Ryan White HIV/AIDS Program Parts C and D Stakeholders ... · within our nation’s communities....
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Transcript of Ryan White HIV/AIDS Program Parts C and D Stakeholders ... · within our nation’s communities....
Ryan White HIV/AIDS Program Parts C and D Stakeholders Call April 19, 2018
Mahyar Mofidi, DMD, PhDDirector, Division of Community HIV/AIDS Programs (DCHAP)HIV/AIDS Bureau (HAB)Health Resources and Services Administration (HRSA)
Agenda
• HRSA/HAB/DCHAP Overview
• Division Updates• 2018 National Ryan White Conference on HIV Care and
Treatment
• RWHAP Part C Recipient Program Income Presentations
2
Health Resources and Services Administration (HRSA)Overview
Supports more than 90 programs that provide health care to people who are geographically isolated, economically, or medically challenged
HRSA does this through grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities
Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care
3
HIV/AIDS Bureau Vision and Mission
VisionOptimal HIV/AIDS care and treatment for all.
MissionProvide leadership and resources to assure access to and retention in
high quality, integrated care, and treatment services for vulnerable people living with HIV/AIDS and their families.
4
Purpose of Ryan White HIV/AIDS Program
• Public health approach to provide a comprehensive patient-centered system of HIV care
• Ensure low-income people living with HIV (PLWH) receive optimal care and treatment
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DCHAP Mission and Core Values
MissionProvide leadership and resources to assure access to and retention in
high quality, comprehensive HIV care and treatment services for vulnerable people living with HIV/AIDS, their families and providers
within our nation’s communities.
Core Values Communication ∙ Integrity ∙ Professionalism Accountability ∙
Consistency ∙ Respect.
6
Ryan White HIV/AIDS Program by the Numbers: 2016
7Source: HRSA. Ryan White HIV/AIDS Program Data Report (RSR) 2015. Does not include AIDS Drug Assistance Program data.
Viral Suppression among RWHAP Clients, by State, 2010 and 2016—United States and 2 Territoriesa
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Viral suppression: ≥1 OAHS visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/mL.a Puerto Rico and the U.S. Virgin Islands.
Viral Suppression among Key Populations Served by the Ryan White HIV/AIDS Program, 2010 and 2016—United States and 3 Territoriesa
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RWHAP overall, 2016 (84.9%)
RWHAP overall, 2010 (69.5%)
Hispanics/Latinos can be of any race.Viral suppression: ≥1 OAHS visit during the calendar year and ≥1 viral load reported, with the last viral load result <200 copies/mL.a Guam, Puerto Rico, and the U.S. Virgin Islands.
HAB Data Slides and Reports
• Clients Served by the Ryan White HIV/AIDS Program, 2016
• HIV Care Outcomes: Viral Suppression, 2016
• Annual Client-Level Data Reports
• https://hab.hrsa.gov/data/data-reports
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DCHAP Updates
11
2018 National Ryan White Conference on HIV Care and Treatment
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National Ryan White Conference on HIV Care & Treatment
• Theme
Catalyzing Success: Advancing Innovation. Leveraging Data. Ending the HIV Epidemic.
• Dates2018 National Ryan White Conference on HIV Care and Treatment (NRWC)
December 11 – 14, 2018
DCHAP Business Meeting
Tuesday, December 11, 2018
2018 Clinical Conference (to precede NRWC)
December 9 – 11, 2018
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Gaylord National Harbor Hotel and Convention Center
(Oxon Hill, Maryland)
Registration now open!https://ryanwhite2018.hrsa.gov/
DCHAP Business Meeting
December 11th from 8:30 to 2:30pm
• For Part C, D, and F Dental recipients only
• Similar format as the 2016 DCHAP Business Meeting• Plenary Session• Concurrent Breakout Sessions
• Technical assistance presentations • Panel presentations • Roundtable discussions
• Discuss “State of the DCHAP Programs” • Technical assistance• Best practices
• DCHAP will follow up with recipients to get YOUR input on topics that interest YOU
• Additional information will be forwarded to you from your Project Officer
14
NRWC Conference Tracks
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Increasing Access, Engagement, and Retention in HIV Care and Treatment
This track will focus on best practices and models for access to, engagement, retention, and re-engagement in HIV
care and treatment that result in improved health outcomes for PLWH.
