Ryan White Part A Year 23 Contract Renewals Review February 14, 2013

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Why are We Here Today ? Goal: Review the renewals “package” Discuss what is new for 2013 Discuss the process for completing and submitting the renewals forms Provide tips for ensuring your renewal documents are correctly submitted to HIVCS

What we will not be reviewing Specific renewal concerns related to service families Specific contract Maximum Reimbursement Amounts (MRA)

Basics – Why renew contracts? HIVCS requests renewal documents to: –Ensure scope of service reflects current practices and requirements –Receive updated and approved appendices, service target grids, service level rate analysis tool (SLRAT), reimbursement rates and budgets –Obtain required administrative documents

Notice of Intent Notice of intent distinguishes between the full Maximum Reimbursable Amount (MRA) and a partial commitment (Maximum Authorized Amount, or MAA): –Uncertainty of federal government budget –Federal government operating on “continuing resolution” –Partial award for 2013 based on Year 2012 RW Base Formula and MAI awards –Contract year begins March 1, 2013; however, only a portion of the award will be available which is the Maximum Authorized Amount (MAA) –We anticipate that the full Ryan White Base and MAI awards will be announced during the summer What does this mean? The partial Base award would provide funding for Ryan White Base programs for the first four months; this is the contract MAA (March-June) The partial Minority AIDS Initiative (MAI) award would provide funding for the MAI programs for the first five months; this is the contract MAA (March-July) If you drawdown /spend the MAA amount prior to the June or July month reports, any excess drawdown/expenditures will not be reimbursed until the RW awards are received; reimbursement is capped at the MAA.

Renewal Package-Content What is included? Instruction document (includes a discussion of all amendments and appendices) Amendment to Schedule A: Scope of Services –Generally, if your program has additional changes, a description of each change is to be indicated in the Amendment to Schedule A: Scope of Services. –If there are no changes, check the box ‘NO” and each of above sections will remain in your contract as last year. –If there are changes, check the ‘YES’ box, and list the section/question of the Scope of Services that is being revised and provide a description of the changes

Scope of Services Changes Client Eligibility Criteria re-stated based on clarification communicated via 10/24/12 letter. This section replaces requirements in the original Schedule A, Scope of Services and any subsequent amendments effective 3/1/13 Staff Orientation and Training Cultural Competency added as an additional orientation/training element and is defined as the capacity to be respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of the program’s clients Client Satisfaction Survey Developed by DOHMH, and administered on a biennial basis. Distribution and response expectations communicated by DOHMH.

Scope of Services Changes Emergency Closure Notification A policy and procedure to notify clients in the event that their offices are closed (outside of normal closing hours) is required. Other Service Category Specific Changes Some service categories may have additional specific changes including revised service types, rates, service models, etc. Separate specific webinars are being held for categories with significant changes. Please refer to your Scope of Service and Renewal Instructions for specifics.

Scope of Services Changes Program Income If uninsured clients present for Ryan White services and efforts to enroll the client in an insurance program (Medicaid, Medicare, Family Health Plus or private insurance) are eventually successful, the program may back-bill insurance with no penalty to its Ryan White reimbursement. Allowance is valid only for services provided prior to approval of the client’s insurance application. Income received through retroactive billing of the insurance plan must be reported as “program income” and must be spent allowably (see below). This is a requirement of HRSA’s National Monitoring Standards for Part A and B awards Program income includes: Income generated by back-billing initial visit(s) to RW program before client has completed enrollment in Medicaid, Medicare or another third-party plan Fees paid in connection with sliding scale fee schedule, if implemented Note: It is the responsibility of all Ryan White programs to facilitate enrollment in applicable insurance programs for all uninsured clients. Applicable insurance programs may include Medicaid, Medicare, ADAP and ADAP Plus and New York State Family Health Plus.

Scope of Services Changes Program income requires contractors to be able to: Query other billing/reporting systems to determine income received for services from date of enrollment up to the successful enrollment in insurance program Calculate the aggregate amount of income generated (i.e., collected) and costs covered by the program income and report to Public Health Solutions at closeout Ensure that program income is used to expand program services or to cover allowable costs not paid for by contract income (not subject to a cap on administrative costs). Separately track costs associated with contract income and program income. At closeout, Public Health Solutions will require an attestation that program income was used in accordance with applicable cost restrictions.

Primary Care Status Measures (PCSM) All references to requirements related to obtaining, documenting, and reporting PCSM are removed from within the Schedule A: Scope of Services and replaced by Schedule A: Primary Care Status Measures Addendum.

Renewal Package-Content, cont’d Renewal Documents – Appendices A,B,C,D This workbook contains various worksheets. These documents must be completed by providing updated information about your program.

Renewal Package-Content, cont’d Appendix B: Program Information Summary This form indicates where your program targets clients-- citywide, borough-wide, or neighborhood-based and the language(s) spoken by staff. Please update this Appendix with the most current contract information.

Renewal Package-Content, cont’d Appendix A: Arrangements for Comprehensive HIV Services Outlines key services for which clients may need referrals (housing, food, etc.) as well as types of places from where clients may be referred to your program. You must list the agencies in each category with whom you have a linkage to receive referrals. You must list whether you have a Memorandum of Understanding (MOU) or a formal linkage agreement (definitions at the bottom of Appendix A) and the date that the MOU or formal linkage agreement was or will be established for each. If your own agency will provide the service, list “Internal” in the Arrangement Status column. At least one provider must be identified for each service need, but multiple providers may be listed. Please update this Appendix with the most current contract information.

