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Ryan White Services Division

Infectious Disease Bureau

Provider Manual

FY 2019

Ryan White HIV/AIDS Treatment Extension Act

Part A

This Manual is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $14,925,427 with 0 percentage financed with non-governmental sources. The contents are those of the Ryan White Services Division and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

Ryan White HIV/AIDS Treatment Extension Act Part A Boston Eligible Metropolitan Area

Provider Manual Fiscal Year 2019

March 1, 2019 - February 29, 2020

R y a n W h i t e S e r v i c e s D i v i s i o n I n f e c t i o u s D i s e a s e B u r e a u

B o s t o n P u b l i c H e a l t h C o m m i s s i o n

1 0 1 0 M a s s a c h u s e t t s A v e n u e , 2 n d F l o o r B o s t o n , M A 0 2 1 1 8

( 6 1 7 ) 5 3 4 - 4 5 5 9 ( p ) | ( 6 1 7 ) 5 3 4 - 2 4 8 0 ( f )

w w w . b p h c . o r g

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Map of the Boston Eligible Metropolitan Area

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Table of Contents Introduction .......................................................................................................................................... 6

Program Reporting Rules FY 2019 ....................................................................................................... 7

Reporting ...................................................................................................................................................................... 7

Program Performance ................................................................................................................................................. 8

Annual Site Visit .......................................................................................................................................................... 8

Client Eligibility ........................................................................................................................................................... 8

Technical Assistance & Non-Compliance ............................................................................................................... 8

e2Boston ............................................................................................................................................... 9

Adding a New Client ................................................................................................................................................... 9

Client Utilization Form ............................................................................................................................................ 15

Adding Services & Subservices............................................................................................................................... 17

Outcome Measurement Report .............................................................................................................................. 18

Adding Outcomes to a Client Record ................................................................................................................... 20

Ryan White Services Report.................................................................................................................................... 23

Service Descriptions & Subservice Definitions .................................................................................. 24

Core Medical Services ...................................................................................................................... 24

AIDS Drug Assistance Program ....................................................................................................................... 24

Medical Case Management ................................................................................................................................. 25

Medical Nutrition Therapy.................................................................................................................................. 27

Oral Health Care .................................................................................................................................................. 28

Support Services ............................................................................................................................... 29

Emergency Financial Assistance ....................................................................................................................... 29

Food Bank & Home Delivered Meals .............................................................................................................. 30

Health Education & Risk Reduction ................................................................................................................ 31

Housing ................................................................................................................................................................. 32

Medical Transportation ....................................................................................................................................... 34

Non-Medical Case Management ....................................................................................................................... 35

Psychosocial Support .......................................................................................................................................... 37

Substance Use Residential Services ................................................................................................................... 38

Fiscal Reporting Rules FY 2019 .......................................................................................................... 39

Sample of Expense Invoice (Admin Cost Cap) ................................................................................................... 45

Sample of Expense Invoice (Indirect Rate) .......................................................................................................... 46

Sample of Unit Rate Expense Reimbursement .................................................................................................... 47

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Budget Terms ............................................................................................................................................................ 48

Sample Cost Expense Budget (Admin. Cost) ...................................................................................................... 50

Sample Expense Budget (Indirect) ........................................................................................................................ 51

Sample Unit-Rate Budget ........................................................................................................................................ 52

Budget Revision Guidance ...................................................................................................................................... 53

Sample Expense Budget Revision .......................................................................................................................... 55

Annual Site Visits ................................................................................................................................ 56

Reporting Due Dates ........................................................................................................................... 58

Policies and Procedures ...................................................................................................................... 59

Policy Maintenance................................................................................................................................................... 59

Payer of Last Resort Policy ..................................................................................................................................... 61

Federal Monitoring Standards ................................................................................................................................ 62

Sliding Fee Scale Policy for Ryan White Services ................................................................................................ 67

Client Eligibility for Ryan White Services ............................................................................................................. 68

Guide to Collecting Eligibility Documents .......................................................................................................... 71

Sample Six-Month Recertification Form .............................................................................................................. 72

Sample Self-Attestation Form ................................................................................................................................ 73

Client Income Summary .......................................................................................................................................... 74

Sample Eligibility Letter for Exceeding Charges Cap ......................................................................................... 75

Sample Hardship Waiver/No Income .................................................................................................................. 76

Authorization to Obtain/Release Information .................................................................................................... 77

Sample Authorization to Obtain/Release ............................................................................................................. 78

Agency Incident Report Procedures ...................................................................................................................... 79

Sample Incident Report ........................................................................................................................................... 80

Quarterly Report Instructions & Samples ............................................................................................................. 81

Quarterly Report Template ..................................................................................................................................... 85

Contract Transition Policy ...................................................................................................................................... 89

Online Resources ................................................................................................................................ 90

FY 19 Ryan White Services Staff List .................................................................................................. 91

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Introduction

The Ryan White HIV/AIDS Program (RWHAP), classified by Title XXVI of the Public Health Service Act,

and amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009, is the largest Federal program

directed exclusively toward providing core medical and support services to people living with HIV/AIDS

(PLWH) who have no health insurance or gaps in health insurance coverage. Part A provides emergency

assistance to Eligible Metropolitan Areas (EMAs) and Transitional Grant Areas (TGAs) that are most severely

affected by the HIV/AIDS epidemic.

Federally invested, and locally sourced, this program is highly effective with 66% of PLWH receiving Ryan White services nationally being virally suppressed. Results for PLWH receiving care within the Boston EMA are extraordinary: 88% of individuals initially linked to care are retained in care; 99% are started on antiretroviral therapy (ART), and 91% achieved viral suppression. We have achieved so much; and there is more work to be done together. The FY19 Provider Manual for RWHAP Part A was adapted from previous iterations and revised to reflect the most recent HRSA guidance as enumerated in Policy Clarification Notices 13-02, 15-01, 15-02, 16-02, and 18-02, as well as the National HIV/AIDS Strategy. The intent of these revisions is to make program administration as easy and flexible as possible, while ensuring that all practices comply with federal regulations. Service standards and fiscal policies have a client-centered focus maximizing the provision of direct care services and easing administrative burden. The past decade of HIV/AIDS research and care delivery have revealed that we have the tools to eliminate HIV transmission with daily ART and pre-exposure prophylaxis (PrEP). Clinical data demonstrate the importance of wrap-around support services focusing on the social determinants of health. We are also witnessing a changing epidemiology within the HIV epidemic with increasing importance of the syndemics of housing insecurity and injection drug use. Understanding these new influences allows those in public health, health care, and community outreach to tailor our interventions in order to have the greatest impact possible on viral suppression rates and overall health outcomes. Special thanks go to the HRSA Technical Assistance team (Mae Rupert, Susan Robilotto, and Jim McCarthy) and the Boston Public Health Commission for their expert review and support in the development of this iteration of the Provider Manual. I am honored to be your partner in helping to eliminate new HIV infections and ensuring that persons living

with HIV/AIDS and their families have the opportunity to maximize their health and well-being.

Jenifer Leaf Jaeger, MD, MPH

Director, Infectious Disease Bureau and Director, Population Health

Boston Public Health Commission

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Program Reporting Rules FY 2019

Reporting

1) Reporting will be considered a deliverable under the scope of work and for the purpose of determining fulfillment of the Subrecipient’s obligations. Failure to produce timely and adequate reports may jeopardize the Subrecipient’s eligibility or consideration for funding in subsequent years.

2) The Subrecipient must maintain a record of participating Part A clients in BPHC’s e2Boston System. Specifically, Subrecipients must register all clients in e2Boston, including information regarding their demographics, exposure category, diagnostic information, housing and insurance status, and medical history. On a monthly basis, the Subrecipient will enter utilization data for each client including units of service delivered, dates of service, and number of units. See e2Boston - Adding New Client, e2Boston - Client Utilization Form, and e2Boston - Adding Services and Subservices to a Client Record.

3) The Subrecipient will also complete an Outcome Measurement Report to quantify and track the health of each client served. Outcomes reporting will be based on a “Client Clock” model; outcomes are assessed for each 6-month period during which the client received services. See ‘Outcome Measurement Report’.

4) Quarterly reports will be due on the last business day of the month following the end of the quarter. They must include a description of the progress made and efforts undertaken to meet goals and objectives for each activity or service funded, including summary of services provided and those served, any problems, obstacles, or barriers to meeting such goals and objectives, and any actions taken or to be taken to resolve such problems, obstacles, or barriers. Quarterly reports must include updates on personnel changes for Part A staff and a description of any program spending issues during the reporting period. The Ryan White Services Division may request additional information at any time. The Subrecipient must include a description of the implementation and progress on any Action Plans submitted to the Ryan White Services Division. The Ryan White Services Division may provide specific formats for submitting reports, which the Subrecipient is required to follow. See sample Quarterly Report Template and Quarterly Report Instructions. Please note we will send notification to Subrecipient if the templates change.

5) Programs funded with unit-rate contracts must submit a combined fiscal and data report

within thirty (30) days after the end of each month and a quarterly narrative report within thirty (30) days of the close of each quarter.

6) All subrecipients will be expected to complete the Ryan White Services Report (RSR) each

calendar year. Additional information will be provided prior to submission. See Ryan White Services Report.

7) All subrecipients will be expected to comply with the requirements detailed in the Ryan White Standards of Care.

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Program Performance

The Boston Public Health Commission reserves the right to suspend, reduce, or terminate the Subrecipient’s contract if it determines the Subrecipient has failed to make substantial progress on its goals and objectives, that such failure is unreasonable, and the Subrecipient does not demonstrate an adequate strategy to address obstacles to that progress. The Subrecipient’s program performance will be assessed through the following three (3) processes:

1) The review of the Subrecipient’s program utilization, spending, and reporting; 2) An evaluation of compliance regarding program and fiscal reporting requirements, as well as client

file maintenance in relation to HRSA-mandated Part A site visits; 3) The Subrecipient’s demonstrated efforts to retain and maintain clients.

Annual Site Visit

BPHC, or other entities on behalf of BPHC, will conduct site visits to monitor site compliance with grant rules and regulations. The site visit is an opportunity for BPHC staff to support sites with their compliance in order to reduce risk in the case of an audit. While most Subrecipients will receive one (1) site visit during the period of performance, this may vary by site. Site visits include a review of both fiscal and programmatic records and documentation. BPHC staff will coordinate with sites in advance to ensure that key personnel involved in implementation of the Scope of Services are available at locations where funded activities occur.

Additional information may be requested prior to, during, or subsequent to the site visit. The Subrecipient will have a reasonable time to produce such information. The Subrecipient will also receive reasonable notice prior to each site visit. BPHC will attempt to accommodate subrecipients’ schedules as best as possible but reserves the right to visit a funded Subrecipient at a time of our choosing and without advance notice. See ‘Annual Site Visit’.

Client Eligibility

The Subrecipient will be expected to comply with the Financial Eligibility Policy for Ryan White Services which requires funded subrecipients to screen HIV + clients for income eligibility, based on a threshold of 500% of the Federal Poverty Level (FPL) as determined by the U.S. Department of Health and Human Services (HHS). When applicable, the Subrecipient will also adhere to the Ryan White Services Sliding Fee Scale Policies, as indicated by the BPHC. In addition, subrecipients must document client eligibility annually, and recertify every 6 months for changes to eligibility. See ‘Client Eligibility for Ryan White Services’ and Policy Clarification Notice 13-02.

Technical Assistance & Non-Compliance

Contract managers will notify appropriate staff at a subrecipient site if it is out of compliance with programmatic or fiscal requirements. Contract managers will work with the subrecipient to develop a time-bound plan to correct the compliance issue (s) in a timely manner. All subrecipients can request technical assistance at any time from their assigned contract manager.

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e2Boston This section includes instructions about how to add new clients, complete the client utilization form, add services and subservices, report client outcomes, and complete the Ryan White Services Report using the e2Boston database. If you require more assistance, please review the e2boston Manual found within the Resource section of e2Boston or contact Irina Neshcheretnaya at 617-534-2698 or ineshcheretnaya@bphc.org.

Adding a New Client

Intake Information

This entire section highlights the re- quired data elements for a client’s rec- ord. However, we encourage you to fill in as much information as possible, such as Client’s Primary Language and Country of Birth. When you create a client record, you first enter information into the Client Intake page. This information is used to create a Unique Client Identifier (UCI) and a Client Code. e2Boston also uses this information to check if the client already exists in your system. Once you verify the client is new, you can move to Client Demographics.

Client Code/Unique Client Identifier Information

Last 4 Digits of SSN Enter the last 4 digits of the client’s Social Security Number. If this is unknown, please enter “9999”.

Birth Date Enter the client’s date of birth in mm/dd/yyyy format.

Mother’s First Name Enter the first name of the client’s mother. If this is unknown, please enter

“XXX”.

Sex at Birth & Current Gender

Indicate the client’s sex at birth (male or female) and indicate the client’s current

gender (male, female, transgender, or unknown/unreported). If the client’s current

gender is “transgender”, please indicate whether the transition was from male to

female, female to male, other, or unknown if the client declined giving this

information.

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Demographics All pages in the client record, including demographics, use red asterisks to indicate mandatory fields. On any given page, you must fill in all asterisked fields before you can save the information. Most of this demographic data is required for the Ryan White Services Report (RSR), which is required to be submitted to HRSA annually. Completing data entry now for client race and ethnicity means you don’t need to do it later!

Client Contact Information

Street Address, City, State Enter the client’s street address, city, and state of residence.

Zip Code

Enter the client’s 5-digit zip code. Do not enter “99999”. If the client’s housing is unstable, enter the zip code where the client spends the most time or returns to regularly and/or can receive messages and be contacted.

Intake and Activity Information

Date client first received services

Enter the date that the client first received HIV services at your agency in mm/dd/yy format.

Referral Source Indicate the way in which the client was initially referred to your agency for HIV services. If you choose “other”, please specify what the means of referral was.

Activity Status and Reason for Discharge (if inactive)

Indicate whether the client is an active client at your agency. If they are inactive, please indicate the reason for their discharge if known (please select only one and include the date of death in mm/dd/yy format if they are deceased.)

Race, Ethnicity, and Language Information

Client’s Ethnicity Indicate whether client is Hispanic or Latino/a or if the client is not Hispanic or Latino/a.

Race (select all that apply) Select the racial categories with which the client identifies. The “Unknown” category includes Latinos who do not identify with any race.

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Race, Ethnicity, and Language Information

Ethnic Subgroup If a client is Hispanic or Latino/a, Asian, or Native American, an option will appear to mark their Ethnic Subgroup. Please fill this out as it is now part of RSR Reporting.

Primary Language Select the primary language spoken by the client.

Country of Birth Indicate if the client was born in the United States, in a country with U.S. dependency, or outside of the United States.

HIV Status

This page contains info about the client’s HIV status, as well as original exposure category. Multiple exposure categories can be reported per client. The HIV status should be updated if the client’s status changes. (i.e. Diagnosed with AIDS.)

HIV Verification (select one)

Please indicate the client’s current HIV status by selecting one of the available options. If “AIDS, CDC defined” is selected, please provide the year of AIDS diagnosis in yyyy format. Important: HIV verification is required for any HIV positive clients.

HIV exposure category (select all that apply)

Please indicate all applicable exposure categories for the client’s HIV status. You may choose more than one.

Connection to Care Please indicate whether the client currently has an HIV/AIDS medical provider. Also, please provide the date on which this information was updated.

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Housing & Insurance Status This section of the client record contains income information, one of the main components of Ryan White Eligibility. This section must be updated EACH time a client is reassessed for eligibility. Once you have entered the client’s income, income type, and family size, use the “Calculate FPL” button for e2Boston to calculate the client’s Federal Poverty Level.

Source of Client Medical Insurance (check all that apply)

Please indicate the client’s source of primary medical insurance. If the

client has more than one source of insurance, select all applicable

sources. Also, please indicate the date on which this information was

updated.

Housing Status (select one)

Please indicate the client’s housing status and provide the date on which

this information was updated. If “Permanent housing” is selected,

another question will appear asking whether the housing is owned or

rented. If it is rented, also indicate whether it is subsidized.

