Client Services Provider Manual. Ryan White HIV/AIDS Treatment Extension Act Part A FY HIV/AIDS Services Division Infectious Disease Bureau

Transcription

1 Client Services Provider Manual Ryan White HIV/AIDS Treatment Extension Act Part A FY 2016 HIV/AIDS Services Division Infectious Disease Bureau

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3 Ryan White HIV/AIDS Treatment Extension Act Part A Boston Eligible Metropolitan Area Provider Manual Fiscal Year 2016 Edition March 1, February 28, 2017 H I V / A I D S S e r v i c e s D i v i s i o n I n f e c t i o u s D i s e a s e B u r e a u B o s t o n P u b l i c H e a l t h C o m m i s s i o n M a s s a c h u s e t t s A v e n u e, 2 n d F l o o r B o s t o n, M A ( p ) ( f ) w w w. b p h c. o r g

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5 Map of the Boston Eligible Metropolitan Area

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7 Table of Contents INTRODUCTION... 1 PROGRAM OVERVIEW... 3 Program Rules FY Program Reporting Overview... 7 Quarterly Report Instructions Sample Program Narrative Outcome Summary Report Instructions HIV/AIDS Client Code and UCI Instructions for Completing the HIV/AIDS Client Information Form How to Create New Client in e2boston e2boston - Client Utilization Form Sample Unit Rate Client Utilization Data, Fiscal Backup How to Add Services to a Client Record Outcome Measurement Reports How to Add Outcomes to a Client Record Ryan White HIV/AIDS RSR Reporting Standards of Care Overview Site Visit Overview FISCAL OVERVIEW Fiscal Rules FY Sample Cost Reimbursement Invoice Sample Unit Rate Invoice Budgets Sample Cost Reimbursement Budget Sample Unit Rate Budget Budget Revision Request Instructions Sample Cost Reimbursement Budget Revision Sample Unit Rate Budget Revision SERVICE CODE INFORMATION Service Codes by Category Service Code Summary POLICIES AND PROCEDURES GRANTEE ADMINISTRATION INFORMATION Staff Contact List FY Internet Resources Agency Websites ATTACHMENTS Site Visit Documentation Checklist Important Part A & MAI Submission Dates Client Utilization Form Universal Standards Checklist Service Specific Standards Checklist

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9 Introduction Welcome to FY 2016 (Year 26) of the Ryan White Part A Program. This is the 7 th year under the Ryan White HIV/ AIDS Treatment Extension Act of 2009 and the 26 th year of Part A funding for the Boston Eligible Metropolitan Area (EMA). This year marks a transition period during which our Part A service system is shifting its focus to more closely align with the goals of the White House National HIV/AIDS Strategy and the HIV Care Continuum. Among the goals outlined in the strategy, Ryan White funds will continue to play a crucial role in ensuring that PLWH are effectively linked to high quality medical care, access to HIV medications, and ultimately achieve HIV viral suppression. As an early adopter of healthcare reform and our comprehensive coverage through state Medicaid, Part A funds have been utilized less and less for primary care and medication access. Over the past five years, the Boston EMA Planning Council has gradually reprioritized service categories and funding allocations towards Medical Case Management and other health-related supported services that link and retain PLWH in care. Following their direction, patterns and trends within our own Part A program data, and most recent HIV epidemiological trends, now is the time to make strategic investments in services that will yield the greatest benefits for our clients, especially those who are newly infected or have struggled to stay in care. With the completion of the HIV Client Services RFP this year, BPHC has thoroughly reviewed its current investments in services and allocated funding to a range of new and innovative program models for Medical Case Management, Peer Support, and Medical Transportation. Although RFP s are a competitive bid process, the ability to effectively collaborate with local community partners, whether hospital, health center, or community-based AIDS service organizations, will be an important factor for sustainability and providing clients with a comprehensive and accessible range of HIV services. As we evolve our work to better meet the needs of our clients, how do we know we are making progress? One of the challenges shared by all of us to validate the effective use of federal dollars, staff time, and resources is inevitably how much data BPHC can gather to report to HRSA. These typically come in the form of mandates that we understand place major burdens on small organizations and large ones alike. Our e2boston has grown significantly over the last two years since its implementation and we hope we have fulfilled one of our initial promises: your data should be available for your own use. By granting real-time access to the HIV client demographic, service utilization, and now outcome measurement data, our goal is to have agencies develop workplans and evaluate their performance by using their own program data. If you have never used e2boston or seen a report of your own Part A data, please ask one of your staff to run one this is your hard work to help your clients be/stay healthy and achieve viral suppression. I thank you for your hard work, dedication, and service to people living with HIV. Eric Thai Interim Division Director/Director of Client Services

