[104th Congress Public Law 146]
[From the U.S. Government Printing Office]
<DOC>
[DOCID: f:publ146.104]
[[Page 1345]]
RYAN WHITE CARE ACT AMENDMENTS OF 1996
[[Page 110 STAT. 1346]]
Public Law 104-146
104th Congress
An Act
An Act to amend the Public Health <<NOTE: May 20, 1996 - [S. 641]>>
Service Act to revise and extend programs established pursuant to the
Ryan White Comprehensive AIDS Resources Emergency Act of 1990.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled, <<NOTE: Ryan White CARE
Act Amendments of 1996.>>
SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE.
This Act may be cited as the ``Ryan White CARE Act Amendments of
1996''.
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 the Public
Health Service Act (42 U.S.C. 201 et seq.).
SEC. 3. GENERAL AMENDMENTS.
(a) Program of Grants.--
(1) Number of cases.--Section 2601(a) (42 U.S.C. 300ff-11)
is amended--
(A) by striking ``subject to subsection (b)'' and
inserting ``subject to subsections (b) through (d)'';
and
(B) 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 5
calendar years for which such data are available.''.
(2) Other provisions regarding eligibility.--Section 2601
(42 U.S.C. 300ff-11) is amended by adding at the end thereof the
following new 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
[[Page 110 STAT. 1347]]
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.''.
(3) 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.''.
(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 that is in
accordance with paragraph (5).'';
(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, including how best to meet
each such priority and additional factors that a
grantee should consider in allocating funds under
a grant 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
[[Page 110 STAT. 1348]]
(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 public health agency responsible for administering
grants under part B; and
``(E) 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;
(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.'';
and
(F) by adding at the end thereof the following:
``(5) Conflicts of interest.--
``(A) In general.--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.
``(B) Required agreements.--An individual may serve
on the planning council under paragraph (1) only if the
individual agrees that if the individual has a financial
interest in an entity, if the individual is an employee
of a public or private entity, or if the individual is a
member of a public or private organization, and such
entity or organization 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
[[Page 110 STAT. 1349]]
(directly or in an advisory capacity) in the process of
selecting entities to receive such amounts for such
purpose.
``(6) Grievance procedures.--A planning council under
paragraph (1) shall develop procedures for addressing grievances
with respect to funding under this part, including procedures
for submitting grievances that cannot be resolved to binding
arbitration. Such procedures shall be described in the by-laws
of the planning council and be consistent with the requirements
of subsection (c).
``(c) Grievance Procedures.--
``(1) Federal responsibility.--
``(A) Models.--The Secretary shall, through a
process that includes consultations with grantees under
this part and public and private experts in grievance
procedures, arbitration, and mediation, develop model
grievance procedures that may be implemented by the
planning council under subsection (b)(1) and grantees
under this part. Such model procedures shall describe
the elements that must be addressed in establishing
local grievance procedures and provide grantees with
flexibility in the design of such local procedures.
``(B) Review.--The Secretary shall review grievance
procedures established by the planning council and
grantees under this part to determine if such procedures
are adequate. In making such a determination, the
Secretary shall assess whether such procedures permit
legitimate grievances to be filed, evaluated, and
resolved at the local level.
``(2) Grantees.--To be eligible to receive funds under this
part, a grantee shall develop grievance procedures that are
determined by the Secretary to be consistent with the model
procedures developed under paragraph (1)(A). Such procedures
shall include a process for submitting grievances to binding
arbitration.''.
(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
[[Page 110 STAT. 1350]]
(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) Definition.--
``(A) Severe need.--In determining severe need in
accordance with paragraph (1)(B), the Secretary shall
consider the ability of the qualified applicant to
expend funds efficiently and the impact of relevant
factors on the cost and complexity of delivering health
care and support services to individuals with HIV
disease in the eligible area, including factors such
as--
``(i) sexually transmitted diseases, substance
abuse, tuberculosis, severe mental illness, or
other comorbid factors determined relevant by the
Secretary;
``(ii) new or growing subpopulations of
individuals with HIV disease; and
``(iii) homelessness.
