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From page 347... ... Index A Acute infection care trends, 6 Access to care clinical features, 40 CARE Act programs, 12�13, 17 Adherence to HAART case management and, 130�131 clinical significance, 5, 9, 46, 47, 63 current system, 5, 13, 268�269, 271 current rate, 46 demographic disparities, 129�130 determinants of, 46, 47�49 goals, 6�7, 14�15, 16, 33, 36, 50, 134 drug resistance and, 9, 46�47 HAART, 11�13, 14, 129�130, 136, 181, mental illness and, 47, 49, 56�57, 91� 218�223 93, 254, 256�257, 260 insurance access and, 272�274 patient�provider relationship and, 47, mental illness and, 55�56, 252, 258, 49, 163 259�260, 263 predictive factors, 49 outreach to improve, 304 requirements for success, 9, 46, 162�163 provider participation in federal substance abuse and, 59, 91�93, 320� programs and, 12, 14, 19, 111, 136, 321 203 AIDS Drug Assistance Program, 109, 299 public perception, 27�28 barriers to access, 13, 118, 145, 300 shortcomings of current system, 6, 11� drug purchases, 20, 125, 204, 270, 306 12, 14, 19, 135�136 eligibility, 13, 17, 197 state-to-state disparities, 11, 14, 75, 110, HIV-CCP and, 197�198, 207 112, 113, 114�117, 118, 119�122, purpose, 80, 299 284�290, 291, 292, 300, 326 resource allocation, 13, 145, 248, 299 See also Barriers to care spending, 80, 84, 297�298 Accountability, 13, 14, 136 AIDS Education and Training Centers, 29, in Centers of Excellence, 171�174 81, 190, 300 criteria for assessing programs, 142 Alternative delivery and financing systems, goals, 15, 134 195 in Medicare, 146 assessment criteria, 16, 142, 214 347 Read the entire page →
From page 348... ... 348 INDEX block grant program, 153�157 Barriers to care enhanced or expanded Medicaid, 148� in CARE Act programs, 118�122, 300 153, 195, 213�214, 230, 231 conflicting goals among programs, 133� expanded CARE Act programs, 144�145 134 goals, 16, 141�142 coordination among programs and, 127� HAART modeling for evaluation of, 129, 136, 268, 305�306, 328 214�216 cost of care, 132�133 inputs for modeling, 217�225 in current system, 6, 14, 19, 27, 133� Medicare expansion, 145�148, 195 134, 280�283, 304�307 projected enrollment, 224�225 in Medicaid, 12, 17, 109�114, 132�133, projected utilization, 223�224 291�293 prospects, 174�175 in Medicare, 117, 295�297 range of, 15�16, 141, 142, 213 mental illness, 55�56, 131 sensitivity analyses, 234�243 in private insurance programs, 107�109, state participation, 142�144 301, 302�303 See also HIV Comprehensive Care provider reimbursement, 19, 111, 325� Program 326 American Public Health Association, 47 sources of, 129 Antiretroviral drugs for substance abusers, 58�59, 313, 318� access disparities, 129�130 323, 325�327, 330�332 alternative therapies, 46 for women of color, 59 for children, 90 See also Access to care costs, 20, 21, 204, 270 Bipolar disorder, 251 effectiveness, 42, 43�44 Block grants technical evolution, 42�43 advantages, 154 See also Highly active antiretroviral disadvantages, 155�157 therapy structure, 153�154 Anxiety disorders substance abuse treatment, 324 adherence to HIV treatment and, 91 prevalence, 251, 253 risk behavior and, 54�55, 255 C Assessment adherence prediction, 49 Cancer, 44 Candidiasis, 42 depression, 55 insurance status and time of diagnosis, Capitation rates, 111, 114 274 CARE Act. See Ryan White CARE Act Care coordination model of service, 170 role of primary care, 98 Asymptomatic infection, 40�41 Care-seeking behavior At-risk populations, 37 cost of care and, 132 substance abuse and, 58, 94, 319 implications for health care delivery, 50 trends, 9, 10, 38, 50, 63 Case management, 127 Automobile restraints, 187 benefits, 96, 130�131 CARE Act coverage, 298�299 Awareness of HIV status, 156, 181, 218, 226 Centers of Excellence model, 170 definition, 96 delivery models, 96 AZT, 42�43, 269, 299 HAART utilization and, 224 modeling service needs, 223�224 B CD4 lymphocyte levels course of HIV, 41, 42 Bailey Boushay House, 333 depression effects, 93�94 Balanced Budget Act, 18, 197 HAART guidelines, 44, 89 Read the entire page →
From page 349... ... INDEX 349 CD8 lymphocyte levels, depression effects, Coronary angioplasty, 187 93�94 Cost effectiveness Center for Substance Abuse Treatment, 324 current HIV care, 270 Centers for Medicare & Medicaid Services, HAART, 89, 179, 196 114, 128�129, 233�234 HIV-CCP, 16, 22�23, 24, 179, 180�181, Centers of Excellence for HIV care 185�188, 231�232 accountability mechanisms, 171�174 program evaluation methodology, 185� existing programs, 168�169 186, 214 features, 168 Cost of care functions, 7, 170�171 as barrier to care, 132�133 HIV-CCP demonstration project, 180, buy-in provisions, 18, 111 206 care-seeking behavior and, 132 reimbursement practice, 168, 169, 171� drugs, 19�21, 203�205, 270, 306 174, 188 enhanced Medicaid program, 234 structural models, 169�170 goals, 134 Childcare services, 322 HAART, 23, 179, 185, 196, 204�206, Children and adolescents 223, 269�270 CARE Act services, 80�81, 202 HIV care as portion of all health care HIV transmission at childbirth, 19, 90 spending, 270 HIV treatment, 90�91 HIV-CCP budget, 233�234 Medicaid coverage, 278 inputs for modeling alternative mental illness among, 61�62, 252 programs, 217�218, 223�224, 234� sexual abuse as HIV risk factor, 255 243 unsupervised youths, 61�62 preventive intervention outcomes, 193 Chronic care private insurance premiums, 107�108, clinical model, 162�164 302 definition of chronic illness, 161 provider reimbursement rates, 111 HIV/AIDS requirements, 161�162 psychopharmacotherapy, 262 implications for health care delivery, 6, recommendations for federal program, 12, 31, 88, 161�164, 165 21 integrated and coordinated model, 165� spend-down eligibility in federal 168 programs, 18, 326 trends, 6, 12, 63, 88, 100 subsistence purchases and, 131 Colorectal cancer screening, 186�187 substance abuse treatment, 327�328 Community health centers, 303�304 trends, 276 Co-morbidity for uninsured HIV/AIDS patients, 189 among HIV-infected youth, 61�62 Course of disease, 40�42 HIV-CCP coverage, 201, 202 disease state-transition model, 215 infections, 59�60. See also Opportunistic initiation of HAART, 226�227 infection insurance coverage and, 87 recommendations for federal care insurance status and time of diagnosis, program, 19 274 social conditions as, 54, 60�63 mental illness effects, 93�94, 257 trends, 5�6, 10, 38�39 oral manifestations, 98 types of, 52�54 See also Mental illness; Substance abuse; specific disorders D Consolidate Omnibus Reconciliation Act, Data collection 109, 302 Coordination among HIV/AIDS programs on CARE Act program performance, 13, need for, 127�129, 268 14, 122�123, 126�127, 136, 145 current inadequacies, 13, 14, 136 research needs, 305�306 Read the entire page →
From page 350... ... 350 INDEX HAART use and need, 218�223 Department of Veterans Affairs, 33, 282� HIV population characteristics, 218 283, 303, 327 inputs for modeling alternative drug purchases, 19, 20, 203 programs, 217�225 Depression Medicare, 146 adherence to HIV treatment and, 56�57, privacy and confidentiality issues, 196 91, 256 records management in Centers of HIV progression and, 93�94 Excellence, 169�170 identification, 55 on substance abuse, 315�317 immune function and, 257 Delivery of care prevalence, 251, 253 case management services, 96 risk behavior and, 54�55, 255 consideration of substance abusers in Diabetes, 47, 162 policy planning, 314 Drug-resistant viral strains coordination among programs, 124, adherence and, 5, 9, 46�47 125, 127�129, 268, 305�306, 328 screening for, 89 current system, 5�6, 12, 34, 63, 99, 100 trends, 9, 47 demographic factors, 50 Dysthymia, 253 financing of care and, 10 functions of system, 167 future challenges, 36, 38�39 E goals, 14�15, 16, 33, 36, 88, 133�134, Early Treatment for HIV Act, 292 161, 178 historical development, 87�88 Education and training of health providers integrated and coordinated model, 165� CARE Act programs, 29, 81, 190, 300 care for substance abusers, 321 167 organizational structure, 167�168 in Centers of Excellence, 168 primary care, 98�99 Medicaid providers, 111�114 Efficiency of service delivery, 134. See also prospects for reform, 174�175 shortcomings of current system, 13�14, Cost effectiveness 107, 134�136, 165, 167, 194�195 Eligibility, 278, 280�283 alternative block grant program, 153� system evaluation, 32 trends, 6, 12, 36 157 See also Alternative delivery and asset testing for, 198�199 buy-in provisions, 18 financing systems; specific programs Demographic patterns CARE Act, 17, 82, 144�145, 196, 197, access disparities, 129�130, 305 207, 249, 298 criteria for assessing programs, 142 geographic distribution, 51�52 implications for service delivery, 50 current status, 17 infection rate, 9�10, 38, 51 expansion of Medicaid eligibility, 149� 153, 217 insurance access, 272 mental health care utilization, 258 HIV-CCP, 7, 18, 157�158, 178, 179, mental illness risk, 251 181�182, 190, 196�201, 207, 217, 226 mortality, 9 trends, 50, 51�52, 63, 194�195, 270, Medicaid, 17, 18, 75�76, 109, 114, 196, 307 197, 201, 278, 279�290, 291�292, 305, 325 See also Racial/ethnic minorities; Women Medicare, 78, 145�146, 147, 294�295, Dental health. Read the entire page →
