Felicia Lynch said a new D.C. HIV/AIDS Administration program for people receiving Ryan White Care Act funds will make it easier for clients to see multiple health care providers. (Photo by Michael Wise)
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LAUREL FAUST
Friday, September 12, 2003
The D.C. HIV/AIDS Administration is rolling out a new program for people who
receive Ryan White Emergency CARE Act funds aimed at making it easier to receive
health care from multiple service providers. The program, called XPRES, is being
praised by some while others are concerned the program’s new ID cards will
compromise client confidentiality.
Felicia Lynch, HAA’s director of health and support services, said that,
with the old system — which is still in place in a few locations — clients
have to go through separate intake procedures each time they change providers.
With XPRES, there will be a unifying database so providers can pull up the
health history of each client.
Lynch said that HAA began implementing XPRES in pilot programs around the
region beginning in March. Now 98 percent of service providers have the program
and are being trained on how to use it.
Clients are issued a white plastic card with a key code and a four or five
digit number. The cards are swiped in the same manner as a credit card. The
client’s complete medical history shows up on the provider’s computer
screen.
Lynch said the cards can be used by people receiving federal Ryan White CARE
Act Title I and Title II funds. The Ryan White legislation funds primary care
and support services for people living with HIV disease who have no other health
care or the financial ability to pay for their care. Title I provides grants
in metropolitan areas where the epidemic has hit the hardest. Title II provides
funding for states.
“Clients have the choice to receive case management from one provider,
primary medical from another, and complementary therapy from yet another,” Lynch
said. “Because an individual is living with HIV/AIDS and receiving treatment
and care supported by Ryan White dollars does not mean they have given up their
right to choose where, how and from whom they can receive services. Utilizing
the card insures autonomy and choice.”
AIDS Coalition to Unleash Power spokesperson Wayne Turner testified to the
difficulties with the old system. He said that his partner, Steve Michael,
who died on May 25, 1998, went through several case managers and had to get
re-tested for HIV when he saw a new provider.
“He had three new appointments just to go through the intake. There
is excessive red tape. It’s just nightmarish,” Turner said.
The Women’s Collective, a community-based organization run by and for
women living with and at risk for HIV/AIDS, was one of the first to implement
XPRES.
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| Dr. Pat Hawkins, associate executive director for policy at the Whitman-Walker
Clinic and a member of the Ryan White Planning Council and its Quality
Insurance Committee, said there is a lot of confusion about the identification
cards. (File photo) |
Women’s Collective case manager Diana Kenlow said that the new system
is quicker and less “tedious” than the old one.
“When a person comes into care for a specific service, we’re able
to track that person in terms of other services provided,” Kenlow said.
She said under the old system, people were able to “agency hop” and
receive duplicate services from many providers. She said the new system should
prevent this from happening. Kenlow added that the case managers can follow
up to see if their clients follow through with their referrals.
Dr. Pat Hawkins, associate executive director for policy at the Whitman-Walker
Clinic, is also a member of the Ryan White Planning Council and its Quality
Insurance Committee. She said there is mixed information and confusion about
XPRES.
She said that some people with HIV and AIDS are concerned about what will
happen if people find out what the cards are for. They’re afraid, because
of the stigma surrounding the illness, that people might use the cards to somehow
target people with AIDS and HIV.
Lynch said this won’t happen because there is no identifying information
on the cards.
“It can only identify the individual once it is swiped in a card reader,” Lynch
said.
Hawkins expressed concern about the confidentiality of the clients. She said
that under the Health Insurance Portability & Accountability Act of 1996,
patients are given the option to not disclose certain medical information.
Hawkins gave the example of a person who has a substance abuse or a mental
health problem. She said the person might not want this information revealed
to their general practitioner.
“We support the concept of a unified database, but we don’t support
it without the protections in place,” she said.
Lynch insisted that despite confusion about the XPRES card, that the program
is “totally HIPAA compliant.” Lynch said the Health Resources & Services
Administration requires that all the Ryan White Title programs provide reports
on services provided and utilization of services.
“We felt if we were going to be revamping the entire system that we
ought to have improved access for the clients,” Lynch said.
She said there are no additional costs for XPRES — that the same funds
that were used to fund the old program will be used for the new one.
More than 13,000 people with HIV/AIDS in the metropolitan area are eligible
to receive local funds and federal funds through the Ryan White Emergency CARE
act. In D.C. alone, 9,000 clients receive primary medical care, case management
and other support services including medications.
717 14th St., NW, 10th Floor
Washington D.C. 20002
202-727-2500
1407 S St., NW
Washington, DC 20009
202-797-3500
www.wwc.org
1436 U St., Suite 120
Washington, DC 20002
www.womenscollective.org
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