[Congressional Record Volume 141, Number 123 (Thursday, July 27, 1995)]
[Senate]
[Pages S10757-S10767]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  RYAN WHITE CARE REAUTHORIZATION ACT

  The Senate continued with the consideration of the bill.


                           amendment no. 1854

  Mr. LEVIN. Mr. President, I voted against the Helms amendment.
  I am, of course, concerned about and opposed to use of funds 
authorized to be appropriated under this bill to promote any sexual 
activity, whether homosexual or heterosexual. I will support the 
proposal of the manager of the bill, the chairman of the Labor and 
Human Resources Committee, Senator Nancy Kassebaum which will have the 
effect of prohibiting the use of Federal funds for any such activity.
  The amendment offered by Senator Kassebaum more accurately addresses 
the need to make clear the Senate's opposition to the use of Federal 
funds to promote sexual activity--heterosexual or homosexual--without 
endangering the purposes of the legislation.
  The amendment I support and I expect will pass simply states:

       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.
                           Amendment No. 1857

  The PRESIDING OFFICER. Under the previous order, the Senate now 
resumes consideration of amendment No. 1857, offered by the Senator 
from North Carolina, on which there is 10 minutes designated for debate 
equally divided. Who yields time?
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Parliamentary inquiry, we are on amendment No. 1857; 
is that correct?
  The PRESIDING OFFICER. The Senator is correct.
  Mrs. KASSEBAUM. Mr. President, this is a funding equity measure. If I 
may comment for a moment as one who opposes this amendment. What it 
would do would be to prohibit discretionary spending for AIDS and HIV 
activities in excess of discretionary spending for cancer activities.
  Mr. President, I yield to the Democratic leader.
  Mr. DASCHLE. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The assistant legislative clerk proceeded to call the roll.
  Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mrs. KASSEBAUM. Mr. President, if I may just say this. I believe we 
have 10 minutes equally divided.
  The PRESIDING OFFICER. The Senator is correct.
  The Senate will please come to order.
  Mrs. KASSEBAUM. It is my understanding that there are 10 minutes, 
equally divided, under the agreement.
  I suggest that amendment No. 1857 would prohibit discretionary 
spending for AIDS and HIV activities in excess of discretionary 
spending for cancer activities. No one would deny the importance of 
moneys for cancer activities. However, I will be offering an 
alternative amendment, No. 1860, in the sequence later.
  I oppose amendment No. 1857 that is being offered, because it 
compares only discretionary spending amounts and does not take into 
account entitlement spending under programs, such as Medicare and 
Medicaid. The inclusion of entitlement spending dramatically shifts the 
equation. Relatively few AIDS and HIV activities are financed through 
entitlement programs, while substantial entitlement spending is 
directed toward cancer. I think this is an important difference and one 
that I would hope everyone will take into consideration.
  I will yield the floor and reserve the remainder of my time.
  The PRESIDING OFFICER. Who yields time?
  Mr. HELMS. Mr. President, I thought that we had an understanding that 
we would just go to a vote. How much time do I have?
  The PRESIDING OFFICER. The Senator from North Carolina has 5 minutes.
  Mr. HELMS. Mr. President, I hope Senators will look at this amendment 
very carefully. The pending amendment would ensure that any and all 
Federal funds authorized and appropriated for HIV/AIDS would not exceed 
that which is appropriated for cancer. These are not my figures. These 
came from the Congressional Research Service report to the Congress 
dated March 9, 1995. Copies of this will be on the table for any 
Senator who wants to study it.
  The leading cause of death in America today is heart disease, 
followed closely by cancer. HIV/AIDS ranks eighth in the number of 
deaths caused. It is of interest, Mr. President, that HIV/AIDS receives 
$2.7 billion per year in Federal funding, which exceeds Federal funding 
for any other disease--heart disease or cancer.
  Heart disease, which kills more than 720,000 Americans each year, 
receives $805 million in Federal funds. Cancer, which kills 515,000 
Americans, receives $2.3 billion. Mr. President, more people are dying 
from heart disease, cancer, stroke, lung disease, accidents, pneumonia, 
and diabetes than die from AIDS. Yet, AIDS receives more of the 
taxpayers' money.
  Something is amiss and needs to be corrected. This amendment will do 
it.
  Today, on the average, the Federal Government spends about $91,000 
per AIDS death, and only about $5,000 per cancer death. So, in a 
nutshell, the pending amendment will bring a measure of equity and 
fairness to the existing priorities in the area of HIV/AIDS funding. As 
long as cancer kills 18 times as many people as AIDS, and AIDS receives 
more Federal funding, it is time that Congress establishes some new, 
equitable, and fair priorities.
  That concludes my remarks. If I have any more time remaining, I yield 
it back.
  Mrs. KASSEBAUM. Mr. President, I would just like to say that we must 
take into account both discretionary and mandatory spending. When you 
do that, HIV/AIDS receives $5.4 billion, cancer receives $15 billion, 
and heart disease receives $34 billion.
  I believe it is very important for us to take into consideration both 
the discretionary and the mandatory spending. I think that when we 
assess total Federal spending, it gives a more accurate picture. The 
funds for support services, for patients with cancer and heart disease 
come largely through mandatory spending. This fact is not represented 
by the chart shown by the Senator from North Carolina.
  I yield whatever time is left to the Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I hope the membership will pay attention 
to what the Senator from Kansas has stated. Basically, when you compare 
apples and apples and oranges and oranges, you have that kind of 
result, where you have substantial additional spending in the areas of 
cancer and heart disease.
  The Senator from North Carolina has taken a very selected area in 
terms of the spending and tried to use that as the comparison. I think 
that all of us understand that we should not be trying to rob one 
particular kind of research or treatment. All of us are interested in 
the treatment of cancer and HIV. The proposal we have before us, I 
believe, deals with that.
  Mr. HELMS. Mr. President, I reclaim my time to defend my position. 

