Central Texas HIV Planning Council Allocations for Bryan-College Station HSDA Ryan White and State Services Christopher Hamilton, M.P.H., Planner Brazos Valley Council of Governments x:2225

Ryan White CARE Act oFederal Act, funds o5 Titles oTitle II provides funds for Bryan – College Station Health Services Delivery Area (HSDA): Brazos, Burleson, Grimes, Leon, Madison, Robertson, and Washington Counties oFunding cycle starts April 1 of each year

State Services oHIV Health and Social Services (State Services) funds from State of Texas oProvides funds in same counties as RWCA oFunding cycle starts September 1 of each year

Managing Conflict of Interest oRepresentatives of each HSDA on Allocations Committee oMembers from an HSDA are not allowed to vote on funding for their own HSDA, but do provide input into the process

Thresholds “For both Titles I and II, HRSA requires that funds be allocated to the six core categories of Ambulatory Medical Care, Case Management Services, Mental Health Services, Drug Reimbursement, Substance Abuse Services (inpatient & outpatient) and Oral Health or to explain how these services are funded through other sources.” 1 1 Texas Department of State Health Services “Priority Setting and Resource Allocation Procedures for HIV Care Services” DraftApril2005

Thresholds continued “The Texas Department of State Health Services requires that all Ryan White Title II Planning Assemblies establish minimum funding thresholds for each of the HRSA core service categories to ensure minimum funds required to preserve the current level of services… Minimum funding thresholds must be submitted to and approved by DSHS Planning staff.” 1

What is a threshold o“A minimum funding threshold is the minimum dollar amount needed to adequately provide the service.” 1 o “ A minimum funding threshold is the minimum dollar amount needed to preserve the current level of services.” 1 1 Texas Department of State Health Services “Priority Setting and Resource Allocation Procedures for HIV Care Services” DraftApril2005

Allocating based on thresholds oThe minimum allocation to a service category is the determined threshold oIf the allocation is less than the threshold, it must be well documented and justified as to why oEFA: must be allocated at sub-category level (utilities, food, medication)

Threshold Calculation Total Active Clients Total Using Service % using service Allocation Allocation per client 2003 PLWHA 2004 PLWHA %$24,691$ AOMC Example 50 new infections from ‘03 to ‘04 34 new active clients for ‘ total active clients for ‘ total using service for ‘04 $29, Threshold

Thresholds oAmbulatory / Outpatient Medical Care: $29, oDrug Reimbursement: $23, oOral Health: $17, oCase Management: $261, oMental Health: $3, oSubstance Abuse: $3,250.99

Allocations oOperating under the assumption of flat funding from oTotal allocation to HSDA: $295,375 o$233,821 RW o$61,554 SS

06-07 Ambulatory Outpatient Medical Care (1) o $25,000 total, all from RW oThreshold set at $29, This is level funded from Based on historic data of utilization and expenditures, funding the threshold would result in surplus funds at the end of the grant year. Additionally, a Federally Qualified Health Center provides care at reduced cost. If there is a reduction in overall funds to the HSDA, funds will be taken from Food Bank, Health Insurance, and then Transportation, in that order, to fund this category.

06-07 Food Bank (2) o $2,500 total, all from SS oThis is a decrease from because of the need to fund core categories and other services. There is not as much need for funds as before because of arrangements with community food bank and other community resources. This category will be cut 100% first to fund the core services if there is an overall reduction in funds to the HSDA.

06-07 Drug Reimbursement (3) o $23,546 total, all from SS oThreshold set at $23, Funded at threshold due to trends in utilization data, and to accommodate incoming clients. If there is a reduction in overall funds to the HSDA, funds will be taken from Food Bank, Health Insurance, and then Transportation, in that order, to fund this category.

06-07 Transportation (4) o $23,380 total o$4,743 RW + $18,637 SS oThis is a decrease from because of the need to fund core categories and other services. There were also changes in transportation patterns in the area, primarily less transportation to Houston to access dental clinic. This category will be cut 100% third to fund the core services if there is an overall reduction in funds to the HSDA.

06-07 Oral Health (5) o $8,000 total, all from SS oThreshold set at $17, Threshold is based on an estimated utilization of all clients accessing a local dentist that charges. In reality, most clients access free clinic in Houston, thus, not fully funding threshold. Also, historic utilization data indicate that the real level of need is below that of the calculated threshold. If there is a reduction in overall funds to the HSDA, funds will be taken from Food Bank, Health Insurance, and then Transportation, in that order, to fund this category.

06-07 Case Management (8) o $204,078 total, all from RW oThreshold set at $261, Not funding at threshold because case management reaches a marginal cost, it does not cost more for case managers to see a few additional clients. The funding does include a 3% cost of living increase over If there is a reduction in overall funds to the HSDA, funds will be taken from Food Bank, Health Insurance, and then Transportation, in that order, to fund this category.

06-07 Substance Abuse (12) o$0 allocated oThreshold set at $3, for substance abuse (not differentiated between inpatient or outpatient). Threshold calculated on estimate of cost for one intensive inpatient detox. Other community resources are available that meet the need of this service. There is no historic utilization data and little to no expression of need for the service.

06-07 Health Insurance (15) o $5,000 total, all from SS oThis funding level is a slight decrease from because funds needed to be dispersed into other categories. This category will be cut 100% second to fund the core services if there is an overall reduction in funds to the HSDA.

06-07 Mental Health (21) o $3,871 total, all from SS oThreshold set at $3, Fully funding at threshold. Clients will need some access to counseling services and some psychiatric services no longer available at MHMR due to funding cuts at MHMR. If there is a reduction in overall funds to the HSDA, funds will be taken from Food Bank, Health Insurance, and then Transportation, in that order, to fund this category.

06-07 Allocations oAOMC: $25,000 oFood Bank: $2,500 oDrug Reimbursement: $23,546 oTransportation: $23,380 oOral Health: $8,000 oCase Management: $204,078 oSubstance Abuse: $0 oHealth Insurance: $5,000 oMental Health: $3,871

Comments oItems to include: service category, suggested amount, reason for amount oIf it is a core service and reducing the amount, must take into consideration where additional resources will fill the gap between threshold and allocation

CTHPC Approval oThe Central Texas HIV Planning Council meeting on November 15, 2005 at 10 a.m. in Austin to approve the allocations. This request is then sent to DSHS for approval.