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104th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES

 2d Session                                                     104-545
_______________________________________________________________________


 
                 RYAN WHITE CARE ACT AMENDMENTS OF 1996

                                _______


                 April 30, 1996.--Ordered to be printed

_______________________________________________________________________


 Mr. Bliley, from the committee of conference, submitted the following

                           CONFERENCE REPORT

                         [To accompany S. 641]

      The committee of conference on the disagreeing votes of 
the two Houses on the amendments of the House to the bill (S. 
641), to reauthorize the Ryan White CARE Act of 1990, and for 
other purposes, having met, after full and free conference, 
have agreed to recommend and do recommend to their respective 
Houses as follows:
      That the Senate recede from its disagreement to the 
amendment of the House to the text of the bill and agree to the 
same with an amendment as follows:
      In lieu of the matter proposed to be inserted by the 
House amendment, insert the following:

SECTION 1. 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 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
                            (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 (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
                            (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;
                    ``(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'';
                            (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 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 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.''.
            (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);
                    (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:

``SEC. 2621. 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. 
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 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) 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.--
            ``(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 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 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 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. SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE.

    ``(a) In General.--Of the amount appropriated under each of 
parts A, B, C, and D of this title for each fiscal year, the 
Secretary shall use the greater of $20,000,000 or 3 percent of 
such amount appropriated under each such part, but not to 
exceed $25,000,000, to administer a special projects of 
national significance program to award direct grants to public 
and nonprofit private entities including community-based 
organizations to fund special programs for the care and 
treatment of individuals with HIV disease.
    ``(b) Grants.--The Secretary shall award grants under 
subsection (a) based on--
            ``(1) the need to assess the effectiveness of a 
        particular model for the care and treatment of 
        individuals with HIV disease;
            ``(2) the innovative nature of the proposed 
        activity; and
            ``(3) the potential replicability of the proposed 
        activity in other similar localities or nationally.
    ``(c) Special Projects.--Special projects of national 
significance shall include the development and assessment of 
innovative service delivery models that are designed to--
            ``(1) address the needs of special populations;
            ``(2) assist in the development of essential 
        community-based service delivery infrastructure; and
            ``(3) ensure the ongoing availability of services 
        for Native American communities to enable such 
        communities to care for Native Americans with HIV 
        disease.
    ``(d) Special Populations.--Special projects of national 
significance may include the delivery of HIV health care and 
support services to traditionally underserved populations 
including--
            ``(1) individuals and families with HIV disease 
        living in rural communities;
            ``(2) adolescents with HIV disease;
            ``(3) Indian individuals and families with HIV 
        disease;
            ``(4) homeless individuals and families with HIV 
        disease;
            ``(5) hemophiliacs with HIV disease; and
            ``(6) incarcerated individuals with HIV disease.
    ``(e) Service Development Grants.--Special projects of 
national significance may include the development of model 
approaches to delivering HIV care and support services 
including--
            ``(1) programs that support family-based care 
        networks 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. 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 transmission 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)) 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)) 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;
                                    ``(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
                            ``(i)(I) with respect to a State or 
                        District that has 90 or more living 
                        cases of acquired immune deficiency 
                        syndrome, as determined under paragraph 
                        (2)(D), $250,000;
                            ``(ii) an amount determined under 
                        paragraph (2); and
                    ``(B) each territory of the United States, 
                as defined in paragraph (3), shall be an amount 
                determined under paragraph (2).
            ``(2) Determination.--
                    ``(A) Formula.--The amount referred to in 
                paragraph (1)(A)(ii) for a State and paragraph 
                (1)(B) for a territory of the United States 
                shall be the product of--
                            ``(i) an amount equal to the amount 
                        appropriated under section 2677 for the 
                        fiscal year involved for grants under 
                        part B, 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.
                    ``(B) State distribution factor.--For 
                purposes of subparagraph (A)(ii)(I), the term 
                `State distribution factor' means an amount 
                equal to the estimated number of living cases 
                of acquired immune deficiency syndrome in the 
                eligible area involved, as determined under 
                subparagraph (D).
                    ``(C) Non-ema distribution factor.--For 
                purposes of subparagraph (A)(ii)(II), the term 
                `non-EMA distribution factor' means an amount 
                equal to the sum of--
                            ``(i) the estimated number of 
                        living cases of acquired immune 
                        deficiency syndrome in the State or 
                        territory involved, as determined under 
                        subparagraph (D); less
                            ``(ii) the estimated number of 
                        living cases of acquired immune 
                        deficiency syndrome in such State or 
                        territory that are within an eligible 
                        area (as determined under part A).
                    ``(D) Estimate of living cases.--The amount 
                determined in this subparagraph is an amount 
                equal to the product of--
                            ``(i) the number of cases of 
                        acquired immune deficiency syndrome in 
                        the State or territory during each year 
                        in the most recent 120-month period for 
                        which data are available with respect 
                        to all States and territories, as 
                        indicated by the number of such cases 
                        reported to and confirmed by the 
                        Director of the Centers for Disease 
                        Control and Prevention for each year 
                        during such period; and
                            ``(ii) with respect to each of the 
                        first through the tenth year during 
                        such period, the amount referred to in 
                        2603(a)(3)(C)(ii).
                    ``(E) Puerto rico, virgin islands, guam.--
                For purposes of subparagraph (D), the cost 
                index for Puerto Rico, the Virgin Islands, and 
                Guam shall be 1.0.
                    ``(F) Unexpended funds.--The Secretary may, 
                in determining the amount of a grant for a 
                fiscal year under this subsection, adjust the 
                grant amount to reflect the amount of 
                unexpended and uncanceled grant funds remaining 
                at the end of the fiscal year preceding the 
                year for which the grant determination is to be 
                made. The amount of any such unexpended funds 
                shall be determined using the financial status 
                report of the grantee.
                    ``(G) Limitation.--
                            ``(i) In general.--The Secretary 
                        shall ensure that the amount of a grant 
                        awarded to a State or territory for a 
                        fiscal year under this part is equal to 
                        not less than--
                                    ``(I) with respect to 
                                fiscal year 1996, 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;

                        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. 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. 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)--
                    (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) 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), 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
            (3) by adding at the end thereof the following new 
        subpart:

      ``Subpart II--Provisions Concerning Pregnancy and Perinatal 
                          Transmission of HIV

``SEC. 2625. CDC GUIDELINES FOR PREGNANT WOMEN.