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Medical History (Medical Case Management Only) This page contains information about the client’s medical history. You will need to go through each of the tabs outlined in the image to the right and complete the sections entitled, “General, Care Dates, CD4, and Viral Load.” The information completed in those sections will then auto populate on the “Main” tab. General Medical This section is to input data on the client’s first HIV/AIDS medical visit and the most recent visit. Please complete the question under “One-Time Data” on the first medical visit that the client had at their current medical physician’s office.

Next, under “General Medical” please put in an entry for the medical visit referred to in the first section and complete the following questions. Click “save” when complete.

One-Time Data: Client’s first HIV/AIDS Medical Visit

Record client’s first HIV/AIDS medical visit at the location in which they are currently receiving medical care.

General Medical: New Entry, General Medical

Answer this section based on the client’s previously noted HIV/AIDS medical appointment.

Care Dates In this tab, please list the dates of all the client’s HIV/Medical Care visit dates during the past calendar year. If they had more than one appointment, please list them all to the best of the client’s recollection.

CD4 Please enter the client’s most recent CD4 results with the date that the test was taken. If information is given by self-report, record to the best of the client’s recollection.

Viral Load Enter the client’s most recent viral load results with the date the test was taken. If information is given by self-report, record to the best of the client’s recollection. If the client’s viral load is <75 ppm, please check the box “Viral Load Undetectable

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Medical II (Medical Case Management Only) This page contains information about the client’s history of being screened for STIs and other infectious diseases. You will need to go through each of the tabs outlined in the image to the right and complete the sections titled, “Gonorrhea, Chlamydia, Hepatitis A/B/C, Syphilis, TB, and HPV Screenings.”

Gonorrhea/Chlamydia

Add a new entry for any new testing for gonorrhea or chlamydia. After clicking “New Entry”, complete the additional questions in that section and click “Save.” If the client has not had a screening for these infections, then click through to the “Hepatitis A/B/C” tab.

Hepatitis A/B/C

Respond to the questions in this section regarding screenings and treatment

for hepatitis A, B, & C. All questions marked with an asterisk are required.

Click through to the “Syphilis” tab when complete.

Syphilis

Add a new entry for any new testing for syphilis. After clicking “New Entry,” complete the following questions in that section and click “Save.” If the client has not had a screening for these then click through to the “TB” tab.

TB

Respond to the questions in this section regarding screenings and treatment

for tuberculosis. All questions marked with an asterisk are required. Click

through to the “HPV Screenings” tab when complete.

HPV Screenings

Add a new entry for any testing for HPV. After clicking “New Entry,” complete the additional questions in that section and click “Save.” If the client has not had a screening for HPV and all other Medical II data is complete, you may move to the “Services” section of the intake.

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Client Utilization Form

Programs are required to use e2Boston to track service utilization for funded activities. BPHC uses the client code and unique client identifier to link service activities to specific clients. In addition to submitting an overview of utilization data with the quarterly reports, all programs must upload/import utilization data into e2Boston monthly. Client utilization data are entered or uploaded at least monthly for review and submitted quarterly for programs with cost expense budgets. Likewise, programs with unit-rate budgets must submit client utilization data at least monthly. For additional details, see the Program Reporting Requirements section of this manual. Instructions While the reporting deadlines and requirements vary for expense reimbursement and unit-rate programs, client activity itself is reported similarly for both types of programs. Unit rate budgets must submit combined fiscal and data report monthly. Client utilization data will be used as fiscal backup documentation for units billed. Client activity is recorded in one of three ways: by amount of time of service provided, upon completion of service, or by units of service provided.

1. Time-based Units of Service: If a client activity is measured in hours, it can be broken down into quarter units. Examples:

a. If a client meets face-to-face with his Case Manager for 30 minutes, the visit is recorded as 0.5 units.

b. If staff holds an individual psychosocial support session with a client for 90 minutes in her office, the visit is recorded as 1.5 units.

2. Completion of Service: Not all units of client activity correspond to hours of time. Instead, they are reported as one (1) unit when the activity is completed, regardless of how long the activity took to complete. Examples:

a. Phone calls that provide client-centered assistance are recorded as one (1) unit regardless of the length of the phone call.

b. Case Management Intakes are recorded as one (1) unit when they are completed c. Supported referrals are recorded as one (1) unit when they are completed.

3. Units of Service: Some client activities are recorded in units of service provided. The units may be

in the form of discrete service units provided (e.g. meals, bed days) or client discrete client activities. Examples:

• A transitional housing program funded to provide bed days for clients would record each bed day provided for each client as one (1) unit.

• A meals program funded to provide food bank packages for clients would record each package distributed to clients as one (1) unit.

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Instructions for Completing Part A Unit-Rate Client Utilization Data Fiscal Backup

Reminder: Report service utilization only on clients whose services are paid for under Part A contracts.

1. Subrecipient Name Enter the Subrecipient name as indicated on the contract, followed by specific program name.

2. Service Category Enter the service category for which utilization is being reported

3. Client Code

Enter the client code exactly as it was generated from the e2Boston Data

System. If the client code varies from the e2Boston Data System, the client

codes will need to be corrected.

4. Unique Client

Identifier

Enter the UCI exactly as it was generated from the e2Boston Data System. If

UCI varies from the e2Boston Data System, UCIs will need to be

corrected.

5. Date Enter the date the service was provided. Do not include dates that fall in

future or past quarters on the Client Utilization Data Fiscal Backup.

6. Number of Units

Enter the number of units of service provided for each service code listed.

Each service unit must be recorded using whole or partial units of service as

defined in the Service Code Summary.

7. Unit of Service

Description Describe the service provided as indicated in the Service Code Summary.

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Adding Services & Subservices

Instructions First, select the service date. Some services, such as Rental Assistance, have special conditions listed for services that will appear on screen if you enter the date wrong. Next, choose the Service Category and Subservice Category for the service rendered. The Program and Contract forms will automatically fill in based on the date of service you input. After you hit the Add Service button, the Service Details screen will appear underneath the Add Services field. Provide the required details for the service and double check to make sure the information is correct. All Service Detail screens provide additional space to write Service Notes. You may use notes to include additional details about a visit or service for your own reference, or for BPHC to look at later. All service notes are saved in e2Boston and accessible in a client’s Service History.

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Outcome Measurement Report

The Outcome Measurement Report is used to quantify and track the health of each client served; it is a tool to evaluate the impact of services on key indicators of health and wellness among clients. Outcomes reporting will be based on a “Client Clock” model; outcomes are assessed for each 6-month period during which the client received services. This model allows each client to have their own custom reporting period, which begins when the client receives a service at a Part A funded agency. Outcomes Descriptions and Definitions Subrecipients should use their professional assessment skills when completing the outcomes reporting forms. While each level for each outcome is defined, please keep in mind the broader status level categories (i.e., in crisis, poor, fair/good, and excellent).

• Access to Support Network: Support Networks may include friends, family, religious groups, or other peer groups from which the client obtains emotional, social, spiritual, or material support.

• Adherence to HIV Medication: Select whether the client always (0 missed doses in the last week), frequently (1-2 missed doses in last week), sometimes (3-4 missed doses in last week) or rarely (>4 missed doses in last week) adheres to prescribed HIV-related medical therapies. Subrecipients can use the criteria that they use in practice to measure adherence. Do not answer this question if the client is not on ART.

• Case Management Status: Record whether the client is receiving HIV case management services (social or medical) at any agency.

• Care Adherence: HIV-related appointments include medical appointments, mental health appointments, psychosocial support, case management, and anything else related to care completion and/or support.

• CD-4 Count: Choose the level for the most recent test result in the reporting period that you have seen or that the client has reported.

• Housing Status: This outcome aims to understand a client’s stability in housing, regardless of type of housing.

• Mental Health Status: Use information gathered from clients during intakes, assessments and regular interactions to evaluate client’s mental health status. This measure is not to be used as a mental health diagnosis.

• Primary Medical Care Engagement: Record the month and year in which the client was last seen by his/ her HIV medical provider (the provider the client most commonly sees for their HIV medical care).

• Severity of Side Effects of HIV-Related Medications: This outcome measure aims to assess the client’s subjective experience of side effects from HIV medications. Wherever possible, this measure

should be based on the direct report of the client. Do not answer this question if the client is not on ART.

• Viral Load: Record the actual value for the most recent test result in the reporting period that you have seen or that the client reported.

Rules for Custom Reporting Periods

1) An outcome reporting period begins for a given client if the client receives a service at a given agency AND a clock for that reporting period is not already going.

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2) Once the outcomes reporting period begins, the provider has exactly 26 weeks (6 months) to complete an outcomes form corresponding to the client. After this 6-month period has elapsed, the provider may no longer submit a form corresponding to that reporting period for that client.

3) After the outcomes reporting period ends, regardless of whether a corresponding outcomes form was submitted, the “next” outcomes reporting period starts for a client on the first day that they receive a service after the end of the preceding outcomes reporting period.

4) If an outcomes form is completed for a given client at any time during a given outcomes reporting period, the clock does NOT reset. Rather, the clock continues to run for 6 months. After the 6-month period is over, the next service that the client receives at the agency starts a new clock.

Reports

1) All reports involving Outcomes data will pull data SUBMITTED during the date range given in the report unless otherwise specified.

2) The Outcomes Completion and Eligibility report will allow subrecipients to track clients that are in each of the 4 submission states, particularly “Eligible for Submission” and “Submission Required”. This report will also allow BPHC and subrecipients to track how many missed outcomes reports a provider or a given client has.

Outcomes Instructions & Submission Process

• Resources can be found in the e2Boston Resource Center.

• Outcomes will only be accepted electronically via e2Boston. Once an outcome report is missed, there is no way to submit the data to BPHC. It is better to submit an INCOMPLETE outcome report than to submit nothing at all. Contact Information For technical assistance, policy and/or reporting requirement information, please contact your BPHC program coordinator.

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Adding Outcomes to a Client Record

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Ryan White Services Report

ALL Ryan White funded subrecipients are required to complete the 2019 RSR, which covers the reporting

period from January 1, 2019 to December 31, 2019. For FY 2019, subrecipients will be required to use

e2Boston to generate the appropriate XML file for their client-level data. Only information for Part A clients

can be entered into e2Boston, so subrecipients that are funded under multiple Ryan White Parts will have to

rely on other systems to track their non-Part A clients.

There are three (3) components to the RSR:

• Recipient Report – to be completed by entities funded DIRECTLY by HRSA, including BPHC

as the Part A Recipient, DPH as the Part B Recipient, and all directly funded Part C and D providers.

• Service Provider Report – to be completed by ALL Ryan White funded subrecipients. This report

contains information about your agency and the services you provide under Ryan White.

• Client Report – to be completed by ALL Ryan White funded subrecipients. This report contains the

Client Level Data (CLD) and is submitted electronically in an XML format with encrypted client

identifiers.

More information, including instructions for completing the RSR and full Client Level Data compliance, is available at the following website: https://targethiv.org/library/topics/rsr.

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Service Descriptions & Subservice Definitions This section offers the user a description of each Boston EMA service category and the respective subservices. The service description or ‘HRSA Description’ is intended to outline allowable services under the service category. Some of the service descriptions include program guidance. This is guidance that is intended to help recipients and subrecipients implement the services as defined by legislation. The goal and objective for each service category succinctly outlines the overall purpose of the service. This section should be used to guide program managers and direct services workers on assessing allowable service delivery activity and reporting into e2Boston.

Core Medical Services

AIDS Drug Assistance Program HRSA Description: The AIDS Drug Assistance Program (ADAP) is a state-administered program authorized under RWHAP Part B to provide U.S. Food and Drug Administration (FDA)-approved medications to low-income clients living with HIV who have no coverage or limited health care coverage. HRSA RWHAP ADAP formularies must include at least one FDA approved medicine in each drug class of core antiretroviral medicines from the U.S. Department of Health and Human Services’ Clinical Guidelines for the Treatment of HIV. HRSA RWHAP ADAPs can also provide access to medications by using program funds to purchase health care coverage and through medication cost sharing for eligible clients. HRSA RWHAP ADAPs must assess and compare the aggregate cost of paying for the health care coverage versus paying for the full cost of medications to ensure that purchasing health care coverage is cost effective in the aggregate. HRSA RWHAP ADAPs may use a limited amount of program funds for activities that enhance access to, adherence to, and monitoring of antiretroviral therapy with prior approval. Program Guidance:

• HRSA RWHAP Parts A, C and D recipients may contribute RWHAP funds to the RWHAP Part B

ADAP for the purchase of medication and/or health care coverage and medication cost sharing for

ADAP-eligible clients.

• See PCN 07-03: The Use of Ryan White HIV Program, Part B AIDS Drug Assistance Program

(ADAP) Funds for Access, Adherence, and Monitoring Services

• See PCN 18-01: Clarifications Regarding the use of Ryan White HIV Program Funds for Health

Care Coverage Premium and Cost Sharing Assistance

• See also AIDS Pharmaceutical Assistance and Emergency Financial Assistance Goal: The goal of the ADAP service category is to ensure that all PLWH have access to and are able to adhere to HIV and other prescribed medical regimens. Objective: The objective of this service category is to ease the financial burden of medical costs for PLWH by providing financial assistance for prescription medication.

Subservice Definition

Prescription

Prescription medication claim reimbursed by ADAP. Claim must include drug name, quantity, and amount paid by Part A. One Unit = One Claim

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Medical Case Management

HRSA Description:

Medical Case Management is the provision of a range of client-centered activities focused on improving health

outcomes in support of the HIV care continuum. Activities provided under this service category may be

provided by an interdisciplinary team that includes other specialty care providers. Medical Case Management

includes all types of case management encounters (e.g., face-to-face, phone contact, and any other forms of

communication).

Key activities include:

• Initial assessment of service needs

• Development of a comprehensive, individualized care plan

• Timely and coordinated access to medically appropriate levels of health and support services and

continuity of care

• Continuous client monitoring to assess the efficacy of the care plan

• Re-evaluation of the care plan at least every 6 months with adaptations as necessary

• Ongoing assessment of the client’s and other key family members’ needs and personal support

systems

• Treatment adherence counseling to ensure readiness for and adherence to complex HIV treatments

• Client-specific advocacy and/or review of utilization of services

In addition to providing the medically oriented activities above, Medical Case Management may also provide

benefits counseling by assisting eligible clients in obtaining access to other public and private programs for

which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs,

Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive

services, and insurance plans through the health insurance Marketplaces/Exchanges).

Program Guidance:

• Activities provided under the Medical Case Management service category have as their objective

improving health care outcomes whereas those provided under the Non-Medical Case Management

service category have as their objective providing guidance and assistance in improving access to

needed services.

• Visits to ensure readiness for, and adherence to, complex HIV treatments shall be considered

Medical Case Management. Treatment Adherence services provided during a Medical Case

Management visit should be reported in the Medical Case Management service category.

Goal: The goal of Medical Case Management is to engage clients who face significant challenges to enter and

maintain treatment for their HIV.

Objectives: The objective of Medical Case Management is to improve health care outcomes for PLWH.

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Subservice Definition

Initial Intake, Started Enter one (1) when initial intake begins.

Assessment, Completed Enter one (1) when assessment is completed.

Visit, General A face-to-face session between provider and client where case

management services are provided. One Unit = One Hour.

Visit, Home-Based

A face-to-face session between provider and client where case

management services are provided in a non-office-based setting,

including but not limited to residential settings. One Unit = One Hour.

Phone, Follow-up Enter one (1) for each non-initial telephone encounter that provides

client-centered assistance. One Unit = One Phone Call.

Reassessment/Follow-up

Service Plan, Completed Enter one (1) when reassessment/follow-up service plan is completed.

Supported Referral

Enter (1) for each active process of connecting a client to any necessary HIV-related or supportive service (i.e. calling and making an appointment with a client, making an appointment on a client’s behalf, etc.).

Client Communication Enter one (1) for each correspondence or interaction that provides client-centered assistance, excluding phone calls, voicemails, and face-to-face sessions. One Unit = One Correspondence.

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Medical Nutrition Therapy HRSA Description: Medical Nutrition Therapy includes:

• Nutrition assessment and screening

• Dietary/nutritional evaluation

• Food and/or nutritional supplements per medical provider’s recommendation

• Nutrition education and/or counseling

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

• All activities performed under this service category must be pursuant to a medical provider’s referral

and based on a nutritional plan developed by the registered dietitian or other licensed nutrition

professional. Activities not provided by a registered/licensed dietician should be considered

Psychosocial Support Services under the HRSA RWHAP.

