Pub.L. 104-147 To amend the Water Resources Research Act of 1984 to extend the authorizations of appropriations through fiscal year 2000, and for other purposes. <> ...

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[[Page 1345]]

                 RYAN WHITE CARE ACT AMENDMENTS OF 1996

[[Page 110 STAT. 1346]]

Public Law 104-146
104th Congress

                                 An Act


 
 An Act to amend the Public Health <<NOTE: May 20, 1996 -  [S. 641]>>  
 Service Act to revise and extend programs established pursuant to the 
     Ryan White Comprehensive AIDS Resources Emergency Act of 1990.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: Ryan White CARE 
Act Amendments of 1996.>> 

SECTION 1. <<NOTE: 42 USC 201 note.>>  SHORT TITLE.

    This Act may be cited as the ``Ryan White CARE Act Amendments of 
1996''.

SEC. 2. REFERENCES.

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

SEC. 3. GENERAL AMENDMENTS.

    (a) Program of Grants.--
            (1) Number of cases.--Section 2601(a) (42 U.S.C. 300ff-11) 
        is amended--
                    (A) by striking ``subject to subsection (b)'' and 
                inserting ``subject to subsections (b) through (d)''; 
                and
                    (B) by striking ``metropolitan area'' and all that 
                follows and inserting the following: ``metropolitan area 
                for which there has been reported to the Director of the 
                Centers for Disease Control and Prevention a cumulative 
                total of more than 2,000 cases of acquired immune 
                deficiency syndrome for the most recent period of 5 
                calendar years for which such data are available.''.
            (2) Other provisions regarding eligibility.--Section 2601 
        (42 U.S.C. 300ff-11) is amended by adding at the end thereof the 
        following new subsections:

    ``(c) Requirements Regarding Population.--
            ``(1) Number of individuals.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), the Secretary may not make a grant 
                under this section for a metropolitan area unless the 
                area has a population of 500,000 or more individuals.
                    ``(B) Limitation.--Subparagraph (A) does not apply 
                to any metropolitan area that was an eligible area under 
                this part for fiscal year 1995 or any prior fiscal year.
            ``(2) Geographic boundaries.--For purposes of eligibility 
        under this part, the boundaries of each metropolitan area are


[[Page 110 STAT. 1347]]

the boundaries that were in effect for the area for fiscal year 1994.
    ``(d) Continued Status as Eligible Area.--Notwithstanding any other 
provision of this section, a metropolitan area that was an eligible area 
under this part for fiscal year 1996 is an eligible area for fiscal year 
1997 and each subsequent fiscal year.''.
            (3) Conforming amendment regarding definition of eligible 
        area.--Section 2607(1) (42 U.S.C. 300ff-17(1)) is amended by 
        striking ``The term'' and all that follows and inserting the 
        following: ``The term `eligible area' means a metropolitan area 
        meeting the requirements of section 2601 that are applicable to 
        the area.''.

    (b) Emergency Relief for Areas With Substantial Need for Services.--
            (1) HIV health services planning council.--Subsection (b) of 
        section 2602 (42 U.S.C. 300ff-12(b)) is amended--
                    (A) in paragraph (1)--
                          (i) by striking ``include'' and all that 
                      follows through the end thereof, and inserting 
                      ``reflect in its composition the demographics of 
                      the epidemic in the eligible area involved, with 
                      particular consideration given to 
                      disproportionately affected and historically 
                      underserved groups and subpopulations.''; and
                          (ii) by adding at the end thereof the 
                      following new sentences: ``Nominations for 
                      membership on the council shall be identified 
                      through an open process and candidates shall be 
                      selected based on locally delineated and 
                      publicized criteria. Such criteria shall include a 
                      conflict-of-interest standard that is in 
                      accordance with paragraph (5).'';
                    (B) in paragraph (2), by adding at the end thereof 
                the following new subparagraph:
                    ``(C) Chairperson.--A planning council may not be 
                chaired solely by an employee of the grantee.'';
                    (C) in paragraph (3)--
                          (i) in subparagraph (A), by striking ``area;'' 
                      and inserting ``area, including how best to meet 
                      each such priority and additional factors that a 
                      grantee should consider in allocating funds under 
                      a grant based on the--
                          ``(i) documented needs of the HIV-infected 
                      population;
                          ``(ii) cost and outcome effectiveness of 
                      proposed strategies and interventions, to the 
                      extent that such data are reasonably available 
                      (either demonstrated or probable);
                          ``(iii) priorities of the HIV-infected 
                      communities for whom the services are intended; 
                      and
                          ``(iv) availability of other governmental and 
                      nongovernmental resources;'';
                          (ii) by striking ``and'' at the end of 
                      subparagraph (B);
                          (iii) by striking the period at the end of 
                      subparagraph (C) and inserting ``, and at the 
                      discretion of the planning council, assess the 
                      effectiveness, either directly or through 
                      contractual arrangements, of the services offered 
                      in meeting the identified needs;''; and

