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Ryan White Care Act Reauthorized;
Conference Report Passes House & Senate;
Resolution On HIV Testing For Pregnant Women & Funding Formulas Included

May 3, 1996

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

After months of negotiations, the Ryan White CARE Act Reauthorization bill is done. The House approved the final bill (S. 641) last night, 402 - 4. The 4 votes in oppostion were; Funderburk (R-NC), Istook (R-OK), Scarborough (R-FL) and Stump (R-AZ). The Senate passed the bill today by unanimous consent. As you know, two of the most contentious issues during negotiations on S. 641 were the HIV testing provision for pregnant women and infants and revisions in funding formulas for the Titles I & II. The following is a summary of these provisions and other highlights. A more detailed summary will soon be available.

** Title I Provisions **


  • Distributes funds based on a 10-year weighted case count -- roughly equivalent to a 2-year living AIDS case count.
  • Does not include the Medicare Wage Index as a measure of the cost of services in different jurisdiction.
  • No existing Title I EMA will lose more than 5% of its existing funding phased in over a 5 year period.
  • Uses Supplemental grants to ensure that losses to Title I EMA's do not exceed the 5% cap.

To avoid conflict of interest Title I Planning Councils are:

  • Prohibited from selecting subgrantees, but they can make recommendations on how priorities are to be met.
  • Required to have in place conflict of interest standards for its members.
  • Prohibited from being chaired solely by the grantee or an employee of the grantee.

Grievance Procedures

  • Planning Councils must develop policies (to be reviewed by HRSA and included in the grantees application for Title I funds) for resolving disputes, responding to grievances, and minimizing and managing conflicts of interests.
  • The HHS Secretary must develop, involving grantees and outside experts, models for grievance procedures.

** Title II Provisions **


  • Distributes funds based on a 10-year weighted case count -- roughly equivalent to a 2-year living AIDS case count. 80% of funds are distributed based on total state AIDS case count and the remaining 20% is distributed based on AIDS cases reported outside of the state's EMA.
  • No state will lose more than 5% of its existing Title II funding phased in over a 5 year period.
  • Increases the minimum grant to states with 90 or more cases from $100,000 to $250,000. The minimum for states with less than 90 cases is $100,000.
  • Distributes funds recently appropriated for the AIDS Drug Assistance Program based on total state AIDS case counts.

Use of Funds

  • The 50% consortia requirement for states having more than 1% of the total AIDS cases is eliminated.

Access to Drugs

  • Requires the HHS Secretary to review the current status of state drug reimbursement programs and assess barriers to the expanded availability of HIV-related drugs and to require states to document the progress made in making those treatments available.

** Title I And II Provisions **

Administrative Costs

  • Defined as routine grant administration and monitoring activities including the development of grant applications, the receipt and disbursal of program funds, the development and establishment of reimbursement and accounting systems, the preparation of routine programmatic and financial reports, and compliance with grant conditions and audit requirements; and all activities associated with the grantees contract award procedures, including the development of requests for proposals, contract proposal review activities, negotiation and awarding of contracts, monitoring of contract through telephone consultation, written documentation of onsite visits, reporting on contracts, and funding reallocation activities.
  • Grantees: There was no change in administrative cost limits for Title I grantees, they are maintained at 10%. Title II administrative costs are capped at 10%. In addition, there is a new 10% cap on planning and evaluation activities for Title II grantees. Total spending on administration, planning, and evaluation cannot exceed 15% under Title II.
  • Subgrantees: Administrative costs for Title I and II subgrantees are capped at 10%. This cap is an aggregate cap on total funds distributed to all subgrantees. This means that an individual subgrantee is not limited by the 10% cap. However, the total amount spent on administrative costs by all subgrantees may not exceed 10% of the total amount awarded to all subgrantees by the grantee.

** Women, Infants And Children Set-asides **

  • Title I and Title II grantees are required to utilize a portion of their funds equal to the ratio of women, infants, and children with AIDS to the entire population with AIDS to provide health and support services to women, infants and children. These services may include but are not limited to treatments to prevent the perinatal transmission of HIV.

** Title V Provisions (a new title) **

  • Special Projects of National Significance (SPNS) is moved from Title II into the new Title V. It will be funded through a 3% tap on Titles I - IV. Newly eligible for SPNS grants are programs that provide critical care services and/or build organizational capacity in underserved communities, and programs that ensure the ongoing availability of HIV care to Native American communities.
  • The AIDS Education and Training Center (AETC) program and AIDS Dental Reimbursement Program are included as components of the new Title V. The AETC's & Dental Programs are funded as separate programs in Title V.

** HIV Testing Provision For Pregnant Women And Infants **

  • Although conferees worked to shift emphasis to voluntary counseling and testing, and to ensure that provisions to reduce perinatal HIV transmission could be satisfied without ever requiring states to enact mandatory testing laws, our fear is that state legislatures will view these provisions as encouraging mandatory testing and will enact testing laws to protect themselves against the loss of Title II dollars.
  • Authorizes $10 million to assist states, who have adopted CDC guidelines, in implementing these guidelines which call for voluntary HIV counseling, testing and treatment for pregnant women. Funds may be used for HIV counseling, outreach to pregnant women not in prenatal care, voluntary testing, offsetting state costs related to determining HIV perinatal transmission rates and identifying the causes of perinatal transmission. In addition, and of concern, these funds may be used to offset the costs associated with the implementation of mandatory newborn testing.
  • By September, 1996, the CDC, in consultation with states must develop and implement a system for states to collect data related to perinatal transmission and to document reduction in transmission.
  • The Institute of Medicine under contract with HHS will evaluate how effective states have been in reducing HIV perinatal transmission and will analyze barriers to further reduction in transmission rates. By May, 1998, the HHS Secretary shall report these findings to Congress along with recommendations from the Institute of Medicine.
  • By September, 1998, the HHS Secretary shall make a determination, in consultation with states, national groups and other experts, of whether mandatory testing of newborns whose mothers have not been HIV-tested has become routine practice in the U.S.
  • If the HHS Secretary determines that mandatory infant testing has become routine practice, states have 18 months (until March, 2,000) in which to demonstrate one of the following or lose its Title II funding:
    1. 50 percent reduction (or a comparable measure for states with less than 10 cases) in the rate of new AIDS cases resulting from perinatal transmission comparing most recent data to 1993 data; 2) at least 95 per cent of women who have received at least 2 prenatal visits prior to 34 weeks gestation have been tested for HIV; 3) a program of mandatory testing of all newborns whose mothers have not undergone prenatal HIV testing.

** Spousal Notification (Helms amendment) **

  • The HHS Secretary cannot give any state a Title II grant unless the state requires a good faith effort to notify the spouse of a known HIV-infected patient that he or she may have been exposed to HIV and should seek testing. The definition of "spouse" in this provision is any current marriage partner or former marriage partner at any time within the ten years prior to the diagnosis of HIV infection.

For more information, contact:
Tracy Mickens, Director of Community Outreach
AIDS Action Council
1875 Connecticut Avenue NW #700
Washington DC 20009
202-986-1345 (fax)
202-332-9614 (tty)

A note from The field of medicine is constantly evolving. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

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This article was provided by AIDS Action Council.
See Also
Purpose of the CARE Act
Guiding Principles for CARE Act Programs
More News on the Ryan White CARE Act