``(B) Prevalence.--In determining the impact of the
factors described in subparagraph (A), the Secretary
shall, to the extent practicable, use national,
quantitative incidence data that are available for each
eligible area. Not later than 2 years after the date of
enactment of this paragraph, the Secretary shall develop
a mechanism to utilize such data. In the absence of such
data, the Secretary may consider a detailed description
and qualitative analysis of severe need, as determined
under subparagraph (A), including any local prevalence
data gathered and analyzed by the eligible area.
``(C) Priority.--Subsequent to the development of
the quantitative mechanism described in subparagraph
(B), the Secretary shall phase in, over a 3-year period
beginning in fiscal year 1998, the use of such a
mechanism to determine the severe need of an eligible
area compared to other eligible areas and to determine,
in part, the amount of supplemental funds awarded to the
eligible area under this part.''.
(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 sentences: ``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, 100 percent;
[[Page 110 STAT. 1351]]
``(B) with respect to fiscal year 1997, 99 percent;
``(C) with respect to fiscal year 1998, 98 percent;
``(D) with respect to fiscal year 1999, 96.5
percent; and
``(E) with respect to fiscal year 2000, 95 percent;
of the amount allocated for fiscal year 1995 to such entity
under this subsection.''.
(C) Additional requirements for grants.--Section
2603 (42 U.S.C. 300ff-13) is amended by adding at the
end thereof 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.''.
(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'';
(C) by adding at the end of subsection (b), the
following new 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, including treatment
measures to prevent the perinatal transmission of HIV, the chief
elected official of an eligible area, in accordance with the
established priorities of the planning council, shall use, from
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.''; 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'';
[[Page 110 STAT. 1352]]
(iii) by striking ``accounting, reporting, and
program oversight functions'';
(iv) by adding at the end thereof the
following new sentence: ``In the case of entities
and subcontractors 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).''; 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
[[Page 110 STAT. 1353]]
process where it has been initiated by the State public health
agency responsible for administering grants under part B, 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''; and
(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,'';
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 assistance from other grantees,
contractors or subcontractors under this title 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.''.
(c) Care Grant Program.--
(1) Priority for women, infants and children.--Section 2611
(42 U.S.C. 300ff-21) is amended--
(A) by striking ``The'' and inserting ``(a) In
General.--The''; and
(B) by adding at the end thereof the following new
subsection:
``(b) Priority for Women, Infants and Children.--For the purpose of
providing health and support services to infants, children, and women
with HIV disease, including treatment measures to prevent the perinatal
transmission of HIV, 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
[[Page 110 STAT. 1354]]
acquired immune deficiency syndrome to the general population in the
State of individuals with such syndrome.''.
(2) Use of Grants.--Section 2612 (42 U.S.C. 300ff-22) is
amended--
(A) in subsection (a)--
(i) by striking the subsection designation and
heading;
(ii) by redesignating paragraphs (1) through
(4) as paragraphs (2) through (5), respectively;
(iii) by inserting the following new
paragraph:
``(1) to provide the services described in section
2604(b)(1) for individuals with HIV disease;'';
(iv) in paragraph (5) (as so redesignated), by
striking ``treatments'' and all that follows
through ``health,'' and inserting ``therapeutics
to treat HIV disease''; and
(v) by adding at the end thereof the following
flush sentences:
``Services described in paragraph (1) shall be delivered through
consortia designed as described in paragraph (2), where such consortia
exist, unless the State demonstrates to the Secretary that delivery of
such services would be more effective when other delivery mechanisms are
used. In making a determination regarding the delivery of services, the
State shall consult with appropriate representatives of service
providers and recipients of services who would be affected by such
determination, and shall include in its demonstration to the Secretary
the findings of the State regarding such consultation.''; and
(B) by striking subsection (b).
(2) 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,''; and
(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
inserting ``; and''; and
(III) by adding after subparagraph
(B), the following new 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.''.
