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B of the Ryan
White HIV/AIDS Treatment Modernization
Act of 2006 provides grants to all
50 States, the District of Columbia,
Puerto Rico, Guam, the U.S. Virgin Islands,
and five U.S. Pacific Territories or
Associated Jurisdictions. Part B grants
include a base grant, the AIDS Drug
Assistance Program (ADAP) award, ADAP
Supplemental grants and grants to States
for Emerging Communities-those reporting
between 500 and 999 cumulative reported
AIDS cases over the most recent 5 years.
All funding is distributed via formula
and other criteria. |
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| FUNDING |
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Part
B funds may be used to fund 75% core
medical services which include: outpatient
and ambulatory health services, ADAP,
AIDS pharmaceutical assistance, oral
health care, early intervention services,
health insurance premium and cost
sharing assistance, home health care,
medical nutrition therapy, hospice
care, community-based health services,
substance abuse outpatient care, medical
case management, include treatment
adherence services.
The
remaining 25% must fund support services
that are needed for individuals with
HIV/AIDS to achieve their medical
outcomes (such as respite care for
persons caring for persons caring
for individuals with HIV/AIDS, outreach
services, medical transportation,
linguistic services, and referrals
for health care and support services.
In
FY07, a total of $1.195 billion was
appropriated to Part B programs, of
which $789,546 million was earmarked
for ADAP. Read more about the ADAP
Program below.
- Base
Part B grants are awarded to States
and Territories using a formula
that, based on living cases of HIV/AIDS
reported data. Also States with
more than 1% of total AIDS cases
reported in the United States during
the previous 2 years must provide
matching funds with their own resources
using a formula outlined in the
legislation.
- Additional
Part B funds are "earmarked"
for ADAP, which primarily provide
medications. Fundable services also
include treatment adherence and
support as well as health insurance
coverage with prescription drug
benefits. 5% of the ADAP earmark
is reserved for grants to States
and Territories that have a severe
need for medication assistance.
- A
new Supplemental competitive programs
is now available to States and Territories
based on demonstrated need criteria.
This program has not been funded
to date.
- Part
B provides $5.0 million in supplemental
grants to States for Emerging Communities-cities
with between 500 and 999 reported
AIDS cases in the most recent 5
years.
- Part
B provides a competitive grant of
$7 million for the Minority
AIDS Initiative to provide education
and outreach services to increase
the number of eligible racial and
ethnic minorities who have access
to treatment through Part B.
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| PROVIDERS |
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Part B providers may include public
or nonprofit entities. For-profit entities
are eligible only if they are the sole
available providers of quality HIV care
in the area.
Most
States provide some services directly,
but others work through subcontracts
with Part B HIV Care Consortia. A
consortium is an association of public
and nonprofit health care and support
service providers and community-based
organizations that plans, develops,
and delivers services for people living
with HIV disease. Services provided
through a consortium is considered
support services.
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AIDS
DRUG ASSISTANCE PROGRAM (ADAP)
The
ADAP provides medications for the
treatment of HIV disease. Program
funds may also be used to purchase
health insurance for eligible clients
and for services that enhance access
to, adherence to, and monitoring of
drug treatments.
Funding
- Grants
are awarded to all 50 States, the
District of Columbia, Puerto Rico,
Guam, the U.S. Virgin Islands, and
the Pacific jurisdictions
- Congress
"earmarks" funds that
must be used for the ADAP, an important
distinction because other Part B
spending decisions are made locally.
The ADAP earmark grew from $52 million
in 1996 to $789,005 million in 2006
and $789,546 million in 2007. In
FY08 the appropriation is $808,500
million. However, total ADAP spending
is even higher, because State ADAPs
also receive money from their respective
States, from other Ryan White HIV/AIDS
Program compenents, and through
cost-saving strategies.
- A
formula based on the most recent
calendar year of living HIV/AIDS
cases is used to award ADAP funds
to States and Territories. However,
5% of the total earmark is reserved
for supplemental grants to States
and Territories with demonstrated
severe need that prevents them from
providing medications consistent
with Public Health Service guidelines.
In previous years, estimated living
cases of AIDS was used in determining
the formula and 3% was reserved
for supplemental grants.
Implementation
The
ADAP in each State and Territory is
unique in that it decides which medications
will be included in its formulary
and how those medications will be
distributed. New legislation requires
that each State/Territory establish
of a list of drug classes under which
ADAPs must provide therapeutics.
- Many
States and Territories provide medications
through a pharmacy reimbursement
model. Patients show enrollment
cards at participating pharmacies
to receive their medications, and
the pharmacy invoices the ADAP for
payment.
- Some
ADAPs use pharmacies located within
public health clinics to distribute
drugs.
- A
few ADAPs purchase drugs and mail
them to clients directly.
Eligibility
Each
State and Territory establishes its
own eligibility criteria. However,
all States/Territories are required
to implement an ADAP recertification
process every six months to ensure
only eligible clients are served.
All require that program participants
document their HIV status.
Increasing
Demand
Pressure
on ADAP resources has increased substantially.
- Highly
active antiretroviral therapy (HAART)
is the standard of care for the
majority of people living with HIV
disease. Its cost may be $12,000
or more per year, in addition to
the costs of addressing opportunistic
infections, side effects, and other
treatment issues.
- AIDS
mortality has decreased dramatically
in the United States since 1995,
and HIV incidence remains constant
at approximately 40,000 new infections
annually. Therefore, the total number
of people living with HIV disease
continues to climb.
- The
epidemic is growing rapidly among
minorities, who have historically
experienced higher risk for poverty,
lack of health insurance, comorbidity,
and disenfranchisement from the
health care system. The result is
a growing number of people living
with HIV disease who require public
support.
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