Ryan White Services Division Infectious Disease Bureau. Client Services Provider Manual FY Ryan White HIV/AIDS Treatment Extension Act Part A

Transcription

1 Ryan White Services Division Infectious Disease Bureau Client Services Provider Manual FY 2017 Ryan White HIV/AIDS Treatment Extension Act Part A

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3 Ryan White HIV/AIDS Treatment Extension Act Part A Boston Eligible Metropolitan Area Provider Manual Fiscal Year 2017 Edition March 1, February 28, 2018 R y a n W h i t e S e r v i c e s D i v i s i o n I n f e c t i o u s D i s e a s e B u r e a u B o s t o n P u b l i c H e a l t h C o m m i s s i o n M a s s a c h u s e t t s A v e n u e, 2 n d F l o o r B o s t o n, M A ( ) ( p ) ( ) ( f ) w w w. b p h c. o r g

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5 Map of the Boston Eligible Metropolitan Area

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7 Table of Contents INTRODUCTION From the Director PROGRAM OVERVIEW 1 Program Rules FY Program Reporting Overview... 5 Ryan White Part A FY 2017 Submission Dates.7 Quarterly Report Instructions... 8 Sample Program Narrative Outcome Summary Report Instructions How to Create New Client in e2boston e2boston - Client Utilization Form Sample Unit Rate Client Utilization Data, Fiscal Backup How to Add Services to a Client Record Outcome Measurement Reports How to Add Outcomes to a Client Record Ryan White HIV/AIDS RSR Reporting Site Visit Overview FISCAL OVERVIEW Fiscal Rules FY Annual Gross Income Total Allowable Annual Charges.41 Sample Cost Reimbursement Invoice Sample Unit Rate Invoice Budgets Sample Cost Reimbursement Budget Sample Unit Rate Budget Budget Revision Request Instructions Sample Cost Reimbursement Budget Revision Sample Unit Rate Budget Revision SERVICE CODE INFORMATION Service Codes by Category Service Code Summary POLICIES AND PROCEDURES GRANTEE ADMINISTRATION INFORMATION Staff Contact List FY Internet Resources Agency Websites ATTACHMENTS Site Visit Documentation Checklist Important Part A & MAI Submission Dates Client Utilization Form Universal Standards Checklist Service Specific Standards Checklist

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9 Introduction Welcome to FY 2017 (Year 27) of the Ryan White Part A Program. This is the 8 th year under the Ryan White HIV/ AIDS Treatment Extension Act of 2009 and the 27 th year of Part A funding for the Boston Eligible Metropolitan Area (EMA). First, I would like to thank you for your commitment to serving over 5,000 people living with HIV across 10 counties in Massachusetts and New Hampshire. The diverse array of services that all of you deliver ensure that individuals in greatest need of support are able to obtain and maintain access to health care. Primarily, programs such of yours continue to provide an avenue for folks to obtain viral suppression, which is a key component to living a full, productive life. As we adapt each year to political and epidemiological changes, BPHC remains committed to administering payer-oflast-resort Part A funds through programs such as yours. This grant will continue to support activities that address unmet needs and fill unnecessary gaps in services. In doing so, our office is available to provide guidance. We have put together this Provider Manual for BPHC Part A- and Part A MAI-funded programs to provide all the information, tools, and instructions needed to meet our agencies contractual requirements. This manual covers all federal and BPHC program and fiscal policies, and contains instructions for completing all program, data, and fiscal reporting. Whether you are a newly funded agency or one that has been funded for many years, it is important to thoroughly review all sections of the manual. Policies and procedures are updated each year, and it is important that all providers operate with the same up-to-date information. Please share this manual will all of your staff members associated with Part A funding, including those responsible for administering the program, completing program reports, entering and submitting program data, maintaining client files, and producing and submitting invoices. Questions about its contents can be directed back to BPHC staff. We will need to work together over the coming year to ensure that the system of care of PLWH adapts to the changing needs of the community and the changing funding environment. Our shared goal is that PLWH have coordinated access to medical care and health-related support services. We look forward to another year of partnership and collaboration between BPHC and HIV service providers. Thank you for your hard work, dedication, and service to people living with HIV. Dennis Brophy Director, Ryan White Services Division

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11 Program Overview In this section: Program Rules FY Program Reporting Overview... 5 Quarterly Report Instructions... 8 Sample Program Narrative Outcome Summary Report Instructions How to Create New Client in e2boston e2boston - Client Utilization Form Sample Unit Rate Client Utilization Data, Fiscal Backup How to Add Services to a Client Record Outcome Measurement Reports How to Add Outcomes to a Client Record Ryan White HIV/AIDS RSR Reporting Site Visit Overview... 29

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13 Program Rules FY 2017 Reporting 1. Reporting shall be considered a deliverable under this agreement for purposes of determining fulfillment of the Subrecipient s obligations. Failure to produce timely and adequate reports may jeopardize the Subrecipient s funding during the current award period, as well as its eligibility or consideration for funding in subsequent years, and shall result in a delay in payment. 2. The Subrecipient shall submit quarterly reports and statistical reports. Statistical reports shall include, at a minimum, the submission of (1) Client Information: including a unique client code, client demographics, exposure category, diagnostic information, housing status, and insurance status, and (2) Client Utilization Data: including units of service delivered, dates of service, and number of units. Such submissions must be made via BPHC s e2boston System. Quarterly reports shall include a description of the progress made and efforts undertaken to meet goals and objectives for each activity or service funded, including summary of services provided and those served (Program Utilization and Client Demographics), any problems, obstacles or barriers to meeting such goals and objectives, and any actions taken or to be taken to resolve such problems, obstacles, or barriers. Quarterly reports must include updates on personnel changes for Part A staff and a description of any program spending issues during the reporting period. The Boston Public Health Commission may request additional information at any time. 3. All quarterly reports shall contain information that is concise and provides sufficient detail to allow evaluation of funded efforts. All tables included in the Quarterly Report template must be completed and narrative descriptions provided, where appropriate. Also, the Subrecipient shall include a description of the implementation and progress on any Plans of Corrective Action submitted to the Boston Public Health Commission. Furthermore, while funding through other sources that complement Part A funded activities may be cited, the application of Part A funds shall be made explicit and documented separately in reports. The Boston Public Health Commission may provide specific formats for submitting reports, which the Subrecipient shall be required to follow. The Subrecipient shall be required to adhere to new reporting requirements in submitting their quarterly reports subsequent to that date. Training will be provided. 4. Quarterly reports shall be submitted within fifteen (15) days after the end of the quarter. If applicable, annual reports shall be submitted within fifteen (15) days of the close of the reporting period. All reports shall be submitted to the Boston Public Health Commission. 5. Programs funded with unit rate contracts must submit a combined fiscal and data report within fifteen (15) days after the end of each month, and a quarterly narrative report within fifteen (15) days of the close of each quarter. 6. Client level outcome measures have been developed for all service categories. Subrecipients shall submit reports on outcome measures throughout the year, according to the Client Clock Model. Funded programs are expected to submit at least 85% of outcome reports while funded. If less than 85% are submitted, the program must complete the corresponding section in their quarterly report explain why less than 85% were submitted, and indicate a goal for improvement in the next quarter. 7. All Subrecipients will be expected to complete the Ryan White Ryan White Services Report (RSR) each calendar year. Additional information will be provided prior to submission. 8. All subcontracts will be expected to comply with the specific requirements detailed in the National Monitoring Standards for Ryan White programs. FY 2017 Ryan White Part A Provider Manual 3

14 Program Performance The Boston Public Health Commission reserves the right to suspend, reduce or terminate the Subrecipient s contract if it determines the Subrecipient has failed to make substantial progress on its goals and objectives, that such failure is unreasonable, and the Subrecipient does not demonstrate an adequate strategy to address obstacles to that progress. The Subrecipient s program performance will be assessed through; review of the Subrecipient s program utilization, spending and reporting; evaluation of compliance regarding program and fiscal reporting requirements, and client file maintenance in relation to HRSA-mandated Part A site visits; and the Subrecipient s demonstrated efforts to retain and maintain clients in the HIV Continuum of Care. Monitoring The Boston Public Health Commission or other entities on behalf of the Boston Public Health Commission will conduct site visits. The Subrecipient will receive no less than one (1) site visit during the period of performance. Site visits include a review of both fiscal and programmatic documentation. Key personnel involved in implementation of the Scope of Services at any and all locations where funded activities occur should be available for site visits, and make all appropriate records available to BPHC staff. Additional information may be requested prior to, at, or subsequent to the site visit(s). The Subrecipient will have a reasonable time to produce such information. The Subrecipient will also receive reasonable notice prior to each site visit. BPHC Site visit dates are communicated up to one year in advance to the Program Manager of the funded agency. While BPHC will attempt to accommodate agencies schedules within the assigned month, BPHC reserves the right to visit a funded program at a time of its choosing and without advance notice. Client Eligibility The Subrecipient will be expected to comply with the Financial Eligibility Policy for Ryan White Services which requires funded providers to screen HIV + clients for income eligibility, based on a threshold of 500% of the Federal Poverty Level (FPL) as determined by the U.S. Department of Health and Human Services (HHS). When applicable the Subrecipient will also adhere to the Ryan White Services Sliding Fee Scale Policies, as indicated by the Boston Public Health Commission (BPHC). In addition, subrecipients must asses such eligibility every 6 months. 4 Ryan White Services Division, Boston Public Health Commission

15 Program Reporting Overview BPHC uses quarterly reports to monitor each program s progress on meeting its contracted goals and objectives. Quarterly reporting requirements include the submission of a Quarterly Report and three forms of client-level data, including demographic, service utilization and outcome data. Each individually funded program must submit quarterly reports. If your agency is funded for multiple programs (e.g., Medical Case Management, Psychosocial Support - Mental Health and Substance Abuse - Residential), you must submit separate quarterly reports for each funded program. Reporting requirements differ for programs with unit rate budgets and for those with cost reimbursement budgets. Substance Abuse - Residential is currently the only category with a unit rate budget. Programs in all other service categories, including Minority AIDS Initiative (MAI), have cost reimbursement budgets unless specifically noted. Complete quarterly reporting requirements and instructions follow. Reporting Requirements Unit Rate Programs Each Month, programs with unit rate budgets will submit one signed original copy of combined fiscal and data report consisting of: One (1) copy of Fiscal Invoice. One (1) copy of Utilization Summary Report. This service utilization data will serve as the data submission and as fiscal backup documentation for units billed. Unit rate programs may submit utilization forms as a direct print out from the e2boston data system or create their own spreadsheet. Spreadsheets must include the following: agency name, service category, client code in alpha order, unique client identifier, service code, date of service, number of units, unit rate, and total cost. Programs should not submit duplicate versions of the same data. Refer to page 29 for a sample. The one signed original copy of combined fiscal and data report is due within 15 days of the month s end. Reports should be sent to: Each Quarter, All Programs will submit: Accounts Payable Boston Public Health Commission 1010 Massachusetts Avenue, 2 nd Floor Boston, MA Or Accountspayable@bphc.org CC: All Ryan White Fiscal Staff Quarterly Reporting A quarterly report. The Quarterly Report provides a detailed description of Part A funded activities during the quarter. A fully completed electronic statistical report (demographic and client utilization report) for all clients that received services during the quarter. This completed electronic statistical report will serve as a data submission. Please Note: All submission of client data must be done via the e2boston Data System. Agencies interested in uploading their electronic data instead of directly entering it into e2boston may contact their Program Coordinator to start the process. FY 2017 Ryan White Part A Provider Manual 5

16 All programs will submit the Quarterly Report via to your BPHC contract manager. Outcome Summary Report Twice a year agencies will complete and submit an Outcomes Summary Report, which will look at data based on all outcome reports submitted in the previous six months. These reports will be due in addition to your Q2 and Q4 quarterly reports, so your report due at Q2 will include Q1 and Q2 information, and your report due at Q4 will contain Q3 and Q4 information. In particular, we want to use the report to highlight clients who are not virally suppressed and encourage all agencies to think about how to engage those clients more. Non-Compliance Agencies may be held in non-compliance at the end of each month if they do not meet the reporting requirements listed above. This includes non-submission of required information and incorrect or incomplete submission. If submitted reporting is incorrect and/or incomplete, it will be returned to the agency and the agency will be required to submit new corrected information. Agencies are notified of non-compliance in writing. Payment will be held if complete data and quarterly reports are not received when due and/or if fiscal documentation is incomplete. Non-compliance shall be lifted as soon as all submissions are complete. Formal extensions of the deadlines for quarterly reporting are not granted under any circumstance. 6 Ryan White Services Division, Boston Public Health Commission

17 Important Ryan White Part A & Ryan White Part A Minority AIDS Initiative (MAI) FY 2017 Submission Dates Submission Reporting Period Due Date 1 st Quarterly Report Mar 1 - May 31 June 15, nd Quarterly Report June 1 - Aug 31 Sept 15, 2017 Outcomes Summary Report Mar 1 - Aug 31 Sept 15, rd Quarterly Report Sept 1 - Nov 30 Dec 15, th Quarterly Report Dec 1 - Feb 28 Mar 15, 2018 Outcomes Summary Report Sept 1 - Feb 28 Mar 15, 2018 Unit Rate Programs Submission of Fiscal Invoice and Client Utilization Data Each Month 15 days after each month s end (April 15, 2017 thru March 15, 2018) FY 2017 Ryan White Part A Provider Manual 7

18 Quarterly Report Instructions Quarterly Report Instructions Providers are expected to provide a detailed description of recent Part A funded activities in the program s quarterly report. Providers are required to complete a Quarterly Report for each funded service category. A template will be provided each quarter by your BPHC Program Coordinator. The following sections of the Quarterly Report must be completed to ensure Part A reporting requirements have been met. 1. Client Utilization Provide an update on your progress towards meeting the target utilization goal set in your Scope of Services. To complete the utilization table reference the program s target utilization goals outlined in the scope, the actual number of units and the percentage completed for the quarter. Should the program not meet the expected percentage goal for the quarter, an explanation must be provided describing why the program was unable to meet the goal. Attach a copy of the client utilization report from e2boston for the corresponding reporting period. Your Quarterly Report response regarding this section should utilize the data from this report. 2. Client Demographics Attach a copy of the client demographic reports from e2boston for the corresponding reporting period. 3. Personnel Provide an update on Part A program personnel, including any staff changes and/or TBD status of any open positions. If Part A funded staff attended any professional training during the quarter, complete the chart and include the date, the name of the training and the staff that attended. 4. Program Spending Provide an update on current program expenditures. To complete the program spending section reference the program budget and total amount billed to date to determine the percentage of funding billed out for the quarter. If there were under billed salary and program expense lines complete the table by including the salary/expense line(s) and the under billed amount(s). Also, Provide an explanation and plan for the reallocation of the under billed dollars. Consult your fiscal staff if you require assistance in completing this section. 5. Service Specific Questions Respond to category specific questions regarding the program s current efforts in providing services and support, implementing policies, and enacting strategies to ensure Ryan White Part A clients are retained in HIV care and are virally suppressed. These questions may differ each quarter, and will be included in the template provided by your BPHC Program Coordinator each quarter. Also, when responding to these questions, you may need to reference the programs client utilization, demographics and outcomes when appropriate. 8 Ryan White Services Division, Boston Public Health Commission

19 6. Other Program Update Provide any program updates such as new initiatives, program or agency expansion, or events the agency would like to highlight. 7. Unmet Need, Problems and Challenges Discuss any problem(s), obstacle(s) and/or challenge(s) faced internally by the program, how you met them, and how they affected your program. Include actions taken or to be taken to resolve such problem(s), obstacle(s) or challenge(s). Also, describe any training or technical assistance needs of program. 8. Plan of Corrective Action Describe your program s progress in addressing the citation(s) received at your last site visit. In answering the following questions, refer to your approved Plan of Correction Action, which outlines the action steps and deadlines for addressing the challenges that led to the citation(s). A sample Medical Case Management Quarterly Report can be found on the following page. FY 2017 Ryan White Part A Provider Manual 9

20 Sample Program Narrative HELPFUL HINTS Has there been any changes regarding program contacts such as a new contact, name/title change or new address? Reference the e2boston client utilization data to complete the chart and when describing any challenges in meeting the expected goals for the quarter you are reporting on. 10 Ryan White Services Division, Boston Public Health Commission

21 HELPFUL HINTS Have there been any personnel changes within the program such as, new hires, open positions, or vacancies? Include information regarding start and end dates of employment, plans for hiring new staff and any changes in supervisory structure. Are there any current or potential spending issues? Use this section to inform BPHC of these issues and how your program intends on resolving any issues. Consult your fiscal staff if you need assistance in completing this section. FY 2017 Ryan White Part A Provider Manual 11

22 HELPFUL HINTS When responding to service specific questions the answers should provide quantifiable and specific information. When applicable programs should reference the data submitted in their report. Are there updates such as future initiatives, program or agency expansions, or events the agency would like to highlight? Are there challenges that the program encountered in service delivery this quarter? Has your program developed and/or implemented strategies overcome them? 12 Ryan White Services Division, Boston Public Health Commission

