Ryan White Patient Equity and Choice Act - Amends the Public Health Service Act to require the Secretary of Health and Human Services (HHS) to report to Congress on whether the allocation of funding under the HIV Health Care Services Program enables areas where the HIV epidemic is growing to meet the need for medical services.
Restricts approval of a waiver allowing use of less than 75% of emergency relief, care grant, and early intervention funds for core medical services unless approval of the waiver will positively contribute to all eligible individuals being identified and retained in care.
Includes as core medical services HIV care continuum services consisting of early intervention HIV and sexually transmitted disease testing, referral, and case management services.
Requires HHS to ensure that: (1) individuals receiving such core medical services have an identified medical home that includes a primary care team led by an experienced HIV medical provider, and (2) those receiving HIV primary care and case management services obtain the care and coordination through the medical home approach.
Includes testing for other sexually transmitted diseases among early intervention services. Expands early intervention linkage-to-care services to include the following:
Requires states providing drug assistance to offer pharmaceutical services through extensive pharmacy networks, including specialty pharmacies and pharmacies that focus on the HIV population.
Adds as a criterion for award of grants for HIV care the degree to which funding will promote the incorporation of principles of patient-centered care into providing support services. Describes "patient-centered care" as care adhering to principles of customization to reflect patient needs, values, and choices; patient safety; transparency; patient control; and caregiver cooperation. Provides guidelines for funding patient-centered model of care projects, to be carried out through individual savings accounts known as Ryan White Savings Accounts.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4260 Introduced in House (IH)]
113th CONGRESS
2d Session
H. R. 4260
To ensure that the Ryan White Comprehensive AIDS Resources Emergency
Act program is as effective as possible in saving lives and preventing
the spread of the HIV epidemic by ensuring that funding allocations are
evidenced-based and by promoting greater utilization of patient-
centered care.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 14, 2014
Mrs. Ellmers (for herself, Mr. Thompson of Mississippi, and Ms. Eddie
Bernice Johnson of Texas) introduced the following bill; which was
referred to the Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To ensure that the Ryan White Comprehensive AIDS Resources Emergency
Act program is as effective as possible in saving lives and preventing
the spread of the HIV epidemic by ensuring that funding allocations are
evidenced-based and by promoting greater utilization of patient-
centered care.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Ryan White Patient
Equity and Choice Act''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Prioritization of evidence-based funding allocations to address
the continuum of HIV care.
Sec. 3. Promotion of patient-centered care.
SEC. 2. PRIORITIZATION OF EVIDENCE-BASED FUNDING ALLOCATIONS TO ADDRESS
THE CONTINUUM OF HIV CARE.
(a) Ensuring Funding Is Prioritized for Areas Where the HIV
Epidemic Is Growing.--Part E of title XXVI of the Public Health Service
Act is amended--
(1) by redesignating section 2689 of such Act (42 U.S.C.
300ff-88) as section 2689C; and
(2) by inserting after section 2688 of such Act (42 U.S.C.
300ff-87a) the following:
``SEC. 2689. GENERAL PROVISIONS ON THE DISTRIBUTION OF GRANTS.
``Not later than September 30, 2014, the Secretary shall--
``(1) submit to Congress a report on whether the allocation
of funding under the parts of this title enables areas where
the HIV epidemic is growing to meet the need for medical
services; and
``(2) include in such report a plan to ensure that--
``(A) areas where the HIV epidemic is growing are
receiving sufficient funding to expand the provision of
core medical services (as described in section 2604(c))
to eligible individuals;
``(B) rural areas with limited public
transportation are able to expand the use of medical
transportation services for eligible individuals in
need of such services; and
``(C) the level of funds under parts A and B of
this title in any State, per living individual with
HIV/AIDS, does not vary by more than 5 percent relative
to such total level in any other State.''.
