1. Strengthening the Circle of Care Ryan White CARE Act Reauthorization, 2005

2. Introduction Marsha Martin, DSW, AIDS Action Stephen Boswell, MD, CAEAR Coalition Ernest Hopkins, CAEAR Coalition Gunther Freehill, AIDS Action

3. CAEAR Coalition Communities Advocating Emergency AIDS Relief  National Membership Organization  Founded in 1991  Dedicated to meeting the critical needs of persons living with HIV/AIDS, through Title I and Title III of the Ryan White CARE Act.  Represents more than 400 Title I and Title III grantees, including 51 Title I EMAs, plus providers and consumers of CARE Act services.

4. AIDS Action The National Voice on AIDS  Founded in 1984  Dedicated to Sound Policies and Programs to Respond to the HIV/AIDS Epidemic  Dissemination of Information  Advocacy for Those With and Affected by HIV  Comprehensive Engagement with AIDS Portfolio  Collaborates With Public Health Community  Enhance HIV Prevention Programs  Improve HIV Care and Treatment Services  Secure Comprehensive Resources

5. Joint Policy Recommendations  Product of a Partnership Between CAEAR Coalition and AIDS Action  Emphasizes  Title I  Title III  Part F  Coordination and Collaboration  System Issues

6. Overview of Reauthorization  Maintain the CARE Act Response to Ongoing Health Emergency  Continue Existing, Effective Programs  Ensure an Appropriate Standard of Care  Respond to Changes in the HIV/AIDS Epidemics

7. CARE Act Successes Marsha Martin, DSW, AIDS Action Stephen Boswell, MD, CAEAR Coalition Ernest Hopkins, CAEAR Coalition Gunther Freehill, AIDS Action

10. Number of cases

11. Increasing Prevalence of Resistant Virus In Newly Infected Patients: Genotypic Analysis 1995-1998 1999-2000 Presence of major resistance mutations (%) Any ARVNRTIsNNRTIsPIsMDR 0 5 10 15 20 25 8.0 22.7 8.5 15.9 1.7 7.3 0.9 9.1 3.8 10.2 Little SJ, et al. N Engl J Med. 2002;347:385-394.

12. CARE Act Title I Marsha Martin, DSW, AIDS Action Stephen Boswell, MD, CAEAR Coalition Ernest Hopkins, CAEAR Coalition Gunther Freehill, AIDS Action

13. Title I  Maintain Investment in Hardest-Hit Eligible Metropolitan Areas (EMA)  Modernize Title I Formula  Living AIDS Cases, Adjusted for Reporting Delays, 2006  Living HIV/AIDS Cases, Adjusted for Reporting Delays  By 2007  Ensure Comparable and Complete Data Sets

14. Title I EMAs by Year of Eligibility

15. Title I EMA Eligibility  Current: 2,000 AIDS Cases in Five Years  Proposed (2006): 1,500 Living AIDS Cases  Proposed (2007):  Living HIV/AIDS Cases  Threshold for Cases Established by Secretary, Health and Human Services  Impact: Four or Five New Title I EMAs

16. Title I EMA Boundaries  Reflect Office of Management and Budget  Combined Statistical Area (CSA)  Metropolitan Statistical Area (MSA)  Metropolitan Division (MD)  Impact: Incorporation of Three EMAs  Bergen-Passaic, NJ – to NYC EMA  Caguas, PR – to San Juan EMA  Jersey City, NJ – to NYC EMA

17. Title IFormula Grants  Modernize Basis for Formula  Living AIDS Cases (2006)  Living HIV/AIDS Cases (2007)

18. Title IProtection Period Current Proposed First Consecutive Year2%4% Second Consecutive Year3%4% Third Consecutive Year3%4% Fourth Consecutive Year3%4% Fifth Consecutive Year4%5% MAXIMUM15%21%

19. Title ISupplemental Grants  Implement Requirement for Severe Need Indicators  Measurable  Comparable  Objective  For 2007: Use Indicators to Determine Supplemental Awards

20. Title IServices  Maintain Allowable Services  Support Local Control  Assessment of Need  Identify Alternate Payor Sources  Develop Plan for Delivery of Services  Evaluate Service Outcomes

21. Title I Planning Councils  Maintain Roles and Responsibilities  Maintain Requirement for One-Third of Members to be  Non-Aligned Consumers or  Non-Aligned Caregivers  Assess and Report on Membership Annually

22. CARE Act Title II, III, IV and F Marsha Martin, DSW, AIDS Action Stephen Boswell, MD, CAEAR Coalition Ernest Hopkins, CAEAR Coalition Gunther Freehill, AIDS Action

23. Title IIGrants to States  Maintain Program  Supports programs in all 50 states/ DC/PR/territories  Outpatient and home health care  Insurance continuation  HIV Care Consortia

24. Title IIAIDS Drug Assistance Program (ADAP)  Maintain Program  Ensure Ancillary Services  Maximize Cost Effectiveness  Identify Lowest Federal Price  Ensure Lowest Federal Price for All Grantees

