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JANUARY 18, 2013
CMS Releases Proposed Medicaid, CHIP and Health Insurance Exchange Rule

On Monday, the Centers for Medicare and Medicaid Services (CMS) released an extensive proposed rule covering implementation of both the Affordable Care Act (ACA) and the Children’s Health Insurance Program (CHIP) Reauthorization Act of 2009.

Broadly, the rule covers eligibility requirements for CHIP and the ACA’s expanded Medicaid provisions, options for states to coordinate the Medicaid and CHIP open enrollment process, and providing states options to coordinate eligibility appeals for Medicaid, CHIP and health exchanges and a process for coordinated notices relating to these programs. Additionally, the proposed rule changes Medicaid’s benchmark regulations to implement new benefit options for low income adults and clarifies the relationship between benchmark plans and the Essential Health Benefits provisions in the ACA. The rule also seeks to simplify Medicaid cost sharing calculations for the states. Cost sharing has emerged as a concern because the new rules would potentially increase how much states could charge people with a low income for non-preferred drugs and non-emergency care in emergency departments. The cost of drugs is a major factor for people living with HIV.

Staff members of AIDS United are currently working to review the document to ensure that people living with HIV will receive maximum eligibility and access to comprehensive HIV prevention, care and treatment services. Comments must be submitted by 5:00 p.m. on February 13, 2013. Comments may be submitted electronically by clicking here (comments should reference file code CMS-2334-P). Means to submit comments by regular or express mail or by hand are detailed on pages 2-4 of the proposed rule.

The complete rule can be found here.

A short fact sheet giving an overview of the rule can be found by clicking here.

HHS Releases Report on Effectiveness of HIV Prevention Programs Focusing on African Americans

The Department of Health and Human Services (HHS) recently released a report detailing a collaboration to identify and assess the efficacy of HHS-funded, discretionary initiatives and programs to reduce HIV infections among African Americans. HHS created the report in response to the National HIV/AIDS Strategy, which identified the profound burden of HIV among African Americans; according to the CDC, African Americans represent 14% of the U.S. population but 44% of all people living with HIV/AIDS in the United States.

The report identifies fifty-six HIV prevention programs specifically serving African Americans funded by HHS in fiscal years 2009-2011. In total, the programs received $239 million in funding per year. While the majority of these programs provided HIV prevention and related services (71.7%), other provisions included mental health/substance use services (11.8%), outreach and education (5.2%), family planning services (3.8 %), and capacity building/technical assistance (2.2%). According to the report, the investments in these programs generally follow the epidemiological trends of HIV among African Americans. However, it also identified disproportionately affected subgroups that could use additional targeted assistance and programming, including young men who have sex with both men and women and African Americans in the South and Northeast. This cross-departmental collaboration on the effectiveness of HHS-funded programs may ensure that future resources are allocated most effectively to make sure that the subgroups most in need of prevention programs have access to them.

To read the blog written by Dr. Ronald Valdiserri, Deputy Assistance Secretary for Health and Infectious Diseases and Director of the Office of HIV/AIDS and Infectious Disease Policy at the U.S. Department of Health and Human Services, click here.

To read the full HHS report, click here.

Fiscal Cliff Trilogy Continues...

Although Congress and the President passed legislation earlier this month preserving tax cuts for most Americans and extending unemployment, they left three major spending issues to be resolved by the new Congress.

First, the federal debt limit was reached on December 31, 2012. Despite reaching the limit (the maximum amount that the government may borrow authorized by law), the U.S. has so far been able to manage government payments. However, Treasury Department officials have said that the U.S. will exhaust its ability to continue managing funds around February 15thand no longer have the ability to pay bills that have already been accrued. President Obama has stated that he will not negotiate over the funding necessary to pay the bills we have already incurred, stating on Monday that “we are not a deadbeat nation.”

Second, Congress moved the deadline for sequestration, automatic spending cuts to discretionary defense and non-defense programs enacted in 2011, for two months until March 1st. Finally, the Fiscal Year 2013 (FY13) Continuing Resolution will expire on March 27th creating a third fiscal cliff issue.

AIDS United is monitoring all three situations and the impact on the HIV community. As of right now the House Republicans have said that they are not planning to debate the debt limit, although it is not clear by how much or how long they would agree to raise it. Reports say the Republicans are more interested in the negotiations around sequestration and the Fiscal Year 2013 (FY13) appropriations bills. If sequestration is enacted, there will be severe cuts to non-defense discretionary (NDD) programs; HIV/AIDS programs alone could be cut by at least 5.8% for the reminder of FY13 (March 1, 2013 – September 30, 2013). Other related programs that may be vulnerable include the Supplemental Nutrition Assistance Program (food stamps), transportation programs, housing programs, and other domestic and foreign programs.

