[Congressional Record Volume 141, Number 159 (Friday, October 13, 1995)]
[Senate]
[Pages S15170-S15176]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  RYAN WHITE CARE REAUTHORIZATION ACT of 1995--MESSAGE FROM THE HOUSE

  Mr. DOLE. Mr. President, I ask that the Chair lay before the Senate a 
message from the House of Representatives on S. 641, a bill to 
reauthorize the Ryan White CARE Act of 1990, and for other purposes.
  The PRESIDING OFFICER laid before the Senate the following message 
from the House of Representatives:

       Resolved, That the bill from the Senate (S. 641) entitled 
     ``An Act to reauthorize the Ryan White CARE Act of 1990, and 
     for other purposes'', do pass with the following amendments:
       Strike out all after the enacting clause, and insert:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Ryan White CARE Act 
     Amendments of 1995''.

     SEC. 2. REFERENCES.

       Whenever in this Act an amendment is expressed in terms of 
     an amendment to a section or other provision, the reference 
     shall be considered to be made to that section or other 
     provision of the Public Health Service Act (42 U.S.C. 201 et 
     seq.).
     
[[Page S 15171]]

 TITLE I--EMERGENCY RELIEF FOR AREAS WITH SUBSTANTIAL NEED FOR SERVICES

     SEC. 101. ESTABLISHMENT OF PROGRAM OF GRANTS.

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

     SEC. 102. HIV HEALTH SERVICES PLANNING COUNCIL.

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

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

     SEC. 103. TYPE AND DISTRIBUTION OF GRANTS.

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

[[Page S 15172]]

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

     SEC. 104. USE OF AMOUNTS.

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

     SEC. 105. APPLICATION.

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

     SEC. 106. TECHNICAL ASSISTANCE; PLANNING GRANTS.

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

     SEC. 201. GENERAL USE OF GRANTS.

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

     ``SEC. 2612. GENERAL USE OF GRANTS.

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

     SEC. 202. GRANTS TO ESTABLISH HIV CARE CONSORTIA.

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

     SEC. 203. PROVISION OF TREATMENTS.

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

     SEC. 204. ADDITIONAL REQUIREMENTS FOR GRANTS.

       (a) Findings.--The Congress finds as follows:
       (1) Research studies have demonstrated that administration 
     of antiviral medication during pregnancy can significantly 
     reduce the transmission of the human immunodeficiency virus 
     (commonly known as HIV) from an infected mother to her baby.
       (2) The Centers for Disease Control and Prevention have 
     recommended that all pregnant 

[[Page S 15173]]
     women receive HIV counseling; voluntary, confidential HIV testing; and 
     appropriate medical treatment (including antiviral therapy) 
     and support services.
       (3) The provision of such testing without access to such 
     counseling, treatment, and services will not improve the 
     health of the woman or the child.
       (4) The provision of such counseling, testing, treatment, 
     and services can reduce the number of pediatric cases of 
     acquired immune deficiency syndrome, can improve access to 
     and provision of medical care for the woman, and can provide 
     opportunities for counseling to reduce transmission among 
     adults.
       (5) The provision of such counseling, testing, treatment, 
     and services can reduce the overall cost of pediatric cases 
     of acquired immune deficiency syndrome.
       (6) The cancellation or limitation of health insurance or 
     other health coverage on the basis of HIV status should be 
     impermissible under applicable law. Such cancellation or 
     limitation could result in disincentives for appropriate 
     counseling, testing, treatment, and services.
       (7) For the reasons specified in paragraphs (1) through 
     (6)--
       (A) mandatory counseling and voluntary testing of pregnant 
     women should be the standard of care; and
       (B) the relevant medical organizations as well as public 
     health officials should issue guidelines making such 
     counseling and testing the standard of care.
       (b) Additional Requirements for Grants.--Part B (42 U.S.C. 
     300ff-21 et seq.) is amended--
       (1) in section 2611, by adding at the end the following 
     sentence: ``The authority of the Secretary to provide grants 
     under this part is subject to section 2673D (relating to the 
     testing of pregnant women and newborn infants).''; and
       (2) by inserting after section 2616 the following section:

