following 
                new paragraph:
            ``(3) the public health agency administering the grant for 
        the State shall convene a meeting at least annually of 
        individuals with HIV who utilize services under this part 
        (including those individuals from traditionally underserved 
        populations and subpopulations) and representatives of grantees 
        funded under this title (including HIV health services planning 
        councils, early intervention programs, children, youth and 
        family service projects, special projects of national 
        significance, and HIV care consortia) and other providers 
        (including federally qualified health centers) and public 
        agency representatives within the State currently delivering 
        HIV services to affected communities for the purpose of 
        developing a Statewide coordinated statement of need; and''; 
        and
                    (D) by adding at the end thereof the following 
                flush sentence:
``The State shall not be required to finance attendance at the meetings 
described in paragraph (3). A State may pay the travel-related expenses 
of individuals attending such meetings where appropriate and necessary 
to ensure adequate participation.''.
            (4) Planning, evaluation and administration.--Section 
        2618(c) (42 U.S.C. 300ff-28(c)) is amended--
                    (A) in paragraphs (3) and (4), to read as follows:
            ``(3) Planning and evaluations.--Subject to paragraph (5) 
        and except as provided in paragraph (6), a State may not use 
        more than 10 percent of amounts received under a grant awarded 
        under this part for planning and evaluation activities.
            ``(4) Administration.--
                    ``(A) In general.--Subject to paragraph (5) and 
                except as provided in paragraph (6), a State may not 
                use more than 10 percent of amounts received under a 
                grant awarded under this part for administration. An 
                entity (including subcontractors) receiving an 
                allocation from the grant awarded to the State under 
                this part shall not use in excess of 12.5 percent of 
                amounts received under such allocation for 
                administration.
                    ``(B) Administrative activities.--For the purposes 
                of subparagraph (A), amounts may be used for 
                administrative activities that include routine grant 
                administration and monitoring activities.
                    ``(C) Subcontractor administrative costs.--For the 
                purposes of this paragraph, subcontractor 
                administrative activities include--
                            ``(i) usual and recognized overhead, 
                        including established indirect rates for 
                        agencies;
                            ``(ii) management oversight of specific 
                        programs funded under this title; and
                            ``(iii) other types of program support such 
                        as quality assurance, quality control, and 
                        related activities.'';
                    (B) by redesignating paragraph (5) as paragraph 
                (7); and
                    (C) by inserting after paragraph (4), the following 
                new paragraphs:
            ``(5) Limitation on use of funds.--Except as provided in 
        paragraph (6), a State may not use more than a total of 15 
        percent of amounts received under a grant awarded under this 
        part for the purposes described in paragraphs (3) and (4).
            ``(6) Exception.--With respect to a State that receives the 
        minimum allotment under subsection (a)(1) for a fiscal year, 
        such State, from the amounts received under a grant awarded 
        under this part for such fiscal year for the activities 
        described in paragraphs (3) and (4), may, notwithstanding 
        paragraphs (3), (4), and (5), use not more than that amount 
        required to support one full-time-equivalent employee.''.
            (5) Technical assistance.--Section 2619 (42 U.S.C. 300ff-
        29) is amended--
                    (A) by striking ``may'' and inserting ``shall''; 
                and
                    (B) by inserting before the period the following: 
                ``, including technical assistance for the development 
                and implementation of Statewide coordinated statements 
                of need''.
            (6) Grievance procedures and coordination.--Part B of title 
        XXVI (42 U.S.C. 300ff-21) is amended by adding at the end 
        thereof the following new sections:

``SEC. 2621. GRIEVANCE PROCEDURES.

    ``Not later than 90 days after the date of enactment of this 
section, the Administration, in consultation with affected parties, 
shall establish grievance procedures, specific to each part of this 
title, to address allegations of egregious violations of each such 
part. Such procedures shall include an appropriate enforcement 
mechanism.

``SEC. 2622. COORDINATION.

