Service Categories and Priority Rankings



[pic]

TABLE OF CONTENTS

Page

I. Introduction, Participation, Roles and Responsibilities 1

II. Data 2

III. The Process 3

IV. Results 8

V. Directives to the Grantee 16

VI. Contingency Scenarios 18

Exhibit A – Abbreviations 19

Exhibit B – Priority Setting Worksheet 20

Exhibit C – Resource Allocation Worksheet 21

PATERSON-PASSAIC COUNTY – BERGEN COUNTY

HIV HEALTH SERVICES PLANNING COUNCIL

PRIORITY SETTING FY 2014

REPORT TO THE GRANTEE

I. INTRODUCTION, PARTICIPATION, ROLES AND RESPONSIBILITIES

Each year, the Planning Council engages in a comprehensive review of the priority ranking and resource allocations process. To prepare for FY 2014 deliberations, the Planning Council moved to strengthen the ability of Planning Council members to make informed decisions. Specifically, relevant data were provided to reflect defined criteria and to enhance Planning Council’s understanding of service need and use. Additionally, steps taken in previous years were re-visited to (1) assure absence of conflict of interest by Planning Council members, (2) avoid opportunities for impassioned plea, and (3) assume sole responsibility by the Planning Council for reviewing all data, establishing policy, priorities and allocations. As a result, a thorough and unbiased priority setting process was successfully implemented again in FY 2014.

To remove potential conflict of interest by aligned members of the Planning Council, each service category under consideration was voted separately, and members aligned with that service category were required to declare their status and not permitted to vote. Council members were permitted to offer their views and experiences during discussions to highlight the data. However, comments considered personal or self-serving in nature were not allowed.

The Planning & Development Committee accepted responsibility for assuring a smooth and effective priority setting process on behalf of the Planning Council by establishing and maintaining a year-round detailed month-by-month timeline for completing the required tasks of priority setting, resource allocations and directives. The Committee reviewed the priority setting timeline at each of its monthly meetings and then intensified its efforts in May through August of 2013. The committee’s work included review of data and materials that would be brought to the Planning Council for review, guidance on procedural matters and formulating recommendations for consideration by the Council.

The tasks of the Planning Council were to:

• Define criteria for priority ranking and resource allocations;

• Review service category definitions and identify which categories would be prioritized and funded;

• Review HRSA Statement of Need;

• Review and respond to the Statewide Coordinated Statement of Need;

• Review the Comprehensive HIV Health Services Plan;

• Review all associated data as described below;

• Determine priority rankings;

• Establish resource allocations;

• Formulate directives to the grantee;

• Establish contingency scenarios; and

• Submit a report to the grantee for the best use of Ryan White Part A and MAI funds.

Persons living with HIV/AIDS (PLWHA) participated in the priority setting and resource allocation process on multiple levels. All new Planning Council members, including PLWHA, received a full-day orientation that included training on the priority setting and resource allocation process. Additionally, on July 10, 2013 consumers and Planning Council members with an interest in improving their understanding of the data and the process were invited to an optional meeting. Participants used the environmental assessment, needs assessment presentation and data work book to discuss factors relating to priorities and allocations. This allowed PLWHA to view the process prior to the actual deliberations. Seven Planning Council members, two of whom were consumers, participated. Finally, members of the public, many of who were PLWHA, were invited to the Council’s priority setting and resource allocations meetings and permitted to participate in discussions prior to the voting.

The Planning Council formally began the priority setting process on July 9, 2013 and completed resource allocations and directives to the grantee on September 10, 2013. Information and vital issues were discussed with motions and recommendations made from the floor. The overall process was successful and resulted in carefully considered priorities, allocations, and directives firmly grounded in the use of data for decision making. This report describes the process as well as the decisions by the Planning Council.

II. DATA

As part of the priority setting process, the Planning Council reviewed an EpiProfile and Environmental Assessment of the Bergen-Passaic TGA, utilizing New Jersey Department of Health, U.S. Bureau of the Census, and other publically available data. Under the guidance of the Planning & Development Committee, a complete data set in the form of a four-part Priority Setting Data Work Book was assembled for the Planning Council with elements addressing the various criteria and variables considered crucial to decision making. The FY 2014 Priority Setting Data Work Book was intended to assist members of the Paterson-Passaic County – Bergen County HIV Health Services Planning Council as they determined priorities, allocations and directives. Data tables contained information requested by the Planning Council, supplemented by information and recommendations from the 2012-2013 Comprehensive Needs Assessment and earlier special population studies describing specific characteristics of the population as well as service needs, access and barriers.