From page 351... ... INDEX 351 recommendations for improving access, criteria for assessing programs, 142 18 current HIV spending, 73, 188, 274�277 Social Security Disability Insurance, 294 current system, 5, 11, 73, 100, 216, 268 spend-down provisions, 18, 197�198, delivery system and, 10 279, 326 federal block grant program, 153�157 substance abuse treatment, 325 geographic variation, 122 Supplemental Security Income, 279, 325 goals, 14�15, 16, 178 Eligible Metropolitan Areas, 119, 122�123, insurance coverage distribution, 271� 246�247, 298�299, 329, 331 274 Emergency room admission, 59 prevention services, 306�307 current utilization, 99 problems of federal-state partnership, 6, modeling service needs, 223 11, 14, 136 substance abuser care-seeking behaviors, shortcomings of current system, 6, 11, 319 14, 134�136, 194�195, 268�269, Entitlement programs, 73, 153, 156, 276 304�307 Evidence-based practice, 163 substance abuse services, 323�326, 327� 328 See also Alternative delivery and F financing systems; Cost of care; specific programs Federal Ceiling Price, 20, 21 Fusion inhibitors, 37 recommendations for HIV-CCP, 179� 180, 203, 205 Federal Employee Health Benefits, 304 G Federal programs for HIV/AIDS care, 278, 280�283, 328 Geographic distribution barriers to access, 132, 133�134 CARE Act spending, 122 benefits, 280�283 disease prevalence, 51�52 Centers of Excellence oversight, 174 drug use patterns, 316 current spending, 73, 75, 78, 188, 274� uninsured population, 129 277 Guidelines for the Use of Antiretroviral eligibility, 280�283 Agents in HIV-Infected Adults and financing mechanisms, 73, 100 Adolescents, 44�46, 89 goals, 8, 133�134 mandatory vs. discretionary spending, 276 H origins and development, 8 HAART. Read the entire page →
From page 352... ... 352 INDEX assessment for, 49 maintenance of effort requirements, 160 cost-effectiveness, 89, 179, 196 morbidity and mortality outcomes, costs, 20�21, 23, 159, 179, 185, 196, projected, 16, 22, 179, 183�184, 204�206, 223, 269�270 225, 230�231 criteria for evaluating alternative prevention effect, 192�193 delivery and financing systems, 214� private insurance market effects, 181, 215 199�200 current access, 11�13, 14, 129�130, projected enrollment, 22, 178, 182�183, 136, 181, 214�215, 218�223, 226 190, 217, 224�225, 226 disease status of recipients, 226�227 projected service utilization, 217�224 dosing schedule, 48�49 projected spending, 23, 160, 179, 188� drug interactions, 127, 320 189, 233�234 effectiveness, 5, 8, 31, 37, 43�44, 130, provider payment, 19, 158, 179, 185, 184�185 188, 202�203, 217 implications for care delivery system, 6, quality of care goals, 21 31, 36, 39, 88 rationale, 16, 23�24, 33, 158�159, 179, income levels of recipients, 222 193�194, 208�209 insurance status of recipients, 181, 222 recommendation for establishment of, Medicaid coverage, 77, 217, 230 17, 179, 194�196 in pregnancy, 90 Ryan White CARE Act and, 21�22, 160, requirements for clinical effectiveness, 18 180, 189�191, 206�208 substance abusers and, 320 state participation, 159�160, 195, 196, transmission risk and, 8, 37�38, 135 234 treatment guidelines, 44�46, 89 Home and community-based services, 223, viral resistance to, 9 303�304 See also Adherence to HAART CARE Act coverage, 329 High-risk pools, 304 Medicaid coverage, 114, 290�291 HIV/AIDS Integrated Services Project, 306 Homelessness, 61 HIV/AIDS Mental Health Services Housing Opportunities for Persons with Demonstration Program, 95 AIDS, 276 HIV Comprehensive Care Program, 213 administrative structure, 157, 159 benefit package, 18�19, 157, 158, 179, I 186, 201�202, 215�216, 217 Centers of Excellence demonstration Immigrant population, 62, 200 project, 180, 206 Immunophysiology AIDS, 41�42 cost-effectiveness, 22�23, 24, 179, 180� 181, 185�188 chronic stage infection, 40�41 disadvantages, 159�160 co-morbid disease infection, 60 depression effects, 257 drug purchases, 21, 159, 179�180, 203� 206 HAART, 44�45 eligibility, 7, 18, 157�158, 178, 179, primary infection, 40 tuberculosis risk, 60 181�182, 190, 196�201, 207, 217, 226 Incarcerated populations, 62�63, 200�201, financing, 157, 158�160, 196, 217, 326 Incidence 233�234 goals, 6�7 current rate, 5, 7�8, 27, 36�37 HAART access and use under, 159, demographic patterns, 9�10, 38, 307 trends, 9�10, 37�38, 194�195, 307 178�179, 182�183, 217, 226�230 inputs for modeling, 217�225 Read the entire page →
From page 353... ... INDEX 353 L dental services, 130 drug purchases, 20, 21, 203�204, 270, Low-income population 293, 306 care delivery system goals, 14�15 dual enrollment, 271, 294 challenges for service delivery, 50 eligibility for AIDS/HIV care, 17, 18, crowd-out response to government 75�76, 109, 114, 149�153, 196, programs, 181 197, 201, 278, 279�290, 291�292, current estimates, 218, 270 305 current HIV/AIDS care system, 34 enhanced or expanded models, 15�16, definition, 197 141, 148�153, 195, 213�214, 217, eligibility for federal care programs, 17, 230, 231, 234 18, 197 managed-care services, 111�113, 293 eligibility for Medicaid HIV benefits, mental illness treatment, 115 109, 111, 279, 290 performance evaluation, 32 expansion of eligibility for Medicaid preventive interventions, 97 HIV benefits, 149�153 primary care services, 98 HAART access among, 222 provider participation and HIV-CCP eligibility, 179, 181�182, 196, reimbursement, 12, 19, 111, 114, 197�199 202�203, 325�326 infection risk, 38 quality of care, 273�274 mental illness risk, 251 role in HIV care system, 7 poverty level, 181, 196 Section 1115 waivers for HIV care prior recommendations for CARE Act to disability, 7, 15, 109, 111, 149� programs, 22 150, 291�292, 305 social co-morbidities, 54, 60�61 spending, 75, 274�275, 276, 279, 328 substance abuse treatment access among, state cost control strategies, 293 58�59 state-to-state disparities, 11, 14, 75, 110, 112, 113, 114�117, 284�290, 291, 292, 305 M strategies for improving service delivery, Mammography, 187 114 Managed care, 117 structure, 75, 278 substance abuse treatment, 95, 115, Centers of Excellence model, 170 Medicaid, 111�113, 293 325�326 Medicaid Medicaid Managed Care Organizations, 205 barriers to access, 12, 17, 109�114, 132�133, 272�273, 291�293, 305 Medicare benefits, 76�77, 290�291 access, 19 barriers to access, 117, 295�297, 305 capitation rates, 111, 114 case management services, 96 benefits, 79, 117, 147�148, 295 community-based services, 304 coverage, 77�78, 293 current enrollment, 10, 73, 78, 129, coordination with other programs, 128� 129 218, 271, 272, 293�294, 328 coverage for privately-insured dual enrollment, 271, 294, 296�297 eligibility, 78, 145�146, 147, 294�295, individuals, 199 coverage for working individuals, 109� 305 111, 291�292 expansion of, to improve care, 141, 145�148, 195 current participation, 10, 73, 75, 129, 218, 271, 272, 274, 278�279 financing sources, 146 definition of "disability," 279 prescription drug coverage, 79, 147� 148, 294�295, 296�297, 305, 306 demographic patterns in HIV care, 272 Read the entire page →
From page 354... ... 354 INDEX program accountability, 146 HIV-CCP projected outcomes, 22, 179, project growth in enrollment, 78, 294 183�184, 230�233 provider participation and insurance coverage and, 130 reimbursement, 12, 19, 111, 146, mental illness, 251�252 203 obstacles to greater reduction, 5�6, 12 spending, 78, 274�275, 276, 294, 328 treatment effectiveness, 43 strategies for improving service delivery, trends, 8, 42 117 Multidisciplinary treatment approach, 163� utilization patterns, 127�128 164 Medicare Prescription Drug, Improvement and Modernization Act, 147, 294� 295 N Medigap policies, 117, 296 Mental illness National health insurance, 33 access to care, 252, 263 Natural history. See Course of disease Nonmedical services, 190 adherence to HIV treatment and, 47, 49, 56�57, 91�93, 254, 256�257, 260 Medicare coverage, 117 among HIV-infected youth, 61�62 modeling service needs, 223 NorthSTAR Behavioral Health Pilot barriers to care, 55�56, 131, 258, 259� 260 Program, 334 challenges for service delivery, 50 clinical features, 251 O co-morbid substance abuse, 251, 327 disability outcomes, 251, 252 Obstetric care, 19, 90, 201, 223 HAART utilization and, 224 Omnibus Budget Reconciliation Act, 203� HIV-CCP coverage, 201 204, 279 HIV detection in people with, 55, 258 Opportunistic infection, 42, 89�90 HIV risk, 54�55, 94, 252�253, 254�256 guidelines for prevention and treatment, impact on course of disease, 93�94, 257 90 implications for HIV treatment, 95, 250, HAART effectiveness, 44 261�263 modeling service needs, 223 Medicaid coverage, 115 types of, 90 modeling service needs, 223�224 Oral health mortality, 251�252 access to care, 130 pharmacotherapy, 261�262 CARE Act provisions, 30, 81, 98�99, prevalence, 54, 250, 251, 252�253 190, 202, 299 severe forms, 252 disease progression, 98 socioeconomic status and, 251 Medicaid services, 130 standard of HIV care, 10, 19 modeling service needs, 223 stigmatization and discrimination, 260 primary care, 98 trends, 10, 253�254 Origins of HIV, 40 Montefiore Substance Abuse Treatment Center, 333 Mortality P cause of death in HIV disease, 42 co-morbid depression, 94 Panic disorder, 91, 253 course of HIV, 42 Patient�provider relationship current rate, 5, 7�8, 37 discrimination against client with mental demographic patterns, 9, 51 illness, 260 HAART outcomes, 5, 8, 37, 130, 184 HAART adherence and, 47, 49, 163 HIV-CCP goals, 16 substance abusing patients, 321�322 Read the entire page →