Data Utilization
This track will examine data integration, data analysis, and data utilization with a focus on how these activities
improve engagement/re-engagement, service delivery, and public health approaches to ending the HIV epidemic
and curing Hepatitis C in the RWHAP.
Leveraging Innovative Practices to Improve Outcomes and Address Emerging Priorities
This track will highlight new and innovative models for PLWH engagement, HIV workforce development and
deployment, service integration, and service delivery that lead to improvements in health outcomes along the HIV
care continuum as well as addressing emerging priorities such as curing Hepatitis C in the RWHAP, behavioral health
integration, and the opioid epidemic.
NRWC Conference Tracks
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Clinical Quality Management and Clinical Improvement
This track will examine the fundamentals and best practices for clinical quality management programs to measure and improve HIV service delivery and health outcomes with the ultimate goal of reducing health disparities.
Ryan White HIV/AIDS Program Planning and Resource Allocation: Collaborative Partnerships and Community
Engagement
This track will focus on requirements and best practices for integrated planning, program implementation,
workforce development, and resource allocation and utilization, including examples of collaborative partnerships
and community engagement initiatives that result in a quality, comprehensive system of HIV prevention, care,
and treatment that is responsive to the evolving HIV epidemic.
Ryan White HIV/AIDS Program Fiscal and Grant Management Boot Camp
This track is a technical assistance track focusing on training RWHAP recipients and subrecipients on fiscal and
grant management requirements and best practices.
NRWC Conference Logistics
• Registration decisions (confirm/deny) are made by Project Officers
• Hotel reservations can be made after registration has been confirmed by Project Officer
• Cap per RWHAP:
• Part C: 4
• Part D: 4
• Part F: 2
• Staff attending the Clinical Conference ONLY will not count towards cap
• Additional registration slots are available for consumers and subrecipients- first come, first served
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NRWC- Call for Abstracts
• Call for Abstracts: Deadline: April 30, 2018https://ryanwhite2018.hrsa.gov
• Session types • Breakout sessions 90 minute workshop (Multi-speaker session with time for attendee
participation or interaction)• 30 minute oral presentation• Poster presentations- visual information presentations sharing best practices, lessons
learned, unique strategies or tools and research findings
Plenary sessions• Tuesday, December 11, 2018 – Opening Plenary (approximately 3 pm EST)• Wednesday, December 12, 2018• Thursday, December 13, 2018• Friday, December 14, 2018 – Closing Plenary
18
Program Updates
19
Notice of Award (NoA)
Starts FY 18 Partial awards Reporting Requirements
January
5 months Ryan White HIV/AIDS Program Services Report (RSR),
Federal Financial Report (FFR), Expenditure Report
Allocation report will be added on balance of award NoA
April3 months RSR, FFR, Expenditure Report
Allocation report will be added on balance of award NoA
May3 months RSR, FFR, Expenditure Report
Allocation report will be added on balance of award NoA
• No Conditions of Awards (COAs) and Minority AIDS Initiative (MAI) designation on initial NoA• Balance of award NoA will have COAs and MAI designation
20
HRSA-18-092
• This competition was open to current RWHAP Part C Early Intervention Services (EIS) recipients and new organizations proposing to provide RWHAP Part C EIS funded services in new geographic service areas as described by the applicant.
• NOAs will be released in this month for a May 1st start date.
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2018 Stakeholder Call ScheduleUpcoming Dates
Date Time
Thursday, July 19, 2018 2 pm – 4 pm ET
Thursday, October 25, 2018 2 pm – 4 pm ET
22
EHB Updates and Helpful Links
• Site Visit Action Plan (Corrective Action Plan)• The EHB now allows HRSA staff to collaboratively plan a Corrective Action Plan with
grantees/recipients
• All information related to the Corrective Action Plan will be entered through the EHB
• HRSA staff (PO) will enter the initial information in the EHB and send the Corrective Action Plan to the recipient to enter “resolve action plan” tasks
• The Corrective Action Plan must be sent back to the HRSA staff (PO) for review and approval before the recipient can begin working on resolving the issues
• Only after all site visit findings, included in the plan, have been resolved can the Corrective Action Plan be closed by the PO
23
The Site Visit Action Plan EHB Help Page: https://help.hrsa.gov/x/jYCZAwTier 2 Support: 301-443-2112
Questions
24
Program Income
25
Program Income
Background
• Since 2016 DCHAP has provided focused technical assistance on recipients’ use of program income (tracking, allocating, and spending)
• Technical assistance provided through PCNs; FAQs; webinars; 2016 NRWC; TARGET Center; monitoring calls; site visits; and linking recipients for collaborative learning.
