,i #aacth ,,congress #b;d ,session ,h4 ,r4 #dbfj ,,in ,,the ,,house ,,of ,,representatives ,march #ad1 #bjad ,mrs4 ,ellmers 7for herself1 ,mr4 ,thompson of ,mississippi1 and ,ms4 ,eddie ,bernice ,johnson of ,texas7 introduced the following bill2 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 care4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,ryan ,white ,patient ,equity and ,choice ,act 4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,prioritization of evidence-based funding allocations to address the continuum of ,,hiv care4 ,sec4 #c4 ,promotion of patient-centered care4 #b4 ,prioritization of evidence-based funding allocations to address the continuum of ,,hiv care 7a7 ,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-- 7#a7 by redesignating section #bfhi of such ,act 7#db ,u4,s4,c4 #cjj;ff-#hh7 as section #bfhi;,c2 and 7#b7 by inserting after section #bfhh of such ,act 7#db ,u4,s4,c4 #cjj;ff-#hg;a7 the following3 #bfhi4 ,general provisions on the distribution of grants ,not later than ,september #cj1 #bjad1 the ,secretary shall-- 7#a7 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 services2 and 7#b7 include in such report a plan to ensure that-- 7,a7 areas where the ,,hiv epidemic is growing are receiving sufficient funding to expand the provision of core medical services 7as described in section #bfjd7;c77 to eligible individuals2 7,b7 rural areas with limited public transportation are able to expand the use of medical transportation services for eligible individuals in need of such services2 and 7,c7 the level of funds under parts ,a and ,b of this title in any ,state1 per living individual with ,,hiv_/,,aids1 does not vary by more than #e percent relative to such total level in any other ,state4 4 7b7 ,use of ,services ,to ,eliminate ,gaps in the ,continuum of ,,hiv ,care 7#a7 ,use of funding for part ,a ,section #bfjd7;c7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ad7 is amended-- 7,a7 in paragraph 7#b77;,a7-- 7i7 in clause 7i71 by striking and at the end2 7ii7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following3 7iii7 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 care4 2 7,b7 in paragraph 7#c7-- 7i7 by striking subparagraph 7,m72 7ii7 by redesignating subparagraphs 7,a7 through 7,l7 as subparagraphs 7,b7 through 7,m71 respectively2 and 7iii7 by inserting before subparagraph 7,b71 as so redesignated1 the following3 7,a7 ,,hiv care continuum services described in paragraph 7#d74 2 and 7,c7 by adding at the end the following new paragraphs3 7#d7 ,,hiv care continuum services ,the services referred to in paragraph 7#c77;,a7 are as follows3 7,a7 ,,hiv and sexually transmitted disease testing services described in section #bfea7;e77#a77;,b74 7,b7 ,,hiv linkage to care services de- scribed in section #bfea7;e77#a77;,c74 7,c7 ,medical case management1 including care retention services and treatment adherence services4 7#e7 ,medical home 7,a7 ,in general ,the ,secretary shall ensure that each individual receiving core medical services described in paragraph 7#c7 through a grant under this title has an identified medical home which includes a primary care team led by an experienced ,,hiv medical provider4 7,b7 ,primary medical care and medical case management ,the ,secretary shall ensure that1 wherever possible1 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 7,a74 4 7#b7 ,use of funding for part ,b ,section #bfab7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#bb7;b77 is amended-- 7,a7 in paragraph 7#b77;,a7-- 7i7 in clause 7i71 by striking and at the end2 7ii7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following3 7iii7 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 care4 2 and 7,b7 by striking paragraph 7#c7 and inserting the following3 7#c7 ,core medical services ,for the purposes of this subsection1 the term core medical services1 with respect to an individual infected with ,,hiv_/,,aids 7including co-occurring conditions of the individual7 has the meaning given to such term in section #bfjd7;c77#c74 7#d7 ,medical home ,section #bfjd7;c77#e7 applies with respect to core medical services under this title to the same extent and in the same manner as section #bfjd7;c77#e7 applies with respect to core medical services under part ,a4 4 7#c7 ,use of funding for part ,c ,section #bfea of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ea7 is amended-- 7,a7 in subsection 7c77#b77;,a7-- 7i7 in clause 7i71 by striking and at the end2 7ii7 in clause 7ii71 by striking the period at the end and inserting 2 and2 and 7iii7 by adding at the end the following3 7iii7 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 care4 2 7,b7 in subsection 7c71 by striking paragraph 7#c7 and inserting the following3 