Ryan White HIV/AIDS Program Legislation

The U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) administers the Ryan White HIV/AIDS Program (RWHAP).

This is the largest federal program focused on HIV. The RWHAP funds HIV care and treatment services for low-income people with HIV. Many people who receive services through the RWHAP are uninsured or underserved.

HRSA awards RWHAP grants to cities, states, 1 counties, and community-based groups to:

• Provide HIV medical care, treatment, and support services for people with HIV
• Improve health outcomes and reduce the transmission of HIV

The Ryan White HIV/AIDS Program legislation (PDF - 1 MB) was first enacted in 1990 as the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. It has been amended and reauthorized four times in 1996, 2000, 2006, and 2009.

These changes accommodate new and emerging needs, such as an increased emphasis on funding core medical services and changes in funding formulas.

Program legislation overview

The legislation is divided into several parts. The Ryan White HIV/AIDS Program Parts provide a flexible way to address HIV care needs based on:

• Different geographic areas (metropolitan areas, states, and communities across the U.S.)
• Populations hit hardest by the HIV epidemic
• Types of HIV-related services
• Service system needs (e.g., technical assistance for programs, clinical training, research on innovative models of care)

Legislative provisions (called Sections) address:

• Planning and decision-making
• Types of available grants
• How funds may be used
• Requirements for submitting applications for funding
• Available technical assistance to help programs run more effectively

Program legislation highlights

Following is a summary of several provisions in the current legislation:

• While RWHAP authorization expired in 2013, the legislation continues the RWHAP through fiscal year 2013 and beyond, so long as Congress appropriates funds.
• Minority AIDS Initiative (MAI) funds under Parts A and B are distributed according to a formula based on the distribution of populations disproportionately impacted by HIV/AIDS, and coincide with grant cycles under each Part.
• Part A grant recipients are required to determine the number and demographics of people with HIV and those who are unaware of their HIV status. One-third of the Part A supplemental grants score is based on the area's ability to demonstrate its success in identifying people with HIV who are unaware of their status.
• Part A and Part B grant recipients must develop strategic plans for identifying people with HIV who do not know their status and helping them find HIV care. The strategy must include ways to reduce barriers to routine HIV testing and provide better access to HIV care and treatment services for minorities and underserved communities.
• The payor of last resort provision applies to Parts A, B, C, and D. Public and nonprofit private entities funded under Part D can provide care through memoranda of understanding in addition to contracts.
• The Clinical Quality Management program assesses whether HIV health services provided to patients are consistent with the most recent Public Health Service Guidelines for the treatment of HIV/AIDS and related to opportunistic infection. The program also develops strategies to ensure services are consistent with the guidelines to improve access to and quality of HIV health services.
• RWHAP Parts A, B, and C recipients must expend 75% of grant funds on Core Medical Services, after reserving permissible amounts for administrative and clinical quality management costs. A waiver of this 75% core medical services requirement is permitted if
  • (1) there are no waiting lists for the AIDS Drug Assistance Program and
  • (2) core medical services are available to all individuals identified and eligible in an applicant's service area.

  _{1 For the purposes of the RWHAP statute, states includes, in addition to the several States, the District of Columbia, the Commonwealth of Puerto Rico, the Northern Mariana Islands, American Samoa, Guam, the U.S. Virgin Islands, the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau.}