BILL ANALYSIS
AJR 9
Page 1
Date of Hearing: March 31, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AJR 9 (John A. Perez) - As Introduced: February 26, 2009
SUBJECT : Ryan White HIV/AIDS Treatment Modernization Act of
2006.
SUMMARY : Urges the Congress and President of the United States
(U.S.) to enact legislation to extend, from September 30, 2009
to September 30, 2012, the sunset of the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 (Ryan White Act).
Specifically, this bill :
1)Resolves that the Legislature urges the Congress and President
of the U.S. to enact legislation to extend, from September 30,
2009 to September 30, 2012, the sunset of the Ryan White Act.
2)Makes various findings and declarations, including the
following:
a) The Department of Public Health (DPH) reports that
approximately 151,921 individuals have been diagnosed with
acquired immune deficiency syndrome (AIDS) in California
since 1983, 60,014 are living with AIDS, and more than
170,000 Californians are estimated to be living with the
human immunodeficiency virus (HIV).
b) The Office of AIDS, within DPH, in collaboration with
local governments and private providers, has developed a
complex and interdependent system of HIV/AIDS care and
treatment that relies on federal financial participation
through the Ryan White Act to assist the state in meeting
the growing health care and social service needs of people
living with HIV disease.
EXISTING STATE LAW :
1)Establishes the Office of AIDS as the lead agency within the
state responsible for coordinating state programs, services,
and activities relating to HIV, AIDS, and AIDS-related
conditions.
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2)Requires health care providers and clinical laboratories to
report cases of HIV infection to local health officers (LHOs)
using patient names, and requires LHOs to report unduplicated
HIV cases by name to DPH.
EXISTING FEDERAL LAW establishes the Ryan White Act,
administered by the U.S. Department of Health and Human Services
(HHS), Health Resources and Services Administration (HRSA),
HIV/AIDS Bureau, to provide HIV/AIDS care for those who do not
have sufficient health care coverage or financial resources for
coping with HIV disease. The Ryan White Act provides funding
through states, localities, and providers for primary health
care, drugs, and support services.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed to protect funding for California; preserve existing
systems of treatment, care and other vital services for people
living with HIV/AIDS; and, ensure that California and other
states have sufficient time to mature their names-based HIV
reporting systems. The author states the Ryan White Act
currently requires the use of names-based HIV data to
determine the allocation formula for funding to states and
certain local jurisdictions, but also includes exceptions to
the names-based HIV data requirement for states with immature
HIV data systems. California did not institute a names-based
system of HIV data collection until 2006, and currently does
not have a fully mature names-based data system. The author
states that without the protections that exist in the Ryan
White Act for states that do not have fully matured
names-based HIV data systems, California could suffer a
substantial reduction in formula funding which could devastate
established treatment, care, and support systems throughout
the state.
2)RYAN WHITE ACT . The Ryan White Act was first enacted by
Congress in 1990 as the Ryan White Comprehensive AIDS
Resources Emergency Act and has been reauthorized three times
to improve the quality and availability of care for
low-income, uninsured, and underinsured individuals and
families affected by HIV. The federal government provides
over $2.1 billion annually for Ryan White Act programs, which
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provide primary medical care, pharmaceutical treatments, and
support services for over 500,000 Americans living with HIV
disease who would otherwise not have access to these services.
According to HRSA, the Ryan White Act has five parts. Part A
provides emergency assistance to Eligible Metropolitan Areas
and Transitional Grant Areas that are most severely affected
by the HIV/AIDS epidemic. Part B provides grants to all
states and territories, each of which include a base grant,
the AIDS Drug Assistance Program (ADAP) award, ADAP
supplemental grants, and grants to states for Emerging
Communities - those reporting between 500 and 999 cumulative
AIDS cases over the most recent five years. The majority of
Part B funding is distributed through the ADAP, the formula
for which is based on each state's proportion of the nation's
estimated living HIV/AIDS cases (ELCs); Part B base grants are
also based on ELCs. Part C, the Early Intervention Services
program, funds comprehensive primary health care in outpatient
settings for people living with HIV disease. Part D grants
are for agencies that provide family-centered primary medical
care, treatment, and support services to improve access to
health care for women, infants, children, and youth with
HIV/AIDS. Part F comprises several programs to serve
underserved populations, provide dental care, support training
centers to train health care providers who treat patients with
HIV/AIDS, and evaluate and address the disproportional impact
of HIV/AIDS on women and minorities.
Names-based HIV Reporting . The Ryan White Act requires that
states have name-based HIV data (for determining ELCs) which
the secretary of HHS has certified are accurate and reliable.
In the most recent reauthorization of the Ryan White Act,
states with maturing name-based reporting systems, such as
California, are allowed to submit HIV data to HRSA, but incur
a 5% penalty on Part A and Part B funds. Once the secretary
of HHS certifies a state's data as accurate and reliable, the
state may use the U.S. Centers for Disease Control and
Prevention (CDC) HIV data system and avoid the 5% penalty.
CDC estimates that the earliest all states will have mature
HIV data systems is 2012. California, having begun
names-based reporting in April of 2006, has not had enough
time to collect enough names-based data to have certifiable
data.
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California Allocation . California's federal fiscal year
2007-08 allocation of Part B funds, including ADAP, was
approximately $122 million. DPH estimates allocations to
local governments and community-based organizations at $111
million, for a combined total exceeding $230 million for
California through the Ryan White Act in fiscal year 2007-08.
