1. 2019 Priority Setting and Resource Allocations

2. Norfolk TGA At-A-Glance
Who we serve:
Chesapeake
Norfolk
Virginia Beach
Portsmouth
Suffolk
Isle of Wight
Hampton
Poquoson
Newport News
Williamsburg
James City County
Gloucester County
Mathews County
York County
Currituck Co., NC
The Norfolk Transitional Grant Area (TGA) has a population of 1,705,057. The TGA is unique in that it serves two States, Virginia and North Carolina. The population of the TGA is comprised of 14 Cities/Counties in Virginia and one county in North Carolina. Forty percent, 6 of 15 Cities/Counties of the TGA have a population living at/or below Federal Poverty level and a higher rate than the National average of 14.8%. The TGA’s general population racial/ethnic representation is about 70% White/Caucasian, 19% Black/African American, 3% Multiracial, 6% Asian, and less than 1% combined for American Indians, Alaskan Natives, Native Hawaiians and/or Pacific Islanders. Approximately 9% of above races identify as being Hispanic or Latin in origin.

3. Norfolk TGA ROLES AND RESPONSIBILITIES
Based on needs assessment, utilization, and epidemiologic data— the Planning Council decides what services are most needed by people living with HIV in the TGA (priority setting) and decides how much RWHAP Part A money should be used for each of these service categories (resource allocations).
The planning council may also provide guidance to the recipient on service models, targeting of populations or service areas, and other ways to best meet the identified priorities (directives)

4. Norfolk TGA LEGISLATIVE REQUIREMENTS
The planning council uses needs assessment data as well as data from a number of other sources to set priorities and allocate resources. This means the members decide which services are most important to people living with HIV in the EMA or TGA (priority setting) and then agree on which service categories to fund and how much funding to provide (resource allocations). In setting priorities, the planning council should consider what service categories are needed to provide a comprehensive system of care for people living with HIV in the EMA or TGA, without regard to who funds those services.
The planning council must prioritize only service categories that are included in the RWHAP legislation as core medical services or support services. These are the same service categories that can be funded by RWHAP Part B and RWHAP Part C programs.

5. Norfolk TGA LEGISLATIVE REQUIREMENTS
After it sets priorities, the planning council must allocate resources, which means it decides how much RWHAP Part A funding will be used for each of these service priorities. For example, the planning council decides how much funding should go for outpatient/ ambulatory health services, mental health services, etc. In allocating resources, planning councils need to focus on the legislative requirement that at least 75 percent of funds must go to cover medical services and not more than 25 percent to support services, unless the EMA or TGA has obtained a waiver of this requirement. Support services must contribute to positive medical outcomes for clients. Typically, the planning council makes resource allocations using three scenarios that assume unchanged, increased, and decreased funding in the coming program year.
75%
Core
25%
SUPPORT
The planning council makes decisions about priorities and resource allocations based on many factors, including:
Needs assessment findings;
Information about the most successful and economical ways of providing services;
Actual service cost and utilization data (provided by the recipient);
Priorities of people living with HIV who will use services ;
Use of RWHAP Part A funds to work well with other services like HIV prevention and substance abuse treatment services, and within the changing healthcare landscape; and
The amount of funds provided by other sources like Medicaid, Medicare, state and local government, and private funders— since RWHAP is the “payor of last resort” and should not pay for services that can be provided with other funding.

6. Norfolk TGA Notice of funding opportunity
Funding Opportunity Number: HRSA
Funding Opportunity Type(s): Competing Continuation
Catalog of Federal Domestic Assistance (CFDA) Number:
Application Due Date: September 21, 2018
B. Planning Responsibilities
Section 2602(b)(4)(C) of the PHS Act requires PC/PBs to determine the priority for RWHAP allowable services and service allocations of RWHAP Part A funds every year. To fulfill this responsibility, EMA/TGA PC/PBs set service priorities and allocate RWHAP Part A funds based on the size, demographics, and needs of people living with or affected by HIV, with particular focus on individuals who know their HIV status but are not in care. The RWHAP Part A PC/PBs also are responsible for evaluating the efficiency of the recipient in distributing funds to service providers.
PC/PBs analyze information to develop an in-depth understanding of the current HIV epidemic and its impact on the service area. PC/PBs review needs assessment data, HIV epidemiologic data, and co-occurring conditions data. The review includes service utilization data related to complexity of providing care, including service availability and unit cost per service, as well as service needs of emerging populations. The purpose of these data reviews is to guide decisions about HIV-related services and resources in the EMA/TGA. Furthermore, planning and implementation of the RWHAP Part A is driven by overall comprehensive planning and the recently developed Integrated HIV Prevention and Care Plan, including the Statewide Coordinated Statement of Need, CY as a roadmap for relevant goals, objectives, and strategies for delivering RWHAP Part A services along the HIV continuum of care

