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RWPC Primer

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Mari Ross-Russell presented a primer on the Ryan White Planning Council at the December 2016 meeting of the HIV Prevention Planning Group.

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RWPC Primer

  1. 1. RWPC Primer 12-14-16
  2. 2. Ryan White HIV/AIDS Program
  3. 3. Ryan White Legislation • Currently, Title XXVI of the Public Health Service Act, HIV Health Care Services Program o Originally enacted in 1990 • “The Ryan White HIV/AIDS Program provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured. The Program works with cities, states, and local community-based organizations to provide HIV care and treatment services to more than half a million people each year. The Program reaches approximately 52% of all people diagnosed with HIV in the United States.” (HRSA HAB website)
  4. 4. Ryan White Legislation • The legislation is divided in to several portions, called Parts. The Ryan White Planning Council is concerned with Part A. • Parts B-F provide funding for states; early intervention; programs for children, youth, and women; and education/training.
  5. 5. Ryan White Part A Program • Ryan White Part A provides funding for EMAs (Eligible Metropolitan Areas) and TGAs (Transitional Grant Areas) that are most severely affected by the HIV epidemic • The Philadelphia EMA is made out of 9 counties in PA and NJ: Philadelphia, Bucks, Chester, Delaware, Montgomery, Burlington, Camden, Gloucester, and Salem • Part A Funding based on numbers of PLWHA (A total of more than 2,000 cases in the most recent 5 years and a cumulative total of 3,000 living cases as of 12/31 for the most recent calendar year) in Philadelphia EMA compared to other EMAs in the US o The Philadelphia Ryan White Part A EMA received $21 million in funding in 2015 o The EMA also receives Minority AIDS Initiative (MAI) funding that is used to fund programs serving minority populations (approx. $2 million)
  6. 6. Ryan White Part A Program • Clients who meet certain qualifications (HIV status, income and residency) can apply for Ryan White certification • Clients must recertify every 6 months to use Ryan White services • No one is turned away from Ryan White providers, regardless of their ability to pay
  7. 7. Part A Legislative Requirements • Ryan White is the payer of last resort o Ryan White cannot be used to pay for any service that is covered or can be covered by another funding source
  8. 8. Ryan White Planning Council Structure and Membership
  9. 9. Planning Council Nominations Process • Conducted by the RWPC Nominations Committee • Applications are accepted throughout the year and reviewed twice annually, typically in the Fall and Spring o Applications are scored numerically by members of the nominations panel, and scores are averaged o Accepted applicants are reviewed and appointed by the CEO • The Nominations Committee also periodically reviews membership demographics and attendance
  10. 10. Planning Council Composition • Planning Council must be at least 33% unaligned Ryan White consumers o Unaligned consumers are not paid staff, consultants, or board members of Part A funded agencies, but they may receive services at these agencies o In the Philadelphia EMA, we aim for 50% consumer representation
  11. 11. Planning Council Composition • Membership reflects demographics of local HIV epidemic o 17 categories for membership • Health care providers, including federally qualifying health centers (FQHCs) • CBOs serving affected populations/ASOs • Social service providers (including housing and homeless services) • Mental health providers • Substance abuse providers • Local public health agencies • Hospital/health care planning agencies • Affected communities (PLWH and historically underserved sub- populations) • Non-elected community leaders • State Medicaid agency • State Part B agency • Part C grantees • Part D grantees • Grantees of other Federal HIV programs (including prevention) • Formerly incarcerated PLWH or their representatives • Members of Federally Recognized Indian Tribe
  12. 12. Membership & Expectations • Members are expected to attend the Planning Council meeting each month on the second Thursday of the month • Members are also expected to choose a subcommittee and attend meetings • RSVPs are required for meetings. Absences will only be excused with prior notification. o Members with too many absences will receive a warning and may be removed from the RWPC
  13. 13. Planning Council Activities
  14. 14. RWPC Activities • Conducts Needs assessment activities to determine needs of consumers • Sets HIV-related service priorities • Allocates Part A funds • Monitors the administrative mechanism • Develops a comprehensive plan
  15. 15. Needs Assessments
  16. 16. Needs Assessments • Monitored and developed by the Needs Assessment Committee • Used to determine unmet needs of PLWHA in the EMA, including those who are not in care o Focus on extent of the need, available services, and service gaps by population segment and geographic area • Used for priority setting, comprehensive planning, completing grant applications, documenting need, and collecting data
  17. 17. Needs Assessment Activities • Focus Groups o held at the OHP in 2014-2015 concerning healthcare access for young men who have sex with men (YMSM) and high-risk heterosexuals • Surveys o provider and consumer transportation surveys conducted in 2015 o Local Pharmaceutical Assistance Program 2016 o Currently, a Consumer Survey is being distributed by providers in the EMA to measure demographics, healthcare utilization, unmet need, etc.
  18. 18. Needs Assessment Activities • Epidemiological profile o Completed annually o Contains wide-reaching data and analysis • Demographics (age, race, sex, geography) • Social determinants of health (e.g. poverty, education, insurance status, housing, risk behaviors) • Statistics specific to HIV (for instance, incidence and prevalence rates).
