I 

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 patientcentered 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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Ryan White Patient Equity and Choice Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents for 

2 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. 

3 SEC. 2. PRIORITIZATION OF EVIDENCE-BASED FUNDING AL4 LOCATIONS TO ADDRESS THE CONTINUUM 

5 OF HIV CARE. 

6 (a) ENSURING FUNDING IS PRIORITIZED FOR AREAS

7 WHERE THE HIV EPIDEMIC IS GROWING.—Part E of 

8 title XXVI of the Public Health Service Act is amended— 

9 (1) by redesignating section 2689 of such Act 

10 (42 U.S.C. 300ff–88) as section 2689C; and 

11 (2) by inserting after section 2688 of such Act 

12 (42 U.S.C. 300ff–87a) the following: 

13 ‘‘SEC. 2689. GENERAL PROVISIONS ON THE DISTRIBUTION 

14 OF GRANTS. 

15 ‘‘Not later than September 30, 2014, the Secretary 

16 shall— 

17 ‘‘(1) submit to Congress a report on whether 

18 the allocation of funding under the parts of this title 

19 enables areas where the HIV epidemic is growing to 

20 meet the need for medical services; and 

21 ‘‘(2) include in such report a plan to ensure 

22 that— 


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1 ‘‘(A) areas where the HIV epidemic is 

2 growing are receiving sufficient funding to ex3 pand the provision of core medical services (as 

4 described in section 2604(c)) to eligible individ5 uals; 

6 ‘‘(B) rural areas with limited public trans7 portation are able to expand the use of medical 

8 transportation services for eligible individuals in 

9 need of such services; and 

10 ‘‘(C) the level of funds under parts A and 

11 B of this title in any State, per living individual 

12 with HIV/AIDS, does not vary by more than 5 

13 percent relative to such total level in any other 

14 State.’’. 

15 (b) USE OF SERVICES TO ELIMINATE GAPS IN THE

16 CONTINUUM OF HIV CARE.— 

17 (1) USE OF FUNDING FOR PART A.—Section 

18 2604(c) of the Public Health Service Act (42 U.S.C. 

19 300ff–14) is amended— 

20 (A) in paragraph (2)(A)— 

21 (i) in clause (i), by striking ‘‘and’’ at 

22 the end; 

23 (ii) in clause (ii), by striking the pe24 riod at the end and inserting ‘‘; and’’; and 


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1 (iii) by adding at the end the fol2 lowing: 

3 ‘‘(iii) approval of the waiver will posi4 tively contribute to the eligible area’s abil5 ity to ensure that all individuals eligible for 

6 core medical services under this title have 

7 been identified and are retained in care.’’; 

8 (B) in paragraph (3)— 

9 (i) by striking subparagraph (M); 

10 (ii) by redesignating subparagraphs 

11 (A) through (L) as subparagraphs (B) 

12 through (M), respectively; and 

13 (iii) by inserting before subparagraph 

14 (B), as so redesignated, the following: 

15 ‘‘(A) HIV care continuum services de16 scribed in paragraph (4).’’; and 

17 (C) by adding at the end the following new 

18 paragraphs: 

19 ‘‘(4) HIV CARE CONTINUUM SERVICES.—The 

20 services referred to in paragraph (3)(A) are as fol21 lows: 

22 ‘‘(A) HIV and sexually transmitted disease 

23 testing services described in section 

24 2651(e)(1)(B). 


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1 ‘‘(B) HIV linkage to care services de2 scribed in section 2651(e)(1)(C). 

3 ‘‘(C) Medical case management, including 

4 care retention services and treatment adherence 

5 services. 

6 ‘‘(5) MEDICAL HOME.— 

7 ‘‘(A) IN GENERAL.—The Secretary shall 

8 ensure that each individual receiving core med9 ical services described in paragraph (3) through 

10 a grant under this title has an identified ‘med11 ical home’ which includes a primary care team 

12 led by an experienced HIV medical provider. 

13 ‘‘(B) PRIMARY MEDICAL CARE AND MED14 ICAL CASE MANAGEMENT.—The Secretary shall 

15 ensure that, wherever possible, individuals re16 ceiving primary medical care and medical case 

17 management care coordination through a grant 

18 under this title obtain such care and coordina19 tion through a medical home described in sub20 paragraph (A).’’. 

21 (2) USE OF FUNDING FOR PART B.—Section 

22 2612(b) of the Public Health Service Act (42 U.S.C. 