[[Page S 10758]]

  The PRESIDING OFFICER. The Senator has that right.
  Mr. HELMS. The Senator referred to apples and apples. But he is 
talking about apples and oranges. The administration's numbers prove 
the disparity. They knock down the argument that the distinguished 
Senator from Kansas offered and that the distinguished Senator from 
Massachusetts supports.
  Even using their skewed approach which combines discretionary and 
mandatory spending, the numbers prove there is still a disparity. Heart 
disease receives $38 billion in Federal funds. The number of people 
suffering from heart ailments is 20 million. The funds per patient--
Federal funds, mind you--are $1,900. That is per heart patient.
  Cancer is $17.5 billion of Federal funds. The number of people who 
have cancer in America is 8 million. The funds per cancer patient is 
$2,187.
  Look at HIV/AIDS, if you want to talk about fairness: $7 billion. The 
number of people who have it is 1.4 million. And the Federal funds per 
patient is $5,000. If you want fairness, the $5,000 is not it.
  Mr. President, this amendment will insure any and all Federal funds 
authorized and appropriated for HIV/AIDS will not exceed Federal funds 
authorized and appropriated for cancer.
  The leading cause of death in America today is heart disease, 
followed closely by cancer. HIV/AIDS ranks ninth in the number of 
deaths caused. It is of interest, Mr. President, that HIV/AIDS receives 
$2.7 billion per year in Federal funding, which exceeds Federal funding 
with any other disease. Heart disease, which kills more than 720,000 
Americans each year, receives $805 million in Federal funds. Cancer, 
which kills 515,000 Americans, receives $2.3 billion.
  Mr. President, more people are dying from heart disease, cancer, 
stroke, lung disease, accidents, pneumonia, diabetes, and suicide than 
die from AIDS; yet AIDS receives more of the American taxpayers' money. 
Something is amiss and needs to be corrected.
  Today, on average, the Federal Government spends about $91,000 on 
every person who dies of AIDS, and only about $5,000 on every person 
who dies of cancer. I suggest most Americans agree that this 
discrepancy is simply neither fair nor equitable.
  Mr. President, in a nutshell, the pending amendment will being a 
measure of equity to the existing priorities in the area of HIV/AIDS 
funding. As long as cancer kills 18 times as many people as AIDS, and 
AIDS receives more Federal funding, it is time that Congress 
established some new equitable priorities.
  Mr. President, I ask unanimous consent that a letter to me by the 
President of the Family Research Council be printed in the Record.
  There being no objection, the letter was ordered to be printed in the 
Record, as follows:

