Ryan White Part A Overview April 25, 2018 Dennis Brophy Director, Ryan White Services Division
Learning Objectives Ryan White Grant Principles Ryan White Funding Status EMA Services Direction of Services
Ryan White HIV/AIDS Program The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, the legislation that created the Ryan White HIV/AIDS Program, established in 1990. Administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). https://hab.hrsa.gov/about-ryanwhite-hivaids-program/about-ryanwhite-hivaids-program 3
To protect, preserve, and promote the health and well-being of all residents, particularly the most vulnerable. BPHC Mission Through: providing and supporting accessible high quality community-based health and social services, community engagement and advocacy, development of health promoting policies and regulations, disease and injury prevention, emergency services, health promotion, and health education services.
Our primary goals will always be 1 2 3 Improve access to care Reduce health disparities Reduce new infections 5
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) The eligible area must have an HIV health services planning council. Funds will supplement not supplant State funds. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 6
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Establish priorities for the allocation of funds Population size and demographics. Individual needs. Community priorities. Demonstrated cost effectiveness and outcome effectiveness of proposed interventions. Coordination for HIV prevention and for prevention & comprehensive treatment of substance abuse. Availability of other resources, including the State Medicaid plan, to cover health care costs of eligible individuals and families with HIV/AIDS. Capacity development needs resulting from disparities in the availability of HIVrelated services in historically underserved communities. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 7
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Provide direct financial assistance to public or nonprofit private entities, or private for-profit entities if they are the only available provider of quality HIV care in the area. Participate, as entities within the eligible area, in an established HIV community-based continuum of care. Constitute, as entities within the eligible area, as key points of access to the health care system for individuals with HIV/AIDS. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 8
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Provide HIV health care and support without regard to (i) to the ability of the individual to pay for such services; and (ii) to the current or past health condition of the individual to be served. Provide services in a setting that is accessible to low-income individuals with HIV Disease. Provide outreach to low-income individuals with HIV-disease to inform such individuals of such services. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 9
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Establish a clinical quality management program to assess the extent to which HIV health services provided are consistent with the most recent Public Health Service guidelines for the treatment of HIV/AIDS and related opportunistic infection. Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV health services. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 10
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Do not utilize funds to make payments for any item or service to the extent that payment has been made, or can reasonably be expected to be made under any State compensation program, under an insurance policy, or under any Federal or State health benefits program or by an entity that provides health services on a prepaid basis. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 11
Key Ryan White Grant Provisions Public Law 111-87 (sec 2605) Direct financial assistance is for the purpose of providing core medical services and support services. https://hab.hrsa.gov/sites/default/files/hab/about/ryanwhite/legislationtitlexxvi.pdf 12
Ryan White Core Medical Services Outpatient and ambulatory health services AIDS Drug Assistance Program treatments AIDS pharmaceutical assistance Oral health care Health insurance premium and cost sharing assistance for low-income individuals in accordance with section 2615 Home health care Medical nutrition therapy Hospice services Home and community-based health services as defined under section 2614(c) Mental health services Substance abuse outpatient care Medical case management, including treatment adherence services
Ryan White Support Services Support services means services that are needed for individuals with HIV/AIDS to achieve their medical outcomes those outcomes affecting the HIV-related clinical status of an individual with HIV/AIDS.
Ideal RW Funding Process Federal Budget Full Award Part A Fiscal Year 15
Actual RW Funding Process Continuing Resolution Partial Award Part A Fiscal Year Partial Award Federal Budget Full Award 16
RW Part A Recipient Boston EMA In FY17, a total of ~$629M of RW Part A awarded to 52 EMAs and TGAs Boston received the 13 th highest total amount: $14.9M 17
Ryan White Award Components Formula Award for the number of living cases of HIV/AIDS, as of December 31 of the most recent calendar year for which such data is available. MAI Award for activities to evaluate and address the disproportionate impact of HIV/AIDS on, and the disparities in access, treatment, care, and outcomes for, racial and ethnic minorities. Supplemental Grant Award for demonstrated need, on an objective and quantified basis, for supplemental financial assistance to combat the HIV epidemic 18
Millions Ryan White Part A Awards $15 $14 $13 $12 $11 $10 $9 $8 $7 $6 $5 FY14 FY15 FY16 FY17 FY18* Formula Supplemental MAI 19
FY 2018 Award Notice Award Amount Period Spending Cap** January 2018 Partial* ~$3.1M March 1 April 30 20% March 2018 Partial* ~$6.7M March 1 June 30 44% TBD Full TBD March 1 February 28 n/a *Partial Award only includes Formula & MAI **Based on level-funding scenario, approved by RW Planning Council 20
RW Allocations Quality Management: 5% max Administration: 10% max Direct Services: 85% 21
FY 2018 Subrecipients AIDS Project Worcester AIDS Response Seacoast Beth Israel Deaconess Hospital Plymouth BMC Pediatric AIDS Program Boston Health Care for the Homeless Program BPHC MCM Training BPHC Ryan White Dental Program Cambridge Health Alliance Casa Esperanza Catholic Charitable Bureau of the Archdiocese of Boston Codman Square Health Center Community Research Initiative of New England Community Servings Dimock Community Health Center East Boston Neighborhood Health Center Edward M. Kennedy Community Health Center Father Bill s & MainSpring Fenway Community Health Center Greater Lawrence Family Health Center Harbor Health Services, Inc. Justice Resource Institute Lynn Community Health Center Massachusetts Alliance of Portuguese Speakers MGH Chelsea MGH Boston Merrimack Valley Assistance Program Montachusett Opportunity Council NH Department of Health and Human Services Upham s Community Health Center Southern New Hampshire HIV/AIDS Task Force 22
FY 2018 Direct Services Boston EMA Core Services AIDS Drug Assistance Medical Case Management, including Treatment Adherence Services Medical Nutrition Therapy Medical Transportation Oral Health
FY 2018 Direct Services Boston EMA Support Services Food Bank & Home-Delivered meals Housing Non-Medical Case Management* Psychosocial Support Substance Abuse Residential care
Standards of Care Universal Align with HRSA Policy and National Monitoring Standards. Covers: Eligibility Policy and Procedures Personnel Documentation & Data Management Safety Service-Specific Congruent with HRSA policy on Core and Support service definitions and allowable activities. 25
Measuring Impact of Direct Services Program Goals Population Demographics Health Outcomes Expenditures Program Sustainability 26
FY 2019 Award Service priorities (April 2018). Funding allocations (May 2018). Funding scenarios (May 2018) Procurement (Summer 2018) 27
Procurement Factors that go into procurement: Community Need Available Resources Federal Policy Changes Impact of Services Service Infrastructure 28
Service Procurements FY 2011 Core HIV Case Management and Health-Related Services Support FY 2014 Oral Health, Mental Health, Outpatient Care, Substance Abuse Outpatient Substance Abuse Residential FY 2016 Medical Case Management, Medical Transportation Psychosocial Support FY 2017 FY 2019 All services approved and funded by PC Housing All services approved and funded by PC 29
Conclusion BPHC is committed to ensuring that resources go to where they are most needed. Grant recipients and subrecipients have a shared obligation to meet legislative requirements in accordance with HRSA policy. We are partners in this effort to effectively serve people living with HIV and end the epidemic. 30