  19. 19. Needs Assessment Activities • Resource Inventory o Includes a workforce profile, which reveals gaps o A list of Ryan White funded and private providers in the EMA that serve PLWHA o Categorized by service category, with additional information like address, phone number, website, accepts insurance, etc. o Online resource inventory currently being developed, which will be available on the OHP website in the future • Town halls and other activities
  20. 20. Priority Setting
  21. 21. Priority Setting • Carried out by the Comprehensive Planning Committee • Establishes priorities for the allocation of funds consistent with locally identified needs • Philadelphia EMA priority-setting process is quantifiable, objective, and uses factors and weights
  22. 22. Service Categories Services eligible for Ryan White funding, ranked during priority setting: • AIDS Drug Assistance Program Treatments • AIDS Pharmaceutical Assistance • Child Care Services • Early Intervention Services (EIS) • Emergency Financial Assistance (DEFA) • Food Bank/Home Delivered Meals • Health Education/Risk Reduction • Health Insurance Premium and Cost Sharing Assistance • Home and Community-Based Health Services • Home Health Care • Hospice Services • Housing • Legal Services • Linguistic Services/Interpretation • Medical Case Management • Medical Nutrition Therapy • Medical Transportation • Mental Health Services • Non-medical Case Management • Oral Health Care • Other Professional Services • Outpatient/Ambulatory Health Services • Outreach Services • Permanency Planning • Psychosocial Support Services • Referral for Health Care and Support services • Rehabilitation Services • Respite Care • Substance Abuse Outpatient Care • Substance Abuse Services (residential) **Bold denotes core medical services **Not all services on this list are currently funded
  23. 23. Priority Setting Factors • Weights recently altered due to expansion of Medicaid related to the Affordable Care Act • Consumer Survey (25%) • Care Continuum (30%) o Plots services along the care continuum, developed by the Comprehensive Planning Committee • Unmet Need (30%) o Numbers gathered from various data sources • Essential Health Benefits (15%) • All factors are quantifiable. Values for each service/factor are tabulated to determine rankings.
  24. 24. Allocations
  25. 25. Allocations • Process of distributing fiscal resources across Part A funded service categories in the EMA based on documented need o Based on size, demographics, and needs of PLWHA • 75% minimum of the grant total must be allocated to core medical services, 25% max for supportive services
  26. 26. Allocations Process • Allocations are carried out at 3 separate regional meetings • All Planning Council members can attend and vote at the regional meetings • Allocations are overseen and reviewed by the Finance Committee, followed by the Planning Council
  27. 27. Allocations Process, cont. • Each region can also make instructions/directives to the recipient (AACO) • Instructions may direct the recipient to provide more information or direct the recipient to provide a particular service, focus services to a population or geographic area, request a needs assessment, etc.
  28. 28. Recipient Responsibilities • Recipient issues Requests for Proposals (RFPs) and procures contracts with agencies to conduct the work • The Planning Council cannot be involved in the selection of providers (subrecipients) that receive Part A funding • The recipient is mandated to follow the Planning Council’s allocations for each service category
  29. 29. Other RWPC Responsibilities
  30. 30. Assessing the Administrative Mechanism • Finance Committee reviews spending and underspending reports quarterly, approves reallocation requests, which are then presented to the RWPC o Ensure funds are rapidly distributed o Make sure spending and priorities, instructions to recipients, and allocations match o Ensure that services are delivered to areas of greatest need and contracts are procured efficiently/effectively
  31. 31. Comprehensive Planning • Comprehensive Plan for 2017-2021 was recently released • Includes: o Strategies for identifying individuals who know their HIV status and are not receiving services o Process for getting people in care o Particular attention to eliminating disparities in access and services among high- risk groups and historically underserved communities o Includes discrete goals, a timetable, and appropriate allocation of funds • Staff, AACO, and Comprehensive Planning Committee work together to complete the Comprehensive Plan
  32. 32. More Information
  33. 33. Schedule • First Thursday of each month o Finance Committee, 2-4pm • Second Monday of each month o Positive Committee, 12-2pm o Needs Assessment Committee, 2-4pm • Second Thursday of each month o RWPC Nominations committee, 12-2pm o RWPC, 2-4pm • Third Thursday of each month o Comprehensive Planning Committee, 2-4pm
  34. 34. Positive Committee • Committee for people living with HIV and AIDS • Holds regular trainings, educational presentations, and group discussions • Gathers consumer feedback • Helps PLWHA participate in the planning process and potentially become involved in the RWPC • Participants develop flyers, brochures, and newsletters to distribute to the community
  35. 35. Additional Planning Council Activities • The Planning Council routinely hears presentations from outside agencies, AACO, Co- Chairs, and staff o Kathleen Brady’s annual Epidemiological Presentation o AACO CSU and Prevention Reports o All slides are posted on the OHP website and Slideshare accounts
  36. 36. Current and Recent Planning Council Topics • Housing • Social Determinants of Health • PrEP • Medicaid/Medicare/ACA Insurance Plans • Health Insurance Premium/Cost-Sharing Assistance • Opioid Crisis