From page 355... ... INDEX 355 Pneumonia, 42 Primary infection, 40 Posttraumatic stress disorder, 253, 255 Prisons. See Incarcerated populations Pregnancy Privacy and confidentiality issues, 196 HAART and, 90 Private insurance, 33 HIV transmission prevention in, 19, 90� anti-discrimination protections, 301�302 91 barriers to care, 107�109, 301, 302�303 Prescription drugs CARE Act purchases, 108�109, 302 CARE Act coverage, 118, 204 COBRA extensions, 302 costs, 19�20, 270, 306 consumer costs, 107�108 goals for federal purchasing, 7 coverage over course of disease, 87 HIV-CCP drug purchases, 21, 159, 179� crowd-out response to government 180, 203�206 programs, 181, 199�200 Medicaid benefits, 76�77, 113, 203� current coverage, 10, 73, 85, 100, 108, 204, 290, 291, 293, 328 129, 218, 271, 272, 274, 301 Medicaid spending, 270 demographic patterns in HIV care, 272 Medicare benefits, 79, 117, 147�148, denial of service, 108, 301 294�295, 296�297, 305 HIV-CCP eligibility and, 199 pharmacy assistance programs, 304 Medigap policies, 117, 296 psychotropic medications, 261�262 portability protections, 301 research and development, 20�21 regulation, 85�87, 108, 301�302 See also AIDS Drug Assistance Program; state-by-state variation in care, 108 Highly active antiretroviral therapy PROTOTYPES, 332�333 Prevalence Public perception and understanding CARE Act EMA eligibility, 246�247 of HIV/AIDS care, 27�28 childhood sexual abuse, 62, 255 stigmatization of HIV-infected persons, co-morbid disease infection, 60 260 co-morbid mental illness, 54, 252�253 co-morbid substance abuse, 57�58, 253, 316�317 Q current estimates, 218, 226 Quality-adjusted life years geographic distribution, 51�52 homelessness, 61 evaluation of alternative care systems, mental illness, 54, 250, 251 22, 215, 216 HIV-CCP goals, 16 socioeconomic distribution, 270 trends, 37�38 HIV-CCP projected outcomes, 22�23, Preventive interventions 179, 184�185, 186�188, 231�233 Quality of care among HIV-positive individuals, 97 antiretroviral therapy, 97 CARE Act programs, 118, 123 financing, 306�307 current system, 305 goals, 15, 134, 164�165 HIV-CCP coverage, 201, 202 HIV-CCP effects, 192�193 HIV-CCP goals, 21 with mentally ill individuals, 262�263 insurance access and, 273�274 in managed-care organizations, 111�113 Primary care access, 10 Medicaid providers, 111�114 advantages of health care delivery in, 98 mental illness and, 260, 262�263 promptness of diagnosis, 274 CARE Act provisions, 98�99, 118, 126 HIV-CCP coverage, 201 in rural areas, 99 Medicaid coverage, 98 specialists in HIV care, 113, 114 strategies for improving, 164�165 role in HIV care system, 98 scope of services, 98 substance abuse and, 319�320 Read the entire page →
From page 356... ... 356 INDEX R eligibility, 17, 82, 144�145, 196, 197, 207, 298 Racial/ethnic minorities, 38 Eligible Metropolitan Areas, 119, 122� barriers to care, 59, 129�130, 131, 132� 123, 298�299, 329, 331 133 emerging communities awards, 249, 299 CARE Act services, 82, 247, 249 expansion of, to improve care, 141, co-morbid disease infection, 60 144�145 HIV risk, 9, 38 funding, 118, 145, 297�298, 300, 328 infection patterns, 51, 307 HIV-CCP and, 21�22, 160, 180, 189� insurance access and utilization, 272 191, 206�208 mental health care utilization, 258 HIV treatment evolution and, 30�31 mental illness risk, 251 performance evaluation, 13, 14, 122� mortality patterns, 9 123, 126�127, 136, 145 substance use in HIV transmission planning bodies, 13, 84�85, 123�127, among, 57, 315 144, 329, 331 Reimbursement primary care services, 98�99, 118, 126 alternative block grant program, 156 private insurance purchases under, 108� carve-out programs, 114, 170 109, 302 Centers of Excellence, 168, 169, 171� purpose, 8, 11, 28�30, 50, 79, 268, 297 174 services and components, 29�30, 80�81, criteria for assessing programs, 142 82�84 disincentive programs, 173�174 spending, 80, 81, 119, 125, 276, 298, HIV-CCP, 19, 158, 179, 185, 188, 202� 299, 300 203, 217 state and local administration, 13, 80, Medicaid, 12, 14, 19, 114, 132�133, 144, 145, 248, 298, 299, 329 202�203, 293, 325�326 state-to-state disparities, 17, 118, 119� Medicare, 12, 19, 111, 146, 203 122, 144�145, 284�290, 298, 300, obstacles to access, 12, 14, 19, 132�133, 305 136, 203, 293 substance abuse treatment, 95, 314, risk-adjusted capitation, 114 328�331, 334�335 state-to-state variation, 326 Title I, 13, 29, 80, 82, 84, 85, 96, 119, Research and development in 123, 125, 145, 190, 207, 246�247, pharmaceutical industry, 20�21 298�299, 328�330 Rivington House, 334 Title II, 13, 29, 80, 82�84, 96, 108�109, Rural areas, 323 119, 122, 190, 207, 248�249, 299, Centers of Excellence in, 173 328�330 quality of care in, 12, 99 Title III, 29, 80, 119, 190, 202, 207� substance abuse treatment in, 326 208, 299 Ryan White CARE Act, 7, 11, 28 Title IV, 29, 80�81, 119, 190, 202, 299 barriers to care, 12�13, 118�122, 300 See also AIDS Drug Assistance Program benefits, 202, 298�300 Ryan White Planning Councils and case management services, 96 Consortia, 123�127 clients, 30, 35, 81�82, 298 coordination with other programs, 124, 125, 128�129 S dental program, 30, 81, 98�99, 190, 202, 299 Schizophrenia, 251, 253, 255, 261 early intervention services, 80, 119, 202, Screening 207�208, 299 cost-effectiveness, 186�187 education and training centers, 29, 81, for drug-resistant viral strains, 89 190, 300 HIV detection in people with mental effectiveness, 31�32 illness, 55, 258 Read the entire page →
From page 357... ... INDEX 357 incarcerated persons, 63 HIV care spending, 276, 279, 328 prenatal, 90�91 in HIV-CCP, 17, 157�158, 159�160, rapid testing, 37 189, 195, 196, 234 Sensitivity analysis, 234�243 inadequacies of current care system, 6, 7 Settings for care insurance regulation, 108 current utilization, 12, 99, 100 Medicaid administration, 11, 75, 76�77, insurance coverage and, 10, 268 279�290, 291, 328 for substance abusers, 59, 319�320 problems of federal�state partnership, 6, trends, 6, 87�88, 165 11, 14, 136 Sexual abuse purchase of private insurance by, 108 HIV transmission risk and, 255 role in alternative delivery and financing prevalence, 62, 255 systems, 142�144 Sexual behavior substance abuse treatment programs, HAART and, 135 323�324 mental illness and, 54�55, 94, 254�256 State-to-state variation in services prevention of transmission-risk CARE Act programs, 118, 119�122, behaviors, 97 144�145, 284�290, 298, 300, 305 prior sexual abuse and, 255 current system, 6, 7, 305 substance use and, in HIV transmission, Medicaid programs, 11, 14, 75, 110, 315 112, 113, 114�117, 284�290, 291, Sexually transmitted diseases, co-morbid, 305 59�60 private insurance, 108 Social co-morbidity, 54, 60�63 reimbursement policies, 326 Social Security Disability Insurance Stigmatization, 260, 318 eligibility, 294 Substance abuse Medicare eligibility and, 78, 294 abuser attitudes toward health care, spending, 275�276 321�322 Social services access, 10 among HIV-infected populations, 57�58, Special Projects of National Significance, 61�62, 253, 316�317 29, 81, 190, 300 barriers to HIV/AIDS care, 313, 318� Standard of care, 10, 88�89, 100 323, 330�332 alternative block grant program, 155� CARE Act provisions, 314, 328�331, 156 334�335 criteria for assessing programs, 142 care-seeking behavior and, 58, 94, 319 current delivery system, 6 challenges for service delivery, 50, 57, HIV-CCP, 158, 179, 201�202 58�59 recommendations for federal program, co-morbid mental illness, 251, 327 18�19 considerations in HIV policy planning, State Children's Health Insurance Program, 314 142, 153�154, 155, 200, 201 current research base, 315�317 State governments current treatment system, 323�332 alternative block grant program, 153� denial of services based on, 322 157 effective programs, 331�335 CARE Act administration, 80, 119, 122, funding for treatment services, 323�326, 248, 298, 299 327�328 drug purchases, 203�204 HAART utilization and, 224, 320 eligibility for AIDS/HIV care, 17 hepatitis infection and, 60 expansion of Medicaid eligibility, 149� HIV-CCP coverage, 201 153 HIV course and, 91, 93�94 health care for incarcerated persons, HIV transmission and, 57, 94, 313, 315 200�201 Medicaid coverage, 115, 325�326 Read the entire page →
From page 358... ... 358 INDEX modeling service needs, 223�224 U patterns, 315�316 provider attitudes, 321 Underinsured/uninsured population, 33 recommendations for federal care among individuals with HIV/AIDS, 11, program, 19 100, 129, 226, 271, 272, 274 service needs of HIV-infected substance CARE Act coverage, 79, 82, 297 abusers, 91, 95, 317�318 costs of HIV care, 189 standard of HIV care, 10, 19 demographic patterns, 272 syringe exchange program, 314 geographic distribution, 129 treatment adherence and, 47, 49, 59, HAART access and utilization, 181 91�93, 320�321 HIV-CCP projections, 189 treatment capacity, 326�327 infection trends, 38, 50 treatment for, 322�323 settings for care, 10, 268 Substance Abuse and Mental Health substance abuse treatment access among, Services Administration, 95, 315� 58�59 316, 324 Substance Abuse Prevention and Treatment Block Grants, 95 V Supplemental Security Income, 18, 76, 112, Viral load, 41�42, 43 197, 275�276, 279, 305, 325 depression effects, 93�94 Syringe exchange program, 314 W T Women Teaching hospitals, 99 barriers to care, 59, 322 Temporary Assistance for Needy Families, CARE Act services, 80, 82, 202 112 depression risk, 251 Testing. See Screening infection patterns, 9�10, 51 Therapeutic relationship. Read the entire page →