                                      Family Research Council,

                                    Washington, DC, July 27, 1995.
     Hon. Jesse Helms,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Helms: On behalf of the 250,000 families which 
     are presented by the Family Research Council, I commend your 
     efforts to reform the Ryan White Care Act [S. 641].
       I am proud to endorse your amendments and encourage the 
     rest of the Senate to join you in redirecting federal AIDS 
     spending toward more effective approaches.
       One of the biggest problems with the Ryan White Act is its 
     lack of accountability. Under the Health Resources 
     Administration, 146 large grants are disbursed to state and 
     local programs and further divided up into countless 
     subgrants. Unlike most federal funds which are accounted for, 
     these subgrants use the money without reporting where or to 
     whom the money has been allocated.
       In addition to a lack of financial accountability, millions 
     of dollars for AIDS victims is being spent to normalize and 
     promote the homosexual lifestyle. Many of these efforts are 
     being directed toward school children. The Gay Men's Health 
     Crisis, a recipient of Ryan White funds, produced graphically 
     illustrated brochures which were given to students in New 
     York City. The brochures are replete with shocking vulgarity 
     and urge kids to wear condoms and latex gloves while engaging 
     in perverse sexual activity. They recommend singular and 
     group masturbation.
       Congress should reconsider AIDS education which now 
     emphasizes condoms and has been shown in countless studies to 
     be ineffective. Programs seeking funding renewal should be 
     required to show evidence that they have reduced HIV 
     transmission. Current formulas for funding should be 
     reexamined. For example, money ought to go where it is needed 
     most, which is, increasingly, to under-served minority 
     communities.
       Congress should take advantage of this opportunity to 
     examine the allocations of federal AIDS dollars. Instead of 
     bowing to the demands of homosexual activists, Congress 
     should reexamine the use of Ryan White funds and take steps 
     to overhaul AIDS spending.
       AIDS is a tragedy that has been politicized for too long. 
     The American people, as well as the victims of this terrible 
     disease, deserve better.
       Thank you for your hard work and your commitment to making 
     individual responsibility the touchstone of public policy.
           Sincerely,
                                                    Gary L. Bauer,
                                                        President.

  Mr. HELMS. I reserve the balance of my time in case there is more 
argument, because I can go on and on about this.
  The PRESIDING OFFICER. Who yields time?
  Mrs. KASSEBAUM. I yield back any remaining time I may have.
  Mr. HELMS. Mr. President, I wish to reiterate that in case any 
Senator wants to examine the arithmetic, here it is. I will say again 
that the administration's figures prove the disparity that I have been 
talking about.
  I yield the remainder of my time.
  The PRESIDING OFFICER. All time has expired.
  The question is on agreeing to the amendment, No. 1857, offered by 
the Senator from North Carolina.
  The yeas and nays have been ordered.
  The clerk will call the roll.
  The assistant legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Utah [Mr. Bennett] is 
necessarily absent.
  The PRESIDING OFFICER (Mr. Campbell). Are there any other Senators in 
the Chamber desiring to vote?
  The result was announced--yeas 15, nays 84, as follows:

                      [Rollcall Vote No. 336 Leg.]

                                YEAS--15

     Bond
     Cochran
     Faircloth
     Grams
     Helms
     Hollings
     Inhofe
     Kyl
     Lott
     McConnell
     Nickles
     Shelby
     Smith
     Thomas
     Thurmond

                                NAYS--84

     Abraham
     Akaka
     Ashcroft
     Baucus
     Biden
     Bingaman
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Gramm
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Hutchison
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lugar
     Mack
     McCain
     Mikulski
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nunn
     Packwood
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Simon
     Simpson
     Snowe
     Specter
     Stevens
     Thompson
     Warner
     Wellstone

                             NOT VOTING--1

       
     Bennett
       
  So the amendment (No. 1857) was rejected.
  Mrs. KASSEBAUM. Mr. President, I move to reconsider the vote.
  Mr. KENNEDY. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mrs. KASSEBAUM. Mr. President, I suggest there are three more votes 
that we will have. There will be two amendments that I will offer and 
then final passage. I will speak briefly on the two amendments that I 
have offered. I do not know if the Senator from North Carolina would 
like to respond.