[[Page 110 STAT. 1355]]
(3) Provision of treatments.--Section 2616 (42 U.S.C. 300ff-
26) is amended--
(A) in subsection (a)--
(i) by striking ``may use amounts'' and
inserting ``shall use a portion of the amounts'';
(ii) by striking ``section 2612(a)(4)'' and
all that follows through ``prolong life'' and
inserting ``section 2612(a)(5) to provide
therapeutics to treat HIV disease''; and
(iii) by inserting before the period the
following: ``, including measures for the
prevention and treatment of opportunistic
infections'';
(B) in subsection (c)--
(i) in paragraph (3), by striking ``and'' at
the end thereof;
(ii) in paragraph (4), by striking the period
and inserting ``; and''; and
(iii) by adding at the end thereof the
following new paragraph:
``(5) document the progress made in making therapeutics
described in subsection (a) available to individuals eligible
for assistance under this section.''; and
(C) by adding at the end thereof the following new
subsection:
``(d) Duties of the Secretary.--In carrying out this section, the
Secretary shall review the current status of State drug reimbursement
programs established under section 2612(2) and assess barriers to the
expanded availability of the treatments described in subsection (a). The
Secretary shall also examine the extent to which States coordinate with
other grantees under this title to reduce barriers to the expanded
availability of the treatments described in subsection (a).''.
(4) 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; and'';
(B) by redesignating paragraph (3) as paragraph (4);
(C) by inserting after paragraph (2), the following
new paragraph:
``(3) an assurance that the public health agency
administering the grant for the State will periodically convene
a meeting of individuals with HIV, representatives of grantees
under each part under this title, providers, and public agency
representatives for the purpose of developing a statewide
coordinated statement of need; and''.
(5) Planning, evaluation and administration.--Section
2618(c) (42 U.S.C. 300ff-28(c)) is amended--
(A) by striking paragraph (1);
[[Page 110 STAT. 1356]]
(B) 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. In the case
of entities and subcontractors 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).
``(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.'';
(C) by redesignating paragraph (5) as paragraph (7);
and
(D) 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.''.
(6) 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''.
(7) Coordination.--Part B of title XXVI (42 U.S.C. 300ff-21
et seq.) is amended by adding at the end thereof the following
new section:
[[Page 110 STAT. 1357]]
``SEC. 2621. <<NOTE: 42 USC 300ff-31.>> 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. <<NOTE: Reports.>> Not later than October 1, 1996, and
biennially 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.''.
(d) Early Intervention Services.--
(1) Establishment of program.--Section 2651(b) (42 U.S.C.
300ff-51(b)) is amended--
(A) 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 for individuals with HIV
disease''; 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 for the purpose
[[Page 110 STAT. 1358]]
of enabling such entities to provide HIV early intervention
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 provide
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
``7.5 percent including planning and evaluation'';
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.''.
(e) Demonstration Grants for Research and Services for Pediatric
Patients.--Section 2671 (42 U.S.C. 300f-71) <<NOTE: 42 USC 300ff-71.>>
is amended to read as follows:
``SEC. 2671. GRANTS FOR COORDINATED SERVICES AND ACCESS TO
RESEARCH FOR WOMEN, INFANTS, CHILDREN,
AND YOUTH.
``(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 make
grants to public and nonprofit private entities that provide primary
care (directly or through contracts) for the following purposes:
``(1) Providing through such entities, in accordance with
this section, opportunities for women, infants, children, and
youth to be voluntary participants in research of potential
clinical benefit to individuals with HIV disease.
``(2) In the case of women, infants, children, and youth
with HIV disease, and the families of such individuals,
providing to such individuals--
``(A) health care on an outpatient basis; and
``(B) additional services in accordance with
subsection (d).
``(b) Provisions Regarding Participation in Research.--
[[Page 110 STAT. 1359]]
``(1) In general.--With respect to the projects of research
with which an applicant under subsection (a) is concerned, the
Secretary may make a grant under such subsection to the
applicant only if 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, children, and youth
who would be appropriate participants in the
projects;
``(ii) to carry out clause (i) through the use
of criteria provided for such purpose by the
entities that will be conducting the projects of
research; and
``(iii) to offer women, infants, children, and
youth the opportunity to participate in the
projects (as appropriate), including the provision
of services under subsection (d)(3).
``(B) The applicant agrees that, in the case of the
research-related functions to be carried out by the
applicant pursuant to subsection (a)(1), the applicant
will comply with accepted standards that are applicable
to such functions (including accepted standards
regarding informed consent and other protections for
human subjects).
``(C) For the first and second fiscal years for
which grants under subsection (a) are to be made to the
applicant, the applicant agrees that, not later than the
end of the second fiscal year of receiving such a grant,
a significant number of women, infants, children, and
youth who are patients of the applicant will be
participating in the projects of research.
