Ryan White HIV/AIDS Program, Part A Emergency Relief Grants

Authorizing Legislation: Title XXVI, Sections 2601-2610 of the Public Health Service Act, as amended.

Program Description and Accomplishments
Part A of the Ryan White HIV/AIDS Program prioritizes primary medical care, access to anti-retroviral therapies, and medical case management as the areas of greatest need for persons with HIV disease. Part A funds may be used to provide a continuum of care for people living with HIV disease who are primarily low income, underserved, uninsured and underinsured. The grants fund systems of care to provide 13 core medical services and other additional support services for individuals with HIV/AIDS in 22 Eligible Metropolitan Areas (EMAs), which are jurisdictions with over 2,000 living AIDS cases over the last five years and 34 transitional grant areas (TGAs) (jurisdictions with between 1,000 and 2,000 living AIDS cases over the last five years). Two-thirds of the funds available are awarded according to a formula based on the number of living cases of HIV/AIDS in the EMAs and TGAs. The statute also includes a hold harmless provision which limits a potential loss in EMA’s formula award to a specific percentage of the amount of the award in the previous year. The remaining funds, less any hold harmless amounts, are awarded as discretionary supplemental grants based on the demonstration of additional need by the EMAs and TGAs and as competitive Minority AIDS Initiative grants.

More than 70 percent of all people living with HIV/AIDS in the U.S. reside in a metropolitan area served by Part A. Part A serves an estimated 300,000 people living with HIV/AIDS each year. Seventy-five percent of Part A clients are people of color and 30 percent are women. In 2004 Part A provided 3.11 million visits for health-related care (primary medical, dental, mental health, substance abuse, rehabilitative, and home health) and 3.18 million visits were provided in 2005. In FY 2006, 2.47 million visits were provided by 51 Part A grantees. This number is 440,000 below the 2006 target. The decrease in visits for FY 2005 and FY 2006 is may be a result of the decline in Ryan White HIV/AIDS Program resources available for funding service provision, which resulted in fewer PART A providers and clients, and the impact of healthcare inflation.

Cervical Intraepithelial Neoplasia (CIN) refers to cellular changes in the cervix, thought to be precursors of cervical cancer that can be detected with PAP screening. Researchers conclude that HIV+ women are three times as likely as HIV negative women to have CIN. Part A has continued to increase the proportion of women that receive PAP screening. In 2005, 38% of women received PAP screening and in 2004 35.8% of women received such screening. In FY 2006, the Part A program provided 40.8% of women served with PAP screening. This fell short of the target by 6.6 percentage points.

Latent TB is much more likely to become active TB in someone who is HIV infected. This is because HIV weakens the immune system, allowing TB to flourish. The CDC recommends HIV-infected persons get tested for TB, with a TB Skin Test (TST). The Part A program provided TB skin tests to 28% of clients in 2004, and 54% of client in 2005. In FY 2006, the Part A program provided 52.5% of clients with TB skin tests. This exceeded the target by 18.5 percentage points.

Program Assessment Rating Tool: Part A was included in the combined PART reassessment conducted in 2007 for the Ryan White HIV/AIDS Program. The Program received an Effective rating. See Summary of Request for more details.

External Evaluation: Part A is regularly evaluated by independent entities, such as Office of the Inspector General and Government Accountability Office. In the past year an OIG Audit was conducted entitled “Review of the Management of Unobligated Funds Provided by Part A of the Ryan White Comprehensive AIDS Resources Emergency Act” (A-02-03-02006) (Final Report - February 2007). The findings of these Audits indicated that HRSA did not always comply with Departmental policy that limit the carryover of unobligated grant balances to the next budget year only. These funds were originally awarded to provide services during a specific budget year but were carried over for use in subsequent budget periods. Departmental policy guidance issued after the audit period now permits the carryover of unobligated grant funds into either of the next two budget periods. HAB has taken appropriate steps and follows current Departmental policy regarding the approval of carryover requests from Part A grantees.

The GAO conducted an evaluation in the past year entitled “Impact of Legislative Funding Proposal on Urban Areas” (GAO-08-137R) (Final Report - October 2007). The Legislative Funding Proposal found that prior to the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (enacted December 19, 2006), the Part A funding amounts were evenly split between formula and supplemental grants. The new legislation changed the distribution such that two-thirds of Part A funds are distributed as formula grants and one-third as supplemental grants. The findings showed how the proposed hold-harmless provision from H.R. 3043 would impact funding for urban areas under the proposed funding levels.

Funding includes costs associated with grant reviews, processing of grants through the Grants Administration Tracking and Evaluation System (GATES) and HRSA’s electronic handbook, and follow-up performance reviews.

Funding History

Excludes comparable amounts for SPNS

Budget Request
The FY 2009 Request of $619,424,000 is $7,725,000 below the FY 2008 Enacted level but does support authorized program activities and services in the 22 Eligible Metropolitan Areas and 34 Transition Grant Areas.

The FY 2009 target for the number of visits for health-related care (primary medical, dental, mental health, substance abuse, rehabilitative, and home health) to the level that approximates inclusion of new clients is set at 2.44 million visits. The proportion of women that receive PAP screening has a FY 2009 target 45.9% (baseline plus 1.5%). The FY 2009 target for the proportion of clients that receive TB skin test will be to sustain the FY 2008 result. Part A funding will also contribute to achieving the FY 2009 targets for the Ryan White Program’s over-arching performance measures, including proportion of racial/ethnic minorities and women served, persons tested for CD4 count and viral load, and providers implementing a quality management program. (See Summary of Request for targets and for strategies and challenges.)

Notes:
a This FY 2008 target was changed from that shown in the FY 2008 Congressional Justification to be consistent with recent performance.

FY 2007 Ryan White HIV/AIDS Treatment Modernization Act of 2006
Part A - Formula & Supplemental Grants