Alisha Barrett Ryan White Part A Grantee Clark County Social Service

Ryan White Ryan White was diagnosed with AIDS at age 13. He and his mother Jeanne White Ginder fought for his right to attend school, gaining international attention as a voice of reason about HIV/AIDS. In 1990, at the age of 18, Ryan White died, just months before Congress passed the AIDS bill that bears his name – the Ryan White CARE Act.

Basics of Ryan White hiv/aids Program An Overview The majority of Ryan White funds support medical care and essential support services. Ryan White funds are the payer of last resort, as required by Congress. Also, a smaller, but equally critical, portion funds technical assistance, clinical training and research on innovative models of care.

Basics of Ryan White HIV/AIDS Program The Ryan White legislation created a number of programs, called Parts, to meet needs for different communities and populations affected by HIV/AIDS. Part A: provides emergency assistance to Eligible Metropolitan Areas and Transitional Grant Areas that are most severely affected by the HIV/AIDS epidemic. Part B: provides grants , including ADAP assistance, to all 50 States and U.S. Territories. Part C: provides primary health care in an outpatient setting for people living with HIV disease. Part D: provides outpatient health care for women, infants, children and youth with HIV/AIDS. Minority AIDS Initiative (MAI): provides funding to evaluate and address the disproportionate impact of HIV/AIDS on minorities.

How does this relate to the Las Vegas area?

Part A Program Eligible Metropolitan Area (EMA): 2,000 new AIDS cases in the last 5 years Population of at least 50,000 persons Transitional Grant Area (TGA): 1,000 – 1,999 new AIDS cases in the last 5 years Las Vegas Area

Las Vegas TGA

History of Las Vegas Part A TGA Las Vegas Part A TGA includes: Nye County, Nevada Clark County, Nevada Mohave County, Arizona Las Vegas EMA was established in 1998 Reclassified from an EMA to a TGA in 2005 Chief Executive Officer (CEO) is Chair of the Clark County Commission Clark County Social Service has been designated by CEO to manage Part A grant funds

Ryan White CARE Act and Affordable Care Act The federal Ryan White CARE Act legislation was originally authorized by Congress in 1990. The authorization of the Affordable Care Act has altered the role of the Ryan White Program.

ASSESSMENT Assess service needs and gaps in state and local systems for HIV care, including special populations. Assess capacity and training needs of the workforce to provide comprehensive system of care for People Living with HIV. Assess Models of Care and services required to care completion. Assess and monitor the public health impact of the HIV disease.

POLICY Provides Federal leadership on State and local initiatives that impact People Living with HIV. Establish Federal HIV care and treatment policy guidelines that safeguards public health and ensures continued progress in the goal of a AIDS Free generation. Engage State and locate entities in partnership to realize an AIDS Free generation.

CAPACITY DEVELOPMENT Train the health care workforce to provide high quality HIV care and treatment. Ensure capacity of state and local systems to meet the care and treatment needs of People Living with HIV. Support the Health Information Technology to increase quality and capacity of care. Provide technical assistance to support the provision of evidence-based Models of Care.

QUALITY ASSURANCE Establish and monitor the HIV quality measures/indicators to assure high-quality care that adheres to DHHS standards of care. Collect, analyze, evaluate and report on health outcomes of People Living with HIV to improve and advance the treatment of care. Assure the availability of HIV care and treatment across the nation.

ACTION STEPS Align client eligibility determination with Marketplace enrollment periods Reduce burden by using AGI Collect Marketplace/Medicaid notice of eligibility determination for annual RWHAP recertifications Be able to document process for pursuing enrollment Establish methodology for conducting Marketplace cost-effectiveness

Part A Federal Grant Funds Ryan White Funding Part A Federal Grant Funds Part A federal grants include two parts, Formula and Supplemental. Formula grants are based on reported living HIV/AIDS cases as of December 31 in the most recent calendar year for which data is available from the Center for Disease Control Supplemental grants are awarded competitively on the basis of demonstrated need and other criteria determined by the federal government

Part A Federal Grant Funding Flow Chart Congress passes Ryan White Legislation and awards funding Health Resources and Services Administration (HRSA) manages Federal Grant Federal Grants are awarded to areas that qualify as a Part A, and MAI

Las Vegas TGA Part A Funding Flow Chart HRSA awards federal grant to Las Vegas TGA’s CEO CEO (Chair of Clark County Commission) accepts federal grant funds Clark County Social Service (CCSS) manages federal grant CCSS contracts funds with local providers

Las Vegas TGA Part A Funding Federal grant funds include 85% Direct Services 10% Administration 5% Clinical Quality Management Las Vegas Grant Amount Part A Grant Year 2013-2014 $4,998,237.00 Las Vegas Grant Amount MAI Grant Year 2013-2014 $341,702.00 Funding contracted to Providers 90% Direct Service

Ryan white part A services Core and Support Services Part A funds may be used to provide a wide variety of medical and support services for people living with HIV disease. Services categories and definitions are mandated by Ryan White Legislation.