    ``(a) 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. 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.
    ``(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 the 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). The Director shall 
issue guidelines to ensure that the data collected is 
statistically valid.
    ``(d) 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.
    ``(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. 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 (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. 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 immunodeficiency 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. 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. 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.
            (3) State.--The term ``State'' means any of the 50 
        States, the District of Columbia, or any territory of 
        the United States.

SEC. 9. 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. 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. 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), 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 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'';
            (5) 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);
            (6) 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'';
            (7) 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'';
            (8) 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)'';
            (9) in part E, by converting the headings for 
        subparts I and II to Roman typeface; and
            (10) in section 2684(b), in the matter preceding 
        paragraph (1), by striking ``section 2682(d)(2)'' and 
        inserting ``section 2683(d)(2)''.

SEC. 13. 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.
      And the House agree to the same.
      That the Senate recede from its disagreement to the 
amendment of the House to the title of the bill, and agree to 
the same.
                                   Tom Bliley,
                                   Michael Bilirakis,
                                   Tom Coburn,
                                   Henry A. Waxman,
                                   Gerry Studds,
                                 Managers on the Part of the House.
                                   Nancy Landon Kassebaum,
                                   Jim Jeffords,
                                   Bill Frist,
                                   Edward M. Kennedy,
                                   Christopher J. Dodd,
                                Managers on the Part of the Senate.
       JOINT EXPLANATORY STATEMENT OF THE COMMITTEE ON CONFERENCE

                             1. short title

      The Senate Bill titles the Act the Ryan White CARE 
Reauthorization Act of 1995. The House bill is titled the Ryan 
White CARE Act Amendments of 1995. The Senate recedes.

                   2. eligibility and effective dates

      The Conferees agreed to make October 1, 1996 the general 
effective date for the Act. However, the amendments limiting 
eligible areas to those with a population of 500,000 or higher, 
continuing the eligibility of current EMAs, and all formula 
changes (including the provisions on single appropriations and 
funding for Special Projects of National Significance) are 
effective immediately upon passage of the Act. The Secretary is 
required to make a report to Congress on the single 
appropriations provision by July 1, 1996.
      It is the intent of the Conferees that, beginning in 
fiscal year 1996 and continuing through the reauthorization 
period, no new metropolitan area with fewer than 500,000 people 
be eligible for Part A funds. On October 1, 1996, the period 
for counting AIDS cases to determine eligibility is reduced to 
the most recent five calendar years. The Conferees wish to make 
clear, however, that metropolitan areas, once eligible to 
receive Part A funds, and all metropolitan areas currently 
receiving such funds, shall remain eligible regardless of 
fluctuations in the five year case count over time.

             3. planning council roles and responsibilities

      The Senate bill prohibits the Planning Council from being 
chaired solely by an employee of the grantee. The House bill 
contains no such prohibition. The House recedes.
      The House bill provides that the planning council may not 
be directly involved in the administration of a grant to a 
provider under Section 2601(a) nor designate particular 
entities as recipients of grants. Planning council members must 
also agree to comply with measures relating to conflicts of 
interest. The Senate bill does not contain such provisions. The 
Senate recedes with an amendment that the duties of the 
planning council, in addition to establishing funding 
priorities, include making recommendations concerning how best 
to meet established priorities.
      It is the intent of the Conferees that the planning 
council provide guidance to the grantee regarding the types of 
organizations that may best meet each service priority 
established by the planning council. Types of organizations 
may, for example, include outpatient clinics, community-based 
organizations that historically have served affected 
communities and other types of organizations that meet criteria 
outlined in the legislation (i.e., cost effectiveness, priority 
of the affected community, etc.) While the conferees expect the 
grantee through the grant making process to satisfy the target 
population, service, and service delivery priorities 
established by the planning council, they do not intend that 
the planning council select which particular organizations 
receive funding, either by specific direction or by narrowly 
describing a type of organization. The legislation clearly 
states that such a planning council role is prohibited. The 
Conferees expect that the planning council will help to guide 
the grantee in how best to meet the established service 
priorities.

                        4. grievance procedures

      The Senate bill mandates that planning councils establish 
operating procedures which include specific policies for 
resolving disputes, responding to grievances, and minimizing 
and managing conflicts of interest. The House bill contains no 
such mandate. The House recedes with an amendment that the 
operating procedures relating to conflict of interest and 
grievance procedures be locally developed and included in the 
eligible area's application for Part A formula funds.
      The Senate bill includes a requirement that the Secretary 
develop grievance procedures specific to each part of the Act, 
to resolve egregious violations of each part, and to establish 
appropriate enforcement mechanisms. The House bill contains no 
such provision. The Senate recedes with an amendment to require 
the Secretary to convene a process involving grantees and 
outside experts to develop models and prototypes for locally 
established grievance procedures, and lay out key elements that 
should be addressed in setting up grievance and arbitration 
processes at the local level.
      The Committee wishes to emphasize that the grievance 
procedures should be locally established, with assistance from 
the Secretary. The procedures are to be reviewed by the Health 
Resources and Services Administration to ensure that they 
adequately address potential conflicts and grievances. While 
the bill does not require the Secretary to establish federal 
grievance procedures, the Committee emphasizes that the 
Secretary has the power, under this Act and existing law on 
federal contracts and grants, to withhold funds for violations 
of the Act.