[[Page 110 STAT. 1348]]

                          (iv) by adding at the end thereof the 
                      following new subparagraphs:
                    ``(D) participate in the development of the 
                statewide coordinated statement of need initiated by the 
                State public health agency responsible for administering 
                grants under part B; and
                    ``(E) establish methods for obtaining input on 
                community needs and priorities which may include public 
                meetings, conducting focus groups, and convening ad-hoc 
                panels.'';
                    (D) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively;
                    (E) by inserting after paragraph (1), the following 
                new paragraph:
            ``(2) Representation.--The HIV health services planning 
        council shall include representatives of--
                    ``(A) health care providers, including federally 
                qualified health centers;
                    ``(B) community-based organizations serving affected 
                populations and AIDS service organizations;
                    ``(C) social service providers;
                    ``(D) mental health and substance abuse providers;
                    ``(E) local public health agencies;
                    ``(F) hospital planning agencies or health care 
                planning agencies;
                    ``(G) affected communities, including people with 
                HIV disease or AIDS and historically underserved groups 
                and subpopulations;
                    ``(H) nonelected community leaders;
                    ``(I) State government (including the State medicaid 
                agency and the agency administering the program under 
                part B);
                    ``(J) grantees under subpart II of part C;
                    ``(K) grantees under section 2671, or, if none are 
                operating in the area, representatives of organizations 
                with a history of serving children, youth, women, and 
                families living with HIV and operating in the area; and
                    ``(L) grantees under other Federal HIV programs.''; 
                and
                    (F) by adding at the end thereof the following:
            ``(5) Conflicts of interest.--
                    ``(A) In general.--The planning council under 
                paragraph (1) may not be directly involved in the 
                administration of a grant under section 2601(a). With 
                respect to compliance with the preceding sentence, the 
                planning council may not designate (or otherwise be 
                involved in the selection of) particular entities as 
                recipients of any of the amounts provided in the grant.
                    ``(B) Required agreements.--An individual may serve 
                on the planning council under paragraph (1) only if the 
                individual agrees that if the individual has a financial 
                interest in an entity, if the individual is an employee 
                of a public or private entity, or if the individual is a 
                member of a public or private organization, and such 
                entity or organization is seeking amounts from a grant 
                under section 2601(a), the individual will not, with 
                respect to the purpose for which the entity seeks such 
                amounts, participate

[[Page 110 STAT. 1349]]

                (directly or in an advisory capacity) in the process of 
                selecting entities to receive such amounts for such 
                purpose.
            ``(6) Grievance procedures.--A planning council under 
        paragraph (1) shall develop procedures for addressing grievances 
        with respect to funding under this part, including procedures 
        for submitting grievances that cannot be resolved to binding 
        arbitration. Such procedures shall be described in the by-laws 
        of the planning council and be consistent with the requirements 
        of subsection (c).