``(D) Except as provided in paragraph (3) (and
paragraph (4), as applicable), for the third and
subsequent fiscal years for which such grants are to be
made to the applicant, the Secretary has determined that
a significant number of such individuals are
participating in the projects.
``(2) Prohibition.--Receipt of services by a patient shall
not be conditioned upon the consent of the patient to
participate in research.
``(3) Significant participation; consideration by secretary
of certain circumstances.--In administering the requirement of
paragraph (1)(D), the Secretary shall take into account
circumstances in which a grantee under subsection (a) 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.
``(4) Significant participation; temporary waiver for
original grantees.--
``(A) In general.--In the case of an applicant under
subsection (a) who received a grant under such
subsection for fiscal year 1995, the Secretary may,
subject to subparagraph (B), provide to the applicant a
waiver of the requirement of paragraph (1)(D) if the
Secretary determines that the applicant is making
reasonable progress toward meeting the requirement.
``(B) Termination of authority for waivers.--The
Secretary may not provide any waiver under subparagraph
(A) on or after October 1, 1998. Any such waiver
provided
[[Page 110 STAT. 1360]]
prior to such date terminates on such date, or on such
earlier date as the Secretary may specify.
``(c) Provisions Regarding Conduct of Research.--
``(1) In general.--With respect to eligibility for a grant
under subsection (a):
``(A) 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, except for such research-
related functions as are appropriate for providing
opportunities under subsection (a)(1) (including the
functions specified in subsection (b)(1)).
``(B) The grant may be made only if the Secretary
makes the following determinations:
``(i) The applicant or other entity (as the
case may be under subparagraph (A)) 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.
``(ii) The project of research is being
conducted in accordance with a research protocol
to which the Secretary gives priority regarding
the prevention or treatment of HIV disease in
women, infants, children, or youth, subject to
paragraph (2).
``(2) List of research protocols.--
``(A) In general.--From among the research protocols
described in paragraph (1)(B)(ii), the Secretary shall
establish a list of research protocols that are
appropriate for purposes of subsection (a)(1). Such list
shall be established only after consultation with public
and private entities that conduct such research, and
with providers of services under subsection (a) and
recipients of such services.
``(B) Discretion of secretary.--The Secretary may
authorize the use, for purposes of subsection (a)(1), of
a research protocol that is not included on the list
under subparagraph (A). The Secretary may waive the
requirement specified in paragraph (1)(B)(ii) in such
circumstances as the Secretary determines to be
appropriate.
``(d) Additional Services for Patients and Families.--A grant under
subsection (a) may be made only if the applicant for the grant agrees as
follows:
``(1) The applicant will provide for the case management of
the patient involved and the family of the patient.
``(2) The applicant will provide for the patient and the
family of the patient--
``(A) referrals for inpatient hospital services,
treatment for substance abuse, and mental health
services; and
``(B) referrals for other social and support
services, as appropriate.
``(3) The applicant will provide the patient and the family
of the patient with such transportation, child care, and other
incidental services as may be necessary to enable the patient
[[Page 110 STAT. 1361]]
and the family to participate in the program established by the
applicant pursuant to such subsection.
``(e) Coordination With Other Entities.--A grant under subsection
(a) may be made only if 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 public health agency responsible for
administering grants under part B) and in revisions of such
statement.
``(f) Application.--A grant under subsection (a) may be made only if
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.
``(g) 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 subsection (a), shall require that the projects, as
appropriate, enter into arrangements for purposes of such subsection,
and shall require that each project entering into such an arrangement
inform the applicant or grantee under such subsection of the needs of
the project for the participation of women, infants, children, and
youth.
``(h) Annual Review of Programs; Evaluations.--
``(1) Review regarding access to and participation in
programs.--With respect to a grant under subsection (a) for an
entity for a fiscal year, the Secretary shall, not later than
180 days after the end of the fiscal year, provide for the
conduct and completion of a review of the operation during the
year of the program carried out under such subsection by the
entity. The purpose of such review shall be the development of
recommendations, as appropriate, for improvements in the
following:
``(A) Procedures used by the entity to allocate
opportunities and services under subsection (a) among
patients of the entity who are women, infants, children,
or youth.
``(B) Other procedures or policies of the entity
regarding the participation of such individuals in such
program.
``(2) Evaluations.--The Secretary shall, directly or through
contracts with public and private entities, provide for
evaluations of programs carried out pursuant to subsection (a).