                     Amendments Nos. 1858 and 1860

  The PRESIDING OFFICER. The question occurs on amendment 1858.
  Mr. KENNEDY. Mr. President, could we have order in the Chamber?
  The PRESIDING OFFICER. The Senate will be in order.
  Mrs. KASSEBAUM. My amendment, No. 1858, is an alternative to the one 
that was put forward earlier by the Senator from North Carolina and 
approved by the Senate. My amendment prohibits funds under the act from 
being used to directly promote or encourage intravenous drug use or 
sexual activity, both homosexual or heterosexual. It assures that funds 
are used 

[[Page S 10759]]
for treatment and support services only, not for prevention activities.
  This amendment is targeted to making sure that CARE Act funds are 
used for what they were designed for. Specifically that is for the 
treatment and support services for patients and families afflicted with 
AIDS.
  I would like to also address my second amendment, No. 1860, which 
addresses the issues of funding equity. My amendment is an alternative 
to one that was put forth by the Senator from North Carolina, that was 
just rejected. This amendment provides that Federal spending for AIDS 
and HIV activities may not exceed spending for cancer activities, 
taking into account both discretionary and entitlement spending.
  These are the two amendments that we will be considering; first 1858 
and then 1860.
  I will be happy to reserve the remainder of my time but I am prepared 
to yield it back.
  The PRESIDING OFFICER. Who yields time?
  Mr. HELMS. Mr. President, Senators at least should be aware of which 
amendment we are voting on now.
  Will the Chair state that, and will Senator Kassebaum describe that 
amendment? Because she talked about two amendments and I do not want 
Senators to be confused.
  Mrs. KASSEBAUM. The first amendment is 1858, which would prohibit 
funds from being used to promote or encourage intravenous drug use or 
sexual activity, both homosexual or heterosexual.
  Mr. HELMS. Right.
  I thank the Senator and I thank the Chair.
  Mr. President, the Kassebaum amendment that will be voted on next 
will gut, and is intended to gut, the Helms amendment that just passed 
the Senate by 54 to 45. The intent of the Kassebaum amendment is to 
take any teeth out of the amendment that the Senate has already 
approved.
  With all due respect to Senator Kassebaum, and I do respect her, her 
amendment is vague. It deletes the definition of activities that 
promote homosexuality. That is exactly what the homosexual activists 
want to happen to this amendment.
  I say no, and I hope the Senate will say no to this gutting amendment 
by the distinguished Senator from Kansas.
  Mr. President, the promotion, the advocacy of homosexuality does 
nothing to help the innocent victims of AIDS, like Ryan White, whose 
name is being exploited in this legislation.
  Every Senator who voted for the Helms amendment No. 1854, should vote 
against the Kassebaum amendment which is next to be voted on.
  I reserve the remainder of my time. I will be glad to yield it back.
  Mrs. KASSEBAUM. Mr. President, I yield back any remaining time, and I 
ask unanimous consent that the votes be 10-minute votes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Is all time yielded back?
  Mr. HELMS. I yield back the remainder of my time.


                       Vote on Amendment No. 1858

  The PRESIDING OFFICER. The question is on agreeing to the amendment 
of the Senator from Kansas. On this question, the yeas and nays have 
been ordered, and the clerk will call the roll.
  The legislative clerk called the roll.
  Mr. LOTT. I announce that the Senator from Utah [Mr. Bennett] is 
necessarily absent.
  The PRESIDING OFFICER. Are there any other Senators in the Chamber 
who desire to vote?
  The result was announced--yeas 76, nays 23, as follows:

                      [Rollcall Vote No. 337 Leg.]