Renewal Package-Content, cont’d Appendix C: Target Neighborhoods This form describes if services provided by this contract are neighborhood-based, identifies the target areas by ZIP code from which the program recruits clients. Please update this Appendix with the most current contract information by placing an “x” in the corresponding boxes.

Renewal Package-Content, cont’d Appendix D: Target Client Demographics This provides information on the clients targeted by your contract. Information includes age, gender, race/ethnicity, and other population characteristics. Target percentages are reported as percentages of your total population served by this contract. Appendix D has a new format for Year 23. Please update this Appendix with the most current contract information. Should be best-estimate of target population for Year 23; may be based on previous year’s projections or actuals. Limited client demographic information can be found in eSHARE in the ‘Client Level Enrollment Report’ and the ‘Payment Data Extract’. Both reports can be found under the ‘Canned Report’ menu in eSHARE. Guides detailing the use of the reports can be found in the ‘Resources’ section on the eSHARE landing page.

Renewal Package-Content, cont’d Service Target Grids The Service Target Grid may be pre-populated with pro- rated service target projections or blank with new revised service types or rates depending on the service category. Please refer to your renewal instructions. You may adjust monthly allocations without changing annual totals. If you wish to further revise service target projections, please contact your HIVCS Contract Manager (CM).

Renewal Package-Content, cont’d Schedule F: Service Level Analysis (Performance- based only) The Service Level Analysis lists the approved rate for each service type and populates the projected number of each service type from the Service Target Grid. Please do not make any changes to this document

Work Analysis (Cost-Based Contracts) The work analysis populates projected numbers of services for the contract year and the approved time per service based on the scope of services.

Deliverables Schedule (if applicable) The deliverables schedule pre-populates with contract deliverables, the description of the deliverables, the rate and total reimbursable amount. Please refer to your renewal instructions

Renewal Package-Content, cont’d Service Site Locations Workbook/ Appendix G.1: Service Site Location Prior to completing Appendix G.1: Coordinate a cross-contract review and revision of service types in eSHARE Ensure that the service site names are descriptive, unique and not duplicated While completing Appendix G.1, list names as they appear in eSHARE Process Complete all items for each service site where contracted services are provided, including administrative services. Set up all locations where you provide services as service sites (part of the Agency Profile Information in eSHARE): –Select and add service sites to each contract as part of the Contract Profile in eSHARE –Your HIVCS CM verifies that the service site locations set up and assigned to each contract in eSHARE match the service sites on the Appendix G1 –Ensure service site names are used consistently across contracts (eSHARE and contract documents) Note: Edit service site names in eSHARE as needed and ensure staff from all contracts are aware if there are any changes regarding which sites to select when assigning to contracts and entering services.

Renewal Package-Content, cont’d Services Tab This section has a drop down list of all contracted services. Using your Service Target Grid, select only the services funded under this contract Appendix G.2: Services by Service Site The service sites listed in Appendix G.1 and the service types listed on the Services Tab automatically populate to this page. The yellow cells with “x” indicate the service provided at each site. Please update this Appendix with the most current contract information.

Budget Per Ryan White monitoring standards, all contracts are required to submit a line-item budget Budget templates and instructions are provided in your renewal packages

Budget Changes Food Related Space Costs as Program (Food and Nutrition Programs only) Space costs associated with the storage, preparation, and/or serving of food (FNS programs only) may now be classified as programmatic on the budget (instead of 100% admin). Equipment Purchases Only equipment purchases of $25,000 or more per unit (not aggregate purchases) will require HRSA approval. Note: HRSA’s approval process is likely to take several weeks so you are advised to keep this in mind when planning for purchases that meet the $25,000 threshold. Equipment Request Forms must be used and are available on the Public Health Solutions website Requests must Include the following information: –Contractor name –Annual Maximum Reimbursable Amount –Contract term –Equipment type, cost, information on cost sharing, and intended use

The use of Ryan White Part A funds for client incentives in the form of gift cards must be submitted to HRSA for approval.  Gift cards may not be in the form of pre-paid credit cards  Unallowable uses of gift cards include, but are not limited to –Purchase of alcohol, tobacco, illegal drugs and firearms  Gift cards may not be redeemed or be redeemable for cash  Programs include in their program policies and procedures a requirement that all recipients of gift card incentives sign an acknowledgement of the purpose of and restrictions on the use of gift cards. A record of the signed acknowledgment must be included in client files. Client Incentives

NICRA Indirect Costs may only be included in the budget if the agency has a current DHHS-approved NICRA approved. Contractors that do not currently have a DHHS- approved NICRA must budget direct administrative costs (e.g. Accountant, Audit and Bank Fees, Payroll Processing fees) on the line item budget.

Reporting Schedule A reporting schedule customized for service categories is included in the renewal package The reporting schedule indicates which reports are required and due dates for reports

Deliverables Voucher (if applicable) For Deliverables-Based contracts only or the Deliverables component of a contract A template form is used when submitting the deliverables document (hard copy or )

Tips for a Successful Renewal Changes are to be made in cells highlighted in yellow only. In the document, some cells have been pre-populated with data that must not be changed. Blue cells contain formulas that must not be altered. These formulas either perform various calculations or populate cells with data from other locations. The format of the documents should not be changed or altered. Review the forms and ensure the information contained therein is applicable to this year. If there have been any changes to your program from last year, describe the changes in detail in the Amendment to Schedule A: Scope of Services. To check a box, double left-click on the box and select “check” then OK. Boxes in Schedule A that are already checked are required and a response is necessary. Contact your HIVCS Contract Manager with any questions

Last, but not least.. your completed Ryan White renewal packages to:

Questions? Thanks for Participating!