[Congressional Record Volume 141, Number 145 (Monday, September 18, 1995)]
[House]
[Pages H9050-H9068]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 RYAN WHITE CARE ACT AMENDMENTS OF 1995

  Mr. BILIRAKIS. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1872) to amend the Public Health Service Act to revise and 
extend programs established pursuant to the Ryan White Comprehensive 
AIDS Resources Emergency Act of 1990, as amended.
  The Clerk read as follows:

                               H.R. 1872

       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 Act 
     Amendments of 1995''.

     SEC. 2. REFERENCES.

       Whenever in this Act an amendment is expressed in terms of 
     an amendment to a section or other provision, the reference 
     shall be considered to be made to that section or other 
     provision of the Public Health Service Act (42 U.S.C. 201 et 
     seq.).
 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

     SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS.

       (a) Number of Cases; Delayed Applicability.--Effective 
     October 1, 1996, section 2601(a) (42 U.S.C. 300ff-11) is 
     amended--
       (1) by striking ``subject to subsection (b)'' and inserting 
     ``subject to subsections (b) through (d)''; and
       (2) by striking ``metropolitan area'' and all that follows 
     and inserting the following: 

[[Page H 9051]]
     ``metropolitan area for which there has been reported to the Director 
     of the Centers for Disease Control and Prevention a 
     cumulative total of more than 2,000 cases of acquired immune 
     deficiency syndrome for the most recent period of five 
     calendar years for which such data are available.''.
       (b) Other Provisions Regarding Eligibility.--Section 2601 
     (42 U.S.C. 300ff-11) is amended by adding at the end thereof 
     the following subsections:
       ``(c) Requirements Regarding Population.--
       ``(1) Number of individuals.--
       ``(A) In general.--Except as provided in subparagraph (B), 
     the Secretary may not make a grant under this section for a 
     metropolitan area unless the area has a population of 500,000 
     or more individuals.
       ``(B) Limitation.--Subparagraph (A) does not apply to any 
     metropolitan area that was an eligible area under this part 
     for fiscal year 1995 or any prior fiscal year.
       ``(2) Geographic boundaries.--For purposes of eligibility 
     under this part, the boundaries of each metropolitan area are 
     the boundaries that were in effect for the area for fiscal 
     year 1994.
       ``(d) Continued Status as Eligible Area.--Notwithstanding 
     any other provision of this section, a metropolitan area that 
     was an eligible area under this part for fiscal year 1996 is 
     an eligible area for fiscal year 1997 and each subsequent 
     fiscal year.''.
       (c) Conforming Amendment Regarding Definition of Eligible 
     Area.--Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by 
     striking ``The term'' and all that follows and inserting the 
     following: ``The term `eligible area' means a metropolitan 
     area meeting the requirements of section 2601 that are 
     applicable to the area.''.

     SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

       (a) Establishment.--Section 2602(b)(1) (42 U.S.C. 300ff-
     12(b)(1)) is amended--
       (1) in subparagraph (A), by inserting before the semicolon 
     the following: ``, including federally qualified health 
     centers'';
       (2) in subparagraph (D), by inserting before the semicolon 
     the following: ``and providers of services regarding 
     substance abuse'';
       (3) in subparagraph (G), by inserting before the semicolon 
     the following: ``and historically underserved groups and 
     subpopulations'';
       (4) in subparagraph (I), by inserting before the semicolon 
     the following: ``, including the State medicaid agency and 
     the agency administering the program under part B'';
       (5) in subparagraph (J), by striking ``and'' after the 
     semicolon;
       (6) by striking subparagraph (K); and
       (7) by adding at the end the following subparagraphs:
       ``(K) grantees under section 2671, or, if none are 
     operating in the area, representatives of organizations in 
     the area with a history of serving children, youth, women, 
     and families living with HIV; and
       ``(L) grantees under other HIV-related Federal programs.''.
       (b) Duties.--Section 2602(b)(3) (42 U.S.C. 300ff-12(b)(3)) 
     is amended--
       (1) by striking ``The planning'' in the matter preceding 
     subparagraph (A) and all that follows through the semicolon 
     at the end of subparagraph (A) and inserting the following: 
     ``The planning council under paragraph (1) shall carry out 
     the following:
       ``(A) Establish priorities for the allocation of funds 
     within the eligible area based on the following factors:
       ``(i) Documented needs of the HIV-infected population.
       ``(ii) Cost and outcome effectiveness of proposed 
     strategies and interventions, to the extent that such data 
     are reasonably available.
       ``(iii) Priorities of the HIV-infected communities for 
     which the services are intended.
       ``(iv) Availability of other governmental and 
     nongovernmental resources.'';
       (2) in subparagraph (B)--
       (A) by striking ``develop'' and inserting ``Develop''; and
       (B) by striking ``; and'' and inserting a period;
       (3) in subparagraph (C)--
       (A) by striking ``assess'' and inserting ``Assess'';
       (B) by striking ``rapidly''; and
       (C) by inserting before the period the following: ``, and 
     assess the effectiveness, either directly or through 
     contractual arrangements, of the services offered in meeting 
     the identified needs''; and
       (4) by adding at the end the following subparagraphs:
       ``(D) Participate in the development of the statewide 
     coordinated statement of need initiated by the State health 
     department (where it has been so initiated).
       ``(E) Obtain input on community needs through conducting 
     public meetings.''.
       (c) General Provisions.--Section 2602(b) (42 U.S.C. 300ff-
     12(b)) is amended by adding at the end the following 
     paragraph:
       ``(4) General provisions.--
       ``(A) Composition of council.--The planning council under 
     paragraph (1) shall (in addition to requirements under such 
     paragraph) reflect in its composition the demographics of the 
     epidemic in the eligible area involved, with particular 
     consideration given to disproportionately affected and 
     historically underserved groups and subpopulations. 
     Nominations for membership on the council shall be identified 
     through an open process, and candidates shall be selected 
     based on locally delineated and publicized criteria. Such 
     criteria shall include a conflict-of-interest standard for 
     each nominee.
       ``(B) Conflicts of interest.--
       ``(i) The planning council under paragraph (1) may not be 
     directly involved in the administration of a grant under 
     section 2601(a). With respect to compliance with the 
     preceding sentence, the planning council may not designate 
     (or otherwise be involved in the selection of) particular 
     entities as recipients of any of the amounts provided in the 
     grant.
       ``(ii) An individual may serve on the planning council 
     under paragraph (1) only if the individual agrees to comply 
     with the following:

       ``(I) If the individual has a financial interest in an 
     entity, and such entity is seeking amounts from a grant under 
     section 2601(a), the individual will not, with respect to the 
     purpose for which the entity seeks such amounts, participate 
     (directly or in an advisory capacity) in the process of 
     selecting entities to receive such amounts for such purpose.
       ``(II) In the case of a public or private entity of which 
     the individual is an employee, or a public or private 
     organization of which the individual is a member, the 
     individual will not participate (directly or in an advisory 
     capacity) in the process of making any decision that relates 
     to the expenditure of a grant under section 2601(a) for such 
     entity or organization or that otherwise directly affects the 
     entity or organization.''.

     SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

       (a) Formula Grants Based on Relative Need of Areas.--
     Section 2603(a) (42 U.S.C. 300ff-13(a)) is amended--
       (1) in paragraph (1)--
       (A) in the second sentence, by inserting ``, subject to 
     paragraph (4)'' before the period; and
       (B) by adding at the end the following sentence: ``Grants 
     under this paragraph for a fiscal year shall be disbursed not 
     later than 60 days after the date on which amounts 
     appropriated under section 2677 become available for the 
     fiscal year, subject to any waivers under section 2605(d).'';
       (2) in paragraph (2), by amending the paragraph to read as 
     follows:
       ``(2) Allocations.--Of the amount available under section 
     2677 for a fiscal year for making grants under section 
     2601(a)--
       ``(A) the Secretary shall reserve 50 percent for making 
     grants under paragraph (1) in amounts determined in 
     accordance with paragraph (3); and
       ``(B) the Secretary shall, after compliance with 
     subparagraph (A), reserve such funds as may be necessary to 
     carry out paragraph (4).''; and
       (3) by adding at the end the following paragraph:
       ``(4) Maximum reduction in grant.--In the case of any 
     eligible area for which a grant under paragraph (1) was made 
     for fiscal year 1995, the Secretary, in making grants under 
     such paragraph for the area for the fiscal years 1996 through 
     2000, shall (subject to the extent of the amount available 
     under section 2677 for the fiscal year involved for making 
     grants under section 2601(a)) ensure that the amounts of the 
     grants do not, relative to such grant for the area for fiscal 
     year 1995, constitute a reduction of more than the following, 
     as applicable to the fiscal year involved:
       ``(A) 1 percent, in the case of fiscal year 1996.
       ``(B) 2 percent, in the case of fiscal year 1997.
       ``(C) 3 percent, in the case of fiscal year 1998.
       ``(D) 4 percent, in the case of fiscal year 1999.
       ``(E) 5 percent, in the case of fiscal year 2000.''.
       (b) Supplemental Grants.--Section 2603(b) (42 U.S.C. 300ff-
     13(b)) is amended--
       (1) in paragraph (1)--
       (A) in the matter preceding subparagraph (A), by striking 
     ``Not later than'' and all that follows through ``section 
     2605(b)--'' and inserting the following: ``After allocating 
     in accordance with subsection (a) the amounts available under 
     section 2677 for grants under section 2601(a) for a fiscal 
     year, the Secretary, in carrying out section 2601(a), shall 
     from the remaining amounts make grants to eligible areas 
     described in this paragraph. Such grants shall be disbursed 
     not later than 150 days after the date on which amounts 
     appropriated under section 2677 become available for the 
     fiscal year. An eligible area described in this paragraph is 
     an eligible area whose application under section 2605(b)--'';
       (B) in subparagraph (D), by striking ``and'' after the 
     semicolon;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (D) by adding at the end thereof the following 
     subparagraph:
       ``(F) demonstrates the manner in which the proposed 
     services are consistent with the local needs assessment and 
     the statewide coordinated statement of need.''; and
       (2)(A) by redesignating paragraphs (2) through (4) as 
     paragraphs (3) through (5), respectively; and
       (B) by inserting after paragraph (1) the following 
     paragraph:
       ``(2) Priority.--
       ``(A) Severe need.--In determining severe need in 
     accordance with paragraph (1)(B), the Secretary shall give 
     priority consideration in awarding grants under this 
     subsection to eligible areas that (in addition to complying 
     with paragraph (1)) demonstrate a more severe need based on 
     the prevalence in the eligible area of--

[[Page H 9052]]

       ``(i) sexually transmitted diseases, substance abuse, 
     tuberculosis, severe mental illness, or other conditions 
     determined relevant by the Secretary, which significantly 
     affect the impact of HIV disease;
       ``(ii) subpopulations with HIV disease that were previously 
     unknown in such area; or
       ``(iii) homelessness.
       ``(B) Prevalence.--In determining prevalence of conditions 
     under subparagraph (A), the Secretary shall use data on the 
     prevalence of the conditions described in such subparagraph 
     among individuals with HIV disease (except that, in the case 
     of an eligible area for which such data are not available, 
     the Secretary shall use data on the prevalences of the 
     conditions in the general population of such area).''.
       (c) Additional Requirements for Grants.--Section 2603 (42 
     U.S.C. 300ff-13) is amended by adding at the end the 
     following subsection:
       ``(c) Compliance With Priorities of HIV Planning Council.--
     Notwithstanding any other provision of this part, the 
     Secretary, in carrying out section 2601(a), may not make any 
     grant under subsection (a) or (b) to an eligible area unless 
     the application submitted by such area under section 2605 for 
     the grant involved demonstrates that the grants made under 
     subsections (a) and (b) to the area for the preceding fiscal 
     year (if any) were expended in accordance with the priorities 
     applicable to such year that were established, pursuant to 
     section 2602(b)(3)(A), by the planning council serving the 
     area.''.

     SEC. 104. USE OF AMOUNTS.

       Section 2604 (42 U.S.C. 300ff-14) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1)(A), by striking ``including case 
     management and comprehensive treatment services, for 
     individuals'' and inserting the following: ``including HIV-
     related comprehensive treatment services (including treatment 
     education and measures for the prevention and treatment of 
     opportunistic infections), case management, and substance 
     abuse treatment and mental health treatment, for 
     individuals'';
       (B) in paragraph (2)(A)--
       (i) by inserting after ``nonprofit private entities,'' the 
     following: ``or private for-profit entities if such entities 
     are the only available provider of quality HIV care in the 
     area,'' ; and
       (ii) by striking ``and homeless health centers'' and 
     inserting ``homeless health centers, substance abuse 
     treatment programs, and mental health programs''; and
       (C) by adding at the end the following paragraph:
       ``(3) Priority for women, infants and children.--For the 
     purpose of providing health and support services to infants, 
     children, and women with HIV disease, the chief elected 
     official of an eligible area shall use, of the grants made 
     for the area under section 2601(a) for a fiscal year, not 
     less than the percentage constituted by the ratio of the 
     population in such area of infants, children, and women with 
     acquired immune deficiency syndrome to the general population 
     in such area of individuals with such syndrome, or 15 
     percent, whichever is less. In expending the funds reserved 
     under the preceding sentence for a fiscal year, the chief 
     elected official shall give priority to providing, for 
     pregnant women, measures to prevent the perinatal 
     transmission of HIV.''; and
       (2) in subsection (e), by adding at the end thereof the 
     following sentence: ``In the case of entities to which such 
     officer allocates amounts received by the officer under the 
     grant, the officer shall ensure that, of the aggregate amount 
     so allocated, the total of the expenditures by such entities 
     for administrative expenses does not exceed 10 percent 
     (without regard to whether particular entities expend more 
     than 10 percent for such expenses).''.

     SEC. 105. APPLICATION.

       Section 2605 (42 U.S.C. 300ff-15) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)(B), by striking ``1-year period'' and 
     all that follows through ``eligible area'' and inserting 
     ``preceding fiscal year'';
       (B) in paragraph (4), by striking ``and'' at the end 
     thereof;
       (C) in paragraph (5), by striking the period at the end 
     thereof and inserting ``; and''; and
       (D) by adding at the end thereof the following paragraph:
       ``(6) that the applicant will participate in the process 
     for the statewide coordinated statement of need (where it has 
     been initiated by the State), and will ensure that the 
     services provided under the comprehensive plan are consistent 
     with such statement.'';
       (2) in subsection (b)--
       (A) in the subsection heading, by striking ``Additional''; 
     and
       (B) in the matter preceding paragraph (1), by striking 
     ``additional'';
       (3) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (4) by inserting after subsection (b), the following 
     subsection:
       ``(c) Single Application.--Upon the request of the chief 
     elected official of an eligible area, the Secretary may 
     authorize the official to submit a single application through 
     which the official simultaneously requests a grant pursuant 
     to subsection (a) of section 2603 and a grant pursuant to 
     subsection (b) of such section. The Secretary may establish 
     such criteria for carrying out this subsection as the 
     Secretary determines to be appropriate.''.

     SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

       Section 2606 (42 U.S.C. 300ff-16) is amended--
       (1) by inserting before ``The Administrator'' the 
     following: ``(a) In General.--'';
       (2) by striking ``may, beginning'' and all that follows 
     through ``title,'' and inserting ``(referred to in this 
     section as the `Administrator') shall''; and
       (3) by adding at the end the following subsection:
       ``(b) Planning Grants Regarding Initial Eligibility for 
     Grants.--
       ``(1) Advance payments on first-year formula grants.--With 
     respect to a fiscal year (referred to in this subsection as 
     the `planning year'), if a metropolitan area has not 
     previously received a grant under section 2601 and the 
     Administrator reasonably projects that the area will be 
     eligible for such a grant for the subsequent fiscal year, the 
     Administrator may make a grant for the planning year for the 
     purpose of assisting the area in preparing for the 
     responsibilities of the area in carrying out activities under 
     this part.
       ``(2) Requirements.--
       ``(A) In general.--A grant under paragraph (1) for a 
     planning year shall be made directly to the chief elected 
     official of the city or urban county that administers the 
     public health agency to which section 2602(a)(1) is projected 
     to apply for purposes of such paragraph. The grant may not be 
     made in an amount exceeding $75,000.
       ``(B) Offsetting reduction in first formula grant.--In the 
     case of a metropolitan area that has received a grant under 
     paragraph (1) for a planning year, the first grant made 
     pursuant to section 2603(a) for such area shall be reduced by 
     an amount equal to the amount of the grant under such 
     paragraph for the planning year. With respect to amounts 
     resulting from reductions under the preceding sentence for a 
     fiscal year, the Secretary shall use such amounts to make 
     grants under section 2603(a) for the fiscal year, subject to 
     ensuring that none of such amounts are provided to any 
     metropolitan area for which such a reduction was made for the 
     fiscal year.
       ``(3) Funding.--Of the amounts available under section 2677 
     for a fiscal year for carrying out this part, the 
     Administrator may reserve not more than 1 percent for making 
     grants under paragraph (1).''.
                      TITLE II--CARE GRANT PROGRAM

     SEC. 201. GENERAL USE OF GRANTS.

       Section 2612 (42 U.S.C. 300ff-22) is amended to read as 
     follows:

     ``SEC. 2612. GENERAL USE OF GRANTS.

       ``(a) In General.--A State may use amounts provided under 
     grants made under this part for the following:
       ``(1) To provide the services described in section 
     2604(b)(1) for individuals with HIV disease.
       ``(2) To provide to such individuals treatments that in 
     accordance with section 2616 have been determined to prolong 
     life or prevent serious deterioration of health.
       ``(3) To provide home- and community-based care services 
     for such individuals in accordance with section 2614.
       ``(4) To provide assistance to assure the continuity of 
     health insurance coverage for such individuals in accordance 
     with section 2615.
       ``(5) To establish and operate consortia under section 2613 
     within areas most affected by HIV disease, which consortia 
     shall be designed to provide a comprehensive continuum of 
     care to individuals and families with such disease in 
     accordance with such section.
       ``(b) Priority for Women, Infants and Children.--For the 
     purpose of providing health and support services to infants, 
     children, and women with HIV disease, a State shall use, of 
     the funds allocated under this part to the State for a fiscal 
     year, not less than the percentage constituted by the ratio 
     of the population in the State of infants, children, and 
     women with acquired immune deficiency syndrome to the general 
     population in the State of individuals with such syndrome, or 
     15 percent, whichever is less. In expending the funds 
     reserved under the preceding sentence for a fiscal year, the 
     State shall give priority to providing, for pregnant women, 
     measures to prevent the perinatal transmission of HIV.''.

     SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

       Section 2613 (42 U.S.C. 300ff-23) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting ``(or private for-profit 
     providers or organizations if such entities are the only 
     available providers of quality HIV care in the area)'' after 
     ``nonprofit private,''; and
       (B) in paragraph (2)(A)--
       (i) by inserting ``substance abuse treatment, mental health 
     treatment,'' after ``nursing,''; and
       (ii) by inserting after ``monitoring,'' the following: 
     ``measures for the prevention and treatment of opportunistic 
     infections, treatment education for patients (provided in the 
     context of health care delivery),''; and
       (2) in subsection (c)(2)--
       (A) in clause (ii) of subparagraph (A), by striking ``and'' 
     after the semicolon;
       (B) in subparagraph (B), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding after subparagraph (B) the following 
     subparagraph:
       ``(C) grantees under section 2671, or, if none are 
     operating in the area, representatives in 

[[Page H 9053]]
     the area of organizations with a history of serving children, youth, 
     women, and families living with HIV.''.

     SEC. 203. PROVISION OF TREATMENTS.

       Section 2616(a) (42 U.S.C. 300ff-26(a)) is amended--
       (1) by striking ``may use amounts'' and inserting ``shall 
     use a portion of the amounts'';
       (2) by striking ``section 2612(a)(4)'' and inserting 
     ``section 2612(a)(2)''; and
       (3) by inserting before the period the following: ``, 
     including measures for the prevention and treatment of 
     opportunistic infections''.

     SEC. 204. ADDITIONAL REQUIREMENTS FOR GRANTS.

       (a) Findings.--The Congress finds as follows:
       (1) Research studies have demonstrated that administration 
     of antiviral medication during pregnancy can significantly 
     reduce the transmission of the human immunodeficiency virus 
     (commonly known as HIV) from an infected mother to her baby.
       (2) The Centers for Disease Control and Prevention have 
     recommended that all pregnant women receive HIV counseling; 
     voluntary, confidential HIV testing; and appropriate medical 
     treatment (including antiviral therapy) and support services.
       (3) The provision of such testing without access to such 
     counseling, treatment, and services will not improve the 
     health of the woman or the child.
       (4) The provision of such counseling, testing, treatment, 
     and services can reduce the number of pediatric cases of 
     acquired immune deficiency syndrome, can improve access to 
     and provision of medical care for the woman, and can provide 
     opportunities for counseling to reduce transmission among 
     adults.
       (5) The provision of such counseling, testing, treatment, 
     and services can reduce the overall cost of pediatric cases 
     of acquired immune deficiency syndrome.
       (6) The cancellation or limitation of health insurance or 
     other health coverage on the basis of HIV status should be 
     impermissible under applicable law. Such cancellation or 
     limitation could result in disincentives for appropriate 
     counseling, testing, treatment, and services.
       (7) For the reasons specified in paragraphs (1) through 
     (6)--
       (A) mandatory counseling and voluntary testing of pregnant 
     women should be the standard of care; and
       (B) the relevant medical organizations as well as public 
     health officials should issue guidelines making such 
     counseling and testing the standard of care.
       (b) Additional Requirements for Grants.--Part B (42 U.S.C. 
     300ff-21 et seq.) is amended--
       (1) in section 2611, by adding at the end the following 
     sentence: ``The authority of the Secretary to provide grants 
     under this part is subject to section 2673D (relating to the 
     testing of pregnant women and newborn infants).''; and
       (2) by inserting after section 2616 the following section:

     ``SEC. 2616A. REQUIREMENT REGARDING HEALTH INSURANCE.

       ``(a) In General.--Subject to subsection (c), the Secretary 
     shall not make a grant under this part to a State unless the 
     State has in effect a statute or regulations regulating 
     insurance that imposes the following requirements:
       ``(1) That, if health insurance is in effect for an 
     individual, the insurer involved may not (without the consent 
     of the individual) discontinue the insurance, or alter the 
     terms of the insurance (except as provided in paragraph (3)), 
     solely on the basis that the individual is infected with HIV 
     disease or solely on the basis that the individual has been 
     tested for the disease.
       ``(2) That paragraph (1) does not apply to an individual 
     who, in applying for the health insurance involved, knowingly 
     misrepresented any of the following:
       ``(A) The HIV status of the individual.
       ``(B) Facts regarding whether the individual has been 
     tested for HIV disease.
       ``(C) Facts regarding whether the individual has engaged in 
     any behavior that places the individual at risk for the 
     disease.
       ``(3) That paragraph (1) does not apply to any reasonable 
     alteration in the terms of health insurance for an individual 
     with HIV disease that would have been made if the individual 
     had a serious disease other than HIV disease.
       ``(b) Regulation of Health Insurance.--A statute or 
     regulation shall be deemed to regulate insurance for purposes 
     of this section only to the extent that it is treated as 
     regulating insurance for purposes of section 514(b)(2) of the 
     Employee Retirement Income Security Act of 1974.
       ``(c) Applicability of Requirement.--
       ``(1) In general.--Except as provided in paragraph (2), 
     this section applies upon the expiration of the 120-day 
     period beginning on the date of the enactment of the Ryan 
     White CARE Act Amendments of 1995.
       ``(2) Delayed applicability for certain states.--In the 
     case of the State involved, if the Secretary determines that 
     a requirement of this section cannot be implemented in the 
     State without the enactment of State legislation, then such 
     requirement applies to the State on and after the first day 
     of the first calendar quarter that begins after the close of 
     the first regular session of the State legislature that 
     begins after the date of the enactment of the Ryan White CARE 
     Act Amendments of 1995. For purposes of the preceding 
     sentence, in the case of a State that has a 2-year 
     legislative session, each year of such session is deemed to 
     be a separate regular session of the State legislature.''.
       (c) Testing of Newborns; Prenatal Testing.--Part D (42 
     U.S.C. 300ff-71 et seq.) is amended by inserting before 
     section 2674 the following sections:

     ``SEC. 2673C. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS; 
                   PROGRAM OF GRANTS.

       ``(a) Program of Grants.--The Secretary may make grants to 
     States described in subsection (b) for the following 
     purposes:
       ``(1) Making available to pregnant women appropriate 
     counseling on HIV disease.
       ``(2) Making available to such women testing for such 
     disease.
       ``(3) Testing newborn infants for such disease.
       ``(4) In the case of newborn infants who test positive for 
     such disease, making available counseling on such disease to 
     the parents or other legal guardians of the infant.
       ``(5) Collecting data on the number of pregnant women and 
     newborn infants in the State who have undergone testing for 
     such disease.
       ``(b) Eligible States.--Subject to subsection (c), a State 
     referred to in subsection (a) is a State that has in effect, 
     in statute or through regulations, the following 
     requirements:
       ``(1) In the case of newborn infants who are born in the 
     State and whose biological mothers have not undergone 
     prenatal testing for HIV disease, that each such infant 
     undergo testing for such disease.
       ``(2) That the results of such testing of a newborn infant 
     be promptly disclosed in accordance with the following, as 
     applicable to the infant involved:
       ``(A) To the biological mother of the infant (without 
     regard to whether she is the legal guardian of the infant).
       ``(B) If the State is the legal guardian of the infant:
       ``(i) To the appropriate official of the State agency with 
     responsibility for the care of the infant.
       ``(ii) To the appropriate official of each authorized 
     agency providing assistance in the placement of the infant.
       ``(iii) If the authorized agency is giving significant 
     consideration to approving an individual as a foster parent 
     of the infant, to the prospective foster parent.
       ``(iv) If the authorized agency is giving significant 
     consideration to approving an individual as an adoptive 
     parent of the infant, to the prospective adoptive parent.
       ``(C) If neither the biological mother nor the State is the 
     legal guardian of the infant, to another legal guardian of 
     the infant.
       ``(3) That, in the case of prenatal testing for HIV disease 
     that is conducted in the State, the results of such testing 
     be promptly disclosed to the pregnant woman involved.
       ``(4) That, in disclosing the test results to an individual 
     under paragraph (2) or (3), appropriate counseling on the 
     human immunodeficiency virus be made available to the 
     individual (except in the case of a disclosure to an official 
     of a State or an authorized agency).
       ``(c) Limitation Regarding Availability of Grant Funds.--
     With respect to an activity described in any of paragraphs 
     (1) through (4) of subsection (b), the requirement 
     established by a State under such subsection that the 
     activity be carried out applies for purposes of this section 
     only to the extent that the following sources of funds are 
     available for carrying out the activity:
       ``(1) Federal funds provided to the State in grants under 
     subsection (a).
       ``(2) Funds that the State or private entities have elected 
     to provide, including through entering into contracts under 
     which health benefits are provided. This section does not 
     require any entity to expend non-Federal funds.
       ``(d) Definitions.--For purposes of this section, the term 
     `authorized agency', with respect to the placement of a child 
     (including an infant) for whom a State is a legal guardian, 
     means an entity licensed or otherwise approved by the State 
     to assist in such placement.
       ``(e) Authorization of Appropriations.--For the purpose of 
     carrying out this section, there is authorized to be 
     appropriated $10,000,000 for each of the fiscal years 1996 
     through 2000.

     ``SEC. 2673D. TESTING OF PREGNANT WOMEN AND NEWBORN INFANTS; 
                   CONTINGENT REQUIREMENT REGARDING STATE GRANTS 
                   UNDER PART B.

       ``(a) Determination by Secretary.--During the first 30 days 
     following the expiration of the 2-year period beginning on 
     the date of the enactment of the Ryan White CARE Act 
     Amendments of 1995, the Secretary shall publish in the 
     Federal Register a determination of whether it has become a 
     routine practice in the provision of health care in the 
     United States to carry out each of the activities described 
     in paragraphs (1) through (4) of section 2673C(b). In making 
     the determination, the Secretary shall consult with the 
     States and with other public or private entities that have 
     knowledge or expertise relevant to the determination.
       ``(b) Contingent Applicability.--
       ``(1) In general.--If the determination published in the 
     Federal Register under subsection (a) is that (for purposes 
     of such subsection) the activities involved have become 
     routine practices, paragraph (2) applies on 

[[Page H 9054]]
     and after the expiration of the 18-month period beginning on the date 
     on which the determination is so published.
       ``(2) Requirement.--Subject to subsection (c), the 
     Secretary shall not make a grant under part B to a State 
     unless the State meets not less than one of the following 
     requirements:
       ``(A) The State has in effect, in statute or through 
     regulations, the requirements specified in paragraphs (1) 
     through (4) of section 2673C(b).
       ``(B) The State demonstrates that, of the newborn infants 
     born in the State during the most recent 1-year period for 
     which the data are available, the HIV antibody status of 95 
     percent of the infants is known.
       ``(c) Limitation Regarding Availability of Funds.--With 
     respect to an activity described in any of paragraphs (1) 
     through (4) of section 2673C(b), the requirements established 
     by a State under subsection (b)(2)(A) that the activity be 
     carried out applies for purposes of this section only to the 
     extent that the following sources of funds are available for 
     carrying out the activity:
       ``(1) Federal funds provided to the State in grants under 
     part B.
       ``(2) Federal funds provided to the State in grants under 
     section 2673C.
       ``(3) Funds that the State or private entities have elected 
     to provide, including through entering into contracts under 
     which health benefits are provided. This section does not 
     require any entity to expend non-Federal funds.''.

     SEC. 205. STATE APPLICATION.

       Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)) is amended--
       (1) in subparagraph (A), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (B), by striking ``and'' after the 
     semicolon; and
       (3) by adding at the end thereof the following 
     subparagraphs:
       ``(C) a description of the activities carried out by the 
     State under section 2616; and
       ``(D) a description of how the allocation and utilization 
     of resources are consistent with a statewide coordinated 
     statement of need, developed in partnership with other 
     grantees in the State that receive funding under this title 
     and after consultation with individuals receiving services 
     under this part.''.

     SEC. 206. ALLOCATION OF ASSISTANCE BY STATES; PLANNING, 
                   EVALUATION, AND ADMINISTRATION.

       Section 2618(c) (42 U.S.C. 300ff-28(c)) is amended--
       (1) by striking paragraph (1);
       (2) by redesignating paragraphs (2) through (5) as 
     paragraphs (1) through (4), respectively; and
       (3) in paragraph (3) (as so redesignated), by adding at the 
     end the following sentences: ``In the case of entities to 
     which the State allocates amounts received by the State under 
     the grant (including consortia under section 2613), the State 
     shall ensure that, of the aggregate amount so allocated, the 
     total of the expenditures by such entities for administrative 
     expenses does not exceed 10 percent (without regard to 
     whether particular entities expend more than 10 percent for 
     such expenses).''.