                                YEAS--76

     Abraham
     Akaka
     Baucus
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Cohen
     Conrad
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Gregg
     Harkin
     Hatch
     Hatfield
     Hutchison
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lugar
     Mack
     McCain
     Mikulski
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nunn
     Packwood
     Pell
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Simon
     Simpson
     Snowe
     Specter
     Thomas
     Warner
     Wellstone

                                NAYS--23

     Ashcroft
     Brown
     Coats
     Cochran
     Coverdell
     Faircloth
     Gramm
     Grams
     Grassley
     Heflin
     Helms
     Hollings
     Inhofe
     Kyl
     Lott
     McConnell
     Nickles
     Pressler
     Shelby
     Smith
     Stevens
     Thompson
     Thurmond

                             NOT VOTING--1

       
     Bennett
       
  So the amendment (No. 1858) was agreed to.
  Mr. KENNEDY. Mr. President, I move to reconsider the vote.
  Mrs. KASSEBAUM. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mrs. KASSEBAUM. Mr. President, in light of the preceding vote on the 
funding equity issue, I am very appreciative of the Senator from North 
Carolina who said he would not object to our voice voting No. 1860, 
which is an amendment of mine which provides that Federal spending for 
AIDS and HIV activities may not exceed spending for cancer activities, 
taking into account both discretionary and entitlement spending, and I 
ask for the approval of that amendment.
  Mr. KENNEDY. I ask unanimous consent that the order for the rollcall 
be vitiated, Mr. President.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                       Vote on Amendment No. 1860

  The PRESIDING OFFICER. Is there further debate on the amendment?
  Mr. KENNEDY. I yield back the time.
  The PRESIDING OFFICER. The question is on agreeing to amendment No. 
1860 offered by the Senator from Kansas.
  The amendment (No. 1860) was agreed to.
  Mr. KENNEDY. Mr. President, I move to reconsider the vote.
  Mrs. KASSEBAUM. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. LAUTENBERG. Mr. President, before the Senate passes the Ryan 
White CARE Act reauthorization bill, my colleague Senator Bradley and I 
would like to engage in a colloquy with the ranking member of the Labor 
and Human Resources Committee.
  Mr. BRADLEY. The bill before us, S. 641, contains a new formula for 
distributing title I and title II funds. As a result of this formula 
change, New Jersey's title I cities will receive over $50,000 less next 
year than they would have under the original formula. In the year 2000, 
New Jersey's title I cities will receive almost half a million dollars 
less than they would have under the original formula. At the same time, 
the revised formula results in several other States receiving 
significant increases in the total amount of Ryan White funding they 
receive. For example, Minnesota will more than double its title I and 
title II funding under the revised formula, Nevada's funding will 
increase by 116 percent, and Vermont's will increase by 141 percent.
  Mr. LAUTENBERG. Mr. President, I recognize that States such as 
Minnesota and Nevada have more residents with AIDS now than they did 
when this bill was originally passed. But at the same time that the 
AIDS epidemic has been spreading across the country, it has continued 
to worsen in New Jersey. Between 1993 and 1994, the total number of 
AIDS cases reported in New Jersey increased by 53 percent. New Jersey 
currently has the fifth-highest number of AIDS cases in the United 
States, and the third-highest number of pediatric AIDS cases. Cutting 
New Jersey's funding so deeply at a time when the epidemic is growing 
so rapidly in the State is not fair to the thousand of New Jersey 
residents who are HIV-positive.
  Mr. BRADLEY. Therefore, Senator Lautenberg and I would like to ask 
our two colleagues if they would work hard in conference to obtain a 
formula which would decrease the reductions in funding to New Jersey.
  Mr. KENNEDY. I will do everything I can to urge the conferees to 
revise the formula to reduce the reductions in funding to New Jersey.
  Mr. LAUTENBERG. Senator Bradley and I would like to thank the 
chairperson and ranking member. Since we have received assurances that 