                         5. supplemental grants

      The Senate bill requires that the supplemental grant 
application demonstrate that the planning council include 
representatives of the requisite population groups, service 
provides, and affected communities. The House bill does not 
include such a provision. The House recedes.
      The House bill requires that the supplemental grant 
application demonstrate that both formula and supplemental 
grant funds from the previous year were distributed according 
to the priorities established by the planning council. The 
Senate bill does not contain such a provision. The Senate 
recedes.

                             6. severe need

      The Conferees agreed to clarify the meaning of ``severe 
need'' for the purposes of supplemental funding under Title I. 
The Secretary is directed to develop a quantitative measurement 
of that need and incorporate it into supplemental funding 
allocation decisions. The development of a quantitative 
measurement of severe need is not intended to replace existing 
factors the Secretary may use to determine supplemental awards, 
such as comprehensive planning, magnitude of the epidemic, 
planning council functioning and CEO responsibilities, program 
and fiscal performance, needs assessment and the match between 
needs and service priorities.
      The Conferees believe that a comparison of severe need 
across EMAs should be part of the review of applications for 
supplemental grants and compare service delivery costs and 
complexity of delivering services due to comorbidity and other 
factors listed in the legislation. The Conferees emphasize that 
the list of factors is not all-inclusive and recognizes that 
data needed to quantify these factors may not be available. The 
Secretary may consider other factors, to account appropriately 
for differences in the cost and complexity of service delivery 
across eligible areas. Those factors which are associated with 
nationwide quantitative data, however, should be given the 
highest importance. The Conferees intend that the Secretary 
have flexibility in developing this quantitative mechanism to 
carry out comparisons across eligible areas.
      In the past, supplemental awards have been allocated on 
the basis of the formula grant. By including criteria for 
severe need, the conferees intend that those eligible areas 
with the greatest public health challenges be given appropriate 
consideration for larger supplemental awards.

                    7. women, infants, and children

      The House bill requires Part A and Part B grantees to 
utilize a portion of their funds to provide health and support 
services to women, infants, and children. The grantees are 
required to utilize at least 5 percent of such funds or a 
percentage of funds equal to the ratio of women, infants, and 
children with AIDS to the entire population with AIDS, 
whichever is less. The Senate bill does not contain such 
provisions. The Senate recedes with an amendment to strike the 
15 percent comparison and, in the case of Part A grantees, to 
require that the grantee utilize the appropriate percentage of 
funds in accordance with the priorities established by the 
planning council.
      The House bill requires that these funds be used 
primarily for the prevention of perinatal HIV transmission. The 
Senate bill does not contain such a provision. The House 
recedes with an amendment that language be included which 
indicates that services funded by the set-aside may include 
treatments to prevent the perinatal transmission of HIV.
      It is the intent of the conferees that funding be 
allocated based on the demographics of the epidemic in a local 
area, and that spending for services for women, infants, and 
children be equal, on a percentage basis, to the percentage of 
women, infants, and children with AIDS.

                        8. administrative costs

      Both the House and Senate bills maintain the 
administrative costs caps for Part A grantees and the Senate 
bill defines these costs. For Part B, the Senate bill defines 
administrative costs and modifies existing administrative cost 
caps for grantees. Part B grantees are limited to spending not 
more than than 10% of the award they receive in a fiscal year 
on administrative costs and 10% of that award on planning and 
evaluation activities. However, total spending on 
administration, planning, and evaluation cannot exceed 15% of 
the award a grantee receives in a fiscal year. The House 
recedes to the definition of administrative costs and to the 
15% cap.
      Regarding entities receiving funds from Part A or Part B 
grantees, the Senate limits expenditures for administrative 
activities to 12.5% for each such entity. The bill specifically 
defines administrative costs for these entities. The House bill 
limits such expenditures to 10% as measured across all entities 
receiving funding from Part A or Part B grantees, without 
regard to whether an individual entity is above or below that 
percentage. For example, if a state or eligible area awards $1 
million to 10 service providers, regardless of the amount an 
individual provider spends on administration, the amount spent 
on administration added across all 10 providers cannot exceed 
$100,000 (10% of $1 million). For Part B grantees, entities 
subject to this cost cap include the lead agencies of consortia 
in carrying out their administrative duties associated with the 
operation of the consortium. The Senate recedes with an 
amendment to include the Senate bill's definition of 
administrative costs.
      The Conferees wish to emphasize that grantees and 
subcontractors that can restrain administrative costs to less 
than 10% should do so. The set amount should be regarded as a 
ceiling, not a floor.

                         9. single application

      The Senate bill allows the Secretary to phase in the use 
of a single application for formula and supplemental Part A 
funds and the awarding of a single grant. The House bill makes 
this allowance contingent upon the request of an individual 
grantee. The House recedes.
      It is the intent of the conferees that the Secretary have 
the authority to implement mechanisms necessary to make a 
single grant based on a single application. It is the 
understanding of the conferees that the use of such a grant and 
application will reduce the administrative burdens on the 
Secretary, grantees, and individual providers. Under current 
methods, these entities often must track two separate funding 
streams that accrue to a single provider for the same services.
      Use of a single grant or single application, however, 
must not result in a delay in allocating funding under the Act.

