Ryan White Part A - Service Categories

This page provides summary of the Service Categories of the Ryan White HIV/AIDS Program (RWHAP) that the Denver HIV Resources Planning Council (DHRPC) currently prioritizes.

 

A Service Category is a provision that is designed to serve a specific need for people with HIV.

There are 2 different types of Service Categories:

  1. Core Medical Services, which meet direct medical need.

  2. Support Services, which are services that assist People Living with HIV (PLHIV) to achieve optimal medical outcomes.

 

Service Categories are reviewed every year by the DHRPC and are ranked in order.  This is called Priority Setting. After the council prioritizes the service categories, they are given funding percentages. This is called Resource Allocation.

Current Service Categories prioritized by the DHRPC

(In alphabetical order)

AIDS Drug Assistance Program

Case Management Continuum

Early Intervention Services

Emergency Financial Assistance

Food Bank/ Home Delivered Meals

Health Insurance Premium & Cost Sharing Assistance

Home and Community-Based Health Services

Housing Services

Linguistic Services

Medical Transportation Services

Mental Health Services

Oral Health Care

Other Professional Services

Outpatient Ambulatory Health

Psychosocial Support

Substance Abuse Services (Outpatient)

AIDS DRUG ASSISTANCE PROGRAM (ADAP)

Status: Currently prioritized, but not allocated funding by the DHRPC.

Note: This category is funded by Part B.

Category type: Core Medical Service

Also called the State Drug Assistance Program (SDAP) this service is currently provided by Ryan White Part B (through the State of Colorado) that provides FDA-Approved medications to low-income people with HIV who have limited or no coverage from private insurance, Medicaid, or Medicare.

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CASE MANAGEMENT CONTINUUM

Status: Currently prioritized and allocated funding under Medical Case Management.

DHR has adopted this case management structure from the Colorado Ryan White Part B Program. The case management continuum is a four-tiered approach to case management service that includes, medical case management (intensive medical needs) and non-medical case management (intensive psychosocial needs), care navigation (health education risk reduction), and referral for health care and support services. The medical and non-medical models of case management provide different levels of service geared to the needs and readiness of the client.

 

Data collected from each tier will inform future funding decisions to increase case manager capacity and improve services for PLHIV.

Tier 1: MEDICAL CASE MANAGEMENT (MCM)

Status: Currently prioritized and allocated funding under Medical Case Management.

Category type: Core Medical Service

Ryan White A - Medical Case Management Data Review

 

Overview: Includes a range of client-centered services that link clients with healthcare, psychosocial, and other services. 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’s needs and personal support systems.

 

Service Standard Definition: Medical Case Management is a proactive case management model intended to serve persons living with HIV with multiple complex medical and/or adherence health-related needs. The model is designed to serve individuals who may require assistance with access, utilization, retention, and adherence to primary health care services. Medical Case management clients need or want ongoing support from case management to actively engage in medical care, and continued adherence to treatment. Medical Case Management services focus on improving health care outcomes. Medical case management services offer a range of client-centered services that link clients with health

care, psychosocial, and other services.

 

TIER 2: NON-MEDICAL CASE MANAGEMENT

Status: Currently prioritized and allocated funding under Medical Case Management.

 

Service Standard Definition: Non-Medical Case Management is a proactive case management model intended to serve people living with HIV with multiple complex psychosocial needs and their families/close support systems.

 

The model is designed to serve individuals who may require or want ongoing case management

support to stabilize their psychosocial needs. Non-medical case management is also an appropriate

service for clients who have completed medical case management but still require or want a

maintenance level of periodic support from a provider (case manager or case management team).

Non-medical case management clients manage their care well enough to avoid chronic disruption to

their medical care but require psychosocial support to maintain a stable lifestyle.

 

Non-medical case management may also be provided to clients with multiple complex needs who may best be served by a medical case management program, but who are not ready or willing at this time to engage in the level of participation required by the medical case management model.

 

TIER 3: CARE NAVIGATION

Status: Currently prioritized and allocated funding under Medical Case Management.

