Federal Policy

The following is a summary of some of the most pressing current federal issues affecting people living with or at risk of contracting HIV/AIDS. APLA’s Government Affairs Division is engaged in many of these policy initiatives. The Division also provides background, research and other valuable educational resources to elected officials regarding these and other issues of importance to the HIV/AIDS community.

Policy at the Federal Level

● Implementation of the Ryan White HIV/AIDS Treatment Modernization Act of 2006.

The Ryan White CARE Act of 1990 is the primary source of care, treatment and support services for the estimated 550,000 low income, un-insured and under-insured persons living with HIV/AIDS in the United States. Treatment programs, medications and services funded by the CARE Act are essential for those without means. On December 19, 2006, President Bush signed the Ryan White HIV/AIDS Treatment Modernization Act of 2006, legislation that re-authorized the CARE Act through September 30, 2009.

► Ryan White HIV/AIDS Treatment Modernization Act of 2006.

The New Federal Law

Ryan White Program Home Page (HRSA)

► Summary of Major Ryan White Program Changes.

Treatment Modernization Act of 2006: At-a-Glance

The new legislation mandates significant changes to many Ryan White CARE Act programs. These changes will impact resources and other vital support to persons living with HIV/AIDS. Together with our state and national coalition partners, APLA is actively working with federal, state and local agencies that administer CARE Act funding to ensure fair and appropriate implementation of the new CARE Act provisions.

Of particular concern are four specific implementation issues. APLA and other members of the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition presented these concerns to the Health Resources and Services Administration (HRSA), the federal agency charged with administering the CARE Act.

Primary concerns are: (a) that HRSA maintain residential substance abuse treatment as an allowable support service; (b) that HRSA implement a definition of “medical case management” that will broadly capture all aspects of case management services under the “core medical services” category of allowable spending; (c) that HRSA develop a robust list of “support services” which satisfy the legislative criterion that allowable services be those “needed for individuals with HIV/AIDS to achieve their medical outcomes”; and (d) that the agency increase communications to ensure improved HRSA guidance and responsiveness to CARE Act grantees, planning councils and service organizations.

Click on the link below to read the complete text of the Coalition’s implementation letter, which was signed by more than 100 national CAEAR Coalition member organizations.

► Coalition Implementation Letter to HHS Secretary Leavitt

Soon after we submitted the CAEAR Coalition’s implementation letter to Secretary Leavitt, HRSA issued a policy response and a revised Part A and Part B Fundable Program Services List addressing the issues we outlined. The revised Service List contains a new definition for Medical Case Management as a Core Medical Service that broadly captures most aspects of case management services. This new definition should enable most jurisdictions to include a broad range of case management activities as Core Medical for purposes of meeting the new requirement that at least 75% of CARE Act funds be spent on Core Medical services. In addition, HRSA now specifically includes residential substance abuse treatment as a fundable support service. Finally, HRSA’s new revision includes a robust list of enumerated support services that the agency will fund, thus providing more flexibility and guidance to local jurisdictions.

● Life and Policy After the Ryan White CARE Act: Designing a National Strategy for HIV Prevention, Care and Treatment in 2009 & Beyond.

Unlike prior five-year reauthorizations of the CARE Act, Congress chose to extend the Ryan White program authorization for only three years. Thus, the CARE Act sunsets on September 30, 2009. APLA is working actively within the Los Angeles County Commission on HIV and with other groups of local, state and national community advocates to begin crafting recommendations for a new federal legislative approach to HIV/AIDS prevention, care and treatment after the Act expires.

APLA is participating in a special post-Ryan White CARE Act planning taskforce of the Los Angeles County Commission on HIV. Nationally, CARE Act planning is moving forward with three consumer institutes tentatively called “Surviving Beyond Ryan White” to be conducted at the Staying Alive Conference in Cleveland, Ohio (August, 2007); the South Carolina STD Conference (October, 2007); and the U.S. Conference on AIDS in Palm Springs, California (November, 2007).