(b) Use of Services To Eliminate Gaps in the Continuum of HIV
Care.--
(1) Use of funding for part a.--Section 2604(c) of the
Public Health Service Act (42 U.S.C. 300ff-14) is amended--
(A) in paragraph (2)(A)--
(i) in clause (i), by striking ``and'' at
the end;
(ii) in clause (ii), by striking the period
at the end and inserting ``; and''; and
(iii) by adding at the end the following:
``(iii) approval of the waiver will
positively contribute to the eligible area's
ability to ensure that all individuals eligible
for core medical services under this title have
been identified and are retained in care.'';
(B) in paragraph (3)--
(i) by striking subparagraph (M);
(ii) by redesignating subparagraphs (A)
through (L) as subparagraphs (B) through (M),
respectively; and
(iii) by inserting before subparagraph (B),
as so redesignated, the following:
``(A) HIV care continuum services described in
paragraph (4).''; and
(C) by adding at the end the following new
paragraphs:
``(4) HIV care continuum services.--The services referred
to in paragraph (3)(A) are as follows:
``(A) HIV and sexually transmitted disease testing
services described in section 2651(e)(1)(B).
``(B) HIV linkage to care services de- scribed in
section 2651(e)(1)(C).
``(C) Medical case management, including care
retention services and treatment adherence services.
``(5) Medical home.--
``(A) In general.--The Secretary shall ensure that
each individual receiving core medical services
described in paragraph (3) through a grant under this
title has an identified `medical home' which includes a
primary care team led by an experienced HIV medical
provider.
``(B) Primary medical care and medical case
management.--The Secretary shall ensure that, wherever
possible, individuals receiving primary medical care
and medical case management care coordination through a
grant under this title obtain such care and
coordination through a medical home described in
subparagraph (A).''.
(2) Use of funding for part b.--Section 2612(b) of the
Public Health Service Act (42 U.S.C. 300ff-22(b)) is amended--
(A) in paragraph (2)(A)--
(i) in clause (i), by striking ``and'' at
the end;
(ii) in clause (ii), by striking the period
at the end and inserting ``; and''; and
(iii) by adding at the end the following:
``(iii) approval of the waiver will
positively contribute to the State's ability to
ensure that all individuals eligible for core
medical services under this title have been
identified and are retained in care.''; and
(B) by striking paragraph (3) and inserting the
following:
``(3) Core medical services.--For the purposes of this
subsection, the term `core medical services', with respect to
an individual infected with HIV/AIDS (including co-occurring
conditions of the individual) has the meaning given to such
term in section 2604(c)(3).
``(4) Medical home.--Section 2604(c)(5) applies with
respect to core medical services under this title to the same
extent and in the same manner as section 2604(c)(5) applies
with respect to core medical services under part A.''.
(3) Use of funding for part c.--Section 2651 of the Public
Health Service Act (42 U.S.C. 300ff-51) is amended--
(A) in subsection (c)(2)(A)--
(i) in clause (i), by striking ``and'' at
the end;
(ii) in clause (ii), by striking the period
at the end and inserting ``; and''; and
(iii) by adding at the end the following:
``(iii) that the approval of a waiver will
positively contribute to the grantee's ability
to ensure that all individuals eligible for
core medical services under this title have
been identified and are retained in care.'';
(B) in subsection (c), by striking paragraph (3)
and inserting the following:
``(3) Core medical services.--For the purposes of this
subsection, the term `core medical services', with respect to
an individual infected with HIV/AIDS (including co-occurring
conditions of the individual) has the meaning given to such
term in section 2604(c)(3).
