The Ryan White HIV/AIDS Program is the largest Federal program focused exclusively on HIV/AIDS care. The program is for individuals living with HIV/AIDS who have no health insurance (public or private), have insufficient health care coverage, or lack financial resources to get the care they need for their HIV disease. As such, the Ryan White HIV/AIDS Program fills gaps in care not covered by other funding sources.
The legislation is called the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87, October 30, 2009). The legislation was first enacted in 1990 as the Ryan White CARE (Comprehensive AIDS Resources Emergency) Act. It has been amended and reauthorized four times: in 1996, 2000, 2006, and 2009. The Ryan White legislation has been adjusted with each reauthorization to accommodate new and emerging needs, such as an increased emphasis on funding of core medical services and changes in funding formulas.
Overview of the Ryan White Legislation
The legislation authorizes programs, called Parts. The purpose is to provide a flexible structure under which this national program can address HIV/AIDS care needs on the basis of:
- Different geographic areas (large metropolitan areas, States, and communities across the Nation)
- Varying populations hit hardest by the epidemic
- Types of HIV-AIDS-related services, and
- Service system needs (e.g., technical assistance for programs, training of clinicians, research on innovative models of care).
Legislative provisions (called Sections) address, for example, planning and decision-making, type of grants that are available, what funds may be used for, requirements for entities submitting applications for funding, and available technical assistance to help programs run more effectively.
The Ryan White HIV/AIDS Program is administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB).
Highlights of the 2009 Ryan White Legislation
Following is a summary of select provisions in the 2009 legislation, with references to key changes from the 2006 legislation.
- The 2009 Ryan White legislation continues the Ryan White HIV/AIDS Program through fiscal year 2013. Authorization levels increase 5 percent for each fiscal year but are dependent on annual appropriations.
- Minority AIDS Initiative (MAI) funds under Parts A and B will be distributed according to a formula (based on the distribution of populations disproportionately impacted by HIV/AIDS), a change from the former competitive process. Also, MAI awards now coincide with grant cycles under each Part.
- Under Part A, the law continues issuance of grant awards to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs). For TGAs that lose their eligibility status, the State in which the former TGA is located shall receive incremental transfers of funding for three years.
- In addition to existing Part A planning council responsibilities, the law adds a new requirement to determine not only the size and demographics of HIV/AIDS infected individuals but also those individuals who are unaware of their HIV status. One-third of Part A supplemental grants are to be based on the area’s ability to demonstrate its success in identifying individuals with HIV/AIDS who are unaware of their status and bringing attention to their status.
- Part A and Part B grantees must develop comprehensive plans that include a strategy for identifying individuals with HIV/AIDS who do not know their status and helping them seek medical services. The strategy must focus on reducing barriers to routine testing and disparities in access to services for minorities and underserved communities.
- The law continues hold harmless protections for Part A and Part B grantees for fiscal years 2009-2013.
- Part A and B grantees currently using code-based data reporting will have three more years to convert to names-based data reporting. Penalties will remain for Part A and Part B areas that report code-based data in fiscal years 2009 through 2012. In fiscal year 2013, only name-based data reporting will be accepted.
- The law makes adjustments in Part A and Part B unobligated balances (UOB) provisions. It retains the three penalties, but with some changes. The trigger for the penalty provisions changed from 2% to 5% of unobligated formula funds. If triggered, grantees are subject, in a future year, to: an offset of the amount of UOB less the amount of approved carryover, a reduction of the amount of UOB less the amount of approved carryover, and ineligibility for a supplemental award. Implementation of the UOB provisions was simplified by providing the Secretary with the option to offset unobligated funds rather than cancel those funds.
Part D funds are not required to be used for primary care services if payments for such services can be provided from other sources (including titles XVIII, XIX, and XXI of the Social Security Act). Public and nonprofit private entities funded under Part D can now provide care through memoranda of understanding in addition to contracts.