• See also Foodbank/Home Delivered Meals

Goal: The goal of this service category is to optimize immunity, reduce weight loss and nutritional deficiencies, and improve the overall wellbeing for PLWH. Objective: The objective of this service category is to identify and treat nutritional deficiencies in PLWH through the provision of medical nutrition therapy which includes nutritional counseling and the prescription of dietary regimens by a physician or licensed nutritionist or registered dietician.

Subservice Definition

Home Delivered Food Number of meals/foods delivered by a professional to the

home for clients and families who are incapacitated by HIV.

Meal, Congregate Number of meals provided in a group setting that is not the

client’s home.

Assessment, Nutritional Enter one (1) when nutritional assessment is completed.

Visit, General Nutritional Counseling

A non-initial face-to-face session between counselor and client

where nutritional support services are provided. One

Unit = One Hour.

Food Bank Package Withdrawal from food bank. Enter one (1) per can or package.

Nutritional Supplement Enter one (1) per can or similar package.

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Oral Health Care HRSA Description: Oral Health Care activities include outpatient diagnosis, prevention, and therapy provided by dental health care professionals, including general dental practitioners, dental specialists, dental hygienists, and licensed dental assistants. Goal: The goal of the Oral Health service category is to prevent and control oral and craniofacial diseases, conditions, and injuries, and improve access to preventive services and dental care for eligible PLWH. Objective: The oral health category aims to increase awareness of the importance of oral health to overall health and well-being, increase the acceptance and adoption of effective preventive interventions and reduce disparities in access to effective preventive and dental treatment services. (Healthy People 2020).

Subservice Definition

Initial Intake, Started Enter one (1) when the initial intake begins.

Treatment Committed Enter one (1) when the treatment approval is made.

Treatment Claim Enter one (1) when the claim is completed.

Phone, Follow-up

Enter one (1) for any non-initial telephone encounter which provides client-centered assistance. Phone calls should be reported only when successful contact is made; messages left should not be reported. One Unit = One Phone Call.

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Support Services

Emergency Financial Assistance HRSA Description: Emergency Financial Assistance 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.

• Continuous provision of an allowable service to a client must not be funded through

Emergency Financial Assistance.

Goal: Emergency Financial Assistance (EFA) helps meet basic needs for low income, vulnerable people living with HIV. Needs include, but are not limited to, cost of medication, housing, utilities, food, or transportation. Objective: Agencies funded for EFA will assess client’s emergency needs related to food security, housing, utilities, transportation and cost of medication, as well as provide appropriate assistance.

Subservice Definition

EFA Voucher

Enter (1) when a payment to an agency is made on behalf of a client or when a voucher is given to a client. Mark the box that best describes the type payment or voucher distributed:

• Housing – Direct Payment to an agency to promote housing stabilization.

• Utility – Direct Payment to an agency of a phone, sewer, water, heating, cooling or electricity expense.

• Food – The distribution of a food voucher.

• Medical Cost – The Direct Payment to an agency or the distribution of medication not covered by ADAP or RWHAP cost.

• Other – The Direct Payment to an agency or distribution of a voucher for a qualifying circumstance, which is described in the scopes of services or approved by a contract manager.

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Food Bank & Home Delivered Meals HRSA Description: Food Bank/Home Delivered Meals refers to the provision of actual food items, hot meals, or a voucher program to purchase food. This also includes the provision of essential non-food items that are limited to the following:

• Personal hygiene products

• Household cleaning supplies

• Water filtration/purification systems in communities where issues of water safety exist

Program Guidance:

• Unallowable costs include household appliances, pet foods, and other non-essential products.

• See Medical Nutrition Therapy. Nutritional services and nutritional supplements provided by a

registered dietitian are considered a core medical service under the HRSA RWHAP.

Goal: The goal of this service category is to prevent hunger and malnutrition among PLWH. Objective: The objective of this service category is to improve access to food sources and to improve nutrition for PLWH with identified food security needs.

Subservice Definition

Home Delivered Food Number of meals/foods delivered by a professional to the home for

clients and families who are incapacitated by HIV.

Meal, Congregate Number of meals provided in a group setting that is not the

client’s home.

Assessment, Nutritional Enter one (1) when nutritional assessment is completed.

Visit, General Nutritional Counseling

A non-initial face-to-face session between counselor and client where

nutritional support services are provided. One

Unit = One Hour.

Food Bank Package Withdrawal from food bank. Enter one (1) per can or package.

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Health Education & Risk Reduction HRSA Description: Health Education/Risk Reduction is the provision of education to clients living with HIV about HIV transmission and how to reduce the risk of HIV transmission. It includes sharing information about medical and psychosocial support services and counseling with clients to improve their health status. Topics covered may include:

• Education on risk reduction strategies to reduce transmission such as pre-exposure prophylaxis

(PrEP) for clients’ partners and treatment as prevention

• Up-to-date health promotions campaigns (i.e. U=U)

• Education on health care coverage options (e.g., qualified health plans through the Marketplace,

Medicaid coverage, Medicare coverage)

• Health literacy

• Treatment adherence education

Program Guidance:

• Health Education/Risk Reduction services cannot be delivered anonymously.

Goal: The goal of this service category is to reduce the risk of HIV transmission. Objective: Agencies will provide education on various topics related to reducing the risk of transmission, as well as identify resources in the community that complement and support risk reduction.

Subservice Definition

Health Education, Group

A time-based unit is entered after the completion of health

education & risk reduction group of three or more participants.

One (1) is equivalent to one hour.

Health Education, Individual

A time-based unit is entered after the completion of health

education & risk reduction face-to-face encounter. One (1) is

equivalent to one hour.

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Housing HRSA Description: 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. 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. Program Guidance:

• HRSA RWHAP recipients and subrecipients that use funds to provide Housing must have

mechanisms in place to assess and document the housing status and housing service needs of new

clients, and at least annually for existing clients.

• HRSA RWHAP recipients and subrecipients, along with local decision-making planning bodies, are

strongly encouraged to institute duration limits to housing activities. HRSA HAB recommends

recipients and subrecipients align duration limits with those definitions used by other housing

programs, such as those administered by the Department of Housing and Urban Development,

which currently uses 24 months for transitional housing.

• Housing activities cannot be in the form of direct cash payments to clients and cannot be used for

mortgage payments or rental deposits, although these may be allowable costs under the HUD

Housing Opportunities for Persons with AIDS grant awards.

Goal: The goal of Housing services is to assist a client to gain or maintain medical care by reducing the barriers to permanent shelter and provide linkages to permanent housing. Objective: Eligible clients will receive assistance in the form of individual sessions with a housing search advocate, or in the form of financial assistance within the parameters listed below.

Note: The following subservices are for both ‘Housing-Rental Assistance’ and ‘Housing-Search & Advocacy’.

Subservice Definition

Visit, Initial First face-to-face session between provider and client where

housing services are provided. One Unit = One Hour.

Visit, Follow-up Any non-initial session between provider and client where housing services are provided. One Unit = One Hour.

Phone, Follow-up Enter one (1) for each telephone encounter that provides

client- centered assistance. One Unit = One Phone Call.

Placement, Temporary Enter one (1) when temporary placement is made.

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Subservice Definition

Placement, Permanent Enter one (1) when permanent placement is made.

Assessment, Completed Enter one (1) when assessment is completed.

Supported Referral

Enter (1) for each active process of connecting a client to any

necessary HIV-related or supportive service (i.e. calling and

making an appointment with a client, making an appointment

on a client’s behalf, etc.)

Housing Support, Group Face-to-face session between an eligible provider and the client participating in a group session with three or more individuals. One Unit = One Hour.

Homelessness Prevention Enter one (1) for each unit (month of payment) of

Homelessness Prevention delivered.

Rental Start Up Enter amount provided for first month, last month, or both

time periods.

Application Processed Enter one (1) for each Rental Assistance application reviewed.

Application Rejected Enter one (1) for each Rental Assistance application rejected or

denied.

Client Communication

Enter one (1) for each correspondence or interaction that

provides client-centered assistance, excluding phone calls,

voicemails, and face-to-face sessions. One Unit = One

Correspondence.

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Medical Transportation HRSA Description: Medical Transportation is the provision of nonemergency transportation that enables an eligible client to access or be retained in core medical and support services. Program Guidance: Medical transportation may be provided through:

• Contracts with providers of transportation services

• Mileage reimbursement (through a non-cash system) that enables clients to travel to needed medical

or other support services, but should not in any case exceed the established rates for federal

Programs (Federal Travel Regulations provide further guidance on this subject)

• Purchase or lease of organizational vehicles for client transportation programs, provided the

recipient receives prior approval for the purchase of a vehicle

• Organization and use of volunteer drivers (through programs with insurance and other liability

issues specifically addressed)

• Voucher or token systems

• Costs for transportation for medical providers to provide care should be categorized under the

service category for the service being provided.

Unallowable costs include:

• Direct cash payments or cash reimbursements to clients

• Direct maintenance expenses (tires, repairs, etc.) of a privately-owned vehicle

• Any other costs associated with a privately-owned vehicle such as lease, loan payments, insurance,

license, or registration fees.

Goal: The goal of this service category is to maintain clients connected to core and support services that contribute to positive health outcomes. Objective: The objective of this service category is to provide allowable transportation resources to eligible clients who otherwise could not access the core and support services needed to meet medical needs and support needs.

Subservice Definition

One-way Ride, Public

Enter one (1) for each one-way transportation by public transport

system (subway or bus passes) for client to access healthcare or

support services.

One-way Ride, Taxi/ Transportation Company

Enter one (1) for each one-way transportation by taxi or other transportation services for a client to access healthcare or support services.

One-way Ride, Van Enter one (1) for each one-way transportation by a funded agency

vehicle for client to access healthcare or support services.

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One-Way Ride, Volunteer Enter one (1) for each one-way transportation by a volunteer for client

to access healthcare or support services.

Non-Medical Case Management HRSA Description: Non-Medical Case Management Services (NMCM) is the provision of a range of client-centered activities focused on improving access to and retention in needed core medical and support services. NMCM provides coordination, guidance, and assistance in accessing medical, social, community, legal, financial, employment, vocational, and/or other needed services. NMCM Services may also include assisting eligible clients to obtain access to other public and private programs for which they may be eligible, such as Medicaid, Children’s Health Insurance Program, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, Department of Labor or Education-funded services, other state or local health care and supportive services, or private health care coverage plans. NMCM Services include all types of case management encounters (e.g., face-to- face, telehealth, phone contact, and any other forms of communication). Key activities include:

• Initial assessment of service needs

• Development of a comprehensive, individualized care plan

• Timely and coordinated access to medically appropriate levels of health and support services and

continuity of care

• Client-specific advocacy and/or review of utilization of services

• Continuous client monitoring to assess the efficacy of the care plan

• Re-evaluation of the care plan at least every 6 months with adaptations as necessary

• Ongoing assessment of the client’s and other key family members’ needs and personal support

systems

Program Guidance:

• NMCM Services have as their objective providing coordination, guidance, and assistance in

improving access to and retention in needed medical and support services to mitigate and eliminate

barriers to HIV care services, whereas Medical Case Management Services have as their objective

improving health care outcomes.

Goal: The goal of non-medical case management services is to enhance access to and retention in essential medical and social support services for PLWH. Objective: The objective of Non-Medical Case Management is to assess a client's needs and develop an Individual Service Plan that provides guidance and assistance in improving access to needed services. (National Monitoring Standards, 2013)

Subservice Definition

Initial Intake, Started Enter one (1) when initial intake begins.

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Subservice Definition

Assessment, Completed Enter one (1) when assessment is completed.

Visit, General A face-to-face session between provider and client where case

management services are provided. One Unit = One Hour.

Visit, Home-Based

A face-to-face session between provider and client where case

management services are provided in a non-office-based setting,

including but not limited to residential settings. One Unit = One Hour.

Phone, Follow-up Enter one (1) for each non-initial telephone encounter which provides

client-centered assistance. One Unit = One Phone Call.

Reassessment/Follow-up

Service Plan, Completed Enter one (1) when reassessment/follow-up service plan is completed.

Supported Referral

Enter (1) for each active process of connecting a client to any necessary

HIV-related or supportive service (i.e. calling and making an

appointment with a client, making an appointment on a client’s behalf,

etc.).

Client Communication Enter one (1) for each correspondence or interaction that provides

client-centered assistance, excluding phone calls, voicemails, and face-to-

face sessions. One Unit = One Correspondence.

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Psychosocial Support HRSA Description: Psychosocial Support Services provide group or individual support and counseling services to assist HRSA RWHAP-eligible PLWH to address behavioral and physical health concerns. Activities provided under the Psychosocial Support Services may include:

• Bereavement counseling

• Child abuse and neglect counseling

• HIV support groups

• Nutrition counseling provided by a non-registered dietitian (see Medical Nutrition Therapy Services)

• Pastoral care/counseling services

Program Guidance:

• Funds under this service category may not be used to provide nutritional supplements (See Food

Bank/Home Delivered Meals).

• HRSA RWHAP-funded pastoral counseling must be available to all eligible clients regardless of their

religious denominational affiliation.

• HRSA RWHAP Funds may not be used for social/recreational activities or to pay for a client’s gym

membership.

Goal: Psychosocial support services will decrease isolation for PLWH and support people living with HIV wellbeing. Objective: Through one-on-one interactions and in small groups, psychosocial support promotes clients’ engagement in health care and emotional support in a respectful setting. Subrecipients of psychosocial support assists in the development of coping skills, reduce feelings of social isolation, and increase self-determination and self-advocacy, helping improve quality of life for participants.

Subservice Definition

Support Session, Group A regularly scheduled HIV support counseling meeting for three

or more people affected by HIV. One Group Unit = One Hour.

Support Session, Individual Any face-to-face counseling session between staff and a person

affected by HIV. One Unit = One Hour.

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Substance Use Residential Services HRSA Description: 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 programs

• 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.

Goal: The goal of this service category is to allow clients coinfected with substance use disorder and HIV to access low threshold services in a residential setting which will stabilize acute substance use needs and contribute to HIV viral suppression. Objective: To provide services in a residential setting that has the appropriate state license and accreditation, as well as properly trained and licensed staff, to address a client’s substance use disorder. Residential services can include pretreatment, harm reduction, counseling, relapse prevention, medication-assisted therapy, and detoxification where appropriate.

Subservice Definition

Residential Recovery Services

Enter one (1) for a provision of services to a client enrolled in a residential substance use program for one day (1 unit is at least 8 to 24 hours).

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Fiscal Reporting Rules FY 2019 All Part A contracted subrecipients are expected to expend 100% of their award in accordance with all federal, local, and BPHC policies. The Recipient will only pay Subrecipients for deliverables that have been mutually agreed on (see Scope of Services and Budget) and upon receipt of appropriate invoices and back-up documentation. If the Subrecipient wishes to revise the Scope of Services or allowable costs, they must submit a proposal to revise the Scope and/or Budget. Failure to meet these expectations may result in suspension or termination of your contract. A. Invoicing General Information

1) A standard invoice including the approved budget must be submitted. Part A payments are based on the approved budget. Invoices must be formatted by computer; handwritten invoices or line items are not acceptable. Only line item budgeted expenses are paid.

2) All contracts must have their invoices signed by a program representative or a contract specialist

before submission to the Part A program.

3) Invoices are submitted monthly, within 30 days of the month's end. Each day thereafter will be considered late, therefore non-compliant. The final invoice is to be submitted by April 15, 2020.

4) Invoices must represent actual monthly expenses. Invoices without the required information or

documentation (including required data and reports) will not be processed. Instead, the Subrecipient will be informed of the deficiency to be corrected, and the invoice will be held for five business days. If the Subrecipient does not correct the invoice after five business days, only the properly documented portion of the invoice will be paid. The Recipient will not pay for the improperly documented portion of the invoice until the deficiency is corrected.

5) If no contracted activities occurred in a given month and there are no reimbursable costs, it is not

necessary to submit an invoice. Inform BPHC in writing that there will be no invoice for the month.

6) Any revised or supplemental invoices are to be clearly labeled as such by including the word “Revised” or “Supplemental” within the “Invoice Number” notation. Retroactive billing may only occur when the expense is not billed to another funding source. Documentation of bills to other funding sources may be required.