    ``The Secretary shall ensure that the Health Resources and Services 
Administration, the Centers for Disease Control and Prevention, and the 
Substance Abuse and Mental Health Services Administration coordinate 
the planning and implementation of Federal HIV programs in order to 
facilitate the local development of a complete continuum of HIV-related 
services for individuals with HIV disease and those at risk of such 
disease. The Secretary shall periodically prepare and submit to the 
relevant committees of Congress a report concerning such coordination 
efforts at the Federal, State, and local levels as well as the 
existence of Federal barriers to HIV program integration.''.
    (c) Early Intervention Services.--
            (1) Establishment of program.--Section 2651(b) (42 U.S.C. 
        300ff-51(b)) is amended--
                    (A) in paragraph (1), by striking ``grant agrees 
                to'' and all that follows through the period and 
                inserting: ``grant agrees to--
                    ``(A) expend the grant for the purposes of 
                providing, on an out-patient basis, each of the early 
                intervention services specified in paragraph (2) with 
                respect to HIV disease; and
                    ``(B) expend not less than 50 percent of the amount 
                received under the grant to provide a continuum of 
                primary care services, including, as appropriate, 
                dental care services, to individuals confirmed to be 
                living with HIV.''; and
                    (B) in paragraph (4)--
                            (i) by striking ``The Secretary'' and 
                        inserting ``(A) In general.--The Secretary'';
                            (ii) by inserting ``, or private for-profit 
                        entities if such entities are the only 
                        available provider of quality HIV care in the 
                        area,'' after ``nonprofit private entities'';
                            (iii) by realigning the margin of 
                        subparagraph (A) so as to align with the margin 
                        of paragraph (3)(A); and
                            (iv) by adding at the end thereof the 
                        following new subparagraph:
                    ``(B) Other requirements.--Grantees described in--
                            ``(i) paragraphs (1), (2), (5), and (6) of 
                        section 2652(a) shall use not less than 50 
                        percent of the amount of such a grant to 
                        provide the services described in subparagraphs 
                        (A), (B), (D), and (E) of section 2651(b)(2) 
                        directly and on-site or at sites where other 
                        primary care services are rendered; and
                            ``(ii) paragraphs (3) and (4) of section 
                        2652(a) shall ensure the availability of early 
                        intervention services through a system of 
                        linkages to community-based primary care 
                        providers, and to establish mechanisms for the 
                        referrals described in section 2651(b)(2)(C), 
                        and for follow-up concerning such referrals.''.
            (2) Minimum qualifications.--Section 2652(b)(1)(B) (42 
        U.S.C. 300ff-52(b)(1)(B)) is amended by inserting ``, or a 
        private for-profit entity if such entity is the only available 
        provider of quality HIV care in the area,'' after ``nonprofit 
        private entity'';
            (3) Miscellaneous provisions.--Section 2654 (42 U.S.C. 
        300ff-54) is amended by adding at the end thereof the following 
        new 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 that are not direct 
        providers of primary care services for the purpose of enabling 
        such providers to provide HIV primary care services.
            ``(2) Requirement.--The Secretary may only award a grant to 
        an entity under paragraph (1) 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 would 
        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.''.
            (4) Authorization of appropriations.--Section 2655 (42 
        U.S.C. 300ff-55) is amended by striking ``$75,000,000'' and all 
        that follows through the end of the section, and inserting 
        ``such sums as may be necessary in each of the fiscal years 
        1996, 1997, 1998, 1999, and 2000.''.
            (5) Required agreements.--Section 2664(g) (42 U.S.C. 300ff-
        64(g)) is amended--
                    (A) in paragraph (2), by striking ``and'' at the 
                end thereof;
                    (B) in paragraph (3)--
                            (i) by striking ``5 percent'' and inserting 
                        ``10 percent including planning, evaluation and 
                        technical assistance''; and
                            (ii) by striking the period and inserting 
                        ``; and''; and
                    (C) by adding at the end thereof the following new 
                paragraph:
            ``(4) the applicant will submit evidence that the proposed 
        program is consistent with the Statewide coordinated statement 
        of need and agree to participate in the ongoing revision of 
        such statement of need.''.
    (d) Grants.--
            (1) In general.--Section 2671 (42 U.S.C. 300ff-71) is 
        amended to read as follows:

``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
              CHILDREN, YOUTH, AND FAMILIES.