[[Page S 10760]]
they will strive to decrease the amount of funding reductions which New 
Jersey will receive as a result of the formula revisions, I ask 
unanimous consent that I be added as a cosponsor of S. 641.
  Mr. BRADLEY. I appreciate my colleagues' assurances. Even with these 
assurances, I still expect that this bill will hurt the State of New 
Jersey. However, I recognize that at some point compromises must be 
made or else the future of the entire Ryan White Program may be at 
risk. Therefore, having received these assurances, I plan to support 
this bill.
  The PRESIDING OFFICER. The majority leader is recognized.
  Mr. DOLE. Let me indicate to my colleagues that after this vote, we 
will have a period for the transaction of morning business to extend 
about 45 minutes. At the expiration of morning business, we hope to 
have--maybe not--an agreement, but we will go to the gift ban proposal 
at about, hopefully, 1:30.
  Mr. CHAFEE. Mr. President, I would like to ask the leader one quick 
question. They are going to dedicate the war memorial at 3 o'clock. 
What is the leader's plans for that?
  Mr. DOLE. We will not recess but we will protect Senators. I know 
there are about 11 Senators who wish to attend that ceremony, and we 
will not have votes during that time.
  Mr. BUMPERS addressed the Chair.
  The PRESIDING OFFICER. The Senator from Arkansas, Mr. Bumpers, is 
recognized.


                             Change of Vote

  Mr. BUMPERS. On rollcall No. 334, I mistakenly voted ``yes'' on what 
I believed was a motion to table. I ask unanimous consent that I be 
recorded as ``no.'' It will not change the outcome of the vote.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  (The foregoing tally has been changed to reflect the above order.)
  The PRESIDING OFFICER. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed for a third reading and was read 
the third time.
  The PRESIDING OFFICER. The bill having been read the third time, the 
question is, Shall the bill pass? On this question, the yeas and nays 
have been ordered. The clerk will call the roll.
  The assistant legislative clerk called the roll.
  The result was announced--yeas 97, nays 3, as follows:
                      [Rollcall Vote No. 338 Leg.]

                                YEAS--97

     Abraham
     Akaka
     Ashcroft
     Baucus
     Bennett
     Biden
     Bingaman
     Bond
     Boxer
     Bradley
     Breaux
     Brown
     Bryan
     Bumpers
     Burns
     Byrd
     Campbell
     Chafee
     Coats
     Cochran
     Cohen
     Conrad
     Coverdell
     Craig
     D'Amato
     Daschle
     DeWine
     Dodd
     Dole
     Domenici
     Dorgan
     Exon
     Faircloth
     Feingold
     Feinstein
     Ford
     Frist
     Glenn
     Gorton
     Graham
     Gramm
     Grams
     Grassley
     Gregg
     Harkin
     Hatch
     Hatfield
     Heflin
     Hollings
     Hutchison
     Inhofe
     Inouye
     Jeffords
     Johnston
     Kassebaum
     Kempthorne
     Kennedy
     Kerrey
     Kerry
     Kohl
     Lautenberg
     Leahy
     Levin
     Lieberman
     Lott
     Lugar
     Mack
     McCain
     McConnell
     Mikulski
     Moseley-Braun
     Moynihan
     Murkowski
     Murray
     Nickles
     Nunn
     Packwood
     Pell
     Pressler
     Pryor
     Reid
     Robb
     Rockefeller
     Roth
     Santorum
     Sarbanes
     Shelby
     Simon
     Simpson
     Snowe
     Specter
     Stevens
     Thomas
     Thompson
     Thurmond
     Warner
     Wellstone

                                NAYS--3

     Helms
     Kyl
     Smith
  So the bill (S. 641), as amended, was passed, as follows:
                                 S. 641

       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 

[[Page S 10761]]
     ``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 

[[Page S 10762]]
     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 

[[Page S 10763]]
     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;

[[Page S 10764]]

       ``(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 

[[Page S 10765]]
     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.

[[Page S 10766]]

       (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.

