By By John Wright Staff Writer

State working to revise policy requiring specialized providers to send some HIV-positive patients elsewhere for general medical care

Raeline Nobles, executive director of AIDS Arms, said changes in policies could result in some HIV-positive patients failing to receive treatment for other medical problems that are typically related to HIV.

HIV medical care providers in Texas are closely monitoring proposed policy changes they say could have devastating impacts on low-income patients.

The policy changes, as currently drafted, would require specialized providers to refer patients receiving grant-funded HIV care to primary providers for general medical care.

Raeline Nobles, executive director of the Dallas-based nonprofit AIDS Arms Inc., said the result of the changes would be that low-income HIV-positive patients fail to receive treatment for other medical problems, which typically are related to the virus.

AIDS Arms’ Peabody Clinic treats 1,200 HIV-positive patients annually, and the vast majority fall at or below the federal poverty level, she said.

“Sometimes HIV is the only reason they are now getting medical care, so to turn them out [for other problems] would just create a huge barrier of care,” Nobles said. “Once people walk into the clinic, let’s treat them holistically. Once you become HIV-positive, it all becomes HIV-related.”

Fortunately, Nobles and others said, after a grassroots effort during a 30-day public comment period that ended April 9, it appears the Department of State Health Services is backing away slightly from some of the changes.

“It sounds like the state, when they were pushed on that point, came back and said we never intended for it to be read that way,” Nobles said. “It’s not good medicine, and it’s not good for the community’s health.”

Janna Zumbrun, health promotion unit manager for DSHS, confirmed she believes there will be additional changes to the policy, known as “Payor of Last Resort,” based on the public comment. After those are made, DSHS will decide whether to conduct another public comment period before enacting it.

“We got some excellent input on this policy from the field, which is exactly what we needed, and we’re in the process of looking at all of that,” Zumbrun said. “We will be very cautions and careful to ensure that our policy doesn’t result in clients not receiving the medical care they need. I think we share that same interest.”

Zumbrun said the proposed changes to the policy were the result of a periodic review that stemmed partly from updated provisions in the federal Ryan White Treatment Modernization Act of 2006.

The proposed changes are designed to ensure the state does not breach federal guidelines for spending the roughly $16 million annually in Ryan White funds it currently receives, Zumbrun said.

The policy also applies to another few million dollars in state funds that are used in conjunction with Ryan White.

Under the Ryan White program, states are required to ensure that the monies are a payor of last resort, meaning if there is another source to pay for the medical care, it must be used first.

For example, if an HIV patient is eligible for Medicaid or has private health insurance, those resources must be exhausted prior to the use of Ryan White funds, Zumbrun said. Or, if the medical condition clearly is not HIV-related, rather than using Ryan White funds the state must help the patient locate another resource, which typically can be found.

Zumbrun said she could not give a specific time frame for further DSHS action related to the policy.

In addition to the Peabody Clinic, changes could affect patients who receive treatment at facilities such as UT Southwestern Medical Center’s Amelia Court Continuity Clinic in Dallas.

A representative from Amelia Court could not be reached for comment this week.


This article appeared in the Dallas Voice print edition April 13, 2007 mobile.wihackhtrkfvf jn ueuk