7. Norfolk TGA Notice of funding opportunity
Planning and Resource Allocation
The purpose of this section is to document the existence of a functioning planning process in the EMA/TGA that is consistent with RWHAP and HRSA program requirements. Such a planning process is imperative for effective local and state decision making to develop systems of prevention and care that are responsive to the needs of persons at risk for HIV infection and PLWH. Both HRSA and CDC support activities that facilitate collaboration and/or develop a joint planning body to address prevention and care. Community engagement is an essential component for planning comprehensive, effective HIV prevention and care programs in the United States.
The composition of the PC/PB must reflect the demographics of the HIV epidemic in the EMA/TGA and be representative of various required categories of membership as cited in Sec. 2602(b)(1)-(2) of the PHS Act. PC/PB members must be trained regarding their legislatively mandated responsibilities and other competencies necessary for full participation in collaborative decision-making. PC/PBs are encouraged to educate members about service issues related to the prevention of domestic and sexual violence, opioid and other drug use, and trauma informed care as part of their ongoing training. PC/PBs should also consider recruiting members who are knowledgeable about these issues. 1
STAGE 1
Planning and
Resource Allocation

8. Norfolk TGA Notice of funding opportunity1
STAGE 1
Planning and
Resource Allocation

9. Norfolk TGA Notice of funding opportunity1
STAGE 1
Planning and
Resource Allocation

10. Norfolk TGA Notice of funding opportunity
Description of the Community Input Process
Describe the overall community input process and how it informs the PC/PB priority setting and resource allocation process for the jurisdiction and include a summary of how the process was conducted. Also, include a discussion of how the Integrated HIV Prevention and Care Plan (IP) has helped inform the RWHAP Part A service priorities and resource allocations, as well as a description of how the IP is interwoven into your Part A activities.
Specifically, address:
i. How PLWH were involved in the planning and allocation processes and how their priorities were considered in the process;
ii. How the input of the community was considered and whether the community input process adequately addressed any funding increases or decreases in the RWHAP Part A award;
iii. How MAI funding was considered during the planning process to enhance services to minority populations;
iv. How data were used in the priority setting and allocation processes to increase access to core medical services, ensure access to services for women, infants, children, and youth (WICY) and to reduce disparities in access to HIV care in the EMA/TGA; and
v. Any significant changes in the prioritization and allocation process from 2018 to 2019 project periods and the rationale for making those changes. 2
STAGE 2
Description of the Community Input Process

11. Norfolk TGA Notice of funding opportunity2
STAGE 2
Description of the Community Input Process

12. REVIEW OF DATA

13. Norfolk TGA EPIDEMOLOGICAL DATA
HIV
2011
2012
2013
2014
2015
2016
2017
-5%
326
311
305
304
Since 2011
298
297
Incidence
289
AIDS
-19%
143
135
132
129
121
Since 2011
110
Incidence
104

14. Norfolk TGA EPIDEMOLOGICAL DATA
2011
2012
2013
2014
2015
2016
2017
HIV
4,075
3,918
3,765
3,635
25%
3,508
3,362
PREVALANCE
3,256
Since 2011
AIDS
2,968
2,886
2,844
2,799
13%
2,722
PREVALANCE
2,673
2,617
Since 2011

15. Norfolk TGA EPIDEMOLOGICAL DATA
2011
2012
2013
2014
2015
2016
2017
TOTAL
22%
7,436
7,229
7,017
CASES
Since 2011 3%
6,877
6,699
6,467
6,307
Since 2016

16. Norfolk TGA EPIDEMOLOGICAL DATA
2011
2012
2013
2014
2015
2016
2017
TOTAL
45+ YEARS
20 – 44 YEARS
CASES - age
13 – 19 years
<13 YEARS

17. Norfolk TGA EPIDEMOLOGICAL DATA
2011
2012
2013
2014
2015
2016
2017
5105
TOTAL
AFRICAN AMERICAN
NATIVE AMERICAN
1676
Asian/Hawaiian
CASES – Race/Ethnicity
362
Hispanic/Latino
Multiracial/other
228
White, non-Hispanic 56 9

18. Norfolk TGA EPIDEMOLOGICAL DATA
2011
2012
2013
2014
2015
2016
2017
TOTAL
69%
CASES – Race/Ethnicity
AFRICAN AMERICANS
23%
WHITE, Non-Hispanic
Hispanic/Latino 5%

19. Norfolk TGA EPIDEMOLOGICAL DATA
GENDER
2011
2012
2013
2014
2015
2016
2017
TOTAL
METHOD OF EXPOSURE
2011
2012
2013
2014
2015
2016
2017
CASES – Gender Method of EXPOSURE