  Mr. KENNEDY. Mr. President, I move to reconsider the vote by which 
the bill was passed.
  Mrs. KASSEBAUM. I move to lay that motion on the table.
  The motion to lay on the table was agreed to.
  Mr. KENNEDY addressed the Chair.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. KENNEDY. Mr. President, I want to express my appreciation to the 
chairman of our committee, Senator Kassebaum, for her leadership on 
this extremely important piece of legislation. It is one of the first 
major reauthorizations of a program that offers such hope for so many 
of our fellow citizens.
  This is an important day for the Senate and I think for our country. 
It is an indication of strong bipartisan support, overwhelming support 
in the Senate, for a program that will provide a degree of hope for 
hundreds of thousands of our fellow citizens who are afflicted by this 
epidemic.
  This program has been successful in the past. Its need has been 
documented. It is an expression of compassion for those who are ill to 
try to make sure that their suffering will be relieved in a significant 
and important way.
  I think it is an extremely important piece of legislation. All of us 
are grateful to our leaders for scheduling this--Senator Dole, Senator 
Daschle. I am particularly appreciative on our side of Senator Daschle 
for his strong support and for his continued efforts to make sure that 
we were going to get an early consideration of the legislation.
  I would like to take a moment of the Senate's time to express a 
strong appreciation for personnel support. I think I speak for the 
Senate in thanking the members of our staffs who have toiled long and 
hard and have worked diligently and with very considerable knowledge 
about this subject matter:
  Michael Iskowitz and Seth Kelbourne in my own office. Mike Iskowitz 
was here with the passing of the first Ryan White legislation and has 
followed it extremely closely and is very much involved in the 
strengthening and improvements to this legislation. I am grateful to 
both of them.
  Marty Ross and Jim Wade worked very closely with us, and I am 
grateful for the common spirit that was so evident by the staff, not 
only our own staff but the work that was done by many of our other 
colleagues who participated and involved themselves as well.
  I am grateful as well for the various AIDS organizations that came 
together to run this program effectively. I am mindful that Jeanne 
White, Ryan's mother, when we first passed this legislation a number of 
years ago, was in the gallery for that occasion. All of us who continue 
to work on this program are mindful that it is named after Ryan, her 
son. Ryan's mother is a strong supporter of this legislation. I think 
all of us thank her for her continued interest.
  There have been many people, not only in the Senate, but also in the 
House, where this is moving along with bipartisan support, and across 
the country who have urged the passage of this. I think the 
overwhelming support from all different political viewpoints that came 
together in support is really a reflection of the genuine sense of 
compassion and sense of decency and caring that is really the Senate 
and our colleagues at their best.
  So I thank all those who participated, and I am grateful for their 
support. We will do everything we can to carry forward in the 
conference and bring strong legislation back to the Senate.
  Mr. President, I am extremely pleased with the action taken by the 
U.S. Senate. By voting 96 to 3 in favor of the Ryan White CARE Act 
reauthorization of 1995--the Senate has sent a strong message of hope 
to hundreds of thousands of Americans living with AIDS.
  In communities across this country, the Ryan White CARE Act programs 
represent America at its best. The Senate demonstrated the capacity to 
put people before politics and act in the public interest. Today's 
action will make a world of difference for individuals and families in 
need.
  For 15 years, America has been struggling with the devastating 
effects of AIDS. More than a million citizens are infected with the 
virus. AIDS itself has now become the leading killer of all young 
Americans ages 25 to 44. Its is killing brothers and sisters, children 
and parents, friends and loved ones--all in the prime of their lives.
  Nearly 500,000 Americans have been diagnosed with AIDS. Over half 
have already died--and yet the epidemic marches on unabated.
  The epidemic is a decade and a half old--but almost 40 percent of the 
AIDS cases in the country have been diagnosed in the last 2 years. One 
more American gets the bad news every 6 minutes. And since we began the 
debate last Friday--we have lost another 500 of our fellow citizens to 
AIDS.
  As the crisis continues year after year, it has become more and more 
difficult for anyone to claim that AIDS is someone else's problem. In a 
very real way, we are all living with AIDS.
  The epidemic has cost this Nation immeasurable talent and energy in 
young and promising lives struck down long before their time. And in 
the pages of history our response to this plague--and the challenges it 
presents--will surely document what we stood for as a society.
  America can take satisfaction that in these difficult times we have 
the ability to do things right. In the case of the CARE Act--we have.
  The act contains a series of carefully crafted components that 
together have reduced in-patient hospitalization and emergency room 
visits. It has allowed more than 350,000 Americans with HIV disease 
this year to live longer, healthier, and more productive lives. In a 
very real way, the CARE Act has saved money and saved lives.
  While much has changed since 1990, the brutality of the epidemic 
remains severe. When the act first took effect, only 16 cities 
qualified for emergency relief. In the past 5 years, that number has 
more than tripled--and by next year it will have quadrupled.
  This crisis is not limited to major urban centers. Caseloads are now 
growing in small towns and rural communities, along the coasts and in 
America's heartland. From Weymouth to Wichita, no community has avoided 
the epidemic's reach.
  We are literally fighting for the lives of hundreds of thousands of 
our fellow 