    ``(a) In General.--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 award grants to appropriate public or nonprofit private entities 
that, directly or through contractual arrangements, provide primary 
care to the public for the purpose of--
            ``(1) providing out-patient health care and support 
        services (which may include family-centered and youth-centered 
        care, as defined in this title, family and youth support 
        services, and services for orphans) to children, youth, women 
        with HIV disease, and the families of such individuals, and 
        supporting the provision of such care with programs of HIV 
        prevention and HIV research; and
            ``(2) facilitating the voluntary participation of children, 
        youth, and women with HIV disease in qualified research 
        protocols at the facilities of such entities or by direct 
        referral.
    ``(b) Eligible Entities.--The Secretary may not make a grant to an 
entity under subsection (a) unless the entity involved provides 
assurances that--
            ``(1) the grant will be used primarily to serve children, 
        youth, and women with HIV disease;
            ``(2) the entity will enter into arrangements with one or 
        more qualified research entities to collaborate in the conduct 
        or facilitation of voluntary patient participation in qualified 
        research protocols;
            ``(3) the entity will coordinate activities under the grant 
        with other providers of health care services under this title, 
        and under title V of the Social Security Act;
            ``(4) the entity will participate in the Statewide 
        coordinated statement of need under section 2619 and in the 
        revision of such statement; and
            ``(5) the entity will offer appropriate research 
        opportunities to each patient, with informed consent.
    ``(c) Application.--The Secretary may not make a grant under 
subsection (a) unless an application for the grant is submitted to the 
Secretary and the application is in such form, is made in such manner, 
and contains such agreements, assurances, and information as the 
Secretary determines to be necessary to carry out this section.
    ``(d) Patient Participation in Research Protocols.--
            ``(1) In general.--The Secretary, acting through the 
        Administrator of the Health Resources and Services 
        Administration and the Director of the Office of AIDS Research, 
        shall establish procedures to ensure that accepted standards of 
        protection of human subjects (including the provision of 
        written informed consent) are implemented in projects supported 
        under this section. Receipt of services by a patient shall not 
        be conditioned upon the consent of the patient to participate 
        in research.
            ``(2) Research protocols.--
                    ``(A) In general.--The Secretary shall establish 
                mechanisms to ensure that research protocols proposed 
                to be carried out to meet the requirements of this 
                section, are of potential clinical benefit to the study 
                participants, and meet accepted standards of research 
                design.
                    ``(B) Review panel.--Mechanisms established under 
                subparagraph (A) shall include an independent research 
                review panel that shall review all protocols proposed 
                to be carried out to meet the requirements of this 
                section to ensure that such protocols meet the 
                requirements of this section. Such panel shall make 
                recommendations to the Secretary as to the protocols 
                that should be approved. The panel shall include 
                representatives of public and private researchers, 
                providers of services, and recipients of services.
    ``(e) Training and Technical Assistance.--The Secretary, acting 
through the Administrator of the Health Resources and Services 
Administration, may use not to exceed five percent of the amounts 
appropriated under subsection (h) in each fiscal year to conduct 
training and technical assistance (including peer-based models of 
technical assistance) to assist applicants and grantees under this 
section in complying with the requirements of this section.
    ``(f) Evaluations and Data Collection.--
            ``(1) Evaluations.--The Secretary shall provide for the 
        review of programs carried out under this section at the end of 
        each grant year. Such evaluations may include recommendations 
        as to the improvement of access to and participation in 
        services and access to and participation in qualified research 
        protocols supported under this section.
            ``(2) Reporting requirements.--The Secretary may establish 
        data reporting requirements and schedules as necessary to 
        administer the program established under this section and 
        conduct evaluations, measure outcomes, and document the clients 
        served, services provided, and participation in qualified 
        research protocols.
            ``(3) Waivers.--Notwithstanding the requirements of 
        subsection (b), the Secretary may award new grants under this 
        section to an entity if the entity provide assurances, 
        satisfactory to the Secretary, that the entity will implement 
        the assurances required under paragraph (2), (3), (4), or (5) 
        of subsection (b) by the end of the second grant year. If the 
        Secretary determines through the evaluation process that a 
        recipient of funds under this section is in material 
        noncompliance with the assurances provided under paragraph (2), 
        (3), (4), or (5) of subsection (b), the Secretary may provide 
        for continued funding of up to one year if the recipient 
        provides assurances, satisfactory to the Secretary, that such 
        noncompliance will be remedied within such period.
    ``(g) Definitions.--For purposes of this section:
            ``(1) Qualified research entity.--The term `qualified 
        research entity' means a public or private entity with 
        expertise in the conduct of research that has demonstrated 
        clinical benefit to patients.
            ``(2) Qualified research protocol.--The term `qualified 
        research protocol' means a research study design of a public or 
        private clinical program that meets the requirements of 
        subsection (d).
    ``(h) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of the fiscal years 1996 through 2000.''.
            (2) Conforming amendment.--The heading for part D of title 
        XXVI of the Public Health Service Act is amended to read as 
        follows:

 ``PART D--GRANTS FOR COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
                    CHILDREN, YOUTH, AND FAMILIES''.