     SEC. 207. TECHNICAL ASSISTANCE.

       Section 2619 (42 U.S.C. 300ff-29) is amended by inserting 
     before the period the following: ``, including technical 
     assistance for the development and implementation of 
     statewide coordinated statements of need''.
                 TITLE III--EARLY INTERVENTION SERVICES

     SEC. 301. ESTABLISHMENT OF PROGRAM.

       Section 2651(b) (42 U.S.C. 300ff-51(b)) is amended--
       (1) in paragraph (1), by inserting before the period the 
     following: ``, and unless the applicant agrees to expend not 
     less than 50 percent of the grant for such services that are 
     specified in subparagraphs (B) through (E) of such 
     paragraph''; and
       (2) in paragraph (4), by inserting after ``nonprofit 
     private entities'' the following: ``(or private for-profit 
     entities, if such entities are the only available providers 
     of quality HIV care in the area)''.

     SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

       Section 2652(b)(1)(B) (42 U.S.C. 300ff-52(b)(1)(B)) is 
     amended by inserting after ``nonprofit private entity'' the 
     following: ``(or a private for-profit entity, if such an 
     entity is the only available provider of quality HIV care in 
     the area)''.

     SEC. 303. MISCELLANEOUS PROVISIONS; PLANNING AND DEVELOPMENT 
                   GRANTS.

       Section 2654 (42 U.S.C. 300ff-54) is amended by adding at 
     the end thereof the following subsection:
       ``(c) Planning and Development Grants.--
       ``(1) In general.--The Secretary may provide planning 
     grants, in an amount not to exceed $50,000 for each such 
     grant, to public and nonprofit private entities for the 
     purpose of enabling such entities to provide early 
     intervention services.
       ``(2) Requirement.--The Secretary may award a grant to an 
     entity under paragraph (1) only if the Secretary determines 
     that the entity will use such grant to assist the entity in 
     qualifying for a grant under section 2651.
       ``(3) Preference.--In awarding grants under paragraph (1), 
     the Secretary shall give preference to entities that provide 
     HIV primary care services in rural or underserved 
     communities.
       ``(4) Limitation.--Not to exceed 1 percent of the amount 
     appropriated for a fiscal year under section 2655 may be used 
     to carry out this section.''.

     SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

       Section 2664(a)(1) (42 U.S.C. 300ff-64(a)(1)) is amended--
       (1) in subparagraph (A), by striking ``and'' after the 
     semicolon; and
       (2) by adding at the end the following subparagraph:
       ``(C) evidence that the proposed program is consistent with 
     the statewide coordinated statement of need and that the 
     applicant will participate in the ongoing revision of such 
     statement of need.''.

     SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

       Section 2655 (42 U.S.C. 300ff-55) is amended by striking 
     ``$75,000,000'' and all that follows and inserting ``such 
     sums as may be necessary for each of the fiscal years 1996 
     through 2000.''.
                      TITLE IV--GENERAL PROVISIONS

     SEC. 401. COORDINATED SERVICES AND ACCESS TO RESEARCH FOR 
                   WOMEN, INFANTS, AND CHILDREN.

       (a) In General.--Section 2671 (42 U.S.C. 300ff-71) is 
     amended--
       (1) in subsection (a), by amending the subsection to read 
     as follows:
       ``(a) In General.--
       ``(1) Program of grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and in consultation with the Director of the 
     National Institutes of Health, shall make grants to public 
     and nonprofit private entities that provide primary care 
     (directly or through contracts) for the purpose of--
       ``(A) providing through such entities, in accordance with 
     this section, opportunities for women, infants, and children 
     to be participants in research of potential clinical benefit 
     to individuals with HIV disease; and
       ``(B) providing to women, infants, and children health care 
     on an outpatient basis.
       ``(2) Provisions regarding participation in research.--With 
     respect to the projects of research with which an applicant 
     under paragraph (1) is concerned, the Secretary may not make 
     a grant under such paragraph to the applicant unless the 
     following conditions are met:
       ``(A) The applicant agrees to make reasonable efforts--
       ``(i) to identify which of the patients of the applicant 
     are women, infants, and children who would be appropriate 
     participants in the projects; and
       ``(ii) to offer women, infants, and children the 
     opportunity to so participate (as appropriate), including the 
     provision of services under subsection (f).
       ``(B) The applicant agrees that the applicant, and the 
     projects of research, will comply with accepted standards of 
     protection for human subjects (including the provision of 
     written informed consent) who participate as subjects in 
     clinical research.
       ``(C) For the third or subsequent fiscal year for which a 
     grant under such paragraph is sought by the applicant, the 
     Secretary has determined that--
       ``(i) a significant number of women, infants, and children 
     who are patients of the applicant are participating in the 
     projects (except to the extent this clause is waived under 
     subsection (k)); and
       ``(ii) the applicant, and the projects of research, have 
     complied with the standards referred to in subparagraph (B).
       ``(3) Prohibition.--Receipt of services by a patient shall 
     not be conditioned upon the consent of the patient to 
     participate in research.
       ``(4) Consideration by secretary of certain 
     circumstances.--In administering the requirement of paragraph 
     (2)(C)(i), the Secretary shall take into account 
     circumstances in which a grantee under paragraph (1) is 
     temporarily unable to comply with the requirement for reasons 
     beyond the control of the grantee, and shall in such 
     circumstances provide to the grantee a reasonable period of 
     opportunity in which to reestablish compliance with the 
     requirement.'';
       (2) in subsection (c), by amending the subsection to read 
     as follows:
       ``(c) Provisions Regarding Conduct of Research.--With 
     respect to eligibility for a grant under subsection (a):
       ``(1) A project of research for which subjects are sought 
     pursuant to such subsection may be conducted by the applicant 
     for the grant, or by an entity with which the applicant has 
     made arrangements for purposes of the grant. The grant may 
     not be expended for the conduct of any project of research.
       ``(2) The grant may not be made unless the Secretary makes 
     the following determinations:
       ``(A) The applicant or other entity (as the case may be 
     under paragraph (1)) is appropriately qualified to conduct 
     the project of research. An entity shall be considered to be 
     so qualified if any research protocol of the entity has been 
     recommended for funding under this Act pursuant to technical 
     and scientific peer review through the National Institutes of 
     Health.
       ``(B) The project of research is being conducted in 
     accordance with a research protocol to which the Secretary 
     gives priority regarding the prevention and treatment of HIV 
     disease in women, infants, and children. After consultation 
     with public and private entities that conduct such research, 
     and with providers of services under this section and 
     recipients of such services, the Secretary shall establish a 
     list of such protocols that are appropriate for purposes of 
     this section. The Secretary may give priority under this 

[[Page H 9055]]
     subparagraph to a research protocol that is not on such list.'';
       (3) by striking subsection (i);
       (4) by redesignating subsections (g) and (h) as subsections 
     (h) and (i), respectively;
       (5) by inserting after subsection (f) the following 
     subsection:
       ``(g) Additional Provisions.--The Secretary may not make a 
     grant under subsection (a) unless the applicant for the grant 
     agrees as follows:
       ``(1) The applicant will coordinate activities under the 
     grant with other providers of health care services under this 
     Act, and under title V of the Social Security Act.
       ``(2) The applicant will participate in the statewide 
     coordinated statement of need under part B (where it has been 
     initiated by the State) and in revisions of such 
     statement.'';
       (6) by redesignating subsection (j) as subsection (m); and
       (7) by inserting before subsection (m) (as so redesignated) 
     the following subsections:
       ``(j) Coordination With National Institutes of Health.--The 
     Secretary shall develop and implement a plan that provides 
     for the coordination of the activities of the National 
     Institutes of Health with the activities carried out under 
     this section. In carrying out the preceding sentence, the 
     Secretary shall ensure that projects of research conducted or 
     supported by such Institutes are made aware of applicants and 
     grantees under this section, shall require that the projects, 
     as appropriate, enter into arrangements for purposes of this 
     section, and shall require that each project entering into 
     such an arrangement inform the applicant or grantee under 
     this section of the needs of the project for the 
     participation of women, infants, and children.
       ``(k) Temporary Waiver Regarding Significant 
     Participation.--
       ``(1) In general.--In the case of an applicant under 
     subsection (a) who received a grant under this section for 
     fiscal year 1995, the Secretary may, subject to paragraph 
     (2), provide to the applicant a waiver of the requirement of 
     subsection (a)(2)(C)(i) if the Secretary determines that the 
     applicant is making reasonable progress toward meeting the 
     requirement.
       ``(2) Termination of authority for waivers.--The Secretary 
     may not provide any waiver under paragraph (1) on or after 
     October 1, 1998. Any such waiver provided prior to such date 
     terminates on such date, or on such earlier date as the 
     Secretary may specify.
       ``(l) Training and Technical Assistance.--Of the amounts 
     appropriated under subsection (m) for a fiscal year, the 
     Secretary may use not more than five percent to provide 
     training and technical assistance to assist applicants and 
     grantees under subsection (a) in complying with the 
     requirements of this section.''.
       (b) Conforming Amendments.--Section 2671 (42 U.S.C. 300ff-
     71) is amended--
       (1) in the heading for the section, by striking 
     ``DEMONSTRATION'' and all that follows and inserting 
     ``COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN, 
     INFANTS, AND CHILDREN.'';
       (2) in subsection (b), by striking ``pediatric patients and 
     pregnant women'' and inserting ``women, infants, and 
     children''; and
       (3) in each of subsections (d) through (f), by striking 
     ``pediatric'', each place such term appears.
       (c) Authorization of Appropriations.--Section 2671 (42 
     U.S.C. 300ff-71) is amended in subsection (m) (as 
     redesignated by subsection (a)(6)) by striking ``there are'' 
     and all that follows and inserting the following: ``there are 
     authorized to be appropriated such sums as may be necessary 
     for each of the fiscal years 1996 through 2000.''.

     SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

       (a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71 
     et seq.) is amended by inserting after section 2673 the 
     following section:

     ``SEC. 2673A. DEMONSTRATION PROJECTS OF NATIONAL 
                   SIGNIFICANCE.

       ``(a) In General.--The Secretary shall make grants to 
     public and nonprofit private entities (including community-
     based organizations and Indian tribes and tribal 
     organizations) for the purpose of carrying out demonstration 
     projects that provide for the care and treatment of 
     individuals with HIV disease, and that--
       ``(1) assess the effectiveness of particular models for the 
     care and treatment of individuals with such disease;
       ``(2) are of an innovative nature; and
       ``(3) have the potential to be replicated in similar 
     localities, or nationally.
       ``(b) Certain Projects.--Demonstration projects under 
     subsection (a) shall include the development and assessment 
     of innovative models for the delivery of HIV services that 
     are designed--
       ``(1) to address the needs of special populations 
     (including individuals and families with HIV disease living 
     in rural communities, adolescents with HIV disease, Native 
     American individuals and families with HIV disease, homeless 
     individuals and families with HIV disease, hemophiliacs with 
     HIV disease, and incarcerated individuals with HIV disease); 
     and
       ``(2) to ensure the ongoing availability of services for 
     Native American communities to enable such communities to 
     care for Native Americans with HIV disease.
       ``(c) Coordination.--The Secretary may not make a grant 
     under this section unless the applicant submits evidence that 
     the proposed program is consistent with the applicable 
     statewide coordinated statement of need under part B, and the 
     applicant agrees to participate in the ongoing revision 
     process of such statement of need (where it has been 
     initiated by the State).
       ``(d) Replication.--The Secretary shall make information 
     concerning successful models developed under this section 
     available to grantees under this title for the purpose of 
     coordination, replication, and integration.
       ``(e) Funding; Allocation of Amounts.--
       ``(1) In general.--Of the amounts available under this 
     title for a fiscal year for each program specified in 
     paragraph (2), the Secretary shall reserve 3 percent for 
     making grants under subsection (a).
       ``(2) Relevant programs.--The programs referred to in 
     subsection (a) are the program under part A, the program 
     under part B, the program under part C, the program under 
     section 2671, the program under section 2672, and the program 
     under section 2673.''.
       (b) Striking of Related Provision.--Section 2618 (42 U.S.C. 
     300ff-28) is amended by striking subsection (a).

     SEC. 403. SPECIAL TRAINING PROJECTS.

       (a) Transfer of Program.--The Public Health Service Act (42 
     U.S.C. 201 et seq.) is amended--
       (1) by transferring section 776 from the current placement 
     of the section;
       (2) by redesignating the section as section 2673B; and
       (3) by inserting the section after section 2673A (as added 
     by section 402(a)).
       (b) Modifications.--Section 2673B (as transferred and 
     redesignated by subsection (a)) is amended--
       (1) in subsection (a)(1)--
       (A) by striking subparagraphs (B) and (C);
       (B) by redesignating subparagraphs (A) and (D) as 
     subparagraphs (B) and (C), respectively;
       (C) by inserting before subparagraph (B) (as so 
     redesignated) the following subparagraph:
       ``(A) to train health personnel, including practitioners in 
     programs under this title and other community providers, in 
     the diagnosis, treatment, and prevention of HIV disease, 
     including the prevention of the perinatal transmission of the 
     disease and including measures for the prevention and 
     treatment of opportunistic infections;'';
       (D) in subparagraph (B) (as so redesignated), by adding 
     ``and'' after the semicolon; and
       (E) in subparagraph (C) (as so redesignated), by striking 
     ``curricula and'';
       (2) by striking subsection (c) and redesignating subsection 
     (d) as subsection (c); and
       (3) in subsection (c) (as so redesignated)--
       (A) in paragraph (1)--
       (i) by striking ``is authorized'' and inserting ``are 
     authorized''; and
       (ii) by inserting before the period the following: ``, and 
     such sums as may be necessary for each of the fiscal years 
     1996 through 2000''; and
       (B) in paragraph (2)--
       (i) by striking ``is authorized'' and inserting ``are 
     authorized''; and
       (ii) by inserting before the period the following: ``, and 
     such sums as may be necessary for each of the fiscal years 
     1996 through 2000''.

     SEC. 404. EVALUATIONS AND REPORTS.

       Section 2674 (42 U.S.C. 300ff-74) is amended--
       (1) in subsection (b)--
       (A) in the matter preceding paragraph (1), by striking 
     ``not later than 1 year'' and all that follows through 
     ``title,'' and inserting the following: ``not later than 
     October 1, 1996,'';
       (B) by striking paragraphs (1) through (3) and inserting 
     the following paragraph:
       ``(1) evaluating the programs carried out under this title; 
     and''; and
       (C) by redesignating paragraph (4) as paragraph (2); and
       (2) by adding at the end the following subsection:
       ``(d) Allocation of Funds.--The Secretary shall carry out 
     this section with amounts available under section 241. Such 
     amounts are in addition to any other amounts that are 
     available to the Secretary for such purpose.''.

     SEC. 405. COORDINATION OF PROGRAM.

       Section 2675 of the Public Health Service Act (42 U.S.C. 
     300ff-75) is amended by adding at the end the following 
     subsection:
       ``(d) Annual Report.--Not later than October 1, 1996, and 
     annually thereafter, the Secretary shall submit to the 
     appropriate committees of the Congress a report concerning 
     coordination efforts under this title at the Federal, State, 
     and local levels, including a statement of whether and to 
     what extent there exist Federal barriers to integrating HIV-
     related programs.''.
                     TITLE V--ADDITIONAL PROVISIONS

     SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.

       Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) 
     is amended to read as follows:
       ``(3) Amount of grant.--
       ``(A) In general.--Subject to the extent of amounts made 
     available in appropriations Acts, a grant made for purposes 
     of this paragraph to an eligible area shall be made in an 
     amount equal to the product of--
       ``(i) an amount equal to the amount available for 
     distribution under paragraph (2) for the fiscal year 
     involved; and

[[Page H 9056]]

       ``(ii) the percentage constituted by the ratio of the 
     distribution factor for the eligible area to the sum of the 
     respective distribution factors for all eligible areas.
       ``(B) Distribution factor.--For purposes of subparagraph 
     (A)(ii), the term `distribution factor' means the product 
     of--
       ``(i) an amount equal to the estimated number of living 
     cases of acquired immune deficiency syndrome in the eligible 
     area involved, as determined under subparagraph (C); and
       ``(ii) the cost index for the eligible area involved, as 
     determined under subparagraph (D).
       ``(C) Estimate of living cases.--The amount determined in 
     this subparagraph is an amount equal to the product of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the eligible area during each year in the most 
     recent 120-month period for which data are available with 
     respect to all eligible areas, as indicated by the number of 
     such cases reported to and confirmed by the Director of the 
     Centers for Disease Control and Prevention for each year 
     during such period; and
       ``(ii) with respect to--

       ``(I) the first year during such period, .06;
       ``(II) the second year during such period, .06;
       ``(III) the third year during such period, .08;
       ``(IV) the fourth year during such period, .10;
       ``(V) the fifth year during such period, .16;
       ``(VI) the sixth year during such period, .16;
       ``(VII) the seventh year during such period, .24;
       ``(VIII) the eighth year during such period, .40;
       ``(IX) the ninth year during such period, .57; and
       ``(X) the tenth year during such period, .88.

       ``(D) Cost index.--The amount determined in this 
     subparagraph is an amount equal to the sum of--
       ``(i) the product of--

       ``(I) the average hospital wage index reported by hospitals 
     in the eligible area involved under section 1886(d)(3)(E) of 
     the Social Security Act for the 3-year period immediately 
     preceding the year for which the grant is being awarded; and
       ``(II) .70; and

       ``(ii) .30.
       ``(E) Unexpended funds.--The Secretary may, in determining 
     the amount of a grant for a fiscal year under this paragraph, 
     adjust the grant amount to reflect the amount of unexpended 
     and uncanceled grant funds remaining at the end of the most 
     recent fiscal year for which the amount of such funds can be 
     determined using the required financial status report. The 
     amount of any such unexpended funds shall be determined using 
     the financial status report of the grantee.
       ``(F) Puerto rico, virgin islands, guam.--For purposes of 
     subparagraph (D), the cost index for an eligible area within 
     Puerto Rico, the Virgin Islands, or Guam shall be 1.0.''.

     SEC. 502. AMOUNT OF CARE GRANTS.

       Section 2618 (42 U.S.C. 300ff-28), as amended by section 
     402(b), is amended by striking subsection (b) and inserting 
     the following subsections:
       ``(a) Amount of Grant.--
       ``(1) In general.--Subject to subsection (b) (relating to 
     minimum grants), the amount of a grant under this part for a 
     State for a fiscal year shall be the sum of--
       ``(A) the amount determined for the State under paragraph 
     (2); and
       ``(B) the amount determined for the State under paragraph 
     (4) (if applicable).
       ``(2) Principal formula grants.--For purposes of paragraph 
     (1)(A), the amount determined under this paragraph for a 
     State for a fiscal year shall be the product of--
       ``(A) the amount available under section 2677 for carrying 
     out this part, less the reservation of funds made in 
     paragraph (4)(A) and less any other applicable reservation of 
     funds authorized or required in this Act (which amount is 
     subject to subsection (b)); and
       ``(B) the percentage constituted by the ratio of--
       ``(i) the distribution factor for the State; to
       ``(ii) the sum of the distribution factors for all States.
       ``(3) Distribution factor for principal formula grants.--
     For purposes of paragraph (2)(B), the term `distribution 
     factor' means the following, as applicable:
       ``(A) In the case of each of the 50 States, the District of 
     Columbia, and the Commonwealth of Puerto Rico, the product 
     of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the State, as indicated by the number of cases 
     reported to and confirmed by the Secretary for the 2 most 
     recent fiscal years for which such data are available; and
       ``(ii) the cube root of the ratio (based on the most recent 
     available data) of--

       ``(I) the average per capita income of individuals in the 
     United States (including the territories); to
       ``(II) the average per capita income of individuals in the 
     State.

       ``(B) In the case of a territory of the United States 
     (other than the Commonwealth of Puerto Rico), the number of 
     additional cases of such syndrome in the specific territory, 
     as indicated by the number of cases reported to and confirmed 
     by the Secretary for the 2 most recent fiscal years for which 
     such data is available.
       ``(4) Supplemental amounts for certain states.--For 
     purposes of paragraph (1)(B), an amount shall be determined 
     under this paragraph for each State that does not contain any 
     metropolitan area whose chief elected official received a 
     grant under part A for fiscal year 1996. The amount 
     determined under this paragraph for such a State for a fiscal 
     year shall be the product of--
       ``(A) an amount equal to 7 percent of the amount available 
     under section 2677 for carrying out this part for the fiscal 
     year (subject to subsection (b)); and
       ``(B) the percentage constituted by the ratio of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the State (as determined under paragraph 
     (3)(A)(i)); to
       ``(ii) the sum of the respective numbers determined under 
     clause (i) for each State to which this paragraph applies.
       ``(5) Definitions.--For purposes of this subsection and 
     subsection (b):
       ``(A) The term `State' means each of the 50 States, the 
     District of Columbia, and the territories of the United 
     States.
       ``(B) The term `territory of the United States' means each 
     of the Virgin Islands, Guam, American Samoa, the Commonwealth 
     of the Northern Mariana Islands, the Commonwealth of Puerto 
     Rico, and the Republic of the Marshall Islands.
       ``(b) Minimum Amount of Grant.--
       ``(1) In general.--Subject to the extent of the amounts 
     specified in paragraphs (2)(A) and (4)(A) of subsection (a), 
     a grant under this part for a State for a fiscal year shall 
     be the greater of--
       ``(A) the amount determined for the State under subsection 
     (a); and
       ``(B) the amount applicable under paragraph (2) to the 
     State.
       ``(2) Applicable amount.--For purposes of paragraph (1)(B), 
     the amount applicable under this paragraph for a fiscal year 
     is the following:
       ``(A) In the case of the 50 States, the District of 
     Columbia, and the Commonwealth of Puerto Rico--
       ``(i) $100,000, if it has less than 90 cases of acquired 
     immune deficiency syndrome (as determined under subsection 
     (a)(3)(A)(i)); and
       ``(ii) $250,000, if it has 90 or more such cases (as so 
     determined).
       ``(B) In the case of each of the territories of the United 
     States (other than the Commonwealth of Puerto Rico), $0.0.''.

     SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.

       (a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71) 
     is amended by adding at the end thereof the following 
     section:

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--For the purpose of carrying out parts A 
     and B, there are authorized to be appropriated such sums as 
     may be necessary for each of the fiscal years 1996 through 
     2000. Subject to section 2673A and to subsection (b), of the 
     amount appropriated under this section for a fiscal year, the 
     Secretary shall make available 64 percent of such amount to 
     carry out part A and 36 percent of such amount to carry out 
     part B.
       ``(b) Development of Methodology.--With respect to each of 
     the fiscal years 1997 through 2000, the Secretary may develop 
     and implement a methodology for adjusting the percentages 
     referred to in subsection (a).''.
       (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 
     and 300ff-30) are repealed.
       (c) Conforming Amendments.--Section 2605(d)(1) (as 
     redesignated by section 105(3)), is amended by striking 
     ``2608'' and inserting ``2677''.

     SEC. 504. ADDITIONAL PROVISIONS.

       (a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) 
     is amended by inserting ``funeral-service practitioners,'' 
     after ``emergency medical technicians,''.
       (b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 
     300d(a)) is amended in the matter preceding paragraph (1) by 
     striking ``The Secretary,'' and all that follows through 
     ``shall,'' and inserting ``The Secretary shall,''.
       (c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 
     et seq.) is amended--
       (1) in section 2601(a), by inserting ``section'' before 
     ``2604'';
       (2) in section 2603(b)(4)(B), by striking ``an expedited 
     grants'' and inserting ``an expedited grant'';
       (3) in section 2617(b)(3)(B)(iv), by inserting ``section'' 
     before ``2615'';
       (4) in section 2618(b)(1)(B), by striking ``paragraph 3'' 
     and inserting ``paragraph (3)'';
       (5) in section 2647--
       (A) in subsection (a)(1), by inserting ``to'' before 
     ``HIV'';
       (B) in subsection (c), by striking ``section 2601'' and 
     inserting ``section 2641''; and
       (C) in subsection (d)--
       (i) in the matter preceding paragraph (1), by striking 
     ``section 2601'' and inserting ``section 2641''; and
       (ii) in paragraph (1), by striking ``has in place'' and 
     inserting ``will have in place'';
       (6) in section 2648--
       (A) by converting the heading for the section to boldface 
     type; and
       (B) by redesignating the second subsection (g) as 
     subsection (h);
       (7) in section 2649--
       (A) in subsection (b)(1), by striking ``subsection (a) 
     of''; and
       (B) in subsection (c)(1), by striking ``this subsection'' 
     and inserting ``subsection'';
       (8) in section 2651--
       (A) in subsection (b)(3)(B), by striking ``facility'' and 
     inserting ``facilities''; and

[[Page H 9057]]

       (B) in subsection (c), by striking ``exist'' and inserting 
     ``exists'';
       (9) in section 2676--
       (A) in paragraph (2), by striking ``section'' and all that 
     follows through ``by the'' and inserting ``section 2686 by 
     the''; and
       (B) in paragraph (10), by striking ``673(a)'' and inserting 
     ``673(2)'';
       (10) in part E, by converting the headings for subparts I 
     and II to Roman typeface; and
       (11) in section 2684(b), in the matter preceding paragraph 
     (1), by striking ``section 2682(d)(2)'' and inserting 
     ``section 2683(d)(2)''.
                        TITLE VI--EFFECTIVE DATE

     SEC. 601. EFFECTIVE DATE.

       Except as provided in section 101(a), this Act takes effect 
     October 1, 1995.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Florida [Mr. Bilirakis] will be recognized for 20 minutes, and the 
gentleman from California [Mr. Waxman] will be recognized for 20 
minutes.
  The Chair recognizes the gentleman from Florida [Mr. Bilirakis].
  Mr. BILIRAKIS. Mr. Speaker, I yield myself such time as I may 
consume.
  (Mr. BILIRAKIS asked and was given permission to revise and extend 
his remarks.)
  Mr. BILIRAKIS. Mr. Speaker, H.R. 1872, as amended, exemplifies a true 
bipartisan effort which included Chairman Tom Bliley, Ranking Minority 
Member John Dingell, Subcommittee Ranking Minority Member Henry Waxman, 
and myself. The bill before us represents the bill as reported out of 
the Commerce Committee with technical and clarifying changes and an 
amendment negotiated by Congressmen Coburn and Waxman regarding HIV 
testing of newborns.
  The Ryan White Care Act was first enacted into law in 1990 to provide 
emergency relief to areas hardest hit by the AIDS epidemic and to 
provide essential health services to individuals afflicted by HIV and 
AIDS. This reauthorization has provided the first opportunity to 
evaluate how the program is working. Generally, I believe the program 
is working as intended. The bill before us makes modifications and 
clarifications to respond to the changes in the AIDS epidemic over the 
last 5 years.
  Some of the key provisions of H.R. 1872 include: Modifications to 
both the title I and title II formulas; conflict of interest provisions 
for title I planning councils; priority for supplemental grants to 
areas with greater prevalence of specified comorbidity factors; and 
limits on administrative costs. In addition, the bill includes a 
requirement that all four titles contribute 3 percent to the Projects 
of National Significance; clarification that the intent of title IV is 
to increase the number of women and children in clinical research 
projects; transfer of the dental reimbursement program from title 7 of 
the Public Health Service Act; and reauthorization of all programs at 
such sums through fiscal year 2000.

  Clearly, one of the most difficult issues we faced was the funding 
formulas for title I and II. Because of the spread of HIV across the 
country, some States were seeing significant increases in their number 
of HIV-AIDS cases but did not have any one area with enough cases to 
qualify as an eligible metropolitan area. Our goal was to provide these 
States with very needed additional funds without shifting large amounts 
of money from other States with a high percentage of AIDS cases. We 
tried to balance the need for additional money with our concern that 
services currently being provided to people with AIDS not be disrupted. 
The bill ensures that all States will receive at least the current 
dollar amount appropriated to them. And many States will receive 
increases over what they are currently receiving--no State will lose 
money.
  I urge my colleagues to support H.R. 1872, but, before I reserve the 
balance of my time, at this point I would like to express my 
appreciation to the staffs, the staff of the majority of the 
subcommittee, Melody Harned, and also to the staff of the gentleman 
from California [Mr. Waxman] and other people who helped us to craft 
this very, very needed bill and to handle the controversy, if I can 
call it that, that involved the testing of newborns.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WAXMAN. Mr. Speaker, I yield myself such time as I may consume.
  (Mr. WAXMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. WAXMAN. Mr. Speaker, I rise in support of the motion to suspend 
the rules, and I urge my colleagues to support the bill. The bill has 
passed the Senate, was reported by the Commerce Committee unanimously, 
and it should be acted on expeditiously by the House.
  The Ryan White program was originally enacted in 1990 to respond to 
the crisis in AIDS health services in America's cities and States, and 
in its clinics and hospitals. This act has been a great success.
  Outpatient services are now available as an alternative to expensive 
hospital care; prescription drugs are provided to people who have no 
other source of coverage; early intervention treatments can be given to 
keep people healthy longer; and, effective service programs for mothers 
and children are up and running, programs which also coordinate their 
activities with research organizations to assure that appropriate 
research opportunities are available to their clients.
  This law has improved health care for people with AIDS and HIV all 
over the country.
  This bill renews the authorization for these successful programs and 
fine tunes the response to the new and changing needs of the epidemic. 
I'm especially pleased to say that this legislation, and the committee 
report that accompanies it, emphasize those basic services that people 
with HIV need most--the services that slow the progress of the disease, 
that prevent opportunistic infections, and that meet basic primary care 
needs--and that it targets assistance to those people least likely to 
be able to afford such services themselves. At a time when funding will 
continue to be limited, it is important that all services programs 
focus on the primary care of people with HIV.
  This legislation does contain some controversial items. The 
inevitable disputes over formulas among cities and States appear here, 
as they have done and will continue to do in so much legislation before 
this Congress. The formulas contained in this bill represent a good 
faith effort to provide basic care to all Americans with HIV, and this 
bill is a balanced political compromise.
  In addition, this legislation contains compromise provisions 
regarding the testing of newborns that I have worked out with the 
gentleman from Oklahoma [Mr. Coburn]. Although the so-called Coburn-
Waxman amendment bears my name, I do have many reservations about this 
provision, as, I am sure, does the gentleman from Oklahoma. It deals 
with an issue about which there are profound differences in approach, 
which cannot be smoothed over. However, I believe the compromise 
approach embodied in this bill is necessary to move the Ryan White 
reauthorization forward and I urge Members to support it today.
  Let me be clear at the outset: We do not disagree about the ultimate 
goals here. Mr. Coburn and I both want to reduce the number of HIV 
infections passed from mother to infant, and we have agreed that the 
most effective means of achieving that goal is counseling and voluntary 
testing of pregnant women. This agreement is reflected in the findings 
of the Coburn-Waxman provisions.
  Mr. Coburn and I also agree that we want to reduce the rate of 
preventable pneumonia and other illnesses among HIV-infected infants 
and to improve their health care. Where we have differences is the most 
effective way of achieving the goal.
  During the committee's consideration of this bill, an amendment was 
offered by Mr. Coburn that would have required all States to initiate 
the mandatory testing of all newborns immediately. I opposed that 
amendment, as did a wide variety of health and medical groups. I asked 
the gentleman from Oklahoma to withdraw his amendment and to work with 
me to produce an amendment that would provide alternatives to the 
mandatory approach.
  I am gratified to say that he was willing to do so and that our 
staffs have worked since that time to come to some agreement. The 
provisions reflected in this bill are the product of that work.
  This provision is not perfect by any means. As I say, I have serious 
concerns about its possible effects.
  I believe that voluntary programs of HIV testing of infants would 
result in more infants receiving the care needed 

