i've written a letter to daddy

May 7, 2007

The Honorable Mike Leavitt
Secretary, Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Secretary Leavitt:

The ongoing implementation of the Ryan White HIV/AIDS Treatment Modernization Act of 2006 is raising significant concerns among people living with HIV/AIDS and those who coordinate and provide their care.

While many of those concerns relate to legislative provisions over which the Department has little discretion, there are others where the Department’s actions can have a significant positive impact on the health and well-being of people living with HIV/AIDS. The organizations listed below ask that the Department act quickly to resolve the following four issues:

1. Maintain Residential Substance Abuse Treatment as an Allowable Support Service
Residential substance abuse treatment is a critical component of the HIV/AIDS care continuum. In FY 2004––the most recent year for which data are publicly available––20 of the 51 Title I jurisdictions used Title I funds to support residential substance abuse treatment.• It is crucial that all jurisdictions continue to have the option of funding these services.

Residential treatment is one of the modalities included in the Substance Abuse and Mental Health Services Administration’s Treatment for HIV-Infected Alcohol and Other Drug Abusers, Treatment Improvement Protocol (TIP) Series: 15. Limiting funded substance abuse services to outpatient settings would contradict the first principle of the National Institute on Drug Abuse’s Principles of Drug Addiction Treatment, which states, “No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.”

Residential substance abuse treatment services clearly meet the criteria laid out in Section 2604 (d)(1) that support services are “services, subject to the approval of the Secretary, that are needed for individuals with HIV/AIDS to achieve their medical outcomes…” Treatment of addiction is an essential part of reaching optimal medical outcomes and untreated substance abuse is a significant barrier to accessing medical care for many people living with HIV/AIDS. Many residential programs treating people living with HIV/AIDS provide on-site medical services, including support for adherence to prescribed medications. Residential substance abuse treatment is well documented as an effective treatment modality that results in significant improvement in
drug use, crime, and employment , and is recognized by SAMHSA as an evidence-based treatment modality, especially for individuals with co-occurring disorders, those released from the criminal justice system, and women. It is particularly effective with homeless and marginally housed individuals. For some people living with HIV/AIDS, inpatient and residential substance abuse treatment is their first encounter with the system of care, including primary medical care.

The range of effective substance abuse treatment modalities, specifically including residential treatment, should be allowed under the “Other Support Services” category if it addresses unmet local needs.

2. Maintain Other Support Services that Meet the Legislative Criteria
The list of fundable support services must include all support services “that are needed for individuals with HIV/AIDS to achieve their medical outcomes” so that grantees and planning councils can address the full range of unmet needs in their communities. There are a number of support services that help people living with HIV/AIDS access and remain in HIV care and treatment. The need for services varies from community to community, depending upon factors such as available services supported by other funding streams and the demographics and characteristics of those in care. The inclusion of all support services that meet the legislative criteria is key to ensuring that communities can continue to offer the continuum of care that meets the needs of the people living with HIV/AIDS in their jurisdictions.

3. Allow for Flexible Core Medical Services that Will Best Serve the Treatment and Care Needs of People Living with HIV/AIDS
We are encouraged by the recent public statements of HRSA HIV/AIDS Bureau leadership that the agency will not issue language further defining any of the core medical services. This gives grantees and planning councils the flexibility to support core medical services that address the health needs of people living with HIV/AIDS in their communities. A timely notification from HRSA to Ryan White grantees of this fact will allow them to move forward with their planning and allocation processes.

4. Ensure Improved HRSA Guidance and Responsiveness
The passage of the reauthorization legislation in the middle of FY 2007 is presenting a significant challenge for everyone––from the Department level to those working on the frontlines. As the process moves forward, it is crucial that HRSA HIV/AIDS Bureau leadership and staff communicate clearly and in a timely fashion with grantees and that they respond to grantee questions and requests for additional information promptly. Too often over the past few months, grantees have been given little time to prepare and plan for significant programmatic changes and funding shifts and important questions have been left unanswered. Grantees, planning councils, providers, and consumers are now two months into the Part A fiscal year, and any significant changes should be postponed until the next fiscal year to avoid any additional disruption of services.

We are eager to work with the Department, HRSA and HAB leadership and staff to ensure that the implementation of the reauthorization legislation best meets the needs of the people living with HIV/AIDS who depend on the Ryan White Program for their care and treatment. We offer our advice, feedback, and communication mechanisms to make this process smoother, easier, and more responsive to the needs of people living with HIV/AIDS. We look forward to your timely response to these critical issues.


This letter was signed by at least 40 large metropolitan treatment agencies. i wonder if it will have any impact. maybe this can help shed some light on the situation.