7) Monthly invoices containing all required information will be paid within 30 days of receipt.

Invoices are sent to:

IDBinvoices@bphc.org

If electronic submission is impossible, paper invoices may be sent to:

Infectious Disease Bureau Attention: Fiscal Office

Boston Public Health Commission 1010 Massachusetts Ave, 2nd Floor

Boston, MA 02118

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Personnel Expense and Other Direct Care Cost Invoicing

1) Appropriate supporting documents for monthly staff expenses invoices include:

a. Payroll registers and labor distribution reports b. Copies of vendor invoices c. Cancelled checks d. Copies of reimbursement/voucher forms

2) The budget on the invoice must illustrate the approved contract budget. Actual monthly payroll

expenses incurred are billed on the invoice. Subrecipients may not accrue payroll expenses not yet incurred. The year-to-date amounts in the “Cumulative” billing column must be correct. Also, the salaries and FTEs which are billed must correspond to the approved contract budget.

3) The fringe rate must be the internally audited fringe rate. Verification of this rate is subject to audit. (Fringe is defined as government mandated and employer selected employee benefits including: Social Security, unemployment, workers’ and disability compensation, retirement programs, and health insurance).

4) The following is required for any invoices submitted for the purchase of client related travel, meals/food, and other client consumables in below line items on any program budget:

a. Itemized receipts must include the merchant or provider name, service received, or specific item purchased, date of service and amount of expense.

b. Itemized list indicating the client codes of those receiving the service and service utilization information (i.e., the dates and quantity of service provided to each client).

These are required at the time of billing for all (but not limited to) the following line items:

• Bus and subway fare

• Commuter rail

• Contracted services rides • Food provided with client activities (e.g., Psychosocial Support group meals) • The Ride tickets • Taxi vouchers

• Volunteer mileage Sample of itemized list for transportation and housing assistance:

Client Code/

UCI Date Unit of Service Amount Vendor

MAR0609547899/ RSCR0609542

03/03/19 Rental Start Up $300 Century 21

MAR0609547899/ RSCR0609542

03/10/19 One-Way Taxi to

Medical Appointment $22.50 Boston Taxi

Please note: RW funds cannot be paid directly to clients. Housing Rental Assistance may not be used for mortgage payments, or rental security deposits. The itemized lists for Transportation must include to and from location and the purpose of the trip.

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5) Contracts can only include an “Indirect” line item (capped at 10%) if the subrecipient has a certified

HHS-negotiated indirect cost rate using the Certification of Cost Allocation Plan or Certification of Indirect Costs, or if the subrecipient has never before had a negotiated indirect cost rate, the subrecipient may utilize the de minimis rate of 10% or less. In all circumstances, the subrecipient must adhere to a 10% cap on administrative expenses, which may include but are not limited to indirect costs. Administrative expenses must be clearly itemized on budgets.

6) Vehicle mileage is reimbursed at a per mile rate not to exceed the Internal Revenue Service’s standard mileage rate, which is currently $0.58 per mile.

Unit-Rate Invoicing

1) Unit-rate billing uses the non-personnel expense portion of the standard Part A invoice (bottom half).

2) Unit-rate billing documentation differs from personnel expense billing in that service utilization data

serves as the fiscal backup documentation for units billed. Billing backup can be a direct print out from the e2Boston data system or prepared as shown in the example below.

Client Code/UCI Date Unit of Service # of units Rate Total

MAR0609547899/ RSCR0609542

03/03/19 Residential Recovery

Services (RRS—Bed Day) 29 $75 $2,175

B. Fiscal Compliance

1) Under the Ryan White HIV/AIDS Treatment Modernization Act of 2009, there are significant penalties to the EMA if there are unexpended dollars at the end of the fiscal year. Therefore, all programs are expected to expend 100% of their contracted award. Contract expenses, as shown on invoices, are reviewed each quarter of the fiscal year. The Subrecipient is informed after the first quarter, in writing, of any under billing. Any contract under billed through the second quarter may be reduced. If the under billing is due to a late start, the contract is reduced by the amount of the unspent funds to date. If the under billing is chronic, the contract is reduced by both the unspent funds and the projected under spending to year-end. These unexpended funds are then reallocated to other subrecipient contracts in accordance with the Ryan White Planning Council’s service priorities. Reallocations within individual categories and the resulting contract revisions do not require Planning Council approval.

2) The Subrecipient may be held in non-compliance at the end of each month if they do not meet the invoicing requirements. This includes non-submission of invoices, or late invoices. The Recipient will only pay for those expenses that are properly presented and documented. Non-compliance shall be lifted as soon as all submissions are complete.

3) Contract spending may vary by up to 25% monthly within a budget line item as long as the total amount billed does not exceed the budget’s maximum obligation for the fiscal year. For example, if you are projected to bill a monthly salary of $500 (annual salary of $6,000), you may spend $625

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within that line per month (therefore, cannot exceed $7500 annually) with sufficient back-up. For other direct care cost, e.g. if you are budgeted for a $1,000 office supply line for the year, you may spend up to $1,250 within that line (you may bill this in one month or it may be divided among several months). Overspending will not be paid.

4) Contract funding for a Part A fiscal year may not be used in a subsequent fiscal year. Fiscal years are discrete; the funding is separate and is not “carried over.” This does not prevent the purchasing of supplies during one fiscal year that may be used in the current fiscal year and subsequent fiscal years.

C. Audits Subrecipients must perform a single audit of their financial records as described in the 45 CFR Part 75 Subpart F if they expend $750,000 or more in federal funding in a fiscal year. For subrecipients that expend less than $750,000 in federal funding for the fiscal year, the subrecipient is exempt from Federal Audit requirement for that year, but records must be available for review or audit by official of HRSA, BPHC, and Government Accountability Office (GAO). When completed, this audit must be sent to:

grants@bphc.org

If electronic submission is impossible, paper audits may be sent to:

Post-Award Grants Manager

Boston Public Health Commission 1010 Massachusetts Ave, 6th Floor

Boston, MA 02118 In addition, this audit and all required fiscal records must be available at the program location for review during the on-site financial review. D. Budget Revisions

1) Budget changes may be noted on subsequent invoices when cumulative transfers among direct cost budget categories for the current budget period do not exceed 25 percent of the total approved budget (which includes direct and indirect costs, whether chargeable to Federal funds or required matching or cost sharing) for that budget period or $250,000, whichever is less.

2) Budget changes more than 25% of cumulative costs or more than $250,000 must follow the procedure below. A revised budget request in the same format as the contract budget and accompanied by line item explanations of proposed revisions is required. If the budget revision does not match the most up to date contract budget, it will be returned to the agency. Complete instructions are available under the budget revision section of the manual.

• Agency requests to revise contract budgets are sent via email to kkeating@bphc.org or mailed to: o Katie Keating, Director, Ryan White Services Division , Boston Public

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Health Commission, 1010 Massachusetts Ave, 2nd Floor, Boston, MA 02118

• Budget revision requests must include the following: (1) a letter with a detailed explanation for making the proposed revision; (2) a current budget with the proposed changes made in the same format; and (3) a detailed line item budget explanation attached.

• Generally, appropriate requests are those which propose using different means to accomplish the specific program features which were approved and detailed in the original Scope of Services. In general, adding new line items is not an acceptable request.

• Budget revisions will be accepted until February 15, 2020. Revisions submitted after this deadline will only be considered to fill vacant positions, and for legal name and position title changes.

• Initial appeals of denied budget revision requests are made, in writing, to Katie Keating, Director, Ryan White Services Division . Further appeals may be submitted, in writing, to the Director of Administration and Finance, Grace Connolly (gconnolly@bphc.org).

E. Additional Funding Restrictions

1) Grant funds may not be used to supplant or replace current state or local HIV-related funding.

2) Funds may not be used to purchase or improve land or to purchase, construct, or make permanent improvement to any building except for minor remodeling.

3) Funds may not be used to make cash payments to clients.

4) Recipients of grant funds must participate in a community-based continuum of care. A continuum

of care is defined as:

A comprehensive continuum of care includes primary medical care for the treatment of HIV infection that is consistent with Public Health Service guidelines. Such care must include access to antiretrovirals and other drug therapies, including prophylaxis and treatment of opportunistic infections as well as combination antiretroviral therapies. Comprehensive HIV care also must include access to substance-abuse treatment, mental health treatment, oral health, and home health or hospice services. In addition, this continuum of care should include supportive services that enable individuals to access and remain in primary medical care as well as other health or supportive services that promote health and enhance quality of life.

5) The aggregate total of Part A subrecipients’ administrative expenditures shall not exceed 10% of the aggregate total of Part A funds awarded to the subrecipients (without regard to whether any of these Subcontractors expend more or less than 10 percent for such expenses). For the purposes of the 10% aggregate cost cap, administrative activities include:

• Usual and recognized overhead activities, including rent, utilities, and facility costs.

• Costs of management oversight of specific programs funded under this title, including

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program coordination; clerical, financial, and management staff not directly related to patient care; program evaluation; liability insurance; audits; and computer hardware/software not directly related to patient care.

6) If a service is available under the state Medicaid Plan, the political subdivision involved must either

provide the service directly or must enter into an agreement with a public or private entity to provide the service. The Subrecipient providing the service must enter into a participation agreement under the state Medicaid Plan and must be qualified to receive payment under the state Medicaid Plan.

7) Funds may not be used to provide items or services for which payment already has been made, or

reasonably can be expected to be made, by third-party payers, including Medicaid, Medicare, and/or other state or local entitlement programs, prepaid health plans, or private insurance. It is therefore incumbent upon subrecipients of Part A funds to assure that eligible individuals are expeditiously enrolled in Medicaid and that Part A funds are not used to pay for any Medicaid-covered services for Medicaid-eligible PLWH. Part A subrecipients are subject to audit on this and other restrictions on use of funds.

8) If the Part A Subrecipient charges for services, it must do so on a sliding-fee schedule that is made available to the public. Individual annual aggregate charges to clients receiving Part A services must conform to statutory limitations. The intent is to establish a cap on charges to Part A services recipients.

9) Establishing a fee schedule should not result in a bureaucratic system to means-test individuals or families before Part A-supported services are provided. A simple application that requests information on the annual gross salary of the individual/family should provide the baseline by which the caps on fees will be established.

Individual & Family Annual Gross Income and Total Allowable Annual Chargers

Individual/Family Annual Gross Income Total Allowable Annual Charges

Equal to or below the official poverty line No charges permitted

101 to 200 percent above the official poverty line 5% or less of gross income

201 to 300 percent above the official poverty line 7% or less of gross income

More than 300 percent above the official poverty line 10% or less of gross income

10) Funds are to be used in a manner consistent with current and future program policies developed

for Part A regarding allowable categories of services and eligibility for services. Please review all current HRSA/HAB and BPHC program policies.

11) Funds may not be used for outreach programs which have HIV prevention education as their

exclusive purpose or broad-scope awareness activities about HIV services that target the general public.

Sample invoices can be found on the following pages.

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Sample of Expense Invoice (Admin Cost Cap)

Company Name: Category: ENTER CATEGORY HERE

Address: ENTER AGENCY ADDRESS HERE

Remit to Address:

ENTER AGENCY ADDRESS HERE

Date: ENTER DATE

Boston Public Health Commission PO# Agency Invoice #: RW29

Billing Period: Activity#: 3496002

Bill To: Boston Public Health Commission Ship To: Accounts Payable

Attn: Account Payable 1010 Massachusetts Ave. 6th Floor

1010 Massachusetts Avenue Boston, MA 02118

Boston, MA 02118

Amount this Cumulative Remaining

DIRECT CARE STAFF FTE Budget Invoice Billing Balance

(A) (B) (C) (D)

Program Director 0.00 $0 $0 $0 $0

Medical Case Manager 0.00 $0 $0 $0 $0

Medical Case Manager 0.00 $0 $0 $0 $0

$0 $0 $0 $0

Sub-total 0.00 $0 $0 $0 $0

Fringe 30.00% $0 $0 $0 $0

Personnel Totals $0 $0 $0 $0

OTHER DIRECT CARE COST

Local Travel $0 $0 $0 $0

Staff Training $0 $0 $0 $0

Program Supplies $0 $0 $0 $0

$0 $0 $0 $0

Sub-total $0 $0 $0 $0

DIRECT CARE TOTAL $0 $0 $0 $0

HHS Indirect Approved Rate

Ryan White Indirect Rate Cap 10% $0 $0 $0 $0

HHS INDIRECT APPROVED RATE COST TOTAL (10% Cap) $0 $0 $0 $0

TOTALS EXPENSE $0 $0 $0 $0

M ONTH TOTAL

$0 FOR INFECTIOUS DISEASE BUREAU USE ONLY

I certify that the actual bills and payroll documentation attached USE APPROVED FOR PAYM ENT

are expenditures solely associated with Ryan White Part A contracts AMOUNT:

ACTIVITY:

Please sign in blue ink. PO #:

Program Director/Financial Authorization

DATE:

Prepared by (Please print): ___________________________ Phone: _______________________

Contact Name & phone Number: SIGN:

Email:

Please Pay This Amount

3496002

BPHC Funding Source ExampleCost Reimbursement M onthly Invoice

MUST WRITE OUT COMPLETE NAME OF AGENCY

[Insert M ONTH & CATEGORY abbrev.]

Enter new PO#

Enter Billing Period

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Sample of Expense Invoice (Indirect Rate)

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Sample of Unit Rate Expense Reimbursement

Company Name: Category: ENTER CATEGORY HERE

Address: ENTER AGENCY ADDRESS HERE

Remit to Address:

ENTER AGENCY ADDRESS HERE

Date: ENTER DATE

Boston Public Health Commission PO# Agency Invoice #: RW29

Billing Period: Activity#: 3496002

Bill To: Boston Public Health Commission Ship To: Accounts Payable

Attn: Account Payable 1010 Massachusetts Ave. 6th Floor

1010 Massachusetts Avenue Boston, MA 02118

Boston, MA 02118

Amount this Cumulative Remaining

DIRECT CARE COST RATE Budget Invoice Billing Balance

(A) (B) (C) (D)

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

Sub-total 0.00 $0 $0 $0 $0

Fringe 30.00% $0 $0 $0 $0

Personnel Totals $0 $0 $0 $0

OTHER DIRECT CARE COST

RRS-Bed Day @ $100.08 150 units $0 $0 $0 $0

TSS-Bed Day @131.04 400 units $0 $0 $0 $0

$0 $0 $0 $0

$0 $0 $0 $0

Sub-total $0 $0 $0 $0

DIRECT CARE TOTAL $0 $0 $0 $0

ADM INISTRATIVE COST (10% Cap)

$0 $0 $0 $0

$0 $0 $0 $0

ADM INISTRATIVE COST TOTAL 10.00% $0 $0 $0 $0

TOTALS EXPENSE $0 $0 $0 $0

M ONTH TOTAL

$0 FOR INFECTIOUS DISEASE BUREAU USE ONLY

I certify that the actual bills and payroll documentation attached USE APPROVED FOR PAYM ENT

are expenditures solely associated with Ryan White Part A contracts AMOUNT:

ACTIVITY:

Please sign in blue ink. PO #:

Program Director/Financial Authorization

DATE:

Prepared by (Please print): ___________________________ Phone: _______________________

Contact Name & phone Number: SIGN:

Email:

Please Pay This Amount

3496002

BPHC Funding Source ExampleUnit Rate M onthly Invoice

MUST WRITE OUT COMPLETE NAME OF AGENCY

[Insert M ONTH & CATEGORY abbrev.]

Enter new PO#

Enter Billing Period

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Budget Terms Budgets cover a twelve-month period and are presented in whole dollars (no cents).

Payment of Expenses

• The Core/Support Service Direct Cost column indicates the position title.

• The Personnel column indicates the name of the staff person occupying the position with staff first initial and last name (e.g., J. Smith) for the purpose of verifying expenses. Changes in personnel do NOT require a budget revision. However, information regarding new staff including a CV should be sent to the Ryan White Services Division, Fiscal Program Manager. Enter TBD if the position is currently vacant. Program administration positions are funded, but only if their primary focus is the proposed service. Ryan White direct services dollars are not to be used to pay for Subrecipient’s administration.