● Some of the federal legislation APLA is supporting or tracking:

(a) Early Treatment of HIV Act (ETHA) [S. 860 (Clinton – NY) (Smith – OR)]. As proposed, the bill would provide federal incentives to states that expand access to Medicaid-funded care and treatment for non-AIDS-diagnosed persons living with HIV. A companion bill, H.R. 3326, was introduced in the House of Representatives on August 2, 2007, with 54 original co-sponsors comprised equally of Members from both parties.

► Text of S. 860

(b) Justice Act of 2007 [HR 178 (Lee – CA)]. This legislation would require federal prisons to conduct a system-wide survey and provide comprehensive sex education and screening for sexually transmitted diseases. It would also authorize condom distribution by community-based organizations in federal prisons and permit inmates to have condoms without retribution.

► Text of H.R. 178

(c) Stop AIDS in Prison Act of 2007 [HR 1943 (Waters – CA)]. Would require the Federal Bureau of Prisons to develop a comprehensive policy to provide HIV testing, treatment and prevention for inmates in correctional settings.

► Text of H.R. 1943

(d) Protection Against Transmission of HIV for Women & Youth (PATHWAY) Act of 2007 [HR 1713 (Lee – CA)]. This legislation would establish a comprehensive and integrated HIV prevention strategy aimed at addressing the vulnerabilities of women and girls in recipient countries. It also proposes to strike the abstinence-until-marriage earmark.

► Text of H.R. 1713

(e) Routine HIV/AIDS Screening Coverage Act of 2007 [HR 822 (Waters – CA)]. Among other reforms, the bill would require individual, group health insurance plans and federal employee health benefit plans to provide coverage for routine HIV testing under the same terms and conditions that they allow for coverage of other routine health screening procedures.

► Text of H.R. 822

(f) Section 8 Voucher Reform Act of 2007 [HR 1851 (Waters – CA)]. Seeking to improve program efficiency and expand access, the legislation would change property inspection requirements, amend income eligibility standards and adjust voucher renewal funding, among other program performance-related reforms.

► Text of H.R. 1851

(g) Microbicide Development Act of 2007 [HR 1420 (Schakowski – IL)]. This bill would amend the Public Health Service Act with respect to facilitating the development of microbicides for preventing transmission of HIV/AIDS and other diseases.

► Text of H.R. 1420

(h) Helping Fill the Medicare Rx Gap Act of 2007 [HR 2058 (Holt – NJ) & S. 1103 (Bingaman – NM)]. Designed to improve Medicare Part D prescription coverage benefits, the bill would include costs incurred by an AIDS drug assistance program (ADAP), certain hospitals, the Indian Health Service (a federally qualified health center) or a pharmaceutical manufacturer patient-assistance program in providing prescription drugs to a patient beneficiary toward the “true out of pocket (TrOOP)” costs under Medicare Part D.

► Text of H.R. 2058

(i) Federal After Care Act of 2007 [HR 2554 (Watson – CA)]: Amends the federal criminal code to require: (1) the Attorney General to provide for the testing of prisoners about to be released from a federal facility for the human immunodeficiency virus; and (2) courts to order defendants testing positive for the virus to accept HIV/AIDS treatment as a condition of supervised release and to notify any prospective sexual partner of HIV/AIDS status. Requires the Attorney General and the Secretary of Health and Human Services to establish and maintain a program for HIV/AIDS treatment of prisoners for two years after release by the Bureau of Prisons. Prohibits individuals receiving HIV/AIDS medication, including antiretrovirals, through a federal program from selling or trading such medication.

► Text of H.R. 2554

(j) Budget Issues: Congress will be making key budget decisions on all elements of the national portfolio of HIV/AIDS prevention, care, and treatment programs. Of special interest:

(1) HOPWA budget increase
(2) PEPFAR re-authorization
(3) Ryan White Appropriations
(4) Minority AIDS Initiative
(5) NIH (National Institutes of Health) and CDC (Centers for Disease Control and Prevention) funding.

● National Advocacy Coalitions

APLA works with several national HIV/AIDS advocacy coalitions to develop and advance effective public policy on the national level. Among the many different organizations with which we partner are:

● AIDS Action Council
● Communities Advocating Emergency AIDS Relief (CAEAR) Coalition
● National AIDS Housing Coalition
● National Association of People with AIDS
● National Minority AIDS Counci
● The ADAP Working Group

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