The ABC s of Ryan White Healthcare

Transcription

1 The ABC s of Ryan White Healthcare An Overview of the Ryan White CARE Act in Texas July 2016 Dr. Brent J. Pimentel, MD/MPH Texas Program Manager SCAETC 1

2 Objective 1 Review the history of federal funding for HIV prevention and services Objective 2 Discuss the Parts of the Ryan White CARE Act (RWCA) Objective 3 Understand how and where Texas receives funding under the RWCA 2

3 Objective 1 Review the history of federal funding for HIV prevention and services 3

4 Common Federal Acronyms HHS U.S. Department of Health & Human Services HRSA Health Resources and Services Administration HAB HIV/AIDS Bureau RWCA Ryan White CARE Act (Can Refer to Any Item) PLWH(A) People Living with HIV (and/or AIDS) 4

5 Timeline of Federal Healthcare Administration Federal Level Administration of Healthcare Begins U.S Department of Health and Human Services (HHS) created Pre-1943, health insurance only available to those able to pay for it themselves Initial HHS legislation made insurance plans for workers tax-exempt for their employers Mainly intended to help the growing elderly population and returning disabled soldiers 1982 HHS Forms HRSA by Merging Two Separate Programs Done to maximize resource allocation, minimize cost, and reduce duplication of services Both programs were part of the original 1943 legislation Health Resources Management Health Services Administration New Agency = Health Resources and Services Administration 5

6 HRSA and the Response to HIV 1981 CDC Report re: Cluster of Five Pneumonia Cases in Los Angeles, CA All found in previously healthy men who suddenly developed severe immunosuppression Causative agent, Pneumocystis carinii, usually defeated by intact immune response December 1981: 270 total cases nationwide and 121 of those deceased Mid 80 s HIV identified and AIDS defined Clinically, only available options revolved around the relief of pain and suffering 1987 HRSA Creates AIDS Education and Training Centers Program Initial focus was to train providers about issues related to death and dying As better treatment options emerged, program expanded training topics Was one of six different initiatives intended to address HIV-related issues 6

7 HRSA and the Response to HIV August 18, 1990 Ryan White CARE Act passed CARE = Comprehensive AIDS Resources Emergency Implementation required involvement of HIV+ population at local/state levels Discretionary funding with availability contingent on annual federal budget each year Intended as the payer of last resort and cannot supplement other resources Originally funded for five years, reauthorized in 1996 and Renamed the Ryan White HIV/AIDS Treatment Modernization Act Moved program away from emergency response and toward promotion of long-term services Most significant change increased funding to areas with highest burden of disease (Part A) 2009 Continued as the Ryan White HIV/AIDS Treatment Extension Act Increased focus on non-duplication of services & improving care in minority and rural populations 7

8 HRSA and the AETC Program 1994 AZT Trials show Significant Reduction of Infants born with HIV Infection HIV+ women were treated during pregnancy and had extremely decreased rates of transmission AETC provided a critical role in disseminating information and treatment protocol to clinicians 1987 to AETC Program Expansion AETC centers / 16 states covered / $2 million per year budget For the current funding cycle: 3 national & 8 regional centers All states covered > $30 million per year budget (actual funding contingent on annual federal budget) 8

9 The AETC Program and Ryan White Funding 1996 Ryan White CARE Act reauthorized through 2000 Part D funding continued for first time since original legislation in 1990 AIDS Drug Assistance Program (ADAP) funded as a separate line item Part F created to fund three ongoing programs originally started in 1987 HIV+ Dental Care Program Special Projects of National Significance Program (SPNS) AETC Program 9

10 HRSA-Supported RWCA Services Funded Services are divided into 2 broad categories Medical Services (12 subcategories) Support Services (16 subcategories) For each subcategory, HRSA further specifies A definition Activities which MAY be funded Activities which CANNOT be funded by the RWCA Applies to ALL parts except Part F Agencies receiving Parts B, C, D determine funding priorities For Part A recipients, funding priorities determined by planning council At least 75% of funded activities must be MEDICAL Services 10

11 RWCA Funded Services - MEDICAL Ambulatory / Outpatient Medical Care AIDS Drug Assistance Program (ADAP) Oral Health Care Early Intervention Services (EIS) Home Health Care Health Insurance Premium & Home & Community-Based Health Services Hospice Services Mental Health Services Medical Nutritional Therapy Medical Case Management Outpatient Substance Abuse Services Cost-Sharing Assistance 11

