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Ryan White CARE Act: Estimated Effect of Continued Application of the Fiscal Year 2010 Stop-Loss Provision on 2011 Funding for Urban Areas

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if the stop-loss provision applicable in fiscal year 2010 was applied to funding for 2011 under a continuing resolution. The CARE Act, administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. Under the CARE Act, funding for urban areas--eligible metropolitan areas (EMA) and transitional grant areas (TGA)--is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS in an urban area; (2) supplemental grants that are awarded on a competitive basis based on an urban area's demonstration of need, including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are awarded for urban areas to address disparities in access, treatment, care, and health outcomes."
Date: February 18, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss Provision in H.R. 3293 on Urban Areas

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision is enacted. The CARE Act, administered by the Department of Health and Human Services's (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In December 2006, the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RWTMA) reauthorized CARE Act programs for fiscal years 2007 through 2009. In July 2009, the House of Representatives passed H.R. 3293, the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriation Act, 2010, which contains a stop-loss provision covering CARE Act funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate. Under the CARE Act, funding for urban areas--Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA)--is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS in an urban area; (2) supplemental grants that are awarded on a competitive basis based on an urban area's demonstration of need, including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are supplemental grants awarded on a competitive basis for urban areas to address disparities in access, treatment, care, and health outcomes. Changes in grantees' characteristics and funding formulas can cause increases or decreases in grantees' funding."
Date: August 3, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Title I Funding for San Francisco

Description: Correspondence issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on funding for San Francisco under the Ryan White CARE Act, focusing on: (1) comparing San Francisco's fiscal (FY) 2000 title I grant award, which was determined using the act's hold-harmless provision, with what the award would have been had deceased acquired immunodeficiency syndrome (AIDS) cases been included in the calculation; and (2) how funding for San Francisco that was based on the inclusion of deceased AIDS cases would have compared with the amount San Francisco would have received if the FY 2000 hold-harmless level had been reduced by 25 percent."
Date: August 24, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Ryan White Care Act: First-Year Experiences under the Part D Administrative Expense Cap

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) makes federal funds available to assist those infected and affected by HIV/AIDS. Through the CARE Act, the Health Resources and Services Administration (HRSA), part of the Department of Health and Human Services (HHS), awards grants (known as Part D grants) to provide services to women, infants, children, and youth with HIV/AIDS and their families. These grantees incur administrative expenses and indirect costs, such as rent and utilities. The Ryan White HIV/AIDS Treatment and Modernization Act of 2006 (RWTMA), which took effect in fiscal year 2007, capped at 10 percent the amount that Part D grantees could spend on administrative expenses. According to HRSA, there is no cap on indirect costs, but grantees must have an indirect cost rate to use funds for indirect costs. RWTMA directed GAO to examine Part D spending. In this report GAO describes (1) the services that Part D grantees provide and what effect, if any, the administrative expense cap has had on those services and on grantee programs; (2) how Part D grantees report on administrative expenses, indirect costs, and compliance with the cap; and (3) how HRSA implemented the cap and grantees' views on that implementation. GAO surveyed all Part D grantees, interviewed selected grantees, reviewed Part D grant applications and guidance, and interviewed HRSA officials."
Date: December 19, 2008
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Estimated Effect of Draft Stop-Loss Provision

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked us to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if a certain stop-loss provision was enacted. The CARE Act, administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In October 2009, the Ryan White HIV/AIDS Treatment Extension Act of 2009 (RWTEA) reauthorized CARE Act programs for fiscal years 2010 through 2013. The stop-loss provision that you asked us to address was contained in a draft consolidated appropriations bill for fiscal year 2011."
Date: January 21, 2011
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Effects of Certain Funding Provisions on Grant Awards