From page 347...

... Index A Acute infection care trends, 6 Access to care clinical features, 40 CARE Act programs, 12�13, 17 Adherence to HAART case management and, 130�131 clinical significance, 5, 9, 46, 47, 63 current system, 5, 13, 268�269, 271 current rate, 46 demographic disparities, 129�130 determinants of, 46, 47�49 goals, 6�7, 14�15, 16, 33, 36, 50, 134 drug resistance and, 9, 46�47 HAART, 11�13, 14, 129�130, 136, 181, mental illness and, 47, 49, 56�57, 91� 218�223 93, 254, 256�257, 260 insurance access and, 272�274 patient�provider relationship and, 47, mental illness and, 55�56, 252, 258, 49, 163 259�260, 263 predictive factors, 49 outreach to improve, 304 requirements for success, 9, 46, 162�163 provider participation in federal substance abuse and, 59, 91�93, 320� programs and, 12, 14, 19, 111, 136, 321 203 AIDS Drug Assistance Program, 109, 299 public perception, 27�28 barriers to access, 13, 118, 145, 300 shortcomings of current system, 6, 11� drug purchases, 20, 125, 204, 270, 306 12, 14, 19, 135�136 eligibility, 13, 17, 197 state-to-state disparities, 11, 14, 75, 110, HIV-CCP and, 197�198, 207 112, 113, 114�117, 118, 119�122, purpose, 80, 299 284�290, 291, 292, 300, 326 resource allocation, 13, 145, 248, 299 See also Barriers to care spending, 80, 84, 297�298 Accountability, 13, 14, 136 AIDS Education and Training Centers, 29, in Centers of Excellence, 171�174 81, 190, 300 criteria for assessing programs, 142 Alternative delivery and financing systems, goals, 15, 134 195 in Medicare, 146 assessment criteria, 16, 142, 214 347