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

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

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

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

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

       ``(a) Determination by Secretary.--During the first 30 days 
     following the expiration of the 2-year period beginning on 
     the date of the enactment of the Ryan White CARE Act 
     Amendments of 1995, the Secretary shall publish in the 
     Federal Register a determination of whether it has become a 
     routine practice in the provision of health care in the 
     United States to carry out each of the activities described 
     in paragraphs (1) through (4) of section 2673C(b). In making 
     the determination, the Secretary shall consult with the 
     States and with other public or private entities that have 
     knowledge or expertise relevant to the determination.
       ``(b) Contingent Applicability.--
       ``(1) In general.--If the determination published in the 
     Federal Register under subsection (a) is that (for purposes 
     of such subsection) the activities involved have become 
     routine practices, paragraph (2) applies on and after the 
     expiration of the 18-month period beginning on the date on 
     which the determination is so published.
       ``(2) Requirement.--Subject to subsection (c), the 
     Secretary shall not make a grant under part B to a State 
     unless the State meets not less than one of the following 
     requirements:
       ``(A) The State has in effect, in statute or through 
     regulations, the requirements specified in paragraphs (1) 
     through (4) of section 2673C(b).
       ``(B) The State demonstrates that, of the newborn infants 
     born in the State during the most recent 1-year period for 
     which the data are available, the HIV antibody status of 95 
     percent of the infants is known.
       ``(c) Limitation Regarding Availability of Funds.--With 
     respect to an activity described in any of paragraphs (1) 
     through (4) of section 2673C(b), the requirements established 
     by a State under subsection (b)(2)(A) that the activity be 
     carried out applies for purposes of this section only to the 
     extent that the following sources of funds are available for 
     carrying out the activity:
       ``(1) Federal funds provided to the State in grants under 
     part B.
       ``(2) Federal funds provided to the State in grants under 
     section 2673C.
       ``(3) Funds that the State or private entities have elected 
     to provide, including through entering into contracts under 
     which health benefits are provided. This section does not 
     require any entity to expend non-Federal funds.''.

     SEC. 205. STATE APPLICATION.

       Section 2617(b)(2) (42 U.S.C. 300ff-27(b)(2)) is amended--
       (1) in subparagraph (A), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (B), by striking ``and'' after the 
     semicolon; and
       (3) by adding at the end thereof the following 
     subparagraphs:
       ``(C) a description of the activities carried out by the 
     State under section 2616; and
       ``(D) a description of how the allocation and utilization 
     of resources are consistent with a 

[[Page S 15174]]
     statewide coordinated statement of need, developed in partnership with 
     other grantees in the State that receive funding under this 
     title and after consultation with individuals receiving 
     services under this part.''.

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

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

     SEC. 207. TECHNICAL ASSISTANCE.

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

     SEC. 301. ESTABLISHMENT OF PROGRAM.

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

     SEC. 302. MINIMUM QUALIFICATIONS OF GRANTEES.

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

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

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

     SEC. 304. ADDITIONAL REQUIRED AGREEMENTS.

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

     SEC. 305. AUTHORIZATION OF APPROPRIATIONS.