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Funds are made available under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) for individuals affected by HIV/AIDS. Part A provides for grants to metropolitan areas and Part B provides for grants to states and territories and associated jurisdictions for HIV/AIDS services and for AIDS Drug Assistance Programs (ADAP). The Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RWTMA) reauthorized CARE Act programs for fiscal years 2007 through 2009. RWTMA requires name-based HIV case counts for determining CARE Act funding, but an exemption allows the use of code-based case counts through fiscal year 2009. RWTMA formulas include hold-harmless provisions that protect grantees' funding at specified levels. RWTMA also included provisions under which Part A and B grantees with unobligated balances over 2 percent at the end of the grant year incur a penalty in future funding. GAO was asked to examine CARE Act funding provisions. This report provides information on (1) how many Part B grantees collect and use name-based HIV case counts for CARE Act funding; (2) the distribution of Part A hold-harmless funding; and (3) reductions in Part B grantees' funding due to unobligated balance provisions. GAO reviewed agency documents and analyzed data on CARE Act funding. GAO interviewed 19 grantees chosen by geography, number of HIV/AIDS cases, and other criteria. GAO also interviewed federal government officials and other experts."
Date: September 18, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Estimated Effect of Proposed Stop-Loss Provision on Urban Areas

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "Congress asked GAO to estimate the effect on Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) funding to urban areas if certain stop-loss provisions are enacted. The CARE Act, administered by the Department of Health and Human Services's (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). In December 2006, the Ryan White HIV/AIDS Treatment Modernization Act of 2006 (Modernization Act of 2006) reauthorized CARE Act programs for fiscal years 2007 through 2009. In February 2009, the House of Representatives passed H.R. 1105, the Omnibus Appropriations Act, 2009, which contains a stop-loss provision covering CARE Act funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate."
Date: March 6, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Health Resources and Services Administration's Implementation of Certain Provisions Hampered by Lack of Timely and Accurate Information

Description: A letter report issued by the Government Accountability Office with an abstract that begins "Under the CARE Act, funds are made available to assist over 530,000 individuals affected by HIV/AIDS. Grantees directly provide services to individuals (clients) or arrange with service providers to do so. The Department of Health and Human Services's (HHS), Health Resources and Services Administration (HRSA), which administers CARE Act programs, is required to cancel balances of grants that are unobligated after one year and redistribute amounts to grantees in need. HRSA began to collect client-level data in 2009. Under the CARE Act, states and territories receive grants for AIDS Drug Assistance Programs (ADAP), which provide HIV/AIDS drugs. GAO was asked to examine elements of the CARE Act. In this report, we review: (1) HRSA's implementation of the unobligated balance provisions, (2) HRSA's actions to collect client-level data, and (3) the status of ADAP waiting lists. GAO reviewed reports and agency documents and interviewed federal officials, officials from 13 state and 5 local health departments chosen based on location and number of cases, and other individuals knowledgeable about HIV/AIDS."
Date: September 29, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White Care Act: Improvements Needed in Oversight of Grantees

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) does not consistently follow HHS regulations and guidance in its oversight of Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) grantees when conducting key elements of grantee oversight, including routine monitoring and implementing restrictive drawdowns. Additionally, HRSA did not demonstrate a risk-based strategy for selecting grantees for site visits. Project officers (POs) do not consistently document routine monitoring or follow up on that monitoring to help grantees address problems, as required by HHS and HRSA guidance. The purpose of routine monitoring is to enable POs to answer grantee questions about program requirements, provide technical assistance (TA), and follow up on grantee corrective actions in response to previously provided TA. However, GAO found that most POs did not document routine monitoring calls with grantees—only 4 of the 25 PO files GAO reviewed from 2010 and 8 of the 25 files GAO reviewed from 2011 contained documentation of monitoring calls at least quarterly. HRSA often did not follow HHS regulations and guidance in implementing restrictive drawdowns, a special award condition HRSA can place on grantees with serious problems. Restrictive drawdown requires that prior to spending any grant funds, grantees must submit a request, along with documentation of the need, for funds for HRSA review. Six of the 52 Part A grantees and 13 of the 59 Part B grantees were placed on restrictive drawdown from 2008 through 2011. GAO found that HRSA did not consistently provide grantees in GAO’s sample that were on restrictive drawdown with the reasons the restrictive drawdown was implemented, instructions for meeting the conditions of the restrictive drawdown, or guidance on the types of corrective actions needed. ...
Date: June 11, 2012
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White Care Act: Impact of Legislative Funding Proposal on Urban Areas