    (e) Demonstration and Training.--
            (1) In general.--Title XXVI is amended by adding at the 
        end, the following new part:

                  ``PART F--DEMONSTRATION AND TRAINING

         ``Subpart I--Special Projects of National Significance

``SEC. 2691. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of parts 
A, B, C, and D of this title for each fiscal year, the Secretary shall 
use the greater of $20,000,000 or 3 percent of such amount appropriated 
under each such part, but not to exceed $25,000,000, to administer a 
special projects of national significance program to award direct 
grants to public and nonprofit private entities including community-
based organizations to fund special programs for the care and treatment 
of individuals with HIV disease.
    ``(b) Grants.--The Secretary shall award grants under subsection 
(a) based on--
            ``(1) the need to assess the effectiveness of a particular 
        model for the care and treatment of individuals with HIV 
        disease;
            ``(2) the innovative nature of the proposed activity; and
            ``(3) the potential replicability of the proposed activity 
        in other similar localities or nationally.
    ``(c) Special Projects.--Special projects of national significance 
shall include the development and assessment of innovative service 
delivery models that are designed to--
            ``(1) address the needs of special populations;
            ``(2) assist in the development of essential community-
        based service delivery infrastructure; and
            ``(3) ensure the ongoing availability of services for 
        Native American communities to enable such communities to care 
        for Native Americans with HIV disease.
    ``(d) Special Populations.--Special projects of national 
significance may include the delivery of HIV health care and support 
services to traditionally underserved populations including--
            ``(1) individuals and families with HIV disease living in 
        rural communities;
            ``(2) adolescents with HIV disease;
            ``(3) Indian individuals and families with HIV disease;
            ``(4) homeless individuals and families with HIV disease;
            ``(5) hemophiliacs with HIV disease; and
            ``(6) incarcerated individuals with HIV disease.
    ``(e) Service Development Grants.--Special projects of national 
significance may include the development of model approaches to 
delivering HIV care and support services including--
            ``(1) programs that support family-based care networks 
        critical to the delivery of care in minority communities;
            ``(2) programs that build organizational capacity in 
        disenfranchised communities;
            ``(3) programs designed to prepare AIDS service 
        organizations and grantees under this title for operation 
        within the changing health care environment; and
            ``(4) programs designed to integrate the delivery of mental 
        health and substance abuse treatment with HIV services.
    ``(f) Coordination.--The Secretary may not make a grant under this 
section unless the applicant submits evidence that the proposed program 
is consistent with the Statewide coordinated statement of need, and the 
applicant agrees to participate in the ongoing revision process of such 
statement of need.
    ``(g) Replication.--The Secretary shall make information concerning 
successful models developed under this part available to grantees under 
this title for the purpose of coordination, replication, and 
integration. To facilitate efforts under this subsection, the Secretary 
may provide for peer-based technical assistance from grantees funded 
under this part.''.
            (2) Repeal.--Subsection (a) of section 2618 (42 U.S.C. 
        300ff-28(a)) is repealed.
    (f) HIV/AIDS Communities, Schools, Centers.--
            (1) New part.--Part F of title XXVI (as added by subsection 
        (e)) is further amended by adding at the end, the following new 
        subpart:

           ``Subpart II--AIDS Education and Training Centers

``SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.''.