The Data Work Book was organized into four parts: (1) an introduction and summary tables; (2) profiles for each funded service category pertaining to priority ranking; (3) profiles for each service category pertaining to resource allocations, and (4) recommendations from the 2012-2013 Comprehensive Needs Assessment and previous special population studies. Part I described how to use the work books and provided major summary tables from Parts II and III. Part II looked at each service category in the Ryan White Part A program that was funded in the previous fiscal year and likely to be funded again in FY 2014. Data tables provided information from the 2012-2013 Comprehensive Needs Assessment, the Gaps Analysis and other related studies. Part III again looked at each service category in the Ryan White Part A program that was funded in FY 2013 and considered for funding in FY 2014. The Work Book provided information about how the funds were utilized in this fiscal year and other sources of public funds, apart from Part A, that were available to support the needs of PLWHA. Part IV was intended as a reference tool containing current and past recommendations from needs assessments and special population studies.

III. THE PROCESS

The FY 2014 Priority Setting Process was adopted by the Planning Council on July 9, 2013, and is stated in full as follows.

Process Components

1. Review of priority setting process

2. Review of priority setting criteria

3. Review of service category definitions and identification of which categories would be prioritized

4. SCSN, Comprehensive Plan, and Client Satisfaction reviews

5. Data reviews

6. Priority ranking

7. Resource allocations

8. Contingency scenarios

9. Directives to the grantee

10. Report to the grantee

11. Process evaluation

Priority Ranking Criteria

Priority Ranking defines the importance of each service category in maintaining engagement or providing access to HIV medical care.

FY 2014 criteria, stated in priority order:

1. In-Care PLWHAs: The service addresses their needs and maintains them in medical care, as indicated by:

• Service use in the needs assessment;

• Unmet needs identified in the needs assessment;

• Other available information.

2. Out-of-Care PLWHA and Unaware: The service addresses their needs, as indicated by:

• Service needs identified in the needs assessment;

• Access and barriers as identified in the needs assessment;

• Other available information.

3. Access: The service addresses access issues that get in the way of participation in medical care, as indicated by:

• Capacity to increase access and remove barriers for needed services;

• Gaps analysis;

• Other available information.

A priority ranking model used the criteria identified above, each of which was given a score of one to five points, with one of least value and five of highest value.

Members voted for each service category individually with Part A and MAI voted upon separately. Aligned members of the Planning Council did not vote on the service category to which they were aligned.

PRIORITY RANKING CRITERIA

SCORING TOOL

|1 = No Value | |5 = Very High Value |

|In-Care PLWHA |

|Utilization: |MAINTENANCE IN MEDICAL CARE AND UNMET NEED FOR |Utilization: |

|For PLWHA who are engaged in HIV primary |IN-CARE PLWHA |For PLWHA who are engaged in HIV primary |

|medical care (in care), the service does not | |medical care (in care), the service |

|significantly contribute to maintenance in | |significantly contributes to maintenance in |

|care. | |care. |

|Unmet Need: | |Unmet Need: |

|The service has NOT been identified by PLWHA | |The service has been identified by PLWHA who |

|who are engaged in HIV primary medical care as | |are engaged in HIV primary medical care as an |

|an unmet need. | |unmet need. |

|Out-of-Care PLWHA and Unaware |

|Need: |NEED AND ACCESS TO MEDICAL CARE FOR OUT-OF-CARE|Need: |

|For PLWHA who are NOT engaged in HIV primary |PLWHA |For PLWHA who are NOT engaged in HIV primary |

|medical care (out-of-care), the service is not | |medical care (out-of-care), the service is |

|identified as a service need. | |identified as a service need. |

|Access to Medical Care: | |Access to Medical Care: |

|For PLWHA who are NOT engaged in HIV primary | |For PLWHA who are NOT engaged in HIV primary |

|medical care (out-of-care), the service does | |medical care (out-of-care), the service |

|not significantly enhance access to care. | |significantly enhances access to care. |

|1 = No Value | |5 = Very High Value |

|Access to Medical Care |

|Barriers: |ACCESS TO THE NETWORK OF AVAILABLE SERVICES |Barriers: |

|The service does NOT help to remove barriers to| |The service significantly helps to remove |

|obtaining HIV primary medical care. | |barriers to obtaining HIV primary medical care.|

|Gaps in Services: | |Gaps in Services: |

|The service is NOT identified in the gaps | |The service is identified in the gaps analysis |

|analysis as significant to the network of | |as significant to the network of services that |

|services that enhance access to HIV primary | |enhance access to HIV primary medical care. |

|medical care. | | |

Scoring Range:

1 = No value

2 = Small value

3 = Moderate value

4 = High value

5 = Very high value

Resource Allocation Criteria

Resource allocations criteria were used to determine the level of funding for services that supported engagement and retention in medical care.