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From page 348...

... 348 INDEX block grant program, 153�157 Barriers to care enhanced or expanded Medicaid, 148� in CARE Act programs, 118�122, 300 153, 195, 213�214, 230, 231 conflicting goals among programs, 133� expanded CARE Act programs, 144�145 134 goals, 16, 141�142 coordination among programs and, 127� HAART modeling for evaluation of, 129, 136, 268, 305�306, 328 214�216 cost of care, 132�133 inputs for modeling, 217�225 in current system, 6, 14, 19, 27, 133� Medicare expansion, 145�148, 195 134, 280�283, 304�307 projected enrollment, 224�225 in Medicaid, 12, 17, 109�114, 132�133, projected utilization, 223�224 291�293 prospects, 174�175 in Medicare, 117, 295�297 range of, 15�16, 141, 142, 213 mental illness, 55�56, 131 sensitivity analyses, 234�243 in private insurance programs, 107�109, state participation, 142�144 301, 302�303 See also HIV Comprehensive Care provider reimbursement, 19, 111, 325� Program 326 American Public Health Association, 47 sources of, 129 Antiretroviral drugs for substance abusers, 58�59, 313, 318� access disparities, 129�130 323, 325�327, 330�332 alternative therapies, 46 for women of color, 59 for children, 90 See also Access to care costs, 20, 21, 204, 270 Bipolar disorder, 251 effectiveness, 42, 43�44 Block grants technical evolution, 42�43 advantages, 154 See also Highly active antiretroviral disadvantages, 155�157 therapy structure, 153�154 Anxiety disorders substance abuse treatment, 324 adherence to HIV treatment and, 91 prevalence, 251, 253 risk behavior and, 54�55, 255 C Assessment adherence prediction, 49 Cancer, 44 Candidiasis, 42 depression, 55 insurance status and time of diagnosis, Capitation rates, 111, 114 274 CARE Act. See Ryan White CARE Act Care coordination model of service, 170 role of primary care, 98 Asymptomatic infection, 40�41 Care-seeking behavior At-risk populations, 37 cost of care and, 132 substance abuse and, 58, 94, 319 implications for health care delivery, 50 trends, 9, 10, 38, 50, 63 Case management, 127 Automobile restraints, 187 benefits, 96, 130�131 CARE Act coverage, 298�299 Awareness of HIV status, 156, 181, 218, 226 Centers of Excellence model, 170 definition, 96 delivery models, 96 AZT, 42�43, 269, 299 HAART utilization and, 224 modeling service needs, 223�224 B CD4 lymphocyte levels course of HIV, 41, 42 Bailey Boushay House, 333 depression effects, 93�94 Balanced Budget Act, 18, 197 HAART guidelines, 44, 89

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From page 349...

... INDEX 349 CD8 lymphocyte levels, depression effects, Coronary angioplasty, 187 93�94 Cost effectiveness Center for Substance Abuse Treatment, 324 current HIV care, 270 Centers for Medicare & Medicaid Services, HAART, 89, 179, 196 114, 128�129, 233�234 HIV-CCP, 16, 22�23, 24, 179, 180�181, Centers of Excellence for HIV care 185�188, 231�232 accountability mechanisms, 171�174 program evaluation methodology, 185� existing programs, 168�169 186, 214 features, 168 Cost of care functions, 7, 170�171 as barrier to care, 132�133 HIV-CCP demonstration project, 180, buy-in provisions, 18, 111 206 care-seeking behavior and, 132 reimbursement practice, 168, 169, 171� drugs, 19�21, 203�205, 270, 306 174, 188 enhanced Medicaid program, 234 structural models, 169�170 goals, 134 Childcare services, 322 HAART, 23, 179, 185, 196, 204�206, Children and adolescents 223, 269�270 CARE Act services, 80�81, 202 HIV care as portion of all health care HIV transmission at childbirth, 19, 90 spending, 270 HIV treatment, 90�91 HIV-CCP budget, 233�234 Medicaid coverage, 278 inputs for modeling alternative mental illness among, 61�62, 252 programs, 217�218, 223�224, 234� sexual abuse as HIV risk factor, 255 243 unsupervised youths, 61�62 preventive intervention outcomes, 193 Chronic care private insurance premiums, 107�108, clinical model, 162�164 302 definition of chronic illness, 161 provider reimbursement rates, 111 HIV/AIDS requirements, 161�162 psychopharmacotherapy, 262 implications for health care delivery, 6, recommendations for federal program, 12, 31, 88, 161�164, 165 21 integrated and coordinated model, 165� spend-down eligibility in federal 168 programs, 18, 326 trends, 6, 12, 63, 88, 100 subsistence purchases and, 131 Colorectal cancer screening, 186�187 substance abuse treatment, 327�328 Community health centers, 303�304 trends, 276 Co-morbidity for uninsured HIV/AIDS patients, 189 among HIV-infected youth, 61�62 Course of disease, 40�42 HIV-CCP coverage, 201, 202 disease state-transition model, 215 infections, 59�60. See also Opportunistic initiation of HAART, 226�227 infection insurance coverage and, 87 recommendations for federal care insurance status and time of diagnosis, program, 19 274 social conditions as, 54, 60�63 mental illness effects, 93�94, 257 trends, 5�6, 10, 38�39 oral manifestations, 98 types of, 52�54 See also Mental illness; Substance abuse; specific disorders D Consolidate Omnibus Reconciliation Act, Data collection 109, 302 Coordination among HIV/AIDS programs on CARE Act program performance, 13, need for, 127�129, 268 14, 122�123, 126�127, 136, 145 current inadequacies, 13, 14, 136 research needs, 305�306

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From page 350...