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24 Outcome Summary Report Instructions Providers are expected to provide a detailed description of health and quality of life outcomes for clients who received services. This report will be due twice per year, once with your Q2 Quarterly Report, and once with your Q4 Quarterly report. With each report you will examine data from the previous six month period, so the first report will cover March 1-August 31, and the second report will cover September 1-February 28. If the program is funded for multiple service categories, you only need to fill out one report. In order to report on outcomes across two or more service categories, use e2boston to look at all outcomes data your agency has. Viral Suppression Report the percentage of clients who are virally suppressed, based on the number of outcome reports received and the number of clients served. This number will typically be lower than the viral suppression percentage among clients with outcome reports, but it will give you an idea of viral suppression across your agency. Outcome Report Submission This section is only for agencies who have submitted less than 85% of their outcome reports in the preceding six month period. In order to determine this number, use the Performance Summary report in e2boston with the corresponding date range. This report only takes into account the number of submitted reports and the number of deadlines that have passed in the six month period. The number of outcome reports you have yet to complete does not factor in. Virally Unsuppressed Individuals All services play an important role in the health and well being of PLWH, and this section will highlight some of the most vulnerable PLWH. Understanding who they are will help tailor services to their needs and ultimately help them reach and maintain viral suppression. 14 Ryan White Services Division, Boston Public Health Commission

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26 Instructions for Adding a New Client to e2boston This entire section highlights the necessary data elements we need in a client s record. However, we encourage you to fill in as much information as possible, such as Client s Primary Language or Country of Birth. When you create a client, you first enter information into the Client Intake page. This information is used to create a Unique Client Identifier (UCI) and a Client Code. e2boston also uses this information to check if the client already exists in your system. Once you verify the client is new, you can move to Client Demographics. Client Code/Unique Client Identifier Information Last 4 Digits of SSN Birth Date Enter the last 4 digits of the client s Social Security Number. If this is unknown, please enter Enter the client s date of birth in mm/dd/yy format. Street Address, City, State (optional) Zip Code Enter the client s street address, city, and state of residence. Enter the client s 5-digit zip code. Do not enter If the client s housing is unstable, enter the zip code where the client spends the most time or returns to regularly and/or can receive messages and be contacted. Mother s First Name Enter the first name of the client s mother. If this is unknown, please enter XXX. Sex at Birth & Current Gender Indicate the client s sex at birth (male or female) and also indicate the client s current gender (male, female, transgender, or unknown/unreported). If the client s current gender is transgender, please indicate whether the transition was from male to female, female to male, unspecified, or if the client declined giving this information. 16 Ryan White Services Division, Boston Public Health Commission

27 Continued: Creating a New Client in e2boston All pages in the client record, including Demographics, use red asterisks to indicate mandatory fields. On any given page, you must fill in all asterisked fields before you can save the information. A lot of the Demographic data is required for the Ryan White Services Report (RSR), which you submit to HRSA once a year. Completing data entry now for client race and ethnicity means you don t need to do it later! Date client first received services Enter the date that the client first received HIV services at your agency in mm/dd/yy format. Referral Source Activity Status & Reason for Discharge (if inactive) Race (select all that apply) Client s Ethnicity Ethnic Sub-group Indicate the way in which the client was initially referred to your agency for HIV services. If you choose other, please specify what the means of referral was. Indicate whether the client is an active client at your agency. If they are inactive, please indicate the reason for their discharge is known (please select only one and include the date of death in mm/dd/yy format if they are deceased.) Please select the racial categories that the client identifies as. The Unknown category includes Latinos who do not identify with any race). Please indicate whether the client is Hispanic or Latino/a or if the client is not Hispanic or Latino/a. If a client is Hispanic or Latino/a, Asian, or Native American, an option will appear to mark their Ethnic Subgroup. Please fill this out as it is now part of RSR Reporting. FY 2017 Ryan White Part A Provider Manual 17

28 Continued: Creating a New Client in e2boston Diagnostic information This page contains info about the client s HIV status, as well as original exposure category. Multiple exposure categories can be reported per client. The HIV status should be updated if the client s status changes, i.e. is diagnosed with AIDS. Diagnostic Information (select one) Current HIV/AIDS Medical Provider (if HIV positive) Exposure category (if HIV positive) (select all that apply) Please indicate the client s current HIV status by selecting one of the available options. If AIDS, CDC defined is selected, please provide the year of AIDS diagnosis in yyyy format. Important: HIV verification is required for any HIV positive clients Please indicate whether the client, if they are HIV positive, currently has an HIV/AIDS medical provider. Also, please provide the date on which this information was updated. If the client is HIV positive, please indicate all applicable exposure categories. Housing and Insurance This section of the client records contains one of the main components of Ryan White Eligibility: income information. This section must be updated each time a client is reassessed for eligibility. Once you have filled in income, income type, and family size, use the Calculate FPL button for e2boston to calculate the client s FPL for you. This FPL number can be used on the Income Verification sheet so you don t need to calculate it yourself. Housing Status (select one) & Housing type (if permanently housed) Source of Primary Medical Insurance (select one) & Source of other Medical Insurance Please indicate the client s housing status and provide the date on which this information was updated. If Permanent housing is selected, move to item 17 and indicate whether or not the housing is owned or rented. If it is rented, also indicate whether it is subsidized. Please indicate the client s source of primary medical insurance. If the client has more than one source of insurance, select all applicable sources. Also, please indicate the date on 18 Ryan White Services Division, Boston Public Health Commission

29 Programs are required to use e2boston to track service utilization for funded activities. BPHC uses the client code and unique client identifier to link service activities to specific clients. In addition to submitting an overview of utilization data with the quarterly reports, all programs must regularly upload/import utilization data into e2boston. Client utilization data are entered or uploaded at least monthly for review and submitted quarterly for programs with cost reimbursement budgets. Likewise, programs with unit rate budgets must submit client utilization data at least monthly. Reporting Requirements * Cost Reimbursement: Programs with cost reimbursement budgets will submit client utilization data quarterly, incorporating data from e2boston. * Unit Rate: Programs with unit rate budgets will submit a combined fiscal and data report consisting of a Fiscal Invoice and Client Utilization Data on a monthly basis. The monthly client utilization data will serve as fiscal backup documentation for units billed. Unit rate programs are encouraged to create and submit their own spreadsheet or submit a print out from the e2boston data system as their client utilization data fiscal backup. The submission should include the following: agency name, service category, client code in alphanumerical order, service code, date of service, number of units, rate, and total cost. Programs should not submit duplicate versions of the same data. Refer to page 27 for a sample submission. Instructions e2boston - Client Utilization Form While the reporting deadlines and requirements vary for cost reimbursement and unit rate programs, client activity itself is reported similarly for both types of programs. Client activity is recorded in one of three ways: by amount of time of service provided, upon completion of service, or by units of service provided. 1. Time-based Units of Service: If a client activity is measured in hours, it can be broken down into quarterunits. Examples: * If a client meets face-to-face with his Case Manager for 30 minutes, the visit is recorded as 0.5 units. * If a mental health clinician holds an individual psychosocial support session with a client for 90 minutes in her office, the visit is recorded as 1.5 units. 2. Completion of Service: Not all units of client activity correspond to hours of time. Instead, they are reported as one (1) unit when the activity is completed, regardless of how long the activity took to complete. Examples: * Phone calls that provide client-centered assistance are recorded as one (1) unit regardless of the length of the phone call. * Case Management intakes are recorded as one (1) unit when they are completed. * Supported Referrals are recorded as one (1) unit when they are completed. 3. Units of Service: Some client activities are recorded in units of service provided. The units may be in the form of discrete service units provided (e.g., meals, bed days). In some cases, they are client activities which are defined as units. FY 2017 Ryan White Part A Provider Manual 19

30 Examples: A transitional housing program funded to provide bed days for clients would record each bed day provided for each client as one (1) unit. A meals program funded to provide food bank packages for clients would record each package distributed to clients as one (1) unit. Refer to the Service Code Summary on page 65 for complete service code definitions and reporting instructions. Instructions for Completing Part A Unit Rate Client Utilization Data Fiscal Backup Reminder: Report service utilization only on clients whose services are paid for under Part A contracts. *All Fields Are Required Unless Otherwise Indicated* 1. Provider Name 2. Service Category 3. Client Code 4. Unique Client Identifier 5. Unit of Service Code 6. Date 7. Number of Units 8. Unit of Service Description, Optional Enter the Provider name as indicated on the contract. If desired, the program name may be entered after the Provider name. Enter the service category for which utilization is being reported (e.g., Substance Abuse - Residential). Enter the client code exactly as it was generated from the e2boston Data System. If the client code varies from the e2boston Data System, the client codes will need to be corrected. Enter the UCI exactly as it was generated from the e2boston Data System. If the UCI varies from the e2boston Data System, the UCIs will need to be corrected. Enter the service code for the specific unit of service provided using codes from the Service Code Summary (see page 70). Part A will only recognize codes from the Service Code Summary for which your program is funded. Only submit codes for the service category on which you are reporting. Enter the date the service was provided. Do not include dates that fall in future or past quarters on the Client Utilization Data Fiscal Backup. Enter the number of units of service provided for each service code listed. Each service unit must be recorded using whole or partial units of service as defined in the Service Code Summary. Describe the service provided as indicated in the Service Code Summary. For Cost Reimbursement and unit Rate programs, report utilization using Part A or Part A MAI codes listed in your Scope of Services only, as indicated in e2boston. 20 Ryan White Services Division, Boston Public Health Commission

31 Sample Unit Rate Client Utilization Data, Fiscal Backup Unit rate contracts must submit their client utilization data on a monthly basis via e2boston and as fiscal backup with their unit rate invoice. Below is a sample of a unit rate client utilization data submission that is submitted monthly with the agency s invoice. The submission serves as the fiscal backup documentation. Agencies that have a Substance Abuse - Residential unit rate contract should submit a form like the one below on a monthly basis with their invoice. The form should list client codes in alphabetical order. AIDS Service Organization Ryan White Part A Client Utilization Data, Fiscal Backup Service Category: Substance Abuse - Residential Month: March 2017 Client Code/UCI Dates of service Service Description # Units Rate Total Code LYA / JNSO March 3, 2017 March 31, Bed Day - RRS 29 $ $2, ASH / JMBO March 4, 2017 March 31, Bed Day - TSS 27* $ $3, *Client discharged on March 31, FY 2017 Ryan White Part A Provider Manual 21

32 Screenshot of e2boston How to Add Services to a Client Record First, select the service date. Some services, such as Rental Assistance, have special conditions listed for services that will appear on screen if you enter the date wrong. Next, choose the Service Category and Subservice Category for the service rendered. The Program and Contract forms will automatically fill in based on the date of service you input. After you hit the Add Service button, the Service Details screen will appear underneath the Add Services field. The Provide the required details for the service and double check to make sure the information is correct. All Service Detail screens provide additional space to write Service Notes. You may use notes to include additional details about a visit or service for your own reference, or for BPHC to look at later. All services notes are saved in e2boston and accessible in a client s Service History. 22 Ryan White Services Division, Boston Public Health Commission

33 Outcome Measurement Reports The Outcome Measurement Report is used to quantify and track the health of each client served. The primary outcome is whether or not a client is virally suppressed. It is not meant as a comprehensive assessment; rather, it is a tool to evaluate the impact of services on key indicators of health and wellness among clients. Outcomes reporting will be based on a Client Clock model; outcomes are assessed for each 6 month period during which the client received services. This model allows each client to have their own custom reporting period, which begins when the client receives a service at a Part A funded agency. Rules for Custom Reporting Periods 1. An outcomes reporting period begins for a given client if the client receives a service at a given agency AND a clock for that reporting period is not already going. 2. Once the outcomes reporting period begins, the provider has exactly 26 weeks (6 months) to complete an outcomes form corresponding to the client. After this 6 month period has elapsed, the provider may no longer submit a form corresponding to that reporting period for that particular client. 3. After the outcomes reporting period ends, regardless of whether or not a corresponding outcomes form was submitted, the next outcomes reporting period starts for a particular client on the first day that they receive a service after the end of the preceding outcomes reporting period. 4. If an outcomes form is completed for a given client at any time during a given outcomes reporting period, the clock does NOT reset. Rather, the clock continues to run for 6 months. After the 6 month period is over, the next service that the client receives at the agency starts a new clock. Reports 1. All reports involving Outcomes data will pull data SUBMITTED during the date range given in the report unless otherwise specified. 2. The Outcomes Completion and Eligibility report will allow providers to track clients that are in each of the 4 submission states, particularly Eligible for Submission and Submission Required. This report will also allow BPHC and providers to track how many missed outcomes reports a provider or a given client has. Outcomes Instructions & Submission Process Resources can be found in the e2boston Resource Center. Outcomes will only be accepted electronically via e2boston. Once an outcome report is missed, there is no way to submit the data to BPHC. It is better to submit an INCOMPLETE outcome report than to submit nothing at all. Contact Information For technical assistance, policy and/or reporting requirement information, please contact your contract manager. Outcomes Descriptions and Definitions Providers should use their professional assessment skills when completing the outcomes reporting forms. While each level for each outcome is defined, please keep in mind the broader status level categories (i.e., in crisis, poor, fair/ good, and excellent). FY 2017 Ryan White Part A Provider Manual 23

34 CD-4 Count: Choose the level for the most recent test result in the reporting period that you have seen or that he client has reported. Viral Load: Record the actual value for the most recent test result in the reporting period that you have seen or that the client reported. Primary Medical Care Engagement: Record the month and year in which the client was last seen by his/her HIV medical provider (the provider the client most commonly sees for their HIV medical care). Case Management Status: Record whether or not the client is receiving HIV case management services (social or medical) at any agency. Adherence to HIV Medication: Select whether the client always (0 missed doses in the last week), frequently (1-2 missed doses in last week), sometimes (3-4 missed doses in last week) or rarely (>4 missed doses in last week) adheres to prescribed HIV-related medical therapies. Providers can use the criteria that they use in practice to measure adherence. Do not answer this question if the client is not on ART. Severity of Side Effects of HIV-Related Medications: This outcome measure aims to assess the client s subjective experience of side effects from HIV medications. Wherever possible, this measure should be based on the direct report of the client. Do not answer this question if the client is not on ART. Mental Health Status: Use information gathered from clients during intakes, assessments and regular interactions to evaluate client s mental health status. This measure is not to be used as a mental health diagnosis. Access to Support Network: Support Networks may include friends, family, religious groups, or other peer groups from which the client obtains emotional, social, spiritual, or material support. Care Adherence: HIV-related appointments include medical appointments, mental health appointments, peer support, case management, and anything else related to care completion and/or support. Housing Status: This outcome aims to understand a client s stability in housing, regardless of type of housing. Care Adherence: HIV-related appointments include medical appointments, mental health appointments, peer support, case management, and anything else related to care completion and/or support. 24 Ryan White Services Division, Boston Public Health Commission

35 How to Add Outcomes to a Client Record Screen shot of e2boston FY 2017 Ryan White Part A Provider Manual 25

36 How to Add Outcomes to a Client Record 26 Ryan White Services Division, Boston Public Health Commission

37 How to Add Outcomes to a Client Record FY 2017 Ryan White Part A Provider Manual 27

38 Ryan White RSR Reporting Ryan White Services Report (RSR) ALL Ryan White funded providers are required to complete the 2017 RSR, which covers the reporting period from January 1, 2017 to December 31, For FY 2017, agencies will be required to use e2boston to generate the appropriate XML file for their client-level data. Only information for Part A clients can be entered into e2boston, so providers that are funded under multiple Ryan White Parts will have to rely on other systems to track their non-part A clients. There are three components to the RSR: Grantee Report to be completed by entities funded DIRECTLY by HRSA, including BPHC as the Part A Grantee, DPH as the Part B Grantee, and all directly funded Part C and D providers. Service Provider Report to be completed by ALL Ryan White funded providers. This report contains information about your agency and the services you provide under Ryan White. Client Report to be completed by ALL Ryan White funded providers. This report contains the Client Level Data (CLD) and is submitted electronically in an XML format with encrypted client identifiers. More information, including instructions for completing the RSR and full Client Level Data compliance, is available at the following HRSA websites: and careacttarget.org/topics/rsr.asp. 28 Ryan White Services Division, Boston Public Health Commission

39 Site Visit Overview In compliance with HRSA National Monitoring Standards, the Boston Public Health Commission conducts annual site visits to ensure that Part A funds are being utilized appropriately, to verify that federal and local requirements are being met, and to offer programmatic and fiscal technical assistance to agency staff. All agencies are monitored during the Part A contract period by BPHC s program and fiscal management teams. Program and fiscal reviews may be conducted simultaneously or on separate dates. Site visit dates are communicated up to one year in advance by BPHC to the Program Manager of the funded agency. While BPHC will attempt to accommodate agencies schedules within the assigned month, BPHC reserves the right to visit a funded program at a time of its choosing and without advance notice. Site Visit Planning Program Visit Site visits are scheduled three months prior to the beginning of the fiscal year. Agencies typically receive notice of their annual site visit in December of the previous year. A BPHC representative from the agency monitoring team will be assigned as a site visit leader. The site visit lead will be responsible for contacting you the program four to six weeks prior to the pre-scheduled visit. The site visit lead for your program will be different year to year. The Part A funded agency s Program Manager will receive a packet which includes: 1. A confirmation letter 2. Site Visit Documentation Checklist 3. Monitoring Tool 4. Standards of Care Checklist 5. Summary of policies on client file maintenance 6. File Review summary The Monitoring Tool contains questions that need to be answered by the agency prior to the visit. The agency must submit a completed Monitoring Tool at least two weeks prior to the visit. Agencies that submit documentation prior the visit will benefit from having a shorter review process. The remaining packet documents clarify reporting requirements and previous compliance by the funded program. Questions regarding any of these items may be directed to the site visit coordinator. All agencies are required to be compliant with the Universal and Service Category Specific Standard of Care. The Ryan White Services Planning Council developed the Standards of Care for Ryan White Services for each service category. All Part A and MAI funded programs are expected to comply with these standards. Through site visits and program monitoring, the Boston Public Health Commission will monitor each program s compliance to the Standards of Care. The Standards of Care can be found on the BPHC website, and in the attachments section of this manual. All programmatic site visits include a comprehensive review of randomly selected client files. The agency will receive a list of the client codes between hours prior to the visit via secure . Fiscal Visit The BPHC fiscal coordinator will be in contact with the funded agency s fiscal team and will provide a fiscal Monitoring Tool. This form will need to be completed and submitted back to the BPHC fiscal coordinator at least two weeks prior to the fiscal visit. FY 2017 Ryan White Part A Provider Manual 29