                        10. use of part b funds

      The House bill adds a fifth eligible use of Part B funds, 
allowing states to fund services directly. The Senate bill does 
not include such a provision. The Senate recedes with an 
amendment that, in order to fund these services outside an 
existing consortia system, the state must demonstrate to the 
Secretary that utilizing other service delivery mechanisms is 
more effective. In making that determination, the State must 
consult with service provider representatives and recipients of 
services.
      The House bill eliminates the requirement that states 
with more than 1% of all cases of AIDS expend at least 50% of 
their Part B funds on consortia. The Senate does not eliminate 
this provision. The Senate recedes.
      The Conferees want to emphasize that the purpose of the 
Act is to provide health care services to individuals with HIV 
and AIDS. It is the expectation of the conferees that states 
will maximize the funds spent directly on health care services.
      The Conferees wish to emphasize that the eligible funding 
areas under Part B are flexible enough to allow states to 
implement an appropriate array of services. With Part B funds, 
states can establish treatment programs, health insurance 
continuation programs, home health care programs and consortia. 
The Conferees expect states to use funds to provide or ensure 
the provision of services eligible for funding under Part A. 
Where consortia exist or are established under this part, in 
areas that would have been eligible for direct part A funding 
prior to enactment of this Act, they should function as 
planning bodies for local service delivery, much as planning 
councils function under Part A.
      The Conferees also emphasize that the elimination of the 
requirement that states with more than 1% of national AIDS 
cases expend at least 50% of their Part B award on consortia is 
not to be interpreted to mean that Part A medical services 
should not be provided to beneficiaries who reside outside an 
eligible area. Eliminating the 50% expenditure requirement 
provides more flexibility to respond to local needs.

                       11. minimum drug formulary

      The Senate bill requires the Secretary to develop a 
minimum drug formulary for suggested use by the states which 
must document their success in implementing the developed 
formulary. The House bill requires some portion of Part B funds 
to be used to fund drug assistance programs, including measures 
for the prevention and treatment of opportunistic infections. 
The Senate recedes with an amendment to strike references in 
Section 2612(a)(2) and Section 2616(a) to ``treatments that 
have been determined to prolong life'' and replace them with 
``therapeutics to treat HIV disease''.
      These amendments expand State flexibility to provide a 
broader range of treatments through State drug treatment 
programs funded by Ryan White Care Act funds, by allowing State 
drug treatment programs to provide any therapeutics that treat 
HIV and AIDS, rather than only those that ``have been 
determined to prolong life.'' This is intended to increase 
access for persons with HIV and AIDS to treatments targeted 
toward various aspects of the disease, to prolong life. Such 
treatments may, for example, by addressing certain specific 
symptoms of HIV and AIDS, improve an individual's quality of 
life. With this flexibility, states will be able to improve 
access to the growing range of treatment options for HIV and 
AIDS, enabling patients to benefit from recent advances in the 
treatment of the disease.
      The Senate bill requires the Secretary to review the 
current status of State drug reimbursement programs and assess 
barriers to the expanded availability of prophylactic 
treatments for opportunistic infections. The House bill does 
not contain such provisions. The House recedes with an 
amendment to replace ``prophylactic treatment'' with 
``treatments described in subsection (a)'' and to require 
states to document their progress in making those treatments 
available.
      In addition, the amendments require the Secretary to 
evaluate the effectiveness of State drug treatment programs in 
removing barriers to the availability of this wider range of 
therapeutics to treat HIV and AIDS, and also to evaluate the 
extent to which State drug treatment programs coordinate with 
other recipients of Ryan White Care Act funds to remove 
barriers to the availability of treatments for HIV and AIDS. 
States also are required to document their progress in making 
treatments available to those eligible for assistance under the 
Ryan White Care Act, namely low-income individuals who have 
been medically diagnosed with HIV or AIDS. These requirements 
for evaluation and documentation are designed to assure that 
these funds are being used efficiently and effectively to 
achieve the goals of the Ryan White Care Act, specifically in 
the area of improving access for low income individuals to 
medical treatments for HIV and AIDS.
      The Conferees emphasize that the Secretary is encouraged 
to advise states on classes of drugs that have been found 
effective in preventing and treating HIV disease as part of the 
assessment of barriers to expanded availability of 
therapeutics. For the purposes of this section, the Conferees 
include as therapeutics as pharmaceuticals (including the 
necessary equipment to utilize them) and other therapies which 
prevent the onset of opportunistic infections or deterioration 
of health.

              12. statewide coordinated statement of need

      The Senate bill requires the state public health agency 
administering Part B funds to convene an annual meeting for the 
development of a coordinated statement of need. The House bill 
does not define the Statewide Coordinated Statement of Need. 
The House recedes with an amendment to require a periodic 
convening of such a meeting and to remove the parentheticals 
which describe required attendees.
      The Conferees intend for this activity to result in a 
joint written statement developed in partnership with all CARE 
Act grantees within the State which identifies unmet need, 
epidemiological trends, barriers to care and other appropriate 
issues which impact on service availability.
      The Conferees wish to emphasize that the Statewide 
Coordinated Statement of Need and the process to create it 
should not supplant existing planning processes utilized by 
grantees under this Act. It is meant to augment such planning 
and should be used as a tool to maximize coordination, 
integration, and effective linkages among the individual 
entities funded by the Act. For existing grantees, local plans 
and programs shall be considered consistent with the 
Coordinated Statement of Need if the grantees can show a good 
faith effort to participate in crafting the statement and a 
good faith consideration of the statement in their planning and 
decision making processes. New grantees must demonstrate their 
good faith consideration of the statement in making their 
applications for funding.