            (2) Amendments.--Section 776(a)(1) (42 U.S.C. 294n(a)) is 
        amended--
                    (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 new subparagraph:
                    ``(A) training health personnel, including 
                practitioners in title XXVI programs and other 
                community providers, in the diagnosis, treatment, and 
                prevention of HIV infection and disease;''; and
                    (D) in subparagraph (B) (as so redesignated) by 
                adding ``and'' after the semicolon.
            (3) Transfer.--Subsection (a) of section 776 (42 U.S.C. 
        294n(a)) (as amended by paragraph (2)) is amended by 
        transferring such subsection to section 2692 (as added by 
        paragraph (1)).
            (4) Authorization of appropriations.--Section 2692 (as 
        added by paragraph (1)) is amended by adding at the end thereof 
        the following new subsection:
    ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section, such sums as may be necessary 
for each of the fiscal years 1996 through 2000.''.

SEC. 4. 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 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).
                    ``(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) 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 fiscal year preceding 
                the year for which the grant determination is to be 
                made. The amount of any such unexpended funds shall be 
                determined using the financial status report of the 
                grantee.
                    ``(E) 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. 5. AMOUNT OF CARE GRANTS.

    Paragraphs (1) and (2) of section 2618(b) (42 U.S.C. 300ff-28(b)(1) 
and (2)) are amended to read as follows:
            ``(1) Minimum allotment.--Subject to the extent of amounts 
        made available under section 2677, the amount of a grant to be 
        made under this part for--
                    ``(A) each of the several States and the District 
                of Columbia for a fiscal year shall be the greater of--
                            ``(i)(I) with respect to a State or 
                        District that has less than 90 living cases of 
                        acquired immune deficiency syndrome, as 
                        determined under paragraph (2)(D), $100,000; or
                            ``(i)(I) with respect to a State or 
                        District that has 90 or more living cases of 
                        acquired immune deficiency syndrome, as 
                        determined under paragraph (2)(D), $250,000;
                            ``(ii) an amount determined under paragraph 
                        (2); and
                    ``(B) each territory of the United States, as 
                defined in paragraph (3), shall be an amount determined 
                under paragraph (2).
            ``(2) Determination.--
                    ``(A) Formula.--The amount referred to in paragraph 
                (1)(A)(ii) for a State and paragraph (1)(B) for a 
                territory of the United States shall be the product 
                of--
                            ``(i) an amount equal to the amount 
                        appropriated under section 2677 for the fiscal 
                        year involved for grants under part B; and
                            ``(ii) the percentage constituted by the 
                        sum of--
                                    ``(I) the product of .50 and the 
                                ratio of the State distribution factor 
                                for the State or territory (as 
                                determined under subsection (B)) to the 
                                sum of the respective State 
                                distribution factors for all States or 
                                territories; and
                                    ``(II) the product of .50 and the 
                                ratio of the non-EMA distribution 
                                factor for the State or territory (as 
                                determined under subparagraph (C)) to 
                                the sum of the respective distribution 
                                factors for all States or territories.
                    ``(B) State distribution factor.--For purposes of 
                subparagraph (A)(ii)(I), the term `State distribution 
                factor' means an amount equal to the estimated number 
                of living cases of acquired immune deficiency syndrome 
                in the eligible area involved, as determined under 
                subparagraph (D).
                    ``(C) Non-ema distribution factor.--For purposes of 
                subparagraph (A)(ii)(II), the term `non-ema 
                distribution factor' means an amount equal to the sum 
                of--
                            ``(i) the estimated number of living cases 
                        of acquired immune deficiency syndrome in the 
                        State or territory involved, as determined 
                        under subparagraph (D); less
                            ``(ii) the estimated number of living cases 
                        of acquired immune deficiency syndrome in such 
                        State or territory that are within an eligible 
                        area (as determined under part A).
                    ``(D) 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 State or 
                        territory during each year in the most recent 
                        120-month period for which data are available 
                        with respect to all States and territories, 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 each of the first 
                        through the tenth year during such period, the 
                        amount referred to in 2603(a)(3)(C)(ii).
                    ``(E) Puerto rico, virgin islands, guam.--For 
                purposes of subparagraph (D), the cost index for Puerto 
                Rico, the Virgin Islands, and Guam shall be 1.0.''.
                    ``(F) Unexpended funds.--The Secretary may, in 
                determining the amount of a grant for a fiscal year 
                under this subsection, adjust the grant amount to 
                reflect the amount of unexpended and uncanceled grant 
                funds remaining at the end of the fiscal year preceding 
                the year for which the grant determination is to be 
                made. The amount of any such unexpended funds shall be 
                determined using the financial status report of the 
                grantee.
                    ``(G) Limitation.--
                            ``(i) In general.--The Secretary shall 
                        ensure that the amount of a grant awarded to a 
                        State or territory for a fiscal year under this 
                        part is equal to not less than--
                                    ``(I) with respect to fiscal year 
                                1996, 98 percent;
                                    ``(II) with respect to fiscal year 
                                1997, 97 percent;
                                    ``(III) with respect to fiscal year 
                                1998, 95.5 percent;
                                    ``(IV) with respect to fiscal year 
                                1999, 94 percent; and
                                    ``(V) with respect to fiscal year 
                                2000, 92.5 percent;
                        of the amount such State or territory received 
                        for fiscal year 1995 under this part. In 
                        administering this subparagraph, the Secretary 
                        shall, with respect to States that will receive 
                        grants in amounts that exceed the amounts that 
                        such States received under this part in fiscal 
                        year 1995, proportionally reduce such amounts 
                        to ensure compliance with this subparagraph. In 
                        making such reductions, the Secretary shall 
                        ensure that no such State receives less than 
                        that State received for fiscal year 1995.
                            ``(ii) Ratable reduction.--If the amount 
                        appropriated under section 2677 and available 
                        for allocation under this part is less than the 
                        amount appropriated and available under this 
                        part for fiscal year 1995, the limitation 
                        contained in clause (i) shall be reduced by a 
                        percentage equal to the percentage of the 
                        reduction in such amounts appropriated and 
                        available.''.

