Core Medical Services and Reallocations

1. Core Medical Services and Reallocations Courtney McElhaney, M.P.H. Planner, BVCOG cmcelhaney@bvcog.org

2. Core Medical Services Established by Congress with the Ryan White Treatment and Modernization Act of 2006; renewed with the Ryan White HIV/AIDS Treatment Extension Act of 2009. Guidelines state that 75% of funds MUST be used for core medical services.

3. Outpatient Ambulatory Medical Care • Medical Case Management • Mental Health Services • Substance Abuse Services- Outpatient • Hospice Services • Early Intervention Services • Oral Health Care • Health Insurance Premium and Cost Sharing Assistance • AIDS Pharmaceutical Assistance- Local • Medical Nutrition Therapy • Home and Community Based Health Services • Home Health Care Core Medical Services

4. CTHASA Core Medical Services These services are the minimum that should be available in Any HSDA of the CTHASA. Determined by needs assessment and other data. Services necessary for clients to access and maintain medical care.

5. Outpatient Ambulatory Medical Care • Case Management (Medical and Non-Medical) • Mental Health Services • Substance Abuse Services- Outpatient • Oral Health Care • Health Insurance Premium and Cost Sharing Assistance • AIDS Pharmaceutical Assistance- Local • Transportation • Housing • Food Bank/Home Delivered Meals CTHASA Core Medical Services

6. First Round Allocations Setting allocations involves using historical data, surveillance data, and some guesswork. Your help is needed when deciding which service categories are most important to clients. If a client or multiple clients cannot be provided with a service, this needs to be communicated.

7. Example Your agency only has enough Oral Health funding to provide cleanings and fillings, but several clients need to have extractions. The cost of the extractions is going to be several thousand dollars more than the current Oral Health allocation. Rather than telling clients there’s no money for extractions, communicate the need for this service to supervisors and BVCOG. Occasionally additional funds become available and if there is a documented need, chances are greater that your agency can benefit!

8. Restrictions and Waiting Lists • Scenario… • Client: “Do you have any short-term HOPWA available this month?” • Case Manager: “No.” • Is this a denial of services? • Due to limited funding, you may be denying services to clients because you can’t do it all. • This is acceptable BUT it should be tracked and reported to BVCOG.

9. Tracking and Reporting It’s incredibly important to track and report these kinds of denials in Quarterly and monthly Service Category Expenditure Reports because it lets BVCOG know about the needs of clients. Your agency will NOT be punished for these denials; as mentioned earlier, there are times when additional funding becomes available and this allows us to know who can use more money. Denials can initiate a waiting list, this is perfectly fine! Your agency will NOT be punished for starting a waiting list. Report the creation of a waiting list to BVCOG.

10. Waiting Lists • If you do start a waiting list, what written policies/procedures do you have to move people off? • From previous scenario… • Who will be the first client to receive services if/when funding becomes available? • What information do you look at? • Drug use? • Medication and/or appointment adherence? • Income level? • Disease stage? • Provider opinion?

11. Waiting Lists Waiting lists are ok; they are a documented statement of need that allows BVCOG to know about emerging needs of clients in your HSDA. BVCOG can work with your agency on developing procedures for removing clients from the waiting list. Lists may be used to determine future funding levels.

12. Reallocations • Have you had to tell clients that you’re out of money for a service and to call back later? • Do you have a waiting list? • Do you not provide a service that many clients need? • Reallocations can address many issues: • Prevent an agency from running out of funds for services • Allow funds to be moved within an agency between service categories • Funds can also be moved between agencies or HSDAs • Used to address emerging or changing needs

13. Reallocation Process When evaluating your agency’s expenditure and utilization data, look at the percentage of funds spend in relation to the grant year. If a service is only 10% spent at 50% of the grant year, a reallocation can be done to put some of that money in to another category. Fill out the Reallocation Request form and send to Courtney McElhaney.

14. Reallocation Request Form Page 1 SUBCONTRACTOR REQUEST FOR ADDITIONAL SERVICE CATEGORY FUNDS (RE-ALLOCATION) **This form must be used by BVCOG subcontractors requesting additional funds in any service category for either Ryan White Part B or State Services funds. A separate request must be completed for each primary service category for which funds are requested. Requests must be fully justified and explained in detail; there is no page limit for the request. Incomplete or inadequately justified requests will be returned to the agency for correction. Please refer to BVCOG’s reallocation/redistribution policy for more information.** Date of Request: HIV Service Delivery Area (HSDA): Agency Name: Contact name for this request:Phone: Funding Source: Ryan White B State Services Funding Year:

15. Reallocation Request Form Page 2 • What is the reason for this request? Provide an overview of the need for additional funds in this category and why there are excess funds available. • Describe your expenditures and utilization in these categories to date. Include detailed information about trends in expenditures and client utilization, projections for the remainder of the contract year, explanations for fluctuations in the data, and any other relevant information. • Provide a detailed work plan for use of these funds. Address the following questions: • Will the funds be divided by subcategory? How? • What will be accomplished with the additional funds? • Will the funds be used to expand/increase use of the service or are they needed to avoid denying the service to clients? Explain (include a narrative explanation as well as actual numbers and other data to the extent possible). • How much of the funds will be used for direct services? How will it be divided, if at all, between direct services to clients, administrative costs, salaries/fringe, travel, etc.? • What affect would the denial of this request have on clients?

16. Contract Amendments • A contract amendment must be done every time funds are added or subtracted to a contract. • This is done after reallocations are approved, but can also be done if you would like to add funds to a secondary service category. • For Example: • You are funded for Oral Health, and currently only provide Routine and Prophylaxis services. • A client requests specialty Oral Health services (dentures, partial, etc.). • Funds currently in the Oral Health primary service category can be used for this service, just submit a completed Contract Amendment Form along with the appropriate documents.