Planning Councils and Planning Bodies Lennie Green Dept. of Health & Human Services Health Resources & Services Administration HIV/AIDS Bureau Division of Metropolitan HIV/AIDS Programs July 29-31, 2013

Ryan White Treatment Modernization Act (RWTM Act) Overview Learning Objectives: Describe goals, programs, and guiding principles Describe Part A scope, programs, and funding process Explain how Ryan White Act programs are administered within the HIV/AIDS Bureau

Ryan White Funding Largest Federal government program specifically designed to provide services for people living with HIV/AIDS. Since 1991, about $14.2 billion in grant awards have been made to 51 Eligible Metropolitan Areas (EMAs), 50 States, the District of Columbia, Puerto Rico, Guam, the Virgin Islands, and the Pacific Islands Jurisdictions.

HIV/AIDS Bureau (HAB) Administers the Ryan White Treatment Modernization Act (RWTM Act) programs. Programs benefit low-income, uninsured and underinsured individuals and families affected by HIV/AIDS.

HIV/AIDS Bureau (HAB) Four Critical Principles Focusing services on the underserved in response to the HIV/AIDS epidemic’s growing impact among underserved minority and hard-to-reach populations. Ensuring access to existing and emerging HIV/AIDS treatments that can make a difference.

HIVAIDS Bureau Four Critical Principles Adapting to changes in the financing of the health care delivery system. The role the Ryan White Treatment Modernization Act serves in filling gaps in care. Documenting the impact of RWTM Act funded services on: improving access to quality care/treatment areas of continued need

Ryan White Programs Part A Emergency funding for eligible metropolitan areas that are severely and disproportionately affected by the HIV epidemic Part B Grants to all 50 States, territories and jurisdictions AIDS Drug Assistance Program (ADAP) Grants to emerging communities Parts A and B are administered by the Division of Metropolitan HIV/AIDS Programs (DMHAP)

Other Ryan White Programs Part C Capacity Building, Planning, Early Intervention Services Part D Improving access to care for Women, Infants, Children & Youth Part F Special Projects of National Significance (SPNS) HIV/AIDS Education and Training Centers (AETCs) Dental Reimbursement Programs & Community Based Dental Partnership Program Data and Evaluation

Part A provides grant funds to eligible metropolitan areas (EMAs) that are severely and disproportionately affected by the HIV epidemic. Part A

Funds are awarded to the Chief Elected Official (CEO) of the city or county that administers the health agency providing services to the greatest number of people living with HIV disease within the EMA. The CEO designates the grantee to select service providers and administer contracts. The CEO establishes the Planning Council and appoints members to it.

What Part A Funds Outpatient Health Care Medical and dental care and developmental and rehabilitative services Support Services Case management, home health and hospice care, housing and transportation assistance, nutrition services, day/respite care Early Intervention Services Include outreach, HIV counseling and testing, referral, and the provision of outpatient medical care designed and coordinated to bring individuals into the continuum of care

Minority AIDS Initiative (MAI) Used to modify or expand HIV care services for disproportionately impacted communities of color. Subject to the same requirements as Part A funds.

Part A Providers Public or non-profit entities Private for-profit entities (If they are the only available provider of quality HIV care in the area)

Flow of Part A Decision-Making and Funds Presenter: Lennie Green

Roles and Responsibilities of Planning Councils Learning Objectives: Describe the cycle of annual planning activities that the Council performs List the mandated responsibilities of the Planning Council Explain the collaborative roles between the grantee, Council, and Council support staff

Planning Councils Established by the Chief Elected Official Membership must reflect local HIV/AIDS epidemic Must include representatives from groups designated by the RWTM Act At least 33 percent of voting members must be PLWH not affiliated with Part A service providers and receiving Part A services Must have an open nomination process and grievance procedures

Major Requirements of Planning Councils Planning Council Operations Needs Assessment Comprehensive Planning Priority Setting Resource Allocation Service Coordination Assessment of Efficiency of Administrative Mechanism

Other Responsibilities of Planning Councils Evaluation of Effectiveness of Care Strategies (optional/best practice) Standards of Care for Service Categories Quality Management (shared with grantee)

Planning Council Operations Rules to help Councils operate smoothly and fairly (e.g., by- laws, open nominations process, policies and procedures). Includes new member recruitment, orientation, and training.

Needs Assessment Find out: Number and characteristics of persons living with HIV/AIDS in the EMA Needs of people who know their HIV status but are not in care Differences in care for different populations Capacity development needs of agencies How RWTM Act services can coordinate with other services (e.g., substance abuse, HIV prevention)

Comprehensive Planning Develops the roadmap or vision for HIV service delivery system in the EMA Guides decisions for next several years Should be in harmony with the Statewide Coordinated Statement of Need (SCSN)

Priority Setting Deciding which HIV/AIDS services are the most needed and ranking of importance in the EMA Giving directives to the grantee about how best to meet these priorities

Resource Allocation Deciding how much funding is needed for each of the priority service categories Solely the responsibility of the Planning Council May use funds to pay for special projects, studies, or capacity building

Service Coordination Coordinates with other RWTM programs and other services for PLWH. Avoids duplication and reduces gaps in care. Participates in the Statewide Coordinated Statement of Need process along with other RWTM Act Titles.

Evaluate the Effectiveness of Care Strategies How well are Part A funded services meeting the needs of PLWH? Are PLWH engaged in care and remaining in care? Are we reducing morbidity and mortality in the EMA?

Assess the Administrative Mechanism Is the grantee funding the Planning Council priorities? Are the Planning Council directives incorporated into the RFP and the contract language? How quickly are contracts for service providers signed? Are providers paid in a timely manner?

