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| Language proposed
by the Coalition for inclusion in 2005 Ryan White CARE Act Amendments |
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The following sections are current language included in the 2000 version of the Ryan White Care Act. The statements in bold suggest that without any changes to the act, HCV disease, classified as an Opportunistic Infection by the most current Public Health Guidelines available, should be addressed by entities receiving grants under Ryan White legislation.
Section 2664: Additional Required Agreements
(g) ADMINISTRATION OF GRANT.-The Secretary may not make a grant under this part unless the applicant for the grant agrees that-
(5) (A) to assess the extent to which medical services funded under this title that are provided to patients are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines; and
** According to the Public Health Service guidelines, hepatitis C is an Opportunistic Infection associated with HIV disease.
SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a)(1)(A) to train health personnel, including practitioners in programs under this title and other community providers, in the diagnosis, treatment, and prevention of HIV disease, including the prevention of the perinatal transmission of the disease, including measures for the prevention and treatment of opportunistic infections
In addition we ask that the definition of "HIV-related care" be expanded to include care associated with hepatitis B and hepatitis C coinfection needs.
Following are sections of the Ryan White CARE Act. Bold faced text denotes suggestions made by the National HCV/HIV Coinfection Coalition regarding the incorporation of hepatitis related services for individuals coinfected with HIV and hepatitis b and/or hepatitis c.
Section 2602 - Administration and Planning Council
(b) HIV Health Planning Council:
(1) ESTABLISHMENT
To be eligible for assistance under this part, the chief elected official described in subsection (a)(1) shall establish or designate an HIV health services planning council that shall reflect in its composition the demographics of the population of individuals with HIV disease, and a proportionate number of those coinfected with chronic hepatitis in the eligible area involved with particular consideration given to disproportionately affected and historically underserved groups and subpopulations. Nominations for membership on the council shall be identified through an open process and candidates shall be selected based on locally delineated and publicized criteria. Such criteria shall include a conflict-of-interest standard that is in accordance with paragraph (5).
(2) REPRESENTATION.-The HIV health services planning council shall include representatives of-
points A - I follow
(G) affected communities, including people with HIV disease, those coinfected with Hepatitis B and C, and historically underserved groups and subpopulations;
(4) DUTIES: The planning council established or designated under
paragraph (1) shall-
(A) ...
(B)determine the size and demographics of the population of individuals coinfected with HIV and Hepatitis B/C.
(C) establish priorities for the allocation of funds within the eligible area, including how best to meet each such priority and additional factors that a grantee should consider in allocating funds under a grant based on the-
(iv) coordination in the provision of services to such individuals with combined programs for HIV and Hepatitis education, prevention, counseling and testing, and for the prevention and treatment of substance abuse, including programs that provide comprehensive treatment for such abuse
(d) PROCESS FOR ESTABLISHING ALLOCATION PRIORITIES- Promptly after the date of the submission of the report required in section 501(b) of the Ryan White CARE Act Amendments of 2000 (relating to the relationship between epidemiological measures and health care for certain individuals with HIV disease), the Secretary, in consultation with planning councils and entities that receive amounts from grants under section 2601(a) or 2611, shall develop epidemiologic measures-
(1) ...
(2) for establishing the number of individuals living with HIV/Hepatitis C coinfection who do not receive health services for their hepatitis from a specialist
Section 2603: Type and Distribution of Grants
(2) Amount of Grant
B: SEVERE NEED (i) sexually transmitted diseases, substance abuse, tuberculosis, severe mental illness, coinfection with hepatitis C and/or hepatitis B or other comorbid factors determined relevant by the Secretary.
C: PREVALENCE - In determining the impact of the factors described in subparagraph (B), the Secretary shall, to the extent practicable, use national, quantitative incidence data that are available for each eligible area. Not later than 18 months after the date of the enactment of the Ryan White CARE Act Amendments of 2000, the Secretary shall develop a mechanism to utilize such data. Such a mechanism shall be modified to reflect the findings of the study under section 501(b) of the Ryan White CARE Act Amendments of 2000 (relating to the relationship between epidemiological measures and health care for certain individuals with HIV disease).
In the absence of such data, the Secretary may consider a detailed description and qualitative analysis of severe need, as determined under subparagraph (B), including any local prevalence data gathered and analyzed by the eligible area. Local and regional prevalence data can also be used to justify severe need and allocation of funds for eligible areas where coinfection with hepatitis B and/or hepatitis C is prevalent.
Section 2604: Use of Amounts
(a) Requirements
(1) In General - (A) Outpatient and ambulatory health services, including substance abuse treatment, mental health treatment, and comprehensive treatment services, which shall include treatment education and prophylactic treatment for opportunistic infections, education and treatment for people who are coinfected with hepatitis B and/or hepatitis C and for individuals and families with HIV disease.
