Please see the following changes to PCN 16-02 and the service definitions below. Changes or additions in bold and italics.
These changes and requirements are in effect as of 12/1/2018.
Emergency Financial Assistance
Definition of Service
Emergency Financial Assistance provides limited one-time or short-term payments to assist the RWHAP client with an emergent need for paying for essential utilities, housing, food (including groceries, and food vouchers), transportation, and medication. Emergency financial assistance can occur as a direct payment to an agency or through a voucher program. Payments should be limited in time and amount, and continuous provision of an allowable service to a client should not be funded through emergency financial assistance. EFA in a given line item may only be used for 30 days per client.
Direct cash payments to clients are not permitted.
Services Provided
Payments may be made on behalf of eligible clients who are unable to access assistance from other resources or other Ryan White categories; while awaiting intake to medical care or confirmation of HIV status; while awaiting intake or results from applications to Medicaid or other social services; or who have a case manager documented emergency not covered by another service category.
Services available through this category may include:
- Essential Utilities (water, gas, electricity, phone)
- Housing expenses (mortgage, or rent)
- Transportation
- Medications not covered by LAHAP
- Food or food vouchers
Housing
Ryan White housing funds should be used to assist individuals with transitional, short term or emergency housing assistance.
These may come in the form of paying for a stay in a hotel before a family can move in to a home, a shelter voucher, or a rent payment. These payments should total no more than 90 days of assistance but may be extended with permission from the agency Case Management Supervisor or Executive Director.
Per HRSA guidelines this item may not be used to pay mortgages or rental deposits.
Non-Medical Case Management
Definition of Service
Non-Medical Case Management Services (NMCM) provide guidance and assistance in accessing medical, social, community, legal, financial, and other needed services. Non-Medical Case management 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, Medicare Part D, the state AIDS Drug Assistance Program (ADAP), Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services, or health insurance Marketplace plans.
Key activities include:
- Initial assessment of service needs;
- Development of a comprehensive, individualized care plan;
- Client specific advocacy and/or review of utilization of services;
- 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; and
- Ongoing assessment of the client’s and other key family members’ needs and personal support systems
The Non-Medical Case Management Services objective is to provide coordination, guidance and assistance in improving access to and retention in medical and support services to mitigate and eliminate barriers to health care services.
Non-Medical Case Management does not involve coordination and follow-up of medical treatments, as Medical Case Management does.
Services Provided
Non-Medical Case Management services are home and community-based. Case Managers will encounter clients in their environment, which may include a residence, a public facility, in the streets, or in the facilities of the Case Management service provider agency.
Services will be provided to individual clients who have difficulty functioning well in the community due to barriers which include, but are not limited to: lack of knowledge regarding available services, inability to maintain financial independence, homelessness, deteriorating medical condition, psychiatric illness, substance abuse, illiteracy, inability to complete necessary forms, inability to arrange and complete entitlement and medical appointments, language/cultural barriers, and/or the absence of speech, sight, hearing, or mobility
Essential functions include:
-
- Continuation in care;
- Periodic assessment of client needs;
- Limited service planning;
- Limited monitoring and follow up; and
- Discharge and Transition planning into self-management
Additional Client Eligibility Requirements
- None
Units of Service
-
- 1 assessment / re-assessment event = 1 unit
- 1 intake = 1 unit
- 1 15 min. social work face to face encounter = 1 unit (non – intake)
- 1 15 min. other staff face to face encounter = 1 unit (non – intake)
- 1 15 min. social work other encounter = 1 unit (telephone contact with client, or on client’s behalf)
- 1 15 min. other staff, other encounter = 1 unit (telephone contact with client, or on client’s behalf)
Requirements to Participate
- Non-Medical Case Management must meet the Ryan White Requirements to Participate as outlined in the Ryan White Part B Service Definitions.
- It is recommended that caseloads not exceed forty (40) non-medical case managed clients per full-time case manager.
- Non-Medical Case Managers must have achieved a Bachelor’s degree in a human services field with at least one year of case management experience.
Outreach
Definition of Service
At this time Ryan White Part B Outreach services should be focused on individuals who have been lost to care, are not in care and/or those who other reengagement activities. Outreach Services provide linkage or re-engagement of PLWH who know their status into HRSA RWHAP services, including provision of information about health care coverage options. Outreach should be conducted for purposes of educating individuals living with HIV about treatment opportunities available within the community, reengaging clients in care, and following-up on a periodic basis to ensure the client is still in medical care or support services.
Services Provided
Outreach Services include the provision of reengagement services to people who know their status into health services.
Funds may not be used to pay for HIV counseling or testing under this service category. Outreach services may not be delivered anonymously.
Additional Client Eligibility Requirements
- None.
Units of Service
- 1 15 min. of outreach = 1 unit
Requirements to Participate
- Outreach Services must meet the Ryan White Requirements to Participate as outlined in the Ryan White Part B Service Definitions.
- Provider(s) must demonstrate that employees hired to provide Outreach services have adequate knowledge of local primary care sites and agencies that provide supportive services, and are able to appropriately assist eligible people living with HIV in accessing these services.
- Outreach services should be conducted for up to six months following the Ryan White Part B eligibility expiration. After six months the case should be closed.