20. Norfolk TGA EARLY INTERVENTION SERVICES
NEWLY DIAGNOSED 41
NEWLY Dx LINKED TO CARE 32
EIS
NEW TO CARE 59
NEWLY Dx LINKED TO CARE 42
TOTAL CLIENTS 298
OUT OF CARE
188
OUT OF CARE LINKED TO CARE
111
78%
71%
59%
Newly DX LINKED
New TO CARE LINKED
OUT OF CARE LINKED

21. Norfolk TGA SERVICE UTILIZATION DATA
EIS
2014
2015
2016
2017
Total Clients Served
175
227
245
197
Early Intervention Services
Minority AIDS Initiative
UNITS OF SERVICE
4,310
7,227
6,141
2,550
COST PER CLIENT
$2,816.69
$2,144.45
$1,875.84
$2,270.06
TOTAL EXPENDED
$492,921
$486,789
$459,582
$447,201
-9.3%
13%
-19%
2014
2014
2017
2017
2017
Total expended
2014
TOTAL CLIENTS SERVED
Cost per client

22. Norfolk TGA SERVICE UTILIZATION DATA
EIS
2014
2015
2016
2017
Total Clients Served 49
101
Not funded
Not funded
Early Intervention Services
REGULAR
UNITS OF SERVICE
397
913
Not funded
Not funded
COST PER CLIENT
Not funded
Not funded
$2,127.82
$1,600.83
TOTAL EXPENDED
Not funded
Not funded
$104,263
$161,683
55%
106%
-25%
2014
2017
2017
2017
2016
Total expended
2016
TOTAL CLIENTS SERVED
Cost per client

23. Norfolk TGA SERVICE UTILIZATION DATA
OAHS
2014
2015
2016
2017
Total Clients Served
813
659
677
737
UNITS OF SERVICE
1,836
1,560
1,459
1,639
Outpatient Ambulatory
Health Services
COST PER CLIENT
$2,193.48
$2,716.21
$2,204.51
$1,667.80
TOTAL EXPENDED
$1,783,296
$1,789,977
$1,492,252
$1,229,170
-31%
-9.3%
-24%
2014
2014
2014
2017
2017
2017
Total expended
TOTAL CLIENTS SERVED
Cost per client

24. Norfolk TGA SERVICE UTILIZATION DATA
MCM
2014
2015
2016
2017
Total Clients Served
1,385
1,299
1,283
1,309
Medical Case Management Services
UNITS OF SERVICE
69,923
68,961
68,689
68,942
COST PER CLIENT
$769.42
$1,003.11
$1,113.36
$1,110.05
TOTAL EXPENDED
$1,065,652
$1,303,037
$1,428,447
$1,453,050
36%
-5.5%
44%
2014
2017
2017
2017
2014
Total expended
TOTAL CLIENTS SERVED
2014
Cost per client

25. Norfolk TGA SERVICE UTILIZATION DATA
HIPCSA
2014
2015
2016
2017
Total Clients Served
835
1,038
1,091
1,388
Health insurance premium
And cost sharing assistance
UNITS OF SERVICE
3,481
3,879
4,134
4,191
COST PER CLIENT
$491.69
$222.32
$273.99
$196.15
TOTAL EXPENDED
$199,189
$230,769
$298,928
$272,251
37%
66%
-60%
2014
2017
2017
2017
2014
Total expended
2014
TOTAL CLIENTS SERVED
Cost per client

26. Norfolk TGA SERVICE UTILIZATION DATA
lpap
2014
2015
2016
2017
Total Clients Served
302
162
167
171
Local Pharmaceutical Assistance Program
UNITS OF SERVICE
854
417
436
503
COST PER CLIENT
$299.25
$339.78
$316.58
$411.20
TOTAL EXPENDED
$90,375
$55,044
$52,869
$70,315
-22%
-43%
37%
2014
2014
2017
2017
2017
Total expended
TOTAL CLIENTS SERVED
2014
Cost per client

27. Norfolk TGA SERVICE UTILIZATION DATAMH
2014
2015
2016
2017
Total Clients Served
130
115 83
102
MENTAL HEALTH
SERVICES
UNITS OF SERVICE
786
599
501
664
COST PER CLIENT
$511.16
$449.01
$514.57
$605.54
TOTAL EXPENDED
$66,451
$51,636
$42,709
$61,765
-7%
-22%
18%
2014
2014
2017
2017
2017
Total expended
TOTAL CLIENTS SERVED
2014
Cost per client