                            13. coordination

      The Senate bill requires the Public Health Service to 
coordinate the activities of the Health Resources and Services 
Administration, the Centers for Disease Control and Prevention, 
and the Substance Abuse and Mental Health Services 
Administration regarding the local development of a complete 
continuum of HIV-related services for individuals with HIV 
disease or at risk for HIV disease. The House bill requires the 
Secretary to submit a report to Congress on coordination of 
agency activities. The Senate recedes with an amendment that 
the report be submitted biennially beginning October 1, 1996.

                    14. early intervention programs

      The Senate bill stipulates that early intervention funds 
are for primary care services for people with HIV. The House 
bill lists four types of services that are eligible for early 
intervention funds. The Senate recedes with an amendment that 
the House listed services are for people with HIV.
      The Senate requires that 50% of early intervention grants 
to primary health care facilities, including migrant health 
centers, centers that provide health services for the homeless, 
and other federally-qualified health centers, be expended on-
site or at sites where other primary care services are 
rendered. The House bill does not contain such a provision. The 
House recedes.
      The Conferees recognize that some grantees operate as 
consortia to provide services specifically designed for HIV/
AIDS. These programs and the guidelines developed must meet the 
needs of people living with HIV/AIDS and assure that direct 
services are provided consistent with the needs of consumers.
      The Senate bill provides planning and development grants 
to public and nonprofit entities that are not direct providers 
of primary health care to provide HIV-specific care services. 
The House bill provides the grants to all eligible public and 
private nonprofit entities to provide early intervention 
services. The Senate recedes with an amendment to add ``HIV'' 
to ``early intervention services''.
      The Senate bill requires the Secretary to give preference 
to entities that would provide HIV primary care services in 
rural or under-served communities. The House bill requires 
preference to entities that currently provide HIV primary care 
services in rural and under-served communities. The Senate 
recedes with an amendment to delete ``HIV'' from ``HIV primary 
care services''.
      The Senate bill requires family planning and hemophilia 
center grantees to ensure the availability of early 
intervention services through a series of linkages to 
community-based primary care providers and to establish 
mechanisms for referrals and follow-up. The House bill does not 
contain such a provision. The House recedes.
      The Senate bill increases the cap on administrative costs 
to 10% and expands those costs to include planning, evaluation, 
and technical assistance. The House bill contains no such 
provision. The House recedes with an amendment to lower the cap 
to 7.5% and eliminate inclusion of technical assistance.

