Strengthening the Circle of Care Ryan White CARE Act Reauthorization, 2005

1
Strengthening the Circle of CareRyan White CARE
Act Reauthorization, 2005
2
Introduction

• Marsha Martin, DSW, AIDS Action
• Stephen Boswell, MD, CAEAR Coalition
• Ernest Hopkins, CAEAR Coalition
• Gunther Freehill, AIDS Action

3
CAEAR CoalitionCommunities Advocating Emergency
AIDS Relief

• National Membership Organization
• Founded in 1991
• Dedicated to meeting the critical needs of
  persons living with HIV/AIDS, through Title I and
  Title III of the Ryan White CARE Act.
• Represents more than 400 Title I and Title III
  grantees, including 51 Title I EMAs, plus
  providers and consumers of CARE Act services.

4
AIDS ActionThe National Voice on AIDS

• Founded in 1984
• Dedicated to Sound Policies and Programs to
  Respond to the HIV/AIDS Epidemic
• Dissemination of Information
• Advocacy for Those With and Affected by HIV
• Comprehensive Engagement with AIDS Portfolio
• Collaborates With Public Health Community
• Enhance HIV Prevention Programs
• Improve HIV Care and Treatment Services
• Secure Comprehensive Resources

5
Joint Policy Recommendations

• Product of a Partnership Between CAEAR Coalition
  and AIDS Action
• Emphasizes
• Title I
• Title III
• Part F
• Coordination and Collaboration
• System Issues

6
Overview of Reauthorization

• Maintain the CARE Act Response to Ongoing Health
  Emergency
• Continue Existing, Effective Programs
• Ensure an Appropriate Standard of Care
• Respond to Changes in the HIV/AIDS Epidemics

7
CARE Act Successes

• Marsha Martin, DSW, AIDS Action
• Stephen Boswell, MD, CAEAR Coalition
• Ernest Hopkins, CAEAR Coalition
• Gunther Freehill, AIDS Action

8
(No Transcript)
9
(No Transcript)
10
Number of cases
11
Increasing Prevalence of Resistant Virus In Newly
Infected Patients Genotypic Analysis
25
22.7
1995-1998
20
1999-2000
15.9
15
Presence of major resistance mutations ()
10.2
9.1
10
8.5
8.0
7.3
3.8
5
1.7
0.9
0
Any ARV
NRTIs
NNRTIs
PIs
MDR
Little SJ, et al. N Engl J Med. 2002347385-394.
12
CARE Act Title I

• Marsha Martin, DSW, AIDS Action
• Stephen Boswell, MD, CAEAR Coalition
• Ernest Hopkins, CAEAR Coalition
• Gunther Freehill, AIDS Action

13
Title I

• Maintain Investment in Hardest-Hit Eligible
  Metropolitan Areas (EMA)
• Modernize Title I Formula
• Living AIDS Cases, Adjusted for Reporting Delays,
  2006
• Living HIV/AIDS Cases, Adjusted for Reporting
  Delays
• By 2007
• Ensure Comparable and Complete Data Sets

14
Title I EMAs by Year of Eligibility
15
Title I EMA Eligibility

• Current 2,000 AIDS Cases in Five Years
• Proposed (2006) 1,500 Living AIDS Cases
• Proposed (2007)
• Living HIV/AIDS Cases
• Threshold for Cases Established by Secretary,
  Health and Human Services
• Impact Four or Five New Title I EMAs

16
Title I EMA Boundaries

• Reflect Office of Management and Budget
• Combined Statistical Area (CSA)
• Metropolitan Statistical Area (MSA)
• Metropolitan Division (MD)
• Impact Incorporation of Three EMAs
• Bergen-Passaic, NJ to NYC EMA
• Caguas, PR to San Juan EMA
• Jersey City, NJ to NYC EMA

17
Title I Formula Grants

• Modernize Basis for Formula
• Living AIDS Cases (2006)
• Living HIV/AIDS Cases (2007)

18
Title I Protection Period

• Current
  Proposed
• First Consecutive Year 2 4
• Second Consecutive Year 3 4
• Third Consecutive Year 3 4
• Fourth Consecutive Year 3 4
• Fifth Consecutive Year 4 5
• MAXIMUM 15 21

19
Title I Supplemental Grants

• Implement Requirement for Severe Need Indicators
• Measurable
• Comparable
• Objective
• For 2007 Use Indicators to Determine
  Supplemental Awards

20
Title I Services

• Maintain Allowable Services
• Support Local Control
• Assessment of Need
• Identify Alternate Payor Sources
• Develop Plan for Delivery of Services
• Evaluate Service Outcomes

21
Title I Planning Councils

• Maintain Roles and Responsibilities
• Maintain Requirement for One-Third of Members to
  be
• Non-Aligned Consumers or
• Non-Aligned Caregivers
• Assess and Report on Membership Annually

22
CARE Act Title II, III, IV and F

• Marsha Martin, DSW, AIDS Action
• Stephen Boswell, MD, CAEAR Coalition
• Ernest Hopkins, CAEAR Coalition
• Gunther Freehill, AIDS Action

23
Title II Grants to States

• Maintain Program
• Supports programs in all 50 states/
  DC/PR/territories
• Outpatient and home health care
• Insurance continuation
• HIV Care Consortia

