HRSA Moves to Define Severe Need

In the 2000 reauthorization of the Ryan White HIV/AIDS Program, Congress asked the Institute of Medicine (IOM) to report on

• how to better measure severity of need,
• the use of HIV data (in addition to reported AIDS cases) in funding formulas, and
• recommendations on using quantitative measures for evaluating quality of care.

At the time the request was made, applicants for funding were using the best measures available to them, but those measures were not the same across all applicants. Thus, a discrepancy existed on how severe need was defined and described, making comparison of one application to another difficult.

In its report Measuring What Matters: Allocation, Planning and Quality Assessment for the Ryan White CARE Act, published in 2004, the IOM stated that a single index was needed to calculate severe need for all funding applicants. The response was HRSA’s HIV/AIDS Severity of Need Collaboration.

The Collaboration convened more than 47 panelists and examined more than 56 variables for possible consideration. The result is that the agency will be rolling out a severity-of-need index in FY 2009.

Since enactment, the purpose of the Ryan White HIV/AIDS Program has been to serve people with nowhere else to turn—those who are un- or underinsured, who are impoverished, or who may have lost the capacity to provide for themselves because of their illness. The new severity-of-need index will help HRSA identify areas where access to resources is poorest. The agency will then be able to concentrate resources where need is greatest.