25. Title IIIEarly Intervention  Increase Collaboration between the HIV/AIDS Bureau and Bureau of Primary Health Care  Provide HIV/AIDS Care Through 330 clinics and other Federally Qualified Health Centers (FQHC)  Assist Community-Based HIV/AIDS Care Providers to Qualify as 330 clinics or other FQHC  Enhance Awareness of Available Technical Assistance in the development of unique, effective service delivery models

26. Title III Early Intervention (Cont’d)  Strengthen the HIV care infrastructure  Rural Areas  Medically Underserved Areas  Collaborate with CDC on Advancing HIV Prevention Initiative  Increase Planning, Capacity Building and Service Grants  Culturally Competent Organizations  Indigenous Organizations

27. Title III Early Intervention (Cont’d)  Create Flexibility in Capacity Building Program  Require Documented Consumer Involvement

28. Title IV Women, Infants, Children and Families  Maintain Services for Vulnerable Populations  Contributes to Reduction of Perinatal Transmission

29. Part F: AIDS Education and Training Centers (AETC)  Maintain Existing Training and Education Programs  Contributes to Availability of Effective HIV Care and Treatment  Rural and Remote Areas  Areas of Emerging Need

30. Part F: Oral Health Services  Reauthorize  HIV/AIDS Dental Reimbursement Program  Community-Based Dental Partnership Program  Maintain Dental Reimbursement Program  Maintain Eligibility Criteria  Ensure Services to People with HIV  If New Funding  Add Dental Schools Where Available  Add Community Organizations If No Dental School  Support Grantee Participation in CARE Act Meetings

31. Part F: Infrastructure and Capacity Expansion Program  New Program  Modeled on Title III Capacity Building Program  Ensure Resources for  Medically Underserved Areas  High Poverty Areas  Areas with Increases in HIV/AIDS Prevalence

32. Appropriations by Proportion

33. CARE Act Funding Levels FY02-05 ProgramFY 2002FY 2003FY 2004FY 2005 Title I$619.5m$618.7m$615.02m$610.10m Title II Base$338.4m$339.1m$337.03m$334.33m Title ADAP$639.0m$714.3m$748.87m$787.52m Title III$194.3m$198.4m$197.2m$195.59m Title IV$70.99m$73.6m$73.11m$72.52m AETC$35.3m$35.6m$35.3m$35.05m Dental$13.3m$13.4m$13.3m$13.21m

34. FY 2006 Appropriations 2004 2003 2002 2001 CARE Act Funding DECREASING, except for Title II ADAP Need Continues to Increase *40,000 new HIV infections per year *Number of people living with AIDS increased 70,000 in past three years Caseloads 2005

35. Appropriations and Cases  More People Living with AIDS Than Ever Before  Among Title I Jurisdictions  Caseload Increase for FY 200414.5%  Reduced Funding Available

36. System Issues Marsha Martin, DSW, AIDS Action Stephen Boswell, MD, CAEAR Coalition Ernest Hopkins, CAEAR Coalition Gunther Freehill, AIDS Action

37. Enhance Federal Coordination  Involve Federal Grantees in HIV/AIDS Planning  SAMHSA  Veterans Administration  CMS  Resolve Conflicting Federal Guidance and Practices  Ensure Participation of State Medicaid Agency in CARE Act planning

38. Improve Accountability at HRSA  Require Annual Report from HRSA  Evaluation (2%)  Technical Assistance (1%)  Ensure Utility of Evaluation and Technical Assistance Programs  For Service Provision  For Planning

39. Unduplicated Service Data  Create National System of Unduplicated Client-Level Data  Numbers and demographics of those served  Target services/measure outcomes  Compliant with HIPAA and stronger state/federal confidentiality law  Match Requirements with Resources

40. Minority AIDS Initiative (MAI)  Maintain the Minority AIDS Initiative (MAI)  Ensure MAI Increases, Not Supplants, Services  Maintain Remainder of MAI  Centers for Disease Control and Prevention  Office of the Secretary, HHS  Office of Minority Health  Substance Abuse and Mental Health Services Administration  National Institutes of Health

41. Marsha A. Martin, DSW Executive Director AIDS Action 1906 Sunderland Pl NW Washington DC 20036 Phone: 202-530-8030 x3044 Fax: 202-530-8031 E-mail: mmartin@aidsaction.org

42. Stephen Boswell, M.D. Executive Director Fenway Community Health 7 Haviland Street Boston, MA 02115 Phone: 617/ 927-6170 Fax: 617-859-1250

43. Ernest Hopkins Director of Federal Affairs San Francisco AIDS Foundation 995 Market Street, Suite 200 Phone: 415/487-3096 Fax: 415/487-3089 E-mail: ehopkins@sfaf.org

44. Gunther Freehill Director, Public Affairs Los Angeles County Office of AIDS Programs and Policy 600 South Commonwealth Avenue Sixth Floor Los Angeles, California 90005-4001 Phone: 213/351-8340 Fax: 213/738-9371 E-mail: gfreehill@ladhs.org

45. William McColl Political Director AIDS Action 1906 Sunderland Pl NW Washington DC 20036 Phone: 202-530-8030 x3096 Fax: 202-530-8031 E-mail: wmccoll@aidsaction.org