40 Day of Site Visit The program visit will focus primarily on reviewing client files. This will take place in the morning and part of the afternoon, and may produce questions for the program s staff. After the file review, BPHC will lead a discussion with agency staff members regarding preliminary findings, reporting requirements, and service coordination. As such, agency staff members are expected to be available during the day of the visit while BPHC conducts the visit. However, BPHC will do its best to limit the disruption of service delivery to clients seeking support. It is common for a post-review discussion to only require the time of the program manager. Client File Review A random sample of up to 40 client files is selected to verify that valid and accurate documentation is present for both eligibility requirements and the services delivered. All files must demonstrate the client s acknowledgement that the BPHC may review their record. (A sample acknowledgement form is provided in this manual.) As outlined in your Scope of Services, BPHC reserves the right to review any files without a current, signed Acknowledgement Form or Consent. If a client does not acknowledge the authorization, then a shadow client file must be presented for review, taking care to protect client s name. No identifying information will be removed from your agency. During the review, each file is scored on worksheets for compliance with reporting requirements and then aggregated in the File Review Summary Form. These findings will be included in the Letter of Findings sent to agencies. Required documentation includes, but is not limited to: HIV Verification Client Consent for Funder to Review and Authorization (s) to Release Information Grievance Procedure Income Verification and Financial Eligibility Insurance Status Residency Verification Evidence of Supervisory Review Please review the Maintenance of Client File Policy in this manual for a more detailed summary of required documentation, which also contains service-specific reporting requirements. Utilization data are also compared to progress notes to verify the provision of services, especially for unit rate programs. For unit rate programs, the same random sample is reviewed to ensure all billed units are supported by appropriate and accurate documentation and progress notes. The agency is responsible for repayment for services that cannot be verified. 30 Ryan White Services Division, Boston Public Health Commission

41 Fiscal Review The fiscal site visit involves comparing monthly invoices and supporting documentation to site records, verifying systems that track and monitor other funding streams, evaluating purchasing practices, and verifying an A-133, or agency audit, has been completed and is on file at the BPHC s Grants & Development Office. Items not adequately addressed in the fiscal Monitoring Tool may also come under review. Site Visit Letter of Findings Each agency will receive a Letter of Findings within 45 days of the program and fiscal visits. Letters will be sent to Program Managers and the agency s Executive Director. The findings will acknowledge a program s strengths and identify areas in need of improvement. Citations and Plan of Corrective Action Agencies that are out of compliance with BPHC s documentation standards will receive citations for the areas in need of significant improvement. Providers who receive a citation must respond to the site visit coordinator within 30 days of the Findings with a formal Plan of Corrective Action. The Plan must detail the steps that the agency will take to rectify the problem and prevent it from occurring again. Any plans that do not meet BPHC approval will need to be resubmitted. While working to address the issues cited, program managers must be prepared to discuss the progress during monthly calls with the program s BPHC Program Coordinator. Likewise, the agency must report on the status of the plan in all subsequent quarterly reports until improvement can be verified at the next site visit, at which time the citations may be lifted. Persistent, uncorrected issues may result in contract suspension or termination. Programmatic and fiscal compliance is tracked throughout the contract period. Agency programmatic and fiscal performance history is also factored into consideration for future awards and funding extensions. To see sample site visit materials, please refer to the Attachments section of the Provider Manual. FY 2017 Ryan White Part A Provider Manual 31

42 How to Prepare for Your Site Visit In the months preceding the site visit, the program manager should review the Standards of Care for their service category, any previous findings that were issued by BPHC, and service utilization reported to BPHC in the last 6 months. All Quarterly Reports between past and upcoming site visits should reflect the progress made toward addressing a citation issued at the previous site visit. Any progress or ongoing challenges close to the date of the visit should be reported to the contract manager during regularly scheduled monthly calls so that the BPHC monitoring team may take the program s efforts into consideration during the file review. Program managers should prepare their staff within their own agency by informing them that BPHC will need access to a sample group of files. If client records are in an electronic health record format, the program may need to produce paperwork for BPHC to sign so that the program IT staff can set up read-only logins. Due to HIPAA contractual agreements, BPHC may review all records that it requests; the program may wish to review this with their compliance officer ahead of the visit. All client records should be periodically reviewed to determine that they have an acknowledgment of BPHC review signed by the client. Shadow files must be presented in cases where the client declines to share personal information. BPHC does not intend to disrupt service delivery, but program staff may be called upon to present documentation or to participate in a post-review discussion. If time allows, agency staff may also wish to present a case study that illustrates the program s strengths and challenges. Part A-funded staff should be familiar with previous findings, especially areas where corrective action was required. For example, if the program was once cited for incomplete needs assessments, it should be prepared to demonstrate progress in this area and documentation of staff efforts to meet reporting goals. As the date of the visit approaches, program managers are welcome to discuss any program concerns with the BPHC contract manager. Prior to contact by the BPHC monitoring team, any questions or concerns about the logistics of the visit or overall expectations by contacting their site visit lead. 32 Ryan White Services Division, Boston Public Health Commission

43 Below is a sample timeline of steps that take place before and after a Ryan White Part A program s annual site visit. ** Providers should feel free to contact the site visit lead for their agency s site visit at any time during the process if questions arise. For a copy of the Monitoring Tool that agencies submit to BPHC prior to the site visit, please see the attachments section of this manual.

44

45 Fiscal Overview In this section: Fiscal Rules FY Annual Gross Income and Total Allowable Annual Charges.41 Sample Cost Reimbursement Invoice Sample Unit Rate Invoice Budgets Sample Cost Reimbursement Budget Sample Unit Rate Budget Budget Revision Request Instructions Sample Cost Reimbursement Budget Revision Sample Unit Rate Budget Revision... 51

46 Fiscal Rules FY 2017 The Boston Public Health Commission expects that all Part A contracted providers will expend 100% of their award in accordance with all federal, local, and BPHC policies. The Grantee will only reimburse providers for deliverables that have been mutually agreed (see Scope of Services and Budget) upon receipt of appropriate invoices and back-up documentation. If the provider wishes to revise the Scope of Services or allowable costs, they must submit a proposal to revise the Scope and/or Budget. In addition, it may be required that a program/agency audit be submitted. Failure to meet these expectations may result in suspension or termination of your provider contract. Invoicing General Information 1. A standard invoice including the approved budget must be submitted. Part A payments for cost reimbursement and unit rate contracts are based on the approved budget. Invoices must be formatted by computer; hand written invoices are not acceptable. Please note there cannot be anything handwritten on an invoice. Only line item budgeted expenses are reimbursed. 2. All contracts must have their invoices signed by a program representative or a contract specialist before submission to the Part A program. 3. Invoices are submitted monthly, within 15 days of the month's end. Invoices must represent actual monthly e expenses. The final invoice is to be submitted by March 15, Each day thereafter will be considered late, therefore non-compliant. 4. Invoices without the required information or documentation (including required data and reports) will not be processed. Instead, the agency is informed of the deficiency to be corrected, and the invoice is held for five business days. If there is no response after five business days, the invoice is deleted and the agency will need to resubmit the invoice. 5. An invoice must be submitted to the BPHC for each month in the contract period. If no contracted activities occurred in a given month, there would be no reimbursable costs; an invoice with a $0 monthly total must be submitted. 6. Any revised or supplemental invoices are to be clearly labeled as such by including the word Revised or Supplemental within the Invoice Number notation. Retroactive billing may only occur when the expense is not billed to another funding source. Documentation of bills to other funding sources may be required. 7. Monthly invoices containing all required information will be paid within 30 days of receipt. Payment will be held if complete quarterly reports are not received when due and/or if fiscal documentation is incomplete; agencies are informed in writing. Invoices are sent to: Accounts Payable Boston Public Health Commission 1010 Massachusetts Ave, 2 nd Floor Boston, MA Or Accountspayable@bphc.org CC: All Ryan White Fiscal Staff 36 Ryan White Services Division, Boston Public Health Commission

47 Cost Reimbursement Invoicing 1. Appropriate supporting documents for monthly cost reimbursement invoices include: Payroll registers and labor distribution reports Purchase requisitions accompanied with vendor invoice copy Cancelled checks Copies of vendor invoices Copies of reimbursement/voucher forms 2. The budget on the invoice must illustrate the exact approved contract budget. The name of each staff member must be noted next to each position on the budget. Actual monthly payroll expenses paid (not accrued) are billed on the invoice. The year-to-date amounts in the Cumulative billing column must be correct. Also, the salaries and FTEs which are billed must correspond to the approved contract budget. If any of these are incorrect on an invoice, it will not be processed. A budget revision request and/or revised invoice may be submitted. 3. The fringe rate must be the internally audited fringe rate. Verification of this rate is subject to audit. (Fringe is defined as government mandated and employer selected employee benefits including: social security, unemployment, workers, and disability compensation, retirement programs, and health insurance). 4. The following is required for any invoices submitted for the purchase of client related travel, meals/food, and other client consumables in below line items on any program budget: Itemized receipts must include the merchant or provider name, service received or specific item purchased, date of service and amount of expense. Itemized list indicating the client codes of those receiving the service and service utilization information (i.e., the dates and quantity of service provided to each client). These are required at the time of billing for all (but not limited to) the following line items: Food provided with client activities (e.g., Psychosocial Support group meals) Taxi vouchers The Ride tickets Commuter rail Bus and subway fare Volunteer mileage Contracted services rides A sample itemized list for transportation, and rental assistance is as follows: Client Code/ UCI MAR / RSCR MAR / RSCR Unit of Service Code Date Unit of Service Amount Vendor /03/17 Rental Assistance $300 Century /10/17 Taxi to Medical Appointment $22.50 Boston Taxi Please note: RENTAL ASSISTANCE may not be used for mortgage payments or back rent. Programs will be allowed to utilize resources to pre-purchase food, tokens, and taxi vouchers if done so by December 15, FY 2017 Ryan White Part A Provider Manual 37

48 5. The following must be submitted before billing for a consultant line: A resume and list of qualifications for any consultant hired. A detailed description of the services/activities performed by the consultant. The consultant s last name must be indicated on the invoice cover sheet when an invoice is submitted. 6. Contracts can only include an Indirect line item (capped at 10%) if the provider has a certified HHSnegotiated indirect cost rate using the Certification of Cost Allocation Plan or Certification of Indirect Costs, or adhere to a 10% cap on administrative expenses. 7. Vehicle mileage is reimbursed at a per mile rate not to exceed the Internal Revenue Service s standard mileage rate, which is currently $0.535 per mile. 8. Travel outside of the EMA is not allowed and will not be reimbursed. Exceptions to this may be made with the written prior approval from the Ryan White Services Division, where travel outside the EMA is for necessary trainings which may be held in various parts of the state. Unit Rate Invoicing 1. Unit rate billing uses the non-personnel expense portion of the standard Part A invoice (bottom half). 2. Unit rate billing documentation differs from Cost Reimbursement in that service utilization data serves as the fiscal backup documentation for units billed. Billing backup can be a direct print out from the e2boston data system or prepared as shown in the example below. Client Code/UCI MAR / RSCR Unit of Service Code Date Unit of Service # of units Rate Total /04/17 Bed Day, RRS 30 $75 $2,250 B. Fiscal Compliance 1. Under the Ryan White HIV/AIDS Treatment Modernization Act of 2009, there are significant penalties to the EMA if there are unexpended dollars at the end of the fiscal year. This includes the need to return unexpended dollars to the federal government. Therefore, all programs are expected to expend 100% of their contracted award. Contract expenses, as shown on invoices, are reviewed each quarter of the fiscal year. The agency is informed after the first quarter, in writing, of any under billing. Any contract under billed through the second quarter may be reduced. If the under billing is due to a late start, the contract is reduced by the amount of the unspent funds to date. If the under billing is chronic, the contract is reduced by both the unspent funds and the projected under spending to year-end. These unexpended funds are then reallocated to other provider contracts in accordance with the Ryan White HIV Services Planning Council s service priorities. Reallocations within individual categories and the resulting contract revisions do not require Planning Council approval. 2. In addition, the program may be held in non-compliance at the end of each month if they do not meet the invoicing requirements. This includes non-submission of invoices, or late invoices. If the invoice is incorrect and/or incomplete, it will be returned to the agency and the agency will be required to submit new corrected information. Agencies are notified of non-compliance in writing. Non-compliance shall be lifted as soon as all submissions are complete. 38 Ryan White Services Division, Boston Public Health Commission

49 3. On a case by case basis, contract spending may differ from each personnel line item by no more than 10% monthly, for example if you are projected to bill a monthly salary of $500 (annual salary of $6,000), you may spend $550 within that line per month (therefore, cannot exceed $6,600 annually) with the sufficient back up. For below line items, e.g. if you are budgeted for a $1,000 office supply line for the year, you may spend up to $1,100 within that line (you many bill this in one month or it may divided between several months). Both of these stipulations are as long as the total amount billed does not exceed the budget s maximum obligation. Overspending will not be reimbursed. 4. Contract funding for a Part A fiscal year may not be used in a subsequent fiscal year. Fiscal years are discrete; the funding is separate and is not carried over. C. Audits Agencies must perform audits of agency financial records as described in the OMB Circular A-133 if they receive more than $500,000 in federal funding. For agencies that receive less than $500,000 in federal funding, the agency is required to have annual audits and financial statements prepared by independent auditors. When completed, this audit must be sent to: William Kibaja, Controller Boston Public Health Commission 1010 Massachusetts Ave, 2 nd Floor Boston, MA In addition, this audit and all required fiscal records must be available at the program location for review during the on-site financial review. D. Budget Revisions 1. Contract budgets are not changed without the approval of the Boston Public Health Commission. A revised budget request in the same format as the contract budget and accompanied by line item explanations of proposed revisions is required. If the budget revision does not match the most up to date contract budget, it will be returned to the agency. Complete instructions are available under the budget revision section of the manual. 2. Agency requests to revise contract budgets are sent via to dbrophy@bphc.org or mailed to: Dennis Brophy Director Ryan White Services Division Boston Public Health Commission 1010 Massachusetts Ave, 2 nd Floor Boston, MA Budget revision requests must include the following: (1) a letter with a detailed explanation for making the proposed revision; (2) a current budget with the proposed changes made in the same format; and (3) a detailed line item budget explanation attached. 4. Generally, appropriate requests are those which propose using different means to accomplish the specific program features which were approved and detailed in the original Scope of Services. In general, adding new line items is not an acceptable request. With prior approval, agencies are allowed to shift funds between existing line items due to evolving service needs. 5. Budget revisions will not be accepted after December 15, FY 2017 Ryan White Part A Provider Manual 39

50 6. Initial appeals of denied budget revision requests are made, in writing, to the Interim Division Director. Further appeals may be submitted, in writing, to the Director of the Infectious Disease Bureau, Dr. Anita Barry. E. Additional Funding Restrictions 1. Grant funds may not be used to supplant or replace current state or local HIV-related funding. 2. Funds may not be used to purchase or improve land or to purchase, construct, or make permanent improvement to any building except for minor remodeling. 3. Funds may not be used to make payments to recipients of services. 4. Recipients of grant funds must participate in a community-based continuum of care. A continuum of care is defined as: A comprehensive continuum of care includes primary medical care for the treatment of HIV infection that is consistent with Public Health Service guidelines. Such care must include access to antiretrovirals and other drug therapies, including prophylaxis and treatment of opportunistic infections as well as combination antiretroviral therapies. Comprehensive HIV care also must include access to substance-abuse treatment, mental-health treatment, oral health, and home health or hospice services. In addition, this continuum of care should include supportive services that enable individuals to access and remain in primary medical care as well as other health or supportive services that promote health and enhance quality of life. 5. Of the total amount of funds awarded to a service provider through Part A, the total expenditures for administrative expenses shall not exceed 10 percent (without regard to whether any of these Subcontractors expend more or less than 10 percent for such expenses). For the purposes of the 10% aggregate cost cap, administrative activities include: Usual and recognized overhead activities, including rent, utilities, and facility costs. Costs of management oversight of specific programs funded under this title, including program coordination; clerical, financial, and management staff not directly related to patient care; program evaluation; liability insurance; audits; and computer hardware/software not directly related to patient care. 6. If a particular service is available under the state Medicaid Plan, the political subdivision involved must either provide the service directly or must enter into an agreement with a public or private entity to provide the service. The Subcontractor providing the service must enter into a participation agreement under the state Medicaid Plan and must be qualified to receive payment under the state Medicaid Plan. 7. Funds may not be used to provide items or services for which payment already has been made, or reasonably can be expected to be made, by third-party payers, including Medicaid, Medicare, and/or other state or local entitlement programs, prepaid health plans, or private insurance. It is therefore incumbent upon recipients of Part A funds to assure that eligible individuals are expeditiously enrolled in Medicaid and that Part A funds are not used to pay for any Medicaid-covered services for Medicaid-eligible PLWH. Applicants are reminded that Part A Grantees/Sub-Recipients are subject to audit on this and other restrictions on use of funds. 40 Ryan White Services Division, Boston Public Health Commission