23 300ff–22(b)) is amended— 

24 (A) in paragraph (2)(A)— 


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1 (i) in clause (i), by striking ‘‘and’’ at 

2 the end; 

3 (ii) in clause (ii), by striking the pe4 riod at the end and inserting ‘‘; and’’; and 

5 (iii) by adding at the end the fol6 lowing: 

7 ‘‘(iii) approval of the waiver will posi8 tively contribute to the State’s ability to 

9 ensure that all individuals eligible for core 

10 medical services under this title have been 

11 identified and are retained in care.’’; and 

12 (B) by striking paragraph (3) and insert13 ing the following: 

14 ‘‘(3) CORE MEDICAL SERVICES.—For the pur15 poses of this subsection, the term ‘core medical serv16 ices’, with respect to an individual infected with 

17 HIV/AIDS (including co-occurring conditions of the 

18 individual) has the meaning given to such term in 

19 section 2604(c)(3). 

20 ‘‘(4) MEDICAL HOME.—Section 2604(c)(5) ap21 plies with respect to core medical services under this 

22 title to the same extent and in the same manner as 

23 section 2604(c)(5) applies with respect to core med24 ical services under part A.’’. 


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1 (3) USE OF FUNDING FOR PART C.—Section 

2 2651 of the Public Health Service Act (42 U.S.C. 

3 300ff–51) is amended— 

4 (A) in subsection (c)(2)(A)— 

5 (i) in clause (i), by striking ‘‘and’’ at 

6 the end; 

7 (ii) in clause (ii), by striking the pe8 riod at the end and inserting ‘‘; and’’; and 

9 (iii) by adding at the end the fol10 lowing: 

11 ‘‘(iii) that the approval of a waiver 

12 will positively contribute to the grantee’s 

13 ability to ensure that all individuals eligible 

14 for core medical services under this title 

15 have been identified and are retained in 

16 care.’’; 

17 (B) in subsection (c), by striking para18 graph (3) and inserting the following: 

19 ‘‘(3) CORE MEDICAL SERVICES.—For the pur20 poses of this subsection, the term ‘core medical serv21 ices’, with respect to an individual infected with 

22 HIV/AIDS (including co-occurring conditions of the 

23 individual) has the meaning given to such term in 

24 section 2604(c)(3). 


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1 ‘‘(4) MEDICAL HOME.—Section 2604(c)(5) ap2 plies with respect to core medical services under this 

3 title to the same extent and in the same manner as 

4 section 2604(c)(5) applies with respect to core med5 ical services under part A.’’; 

6 (C) by amending subsection (e)(1)(B) to 

7 read as follows: 

8 ‘‘(B) testing individuals with respect to 

9 HIV/AIDS and sexually transmitted diseases, 

10 including tests— 

11 ‘‘(i) to confirm the presence of HIV 

12 and other sexually transmitted diseases; 

13 ‘‘(ii) to diagnose the extent of defi14 ciency in the immune system; and 

15 ‘‘(iii) to provide information on appro16 priate therapeutic measures for preventing 

17 and treating— 

18 ‘‘(I) the deterioration of the im19 mune system; and 

20 ‘‘(II) conditions arising from 

21 HIV/AIDS;’’; 

22 (D) by amending subsection (e)(1)(C) to 

23 read as follows: 

24 ‘‘(C) linkage to care services described in 

25 paragraph (2);’’; and 


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1 (E) by amending subsection (e)(2) to read 

2 as follows: 

3 ‘‘(2) LINKAGE TO CARE SERVICES.—The serv4 ices referred to in paragraph (1)(C) shall assist indi5 viduals with HIV/AIDS in entering HIV medical 

6 care shortly after a positive HIV test result, and 

7 may include as appropriate— 

8 ‘‘(A) referrals of individuals with HIV/ 

9 AIDS to appropriate providers of health and 

10 support services, including, as appropriate— 

11 ‘‘(i) to entities receiving amounts 

12 under part A or B for the provision of 

13 such services; 

14 ‘‘(ii) to biomedical research facilities 

15 of institutions of higher education that 

16 offer experimental treatment for such dis17 ease, or to community-based organizations 

18 or other entities that provide such treat19 ment; or 

20 ‘‘(iii) to grantees under section 2671, 

21 in the case of a pregnant woman; 

22 ‘‘(B) educating individuals with HIV/AIDS 

23 at the time of their diagnosis about the benefits 

24 of HIV medical care for improving personal 

25 health and preventing HIV transmission; 


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1 ‘‘(C) ensuring individuals with HIV/AIDS 

2 attend their first doctor visit; 

3 ‘‘(D) coordinating with a medical case 

4 manager who will develop an HIV care plan; 

5 ‘‘(E) assisting individuals with HIV/AIDS 

6 to re-engage into HIV medical care if they have 

7 dropped out of care; and 

8 ‘‘(F) ensuring individuals with HIV/AIDS 

9 have an identified medical home (as described 

10 in subsection (c)).’’. 