``(i) Training and Technical Assistance.--Of the amounts
appropriated under subsection (j) for a fiscal year, the Secretary may
use not more than five percent to provide, directly or through contracts
with public and private entities (which may include grantees under
subsection (a)), training and technical assistance to assist applicants
and grantees under subsection (a) in complying with the requirements of
this section.
``(j) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated
[[Page 110 STAT. 1362]]
such sums as may be necessary for each of the fiscal years 1996 through
2000.''.
(f) 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.''.
(g) 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. <<NOTE: 42 USC 300ff-101.>> 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.
[[Page 110 STAT. 1363]]
``(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 and
programs that build organizational capacity critical to the
delivery of care in minority communities;
``(2) programs designed to prepare AIDS service
organizations and grantees under this title for operation within
the changing health care environment; and
``(3) 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.
(h) 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. <<NOTE: 42 USC 300ff-111.>> HIV/AIDS COMMUNITIES, SCHOOLS,
AND CENTERS.''.
(2) Amendments.--Section 776 (42 U.S.C. 294n) is amended--
(A) by striking the section heading; and
(B) in subsection (a)(1)--
(i) by striking subparagraphs (B) and (C);
(ii) by redesignating subparagraphs (A) and
(D) as subparagraphs (B) and (C), respectively;
(iii) 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, including the prevention
of the perinatal trans
[[Page 110 STAT. 1364]]
mission of the disease and including measures for the
prevention and treatment of opportunistic infections;'';
and
(iv) in subparagraph (B) (as so redesignated)
by adding ``and'' after the semicolon.
(3) Transfer.--Section 776 (42 U.S.C. 294n) (as amended by
paragraph (2)) <<NOTE: 42 USC 300ff-111.>> is amended by
transferring such section to section 2692 (as added by paragraph
(1)).
(4) Authorization of appropriations.--Section 2692 (as added
by paragraph (1)) <<NOTE: 42 USC 300ff-111.>> is amended by
adding at the end thereof the following new subsection:
``(d) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of the fiscal years 1996 through 2000.''.
SEC. 4. AMOUNT OF EMERGENCY RELIEF GRANTS.
Paragraph (3) of section 2603(a) (42 U.S.C. 300ff-13(a)(3)) is
amended to read as follows:
``(3) Amount of grant.--
``(A) In general.--Subject to the extent of amounts
made available in appropriations Acts, a grant made for
purposes of this paragraph to an eligible area shall be
made in an amount equal to the product of--
``(i) an amount equal to the amount available
for distribution under paragraph (2) for the
fiscal year involved; and
``(ii) the percentage constituted by the ratio
of the distribution factor for the eligible area
to the sum of the respective distribution factors
for all eligible areas.
``(B) Distribution factor.--For purposes of
subparagraph (A)(ii), the term `distribution factor'
means an amount equal to the estimated number of living
cases of acquired immune deficiency syndrome in the
eligible area involved, as determined under subparagraph
(C).
``(C) Estimate of living cases.--The amount
determined in this subparagraph is an amount equal to
the product of--
``(i) the number of cases of acquired immune
deficiency syndrome in the eligible area during
each year in the most recent 120-month period for
which data are available with respect to all
eligible areas, as indicated by the number of such
cases reported to and confirmed by the Director of
the Centers for Disease Control and Prevention for
each year during such period; and
``(ii) with respect to--
``(I) the first year during such
period, .06;
``(II) the second year during such
period, .06;
``(III) the third year during such
period, .08;
``(IV) the fourth year during such
period, .10;
``(V) the fifth year during such
period, .16;
``(VI) the sixth year during such
period, .16;
``(VII) the seventh year during such
period, .24;
``(VIII) the eighth year during such
period, .40;
[[Page 110 STAT. 1365]]
``(IX) the ninth year during such
period, .57; and
``(X) the tenth year during such
period, .88.
The yearly percentage described in subparagraph (ii)
shall be updated biennially by the Secretary, after
consultation with the Centers for Disease Control and
Prevention. The first such update shall occur prior to
the determination of grant awards under this part for
fiscal year 1998.
``(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.''.
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
``(II) 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, subject to
subparagraph (H); and
``(ii) the percentage constituted by the sum
of--
``(I) the product of .80 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 .20 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.