[[Page S 10767]]
citizens. These realities challenge us to move forward together in the 
best interest of all people living with HIV and all Americans. And that 
is what Senator Kassebaum and I have attempted to do.
  The compromise in this legislation acknowledges that the HIV epidemic 
has expanded its reach. But we have not forgotten its roots. While new 
faces and new places are affected, the epidemic rages on in the areas 
of the country hit hardest and longest.
  The pain and suffering of individuals and families with HIV is real, 
widespread, and growing. All community-based organizations, cities, and 
States need additional support from the Federal Government to meet the 
needs of those they serve.
  This legislation represents a compromise, and like most compromises, 
it is not perfect and it will not please everyone. But on balance, it 
is a good bill--and its enactment will benefit all people living with 
HIV everywhere in the Nation.
  We have sought common ground. We have listened to those on the front-
lines. And we have attempted to support their efforts, not tie their 
hands. The Senate put aside political, geographic, and institutional 
differences to face this important challenge squarely and successfully.
  Although the resources fall short of meeting the growing need, the 
act is working. It has provided life-saving care and support for 
hundreds of thousands of individuals and families affected by HIV and 
AIDS.
  The act is about more than Federal funds and health care services. It 
is also about the caring American tradition of reaching out to people 
who are suffering and in need of help. Ryan White would be proud of 
what is taking place in his name. His example, and the hard work of so 
many others, are bringing help and hope to our American family with 
AIDS.
  Since the beginning, the CARE Act has been a model of bipartisan 
cooperation and effective Federal leadership. Today that tradition 
continues and 64 Senators joined Chairman Kassebaum and me in 
presenting this bill to the Senate--and 96 Senators supported its 
passage. It does not get much clearer than that.
  This is an important day for people living with HIV and AIDS and all 
Americans. We must do more to provide care and support for those 
trapped in the epidemic's path. And with this legislation, we will.
  Mrs. KASSEBAUM addressed the Chair.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mrs. KASSEBAUM. Mr. President, I will just add in support of what the 
ranking member of the Labor and Human Resources Committee, Senator 
Kennedy, has said in acknowledging the support of the leaders, both the 
majority leader and the minority leader in the Senate, who have been 
instrumental in helping us move forward with this legislation and final 
passage.
  Mr. President, I am pleased that the Senate has just concluded its 
action on the Ryan White CARE Reauthorization Act of 1995. As a result 
of this act, many individuals and families in this country who suffer 
from the HIV virus will continue to receive compassionate treatment and 
support services.
  As you know, I have not been alone in my support for this 
legislation. I wish to thank my 65 Senate colleagues who are cosponsors 
of this legislation. In particular, the ranking member on the Committee 
on Labor and Human Resources, Senator Kennedy, has been instrumental in 
the development and eventual passage of the reauthorization bill.
  The development of this legislation has been difficult at times, 
requiring the personal commitment of many individuals from various 
organizations. Without mentioning each, I wish to acknowledge their 
efforts.
  Finally, I thank Labor Committee staff who developed and helped 
orchestrate the passage of this act. In particular, I wish to 
acknowledge the dedication of Michael Iskowitz and Seth Kelbourne on 
Senator Kennedy's staff and Doctors Marty Ross and James Wade on my own 
staff.


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