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					                       Ryan White CARE Act Reauthorization
                                   Fact Sheet
                                  June 14, 2006

This fact sheet is intended to update anyone interested on how the CARE Act reauthorization is
proceeding with simple facts and information about where we are in the process and what to
expect. This fact sheet will be updated and distributed roughly once a month until the CARE Act
is reauthorized.

Congressional Update
    In May, the Congressional workgroup finally finished its bi-partisan, bi-cameral process
      of drafting reauthorization legislation. The workgroup had been made up of key staff of
      the Senate HELP and House E&C Committees.* Their intent is to file the same bill in
      both the House and the Senate, averting any conference committee to settle differences
      between the two in order to get reauthorization done this summer.
    On May 9th, the Committees** released an outline of their proposed legislation and met
      with community stakeholders to explain their proposal and respond to questions and
      concerns from the community. A draft bill was released the next day.
    On May 10th, the Congressional Black Caucus sent a letter to the authors of the bill
      asking that the portion of the Minority AIDS Initiative (MAI) in the CARE Act be
      codified as a separate Title of the CARE Act.
    On May 17th, the Senate HELP Committee “marked up” the bill and filed it as S. 2823 –
      “The Ryan White HIV/AIDS Treatment Modernization Act of 2006”. A “mark up” is a
      meeting to review and approve a bill. The vote was 19-1. Senator Hillary Clinton (D-NY)
      voted against the bill due to her concerns about possible New York State losses of
      funding under the proposal.
    On May 19th, the bi-cameral, bi-partisan panel held another feedback session with the
      community to answer questions publicly on the draft bill that was released.
    Fulfilling a promise to the HIV community, the House E&C Committee held an off-the-
      record “hearing” on May 24th. At the session, Members of the Committee made
      statements about the bill and asked questions of specific stakeholders on various parts of
      the legislation.
    The House E&C Committee is expected to “mark up” its version of the bill sometime in
      June. If it’s at all different from the Senate bill then a conference committee of a few
      delegates from each the House and Senate will hammer out a compromise. The
      conferenced bill will then have to go back to the floor of both the House and the Senate
      for their final vote.

Major changes to the CARE Act in S. 2823
    The information below is based on the bill that passed out of Senate HELP. You can read
       a side-by-side analysis of the bill, which compares current law to the proposed
       reauthorization legislation at
       http://64.177.16.246/web//images/stories/pdfs/rw_sen__help_sbys_update.PDF.
    Three Tiers in Title I
            o Title I funds metropolitan areas that have been heavily impacted by HIV/AIDS
                (currently called “Eligible Metropolitan Areas” or EMAs)
            o Eligibility requirements to be a Title I funded area will expand. This will increase
                the number of Title I jurisdictions.
            o Three “tiers” will be created in Title I. The tier an area falls into will depend on
                its living AIDS cases reported in the last five years.
            o Tier one jurisdictions have 2,000 living AIDS cases reported in the previous five
                years.
            o Tier two jurisdictions have between 1,000 to 1,999 living AIDS cases reported in
                the previous five years. Tier two will also contain current “grandfathered”
           EMAs, which are those that have stopped meeting eligibility requirements, but
           remained EMAs. The grandfathered areas will stay in Tier two for three years.
           After that, their status will be based on their living AIDS counts.
       o Tier three jurisdictions have between 500 and 999 living AIDS cases in the
           previous five years.
   Hold Harmless
       o The “hold harmless” provision, which protected Title I EMAs and states from
           being cut more than a certain percentage from year to year, is being phased out.
       o Hold harmless will remain for the next three years for Tier One jurisdictions in
           Title I and for states (Title II funding). After three years, there will be no more
           hold harmless
   Funding Formula Changes
       o The way money is distributed through Title I and Title II would change under the
           new legislation.
       o For Tiers one and two of Title I, funding will be distributed based on two-thirds
           formula and one-third supplemental grant. Currently, Title I funds are distributed
           based on 50 percent formula and 50 percent supplemental.
       o All Tier three funding in Title I will be distributed based on formula.
       o Title I formula will be based on both living HIV and AIDS cases. Areas that are
           transitioning to a newer HIV reporting system will have a “proxy” of .9 times the
           number of AIDS cases until they have a complete data set.
   Mandatory Spending on “Core Medical Services”
       o 75% of all Ryan White CARE Act funding (except for Title IV) must be spent on
           “Core Medical Services”. The remaining 25% may be used for “support services
           needed to achieve medical outcomes.”
       o Core Medical Services would be defined as:
              outpatient and ambulatory                home health care;
               health services                          home and community-based health
              pharmaceuticals                         services
              oral health                              hospice services
              early intervention services              mental health services
              health insurance                         outpatient substance abuse care
               premiums and cost-                       medical case management, including
               sharing assistance for                  treatment adherence services.
               low-income people;
       o The 75% requirement shall be waived by the Secretary of Health and Human
           Services if the grantee can show that core medical services are available to all
           people living with HIV/AIDS, and that there is no AIDS Drug Assistance
           Program waiting list in the area.
   Addressing the AIDS Drug Assistance Program (ADAP) Crisis
       o Each state will be required to provide a minimum list of antiretroviral drugs
           (ARVs) to be determined by HHS.
       o The amount of money set aside from ADAP funding for supplemental grants will
           increase from 3% to 5%. Supplemental grants give extra money to states that are
           having problems providing ADAP services to everyone who needs them.
       o There is a recommended one-time $40 million “ADAP booster”. This is money
           that would go to the Secretary of Health and Human Services to use at his
           discretion to help states that are struggling with their ADAPs.
    Funding Levels
        The legislation authorizes funding levels for all Titles and Parts of the CARE
           Act. These are recommendations of how much money should be allocated to
           each section of the CARE Act per year in the appropriations process.
           Appropriators are not supposed to fund programs higher than authorized levels,
           although there are cases where this happens. Under S. 2823:
                       Title I funding would be increased by $10 million to absorb the existing
                        Emerging Communities that would move to Title I.
                       Title II funding would be increased by $30 million in FY07, with $10
                        million of the funds for a new supplemental grant pool
                       Titles I, II, III can receive an annual funding increase of 3.7 percent,
                        although ADAP could not receive any increase in FY07.
                       Title IV, AIDS Education and Training Centers and the Dental Program
                        would be flat funded over the next five years.
Other updates