• Major challenges identified: Correctly tracking, allocating, and spending program income in accordance with the parameters of the RWHAP statute and the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR Part 75).
26
Program Income
Per 45 CFR §75.2, Program Income: Program income means gross income earned by the non-Federal entity that is directly generated by a supported activity or earned as a result of the Federal award during the period of performance except as provided on 45 CFR §75.307(f). Program income includes but is not limited to income from fees for services performed, the use or rental of [sic.] real or personal property acquired under Federal awards, the sale of commodities or items fabricated under a Federal award, license fees and royalties on patents and copyrights, and principal and interest on loans made with Federal award funds. Interest earned on advances of Federal funds is not program income. Except as otherwise provided in Federal statutes, regulation, or the terms and conditions of the Federal award, program income does not include rebates, credits, discounts, and interest earned on any of them.
27
Program Income
Use of Program Income – RHWAP Part C
To support comprehensive primary health care and support services in an outpatient setting for low income, uninsured, and underserved people living with HIV (PLWH).
Early Intervention Services
Core Medical Services
Support Services
Administrative expenses
Clinical quality management activities
Not subject to statutory distribution requirements (i.e., 10% administration)
28
Program Income
Use of Program Income – RWHAP Part D
To support a comprehensive system of family-centered care for low-income women, infants, children, and youth affected by or living with HIV.
Core Medical Services
Support Services
Administrative expenses
Clinical quality management activities
Not subject to statutory distribution requirements (i.e., 10% admin)
29
Program Income
Expenditure of Program Income
• To the extent available, recipients and sub-recipients must disburse funds available from program income, rebates, refunds, contract settlements, audit recoveries and interest earned on such funds before requesting additional cash payments (45 CFR §75.305(b)(5)).
• Estimate accrued program income and determine RWHAP funds that will be needed during current performance period.
30
HAB/OFAM Program Income Initiative
• Program Income Initiative
• Collaboration between HRSA HAB/DCHAP and the HRSA Office of Federal Assistance Management (OFAM)
• Goals:
1. Identify recipients who have established appropriate processes and procedures related to program income (allocation, spending, tracking, and reporting)
2. Disseminate information about these processes and procedures
• During June and July 2017, HAB and OFAM staff interviewed nine Part C recipients.
• Recipient presentations
• Presenting examples of internal control and allocation practices
31
Recipient Program Income Presentations: Internal Controls and Allocation
32
Rock Hill, South Carolina
BackgroundCare Setting
• Mission, Vision, Values• Opened as HIV service organization – 2000• Transitioned to FQHC – 2015• Four service sites – York County, SC
• 2 Rural, 2 suburban
• 1.5 Physicians, 3 Nurse Practitioners, 0.2 Certified Nurse Midwife• 4,367 patients served in 2017
• Approx. 600 HIV+• 66% living below poverty• 61% uninsured
34
Background
Model of Care• Integrated Services
• Primary care, HIV specialty care, Hepatitis C Virus (HCV) treatment, Pre-exposure Prophylaxis (PrEP) & Post-exposure Prophylaxis (PEP), dental care, behavioral health, medical case management
• Other HIV Services• Housing, peer support, emergency financial assistance,