FY 2014 criteria, stated in priority order:

1. Utilization of services provided by Ryan White Part A or MAI, as indicated by:

• Part A data on number of clients served;

• Cost per case and percentage of funds expended.

2. Capacity to provide services under Part A or MAI, as indicated by:

• Ratio of clients contracted to clients served.

3. Availability of other sources of funds that may be used to serve PLWHA, as indicated by:

• Information provided by publically funded agencies.

RESOURCE ALLOCATION CRITERIA

SCORING TOOL

|1 = No Value | |5 = Very High Value |

|Utilization: |SERVICE UTILIZATION AND CAPACITY |Utilization: |

|This service is NOT well utilized by PLWHA to | |This service is very well utilized by PLWHA to|

|maintain engagement in HIV primary medical | |maintain engagement in HIV primary medical |

|care. | |care. |

|Capacity: | |Capacity: |

|Existing provider capacity is more than enough| |Existing provider capacity is not enough to |

|to address the needs of PLWHA. | |address the needs of PLWHA. |

|Funding Resources: |OTHER SOURCES OF FUNDS |Funding Resources: |

|Adequate funding sources are available to | |There are few (or no) adequate funding sources|

|provide the same or a similar service. | |that provide the same or a similar service. |

The resource allocation model used the criteria identified above, each of which was given a score of one to five points

Scoring Range:

1 = Allocate 10% less dollars

2 = Allocate 5% less dollars

3 = No change

4 = Allocate 5% more dollars

5 = Allocate 10% more dollars

For each service category, Planning Council members apply the resource allocation criteria by assigning a score of 1 to 5 to each criterion. Each score was associated with funding increases or decreases. Scores of the three criteria were aggregated for each service category.

As with Priority Ranking, the Planning Council assumed responsibility for reviewing data pertaining to service utilization and other sources of funds.

Voting was for each service category individually with Part A and MAI separately voted upon. Aligned members of the Planning Council did not vote on the service category to which they were aligned.

A decision model was constructed to determine the new allocations. The model assigned dollars to each service category and then adjusted each service category after the voting.

1. Allocations began with an assumption of stable funding, i.e. no increase or decrease from FY 2013.

2. A baseline, expressed in dollars allocated to each service category, established funding at one hundred percent of the prior year.

3. Each category was scored for utilization and other sources of available funds.

4. The scores were weighted and dollars adjusted for each service category. The total of all service categories were different from the baseline.

|Score |Weight |Meaning |

|1 |0.90 |Weight assigns 10% less dollars |

|2 |0.95 |Weight assigns 5% less dollars |

|3 |1.00 |Weight assigns no change in dollars |

|4 |1.05 |Weight assigns 5% more dollars |

|5 |1.10 |Weight assigns 10% more dollars |

5. The difference was then allocated through deliberations by the Planning Council. Some service categories received more funds and some less, depending on the consensus of the Council.

6. When deliberations were completed, allocations were then translated into percentages and voted on by the Planning Council.

Contingency Scenarios

FY 2013 Contingency scenarios were reviewed by the Planning Council for their appropriateness in FY 2014. Decisions were formulated based on consensus of the Planning Council.

Directives

The Planning Council reviewed the most recent information and recommendations from:

• Comprehensive HIV Health Services Plan;

• Outcomes and Satisfaction Surveys;

• Quality Measurements;

• Unit Cost and Cost per Case;

• Needs Assessments, Special Population Studies, Epi-Profiles, Environmental Assessments, CARS data, etc.;

• Statewide Coordinated Statement of Need (not available for FY 2014).

Directives were offered as recommendations by members of the Planning Council and its committees. Discussion and voting occurred at the Planning Council meeting by all members. Aligned members did not vote on behalf of the service category to which they are aligned.

Report To The Grantee

Results of the Council’s priority setting decisions, as reflected in the meeting minutes, were compiled into the present report to the grantee. The Planning & Development Committee will review the drafts and forward a final draft to the Steering Committee for further review. The report will then be forwarded to the Council for ratification. The Planning Council may edit the report for accuracy prior to final adoption.