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

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

       (a) In General.--Section 2671 (42 U.S.C. 300ff-71) is 
     amended--
       (1) in subsection (a), by amending the subsection to read 
     as follows:
       ``(a) In General.--
       ``(1) Program of grants.--The Secretary, acting through the 
     Administrator of the Health Resources and Services 
     Administration and in consultation with the Director of the 
     National Institutes of Health, shall make grants to public 
     and nonprofit private entities that provide primary care 
     (directly or through contracts) for the purpose of--
       ``(A) providing through such entities, in accordance with 
     this section, opportunities for women, infants, and children 
     to be participants in research of potential clinical benefit 
     to individuals with HIV disease; and
       ``(B) providing to women, infants, and children health care 
     on an outpatient basis.
       ``(2) Provisions regarding participation in research.--With 
     respect to the projects of research with which an applicant 
     under paragraph (1) is concerned, the Secretary may not make 
     a grant under such paragraph to the applicant unless the 
     following conditions are met:
       ``(A) The applicant agrees to make reasonable efforts--
       ``(i) to identify which of the patients of the applicant 
     are women, infants, and children who would be appropriate 
     participants in the projects; and
       ``(ii) to offer women, infants, and children the 
     opportunity to so participate (as appropriate), including the 
     provision of services under subsection (f).
       ``(B) The applicant agrees that the applicant, and the 
     projects of research, will comply with accepted standards of 
     protection for human subjects (including the provision of 
     written informed consent) who participate as subjects in 
     clinical research.
       ``(C) For the third or subsequent fiscal year for which a 
     grant under such paragraph is sought by the applicant, the 
     Secretary has determined that--
       ``(i) a significant number of women, infants, and children 
     who are patients of the applicant are participating in the 
     projects (except to the extent this clause is waived under 
     subsection (k)); and
       ``(ii) the applicant, and the projects of research, have 
     complied with the standards referred to in subparagraph (B).
       ``(3) Prohibition.--Receipt of services by a patient shall 
     not be conditioned upon the consent of the patient to 
     participate in research.
       ``(4) Consideration by secretary of certain 
     circumstances.--In administering the requirement of paragraph 
     (2)(C)(i), the Secretary shall take into account 
     circumstances in which a grantee under paragraph (1) is 
     temporarily unable to comply with the requirement for reasons 
     beyond the control of the grantee, and shall in such 
     circumstances provide to the grantee a reasonable period of 
     opportunity in which to reestablish compliance with the 
     requirement.'';
       (2) in subsection (c), by amending the subsection to read 
     as follows:
       ``(c) Provisions Regarding Conduct of Research.--With 
     respect to eligibility for a grant under subsection (a):
       ``(1) A project of research for which subjects are sought 
     pursuant to such subsection may be conducted by the applicant 
     for the grant, or by an entity with which the applicant has 
     made arrangements for purposes of the grant. The grant may 
     not be expended for the conduct of any project of research.
       ``(2) The grant may not be made unless the Secretary makes 
     the following determinations:
       ``(A) The applicant or other entity (as the case may be 
     under paragraph (1)) is appropriately qualified to conduct 
     the project of research. An entity shall be considered to be 
     so qualified if any research protocol of the entity has been 
     recommended for funding under this Act pursuant to technical 
     and scientific peer review through the National Institutes of 
     Health.
       ``(B) The project of research is being conducted in 
     accordance with a research protocol to which the Secretary 
     gives priority regarding the prevention and treatment of HIV 
     disease in women, infants, and children. After consultation 
     with public and private entities that conduct such research, 
     and with providers of services under this section and 
     recipients of such services, the Secretary shall establish a 
     list of such protocols that are appropriate for purposes of 
     this section. The Secretary may give priority under this 
     subparagraph to a research protocol that is not on such 
     list.'';
       (3) by striking subsection (i);
       (4) by redesignating subsections (g) and (h) as subsections 
     (h) and (i), respectively;
       (5) by inserting after subsection (f) the following 
     subsection:
       ``(g) Additional Provisions.--The Secretary may not make a 
     grant under subsection (a) unless the applicant for the grant 
     agrees as follows:
       ``(1) The applicant will coordinate activities under the 
     grant with other providers of health care services under this 
     Act, and under title V of the Social Security Act.
       ``(2) The applicant will participate in the statewide 
     coordinated statement of need under part B (where it has been 
     initiated by the State) and in revisions of such 
     statement.'';
       (6) by redesignating subsection (j) as subsection (m); and
       (7) by inserting before subsection (m) (as so redesignated) 
     the following subsections:
       ``(j) Coordination With National Institutes of Health.--The 
     Secretary shall develop and implement a plan that provides 
     for the coordination of the activities of the National 
     Institutes of Health with the activities carried out under 
     this section. In carrying out the preceding sentence, the 
     Secretary shall ensure that projects of research conducted or 
     supported by such Institutes are made aware of applicants and 
     grantees under this section, shall require that the projects, 
     as appropriate, enter into arrangements for purposes of this 
     section, and shall require that each project entering into 
     such an arrangement inform the applicant or grantee under 
     this section of the needs of the project for the 
     participation of women, infants, and children.
       ``(k) Temporary Waiver Regarding Significant 
     Participation.--
       ``(1) In general.--In the case of an applicant under 
     subsection (a) who received a grant under this section for 
     fiscal year 1995, the Secretary may, subject to paragraph 
     (2), provide to the applicant a waiver of the requirement of 
     subsection (a)(2)(C)(i) if the Secretary determines that the 
     applicant is making reasonable progress toward meeting the 
     requirement.
       ``(2) Termination of authority for waivers.--The Secretary 
     may not provide any waiver under paragraph (1) on or after 
     October 1, 1998. Any such waiver provided prior to such date 
     terminates on such date, or on such earlier date as the 
     Secretary may specify.
       ``(l) Training and Technical Assistance.--Of the amounts 
     appropriated under subsection (m) for a fiscal year, the 
     Secretary may use not more than five percent to provide 
     training and technical assistance to assist applicants and 
     grantees under subsection (a) in complying with the 
     requirements of this section.''.