[[Page H 9058]]
to prevent pneumonia and improve their health.
  I believe that mothers who are highly encouraged to have their babies 
tested will be better partners in the lifelong medical care of these 
children than will mothers who are required to do so.
  And I remain very concerned that the emphasis on newborn testing will 
divert attention and resources from the more important goal of 
encouraging pregnant women to be tested themselves in time to provide 
care that will reduce the chance that the baby will be infected.
  But I believe that the Coburn-Waxman amendment is a significant 
improvement over other proposals that have been considered. This 
provision postpones requirements that a State mandatorily test all 
newborns until a time when it is agreed such mandatory testing is the 
recommended standard of medical care. Some believe that day will 
inevitably come, but, at this time, virtually all medical groups oppose 
the practice.
  The provision also gives States 2 years to develop effective 
alternatives to mandatory testing. If, after that time, mandatory 
testing is determined to be the routine of practice and if the State is 
not reaching most of its infants, the State will have up to 18 months 
to enact a mandatory testing law.
  I support the Coburn-Waxman amendment as far preferable to the 
alternative of an immediately effective requirement of mandatory 
testing. I thank the gentleman from Oklahoma for his willingness to 
work with me on this more flexible approach.
  I also want to take this moment to remind my colleagues why this 
action is taking place. Over the past year, new research developments 
have made it possible to prevent pneumonia and other diseases in 
newborns. That is why the question of testing babies is being debated 
and legislated about.
  In addition, there have been research breakthroughs that are truly 
good news about the possibility of reducing HIV transmission from 
mother to child. That is what the findings of this bill are about, 
stating that voluntary prenatal testing should be the standard of care. 
This is not about testing newborns, but it has often been discussed in 
the same breath.
  But both of these possibilities--preventing HIV through prenatal 
services and preventing disease in infected newborns through early 
intervention services--require services. Testing is not the answer; 
medical care is. Testing without care will make no difference. Testing 
without treatment is a cruel hoax on everyone concerned.
  And, in truth, most of the care for HIV-infected pregnant women and 
children come from one source--Medicaid. I hope that as my colleagues 
move to reshape the Medicaid Program, that they will remember that 
there are services that we can all agree should be available to poor 
people.
  Many of my colleagues, from both sides of the aisle, support the 
Coburn-Waxman amendment that may require States to provide testing of 
newborns if it is determined to be the medical standard of care. I hope 
that their enthusiasm for testing will be reflected in equal enthusiasm 
for assuring that the health care services are paid for.
  Finally, the Coburn-Waxman amendment includes provisions about health 
insurance. These provisions repeat the protections that the Americans 
With Disabilities Act provides for people with any disability, in any 
employment setting. It was believed to be appropriate to repeat these 
protections here so that anyone concerned that HIV testing would be 
used inappropriately could see the testing provision and the protection 
in one place.
  In addition, the provision describes how insurers may respond if 
fraud was committed. It is my clear understanding that this provision 
does not override any ADA, State law, or NAIC provisions that limit 
what may be asked for a person seeking insurance or holding insurance. 
These provisions are included to provide clear consumer protection and 
to allow insurers to respond appropriately if there is fraud in the 
answering of a permissible question. For instance, the National 
Association of Insurance Commissioners and many States have regulations 
restricting what can be asked of a person who is insured or seeking 
insurance. The insurance provisions of the Coburn-Waxman amendment 
provide additional protection for these consumers and are not intended 
to undo the NAIC and State actions.
  In conclusion, I would note for my colleagues that this bill was 
reported from the Commerce Committee unanimously. Whatever the 
differences among us on other issues, we have come together to 
reauthorize this program of AIDS health care services and to assure 
those who depend on it that it will continue. I urge my colleagues to 
do so today.
  Finally I would like to thank the staff involved for their diligent 
work on this important bill. Karen Nelson, Kay Holcombe, Melody Harned, 
Mark Agrast, Roland Foster, and Peter Goodloe have put in many long 
hours on this legislation and I want to express my appreciation to 
them.

                             {time}   1515

  Mr. BILIRAKIS. Mr. Speaker, I yield such time as he may consume to 
the distinguished gentleman from North Carolina [Mr. Burr].
  Mr. BURR. Mr. Speaker, I rise today to offer support for the passage 
of the Ryan White CARE Act. I strongly support the intent of this 
legislation, but have some strong concerns about the inequitable 
distribution of funds to non-title I areas.
  Currently, there is a 15 percent increase in the incidence of AIDS in 
rural areas. This is far greater than the 5 percent increase in cities 
of more than 50,000. I believe that we must address the serious 
problems associated with AIDS in all pockets of this country, not just 
the ones that are most visible. It is for this reason that I support 
inclusion of the Senate passed title II distribution formula.
  By adopting the Senate title II formula, the conference committee has 
an opportunity to put a stop to unfair double counting. In effect, 
double counting places a higher priority on the needs of AIDS patients 
in 42 metropolitan areas than it does the needs of AIDS victims across 
the rest of America. After all, who are we to geographically prioritize 
the value of American lives.
  As I have become more familiar with the horrors of this disease, I am 
acutely aware of the need for AIDS funding, and I appreciate the 
efforts of the chairman to craft a bill which addresses this growing 
concern. I hope that the conference committee will go one step further 
by adopting a title II formula which looks to the needs of all AIDS 
victims, and helps to prevent the spread of this dreadful disease in 
both urban and rural areas.
  Mr. Speaker, I along with other Members of the Commerce Committee, 
urge this body to support the reauthorization. I encourage the chairman 
and the ranking minority member to fight in Congress for the Senate 
formula so that all areas of this country can be represented.
  Mr. WAXMAN. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California [Ms. Pelosi].
  Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding me time. 
I rise in support of the reauthorization of the Ryan White Care Act, 
and in doing so commend the gentleman from Florida, Chairman Bilirakis, 
and the gentleman from California, the ranking member, Mr. Waxman, for 
their leadership in bringing this bill today to the Floor in a 
bipartisan fashion.
  Originally enacted in 1990, with strong bipartisan support then, this 
program provides assistance for health care with people with AIDS. 
Congress should take great pride in its actions in regard to the Ryan 
White CARE Act, both in the past 5 years and in the legislative 
activity that is happening today.
  The Ryan White program provides vital grants to metropolitan areas 
with high numbers of AIDS cases for outpatient health care and social 
services. In the coming year, 49 cities will receive direct emergency 
assistance through a formula grant, and will be eligible to compete for 
supplemental funds to assist with meeting the health care needs of 
people with AIDS.
  Mr. Speaker, as Chairman Bilirakis mentioned in his opening remarks, 
the Ryan White program also provides comprehensive care grants to 
states for the operation of HIV service delivery consortia in 
localities most heavily affected, for the provision of home and 

[[Page H 9059]]
community-based care, for the continuation of insurance coverage for 
infected persons, and for purchase of therapeutic drugs.

  In addition, the Ryan White CARE Act provides grants to community, 
migrant and homeless health centers, family granting grantees, 
hemophilia centers and other nonprofit entities that provide 
comprehensive primary care services to people with AIDS or population 
at increased risk for HIV inspection.
  Mr. Speaker, separate grants are also made to foster collaboration 
between clinical research institutions and primary community-based 
medical and social service providers for the target population of HIV 
infected children, pregnant women, and their families.
  Mr. Speaker, since 1981, my community of San Francisco has reported 
22,000 cases of AIDS. Imagine if this happened in your district, my 
colleagues; 14,600 deaths. You can see how grateful we are to the 
leaders of the committee for this as well as the fact that this is a 
national tragedy. We do not want our colleagues to experience the 
tragedy we have had in our community.
  I commend our colleagues for their leadership in bringing this to the 
floor and laying the foundation for a compromise on other issues.
  Mr. BILIRAKIS. Mr. Speaker, I yield such time as he may consume to 
the gentleman from Wisconsin [Mr. Gunderson].
  (Mr. GUNDERSON asked and was given permission to revise and extend 
his remarks.)
  Mr. GUNDERSON. Mr. Speaker, let me begin by saying a special thank 
you to the gentleman from Florida, Chairman Bilirakis, to the gentleman 
from Virginia, Chairman Bliley, to the gentleman from California, Mr. 
Waxman, and others for bringing up this legislation today. it is 
essential we pass this before the end of the month, and, obviously, 
that time clock is ticking.
  Mary Fisher, an active well-known Republican who spoke so eloquently 
to the Nation at the Republican National Convention in 1992 talks often 
about pilgrims in the road to AIDS. Today each one of us, in our own 
small way, are able to be one of those pilgrims. We are about to do a 
small part in this fight.
  We have learned a lot as we deal with the reauthorization of Ryan 
White. We have learned that the cure is much harder to find, the 
services are much harder to fund, and that the fighters, the pilgrims 
in this fight, are much more tired than they were 4 or 5 years ago. 
Recognizing all of that, I think we have also learned in this 
reauthorization that AIDS is no longer unique to big cities. It is no 
longer unique to the gay community. It is no longer unique just to the 
low income. It touches everybody in a different way.
  Mr. Speaker, my guess is that every person on Capitol Hill in some 
way, shape or form has been touched by AIDS. We have either known a 
family member, a friend, or a coworker who either has lost their life 
or is presently suffering from this disease. Just yesterday in 
Wisconsin over 10,000 people marched, the largest ever in the State of 
Wisconsin, in their AIDS walk. This coming Saturday, here in 
Washington, DC, the AIDS walk will be held again, and many people, 
myself included, will join that effort at a time when our Nation's 
Capital is more challenged by resources to fight AIDS than ever before 
in its history.
  And so, Mr. Speaker, this year, as we reauthorize Ryan White, we do 
not just continue the programs, but we recognize that rural America, 
that small States as well as big cities and populace areas, all have 
been touched by AIDS and the funding formulas need to and do recognize 
that. My home State of Wisconsin, under this funding formula will 
receive over $600,000 more annually than they have under the previous 
act.
  As we pass this legislation, let us remember, as Mary Fisher so 
eloquently has said, we are all pilgrims in the road to AIDS. Each of 
us today has a chance in a small way to do our part.
  Mr. WAXMAN. Mr. Speaker, I yield 7 minutes to the gentleman from New 
York [Mr. Ackerman].
  (Mr. ACKERMAN asked and was given permission to revise and extend his 
remarks.)
  Mr. ACKERMAN. Mr. Speaker, I rise today in the strongest of support 
for H.R. 1872, the Ryan White CARE Act amendments of 1995. By adopting 
this legislation today, we can stop sending women and infants home from 
the hospital without knowing their HIV status. Language included in 
this bill for the first time would require all newborns in America to 
be tested for HIV if the infant's mother was not voluntarily tested 
during her pregnancy.
  Mr. Speaker, H.R. 1872 encourages voluntary HIV counseling, testing, 
and treatment of pregnant women as recommended by the Centers for 
Disease Control and forbids insurance companies for terminating the 
insurance of anybody who undergoes tests for AIDS.
  I want to pay special tribute today to the gentleman from Virginia, 
Chairman Bliley, and the gentleman from Michigan, Mr. Dingell, the 
gentleman from Florida, Chairman Bilirakis, the gentleman from 
California, Mr. Waxman, and especially the gentleman from Oklahoma, Dr. 
Coburn, for his tireless efforts on behalf of this legislation.
  Mr. Speaker, make no mistake about it, with regard to this aspect of 
the legislation, there is not a person that I have met who does not 
prefer to encourage every pregnant woman in America to voluntarily be 
tested, to know her HIV status so that she might be treated with AZT, 
so that in at least 65 percent of the cases the in utero transmission 
of the virus will not be passed on to the yet-to-be-born child. This 
has been a national tragedy, Mr. Speaker. For years our country has 
been testing newborn infants anonymously to determine whether or not 
they have their mother's antibodies for HIV and then allowing those 
infants and mothers to go home from the hospital, never being told that 
the child tested positive, never allowing that child, that newborn 
infant, to access the medical system so that his or her young life 
might be made a little bit more comfortable.
  Usually, the first time that that mother, whose child had been tested 
for six or seven other kinds of diseases, such as hepatitis B, or 
syphilis, or so many other things, was told that the child tested 
positive to anything that the States required testing for but we were 
silent, absolutely silent if the child tested positive for the mother's 
antibodies to HIV, that mother thought she was taking home an otherwise 
healthy child, the next time that that child often appeared in the 
health care system was when he or she began dying of AIDS. That is 
absolutely unconscionable.
  And that test, Mr. Speaker, has now been stopped. But we must deal 
with this problem, the problem of transmission to thousands of young 
lives, newborn infants. And how do we do that? First, we try to get the 
mothers to undergo voluntary testing. But in some cases the mothers do 
not volunteer. We are all hopeful there will be 100 percent who would 
be willing to know what their status is and what the status of their 
newborn infant is, but that does not happen. Some mothers show up at 
the health care system the very first time when she is about to 
deliver. Other mothers, for whatever reasons, decide they do not want 
to know themselves and refuse testing.
  What happens to the children of those mothers should they be 
condemned to death? Should not somebody be advocating for those young 
people? If their mothers are not advocating for them, who will act in 
loco parentis? For the first time, Mr. Speaker, we address that 
problem, and, hopefully, it will be a very, very small percentage, 
because those mothers will undergo voluntary counseling and testing.
  What we do in this legislation, which this House should be so proud 
of, is we take all of those infants whose mother's status is not known, 
which is, hopefully, a very small number, and make sure that they get 
tested. Some have advocated that the mother has a right to privacy, and 
in testing the child we have inadvertently or deliberately tested the 
mother to determine her status, and that the mother has a right to 
remain ignorant of her status if she so chooses. That may be so, but 
the child has a right to live.
  In this complex and complicated society, so often rights conflict. We 
must make tough decisions, and we have made this decision before, 
certainly in the case of those mothers, in those cases where a family 
has their own religious beliefs and does not believe in 

[[Page H 9060]]
medical intervention and their religion calls for the divine 
intervention instead. If the life of the child is threatened and the 
mother refuses to allow the medical community to assist the child 
because of her religion, we have made the decision that the life of the 
child takes precedence. Every ethical panel has made that decision. 
Certainly if the right of the child to survive is more important than 
the constitutional right of freedom of religion, certainly it is 
equally important as the mother's right to remain ignorant.

