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H H S Department of Health and Human Services
Health Resources and Services Administration
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Severity of Need (SON) Index - History - Legislative Language on Ryan White Severity of Need

Severity of Need (SON) has evolved as a Ryan White legislative term. Following is the sequence of definitions, starting with the most recent:

2006 – Ryan White HIV/AIDS Treatment Modernization Act of 2006

Section 2687. SEVERITY OF NEED INDEX

(a) Development of Index- Not later than September 30, 2008, the Secretary shall develop and submit to the appropriate committees of Congress a severity of need index in accordance with subsection (c).

(b) Definition of Severity of Need Index- In this section, the term `severity of need index' means the index of the relative needs of individuals within a State or area, as identified by a number of different factors, and is a factor or set of factors that is multiplied by the number of living HIV/AIDS cases in a State or area, providing different weights to those cases based on needs. Such factors or set of factors may be different for different components of the provisions under this title.

(c) Requirements for Secretarial Submission- When the Secretary submits to the appropriate committees of Congress the severity of need index under subsection (a), the Secretary shall provide the following:

(1) Methodology for and rationale behind developing the severity of need index, including information related to the field testing of the severity of need index.

(2) An independent contractor analysis of activities carried out under paragraph (1).

(3) Information regarding the process by which the Secretary received community input regarding the application and development of the severity of need index.

(d) Annual Reports- If the Secretary fails to submit the severity of need index under subsection (a) in either of fiscal years 2007 or 2008, the Secretary shall prepare and submit to the appropriate committees of Congress a report for such fiscal year--

(1) that updates progress toward having client level data;

(2) that updates the progress toward having a severity of need index, including information related to the methodology and process for obtaining community input; and

(3) that, as applicable, states whether the Secretary could develop a severity of need index before fiscal year 2009.

Section 2603(b) SUPPLEMENTAL GRANTS [Part A]

(1) IN GENERAL.— Subject to subsection (a)(4)(B)(i) and section 2610(d), the Secretary shall disburse the remainder of amounts not disbursed under section 2603(a)(2) for such fiscal year for the purpose of making grants under section 2601(a) to eligible areas whose application under section 2605(b)—

(B) demonstrates the need in such area, on an objective and quantified basis for supplemental financial assistance to combat the HIV epidemic;

Section 2620(b). SUPPLEMENTAL GRANTS. [Part B]

Demonstrated Need- The factors considered by the Secretary in determining whether an eligible area has a demonstrated need for purposes of subsection (a)(1) may include any or all of the following:

(1) The unmet need for such services, as determined under section 2617(b).

(2) An increasing need for HIV/AIDS-related services, including relative rates of increase in the number of cases of HIV/AIDS.

(3) The relative rates of increase in the number of cases of HIV/AIDS within new or emerging subpopulations.

(4) The current prevalence of HIV/AIDS.

(5) Relevant factors related to the cost and complexity of delivering health care to individuals with HIV/AIDS in the eligible area.

(6) The impact of co-morbid factors, including co-occurring conditions, determined relevant by the Secretary.

(7) The prevalence of homelessness.

(8) The prevalence of individuals described under section 2602(b)(2)(M).

(9) The relevant factors that limit access to health care, including geographic variation, adequacy of health insurance coverage, and language barriers.

(10) The impact of a decline in the amount received pursuant to section 2618 on services available to all individuals with HIV/AIDS identified and eligible under this title.

2000 - Ryan White CARE Act Amendments of 2000

Section 2603. [300ff-13] TYPE AND DISTRIBUTION OF GRANTS [to Title I EMAs]

(B) SEVERE NEED.-In determining severe need in accordance with paragraph (1)(B), the Secretary shall consider the ability of the qualified applicant to expend funds efficiently and the impact of relevant factors on the cost and complexity of delivering health care and support services to individuals with HIV disease in the eligible area, including factors such as-
(i) sexually transmitted diseases, substance abuse, tuberculosis, severe mental illness, or other comorbid factors determined relevant by the Secretary;
(ii) new or growing subpopulations of individuals with HIV disease;
(iii) homelessness;
(iv) the current prevalence of HIV disease;
(v) an increasing need for HIV-related services, including relative rates of increase in the number of cases of HIV disease; and
(vi) unmet need for such services, as determined under section 2602(b)(4).

(C) PREVALENCE.-In determining the impact of the factors described in subparagraph (B), the Secretary shall, to the extent practicable, use national, quantitative incidence data that are available for each eligible area. Not later than 18 months after the date of the enactment of the Ryan White CARE Act Amendments of 2000, the Secretary shall develop a mechanism to utilize such data. Such a mechanism shall be modified to reflect the findings of the study under section 501(b) of the Ryan White CARE Act Amendments of 2000 (relating to the relationship between epidemiological measures and health care for certain individuals with HIV disease). In the absence of such data, the Secretary may consider a detailed description and qualitative analysis of severe need, as determined under subparagraph (B), including any local prevalence data gathered and analyzed by the eligible area.

(D) PRIORITY.-Subsequent to the development of the quantitative mechanism described in subparagraph (C), the Secretary shall phase in, over a 3-year period beginning in fiscal year 1998, the use of such a mechanism to determine the severe need of an eligible area compared to other eligible areas and to determine, in part, the amount of supplemental funds awarded to the eligible area under this part.

1996 - Ryan White CARE Act of 1990 as Amended by the Ryan White CARE Act Amendments of 1996

Section 2603. TYPE AND DISTRIBUTION OF GRANTS [to Title I EMAs]

(b)(2) DEFINITION.--
“(A) SEVERE NEED.--In determining severe need in accordance with paragraph (1)(B), the Secretary shall consider the ability of the qualified applicant to expend funds efficiently and the impact of relevant factors on the cost and complexity of delivering health care and support services to individuals with HIV disease in the eligible area, including factors such as--
“(i) sexually transmitted diseases, substance abuse, tuberculosis, severe mental illness, or other comorbid factors determined relevant by the Secretary;
“(ii) new or growing subpopulations of individuals with HIV disease; and
“(iii) homelessness.

“(B) PREVALENCE.--In determining the impact of the factors described in subparagraph (A), the Secretary shall, to the extent practicable, use national, quantitative incidence data that is available for each eligible area. Not later than two years after the date of enactment of this paragraph, the Secretary shall develop a mechanism to use such data. In the absence of such data, the Secretary may consider a detailed description and qualitative analysis of severe need, as determined under subparagraph (A), including any local prevalence data gathered and analyzed by the eligible area.

“(C) PRIORITY.--Subsequent to the development of the quantitative mechanism described in subparagraph (B), the Secretary shall phase-in, over a three year period, beginning in fiscal year 1998, the use of such a mechanism to determining the severe need of an eligible area compared to other eligible areas and to determine, in part, the amount of supplemental funds awarded to the eligible area under this part.”