Ryan White Part A Core Services The Las Vegas TGA is required to allocate at least 75% of the award amount on Core Medical Services per legislation. Outpatient/Ambulatory Medical Care AIDS Pharmaceutical Assistance Oral Health Care Early Intervention Services Health Insurance Continuation Medical Nutrition Therapy Hospice Services Home/Comm Based Health Services Mental Health Services Substance Abuse Outpatient Care Home Health Care Medical Case Management Core Services Include:

Ryan White Part A Support Services The Las Vegas TGA is required to allocate no more than 25% of the award amount on support services. All support services must be linked to medical outcomes per legislation. Support Services Include: Case Management (non-medical) Child Care Services Emergency Financial Assistance Utilities Housing Food Medication Food Bank/Home Delivered Meals Health Ed/Risk Reduction Housing Services Treatment Adherence Legal Services Linguistics Services Medical Transportation Services Outreach Services Permanency Planning Psychosocial Support Services Referral: Healthcare/Supp Service Substance Abuse (Residential) Rehabilitation Services Respite Care

Priority Setting & Resource Allocation GY 2013-2014

Las Vegas Part A TGA Services Today The Las Vegas TGA provides comprehensive medical and support services to people living with HIV disease that are eligible for the Ryan White Part A Program.

Las Vegas Part A TGA Service Providers March 1, 2014 – February 28, 2015 Aid for AIDS of Nevada 1120 Almond Tree Lane Las Vegas, NV 89104 (702) 382-2326 AIDS Healthcare Foundation 1815 E. Lake Mead Blvd. STE113 North Las Vegas, NV 89030 (702) 639-8110 3201 S. Maryland Parkway STE 218 Las Vegas, NV 89109 (702) 862-8075 Community Counseling Center 714 E. Sahara Ave #101 Las Vegas, NV 89104 (702) 369-8700 Community Outreach Medical Center 1140 Almond Tree Lane, Suite 306 (702) 657-3873 Golden Rainbow 801 S. Rancho Dr. Suite B-1B Las Vegas, NV 89106 (702) 384-2899

Las Vegas Part A TGA Service Providers March 1, 2014 – February 28, 2015 North Country Healthcare 1510 Stockton Hill Road Kingman, AZ 86401 (928) 718-4530 Nye County Health & Human Services 1981 E. Calvada Blvd. North STE#120 Pahrump, NV 89048 (775)751-7090 Southern Nevada Health District Sexual Health Clinic 400 Shadow Lane STE 106 Las Vegas, NV 89107 (702) 759-0702 UMC Wellness Center 701 Shadow Lane, Suite 200 Las Vegas, NV 89106 (702) 383-2691 UNLV School of Dental Medicine 1700 W. Charleston Blvd. Bldg A (702) 774-2451

Ryan White Program 2013 and Beyond Ryan White did not see legislative action in 2013 Appropriations/debt ceiling/sequestration taking up much of legislative discussion and debate Committees have other priority areas that MUST be worked on Need real information about how Affordable Care Act (ACA) will impact Ryan White clients Ryan White’s authorization will lapse BUT program will continue to be funded and implemented Ryan White recipient organizations continue to teach Members of Congress and their staff on importance of Ryan White post-ACA implementation

How you can get involved Las Vegas TGA Planning Council Planning Councils are a legislatively mandated group. They play a key role in providing a comprehensive system of care for people living with HIV.

Las Vegas Part A TGA Planning Council Roles and Responsibilities Develop Operating Policies & Procedures Assess needs of TGA Develop comprehensive plan Set priorities and allocate resources to core and support service categories Help ensure coordination of services with other HIV- related services Assess the administrative mechanism Develop standards of care

Las Vegas Part A TGA Planning Council If you would like to learn more about our Planning Council please visit: www.lasvegasema.org

Las Vegas Part A TGA Planning Council Upcoming Meeting Meeting Specifics: Date: May 28, 2014 Time: 10:00 am – 12:00 pm Location: Clark County Social Service 3rd Floor Training Room 1600 Pinto Lane Las Vegas, NV 89106 Questions: 702-455-1071

Questions?? Las Vegas Part A TGA Alisha Barrett Grant Administrator email: akc@clarkcountynv.gov