So many things have changed since that first authorization in 1990. Last authorized in 2006, the Act now known as the Ryan White HIV/AIDS Treatment Modernization Act of 2006 continues to be the single most important part of HIV care in the United States. Let's look at the updated Act in preparation for reauthorization efforts that will begin in 2009.
The Legacy of Ryan WhiteBorn December 6, 1971, Ryan White was a typical Midwestern boy until he was diagnosed with HIV in the mid 1980s. Born with the blood clotting condition known as hemophilia he required regular intravenous infusions of clotting factor in order for his blood to clot properly. Unfortunately, it was those very blood clotting factors that caused his HIV infection. Soon after his diagnosis, the Kokomo, Indiana school board expelled him from school because they felt he was a health risk to other students. The school board felt that if permitted to attend classes other students would be at risk for HIV infection. What ensued was a battle he and his family fought against the school board in an effort to allow him to attend public school.
The battle in Kokomo reached a breaking point when gunshots were fired into the White home. Fearing for their safety, the family moved to nearby Cicero, Indiana, where Ryan was welcomed with open arms. The faculty, staff and townspeople were fully educated about HIV and realized that Ryan was not a risk to anyone. During his young life, Ryan and his family worked to educate the world on the true nature of HIV; to dispel the many myths associated with the disease; myths that led to prejudice against those infected. Ryan died on April 8, 1990, but his spirit has lived on in each and every HIV caregiver funded by the Congressional Act that bears his name.
Explaining the Ryan White HIV/AIDS ProgramsThe funding that is provided by the Ryan White legislation is divided into several parts, each addressing specific needs of the HIV population.
- Part A ($604 million FY 2007) - These funds are given to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) that are most severely affected by HIV/AIDS. Cities such as Detroit, Atlanta, and Chicago are examples of currently funded EMAs. Cities such as Indianapolis and Austin are examples of currently funded TGAs. To receive funding EMAs must have at least 2,000 HIV cases and a population greater than 50,000. TGAs on the other hand must have 1,000 to 1,999 cases to qualify for funding. Monies from Part A can be used for:
- outpatient and ambulatory services
- pharmaceutical assistance
- dental health
- early intervention services
- health insurance premium and cost sharing assistance for low-income individuals
- home health care
- medical nutrition therapy
- hospice services
- home and community-based health services
- mental health services
- substance abuse outpatient care
- medical case management, including treatment adherence services.
- Part B ($1.195 billion in FY 2007) - Part B funds are provided to all 50 states, Washington DC, Puerto Rico, Guam, the U.S. Virgin Islands, and U.S. Pacific Territories. The amount of funding each state receives is based on a formula that includes the number of HIV/AIDS cases in a given state. Any state that accounts for more than one percent of the total number of U.S. AIDS cases must provide matching funds to supplement the total awarded through the Ryan White Part B program. Some examples of services provided by Part B funds include:
- the AIDS Drug Assistance Program (ADAP)
- outpatient health services
- AIDS pharmaceutical assistance
- oral health care
- insurance premium assistance
- home health care
- nutrition services
- medical case management
- treatment adherence.
- Part C ($1.85 billion FY 2007) - Part C funds provided by way of grants directly to service providers including hospital outpatient clinics, free standing clinics, and HIV practices providing early intervention services and ambulatory care. Also included in Part C funding are planning grants which support organizations improving the HIV care delivery system and capacity development grants which fund efforts to expand HIV health care services in underserved, rural, or minority communities. Some of the things funded by Part C include:
- Early Intervention Services - funds the cost associated with providing direct medical care (e.g., doctors, diagnostic tests, medical and dental equipment, medical case management).
- Core Medical Services - funds costs associated with medical support services (e.g., HIV counseling, patient education, electronic medical record).
- Clinical Quality Management - can fund the cost associated with continuous quality improvement (CQI) (e.g., quality management coordination, staff training, technical assistance, data collection).
- Support Services - funds the cost associated with those things that assist patients in achieving their health outcome goals (e.g., transportation to medical appointments; staff travel to provide services; patient education materials).
- Administrative - funds those costs not directly associated with the provision of healthcare services (e.g., rent, utilities, facility support costs, office supplies, salary and fringe benefits of program management staff).
Page 2 - Parts D and F