medication/insurance assistance, outreach/specialized case management, HIV/HCV/STD screening, linkage to care, 3MV
• Level 3 Patient Centered Medical Home – National Committee for Quality Assurance (NCQA)
• Care Team Model
35
Background
Federal Awards
• Ryan White HIV/AIDS Program (RWHAP) Part B since 2000
• Housing Opportunities for Persons with HIV (HOPWA) since
2000
• RWHAP Part C since 2001
• RWHAP Part A since 2008
• HRSA Section 330 since 2015
36
Background
Types of Program Income
• Third Party Insurance Payers
• Medicaid, Medicare, Private Insurance
• Patient Services Revenue
• Self-pay
• Sliding fee
• 340B Drug Pricing Program
• Contract, mail order pharmacy
37
Background
38
16%
8%
16%
60%
11%
23%
39%
27%
-5%
5%
15%
25%
35%
45%
55%
65%
Medicaid Medicare Private Insurance Uninsured
Affinity Health CenterThird Party Payer
Breakdown
All Patients RWHAP Patients
Background
Organizational Structure
• 501(c)(3) tax-exempt non-profit
• Board of Directors
• Currently 13 members
• 61.5% consumer directors
• 6 member Leadership Team
• Fund Accounting
39
Challenges Tracking Program Income (PI)
• Tracking/Internal Control for Earned PI
• Transactional versus Allocation Accounting
• Accounting for revenue by encounter
• Tracking/Internal Control for Expenditure of PI
• Transactional versus Allocation Accounting
• Spending versus Encumbering PI
40
Overcoming Challenges
• Use of information technology
• Staff education & training
• Internal control methods
• Trend & reporting analysis
41
Overcoming ChallengesUse of Information Technology
• Fund accounting software
• Use of Abila MIP
• Robust chart of accounts
• GL Acct / Grant / Program / Location
• Built-in reporting
• Use of add-on modules
• Allocations
• Advanced Reporting
42
Overcoming ChallengesStaff Education & Training
• 45 CFR 75
• HRSA resources
• Policy clarification notices
• Webinars
• TARGET Center
• In-person trainings
• Internal policies & procedures
• Organizational specific IT
43
Overcoming ChallengesInternal Control Methods
• Segregation of Duties
• Purchase authorization procedures
• Line level coding
• Review and approval of coding (pre-posting)
• Post disbursement review & approval
44
Overcoming ChallengesTrend & Reporting Analysis
• Organizational financial statements
• Prepared and reviewed monthly (Accounting Department)
• Reviewed and analyzed by organizational leadership
• Summarized and presented to Board
• Grant & fund reporting
• Prepared and reviewed monthly (Accounting Department)
• Reviewed and analyzed by organizational leadership
45
East Carolina UniversityGreenville, North Carolina
Numbers on map correspond to numbers in location column Table 7. Area includes East of I-95 & North of I-40
Entity Location Counties Covered# of HIV Patients
Main Source of Funding
ECU-BSOMHIVP Greenville, NC1
RWPC/D - Beaufort, Bertie, Chowan, Craven, Gates, Hertford, Hyde, Martin, Pamlico, Pasquotank, Perquimans, Pitt, Tyrell, WashingtonRWPB - Beaufort, Carteret, Craven, Greene, Jones, Lenoir, Martin, Pamlico, Pitt, Washington, Wayne
1,500 Part B, C, D
Hertford Co Public Health Ahoskie, NC2
RWPB - Bertie, Camden, Chowan, Dare, Gates, Hertford, Hyde, Pasquotank, Perquimans, Tyrrell
≈130 Part B
Carolina Family Health Centers Wilson, NC3
RWPC - Edgecombe, Nash, WilsonRWPB - Edgecombe, Halifax, Nash, Northampton, Wilson
≈350 Part B,C
Warren-Vance Community Health Center, Inc. Infectious Diseases
Henderson, NC 4
RWPC - Franklin, Granville, Person, Vance, Warren. ≈100 Part C
3 1
4 2
• Primary Provider for HIV Care in Eastern North Carolina (ENC)
• Catchment area - 30 Counties
ECU HIV Program
47
1500+ active patients/PLWH.