[[Page 110 STAT. 1366]]
``(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 section 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, 100 percent;
``(II) with respect to fiscal year
1997, 99 percent;
``(III) with respect to fiscal year
1998, 98 percent;
``(IV) with respect to fiscal year
1999, 96.5 percent; and
``(V) with respect to fiscal year
2000, 95 percent;
[[Page 110 STAT. 1367]]
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.
``(H) Appropriations for treatment drug program.--
With respect to the fiscal year involved, if under
section 2677 an appropriations Act provides an amount
exclusively for carrying out section 2616, the portion
of such amount allocated to a State shall be the product
of--
``(i) 100 percent of such amount; and
``(ii) the percentage constituted by the ratio
of the State distribution factor for the State (as
determined under subparagraph (B)) to the sum of
the State distribution factors for all States.''.
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. <<NOTE: 42 USC 300ff-77.>> 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.
``(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 allocated to part A
and part B to account for grants to new eligible areas under
part A and other relevant factors. <<NOTE: Reports.>> Not later
than July 1, 1996, 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 determines
that such a methodology under paragraph (1) cannot be developed,
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)--
[[Page 110 STAT. 1368]]
(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. PERINATAL TRANSMISSION OF HIV DISEASE.
(a) <<NOTE: 42 USC 300ff-33 note.>> Findings.--The Congress finds
as follows:
(1) Research studies and statewide clinical experiences have
demonstrated that administration of anti-retroviral 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 anti-retroviral 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, and from mother to child.
(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) routine HIV counseling and voluntary testing of
pregnant women should become 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 of title XXVI (42
U.S.C. 300ff-21 et seq.) is amended--
(1) by inserting after the part heading the following:
``Subpart I--General Grant Provisions'';
(2) in section 2611(a), <<NOTE: 42 USC 300ff-21.>> by
adding at the end the following sentence: ``The authority of the
Secretary to provide grants under part B is subject to section
2626(e)(2) (relating to the decrease in perinatal transmission
of HIV disease).''; and
[[Page 110 STAT. 1369]]
(3) by adding at the end thereof the following new subpart:
``Subpart II--Provisions Concerning Pregnancy and Perinatal Transmission
of HIV
``SEC. 2625. <<NOTE: 42 USC 300ff-33.>> CDC GUIDELINES FOR PREGNANT
WOMEN.
``(a) <<NOTE: Certification.>> Requirement.--Notwithstanding any
other provision of law, a State shall, not later than 120 days after the
date of enactment of this subpart, certify to the Secretary that such
State has in effect regulations or measures to adopt the guidelines
issued by the Centers for Disease Control and Prevention concerning
recommendations for human immunodeficiency virus counseling and
voluntary testing for pregnant women.
``(b) Noncompliance.--If a State does not provide the certification
required under subsection (a) within the 120-day period described in
such subsection, such State shall not be eligible to receive assistance
for HIV counseling and testing under this section until such
certification is provided.
``(c) Additional Funds Regarding Women and Infants.--
``(1) In general.--If a State provides the certification
required in subsection (a) and is receiving funds under part B
for a fiscal year, the Secretary may (from the amounts available
pursuant to paragraph (2)) 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 voluntary HIV
testing for such disease.
``(D) Offsetting other State costs associated with
the implementation of this section and subsections (a)
and (b) of section 2626.
``(E) Offsetting State costs associated with the
implementation of mandatory newborn testing in
accordance with this title or at an earlier date than is
required by this title.
``(2) Funding.--For purposes 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 section unless otherwise
authorized.
``(3) Priority.--In awarding grants under this subsection
the Secretary shall give priority to States that have the
greatest proportion of HIV seroprevalance among child bearing
women using the most recent data available as determined by the
Centers for Disease Control and Prevention.
``SEC. 2626. <<NOTE: 42 USC 300ff-34.>> PERINATAL TRANSMISSION OF
HIV DISEASE; CONTINGENT REQUIREMENT
REGARDING STATE GRANTS UNDER THIS
PART.
``(a) Annual Determination of Reported Cases.--A State shall
annually determine the rate of reported cases of AIDS as a result of
perinatal transmission among residents of the State.