 

Service Standard Definition: Care Navigation is intended to assist people living with HIV in accessing services and decision-making for their health-related and/or psychosocial needs. This model is designed to assist individuals whose needs are minimal and infrequent. It may also be used to provide services to those who do not want or are not ready to engage in more intensive case management services.

 

Care Navigation strives to provide a varying level of support to a client’s need. When receiving Care Navigation services, the client may receive assistance in obtaining medical, social, community, legal, financial, and other needed services. However, Care Navigation does not involve coordination and follow-up of medical treatments, as medical case management does.

 

Care Navigation also does not include the development and monitoring of a treatment plan.

 

TIER 4: REFERRAL FOR HEALTH CARE

Status: Currently prioritized and allocated funding under Medical Case Management.

 

Service Standard Definition: Referral for Health Care and Support Services focuses on people living with HIV who were formerly engaged in more intensive tiers of case management and have progressed to self-management or are only in need of Referral Services at this time. Referral Services assist clients to connect with needed core medical or support services and may be provided in person or through telephone, written, or other type of communication. Referral Services is intended to assess the sufficiency of self-management and to provide additional services as indicated by the client. Referral Services clients may have low acuity or may have high acuity but do not want to engage in more intensive case management services at this

time.

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EARLY INTERVENTION SERVICES (EIS)

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Core Medical Service

Ryan White A - Early Intervention Services Data

Overview: Includes counseling individuals, including the newly diagnosed, with respect to HIV; perform confirmatory testing, provide referrals to link individuals to clinical and support services to ensure successful care engagement for PLHIV.

 

Service Standard Definition: An Early Intervention Services program is a package of services designed to identify and link a newly diagnosed person to Outpatient/Ambulatory Health Services (OAHS), Medical Case Management (MCM), and Substance Use Outpatient Services (SAO), if indicated (see “Linked” definition below). The package of services is defined below, and includes screening for barriers and needs, creating a plan to address client needs, and health education and literacy. Once a client has been successfully linked to OAHS or SAO, the EIS engagement is complete. If a client needs ongoing support, the support would happen in MCM Services.

 

Early Intervention Services (EIS) for Part A may include targeted HIV testing to help the unaware learn of their HIV status and receive referral to HIV care and treatment services if found to be living with HIV; referral services to improve HIV care and treatment services at key points of entry; access and linkage to HIV care and treatment services such as OAHS, MCM, and SAO. If an EIS program provides targeted testing, the program will coordinate testing services with other HIV prevention and testing programs to avoid duplication of efforts and ensure that HIV testing paid for by EIS does not supplant testing efforts paid for by other sources.

EMERGENCY FINANCIAL ASSISTANCE (EFA)

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Ryan White A - Emergency Financial Assistance Data

Overview: Provides short-term payments to agencies or establishment of voucher programs to assist with the emergency expenses related to essential utilities, housing, food, and medication when other resources are not available.

 

Service Standard Definition: Emergency Financial Assistance (EFA) provides limited one-time or short-term payments to assist a RWHAP Part A client with an urgent need for essential items or services necessary to improve health outcomes, including: utilities, housing, food (including groceries and food vouchers), transportation, medication not covered by an AIDS Drug Assistance program or AIDS Pharmaceutical Assistance, or another HRSA RWHAP-allowable cost needed to improve health outcomes. Emergency Financial Assistance must occur as a direct payment to an agency or through a voucher program.

 

The Denver Part A RWHAP currently funds Medical Transportation, Housing Services, and Food

Bank / Home-delivered Meals service categories.

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FOOD BANK/ HOME DELIVERED MEALS

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Ryan White A- Food Bank/ Home Delivered Meals Data

Overview: Provides actual food or meals, and essential household supplies such as hygiene items and household cleaning supplies.

 

Service Standard Definition: Food bank and home-delivered meals involves the provision of actual food items or prepared meals. This includes the provision of both frozen and hot 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, household cleaning supplies, and water filtration/purification systems in communities where issues of water safety exist should be included in this item.

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HEALTH INSURANCE PREMIUM & COST SHARING ASSISTANCE

Status: Currently prioritized, but not allocated funding by the DHRPC.

Note: This category is funded by Part B.

