Kentucky Statewide Coordinated Statement of Need

1. Kentucky Statewide Coordinated Statement of Need • RWCA statutory references to the SCSN: • “a description of how the allocation and utilization of resources are consistent with the Statewide coordinated statement of need (including traditionally underserved populations and subpopulations) developed in partnership with other grantees in the State that receive funding under this title; and… “

2. Kentucky Statewide Coordinated Statement of Need • “… an assurance that the public health agency administering the grant for the State will periodically convene a meeting of individuals with HIV, representatives of grantees under each part of this title, providers, and public agency representatives for the purpose of developing a Statewide coordinated statement of need…”

3. HRSA’s rules on formatting and methodology for the SCSN • There are no formatting or methodology guidelines from HRSA. Each state may develop their own.

4. Previous approaches to the SCSN for Kentucky • A description of the process; • The epidemiological profile included in the RWCA grant application; • Current and ongoing needs: from the 1995 Needs Assessment, public comment, and staff. • Related issues: these were issues that fell outside of the needs assessment categories, such as Medicaid Managed Care and Insurance Reform; • Future SCSN activities: issues that were anticipated for the future, e.g., KADAP mail order.

5. Challenges with the previous format • Based on an outdated Needs Assessment; • Covered the entire state, which was overly broad; • Included many complex issues; • Little objective documentation of each issue; • Lack of tie-in to other projects, e.g. HP 2010; • Stated need, but not goals toward meeting need and progress on reaching goals.

6. New SCSN format -- Issues • Divided into issues that are either currently major program activities/expenditures (e.g., case management, drug assistance) or that are emphasized by HRSA (e.g., medical care] • Drug assistance • Case management • Medical care • Dental care • Mental health care • Substance abuse treatment

7. New SCSN format -- Issues • Third-party payer systems (e.g., Medicaid, insurance) • Transportation • Emergency financial assistance (food, utilities, etc.) • Perinatal HIV transmission prevention

8. New SCSN format -- Regional analysis • Because each region has unique resources, each issue is broken down into a regional analysis. • Regions were based on the Care Coordinator Regions: • Barren River • Cumberland Valley • Lexington • Louisville • Northern Kentucky • Purchase

9. New SCSN format -- Sectional components • Each SCSN will be broken down into three areas: • Service provision; • Program administration; • State and national planning projects

10. Service provision components • Outreach: how the provider makes clients (and other providers) aware of their services (e.g., how they advertise their services); • Access:how the clients get to the provider. This involves physical access issues (such as the location of the provider’s offices) and eligibility issues (e.g., meeting income criteria); • Enrollment: what the client and provider must do before services can be provided (e.g., application forms and approval procedures);

11. Service provision components • Services provided: the services the provider offers (e.g., drug assistance through a mail order pharmacy system); • Service utilization: the service actually provided or obtained by the client (e.g., how many drugs a client receives during a certain period); • Quality assurance evaluation and improvement: assessing the difference (if any) between what the providers says they provide and what was actually provided, and steps taken to correct differences (e.g., in a drug program, whether the client received their drugs within the time frame specified);

12. Service provision components • Outcomes evaluation & improvement: similar to quality assurance but assesses impact program had on an objective (e.g., for drug assistance, whether receiving the HIV drugs resulted in an increase in CD4+ cell counts) and steps taken to improve results; • Other issues related to that program area: other issues that impact the services offered or the outcomes desired (e.g., a drug assistance program may address treatment adherence issues).

13. Program administration components (may revise) • Funding: the amount of money a provider has to provide the services; • Program and fiscal administration: administrative duties that the provider must do to provide the services (e.g., processing and paying invoices); • Reporting requirements: the reports a provider must create on a regular basis (NOTE: included as it may be a good resource for data/documentation); • Collaboration/coordination with other resources: the relationships between providers and referral procedures between providers.

14. State and national planning projects • These were included to serve as a one-stop resource of objectives developed by state and national agencies. These include: • Ryan White CARE Act Title II FY 2000 grant application goals; • Healthy Kentuckians 2010 objectives; • Ryan White CARE Act Evaluation Questions; • Paul Mason Memorial HIV/AIDS Task Force Recommendations; • KY DPH Action Plan

15. Analysis components • Objectives for the program component: the ideal version of that program component (e.g., drug assistance -- a list of all drugs that ideally should be available to clients); • Assessment of the current situation: what is currently occurring, or what services are currently available. This might include a resource inventory or a narrative description (e.g., a list of all drug assistance providers within a region);

16. Analysis components • Gaps and/or barriers in the current situation that prevents achievement of the objectives: what is lacking or blocking achievement of objectives (e.g., a lack of deaf interpreters prevents access to a program); • Goals to achieve objectives: these define the work that must be accomplished to create the ideal situation (e.g., if the current objective is to allow access to all populations, each goal might target a specific underserved population).

17. Action plan • Began with Drug Assistance in the Louisville area as a pilot. • Conducted a survey of providers (see handout). • Conduct needs assessment(s) of clients/providers. • Action plan must be developed for each regional issue. • Take it step by step, so first year would likely be limited to drug assistance, case management and medical care.

18. Questions and comments • Questions and comments from audience