[[Page 110 STAT. 1370]]
``(b) Causes of Perinatal Transmission.--In determining the rate
under subsection (a), a State shall also determine the possible causes
of perinatal transmission. Such causes may include--
``(1) the inadequate provision within the State of prenatal
counseling and testing in accordance with the guidelines issued
by the Centers for Disease Control and Prevention;
``(2) the inadequate provision or utilization within the
State of appropriate therapy or failure of such therapy to
reduce perinatal transmission of HIV, including--
``(A) that therapy is not available, accessible or
offered to mothers; or
``(B) that available therapy is offered but not
accepted by mothers; or
``(3) other factors (which may include the lack of prenatal
care) determined relevant by the State.
``(c) CDC Reporting System.--Not later than 4 months after the date
of enactment of this subpart, the Director of the Centers for Disease
Control and Prevention shall develop and implement a system to be used
by States to comply with the requirements of subsections (a) and
(b). <<NOTE: Guidelines.>> The Director shall issue guidelines to
ensure that the data collected is statistically valid.
``(d) <<NOTE: Federal Register, publication.>> Determination by
Secretary.--Not later than 180 days after the expiration of the 18-month
period beginning on the date on which the system is implemented under
subsection (c), 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 (5) of section 2627. 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.
``(e) Contingent Applicability.--
``(1) In general.--If the determination published in the
Federal Register under subsection (d) is that (for purposes of
such subsection) the activities involved have become routine
practices, paragraph (2) shall apply 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 (f), 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) A 50 percent reduction (or a comparable
measure for States with less than 10 cases) in the rate
of new cases of AIDS (recognizing that AIDS is a
suboptimal proxy for tracking HIV in infants and was
selected because such data is universally available) as
a result of perinatal transmission as compared to the
rate of such cases reported in 1993 (a State may use HIV
data if such data is available).
``(B) At least 95 percent of women in the State who
have received at least two prenatal visits
(consultations) prior to 34 weeks gestation with a
health care provider or provider group have been tested
for the human immunodeficiency virus.
``(C) The State has in effect, in statute or through
regulations, the requirements specified in paragraphs
(1) through (5) of section 2627.
[[Page 110 STAT. 1371]]
``(f) Limitation Regarding Availability of Funds.--With respect to
an activity described in any of paragraphs (1) through (5) of section
2627, the requirements established by a State under this section apply
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 or under section 2625, or through other Federal sources
under which payments for routine HIV testing, counseling or
treatment are an eligible use.
``(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.
``SEC. 2627. <<NOTE: 42 USC 300ff-35.>> TESTING OF PREGNANT WOMEN AND
NEWBORN INFANTS.
``An activity or requirement described in this section is any of the
following:
``(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.
``(D) To the child's health care provider.
``(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).
``(5) With respect to State insurance laws, that such laws
require--
``(A) 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
subparagraph
[[Page 110 STAT. 1372]]
(C)), 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 or its
manifestation;
``(B) that subparagraph (A) does not apply to an
individual who, in applying for the health insurance
involved, knowingly misrepresented the HIV status of the
individual; and
``(C) that subparagraph (A) 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.
For purposes of this subparagraph, a statute or regulation shall
be deemed to regulate insurance for purposes of this paragraph
only to the extent that such statute or regulation is treated as
regulating insurance for purposes of section 514(b)(2) of the
Employee Retirement Income Security Act of 1974.
``SEC. 2628. <<NOTE: 42 USC 300ff-36.>> REPORT BY THE INSTITUTE OF
MEDICINE.
``(a) In General.--The Secretary shall request that the Institute of
Medicine of the National Academy of Sciences conduct an evaluation of
the extent to which State efforts have been effective in reducing the
perinatal transmission of the human immuno
deficiency virus, and an analysis of the existing barriers to the
further reduction in such transmission.
``(b) Report to Congress.--The Secretary shall ensure that, not
later than 2 years after the date of enactment of this section, the
evaluation and analysis described in subsection (a) is completed and a
report summarizing the results of such evaluation and analysis is
prepared by the Institute of Medicine and submitted to the appropriate
committees of Congress together with the recommendations of the
Institute.
``SEC. 2629. <<NOTE: 42 USC 300ff-37.>> STATE HIV TESTING
PROGRAMS ESTABLISHED PRIOR TO OR AFTER
ENACTMENT.
