Central Texas HIV Planning Council Allocations for Concho 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 Concho Health Services Delivery Area (HSDA): Coke, Concho, Crockett, Irion, Kimble, McCulloch, Mason, Menard, Reagan, Schleicher, Sterling, Sutton, and Tom Green 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 1 Texas Department of State Health Services “Priority Setting and Resource Allocation Procedures for HIV Care Services” DraftApril2005

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 %$37,521$ AOMC Example 15 new infections from ‘03 to ‘04 10 new active clients for ‘04 76 total active clients for ‘04 64 total using service for ‘04 $43, Threshold

Thresholds oAmbulatory/Outpatient Medical Care: $43, oDrug Reimbursement: $41, oOral Health: $3, oCase Management: $94, oMental Health: $ oSubstance Abuse: $9, o Total: $183,094.42

Allocations oOperating under the assumption of flat funding from total allocation to HSDA: $217,852 o$163,504 RW o$54,348 SS

Ambulatory/Outpatient Medical Care (1) o $40,000 total, all from RW oThreshold set at $43, Funded slightly below because there are other resources in the area that will make up the difference. If there is a reduction in overall funds to the HSDA, Food Bank will be cut up to 70%, Transportation cut up to 20%, and Health Insurance up to 10%, in that order.

06-07 Case Management (2) o $97,105 total o$84,357 RW + $12,748 SS oThreshold set at $94, The RW portion includes a 3% cost of living increase over levels. A State Services component was added to this category which came from Related Housing Services, which was paying a portion of a salary to find housing and services for clients, along the lines of case management. If there is a reduction in overall funds to the HSDA, Food Bank will be cut up to 70%, Transportation cut up to 20%, and Health Insurance up to 10%, in that order.

06-07 Drug Reimbursement (3) o $35,500 total, all from RW oThreshold set at $41, Funded below the threshold because past utilization and expenditure data show that the need is being met at this level of funding. If there is a reduction in overall funds to the HSDA, Food Bank will be cut up to 70%, Transportation cut up to 20%, and Health Insurance up to 10%, in that order.

06-07 Food bank (4) o $10,000 total, all from SS oThis is a slight decrease from Need for the service is still present, but difference in funds from had to be applied to core services and other service categories. If there is an overall reduction in funds to the HSDA, this service will be cut up to 70% to fund core services.

06-07 Oral Health (5) o $3,100 total, all from SS oThreshold set at $3, Fully funded threshold. Need is still present in the area. If there is a reduction in overall funds to the HSDA, Food Bank will be cut up to 70%, Transportation cut up to 20%, and Health Insurance up to 10%, in that order.

06-07 Transportation (9) o $6,647 total o$3,647 RW + $3,000 SS oThis amount is a modest increase from to accommodate new clients and the increase in the price of gas and other transportation costs. This service is needed so clients may access other services. If there is an overall reduction in funds to the HSDA, this service will be cut up to 20% to fund the core services.

06-07 Health Insurance (11) o $23,000 total, all from SS oBased on past utilization and expenditure data, there appears to be an increase in need for this service. Health insurance payments result in long term savings in other categories. If there is an overall reduction in funds to the HSDA, this service will be cut up to 10% to fund the core services.

06-07 Mental Health (18) o $2,500 total, all from SS oThreshold set at $ Funding above threshold. The threshold is in part based on a previous allocation of $531 for This is level funded from and appears to meet the need based on prior utilization and expenditure data. If there is a reduction in overall funds to the HSDA, Food Bank will be cut up to 70%, Transportation cut up to 20%, and Health Insurance up to 10%, in that order.

06-07 Substance Abuse (22) o$0 allocated oThreshold for substance abuse set at $9, (not differentiated between inpatient and outpatient). Threshold is based on calculation of cost to treat one intensive inpatient. This category has never been funded and there is no expressed need for this service in the area. Any needs that do arise may be met through other community resources.

06-07 Allocations oAOMC: $40,000 oCase Management: $97,105 oDrug Reimbursement: $35,500 oFood Bank: $10,000 oOral Health: $3,100 oTransportation: $6,647 oHealth Insurance: $23,000 oMental Health: $2,500 oSubstance Abuse: $0

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.