Reporting Expenditures by Service Planning Area County of Los Angeles Department of Health Services Office of AIDS Programs and Policy April 11, 2003

Charles L. Henry Director Office of AIDS Programs and Policy

3 Geographic Estimate of Need Is.. One of Multiple Planning Perspectives Geographic  Five Supervisorial Districts  Eight Service Planning Areas  Twenty-six Health Districts Population(s) Served Population(s) Targeted Service Categories One Frame of Accountability

4 Geographic Estimate of Need Is Not.. Limitation on Client Choice or Preference Net Increase of Funds Quality Assurance of Services Provided Identification of Behavioral Risk or Other Target Populations

5 Geographic Estimate of Need Presents Opportunities for.. Comparison of Service Sub-Systems Guidance for Expansion of Services Targeting Capacity Building Activities Comparison of Estimated Need and Expenditures

Gunther Freehill Director, Public Affairs Office of AIDS Programs and Policy

7 Background “Divide by Five” Planning Council Priorities Service Expansions Community Planning AIDS Politics

8 March 2002 CARE Act Title I Award Increase of $3 Million Increased Support for Quality Management Increased Program Support Increased Commission Support Grant Award Accepted by Board of Supervisors

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10 Board Request Domains of Distribution Indicators of Need Allocation of Funds Distribution of Services

11 Underlying Questions How is the HIV/AIDS epidemic distributed in Los Angeles County? Is the epidemic emerging in some areas? Is it receding in others? Does the distribution of funds match the distribution of need? Does the distribution of funds make sense? Is my area getting its fair share?

12 Domains of Distribution Zip Code Zones Zones in Los Angeles County524 Zones > Half of Clients36 Zones > 200 Clients15 Zones < = Five Clients286

13 Domains of Distribution

14 Indicators of Need CARE Clients AIDS Cases HIV Test Results

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26 Estimating Geographic Need for Care Services

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30 Estimating Geographic Need for Prevention Services

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35 Allocations of Funds and Estimates of Need

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45 Challenges to Meeting Geographic Estimate of Need Established Service Delivery Systems “Land Locked” Services Residential Substance Abuse Public Health Facilities Diseconomies of Scale Lack of Provider Capacity Client Choice

46 Programmatic Recommendations Increase Outpatient Medical Services Expansion Service Sites Augment Existing Services Re-Design Specialty Consultations

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49 Programmatic Recommendations Increase Translation & Interpretation Increase Child Care Increase Peer Support Services Increase Substance Abuse Services

50 Administrative Recommendations Conduct Rate Reviews Conduct Fiscal Reviews Increase Efficiency in Contracting Increase Monitoring Enhance Community Planning

51 Board Response Distribution of Report Review and Comment by Commission on HIV Health Services Request Report on Expenditures by Service Planning Area

52 Year 13 CARE Services

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56 Re-Solicitation of Services 2003 Child Care Translation and Interpretation Legal Services, Permanency Planning HIV Peer Support Food

57 Re-Solicitation of Services 2004 Outpatient Medical Services * Substance Abuse Services * Treatment Education and Adherence Oral Health Residential Services * HIV Prevention * Pending Rate Review

58 Re-Solicitation of Services 2005 Mental Health Case Management Training

59 Questions and Discussion

Mario J. Pérez Director, Prevention Services Division Robert C. Fish, Ph.D. Director, Care Services Division Office of AIDS Programs and Policy

61 Expenditures of Funds by Service Planning Area Cost Allocation Bases Reports to the Board of Supervisors Terms of Reports Summary Reports

62 Cost Allocation Bases Varies Among Service Categories Consistent Within Service Category

63 Direct Service Hours Time spent on the provision of services attributable to a specific client, group, couple or family. Direct service hours include Time invested to prepare for a client, group, couple or family intervention Intake, assessment, and treatment time Time invested to document the client, group, couple or family contact

64 Direct Service Hours (Cont.) Direct service hours does not include Time invested for trainings (including certification trainings) Service category specific meetings or staff meetings Development of program associated materials and forms (e.g. curriculums, pamphlets) All other activities not attributable to a specific client, group, couple, or family

65 Cost Allocation Basis No. 1 Unit  Case Management, Medical  Case Management, Psychosocial  Client Advocacy  Health Education, Risk Reduction  Home Based Case Management  Legal Services  Mental Health, Counseling Services Hours of Direct Service  Mental Health, Psychiatric Services  Other support: Child Care  Other support: Translation, Interpretation  Partner Counseling & Referral Services  Permanency Planning  Prevention for HIV Positives  Psychosocial Support Services  Substance Abuse, Crisis Counseling  Treatment Adherence

66 Cost Allocation Basis No. 1 (Cont.) UnitService Certifications and Recertifications AIDS Drug Assistance Program Consultations (by SPA of referral) Outpatient Medical, Specialty Cost of rides (by SPA of client) Transportation - Taxi Doses Substance Abuse, Methadone Maintenance

67 Cost Allocation Basis No. 1 (Cont.) UnitService Interventions Completed Perinatal Demonstration Project Meals Food Bank, Home Delivered Meals Procedures Oral Health Care Residential Days Housing Assistance, Residential Services Hospice (Residential, In- home) Substance Abuse, All Residential

68 Cost Allocation Basis No. 1 (Cont.) UnitService Rides Transportation - Van Tokens, Monthly Stickers (Disability Passes) Transportation – MTA, Metrolink Visits Early Intervention, Bridge Nutritional Counseling Outpatient Medical Substance Abuse, Day Treatment

69 Cost Allocation Basis No. 2 UnitService Cost for Service (Each Service x Each Fee) HIV/AIDS Counseling and Testing

70 Exercise 180 (100%) 54 (30%)18 (10%)108 (60%)TOTAL 4500 Group Level Interventions Individual Level Interventions Outreach (Contacts and Encounters) TotalSPA 5SPA 4SPA 2

71 Monthly Reports 8. Service Planning Areas (SPAs) [Please write the number of units of service delivered in the following SPA(s) this month and year to date]: SPA This MonthContract Year-to-Date Unit = SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 TOTAL Hours

72 Monitoring Compliance Include in General Program Management and Monitoring Reviewed Monthly Discrepancies Identified Plans of Corrective Action Considered in Contract Negotiation

73 Quarterly Expenditure Reports to the Board Reports Organized by Grants CARE Act Title I CARE Act Title II Centers for Disease Control and Prevention (CDC) State Net County Cost

74 Terms of Reports First Six Months: Negotiated Deliverables Second Six Months: Actual Delivery, First Six Months Final: Actual Delivery, Twelve Months

75 Service Category Summary Reports Commission on HIV Health Services Prevention Planning Committee Available upon request

76 Questions and Discussion Closing Remarks

77 Exercise TOTAL Group Level Interventions Individual Level Interventions Outreach (Contacts and Encounters) TotalSPA 5SPA 4SPA 2

78 Monthly Reports 8. Service Planning Areas (SPAs) [Please write the number of units of service delivered in the following SPA(s) this month and year to date]: SPA This MonthContract Year-to-Date Unit = SPA 1 SPA 2 SPA 3 SPA 4 SPA 5 SPA 6 SPA 7 SPA 8 TOTAL