11 (c) ENHANCING TREATMENT ADHERENCE THROUGH

12 THE PROVISION OF PHARMACEUTICAL SERVICES.—Sec13 tion 2616 of the Public Health Service Act (42 U.S.C. 

14 300ff–26) is amended by adding at the end the following: 

15 ‘‘(h) ENHANCING TREATMENT ADHERENCE

16 THROUGH THE PROVISION OF PHARMACEUTICAL SERV17 ICES.— 

18 ‘‘(1) EXTENSIVE PHARMACY NETWORKS.—In 

19 providing therapeutics pursuant to this section, a 

20 State shall offer pharmaceutical services through ex21 tensive pharmacy networks, including specialty phar22 macies and pharmacies that focus on the HIV popu23 lation. 


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1 ‘‘(2) NO SINGLE RETAIL CHAIN.—A pharmacy 

2 network under paragraph (1) shall not be limited to 

3 a single retail chain. 

4 ‘‘(3) MAIL ORDER SERVICES.—Pharmaceutical 

5 services provided pursuant to paragraph (1) may in6 clude mail order services, but only if— 

7 ‘‘(A) such mail order services are optional; 

8 and 

9 ‘‘(B) the patient continues to be able to 

10 choose the services of a community or other in11 person pharmacist instead of mail order serv12 ices.’’. 

13 SEC. 3. PROMOTION OF PATIENT-CENTERED CARE. 

14 (a) ESTABLISHMENT OF A PATIENT-CENTERED

15 MODEL OF CARE.—Section 2691 of the Public Health 

16 Service Act (42 U.S.C. 300ff–101) is amended— 

17 (1) in subsection (a)— 

18 (A) in paragraph (1), by striking ‘‘and’’ at 

19 the end; 

20 (B) in paragraph (2)— 

21 (i) by striking ‘‘to fund’’ and inserting 

22 ‘‘fund’’; and 

23 (ii) by striking the period at the end 

24 and inserting ‘‘; and’’; and 

25 (C) by adding at the end the following: 


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1 ‘‘(3) fund projects that research and promote 

2 the utilization of patient-centered models of care.’’; 

3 (2) in subsection (b)— 

4 (A) in paragraph (5), by striking ‘‘or’’ at 

5 the end; 

6 (B) in paragraph (6), by striking the pe7 riod at the end and inserting ‘‘; or’’; and 

8 (C) by adding at the end the following: 

9 ‘‘(7) whether the funding will promote the in10 corporation of the principles of patient-centered 

11 care, as described in subsection (f)(5), into the pro12 vision of support services under this title.’’; and 

13 (3) by adding at the end the following: 

14 ‘‘(f) PATIENT-CENTERED MODEL OF CARE

15 PROJECTS.— 

16 ‘‘(1) IN GENERAL.—Of the amount used under 

17 subsection (a) for a fiscal year, the Secretary shall 

18 use the greater of $5,000,000 or an amount equal 

19 to 20 percent of such amount, but not to exceed 

20 $7,000,000, to award grants to one or more States 

21 for patient-centered model of care projects. 

22 ‘‘(2) PROJECTS DESCRIBED.—Projects funded 

23 under this subsection shall— 

24 ‘‘(A) facilitate patient choice in the utiliza25 tion of eligible services by eligible individuals 


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1 through the use of Ryan White Savings Ac2 counts described in paragraph (3); 

3 ‘‘(B) increase patient knowledge of, and 

4 participation in, their care plan by facilitating 

5 greater transparency about providers, care op6 tions, costs, and medical outcomes; and 

7 ‘‘(C) provide for patient-based evaluation 

8 of service providers. 

9 ‘‘(3) RYAN WHITE SAVINGS ACCOUNTS.— 

10 ‘‘(A) IN GENERAL.—Services provided 

11 under this subsection for eligible individuals 

12 shall be funded through individual savings ac13 counts— 

14 ‘‘(i) to be known as Ryan White Sav15 ings Accounts; and 

16 ‘‘(ii) to be established and overseen by 

17 the State receiving the grant for the 

18 project involved. 

19 ‘‘(B) ACCOUNT DESCRIPTION.—The Sec20 retary shall ensure that each Ryan White Sav21 ings Account meets the following: 

22 ‘‘(i) Eligible individuals, with appro23 priate coordination with their care pro24 viders, have discretion to choose the eligiVerDate Mar 15 2010 04:27 Mar 21, 2014 Jkt 039200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H4260.IH H4260

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1 ble services to be funded through the Ac2 count. 

3 ‘‘(ii) Each account shall be used ex4 clusively for the purpose of paying for eli5 gible services. 