                              15. title iv

      The House bill titles Section 2671, Coordinated Services 
and Access to Research for Women, Infants, and Children. The 
Senate bill titles this section, Grants for Coordinated 
Services and Access to Research for Children, Youth, and 
Families. The Senate recedes with an amendment to add ``Grants 
for'' at the beginning of the title, and ``and Youth'' at the 
end of the title.
      The House bill makes grants available to primary health 
care providers to provide opportunities for women, infants, and 
children to participate as subjects in research of potential 
clinical benefit. The Senate bill makes available such grants 
to facilitate voluntary participation of those groups in 
research protocols at the facility or by direct referral. The 
Senate recedes with an amendment to include youth in the 
eligible population group.
      The House bill requires entities to provide outpatient 
health care to women, infants, and children. The Senate bill 
requires that health care and support services be provided to 
children, youth, and women with HIV disease and the families of 
such individuals. The Senate recedes with an amendment to 
require applicants to provide to patients and their families 
case management, transportation, child care, and other 
incidental services as may be necessary to enable the patient 
and the family to participate in the applicant's program, and 
referrals to inpatient hospital services, treatment for 
substance abuse, mental health services, and other support 
services as appropriate.
      The House bill requires the grant applicant to make 
reasonable efforts to identify prospective patients who would 
be appropriate participants in research projects and to offer 
patients the opportunity to participate in projects. The Senate 
bill requires a broader list of assurances from the applicant, 
including that the grant will be used primarily to serve 
children, youth, and women; and that the applicant will arrange 
with research entities to collaborate in the conduct of 
facilitation of voluntary patient participation in qualified 
research protocols. The Senate recedes with an amendment to 
require entities to identify appropriate patients through the 
use of criteria provided by the entity for that purpose.
      The House bill requires that applicant and the project of 
research comply with accepted standards of protection for human 
subjects including the provision of written informed consent. 
The Senate bill requires the Secretary to establish procedures 
which ensure those requirements. The Senate recedes.
      The Conferees wish to emphasize that receipt of services 
by a patient shall not be conditioned upon consent to 
participate in research.
      The House bill requires that for the third or subsequent 
fiscal year for which an applicant seeks a grant, the applicant 
must assure that a significant number, as determined by the 
Secretary, of women, infants, and children who are patients of 
the applicant are participating in research projects. The 
Senate bill does not contain such a provision. The Senate 
recedes.
      Under the House bill, if the grantee is temporarily 
unable to comply with the ``significant number'' requirement, 
the Secretary may grant a reasonable amount of time for the 
grantee to reestablish compliance, under certain circumstances. 
The Senate bill does not contain such a provision. The Senate 
recedes.
      In the House bill, the Secretary may waive the 
``significant numbers'' requirement for an applicant who 
received a grant in fiscal year 1995 if the applicant is making 
a reasonable effort toward meeting this goal. The authority for 
the Secretary to issue this waiver expires on October 1, 1998, 
and waivers issued before October 1, 1998, expire on or before 
that date. The Senate bill does not contain such a provision. 
The Senate recedes with an amendment to provide that applicants 
must, not later than the end of the second fiscal year, meet 
the requirement that a significant number of women, infants, 
children, and youth participate in research projects.
      The Conferees intend that the Secretary interpret the 
term ``significant number'' in a relative way. For grantees 
located in areas where there is access to many research 
activities, the ``significant number'' will be higher than for 
grantees located in more remote areas where research for women, 
infants, and children is less accessible. The Conferees intend 
that the Secretary take into account a variety of factors in 
determining ``significant numbers'', including: the number and 
type of clients serviced by the grantee, and the nature and 
availability of research programs accessible to patients of the 
grantee, and other factors the Secretary considers to be 
relevant.
      The Senate bill includes a provision requiring submission 
of an application in such form as the Secretary determines is 
necessary. The House bill does not contain such a provision. 
The House recedes.
      The House bill includes a section on Provisions Regarding 
Conduct of Research, allowing for the project of research to be 
conducted by the applicant or by an entity with which the 
applicant has made arrangements. The Senate bill does not 
contain such a provision. The Senate recedes.
      The House bill requires that the grant may not be 
expended for the conduct of any research project, that the 
research entity must be appropriately qualified to conduct the 
project, and that the research project must be in accordance 
with the priorities determined and listed by the Secretary in 
consultation with public and private research entities, 
providers and recipients of services under Part B. An entity 
shall be considered 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. Under certain circumstances, the 
Secretary may give priority to a research protocol not on the 
list of high priority research. The Senate bill requires the 
Secretary to establish mechanisms, including an independent 
research review panel, to ensure that the research projects are 
of potential clinical benefit and meet accepted standards of 
research design. The Senate recedes with an amendment to allow 
grantees to fund services that facilitate and coordinate client 
access to comprehensive care services and research projects.
      The Senate bill allows the Secretary to waive the 
requirements regarding coordination, statewide coordinated 
statement of need, and appropriate research opportunities if 
the applicant provides assurances that the requirements will be 
met by the end of the second grant year, or, in the case of 
existing grantees, within one year. The House bill does not 
contain such a provision. The Senate recedes.
      The Senate bill contains a provision on Evaluations and 
Data Collection, requiring the Secretary to review the programs 
carried out under the section at the end of each fiscal year. 
The review may include recommendations on improving access to 
and participation in research protocols. The House bill does 
not contain such a provision. The House recedes with an 
amendment to title this section ``Review Regarding Access To 
And Participation in Programs;'' to require the review to be 
completed not later than 180 days after the end of the fiscal 
year; to state that the purpose of the review shall be to 
develop recommendations on procedures to allocate services and 
opportunities among patients of the entity and other procedures 
and policies of the entity regarding the participation of 
women, infants, children, and youth in research programs; and 
to require the Secretary to provide for evaluations of programs 
carried out by the entity.
      The Senate bill allows the Secretary to establish 
reporting requirements necessary to administer the program and 
carry out the reviews, measure outcomes, and document clients 
served, services provided and participation in research 
protocols. The House bill does not contain such provisions. The 
Senate recedes.
      The Senate bill includes a definition of qualified 
research entities and qualified research protocols. The House 
bill does not contain such a provision. The Senate recedes.
      The House bill requires the Secretary to develop a plan 
that provides for the coordination of the activities of the 
National Institutes of Health (NIH) with the activities of this 
section, including that the projects of research conducted or 
supported by NIH are made aware of applicants and grantees of 
this section and that those projects as appropriate enter into 
arrangements for purposes of this section. The Senate bill does 
not contain such a provision. The Senate recedes.
      The Conferees emphasize that Part D was enacted to 
provide funds for coordinated health and social services in 
association with voluntary participation in research programs. 
Such research will lead to a greater understanding of HIV 
disease among women, infants and children and to the 
development of preventive and therapeutic measures appropriate 
for those populations. The Conferees recognize that 
participation of children, youth, and pregnant women in HIV 
research programs is more successful when projects are 
convenient to women and children with HIV disease, when they 
are sensitive to needs for nontraditional services such as 
child care and transportation services, and when the 
opportunities to participate in research are provided within an 
established, comprehensive and community based HIV care system. 
For this reason, it is the intent of the Conferees that 
entities receiving grants under this program provide or arrange 
for innovative comprehensive HIV care for children, youth, 
women, and families with or affected by HIV.
      It is the intent of the Conferees for this program to be 
flexible but to organize, coordinate and support a broad range 
of HIV services linking institutional and community-based 
providers. Grantees may provide a wide range of health services 
and may make referrals for, or provide services to, facilitate 
access to care.

                    16. aids dental school training

      The House bill reauthorizes the current program and 
transfers it from Title 7 of the Public Health Service Act to 
Title 26. The Senate bill does not reauthorize the program. The 
Senate recedes.

                 17. evaluation of ryan white programs

      The House bill authorizes funding for the evaluation of 
Ryan White programs to come from the 1% Public Health Service 
set aside. The Senate bill does not contain such a provision. 
The Senate recedes.

             18. special projects of national significance

      The Senate bill includes service delivery grants as 
special projects and describes those grants, which include 
programs that support family-based care networks critical to 
the delivery of care in minority communities and programs that 
build organizational capacity in disenfranchised communities. 
The House bill does not specifically define such grants. The 
House recedes with an amendment to replace the term 
``disenfranchised communities'' with ``minority communities''.

                19. aids education and training centers

      The House bill includes as an eligible activity the 
training of health providers in the prevention of perinatal HIV 
transmission and prevention and treatment of opportunistic 
infections. The Senate bill does not include such language. The 
Senate recedes.
      By including the AIDS Education and Training Centers in 
the CARE Act reauthorization, the conferees reaffirm that this 
is an important federal program and will serve an important 
role in the future.