Process Evaluation

A formal evaluation of the priority setting process is conducted in two phases: (1) an evaluation following each Planning Council meeting in which priority setting is an agenda item, and (2) a final evaluation of the entire process.

The first phase utilizes a survey instrument that each Planning Council member completes at the end of each meeting. The Planning Council administrator assembles the results and forwards them to Planning & Development Committee for discussion.

The second phase is completed by the Planning and Development Committee and includes (1) a review of the FY 2014 Priority Setting calendar for completed tasks during the fiscal year and (2) review of the Planning Council’s survey responses following the completion of the entire process. Results are forwarded to Steering Committee for further review along with recommendations for the next fiscal year. The Planning Council receives a report at its January meeting and determines appropriate improvements to be implemented in FY 2015.

IV. RESULTS

Service Categories

The Planning Council reviewed all allowable service categories and determined which would be prioritized in FY 2014. All service categories approved in FY 2013 were again approved in FY 2014. One additional service category, Linguistic Services, was added in FY 2014. The addition of Linguistic Services reflects the extraordinary diversity of the Bergen-Passaic TGA, the high percentage that does not speak English well, and the need for accurate translation of medical and other information. The approved service categories are listed in Tables 1-3 along with their numerical ranking.

Priority Rankings

For FY 2014, members of the Planning Council determined that need and importance had not changed significantly from FY 2013 and thus decided to set aside the voting process for this year only and accept priority rankings of the sixteen FY 2013 service categories. One additional service category, Linguistic Services, was ranked priority seventeen.

Five service categories were combined with other categories: (1) Home & Community-based Health Services and AIDS Pharmaceutical Assistance (local) were combined with the AIDS Drug Assistance Program (ADAP); (2) Case Management was combined with Treatment Adherence; (3) Outreach Services was combined with Health Education and Risk Reduction (HERR); (4) Non-medical Treatment Adherence Counseling was combined with Non-Medical Case Management; and (5) Legal Services was combined with Permanency Planning. These decisions were unchanged from FY 2013. See Table 1.

Table 1

Prioritized Service Categories FY 2014

Ryan White Part A Rankings

|FY 2013 |FY 2014 |Service Category |

|Rank |Rank | |

| | |Core Services |

|1 |1 |Ambulatory/Outpatient Medical Care |

|2 |2 |AIDS Drug Assistance Program (ADAP)/AIDS Pharmaceutical Assistance (local)/Home & |

| | |Community-based Health Services |

|3 |3 |Oral Health Care |

|4 |4 |Early Intervention Services |

|5 |5 |Medical Case Management/Treatment Adherence |

|6 |6 |Mental Health Services |

|7 |7 |Substance Abuse Services Outpatient |

|16 |16 |Health Insurance Premium & Cost Sharing Assistance |

| | |Support Services |

|8 |8 |Outreach Services/Health Ed. and Risk Reduction |

|9 |9 |Housing Services |

|10 |10 |Food Bank/Home Delivered Meals |

|11 |11 |Case Management - Non-medical/Non-medical Treatment Adherence Counseling |

|12 |12 |Medical Transportation Services |

|13 |13 |Legal Services/Permanency Planning |

|14 |14 |Emergency Financial Assistance |

|15 |15 |Psychosocial Support Services |

|NR |17 |Linguistic Services |

NR=Not Ranked

Service categories and priorities for MAI funds also remained unchanged from FY 2013. In all, five service categories were ranked in FY 2014 for MAI. See Table 2.

Table 2

Prioritized Service Categories FY 2014

MAI Priority Rankings

|FY 2013 |FY 2014 |Service Category |

|Rank |Rank | |

|1 |1 |Early Intervention Services |

|2 |2 |Emergency Financial Assistance |

|3 |3 |Substance Abuse Services/Outpatient |

|4 |4 |Outreach Services/ Health Education/Risk Reduction |

|5 |5 |Non-Medical Case Management |

For Ryan White Part A, nine HRSA approved service categories were not prioritized for FY 2014. The rationale for excluding these service categories was based on their availability through other programs in the TGA, either within or outside of Ryan White.