Category type: Core Medical Service

Overview: Provided to an eligible client in an integrated setting appropriate to that client’s needs, based on a written plan of care established by a medical care team under the direction of a licensed clinical provider. Includes home health aide services and personal care services in the home.

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HOME AND COMMUNITY-BASED HEALTH SERVICES

Status: Currently prioritized, but not allocated funding by the DHRPC.

Note: This category is funded by Part B.

Category type: Core Medical Service

Overview: The provision of financial assistance for eligible PLHIV to maintain a continuity of health insurance or receive medical benefits under a health insurance program. This includes premium payments, copayments, and deductibles.

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HOUSING SERVICES

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Ryan White A- Housing Services Data

Overview: Housing provides transitional, short-term, or emergency housing assistance to enable a client or family to gain or maintain outpatient/ambulatory health services and treatment, including temporary assistance necessary to prevent homelessness and to gain or maintain access to medical care.

 

Service Standard Definition: Housing Services provides transitional, short-term, or emergency housing assistance to enable a client or family to gain or maintain outpatient/ambulatory health services and treatment, including temporary assistance necessary to prevent homelessness and to gain or maintain access to medical care. Activities within the Housing category must also include the development of an individualized housing plan, updated annually, to guide the client’s linkage to permanent housing. Housing may provide some type of core medical (e.g., mental health services) or support services (e.g., residential substance use disorder services).

 

Housing activities also include housing referral services, including assessment, search,

placement, and housing advocacy services on behalf of the eligible client, as well as

fees associated with these activities.

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LINGUISTIC SERVICES

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Overview: Linguistic Services provide interpretation and translation services, both oral and written, to eligible clients.

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MEDICAL TRANSPORTATION SERVICES (MTS)

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Ryan White A- Medical Transportation Services Data

Overview: The conveyance (transport) services provided, directly or through voucher, to a client so that he or she may access health care services.

 

Service Standard Definition: Medical Transportation is the provision of nonemergency transportation that enables an eligible client to access or be retained in core medical and support services.

 

Medical transportation is classified as a support service and is used to provide transportation for eligible RW HIV/AIDS Program clients to core medical services and support services. Medical transportation must be reported as a support services in all cases, regardless of whether the client transported to a medical core service or to a support service.

 

Transport service include bus tickets, cab vouchers, mileage reimbursement, and rideshare.

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MENTAL HEALTH SERVICES

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Core Medical Service

Ryan White A- Mental Health Services Data

Overview: Psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, and provided by a mental health professional licensed or authorized within the State to render such services.

 

Service Standard Definition: Mental Health Services are psychological and psychiatric treatment and counseling services for individuals with a diagnosed mental illness. They are conducted in a group or individual setting and provided by a mental health professional licensed or authorized within the State to render such services. Such professionals typically include psychiatrists, psychologists, and licensed clinical social workers. In some cases, a client may be seen for a brief intervention. A brief intervention, also known as a brief conversation, occurs in various settings, such as a primary healthcare setting and lasts a short duration with anticipation that each session could be the last session. In contrast, ongoing mental health services take place when there is the expectation that an individual will receive ongoing care and treatment.

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ORAL HEALTH CARE

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Core Medical Service

Ryan White A- Oral Health Care Data

Overview: Provides diagnostic, preventative, and therapeutic services provided by general dental practitioners, dental specialists, auxiliaries, and other trained primary care providers.

 

Service Standard Definition: Oral Health Care activities include outpatient diagnosis, prevention, and therapy provided by dental health care professionals, licensed to provide health care in the State or jurisdiction, including general dental practitioners, dental specialists, dental hygienists, and licensed dental assistants.

 

The goal of the Oral Health service category is to prevent and control oral and craniofacial disease, conditions, and injuries, and improve access to preventive services and dental care for eligible PLHIV. Services shall be provided in a manner that has the greatest likelihood of ensuring maximum participation in the program involved.

 

Oral Health Care Services include emergency, diagnostic, preventive, basic restorative including removable partial and complete prosthetics, limited oral surgical and limited endodontic services.

 

ORAL HEALTH FUND is a percentage of the Oral Health Care service category allocations annually decided upon by the Denver HIV Resources Planning Council in alignment with regulations from the Health Resources and Services Administration (HRSA).