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11 Program Overview In this section: Program Rules FY Program Reporting Overview... 7 Quarterly Report Instructions Sample Program Narrative Outcome Summary Report Instructions HIV/AIDS Client Code and UCI Instructions for Completing the HIV/AIDS Client Information Form How to Create New Client in e2boston e2boston - Client Utilization Form Sample Unit Rate Client Utilization Data, Fiscal Backup How to Add Services to a Client Record Outcome Measurement Reports How to Add Outcomes to a Client Record Ryan White HIV/AIDS RSR Reporting Standards of Care Overview Site Visit Overview... 34

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13 Program Rules FY 2016 Reporting A. Reporting shall be considered a deliverable under this agreement for purposes of determining fulfillment of the Subrecipient s obligations. Failure to produce timely and adequate reports may jeopardize the Subrecipient s funding during the current award period, as well as its eligibility or consideration for funding in subsequent years, and shall result in a delay in payment. B. The Subrecipient shall submit quarterly reports and statistical reports. Statistical reports shall include, at a minimum, the submission of (1) Client Information: including a unique client code, client demographics, exposure category, diagnostic information, housing status, and insurance status, and (2) Client Utilization Data: including units of service delivered, dates of service, and number of units. Such submissions must be made via BPHC s e2boston System. Quarterly reports shall include a description of the progress made and efforts undertaken to meet goals and objectives for each activity or service funded, including summary of services provided and those served (Program Utilization and Client Demographics), any problems, obstacles or barriers to meeting such goals and objectives, and any actions taken or to be taken to resolve such problems, obstacles, or barriers. Quarterly reports must include updates on personnel changes for Part A staff and a description of any program spending issues during the reporting period. The Boston Public Health Commission may request additional information at any time. C. All quarterly reports shall contain information that is concise and provides sufficient detail to allow evaluation of funded efforts. All tables included in the Quarterly Report template must be completed and narrative descriptions provided, where appropriate. Also, the Subrecipient shall include a description of the implementation and progress on any Plans of Corrective Action submitted to the Boston Public Health Commission. Furthermore, while funding through other sources that complement Part A funded activities may be cited, the application of Part A funds shall be made explicit and documented separately in reports. The Boston Public Health Commission may provide specific formats for submitting reports, which the Subrecipient shall be required to follow. The Subrecipient shall be required to adhere to new reporting requirements in submitting their quarterly reports subsequent to that date. Training will be provided. D. Quarterly reports shall be submitted within fifteen (15) days after the end of the quarter. If applicable, annual reports shall be submitted within fifteen (15) days of the close of the reporting period. All reports shall be submitted to the Boston Public Health Commission. E. Programs funded with unit rate contracts must submit a combined fiscal and data report within fifteen (15) days after the end of each month, and a quarterly narrative report within fifteen (15) days of the close of each quarter. F. Client level outcome measures have been developed for all service categories. Subrecipients shall submit reports on outcome measures throughout the year, according to the Client Clock Model. Funded programs are expected to submit at least 85% of outcome reports while funded. If less than 85% are submitted, the program must complete the corresponding section in their quarterly report explain why less than 85% were submitted, and indicate a goal for improvement in the next quarter. G. All Subrecipients will be expected to complete the Ryan White HIV/AIDS Services Report (RSR) each calendar year. Additional information will be provided prior to submission. FY 2016 Ryan White Part A Provider Manual 5