51 Individual/Family Annual Gross Income And Total Allowable Annual Charges Individual/Family Annual Gross Income Equal to or below the official poverty line Total Allowable Annual Charges No charges permitted 101 to 200 percent above the official poverty line 5% or less of gross income 201 to 300 percent above the official poverty line 7% or less of gross income More than 300 percent above the official poverty line 10% or less of gross income 8. If a Part A service provider charges for services, it must do so on a sliding-fee schedule that is made available to the public. Individual, annual aggregate charges to clients receiving Part A services must conform to statutory limitations (see chart below). The intent is to establish a ceiling on the amount of charges to recipients of services funded under Part A. Please refer to the following chart for allowable charges. Establishing a fee schedule should not result in a bureaucratic system to means-test individuals or families before Part A-supported services are provided. A simple application that requests information on the annual gross salary of the individual/family should provide the baseline by which the caps on fees will be established. The client should ensure that the information provided is accurate. 9. Funds are to be used in a manner consistent with current and future program policies developed for Part A regarding allowable categories of services and eligibility for services. Please review all current HRSA/HAB and BPHC program policies. 10 All travel must be local (within the EMA) and directly related to the services provided under the specific contract. 11. Funds may not be used for outreach programs which have HIV prevention education as their exclusive purpose or broad-scope awareness activities about HIV services that target the general public. Sample cost reimbursement and unit rate invoices can be found on the following pages. FY 2017 Ryan White Part A Provider Manual 41

52 Sample of Cost Reimbursement Invoice 42 Ryan White Services Division, Boston Public Health Commission

53 Sample Unit Rate Invoice FY 2017 Ryan White Part A Provider Manual 43

54 Budgets Following is a description of the terms used on agency budgets. Budgets cover a twelve month period and are presented in whole dollars (no cents). Cost Reimbursement The Item column indicates the position title. The Personnel column indicates the name of the staff person occupying the position. Revisions should be submitted with staff first initial and last name (e.g., J. Smith). Enter TBD if the position is currently vacant. Program administration positions are funded, but only if their primary focus is the proposed service. Ryan White funds are not to be used to pay for agency s administration. The Salary column reflects a Full Time Equivalent (1 FTE total) salary. The FTE column is the percentage of time (carried to no more than two decimals) that the position listed is paid for by Ryan White Part A funding. To meet audit requirements, employees cannot exceed a total FTE of 1.0 across all funding sources. The Months column is the number of months the position listed will be occupied in the contracted period. The Annual column is the total salary amount that will be paid by Ryan White Part A in a twelve month budget period for the listed position based on the given FTE and Months. Salary 12 x FTE x Months = Annual The Fringe rate must be the agency s internal audited fringe rate, with a maximum of 42.53%. Verification of this rate is subject to audit. Fringe is defined as: government mandated and employer selected employee benefits including social security, unemployment, workers and disability compensation, retirement programs, and health insurance. Non-personnel, expense line item titles should be specific (e.g., Food, Office Supplies, Staff Training). The Indirect line item is capped at 10%. For Subcontractors wishing to use an indirect rate, documentation of Certificate of Indirect Costs that is HHS-negotiated, signed by an individual at a level no lower than Chief Financial Officer, must be provided. The Administrative Costs line item includes usual and recognized overhead activities, including rent, utilities, and facility costs. It also applies to costs of management and oversight of the specific program funded. Under this title it includes program coordination; clerical, financial, and management staff not directly related to patient care; program evaluation; liability insurance; audits; computer hardware/software not directly related to patient care. Administrative Costs are funded at a maximum rate of 10% of the total direct program costs. In addition, the Subcontractor is responsible for preparing a project budget that meets administrative cost guidelines and provides expense reports that track administrative expenses. 44 Ryan White Services Division, Boston Public Health Commission

55 Program Total cost (total direct cost) is the sum of the Personnel Total and the Expense Total. Unit Rate Unit Rate The Service refers to the activities the agency is funded to provide. The Unit represents the duration of the service activity. The Rate is the approved billable rate proposed per one unit of service. Rates may match but never exceed rates of reimbursement by other third-party payers (e.g., Medicare, Medicaid, Bureau of Substance Abuse Services) for same service activity. All current rates and documentation must be provided. The Volume represents the number of units to be delivered in a twelve month period. The Annual is the proposed rate times the volume. Proposed Rate x Volume = Annual Sample cost reimbursement and unit rate budgets can be found on the following pages. FY 2017 Ryan White Part A Provider Manual 45

56 Sample Cost Reimbursement Budget 46 Ryan White Services Division, Boston Public Health Commission

57 Sample Unit Rate Budget FY 2017 Ryan White Part A Provider Manual 47

58 Budget Revision Request Instructions Appropriate budget revision requests are those which propose to use different means to accomplish the original agreed upon goals and objectives outlined in the Scope of Services. In general, adding new line items are not acceptable requests. Agencies may be allowed to shift funds between existing line items due to evolving service needs. Program budgets may only be revised with the written approval of the Director of the Boston Public Health Commission Ryan White Services Division. In order to receive written approval, agencies must submit a budget revision request, including a proposed budget in the appropriate format (see sample on the following page) and a line item budget justification via to dbrophy@bphc.org or via mail to : Dennis Brophy Director Ryan White Services Division Boston Public Health Commission 1010 Massachusetts Ave, 2 nd Floor Boston, MA Budget revision requests must include the following: 1. A current budget with the proposed changes, and final proposed annual amounts to the right of each personel and/or expense line item. 2. A detailed explanation for each change being proposed and how it will assist you in meeting your contracted goals and objectives. 3. If proposing to change staffing, please list both the prior and proposed staff on separate lines, detailing the actual salary and FTE for each and applying the appropriate number of months on the contract. Personnel explanations should include: the last name of the employee or, if vacant, the estimated date of hire and a brief description of the position s duties and responsibilities as they relate to Ryan White funding. 4. Supporting documentation for each new staff person including a resume showing qualifications for the position, and proof of annual salary such as an offer letter or employee action form. 48 Ryan White Services Division, Boston Public Health Commission

59 5. If proposing to change expense items (e.g., food, program supplies, staff training, travel), explanations should incorporate quantities whenever possible. Explanations should state why an expense item is necessary and how it will be used. For example, travel expenses must specify who, where, when and why the travel is necessary. 6. For unit rate changes, please provide the rationale and the calculation for the number of units proposed. Any program proposing to add a consultant line or to move money into an existing consulting line must submit: 1. A resume and list of qualifications for any consultant hired as a condition of funding. 2. A detail description of the services/activities performed by the consultant should be provided with the budget revision and at the time of billing. 3. Following approval of the consultant line, agency must insert the Consultant s Last Name on the invoice coversheet. If these conditions are not met, no payments on consultant lines will be allowed. Initial appeals of denied budget revision requests are made, in writing, to the Client Services Director of the Boston Public Health Commission. Further appeals may be submitted, in writing, to the Director of the Infectious Disease Bureau, Dr. Anita Barry. Budget revisions will not be accepted after December 15, FY 2017 Ryan White Part A Provider Manual 49

60 Sample Cost Reimbursement Budget Revision In this example, Case Manager Jones has left the agency after 3 months on the Part A contract. Case Manager Valdez has replaced Jones for the remaining 9 months of the fiscal year. The agency has decided to raise the new Case Manager's FTE from.75 to.85 on the Part A contract. In order to cover the additional dollars, the agency had to reduce Program Coordinator Davis s FTE from 1.0 to.92 and remove $548 dollars from their Program Supplies line to put into the Case Manager's line. The agency s original budget is reflected in the first six columns. Items and staff names may be added if new staff has been hired. For example, a new line has been inserted to reflect the hiring of Case Manager Valdez. Following are terms related to budget revisions. Change is the difference between the Annual and the New Annual (Change = Annual - New Annual). New Salary is the Full Time Equivalent (1 FTE total) salary. If there is a salary adjustment from the original Salary, back-up documentation is required (e.g., hire letter). New FTE is the new percentage of time that the position listed will be paid through this contract. New Months indicates the new number of months that the employee will work; the number would differ from the original budget when a staff person is added or removed from a budget based on hiring or departure. New Annual is the updated total salary amount that will be paid for by Part A based on changes made to the salary, FTE, or months in the budget revision. New Annual for a staff member who is being removed from a budget must be the actual amount expended based on monthly invoices submitted to date. 50 Ryan White Services Division, Boston Public Health Commission

61 Sample Unit Rate Budget Revision In this example, the agency is requesting to move $30,024 from the RRS-Bed Day (4703) line and adding it to a new TSS-Bed Day (4704) line. In this case, the scope of services will be revised due to the addition of a new TSS- Bed Day line. This will add a new line amounting to $30,024. Unit changes are reflected in the New Volume column. FY 2017 Ryan White Part A Provider Manual 51

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63 Service Code Information FY 2017 Units and Definitions Service Codes by Category: AIDS Drug Assistance Program (ADAP/HDAP) Food Bank/Home-Delivered Meals/Medical Nutrition Therapy Medical Case Management (Part A & Part A MAI) Housing Medical Transportation Oral Health Care Psychosocial Support (Part A & Part A MAI) Substance Abuse (Residential) Outreach Service Code Summary... 65

64 AIDS Drug Assistance Program (ADAP/HDAP) Boston Part A EMA Ryan White Services Planning Council Service Category Definition: A State-administered program authorized under Part B of the Ryan White Program that provides FDA-approved medications to low-income individuals with HIV disease who have limited or no coverage from private insurance, Medicaid, or Medicare. Subservice Code Definition Prescription 4181 Please list using drug type code. 54 Ryan White Services Division, Boston Public Health Commission

65 Food Bank/Home-Delivered Meals/ Medical Nutrition Therapy Boston Part A EMA Ryan White Services Planning Council Service Category Definition: The provision of actual food or meals. It does not include finances to purchase food or meals, but may include vouchers to purchase food. The provision of essential household supplies, such as hygiene items and household cleaning supplies, also should be included in this item. The provision of food and/or nutritional supplements by a non-registered dietician should be included in this item as well. Subservice Code Definition Home Delivered Food, by a Professional Home Delivered Food, by a Volunteer 4221 Number of meals/food delivered by a professional to the home for clients and families who are incapacitated by HIV Number of meals/food delivered by a volunteer to the home for clients and families who are incapacitated by HIV. Meal, Congregate 4223 Number of meals provided in a group setting that is not the client s home. Assessment, Nutritional 4224 Enter one (1) when nutritional assessment is completed. Visit, General Nutritional Counseling 4225* A non-initial face-to-face session between counselor and client where nutritional support services are provided. One Unit = One Hour. Food Bank Package 4226 Withdrawal from food bank. Enter one (1) per can or package. Nutritional Supplement 4227 Enter one (1) per can or similar package. * Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. FY 2017 Ryan White Part A Provider Manual 55

66 Medical Case Management (Part A & Part A MAI) Boston Part A EMA Ryan White Services Planning Council Service Category Definition: A range of client-centered services that link clients with health care, psychosocial, and other services. The coordination and follow-up of medical treatments are a component of medical case management. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care through ongoing assessment of the client and other key family members needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV treatments. Key activities include: (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and periodic reevaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and review of utilization of services. This includes all types of case management, including face-to-face, telephone, and any other forms of communication. The purpose of MAI medical case management is to provide services that are culturally and linguistically appropriate to African Americans, individuals of African descent, Latinos, Native Americans, Asian Americans, Native Hawaiians, Pacific Islanders, and individuals of Asian descent who are living with HIV. Boston EMA Addendum: Services are to be offered in a variety of locations which may include one or more of the following venues: the agency or office setting, home visits, or other community-based settings. Subservice Code Definition Initial Intake, Started 4080 Enter one (1) when initial intake begins. Assessment, Completed 4081 Enter one (1) when assessment is completed. Visit, General 4082* A face-to-face session between provider and client where case management services are provided. One Unit = One Hour. Visit, Home-Based 4282* A face-to-face session between provider and client where case management services are provided in a non-office based setting, including but not limited to residential settings (i.e., independent living environment, congregate HIV or other supportive residential programs). Phone, Follow-up 4083** Enter one (1) for each non-initial telephone encounter which provides client-centered assistance. One Unit = One Phone Call. Reassessment/Followup Service Plan, Completed 4084 Enter one (1) when reassessment/follow-up service plan is completed. Supported Referral 4612 Enter one (1) for each active process of facilitating a client s access to HIV Support Services and any other services necessary to reduce barriers to care. * Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. ** Phone calls should be reported only when successful contact is made; messages left should not be reported. 56 Ryan White Services Division, Boston Public Health Commission

67 Housing Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Short-term assistance to support emergency, temporary, or transitional housing to enable an individual or family to gain or maintain medical care. Housing-related referral services include assessment, search, placement, advocacy, and the fees associated with them. Eligible housing can include both housing that does not provide direct medical or supportive services and housing that provides some type of medical or supportive services, such as residential mental health services, foster care, or assisted living residential services. Additional Clarification Regarding Use of Part A Funding: Housing Related Services includes assessment, search, placement, and advocacy services provided by professionals who possess an extensive knowledge of local, State and Federal housing programs and how they can be accessed. (For Use of Ryan White HIV/AIDS Program Funds for Housing Referral Services and Short Term or Emergency Housing Needs, please see HRSA HAB Policy Notice on page 141). * Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. ** Phone calls should be reported only when successful contact is made; messages left should not be reported. Subservice Code Definition Visit, Initial 4261* First face-to-face session between provider and client where housing services are provided. One Unit = One Hour. Visit, Followup Phone, Follow -up Placement, Temporary Placement, Permanent Assessment, Completed Supported Referral Housing Support, Group 4262* Any non-initial session between provider and client where housing services are provided. One Unit = One Hour. 4263** Enter one (1) for each telephone encounter which provides client-centered assistance. One Unit = One Phone Call Enter one (1) when temporary placement is made Enter one (1) when permanent placement is made Enter one (1) when assessment is completed 4268 Enter (1) for each active process of facilitating a client s access to HIV Support Services and any other services necessary to reduce barriers to care Face-to-face session between an eligible provider and the client participating in a group session with three or more individuals. One Unit = One Hour. FY 2017 Ryan White Part A Provider Manual 57

68 Housing Additional Clarification Regarding Use of Part A Funding: Rental Assistance is limited to short-term or emergency financial assistance to support temporary and/or transitional housing to enable the individual or family to gain and/or maintain medical care. Use of Ryan White Part A funds for short-term or emergency housing must be linked to medical and/or healthcare or be certified as essential to a client s ability to gain/maintain access to HIV-related medical care or treatment. * Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. ** Phone calls should be reported only when successful contact is made; messages left should not be reported. Subservice Code Definition Homelessness Prevention 4276 Enter one (1) for each unit (month of payment) of Homeless Prevention delivered. Rental Start Up 4277 Enter amount provided for first month, last month, or both time periods. Application Processed Application Rejected Client Communication 4273 Enter one (1) for each Rental Assistance application reviewed Enter one (1) for each Rental Assistance application rejected or denied Enter one (1) for each non-initial communication to a client related to rental assistance services. For example, One Unit = One Phone Call. 58 Ryan White Services Division, Boston Public Health Commission

69 Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Conveyance services provided, directly or through a voucher, to a client to enable him or her to access health care services. Subservice Code Definition Medical Transportation One-way Ride, Public 4441 One-way transportation by public transport system (subway or bus passes) for client to access healthcare or support services. One-way Ride, Taxi/ Transportation Company 4442 One-way transportation by taxi or other similar company for client to access healthcare or support services. One-way Ride, Van 4443 One-way transportation by a funded agency vehicle for client to access healthcare or support services. One-way Ride, Volunteer 4444 One-way transportation by a volunteer for client to access healthcare or support services. FY 2017 Ryan White Part A Provider Manual 59

70 Oral Health Care Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Diagnostic, preventive, and therapeutic services provided by a dental health care professional licensed to provide health care in the State or jurisdiction, including general dental practitioners, dental specialists, and dental hygienists, as well as licensed and trained and dental assistants. Boston EMA Addendum: Services funded by this category include education for, outreach to, and recruitment of dental providers. Subservice Code Definition Initial Intake, Started 4161 Enter one (1) when the initial intake begins. Treatment Committed 4162 Enter one (1) when the treatment approval is made. Treatment Claim 4163 Enter one (1) when the claim is completed. Phone, Follow-up 4164** Enter one (1) for any non-initial telephone encounter which provides client-centered assistance. One Unit = One Phone Call. ** Phone calls should be reported only when successful contact is made; messages left should not be reported. 60 Ryan White Services Division, Boston Public Health Commission

