Ryan White Part A - Service Categories

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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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.

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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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Service Standard Definition: Supports intermittent Child Care Services for the children living in the household of PLHIV who HRSA RWHAP-eligible clients for the purpose of are enabling those clients to attend medical visits, related appointments, and/or HRSA RWHAP-related meetings, groups, or training sessions. Allowable use of funds include: 1) A licensed or registered childcare provider to deliver intermittent care; 2) Informal childcare provided by a neighbor, family member, or other person (with the understanding that existing federal restrictions prohibit giving cash to clients or primary caregivers to pay for these services).

Program Guidance: The use of funds under this service category should be limited and carefully monitored. Direct cash payments to clients are not permitted. Such arrangements may also raise liability issues for the funding source which should be carefully weighed in the decision process.

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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.

Provides limited one-time or short-term payments to assist an HRSA RWHAP 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.

Program Guidance: Emergency Financial Assistance funds used to pay for otherwise allowable HRSA RWHAP services must be accounted for under the Emergency Financial Assistance category.  Direct cash payments to clients are not permitted. 

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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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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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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Overview: Home Health Care is the provision of services in the home that are appropriate to an eligible client’s needs and are performed by licensed professionals. Activities provided under Home Health Care must relate to the client’s HIV disease and may include: 1) Administration of prescribed therapeutics (e.g. intravenous and aerosolized treatment, and parenteral feeding); 2) Preventive and specialty care; 3) Wound care.

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Provides end-of-life services to clients in the terminal stage of HIV related illness, at home or in a residential facility.

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

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Overview: Medical Nutrition Therapy includes: 1) Nutrition assessment and screening; 2) Dietary/nutritional evaluation; 3) Food and/or nutritional supplements per medical provider’s recommendation;  4) Nutrition education and/or counseling

These activities can be provided in individual and/or group settings and outside of HIV Outpatient/Ambulatory Health Services. 

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See Home Delivered Meals

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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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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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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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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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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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Description: The Outreach Services category has as its principal purpose identifying PLWH who either do not know their HIV status, or who know their status but are not currently in care. As such, Outreach Services provide the following activities: 1) identification of people who do not know their HIV status and/or 2) linkage or re-engagement of PLWH who know their status into HRSA RWHAP services, including provision of information about health care coverage options. Because Outreach Services are often provided to people who do not know their HIV status, some activities within this service category will likely reach people who are HIV negative. When these activities identify someone living with HIV, eligible clients should be linked to HRSA RWHAP services.  

Outreach Services must:  

• Use data to target populations and places that have a high probability of reaching PLHIV who have: 

• Have never been tested and are undiagnosed,  

• Have been tested, diagnosed as HIV positive, but have not received their test results, or  

• Have been tested, know their HIV positive status, but are not in medical care;  

• Be conducted at times and in places where there is a high probability that PLWH will be identified; and  

• Be delivered in coordination with local and state HIV prevention outreach programs to avoid duplication of effort.  

Outreach Services may be provided through community and public awareness activities (e.g., posters, flyers, billboards, social media, TV or radio announcements) that meet the requirements above and include explicit and clear links to and information about available HRSA RWHAP services. Ultimately, HIV-negative people may receive Outreach Services and should be referred to risk reduction activities. When these activities identify someone living with HIV, eligible clients should be linked to HRSA RWHAP services.  

Program Guidance: Outreach Services provided to an individual or in small group settings cannot be delivered anonymously, as some information is needed to facilitate any necessary follow-up and care. Outreach Services must not include outreach activities that exclusively promote HIV prevention education. Recipients and subrecipients may use Outreach Services funds for HIV testing when HRSA RWHAP resources are available and where the testing would not supplant other existing funding. 

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See Other Professional Services 

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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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Overview: Rehabilitation Services provide HIV related therapies intended to improve or maintain a client’s quality of life and optimal capacity for self-care on an outpatient basis, and in accordance with an individualized plan of HIV care.  

Program Guidance: Allowable activities under this category include physical, occupational, speech, and HIV/AIDS BUREAU  vocational therapy. Rehabilitation services provided as part of inpatient hospital services, nursing homes, and other long-term care facilities are not allowable.  

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Description: Respite Care is the provision of periodic respite care in community or home-based settings that includes non-medical assistance designed to provide care for an HRSA RWHAP-eligible client to relieve the primary caregiver responsible for their day-to-day care.  

Program Guidance: Recreational and social activities are allowable program activities as part of a Respite Care provided in a licensed or certified provider setting including drop-in centers within HIV Outpatient/Ambulatory Health Services or satellite facilities. Funds may be used to support informal, home-based Respite Care, but liability issues should be included in the consideration of this expenditure. Direct cash payments to clients are not permitted. Funds may not be used for off premise social/recreational activities or to pay for a client’s gym membership.  

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Overview: Substance Abuse Services (residential) activities are those provided for the treatment of drug or alcohol use disorders in a residential setting to include screening, assessment, diagnosis, and treatment of substance use disorder. Activities provided under the Substance Abuse Services (residential) service category include pretreatment/recovery readiness program, harm reduction, behavioral health counseling associated with substance use disorder, medication assisted therapy, neuro-psychiatric pharmaceuticals, relapse prevention, detoxification, if offered in a separate licensed residential setting (including a separately licensed detoxification facility within the walls of an inpatient medical or psychiatric hospital) 

Program Guidance: Substance Abuse Services (residential) is permitted only when the client has received a written referral from the clinical provider as part of a substance use disorder treatment program funded under the HRSA RWHAP. Acupuncture therapy may be an allowable cost under this service category only when it is included in a documented plan as part of a substance use disorder treatment program funded under the HRSA RWHAP. HRSA RWHAP funds may not be used for inpatient detoxification in a hospital setting, unless the detoxification facility has a separate license. 

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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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