14 Program Performance The Boston Public Health Commission reserves the right to suspend, reduce or terminate the Subrecipient s contract if it determines the Subrecipient has failed to make substantial progress on its goals and objectives, that such failure is unreasonable, and the Subrecipient does not demonstrate an adequate strategy to address obstacles to that progress. The Subrecipient s program performance will be assessed through; review of the Subrecipient s program utilization, spending and reporting; evaluation of compliance regarding program and fiscal reporting requirements, and client file maintenance in relation to HRSA-mandated Part A site visits; and the Subrecipient s demonstrated efforts to retain and maintain clients in the HIV Continuum of Care. Monitoring The Boston Public Health Commission or other entities on behalf of the Boston Public Health Commission will conduct site visits. The Subrecipient will receive no less than one (1) site visit during the period of performance. Site visits include a review of both fiscal and programmatic documentation. Key personnel involved in implementation of the Scope of Services at any and all locations where funded activities occur should be available for site visits, and make all appropriate records available to BPHC staff. Additional information may be requested prior to, at, or subsequent to the site visit(s). The Subrecipient will have a reasonable time to produce such information. The Subrecipient will also receive reasonable notice prior to each site visit. BPHC Site visit dates are communicated up to one year in advance to the Program Manager of the funded agency. While BPHC will attempt to accommodate agencies schedules within the assigned month, BPHC reserves the right to visit a funded program at a time of its choosing and without advance notice. Client Eligibility The Subrecipient will be expected to comply with the Financial Eligibility Policy for Ryan White Services which requires funded providers to screen HIV + clients for income eligibility, based on a threshold of 500% of the Federal Poverty Level (FPL) as determined by the U.S. Department of Health and Human Services (HHS). When applicable the Subrecipient will also adhere to the Ryan White Services Sliding Fee Scale Policies, as indicated by the Boston Public Health Commission (BPHC). In addition, subrecipients must asses such eligibility every 6 months. 6 HIV/AIDS Services Division, Boston Public Health Commission

15 Program Reporting Overview BPHC uses quarterly reports to monitor each program s progress on meeting its contracted goals and objectives. Quarterly reporting requirements include the submission of a Quarterly Report and three forms of client-level data, including demographic, service utilization and outcome data. Each individually funded program must submit quarterly reports. If your agency is funded for multiple programs (e.g., Medical Case Management, Psychosocial Support - Mental Health and Substance Abuse - Residential), you must submit separate quarterly reports for each funded program. Reporting requirements differ for programs with unit rate budgets and for those with cost reimbursement budgets. Substance Abuse - Residential is currently the only category with a unit rate budget. Programs in all other service categories, including Minority AIDS Initiative (MAI), have cost reimbursement budgets unless specifically noted. Complete quarterly reporting requirements and instructions follow. Reporting Requirements Unit Rate Programs Each Month, programs with unit rate budgets will submit one signed original copy of combined fiscal and data report consisting of: One (1) copy of Fiscal Invoice. One (1) copy of Utilization Summary Report. This service utilization data will serve as the data submission and as fiscal backup documentation for units billed. Unit rate programs may submit utilization forms as a direct print out from the e2boston data system or create their own spreadsheet. Spreadsheets must include the following: agency name, service category, client code in alpha order, unique client identifier, service code, date of service, number of units, unit rate, and total cost. Programs should not submit duplicate versions of the same data. Refer to page 29 for a sample. The one signed original copy of combined fiscal and data report is due within 15 days of the month s end. Reports should be sent to: Quarterly Reporting Accounts Payable Boston Public Health Commission 1010 Massachusetts Avenue, 2 nd Floor Boston, MA Each Quarter, All Programs will submit: A quarterly report. The Quarterly Report provides a detailed description of Part A funded activities during the quarter. A fully completed electronic statistical report (demographic and client utilization report) for all clients that received services during the quarter. This completed electronic statistical report will serve as a data submission. Please Note: All submission of client data must be done via the e2boston Data System. Agencies interested in uploading their electronic data instead of directly entering it into e2boston may contact their Program Coordinator to start the process. FY 2016 Ryan White Part A Provider Manual 7