[[Page S 15175]]

       (b) Conforming Amendments.--Section 2671 (42 U.S.C. 300ff-
     71) is amended--
       (1) in the heading for the section, by striking 
     ``DEMONSTRATION'' and all that follows and inserting 
     ``COORDINATED SERVICES AND ACCESS TO RESEARCH FOR WOMEN, 
     INFANTS, AND CHILDREN.'';
       (2) in subsection (b), by striking ``pediatric patients and 
     pregnant women'' and inserting ``women, infants, and 
     children''; and
       (3) in each of subsections (d) through (f), by striking 
     ``pediatric'', each place such term appears.
       (c) Authorization of Appropriations.--Section 2671 (42 
     U.S.C. 300ff-71) is amended in subsection (m) (as 
     redesignated by subsection (a)(6)) by striking ``there are'' 
     and all that follows and inserting the following: ``there are 
     authorized to be appropriated such sums as may be necessary 
     for each of the fiscal years 1996 through 2000.''.

     SEC. 402. PROJECTS OF NATIONAL SIGNIFICANCE.

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

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

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

     SEC. 403. SPECIAL TRAINING PROJECTS.

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

     SEC. 404. EVALUATIONS AND REPORTS.

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

     SEC. 405. COORDINATION OF PROGRAM.

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

     SEC. 501. AMOUNT OF EMERGENCY RELIEF GRANTS.

       Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) 
     is amended to read as follows:
       ``(3) Amount of grant.--
       ``(A) In general.--Subject to the extent of amounts made 
     available in appropriations Acts, a grant made for purposes 
     of this paragraph to an eligible area shall be made in an 
     amount equal to the product of--
       ``(i) an amount equal to the amount available for 
     distribution under paragraph (2) for the fiscal year 
     involved; and
       ``(ii) the percentage constituted by the ratio of the 
     distribution factor for the eligible area to the sum of the 
     respective distribution factors for all eligible areas.
       ``(B) Distribution factor.--For purposes of subparagraph 
     (A)(ii), the term `distribution factor' means the product 
     of--
       ``(i) an amount equal to the estimated number of living 
     cases of acquired immune deficiency syndrome in the eligible 
     area involved, as determined under subparagraph (C); and
       ``(ii) the cost index for the eligible area involved, as 
     determined under subparagraph (D).
       ``(C) Estimate of living cases.--The amount determined in 
     this subparagraph is an amount equal to the product of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the eligible area during each year in the most 
     recent 120-month period for which data are available with 
     respect to all eligible areas, as indicated by the number of 
     such cases reported to and confirmed by the Director of the 
     Centers for Disease Control and Prevention for each year 
     during such period; and
       ``(ii) with respect to--

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

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

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

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

     SEC. 502. AMOUNT OF CARE GRANTS.

       Section 2618 (42 U.S.C. 300ff-28), as amended by section 
     402(b), is amended by striking subsection (b) and inserting 
     the following subsections:
       ``(a) Amount of Grant.--
       ``(1) In general.--Subject to subsection (b) (relating to 
     minimum grants), the amount of a grant under this part for a 
     State for a fiscal year shall be the sum of--
       ``(A) the amount determined for the State under paragraph 
     (2); and
       ``(B) the amount determined for the State under paragraph 
     (4) (if applicable).
       ``(2) Principal formula grants.--For purposes of paragraph 
     (1)(A), the amount determined under this paragraph for a 
     State for a fiscal year shall be the product of--

[[Page S 15176]]