12 RWCA Funded Services - SUPPORT Case Management (Non-Medical) Child Care Services Emergency Financial Assistance Food Bank / Home-Delivered Meals Health Education / Risk Reduction Housing Services Legal Services Linguistics Services (Interpretation & Translation) Medical Transportation Services Outreach Services Psychosocial Support Services Referrals for Health Care / Supportive Services Rehabilitation Services Respite Care Residential Substance Abuse Services Treatment Adherence Counseling 12

13 Objective 2 Discuss the Parts of the Ryan White CARE Act (RWCA) 13

14 Basic Concepts of RWCA Legislation Focused on providing care and services to HIV+ people Payer of Last Resort for the uninsured / underinsured Legislation organized into programs or Parts Flexible structure allows a national program to address local needs Needs differ based on several variables Geographic areas (i.e. rural vs urban) Locations where the population has a higher rate of infection Types of HIV-related services needed/required for a population System needs (i.e. technical assistance, network building) 14

15 Index of Parts Part A Part B Part C Part D Part F Provides funds directly to hardest hit areas Addresses prevention activities Capacity building to develop/expand access Services to women/children/infants Funds AETC/Dental Program/SPNS 15

16 RWCA Part A Funding Gives areas with high prevalence of infection DIRECT funding Rationale: Provide local prioritization of services based on need Eligibility for funding determined by HRSA using census tracts and zip codes Eligible Part A grantees divided into two categories EMA = Eligible Metropolitan Area TGA = Transitional Grant Area 16

17 RWCA Part A Funding EMA vs TGA Determined by HRSA based on two criteria Total Population Less than 50K = Disqualified Greater than 50K = Criterion Met for both TGA and EMA Status Number of New Diagnosis of HIV Infection over a Five-year period Under 1000 = Disqualified Between = Criterion Met for TGA Status Greater than 2000 = Criterion Met for EMA Status For each one, HRSA designates the geographic area of coverage 17

18 RWCA Part A Grantee Basics Each Part A Recipient has two components when funded Planning Council (RWPC) Made of volunteers living in the EMA or TGA itself Some HRSA-mandated seats Ideally, members will mirror race/ethnicity of HIV+ population for that area Must have a HRSA-mandated minimum number of members who are HIV+ Determines Priorities for Funding within Service Subcategories Administrative Agency (RWAA) Staffed positions paid by HRSA Enters into contracts with service providers in the designated area Uses Planning Council to guide contracts through the funding priorities 18

19 EXAMPLE - RWCA Part A Subcategory Hospice Services is a subcategory of Medical Services HRSA Definition: Includes room, board, nursing care, counseling, physician services, and palliative therapeutics provided to clients in the terminal stages of illness in a residential setting, including a non-acute-care section of a hospital that has been designated and staffed to provide hospice services for terminal clients. HRSA Activities: MAY Include: medically-ordered care, nursing care, counseling, physician services, palliative care, room and board, social support, spiritual guidance MAY NOT include: home-based hospice care Dallas EMA 2015 Continuum of Care Activities MUST include: medically-ordered care Activities MAY include: nursing care, counseling, physician services, palliative care, room and board, social support, spiritual guidance 19

20 RWCA Part B Funding Available to all 50 states, Puerto Rico, Virgin Islands, Pacific Islands Grantee is the state entity managing state public health programs Programs funded include: State-wide prevention and treatment initiatives (Base Grant) AIDS Drug Assistance Program (ADAP) Minority AIDS Initiative (MAI) Program Funding for Emerging Communities Total population of area is greater than 50K Area has reported between cases / past 5 years 20

21 RWCA Part C Funding Grantees are organizations seeking to expand/enhance their activities Divided into two components Capacity Development Grant Program Assists efforts to increase or improve the delivery of HIV primary care services Emphasis on expanding access to underserved or rural populations Grantees must be public or private nonprofit organizations Activities must promote organizational infrastructure development Community-Based Early Intervention Services (EIS) Program Funds comprehensive primary health care in outpatient settings Grantees cover defined medical and support services 21

22 RWCA Part D Funding Provides services for HIV+ women, infants, children, and youths Covers ambulatory, outpatient services, not inpatient hospitalization Grantees are organizations seeking to expand/enhance their activities Services provided through outpatient family-centered primary care Defined medical and support services covered 22

23 RWCA Part F Funding AIDS Education and Training Centers Program Provided training and technical assistance to providers at all levels Covers wide range of topics related to care of HIV+ clients Dental Programs: Two components Dental Reimbursement Program (DRP) Assists institutions with unreimbursed cost associated with providing care Community-Based Dental Partnership Program (CBDPP) Multi-partner collaborations between schools of education and clinics Special Projects of National Significance (SPNS) Supports the development, dissemination & replication of innovative ideas for care Programs are called Initiatives or Models of Care Currently, there are 7 funded initiatives nationwide 23