7#c7 ,core medical services ,for the purposes of this subsection1 the term core medical services1 with respect to an individual infected with ,,hiv_/,,aids 7including co-occurring conditions of the individual7 has the meaning given to such term in section #bfjd7;c77#c74 7#d7 ,medical home ,section #bfjd7;c77#e7 applies with respect to core medical services under this title to the same extent and in the same manner as section #bfjd7;c77#e7 applies with respect to core medical services under part ,a4 2 7,c7 by amending subsection 7e77#a77;,b7 to read as follows3 7,b7 testing individuals with respect to ,,hiv_/,,aids and sexually transmitted diseases1 including tests-- 7i7 to confirm the presence of ,,hiv and other sexually transmitted diseases2 7ii7 to diagnose the extent of deficiency in the immune system2 and 7iii7 to provide information on appropriate therapeutic measures for preventing and treating-- 7,i7 the deterioration of the immune system2 and 7,,ii7 conditions arising from ,,hiv_/,,aids2 2 7,d7 by amending subsection 7e77#a77;,c7 to read as follows3 7,c7 linkage to care services described in paragraph 7#b72 2 and 7,e7 by amending subsection 7e77#b7 to read as follows3 7#b7 ,linkage to care services ,the services referred to in paragraph 7#a77;,c7 shall assist individuals with ,,hiv_/,,aids in entering ,,hiv medical care shortly after a positive ,,hiv test result1 and may include as appropriate-- 7,a7 referrals of individuals with ,,hiv_/,,aids to appropriate providers of health and support services1 including1 as appropriate-- 7i7 to entities receiving amounts under part ,a or ,b for the provision of such services2 7ii7 to biomedical research facilities of institutions of higher education that offer experimental treatment for such disease1 or to community-based organizations or other entities that provide such treatment2 or 7iii7 to grantees under section #bfga1 in the case of a pregnant woman2 7,b7 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 transmission2 7,c7 ensuring individuals with ,,hiv_/,,aids attend their first doctor visit2 7,d7 coordinating with a medical case manager who will develop an ,,hiv care plan2 7,e7 assisting individuals with ,,hiv_/,,aids to re-engage into ,,hiv medical care if they have dropped out of care2 and 7,f7 ensuring individuals with ,,hiv_/,,aids have an identified medical home 7as described in subsection 7c774 4 7c7 ,enhancing treatment adherence through the provision of pharmaceutical services ,section #bfaf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#bf7 is amended by adding at the end the following3 7h7 ,enhancing ,treatment ,adherence ,through the ,provision of ,pharmaceutical ,services 7#a7 ,extensive pharmacy networks ,in providing therapeutics pursuant to this section1 a ,state shall offer pharmaceutical services through extensive pharmacy networks1 including specialty pharmacies and pharmacies that focus on the ,,hiv population4 7#b7 ,no single retail chain ,a pharmacy network under paragraph 7#a7 shall not be limited to a single retail chain4 7#c7 ,mail order services ,pharmaceutical services provided pursuant to paragraph 7#a7 may include mail order services1 but only if-- 7,a7 such mail order services are optional2 and 7,b7 the patient continues to be able to choose the services of a community or other in-person pharmacist instead of mail order services4 4 #c4 ,promotion of patient-centered care 7a7 ,establishment of a patient-,centered model of care ,section #bfia of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#aja7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#a71 by striking and at the end2 7,b7 in paragraph 7#b7-- 7i7 by striking to fund and inserting fund2 and 7ii7 by striking the period at the end and inserting 2 and2 and 7,c7 by adding at the end the following3 7#c7 fund projects that research and promote the utilization of patient-centered models of care4 2 7#b7 in subsection 7b7-- 7,a7 in paragraph 7#e71 by striking or at the end2 7,b7 in paragraph 7#f71 by striking the period at the end and inserting 2 or2 and 7,c7 by adding at the end the following3 7#g7 whether the funding will promote the incorporation of the principles of patient-centered care1 as described in subsection 7f77#e71 into the provision of support services under this title4 2 and 7#c7 by adding at the end the following3 7f7 ,patient-,centered model of care projects 7#a7 ,in general ,of the amount used under subsection 7a7 for a fiscal year1 the ,secretary shall use the greater of #e1jjj1jjj or an amount equal to #bj percent of such amount1 but not to exceed #g1jjj1jjj1 to award grants to one or more ,states for patient-centered model of care projects4 7#b7 ,projects described ,projects funded under this subsection