``(4) Medical home.--Section 2604(c)(5) applies with
respect to core medical services under this title to the same
extent and in the same manner as section 2604(c)(5) applies
with respect to core medical services under part A.'';
(C) by amending subsection (e)(1)(B) to read as
follows:
``(B) testing individuals with respect to HIV/AIDS
and sexually transmitted diseases, including tests--
``(i) to confirm the presence of HIV and
other sexually transmitted diseases;
``(ii) to diagnose the extent of deficiency
in the immune system; and
``(iii) to provide information on
appropriate therapeutic measures for preventing
and treating--
``(I) the deterioration of the
immune system; and
``(II) conditions arising from HIV/
AIDS;'';
(D) by amending subsection (e)(1)(C) to read as
follows:
``(C) linkage to care services described in
paragraph (2);''; and
(E) by amending subsection (e)(2) to read as
follows:
``(2) Linkage to care services.--The services referred to
in paragraph (1)(C) shall assist individuals with HIV/AIDS in
entering HIV medical care shortly after a positive HIV test
result, and may include as appropriate--
``(A) referrals of individuals with HIV/AIDS to
appropriate providers of health and support services,
including, as appropriate--
``(i) to entities receiving amounts under
part A or B for the provision of such services;
``(ii) to biomedical research facilities of
institutions of higher education that offer
experimental treatment for such disease, or to
community-based organizations or other entities
that provide such treatment; or
``(iii) to grantees under section 2671, in
the case of a pregnant woman;
``(B) educating individuals with HIV/AIDS at the
time of their diagnosis about the benefits of HIV
medical care for improving personal health and
preventing HIV transmission;
``(C) ensuring individuals with HIV/AIDS attend
their first doctor visit;
``(D) coordinating with a medical case manager who
will develop an HIV care plan;
``(E) assisting individuals with HIV/AIDS to re-
engage into HIV medical care if they have dropped out
of care; and
``(F) ensuring individuals with HIV/AIDS have an
identified medical home (as described in subsection
(c)).''.
(c) Enhancing Treatment Adherence Through the Provision of
Pharmaceutical Services.--Section 2616 of the Public Health Service Act
(42 U.S.C. 300ff-26) is amended by adding at the end the following:
``(h) Enhancing Treatment Adherence Through the Provision of
Pharmaceutical Services.--
``(1) Extensive pharmacy networks.--In providing
therapeutics pursuant to this section, a State shall offer
pharmaceutical services through extensive pharmacy networks,
including specialty pharmacies and pharmacies that focus on the
HIV population.
``(2) No single retail chain.--A pharmacy network under
paragraph (1) shall not be limited to a single retail chain.
``(3) Mail order services.--Pharmaceutical services
provided pursuant to paragraph (1) may include mail order
services, but only if--
``(A) such mail order services are optional; and
``(B) the patient continues to be able to choose
the services of a community or other in-person
pharmacist instead of mail order services.''.
SEC. 3. PROMOTION OF PATIENT-CENTERED CARE.
(a) Establishment of a Patient-Centered Model of Care.--Section
2691 of the Public Health Service Act (42 U.S.C. 300ff-101) is
amended--
(1) in subsection (a)--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) in paragraph (2)--
(i) by striking ``to fund'' and inserting
``fund''; and
(ii) by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following:
``(3) fund projects that research and promote the
utilization of patient-centered models of care.'';
(2) in subsection (b)--
(A) in paragraph (5), by striking ``or'' at the
end;
(B) in paragraph (6), by striking the period at the
end and inserting ``; or''; and
(C) by adding at the end the following:
``(7) whether the funding will promote the incorporation of
the principles of patient-centered care, as described in
subsection (f)(5), into the provision of support services under
this title.''; and
(3) by adding at the end the following:
``(f) Patient-Centered Model of Care Projects.--
``(1) In general.--Of the amount used under subsection (a)
for a fiscal year, the Secretary shall use the greater of
$5,000,000 or an amount equal to 20 percent of such amount, but
not to exceed $7,000,000, to award grants to one or more States
for patient-centered model of care projects.
``(2) Projects described.--Projects funded under this
subsection shall--
``(A) facilitate patient choice in the utilization
of eligible services by eligible individuals through
the use of Ryan White Savings Accounts described in
paragraph (3);
``(B) increase patient knowledge of, and
participation in, their care plan by facilitating
greater transparency about providers, care options,
costs, and medical outcomes; and
``(C) provide for patient-based evaluation of
service providers.