24 Objective 3 Understand how and where Texas receives funding under the RWCA 24

25 Index of Parts Part A Part B Part C Part D Part F Provides funds directly to hardest hit areas Addresses prevention activities Capacity building to develop/expand access Services to women/children/infants Funds AETC/Dental Program/SPNS 25

26 RWCA Part A Funding Texas Grantees Five Part A Grantees Two EMAs Dallas EMA = 12 Counties Houston EMA = 6 Counties Three TGAs Austin TGA = 5 Counties Fort Worth TGA = 8 Counties San Antonio TGA = 4 Counties 26

27 RWCA Part A Funding Texas Grantees 27

28 RWCA Part B Funding Texas Department of State Health Services 28

29 RWPC Part C Funding: Capacity Building Grantees Institution City Totals AIDS Arms, Inc. Dallas 2 Grantees Houston Regional HIV/AIDS Resource Group, Inc. Houston $200k in Funding 29

30 RWPC Part C Funding: Early Intervention Services (EIS) Program Grantees Institution AIDS Arms, Inc. Austin / Travis County Health & Human Services Centro de Salud Familiar (Le Fe, Inc.) Dallas County Hospital District El Centro del Barrio Harris County Hospital District Houston Regional HIV/AIDS Resource Group, Inc. Special Health Resources for Texas, Inc. Tarrant County Texas, Inc. Valley AIDS Council City Dallas Austin El Paso Dallas San Antonio Houston Houston Longview Fort Worth Harlingen Totals 10 Grantees $7.2k in Funding 30

31 RWCA Part D Funding Texas Grantees Institution Dallas County Hospital District Harris County Hospital District Houston Regional HIV/AIDS Resource Group, Inc. Tarrant County Texas, Inc. University of Texas Health Science Center University of Texas Southwestern Medical Center Valley AIDS Council Your Health / Callie Clinic City Dallas Houston Houston Fort Worth San Antonio Dallas Harlingen Sherman Totals 8 Grantees $4.9k in Funding 31

32 Ryan White Part F Dental Grantees Community-Based Dental Partnership Program (CBDPP) Two Grantees in Texas Baylor College of Dentistry, Texas A&M University Health Science Center, Dallas, TX University of Texas Health Science Center, San Antonio, TX Dental Reimbursement Program (DRP) Available to any dentist providing primary dental care Patient panel must contain a minimum percentage of HIV+ clients 32

33 Ryan White Part F SPNS Grantees Four current Initiatives and Five Agencies funded in Texas (updated July 2016) Use of Social Media to Improve Engagement, Retention, & Health Outcomes along the HIV Care Continuum Coastal Bend Wellness Foundation, Inc. (Corpus Christi) Workforce Capacity Building for Integrating HIV Primary Care in Community Health Center Settings Coastal Bend Wellness Foundation, Inc. (Corpus Christi) SHRT or Special Health Resources of Texas, Inc. (Longview) Culturally-Appropriate Interventions of Outreach, Access, & Retention among Latino(a) Populations AIDS Arms, Inc. (Dallas) University of Texas Health Science Center (San Antonio, TX) Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations AIDS Arms, Inc. (Dallas) Harris County Hospital District (Houston, TX) 33

34 Ryan White Part F AETC Program 3 National Centers 8 Regions 34

35 11 Partners in Five States Two New Sites Arcare (AR) Tulane University School of Medicine (LA) 35

36 Ryan White CARE Act Funding in Texas Part Program # of Active Grantees A N/A 2 EMAs & 3 TGAs B N/A 1 C Capacity Building 2 Early Intervention Services 10 D N/A 8 AETC Program 1 F Dental Program (CBDPP) 2 SPNS Initiatives 4 Initiatives / 5 Grantees 36

37 Objective 1 Review the history of federal funding for HIV prevention and services Objective 2 Discuss the Parts of the Ryan White Care Act (RWCA) Objective 3 Understand how and where Texas receives funding under the RWCA 37

38 Data Sources RWCA Timeline and Legislation RWCA Fact Sheets and Parts RWCA Current Grantees Greater Dallas Area EMA AETC Program Information 38

39 Thanks for your time!! Brent J Pimentel, MD/MPH Texas Program Manager, South Central AETC 8435 N Stemmons Fwy, Ste 1125, Dallas, TX, Work: (214) Fax: (214) brent.pimentel@phhs.org I have no financial relationships or conflicts of interest. 39