... 350 INDEX HAART use and need, 218�223 Department of Veterans Affairs, 33, 282� HIV population characteristics, 218 283, 303, 327 inputs for modeling alternative drug purchases, 19, 20, 203 programs, 217�225 Depression Medicare, 146 adherence to HIV treatment and, 56�57, privacy and confidentiality issues, 196 91, 256 records management in Centers of HIV progression and, 93�94 Excellence, 169�170 identification, 55 on substance abuse, 315�317 immune function and, 257 Delivery of care prevalence, 251, 253 case management services, 96 risk behavior and, 54�55, 255 consideration of substance abusers in Diabetes, 47, 162 policy planning, 314 Drug-resistant viral strains coordination among programs, 124, adherence and, 5, 9, 46�47 125, 127�129, 268, 305�306, 328 screening for, 89 current system, 5�6, 12, 34, 63, 99, 100 trends, 9, 47 demographic factors, 50 Dysthymia, 253 financing of care and, 10 functions of system, 167 future challenges, 36, 38�39 E goals, 14�15, 16, 33, 36, 88, 133�134, Early Treatment for HIV Act, 292 161, 178 historical development, 87�88 Education and training of health providers integrated and coordinated model, 165� CARE Act programs, 29, 81, 190, 300 care for substance abusers, 321 167 organizational structure, 167�168 in Centers of Excellence, 168 primary care, 98�99 Medicaid providers, 111�114 Efficiency of service delivery, 134. See also prospects for reform, 174�175 shortcomings of current system, 13�14, Cost effectiveness 107, 134�136, 165, 167, 194�195 Eligibility, 278, 280�283 alternative block grant program, 153� system evaluation, 32 trends, 6, 12, 36 157 See also Alternative delivery and asset testing for, 198�199 buy-in provisions, 18 financing systems; specific programs Demographic patterns CARE Act, 17, 82, 144�145, 196, 197, access disparities, 129�130, 305 207, 249, 298 criteria for assessing programs, 142 geographic distribution, 51�52 implications for service delivery, 50 current status, 17 infection rate, 9�10, 38, 51 expansion of Medicaid eligibility, 149� 153, 217 insurance access, 272 mental health care utilization, 258 HIV-CCP, 7, 18, 157�158, 178, 179, mental illness risk, 251 181�182, 190, 196�201, 207, 217, 226 mortality, 9 trends, 50, 51�52, 63, 194�195, 270, Medicaid, 17, 18, 75�76, 109, 114, 196, 307 197, 201, 278, 279�290, 291�292, 305, 325 See also Racial/ethnic minorities; Women Medicare, 78, 145�146, 147, 294�295, Dental health.

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From page 351...

... INDEX 351 recommendations for improving access, criteria for assessing programs, 142 18 current HIV spending, 73, 188, 274�277 Social Security Disability Insurance, 294 current system, 5, 11, 73, 100, 216, 268 spend-down provisions, 18, 197�198, delivery system and, 10 279, 326 federal block grant program, 153�157 substance abuse treatment, 325 geographic variation, 122 Supplemental Security Income, 279, 325 goals, 14�15, 16, 178 Eligible Metropolitan Areas, 119, 122�123, insurance coverage distribution, 271� 246�247, 298�299, 329, 331 274 Emergency room admission, 59 prevention services, 306�307 current utilization, 99 problems of federal-state partnership, 6, modeling service needs, 223 11, 14, 136 substance abuser care-seeking behaviors, shortcomings of current system, 6, 11, 319 14, 134�136, 194�195, 268�269, Entitlement programs, 73, 153, 156, 276 304�307 Evidence-based practice, 163 substance abuse services, 323�326, 327� 328 See also Alternative delivery and F financing systems; Cost of care; specific programs Federal Ceiling Price, 20, 21 Fusion inhibitors, 37 recommendations for HIV-CCP, 179� 180, 203, 205 Federal Employee Health Benefits, 304 G Federal programs for HIV/AIDS care, 278, 280�283, 328 Geographic distribution barriers to access, 132, 133�134 CARE Act spending, 122 benefits, 280�283 disease prevalence, 51�52 Centers of Excellence oversight, 174 drug use patterns, 316 current spending, 73, 75, 78, 188, 274� uninsured population, 129 277 Guidelines for the Use of Antiretroviral eligibility, 280�283 Agents in HIV-Infected Adults and financing mechanisms, 73, 100 Adolescents, 44�46, 89 goals, 8, 133�134 mandatory vs. discretionary spending, 276 H origins and development, 8 HAART.

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From page 352...

... 352 INDEX assessment for, 49 maintenance of effort requirements, 160 cost-effectiveness, 89, 179, 196 morbidity and mortality outcomes, costs, 20�21, 23, 159, 179, 185, 196, projected, 16, 22, 179, 183�184, 204�206, 223, 269�270 225, 230�231 criteria for evaluating alternative prevention effect, 192�193 delivery and financing systems, 214� private insurance market effects, 181, 215 199�200 current access, 11�13, 14, 129�130, projected enrollment, 22, 178, 182�183, 136, 181, 214�215, 218�223, 226 190, 217, 224�225, 226 disease status of recipients, 226�227 projected service utilization, 217�224 dosing schedule, 48�49 projected spending, 23, 160, 179, 188� drug interactions, 127, 320 189, 233�234 effectiveness, 5, 8, 31, 37, 43�44, 130, provider payment, 19, 158, 179, 185, 184�185 188, 202�203, 217 implications for care delivery system, 6, quality of care goals, 21 31, 36, 39, 88 rationale, 16, 23�24, 33, 158�159, 179, income levels of recipients, 222 193�194, 208�209 insurance status of recipients, 181, 222 recommendation for establishment of, Medicaid coverage, 77, 217, 230 17, 179, 194�196 in pregnancy, 90 Ryan White CARE Act and, 21�22, 160, requirements for clinical effectiveness, 18 180, 189�191, 206�208 substance abusers and, 320 state participation, 159�160, 195, 196, transmission risk and, 8, 37�38, 135 234 treatment guidelines, 44�46, 89 Home and community-based services, 223, viral resistance to, 9 303�304 See also Adherence to HAART CARE Act coverage, 329 High-risk pools, 304 Medicaid coverage, 114, 290�291 HIV/AIDS Integrated Services Project, 306 Homelessness, 61 HIV/AIDS Mental Health Services Housing Opportunities for Persons with Demonstration Program, 95 AIDS, 276 HIV Comprehensive Care Program, 213 administrative structure, 157, 159 benefit package, 18�19, 157, 158, 179, I 186, 201�202, 215�216, 217 Centers of Excellence demonstration Immigrant population, 62, 200 project, 180, 206 Immunophysiology AIDS, 41�42 cost-effectiveness, 22�23, 24, 179, 180� 181, 185�188 chronic stage infection, 40�41 disadvantages, 159�160 co-morbid disease infection, 60 depression effects, 257 drug purchases, 21, 159, 179�180, 203� 206 HAART, 44�45 eligibility, 7, 18, 157�158, 178, 179, primary infection, 40 tuberculosis risk, 60 181�182, 190, 196�201, 207, 217, 226 Incarcerated populations, 62�63, 200�201, financing, 157, 158�160, 196, 217, 326 Incidence 233�234 goals, 6�7 current rate, 5, 7�8, 27, 36�37 HAART access and use under, 159, demographic patterns, 9�10, 38, 307 trends, 9�10, 37�38, 194�195, 307 178�179, 182�183, 217, 226�230 inputs for modeling, 217�225

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From page 353...