71 Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Support and counseling activities, child abuse and neglect counseling, HIV support groups, pastoral care, caregiver support, and bereavement counseling. They include nutrition counseling provided by a non-registered dietitian, but exclude the provision of nutritional supplements. The purpose of MAI psychosocial support is to provide services that are culturally and linguistically appropriate to African Americans, individuals of African descent, Latinos, Native Americans, Asian Americans, Native Hawaiians, Pacific Islanders, and individuals of Asian descent who are living with HIV. Boston EMA Addendum: Services funded under this category include peer support, where the person providing the psychosocial support is a person infected with HIV and of the client s self-identified community, and mental health, where psychological and psychiatric services are provided by mental health professionals including psychiatrists, psychologists, and clinical social workers who are licensed by the appropriate state authority to render such services, and substance abuse - outpatient, where medical or other treatment and/or counseling services are provided to address substance abuse problems (i.e. alcohol, and/or legal and illegal drugs) in an outpatient setting by a physician or under the supervision of a physician, or by other qualified personnel. Funded Mental Health and Substance Abuse - Outpatient services are intended to serve clients in agencies and settings that are not certified to bill Medicaid or other insurers. Mental Health and Substance Abuse - Outpatient services that are reimbursable by third parties are not eligible for funding under this service category. Peer Support Subservice Code Definition Psychosocial Support (Part A & Part A MAI) Peer Support Session, Group Peer Support Session, Individual Peer Networking Peer Support Session 4361* A regularly scheduled meeting for three or more people with HIV and facilitated by someone who is HIV infected. One Group Unit = One Hour. 4365* Any face-to-face encounter between an HIV infected peer advocate and client where peer support services are provided. One Unit = One Hour A regularly scheduled meeting session for three or more people with HIV where participants are provided with a range of activities that reinforce their social network and psychosocial support. Mental Health Subservice Code Definition Mental Health Session, Individual Mental Health Session, Group Mental Health Session, Family 4371* Face-to-face session between an eligible provider and client where mental health services are provided. One Unit = One Hour. 4372* Face-to-face session between an eligible provider and client participating in a group session with three or more individuals. One Group Unit = One Hour. 4373* Face-to-face session between an eligible provider and the client s family. One Unit = One Hour. FY 2017 Ryan White Part A Provider Manual 61

72 Psychosocial Support continued.. Substance Abuse - Outpatient Subservice Code Definition Hour, Individual 4421* Face-to-face session between an eligible provider and client where substance abuse services are provided. One Unit = One Hour, Group 4422* Face-to-face session between an eligible provider and client participating in a group session with three or more individuals. One Group Unit = One Hour. Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. Group units are calculated on a client basis. This means that if three clients attend a group session, three client codes and corresponding units must be included in the billing. 62 Ryan White Services Division, Boston Public Health Commission

73 Substance Abuse (Residential) Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Substance Abuse (Residential): Treatment to address substance abuse problems (including alcohol and/or legal and illegal drugs) in a residential health service setting (short-term). Subservice Code Definition Bed Day, RRS 4703 Unit of service greater than eight hours and less than 24 hours. This unit indicates the provision of services to a client enrolled in a residential program. Bed Day, TSS 4704 Unit of service greater than eight hours and less than 24 hours. This unit indicates the provision of services to a client enrolled in a residential program. FY 2017 Ryan White Part A Provider Manual 63

74 Outreach Boston Part A EMA Ryan White Services Planning Council Service Category Definition: Outreach: In person or over the phone efforts by providers to re-engage clients in care who have been lost to follow-up or have not been seen in last six months, or linking new clients to care. Subservice Code Definition Linkage to Care TBD Unit of service which corresponds to an instance of linking someone newly diagnosed with HIV or AIDS to services. Re-engagement TBD Unit of service that documents an attempt to contact, or successful contact, with a client who has been out of care for the last 6-12 months. This may be a phone call, , or face to face visit. 64 Ryan White Services Division, Boston Public Health Commission

75 Service Code Summary AIDS Drug Assistance Program Prescription 4181 Food Bank/Home Delivered Meals/ MNT Home Delivered Food, Professional 4221 Home Delivered Food, Volunteer 4222 Meals, Congregate 4223 Assessment, Nutritional 4224 Visit, General Nutritional Counseling 4225* Food Bank Package 4226 Nutritional Supplement 4227 Food Vouchers 4228 Medical Case Management (including MAI) Initial Intake, Started 4080 Assessment, Completed 4081 Visit, General 4082* Visit, Home Based 4282* Phone, Follow-up 4083** Reassessment/Follow-up Service Plan Completed 4084 Supported Referral 4612 Housing Visit, Initial 4261* Visit, Follow-up 4262* Phone, Follow-up 4263** Placement, Temporary 4265 Placement, Permanent 4266 Assessment, Completed 4267 Supported Referral 4268 Housing Support, Group 4269 Homelessness Prevention 4276 Rental Start Up 4277 Application Processed 4273 Application Rejected 4274 Client Communication 4275 Medical Transportation (based on one-way rides) Public 4441 Taxi/Transportation Company 4442 Van/Funded Agency Vehicle 4443 Volunteer 4444 Oral Health Care Initial Intake, Started 4161 Treatment Committed 4162 Treatment Claim 4163 Phone, Follow-up 4164** Psychosocial Support (including MAI) Peer Support Session, Group 4361* Peer Support Session, Individual 4365* Peer Networking Peer Support Session 4368 Mental Health Session, Individual 4371* Mental Health Session, Group 4372* Mental Health Session, Family 4373* Substance Abuse (Residential) Bed Day, RRS 4703 Bed Day, TSS 4704 Substance Abuse, Outpatient Hour, Individual 4421 Hour, Group 4422 Outreach Linkage to Care Re-engagement TBD TBD * Time based units may be reported using increments other than one hour. For example: 1.5 units = 90 minutes, 0.5 units = 30 minutes, or 0.25 units = 15 minutes. ** Phone calls should be reported only when successful contact is made; messages left should not be reported. FY 2017 Ryan White Part A Provider Manual 65

76 Policies and Procedures In this section: 1. HRSA Guidelines for HIV Verification Boston EMA Guidelines for HIV Verification Client Eligibility for Ryan White Services Sample Letter of No Income...72 Sample Hardship Waiver Client Income Summary Form Federal Fiscal Monitoring Standards Client Confidentiality Procedures Sample Client Acknowledgement Form Authorization to Obtain/Release Information Authorization to Obtain/Release Form Six Month Eligibility Recertification Six Month Eligibility Recertification Form Sample Letter of Self Attestation to No Changes to Eligibility Status Use of Part A Funds for Housing Services Policy Sample Housing Certification Form Maintenance of Client File Policy Payer of Last Resort Policy Verification of DSM-5 Diagnosis for Part A Funded Mental Health Programs HRSA Guidelines for Client Sliding Fee Scales Single Sliding Fee Scale Policy for Ryan White Services Agency Incident Report Procedures Contract Transition Policy DSS Program Policy Guidance No Eligible Individuals and Services for Individuals Not Infected with HIV HRSA HAB Policy Notices for the use of Ryan White HIV/AIDS Program Funds See for the following policies: 11-04: Use of Ryan White HIV/AIDS Program Funding for Staff Training 14-01: Clarifications Regarding the Ryan White HIV/AIDS Program and Reconciliation of Advance Premium Tax Credits under the Affordable Care Act 13-06: Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Medicaid 13-05: Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Private Health Insurance 13-04: Clarifications Regarding Clients Eligible for Private Health Insurance and Coverage of Services by Ryan White HIV/AIDS Program 13-03: Ryan White HIV/AIDS Program Client Eligibility Determinations: Post ACA Implementation 13-02: Clarifications on Ryan White Program Eligibility Determinations and Recertification Requirements 13-01: Clarifications Regarding Medicaid-Eligible Clients and Coverage of Services by Ryan White 12-02: Part A and Part B Unobligated Balances and Carryover 12-01: Use of Ryan White HIV/AIDS Program Funds for Outreach Services 11-01: Use of Ryan White HIV/AIDS Program Funds for Housing Referral Services and Short-term or Emergency 07-05: Use of Ryan White HIV/AIDS Program Part B ADAP Funds to Purchase Health Insurance 07-04: Use of Ryan White HIV/AIDS Program Funds for Transitional Social Support and Primary Care Services for Incarcerated Persons 07-03: Use of Ryan White HIV/AIDS Program, Part B, ADAP Funds for Access, Adherence, and Monitoring Services 07-02: Use of Ryan White HIV/AIDS Program Funds for HIV Diagnostics and Laboratory Tests Policy 07-01: Use of Ryan White Program Funds for American Indians and Alaska Natives and Indian Health Service Programs 66 Ryan White Services Division, Boston Public Health Commission

77 HRSA CDC HIV Testing Letter Ban on the Federal Funding for Syringe Services Program Interpretation of the Federal Public Benefit Definition of Public Charge in Immigration Laws Ryan White HIV/AIDS Program Services: Eligible Individuals & Allowable Uses of Funds Clarification of the Ryan White HIV/AIDS Program (RWHAP) Policy on Services Provided to Veterans Clarifications Regarding the Ryan White HIV/AIDS Program and Program Income Treatment of Costs under the 10% Administrative Cap for Ryan White HIV/AIDS Program Parts A, B, C, and D Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Medicaid Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Private Health Insurance Ryan White HIV/AIDS Program Client Eligibility Determinations: Considerations Post-Implementation of the Affordable Care Act Clarifications on Ryan White Program Client Eligibility Determinations and Recertification Requirements Veterans and the Ryan White CARE Act: FAQs and Resources TrOOP / ADAP Letter to Grantees

78 1) HRSA Guidelines for HIV Verification HRSA has developed client eligibility guidelines in response to the Office of Inspector General (OIG) s findings that all Eligible Metropolitan Areas (EMAs) need to strengthen systems and controls to ensure that only individuals with HIV disease and their families receive services provided through Ryan White HIV/AIDS Program funds. HRSA requires that each Part A EMA should have in place written procedures to ensure client eligibility. HRSA further states that these procedures should be communicated to and be required of all service providers. The HRSA Guidelines for HIV Verification, expected of all providers supported by Part A funds, include the following: 1. Primary documentation of positive HIV status be kept in the client s file on-site in at least one location within the Ryan White funded network. Examples of acceptable proof of HIV status include lab slips and physician statements. 2. Client files at every location should include primary documentation or reference to the primary documentation in the form of a certified referral form or a notation that eligibility has been confirmed (including the name of person/organization verifying eligibility, date, and nature and location of primary documentation). 3. Program monitoring activities of all service providers will include the review of documentation of client eligibility by programs/providers. Following an OIG audit of the Boston EMA, the following citations were issued: the lack of HIV verification by the agencies and the lack of client eligibility guidelines by BPHC. Therefore, in response to HRSA s guidelines for client eligibility and OIG s citations for the lack of HIV verification, the Boston Ryan White Part A program has developed specific procedures for the verification of HIV status of all clients by all service providers supported by Part A funds. Refer to the following page for the Boston version of the HRSA policy. 68 Ryan White Services Division, Boston Public Health Commission

79 2) Boston EMA Guidelines for HIV Verification In response to the guidelines released by HRSA for establishing client eligibility and verification of HIV status, the Boston Public Health Commission has developed specific procedures for the verification of HIV status of all clients supported by BPHC funds. HRSA specifies that the primary documentation of positive HIV status be kept in the client s file on-site in at least one location among the Ryan White HIV/AIDS Program funded network. In order to verify client eligibility and documentation of HIV status, an auditor (such as OIG) will need to visit the site that holds this documentation to review the client files. This type of review can only be done by obtaining and removing client identifiers to trace back the necessary documentation to each site. This procedure would jeopardize client confidentiality and privacy. To maintain client confidentiality, the Boston Ryan White HIV/AIDS Program Guidelines for HIV Verification adds to the HRSA requirements by requiring that client eligibility for Ryan White Part A services for each provider must include HIV verification. This documentation must be filed in client files at each program. The HRSA Guidelines for HIV Verification, expected of all providers supported by Part A funds, include the following: 1. Primary documentation of positive HIV status: Any document with medical provider s (MD, NP (ACRN), PA, RN, pharmacist) signature certifying HIV status Examples: letter from provider with letterhead Lab results indicating a positive HIV antibody test Home-delivered meals certification 2. The Boston EMA Ryan White HIV/AIDS Program expects that all service providers will obtain primary documentation of HIV status. This documentation must be included in all client files. 3. Program monitoring activities of all service providers will include the review of documentation of client eligibility. FY 2017 Ryan White Part A Provider Manual 69

80 3) Client Eligibility for Ryan White Services Background The Boston Public Health Commission (BPHC) Ryan White Services Division (RWSD) and Massachusetts Department of Public Health (MDPH) Office of HIV/AIDS (OHA) have developed a policy describing a local response to the U.S. Health Resources and Services Administration (HRSA) directive to implement financial eligibility criteria for Ryan White Part A and Part B services. HRSA s requirement is intended to ensure that Ryan White services are reserved for people living with HIV with very limited financial resources. This policy was updated for FY 2017 to include clarifications regarding proof of insurance and residency. Income Threshold Effective March 1, 2013 (BPHC) and April 1, 2013 (MDPH), funded providers must screen HIV+ clients for income eligibility, based on a threshold of 500% of the current Federal Poverty Level (FPL) as determined by the U.S. Department of Health and Human Services (HHS), with an additional allowance for dependents based on the MassHealth dependent allowance (currently $3,960 per dependent). Individuals with incomes at or below this level will be eligible for RWSD and OHA services. Agencies may continue to serve individuals with incomes above this level and must not deny services to clients based on income. However, agencies may not use Ryan White funds to serve clients with incomes above the threshold. Agencies may implement a hardship waiver for clients with incomes over 500% of FPL whose out-of-pocket expenses have exceeded 10% of their income during the year. Agencies may continue to set lower financial eligibility levels for particular services in consultation with BPHC and MDPH. HHS updates poverty guidelines annually, typically in late January. The best place to find updated, accurate information is on the HHS website at Screening and Documentation Providers must screen for financial eligibility at intake and at six-month intervals thereafter, and must document sources of income and FPL range in the client s record. Suitable documentation includes: At least two recent paystubs with pay periods indicated Copy of the most recent federal tax return W-2 for the most recent tax year 1099 form Documentation of SSDI, SSI, unemployment compensation, and any other government benefits or entitlements. If there are no earnings, the client record should contain a signed letter from the medical case manager or health care provider stating that the client has no income and indicating how the client is being supported. Agencies may maintain their own processes to screen for and document financial eligibility. These processes should include documents that obtain accurate, updated income information while ensuring low-threshold access to care and services. Client Income Summary Agencies may use or adapt the BPHC and MDPH Client Income Summary form to record a client s income and FPL. This form is intended to help facilitate access to other client services by communicating the results of financial eligibility screens that are completed by one service provider so that other providers do not need to duplicate this work. If the Client Income Summary form is not used, another means of documenting client income and FPL range must be created. Agencies are required to record the exact percentage of FPL for each client every six months. Agencies may chose to take this figure from the demographics section of the e2boston data base. The percentage must be accurate and visible on the income summary document, and must not be a range or contain more than (>) or less than (<) symbols. The figure must also be calculated based on the client s most recent, up to date income verification. 70 Ryan White Services Division, Boston Public Health Commission

81 With appropriate releases of information, agencies working with common clients can coordinate ongoing sixmonth eligibility screens, share documentation of income and self attestation forms, and assess eligibility without requesting the same information directly from the same client. Agencies sharing Client Income Summaries and self-attestation documents do not need to share actual backup income documentation; however, agencies may request this documentation. Agencies should exchange contact information in order to facilitate communication and information-sharing. Following is an example of how two agencies might coordinate income eligibility screening processes and paperwork: A client s Medical Case Management (MCM) provider screens a client for financial eligibility and works with the client to complete the Client Income Summary. The MCM provider then refers the client for congregate meals. The client or MCM provider gives the completed Client Income Summary to the congregate meals provider along with a signed release of information form. The agencies communicate about who will complete the financial eligibility screens every six months (in most cases, the MCM provider), exchange contact information, and decide how to share results and documentation on a routine basis. As part of the site visit process, specifically the client file review, BPHC and MDPH may request the backup documentation used to determine financial eligibility. In situations where the referring agency is also funded by Part A, and/or the client has signed the appropriate consent form for funder review, BPHC reserves the right to verify that appropriate eligibility review mechanisms are in place and that the related backup documentation is in the client file. If the referring agency is not funded by Part A, BPHC may ask that a provider utilizing Client Income Summary forms without backup documentation requests such documentation from the provider/client who originally completed the financial eligibility review. Proof of Insurance All service providers must obtain primary documentation of current health insurance status and include verifying documentation in all client files every six months. An example of health insurance status could include a current statement from a health insurance provider, an HDAP approval letter, a print out from an electronic medical record that indicates type of coverage, or a print out from the virtual gateway indicating type of insurance coverage. All documents need to be dated within six month of the last date of service recorded for a client. A client may also provide dated correspondence from their insurance provider that states the status of their coverage. BPHC cannot accept a photo copy of client s health insurance card as there is no way to determine if the coverage is active. Providers who are not located within a medical facility may collaborate with a client s medical provider or nursing team to obtain current documentation of a client s insurance. All providers are responsible for ensuring Ryan White Part A funds remain payer of last resort. Agencies are also responsible for identifying clients who may be uninsured, and to assist those clients in applying for health coverage. Proof of Residency All service providers must document current residency in the Boston EMA for clients receiving Part A services. Documentation must be included in all client files. Proof of residency can be in the form of: A non expired driver s license Utility bills Bank statement Real estate tax bill or receipt A current residential lease Proof of income in the form of a paycheck, or government issued benefits statement A signed case manager letter on the organization letter head verifying the town and postal code of residence. This policy became effective March 1st, 2013 and April 1st, 2013 for Parts A and B funded contracts respectively, and applies to all HRSA-funded service areas. The policy was revised on May 1, FY 2017 Ryan White Part A Provider Manual 71

