[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4260 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4260

 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 care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 14, 2014

 Mrs. Ellmers (for herself, Mr. Thompson of Mississippi, and Ms. Eddie 
  Bernice Johnson of Texas) introduced the following bill; 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 care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Ryan White Patient 
Equity and Choice Act''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Prioritization of evidence-based funding allocations to address 
                            the continuum of HIV care.
Sec. 3. Promotion of patient-centered care.

SEC. 2. PRIORITIZATION OF EVIDENCE-BASED FUNDING ALLOCATIONS TO ADDRESS 
              THE CONTINUUM OF HIV CARE.

    (a) 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--
            (1) by redesignating section 2689 of such Act (42 U.S.C. 
        300ff-88) as section 2689C; and
            (2) by inserting after section 2688 of such Act (42 U.S.C. 
        300ff-87a) the following:

``SEC. 2689. GENERAL PROVISIONS ON THE DISTRIBUTION OF GRANTS.

    ``Not later than September 30, 2014, the Secretary shall--
            ``(1) 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 
        services; and
            ``(2) include in such report a plan to ensure that--
                    ``(A) areas where the HIV epidemic is growing are 
                receiving sufficient funding to expand the provision of 
                core medical services (as described in section 2604(c)) 
                to eligible individuals;
                    ``(B) rural areas with limited public 
                transportation are able to expand the use of medical 
                transportation services for eligible individuals in 
                need of such services; and
                    ``(C) the level of funds under parts A and B of 
                this title in any State, per living individual with 
                HIV/AIDS, does not vary by more than 5 percent relative 
                to such total level in any other State.''.
    (b) Use of Services To Eliminate Gaps in the Continuum of HIV 
Care.--
            (1) Use of funding for part a.--Section 2604(c) of the 
        Public Health Service Act (42 U.S.C. 300ff-14) is amended--
                    (A) in paragraph (2)(A)--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iii) 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 care.'';
                    (B) in paragraph (3)--
                            (i) by striking subparagraph (M);
                            (ii) by redesignating subparagraphs (A) 
                        through (L) as subparagraphs (B) through (M), 
                        respectively; and
                            (iii) by inserting before subparagraph (B), 
                        as so redesignated, the following:
                    ``(A) HIV care continuum services described in 
                paragraph (4).''; and
                    (C) by adding at the end the following new 
                paragraphs:
            ``(4) HIV care continuum services.--The services referred 
        to in paragraph (3)(A) are as follows:
                    ``(A) HIV and sexually transmitted disease testing 
                services described in section 2651(e)(1)(B).
                    ``(B) HIV linkage to care services de- scribed in 
                section 2651(e)(1)(C).
                    ``(C) Medical case management, including care 
                retention services and treatment adherence services.
            ``(5) Medical home.--
                    ``(A) In general.--The Secretary shall ensure that 
                each individual receiving core medical services 
                described in paragraph (3) through a grant under this 
                title has an identified `medical home' which includes a 
                primary care team led by an experienced HIV medical 
                provider.
                    ``(B) Primary medical care and medical case 
                management.--The Secretary shall ensure that, wherever 
                possible, 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 (A).''.
            (2) Use of funding for part b.--Section 2612(b) of the 
        Public Health Service Act (42 U.S.C. 300ff-22(b)) is amended--
                    (A) in paragraph (2)(A)--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iii) 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 care.''; and
                    (B) by striking paragraph (3) and inserting the 
                following:
            ``(3) Core medical services.--For the purposes of this 
        subsection, the term `core medical services', with respect to 
        an individual infected with HIV/AIDS (including co-occurring 
        conditions of the individual) has the meaning given to such 
        term in section 2604(c)(3).
            ``(4) Medical home.--Section 2604(c)(5) applies with 
        respect to core medical services under this title to the same 
        extent and in the same manner as section 2604(c)(5) applies 
        with respect to core medical services under part A.''.