200 new and 100 reengaging clients per year (no HIV care > 9 months)
Nutritional Screening and Treatment
Medical Case Management/Linkage Retention Coordinators
Transportation Assistance & Medication Assistance/ADAP
Oral Health Services (School of Dental Medicine) and Vision program
Specialty and Primary Care Referral program
Active Clinical trials program: 6 Active, 1 actively enrolling
48
ECU HIV Program Client Demographics
2017 ECU Client Level Data N (%)
Number of people living with HIV 1563 (100%)
African Americans 1191 (76%)
Females 552 (35%)
Men >24 960 (60%)
FPL <100 960 (61%)
49
ECU HIV Program Insurance Breakdown
Insurance 2017 Total %
Medicaid 355 23%
Medicare 377 24%
No Insurance 511 33%
Private/Other/VA 320 20%
Total 1563 100%
50
RWHAP at ECU
• RWHAP Parts B, C, and D
• Support core medical and support services for PLWH who have no other payer source
• RWHAP Part B: $546,094: covers gaps in services; 11 counties
• RHWAP Part C: $490,977: covers men >24 year of age; covers 14 counties in Eastern North Carolina
• RWHAP Part D: $591,280: covers women, infants, children and youth (WICY); and men <25; and 28 counties
51
Sources of RWHAP Income
• Patient Charges: Record the collections from insurance (third party reimbursement) or client self-payment for the services provided for RWHAP clients.
• Pharmacy: Record all revenue from the 340B program generated by RWHAP client pharmacy transactions.
• Percentages for sources of program income: 75% from 340B revenue and 25% from patient charges.
52
Annual Budgeting Process
• Annual Budget Plan for RWHAP Parts C and D Income
• Monthly variance report
53
Allocation of Program Income
• Personnel: • Developed a methodology of how to allocate different personnel between grant
and program income
• Rent and utilities:• Allocation based on space occupied by RWHAP funded staff and clinic utilization
data
• Specialty Referrals:• We established referral systems where uninsured RWHAP eligible patients can
receive primary and specialty medical services from other clinics within ECU
54
Tracking Expenditures
The Grant Fiscal Coordinator:
1. Runs monthly expenditures report for each fund, RWHAP Part C/ RWHAP Part D/ RWHAP Part C Program Income/ RWHAP Part D Program Income
2. Compares the expenditures with approved budget for each line item (expenditures data)• Find out how much variance is for each line item
3. Generates variance analysis report based on the expenditures data• Analyze to determine reason(s) for the variance(s)
4. Reports to Principal Investigator to assist in decision-making for daily operations
55
Internal Controls
• Principal investigator approval is required when charging any expenditures to program income.
• All transactions require a minimum of two reviewer/approvers at the departmental and institutional level.
• Institutional offices review/approve/process all transactions (Accounts Payable, Travel Office, Payroll, Materials Management).
• No program income payments/transactions can be processed at the local/project level.
5656
Research Administration and Oversight
• The Office of Grants and Contracts (OGC) provides:• Expertise in Federal compliance rules and regulations
• Dedicated oversight for certain expenditures, including financial adjustments and corrections
• Project monitoring
• Award review and setup
• Establishing a dedicated fund specific to the project in Banner
• Support for grant closeout and timely reporting
5757
Internal Controls through OGC
• Dedicated financial reporting• Unique fund dedicated to project expenses and revenues
• Accounts within each code to identify type of expenditure (supplies, etc.)
• Layered/Tiered Approvals• ECU specific routing to ensure appropriate review (Purchasing/
Materials Management, etc.)
• OGC has final approval authority on questionable expenditures
5858
Challenges and Solutions – Spending Program Income
• Challenge: Multiple internal steps are required to document a client’s RWHAP eligibility (RWE) to pay referral invoices from program income.
• Solution: We hired a billing specialist who is familiar with the billing system and has access to different databases to confirm lack of other payors and clients have completed RWE.
59 59
Challenges and Solutions - Spending Program Income
• Challenge: Determining eligibility to use RWHAP income for clients who have made independent referrals
• Solution: We met with ECU Physicians billing department and developed a process to receive overdue requests for payment before clients go into collection.
6060
Next DCHAP Stakeholder Webinar
Date: Thursday, July 19, 2018, 2:00 p.m. to 4:00 p.m. EST
Topic: Program Income Spending and Strategic Planning
61
Questions
62
Contact Information
Mahyar Mofidi, DMD, PhD
Director, Division of Community HIV/AIDS Programs
HIV/AIDS Bureau (HAB)
Health Resources and Services Administration (HRSA)
Email: [email protected]
Phone: 301-443-2075
Web: hab.hrsa.gov
63
Connect with HRSA
64
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