infection, primary care services, case management, and prevention services are essential. To prevent HIV transmission from pregnant women to their newborn children, which is virtually completely avoidable with appropriate drug therapy during pregnancy, obstetric and reproductive health services must be included. Finally, many people with HIV/AIDS suffer from co-morbid conditions such as mental illness or substance abuse disorders that interfere with compliance with treatment regimens. The inclusion of services to address mental illness and substance abuse is fundamental to the continuation of therapies essential to disease management. Accordingly, the Committee recommends:

Recommendation 3: The new program should entitle each eligible individual with HIV to a uniform, federally defined benefit package that reflects the standard of care for HIV/AIDS.

Provider Payment

Even where programs exist for HIV/AIDS care, such as Medicaid and the Ryan White CARE Act program, access to sustained care has been undermined by erratic and uncertain provider participation in the programs. In most cases, this is attributable to inadequate provider reimbursement, specifically under Medicaid. In fact, Medicaid reimbursement to HIV/AIDS providers historically has been so low that in many states access to care for people with HIV/AIDS in Medicaid is the same as for those who are uninsured (Shapiro et al., 1999).

These access barriers are incompatible with the Committee’s objective of achieving reduced morbidity, mortality, and disability. Of the public insurance programs, Medicare has achieved a noteworthy record of improving access to care, and provider participation remains very high (around 96 percent). While recent budget reductions may threaten the level of provider participation and may affect beneficiary access, Medicare still represents a model for improving access to care. Accordingly, the Committee recommends:

Recommendation 4: The new program should reimburse providers who elect to participate at rates comparable to those paid by Medicare for comparable services.

Cost Offsets

Drug manufacturers sell the same product at different prices to different purchasers. Under current law, the price drug manufacturers can charge the Department of Veterans Affairs (VA), the Department of Defense (DOD), the Public Health Service (PHS), and the Coast Guard for products



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