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Implementation of the National HIV

Implementation of the National HIV/AIDS Strategy and ACA Provisions Impacting Ryan White. Ryan White 14th Clinical ConferenceJune 28, 2011Tampa, FloridaLaura W. Cheever, MD, ScMChief Medical Officer, Deputy Associate AdministratorHIV/AIDS BureauHealth Resources and Services AdministrationDe

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Implementation of the National HIV

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    1. Implementation of the National HIV/AIDS Strategy and ACA Provisions Impacting Ryan White Laura W. Cheever, MD, ScM Deputy Associate Administrator Chief Medical Officer, HIV/AIDS Bureau Health Resources and Services Administration

    2. Implementation of the National HIV/AIDS Strategy and ACA Provisions Impacting Ryan White Ryan White 14th Clinical Conference June 28, 2011 Tampa, Florida Laura W. Cheever, MD, ScM Chief Medical Officer, Deputy Associate Administrator HIV/AIDS Bureau Health Resources and Services Administration Department of Health and Human Services

    3. National HIV/AIDS Strategy: Purpose Roadmap for coordinated national action for confronting the HIV epidemic Vision of the strategy: US will become a place where new HIV infections are rare When infections occur, every person will have Unfettered access to high quality, life extending care Free of stigma and discrimination Regardless of age, gender, race/ethnicity, sexual orientation, gender identity, socio-economic status

    4. Goals Reduce new infections Increase access to care and improve health outcomes Reduce HIV-related disparities and health inequities Goals accomplished through a more coordinated national response to the HIV epidemic

    5. Goal 1: Reduce HIV Incidence Intensify HIV prevention efforts in hard-hit communities Expand (“scale-up”) combinations of effective approaches Educate all Americans about HIV

    6. Goal 1: Reducing New Infections Anticipated results by 2015 Lower annual number of new infections by 25% (from 56,000 to 42,225) Reduce HIV transmission rate by 30% (from 5 new infections/100 persons infected to 3.5) Increase from 79% to 90 % persons living with HIV who know their status (from 948,000 to 1,080,000)

    7. Goal 2: Increase Access to Care and Improve Health Outcomes Create and maintain effective linkages to quality care Increase the number and diversity of qualified providers Support people living with HIV with co-occurring health conditions and those who are challenged meeting basic needs

    8. Anticipated results Increase the proportion of newly diagnosed patients clinical to care within 3 months of HIV diagnosis from 65% to 85% Increase the proportion of RW client sin continuous care (2 visit for routine visit in 12 ) from 73 % to 80% Increase RW clients in permantent housing from 82% to 86% Goal 2: Increasing Access to Care and Improving Outcomes

    9. Goal 3: Reduce HIV-related Health Disparities Reduce HIV-related mortality in high-risk communities Adopt community-level approaches to reduce HIV infection Reduce stigma and discrimination against people living with HIV/AIDS

    10. Goal 3: Reducing Disparities Anticipated results Increase proportion of HIV diagnosed in gay and bisexual men with undetectable viral load by 20% Increase proportion of HIV diagnosed in Blacks with undetectable viral load by 20% Increase proportion of HIV diagnosed in Latinos with undetectable viral load by 20%

    11. Highlighted NHAS Implementation Activities DHHS 12 Cities Project HRSA Implementing innovative public health approaches to testing and linkage to care Expanding HIV training in residency Increasing tele-health for HIV care Engaging Community Health Centers

    12. Reduce HIV-related Health Disparities Reduce HIV-related mortality in high-risk communities Adopt community-level approaches to reduce HIV infection Reduce stigma and discrimination against people living with HIV/AIDS c/w the NHAS, focus resouces on 15 cities with 44% of all HIV/AIDS cases in the US, heavy preponderance of R/E miniotiryesc/w the NHAS, focus resouces on 15 cities with 44% of all HIV/AIDS cases in the US, heavy preponderance of R/E miniotiryes

    13. HHS FY 2010 HIV/AIDSFunding

    14. 12 Cities Project: Coordinate Federal Resources and Actions Builds on CDC’s “Enhanced Comprehensive HIV Prevention Planning” (ECHPP) Provide complete mapping of federally-funded HIV/AIDS resources Share data across vertical HHS HIV/AIDS programs to better inform local planning Identify and address local barriers to coordination across HHS grantees Develop common measures and evaluation strategies