• The Salary column reflects a Full Time Equivalent (1 FTE total) salary.

• The FTE column is the percentage of time (carried to no more than two decimals) that the position listed is paid for by Ryan White Part A funding. To meet audit requirements, employees cannot exceed a total FTE of 1.0 across all funding sources.

• The Months column is number of months the position listed will be occupied in the contracted period.

• The Annual column is the total salary amount that will be paid by Ryan White Part A in a twelve-

month budget period for the listed position based on the given FTE and Months. Annual = (FTE

x Months x Salary)/12

• The Fringe rate must be the agency’s internal audited fringe rate, with a maximum of 53.50%. Verification of this rate is subject to audit. Fringe is defined as: government mandated and employer selected employee benefits including social security, unemployment, workers and disability compensation, retirement programs, and health insurance.

• Non-personnel, expense line item titles should be specific (e.g., Food, Office Supplies, Staff

Training) and listed under the Other Direct Costs column.

• The HHS Indirect Approved Rate line item is capped at 10%. Subrecipients who wish to use an indirect rate, must provide documentation of Certificate of Indirect Costs that is HHS-negotiated, signed by an individual authorized to sign on behalf of the Subrecipient. Any other Federal or State agency that has conducted and issued an audit report of the Subrecipient’s indirect cost rate that has been developed in accordance with the requirements of the cost principles contained in 48 CFR part 31 will also be accepted. Please note, the 10% de minimis rate may be used if the Subrecipient has never had a negotiated rate.

• The Administrative Costs column should be specific. These costs include recognized over-head activities, including rent, utilities, and facility costs. It also applies to costs of management and over- sight of the specific program funded. It includes program coordination; clerical, financial, and management staff not directly related to patient care; program evaluation; liability insurance; audits; computer hardware/software not directly related to patient care. Administrative Costs are funded at a maximum rate of 10% of the total direct program costs. Subrecipients are responsible for preparing a project budget that meets administrative cost guidelines and provides expense reports that track administrative expenses.

• Service Award Total is the sum of the direct care total and the administrative or indirect rate cost total.

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Unit-Rate

• The Service refers to the activities the agency is funded to provide.

• The Unit represents the duration of the service activity.

• The Rate is the approved billable rate proposed per one unit of service. Rates may match but never

exceed rates of reimbursement by other third-party payers (e.g., Medicare, Medicaid, Bureau of

Substance Abuse Services) for same service activity. All current rates and documentation must be

provided.

• The Volume represents the number of units to be delivered in a twelve-month period.

• The Annual is the proposed rate times the volume. Annual = Proposed Rate x Volume

See Sample Expense Budget (Admin), Sample Expense Budget (Indirect), and Sample Unit-Rate

Budget.

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Sample Cost Expense Budget (Admin. Cost)

Core/Support Service Direct Cost Personnel Salary FTE Months Annual

Program Director B. Smith $50,000 0.50 12 $25,000

Medical Case Manager K. Jones $45,000 1.00 12 $45,000

Medical Case Manager J. Doe $41,000 0.80 12 $32,800

SUBTOTAL 2.3 $102,800

FRINGE 30.00% $30,840

$133,640

Other Direct Care Cost

Staff Training $1,000

Staff Travel $200

Program Supplies $1,000

SUBTOTAL $2,200

DIRECT CARE TOTAL $135,840

Administrative Cost Personnel Salary FTE Months Annual

Program Director B. Smith $50,000 0.15 12 $7,500

Program Rent (8% of total rent) $6,084

ADMIN COST TOTAL $13,584

DIRECT CARE TOTAL $135,840

ADMINISTRATIVE CAP (10%) $13,584

SERVICE AWARD TOTAL $149,424

AGENCY NAME

Medical Case Management

March 1, 2019– February 29, 2020

ATTACHMENT C

RYAN WHITE PART A: CFDA 93.914

Boston Public Health Commission

FY 2019

Per Federal policy, funds may only be used to support services to those individuals with a documented HIV status. Funds may not be used to provide items or services for which payment already has been made or

reasonably can be expected to be made, by third party payors, including Medicaid, Medicare, and/other State or local entitlement programs, prepaid health plans, or private insurance. Subrecipients are reminded

that this is subject to an audit.

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Sample Expense Budget (Indirect)

Core/Support Service Direct Cost Personnel Salary FTE Months Annual

Peer Support Coordinator B. Smith $32,000 0.50 12 $16,000

Peer Advocate K. Jones $28,000 0.20 12 $5,600

Peer Advocate J. Doe $28,000 0.30 12 $8,400

SUBTOTAL 1.0 $30,000

FRINGE 29.10% $8,730

$38,730

Other Direct Care Cost

Staff Training $1,000

Staff Travel $200

Program Supplies $1,000

SUBTOTAL $2,200

DIRECT CARE TOTAL $40,930

HHS Indirect Approved Rate 40% Annual

Ryan White Indirect Rate Cap 10% $4,093

DIRECT CARE TOTAL $40,930

INDIRECT RATE CAP (10%) $4,093

SERVICE AWARD TOTAL $45,023

AGENCY NAME

Psychosocial Support Services

March 1, 2019– February 29, 2020

ATTACHMENT C

RYAN WHITE PART A: CFDA 93.914

Boston Public Health Commission

FY 2019

Per Federal policy, funds may only be used to support services to those individuals with a documented HIVstatus. Funds may not be used to provide items or services for which payment already has been made or

reasonably can be expected to be made, by third party payors, including Medicaid, Medicare, and/other State or local entitlement programs, prepaid health plans, or private insurance. Subrecipients are reminded

that this is subject to an audit.

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Sample Unit-Rate Budget

Core/Support Service Direct Cost Unit Rate Volume Annual

RRS-Bed Day 1 $100.08 150 $15,028

TSS-Bed Day 1 $131.04 400 $52,416

DIRECT CARE TOTAL $67,444

SERVICE AWARD TOTAL $67,444

Substance Abuse Services (Residential)

ATTACHMENT C

RYAN WHITE PART A: CFDA 93.914

Boston Public Health Commission

FY 2019

March 1, 2019 – February 29, 2020

AGENCY NAME

Per Federal policy, funds may only be used to support services to those individuals with a documented HIV status. Funds may not be used to provide items or services for which payment already has been made or

reasonably can be expected to be made, by third party payors, including Medicaid, Medicare, and/other State or local entitlement programs, prepaid health plans, or private insurance. Subrecipients are reminded that this is

subject to an audit.

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Budget Revision Guidance Appropriate budget revision requests are those which propose to use different means to accomplish the original agreed upon goals and objectives outlined in the Scope of Services. In general, adding new line items are not acceptable requests. Subrecipients are permitted to shift funds between existing line items due to evolving service needs. Service category budgets may only be revised with the written approval of the Director of the Boston Public Health Commission Ryan White Services Division. In order to receive written approval, subrecipients must submit a budget revision request, including a proposed budget in the appropriate format (see sample on the following page) and a line item budget justification via email to kkeating@bphc.org or via mail to: Katie Keating, Director, Ryan White Services Division, Boston Public Health

Commission, 1010 Massachusetts Ave, 2nd Floor, Boston, MA 02118

Subrecipients must submit a budget revision when:

• Cumulative transfers among direct cost budget line items for the current budget period exceed 25%

of the total approved budget (which includes direct and indirect costs) for that budget period or

$250,000, whichever is less; or

• There is any adjustment in Direct Care Total or where moving costs between funded line items

would result in the failure to meet the statutorily required distributions. (i.e. exceeding the 10% of

the award amount for administration, failure to spend at least 90% of the remaining funds for the

fiscal year etc.); or

• Substantial changes are made to the approved work plan or scope of services (i.e. changing the

model of care, transferring substantive work from personnel to contractual etc.); or

• The subrecipient proposes to purchase a piece of equipment, the cost of which is $5,000 or more,

and which was not included in the approved project budget/application.

Budget revision requests must include the following: +

• A current budget with the proposed changes, and final proposed annual amounts to the right of each personnel and/or expense line item.

• An explanation for each proposed change and how it will assist to meet contracted goals & objectives.

• For proposed expense item changes (e.g., food, program supplies, staff training, travel), explanations should incorporate quantities, when possible. Explain why an expense item is necessary and how it will be used. For example, travel expenses should specify who, where, when, and the purpose of the travel.

• For unit-rate changes, please provide the rationale and the calculation for the number of units proposed. Any program proposing to add a consultant line or to move money into an existing consulting line must:

• Provided a detail description of the services/activities performed by the consultant with the budget revision

• Add the Consultant’s Last Name to the invoice coversheet, after approval of the consultant line.

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Initial appeals of denied budget revision requests are made, in writing, to Katie Keating, Director, Ryan White Services Division. Further appeals may be submitted, in writing, to Grace Connolly, Director, Administration and Finance, BPHC.

Budget revisions will be accepted until February 15, 2020. Revisions submitted after this deadline will only be considered to fill vacant positions, and for legal name and position title changes.

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Sample Expense Budget Revision

In this example, Medical Case Manager Jones’s FTE changed from 0.80 to 1 for the year. The subrecipient has decided to decrease the Program Director’s FTE from 0.50 to .36 on the Part A contract to make up for the additional funds needed for Jones. The subrecipient also had to reduce the Staff Training line to $250 and the Program Supplies line to $200. The subrecipient’s original budget is reflected in the first six columns. Staff names may be added if new staff has been hired. Following are terms related to budget revisions. “Change” is the difference between the Annual and the New Annual (Change = Annual - New Annual). “New Salary” is the Full Time Equivalent (1 FTE total) salary. If there is a salary adjustment from the original “Salary,” back-up documentation is required (e.g., hire letter). “New FTE” is the new percentage of time that the position listed will be paid through this contract. “New Months” indicates the new number of months that the employee will work; the number would differ from the original budget when a staff person is added or removed from a budget based on hiring or departure. “New Annual” is the updated total salary amount that will be paid for by Part A based on changes made to the salary, FTE, or months in the budget revision. “New Annual” for a staff member who is being removed from a budget must be the actual amount expended based on monthly invoices submitted to date.

New New New New

Core/Support Service Direct Cost Personnel Salary FTE Months Annual Change Salary FTE Months Annual

Program Director B. Smith $50,000 0.50 12 $25,000 ($7,008) $50,000 0.36 12 $17,992

Medical Case Manager K. Jones $45,000 1.00 12 $45,000 $0 $45,000 1.00 12 $45,000

Medical Case Manager J. Doe $41,000 0.80 12 $32,800 $8,200 $41,000 1.00 12 $41,000

SUBTOTAL 2.30 $102,800 $1,192 SUBTOTAL 2.36 $103,992

FRINGE 30.00% $30,840 $358 FRINGE 30.00% $31,198

PERSONNEL TOTAL $133,640 $1,550 PERSONNEL TOTAL $135,190

Other Direct Care Cost Other Direct Care Cost

Staff Training $1,000 ($750) Staff Training $250

$200 $0 $200

Program Supplies $1,000 ($800) Program Supplies $200

SUBTOTAL $2,200 ($1,550) $650

DIRECT CARE TOTAL $135,840 $0 $135,840

New New New New

Administrative Cost Personnel Salary FTE Months Annual Salary FTE Months Annual

Program Director B. Smith $50,000 0.15 12 $7,500 $0 $50,000 0.15 12 $7,500

Program Rent (8% of total rent) $6,084 $0 $6,084

ADMIN COST TOTAL $13,584 $0 EXPENSE TOTAL $13,584

DIRECT CARE TOTAL $135,840 $0 DIRECT CARE TOTAL $135,840

ADMINISTRATIVE CAP (10%) $13,584 $0 ADMINISTRATIVE CAP (10%) $13,584

SERVICE AWARD TOTAL $149,424 $0 SERVICE AWARD TOTAL $149,424

RYAN WHITE PART A: CFDA 93.914

Staff Travel Staff Travel

Boston Public Health Commission

FY 2019

March 1, 2019 - February 29, 2020

AGENCY NAME

MEDICAL CASE MANAGEMENT

Budget Revision Request

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Annual Site Visits

Boston EMA Ryan White Part A Monitoring Visit

Each Ryan White Part A subrecipient is required to participate in an annual, comprehensive, single-day

monitoring visit. Monitoring visits are conducted to determine your program’s compliance with contractual

obligations, program policies, service standards, and Ryan White HIV/AIDS Program Federal legislation. The

following summarizes what to expect during your annual monitoring visit.

Scheduling

Site visits will be generally be scheduled with at least 3 months of advanced notice, but exceptions may be

made as necessary. Your agency’s executive director and the program contact listed in our records will be

notified of the site visit date. If the assigned date is not feasible, you must formally respond to BPHC via letter

or email requesting a new date; it must include justification for the request.

Pre-Site Visit Preparation One month before your site visit, an assigned BPHC program coordinator will email you a confirmation packet. This coordinator will be your point of contact throughout the entire site visit process. Materials

The confirmation packet includes the following items: • Cover letter • Service Standards • Monitoring Tool

• Pre-Site Visit Assessment Pre-Site Visit Assessment

An assessment will be used to evaluate your program’s compliance with contractual obligations, as well as policies and standards. The due date of this form will be included within the confirmation packet. The assessment must be completed and returned prior to the site visit. The BPHC program coordinator may schedule a call to review the information that is requested in the assessment and to provide instruction. Prior to the visit—24 to 48 hours—you will receive an encrypted email with a list of client codes: these will be the records reviewed during the monitoring visit. The BPHC coordinator will also review with you the logistics for the review and will discuss with you the completed assessment. Federal Requirements Monitoring visits are conducted according to uniform grant guidance for monitoring and evaluating federally funded programs. Much of this language is included in your Part A contract. Programs can prepare for monitoring visits by familiarizing themselves with the basic concepts of grants management and responsibilities. A useful resource is the CFO Grants Training modules that can be found at https://cfo.gov/grants/training The modules include guidance on cost principles, risk management, and administrative requirements, among other topics. Subrecipients should also review the Ryan White Part A Manual (Revised 2015) at: https://hab.hrsa.gov/sites/default/files/hab/About/RyanWhite/habpartbmanual2013.pdf as well as HRSA’s Policy Clarification Notices (PCNs) for the Part A program, particularly 15-01, 15-02, 16-02, and 18-02.

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Day of the Monitoring Visit The program coordinator leading your visit will coordinate with your program contact to determine the logistics of the monitoring visit. The site visit will consist of the following activities:

• Chart Review: A random sample of up to 50 client records will be reviewed to determine subrecipient compliance with contractual policies and service standards. Client records will not be removed from the premises. Subrecipients will receive a client record list 24-48 hours prior to the visit.

• Morning briefing: At the beginning of the site visit, BPHC will discuss with your program staff the logistics and expectations for the day.

• Exit Conference: BPHC will discuss all findings with your program staff at the end of the site visit.

• Facility Tour: BPHC may request to tour the facility, which will be determined prior to the site visit. For example, a tour will be required if your agency recently moved to a new location.

• Fiscal Records Review: Financial records and policies will be tested for compliance with contractual policies and federal legislation. This review is not an audit.

• Policies Review (Program and Fiscal): Your policies will be tested for compliance with contractual obligations, federal legislation, and service standards. For example, a client grievance and your program’s grievance policy may be reviewed together to determine consistency.

• Staff Interviews: Your program’s fiscal team and direct service providers will be interviewed to discuss their roles in providing Part A services.

Space should be reserved at your agency that can accommodate a BPHC monitoring team for the whole day. During the exit conference, your site visit lead will discuss all findings. Site Visit Report You will receive a summary of your agency’s compliance with Ryan White Part A requirements. This summary will include fiscal and programmatic findings and recommendations and note areas in which your program is out of compliance with legislative and programmatic requirements. Your agency may be required to submit an Action Plan (AP) that addresses findings of non-compliance. BPHC staff will provide technical assistance to programs to support compliance.

Action Plan (AP) An Action Plan must be submitted to BPHC within 30 days of the receipt of the written site visit report. BPHC staff are available to assist agencies as they develop Action Plans. Once BPHC approves the Action Plan, the plan will be monitored until your next site visit. If the plan is denied, BPHC will support you to revise the plan which must be resubmitted to BPHC within one business week of denial.