Table 3

Services Not Prioritized in FY 2014

|Service Category |Rationale |

|Core Services | |

|Home Health Care |Alternative programs available |

|Home and Community-based Health Services |Available through ACCAP |

|Hospice Services |Alternative programs available |

|Medical Nutrition Therapy |Provided with outpatient medical care |

|Support Services | |

|Child Care Services |Alternative programs available |

|Developmental Services for HIV-positive Children |Alternative programs available |

|Pediatric Developmental Assessment Services |Alternative programs available |

|Referral for health care/supportive services |Provided with medical and non-medical case management |

|Rehabilitation Services |Alternative programs available |

|Respite Care |Alternative programs available |

Resource Allocations

The Ryan White Part A and MAI resource allocations decisions for FY 2014 were adopted by the Planning Council on July 30, 2013. Allocations are shown in Tables 4 and 5 below. Resource allocations reflect local needs for PLWHA as well as national priorities established by the National AIDS Strategy and HRSA directives. The FY 2014 allocations comply with the legislative requirement to provide a minimum of 75% of Part A and MAI combined funds for core services. Rationales for the Planning Council’s decisions are described beginning page 12.

Table 4

FY 2013 and FY 2014 Resource Allocations

Ryan White Part A Direct Services and MAI

Bergen-Passaic TGA

| |Service Category |FY 2013 |FY 2014 |

|FY 2014 Ranking | |Allocation |Allocation |

| | |(In Percent) |(In Percent) |

| |Core Services | | |

|1 |Ambulatory/Outpatient Medical Care |22.19% |20.87% |

|2 |AIDS Drug Assistance Program (ADAP)/AIDS Pharmaceutical Assistance (local)/Home |- |- |

| |& Community-based Health Services(b) | | |

|3 |Oral Health Care |16.49% |16.49% |

|4 |Early Intervention Services |3.04% |2.72% |

|5 |Medical Case Management |14.43% |16.38% |

|6 |Mental Health Services |10.79% |10.15% |

|7 |Substance Abuse Services/Outpatient(a) |11.42% |10.74% |

|16 |Health Insurance Premium & Cost Sharing Assist. |--- |1.09% |

| |Support Services | | |

|8 |Outreach Services/Health Ed. and Risk Reduction(a) |2.31% |2.29% |

|9 |Housing Services |0.26% |0.26% |

|10 |Food Bank/Home Delivered Meals |1.58% |1.72% |

|11 |Case Management - Non-medical(a) |10.95% |11.14% |

|12 |Medical Transportation Services |4.80% |4.42% |

|13 |Legal Services/Permanency Planning |1.00% |0.99% |

|14 |Emergency Financial Assistance |0.31% |0.32% |

|15 |Psychosocial Support Services |0.43% |0.43% |

|17 |Linguistic Services (b) |- |- |

| |MAI | | |

|1 |Early Intervention Services(b) |- |- |

|2 |Emergency Financial Assistance (b) |- |- |

|3 |Substance Abuse Services Outpatient |37.91% |38.28% |

|4 |Outreach Services/Health Ed. and Risk Reduction |18.74% |18.92% |

|5 |Non-medical Case Management |43.35% |42.79% |

Table 5

FY 2013 and FY 2014 Resource Allocations

Totals

| |FY 2013 |FY 2014 |

|Part A Core Services |78.36% |78.43% |

|Part A Support Services |21.64% |21.57% |

|Total Part A Services |100.00% |100.00% |

| | | |

|MAI Core Services |36.77% |38.28% |

|MAI Support Services |63.23% |61.72% |

|Total MAI Services |100.00% |100.00% |

| | | |

|Part A and MAI Core Services |75.05% |75.01% |

|Part A and MAI Support Services |24.95% |24.99% |

|Total Part A and MAI Services |100.00% |100.0% |

The FY 2014 results reflect the consensus of the Planning Council to approve:

• Increases for two core (one of which is newly funded) and three support services in Part A;

• Decreases for four core and three support services in Part A;

• No change for one core and two support services in Part A;

• An increase for one core service in MAI;

• Decreases for two support services in MAI.

Most changes were less than 1.0% from the prior year. One service category increased by more than 1.0%, and one declined more than 1.0%. Both were in the core services where allocations were in double digits.

One core service and one support service were prioritized but not funded for FY 2014, as described on page 14. Two MAI service categories were prioritized but not funded. See Table 6 for a summary of changes from FY 2013. See Table 6.