Future of the Ryan White Act . According to the Federal AIDS
Policy Partnership Ryan White Work Group (Work Group), a
nationwide group of HIV policy experts, the 2006
reauthorization of the Ryan White Act included many
significant changes, including changing the distribution
formulas from estimated living AIDS cases to actual living HIV
and AIDS cases, a core services requirement, and provisions
regarding unobligated funds. The HIV/AIDS advocacy community
and others have not yet been able to evaluate the effects of
these changes as sufficient data are not currently available.
The Work Group also states the HIV/AIDS community is engaged
in the development of a national AIDS strategy and broader
health reform. The Work Group recommends a minimum three-year
extension of the Ryan White Act as a prudent course of action
in order to maintain health stability for persons living with
HIV/AIDS while the larger issues of our nation's health care
system and a national strategic plan for HIV/AIDS prevention,
care and treatment are developed, assessed and analyzed.
3)SUPPORT . AIDS Project Los Angeles (APLA), the sponsor of this
bill; the Center for AIDS Research, Education, and Services
(CARES); the Southern California HIV Advocacy Coalition;
Altamed Health Services Corporation; Bienestar Human Services,
Inc., and the City of Los Angeles AIDS Coordinator's Office
write in support that the Ryan White Work Group and other
groups are advocating an extension of the existing law rather
than going through the cumbersome process of new legislation.
These supporters write that extending the Ryan White Act would
free up time and energy in Washington for developing a
comprehensive national AIDS strategy and health care reform,
and most importantly, that an extension will give California
more time to mature its names-based HIV case reporting system.
The County of Los Angeles writes that it supports this bill
because an extension of the Ryan White Act will preserve and
possibly increase funding for Los Angeles County, as well as
allow the County to continue to develop HIV data over the next
three years, which would maximize the County's competitiveness
for Ryan White funding. The AIDS Services Foundation Orange
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County (ASF) writes in support that although California's
names-based reporting system is two years old, it has not had
sufficient time to fully capture and reliably report all HIV
cases in California. ASF writes that since federal funding is
allocated using HIV/AIDS case data, additional time is needed
to mature California's reporting system so that funding
corresponds correctly with size and scope of the HIV/AIDS
epidemic in California. ASF further writes that a change in
the Ryan White Act while the California HIV reporting system
is still ramping up would jeopardize federal funding and
threaten to destabilize local systems of care.
4)OPPOSE UNLESS AMENDED . The AIDS Healthcare Foundation (AHF),
which is based in Los Angeles and states it is the nation's
largest provider of HIV/AIDS medical care, writes that it
wholeheartedly agrees with the objective of extending the Ryan
White Act while California's names-based reporting system
matures so that California can receive its fair share of
funding under a new formula. However, AHF objects to
extending the Ryan White Act without changes that would
improve control of the HIV/AIDS epidemic. AHF is concerned
with funding equity within and among states and that the Ryan
White Act does not go far enough to provide a practical means
for California and other states to normalize HIV care,
routinize HIV screening, and improve linkages to care. AHF
further argues that the Ryan White Act allows other states to
minimize care to people with HIV/AIDS, citing waiting lists
for ADAP and incomplete access to all necessary HIV/AIDS
drugs. AHF states it would support this bill if its message
to Congress were solely pertinent to delaying a names-based
funding allocation formula, and suggests that the author amend
this bill to simply urge Congress to include a deferral of the
new funding formula in any reauthorization of the Ryan White
Act.
5)RELATED LEGISLATION .
a) AB 1045 (John A. Perez), pending in the Assembly, limits
a clinical laboratory reporting requirement for CD4+ T-Cell
tests (CD4 tests) to those results related to a case of HIV
infection, and would permit a clinical laboratory to,
instead, elect to report all CD4 test results, regardless
of whether they relate to a case of HIV infection, in a
manner specified by the LHO.
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b) AB 221 (Portantino), pending in the Assembly, allows an
HIV counselor who is not a licensed phlebotomist to perform
skin punctures for the purpose of HIV testing if he or she
works under the direction of a licensed physician and has
been trained in accordance with specified requirements.
6)PREVIOUS LEGISLATION .
a) SB 1184 (Kuehl) Chapter 347, Statutes of 2008, requires
clinical laboratories to report all CD4 test results to the
LHO, and if the CD4 test is related to an HIV infection,
requires the LHO to report the infection to DPH. SB 1184
was intended to make HIV/AIDS reporting and data more
complete.
b) SB 699 (Soto), Chapter 20, Statutes of 2005, requires
HIV cases to be reported to the LHO by name rather than by
code and requires LHOs to report HIV cases by name to the
Department of Health Services (now DPH).
7)POLICY QUESTION . Should this resolution urge Congress and the
President to not only extend the sunset of the Ryan White Act
but also to continue to provide formula-based funding to
states with maturing names-based reporting systems?
REGISTERED SUPPORT / OPPOSITION :
Support
AIDS Project Los Angeles (sponsor)
AIDS Services Foundation Orange County
Altamed Health Services Corporation
American Federation of State, County, and Municipal Employees,
AFL-CIO
Bienestar Human Services, Inc.
Center for AIDS Research, Education, and Services
City of Los Angeles AIDS Coordinator's Office
County of Los Angeles
Southern California HIV Advocacy Coalition
Opposition
None on file
Oppose Unless Amended
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AIDS Healthcare Foundation
Analysis Prepared by : Allegra Kim / (916) 319-2097