Understanding the Ryan White CARE Act
Directly Affecting the Quality of HIV Medical Care
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, last reauthorized in 2000, is currently set to expire in September 2005. Nearly 50 percent of the Academy's members receive Ryan White CARE Act funding. We need your input on how we can advocate for enacting the best possible CARE Act in 2005. Congressional debates on reauthorization will directly affect the quality of care we are able to deliver to our patients with HIV disease.
Background of the CARE ActThe CARE Act makes funds available to cities and states to provide health care and supportive services to uninsured and underinsured individuals living with HIV/AIDS in the United States. First passed in 1990, the Act was reauthorized in 1996 and again in 2000, and it is currently set to expire September 30, 2005. Appropriations for the CARE Act topped $2 billion in fiscal year 2004, with nearly $750 million of that going directly to the AIDS Drug Assistance Program (ADAP). The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services administers the program.
Nearly all of that $2 billion is funneled through the following four major channels (with FY'04 totals):
In addition to titled programs, several Ryan White CARE Act programs for training and innovation are funded outside of the four major titles:
As We Approach Reauthorization
Measuring Quality of CareWith the last reauthorization in 2000, Congress requested some outside evaluations of the CARE Act to help inform its approach to potential alterations in the act in 2005. To fulfill that mandate, the Institutes of Medicine (IOM) released the first of two reports last November. The first report, "Measuring What Matters: Allocation, Planning and Quality Assessment for the Ryan White CARE Act," set some basic recommendations for measuring the quality of care under Ryan White. In this report, the IOM recommended:
A second, more comprehensive report is expected from the IOM in late April 2004, titled "Ryan White CARE Act: Data for Resource Allocation, Planning, and Evaluation."
Themes for Debate: We Need Your InputCertain themes have already emerged in discussions among federal advocacy groups, Congress, and the Bush administration regarding what we might expect in Congressional debate. Advocates are pre-paring to see some discussion regarding:
Many HIV medical providers are voicing their opinions on how the CARE Act should be improved. In February, HIV care providers concerned about Ryan White reauthorization met at the 11th Conference on Retroviruses and Opportunistic Infections in San Francisco to discuss these and other issues. Concern for the potential effects of the CARE Act renewal on the quality of HIV care has inspired many providers to share their thoughts. Now we must translate that into action.
The American Academy of HIV Medicine is working hard to advocate for the best CARE Act possible in 2005. We need your input on how we should proceed. To voice your opinion, or to volunteer for the ad hoc Ryan White Reauthorization Subcommittee, please contact the AAHIVM Federal Policy Analyst, Greg Smiley, at firstname.lastname@example.org.
This article was provided by American Academy of HIV Medicine. It is a part of the publication The Nexus.