6 ‘‘(iii) The balance of each Account 

7 shall remain available for obligation until 

8 such time as— 

9 ‘‘(I) the individual is no longer 

10 eligible to receive services; or 

11 ‘‘(II) the project which relates to 

12 such Account terminates. 

13 ‘‘(iv) If an individual’s Account be14 comes unavailable for obligation because 

15 the individual is no longer eligible for serv16 ices, or because the project terminates, as 

17 described in clause (iii), the Secretary shall 

18 make the remaining balance in the Ac19 count available for other projects under 

20 this subsection. 

21 ‘‘(4) ELIGIBILITY.—For purposes of this sub22 section: 

23 ‘‘(A) INDIVIDUALS.—An individual is eligi24 ble to participate in a project under this sub25 section and receive services through the project 


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1 if the individual is eligible to receive services 

2 under any provision of this title other than this 

3 subsection. 

4 ‘‘(B) SERVICES.—The term ‘eligible serv5 ices’, with respect to an eligible individual, 

6 means— 

7 ‘‘(i) core medical services (as defined 

8 in section 2604(c)(3)); 

9 ‘‘(ii) pharmaceutical services described 

10 in section 2616(h); and 

11 ‘‘(iii) the following 2 types of support 

12 services: 

13 ‘‘(I) Case management services. 

14 ‘‘(II) Medical transportation 

15 services. 

16 ‘‘(5) PRINCIPLES OF PATIENT-CENTERED

17 CARE.—The Secretary shall work to ensure that, 

18 where appropriate, projects funded under this sec19 tion adhere to the following principles: 

20 ‘‘(A) HIV care is customized and reflects 

21 patient needs, values, and choices. 

22 ‘‘(B) Patient safety is a visible priority. 

23 ‘‘(C) Transparency is the rule in the care 

24 of the patient. 


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1 ‘‘(D) The patient is the source of control 

2 for their care. 

3 ‘‘(E) All caregivers cooperate with one an4 other through a common focus on the best in5 terests and personal goals of the patient. 

6 ‘‘(6) PATIENT SURVEY.—Each State receiving a 

7 grant under this subsection shall— 

8 ‘‘(A) conduct a survey on patient satisfac9 tion with services provided pursuant to the 

10 grant; and 

11 ‘‘(B) report the results of the survey to the 

12 Secretary. 

13 ‘‘(7) DEFINITIONS.—In this subsection: 

14 ‘‘(A) The term ‘case management services’ 

15 means advice and assistance in obtaining med16 ical, social, community, legal, financial, and 

17 other needed services. 

18 ‘‘(B) The term ‘medical transportation 

19 services’ means conveyance services provided, 

20 directly or through a voucher, to a patient to 

21 enable him or her to access health care serv22 ices.’’. 

23 (b) GENERAL PROVISIONS.—Part E of title XXVI of 

24 the Public Health Service Act (42 U.S.C. 300ff–81 et 


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1 seq.) is amended by inserting after section 2689A, as 

2 added by section 3, the following: 

3 ‘‘SEC. 2689B. GENERAL PROVISIONS ON THE PROMOTION 

4 OF PATIENT-CENTERED CARE. 

5 ‘‘(a) IN GENERAL.—Not later than September 30, 

6 2014, the Secretary shall submit to Congress a proposed 

7 plan to incorporate the principles of HIV patient-centered 

8 care described in section 2691(f)(5) into the provision of 

9 services under all parts of this title. 

10 ‘‘(b) CONTENTS.—The plan under subsection (a) 

11 shall, at a minimum, include the following: 

12 ‘‘(1) An assessment of current grantees’ utiliza13 tion of patient-centered care across all services pro14 vided under all parts of this title. 

15 ‘‘(2) An analysis of— 

16 ‘‘(A) existing models of patient-centered 

17 care, including the projects funded under sec18 tion 2691(f); and 

19 ‘‘(B) the feasibility of implementing these 

20 models throughout programs and services fund21 ed under this title.’’. 

22 (c) GRANTEE UTILIZATION OF PATIENT-CENTERED

23 CARE.—Section 2602(b)(4) of the Public Health Service 

24 Act (42 U.S.C. 300ff–12(b)(4)) is amended— 


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1 (1) in subparagraph (G), by striking ‘‘and’’ at 

2 the end; 

3 (2) in subparagraph (H), by striking the period 

4 at the end and inserting ‘‘; and’’; and 

5 (3) by adding at the end the following: 

6 ‘‘(I) assess the extent to which the prin7 ciples of HIV patient-centered care described in 

8 section 2691(f)(5) are incorporated into the 

9 provision of services within the eligible area.’’. 

Æ 


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