On April 12, the Senate Health, Education, Labor, and Pensions Committee approved, by voice vote, a bill (S. 2311) that would reauthorize the Ryan White CARE Act (P.L. 101-381). The committee approved the bill after giving voice vote approval to a substitute amendment that made technical changes to the bill.
“With this reauthorization, we mark ten years through which the Ryan White CARE Act has provided needed health care and support services to HIV positive people around the country….I intend to see this bill become law this year so that the people struggling to overcome the challenges of HIV and AIDS continue to benefit from high quality medical care and access to lifesaving drugs,” stated Committee Chair James Jeffords (R-VT), sponsor of the bill.
The Ryan White CARE Act was first passed in 1990 and reauthorized by Congress in 1996. The Act provides emergency assistance to those cities with the largest number of AIDS cases. In order to qualify for funding, cities must have a population of 500,000 as well as 2,000 newly diagnosed AIDS cases in the previous five years.
Cities may use the funds to increase and improve the quality and availability of health and support services for HIV-infected individuals and their families, including outpatient services, substance abuse and mental health treatment, and drug therapy; to provide early intervention services, including HIV testing for high-risk individuals; and to hire and train health care personnel and support staff.
Under current law, funding streams for the Act are divided into five titles: Title I funds programs in cities that have been hardest hit by HIV/AIDS; Title II funds efforts to provide health care, health insurance, and drug therapies in all 50 states; Title III funds primary care and early intervention services; Title IV funds care and support programs for women, children, and families; and Title V funds special projects of national significance. The law requires that at least 15 percent of funds provided under Title II be spent on health and support services for infants, children, women, and families.
As approved by the committee, the bill would reauthorize the program through FY2005, but it does not specify funding amounts. The legislation makes several changes to current law in an effort to provide services to a greater number of individuals and to better aid communities with the greatest need. The bill would allow Title I and II funds to be used for early intervention services. Currently, only Title III funds may be used for early intervention services.
S. 2311 also aims to focus attention on underserved rural and urban communities by providing supplemental grants under Title II to combat the spread of HIV/AIDS in “emerging communities.” Under the bill, emerging communities are defined as those areas with 1,000 to 1,999 cases of AIDS in the previous five years. Additionally, S. 2311 would create a funding preference under Title III for underserved rural areas.
In an effort to strengthen the quality of medical services under the Act, S. 2311 would establish a Quality Management Program for that purpose. Additionally, the bill would require state programs receiving funding through the Act to coordinate with Medicaid and the State Children’s Health Insurance Program.
Under current law, Title IV funds may be used for clinical research on drug therapies for infants, children, and pregnant women. Programs are required to assure “significant enrollment” of clients; however, many rural areas are unable to do so. As a result, S. 2311 would remove this requirement.
The bill also would direct the Institute of Medicine to study the Act’s funding formula and make recommendations on how grantees could improve the coordination of services.