AIDS United staff attended a meeting sponsored by the Coalition on Health Funding with Representative Rosa DeLauro (D-CT), Ranking Member of the Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies (the committee in which the majority of the domestic HIV funding is housed). She gave a rousing speech in which she thanked the broader health community for our support of public health. She explained that the community’s work is not yet done and emphasized that we must remain vigilant as we must explain to the country that the NDD budget has been shrinking as a percentage of the gross domestic product (GDP): in 2011, it constituted 3.4% of the GDP, but if all of the Budget Control Act (BCA) is enacted  (including sequestration), the NDD budget will be only 2.7% of the GDP.

We will need your voices to explain to your Members of Congress the importance of increasing the revenue in the negotiations before any additional cuts are made. President Obama has called for a balanced approach to the fiscal situation; however, there have been far more cuts than revenue to date. Since the implementation of the BCA, there have been $1.7 trillion in cuts to discretionary programs. The bill passed on New Year’s Day had $600 trillion in revenue; there must be an additional $1 trillion in revenue before any additional cuts are made to have balance in the fiscal negotiations.

AIDS United will continue to keep you informed as the fiscal cliff is resolved. We will be in touch with you at the appropriate time to contact your Members of Congress to share your support for a balanced approach to the fiscal deals and to share how the cuts we have already experienced have impacted your agency, your community and your family.

To read the President’s full statement, click here.

To watch the statement on video, click here.

PEPFAR, Prostitution Policy and the First Amendment

By Sarah E. Fay, J.D, Zamora Fellow 2009

This spring, the Supreme Court of the United States (SCOTUS) will decide whether the government can condition PEPFAR funds on the adoption of an explicit anti-prostitution policy.

On January 11th, SCOTUS granted a petition for writ of certiorari in the matter of United States Agency for International Development, et al. v. Alliance for Open Society International, Inc., et al . Specifically, the Court will determine whether a federal policy that requires grantees that receive federal funding to adopt a policy explicitly opposing prostitution and sex trafficking violates the First Amendment. The outcome of this case will have far reaching effects throughout the HIV/AIDS community, as two of the respondents collectively include most of the organizations that receive the Leadership Act funding subject to these requirements in the U.S.

Click here to read Sarah's entire blog about this case. 

Americans Lead Unhealthier, Shorter Lives, According to New Study

Americans have been dying at younger ages than people in almost all other high-income countries, according to a recent report published by the National Research Council and the Institute of Medicine, on behalf of the National Institutes of Health. The report explores the U.S. health disadvantage as compared to other high-income democracies. According to the report, the average age of death for Americans has been decreasing over the past three decades especially among women. Furthermore, Americans’ poorer health is consistent over their entire lifetime.

The report identified nine health areas in which Americans fare worse than other high-income democracies, which includes adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, and disability. These nine areas reduce the chances that Americans will live to the age of 50, and also play a role in worse health later in life. While Americans maintain some health advantages over other countries, the disadvantages they are confronted with are not limited to those who are uninsured or poor; in fact, both poor and wealthier Americans are in worse health than their peers in other countries.

So why are Americans so unhealthy? The report identified multiple explanations for the health disadvantage in the United States, including:

  • health systems (more uninsured people with limited access to quality care)
  • health behaviors (consume more calories, higher rates of drug use, more likely to use firearms in acts of violence)
  • social and economic conditions (higher levels of poverty, lower rates of social mobility, benefit less from safety net programs)
  • physical environments (communities centered around automobiles, which discourages physical activity)

While there is no single answer for the U.S. health disadvantage, these explanations help illuminate some of the factors that may contribute to the shorter life span and worsening health of Americans. To prevent such trends from continuing, greater efforts must be made to address the specific causes of these disadvantages; otherwise, money and lives will continue to be lost unnecessarily.

To read the report brief, click here.

To read the New York Times article in response to the report, click here.

Announcements

Register Today for AIDSWatch 2013

AIDS Watch 2013 is just over a month away, so make your plans and register today! Join the National Association of People with AIDS, the Treatment Access Expansion Project, and AIDS United February 25-26, 2013 in Washington, D.C. to make your voice heard with your Members of Congress about HIV and health-related policy! For more information about AIDSWatch and how to register, please click here.


Webinar: “Cultural Competence: Strengthening the Clinician’s Role in Delivering Quality HIV Care within Veteran Communities”

The AIDS Education and Training Center – National Multicultural Center at Howard University, College of Medicine, will present a webinar titled “Cultural Competence: Strengthening the Clinician’s Role in Delivering Quality HIV Care within Veteran Communities” on Thursday, January 31, 2013. Katherine Holman, MD of the University of Alabama at Birmingham will address the demographics of U.S. veterans living with HIV/AIDS, list risk factors for HIV/AIDS among U.S. veterans, describe clinical strategies for providing culturally competent clinical care to veterans living with HIV/AIDS and identity culturally appropriate resources available to veterans with HIV/AIDS and their care providers.

Click here to register today!


National Black HIV/AIDS Awareness Day is February 7, 2013

National Black HIV/AIDS Awareness Day is less than a month away! To learn more about events and programs being held on February 7, 2013,click here. To learn about other HIV/AIDS awareness days through the year, click here.

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