(3) Priority for Women, Infants and Children
(C) Quality Management
(2) Use of Funds (B) (1) IN GENERAL.-A chief elected official, in accordance with paragraph (3), may use not to exceed 10 percent of amounts received under a grant under section 2601 to provide financial assistance or services, for the purposes described in paragraph (2), to any public or nonprofit private entity, including hospitals (which may include Veterans Administration facilities), nursing homes, subacute and transitional care facilities, and hospices that-
(Preceded by points A and B)
(C) Inpatient case management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities. This case management will be appropriate in addressing any co-morbid conditions affecting a patient, including Hepatitis C coinfection.
(Point D)
(E) Provide comprehensive education, treatment and care to individuals coinfected with hepatitis B and or hepatitis C, and their families.
Section 2612: General Use of Grants
(b) SUPPORT SERVICES; OUTREACH - The purposes for which a grant under this part may be used include delivering or enhancing the following: (1) Outpatient and ambulatory support services under section 2611(a) (including case management) to the extent that such services facilitate, enhance, support, or sustain the delivery, continuity, or benefits of health services for individuals and families with HIV disease and those coinfected with hepatitis B and/or hepatitis C
(c) EARLY INTERVENTION SERVICES
(1) IN GENERAL.-The purposes for which a grant under this part may be used include providing to individuals with HIV disease early intervention services described in section 2651(b)(2), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the services to HIV related health care. The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV disease counseling and testing sites, health care points of entry specified by States or eligible areas, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to services by maintaining referral relationships; (b) and any entity that has incorporated hepatitis B and C into its existing HIV care, prevention or treatment programs.
SEC. 2613: GRANTS TO ESTABLISH HIV CARE CONSORTIA
(a) CONSORTIA.-A State may use amounts provided under a grant awarded under this part to provide assistance under section 2612(a)(1) to an entity that -
(1) is an association of one or more public, and one or more nonprofit private, (or private for-profit providers or organizations if such entities are the only available providers of quality HIV care in the area) health care and support service providers and community based organizations operating within areas determined by the State to be most affected by HIV disease; and most affected by coinfection with chronic hepatitis B and/or hepatitis C.
(2) agrees to use such assistance for the planning, development and delivery, through the direct provision of services or through entering into agreements with other entities for the provision of such services, of comprehensive outpatient health and support services for individuals with HIV disease; that may include-
(A) essential health services such as case management services,
medical, nursing, substance abuse treatment, mental health treatment,
and dental care, diagnostics, monitoring, prophylactic treatment for
opportunistic infections, treatment education to take place in the
context of health care delivery, and medical follow-up services, mental
health, developmental, and rehabilitation services, home health and
hospice care; and
(B) essential support services such as transportation services,
attendant care, homemaker services, day or respite care, benefits
advocacy, advocacy services provided through public and nonprofit
private entities, and services that are incidental to the provision of
health care services for individuals with HIV disease including
nutrition services, housing referral services, and child welfare and family services (including foster care and adoption services). An entity or entities of the type described in this subsection shall hereinafter be referred to in this title as a "consortium or "consortia".
SEC. 2614. GRANTS FOR HOME-AND COMMUNITY-BASED CARE.
(a)USES.-A State may use amounts provided under a grant awarded under this part to make grants under section 2612(a)(2) to entities to-
(3) provide for the coordination of the provision of services under this section with the provision of HIV-related health services, including specialty care for hepatitis C coinfection provided by public and private entities. (b) PRIORITY.-In awarding grants under subsection (a), a State shall give
priority to entities that provide assurances to the State that- (1) such entities will participate in HIV care consortia if such consortia exist within the State;
(2) such entities will utilize amounts provided under such grants for the provision of home-and community-based services to low-income individuals with HIV disease
SEC. 2615. CONTINUUM OF HEALTH INSURANCE COVERAGE
(b) Limitations
(3) to pay any costs related to Hepatitis C diagnostic tests and treatment not covered by private or federally funded insurance plans
SEC. 2616: PROVISION OF TREATMENTS
(a) IN GENERAL.-A State shall use a portion of the amounts provided under a grant awarded under this part to establish a program under section 2612(a)(5) to provide therapeutics to treat HIV disease or prevent the serious deterioration of health arising from HIV disease in eligible individuals, including measures for the prevention and treatment of opportunistic infections: as defined by annual Public Health Guidelines.