82 Sample Letter of No Income [agency letterhead] DATE RE: patient/client name here To Whom It May Concern: The above-named patient/client is currently receiving [insert service type] from me. This patient s /client s income is [insert income], which is >500% of the FPL. His/her documented out-of-pocket expenses have presently exceeded 10% of his/her income, therefore he/she is now eligible for BPHC, Ryan White Services Division and MDPH, Office of HIV/AIDS (OHA) funded services for the rest of the calendar year. If you have any further questions, please call me at Thank you for your assistance. Medical Case Manager /Health Care Provider Signature Here Date: Medical Case Manager/Health Care Provider Printed Name Here Agency Name Here Patient/Client Signature Here Date: Patient/Client Printed Name Here Note: This letter must be completed on agency letterhead. 72 Ryan White Services Division, Boston Public Health Commission

83 Sample Hardship Waiver [agency letterhead] DATE RE: patient/client name here To Whom It May Concern: The above-named patient/client is currently receiving [insert service type] from me. In accordance with your eligibility criteria and to the best of my knowledge, this patient/client currently has zero income and is unable to afford to pay for [insert service type] due to financial hardship. The patient/client is currently being supported by [insert type of support, do not include names]. If you have any further questions, please call me at Thank you for your assistance. Medical Case Manager /Health Care Provider Signature Here Date: Medical Case Manager/Health Care Provider Printed Name Here Agency Name Here Patient/Client Signature Here Date: Patient/Client Printed Name Here Note: This letter must be completed on agency letterhead. FY 2017 Ryan White Part A Provider Manual 73

84 4) Client Income Summary Form 74 Ryan White Services Division, Boston Public Health Commission

85 5) Federal Fiscal Monitoring Standards BPHC, Ryan White Services Division Ryan White Part A Federal Fiscal Monitoring Standards Effective: March 1, 2012 Building a Healthy Boston Based on HRSA issued monitoring standards, the following are all standards that must be adhered to by funded providers/subcontractors. Limitations on Uses of Part A Funding 1. Adherence to 10% cap on Administrative Expenses a. Appropriate provider assignment of Ryan White Part A administrative expenses, with administrative costs to include: Usual and recognized overhead activities, including rent, utilities, and facility costs Costs of management oversight of specific programs funded under this title, including program coordination; clerical, financial, and management staff not directly related to patient care; program evaluation; liability insurance; audits; computer hardware/software not directly related to patient care b. Prepare project budget that meets administrative cost guidelines c. Provide expense reports that track administrative expenses with sufficient detail to permit review of administrative cost elements 2. Inclusion of indirect costs a. Indirect costs (capped at 10%) can be included only where the provider has a certified HHSnegotiated indirect cost rate using the Certification of Cost Allocation Plan or Certificate of Indirect Costs b. Providers/Subcontractors wishing to include an indirect rate must provide documentation of a current Certificate of Cost Allocation Plan or Certificate of Indirect Costs that is HHS-negotiated, signed by an individual at a level no lower than chief financial officer c. If using indirect cost as part or all of its 10% administration costs, obtain and keep on file a federally approved HHS-negotiated Certificate of Cost Allocation Plan or Certificate of Indirect Costs Submit a current copy of the Certificate to the Boston Public Health Commission (BPHC) 3. Provider/Subcontractor expenses for rent and utilities are allowable administrative expenses within the 10% limitation on administrative costs. Rent is considered an overhead expense, and under Ryan White HIV/ AIDS Program guidance, provider/subcontractor overhead expenses are considered to be administrative costs. These costs may not be shown as direct service expenses. 1 The Division of Cost Allocation in HHS negotiates and approves indirect cost agreements for entities receiving funding through the Department. This Division negotiates rates through its four regional field offices and the national headquarters. To obtain information from one of these offices go to: http//rate.psc.gov and click on Contact Information, then click on the appropriate link: National Headquarters, Western, Central States, Mid-Atlantic, Northeastern. Contractors and providers/subcontractors wanting to claim administrative costs in their Ryan White HIV/AIDS Program budget as indirect costs are allowed to do so only FY 2017 Ryan White Part A Provider Manual 75

86 Unallowable Costs All funded providers/subcontractors must: Maintain a file with signed subgrant agreement, assurances, and/or certifications that specify unallowable costs Ensure that budgets do not include unallowable costs Ensure that expenditures do not include unallowable costs Provide budgets and financial expense reports to BPHC with sufficient detail to document that they do not include unallowable costs 1. No use of Part A funds to purchase or improve land, or to purchase, construct, or permanently improve any building or other facility (other than minor remodeling) 2. No cash payments to service recipients a. Maintain documentation of policies that forbid use of Ryan White funds for cash payments to service recipients 3. No use of Part A funds to develop materials designed to promote or encourage intravenous drug use or sexual activity, whether homosexual or heterosexual 4. No use of Part A funds for the purchase of vehicles 5. No use of Part A funds for non-targeted marketing promotions or advertising about HIV services that target the general public, including poster campaigns for display on public transit, TV or radio public service announcements, etc., or for broad-scope awareness activities about HIV services that target the general public a. Prepare a detailed program plan and budget narrative that describe planned use of any advertising or marketing activities 6. No use of Part A funds for outreach activities that have HIV prevention education as their exclusive purpose a. Provide a detailed program plan of outreach activities that demonstrates how the outreach goes beyond HIV prevention education to include testing and early entry into care 7. No use of Part A funds for influencing or attempting to influence members of Congress and other Federal personnel a. Include in personnel manual and employee orientation information on regulations that forbid lobbying with federal funds 8. No use of Part A funds for foreign travel a. Maintain a file documenting all travel expenses paid by Part A funds Income from Fees for Services Performed 1. Use of Part A and third party funds to maximize program income from third party sources and ensure that Ryan White is the payer of last resort. Third party funding sources include Medicaid, State, Children s Health Insurance Programs (SCHIP), Medicare (including the Part D prescription drug benefit), and private insurance. a. Have policies and staff training on the requirement that Ryan White be the payer of last resort and how that requirement is met 76 Ryan White Services Division, Boston Public Health Commission

87 b. Require that each client be screened for insurance coverage and eligibility for third party programs, and helped to apply for such coverage, with documentation of this in client files c. Carry out internal reviews of files and billing system to ensure that Ryan White resources are used only when a third party payer is not available d. Establish and maintain medical practice management systems for billing 2. Ensure billing and collection from third party payers, including Medicare and Medicaid so that payer of last resort requirements are met a. Establish and consistently implement: Billing and collection policies and procedures Billing and collection process and/or electronic system Documentation of accounts receivable 3. Ensure provider/subcontractor participation in Medicaid and certification to receive Medicaid payment a. Document and maintain file information on grantee or individual provider agency Medicaid status b. Maintain file of contracts with Medicaid insurance companies c. If no Medicaid certification, document current efforts to obtain such certification 4. Bill, track, and report to the grantee all program income (including drug rebates) billed and obtained 5. Ensure service provider retention of program income derived from Ryan White-funded services. Funds may be added to resources committed to the project or program and used to further eligible project or program objectives, and/or used to cover program costs. a. Document billing and collection of program income b. Report program income documented by charges, collections, and adjustment reports or by the application of a revenue allocation formula Imposition and Assessment of Client Charges 1. Provider/Subcontractor policies and procedures must specify charges to clients for services, which may include a documented decision to impose only a nominal charge a. Establish, document, and have available for review: Sliding fee discount policy Current fee schedule Sliding fee eligibility applications, in client files Fees charged and paid by clients Process for charging, obtaining, and documenting client charges through a medical practice information system, manual or electronic 2. No charges imposed on clients with incomes below 100% of the Federal Poverty Level (FPL) a. Document that: Sliding fee discount policy and schedule do not allow clients below 100% of FPL to be charged for services Personnel are aware of and following the policy and fee schedule Policy is being consistently followed FY 2017 Ryan White Part A Provider Manual 77

88 3. Charges to clients with incomes greater than 100% of poverty that are based on a discounted fee schedule and a sliding fee scale a. Cap on total annual charges for Ryan White services based on percent of patient s annual income, as follows: 5% for patients with incomes between 100% and 200% of FPL 7% for patients with incomes between 200% and 300% of 10% for patients with incomes greater than 300% of FPL b. Have in place a fee discount policy that includes a cap-on-charges policy and appropriate implementation, including: Annually evaluating clients to establish individual fees and caps Track of Part A charges or medical expenses inclusive of enrollment fees, deductible, copayments, etc. Have a process for alerting the billing system that the client has reached the cap and should not be further charged for the remainder of the year Documentation of policies, fees, and implementation, including evidence that staff understand the policies and procedures Property Standards All funded providers/subcontractors must: Develop and maintain a current, complete, and accurate asset inventory list and a depreciation schedule that lists purchases of equipment by funding source Make the list and schedule available to the grantee upon request 1. Provider/Subcontractor tracking of and reporting on tangible nonexpendable personal property, including exempt property, purchased directly with Ryan White Part A funds, and having a useful life of more than one year and an acquisition cost of $5,000 or more per unit 2. Implementation of adequate safeguards for all capital assets that assure that they are used solely for authorized purposes 3. Real property, equipment, intangible property, and debt instruments acquired or improved with federal funds held in trust by providers/subcontractors, with title of the property vested in BPHC but with the federal government retaining a revisionary interest a. Establish policies and procedures that acknowledge the revisionary interest of the federal government over property improved or purchased with federal dollars b. Maintain file documentation of these policies and procedures for BPHC review 4. Assurance by providers/subcontractors that title of federally-owned property remains vested in the federal government, and if the HHS awarding agency has no further need for the property, it will be declared excess and reported to the General Services Administration (1) with an HHS-approved indirect cost rate in accordance with applicable cost principles; and (2) in accordance with the 10% legislative limitation on administration costs, (i.e., indirect costs are included in the definition of grantee administration under Part A and B, as mandated by the legislation). 78 Ryan White Services Division, Boston Public Health Commission

89 5. Title to supplies to be vested in the recipient upon acquisition, with the provision that if there is a residual inventory of unused supplies exceeding $5,000 in total aggregate value upon termination or completion of the program and the supplies are not needed for any other federally-sponsored program, the recipient shall retain the supplies for use on non-federally sponsored activities or sell them, and compensate the federal government for its share contributed to purchase of supplies a. Develop and maintain a current, complete, and accurate supply and medication inventory list b. Make the list available to BPHC upon request Cost Principles 1. Payments made to providers/subcontractors for services need to be cost based and relate to Ryan White administrative, quality management, and programmatic costs in accordance with standards cited under OMB Circulars or the Code of Federal Regulations a. Ensure that budgets and expenses conform to federal cost principles b. Ensure fiscal staff familiarity with applicable federal regulations 2. Payments made for services to be reasonable, not exceeding costs that would be incurred by a prudent person under the circumstances prevailing at the time the decision was made to incur the cost. a. Make available to the grantee very detailed information on the allocation and costing of expenses for services provided b. Calculate unit costs based on historical data c. Reconcile projected unit costs with actual unit costs on a yearly or quarterly basis 3. Written procedures for determining the reasonableness of costs, the process for allocations, and the policies for allowable costs, in accordance with the provisions of applicable Federal cost principles and the terms and conditions of the award. Costs are considered to be reasonable when they do not exceed what would be incurred by a prudent person under the circumstances prevailing at the time the decision was made to incur the costs. a. Have in place policies and procedures to determine allowable and reasonable costs b. Have in place reasonable methodologies for allocating costs among different funding sources and Ryan White categories c. Make available policies, procedures, and calculations to BPHC on request 4. Calculate unit costs based on an evaluation of reasonable cost of services; financial data must relate to performance data and include development of unit cost information whenever practical a. Have in place systems that can provide expenses and client utilization data in sufficient detail to determine reasonableness of unit costs 5. When determining the unit cost of a service, unit cost cannot exceed the actual cost of providing the service and includes only expenses that are allowable under Ryan White requirements a. Use the following formula to calculate unit cost: allowable administrative costs plus allowable program costs divided by number of units to be provided b. Have in place systems that can provide expenses and client utilization data in sufficient detail to calculate unit cost c. Have unit cost calculations available for BPHC review FY 2017 Ryan White Part A Provider Manual 79

90 6) Client Confidentiality Procedures Boston Public Health Commission believes strongly in protecting client confidentiality. The following guidelines must be adhered to by all providers: 1. Client identifying information should never be transmitted to BPHC by mail or All clients must be offered the opportunity to sign a Client Acknowledgement Form that BPHC staff may, in accordance with Federal guidelines, perform a visual review of their client file. Except in the case of suspected fraud or criminal wrongdoing, no client identifying information shall be removed from the agency s premises. 3. The Client Acknowledgement Form must inform the client that in accordance with BPHC s HIPAA Business Associate Agreement with funded agencies, BPHC reserves the right to review client files even in the absence of signed consent, if necessary. 4. All client consent forms must have an expiration date of one year from date of signature.. Providers failing to implement the above procedures may have their contracts suspended and/or revoked. 80 Ryan White Services Division, Boston Public Health Commission

91 7) Sample Client Acknowledgement Form Agency Letterhead Consent/Acknowledgement of Funder Review of File I,, acknowledge that the staff of has informed me of the authority of the Boston Public Health Commission (BPHC) to examine and review my client record. The purposes of review are for monitoring only. The review may include information such as name, HIV status and related diagnosis, substance abuse treatment, medical care and treatment, financial circumstances, living arrangements, and other information as requested. I understand that the review will be visual only, no records will be copied, and no information identifying me will be recorded. In no way does this acknowledgement authorize BPHC to remove information or collect personal identifiers, except in cases of suspected fraud or other criminal wrongdoing. This signed acknowledgement will have a duration of one year from the date of signing below. I understand I am not required by law to consent to release this information, but choose to do so willingly and voluntarily. I understand I may revoke consent at any time except to the extent action has been taken in reliance of my consent. I am aware that BPHC has a business agreement with the above mentioned agency and is a covered entity under the HIPAA Privacy Rule. Hence, BPHC is permitted to review my file without a signed consent/ acknowledgement form. Client s Signature Date: Birth date: Witness: Date: FY 2017 Ryan White Part A Provider Manual 81

92 Authorization to obtain/release information must be documented for all communication with external partners. Programs must have a release of information form that describes under what circumstances client information can be released. This form must clearly document: the name of agency/individual with whom the information is being shared; the information to be shared; the client signature and date signed; and provide space for revocation of authorization. All authorizations to obtain/release information expire 12 months from the date of signature. Documentation of multiple external partners is allowable on one form. To ensure clear documentation of client authorization, clients must indicate by initialing next to each individual entity with whom information is to be shared. At any point in time, clients reserve the right to revoke authorization to obtain/release information. In an instance where one form contains documentation for multiple entities, all authorizations are revoked and a new form must be completed with the client s initials next to each individual entity as well as a signature of authorization. This form can be used as a living document. Over time clients may want to allow the release of information to additional entities. This is allowable so long as the agency ensures the client initials accordingly. There will be no change to expiration of one year. All releases will expire at the date listed on the bottom of the page. The date listed cannot be changed. There is no extension of the release of information. At the end of one year, the agency needs to work with the client to obtain a new signed and initialed form. Required Elements of authorization Client ID Entity to be shared (specific staff person, when possible) Contact information (phone/fax/address or location?) Date signed Date of expiration (No more than 12 months) Staff Signature Client Signature Client Initials identifying each specific authorization to each individual external agency Revoked Authorization Client Signature Date Staff Initials Optional Emergency Contact Name Relationship Contact Information 8) Authorization to Obtain/Release Information 82 Ryan White Services Division, Boston Public Health Commission

93 9) Authorization to Obtain/Release Form FY 2017 Ryan White Part A Provider Manual 83