            (3) Use of funding for part c.--Section 2651 of the Public 
        Health Service Act (42 U.S.C. 300ff-51) is amended--
                    (A) in subsection (c)(2)(A)--
                            (i) in clause (i), by striking ``and'' at 
                        the end;
                            (ii) in clause (ii), by striking the period 
                        at the end and inserting ``; and''; and
                            (iii) by adding at the end the following:
                            ``(iii) 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 care.'';
                    (B) in subsection (c), by striking paragraph (3) 
                and inserting the following:
            ``(3) Core medical services.--For the purposes of this 
        subsection, the term `core medical services', with respect to 
        an individual infected with HIV/AIDS (including co-occurring 
        conditions of the individual) has the meaning given to such 
        term in section 2604(c)(3).
            ``(4) Medical home.--Section 2604(c)(5) applies with 
        respect to core medical services under this title to the same 
        extent and in the same manner as section 2604(c)(5) applies 
        with respect to core medical services under part A.'';
                    (C) by amending subsection (e)(1)(B) to read as 
                follows:
                    ``(B) testing individuals with respect to HIV/AIDS 
                and sexually transmitted diseases, including tests--
                            ``(i) to confirm the presence of HIV and 
                        other sexually transmitted diseases;
                            ``(ii) to diagnose the extent of deficiency 
                        in the immune system; and
                            ``(iii) to provide information on 
                        appropriate therapeutic measures for preventing 
                        and treating--
                                    ``(I) the deterioration of the 
                                immune system; and
                                    ``(II) conditions arising from HIV/
                                AIDS;'';
                    (D) by amending subsection (e)(1)(C) to read as 
                follows:
                    ``(C) linkage to care services described in 
                paragraph (2);''; and
                    (E) by amending subsection (e)(2) to read as 
                follows:
            ``(2) Linkage to care services.--The services referred to 
        in paragraph (1)(C) shall assist individuals with HIV/AIDS in 
        entering HIV medical care shortly after a positive HIV test 
        result, and may include as appropriate--
                    ``(A) referrals of individuals with HIV/AIDS to 
                appropriate providers of health and support services, 
                including, as appropriate--
                            ``(i) to entities receiving amounts under 
                        part A or B for the provision of such services;
                            ``(ii) to biomedical research facilities of 
                        institutions of higher education that offer 
                        experimental treatment for such disease, or to 
                        community-based organizations or other entities 
                        that provide such treatment; or
                            ``(iii) to grantees under section 2671, in 
                        the case of a pregnant woman;
                    ``(B) 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 transmission;
                    ``(C) ensuring individuals with HIV/AIDS attend 
                their first doctor visit;
                    ``(D) coordinating with a medical case manager who 
                will develop an HIV care plan;
                    ``(E) assisting individuals with HIV/AIDS to re-
                engage into HIV medical care if they have dropped out 
                of care; and
                    ``(F) ensuring individuals with HIV/AIDS have an 
                identified medical home (as described in subsection 
                (c)).''.
    (c) Enhancing Treatment Adherence Through the Provision of 
Pharmaceutical Services.--Section 2616 of the Public Health Service Act 
(42 U.S.C. 300ff-26) is amended by adding at the end the following:
    ``(h) Enhancing Treatment Adherence Through the Provision of 
Pharmaceutical Services.--
            ``(1) Extensive pharmacy networks.--In providing 
        therapeutics pursuant to this section, a State shall offer 
        pharmaceutical services through extensive pharmacy networks, 
        including specialty pharmacies and pharmacies that focus on the 
        HIV population.
            ``(2) No single retail chain.--A pharmacy network under 
        paragraph (1) shall not be limited to a single retail chain.
            ``(3) Mail order services.--Pharmaceutical services 
        provided pursuant to paragraph (1) may include mail order 
        services, but only if--
                    ``(A) such mail order services are optional; and
                    ``(B) the patient continues to be able to choose 
                the services of a community or other in-person 
                pharmacist instead of mail order services.''.

