America Living With AIDS

and indicate whether their agency has taken any action as a result of the recommendations. According to the updated responses by HHS, the Administration agreed with the
intent of 7 and has taken action on 8 of the 75 recommendations identified as the responsibility of the federal government. The 7 recommendations that the Administration
agreed with and initiated action on included: (1) the signing of the Americans with Disabilities Act (ADA), (2) new initiatives on behalf of the National Institutes of Health to
expand drug trials to include underrepresented groups, (3) a grant to the Network of
Runaway and Youth Services to provide HIV education and prevention to homeless and
runaway youth, (4) new demonstration projects to link primary care and drug treatment
for HIV-infected individuals and their families, (5) implementation of Diagnostic Related Groups (DRGs) for Medicare-eligible HIV-infected patients, (6) state medical laboratory regulatory requirements proposed by the Health Care Financing Administration to
be used as state model law, and (7) the extension of COBRA from 18 to 29 months to
continue employer health insurance. The Administration disagreed with the intent of the
eighth recommendation, that funds be appropriated to support home health care programs for underinsured people with HIV. The Administration took action on the eighth
recommendation when Congress passed the HOPE Act (P.L. 100-607), which was signed
into law by the President on November 4, 1988, and which authorized funds for the
Health Resources and Services Administration to provide home health care to underinsured people with HIV.
It is unclear how much influence the Presidential Commission recommendations had
on the implementation of these initiatives. It is probably safe to say that the recommendations played a role in identifying these issues as important and that individual agencies
incorporated the recommendations of the Presidential Commission, along with those of
other external and internal groups, into their own priority setting.
The remaining 67 responses to the recommendations identified as the responsibility of
the federal government cite the continuation of ongoing federally sponsored projects as
fully or partially addressing the recommendations.
Within the recommendations identified as not the reponsiblity of the federal government, there were three different categories of agency response:
1. The recommendation cited is not the responsibility of the federal government,
rather the federal government is setting an example for state and local government
and the private sector by incorporating the recommendation into federally based
programs.
2. The recommendation is not the responsibility of the federal government, but the
federal government has acknowledged the importance of the recommendation by
including it as an incentive for state and local governments and the private sector
to take the recommended action. Action on the recommendation becomes an
incentive either by having the federal agencies include the recommendation as criteria for funding, or by providing funding and/or technical assistance specific to
the recommendation.
3. The recommendation is not the responsibility of the federal government and the
federal agencies are leaving it to state and local governments and the private sector
to address the recommendation in their own projects.
More Effective Process Needed for Evaluation
Unfortunately, the gathering of agency responses to the recommendations (even given
the limited number of recommendations that the National Commission identified as priorities) has become a paper-driven rather that an evaluation-driven process. The most
recent updates provided by the agencies cite "no change" as their response to the majori