SEC. 6. 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 new section:

``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--Subject to subsection (b), there are authorized 
to be appropriated to make grants under parts A and B, such sums as may 
be necessary for each of the fiscal years 1996 through 2000. Of the 
amount appropriated under this section for fiscal year 1996, 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.--
            ``(1) In general.--With respect to each of the fiscal years 
        1997 through 2000, the Secretary shall develop and implement a 
        methodology for adjusting the percentages referred to in 
        subsection (a) to account for grants to new eligible areas 
        under part A and other relevant factors. Not later than 1 year 
        after the date of enactment of this section, the Secretary 
        shall prepare and submit to the appropriate committees of 
        Congress a report regarding the findings with respect to the 
        methodology developed under this paragraph.
            ``(2) Failure to implement.--If the Secretary fails to 
        implement a methodology under paragraph (1) by October 1, 1996, 
        there are authorized to be appropriated--
                    ``(A) such sums as may be necessary to carry out 
                part A for each of the fiscal years 1997 through 2000; 
                and
                    ``(B) such sums as may be necessary to carry out 
                part B for each of the fiscal years 1997 through 
                2000.''.
    (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 and 300ff-
30) are repealed.
    (c) Conforming Amendments.--Title XXVI is amended--
            (1) in section 2603 (42 U.S.C. 300ff-13)--
                    (A) in subsection (a)(2), by striking ``2608'' and 
                inserting ``2677''; and
                    (B) in subsection (b)(1), by striking ``2608'' and 
                inserting ``2677'';
            (2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(1)) is 
        amended by striking ``2608'' and inserting ``2677''; and
            (3) in section 2618 (42 U.S.C. 300ff-28)--
                    (A) in subsection (a)(1), is amended by striking 
                ``2620'' and inserting ``2677''; and
                    (B) in subsection (b)(1), is amended by striking 
                ``2620'' and inserting ``2677''.

SEC. 7. CDC GUIDELINES FOR PREGNANT WOMEN.