``(3) Ryan white savings accounts.--
``(A) In general.--Services provided under this
subsection for eligible individuals shall be funded
through individual savings accounts--
``(i) to be known as Ryan White Savings
Accounts; and
``(ii) to be established and overseen by
the State receiving the grant for the project
involved.
``(B) Account description.--The Secretary shall
ensure that each Ryan White Savings Account meets the
following:
``(i) Eligible individuals, with
appropriate coordination with their care
providers, have discretion to choose the
eligible services to be funded through the
Account.
``(ii) Each account shall be used
exclusively for the purpose of paying for
eligible services.
``(iii) The balance of each Account shall
remain available for obligation until such time
as--
``(I) the individual is no longer
eligible to receive services; or
``(II) the project which relates to
such Account terminates.
``(iv) If an individual's Account becomes
unavailable for obligation because the
individual is no longer eligible for services,
or because the project terminates, as described
in clause (iii), the Secretary shall make the
remaining balance in the Account available for
other projects under this subsection.
``(4) Eligibility.--For purposes of this subsection:
``(A) Individuals.--An individual is eligible to
participate in a project under this subsection and
receive services through the project if the individual
is eligible to receive services under any provision of
this title other than this subsection.
``(B) Services.--The term `eligible services', with
respect to an eligible individual, means--
``(i) core medical services (as defined in
section 2604(c)(3));
``(ii) pharmaceutical services described in
section 2616(h); and
``(iii) the following 2 types of support
services:
``(I) Case management services.
``(II) Medical transportation
services.
``(5) Principles of patient-centered care.--The Secretary
shall work to ensure that, where appropriate, projects funded
under this section adhere to the following principles:
``(A) HIV care is customized and reflects patient
needs, values, and choices.
``(B) Patient safety is a visible priority.
``(C) Transparency is the rule in the care of the
patient.
``(D) The patient is the source of control for
their care.
``(E) All caregivers cooperate with one another
through a common focus on the best interests and
personal goals of the patient.
``(6) Patient survey.--Each State receiving a grant under
this subsection shall--
``(A) conduct a survey on patient satisfaction with
services provided pursuant to the grant; and
``(B) report the results of the survey to the
Secretary.
``(7) Definitions.--In this subsection:
``(A) The term `case management services' means
advice and assistance in obtaining medical, social,
community, legal, financial, and other needed services.
``(B) The term `medical transportation services'
means conveyance services provided, directly or through
a voucher, to a patient to enable him or her to access
health care services.''.
(b) General Provisions.--Part E of title XXVI of the Public Health
Service Act (42 U.S.C. 300ff-81 et seq.) is amended by inserting after
section 2689A, as added by section 3, the following:
``SEC. 2689B. GENERAL PROVISIONS ON THE PROMOTION OF PATIENT-CENTERED
CARE.
``(a) In General.--Not later than September 30, 2014, the Secretary
shall submit to Congress a proposed plan to incorporate the principles
of HIV patient-centered care described in section 2691(f)(5) into the
provision of services under all parts of this title.
``(b) Contents.--The plan under subsection (a) shall, at a minimum,
include the following:
``(1) An assessment of current grantees' utilization of
patient-centered care across all services provided under all
parts of this title.
``(2) An analysis of--
``(A) existing models of patient-centered care,
including the projects funded under section 2691(f);
and
``(B) the feasibility of implementing these models
throughout programs and services funded under this
title.''.
(c) Grantee Utilization of Patient-Centered Care.--Section
2602(b)(4) of the Public Health Service Act (42 U.S.C. 300ff-12(b)(4))
is amended--
(1) in subparagraph (G), by striking ``and'' at the end;
(2) in subparagraph (H), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(I) assess the extent to which the principles of
HIV patient-centered care described in section
2691(f)(5) are incorporated into the provision of
services within the eligible area.''.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.
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