PART C-EARLY INTERVENTION SERVICES
Subpart I-Categorical Grants
(b) Purposes of Grants
(2) SPECIFICATION OF EARLY INTERVENTION SERVICES.-The early intervention services referred to in paragraph (1) are - (A) counseling individuals with respect to HIV disease in accordance with section 2662;
(B) testing individuals with respect to the disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease;
(C) referrals described in paragraph (3); (D) other clinical and diagnostic services regarding HIV and periodic medical evaluations of individuals with the disease
SEC. 2662: PROVISION OF CERTAIN COUNSELING SERVICES.
(a) COUNSELING BEFORE TESTING-The Secretary may not make a grant under this part unless the applicant for the grant agrees that, before testing an individual for HIV disease, the applicant will provide to the individual appropriate counseling regarding the disease (based on the most recently available scientific data), including counseling on-
(1) measures for the prevention of exposure to, and the transmission of, HIV and; measures for the prevention of exposure to, and the transmission of hepatitis B and C.
(2) the accuracy and reliability of the results of testing for HIV disease and; the accuracy and reliability of the results of testing for hepatitis B and hepatitis C;
(3) the significance of the results of such testing, including the potential for developing acquired immune deficiency syndrome
(4) and if diagnosed with chronic hepatitis B and hepatitis C co-infection, the potential of developing hepatitis-related liver disease and its impact on HIV disease;
(5)encouraging the individual, as appropriate, to undergo such testing; (5) the benefits of such testing, including the medical benefits of diagnosing HIV disease in the early stages and the medical benefits of receiving early intervention services during such stages;
(6) provisions of law relating to the confidentiality of the process of receiving such services, including information regarding any disclosures that may be authorized under applicable law and information regarding the availability of anonymous counseling and testing pursuant to section 2664(b); and
(7) provisions of applicable law relating to discrimination against
individuals with HIV disease.
(b) COUNSELING OF INDIVIDUALS WITH NEGATIVE TEST RESULTS-The Secretary may not make a grant under this part unless the applicant for the grant agrees that, if the results of testing conducted for HIV disease indicate that an individual does not have the disease, the applicant will review for the individual the information provided pursuant to subsection (a), including-
(1) the information described in paragraphs (1) through (3) of such
subsection; and
(c) COUNSELING OF INDIVIDUALS WITH POSITIVE TEST RESULTS.-The Secretary may not make a grant under this part unless the applicant for the grant agrees that, if the results of testing for HIV disease indicate that the individual has the disease, the applicant will provide to the individual appropriate counseling regarding such disease, including-
(1) reviewing the information described in paragraphs (1) through (3)
of subsection (a);
(2) reviewing the appropriateness of further counseling, testing, and
education of the individual regarding HIV
(3) providing counseling-
(A) on the availability, through the applicant, of early intervention
services;
(B) on the availability in the geographic area of appropriate health care, mental health care, and social and support services, including providing referrals for such services, as appropriate;
(C)(i) that explains the benefits of locating and counseling any individual by whom the infected individual may have been exposed to HIV and/or hepatitis B and/or C and any individual whom the infected individual may have exposed to HIV and/or hepatitis B and/or C; and
SEC. 2667: USE OF FUNDS - Counseling programs carried out under this part- (1)
shall not be designed to promote or encourage, directly, intravenous drug abuse or sexual activity, homosexual or heterosexual; (2) shall be designed to reduce exposure to and transmission of HIV disease by providing accurate information; and (3) shall provide information on the health risks of promiscuous sexual activity and intravenous drug abuse; and (4) shall provide information on the transmission and prevention of hepatitis A, B and C and the location of entities that provide hepatitis A and B vaccinations to HIV positive persons.
SEC. 2675: COORDINATION
(b) REPORT.-The Secretary shall biennially prepare and submit to the appropriate committees of the Congress a report concerning the coordination efforts at the Federal, State, and local levels described in this section, including a description of Federal barriers to HIV program integration and a strategy for eliminating such barriers and enhancing the continuity of care and prevention services for individuals with HIV disease or those at risk of such disease.
SEC. 2691: SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE
(c)Special Projects - Special projects of national significance shall include the development and assessment of innovative service delivery models that are designed to -
(4) integrate hepatitis coinfection service delivery into existing HIV programs
(d) Special Populations
(e) (2) programs designed to prepare AIDS service organizations and grantees under this title for operation within the changing health care environment, with priority given to projects which address emerging comorbidities.
(Followed by point 3)
SEC. 2692. HIV/AIDS COMMUNITIES, SCHOOLS, AND CENTERS.
(a)(2)(C) train, or result in the training of health professionals and allied health professionals to provide treatment for Hepatitis B and/or C coinfected individuals
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