Central Texas HIV Planning Council

1. Central Texas HIV Planning Council 2006-2007 Allocations for Waco HSDA Ryan White and State Services Christopher Hamilton, M.P.H., Planner Brazos Valley Council of Governments 979.595.2800 x:2225 Chamilton@bvcog.org

2. Ryan White CARE Act • Federal Act, funds • 5 Titles • Title II provides funds for Waco Health Services Delivery Area (HSDA): Bosque, Falls, Freestone, Hill, Limestone, and McLennan Counties • Funding cycle starts April 1 of each year

3. State Services • HIV Health and Social Services (State Services) funds from State of Texas • Provides funds in same counties as RWCA • Funding cycle starts September 1 of each year

4. Managing Conflict of Interest • Representatives of each HSDA on Allocations Committee • Members from an HSDA are not allowed to vote on funding for their own HSDA, but do provide input into the process

5. Thresholds “For both Titles I and II, HRSA requires that funds be allocated to the six core categories of Ambulatory Medical Care, Case Management Services, Mental Health Services, Drug Reimbursement, Substance Abuse Services (inpatient & outpatient) and Oral Health or to explain how these services are funded through other sources.”1 1 Texas Department of State Health Services “Priority Setting and Resource Allocation Procedures for HIV Care Services” DraftApril2005

6. Thresholds continued “The Texas Department of State Health Services requires that all Ryan White Title II Planning Assemblies establish minimum funding thresholds for each of the HRSA core service categories to ensure minimum funds required to preserve the current level of services… Minimum funding thresholds must be submitted to and approved by DSHS Planning staff.”1

7. What is a threshold • “A minimum funding threshold is the minimum dollar amount needed to adequately provide the service.”1 • “A minimum funding threshold is the minimum dollar amount needed to preserve the current level of services.”1 1 Texas Department of State Health Services “Priority Setting and Resource Allocation Procedures for HIV Care Services” DraftApril2005

8. Allocating based on thresholds • The minimum allocation to a service category is the determined threshold • If the allocation is less than the threshold, it must be well documented and justified as to why • EFA: must be allocated at sub-category level (utilities, food, medication)

9. Threshold Calculation AOMC Example 47 new infections from ‘03 to ‘04 37 new active clients for ‘04 291 total active clients for ‘04 126 total using service for ‘04 $35,859.90 Threshold

10. Thresholds • Ambulatory/Outpatient Medical Care: $35,859.90 • Drug Reimbursement: $102,921.58 • Oral Health: $12,397.58 • Case Management: $194,468.12 • Mental Health: $41,222.22 • Substance Abuse: $2,542.04 • Total: 345,647.19

11. 2006-2007 Allocations • Operating under the assumption of flat funding from 2005-2006 • Total allocation to HSDA: $375,411 • $295,160 RW • $80,251 SS

12. 06-07 Ambulatory/Outpatient Medical Care (1) • $30,628 total • $7,114 RW + $23,514 SS • Threshold set at $35,859.90. Funded below threshold because there is less stated need in the area based on input from representatives and providers in the area. Other funding resources are available in the area which are currently meeting the need. If there is an overall reduction in funds to the HSDA, Food Bank will be cut up to 100%, then Transportation cut up to 100%, then Health Insurance cut up to 100% to fund the core services.

13. 06-07 Oral Health (2) • $10,640 total, all from RW • Threshold set at $12,397.58. Funded below threshold because past utilization and expenditure data show this service not being fully utilized at previous funding levels, which are lower than the threshold. There was a 12% increase in expenditures from 03-04 to 04-05, so 12% was added to the 04-05 final expenditure.If there is an overall reduction in funds to the HSDA, Food Bank will be cut up to 100%, then Transportation cut up to 100%, then Health Insurance cut up to 100% to fund the core services.

14. 06-07 Case Management (3) • $176,948 total, all from RW • Threshold set at $194,468.12. Funded below threshold because Case Management reached a marginal cost, it does not cost more to add a few clients to each case manager. This funding level does include a 3% cost of living increase over 05-06 levels. If there is an overall reduction in funds to the HSDA, Food Bank will be cut up to 100%, then Transportation cut up to 100%, then Health Insurance cut up to 100% to fund the core services.

15. 06-07 Drug Reimbursement (4) • $80,000 total • $51,631 RW + $28,369 SS • Threshold set at $102,921.58. Funded below threshold based on prior utilization and expenditure data. Need is being met at the current level of funding. There were some unspent funds in previous years. If there is an overall reduction in funds to the HSDA, Food Bank will be cut up to 100%, then Transportation cut up to 100%, then Health Insurance cut up to 100% to fund the core services.

16. 06-07 Food Bank (6) • $56,737 total • $28,369 RW + $28,368 SS • This service has historically had a large need among clients, and still remains. There is a slight increase over 05-06 due to increase in need. If there is a reduction in funds overall to the HSDA, this service will be cut first up to 100% to fund the core services.

17. 06-07 Transportation (7) • $8,201 total, all from RW • This is almost doubled over 05-06 to accommodate for the increase in the cost of gas and other transportation services as well as include any new clients needing to access ambulatory care. If there is a reduction in funds overall to the HSDA, this service will be cut second up to 100% to fund the core services.

18. 06-07 Substance Abuse (13/14) • $0 allocated • Threshold set at $2,542.04 (does not differentiate between inpatient and outpatient). Threshold calculated on cost to treat one inpatient for 30 days. There are other resources and funding available in the community to meet the need for this service. This service has not been funded in the past and no expression of need for the service.

19. 06-07 Health Insurance (16) • $12,257 total, all from RW • This service is level funded from 05-06. The need still remains for this service. Payments in health insurance reduce costs to other services in the long run. If there is an overall reduction in funds to the HSDA, this service will be cut third up to 100% to fund the core services.

20. 06-07 Mental Health (23) • $0 allocated • Threshold set at $41,222.22. Threshold is based on calculation of cost to treat one person for 30 days of intense inpatient care. This service has not been funded in the past. There is no demonstration of need for this service and any need that does arise may be met through other resources and funding available in the community.

21. 06-07 Allocations • AOMC: $ 30,628 • Oral Health: $10,640 • Case Management: $176,948 • Drug Reimbursement: $80,000 • Food Bank: $56,737 • Transportation: $8,201 • Substance Abuse: $0 • Health Insurance: $12,257 • Mental Health: $0

22. Comments • Items to include: service category, suggested amount, reason for amount • If it is a core service and reducing the amount, must take into consideration where additional resources will fill the gap between threshold and allocation

23. CTHPC Approval • The Central Texas HIV Planning Council meeting on November 15, 2005 at 10 a.m. in Austin to approve the 06-07 allocations. This request is then sent to DSHS for approval.