    ``(c) Grievance Procedures.--
            ``(1) Federal responsibility.--
                    ``(A) Models.--The Secretary shall, through a 
                process that includes consultations with grantees under 
                this part and public and private experts in grievance 
                procedures, arbitration, and mediation, develop model 
                grievance procedures that may be implemented by the 
                planning council under subsection (b)(1) and grantees 
                under this part. Such model procedures shall describe 
                the elements that must be addressed in establishing 
                local grievance procedures and provide grantees with 
                flexibility in the design of such local procedures.
                    ``(B) Review.--The Secretary shall review grievance 
                procedures established by the planning council and 
                grantees under this part to determine if such procedures 
                are adequate. In making such a determination, the 
                Secretary shall assess whether such procedures permit 
                legitimate grievances to be filed, evaluated, and 
                resolved at the local level.
            ``(2) Grantees.--To be eligible to receive funds under this 
        part, a grantee shall develop grievance procedures that are 
        determined by the Secretary to be consistent with the model 
        procedures developed under paragraph (1)(A). Such procedures 
        shall include a process for submitting grievances to binding 
        arbitration.''.
            (2) Distribution of grants.--Section 2603 (42 U.S.C. 300ff-
        13) is amended--
                    (A) in subsection (a)(2), by striking ``Not later 
                than--'' and all that follows through ``the Secretary 
                shall'' and inserting the following: ``Not later than 60 
                days after an appropriation becomes available to carry 
                out this part for each of the fiscal years 1996 through 
                2000, the Secretary shall''; and
                    (B) in subsection (b)
                          (i) in paragraph (1)--
                                    (I) by striking ``and'' at the end 
                                of subparagraph (D);
                                    (II) by striking the period at the 
                                end of subparagraph (E) and inserting a 
                                semicolon; and
                                    (III) by adding at the end thereof 
                                the following new subparagraphs:
                    ``(F) demonstrates the inclusiveness of the planning 
                council membership, with particular emphasis on affected 
                communities and individuals with HIV disease; and
                    ``(G) demonstrates the manner in which the proposed 
                services are consistent with the local needs assessment 
                and the statewide coordinated statement of need.''; and

[[Page 110 STAT. 1350]]

                          (ii) by redesignating paragraphs (2), (3), and 
                      (4) as paragraphs (3), (4), and (5), respectively; 
                      and
                          (iii) by inserting after paragraph (1), the 
                      following new paragraph:
            ``(2) Definition.--
                    ``(A) Severe need.--In determining severe need in 
                accordance with paragraph (1)(B), the Secretary shall 
                consider the ability of the qualified applicant to 
                expend funds efficiently and the impact of relevant 
                factors on the cost and complexity of delivering health 
                care and support services to individuals with HIV 
                disease in the eligible area, including factors such 
                as--
                          ``(i) sexually transmitted diseases, substance 
                      abuse, tuberculosis, severe mental illness, or 
                      other comorbid factors determined relevant by the 
                      Secretary;
                          ``(ii) new or growing subpopulations of 
                      individuals with HIV disease; and
                          ``(iii) homelessness.
                    ``(B) Prevalence.--In determining the impact of the 
                factors described in subparagraph (A), the Secretary 
                shall, to the extent practicable, use national, 
                quantitative incidence data that are available for each 
                eligible area. Not later than 2 years after the date of 
                enactment of this paragraph, the Secretary shall develop 
                a mechanism to utilize such data. In the absence of such 
                data, the Secretary may consider a detailed description 
                and qualitative analysis of severe need, as determined 
                under subparagraph (A), including any local prevalence 
                data gathered and analyzed by the eligible area.
                    ``(C) Priority.--Subsequent to the development of 
                the quantitative mechanism described in subparagraph 
                (B), the Secretary shall phase in, over a 3-year period 
                beginning in fiscal year 1998, the use of such a 
                mechanism to determine the severe need of an eligible 
                area compared to other eligible areas and to determine, 
                in part, the amount of supplemental funds awarded to the 
                eligible area under this part.''.
            (3) Distribution of funds.--
                    (A) In general.--Section 2603(a)(2) (42 U.S.C. 
                300ff-13(a)(2)) (as amended by paragraph (2)) is further 

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