                              {time}  1530

  We deal with this problem squarely in this legislation. And I want to 
caution this House, because this legislation has been brought together 
by people who are liberals and conservatives, Republicans and 
Democrats, parents and not, people of good will, but this should not be 
just delivering the mother a death certificate and saying, ``Your child 
is ill and is going to die.''
  There is no substitution for care. There is no substitution for 
treatment. There is no substitution for the kind of resources this 
Nation is going to have to put behind any effort to eliminate and 
eradicate this dreaded disease. I urge all of our colleagues in the 
House to support this legislation. For the very first time since the 
Ryan White bill has been enacted in this House, we deal with the 
problem of those newest of Americans, those newborn citizens, who 
before had no access to the health care system, had no access to Ryan 
White money, and we treat them the same as if they were anybody else. I 
think that is pretty important.
  Mr. Speaker, I thank all of those who have worked on this 
legislation, and urge strongly passage of this bill.
  Mr. BILIRAKIS. Mr. Speaker, I yield such time as he may consume to 
the gentleman from Florida [Mr. Foley].
  Mr. FOLEY. Mr. Speaker, I thank the gentleman from Florida for 
yielding and for his leadership on this issue.
  Mr. Speaker, I rise in support of the Ryan White Care Act amendments 
of 1995. I stress that the Ryan White Care Act as been passed by the 
Senate 97 to 3.
  Since its enactment in 1990, the CARE Act has been a vital lifeline 
of comprehensive medical and support services for Americans living with 
HIV and AIDS.
  While progress has been made in educating citizens about this deadly 
disease, the statistics are grim: AIDS has become the leading killer of 
young men and women between the ages of 25 and 44.
  Regrettably, one American becomes infected with HIV every 15 minutes 
and is spreading most rapidly among women, adolescents and within 
minority communities.
  My home district of Florida has been severely devastated by this 
deadly disease, with the city of West Palm Beach having the second 
highest case rate of HIV infections in females.
  AIDS also hits the minority communities especially hard, with 
African-Americans in Palm Beach County being 10 times more likely to be 
infected with HIV than whites.
  Mr. Speaker, it is important we continue the educational process. It 
is important that we stress to our youth in America that abstinence is 
the only way to preserve and protect yourself.
  Mr. Speaker, it is critical we preserve the partnership we have 
carved between the Federal, State, and local governments in the fight 
against AIDS.
  Through the cooperation of private and public efforts on all levels, 
the CARE Act has been instrumental in helping meet the emergency 
medical and support needs of communities impacted by the AIDS epidemic.
  These funds all provide needed assistance to help keep thousands of 
men, women, and children affected by AIDS healthy and living longer.
  Since the CARE Act is set to expire on September 30, 1995, 
reauthorization is urgent to ensure there is no disruption in services 
for those suffering with AIDS across the country.
  Mr. Speaker, I ask my colleagues to join me in support of the Ryan 
White CARE Act--it is a vital national investment for all Americans.
  Ms. WOOLSEY. Mr. Speaker, with AIDS now the leading killer of 
Americans between the ages of 25 and 44, it is more important than ever 
that we move forward, and do not retreat, in the fight against AIDS. To 
that end, swift reauthorization of the Ryan White CARE Act is crucial.
  The district I represent in California, Marin and Sonoma Counties, is 
one of the hardest hit by the AIDS epidemic. In fact, it has one of the 
highest incidence of HIV infection for a suburban/rural area in the 
country. While communities in my district have developed HIV/AIDS care 
and prevention systems that are a model for the Nation, they simply 
cannot do it on their own. That is why the care and services funded 
under the Ryan White CARE Act are essential to the men, women, 
children, and families living with HIV and AIDS in Marin and Sonoma 
Counties, CA, and in every community in this Nation.
  The CARE Act has proven to be highly successful at delivering quality 
AIDS-related care in cost-effective home and community-based settings, 
rather than in expensive emergency rooms and acute care hospital 
settings. It keeps people healthy, and lets them live and die with 
dignity in their homes, thus reducing the amount that State and Federal 
Governments spend on Medicaid.
   Mr. Speaker, any way you look at it, the Ryan White CARE Act is a 
wise national investment that must be continued. I urge the House to 
renew its commitment to the fight against AIDS by giving the Ryan White 
CARE Act reauthorization the widespread and bipartisan support it 
deserves.
  Mr. STUDDS. Mr. Chairman, as a cosponsor of H.R. 1872, I rise to 
express my strong support for the bill.
  Some 5 years ago, I joined with colleagues on both sides of the aisle 
in passing the Ryan White Care Act. Since then, this legislation has 
been a lifeline to hundreds of thousands of people in States and 
communities across the United States.
  Since then, AIDS has become the primary cause of death of men and 
women in the prime of their lives. Nearly half a million cases have 
been reported to the Center for Disease Control and Prevention, and 
nearly half that number have died since the first case was formally 
recognized in the early 1980's.
  Included in those grim statistics are two former Members of this 
House and many members of our families and our official family.
  Notwithstanding the recent comments of some public figures, most of 
us now recognize that the AIDS virus is indifferent to the social 
boundaries which separate us from one another. It does not discriminate 
by race or creed or sexual orientation--or even by party affiliation.
  Most of us understand that this is one of those occasions which 
require us to put aside our differences and deal thoughtfully and 
humanely with a crisis that affects us all.
  The effort to reauthorize this legislation has been a long and 
difficult process. It has been, from first to last, a bipartisan 
effort, and I commend Chairman Bliley, the ranking member, Mr. Dingell, 
our subcommittee chairman, Mr. Bilirakis, and the ranking member, Mr. 
Waxman, for all they have done to bring the bill to the floor.
  I urge my colleagues to join together in that spirit to pass the bill 
and send it to conference at the earliest possible date.
  Mrs. MINK of Hawaii. Mr. Speaker, today I rise in strong support of 
H.R. 1872, the reauthorization of the Ryan White CARE Act. This 
legislation has proven to be successful in helping those with HIV/AIDS 
receive adequate health care.
  Over the past 14 years we have watched helplessly as this disease was 
transformed from that of an unknown virus into a killer of epidemic 
proportions. We all know the numbers. AIDS has now infected over 
400,000 Americans. It has become the leading killer of all Americans 
ages 25-44. My own State of Hawaii has had over 1,400 total AIDS cases, 
250 of which were reported over the past year. As striking as these 
numbers may be, they only tell a small part of the story.
  AIDS is unlike any other disease we have ever encountered. In 
addition to having to deal with the day-to-day effects of their 
condition, AIDS victims must also confront daily discrimination brought 
on by fear and lack of awareness. Unlike cancer and heart disease which 
primarily occur later in life, AIDS usually strikes its victims in 
their prime. As a result, they are robbed of their quality of life, 
they are robbed of their opportunity to reach their full potential as 
productive members of society, and their Nation is robbed of a group of 
individuals at an age when they are most likely to contribute to our 
economy, to our work force and to our communities. I firmly believe 
that the Federal Government must step forward to offer the strongest 
possible response to this terrible epidemic.
  Prior to 1990, most Federal AIDS funding went toward research 
programs with the hope of learning more about the disease. Health care 
costs for treating AIDS have been rising astronomically. As a result, 
AIDS has also become detrimental to its victims from an economic 
standpoint. It was not until the implementation of the Ryan White CARE 
Act that money was first made available to help treat the victims of 
this deadly disease. Since that 

[[Page H 9061]]
time we have helped provide essential treatment and services for needy 
AIDS patients with resounding success.
  I would like to take this opportunity to express my concern over the 
language being proposed by my colleague from Oklahoma regarding 
mandatory testing of newborns. I firmly believe that we must test for 
this disease as soon as possible. The sooner we can detect the virus in 
newborns, the higher a quality of life they can expect to lead. In 
fact, if we can treat an infected mother with AZT prior to pregnancy, 
we reduce the risk of transmitting the virus to the infant by almost 
one-third. However, I question whether or not we can accomplish this by 
simply mandating testing. Mandatory testing violates the civil 
liberties of the woman and may produce the opposite response by driving 
them out of medical care. We need to take into account the 
psychological ramifications of this disease by implementing testing 
methods which are not as coercive. This can be accomplished by working 
with these women to offer them adequate counseling and voluntary 
testing.
  I adamantly urge my colleagues to vote to reauthorize this most 
important program. While we must be sure to allocate adequate resources 
for AIDS research and prevention, we must also be sure to do all that 
we can to help lessen the burden on those already infected with the 
virus. We took a huge step forward 5 years ago toward this goal by 
passing the Ryan White CARE Act. This program has successfully helped 
needy AIDS victims attain sufficient treatment. We need to reauthorize 
this vital program, and we need to do it in a timely matter to ensure 
that none of these critical services are interrupted.
  Mrs. MORELLA. Mr. Speaker, I rise in support of H.R. 1872, the Ryan 
White CARE Act reauthorization bill. I am a cosponsor of this 
legislation, and I want to particularly thank subcommittee Chairman 
Michael Bilirakis, Mr. Waxman, and the other members of the 
subcommittee and full committee for their efforts to bring this bill to 
the House floor without further delay. H.R. 1872 was approved by the 
committee by a unanimous vote, and the bill has been cosponsored by a 
diverse, bipartisan group of Members.
  The CARE Act provides medical care to more than 350,000 people living 
with HIV/AIDS. Under the Act, local communities make the decisions as 
to how funding should be allocated, in a manner consistent with this 
Congress' efforts to give States and localities greater control. It is 
critical that we pass this bill today and approve a final 
reauthorization bill as soon as possible.
  The funding formula in H.R. 1872, while far from perfect, is an 
improvement over the Senate version of the bill. I again thank the 
chairman and members of the subcommittee for working to improve the 
Senate formula, and I will be working to ensure that the House funding 
formula prevails in conference.
  In regard to the issue of HIV testing for infants and pregnant women, 
I have serious concerns with any attempt to impose mandatory testing. 
While I certainly share the view that we must do everything possible to 
reduce perinatal transmission of HIV, I believe that we have to try to 
distance ourselves from the emotions and create policies that will 
truly save women and their children.
  The most effective way to prevent perinatal HIV transmission is to 
prevent women from becoming infected in the first place. So far we have 
failed to effectively reach out to women and inform them of their risks 
for HIV and its potential impact on their lives. For this reason, I 
have introduced legislation since 1990 targeting prevention efforts to 
women. And my colleague from California, Congresswoman Pelosi, worked 
tirelessly with CDC to craft the HIV Community Planning process to 
ensure that HIV prevention funding is targeted to the particular needs 
of local communities and that prevention plans are developed and 
implemented by community-based organizations that know best what works 
for the specific populations they serve.
  In addition, the CDC guidelines for routine counseling and voluntary, 
confidential testing of pregnant women will provide access to early 
interventions that will actually prevent perinatal transmission, and 
link them to HIV care and services. Most medical and public health 
groups support a voluntary testing policy. During the subcommittee 
hearing in May, representatives of the American Academy of Pediatrics 
and the American College of Obstetricians and Gynecologists testified 
in support of a voluntary testing policy.
  Preserving a patient-provider relationship of trust is essential to 
keeping women in the health care system. And, clearly, it is women who 
have the greatest investment in the health and well-being of their 
children. Many voluntary counseling and testing programs exist, at 
Harlem Hospital and others; the physicians who run these programs will 
tell you that it is because the testing is voluntary that they are 
successful. In these programs, most all women, after talking with their 
provider, will choose testing and the treatment recommended by their 
provider. We should devote our resources to replicating these models, 
rather than to efforts that will do nothing to prevent perinatal 
transmission.
  Despite my strong reservations with the House testing provision, I 
urge my colleagues to vote in favor of H.R. 1872. We must move quickly 
to reauthorize this critical program providing medial care to all 
people living with HIV/AIDS.
  Mr. OWENS. Mr. Speaker, some of the most passionate letters that I 
have received come from my constituents concerned with the fate of the 
Ryan White Comprehensive AIDS Resources Emergency [CARE] Act (H.R. 
1872). Today, hundreds of thousands of people are breathing sighs of 
relief as we finally reauthorize the Ryan White CARE Act, the bedrock 
of Federal comprehensive assistance for women, men and children living 
with the HIV or AIDS virus.
  As my colleagues and I consider this significant legislation, it is 
crucial that we do not diminish the crisis that currently exists. It is 
a chilling reality that AIDS has etched a place in history as the 
disease that has taken the lives of more Americans in the United States 
than all of the wars combined since the Civil War. I appeal to all to 
remember that AIDS is not a distant nightmare relegated only to those 
communities and individuals who behave irresponsibly.
  We must remember AIDS is now the leading cause of death for 
individuals between the ages of 25 and 44. Since AIDS was first 
identified in the 1980's, one-half million individuals have been 
diagnosed. Tragically, one-half of those, or 250,000 people, have died. 
According to the Centers for Disease Control, between 800,000 and 1 
million Americans are currently HIV infected; and close to 100 
Americans will die from the disease each day.
  Our urban epicenters have become depositories for AIDS/HIV-infected 
persons. My own State of New York has nearly 20 percent of reported 
AIDS cases in the U.S., although the State holds only 7 percent of the 
Nation's population. Moreover, in New York City, AIDS is among the top 
five causes of death for children up to 9 years of age. And by the year 
2000, it is estimated that 30,000 children will be orphaned by AIDS in 
New York City.
  It is in our common interest, socially, medically and fiscally, to 
fully fund the Ryan White CARE Act. Ryan White CARE programs have 
become integral components of the entire health care system. By 
providing early intervention, housing assistance and case management to 
some of our most fragile citizens, these programs have effectively and 
efficiently served as their safety net.
  The impact of these programs is evident everywhere including New York 
State. Despite the fact that the number of people living with AIDS in 
New York doubled between 1989 and 1992, the number hospitalized 
increased by less than one third. In the State, Ryan White HIV home 
care services average a cost of $194 per day, while 1 day at the 
hospital costs $993 and nursing home care costs $424 per day. At the 
very least, we would be fiscally irresponsible to ignore these facts.
  Without a doubt, the scope of this crisis merits the full employment 
of Federal resources. Last month, the House passed other measures that 
acknowledge the AIDS emergency, including funding for AIDS research at 
the Centers for Disease Control and the National Institutes for Health. 
But, more resources should and can be devoted to combatting this 
epidemic. In the Labor-HHS-Education Appropriations bill (H.R. 2127), 
Ryan White AIDS programs were authorized for $67.5 million less than 
the administration's request.
  America cannot afford to fall short on the Ryan White CARE Act. The 
provision of food, housing, medical care, prescription drugs and other 
important services is the least that the government can do to ensure 
that the appropriate level of care reaches the infirm. Ryan White CARE 
programs are to the AIDS community what Social Security is to senior 
citizens. I appeal to my colleagues with any sense of compassion to 
vote ``yes'' for H.R. 1872 and pledge their support for further efforts 
to fully fund these vital programs.
  Mr. WAXMAN. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.
  Mr. BILIRAKIS. Mr. Speaker, I have no further requests for time, and 
I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Florida [Mr. Bilirakis] that the House suspend the rules 
and pass the bill, H.R. 1872, as amended.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.


                             General Leave

  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent that all Members 

[[Page H 9062]]
  may have 5 legislative days within which to revise and extend their 
remarks on H.R. 1872, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. BILIRAKIS. Mr. Speaker, I ask unanimous consent to take from the 
Speaker's table the Senate bill (S. 641) to reauthorize the Ryan White 
CARE Act of 1990, and for other purposes, and ask for its immediate 
consideration in the House.
  The Clerk read the title of the Senate bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  The Clerk read the Senate bill, 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 ``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.''.