    (a) Requirement.--Notwithstanding any other provision of law, a 
State described in subsection (b) shall, not later than 1 year after 
the date of enactment of this Act, certify to the Secretary of Health 
and Human Services that such State has in effect regulations to adopt 
the guidelines issued by the Centers for Disease Control and Prevention 
concerning recommendations for immunodeficiency virus counseling and 
voluntary testing for pregnant women.
    (b) Application of Section.--A State described in this subsection 
is a State that has--
            (1) an HIV seroprevalance among child bearing women during 
        the period beginning on January 1, 1991 and ending on December 
        31, 1992, of .25 or greater as determined by the Centers for 
        Disease Control and Prevention; or
            (2) an estimated number of births to HIV positive women in 
        1993 of 175 or greater as determined by the Centers for Disease 
        Control and Prevention using 1992 natality statistics.
    (c) Noncompliance.--If a State does not provide the certification 
required under subsection (a) within the 1 year period described in 
such subsection, such State shall not be eligible to receive assistance 
for HIV counseling and testing under the Public Health Service Act (42 
U.S.C. 201 et seq.) until such certification is provided.
    (d) Additional Funds Regarding Women and Infants.--
            (1) In general.--If a State described in subsection (b) 
        provides the certification required in subsection (a) and is 
        receiving funds under part B of title XXVI of the Public Health 
        Service Act for a fiscal year, the Secretary of Health and 
        Human Services may (from the amounts available pursuant to 
        paragraph (3)) make a grant to the State for the fiscal year 
        for the following purposes:
                    (A) Making available to pregnant women appropriate 
                counseling on HIV disease.
                    (B) Making available outreach efforts to pregnant 
                women at high risk of HIV who are not currently 
                receiving prenatal care.
                    (C) Making available to such women testing for such 
                disease.
                    (D) Offsetting other State costs associated with 
                the implementation of the requirement of subsection 
                (a).
            (2) Evaluation by institute of medicine.--
                    (A) In general.--The Secretary of Health and Human 
                Services shall request the Institute of Medicine of the 
                National Academy of Sciences to enter into a contract 
                with the Secretary for the purpose of conducting an 
                evaluation of the extent to which grants under 
                paragraph (1) have been effective in preventing the 
                perinatal transmission of the human immunodeficiency 
                virus.
                    (B) Alternative contract.--If the Institute 
                referred to in subparagraph (A) declines to conduct the 
                evaluation under such subparagraph, the Secretary of 
                Health and Human Services shall carry out such 
                subparagraph through another public or nonprofit 
                private entity.
                    (C) Date certain for report.--The Secretary of 
                Health and Human Services shall ensure that, not later 
                than after 2 years after the date of the enactment of 
                this Act, the evaluation required in this paragraph is 
                completed and a report describing the findings made as 
                a result of the evaluation is submitted to the 
                Congress.
            (3) Funding.--For the purpose of carrying out this 
        subsection, there are authorized to be appropriated $10,000,000 
        for each of the fiscal years 1996 through 2000. Amounts made 
        available under section 2677 for carrying out this part are not 
        available for carrying out this subsection.

SEC. 8. SPOUSAL NOTIFICATION.

    (a) Prohibition on the Use of Funds.--The Secretary shall not make 
a grant under this Act to any State or political subdivision of any 
State, nor shall any other funds made available under this Act, be 
obligated or expended in any State unless such State takes 
administrative or legislative action to require that a good faith 
effort shall be made to notify a spouse of an AIDS-infected patient 
that such AIDS-infected patient is infected with the human 
immunodeficiency virus.
    (b) Definitions.--As used in this section--
            (1) AIDS-infected patient.--The term ``AIDS-infected 
        patient'' means any person who has been diagnosed by a 
        physician or surgeon practicing medicine in such State to be 
        infected with the human immunodeficiency virus.
            (2) State.--The term ``State'' means a State, the District 
        of Columbia, or any territory of the United States.
            (3) Spouse.--The term ``spouse'' means a person who is or 
        at any time since December 31, 1976, has been the marriage 
        partner of a person diagnosed as an AIDS-infected patient.
    (c) Effective Date.--Subsection (a) shall take effect with respect 
to a State on January 1 of the calendar year following the first 
regular session of the legislative body of such State that is convened 
following the date of enactment of this section.

SEC. 9. STUDY ON ALLOTMENT FORMULA.

