[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.
S 641 ES----2
S 641 ES----3
S 641 ES----4
S 641 ES----5