... INDEX 353 L dental services, 130 drug purchases, 20, 21, 203�204, 270, Low-income population 293, 306 care delivery system goals, 14�15 dual enrollment, 271, 294 challenges for service delivery, 50 eligibility for AIDS/HIV care, 17, 18, crowd-out response to government 75�76, 109, 114, 149�153, 196, programs, 181 197, 201, 278, 279�290, 291�292, current estimates, 218, 270 305 current HIV/AIDS care system, 34 enhanced or expanded models, 15�16, definition, 197 141, 148�153, 195, 213�214, 217, eligibility for federal care programs, 17, 230, 231, 234 18, 197 managed-care services, 111�113, 293 eligibility for Medicaid HIV benefits, mental illness treatment, 115 109, 111, 279, 290 performance evaluation, 32 expansion of eligibility for Medicaid preventive interventions, 97 HIV benefits, 149�153 primary care services, 98 HAART access among, 222 provider participation and HIV-CCP eligibility, 179, 181�182, 196, reimbursement, 12, 19, 111, 114, 197�199 202�203, 325�326 infection risk, 38 quality of care, 273�274 mental illness risk, 251 role in HIV care system, 7 poverty level, 181, 196 Section 1115 waivers for HIV care prior recommendations for CARE Act to disability, 7, 15, 109, 111, 149� programs, 22 150, 291�292, 305 social co-morbidities, 54, 60�61 spending, 75, 274�275, 276, 279, 328 substance abuse treatment access among, state cost control strategies, 293 58�59 state-to-state disparities, 11, 14, 75, 110, 112, 113, 114�117, 284�290, 291, 292, 305 M strategies for improving service delivery, Mammography, 187 114 Managed care, 117 structure, 75, 278 substance abuse treatment, 95, 115, Centers of Excellence model, 170 Medicaid, 111�113, 293 325�326 Medicaid Medicaid Managed Care Organizations, 205 barriers to access, 12, 17, 109�114, 132�133, 272�273, 291�293, 305 Medicare benefits, 76�77, 290�291 access, 19 barriers to access, 117, 295�297, 305 capitation rates, 111, 114 case management services, 96 benefits, 79, 117, 147�148, 295 community-based services, 304 coverage, 77�78, 293 current enrollment, 10, 73, 78, 129, coordination with other programs, 128� 129 218, 271, 272, 293�294, 328 coverage for privately-insured dual enrollment, 271, 294, 296�297 eligibility, 78, 145�146, 147, 294�295, individuals, 199 coverage for working individuals, 109� 305 111, 291�292 expansion of, to improve care, 141, 145�148, 195 current participation, 10, 73, 75, 129, 218, 271, 272, 274, 278�279 financing sources, 146 definition of "disability," 279 prescription drug coverage, 79, 147� 148, 294�295, 296�297, 305, 306 demographic patterns in HIV care, 272

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From page 354...

... 354 INDEX program accountability, 146 HIV-CCP projected outcomes, 22, 179, project growth in enrollment, 78, 294 183�184, 230�233 provider participation and insurance coverage and, 130 reimbursement, 12, 19, 111, 146, mental illness, 251�252 203 obstacles to greater reduction, 5�6, 12 spending, 78, 274�275, 276, 294, 328 treatment effectiveness, 43 strategies for improving service delivery, trends, 8, 42 117 Multidisciplinary treatment approach, 163� utilization patterns, 127�128 164 Medicare Prescription Drug, Improvement and Modernization Act, 147, 294� 295 N Medigap policies, 117, 296 Mental illness National health insurance, 33 access to care, 252, 263 Natural history. See Course of disease Nonmedical services, 190 adherence to HIV treatment and, 47, 49, 56�57, 91�93, 254, 256�257, 260 Medicare coverage, 117 among HIV-infected youth, 61�62 modeling service needs, 223 NorthSTAR Behavioral Health Pilot barriers to care, 55�56, 131, 258, 259� 260 Program, 334 challenges for service delivery, 50 clinical features, 251 O co-morbid substance abuse, 251, 327 disability outcomes, 251, 252 Obstetric care, 19, 90, 201, 223 HAART utilization and, 224 Omnibus Budget Reconciliation Act, 203� HIV-CCP coverage, 201 204, 279 HIV detection in people with, 55, 258 Opportunistic infection, 42, 89�90 HIV risk, 54�55, 94, 252�253, 254�256 guidelines for prevention and treatment, impact on course of disease, 93�94, 257 90 implications for HIV treatment, 95, 250, HAART effectiveness, 44 261�263 modeling service needs, 223 Medicaid coverage, 115 types of, 90 modeling service needs, 223�224 Oral health mortality, 251�252 access to care, 130 pharmacotherapy, 261�262 CARE Act provisions, 30, 81, 98�99, prevalence, 54, 250, 251, 252�253 190, 202, 299 severe forms, 252 disease progression, 98 socioeconomic status and, 251 Medicaid services, 130 standard of HIV care, 10, 19 modeling service needs, 223 stigmatization and discrimination, 260 primary care, 98 trends, 10, 253�254 Origins of HIV, 40 Montefiore Substance Abuse Treatment Center, 333 Mortality P cause of death in HIV disease, 42 co-morbid depression, 94 Panic disorder, 91, 253 course of HIV, 42 Patient�provider relationship current rate, 5, 7�8, 37 discrimination against client with mental demographic patterns, 9, 51 illness, 260 HAART outcomes, 5, 8, 37, 130, 184 HAART adherence and, 47, 49, 163 HIV-CCP goals, 16 substance abusing patients, 321�322

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From page 355...

... INDEX 355 Pneumonia, 42 Primary infection, 40 Posttraumatic stress disorder, 253, 255 Prisons. See Incarcerated populations Pregnancy Privacy and confidentiality issues, 196 HAART and, 90 Private insurance, 33 HIV transmission prevention in, 19, 90� anti-discrimination protections, 301�302 91 barriers to care, 107�109, 301, 302�303 Prescription drugs CARE Act purchases, 108�109, 302 CARE Act coverage, 118, 204 COBRA extensions, 302 costs, 19�20, 270, 306 consumer costs, 107�108 goals for federal purchasing, 7 coverage over course of disease, 87 HIV-CCP drug purchases, 21, 159, 179� crowd-out response to government 180, 203�206 programs, 181, 199�200 Medicaid benefits, 76�77, 113, 203� current coverage, 10, 73, 85, 100, 108, 204, 290, 291, 293, 328 129, 218, 271, 272, 274, 301 Medicaid spending, 270 demographic patterns in HIV care, 272 Medicare benefits, 79, 117, 147�148, denial of service, 108, 301 294�295, 296�297, 305 HIV-CCP eligibility and, 199 pharmacy assistance programs, 304 Medigap policies, 117, 296 psychotropic medications, 261�262 portability protections, 301 research and development, 20�21 regulation, 85�87, 108, 301�302 See also AIDS Drug Assistance Program; state-by-state variation in care, 108 Highly active antiretroviral therapy PROTOTYPES, 332�333 Prevalence Public perception and understanding CARE Act EMA eligibility, 246�247 of HIV/AIDS care, 27�28 childhood sexual abuse, 62, 255 stigmatization of HIV-infected persons, co-morbid disease infection, 60 260 co-morbid mental illness, 54, 252�253 co-morbid substance abuse, 57�58, 253, 316�317 Q current estimates, 218, 226 Quality-adjusted life years geographic distribution, 51�52 homelessness, 61 evaluation of alternative care systems, mental illness, 54, 250, 251 22, 215, 216 HIV-CCP goals, 16 socioeconomic distribution, 270 trends, 37�38 HIV-CCP projected outcomes, 22�23, Preventive interventions 179, 184�185, 186�188, 231�233 Quality of care among HIV-positive individuals, 97 antiretroviral therapy, 97 CARE Act programs, 118, 123 financing, 306�307 current system, 305 goals, 15, 134, 164�165 HIV-CCP coverage, 201, 202 HIV-CCP effects, 192�193 HIV-CCP goals, 21 with mentally ill individuals, 262�263 insurance access and, 273�274 in managed-care organizations, 111�113 Primary care access, 10 Medicaid providers, 111�114 advantages of health care delivery in, 98 mental illness and, 260, 262�263 promptness of diagnosis, 274 CARE Act provisions, 98�99, 118, 126 HIV-CCP coverage, 201 in rural areas, 99 Medicaid coverage, 98 specialists in HIV care, 113, 114 strategies for improving, 164�165 role in HIV care system, 98 scope of services, 98 substance abuse and, 319�320

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From page 356...