Table 6

Resource Allocations

FY 2014

|Increased |No Change or Not Funded |Decreased |

|Part A Core Services |

|Medical Case Management (from 14.43% to 16.38%) |AIDS Drug Assistance Program (ADAP)/AIDS |Ambulatory/Outpatient Medical Care (from |

| |Pharmaceutical Assistance (local)/Home & |22.19% to 20.87%) |

| |Community-based Health Services (not funded)| |

| |Oral Health Care (16.49%) | |

|Health Insurance Premium & Cost Sharing Assistance | |Early Intervention Services (from 3.04% |

|(newly funded at 1.09%) | |to2.72%) |

| | |Mental Health Counseling (from 10.79% to |

| | |10.15%) |

| | |Substance Abuse Treatment (from 11.42% to |

| | |10.74%) |

|Part A Support Services |

|Food Bank/Home Delivered Meals (from to 1.58% to |Housing Services ( 0.26% ) |Outreach Services/HERR (from 2.31% to 2.29%)|

|1.72%) | | |

|Non-Medical Case Management (from 10.95% to 11.14%) |Psychosocial Support Services (0.43%) |Medical Transportation Services (from 4.80% |

| | |to 4.42%) |

|Emergency Financial Assistance (0.31% to 3.32%) |Linguistic Services (not funded) |Legal Services/Permanency Planning (from |

| | |1.00% to 0.99%) |

| | | |

| | | |

|MAI |

|Substance Abuse Treatment (from 37.91% to 38.28%) |Early Intervention Services (not funded) |Outreach Services/HERR (from 18.74% to |

| | |18.92%) |

| |Emergency Financial Assistance (not funded) |Non-Medical Case Management (from 43.35% to |

| | |42.79%) |

Each service category is addressed further as follows, in the order they were ranked.

Core Services

Ambulatory/Outpatient Medical Care is the first priority of Ryan White Part A Program and will receive the largest amount of funding of all service categories. All other services must be linked to primary medical care. Funds were reduced from 22.19% 20.87% to reflect slightly lower utilization in FY 2013. Additionally, anticipated increases in Medicaid eligibility in FY 2014 would reduce the number of patients needing Part A assistance and thus justify reductions in overall Part A spending.

Funds will be used to (1) meet ongoing need, as indicated by current utilization data; (2) respond to anticipated volume increases from outreach and early intervention efforts; (3) address the rising costs of providing medical care and lab tests; and (4) meet the medical needs of aging PLWHA. Medical providers from the TGA expressed a growing need for sub-specialty care.

AIDS Pharmaceutical Assistance is no longer be funded by Part A. This decision is in accordance with HRSA requirements to provide all medications through ADAP.

Oral Health Care will remain the same from the prior year. The Planning Council decided to adjust its initial allocation, which would have reduced funding for this service, to level funding. This decision reflects continued demand for this service and consumers’ response to the 2013 Consumer Survey. HRSA requires that oral health care receive full funding. Further, the Affordable Care Act does not address oral health care; therefore, demand for this service is expected to remain consistent.

Early Intervention Services will be reduced by less than 0.32%. This service category responds to President Obama’s National AIDS Strategy and HRSA’s initiative to address engagement and linkage of newly diagnosed PLWHA. Programs are being developed and/or expanded in FY 2014 to support the full continuum of testing, referral and engagement in medical care. However, funds from Part B and the Division of Mental Health and Addictions Services are available to support EIS in the TGA.

Medical Case Management will be increased in FY 2014. The Council’s decision is based on the ongoing emphasis on engagement and retention into care and the critical role of the medical case manager in meeting the goals of the FY 2014 Plan. Case managers are further expected to play an important role in the TGA’s Plan to Engage the Unaware Population. Finally, case managers will be called upon to assist Part A recipients with the transition to provisions of the Affordable Care Act. This will require more time spent with clients and a higher level of proficiency with ACA requirements.

Mental Health Therapy and Counseling will be reduced by less than 0.64% in FY 2014. The Council recognizes the need for mental health services to respond to emotional problems arising from co-morbidities, longer life expectancies and added stress of living with HIV/AIDS. Information from the 2009 focus groups and the 2013 out-of-care interviews indicated a need for “emotional supports” that can be provided through mental health counseling/therapy. Mental health treatment helps to engage the newly diagnosed and to maintain adherence to medical regimens. Nevertheless, the Council elected to reduce Ryan White Part A funding due to lower than expected utilization and expanded Medicaid coverage in FY 2014.

Substance Abuse Treatment will decline by 0.68% in FY 2014. This decision was based on effective treatment programs and alternative programs for substance users now available in the TGA. Additionally, the 2013 In-Care Consumer Survey documented reduced dependence on illicit drugs. The Council recognizes the need, however, to maintain substance abuse treatment in this TGA as critical to engagement and retention in HIV care, and therefore allocated 38.28% of MAI funds in addition to 10.74% of Part A funds to substance abuse treatment in FY 2014. MAI funds will be targeted to African-Americans, Hispanics and MSM of Color.