``Nothing in this subpart shall be construed to disqualify a State
from receiving grants under this title if such State has established at
any time prior to or after the date of enactment of this subpart a
program of mandatory HIV testing.''.
SEC. 8. <<NOTE: 42 USC 300ff-27a.>> SPOUSAL NOTIFICATION.
(a) In General.--The Secretary of Health and Human Services shall
not make a grant under part B of title XXVI of the Public Health Service
Act (42 U.S.C. 300ff-21 et seq.) to any State unless such State takes
administrative or legislative action to require that a good faith effort
be made to notify a spouse of a known HIV-infected patient that such
spouse may have been exposed to the human immunodeficiency virus and
should seek testing.
(b) Definitions.--For purposes of this section:
(1) Spouse.--The term ``spouse'' means any individual who is
the marriage partner of an HIV-infected patient, or who has been
the marriage partner of that patient at any time within the 10-
year period prior to the diagnosis of HIV infection.
(2) HIV-infected patient.--The term ``HIV-infected patient''
means any individual who has been diagnosed to be infected with
the human immunodeficiency virus.
[[Page 110 STAT. 1373]]
(3) State.--The term ``State'' means any of the 50 States,
the District of Columbia, or any territory of the United States.
SEC. 9. <<NOTE: 5 USC 4103 note.>> 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, except for training necessary to protect
the health and safety of the Federal employee and the individuals served
by such employees. 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. 10. 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. <<NOTE: 42 USC 300ff-78.>> 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. 11. <<NOTE: 42 USC 300cc note.>> 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. 12. 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), <<NOTE: 42 USC 300ff-11.>> by
inserting ``section'' before ``2604'';
(2) in section 2603(b)(4)(B), <<NOTE: 42 USC 300ff-13.>> by
striking ``an expedited grants'' and inserting ``an expedited
grant'';
(3) in section 2617(b)(3)(B)(iv), <<NOTE: 42 USC 300ff-
27.>> by inserting ``section'' before ``2615'';
(4) in section 2647-- <<NOTE: 42 USC 300ff-47.>>
(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)--
[[Page 110 STAT. 1374]]
(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'';
(5) in section 2648-- <<NOTE: 42 USC 300ff-48.>>
(A) by converting the heading for the section to
boldface type; and
(B) by redesignating the second subsection (g) as
subsection (h);
(6) in section 2649-- <<NOTE: 42 USC 300ff-49.>>
(A) in subsection (b)(1), by striking ``subsection
(a) of''; and
(B) in subsection (c)(1), by striking ``this
subsection'' and inserting ``subsection'';
(7) in section 2651-- <<NOTE: 42 USC 300ff-51.>>
(A) in subsection (b)(3)(B), by striking
``facility'' and inserting ``facilities''; and
(B) in subsection (c), by striking ``exist'' and
inserting ``exists'';
(8) in section 2676-- <<NOTE: 42 USC 300ff-76.>>
(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)'';
(9) in part E, by converting the headings for subparts I and
II to Roman typeface; and
(10) in section 2684(b), <<NOTE: 42 USC 300ff-84.>> in the
matter preceding paragraph (1), by striking ``section
2682(d)(2)'' and inserting ``section 2683(d)(2)''.
SEC. 13. <<NOTE: 42 USC 300ff-11 note.>> 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,
1996.
(b) Exception.--The amendments made by sections 3(a), 5, 6, and 7 of
this Act to sections 2601(c), 2601(d), 2603(a), 2618(b), 2626, 2677, and
2691 of the Public Health Service Act, shall become effective on the
date of enactment of this Act.
Approved May 20, 1996.
LEGISLATIVE HISTORY--S. 641 (H.R. 1872):
---------------------------------------------------------------------------
HOUSE REPORTS: Nos. 104-245 accompanying H.R. 1872 (Comm. on Commerce)
and 104-545 (Comm. of Conference).
SENATE REPORTS: No. 104-25 (Comm. on Labor and Human Resources).
CONGRESSIONAL RECORD:
Vol. 141 (1995):
July 21, 26, 27, considered and
passed Senate.
Sept. 18, H.R. 1872 considered and
passed House; S. 641, amended,
passed in lieu.
Vol. 142 (1996):
May 1, House agreed to conference
report.
May 2, Senate agreed to conference
report.
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 32 (1996):
May 20, Presidential remarks and statement.
<all>