shall-- 7,a7 facilitate patient choice in the utilization of eligible services by eligible individuals through the use of ,ryan ,white ,savings ,accounts described in paragraph 7#c72 7,b7 increase patient knowledge of1 and participation in1 their care plan by facilitating greater transparency about providers1 care options1 costs1 and medical outcomes2 and 7,c7 provide for patient-based evaluation of service providers4 7#c7 ,ryan ,white ,savings ,accounts 7,a7 ,in general ,services provided under this subsection for eligible individuals shall be funded through individual savings accounts-- 7i7 to be known as ,ryan ,white ,savings ,accounts2 and 7ii7 to be established and overseen by the ,state receiving the grant for the project involved4 7,b7 ,account description ,the ,secretary shall ensure that each ,ryan ,white ,savings ,account meets the following3 7i7 ,eligible individuals1 with appropriate coordination with their care providers1 have discretion to choose the eligible services to be funded through the ,account4 7ii7 ,each account shall be used exclusively for the purpose of paying for eligible services4 7iii7 ,the balance of each ,account shall remain available for obligation until such time as-- 7,i7 the individual is no longer eligible to receive services2 or 7,,ii7 the project which relates to such ,account terminates4 7iv7 ,if an individual's ,account becomes unavailable for obligation because the individual is no longer eligible for services1 or because the project terminates1 as described in clause 7iii71 the ,secretary shall make the remaining balance in the ,account available for other projects under this subsection4 7#d7 ,eligibility ,for purposes of this subsection3 7,a7 ,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 subsection4 7,b7 ,services ,the term eligible services1 with respect to an eligible individual1 means-- 7i7 core medical services 7as defined in section #bfjd7;c77#c772 7ii7 pharmaceutical services described in section #bfaf7;h72 and 7iii7 the following #b types of support services3 7,i7 ,case management services4 7,,ii7 ,medical transportation services4 7#e7 ,principles of ,patient-,centered ,care ,the ,secretary shall work to ensure that1 where appropriate1 projects funded under this section adhere to the following principles3 7,a7 ,,hiv care is customized and reflects patient needs1 values1 and choices4 7,b7 ,patient safety is a visible priority4 7,c7 ,transparency is the rule in the care of the patient4 7,d7 ,the patient is the source of control for their care4 7,e7 ,all caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient4 7#f7 ,patient survey ,each ,state receiving a grant under this subsection shall-- 7,a7 conduct a survey on patient satisfaction with services provided pursuant to the grant2 and 7,b7 report the results of the survey to the ,secretary4 7#g7 ,definitions ,in this subsection3 7,a7 ,the term case management services means advice and assistance in obtaining medical1 social1 community1 legal1 financial1 and other needed services4 7,b7 ,the term medical transportation services means conveyance services provided1 directly or through a voucher1 to a patient to enable him or her to access health care services4 4 7b7 ,general provisions ,part ,e of title ,,xxvi of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ha et seq47 is amended by inserting after section #bfhi;,a1 as added by section #c1 the following3 #bfhi;,b4 ,general provisions on the promotion of patient-centered care 7a7 ,in general ,not later than ,september #cj1 #bjad1 the ,secretary shall submit to ,congress a proposed plan to incorporate the principles of ,,hiv patient-centered care described in section #bfia7;f77#e7 into the provision of services under all parts of this title4 7b7 ,contents ,the plan under subsection 7a7 shall1 at a minimum1 include the following3 7#a7 ,an assessment of current grantees' utilization of patient-centered care across all services provided under all parts of this title4 7#b7 ,an analysis of-- 7,a7 existing models of patient-centered care1 including the projects funded under section #bfia7;f72 and 7,b7 the feasibility of implementing these models throughout programs and services funded under this title4 4 7c7 ,grantee utilization of patient-,centered care ,section #bfjb7;b77#d7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;ff-#ab7;b77#d77 is amended-- 7#a7 in subparagraph 7,g71 by striking and at the end2 7#b7 in subparagraph 7,h71 by striking the period at the end and inserting 2 and2 and 7#c7 by adding at the end the following3 7,i7 assess the extent to which the principles of ,,hiv patient-centered care described in section #bfia7;f77#e7 are incorporated into the provision of services within the eligible area4 4