I 113th CONGRESS 2d Session H. R. 4260 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. 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. 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: 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. . 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: 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. .