Health Insurance Premium & Cost Sharing Assistance will be funded for the first time in FY 2014. This was the second year in which the Planning Council recognized the importance of this service category as the cost of insurance coverage continues to inflate and burdens for PLWHA increase. As other available programs in New Jersey are expected to assist persons with gaps in insurance coverage, the Planning Council elected to provide a small amount (1.09%) to fund this service category as a bridge for privately insured clients.

Support Services

Outreach Services/Health Education and Risk Reduction will decline slightly by 0.02% for both Part A and MAI in FY 2014. MAI funds for this service category will be targeted to African-Americans, Hispanics and MSM of Color.

Housing Services will remain stable in FY 2014. HOPWA is the principal source of housing assistance, and it has proven effective as an alternative funding stream. As a result, the need for Part A funds is diminished. However, as a stable housing situation is critical to retention in medical care, the Council believes that a small allocation is justified in the short-term for services not available from HOPWA.

Food Bank/Home Delivered Meals will increase by less than 0.2% in FY 2014. This decision recognizes the need for food from dwindling community resources in the TGA, including HOPWA, understanding the need for proper nourishment among PLWHA.

Non-Medical Case Management will increase by less than 0.2% in FY 2014. As direct services are leveraged with non-HIV providers, PLWHA will need the help of non-medical case managers to direct them to other available services within the community. Non-medical case managers will further play an important role of assisting PLWHA in meeting new requirements of the Affordable Care Act. In recognition of this, the Planning Council allocated 42.79% of MAI funds to non-medical case management targeted to African-Americans, Hispanics and MSM of Color in addition to 11.14% of Part A funds.

Medical Transportation Services will be reduced slightly by 0.38% in FY 2014. The centralized transportation system now in place emphasizes van service as the preferred modality. Bus passes and vouchers, while proven not as effective, will continue to be offered. Nonetheless, the need for medical transportation service remains, and rising costs of fuel and vehicle maintenance are notable.

Legal Services/Permanency Planning will be reduced slightly by 0.01% in FY 2014. This decision to support this service was made in light of continued demand and the need to support PLWHA who are experiencing significant legal barriers to obtaining long term benefits.

Emergency Financial Assistance. Will increase slightly by 0.01% in FY 2014 to support gaps in pharmaceutical assistance prior to formal enrollment in ADAP. The Planning Council provided for a small allocation to cover such emergency needs in FY 2013, and this decision has proven effective.

Psychosocial Support Services will remain stable in FY 2014. This small amount is considered necessary to maintain the effective current support groups in the TGA.

V. DIRECTIVES TO THE GRANTEE

Specific recommendations were provided to the Grantee for all service categories combined and for each individually. Directives focused on funding practices as well as steps to support the 2012-2015 Comprehensive HIV Health Services Plan, the EIIHA Plan, the Quality Management Plan and administrative mechanism requirements.

Table 7

Service Category Directives

|Service Categories |Fiscal Year 2014 Directive |

|Core Services |

|Ambulatory/Outpatient Medical Care|None |

|Early Intervention Services |Educate agencies within the TGA on the process of EIS, in accordance with adopted standards. |

|Oral Health Care |Itemize by ADA Code all cosmetic procedures that will not be funded under Part A. |

| |Establish a standard cost/fee schedule for all Part A providers. |

|Medical Case Management |Begin the evaluation of primary case management as directed in the Comprehensive Plan (Goal II, Objective |

| |4) |

|Mental Health Therapy/Counseling |Anticipate changes in mental health coverage stipulated in the Affordable Care Act by expanding the mental|

| |health network within the TGA to include additional psychiatrists or mental health professionals. |

|Substance Abuse Treatment |None |

|Health Insurance Premium & Cost |Implement payment for HIP&CS in accordance with recently released HRSA policies. |

|Sharing |Provide technical assistance for all applicants who wish to provide this service. |

|Support Services |

|Non-Medical Case Management |Begin the evaluation of primary case management as directed in the Comprehensive Plan (Goal II, Objective |

| |4) |

|Outreach/Health Education and Risk|Provide funding for outreach services within the EIIHA target populations and communities. |

|Reduction |Coordinate quarterly meetings to facilitate outreach to the EIIHA target populations. |

|Housing Services |Continue to provide housing assistance only to those persons who are not eligible for HOPWA assistance |

| |and/or when HOPWA funds are not available. |

|Medical Transportation Services |Fund up to 5% of the total medical transportation allocation for needed off-hour services. |

|Emergency Financial Assistance |Fund only medications needed to bridge the gap between entry into care and benefits from ADAP. |

VI. CONTINGENCY SCENARIOS

In the event that FY 2014 funding levels significantly change from the prior fiscal year, the Planning Council determined the following course of action.