    (a) Study.--The Secretary of Health and Human Services (hereafter 
referred to in this section as the ``Secretary'') shall enter into a 
contract with a public or nonprofit private entity, subject to 
subsection (b), for the purpose of conducting a study or studies 
concerning the statutory formulas under which funds made available 
under part A or B of title XXVI of the Public Health Service Act are 
allocated among eligible areas (in the case of grants under part A) and 
States and territories (in the case of grants under part B). Such study 
or studies shall include--
            (1) an assessment of the degree to which each such formula 
        allocates funds according to the respective needs of eligible 
        areas, State, and territories;
            (2) an assessment of the validity and relevance of the 
        factors currently included in each such formula;
            (3) in the case of the formula under part A, an assessment 
        of the degree to which the formula reflects the relative costs 
        of providing services under such title XXVI within eligible 
        areas;
            (4) in the case of the formula under part B, an assessment 
        of the degree to which the formula reflects the relative costs 
        of providing services under such title XXVI within eligible 
        States and territories; and
            (5) any other information that would contribute to a 
        thorough assessment of the appropriateness of the current 
        formulas.
    (b) National Academy of Sciences.--The Secretary shall request the 
National Academy of Sciences to enter into the contract under 
subsection (a) to conduct the study described in such subsection. If 
such Academy declines to conduct the study, the Secretary shall carry 
out such subsection through another public or nonprofit private entity.
    (c) Report.--The Secretary shall ensure that not later than 6 
months after the date of enactment of this Act, the study required 
under subsection (a) is completed and a report describing the findings 
made as a result of such study is submitted to the Committee on 
Commerce of the House of Representatives and the Committee on Labor and 
Human Resources of the Senate.
    (d) Consultation.--The entity preparing the report required under 
subsection (c), shall consult with the Comptroller General of the 
United States. The Comptroller General shall review the study after its 
transmittal to the committees described in subsection (c) and within 3 
months make appropriate recommendations concerning such report to such 
committees.

SEC. 10. PROHIBITIONS AND LIMITATIONS ON THE USE OF FEDERAL FUNDS

    (a) Promotion or Encouragement of Certain Activities.--No funds 
authorized to be appropriated under this Act may be used to promote or 
encourage, directly or indirectly, homosexuality, or intravenous drug 
use.
    (b) Definition.--As used in subsection (a), the term ``to promote 
or encourage, directly or indirectly, homosexuality'' includes, but is 
not limited to, affirming homosexuality as natural, normal, or healthy, 
or, in the process of addressing related ``at-risk'' issues, affirming 
in any way that engaging in a homosexual act is desirable, acceptable, 
or permissible, or, describing in any way techniques of homosexual sex.

SEC. 11. OPTIONAL PARTICIPATION OF FEDERAL EMPLOYEES IN AIDS TRAINING 
              PROGRAMS.

    (a) In General.--Notwithstanding any other provision of law, a 
Federal employee may not be required to attend or participate in an 
AIDS or HIV training program if such employee refuses to consent to 
such attendance or participation. An employer may not retaliate in any 
manner against such an employee because of the refusal of such employee 
to consent to such attendance or participation.
    (b) Definition.--As used in subsection (a), the term ``Federal 
employee'' has the same meaning given the term ``employee'' in section 
2105 of title 5, United States Code, and such term shall include 
members of the armed forces.

SEC. 12. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

    Part D of title XXVI of the Public Health Service Act (42 U.S.C. 
300ff-71) as amended by section 6, is further amended by adding at the 
end thereof the following new section:

``SEC. 2678. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

    ``None of the funds authorized under this title shall be used to 
fund AIDS programs, or to develop materials, designed to promote or 
encourage, directly, intravenous drug use or sexual activity, whether 
homosexual or heterosexual. Funds authorized under this title may be 
used to provide medical treatment and support services for individuals 
with HIV.''.

SEC. 13. LIMITATION ON APPROPRIATIONS.

    Notwithstanding any other provision of law, the total amounts of 
Federal funds expended in any fiscal year for AIDS and HIV activities 
may not exceed the total amounts expended in such fiscal year for 
activities related to cancer.

SEC. 14. EFFECTIVE DATE.

    (a) In General.--Except as provided in subsection (b), this Act, 
and the amendments made by this Act, shall become effective on October 
1, 1995.
    (b) Eligible Areas.--
            (1) In general.--The amendments made by subsections 
        (a)(1)(A), (a)(2), and (b)(4)(A) of section 3 shall become 
        effective on the date of enactment of this Act.
            (2) Reported cases.--The amendment made by subsection 
        (a)(1)(B) of section 3 shall become effective on October 1, 
        1997.
            Passed the Senate July 27 (legislative day, July 10), 1995.

            Attest:

                                                             Secretary.
104th CONGRESS

  1st Session

                                 S. 641

_______________________________________________________________________

                                 AN ACT

To reauthorize the Ryan White CARE Act of 1990, and for other purposes.
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