28. Norfolk TGA SERVICE UTILIZATION DATASA
2014
2015
2016
2017
Total Clients Served 4 5 4 5
Substance abuse Services
outpatient
UNITS OF SERVICE
1,230
1,864
1,317
1,801
COST PER CLIENT
$3,183.99
$3,148.80
$2,668.50
$2,754.40
TOTAL EXPENDED
$12,736
$15,744
$10,674
$13,722
7.8%
25%
14%
2014
2017
2017
2017
2014
Total expended
2014
TOTAL CLIENTS SERVED
Cost per client

29. Norfolk TGA SERVICE UTILIZATION DATAOH
2014
2015
2016
2017
Total Clients Served
553
642
591
609
ORAL HEALTH
SERVICES
UNITS OF SERVICE
2,013
2,519
2,019
2,085
COST PER CLIENT
$670.63
$671.66
$699.81
$706.77
TOTAL EXPENDED
$370,858
$431,202
$413,587
$430,423
16%
10%
5.3%
2017
2017
2017
2014
Total expended
2014
TOTAL CLIENTS SERVED
2014
Cost per client

30. Norfolk TGA SERVICE UTILIZATION DATA
NMCm
2014
2015
2016
2017
Total Clients Served
295
1,909
2,040
2,307
Case management
Non-medical services
UNITS OF SERVICE
1,863
20,058
20,366
18,820
COST PER CLIENT
$263.85
$128.35
$122.91
$134.61
TOTAL EXPENDED
$77,836
$245,007
$250,737
$310,535
21%
-6.2%
4.8%
2015
2017
2017
2017
2015
Total expended
TOTAL CLIENTS SERVED
2015
Cost per client

31. Norfolk TGA SERVICE UTILIZATION DATA
EFA
2014
2015
2016
2017
Total Clients Served 52
108
109
128
EMERGENCY FINANCIAL ASSISTANCE
UNITS OF SERVICE 55
140
172
218
COST PER CLIENT
$847.03
$398.76
$1,084.23
$1,126.44
TOTAL EXPENDED
$43,775
$43,066
$118,181
$144,184
229%
146%
33%
2017
2017
2017
2014
Total expended
2014
TOTAL CLIENTS SERVED
2014
Cost per client

32. Norfolk TGA SERVICE UTILIZATION DATAMT
2014
2015
2016
2017
Total Clients Served
493
512
484
480
MEDICAL TRANSPORTATION SERVICES
UNITS OF SERVICE
6,403
8,916
9,126
8,809
COST PER CLIENT
$456.13
$520.30
$529.45
$553.16
TOTAL EXPENDED
$224,874
$266,391
$256,256
$265,517
18%
-2.6%
21%
2014
2017
2017
2017
2014
Total expended
TOTAL CLIENTS SERVED
2014
Cost per client

33. Norfolk TGA SERVICE UTILIZATION DATAFB
2017
Total Clients Served
226
FOOD BANK /
HOME DELIVERED MEALS
UNITS OF SERVICE
784
COST PER CLIENT
$115.08
TOTAL EXPENDED
$26,008

34. Norfolk TGA Virginia Medicaid Expansion
Thousands of Virginians aged 19 to 64 will soon be able to sign up for new health coverage that will give them access to services at low cost. Starting January 1, 2019, eligible adults will be able to visit their doctor for help with preventing illness and improving their health.
Family Size
Yearly*
Monthly* 1
$16,754
$1,397 2
$22,715
$1,894 3
$28,677
$2,391 4
$34,638
$2,887 5
$40,600
$3,384 6
$46,562
$3,881 7
$52,523
$4,378 8
$58,485
$4,875

35. Norfolk TGA VIRGINIA MEDICAID EXPANSION
≤ 138% FPL
139% – 400% FPL
VDH ADAP DATA (TGA)
1,367
709
NORFOLK TGA DATA
2,258
856
Approximately 581 clients will become eligible for Medicaid on January 1, This is approximately $968, in services for Outpatient Ambulatory Health Services.
737
Total Clients RECEIVING OAHS
OAHS ≤ 138% FPL
581
OAHS 139% - 400% FPL
156
Approximately 156 clients will be eligible for an ACA/Market Place insurance plan during open enrollment. This is approximately $260, in services for Outpatient Ambulatory Health Services.

36. Norfolk TGA INSURANCE DATA FOR CLIENTS
≤ 138% FPL
139% – 400% FPL
NORFOLK TGA DATA
2,258
856
Total Clients RECEIVING Services
3,114
Clients with no Insurance
672
Clients w/o Insurance ≤ 138%
555
Approximately 117 clients will not qualify for a Virginia Medicaid Plan. This is approximately $136, in services for Outpatient Ambulatory Health Services.
During the 2018 – 2019 grant year, initiatives to identify clients who are eligible for Medicaid (≤138% FPL) and ACA/Market Place Plans ( % FPL) should be initiated and tracked to ensure Ryan White remains the payer of last resort.

37. QUESTIONS?