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by Susan Forrest
Thursday, Aug. 03, 2006 at 1:01 PM
firstname.lastname@example.org 213.738.2816 HIV Commission
Los Angeles County has been flat-funded or getting dwindling funds for HIV and HIV prevention over the past 6 years. At this point, the funds that we are applying for are absolutely inadequate, and the ramifications for people living with, or at risk for HIV infection or AIDS are deadly serious.
The implications of the Ryan White Modernization of the CARE Act are potentially devastating to people living with HIV in LA.
The HIV Commission respectfully submits the attached statement outlining its opposition to the Ryan White Modernization Act (the current, proposed legislation reauthorizing the CARE Act). While the Commission remains committed to CARE Act Reauthorization, it no longer has faith that the current legislation can reauthorize the CARE Act fairly or positively for LA County or California.
Previously, the Commission has publicly noted grave concerns with the proposed legislation (as outlined in the attached legislation), but has balanced those concerns with the proxy provision that had been included. Due to resistance from other states, however, the proxy provision has been removed, and a new formula funding proposal that would further significantly reduce LA County’s and California’s share of HIV/AIDS resources has been proposed in its place (with high likelihood that it will be accepted).
The bill, at this juncture, can no longer be acceptable to Los Angeles County or California, and there seems little likelihood that it can be adequately salvaged to meet the needs of people with HIV/AIDS in our jurisdiction.
Please do not hesitate to contact me if you have any questions or would like further information.
Craig A. Vincent-Jones
Los Angeles County Commission on HIV
3530 Wilshire Boulevard, Suite 1140
Los Angeles, CA 90010
July 21, 2006
Los Angeles County Commission on HIV OPPOSES the Ryan White CARE Modernization Act
The Los Angeles County Commission on HIV has determined that continued deliberation of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 is no longer meaningful, and opposes further efforts towards its passage by the US Congress. To be clear, the Commission continues to support the reauthorization of the Ryan White CARE Act, but has come to the conclusion that the current proposed legislation is not an acceptable vehicle with which to accomplish that objective.
The Commission has arrived at this decision after involvement in months of discussions about the proposed legislation, and believes that, in its current form and as ensuing negotiations are reported, the legislation is poised to cause significant harm to people living with HIV/AIDS in Los Angeles County, other California jurisdictions and the State of California. The proposed Modernization Act threatens to remove vital services and systems upon which people with HIV/AIDS in Los Angeles and California rely, and could be irreparably detrimental to the organizations that provide those services.
Proxy. The latest round of negotiations concerning the “proxy”—a provision in the original version of the legislation that would estimate HIV cases to AIDS cases at a ratio of .9 for those states (like California) in the process of developing mature names-based HIV reporting systems—have resulted in its elimination from the proposed language. While the Commission has always believed that Los Angeles County’s actual ratio is closer to 1.1 or 1.2, it has been willing to accept the proposed compromise as the federal CARE Act system prepares to move towards use of HIV case reports in its formula funding calculations.
The Commission believed this solution was a reasonable one for states such as California that have consistently complied with all federal guidance, and have, as a result, recently converted to a name-based HIV reporting system following the Centers for Disease Control and Prevention (CDC) recommendations in July and December of 2005.
Proposed Plan to Estimate HIV Case Reports. It is widely reported that key decision-makers have decided to replace the proxy with a proposal to include both HIV name-based and code-based case reports, and to effectively penalize code-based jurisdictions with a 14% (or 5%) reduction in their HIV case reports for estimated de-duplication. This measure contradicts the CDC’s past practice of not accepting code-based reports just as states are moving away from code-based systems, and penalizes code-based jurisdictions with a scientifically unfounded “de-duplication” rate. This is an unsupportable measure for Los Angeles County, whose code-based case reporting remains behind, in part, due to the extraordinary measures it has taken to validate and de-duplicate data.
The Commission estimates that, under the current proposal, a third to half of the jurisdiction’s HIV case reports will go uncounted, with resulting negative consequences for CARE Act formula funding to the County. Similar repercussions are expected throughout the State.
Hold Harmless. The hold harmless provisions under the current Ryan White CARE Act would limit some of the damage resulting from converting to HIV case reports without adequate reporting data. The virtual elimination of these “hold harmless” protections in the proposed Modernization Act, coupled with the new proposal to calculate HIV prevalence from code-based data, could unravel HIV/AIDS services in Los Angeles County and the State of California.
Opposing Proposed Legislation. The Commission has previously expressed grave concerns about several of the provisions in the draft legislation, and this newest formula funding proposal could make it worse. This new proposal could catastrophically undermine one of the nation’s most effective and efficient care systems. Without the balance provided by the original proxy provision, the Commission has concluded that the current legislation, as it is advancing through Congress, could irrevocably damage Los Angeles County’s and the State’s HIV/AIDS service delivery systems.
The Commission, as a result, can no longer support the current legislative efforts, and believes that only the following conditions could salvage it:
1. RESTORING THE PROXY PLAN, or FINDING AN ACCEPTABLE SUBSTITUTE: the originally proposed .9 “proxy” is satisfactory for Los Angeles and California and should be maintained.
§ California has followed all HIV reporting laws and requirements, without fail, for the past five years;
§ This is the only protection from the losses of millions of dollars in service resources for the estimated 58,00 people living with HIV/AIDS in Los Angeles County resulting from the switch to formula funding based on HIV case reports as California is developing a mature HIV reporting system completely compliant with law;
§ Alternative proposals to eliminate the proxy, and substitute living AIDS cases, or proposals to use a combination of code-based case reports and fair estimates, with only scientifically supported de-duplication rates, could also be acceptable.
2. BROADEN THE DEFINITION OF “CORE MEDICAL SERVICES”: at a minimum, medical transportation, nutrition therapy/counseling, psychosocial case management, linguistic services, and inpatient substance abuse should be included.
§ If the client cannot get to the appointment, then the service cannot be delivered;
§ As currently structured, if these services are not included as part of the definition of core medical services, LA County would have to shift approximately 20% of its funding away from other important HIV-related services;
§ Another option could be lowering the minimum that has to be allocated to “core medical services” to 50%.
3. ELIMINATE THE APPROPRIATIONS CAPS FROM THE LEGLISLATION: the appropriation levels delineated in the proposed legislation for the next four years are below this year’s levels, and do not adequately represent the funding needs of CARE Act jurisdictions.
§ CARE Act funding has been declining in LA County and California for the last several years, while patient numbers and service complexity have been increasing;
§ Funding must at least keep pace with need, if not further expanded, to address existing unmet need.
4. SEPARATING PLANNING COUNCIL AND ADMINISTRATIVE EXPENSES: the current legislation combines administrative and planning council expenses, undermining the local authority and independence of the planning councils.
§ Capping planning council expenses at 4% or 5% is acceptable, as most planning councils currently spend between 3%-4% on required activities, but they should not fall below 4%;
§ Planning council expenditures should not be defined as “administrative”, nor should their expenses be merged with administrative agency expenses;
§ The planning councils perform planning functions—not administrative activities—which was a central component of the original CARE Act intent to involve consumer and stakeholder voices;
§ Any attempt to define planning council expenses as “administrative” or fold them in with other administrative expenses is a stealth attempt to undermine the authority, autonomy, and local control of planning councils and the consumer voice they represent.
Please do not hesitate to contact the Commission offices at 213.738.2816 for further information.
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