    15. New 12 Cities Projects ($15.5m) Prevention of HIV infection among AA and Hispanic MSM :CDC lead Promoting early dx of HIV and linkage to care for R/E minorities: CDC lead PWP in HIV care for R/E minorities: HRSA lead Promoting retention/re-engagement in HIV care for R/E minorities: HRSA lead Integrating substance use/mental health tx into ongoing HIV care for R/E minorities: SAMHSA lead Partial funding to help support Phase II of ECHPP: CDC $15.5 million carve out of Secretary’s MAI $53 million LOOK UP HRSA PROPOSALS Approx 2.5 million each$15.5 million carve out of Secretary’s MAI $53 million LOOK UP HRSA PROPOSALS Approx 2.5 million each

    16. Innovative HAB Activities-1 NHAS: Facilitate linkages to care. (Goal 2, Step 1) SPNS initiative to use innovative public health approaches and CQI to improve testing and linkage to care Partnerships with RW and non-RW grantees Grants to states of $1 million x 5 years

    17. Innovative HAB Activities-2 NHAS: Consider opportunities to foster residence training in HIV management and care at CHCs (Goal 2, Step 2- Increasing Providers HAB Expanding HIV Training into Graduate Medical Educations Expand HIV training into community based primary care residency training 4 awards; approx $125k/yr x 3 years

    18. Innovative HAB Activities-3 NHAS: Increase the # of clinical providers engaged in innovative rural HIV/AIDS health care delivery systems (e.g. telehealth)(Goal 2, Step 2- Incr. Providers) AETC Telehealth Training Centers Program Develop new networks of co-management and consultation using telehealth 3 awards; approx $200k/yr x 3 years

    19. Innovative BPHC Activities Issued 2 Program Assistance Letters on Testing and Care/Treatment Trained BPHC POs on HIV and treatment guidelines Held national TA call for BPHC grantees on providing HIV services Engaged Primary Care Associations in NHAS activities

    20. Affordable Care Act Provisions that Impact Ryan White 2011 Pre-Existing Conditions Insurance Plans (PCIPs) ADAP counting toward True Out of Pocket (TrOOP) Expenses for Medicare ADAP costs cover eligible patients in the Medicare Part D “donut hole” and then Part D assumes costs 20 Look up PCIPLook up PCIP

    21. Positioning Ryan White Grantees for Anticipated Changes in the Healthcare Environment Medical Homes Maintain/enhance Ryan White delivery systems National Cooperative Agreement to address capacity building Expansion of Community Health Centers Ryan White grantees partnering with existing health centers or becoming health centers National AETC to support HIV care and treatment in CHCs without direct Ryan White funding 21 GET Full name of AETC to quote and the organizationGET Full name of AETC to quote and the organization

    22. The Future of Ryan White Ryan White designed to filled gaps Gaps identified through local needs assessment Gaps in existing Medicaid program will remain. Examples: Number of prescriptions allowed through some Medicaid programs Coverage of oral health services Support services to link clients to care 22 This quote is from POZ  Oct/Nov 2010     I’m assuming those reports will take into consideration that much of health care reform doesn’t kick in until 2014. Within the strategy, we have been very clear that we need to bridge the gap. Even in 2014, the Affordable Care Act won’t solve every problem, but it will make a lot of other problems easier and give us some breathing room to think about what we need. We certainly expect that the Ryan White program will continue after health reform is implemented, but in the short term we have some challenges. But I would also say that these aren’t challenges that are for the federal government alone to solve. There’s a role for state and local governments, private funders and community-based organizations.   http://www.poz.com/articles/Jeffrey_Crowley_HIV_2536_19154.shtml This quote is from POZ  Oct/Nov 2010     I’m assuming those reports will take into consideration that much of health care reform doesn’t kick in until 2014. Within the strategy, we have been very clear that we need to bridge the gap. Even in 2014, the Affordable Care Act won’t solve every problem, but it will make a lot of other problems easier and give us some breathing room to think about what we need.

    23. Contact Information Laura Cheever Chief Medical Officer, HIV/AIDS Bureau 301-443-1993 lcheever@hrsa.gov www. hab.hrsa.gov

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