                              20. formulas

      The Senate bill distributes Part A funds to eligible 
metropolitan areas with a formula based only on weighted AIDS 
case counts. The Senate formula caps funding losses such that 
no eligible area will receive less than 98% of its FY 95 award 
in FY 96, 97% of its FY 95 award in FY 97, 95.5% of its FY 95 
award in FY 98, 94% of its FY 95 award in FY 99, and 92.5% of 
its FY 95 award in FY 2000. The House bill uses the same 
weighted AIDS case count, but includes in its formula the 
Medicare Hospital Wage Index for each metropolitan area as a 
measure of service delivery cost. The House formula caps 
funding losses such that no eligible area will receive less 
than 99% of its FY 95 award in FY 96, 98% of its FY 95 award in 
FY 97, 97% of its FY 95 award in FY 98, 96% of its FY 95 award 
in FY 99, and 95% of its FY 95 award in FY 2000. The House 
recedes with an amendment to replace the Senate funding loss 
caps with losses such that no eligible area will receive less 
than 100% of its FY 95 award in FY 96, 99% of its FY 95 award 
in FY 97, 98% of its FY 95 award in FY 98, 96.5% of its FY 95 
award in FY 99, and 95% of its FY 95 award in FY 2000.
      The conferees feel that the formula changes for Part A, 
including the hold harmless provisions, adequately respond to 
the geographic diversification of the epidemic while 
simultaneously protecting against major disruptions in service 
delivery. The Committee understands that the formula changes 
will reduce the amount of supplemental funds that have been 
traditionally available to all Part A grantees because 
supplemental funds will be used to fund the hold harmless 
provisions. The Committee further understands that this 
reduction in the availability of supplemental funds could 
result in resource shifts beyond those built into the revised 
formula depending on the quality of the supplemental 
application as determined by the review process.
      The Senate bill distributes Part B funds to states based 
on a formula that calculates two distribution factors: the 
state factor, based on weighted AIDS case counts for each state 
and the non-EMA factor based on weighted AIDS case counts for 
areas within the state outside of Part A eligible areas. Each 
of these distribution factors is weighted equally. The Senate 
bill also includes a provisions to cap funding losses such that 
no state will receive less than 98% of its FY 95 award in FY 
96, 97% of its FY 95 award in FY 97, 95.5% of its FY 95 award 
in FY 98, 94% of its FY 95 award in FY 99, and 92.5% of its FY 
95 award in FY 2000. The House bill retains the Part B formula 
contained in current law and sets aside 7% of available funds 
for distribution to states without Part A eligible areas, based 
on the relative case counts within those states. The House 
recedes with an amendment to weight the state factor in the 
Senate formula by a constant of .8 and the non-EMA factor by a 
constant of .2, and to substitute the Senate loss caps with the 
same loss caps used in the House version of the Part A formula.
      Neither the House bill nor the Senate bill contained a 
provision allowing for the adjustment of the weights used to 
determine the estimate of living AIDS cases over the required 
120 month period, in either the Part A or Part B formulas. The 
Conferees feel that such an adjustment may be necessary over 
time as life expectancy and disease progression changes for 
people living with AIDS. Therefore the Conferees expect the 
Secretary, in consultation with the Centers for Disease 
Control, to evaluate the need to update those weights every two 
years beginning with the grant awards in FY 1998 and report to 
the appropriate congressional committees.
      The Conferees intend that if funds are appropriated 
specifically for the Drug Assistance Program, such funds be 
allocated according to the states entire weighted case counts.

                        21. single appropriation

      Under the Senate bill, after one year, if the Secretary 
is unable to devise a methodology to adjust the split in the 
single appropriation between Parts A and B, the single 
appropriation reverts to two separate appropriations, beginning 
in FY 1997. Under the House bill, the single appropriation and 
the 64%/36% split between the two Parts remains in effect over 
the entire reauthorization period. The Secretary has the 
discretion to adjust the apportionment of the single 
appropriation between the two Parts. The House recedes with an 
amendment that, by July 1, 1996, the Secretary devise the 
methodology or recommend that such a methodology is not 
feasible. In addition, the appropriation committee will 
determine the relative allocation of funds for Part A and Part 
B for fiscal year 1996.