CEO and Grantee Responsibilities Establish the Planning Council - (CEO only) Participate in needs assessment Provide information to accomplish tasks Participate in comprehensive planning

CEO & GRANTEE RESPONSIBILITIES Manage procurement Distribute funds according to the priorities Monitor contracts – quality assurance Support Planning Council operations Quality management

CEO/Grantee and Planning Council Roles and Responsibilities

Part A Planning Cycle

Needs Assessment Planning Learning Objectives: List the law’s requirements and HAB’s expectations for needs assessments Describe specific Planning Council and grantee roles and responsibilities regarding needs assessments Explain the importance of estimating unmet need Describe the process for planning a needs assessment

Planning a Needs Assessment

Needs Assessment Planning What do we need to find out? Resource Inventory – are all services available to PLWH/A? Are services focused on sub-populations? Which ones? Is there ease of access? How much of the service need is covered (capacity)? Are services appropriate? If not appropriate, is there documentation on why?

Knowing who needs services and how to reach them Knowing who the service providers are, where they are, and what they can provide and for whom Making good, objective decisions about which services are most needed Interpreting the Needs Assessment

Unmet Need Refers to the unmet need for HIV-related primary health care among individuals who know their HIV status but are not in care Estimation of unmet need is a determination of the approximate number of individuals in your service area who are HIV positive, know their status and are not receiving regular primary medical care Assessment of service needs and gaps for this population

Planning a Needs Assessment Plan for the needs assessment: Determine the scope Determine the timetable and budget Agree on responsibilities for conducting and overseeing the needs assessment Establish a process for community input Consider how to analyze, present, and use results

Planning a Needs Assessment Design the needs assessment methodology: Determine what information is available Select the methods to be used Design the data collection instruments Determine how information will be analyzed

Planning a Needs Assessment Collect the Information Required: Obtain and analyze HIV/AIDS data Obtain and review other existing information Collect new data Analyze the information and present the results in useful formats.

Quantitative Data: Data measured in numbers: Sources may include: surveys, surveillance data, epidemiological studies Example: Centers for Disease Control and Prevention’s HIV/AIDS Surveillance Report

Qualitative Data: Data that cannot be counted or presented in numbers: Sources may include: focus groups, interviews, community forums Example: focus group with case managers to discuss why Black MSM are not using services

Quantitative or Qualitative? Survey of 1000 PLWA says 90 percent are satisfied with their access to ART drugs. Council member reports that she and her friends have trouble getting the ART drugs they need.

Quantitative Data Advantages: Objective Can provide information about a whole population Limitations: May not give adequate detail about subpopulations May not explain why something is happening Requires money and time

Qualitative Data Advantages Good for answering questions about why something is happening Can go in-depth to learn more about something Limitations Can’t draw conclusions about a whole population May not be representative of most people in the EMA / TGA

Comprehensive Planning Learning Objectives: List the RWTM Act requirements regarding comprehensive planning. Explain how comprehensive planning relates to needs assessment and the annual priority setting process.

The Comprehensive Plan Should answer these questions: 1. Where are we now? 2. Where do we need to go? 3. How will we get there? 4. How will we monitor our progress?

Requirements The Plan must include: A strategy for identifying individuals who know their HIV status and are not receiving services Attention to eliminating disparities in access and services among affected subpopulations and historically underserved communities

Priority Setting Learning Objectives: Explain the RWTM Act requirements and HAB’s expectations for priority-setting Use data to prioritize and rank service categories

Priority Setting Process of deciding which HIV/AIDS services are the most needed and ranked as important in the EMA / TGA

Requirements Priorities should be based on: Cost effectiveness and outcome effectiveness of strategies Community priorities Size and demographic of PLWHA and their needs

Priority Setting - Directives Directives are instructions to the grantee on how best to structure priorities to meet the needs of PLWH, particular subpopulations and / or PLWH or providers in a specific geographic area.

Priority Setting - Directives Example: The grantee must target Spanish language case management services in the and zip codes Example: Agencies with a history of service to women with children have priority to be awarded funds under this service category

Principles To Guide Decision Making Decisions must be based on documented needs Services must be responsive to the HIV profile in the service area Priorities should strengthen the continuum of care Address overall needs, not narrow concerns At this stage, do not consider other sources of funding

Meeting Service Priorities Provide for geographic parity Focus on the needs of low-income, underserved, and severe needs populations Facilitate culturally and linguistically appropriate services Ensure equal access to services Ensure primary care services meet Public Health Service treatment guidelines

Strategies for Promoting Collaboration Establish ground rules Ask each member to talk about his or her needs Do not avoid conflict Facilitate open communication Create written policies and procedures for conflict management If all else fails, use mediation or arbitration

Maintaining Consumer Involvement Learning Objectives: List reasons that consumers become disengaged from the Planning Council process Generate ideas for ways to recruit consumers and maintain their involvement Identify tools and/or plans to use in recruiting and retaining consumers

How Can We Support Consumer Involvement? Set a welcoming environment – hold a welcome luncheon, create a mentoring system, appreciation ceremonies Make sure people have the information they need – review important issues/materials before the meeting Everyone on the Planning Council should take responsibility for making sure that consumers are represented and that they remain active (“If not you, who?!”) Remember: quality Planning Councils attract interested people

How Can We Support Consumer Involvement? Orientation – takes place once Training opportunities should be ongoing Be clear about expectations (responsibilities, length of meetings, or length of time to complete tasks) Be clear about the role of staff Make HRSA materials available to everyone and encourage their use

The Beginning

Contact Information Lennie Green Project Officer