16 All programs will submit the Quarterly Report via to your BPHC contract manager. Outcome Summary Report Twice a year agencies will complete and submit an Outcomes Summary Report, which will look at data based on all outcome reports submitted in the previous six months. These reports will be due in addition to your Q2 and Q4 quarterly reports, so your report due at Q2 will include Q1 and Q2 information, and your report due at Q4 will contain Q3 and Q4 information. In particular, we want to use the report to highlight clients who are not virally suppressed and encourage all agencies to think about how to engage those clients more. Non-Compliance Agencies may be held in non-compliance at the end of each month if they do not meet the reporting requirements listed above. This includes non-submission of required information and incorrect or incomplete submission. If submitted reporting is incorrect and/or incomplete, it will be returned to the agency and the agency will be required to submit new corrected information. Agencies are notified of non-compliance in writing. Payment will be held if complete data and quarterly reports are not received when due and/or if fiscal documentation is incomplete. Non-compliance shall be lifted as soon as all submissions are complete. Formal extensions of the deadlines for quarterly reporting are not granted under any circumstance. 8 HIV/AIDS Services Division, Boston Public Health Commission

17 Important Ryan White Part A & Ryan White Part A Minority AIDS Initiative (MAI) FY 2016 Submission Dates Submission Reporting Period Due Date 1 st Quarterly Report Mar 1 - May 31 June 15, nd Quarterly Report June 1 - Aug 31 Sept 15, 2016 Outcomes Summary Report Mar 1 - Aug 31 Sept 15, rd Quarterly Report Sept 1 - Nov 30 Dec 15, th Quarterly Report Dec 1 - Feb 28 Mar 15, 2017 Outcomes Summary Report Sept 1 - Feb 28 Mar 15, 2017 Unit Rate Programs Submission of Fiscal Invoice and Client Utilization Data Each Month 15 days after each month s end (April 15, 2016 thru March 15, 2017) FY 2016 Ryan White Part A Provider Manual 9

18 Quarterly Report Instructions Quarterly Report Instructions Providers are expected to provide a detailed description of recent Part A funded activities in the program s quarterly report. Providers are required to complete a Quarterly Report for each funded service category. A template will be provided each quarter by your BPHC Program Coordinator. The following sections of the Quarterly Report must be completed to ensure Part A reporting requirements have been met. 1. Client Utilization Provide an update on your progress towards meeting the target utilization goal set in your Scope of Services. To complete the utilization table reference the program s target utilization goals outlined in the scope, the actual number of units and the percentage completed for the quarter. Should the program not meet the expected percentage goal for the quarter, an explanation must be provided describing why the program was unable to meet the goal. Attach a copy of the client utilization report from e2boston for the corresponding reporting period. Your Quarterly Report response regarding this section should utilize the data from this report. 2. Client Demographics Attach a copy of the client demographic reports from e2boston for the corresponding reporting period. 3. Personnel Provide an update on Part A program personnel, including any staff changes and/or TBD status of any open positions. If Part A funded staff attended any professional training during the quarter complete the chart and include the date, the name of the training and the staff that attended. 4. Program Spending Provide an update on current program expenditures. To complete the program spending section reference the program budget and total amount billed to date to determine the percentage of funding billed out for the quarter. If there were under billed salary and program expense lines complete the table by including the salary/expense line(s) and the under billed amount(s). Also, Provide an explanation and plan for the reallocation of the under billed dollars. Consult your fiscal staff if you require assistance in completing this section. 5. Service Specific Questions Respond to category specific questions regarding the program s current efforts in providing services, and support, implementing policies, and enacting strategies to ensure Ryan White Part A clients are retained in HIV care and are virally suppressed. These questions may differ each quarter, and will be included in the template provided by your BPHC Program Coordinator each quarter. Also, when responding to these questions you may need to reference the programs client utilization, demographics and outcomes when appropriate. 6. Other Program Update Provide any program updates such as new initiatives, program or agency expansion, or events the agency would like to highlight. 7. Unmet Need, Problems and Challenges Discuss any problem(s), obstacle(s) and/or challenge(s) faced internally by the program, how you met them, and how they affected your program. Include actions taken or to be taken to resolve such problem(s), obstacle(s) or challenge(s). Also, describe any training or technical assistance needs of program. 10 HIV/AIDS Services Division, Boston Public Health Commission

