BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K Alquist, Chair
BILL NO: AJR 9
A
AUTHOR: John A. Perez
J
AMENDED: April 20, 2009
R
HEARING DATE: May 20, 2009
CONSULTANT:
9
Moreno/cjt
SUBJECT
Ryan White HIV/AIDS Treatment Modernization Act of 2006
SUMMARY
Urges the United States Congress and the President to enact
legislation to extend the sunset of the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 (Ryan White Act) from
September 30, 2009 to September 30, 2012.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Ryan White Act, administered by the U.S.
Department of Health and Human Services, Health Resources
and Services Administration (HRSA) 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.
Existing state law
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 the Department of Public
Continued---
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Health (DPH).
This resolution:
Urges the United States Congress and the President to enact
legislation to extend the sunset of the Ryan White Act from
September 30, 2009 to September 30, 2012, including the
existing formula-based funding for states with maturing
names-based HIV reporting systems.
States that such an extension will protect Ryan White
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 case
reporting systems.
FISCAL IMPACT
This resolution is keyed non-fiscal.
BACKGROUND AND DISCUSSION
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.
Ryan White funding
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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 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, Part A of the Ryan White Act 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 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. 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.
Finally, 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 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 (includes data not yet certified as accurate and
reliable by HHS), such as California, are allowed to submit
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HIV data to HRSA, but incur a penalty on part of the funds.
Once the secretary of HHS certifies a state's data as
accurate and reliable, the state may use the Centers for
Disease Control and Prevention (CDC) HIV data system and
avoid the 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.
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 funds that are not
obligated. 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. 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.
Arguments in support
AIDS Project Los Angeles, the sponsor of this bill, and a
number of 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 an extension of the Ryan White Act will
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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 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.
Oppose unless amended
AIDS Healthcare Foundations (AHF) writes that, while they
are eager to see Congress delay implementation of the new
funding allocation until California's data has had a chance
to properly mature, AJR 9 fails to recognize that there are
issues of state and national importance that must be
addressed in a reauthorization of the Ryan White Act. AHF
is concerned that the Act does not go far enough to
normalize HIV care, make HIV screening routine and improve
linkages to care. AHF states that the Act does not
currently provide a practical means for California and
other states to pursue these goals, and that Congress needs
to explore other issues that are less relevant to
California's needs but which must be addressed for the
health of people in other states. AHF would support this
resolution if its message to Congress was solely pertinent
to delaying the names-based funding allocation formula.
Related legislation
AB 1045 (John A. Perez) limits a clinical laboratory
reporting requirement for CD4+ T-Cell tests (CD4 tests) to
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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.
This bill is in the Senate awaiting assignment.
Previous legislation
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.
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).
PRIOR ACTIONS
Assembly Health: 19-0
Assembly Floor: 76-0
POSITIONS
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.
California Communities United Institute
Center for AIDS Research, Education, and Services
City of Los Angeles AIDS Coordinator's Office
GlaxoSmithKline
Los Angeles County Board of Supervisors
Sierra Foothills AIDS Foundation
Sonoma County Commission on AIDS
Southern California HIV Advocacy Coalition
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Tri-City Health Center
Oppose: AIDS Healthcare Foundation (unless amended)
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