       ``(A) the amount available under section 2677 for carrying 
     out this part, less the reservation of funds made in 
     paragraph (4)(A) and less any other applicable reservation of 
     funds authorized or required in this Act (which amount is 
     subject to subsection (b)); and
       ``(B) the percentage constituted by the ratio of--
       ``(i) the distribution factor for the State; to
       ``(ii) the sum of the distribution factors for all States.
       ``(3) Distribution factor for principal formula grants.--
     For purposes of paragraph (2)(B), the term `distribution 
     factor' means the following, as applicable:
       ``(A) In the case of each of the 50 States, the District of 
     Columbia, and the Commonwealth of Puerto Rico, the product 
     of--
       ``(i) the number of cases of acquired immune deficiency 
     syndrome in the State, as indicated by the number of cases 
     reported to and confirmed by the Secretary for the 2 most 
     recent fiscal years for which such data are available; and
       ``(ii) the cube root of the ratio (based on the most recent 
     available data) of--

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

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

     SEC. 503. CONSOLIDATION OF AUTHORIZATIONS OF APPROPRIATIONS.

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

     ``SEC. 2677. AUTHORIZATION OF APPROPRIATIONS.

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

     SEC. 504. ADDITIONAL PROVISIONS.

       (a) Definitions.--Section 2676(4) (42 U.S.C. 300ff-76(4)) 
     is amended by inserting ``funeral-service practitioners,'' 
     after ``emergency medical technicians,''.
       (b) Miscellaneous Amendment.--Section 1201(a) (42 U.S.C. 
     300d(a)) is amended in the matter preceding paragraph (1) by 
     striking ``The Secretary,'' and all that follows through 
     ``shall,'' and inserting ``The Secretary shall,''.
       (c) Technical Corrections.--Title XXVI (42 U.S.C. 300ff-11 
     et seq.) is amended--
       (1) in section 2601(a), by inserting ``section'' before 
     ``2604'';
       (2) in section 2603(b)(4)(B), by striking ``an expedited 
     grants'' and inserting ``an expedited grant'';
       (3) in section 2617(b)(3)(B)(iv), by inserting ``section'' 
     before ``2615'';
       (4) in section 2618(b)(1)(B), by striking ``paragraph 3'' 
     and inserting ``paragraph (3)'';
       (5) in section 2647--
       (A) in subsection (a)(1), by inserting ``to'' before 
     ``HIV'';
       (B) in subsection (c), by striking ``section 2601'' and 
     inserting ``section 2641''; and
       (C) in subsection (d)--
       (i) in the matter preceding paragraph (1), by striking 
     ``section 2601'' and inserting ``section 2641''; and
       (ii) in paragraph (1), by striking ``has in place'' and 
     inserting ``will have in place'';
       (6) in section 2648--
       (A) by converting the heading for the section to boldface 
     type; and
       (B) by redesignating the second subsection (g) as 
     subsection (h);
       (7) in section 2649--
       (A) in subsection (b)(1), by striking ``subsection (a) 
     of''; and
       (B) in subsection (c)(1), by striking ``this subsection'' 
     and inserting ``subsection'';
       (8) in section 2651--
       (A) in subsection (b)(3)(B), by striking ``facility'' and 
     inserting ``facilities''; and
       (B) in subsection (c), by striking ``exist'' and inserting 
     ``exists'';
       (9) in section 2676--
       (A) in paragraph (2), by striking ``section'' and all that 
     follows through ``by the'' and inserting ``section 2686 by 
     the''; and
       (B) in paragraph (10), by striking ``673(a)'' and inserting 
     ``673(2)'';
       (10) in part E, by converting the headings for subparts I 
     and II to Roman typeface; and
       (11) in section 2684(b), in the matter preceding paragraph 
     (1), by striking ``section 2682(d)(2)'' and inserting 
     ``section 2683(d)(2)''.
                        TITLE VI--EFFECTIVE DATE

     SEC. 601. EFFECTIVE DATE.

       Except as provided in section 101(a), this Act takes effect 
     October 1, 1995.
       Amend the title so as to read: ``An Act to amend the Public 
     Health Service Act to revise and extend programs established 
     pursuant to the Ryan White Comprehensive AIDS Resources 
     Emergency Act of 1990.''.

  Mr. DOLE. Mr. President, I move that the Senate disagree to the House 
amendments and request a conference on the disagreeing votes of the two 
Houses, and that the Chair be authorized to appoint conferees on the 
part of the Senate.
  The motion was agreed to, and the Presiding Officer appointed Mrs. 
Kassebaum, Mr. Jeffords, Mr. Frist, Mr. Kennedy, and Mr. Dodd conferees 
on the part of the Senate.

                          ____________________