94 10) Six Month Eligibility Recertification Income, Residency and Insurance status must be verified and documented every 6 months for all clients receiving Ryan White Part A services. Recertification documentation must be present in all client files. All documentation must be dated within 6 months prior to the date of recertification with the exception of leases, state- issued identification and government-issued statements that are valid for one year. At least once per year, eligibility recertification must be accompanied by source documentation. Source documentation options are listed below. One time in a 12 month period clients may sign a letter of selfattestation stating that there have been no changes to income, residency, or insurance. This letter must be on agency letterhead. Letters must contain: 1) a statement explaining that the client s eligibility measures have not changed within the previous six months; 2) the client s printed name; 3) the agency staff member s printed name; 4) the client s signature; and, 5) the date document was signed. Please see the sample letter of self-attestation. Financial: Please see comprehensive Client Eligibility policy. Residency: programs must document each client s proof of residency at least once every 6 months. Proof of residency can be in the form of: Pay Stub, Government Issued Check, Government Correspondence, Valid Driver s License, Utility Bill, Bank Statement, Real Estate Tax Bill, Current Residential Lease, Medical Case Manager Letter (including town and zip code), and Homelessness Certification from shelter provider. Insurance: programs must have documentation of each client s insurance status. Insurance coverage options include: MassHealth (Medicaid), ConnectorCare, Medicare/Medicare Part D, Employer Subsidized, Veteran s Affairs, Private non-groups (qualified health plans via the Health Connector ), Health Safety Net Private, MIC (Mass Insurance Connection) Six Month Eligibility Recertification Summary Form Agencies may use or adapt the six month recertification summary form to record a client s income/fpl, residency and insurance statuses. This form is intended to help facilitate access to other clients services by communication the results of eligibility recertification that are completed by one service provider so that other providers do not need to duplicate this work. If the six Month Eligibility Recertification Summary form is not used, another means of documenting client income/fpl, residency and insurance statuses must be created and submitted to your program coordinator for approval. With appropriate releases of information, agencies working with common clients can coordinate ongoing six-month eligibility screens, share documentation of incomes and self attestation forms, and assess eligibility from clients without requesting the same information directly from the same client. 84 Ryan White Services Division, Boston Public Health Commission

95 11) Six Month Eligibility Recertification Form Six Month Eligibility Recertification Summary The purpose of this form is to document the ongoing components of eligibility: financial, residential and insurance coverage for individuals receiving Ryan White Part A services. This form can be shared among Part A-funded service providers to verify, income, residency and health insurance coverage if the client has signed and dated a release of information document. This form is valid for 6 months after screening date. Agency Name: Agency Address: Agency Phone Number: Client Name: Screening Date: Client Code: Expiration date (six month after screening): Financial Client Annual Income $ % of Federal Poverty Level % Pay Stubs (2 most recent) Social Security (SSDI/SSI) Letter Private Disability Statement Department of Transitional Assistance (TANF/ EAEDC)Letter Veterans Benefits Medical Case Manager Letter Other: Residency Pay Stub Government Issued Check Government Correspondence Valid Driver s License/MA ID Utility Bill Bank Statement Real Estate Tax Bill Current Residential Lease Medical Case Manager Letter including town and zip code Other: Insurance HDAP Approval Letter Letter from Insurer Premium Statement Dated Print out from Exchange Mass Health Approval Letter Other: Signatures Client: Date: Agency Staff: Date: Staff Title FY 2017 Ryan White Part A Provider Manual 85

96 12) Sample Letter of Self Attestation to No Changes to Eligibility Agency Letterhead Letter of Self Attestation to No Changes to Eligibility Status Date RE: Patient/Client Name or Client Code To Whom It May Concern: The above named patient/client is currently receiving [insert service name] from me. This patient s/client s eligibility was last documented on [Insert Date of Last 6 Month Eligibility]. Since that time there has been no change to: (check all that apply) Income: [income at last documentation] Residency: [town and zip code] Insurance:[type of insurance] Staff Signature Staff Name Printed Date Patient/Client Signature Patient/Client Name Printed Date 86 Ryan White Services Division, Boston Public Health Commission

97 13) Use of Part A Funds for Housing Services Policy The following policy applies to all Housing Assistance Programs (including rental startup; rental assistance; the purchase of short-term emergency transitional beds; and any service in which Part A funds are used to pay the cost of housing). Short term or emergency housing assistance must be certified as essential to a client s ability to gain and/or maintain access to HIV related medical care or treatment. Documentation, in the form of a letter or standard form, must be utilized to certify that housing assistance is essential to the client s ability to gain and/or maintain access to HIV related medical care or treatment. See sample certification form. This documentation must be located in the client s file at the program providing the housing service. The documentation does not need to be certified by a primary care physician. The certification should be signed by a qualified professional who makes decisions or coordinates health care for HIV positive individuals. This may include, but is not limited to, nurses, case managers, physicians, or care coordinators. This may include staff of the agency providing the housing assistance. Housing assistance cannot be permanent and must be accompanied by a plan to identify other sources of funding to pay for long term housing needs. Mortgage payments cannot be made with Part A funds. Ryan White HIV/AIDS Program funds can be used for security deposits, but only if there is an approved system to retrieve the security deposit at the end of tenancy and to reapply those dollars toward new requests. There cannot be a di rect cash benefit to the client. Those providers wishing to use Part A funds for security deposits must develop such a system and have it approved by BPHC prior to implementation. FY 2017 Ryan White Part A Provider Manual 87

98 14) Sample Housing Certification Form Agency Letterhead Housing Certification Form Date I, (please print name) provide the following service for (client s name or client code): Primary Care Case Management Other HIV Medical and/or Support Service: I hereby certify that housing assistance is needed in order for the above client to gain and maintain their access to HIV medical and support services. Signature Title/Position Agency Date Phone 88 Ryan White Services Division, Boston Public Health Commission

99 15) Maintenance of Client File Policy BPHC Maintenance of Client File Policy Programs must maintain a file on site for each client receiving Ryan White services which includes, at minimum, the following info unless otherwise noted. Further clarification may also be found in the Standards of Care. Certification Forms AUTHORIZATION TO OBTAIN/RELEASE OF INFORMATION CLIENT ACKNOWLEDGMENT OF FILE REVIEW HIV VERIFICATION INCOME VERIFICATION Programs must have a release of information form which describes under what circumstances client information can be released. A release of information should include: name of agency/ individual with whom the information will be shared; information to be shared; duration of the release consent; client signature; date signed; and expiration date. A Release to multiple providers is allowable. Please see the Policy on Authorization to Obtain/ Release Information on page 88. A sample is included in the attachments. Programs must have an acknowledgement form in which clients are made aware that BPHC will review client files on site during site visits. The policy regarding client confidentiality procedures and a sample acknowledgement form can be found on page 86. Programs must have documentation of each client s HIV status. Primary documentation may include lab slips, HIV test results, and/or medical provider statements acknowledging HIV status. The Boston EMA guidelines for verifying HIV status can be found on page 73. Programs must have documentation of each client s income. Examples of acceptable documentation of income include copies of SSI/SSDI statement(s), pay stubs, MassHealth card, or letter written and signed by provider stating the client has no source of income. FINANCIAL ELIGIBILITY Programs must have documentation of each client s financial eligibility for Part A services. Eligibility thresholds for Part A for Boston EMA clients are 500% of Federal Poverty Level (FPL); clients who are above this threshold are not eligible for Part A services. However, clients may still opt to receive services from that site, but the provider must use other funding streams to cover that client. Providers must complete the Client Income Summary Form (or approved agency form) at intake/ assessment and every six months thereafter to verify client s continued eligibility for services. If a client cannot provide a form of documented income, a letter written and signed by a case manager stating that the client has no income is sufficient. This letter must be accompanied by a completed Client Income Summary Form (or approved agency form) showing that the provider assessed all forms of financial supports and properly assigned the client to the appropriate FPL. The Boston EMA guidelines for verifying Financial Eligibility can be found on page 75. GRIEVANCE PROCEDURE SLIDING FEE RESIDENCY VERIFICATION Programs must have evidence that client was informed of and understands the agency s grievance procedure. An agency grievance procedure ensures that clients have recourse if they feel they are being treated in an unfair manner or do not feel they are receiving quality services. A grievance procedure should include: how to file a grievance; to whom the grievance should be addressed; an alternative addressee if the client does not choose to speak with first designee; how the grievance will be handled; description of reasonable timeliness for processing the grievance; a step-by-step filing process if grievance remains unresolved. Outpatient/Ambulatory Health Care (Primary Care) and/or Mental Health programs must document adherence to sliding fee and cap on charges policy, including charging discounted nominal fees for service visits to clients above 100% FPL or No Charge where applicable. The Boston EMA guidelines for Sliding Fee Scale for Ryan White Services can be found on page 96. Programs must document each client s proof of residency at least once every 6 months. Proof of residency can be in the form of: a driver s license, utility bills, bank statement, real estate tax bill or receipt, a current residential lease, a pay check or a government check or other document issued by a unit of government, or a signed case manager letter on the organization letter head verifying the town and postal code of residence. FY 2017 Ryan White Part A Provider Manual 89

100 HOUSING CERTIFICATION Required only for Housing programs that provide rental assistance DSM-5 DIAGNOSIS Required for Mental Health programs only. INSURANCE STATUS Programs must have documentation in every client file to certify that housing assistance is essential to the client s ability to gain and/or maintain access to HIV related medical care or treatment. The Housing Services policy and a sample of a Housing Certification form can be found on pages Programs must have documentation of DSM-5 diagnosis for each Part A funded client. A letter from BPHC regarding this requirement can be found on page 98. Programs must have documentation of each client s insurance status. Types of insurance coverage can include public (Medicare, Medicaid/MassHealth, Commonwealth Care), private (employer-based, private non-group, COBRA, or subsidized private plans via Commonwealth Choice), or other types of coverage (VA Benefits). If a client is not eligible for any existing insurance plans, then the provider should document the reason and how the client will access medical services and prescription drugs. Intake Information DATE OF INTAKE, REFERRAL SOURCE, AGE, GENDER, RACE/ETHNICITY, PRIMARY LANGUAGE, EXPOSURE CATEGORY, DIAGNOSTIC INFORMATION, ZIP CODE Programs must have documentation of these intake components either entered into e2boston or maintained in the client file. Maintenance of a completed HIV/AIDS Client Information Form in each client file satisfies these intake requirements. Detailed instructions for completing the HIV/AIDS Client Information Form are on page 17. Agencies may choose to collect this information on a separate intake form, if preferred. Coordination of Services ASSESSMENT SERVICE CARE PLAN PROGRESS NOTES REASSESSMENT AND UPDATED SERVICE CARE PLAN Programs must have completed assessments which include the following: medical history and health status, available financial resources, availability of food, shelter, transportation and financial resources, and need for legal assistance if necessary. BPHC and MDPH have developed a recommended assessment form for case management programs, which is available on BPHC s website. Programs must have service care plans which should be developed collaboratively with the client. Service care plans should include a description of specific client needs, goals and objectives, available resources to address the needs, and timelines for implementation. Service care plans must be signed and dated by the client. Programs must have progress notes which are related to the service care plan and show evidence of referrals and follow-up actions. Progress notes should be dated, legible, and organized appropriately and chronologically. For agencies that receive medical transportation funding it is required for your agency to maintain a log of transportation services. Programs must have client reassessments and updated service care plans. These forms must be updated with clients at least once every 6 months. BPHC and MDPH have developed a recommended reassessment form for case management programs, which is available on BPHC s website. SUPERVISORY REVIEW Programs must have evidence of supervisory review in the client files. The contents of an entire file should be reviewed for required eligibility documents as well as service coordination. The supervisory review should include date of the review and signature of the supervisor. 90 Ryan White Services Division, Boston Public Health Commission

101 16) Payer of Last Resort Policy Ryan White HIV/AIDS Program funds are the payer of last resort in relation to all other state and federal funding sources. This includes Medicaid. Specifically federal policy requires: Ryan White HIV/AIDS Program funds may not be used to pay for Medicaid covered services for Medicaid beneficiaries. Ryan White HIV/AIDS Program providers who provide Medicaid covered services must be Medicaid certified. Ryan White HIV/AIDS Program providers are expected to vigorously pursue Medicaid enrollment for individuals who are eligible for Medicaid coverage. Ryan White HIV/AIDS Program providers must seek payment from Medicaid when they provide a Medicaid covered service for a Medicaid beneficiary. Ryan White HIV/AIDS Program providers must back bill Medicaid for any Ryan White Act funded services provided to Medicaid eligible clients once Medicaid eligibility is determined. Providers are expected to exhaust mandatory Medicaid dollars before utilizing discretionary Ryan White HIV/ AIDS Program funds. The Payor of Last Resort policy is currently part of all BPHC Part A provider contracts and is also restated on all program budgets. If you have questions regarding these policies please feel free to call our office. FY 2017 Ryan White Part A Provider Manual 91

102 17) Verification of DSM-5 Diagnosis for Part A Funded Mental Health Programs The federal definition of Part A Mental Health services is: Psychological and psychiatric treatment and counseling services to individuals experiencing a disorder diagnosable under the Diagnostic and Statistical Manual 5 (DSM-5). This diagnosis must be documented in client files and Mental Health services must be provided by a mental health professional that is either licensed or authorized within the State. 92 Ryan White Services Division, Boston Public Health Commission

103 18) HRSA Guidelines for Client Sliding Fee Scales If an EMA or entity receiving Part A funds charges for services, it must do so on a sliding fee schedule that is available to the public. Individual, annual aggregate charges to clients receiving Part A services must conform to statutory limitations. The term, "aggregate charges," applies to the annual charges imposed for all such services under Part A of the RWTMA without regard to whether they are characterized as enrollment fees, premiums, deductibles, cost sharing, co-payments, coinsurance, or other charges for services. This requirement applies to all service providers from which an individual receives Part A funded services. This requirement may be waived by the planning council for an individual service provider in those instances when the provider does not impose a charge or accept reimbursement available from any third-party payer including reimbursement under any insurance policy or any Federal or State health benefits program. The intent is to establish a ceiling on the amount of charges to recipients of services funded under Part A. Please refer to the following chart for allowable charges. INDIVIDUAL/FAMILY ANNUAL GROSS INCOME Equal to or below the official poverty line Individual/Family Annual Gross Income and Total Allowable Annual Charges TOTAL ALLOWABLE ANNUAL CHARGES No charges permitted 101 to 200 percent of the official poverty line 5% or less of gross income 201 to 300 percent of the official poverty line 7% or less of gross income More than 300 percent of the official poverty line 10% or less of gross income Establishing a fee schedule should not result in a bureaucratic system to means-test individuals or families before Part A supported services are available. A simple application that requests information on the annual gross salary of the individual/family should suffice as the baseline by which caps on fees will be established. The client should ensure that the information provided is accurate.

104 19) Single Sliding Fee Scale Policy for Ryan White Services Background Single Sliding Fee Scale Policy for Ryan White Services The Boston Public Health Commission (BPHC) Ryan White Services Division and Massachusetts Department of Public Health (MDPH) Office of HIV/AIDS (OHA) have developed a draft policy describing a local response to the U.S. Health Resources and Services Administration (HRSA) directive to institute sliding fee scales associated with Ryan White services. Sliding Fee Policy BPHC and MDPH identified two Ryan White service areas for which a nominal client fee of $10.00 per visit will be instituted: 1) Outpatient/Ambulatory Health Care (Primary Care), and 2) Mental Health. Clients receiving Ryan White Services Division-funded or OHA-funded primary care or mental health services will be charged this nominal fee. Discounts will be applied on a sliding scale dependent on the client s income indicated in the table below: Client FPL Fee <100% No fee % 5% of fee % 10% of fee % 15% of fee % 25% of fee >500% 100% of fee The federal government has established a cap on annual, aggregate charges to recipients of Ryan White services. These charges include insurance premiums; payments to doctors, dentists, hospitals, pharmacies, and mental health clinicians; premiums and co-pays associated with the HIV/AIDS Drug Assistance Program (HDAP) - including premiums paid by HDAP; and expenses related to private or public transportation that helps clients travel to and from medical appointments. Caps on out-of-pocket expenses are determined by client income as indicated in the table below: 94 Ryan White Services Division, Boston Public Health Commission

105 Client FPL Cap on Out-of-Pocket Expenses <100% N/A (No Out-of-Pocket Expenses) % Actual gross income multiplied by 5% % Actual gross income multiplied by 7% >300% Actual gross income multiplied by 10% Agencies are expected to help clients accessing HASD-funded and OHA-funded primary care and mental health services to understand how the sliding fee scale works and how to track their out-of-pocket expenses. BPHC and MDPH have created a sample form that clients can use for this purpose. Client Income Summary Agencies may use or adapt the BPHC and MDPH Client Income Summary to record the client s income, FPL, and if receiving Ryan White Services Division-funded or OHA-funded primary care or mental health services - cap on out-of- pocket expenses. This form is intended to help facilitate access to other Ryan White services by communicating the results of financial eligibility screens that are completed by one service provider so that other providers do not need to duplicate this work. With appropriate releases of information, agencies working with common clients can coordinate ongoing six-month eligibility screens, share documentation of income, and assess eligibility without requesting the same information directly from the client. For example, a client s Medical Case Management (MCM) provider may screen for financial eligibility and complete the Client Income Summary with a client. The MCM provider may then refer the client for congregate meals. The client or Medical Case Management provider can give this Client Income Summary to the congregate meals provider along with a signed release of information form. The agencies can communicate about who will complete the financial eligibility screens every six months (in most cases, the MCM provider), and will decide how to share results and documentation on a routine basis. Monitoring The Ryan White Services Division and OHA staff will assess compliance with agency policies during routine contract monitoring practices by reviewing documentation of the use of the sliding fee scale, and the application of caps on out-of-pocket expenses. FY 2017 Ryan White Part A Provider Manual 95

