Central Texas HIV Planning Council

1. Central Texas HIV Planning Council 2006-2007 Allocations for Temple 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 Temple-Killeen Health Services Delivery Area (HSDA): Bell, Coryell, Hamilton, Lampasas, Milam, Mills, and San Saba 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 50 new infections from ‘03 to ‘04 27 new active clients for ‘04 202 total active clients for ‘04 83 total using service for ‘04 $10,326.31 Threshold

10. Thresholds • Ambulatory/Outpatient Medical Care: $10,326.31 • Drug Reimbursement: $94,210.88 • Oral Health: $38,495.57 • Case Management: $187,262.86 • Mental Health: $25,695.97 • Substance Abuse: $72,228.88 • Total: $428,220.47

11. 2006-2007 Allocations • Operating under the assumption of flat funding from 2005-2006 • Total allocation to HSDA: $327,502 • RW $262,332 • SS $65,170

12. 06-07 Ambulatory/Outpatient Medical Care (1) • $8,000 total, all from RW • Threshold set at $10,326.31. Funded below threshold based on prior utilization data and there are other resources in the community, including a hospital that provides some services free of charge. If there is an overall reduction in funds to the HSDA, Food bank will be cut up to 81.3%, then Transportation up to 60.7%, then Health Insurance up to 31.9% to fund the core services.

13. 06-07 Case Management (2) • $198,890 total, all from RW • Threshold set at $187,262.86. Funded above threshold. Includes 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 81.3%, then Transportation up to 60.7%, then Health Insurance up to 31.9% to fund the core services.

14. 06-07 Drug Reimbursement (3) • $82,373 total • $56,442 RW + $25,931 SS • Threshold set at $94,210.88. Based on prior utilization data, this meets the need in conjunction with other resources available in the community such as pharmaceutical company patient assistance programs. If there is an overall reduction in funds to the HSDA, Food bank will be cut up to 81.3%, then Transportation up to 60.7%, then Health Insurance up to 31.9% to fund the core services.

15. 06-07 Food Bank (4) • $8,081 total, all from SS • This service is level funded from 05-06. The need for this service has remained steady based on past utilization and expenditure data. If there is an overall reduction in funds to the HSDA, this service will be cut first up to 81.3% to fund the core services.

16. 06-07 Oral Health (5) • $10,036total, all from SS • Threshold set at $38,495.57. Funded below threshold based on past utilization and expenditure data as well as other resources available in the community. If there is an overall reduction in funds to the HSDA, Food bank will be cut up to 81.3%, then Transportation up to 60.7%, then Health Insurance up to 31.9% to fund the core services.

17. 06-07 Transportation (6) • $10,818 total, all from SS • This service is level funded from 05-06. There were not sufficient remaining funds to increase for cost of gas and other transportation services. If there is an overall reduction in funds to the HSDA, this service will be cut second up to 60.7% to fund the core services.

18. 06-07 Mental Health Services (14) • $0 allocated • Threshold set at $25,695.97. Threshold is based on a calculated amount of cost to treat the past year's utilization of 23 clients. Other resources and funding in the community are meeting the need for this service.

19. 06-07 Substance Abuse (18/19) • $0 allocated • Threshold set at $72,228.88 (does not differentiate between inpatient and outpatient). Threshold is calculated based on cost to treat previous year's utilization for 30 days of inpatient care. This category has never been funded before. Other resources and funding in the community are meeting the need for this service.

20. 06-07 Health Insurance (20) • $10,304 total, all from SS • There is a slight decrease in funding to this category from 05-06 because funds needed to be dispersed to core services and other service categories. The need for this service still exists. Funded because payments in health insurance save costs to other service categories in the long run. If there is an overall reduction in funds to the HSDA, this service will be cut third up to 31.9% to fund the core services.

21. 06-07 Allocations • AOMC: $8,000 • Case Management: $198,890 • Drug Reimbursement: $82,373 • Food Bank: $8,081 • Oral Health: $10,036 • Transportation: $10,818 • Mental Health: $0 • Substance Abuse: $0 • Health Insurance: $10,304

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.