Scenario 1: If funding is up to 30% (+/-) of the FY 2013 award, the Grantee will distribute funds proportionately in accordance with percentages established by the Planning Council.

Scenario 2: If funding is increased or decreased by more than 30%, the Planning Council will convene to revise the previously established allocations.

EXHIBIT A

Abbreviations Used in This Report

|ACCAP |AIDS Community Care Alternatives Program |

|ADAP |AIDS Drug Assistance Program | |

|CARS |Client Acuity Rating System | | |

|EIIHA |Early Identification of Individuals with HIV/AIDs |

|EIS |Early Intervention Services | | |

|FY |Fiscal Year | | | |

|HERR |Health Education and Risk Reduction | |

|HIP&CS |Health Insurance Premium and Cost Sharing |

|HIV |Human Immunodeficiency Virus | | |

|HOPWA |Housing for People with AIDS | | |

|HRSA |U.S. Department of Health and Human Services, Health Resources and Services Administration |

|MAI |Minority AIDS Initiative | | |

|MSM |Men who have sex with men | | |

|PLWHA |Persons Living with HIV/AIDS | | |

|SCSN |Statewide Coordinated Statement of Need | |

|TGA |Transitional Grant Area | | |

EXHIBIT B

Priority Ranking Worksheet

|FY 2013 Ranking|FY 2014 Ranking |Core Services |

| |Adopted 7/10/2013| |

|1 |1 |Ambulatory/Outpatient Medical Care |

|2 |2 |AIDS Drug Distribution Program (ADAP)/AIDS Pharmaceutical Assistance |

| | |(local)/Home & Community-based Health Services |

|3 |3 |Oral Health Care |

|4 |4 |Early Intervention Services |

|5 |5 |Medical Case Management Services |

|6 |6 |Mental Health Services |

|7 |7 |Substance Abuse Services / Outpatient |

|16 |16 |Health Insurance Premium & Cost Sharing Assistance |

|  |  |Support Services |

|8 |8 |Outreach Services/Health Education and Risk Reduction |

|9 |9 |Housing Services |

|10 |10 |Food Bank/Home Delivered Meals |

|11 |11 |Non-Medical Case Management/Tx adherence counseling |

|12 |12 |Medical Transportation Services |

|13 |13 |Legal Services/Permanency Planning |

|14 |14 |Emergency Financial Assistance |

|15 |15 |Psychosocial Support Services |

|17 |17 |Linguistic Services |

|  |  |MAI |

|1 |1 |Early Intervention Services |

|2 |2 |Emergency Financial Assistance |

|3 |3 |Substance Abuse |

|4 |4 |Outreach Services/ Health Education/Risk Reduction |

|5 |5 |Non Medical Case Management |

EXHIBIT C

Resource Allocation Worksheet

[pic]

[pic]

-----------------------

Paterson-Passaic County – Bergen County

HIV Health Services Planning Council

FY 2014 Directives to the Grantee

Global Directives to the Grantee

1. Correlate Part A services with requirements of the Affordable Care Act, and address emerging gaps in services that may result from implementation of the Act.

2. The Grantee shall provide a written report on progress with implementation of the Comprehensive HIV Health Services Plan, the EIIHA Plan and the Quality Management Plan. This report shall be undertaken in concert with quarterly progress reviews by the Planning & Development Committee, included in the semi-annual report to the Planning Council and discussed at each quarterly grantee meeting.

3. Require new enrollees in Part A core services to complete the needs assessment consumer survey, and tie this requirement to billing.

4. Work with the Planning Council to prioritize and establish/update all approved standards of care beginning with medical and non-medical case management, primary medical care and substance abuse treatment. Work with the Planning Council to post on its website all approved standards of care with effective date of implementation within one month of adoption.

5. The Grantee shall submit a Semi-annual Report to the Steering Committee, the Planning & Development Committee and the Planning Council in January and July on the effectiveness and compliance of directives. This narrative report shall provide specific documented evidence of compliance with each of the bulleted directives. This report shall be incorporated into the Council’s Priority Setting Process as well as the Administrative Mechanism Review.

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download