[[Page H 9063]]

       (4) Use of amounts.--Section 2604 (42 U.S.C. 300ff-14) is 
     amended--
       (A) in subsection (b)(1)(A)--
       (i) by inserting ``, substance abuse treatment and mental 
     health treatment,'' after ``case management''; and
       (ii) by inserting ``which shall include treatment education 
     and prophylactic treatment for opportunistic infections,'' 
     after ``treatment services,'';
       (B) in subsection (b)(2)(A)--
       (i) by inserting ``, or private for-profit entities if such 
     entities are the only available provider of quality HIV care 
     in the area,'' after ``nonprofit private entities,''; and
       (ii) by striking ``and homeless health centers'' and 
     inserting ``homeless health centers, substance abuse 
     treatment programs, and mental health programs''; and
       (C) in subsection (e)--
       (i) in the subsection heading, by striking ``and Planning;
       (ii) by striking ``The chief'' and inserting:
       ``(1) In general.--The chief'';
       (iii) by striking ``accounting, reporting, and program 
     oversight functions'';
       (iv) by adding at the end thereof the following new 
     sentence: ``An entity (including subcontractors) receiving an 
     allocation from the grant awarded to the chief executive 
     officer under this part shall not use in excess of 12.5 
     percent of amounts received under such allocation for 
     administration.''; and
       (v) by adding at the end thereof the following new 
     paragraphs:
       ``(2) Administrative activities.--For the purposes of 
     paragraph (1), amounts may be used for administrative 
     activities that include--
       ``(A) routine grant administration and monitoring 
     activities, including the development of applications for 
     part A funds, the receipt and disbursal of program funds, the 
     development and establishment of reimbursement and accounting 
     systems, the preparation of routine programmatic and 
     financial reports, and compliance with grant conditions and 
     audit requirements; and
       ``(B) all activities associated with the grantee's contract 
     award procedures, including the development of requests for 
     proposals, contract proposal review activities, negotiation 
     and awarding of contracts, monitoring of contracts through 
     telephone consultation, written documentation or onsite 
     visits, reporting on contracts, and funding reallocation 
     activities.''.
       ``(3) Subcontractor administrative costs.--For the purposes 
     of this subsection, subcontractor administrative activities 
     include--
       ``(A) usual and recognized overhead, including established 
     indirect rates for agencies;
       ``(B) management oversight of specific programs funded 
     under this title; and
       ``(C) other types of program support such as quality 
     assurance, quality control, and related activities.''.
       (5) Application.--Section 2605 (42 U.S.C. 300ff-15) is 
     amended--
       (A) in subsection (a)--
       (i) in the matter preceding paragraph (1), by inserting ``, 
     in accordance with subsection (c) regarding a single 
     application and grant award,'' after ``application'';
       (ii) in paragraph (1)(B), by striking ``1-year period'' and 
     all that follows through ``eligible area'' and inserting 
     ``preceding fiscal year'';
       (iii) in paragraph (4), by striking ``and'' at the end 
     thereof;
       (iv) in paragraph (5), by striking the period at the end 
     thereof and inserting ``; and''; and
       (v) by adding at the end thereof the following new 
     paragraph:
       ``(6) that the applicant has participated, or will agree to 
     participate, in the Statewide coordinated statement of need 
     process where it has been initiated by the State, and ensure 
     that the services provided under the comprehensive plan are 
     consistent with the Statewide coordinated statement of 
     need.'';
       (B) in subsection (b)--
       (i) in the subsection heading, by striking ``Additional'';
       (ii) in the matter preceding paragraph (1), by striking 
     ``additional application'' and inserting ``application, in 
     accordance with subsection (c) regarding a single application 
     and grant award,'';
       (iii) in paragraph (3), by striking ``and'' at the end 
     thereof; and
       (iv) in paragraph (4), by striking the period and inserting 
     ``; and'';
       (C) by redesignating subsections (c) and (d) as subsections 
     (d) and (e), respectively; and
       (D) by inserting after subsection (b), the following new 
     subsection:
       ``(c) Single Application and Grant Award.--
       ``(1) Application.--The Secretary may phase in the use of a 
     single application that meets the requirements of subsections 
     (a) and (b) of section 2603 with respect to an eligible area 
     that desires to receive grants under section 2603 for a 
     fiscal year.
       ``(2) Grant award.--The Secretary may phase in the awarding 
     of a single grant to an eligible area that submits an 
     approved application under paragraph (1) for a fiscal 
     year.''.
       (6) Technical assistance.--Section 2606 (42 U.S.C. 300ff-
     16) is amended--
       (A) by striking ``may'' and inserting ``shall'';
       (B) by inserting after ``technical assistance'' the 
     following: ``, including peer based assistance to assist 
     newly eligible metropolitan areas in the establishment of HIV 
     health services planning councils and,''; and
       (C) by adding at the end thereof the following new 
     sentences: ``The Administrator may make planning grants 
     available to metropolitan areas, in an amount not to exceed 
     $75,000 for any metropolitan area, projected to be eligible 
     for funding under section 2601 in the following fiscal year. 
     Such grant amounts shall be deducted from the first year 
     formula award to eligible areas accepting such grants. Not to 
     exceed 1 percent of the amount appropriated for a fiscal year 
     under section 2677 for grants under part A may be used to 
     carry out this section.''.
       (b) Care Grant Program.--
       (1) HIV care consortia.--Section 2613 (42 U.S.C. 300ff-23) 
     is amended--
       (A) in subsection (a)--
       (i) in paragraph (1), by inserting ``(or private for-profit 
     providers or organizations if such entities are the only 
     available providers of quality HIV care in the area)'' after 
     ``nonprofit private,''; and
       (ii) in paragraph (2)(A)--

       (I) by inserting ``substance abuse treatment, mental health 
     treatment,'' after ``nursing,''; and
       (II) by inserting ``prophylactic treatment for 
     opportunistic infections, treatment education to take place 
     in the context of health care delivery,'' after 
     ``monitoring,'';

       (B) in subsection (c)--
       (i) in subparagraph (C) of paragraph (1), by inserting 
     before ``care'' ``and youth centered''; and
       (ii) in paragraph (2)--

       (I) in clause (ii) of subparagraph (A), by striking 
     ``served; and'' and inserting ``served;'';
       (II) in subparagraph (B), by striking the period at the 
     end; and
       (III) by adding after subparagraph (B), the following new 
     subparagraphs:

       ``(C) grantees under section 2671 and representatives of 
     organizations with a history of serving children, youth, 
     women, and families with HIV and operating in the community 
     to be served; and
       ``(D) representatives of community-based providers that are 
     necessary to provide the full continuum of HIV-related health 
     care services, which are available within the geographic area 
     to be served.''; and
       (C) in subsection (d), to read as follows:
       ``(d) Definition.--As used in this part, the terms `family 
     centered care' and `youth centered care' mean the system of 
     services described in this section that is targeted 
     specifically to the special needs of infants, children 
     (including those orphaned by the AIDS epidemic), youth, 
     women, and families. Family centered and youth centered care 
     shall be based on a partnership among parents, extended 
     family members, children and youth, professionals, and the 
     community designed to ensure an integrated, coordinated, 
     culturally sensitive, and community-based continuum of 
     care.''.
       (2) Provision of treatments.--Section 2616 (42 U.S.C. 
     300ff-26) is amended by striking subsection (c) and inserting 
     the following new subsections:
       ``(c) Standards for Treatment Programs.--In carrying out 
     this section, the Secretary shall--
       ``(1) review the current status of State drug reimbursement 
     programs and assess barriers to the expended availability of 
     prophylactic treatments for opportunistic infections 
     (including active tuberculosis); and
       ``(2) establish, in consultation with States, providers, 
     and affected communities, a recommended minimum formulary of 
     pharmaceutical drug therapies approved by the Food and Drug 
     Administration.

     In carrying out paragraph (2), the Secretary shall identify 
     those treatments in the recommended minimum formulary that 
     are for the prevention of opportunistic infections (including 
     the prevention of active tuberculosis).
       ``(d) State Duties.--
       ``(1) In general.--In implementing subsection (a), States 
     shall document the progress made in making treatments 
     described in subsection (c)(2) available to individuals 
     eligible for assistance under this section, and to develop 
     plans to implement fully the recommended minimum formulary of 
     pharmaceutical drug therapies approved by the Food and Drug 
     Administration.
       ``(2) Other mechanisms for providing treatments.--In 
     meeting the standards of the recommended minimum formulary 
     developed under subsection (c), a State may identify other 
     mechanisms such as consortia and public programs for 
     providing such treatments to individuals with HIV.''.
       (3) State application.--Section 2617(b) (42 U.S.C. 300ff-
     27(b)) is amended--
       (A) in paragraph (2)--
       (i) in subparagraph (A), by striking ``and'' at the end 
     thereof; and
       (ii) by adding at the end thereof the following new 
     subparagraph:
       ``(C) a description of how the allocation and utilization 
     of resources are consistent with the Statewide coordinated 
     statement of need (including traditionally underserved 
     populations and subpopulations) developed in partnership with 
     other grantees in the State that receive funding under this 
     title;'';
       (B) by redesignating paragraph (3) as paragraph (4);
       (C) by inserting after paragraph (2), the following new 
     paragraph:
       ``(3) the public health agency administering the grant for 
     the State shall convene a meeting at least annually of 
     individuals with HIV who utilize services under this part 
     (including those individuals from traditionally underserved 
     populations and subpopulations) and representatives of 
     grantees funded under 

[[Page H 9064]]
     this title (including HIV health services planning councils, early 
     intervention programs, children, youth and family service 
     projects, special projects of national significance, and HIV 
     care consortia) and other providers (including federally 
     qualified health centers) and public agency representatives 
     within the State currently delivering HIV services to 
     affected communities for the purpose of developing a 
     Statewide coordinated statement of need; and''; and
       (D) by adding at the end thereof the following flush 
     sentence:

     ``The State shall not be required to finance attendance at 
     the meetings described in paragraph (3). A State may pay the 
     travel-related expenses of individuals attending such 
     meetings where appropriate and necessary to ensure adequate 
     participation.''.
       (4) Planning, evaluation and administration.--Section 
     2618(c) (42 U.S.C. 300ff-28(c)) is amended--
       (A) in paragraphs (3) and (4), to read as follows:
       ``(3) Planning and evaluations.--Subject to paragraph (5) 
     and except as provided in paragraph (6), a State may not use 
     more than 10 percent of amounts received under a grant 
     awarded under this part for planning and evaluation 
     activities.
       ``(4) Administration.--
       ``(A) In general.--Subject to paragraph (5) and except as 
     provided in paragraph (6), a State may not use more than 10 
     percent of amounts received under a grant awarded under this 
     part for administration. An entity (including subcontractors) 
     receiving an allocation from the grant awarded to the State 
     under this part shall not use in excess of 12.5 percent of 
     amounts received under such allocation for administration.
       ``(B) Administrative activities.--For the purposes of 
     subparagraph (A), amounts may be used for administrative 
     activities that include routine grant administration and 
     monitoring activities.
       ``(C) Subcontractor administrative costs.--For the purposes 
     of this paragraph, subcontractor administrative activities 
     include--
       ``(i) usual and recognized overhead, including established 
     indirect rates for agencies;
       ``(ii) management oversight of specific programs funded 
     under this title; and
       ``(iii) other types of program support such as quality 
     assurance, quality control, and related activities.'';
       (B) by redesignating paragraph (5) as paragraph (7); and
       (C) by inserting after paragraph (4), the following new 
     paragraphs:
       ``(5) Limitation on use of funds.--Except as provided in 
     paragraph (6), a State may not use more than a total of 15 
     percent of amounts received under a grant awarded under this 
     part for the purposes described in paragraphs (3) and (4).
       ``(6) Exception.--With respect to a State that receives the 
     minimum allotment under subsection (a)(1) for a fiscal year, 
     such State, from the amounts received under a grant awarded 
     under this part for such fiscal year for the activities 
     described in paragraphs (3) and (4), may, notwithstanding 
     paragraphs (3), (4), and (5), use not more than that amount 
     required to support one full-time-equivalent employee.''.
       (5) Technical assistance.--Section 2619 (42 U.S.C. 300ff-
     29) is amended--
       (A) by striking ``may'' and inserting ``shall''; and
       (B) by inserting before the period the following: ``, 
     including technical assistance for the development and 
     implementation of Statewide coordinated statements of need''.
       (6) Grievance procedures and coordination.--Part B of title 
     XXVI (42 U.S.C. 300ff-21) is amended by adding at the end 
     thereof the following new sections:

     ``SEC. 2621. GRIEVANCE PROCEDURES.

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

     ``SEC. 2622. COORDINATION.

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

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

       ``(a) In General.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration, and in consultation with the Director of the 
     National Institutes of Health, shall award grants to 
     appropriate public or nonprofit private entities that, 
     directly or through contractual arrangements, provide primary 
     care to the public for the purpose of--
       ``(1) providing out-patient health care and support 
     services (which may include family-centered and youth-
     centered care, as defined in this title, family and youth 
     support services, and services for orphans) to children, 
     youth, women with HIV disease, and the families of such 
     individuals, and supporting the provision of such care with 
     programs of HIV prevention and HIV research; and
       ``(2) facilitating the voluntary participation of children, 
     youth, and women with HIV disease in qualified research 
     protocols at the facilities of such entities or by direct 
     referral.
       ``(b) Eligible Entities.--The Secretary may not make a 
     grant to an entity under subsection (a) unless the entity 
     involved provides assurances that--
       ``(1) the grant will be used primarily to serve children, 
     youth, and women with HIV disease;
       ``(2) the entity will enter into arrangements with one or 
     more qualified research entities to collaborate in the 
     conduct or facilitation of voluntary patient participation in 
     qualified research protocols;
       ``(3) the entity will coordinate activities under the grant 
     with other providers of 

[[Page H 9065]]
     health care services under this title, and under title V of the Social 
     Security Act;
       ``(4) the entity will participate in the Statewide 
     coordinated statement of need under section 2619 and in the 
     revision of such statement; and
       ``(5) the entity will offer appropriate research 
     opportunities to each patient, with informed consent.
       ``(c) Application.--The Secretary may not make a grant 
     under subsection (a) unless an application for the grant is 
     submitted to the Secretary and the application is in such 
     form, is made in such manner, and contains such agreements, 
     assurances, and information as the Secretary determines to be 
     necessary to carry out this section.
       ``(d) Patient Participation in Research Protocols.--
       ``(1) In general.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and the Director of the Office of AIDS 
     Research, shall establish procedures to ensure that accepted 
     standards of protection of human subjects (including the 
     provision of written informed consent) are implemented in 
     projects supported under this section. Receipt of services by 
     a patient shall not be conditioned upon the consent of the 
     patient to participate in research.
       ``(2) Research protocols.--
       ``(A) In general.--The Secretary shall establish mechanisms 
     to ensure that research protocols proposed to be carried out 
     to meet the requirements of this section, are of potential 
     clinical benefit to the study participants, and meet accepted 
     standards of research design.
       ``(B) Review panel.--Mechanisms established under 
     subparagraph (A) shall include an independent research review 
     panel that shall review all protocols proposed to be carried 
     out to meet the requirements of this section to ensure that 
     such protocols meet the requirements of this section. Such 
     panel shall make recommendations to the Secretary as to the 
     protocols that should be approved. The panel shall include 
     representatives of public and private researchers, providers 
     of services, and recipients of services.
       ``(e) Training and Technical Assistance.--The Secretary, 
     acting through the Administrator of the Health Resources and 
     Services Administration, may use not to exceed five percent 
     of the amounts appropriated under subsection (h) in each 
     fiscal year to conduct training and technical assistance 
     (including peer-based models of technical assistance) to 
     assist applicants and grantees under this section in 
     complying with the requirements of this section.
       ``(f) Evaluations and Data Collection.--
       ``(1) Evaluations.--The Secretary shall provide for the 
     review of programs carried out under this section at the end 
     of each grant year. Such evaluations may include 
     recommendations as to the improvement of access to and 
     participation in services and access to and participation in 
     qualified research protocols supported under this section.
       ``(2) Reporting requirements.--The Secretary may establish 
     data reporting requirements and schedules as necessary to 
     administer the program established under this section and 
     conduct evaluations, measure outcomes, and document the 
     clients served, services provided, and participation in 
     qualified research protocols.
       ``(3) Waivers.--Notwithstanding the requirements of 
     subsection (b), the Secretary may award new grants under this 
     section to an entity if the entity provide assurances, 
     satisfactory to the Secretary, that the entity will implement 
     the assurances required under paragraph (2), (3), (4), or (5) 
     of subsection (b) by the end of the second grant year. If the 
     Secretary determines through the evaluation process that a 
     recipient of funds under this section is in material 
     noncompliance with the assurances provided under paragraph 
     (2), (3), (4), or (5) of subsection (b), the Secretary may 
     provide for continued funding of up to one year if the 
     recipient provides assurances, satisfactory to the Secretary, 
     that such noncompliance will be remedied within such period.
       ``(g) Definitions.--For purposes of this section:
       ``(1) Qualified research entity.--The term `qualified 
     research entity' means a public or private entity with 
     expertise in the conduct of research that has demonstrated 
     clinical benefit to patients.
       ``(2) Qualified research protocol.--The term `qualified 
     research protocol' means a research study design of a public 
     or private clinical program that meets the requirements of 
     subsection (d).
       ``(h) Authorization of Appropriations.--There are 
     authorized to be appropriated to carry out this section, such 
     sums as may be necessary for each of the fiscal years 1996 
     through 2000.''.
       (2) Conforming amendment.--The heading for part D of title 
     XXVI of the Public Health Service Act is amended to read as 
     follows:

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

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

                  ``PART F--DEMONSTRATION AND TRAINING

         ``Subpart I--Special Projects of National Significance

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

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

           ``Subpart II--AIDS Education and Training Centers

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

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

     SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.

       Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) 
     is amended to read as follows:

[[Page H 9066]]

       ``(3) Amount of grant.--
       ``(A) In general.--Subject to the extent of amounts made 
     available in appropriations Acts, a grant made for purposes 
     of this paragraph to an eligible area shall be made in an 
     amount equal to the product of--
       ``(i) an amount equal to the amount available for 
     distribution under paragraph (2) for the fiscal year 
     involved; and
       ``(ii) the percentage constituted by the ratio of the 
     distribution factor for the eligible area to the sum of the 
     respective distribution factors for all eligible areas.
       ``(B) Distribution factor.--For purposes of subparagraph 
     (A)(ii), the term `distribution factor' means an amount equal 
     to the estimated number of living cases of acquired immune 
     deficiency syndrome in the eligible area involved, as 
     determined under subparagraph (C).
       ``(C) Estimate of living cases.--The amount determined in 
     this subparagraph is an amount equal to the product of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the eligible area during each year in the most 
     recent 120-month period for which data are available with 
     respect to all eligible areas, as indicated by the number of 
     such cases reported to and confirmed by the Director of the 
     Centers for Disease Control and Prevention for each year 
     during such period; and
       ``(ii) with respect to--

       ``(I) the first year during such period, .06;
       ``(II) the second year during such period, .06;
       ``(III) the third year during such period, .08;
       ``(IV) the fourth year during such period, .10;
       ``(V) the fifth year during such period, .16;
       ``(VI) the sixth year during such period, .16;
       ``(VII) the seventh year during such period, .24;
       ``(VIII) the eighth year during such period, .40;
       ``(IX) the ninth year during such period, .57; and
       ``(X) the tenth year during such period, .88.

       ``(D) Unexpended funds.--The Secretary may, in determining 
     the amount of a grant for a fiscal year under this paragraph, 
     adjust the grant amount to reflect the amount of unexpended 
     and uncanceled grant funds remaining at the end of the fiscal 
     year preceding the year for which the grant determination is 
     to be made. The amount of any such unexpended funds shall be 
     determined using the financial status report of the grantee.
       ``(E) Puerto rico, virgin islands, guam.--For purposes of 
     subparagraph (D), the cost index for an eligible area within 
     Puerto Rico, the Virgin Islands, or Guam shall be 1.0.''.

     SEC. 5. AMOUNT OF CARE GRANTS.

       Paragraphs (1) and (2) of section 2618(b) (42 U.S.C. 300ff-
     28(b)(1) and (2)) are amended to read as follows:
       ``(1) Minimum allotment.--Subject to the extent of amounts 
     made available under section 2677, the amount of a grant to 
     be made under this part for--
       ``(A) each of the several States and the District of 
     Columbia for a fiscal year shall be the greater of--
       ``(i)(I) with respect to a State or District that has less 
     than 90 living cases of acquired immune deficiency syndrome, 
     as determined under paragraph (2)(D), $100,000; or
       ``(i)(I) with respect to a State or District that has 90 or 
     more living cases of acquired immune deficiency syndrome, as 
     determined under paragraph (2)(D), $250,000;
       ``(ii) an amount determined under paragraph (2); and
       ``(B) each territory of the United States, as defined in 
     paragraph (3), shall be an amount determined under paragraph 
     (2).
       ``(2) Determination.--
       ``(A) Formula.--The amount referred to in paragraph 
     (1)(A)(ii) for a State and paragraph (1)(B) for a territory 
     of the United States shall be the product of--
       ``(i) an amount equal to the amount appropriated under 
     section 2677 for the fiscal year involved for grants under 
     part B; and
       ``(ii) the percentage constituted by the sum of--

       ``(I) the product of .50 and the ratio of the State 
     distribution factor for the State or territory (as determined 
     under subsection (B)) to the sum of the respective State 
     distribution factors for all States or territories; and
       ``(II) the product of .50 and the ratio of the non-EMA 
     distribution factor for the State or territory (as determined 
     under subparagraph (C)) to the sum of the respective 
     distribution factors for all States or territories.

       ``(B) State distribution factor.--For purposes of 
     subparagraph (A)(ii)(I), the term `State distribution factor' 
     means an amount equal to the estimated number of living cases 
     of acquired immune deficiency syndrome in the eligible area 
     involved, as determined under subparagraph (D).
       ``(C) Non-ema distribution factor.--For purposes of 
     subparagraph (A)(ii)(II), the term `non-ema distribution 
     factor' means an amount equal to the sum of--
       ``(i) the estimated number of living cases of acquired 
     immune deficiency syndrome in the State or territory 
     involved, as determined under subparagraph (D); less
       ``(ii) the estimated number of living cases of acquired 
     immune deficiency syndrome in such State or territory that 
     are within an eligible area (as determined under part A).
       ``(D) Estimate of living cases.--The amount determined in 
     this subparagraph is an amount equal to the product of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the State or territory during each year in the 
     most recent 120-month period for which data are available 
     with respect to all States and territories, as indicated by 
     the number of such cases reported to and confirmed by the 
     Director of the Centers for Disease Control and Prevention 
     for each year during such period; and
       ``(ii) with respect to each of the first through the tenth 
     year during such period, the amount referred to in 
     2603(a)(3)(C)(ii).
       ``(E) Puerto rico, virgin islands, guam.--For purposes of 
     subparagraph (D), the cost index for Puerto Rico, the Virgin 
     Islands, and Guam shall be 1.0.''.
       ``(F) Unexpended funds.--The Secretary may, in determining 
     the amount of a grant for a fiscal year under this 
     subsection, adjust the grant amount to reflect the amount of 
     unexpended and uncanceled grant funds remaining at the end of 
     the fiscal year preceding the year for which the grant 
     determination is to be made. The amount of any such 
     unexpended funds shall be determined using the financial 
     status report of the grantee.
       ``(G) Limitation.--
       ``(i) In general.--The Secretary shall ensure that the 
     amount of a grant awarded to a State or territory for a 
     fiscal year under this part is equal to not less than--

       ``(I) with respect to fiscal year 1996, 98 percent;
       ``(II) with respect to fiscal year 1997, 97 percent;
       ``(III) with respect to fiscal year 1998, 95.5 percent;
       ``(IV) with respect to fiscal year 1999, 94 percent; and
       ``(V) with respect to fiscal year 2000, 92.5 percent;

     of the amount such State or territory received for fiscal 
     year 1995 under this part. In administering this 
     subparagraph, the Secretary shall, with respect to States 
     that will receive grants in amounts that exceed the amounts 
     that such States received under this part in fiscal year 
     1995, proportionally reduce such amounts to ensure compliance 
     with this subparagraph. In making such reductions, the 
     Secretary shall ensure that no such State receives less than 
     that State received for fiscal year 1995.
       ``(ii) Ratable reduction.--If the amount appropriated under 
     section 2677 and available for allocation under this part is 
     less than the amount appropriated and available under this 
     part for fiscal year 1995, the limitation contained in clause 
     (i) shall be reduced by a percentage equal to the percentage 
     of the reduction in such amounts appropriated and 
     available.''.

     SEC. 6. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.

       (a) In General.--Part D of title XXVI (42 U.S.C. 300ff-71) 
     is amended by adding at the end thereof the following new 
     section:

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

       ``(a) In General.--Subject to subsection (b), there are 
     authorized to be appropriated to make grants under parts A 
     and B, such sums as may be necessary for each of the fiscal 
     years 1996 through 2000. Of the amount appropriated under 
     this section for fiscal year 1996, the Secretary shall make 
     available 64 percent of such amount to carry out part A and 
     36 percent of such amount to carry out part B.
       ``(b) Development of Methodology.--
       ``(1) In general.--With respect to each of the fiscal years 
     1997 through 2000, the Secretary shall develop and implement 
     a methodology for adjusting the percentages referred to in 
     subsection (a) to account for grants to new eligible areas 
     under part A and other relevant factors. Not later than 1 
     year after the date of enactment of this section, the 
     Secretary shall prepare and submit to the appropriate 
     committees of Congress a report regarding the findings with 
     respect to the methodology developed under this paragraph.
       ``(2) Failure to implement.--If the Secretary fails to 
     implement a methodology under paragraph (1) by October 1, 
     1996, there are authorized to be appropriated--
       ``(A) such sums as may be necessary to carry out part A for 
     each of the fiscal years 1997 through 2000; and
       ``(B) such sums as may be necessary to carry out part B for 
     each of the fiscal years 1997 through 2000.''.
       (b) Repeals.--Sections 2608 and 2620 (42 U.S.C. 300ff-18 
     and 300ff-30) are repealed.
       (c) Conforming Amendments.--Title XXVI is amended--
       (1) in section 2603 (42 U.S.C. 300ff-13)--
       (A) in subsection (a)(2), by striking ``2608'' and 
     inserting ``2677''; and
       (B) in subsection (b)(1), by striking ``2608'' and 
     inserting ``2677'';
       (2) in section 2605(c)(1) (42 U.S.C. 300ff-15(c)(1)) is 
     amended by striking ``2608'' and inserting ``2677''; and
       (3) in section 2618 (42 U.S.C. 300ff-28)--
       (A) in subsection (a)(1), is amended by striking ``2620'' 
     and inserting ``2677''; and
       (B) in subsection (b)(1), is amended by striking ``2620'' 
     and inserting ``2677''.

     SEC. 7. CDC GUIDELINES FOR PREGNANT WOMEN.

       (a) Requirement.--Notwithstanding any other provision of 
     law, a State described in subsection (b) shall, not later 
     than 1 year after the date of enactment of this Act, certify 
     to the Secretary of Health and Human Services that such State 
     has in effect regulations to adopt the guidelines issued by 
     the Centers for Disease Control and Prevention concerning 
     recommendations for 

[[Page H 9067]]
     immunodeficiency virus counseling and voluntary testing for pregnant 
     women.
       (b) Application of Section.--A State described in this 
     subsection is a State that has--
       (1) an HIV seroprevalance among child bearing women during 
     the period beginning on January 1, 1991 and ending on 
     December 31, 1992, of .25 or greater as determined by the 
     Centers for Disease Control and Prevention; or
       (2) an estimated number of births to HIV positive women in 
     1993 of 175 or greater as determined by the Centers for 
     Disease Control and Prevention using 1992 natality 
     statistics.
       (c) Noncompliance.--If a State does not provide the 
     certification required under subsection (a) within the 1 year 
     period described in such subsection, such State shall not be 
     eligible to receive assistance for HIV counseling and testing 
     under the Public Health Service Act (42 U.S.C. 201 et seq.) 
     until such certification is provided.
       (d) Additional Funds Regarding Women and Infants.--
       (1) In general.--If a State described in subsection (b) 
     provides the certification required in subsection (a) and is 
     receiving funds under part B of title XXVI of the Public 
     Health Service Act for a fiscal year, the Secretary of Health 
     and Human Services may (from the amounts available pursuant 
     to paragraph (3)) make a grant to the State for the fiscal 
     year for the following purposes:
       (A) Making available to pregnant women appropriate 
     counseling on HIV disease.
       (B) Making available outreach efforts to pregnant women at 
     high risk of HIV who are not currently receiving prenatal 
     care.
       (C) Making available to such women testing for such 
     disease.
       (D) Offsetting other State costs associated with the 
     implementation of the requirement of subsection (a).
       (2) Evaluation by institute of medicine.--
       (A) In general.--The Secretary of Health and Human Services 
     shall request the Institute of Medicine of the National 
     Academy of Sciences to enter into a contract with the 
     Secretary for the purpose of conducting an evaluation of the 
     extent to which grants under paragraph (1) have been 
     effective in preventing the perinatal transmission of the 
     human immunodeficiency virus.
       (B) Alternative contract.--If the Institute referred to in 
     subparagraph (A) declines to conduct the evaluation under 
     such subparagraph, the Secretary of Health and Human Services 
     shall carry out such subparagraph through another public or 
     nonprofit private entity.
       (C) Date certain for report.--The Secretary of Health and 
     Human Services shall ensure that, not later than after 2 
     years after the date of the enactment of this Act, the 
     evaluation required in this paragraph is completed and a 
     report describing the findings made as a result of the 
     evaluation is submitted to the Congress.
       (3) Funding.--For the purpose of carrying out this 
     subsection, there are authorized to be appropriated 
     $10,000,000 for each of the fiscal years 1996 through 2000. 
     Amounts made available under section 2677 for carrying out 
     this part are not available for carrying out this subsection.

     SEC. 8. SPOUSAL NOTIFICATION.

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

     SEC. 9. STUDY ON ALLOTMENT FORMULA.

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

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

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

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

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

     SEC. 12. PROHIBITION ON PROMOTION OF CERTAIN ACTIVITIES.

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

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

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

     SEC. 13. LIMITATION ON APPROPRIATIONS.

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

     SEC. 14. EFFECTIVE DATE.

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


                    motion offered by mr. bilirakis

  Mr. BILIRAKIS. Mr. Speaker, I offer a motion.
  The Clerk read as follows:

       Mr. Bilirakis moves to strike all after the enacting clause 
     of the Senate bill, S. 641, and to insert in lieu thereof the 
     provisions of H.R. 1872, as passed by the House.

  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Florida [Mr. Bilirakis].
  The motion was agreed to.
  The Senate bill was ordered to be read a third time, was read the 
third time, and passed. 

[[Page H 9068]]

  The title of the Senate bill was amended so as to read: ``A bill to 
amend the Public Health Service Act to revise and extend programs 
established pursuant to the Ryan White Comprehensive AIDS Resources 
Emergency Act of 1990.''
  A motion to reconsider was laid on the table.
  A similar House bill (H.R. 1872  was laid on the table.

                          ____________________