... 356 INDEX R eligibility, 17, 82, 144�145, 196, 197, 207, 298 Racial/ethnic minorities, 38 Eligible Metropolitan Areas, 119, 122� barriers to care, 59, 129�130, 131, 132� 123, 298�299, 329, 331 133 emerging communities awards, 249, 299 CARE Act services, 82, 247, 249 expansion of, to improve care, 141, co-morbid disease infection, 60 144�145 HIV risk, 9, 38 funding, 118, 145, 297�298, 300, 328 infection patterns, 51, 307 HIV-CCP and, 21�22, 160, 180, 189� insurance access and utilization, 272 191, 206�208 mental health care utilization, 258 HIV treatment evolution and, 30�31 mental illness risk, 251 performance evaluation, 13, 14, 122� mortality patterns, 9 123, 126�127, 136, 145 substance use in HIV transmission planning bodies, 13, 84�85, 123�127, among, 57, 315 144, 329, 331 Reimbursement primary care services, 98�99, 118, 126 alternative block grant program, 156 private insurance purchases under, 108� carve-out programs, 114, 170 109, 302 Centers of Excellence, 168, 169, 171� purpose, 8, 11, 28�30, 50, 79, 268, 297 174 services and components, 29�30, 80�81, criteria for assessing programs, 142 82�84 disincentive programs, 173�174 spending, 80, 81, 119, 125, 276, 298, HIV-CCP, 19, 158, 179, 185, 188, 202� 299, 300 203, 217 state and local administration, 13, 80, Medicaid, 12, 14, 19, 114, 132�133, 144, 145, 248, 298, 299, 329 202�203, 293, 325�326 state-to-state disparities, 17, 118, 119� Medicare, 12, 19, 111, 146, 203 122, 144�145, 284�290, 298, 300, obstacles to access, 12, 14, 19, 132�133, 305 136, 203, 293 substance abuse treatment, 95, 314, risk-adjusted capitation, 114 328�331, 334�335 state-to-state variation, 326 Title I, 13, 29, 80, 82, 84, 85, 96, 119, Research and development in 123, 125, 145, 190, 207, 246�247, pharmaceutical industry, 20�21 298�299, 328�330 Rivington House, 334 Title II, 13, 29, 80, 82�84, 96, 108�109, Rural areas, 323 119, 122, 190, 207, 248�249, 299, Centers of Excellence in, 173 328�330 quality of care in, 12, 99 Title III, 29, 80, 119, 190, 202, 207� substance abuse treatment in, 326 208, 299 Ryan White CARE Act, 7, 11, 28 Title IV, 29, 80�81, 119, 190, 202, 299 barriers to care, 12�13, 118�122, 300 See also AIDS Drug Assistance Program benefits, 202, 298�300 Ryan White Planning Councils and case management services, 96 Consortia, 123�127 clients, 30, 35, 81�82, 298 coordination with other programs, 124, 125, 128�129 S dental program, 30, 81, 98�99, 190, 202, 299 Schizophrenia, 251, 253, 255, 261 early intervention services, 80, 119, 202, Screening 207�208, 299 cost-effectiveness, 186�187 education and training centers, 29, 81, for drug-resistant viral strains, 89 190, 300 HIV detection in people with mental effectiveness, 31�32 illness, 55, 258

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From page 357...

... INDEX 357 incarcerated persons, 63 HIV care spending, 276, 279, 328 prenatal, 90�91 in HIV-CCP, 17, 157�158, 159�160, rapid testing, 37 189, 195, 196, 234 Sensitivity analysis, 234�243 inadequacies of current care system, 6, 7 Settings for care insurance regulation, 108 current utilization, 12, 99, 100 Medicaid administration, 11, 75, 76�77, insurance coverage and, 10, 268 279�290, 291, 328 for substance abusers, 59, 319�320 problems of federal�state partnership, 6, trends, 6, 87�88, 165 11, 14, 136 Sexual abuse purchase of private insurance by, 108 HIV transmission risk and, 255 role in alternative delivery and financing prevalence, 62, 255 systems, 142�144 Sexual behavior substance abuse treatment programs, HAART and, 135 323�324 mental illness and, 54�55, 94, 254�256 State-to-state variation in services prevention of transmission-risk CARE Act programs, 118, 119�122, behaviors, 97 144�145, 284�290, 298, 300, 305 prior sexual abuse and, 255 current system, 6, 7, 305 substance use and, in HIV transmission, Medicaid programs, 11, 14, 75, 110, 315 112, 113, 114�117, 284�290, 291, Sexually transmitted diseases, co-morbid, 305 59�60 private insurance, 108 Social co-morbidity, 54, 60�63 reimbursement policies, 326 Social Security Disability Insurance Stigmatization, 260, 318 eligibility, 294 Substance abuse Medicare eligibility and, 78, 294 abuser attitudes toward health care, spending, 275�276 321�322 Social services access, 10 among HIV-infected populations, 57�58, Special Projects of National Significance, 61�62, 253, 316�317 29, 81, 190, 300 barriers to HIV/AIDS care, 313, 318� Standard of care, 10, 88�89, 100 323, 330�332 alternative block grant program, 155� CARE Act provisions, 314, 328�331, 156 334�335 criteria for assessing programs, 142 care-seeking behavior and, 58, 94, 319 current delivery system, 6 challenges for service delivery, 50, 57, HIV-CCP, 158, 179, 201�202 58�59 recommendations for federal program, co-morbid mental illness, 251, 327 18�19 considerations in HIV policy planning, State Children's Health Insurance Program, 314 142, 153�154, 155, 200, 201 current research base, 315�317 State governments current treatment system, 323�332 alternative block grant program, 153� denial of services based on, 322 157 effective programs, 331�335 CARE Act administration, 80, 119, 122, funding for treatment services, 323�326, 248, 298, 299 327�328 drug purchases, 203�204 HAART utilization and, 224, 320 eligibility for AIDS/HIV care, 17 hepatitis infection and, 60 expansion of Medicaid eligibility, 149� HIV-CCP coverage, 201 153 HIV course and, 91, 93�94 health care for incarcerated persons, HIV transmission and, 57, 94, 313, 315 200�201 Medicaid coverage, 115, 325�326

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From page 358...

... 358 INDEX modeling service needs, 223�224 U patterns, 315�316 provider attitudes, 321 Underinsured/uninsured population, 33 recommendations for federal care among individuals with HIV/AIDS, 11, program, 19 100, 129, 226, 271, 272, 274 service needs of HIV-infected substance CARE Act coverage, 79, 82, 297 abusers, 91, 95, 317�318 costs of HIV care, 189 standard of HIV care, 10, 19 demographic patterns, 272 syringe exchange program, 314 geographic distribution, 129 treatment adherence and, 47, 49, 59, HAART access and utilization, 181 91�93, 320�321 HIV-CCP projections, 189 treatment capacity, 326�327 infection trends, 38, 50 treatment for, 322�323 settings for care, 10, 268 Substance Abuse and Mental Health substance abuse treatment access among, Services Administration, 95, 315� 58�59 316, 324 Substance Abuse Prevention and Treatment Block Grants, 95 V Supplemental Security Income, 18, 76, 112, Viral load, 41�42, 43 197, 275�276, 279, 305, 325 depression effects, 93�94 Syringe exchange program, 314 W T Women Teaching hospitals, 99 barriers to care, 59, 322 Temporary Assistance for Needy Families, CARE Act services, 80, 82, 202 112 depression risk, 251 Testing. See Screening infection patterns, 9�10, 51 Therapeutic relationship.

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Index Pages 347-358

Index
Pages 347-358