Description: Correspondence issued by the Government Accountability Office with an abstract that begins "The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act), administered by the Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA), was enacted to address the needs of jurisdictions, health care providers, and people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and their family members. In December 2006 the Ryan White HIV/AIDS Treatment Modernization Act of 2006 reauthorized CARE Act programs for fiscal years 2007 through 2009. In July 2007, the House of Representatives passed H.R. 3043, the Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Act for fiscal year 2008, which contains a hold-harmless provision covering funding for urban areas that receive funding under the CARE Act. This bill has not been passed by the Senate. Under the CARE Act, funding for Eligible Metropolitan Areas (EMA) and Transitional Grant Areas (TGA) is primarily provided through three categories of grants: (1) formula grants that are awarded based on the case counts of people with HIV/AIDS living in an urban area; (2) supplemental grants that are awarded on a competitive basis based on an urban area's demonstration of need, including criteria such as HIV/AIDS prevalence; and (3) Minority AIDS Initiative (MAI) grants, which are supplemental grants awarded on a competitive basis for urban areas to address disparities in access, treatment, care, and health outcomes. The CARE Act includes a hold-harmless provision that limited the decrease that an EMA could receive in its formula funding for fiscal year 2007 to 5 percent of the fiscal year 2006 formula funding it would have received if the revised urban area allocations required by the Modernization Act of 2006 had been in place in fiscal year 2006. For fiscal years 2008 ...
Date: October 5, 2007
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Implementation of the New Minority AIDS Initiative Provisions

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) makes federal funds available to assist individuals affected by HIV/AIDS. The Department of Health and Human Services' (HHS) Health Resources and Services Administration (HRSA) awards CARE Act funding to grantees that include states, territories, and metropolitan areas. Because minorities have been disproportionately affected by HIV/AIDS, the CARE Act's Minority AIDS Initiative (MAI) provides funding through five parts (A, B, C, D, and F) of the act with the goal of reducing HIV-related health care disparities among minorities. The reauthorization of CARE Act programs changed the process by which HRSA awards MAI grants under Part A (funding for metropolitan areas) and Part B (for states and territories) from a formula based solely on demographics of the metropolitan area, state, or territory to a competitive process. The CARE Act requires GAO to report on MAI and related issues. This report provides information on (1) the effect on grantees and service providers of the new competitive process for awarding Part A and B MAI funds, (2) the types of services grantees funded under MAI, and (3) barriers to minorities obtaining services from HIV/AIDS programs that were identified by grantees. GAO surveyed CARE Act grantees and interviewed selected grantee and HRSA officials. GAO also reviewed Part A and B MAI applications."
Date: March 27, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Changes Needed to Improve the Distribution of Funding

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The CARE Act, a federal effort to address the HIV/AIDS epidemic, is administered by HHS. The Act uses formulas based upon a grantee's number of AIDS cases to distribute funds to eligible metropolitan areas (EMA), states, and territories. The use of AIDS cases was prescribed because most jurisdictions tracked and reported only AIDS cases when the grant programs were established. HIV cases must be incorporated with AIDS cases in CARE Act formulas no later than fiscal year 2007. GAO was asked to discuss factors that affect the distribution of CARE Act funding. This testimony is based on HIV/AIDS: Changes Needed to Improve the Distribution of Ryan White CARE Act and Housing Funds, GAO-06-332 (Feb. 28, 2006). GAO discusses how specific funding-formula provisions contribute to funding differences among CARE Act grantees and what distribution differences could result from using HIV cases in CARE Act funding formulas."
Date: April 27, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: AIDS Drug Assistance Programs, Perinatal HIV Transmission, and Partner Notification

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Despite progress in HIV/AIDS drug treatments and the reduction of AIDS mortality in the United States, challenges remain concerning the availability of these drugs for individuals with HIV/AIDS and the prevention of new cases. The CARE Act authorizes grants to the states and certain territories specifically for AIDS Drug Assistance Programs (ADAP) to purchase and provide HIV/AIDS drugs to eligible individuals. In its report issued today, Ryan White CARE Act: Improved Oversight Needed to Ensure AIDS Drug Assistance Programs Obtain Best Prices for Drugs (GAO-06-646), GAO examines the program design of ADAPs in the 50 states, the District of Columbia, and Puerto Rico, their funding sources, and drug purchasing. GAO also reports on state approaches to reducing perinatal HIV transmissions and identifying and notifying partners of HIV-infected individuals."
Date: April 26, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Factors that Impact HIV and AIDS Funding and Client Coverage