24
Title II AIDS Drug Assistance Program (ADAP)

• Maintain Program
• Ensure Ancillary Services
• Maximize Cost Effectiveness
• Identify Lowest Federal Price
• Ensure Lowest Federal Price for All Grantees

25
Title III Early Intervention

• Increase Collaboration between the HIV/AIDS
  Bureau and Bureau of Primary Health Care
• Provide HIV/AIDS Care Through 330 clinics and
  other Federally Qualified Health Centers (FQHC)
• Assist Community-Based HIV/AIDS Care Providers to
  Qualify as 330 clinics or other FQHC
• Enhance Awareness of Available Technical
  Assistance in the development of unique,
  effective service delivery models

26
Title III Early Intervention(Contd)

• Strengthen the HIV care infrastructure
• Rural Areas
• Medically Underserved Areas
• Collaborate with CDC on Advancing HIV Prevention
  Initiative
• Increase Planning, Capacity Building and Service
  Grants
• Culturally Competent Organizations
• Indigenous Organizations

27
Title III Early Intervention(Contd)

• Create Flexibility in Capacity Building Program
• Require Documented Consumer Involvement

28
Title IV Women, Infants, Children and Families

• Maintain Services for Vulnerable Populations
• Contributes to Reduction of Perinatal Transmission

29
Part F AIDS Education and Training Centers
(AETC)

• Maintain Existing Training and Education Programs
• Contributes to Availability of Effective HIV Care
  and Treatment
• Rural and Remote Areas
• Areas of Emerging Need

30
Part F Oral Health Services

• Reauthorize
• HIV/AIDS Dental Reimbursement Program
• Community-Based Dental Partnership Program
• Maintain Dental Reimbursement Program
• Maintain Eligibility Criteria
• Ensure Services to People with HIV
• If New Funding
• Add Dental Schools Where Available
• Add Community Organizations If No Dental School
• Support Grantee Participation in CARE Act Meetings

31
Part F Infrastructure and Capacity Expansion
Program

• New Program
• Modeled on Title III Capacity Building Program
• Ensure Resources for
• Medically Underserved Areas
• High Poverty Areas
• Areas with Increases in HIV/AIDS Prevalence

32
Appropriations by Proportion
33
CARE Act Funding Levels FY02-05
34
FY 2006 Appropriations
Need Continues to Increase 40,000 new HIV
infections per year Number of people living
with AIDS increased 70,000 in past three years
Caseloads
CARE Act Funding DECREASING, except for Title II
ADAP
2001
2002
2004
2003
2005
35
Appropriations and Cases

• More People Living with AIDS Than Ever Before
• Among Title I Jurisdictions
• Caseload Increase for FY 2004 14.5
• Reduced Funding Available

36
System Issues

• Marsha Martin, DSW, AIDS Action
• Stephen Boswell, MD, CAEAR Coalition
• Ernest Hopkins, CAEAR Coalition
• Gunther Freehill, AIDS Action

37
Enhance Federal Coordination

• Involve Federal Grantees in HIV/AIDS Planning
• SAMHSA
• Veterans Administration
• CMS
• Resolve Conflicting Federal Guidance and
  Practices
• Ensure Participation of State Medicaid Agency in
  CARE Act planning

38
Improve Accountability at HRSA

• Require Annual Report from HRSA
• Evaluation (2)
• Technical Assistance (1)
• Ensure Utility of Evaluation and Technical
  Assistance Programs
• For Service Provision
• For Planning

39
Unduplicated Service Data

• Create National System of Unduplicated
  Client-Level Data
• Numbers and demographics of those served
• Target services/measure outcomes
• Compliant with HIPAA and stronger state/federal
  confidentiality law
• Match Requirements with Resources

40
Minority AIDS Initiative (MAI)

• Maintain the Minority AIDS Initiative (MAI)
• Ensure MAI Increases, Not Supplants, Services
• Maintain Remainder of MAI
• Centers for Disease Control and Prevention
• Office of the Secretary, HHS
• Office of Minority Health
• Substance Abuse and Mental Health Services
  Administration
• National Institutes of Health

41

• Marsha A. Martin, DSW
• Executive Director
• AIDS Action
• 1906 Sunderland Pl NW
• Washington DC 20036
• Phone [phone] x3044
• Fax [phone]
• E-mail mmartin_at_aidsaction.org

42

• Stephen Boswell, M.D.
• Executive Director
• Fenway Community Health
• 7 Haviland Street
• Boston, MA 02115
• Phone [phone]
• Fax [phone]

43

• Ernest Hopkins
• Director of Federal Affairs
• San Francisco AIDS Foundation
• 995 Market Street, Suite 200
• Phone [phone]
• Fax [phone]
• E-mail ehopkins_at_sfaf.org

44

• Gunther Freehill
• Director, Public Affairs
• Los Angeles County
• Office of AIDS Programs and Policy
• 600 South Commonwealth Avenue Sixth Floor
• Los Angeles, California 90005-4001
• Phone [phone]
• Fax [phone]
• E-mail gfreehill_at_ladhs.org

45

• William McColl
• Political Director
• AIDS Action
• 1906 Sunderland Pl NW
• Washington DC 20036
• Phone [phone] x3096
• Fax [phone]
• E-mail wmccoll_at_aidsaction.org