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Reporting Due Dates

Submission Reporting Period Due Date

Quarter 1 Report Mar 1, 2019 - May 31, 2019 June 28, 2019

Quarter 2 Report June 1, 2019 - Aug 31, 2019 Sept 30, 2019

Quarter 3 Report Sept 1, 2019 - Nov 30, 2019 Dec 31, 2019

Quarter 4 Report Dec 1, 2019 - Feb 29, 2020 March 31, 2020

Unit-rate Programs – Submission of Fiscal Invoice and Client Utilization

Data Mar 1, 2019 - Feb 29, 2020

30 days after each month’s end Apr 30, 2019 – Mar 30, 2020

Deadline for Final Budget Revisions

Mar 1, 2019 - Feb 29, 2020 February 15, 2020

Outcomes Reporting Mar 1, 2019 - Feb 29, 2020 Client outcomes must be entered e2boston within 6 months of last

service date.

HRSA Ryan White Services Report

(Client Level Data)

Jan 1, 2019—Dec 31, 2019

February 15, 2020

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Policies and Procedures

Policy Maintenance

The following is a comprehensive list of policies that your agency must maintain and can expect to submit to Ryan White Services Division during an annual site visit. Many policies must be submitted prior to the day of the visit. The Contract Manager assigned to lead your site visit will help you determine how to organize the submission of policies. Please familiarize yourself with this list and how each relates to your program and Ryan White Part A service category. Please note that some of your policies may be housed in the same document. Program & Service Delivery Policies Required (FY 19 Standards of Care)

• 2.0 Intake, Discharge, Transition & Case Closure • 3.0 Linkage to Care, Client Retention & Client Reengagement • 4.0 Staff Credentials Training & Supervision • 5.0 Staff Safety Standards • 6.0 File Maintenance & Data Security • Service-Specific Policies

Required Fiscal Policies: Audits

• Non-audited interim financial statements

• Audited financial statements

• Single Audit

• Risk Assessment Imposition of Charges

• Fee Schedules

• Sliding Fee Schedule Policy

• Cap on Charges Financial Policies and Procedure Manuals

• Fixed Assets Policy

• Billing and Collection Policy

• Purchasing Policy

• Travel Policy Fiscal Policies and Financial Reports

• Accounting Policies and Procedures Manual

• Policy on revenue, including Program Income

• Policy and Procedures on selection of an auditor

• 12-Month Report of Program Income

• Policy to determine reasonableness of cost

• Medicaid certificate

• Part A agreement and budget

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• Chart of Accounts

• One Month invoices

• Agency income statement

• HHS indirect cost rate (if applicable)

• Summary of HIV Funding including Local, State, and Federal Revenues (HIV Funding Table)

• Quarterly payroll tax report

• IRS agreement for payment of taxes in arrears (if applicable)

• Insurance Policies – Certificate of Liability, Worker’s Comp, Property Liability, Directors and Officers Liability, Automobile Liability.

Human Resources

• Employee Handbook

• Organizational Chart

• Fiscal Document Retention and Destruction Policy

• Whistle Blower Policy

• Board Minutes

• Governance that addresses insider transactions and conflicts of interest Time and Effort Policy and Procedure

• One pay period payroll journal, time sheets, and effort reporting.

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Payer of Last Resort Policy

Ryan White HIV/AIDS Program funds are the payer of last resort in relation to all other state and federal funding sources. This includes Medicaid. Specifically, federal policy requires:

• Ryan White HIV/AIDS Program funds may not be used to pay for Medicaid covered services for Medicaid beneficiaries.

• Ryan White HIV/AIDS Program subrecipients who provide Medicaid covered services must be Medicaid certified.

• Ryan White HIV/AIDS Program subrecipients are expected to vigorously pursue Medicaid enrollment for individuals who are eligible for Medicaid coverage.

• Ryan White HIV/AIDS Program subrecipients must seek payment from Medicaid when they provide a Medicaid covered service for a Medicaid beneficiary.

• Ryan White HIV/AIDS Program subrecipients must back bill Medicaid for any Ryan White Act funded services provided to Medicaid eligible clients once Medicaid eligibility is determined.

Subrecipients are expected to exhaust mandatory Medicaid dollars before utilizing discretionary Ryan White HIV/AIDS Program funds. The Payor of Last Resort policy is currently part of all BPHC Part A provider contracts and is also restated on all program budgets. If you have questions regarding these policies, please feel free to call our office.

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Federal Monitoring Standards

Purpose of the Policy: To guide the administration of the Ryan White Part A Program to ensure compliance with grant requirements related to charges to clients as per the following Health Resources Service Administration guidance:

• Ryan White Legislation:

• §2605 (e)(F)(A)

• §2605 (e)(1)(B)

• §2065 (e)(1-4)(C-F)

• Part A Assurances

• HRSA FOA

• BPHC Ryan White Part A Contract Important Terms:

• Costs are the accrued expenditures incurred by the recipient /Subrecipient during a given period requiring the provision of funds for: (1) goods and other tangible property received; (2) services performed by employees, contractors, Subrecipient, subcontractors, and other payees.

• Charges are the imposition of fees upon payers for the delivery of billable services.

• Payments are the collection of fees from payers that are applied to cover some aspect of costs of billable services.

• Billable services are those for which there is a payer source.

• Charge Master/Schedule of Charges is a comprehensive listing of prices for billable services and/or procedures.

• Sliding fee means that costs change according to the patient’s income, lack of income, or ability to pay. Policy and Procedures:

If the Subrecipient charges health insurers for a service, the Subrecipient must impose the same charge and provide a discount to uninsured clients using the service.

If an entity receiving Part A funds charges for services, it must do so on a sliding fee schedule that is available to the public and is based upon established fees that are reasonable and necessary. Establishing a fee schedule should not result in a bureaucratic system to means-test individuals or families before Part A supported services are available. The sliding fee scale is intended to protect clients from becoming so overwhelmed by financial burdens they leave the system. The sliding fee scale/schedule of charges shall not permit charges to clients with an income ≤ 100% FPL and permits nominal fees for clients with income >100% FPL. Unallowable Costs

All funded subrecipients must: 1. Maintain files with signed subrecipient agreement, assurances, and certifications that specify unallowable costs 2. Provide and maintain budgets, expenditures, and related reports to BPHC with sufficient detail to document that

they do not include unallowable costs 3. Maintain on file policies and documentation consistent with the following cost prohibitions:

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• Cash payments to intended recipients of RWHAP services

• Clothing

• Developing materials that may be perceived to promote or encourage injection drug use

• Drug use and sexual activity

• Employment and Employment Readiness

• Funding liability risk pools

• Funeral, burial, cremation or related expenses

• Household appliances

• International travel

• Local or State personal property taxes (for residential property, private automobiles, or any other personal property)

• Off-premise social/recreational activities or payments for a client’s gym membership

• Pet foods or other non-essential products

• Pre-exposure prophylaxis and Non-Occupational Post-Exposure Prophylaxis

• Purchase of land, construction, or renovations

• Purchase or improve land, or to purchase, construct, or permanently improve (other than minor remodeling) any building or other facility

• Purchase Vehicles without Approval

• Syringes Property Standards

All funded subrecipients/subcontractors must:

1. Develop and maintain a current, complete, and accurate asset inventory list and a depreciation schedule that lists purchases of equipment by funding source

2. Make the list and schedule available to the grantee upon request

3. Provider/Subcontractor tracking of and reporting on tangible nonexpendable personal property, including exempt property, purchased directly with Ryan White Part A funds, and having a useful life of more than one year and an acquisition cost of $5,000 or more per unit

4. Implementation of adequate safeguards for all capital assets that assure that they are used solely for authorized purposes.

5. Real property, equipment, intangible property, and debt instruments acquired or improved with federal funds held in trust by subrecipients/subcontractors, with title of the property vested in BPHC but with the federal government retaining a revisionary interest.

a. Establish policies and procedures that acknowledge the revisionary interest of the federal government over property improved or purchased with federal dollars

b. Maintain file documentation of these policies and procedures for BPHC review

6. Assurance by subrecipients/subcontractors that title of federally owned property remains vested in the federal government, and if the HHS awarding agency has no further need for the property, it will be declared excess and reported to the General Services Administration

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7. Title to supplies to be vested in the recipient upon acquisition, with the provision that if there is a residual inventory of unused supplies exceeding $5,000 in total aggregate value upon termination or completion of the program and the supplies are not needed for any other federally-sponsored program, the recipient shall retain the supplies for use on non-federally sponsored activities or sell them, and compensate the federal government for its share contributed to purchase of supplies

a. Develop and maintain a current, complete, and accurate supply and medication inventory list b. Make the list available to BPHC upon request

Income from Fees for Services Performed

1. Use of Part A and third-party funds to maximize program income from third party sources and ensure that Ryan White is the payer of last resort. Third party funding sources include Medicaid, State, Children’s Health Insurance Programs (SCHIP), Medicare (including the Part D prescription drug benefit), and private insurance.

a. Have policies and staff training on the requirement that Ryan White be the payer of last resort and how that requirement is met

b. Require that each client be screened for insurance coverage and eligibility for third party programs, and helped to apply for such coverage, with documentation of this in client files

c. Carry out internal reviews of files and billing system to ensure that Ryan White resources are used only when a third-party payer is not available

d. Establish and maintain medical practice management systems for billing 2. Ensure billing and collection from third party payers, including Medicare and Medicaid so that payer of last

resort requirements is met: a. Establish and consistently implement:

• Billing and collection policies and procedures

• Billing and collection process and/or electronic system

• Documentation of accounts receivable 3. Ensure provider/subcontractor participation in Medicaid and certification to receive Medicaid payment:

a. Document and maintain file information on grantee or individual provider agency Medicaid status b. Maintain file of contracts with Medicaid insurance companies c. If no Medicaid certification, document current efforts to obtain such certification

4. Bill, track, and report to the grantee all program income (including drug rebates) billed and obtained 5. Ensure service provider retention of program income derived from Ryan White-funded services. Funds may be

added to resources committed to the project or program and used to further eligible project or program objectives, and/or used to cover program costs:

a. Document billing and collection of program income b. Report program income documented by charges, collections, and adjustment reports or by the application of a revenue allocation formula.

Imposition and Assessment of Client Charges

1. Subrecipient/Subcontractor policies and procedures must specify charges to clients for services, which may include a documented decision to impose only a nominal charge

a. Establish, document, and have available for review:

• Sliding fee discount policy

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• Current fee schedule

• Sliding fee eligibility applications, in client files

• Fees charged and paid by clients

• Process for charging, obtaining, and documenting client charges through a medical practice information system, manual or electronic

2. No charges imposed on clients with incomes below 100% of the Federal Poverty Level (FPL)

a. Document that:

• Sliding fee discount policy and schedule do not allow clients below 100% of FPL to be

charged for services

• Personnel are aware of and following the policy and fee schedule

• Policy is being consistently followed

3. Charges to clients with incomes greater than 100% of poverty that are based on a discounted fee schedule and a sliding fee scale

a. Cap on total annual charges for Ryan White services based on percent of client’s annual income, as follows:

• 5% for patients with incomes between 100% and 200% of FPL

• 7% for patients with incomes between 200% and 300% of FPL

• 10% for patients with incomes greater than 300% of FPL b. Have in place a fee discount policy that includes a cap-on-charges policy and appropriate implementation, including:

• Annually evaluating clients to establish individual fees and caps

• Track of Part A charges or medical expenses inclusive of enrollment fees, deductible, co-payments, etc.

• Have a process for alerting the billing system that the client has reached the cap and should not be further charged for the remainder of the year

• Documentation of policies, fees, and implementation, including evidence that staff understand the policies and procedures

Limitations on Uses of Part A Funding 1. Adherence to 10% cap on Administrative Expenses. Appropriate subrecipient administrative activities include:

a. usual and recognized overhead activities, including established indirect rates for agencies; b. management oversight of specific programs funded under this Ryan White; and c. other types of program support such as quality assurance, quality control, and related activities.

2. Inclusion of indirect costs

a. Indirect costs (capped at 10%) can be included only where the subrecipient has a certified HHS-negotiated indirect cost rate using the Certification of Cost Allocation Plan or Certificate of Indirect Costs

b. Subrecipients wishing to include an indirect rate must provide documentation of a current Certificate of Cost Allocation Plan or Certificate of Indirect Costs that is HHS-negotiated, signed by an individual at a level no lower than chief financial officer.1

1 The Division of Cost Allocation in HHS negotiates and approves indirect cost agreements for entities receiving funding through the Department. This Division negotiates rates through its four regional field offices and the national headquarters. To obtain

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c. If using indirect cost as part or all its 10% administration costs, obtain and keep on file a federally approved HHS-negotiated Certificate of Cost Allocation Plan or Certificate of Indirect Costs

d. Submit a current copy of the Certificate to the Boston Public Health Commission (BPHC)

information from one of these offices go to: http//rate.psc.gov and click on Contact Information, then click on the appropriate link: National Headquarters, Western, Central States, Mid-Atlantic, Northeastern. Contractors and subrecipients/subcontractors wanting to claim administrative costs in their Ryan White HIV/AIDS Program budget as indirect costs are allowed to do so only (1) with an HHS-approved indirect cost rate in accordance with applicable cost principles; and (2) in accordance with the 10% legislative limitation on administration costs, (i.e., indirect costs are included in the definition of grantee administration under Part A and B, as mandated by the legislation).

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Sliding Fee Scale Policy for Ryan White Services

Purpose of the Policy: To guide the administration of the Ryan White Part A Program to ensure compliance with grant requirements related to charges to clients as per the following Health Resources Service Administration guidance:

• Ryan White Legislation:

• §2605 (e)(F)(A)

• §2605 (e)(1)(B)

• §2065 (e)(1-4)(C-F)

• Part A Assurances

• HRSA FOA

• BPHC Ryan White Part A Contract Important Terms:

• Costs are the accrued expenditures incurred by the recipient /Subrecipient during a given period requiring the provision of funds for: (1) goods and other tangible property received; (2) services performed by employees, contractors, Subrecipient, subcontractors, and other payees.

• Charges are the imposition of fees upon payers for the delivery of billable services.

• Payments are the collection of fees from payers that are applied to cover some aspect of costs of billable services.

• Billable services are those for which there is a payer source.

• Charge Master/Schedule of Charges is a comprehensive listing of prices for billable services and/or procedures.

• Sliding fee means that costs change according to the patient’s income, lack of income, or ability to pay.

Policy and Procedures: If the Subrecipient charges health insurers for a service, the Subrecipient must impose the same charge and provide a discount to uninsured clients using the service.

If an entity receiving Part A funds charges for services, it must do so on a sliding fee schedule that is available to the public and is based upon established fees that are reasonable and necessary. Establishing a fee schedule should not result in a bureaucratic system to means-test individuals or families before Part A supported services are available. The sliding fee scale is intended to protect clients from becoming so overwhelmed by financial burdens they leave the system. The sliding fee scale/schedule of charges shall not permit charges to clients with an income ≤ 100% FPL and permits nominal fees for clients with income >100% FPL.

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Client Eligibility for Ryan White Services

Background The U.S. Health Resources and Services Administration (HRSA) establishes eligibility criteria for Ryan White Part A services to ensure that Ryan White services are reserved for people living with HIV with very limited financial resources. This policy was updated for FY 2018 to include clarifications regarding HIV verification, income, residency and insurance documentation requirements. With the exception of HIV verification, all eligibility must criteria must be determined annually and recertified at six-months with a letter of self-attestation to no changes. Subrecipient monitoring will include the review of documentation of client eligibility. HIV Verification All Part A Subrecipients must maintain in client records primary documentation of positive HIV status. Examples include:

• Any document with medical provider’s (MD, NP (ACRN), PA, RN, pharmacist) signature certifying HIV status Examples: letter from provider with letterhead

• Lab results indicating a positive HIV antibody test

• Home-delivered meals certification Income Threshold All Part A Subrecipients must screen HIV+ clients for income eligibility, based on a threshold of 500% of the current Federal Poverty Level (FPL) as determined by the U.S. Department of Health and Human Services (HHS), with an additional allowance for dependents based on the MassHealth dependent allowance formula. Individuals with incomes at or below this level will be eligible for RWSD and OHA services. Subrecipients may continue to serve individuals with incomes above this level and must not deny services to clients based on income. However, agencies may not use Ryan White funds to serve clients with incomes above the threshold. Subrecipients may implement a hardship waiver for clients with incomes over 500% of FPL whose out-of-pocket expenses have exceeded 10% of their income during the year. Subrecipients may continue to set lower financial eligibility levels for particular services in consultation with BPHC and MDPH. HHS updates poverty guidelines annually, typically in late January. The best place to find updated, accurate information is on the HHS website at https://aspe.hhs.gov/poverty-guidelines. Screening and Documentation Providers must screen for financial eligibility at intake and at six-month intervals thereafter and must document sources of income and FPL range in the client’s record. Suitable documentation includes:

• At least two recent paystubs with pay periods indicated

• Copy of the most recent federal tax return

• W-2 for the most recent tax year

• 1099 form

• SSDI, SSI, unemployment compensation, and any other government benefits or entitlement documents.