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OTHER PROFESSIONAL SERVICES

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Overview: Allows for the provision of professional and consultant services rendered by members of licensed professions and/or qualified to offer such services by local governing authorities. Such services may include legal services for the coordination of applying for Social Security Disability Insurance (SSDI), establishing powers of attorney, and drafting living wills. This service also provides assistance for identification cards, driver's licenses, and birth certificates.

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OUTPATIENT AMBULATORY HEALTH SERVICES (OAH)

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Core Medical Service

Ryan White A- Outpatient Ambulatory Health Data

Overview: Primary Medical Care for the treatment of HIV including diagnostic testing, screening, practitioner examinations, record of medical history, diagnosis and treatment of physical and mental conditions, prescribing and managing medication therapy, education, counseling, well-baby care, continuing care and management of chronic conditions, referrals to specialty care.

 

Service Standard Definition: Outpatient/Ambulatory Health Services provide diagnostic and therapeutic-related activities directly to a client by a licensed healthcare provider in an outpatient medical setting. Settings include clinics, medical offices, mobile vans, using telehealth technology, and urgent care facilities for HIV-related visits.

 

Non-HIV related visits to urgent care facilities are not allowable costs within the Outpatient/Ambulatory Health Services Category. Emergency room visits are not allowable costs within the Outpatient/Ambulatory Health Services Category.

 

Allowable activities include diagnostic testing (including HIV confirmatory and viral load testing), early intervention and risk assessment, preventive care and screening, physical examination, medical history taking, treatment and management of physical and behavioral health conditions, behavioral risk assessment, subsequent counseling, and referral, preventive care and screening, pediatric developmental assessment, prescription, and management of medication therapy, treatment adherence, education and counseling on health and prevention issues, and referral to and provision of specialty care related to HIV diagnosis, including audiology and ophthalmology.

 

Primary medical care for the treatment of HIV includes the provision of care that is consistent with the U.S. Department of Health and Human Services guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies.

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PSYCHOSOCIAL SUPPORT

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Support Service

Ryan White A- Psychosocial Support Data

Overview: Provides group or individual support and counseling services to assist PLHIV to address behavioral and physical health concerns. Includes social interaction opportunities- including HIV support groups.

 

Service Standard Definition: Psychosocial Support Services provide group or individual support and counseling services to assist HRSA RWHAP-eligible PLHIV to address behavioral and physical health concerns. Activities funded under Psychosocial Support Services may include:

  • Bereavement counseling;

  • Child abuse and neglect counseling;

  • HIV support groups;

  • Nutrition counseling provided by a non-registered dietitian;

  • Pastoral care/counseling services; and

  • Support services may be provided by the program to increase participation in one-on-

  • one or group sessions including food, transportation, or childcare.

 

Funds under Psychosocial Support Services may not be used to provide nutritional supplements and social/recreational activities or to pay for a client’s gym membership.

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SUBSTANCE ABUSE SERVICES (OUTPATIENT)

Status: Currently prioritized and allocated funding by the DHRPC.

Category type: Core Medical Services

Ryan White A- Substance Abuse Services Data

Overview: The provision of medical or other treatment and/or counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting, rendered by a physician or under the supervision of a physician, or by other qualified personnel.

 

Service Standard Definition: Substance Use Services (Outpatient) are medical or other treatment and/or counseling to address substance use 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. They include limited support of auricular detox services clients living with HIV, provided by registered, certified, or licensed practitioners and/or programs.

 

Funds used for outpatient drug or alcohol substance use treatment, including expanded HIV- specific capacity of programs if timely access to treatment and counseling is not available, must be rendered by a physician or provided under the supervision of a physician or other qualified/licensed personnel. Such services should be limited to the following:

  • Pre-treatment/recovery readiness programs, such as, the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program;

  • Harm reduction;

  • Mental health counseling to reduce depression, anxiety and other disorders associated with substance use;

  • Outpatient drug-free treatment and counseling;

  • Medication Assisted Therapy (e.g., suboxone, buprenorphine, naloxone, methadone,​

  • Neuro-psychiatric pharmaceuticals;

  • Relapse prevention; and

  • Other evidence-based methods with evidence provided.

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