Page:United States Statutes at Large Volume 110 Part 2.djvu/558

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110 STAT. 1350 PUBLIC LAW 104-146—MAY 20, 1996 (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 trginsmitted 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;