106 20) Agency Incident Report Procedures BPHC requests that agency staff report major incidents separately from the narrative reports submitted quarterly, and as soon as possible after the incident. The report should include the following information: Reporting staff name Date of incident A detailed description of what happened In addition to alerting Program Coordinators to situations which cause stress to clients and staff, and may temporarily limit the services provided by the agency, these reports will allow BPHC to offer support and guidance where appropriate. BPHC requests the program complete this form for BPHC s internal tracking purposes only. Examples of Incidents which should be reported include, but are not limited to: Physical harm or threat of physical harm to a client or staff member Significant structural damage to agency premises (such as a fire or flood) Involvement of external law enforcement or emergency personnel. The Incident Report Form can be found on the following page. 96 Ryan White Services Division, Boston Public Health Commission

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108 21) Contract Transition Policy Boston Public Health Commission Ryan White Services Division Contract Transition Policy At the end of a contract period, every vendor holding a Ryan White contract with the Boston Public Health Commission (BPHC), Ryan White Services Division is responsible for ensuring that any outstanding contract related issues are resolved. This policy applies in all instances of contract termination, regardless of the reason for the termination. Clients/Client Records (applicable only if services will not continue at agency) 1. The vendor shall notify all clients affected by the contract termination that services will no longer be provided. Such notification shall be provided at least 30 days prior to the contract termination date. The vendor should make every effort to notify clients in person. If in-person notification is not feasible, clients should be notified in writing via certified mail with return receipt. If a return receipt is not delivered within two weeks, a follow-up notice should be sent via regular mail. The notice should include a list of other agencies in the same geographic area that provide the same or similar services. 2. Whenever practicable, the vendor should assist each client with registration for services at another agency of the client s choosing. This will necessarily include transfer of client records, whether maintained on paper or in electronic media, which must be undertaken in accordance with the terms of the confidentiality agreement entered into at the time of contract execution. 3. If a client does not wish for his or her records to be transferred to another agency, the vendor is responsible for the confidential storage of these records, per State and Federal laws. Data 1. No more than 15 days after the contract termination date, vendors must submit all client level data collected for purposes of the contract (including data from subcontracted agencies) up to the contract termination date. Data submissions must be made in the same manner as they had been during the contract period. Reporting 1. No more than 30 days after contract termination, unless the contract manager directs otherwise, vendors must submit a final Progress Report covering the period between the previous submission and the contract termination date. This includes both narrative and data submissions. 2. Vendors must submit a Ryan White HIV/AIDS Program Services Report (RSR) covering the period between the previous RSR submission and the contract termination date. The submission date for the RSR is on an annual basis following the end of each calendar year. If this is impossible, the vendor must work with BPHC staff to ensure that information needed to complete the RSR is available to BPHC. Fiscal 1. No more than 15 days after the contract termination date the vendor will submit any final billing. Purchased Items 1. Program supplies paid for under the contract remain the property of the vendor. 2. Capital and equipment purchases made with funds allocated under the contract are the property of BPHC, unless such capital items have fully depreciated, in which case they remain the property of the vendor. If an item has not fully depreciated, BPHC will determine whether the item must be returned to BPHC or transferred to another vendor. 98 Ryan White Services Division, Boston Public Health Commission

109 22) DSS Program Policy Guidance No. 1 Eligible Individuals and Services for Individuals Not Infected with HIV Formerly Policy No , First Issued: February 1, 1997 June 1, 2000 The principal intent of Titles I and II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is the provision of services to persons infected with the Human Immunodeficiency Virus (HIV), including those whose illness has progressed to the point of clinically defined Acquired Immune Deficiency Syndrome (AIDS). Grantees, planning councils, or consortia when setting and implementing priorities for allocation of funds may optionally define eligibility for certain services more precisely, but they may not broaden the definition of who is eligible for services. Grantees are expected to establish and monitor procedures to ensure that all providers verify and document client eligibility. This policy clarifies eligibility for services provided to individuals. It does not define eligibility for services, such as outreach, which are directed to groups of people or which seek to identify those who may become eligible for individual services. Non-infected individuals may be appropriate candidates for CARE Act services in limited situations, but these services must always have at least indirect benefit to a person with HIV infection. Funds awarded under Title I or Title II of the Ryan White CARE Act may be used for services to individuals not infected with HIV only in the circumstances described below. a) The service has as its primary purpose enabling the non-infected individual to participate in the care of someone with HIV disease or AIDS. Examples include caregiver training for in-home medical or support service; and support groups, counseling, and practical support that assist with the stresses of caring for someone with HIV. b) The service directly enables an infected individual to receive needed medical or support services by removing an identified barrier to care. Examples include payment of premiums for a family health insurance policy to ensure continuity of insurance coverage for a low-income HIV+ family member, or child care for noninfected children while an infected parent secures medical care or support services. c) The service promotes family stability for coping with the unique challenges posed by HIV/AIDS. Examples include permanency planning for infected and uninfected children of HIV parents, mental health services which focus on equipping uninfected family members and caregivers to manage the stress and loss associated with HIV, and short-term post death bereavement counseling. Services to non-infected clients that meet this criteria may not continue subsequent to the death of the HIV-infected family member beyond the period of short-term bereavement counseling and/or permanency planning for uninfected children. FY 2017 Ryan White Part A Provider Manual 99

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111 Grantee Administration Information In This Section: Staff Contact List FY Internet Resources Agency Websites

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113 Staff Contact List FY 2017 ADMINISTRATIVE CONTACTS M. Anita Barry, MD Director, Infectious Disease Bureau Dennis Brophy Director, Ryan White Services Division Cheryl Brickey Senior Program Coordinator Elizabeth Rios Senior Program Coordinator Mahara Pinheiro Program Coordinator Claudiane Philippe Program Coordinator Marcos Palmarin Program Coordinator FISCAL CONTACTS Regis Jean-Marie Bureau Administrator Frantzsou Balthazar-Toussaint Fiscal Manager Monica Araujo Fiscal Coordinator Sheldon Ramdhanie Fiscal Coordinator DATA CONTACTS Irina Neshcheretnaya Data Manager Michael Donovan Project Manager, IT PLANNING COUNCIL SUPPORT Benjamin Penningroth Program Manager, Planning Council Support Prakrity Karki Silwal Program Coordinator Masill Miranda Program Coordinator Boston Public Health Commission Infectious Disease Bureau, Ryan White Division Phone Massachusetts Avenue, 2 nd Floor Fax Boston, MA Web

114 Internet Resources Local Resources Boston Public Health Commission Ryan White Services Division White-Services-Division.aspx The Boston Public Health Commission Ryan White Services Division programs are integral to the distribution of Ryan White Part A funding within the Boston EMA, and the success of our funded agencies to promote health and enhance quality of life for PLWH. Included on the website are provider forms, quality management reports and resources, and pertinent links for HRSA-related information. Massachusetts Department of Public Health Office of HIV/AIDS The Massachusetts Department of Public Health Office of HIV/AIDS provides a variety of services throughout the Commonwealth of Massachusetts. Currently services range from prevention and education to HIV counseling and testing, client services, health, and support services. Federal Resources HRSA Health Resources and Services Administration HRSA administers programs that improve the nation's health by expanding access to comprehensive, quality health care for all Americans. HRSA is the federal grantee of Ryan White Act funding. Links include: HIV/AIDS Bureau, Ryan White Act History and Programs, Grant Opportunities, Tools for Grant Writers, as well as Education and Training Opportunities. HRSA Target Center The TARGET Center website is the central source of technical assistance and training resources for the Ryan White HIV/AIDS Program. The site is the one-stop shop for tapping into the full array of TA and training resources funded by HRSA HIV/AIDS Bureau, which administers Ryan White services. NQC National Quality Center The National Quality Center (NQC) provides no-cost technical assistance to all Ryan White program grantees to improve the quality of HIV care nationwide. Funded through a cooperative agreement with the New York State Department of Health AIDS Institute, NQC serves the needs of Ryan White program grantees across all Parts and funded providers, for technical assistance in quality improvement. CDC Divisions of HIV/AIDS Prevention The CDC Division of HIV/AIDS Prevention mission is to prevent HIV infection and reduce the incidence of HIV-related illness and death in collaboration with community, state, national, and international partners. Links include: Basic Science, Surveillance, Prevention Research, Vaccine Research, Prevention Tools, Treatment, Funding, Testing, Evaluation, Software, Training, STD Prevention, and TB Prevention. SAMHSA Substance Abuse and Mental Health Services Administration SAMHSA is improving the quality and availability of prevention, treatment, and rehabilitative services in order to 104 Ryan White Services Division, Boston Public Health Commission

115 reduce illness, death, disability, and cost to society resulting from substance abuse and mental illness. Links include: Grant Opportunities, Contract Opportunities and Legislative Information. OMH Office of Minority Health The mission of OMH is to improve the health of racial and ethnic minority populations through the development of effective health policies and programs that help eliminate disparities in health. Links include: Minority AIDS Initiative, Conferences, Statistics and a Resource Center for funding opportunities. GRANTS.GOV This is an Internet tool created by the Department for Health and Human Services (DHHS) and Office of Grants Management (OGM) for finding and exchanging information about federal grant programs. Grants.gov serves the general public, the grantee community, and grant-makers. Links include: Funding Opportunities, Technical Assistance for grant writing, Managing Grants, The Federal Register, and a Calendar of Events. FY 2017 Ryan White Part A Provider Manual 105

116 Agency Websites AIDS Project Worcester AIDS Response Seacoast Beth Israel Deaconess Hospital Plymouth Ryan White Dental Program Services-Division/Pages/Dental-Services.aspx BPHC Homeless Services BMC Pediatric AIDS Program services/pediatricaids.htm Boston EMA HIV Health Services Planning Council Boston Health Care for the Homeless 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 HealthCare Center Merrimack Valley Assistance Program Montachusett Opportunity Council New Hampshire Department of Health and Human Services Southern New Hampshire HIV/AIDS Task Force Ryan White Services Division, Boston Public Health Commission

117 Span, Inc. Victory Programs, Inc./Boston Living Center Whittier Street Health Center FY 2017 Ryan White Part A Provider Manual 107

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119 Attachments In this section: Site Visit Documentation Checklist Monitoring Tool 111 Important Part A & MAI Submission Dates Client Utilization Form Universal Standards Checklist Service Specific Standards Checklist

120 Boston Public Health Commission Ryan White Services Division Agency Documentation Checklist Agency name: Items must be submitted to the Boston Public Health Commission. Agency Operation Items for Collection Included Agency Strategic plans, vision documents, or mission statements (Agency-wide & Part A- specific ) Organizational charts (Agency-wide & Part A-specific) Yes No List of Board members, their professions, and aggregated demographic info Yes No Minutes from the last 4 Board meetings Yes No Memoranda of Agreement related to Interagency Coordination Yes No Compliance with ADA criteria for programmatic accessibility. Yes No Yes No Policies to address emergency situations: Crisis management Universal Precautions Medical emergencies Yes Yes Yes No No No Client-related policies Client confidentiality policy Yes No Client grievance policy Yes No Client consent to release medical information Yes No Client rights & responsibilities policy Yes No Acknowledgement of BPHC s right to review client files Yes No Policy describing clients ability to access their files Yes No Service Provision & Documentation Process for client intake / enrollment Yes No Process for tracking inactive clients, and discharging clients Yes No Resource directory for making referrals Yes No Cultural & Linguistic Competence Policy for providing culturally-appropriate services to clients Yes No Policy for providing linguistically-appropriate services to clients Yes No Anti-discrimination, harassment & retaliation policy Yes No 110 Ryan White Services Division, Boston Public Health Commission

121 Site Visit Monitoring Tool SECTION A: AGENCY INFORMATION Instructions to Provider Agency: List and describe those changes that have occurred since the Annual Site Visit. Where no changes have occurred, just check the box. If all Section A information remains unchanged, do not complete Section A. Agency Name: Entire Section A Unchanged since Annual Site Visit Administrative Address: Program(s) Address(es): (List all sites where Part A services are provided. Bold address(es) where actual Site Visit occurred) Phone: Fax: Web Site: Executive Director: Agency Hours of Service: Are these prominently displayed? If hours have changed how, why, and new hours of service? Yes No Part A Funded Services: Contact Information Name and Title: Phone and Fax: address: Program Contact: Data Contact: FY 2017 Ryan White Part A Provider Manual 111

122 Site Visit Monitoring Tool SECTION B: AGENCY ACCESSIBILITY/ENVIRONMENT (to be reviewed at site visit) Fully compliant; no changes since prior visit 1. Have there been any changes in agency accessibility/environment since last year s site visit? Yes No 2. Are there currently accessible elevators, ramps, and TTY per ADA requirements? Yes No 3. Are services currently available in settings accessible to low income individuals? Yes No 4. If yes, on question #1 describe any accessibility/environment changes. 5. How does program staff describe efforts to make their facilities welcoming and comfortable to specific populations, served or targeted? TO BE FILLED OUT BY THE BPHC PROGRAM COORDINATOR IN ADVANCE OF THE SITE VISIT. SECTION D: INTERAGENCY COORDINATION Provide a list of agencies that clients are frequently referred to by completing the chart below and update with any new linkages made (for each funded service) since the last Annual Site Visit. Add rows, if necessary. Does agency have resource directory? Yes No Agency Name Type of Partner (Referral to/from/both)& Specific Linkage to a funded service Description of services offered and utilized by your staff and clients Has MOA been submitted to BPHC? If no please provide a copy as an attachment. 112 Ryan White Services Division, Boston Public Health Commission

123 SECTION E: PROGRAM STAFFING List the names and positions of program staff serving Ryan White Part A clients (including staff not on BPHC budget). Describe the staff member-to-client ratio. (For example, Medical Case Manager or Peer.) Describe the program policy and/or process for supervisory review of client files and staff. SECTION F: CLIENT FILE DOCUMENTATION If your program has made changes since the beginning of the fiscal year (March 1) to any of the following service provision documents, polices or processes, please attach your most recent version. If your program has made significant client file changes since the last site visit, please submit an updated client replicate file. Please note that all form changes must receive prior approval from BPHC before implementation. Agencies using paper files: send an attachment that includes all documents that are present in client files. Agencies using an electronic medical record system: provide a template of the documents that are housed within the EMR. Please describe the type of EMR and where documentation required by Part A is located. Service Provision Documents Replicate Client File Entire Section F Unchanged since Annual Site Visit Attached? Yes No EMR Template & Write Up, if applicable Yes No Client Income Summary form 6 Month Eligibility Recertification form, if in use by program staff. Comprehensive Assessment Tool Reassessment Tool Individual Service Plan Tool Acuity Assessment Tool, if applicable Housing Certification form, if applicable Yes No Yes No Yes No Yes No Yes No Yes No Yes No Medical Certification form, if applicable Yes No FY 2017 Ryan White Part A Provider Manual 113

124 Site Visit Monitoring Tool SECTION G: CLIENT ENGAGEMENT 1. If your program has made changes since the beginning of the fiscal year (March 1), or the last site visit, to any of the following service provision polices or processes, please attach your most recent version. Service Provision Policies & Processes Client Intake Tracking Inactive Clients Discharge Policy Changes Attached? Yes No Yes No Yes No 2. Please briefly describe the program s activities and policies around client engagement that are not captured in the attached documents. If policies are not attached, please describe these elements. SECTION H: RYAN WHITE PART A POLICIES If your program has made changes to any of the following policies since the beginning of the fiscal year (March 1), or the last site visit, please attach your most recent version. Please note that all form changes must receive prior approval from BPHC before implementation. Entire Section H Unchanged since Annual Site Visit Policy Policy Changes Attached? Acknowledgement of BPHC s right to review client files Yes No Anti-discrimination, harassment & retaliation Yes No Client access to culturally-appropriate services Yes No Client access to linguistically-appropriate services Yes No Client right to access file Yes No Client confidentiality Yes No Client consent to release medical information Yes No Client grievance Yes No Client rights and responsibilities Yes No Policies to address emergency situations: Crisis management Yes No Universal Precautions Yes No Medical emergencies Yes No 114 Ryan White Services Division, Boston Public Health Commission

125 Important Ryan White Part A & Ryan White Part A Minority AIDS Initiative (MAI) FY 2017 Submission Dates ** Unit Rate Programs include Outpatient/Ambulatory Medical Care, Mental Health, and Substance Abuse. All other subservice categories are Cost Reimbursement Contracts unless specially noted. Part A Submission Requirements Due Date 1 st Quarterly Report June 15, nd Quarterly Report September 15, rd Quarterly Report December 15, 2017 Deadline for Budget Revisions December 15, 2017 HRSA RSR (Client Level Data) Report February 15, th Quarterly Report March 15, 2018 Unit Rate Programs** Submission of Fiscal Invoice and Client Utilization Data (Fiscal Backup) 15 days after each month s end (April 15, 2017 through March 15, 2018) FY 2017 Ryan White Part A Provider Manual 115

126 Boston Public Health Commission Ryan White Part A Client Utilization Data, Fiscal Backup Provider Name: Service Category: Substance Abuse Residential Month: Client Code/UCI Dates of service Service Code Description # Units Rate Total 116 Ryan White Services Division, Boston Public Health Commission

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145 R y a n W h i t e S e r v i c e s D i v i s i o n I n f e c t i o u s D i s e a s e B u r e a u B o s t o n P u b l i c H e a l t h C o m m i s s i o n M a s s a c h u s e t t s A v e n u e, 2 n d F l o o r B o s t o n, M A ( ) ( p ) ( ) ( f ) w w w. b p h c. o r g