Description: Testimony issued by the Government Accountability Office with an abstract that begins "The Ryan White Comprehensive AIDS Resources Emergency Act (CARE Act) was enacted in 1990 to respond to the needs of individuals and families living with the Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Syndrome (AIDS). In fiscal year 2004, over $2 billion in funding was provided through the CARE Act, the majority of which was distributed through Title I grants to eligible metropolitan areas (EMA) and Title II grants to states, the District of Columbia, and territories. Titles I and II use formulas to distribute grants according to a jurisdiction's reported count of AIDS cases. Title II includes grants for state-administered AIDS Drug Assistance Programs (ADAP), which provide medications to HIV-infected individuals. GAO was asked to discuss the distribution of funding under the CARE Act. This testimony presents preliminary findings on (1) the impact of CARE Act provisions that distribute funds based upon the number of AIDS cases in metropolitan areas, (2) the impact of CARE Act provisions that limit annual funding decreases, (3) the potential shifts in funding among grantees if HIV case counts were incorporated with the AIDS cases that are currently used in funding formulas, and (4) the variation in eligibility criteria and funding sources among state ADAPs."
Date: June 23, 2005
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Program Changes Affecting Minority AIDS Initiative and Part D Grantees

Description: Testimony issued by the Government Accountability Office with an abstract that begins "Under the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (CARE Act) federal funds are made available to assist those affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). The Health Resources and Services Administration (HRSA) awards CARE Act grants to states, territories, metropolitan areas, and others. The Ryan White HIV/AIDS Treatment Modernization Act of 2006 (RWTMA) reauthorized CARE Act programs for fiscal years 2007 through 2009. The CARE Act's Minority AIDS Initiative (MAI) provides for grants through five parts (A, B, C, D, and F) with the goal of reducing HIV-related health disparities among minorities. RWTMA changed how HRSA awards MAI grants under Part A and Part B from a formula based on the demographics of the grantee to a competitive process. Part D provides for grants for services to women, infants, children, and youth with HIV/AIDS and their families. RWTMA capped Part D administrative expenses at 10 percent. GAO was asked to testify about CARE Act changes resulting from RWTMA. This testimony discusses (1) the implementation of the MAI provisions and (2) grantees' experiences under the Part D administrative expense cap. This testimony is based on two GAO reports, Ryan White Care Act: Implementation of the New Minority AIDS Initiative Provisions, GAO-09-315, and Ryan White Care Act: First-Year Experiences under the Part D Administrative Expense Cap, GAO-09-140."
Date: September 9, 2009
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department

Ryan White Care Act: Opportunities to Enhance Funding Equity

Description: Testimony issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO discussed ways to distribute Ryan White Comprehensive AIDS Resources Emergency (CARE) Act funds to states and localities, focusing on the: (1) potential for distributing funds on the basis of counts of persons with human immunodeficiency virus (HIV) infection in each geographic area rather than on counts of only persons whose disease has progressed to acquired immunodeficiency syndrome (AIDS); (2) differences in funding for states with and without an eligible metropolitan area (EMA); and (3) current effect of the hold-harmless provision adopted in the 1996 reauthorization, when the method of counting living AIDS cases replaced the practice of counting cumulative AID cases."
Date: July 11, 2000
Creator: United States. General Accounting Office.
Partner: UNT Libraries Government Documents Department

Ryan White CARE Act: Improved Oversight Needed to Ensure AIDS Drug Assistance Programs Obtain Best Prices for Drugs

Description: A letter report issued by the Government Accountability Office with an abstract that begins "The CARE Act authorized grants to the states and certain territories for AIDS Drug Assistance Programs (ADAP) to purchase and provide HIV/AIDS drugs to eligible individuals. An ADAP's coverage--who and what is covered--is determined by each ADAP's eligibility and other program criteria, and ADAPs may establish waiting lists for eligible individuals. ADAPs may purchase their drugs through the 340B federal drug pricing program, which provides discounts on certain drugs to covered entities. The Health Resources and Services Administration (HRSA) oversees ADAPs and is responsible for monitoring the prices they pay. GAO was asked to examine (1) coverage differences among ADAPs, (2) how the prices ADAPs reported paying for HIV/AIDS drugs compare to 340B prices, (3) how HRSA monitors the drug prices ADAPs pay, and (4) how the 340B prices compare to other selected federal drug pricing programs."
Date: April 26, 2006
Creator: United States. Government Accountability Office.
Partner: UNT Libraries Government Documents Department