On April 25th, the Communities Advocating Emergency AIDS Relief (CAEAR) Coalition
released an analysis of how much CARE Act funding each state receives per person living with
AIDS. The analysis factors in funding from all Titles and components of the CARE Act. You can
read it at http://www.caear.org/coalition/pdf/CAEAR_Funding_Analysis.pdf

On June 5th, members of the Senate HELP and House E&C Committees received a letter signed
by over 50 local, state and national HIV/AIDS organizations urging them to increase the very low
authorizing levels contained in S. 2823. The groups wrote, “The modest increases that were
included (on average 3.7 % or flat funding, depending on the Title) are not nearly enough to keep
pace with the increases in health care costs alone, much less the increasing prevalence of
HIV/AIDS in the United States and the growing need for Ryan White CARE Act Services.” The
letter was drafted and circulated by the Ryan White Reauthorization Workgroup of FAPP. For a
copy of the letter go to: http://64.177.16.246/web/images/stories/pdfs/rwhatma_letter.pdf.pdf

This fact sheet was produced by the Ryan White Reauthorization Workgroup of the Federal AIDS
Policy Partnership (FAPP). Please adapt this form in any way you deem fit to send to your
membership.

    * To do all of the business before it, Congress divides up its work by committee, in which
    only a fraction of the members are involved. On the Senate side, the Health, Education,
    Labor & Pensions (HELP) Committee is in charge of re-writing the Ryan White CARE Act.
    On the House side, it is the Energy & Commerce (E&C) Committee, which has a
    subcommittee on health.

    ** The Congressional workgroup drafting Ryan White legislations was led by the staff
    members of the top Republican (Chair) and top Democrat (Ranking Member) of the Senate
    and the House: Senators Mike Enzi (R-WY) and Edward Kennedy (D-MA) and
    Representatives Joe Barton (R-TX) and John Dingell (D-MI)


For questions on this Fact Sheet or on the Federal AIDS Policy Partnership Ryan White
Reauthorization Workgroup, please contact any of the three co-chairs:

Ryan Clary, Project Inform                              rclary@projectinform.org
Carl Schmid, The AIDS Institute                         cschmid@theaidsinstitute.org
Greg Smiley, American Academy of HIV Medicine:          greg@aahivm.org

				
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