If there are no earnings, the client record should contain a signed letter from the medical case manager or health care provider stating that the client has no income and indicating how the client is being supported. Agencies may maintain their own processes to screen for and document financial eligibility. These processes should include documents that obtain accurate, updated income information while ensuring low-threshold access to care and services.

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Client Income Summary Agencies may use or adapt the BPHC and MDPH Client Income Summary form to record a client’s income and FPL. This form is intended to help facilitate access to other client services by communicating the results of financial eligibility screens that are completed by one service provider so that other providers do not need to duplicate this work. If the Client Income Summary form is not used, another means of documenting client income and FPL range must be created. Agencies are required to record the exact percentage of FPL for each client every six months. Agencies may choose to take this figure from the demographics section of the e2Boston data base. The figure must be calculated based on the client’s most recent, up to date income verification. With appropriate releases of information, agencies working with common clients can coordinate ongoing six-month eligibility screens, share documentation of income and self-attestation forms, and assess eligibility without requesting the same information directly from the same client. Agencies sharing Client Income Summaries and self-attestation documents do not need to share actual backup income documentation; however, agencies may request this documentation. Agencies should exchange contact information in order to facilitate communication and information-sharing. For example, two agencies might coordinate income eligibility screening processes and paperwork. The Medical Case Manager (MCM) screens a client for financial eligibility and works with the client to complete the Client Income Summary. The MCM then refers the client to a meals program with a completed Client Income Summary to the meals provider along with a signed release of information. The agencies communicate about who will complete the financial eligibility screens every six months (in most cases, the MCM), exchange contact information, and decide how to share results and documentation on a routine basis. BPHC and MDPH may request the backup documentation used to determine financial eligibility during a monitoring visit. When the referring agency is also funded by Part A, and/or the client has signed the appropriate consent form for funder review, BPHC reserves the right to verify that appropriate eligibility review mechanisms are in place and that the related backup documentation is in the client file. Proof of Residency All service providers must document current residency in the Boston EMA for clients receiving Part A services. Documentation must be included in all client files. Proof of residency can be in the form of:

• A non-expired driver’s license

• Utility bills

• Bank statement

• Real estate tax bill or receipt

• A current residential lease

• Proof of income in the form of a paycheck, or government issued benefits statement

• A signed case manager letter on letterhead verifying the town and postal code of residence. Proof of Insurance Subrecipients must maintain documentation of clients’ current health insurance status. An example of health insurance status could include a current statement from a health insurance provider, an HDAP approval letter, a printout from an electronic medical record that indicates type of coverage, or a printout from the virtual gateway indicating type of insurance coverage. Providers who are not located within a medical facility may collaborate with a client’s medical provider or nursing team to obtain current documentation of a client’s insurance. Subrecipients are responsible for ensuring Ryan White Part A funds remain payer of last resort and for identifying clients who may be underinsured or uninsured, and to assist those clients in applying for health coverage.

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Six-Month Eligibility Recertification Client income, residency and insurance status must be verified and documented every 6 months for all ACTIVE clients receiving Ryan White Part A services. If the client reports CHANGES to any eligibility status, then the service provider must collect the documents which reflect those changes.

Self-Attestation If the client reports NO CHANGES to any elements of eligibility status, the service provider is not required to collect documents. However, the service provider must complete a letter which attests to no changes at the time of recertification. The letter should be on agency letterhead, indicate the eligibility criteria which has not changed, include signature of the provider, and be maintained in the client file. The service provider can attest to no changes of the client’s income and/or residence status ONCE PER YEAR. Example: An intake is conducted for a new client on April 1st, 2019. During the intake process, the client provides two of their most recent paystubs (Income & Residency), a letter from a physician (HIV Status) & premium statement (Insurance). All required eligibility documents have been collected and the client is then enrolled into e2Boston. October 1st, 2019, the client returns and reports there have been no changes to their HIV status, insurance, income or residency. Staff can have the client self-attest confirming that there have been no changes. On April 1st, 2020, the client must recertify again. It has been a year since the client’s initial intake, and they must now provide a copy of their eligibility documents again. The self-attestation letter can only be used once a year.

Time Period What to Collect?

Intake (4/01/2019) Collect supporting documents

6 Month Recertification (10/01/2019) Client can attest to no changes

1 Year Recertification (4/01/2020) Collect supporting documents

6 Month Recertification (10/1/2020) Client can attest to no changes

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Guide to Collecting Eligibility Documents

Programs must maintain an on-site record for each client receiving Ryan White services, which includes the following documentation. Further clarification may be found in the Ryan White Service Standards.

Eligibility Form

HIV VERIFICATION

Programs must have documentation of each client’s HIV status. Examples include: • Provider statements acknowledging HIV status. • Labs

INCOME VERIFICATION

Programs must have documentation of each client’s income. Examples include: • Benefits statements. • Pay stubs. • MassHealth Eligibility verification • Written letter signed by the client attesting to no income.

Clients must be 500% of the Federal Poverty Level (FPL) or below to receive Part A services.

RESIDENCY VERIFICATION

• Proof of residency can be in the form of: • Driver’s license. • Utility bills. • Bank statement. • Real estate tax bill or receipt. • Current residential lease. • Paycheck or benefits statements. • Written letter signed by the client attesting to residency. .

INSURANCE STATUS

Programs must have documentation of each client’s insurance status. Types of insurance coverage can include public (Medicare, Medicaid/MassHealth, Commonwealth Care), private (employer-based, private non-group, COBRA, or subsidized private plans via Commonwealth Choice), or other types of coverage (VA Benefits). If a client is not eligible for any existing insurance plans, then the provider should document the reason and how the client will access medical services and prescription drugs.

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Sample Six-Month Recertification Form

Agencies may use or adapt this six-month recertification summary form to record a client’s income,

residency and insurance statuses for recertification. This form can be used by a service provider to

facilitate coordination of care to another Ryan White Part A funded service provider. With appropriate

releases of information, agencies working with common clients can coordinate ongoing six-month

eligibility screens, share income documents and other forms without requesting the information directly

from the same client.

This form is valid for 6 months after screening date.

Client Name: Client Code:

Screening Date: Expiration date (six months after screening):

INCOME

Client Annual Income $ % of Federal Poverty Level %

� Pay Stubs (2 most recent)

� Social Security (SSDI/SSI) Letter

� Private Disability Statement

� Masshealth Verification Form

� Client Affidavit

� Department of Transitional Assistance

(TANF/EAEDC)Letter

� Veterans’ Benefits

� Medical Case Manager Letter

� Other:______________

RESIDENCY

� Pay Stub

� Government Issued Check

� Government Correspondence

� Valid Driver’s License/MA ID

� Utility Bill

� Bank Statement

� Real Estate Tax Bill

� Current Residential Lease

� Medical Case Manager Letter including town and zip

code

� Other:_____________

INSURANCE

� HDAP Approval Letter

� Letter from Insurer

� Premium Statement

� Dated Print out from Exchange

� MassHealth Verification Form

� Other:______________

I, _____________________, currently am receiving Ryan White Part A services from [Agency]. In the last six months there have been no changes to my eligibility for Part A services. I understand that I must report any changes to my income, residency, and insurance to remain eligible to receive these services.

Client Signature __________________________________________________________

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Sample Self-Attestation Form

Agency Letterhead

Date __________________

RE: Patient/Client Name or Client Code

To Whom It May Concern:

I, _____________________, am currently receiving Ryan White Part A services from [Agency]. In the last six months there have been no changes to my eligibility for Part A services. I understand that I must report any changes to my income, residency, and insurance to remain eligible to receive these services.

______________________________ Patient/Client Signature

______________________________ Patient/Client Name Printed

______________________________ Date

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Client Income Summary

The purpose of this form is to document financial eligibility for Ryan White HIV/AIDS Program services. The form can be shared

among service providers to verify income screening if the client has signed and dated a release of information document. This form is

valid for six months after the screening date.

Agency name:

Agency address:

Agency phone number:

Client name: Client Code:

Screening date: Expiration date (six months after screening):

Annual income: To determine if the client’s gross annual income is less than 500% of the FPL, if the client provides a pay stub, the gross year-to-date (“YTD”) is used to calculate gross annual income. If the pay stub does not show gross YTD, the client must provide two pay stubs, so that yearly gross earnings can be calculated using the client’s average earnings for the designated pay period. If the client is not working, but receives SSI, SSDI, or any other type of monetary benefit, proof of this must also be shown. If the client is not working and has no income, or if he/she is working but cannot provide proof of this, a letter from the client’s medical case manager is required. If the client does not have a medical case manager, then a letter from his/her clinician is required. If a client is over-income, check to see if the client has dependents. If so, documentation must be provided (usually a copy of page one from the most recent U.S. 1040 tax return, if available), and an additional $4,420 (as of 2019) is then allowed for each dependent.

CLIENT ANNUAL INCOME: $

Documentation provided for client record (check all that apply):

Pay stub(s)

Social Security Administration (SSDI/SSI) letter

Private disability statement

Department of Transitional Assistance (TANF/EAEDC) letter

Veterans’ Benefits

Other:

Federal Poverty Level:

Consult the U.S. Department of Health and Human Services poverty guidelines for the current calendar year at

http://aspe.hhs.gov/poverty. Based on the client’s gross annual income, what is the applicable Federal Poverty Level (FPL) range?

FPL: %

Signatures:

Client: Date: ___________________

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Sample Eligibility Letter for Exceeding Charges Cap

[agency letterhead] DATE

To Whom It May Concern: I, ___________________, receive services from [agency name]. above-named patient/client is currently receiving [insert service type] from me. I earn [insert income] per year, which is >500% of the FPL. My documented out-of-pocket expenses have presently exceeded 10% of my income. If you have any further questions, please call me at 000-000-0000.

Thank you for your assistance.

Medical Case Manager /Health Care Provider Signature Here Date:

Medical Case Manager/Health Care Provider Printed Name Here

Agency Name Here

Patient/Client Signature Here Date:

Patient/Client Printed Name Here

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Sample Hardship Waiver/No Income

[agency letterhead]

DATE To Whom It May Concern: I, _______________________, am currently receiving Ryan White services from [Insert Agency]. I am currently making [insert income] and am unable to pay for [insert service type] due to financial hardship. If you have any further questions, please call me at 000-000-0000. Thank you for your assistance. Medical Case Manager /Health Care Provider Signature Here Date: Medical Case Manager/Health Care Provider Printed Name Here Agency Name Here Patient/Client Signature Here Date: Patient/Client Printed Name Here

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Authorization to Obtain/Release Information

Authorization to obtain/release information must be documented for all communication with external partners. Programs must have a release of information form that describes under what circumstances client information can be released. This form must clearly document: the name of agency/individual with whom the information is being shared; the information to be shared; the client signature and date signed; and provide space for revocation of authorization. All authorizations to obtain/release information expire 12 months from the date of signature. Documentation of multiple external partners is allowable on one form. To ensure clear documentation of client authorization, clients must indicate by initialing next to each individual entity with whom information is to be shared. At any point in time, clients reserve the right to revoke authorization to obtain/release information. In an instance where one form contains documentation for multiple entities, all authorizations are revoked, and a new form must be completed with the client’s initials next to each individual entity as well as a signature of authorization. This form can be used as a living document. Over time clients may want to allow the release of information to additional entities. This is allowable so long as the agency ensures the client initials accordingly. There will be no change to expiration of one year. All releases will expire at the date listed on the bottom of the page. The date listed cannot be changed. There is no extension of the release of information. At the end of one year, the agency needs to work with the client to obtain a new signed and initialed form. Required Elements of authorization

• Client ID

• Entity to be shared (specific staff person, when possible)

• Contact information (phone/fax/address or location?)

• Date signed

• Date of expiration (No more than 12 months)

• Staff Signature

• Client Signature

• Client Initials identifying each specific authorization to each individual external agency Revoked Authorization

• Client Signature

• Date

• Staff Initials

Optional

• Emergency Contact

• Name

• Relationship

• Contact Information

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Sample Authorization to Obtain/Release

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Agency Incident Report Procedures

BPHC requests that agency staff report major incidents separately from the narrative reports submitted quarterly, and as soon as possible after the incident. The report should include the following information:

• Reporting staff name

• Date of incident

• A detailed description of what happened In addition to alerting Program Coordinators to situations which cause stress to clients and staff and may temporarily limit the services provided by the agency, these reports will allow BPHC to offer support and guidance where appropriate. BPHC requests the program complete this form for BPHC’s internal tracking purposes only. Examples of Incidents which should be reported include, but are not limited to:

• Physical harm or threat of physical harm to a client or staff member

• Significant structural damage to agency premises (such as a fire or flood)

• Involvement of external law enforcement or emergency personnel. The Incident Report Form can be found on the following page.

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Sample Incident Report

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Quarterly Report Instructions & Samples

**Please note this is a sample. Your Contract Manager will ensure you have the most current version of this template if any changes are made during the year. A. Agency Overview

1. Enter your ‘Agency Name’ 2. Enter the ‘Service Category’ 3. The reporting quarter is pre-populated. 4. Complete the table. If there are any changes with contacts listed in this table, note the changes in Section D

Question 3 or Section H.

A. Agency Overview

Agency Name Ryan White Services Division

Service Category Psychosocial Support

Reporting Quarter

March 1, 2019 – May 31, 2019

Contact Type Name Title Phone E-Mail

Executive Leadership

Katie Keating Director of Ryan White Services Division

xxx-xxx-xxx kkeating@bphc.org

B. Utilizations

1. Insert the total amount of Unduplicated Clients (UDC) served during the reporting period. 2. Insert the total amount of UDC served within the fiscal year-to-date. Not applicable for the first quarter. (i.e.

Q1 + Q2 = Total UDC) 3. Insert the total # of subservice units delivered for each reportable subservice within the reporting period.

a. Type the subservice within the ‘Enter Subservice’ field b. Enter the number of units delivered within each respective reporting period (Qx). c. The ‘Sum’ is the total number of units delivered for each quarter completed within the report. d. The ‘Estimated Units’ are the total units reported within the ‘Service Category Estimates’ Workbook

or ‘FY19 Scope of Services’. e. Enter the ‘percentage (%)’ of the sum of reported quarters and the estimated units reported for the

fiscal year. 4. Describe the cause for any variance of 5% above or below 25% of quarterly deliverables and plans to

address these variances.

B. Utilization

1. # of unduplicated clients served during Q1: 80

2. # of unduplicated clients served in FY19 through the close of reporting quarter:

N/A

3. Subservice List subservices outlined in Scope of Services.

Q1 Q2 Q3 Q4 Sum FY 19

Projected Units

% (Sum/Projected)

Individual Session 37 37 100 37%

Group Session 8 8 48 16%

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B. Utilization

4. Please provide a description for utilizations 5% above or below the projected 25% quarterly increase anticipated per subservice please provide a description of services. Specifically, describe the contributing factors that may have caused the variance.

The Group Facilitator of our weekly ‘Coming Together’ support group submitted their resignation in April. We were unable to provide groups in May. There has been an increase of one-on-one sessions delivered by the social worker.

C. Demographics

1. Complete the table by reviewing analytics offered by e2Boston or other data sources used to track service delivery.

a. Enter ‘Demographic Category’ that has been identified to be 5% over or under the reporting period.

b. Insert ‘Percentage (%)’ of the demographic category served within the reporting period. c. Insert ‘Comments’ that describe the nature of the variance.