SEC. 3. PROMOTION OF PATIENT-CENTERED CARE.

    (a) Establishment of a Patient-Centered Model of Care.--Section 
2691 of the Public Health Service Act (42 U.S.C. 300ff-101) is 
amended--
            (1) in subsection (a)--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2)--
                            (i) by striking ``to fund'' and inserting 
                        ``fund''; and
                            (ii) by striking the period at the end and 
                        inserting ``; and''; and
                    (C) by adding at the end the following:
            ``(3) fund projects that research and promote the 
        utilization of patient-centered models of care.'';
            (2) in subsection (b)--
                    (A) in paragraph (5), by striking ``or'' at the 
                end;
                    (B) in paragraph (6), by striking the period at the 
                end and inserting ``; or''; and
                    (C) by adding at the end the following:
            ``(7) whether the funding will promote the incorporation of 
        the principles of patient-centered care, as described in 
        subsection (f)(5), into the provision of support services under 
        this title.''; and
            (3) by adding at the end the following:
    ``(f) Patient-Centered Model of Care Projects.--
            ``(1) In general.--Of the amount used under subsection (a) 
        for a fiscal year, the Secretary shall use the greater of 
        $5,000,000 or an amount equal to 20 percent of such amount, but 
        not to exceed $7,000,000, to award grants to one or more States 
        for patient-centered model of care projects.
            ``(2) Projects described.--Projects funded under this 
        subsection shall--
                    ``(A) facilitate patient choice in the utilization 
                of eligible services by eligible individuals through 
                the use of Ryan White Savings Accounts described in 
                paragraph (3);
                    ``(B) increase patient knowledge of, and 
                participation in, their care plan by facilitating 
                greater transparency about providers, care options, 
                costs, and medical outcomes; and
                    ``(C) provide for patient-based evaluation of 
                service providers.
            ``(3) Ryan white savings accounts.--
                    ``(A) In general.--Services provided under this 
                subsection for eligible individuals shall be funded 
                through individual savings accounts--
                            ``(i) to be known as Ryan White Savings 
                        Accounts; and
                            ``(ii) to be established and overseen by 
                        the State receiving the grant for the project 
                        involved.
                    ``(B) Account description.--The Secretary shall 
                ensure that each Ryan White Savings Account meets the 
                following:
                            ``(i) Eligible individuals, with 
                        appropriate coordination with their care 
                        providers, have discretion to choose the 
                        eligible services to be funded through the 
                        Account.
                            ``(ii) Each account shall be used 
                        exclusively for the purpose of paying for 
                        eligible services.
                            ``(iii) The balance of each Account shall 
                        remain available for obligation until such time 
                        as--
                                    ``(I) the individual is no longer 
                                eligible to receive services; or
                                    ``(II) the project which relates to 
                                such Account terminates.
                            ``(iv) If an individual's Account becomes 
                        unavailable for obligation because the 
                        individual is no longer eligible for services, 
                        or because the project terminates, as described 
                        in clause (iii), the Secretary shall make the 
                        remaining balance in the Account available for 
                        other projects under this subsection.
            ``(4) Eligibility.--For purposes of this subsection:
                    ``(A) 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 subsection.
                    ``(B) Services.--The term `eligible services', with 
                respect to an eligible individual, means--
                            ``(i) core medical services (as defined in 
                        section 2604(c)(3));
                            ``(ii) pharmaceutical services described in 
                        section 2616(h); and
                            ``(iii) the following 2 types of support 
                        services:
                                    ``(I) Case management services.
                                    ``(II) Medical transportation 
                                services.
            ``(5) Principles of patient-centered care.--The Secretary 
        shall work to ensure that, where appropriate, projects funded 
        under this section adhere to the following principles:
                    ``(A) HIV care is customized and reflects patient 
                needs, values, and choices.
                    ``(B) Patient safety is a visible priority.
                    ``(C) Transparency is the rule in the care of the 
                patient.
                    ``(D) The patient is the source of control for 
                their care.
                    ``(E) All caregivers cooperate with one another 
                through a common focus on the best interests and 
                personal goals of the patient.
            ``(6) Patient survey.--Each State receiving a grant under 
        this subsection shall--
                    ``(A) conduct a survey on patient satisfaction with 
                services provided pursuant to the grant; and
                    ``(B) report the results of the survey to the 
                Secretary.
            ``(7) Definitions.--In this subsection:
                    ``(A) The term `case management services' means 
                advice and assistance in obtaining medical, social, 
                community, legal, financial, and other needed services.
                    ``(B) The term `medical transportation services' 
                means conveyance services provided, directly or through 
                a voucher, to a patient to enable him or her to access 
                health care services.''.
    (b) General Provisions.--Part E of title XXVI of the Public Health 
Service Act (42 U.S.C. 300ff-81 et seq.) is amended by inserting after 
section 2689A, as added by section 3, the following:

``SEC. 2689B. GENERAL PROVISIONS ON THE PROMOTION OF PATIENT-CENTERED 
              CARE.

    ``(a) In General.--Not later than September 30, 2014, the Secretary 
shall submit to Congress a proposed plan to incorporate the principles 
of HIV patient-centered care described in section 2691(f)(5) into the 
provision of services under all parts of this title.
    ``(b) Contents.--The plan under subsection (a) shall, at a minimum, 
include the following:
            ``(1) An assessment of current grantees' utilization of 
        patient-centered care across all services provided under all 
        parts of this title.
            ``(2) An analysis of--
                    ``(A) existing models of patient-centered care, 
                including the projects funded under section 2691(f); 
                and
                    ``(B) the feasibility of implementing these models 
                throughout programs and services funded under this 
                title.''.
    (c) Grantee Utilization of Patient-Centered Care.--Section 
2602(b)(4) of the Public Health Service Act (42 U.S.C. 300ff-12(b)(4)) 
is amended--
            (1) in subparagraph (G), by striking ``and'' at the end;
            (2) in subparagraph (H), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
                    ``(I) assess the extent to which the principles of 
                HIV patient-centered care described in section 
                2691(f)(5) are incorporated into the provision of 
                services within the eligible area.''.
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