Summer 2013 Update: Priorities and Funding

I shared this Prezi with the Positive Committee at their July 8, 2013 meeting, to give them an update on the Planning Council's activities over the last couple of months. A couple things for you to know/consider before viewing the Prezi:

• You can read more about the priority setting process, including the factors and scoring process here. The Comprehensive Planning Committee is responsible for facilitating the priority setting process at lest once every three years, or whenever there is a need to update the list due to policy or other changes to the care system. Priority setting just means putting the Ryan White care services in order of importance/need according to certain factors, based on information about community need and impact on the continuum of care. 

• The Philadelphia EMA received less of a decrease in the Part A funding than we were told to expect. The grant award was a little more than 6% less than the 2012 award. The Planning Council already developed a plan for a decrease, and this plan is represented by the 2013 pie chart in the Prezi. the 2012 pie chart is how the money was budgeted for last year. You will notice that the most significant differences are in Early Intervention Services and Care Outreach, which were ended as of the first quarter of this grant year (June 30, 2013), due to the funding decreases. Other services will receive less money too, because Early Intervention and Care Outreach Services couldn't absorb all of the cut.

• The Regional Allocations meetings where the community decides how to budget our Ryan White Part A funds will be at the Office of HIV Planning. Everyone is welcome to attend and participate. The Office of HIV Planning plans to provide meeting materials to participants before the meeting. If you would like to attend a meeting, please call 215-574-6760.
• PA Counties (Chester, Bucks, Delaware and Montgomery)- 
• Tuesday, July 23rd from 1-4pm
• NJ Counties (Camden, Burlington, Salem and Glouchester) - 
• Thursday, July 25th from 1-4pm
• Philadelphia - 
• Tuesday, July 30th from 1 - 4pm

Policy Update: Federal AIDS Policy Partnership Meeting Notes

On Wednesday, May 15th I traveled down to Washington DC to attend the quarterly Federal AIDS Policy Partnership (FAPP) membership meeting. This partnership is a way for HIV providers, advocacy groups, health departments, and Ryan White grantees to combine efforts to promote national policies that ensure people living with HIV/AIDS have access to quality and affordable services, fight stigma and discrimination, and decrease health disparities. Membership is open to any organization with an interest in HIV policy. Membership is free but requires endorsement/support from two member organizations. 

You can see some of the materials from the meeting, including slide sets and the agenda here.

The meeting focused on the Affordable Care Act (ACA). A few of the highlights are outlined below.  Most of the conversation focused on the funding for the Ryan White program and how organizations can prepare for full implementation of the ACA in 2014.  I will share what I think are the most important points/facts from the 5 hour meeting.

Resources on ACA and Ryan White

HRSA's HIV/AIDS Bureau (HAB) has developed  and released documents and other tools that will be helpful to Ryan White grantees and providers in preparing the implementation of health reform. Here's the webpage to find them. Sign up for updates on the right side of the page.

TARGET Center is another great resource with tools and best practices from the federal government and Ryan White grantees/providers.

Payer of Last Resort

It was made pretty clear by the end of the meeting from the guest speakers and others in the room that “Ryan White is payer of last resort” is something we are going to be hearing a lot of in the months and years to come. Here’s a paraphrase from the meeting:

If Medicaid or other insurance covers an activity within a visit, then Ryan White CANNOT be billed for that same activity. Generally, third-party payers pay for the activity/service, not the time taken to provide the service. Ryan White funds can ONLY be used for activities that are not covered by any other payer.

For further details, please see this policy clarification from HRSA. 

HRSA and CMS are working closely together to develop policies and guidance to direct Ryan White grantees and providers through this transitional time. Several documents and policies are expected to be officially released in the next several weeks.

Providers should maximize payer options:

• Find out more about Qualified Health Centers
• Contact top three insurers and join their networks
• Essential Community Provider list - get added if your organization is not included
• Contact State Medicaid office to join the networks
• Have flexibility in billing systems for 3rd party billing

Ryan White providers play a key role in enrollment.

Center for Consumer Information & Insurance Oversight (CCIO) is running navigator grant program for federally facilitated marketplaces. Funding Opportunity Announcement (FOA) and standards are posted at CCIO.  There are wide array of entities that are eligible to apply for navigator grants, focused populations or geographical areas.

All organizations should have staff trained to assist patients/clients with the application and enrollment process for marketplace plans and Medicaid

Funding for FY2013 and FY2014

Take a minute to read this blog post from March to get a feel for the kind of funding challenges we are likely to have this year.

There is no real good news about funding for Ryan White or really any other federally funded HIV/AIDS program. The sequester has reduced the amount of money available for non-defense discretionary programs by $25.8 billion (and that was before Congress started to monkey around with it). If President Obama and Congress can make the sequester go away, there's hope that funding for Ryan White and other essential programs can be protected and restored. At this point, good news is unlikely without a "Grand Bargain" between Democrats and Republicans for increases in revenue (taxes) and decreases in spending.

AIDS Budget and Appropriations Coalition - FY2014 Chart

Congress passed a Continuing Resolution in April 2013 for FY 2013. FY2014 budget is still being developed, currently the House and Senate each have their own versions. House bill has $92 billion less than Senate bill.

President’s budget FY2014 restores FY2013 cuts to Ryan White, but this is only a proposal. The House and Senate must agree on a bill, and that bill has to be signed into law by President Obama. We have a long way to go.

But here are some things we do know:

• Operating budgets for CDC and HRSA have been released for FY2013
• Ryan White Program is losing $121 million instead of the $166 million on the ABAC chart, because President Obama found a way to reinstate the $45 million "World AIDS Day funds" that were left out of the continuing resolution for FY2013.

So there you go. These are just the highlights (or is it lowlights?). Stay tuned for more updates on the federal policy and funding news as we move through the summer. Still no word on when we can expect our full FY2013 Part A award, sometime this summer we suspect. But we do still anticipate the 11% decrease, as discussed in this post from March.

Thursday's Meetings Have Been Rescheduled

Hello everyone!

This is a simple notification that the RWPC and Nominations Committee meetings for this Thursday have been rescheduled, due to the impending snowstorm. These meetings will now be held on Thursday, February 18. It is particularly important that Planning Council members attend the full meeting next Thursday, as we will be voting on a reallocation request that needs to be completed before the end of the fiscal year on February 28.

For updated meeting information, please visit www.hivphilly.org/calendar.html. Thanks!