C. Demographics

1. Review e2Boston Demographic data for clients served in Q1. If there is a demographic category with a variance of 5% above or below service delivery projections for the quarter, list the category below, provide the percentage of clients served in that category, and explain the variance . Specifically, state contributing factors that may be a cause for the variance.

Demographic Category % Comments

Female

43%

We saw a huge uptick of women seeking one-on-one services. This may be a result of hiring a new social worker who started a health promotion campaign geared to engaging women. Also, many of the women who were accessing group services were referred one-on-one sessions.

D. Expenditures

1. Insert the most up-to date approved ‘FY19 total program budget’ for the reporting period. a. Enter the ‘Total Expended Funds through the close of the Quarter’ for the fiscal year. The

dollar amount reported should include previous quarter amounts. b. Enter the ‘% of the budget expended through close of the reporting period’

2. Describe the cause for variance of 5% above or below 25% of quarterly expenditures and plans to address variances.

3. Describe program staffing changes or status of vacant positions. 4. Complete the table for line items that are over or under-spent within the reporting period.

a. Enter the ‘Line Item’ from the budget. b. Enter the ‘Under/Over Amount’

D. Expenditures

1. 1. FY19 total program budget Total FY19 billed

through close of quarter Q1

% of budget expended through close of quarter x

$100,000 $18,000 18%

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D. Expenditures

2. Through the close of quarter one, did your program expend 5% above or below 25% of the total program budget? Please describe the cause for the variance. Include in your description any intention to submit a budget revision or other actions to address under/overspending.

We did not bill for the Group Facilitator position for May. With no groups being held, we did not pay for refreshments and/or use program supplies. Also, we do not expect to use the training line until 3rd quarter of this fiscal year. With an increase of clients accessing one-on-one sessions, the social worker line item is slightly over the forecasted budget. We do not suspect to be over or under by the end of the year but plans to submit a budget revision will be made in the Q2 if this trend continues.

3. Provide an update on any program staffing changes and/or status of vacant positions.

RWSD is in the process of hiring a new group facilitator. We are in the interviewing phase. Our team expects to hire by the end of June. We were able to hire a social worker right at the beginning of this fiscal year.

4. List any Core/Support Service Direct Cost, Other Direct Care Cost and/or Administrative Cost line items that will have under or over the budgeted amount by the close of Q1.

Line Item Under/Over Amount

Refreshments for Groups - $200

Social Worker + $1,280

Group Facilitator - $2,000

E. General Program Updates

1. Describe agency initiatives and/or upcoming events. 2. Describe successes and/or challenges your agency is experiencing with the changing healthcare landscape. 3. Complete the table with trainings that were attend by or paid for by Ryan White funds.

a. Enter the ‘Training Date(s)’ attend by staff b. Enter the ‘Training Name’ attended by staff. c. Enter all ‘Staff in Attendance’ of the training.

E. General Program Updates

1. Describe agency initiatives and/or upcoming events would the agency like to highlight.

The clients have advocated to add new support groups into the mix. We’re excited to hire for a new support group facilitator who will champion new types of support groups. The director has led the division to introducing a new monthly engagement meeting. This meeting is going to help bring the team together with other parts of the department to inform a larger engagement strategy.

2. Describe any successes and/or challenges your agency is experiencing as a result of the changing healthcare landscape (i.e. Affordable Care Act (ACA), Flexible Spending, Community Partners, etc.).

MassHealth has changed its enrollment policies. This has slowed down application processing and created some gaps in coverage. We are doing everything we can with our health navigators and case managers to support clients accessing health care. The Application support services for PrEP DAP we implemented last month has been hugely successful. This is because of the increased coordination of services amongst the in house ACO team, prevention team and medical providers completing a brand-new screening for PrEP.

3. Please provide information on Ryan White Staff Training attendance this quarter.

Training Date(s) Training Name Staff in Attendance

05/28/2019 – 05/30/2019 HIV Update Meeting Jenifer Jaeger

F. Service Delivery Success, Challenges and/or Unmet Needs of the Clients

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1. Describe any success your agency is having with the delivery of services. 2. Describe any challenges your agency is having with delivering services. 3. Describe any unmet needs your clients are experiencing (i.e. access to housing, maintaining viral suppression,

access to transportation, access to substance use services etc.) 4. Enter a request for technical assistance and/or describe plans to seek technical assistance.

F. Service Delivery Successes, Challenges and/or Unmet Needs of the Clients

1. Please share successes with service delivery.

We have increased the number of women accessing one on one services. This is partly due to not having groups in May and our social worker’s new Health Promotion Campaign for HIV-positive woman. We are excited about continuing to grow this program. Since June, we have had 6 new PLWH who have previously been out of care. This is from a relationship we established with a non-profit delivering substance use services.

2. Is your program experiencing any challenge(s) delivering services? If yes, please describe the challenges and actions that will be taken to resolve these issues (if any).

We are down one group facilitator and experiencing some clients having trouble completing PT-1 forms because of issues with MassHealth processing applications. We are relying on medical transportation funds to alleviate some of the issues with access. We have created a tool to ensure that we are on-top of who is eligible for PT-1’s, who has a pending a response from MassHealth, and who doesn’t have access to MassHealth transportation services. This has added some administrative burden but has been extremely useful because it will help with ensuring payor of last resort issues don’t arise.

3. Please describe any unmet needs your clients are experiencing.

During this quarter, we saw that transportation and access to cell phones as a consistent need. A lot of clients are also reporting recent evictions notices, especially from the Dorchester area. Our social worker has been helping counsel clients through the emotional trauma of receiving eviction notices and supporting them to access housing services.

4. Please share training and/or technical assistance needs.

Having our staff participate in a training to complete MassHealth applications would be extremely useful.

G. Action Plan

1. Provide an update with the status of any active corrective action plans.

G. Action Plan

1. If your agency received programmatic or legislative findings from your last site visit, please provide an update of your progress towards completing the action plan.

We do not currently have any active Action Plan.

H. Additional Comments

1. Share additional comments that you would like to include with this quarterly report.

H. Additional Comments

1. Please share any additional information below.

Although we have not held ‘Coming Together’ groups in May, we have engaged all clients within one-on-one services. Katie Keating has been added to our contact list, replacing Dr. Jennifer Leaf Jaeger as the executive level contact.

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Quarterly Report Template

A. Agency Overview

Agency Name Click or tap here to enter text.

Service Category Click or tap here to enter text.

Reporting Quarter March 1, 2019 – May 31, 2019

Contact Type Name Title Phone E-Mail

Executive Leadership

First & Last Name Official Title xxx-xxx-xxx E-mail Address

Program First & Last Name Official Title xxx-xxx-xxx E-mail Address

CQM First & Last Name Official Title xxx-xxx-xxx E-mail Address

e2Boston/RSR First & Last Name Official Title xxx-xxx-xxx E-mail Address

Fiscal First & Last Name Official Title xxx-xxx-xxx E-mail Address

B. Utilization

1. # of Unduplicated clients served during Q1: 0

2. # of Unduplicated clients served in FY19 through the close of reporting quarter: N/A

3. Subservice List subservices outlined in Scope of Services.

Q1 Q2 Q3 Q4 Sum FY19

Projected Units

% (Sum/Projected)

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

Enter Subservice 0 0 0 %

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B. Utilization

4. Please provide a description for utilizations 5% above or below the projected 25% quarterly increase anticipated per subservice. Specifically, describe the contributing factors that may have caused the variance.

Click or tap here to enter text.

C. Demographics

1. Review e2Boston Demographic data for clients served in Q1. If there is a demographic category with a variance of 5% above or below service delivery projections for the quarter, list the category below, provide the percentage of clients served in that category, and explain the variance . Specifically, state contributing factors that may be a cause for the variance.

Demographic Category % Comments

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

Click or tap here to enter text. % Click or tap here to enter text.

D. Expenditures

1. FY19 total program budget Total funds expended through

close of quarter % of budget expended through

close of quarter x

$ $ %

2. Through the close of quarter one, did your program expend 5% above or below 25% of the total program budget? Please describe the cause for the variance. Include in your description any intention to submit a budget revision or other actions to address under/overspending.

Click or tap here to enter text.

3. Provide an update on any program staffing changes and/or status of vacant positions.

Click or tap here to enter text.

4. List any Core/Support Service Direct Cost, Other Direct Care Cost and/or Administrative Cost line items that have under/over budgeted amount within the reporting period.

Line Item Under/Over Amount

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

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D. Expenditures

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

Click or tap here to enter text. $

E. General Program Updates

1. Describe agency initiatives and/or upcoming events would the agency like to highlight.

Click or tap here to enter text.

2. Describe any successes and/or challenges your agency is experiencing as a result of the changing healthcare landscape (i.e. Affordable Care Act (ACA), Flexible Spending, Community Partners, etc.).

Click or tap here to enter text.

3. Please provide information on Ryan White Staff Training attendance this quarter.

Training Date(s) Training Name Staff in Attendance

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F. Service Delivery Successes, Challenges and/or Unmet Needs of the Clients

1. Please share successes with service delivery.

Click or tap here to enter text.

2. Is your program experiencing any challenge(s) delivering services? If yes, please describe the challenges and actions that will be taken to resolve these issues (if any).

Click or tap here to enter text.

3. Please describe any unmet needs your clients are experiencing.

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F. Service Delivery Successes, Challenges and/or Unmet Needs of the Clients

Click or tap here to enter text.

4. Please share training and/or technical assistance needs.

Click or tap here to enter text.

G. Action Plan

1. If your agency received programmatic or legislative findings from your last site visit, please provide an update of your progress towards completing the action plan.

Click or tap here to enter text.

H. Additional Comments

1. Please share any additional information below.

Click or tap here to enter text.

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Contract Transition Policy

At the end of a contract period, every vendor holding a Ryan White contract with the Boston Public Health Commission (BPHC) Ryan White Services Division is responsible for ensuring that any outstanding contract related issues are resolved. This policy applies in all instances of contract termination, regardless of the reason for the termination. Clients/Client Records (applicable only if services will not continue at agency)

A. The vendor shall notify all clients affected by the contract termination that services will no longer be provided. Such notification shall be provided at least 30 days prior to the contract termination date. The vendor should make every effort to notify clients in person. If in-person notification is not feasible, clients should be notified in writing via certified mail with return receipt. If a return receipt is not delivered within two weeks, a follow-up notice should be sent via regular mail. The notice should include a list of other agencies in the same geographic area that provide the same or similar services.

B. Whenever practicable, the vendor should assist each client with registration for services at another agency of the client’s choosing. This will necessarily include transfer of client records, whether maintained on paper or in electronic media, which must be undertaken in accordance with the terms of the confidentiality agreement entered into at the time of contract execution.

C. If a client does not wish for his or her records to be transferred to another agency, the vendor is responsible for the confidential storage of these records, per State and Federal laws.

Data

A. No more than 15 days after the contract termination date, vendors must submit all client level data collected for purposes of the contract (including data from subcontracted agencies) up to the contract termination date. Data submissions must be made in the same manner as they had been during the contract period.

Reporting

A. No more than 30 days after contract termination, unless the contract manager directs otherwise, vendors must submit a final Progress Report covering the period between the previous submission and the contract termination date. This includes both narrative and data submissions.

B. Vendors must submit a Ryan White HIV/AIDS Program Services Report (RSR) covering the period between the previous RSR submission and the contract termination date. The submission date for the RSR is on an annual basis following the end of each calendar year. If this is impossible, the vendor must work with BPHC staff to ensure that information needed to complete the RSR is available to BPHC.

Fiscal

A. No more than 15 days after the contract termination date the vendor will submit any final billing. Purchased Items

A. Program supplies paid for under the contract remain the property of the vendor. B. Capital and equipment purchases made with funds allocated under the contract are the property of BPHC,

unless such capital items have fully depreciated, in which case they remain the property of the vendor. If an item has not fully depreciated, BPHC will determine whether the item must be returned to BPHC or transferred to another vendor.

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Online Resources

Local Resources

Boston Public Health Commission Ryan White Services Division www.bphc.org/Ryan White Services Division The Boston Public Health Commission Ryan White Services Division programs are integral to the distribution of Ryan White Part A funding within the Boston EMA, and the success of our funded agencies to promote health and enhance quality of life for PLWH. Included on the website are provider forms, quality management reports and resources, and pertinent links for HRSA-related information. Massachusetts Department of Public Health Office of HIV/AIDS | http://www.mass.gov/dph/aids The Massachusetts Department of Public Health Office of HIV/AIDS provides a variety of services throughout the Commonwealth of Massachusetts. Currently services range from prevention and education to HIV counseling and testing, client services, health, and support services.

Federal Resources HRSA — Health Resources and Services Administration |http://www.hrsa.gov HRSA administers programs that improve the nation's health by expanding access to comprehensive, quality health care for all Americans. HRSA is the federal grantee of Ryan White Act funding. For a listing of all Policy Clarification Notices:

https://hab.hrsa.gov/program-grants-management/policy-notices-and-program-letters. HRSA — Target Center | https://careacttarget.org/ The TARGET Center website is the central source of technical assistance and training resources for the Ryan White HIV/AIDS Program. The site is the one-stop shop for tapping into the full array of TA and training resources funded by HRSA HIV/AIDS Bureau, which administers Ryan White services. NQC — National Quality Center | http://nationalqualitycenter.org The National Quality Center (NQC) provides no-cost technical assistance to all Ryan White program grantees to improve the quality of HIV care nationwide. Funded through a cooperative agreement with the New York State Department of Health AIDS Institute, NQC serves the needs of Ryan White program grantees across all Parts and funded subrecipients, for technical assistance in quality improvement. CDC — Divisions of HIV/AIDS Prevention |http://www.cdc.gov/hiv/default.htm The CDC Division of HIV/AIDS Prevention mission is to prevent HIV infection and reduce the incidence of HIV-related illness and death in collaboration with community, state, national, and international partners. Links include: Basic Science, Surveillance, Prevention Research, Vaccine Research, Prevention Tools, Treatment, Funding, Testing, Evaluation, Software, Training, STD Prevention, and TB Prevention. SAMHSA — Substance Abuse and Mental Health Services Administration | http://www.samhsa.gov SAMHSA is improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to society resulting from substance abuse and mental illness. OMH — Office of Minority Health |http://minorityhealth.hhs.gov The mission of OMH is to improve the health of racial and ethnic minority populations through the development of effective health policies and programs that help eliminate disparities in health. Links include: Minority AIDS Initiative, Conferences, Statistics and a Resource Center for funding opportunities. GRANTS.GOV | http://www.grants.gov This is an Internet tool created by the Department for Health and Human Services (DHHS) and Office of Grants Management (OGM) for finding and exchanging information about federal grant programs. Grants.gov serves the general public, the grantee community, and grant-makers. Links include: Funding Opportunities, Technical Assistance for grant writing, Managing Grants, The Federal Register, and a Calendar of Events.

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FY 19 Ryan White Services Staff List

ADMINISTRATION

Jenifer Leaf Jaeger, MD, MPH

Director, Infectious Disease

Bureau

JJaeger@bphc.org

Katie Keating, BS, MPH

Director, Ryan White Services

Division

KKeating@bphc.org

Regis Jean-Marie

Bureau Administrator, Infectious

Disease Bureau

rjeanmarie@bphc.org

PROGRAM

Marcos A. Palmarin, BS

Senior Program Coordinator

mpalmarin@bphc.org

Aunnakalia Boyce, BA

Program Coordinator

Aboyce@bphc.org

Jonathan DeFreese, BA

Program Coordinator

JDeFreese@bphc.org

Sarah Kuruvilla, BS, MPH

Program Coordinator

SKuruvilla@bphc.org

Wiona Desir, BS, MPH

Program Coordinator

WDesir@bphc.org

QUALITY MANAGEMENT

Katherine D’Onfro, BS, MPH

Senior Program Coordinator

KDonfro@bphc.org

Ori Odugbesan, BS, MD, MPH

Senior Program Coordinator

OOdugbesan@bphc.org

FISCAL

Frantzsou Balthazar-Toussaint, MPH

Fiscal Manager

fbalthazar@bphc.org

Monica Araujo, BS

Fiscal Coordinator

maraujo@bphc.org

Sheldon Ramdhanie

Fiscal Coordinator

SRamdhanie@bphc.org

DATA

Irina Neshcheretnaya, MMath

Data Manager

ineshcheretnaya@bphc.org