                         22. perinatal testing

      The Senate bill mandates that states with an incidence of 
HIV among childbearing women of .25 or greater or an estimated 
number of births to HIV positive women in 1993 of 175 or 
greater have in effect regulations implementing the guidelines 
issued by the Centers for Disease Control (CDC) concerning 
voluntary HIV testing and counseling for pregnant women. The 
House bill does not contain such a provision. The House recedes 
with an amendment to require all states to implement the CDC 
guidelines.
      In the Senate bill, for states providing such 
certification, $10 million in grant funds are made available to 
implement the CDC guidelines, to provide outreach to at-risk 
pregnant women and to make available appropriate counseling and 
voluntary testing. The House bill makes available $10 million 
in grants for states to offer HIV testing and counseling to 
pregnant women, to test newborns for HIV, and to collect data 
on pregnant women and newborns who have undergone HIV testing. 
In order to be eligible for these grants, the state by statute 
or regulation must require that all newborns whose biological 
mother has not undergone prenatal testing for HIV, be tested 
for HIV at birth and that the results be made available to the 
biological mother or guardian of the infant. The House recedes 
with an amendment to restrict access to these funds to states 
that have implemented the CDC guidelines and to prioritize the 
$10 million to those states with high HIV seroprevalence rates 
among childbearing women.
      In the Senate bill, the Secretary is required to evaluate 
the effect of these grants on reducing the perinatal 
transmission of HIV. In the House bill, in two years, if the 
Secretary establishes that testing newborns for HIV has become 
routine practice in the provision of health care, states, by 
regulation or statute, must require such testing of newborns 
and notification to the mother or guardian in order to receive 
Ryan White Part B funds. Alternatively, states can demonstrate 
that of newborns in the state, the HIV status of 95% of the 
infants is known. The House recedes with an amendment to 
require the following.
      (1) Within four months of enactment of this Act, the CDC, 
in consultation with states, will develop and implement a 
reporting system for states to use in determining the rate of 
new cases of AIDS resulting from perinatal transmission and the 
possible causes for that transmission.
      The Secretary of HHS is directed to contract with the 
Institute of Medicine to conduct an evaluation of the extent to 
which state efforts have been effective in reducing perinatal 
transmission of HIV and an analysis of the existing barriers to 
further reduction in such transmission. The Secretary shall 
report these findings to Congress along with any recommendation 
made by the Institute.
      (2) Within two years following the implementation of such 
a system, the Secretary will make a determination whether 
mandatory HIV testing of all infants born in the U.S. whose 
mothers have not undergone prenatal HIV testing has become a 
routine practice. This determination will be made in 
consultation with states and experts. If the Secretary 
determines that such mandatory testing has become a routine 
practice, after an additional 18 month period, a state will not 
recieve Title 2 Ryan White funding unless it can demonstrate 
one of the following:
      (A) A 50% reduction (or a comparable measure for low-
incidence states) in the rate of new AIDS cases resulting from 
perinatal transmission, comparing the most recent data to 1993 
data;
      (B) At least 95% of women who have received at least two 
prenatal visits with a health care provider or provider group 
have been tested for HIV; or
      (C) A program for mandatory testing of all newborns whose 
mothers have not undergone prenatal HIV testing.
      The House bill requires states by statute or regulation 
to prohibit health insurance companies from discontinuing 
coverage for a person solely on the basis that the person is 
infected with HIV or that the individual has been tested for 
HIV. The Senate bill does not contain such a provision. The 
Senate recedes with an amendment that only states which 
implement mandatory testing of newborn infants be required to 
implement such insurance regulations. The conferees intend for 
these insurance provisions to augment, and in no way diminish, 
existing federal or state law.
      The House bill requirements on insurance regulations do 
not apply to persons who knowingly misrepresent their HIV 
status, facts regarding whether the person has been tested for 
HIV, and facts regarding whether the person has engaged in any 
behavior that places the person at risk for HIV. The Senate 
recedes with an amendment to delete the last two exemptions on 
testing and behavior.
      The Conferees wish to emphasize that nothing in this 
provision should be construed to mean that states are required 
to implement HIV reporting.

                        23. spousal notification

      The Senate bill prohibits the Secretary from making any 
grant under the Act to any state, political subdivision of any 
state, or other recipient of CARE Act funds within the state 
unless the state requires a good faith effort to notify the 
spouses of AIDS-infected patients that the patients are 
infected with HIV. The House bill does not contain such a 
provision. The House recedes with an amendment to tie the 
provision to Part B funds only, change ``AIDS-infected 
patient'' to ``known HIV-infected patient'', replace ``such 
AIDS infected patients is infected with the human 
immunodeficiency virus'' with ``he or she may have been exposed 
to the human immunodeficiency virus and should seek testing,'' 
define HIV-infected as any person diagnosed with the human 
immunodeficiency virus, and change the definition of spouse to 
mean a current marriage partner or a person that was the 
marriage partner at any time within the ten years prior to the 
diagnosis of HIV infection.
      The Conferees wish to emphasize that nothing in this 
provision should be construed to require states to implement 
HIV name reporting.

                     24. study on allotment formula

      The Senate bill requires the Secretary to conduct a study 
of the funding formulas contained in the Act and submit a 
report to Congress. The House bill does not contain such a 
provision. The Senate recedes.

 25. prohibitions on the use of federal funds and promotion of certain 
                               activities

      The Senate bill prohibits funds appropriated under the 
Act from being used to promote or encourage, directly or 
indirectly, homosexuality or intravenous drug use. The House 
bill does not contain such a prohibition or definition. The 
Senate recedes.
      The Senate bill prohibits funds appropriated under the 
Act from being used to develop materials designed to promote or 
encourage directly intravenous drug use or sexual activity, 
whether homosexual or heterosexual. The House bill does not 
contain such a provision. The House recedes.

    26. optional participation of federal employees in aids training

      The Senate bill prohibits the federal government from 
requiring any employee to attend or participate in an AIDS or 
HIV training program if the employee refuses to participate. 
The House bill does not contain such a provision. The House 
recedes with an amendment that exempts from this provision 
federal training programs necessary to protect the health and 
safety of federal employees and those they serve.
      This provision is intended to apply to those employees 
whose position requires knowledge of the universal precautions 
for the prevention of the transmission of the HIV virus.

                    27. limitation on appropriations

      The Senate bill requires that of the total amounts of 
Federal funds expended in any fiscal year, funds expended for 
AIDS and HIV activities not exceed the amounts expended for 
activities related to cancer. The House bill does not contain 
such a provision. The House recedes.
      The Conferees wish to make clear that the term ``total 
amounts'' includes all research, treatment and prevention 
funding, including amounts expended through the Medicare and 
Medicaid programs, wherhe administered by the federal 
government or paid to states in block grants.
                                   Tom Bliley,
                                   Michael Bilirakis,
                                   Tom Coburn,
                                   Henry A. Waxman,
                                   Gerry Studds,
                                 Managers on the Part of the House.

                                   Nancy Landon Kassebaum,
                                   Jim Jeffords,
                                   Bill Frist,
                                   Edward M. Kennedy,
                                   Christopher J. Dodd,
                                Managers on the Part of the Senate.