19 8. Plan of Corrective Action Describe your program s progress in addressing the citation(s) received at your last site visit. In answering the following questions, refer to your approved Plan of Correction Action, which outlines the action steps and deadlines for addressing the challenges that led to the citation(s). A sample Medical Case Management Quarterly Report can be found on the following pages. FY 2016 Ryan White Part A Provider Manual 11

20 Sample Program Narrative HELPFUL HINTS Has there been any changes regarding program contacts such as a new contact, name/title change or new address? Reference the e2boston client utilization data to complete the chart and when describing any challenges in meeting the expected goals for the quarter you are reporting on. 12 HIV/AIDS Services Division, Boston Public Health Commission

21 HELPFUL HINTS Have there been any personnel changes within the program such as, new hires, open positions, or vacancies? Include information regarding start and end dates of employment, plans for hiring new staff and any changes in supervisory structure. Are there any current or potential spending issues? Use this section to inform BPHC of these issues and how your program intends on resolving any issues. Consult your fiscal staff if you need assistance in completing this section. FY 2016 Ryan White Part A Provider Manual 13

22 HELPFUL HINTS When responding to service specific questions the answers should provide quantifiable and specific information. When applicable programs should reference the data submitted in their report. Are there updates such as future initiatives, program or agency expansions, or events the agency would like to highlight? Are there challenges that the program encountered in service delivery this quarter? Has your program developed and/or implemented strategies overcome them? 14 HIV/AIDS Services Division, Boston Public Health Commission

23 HELPFUL HINTS FY 2016 Ryan White Part A Provider Manual 15

24 Outcome Summary Report Instructions Providers are expected to provide a detailed description of health and quality of life outcomes for clients who received services. This report will be due twice per year, once with your Q2 Quarterly Report, and once with your Q4 Quarterly report. With each report you will examine data from the previous six month periods, so the first report will cover March 1-August 31, and the second report will cover September 1-February 28. If the program is funded for multiple service categories, you only need to fill out one report. In order to report on outcomes across two or more service categories, use e2boston to look at all outcomes data your agency has. Viral Suppression Report the percentage of clients who are virally suppressed, based on the number of outcome reports received and the number of clients served. This number will typically be lower than the viral suppression percentage among clients with outcome reports, but it will give you an idea of viral suppression across your agency. Outcome Report Submission This section is only for agencies who have submitted less than 85% of their outcome reports in the preceding six month period. In order to determine this number, use the Performance Summary report in e2boston with the corresponding date range. This report only takes into account the number of submitted reports and the number of deadlines that have passed in the six month period. The number of outcome reports you have yet to complete does not factor in. Virally Unsuppressed Individuals All services play an important role in the health and well being of PLWH, and this section will highlight some of the most vulnerable PLWH. Understanding who they are will help tailor services to their needs and ultimately help them reach and maintain viral suppression. Additional Outcome Measures Last year, BPHC chose to detail viral load, CD4 count, medical visit frequencies, and medication adherence to HRSA as part of an annual reporting process. BPHC will continue to report on these measures for the next few years, and hopefully will see improvements in each measure over time. Through our HIV Training and Quality Management/Quality Improvement program, we want to assist all agencies in these goals set by HRSA. 16 HIV/AIDS Services Division, Boston Public Health Commission

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26 HIV/AIDS Client Code and UCI The HIV/AIDS Client Code and UCI are used by both the Boston Public Health Commission and Massachusetts Department of Public Health. BPHC/MDPH Client Code The client code is a 13-character alphanumeric code. The code is made of the first three letters of the client s mother s first name (first three boxes). If unknown, it is made of XXX. The client s date of birth in MMDDYY format (next six boxes). The last four digits of the client s social security number (final four boxes). If the client does not have a social security number, the last four digits of the social security number is replaced by Example: The client is Jon Snow. He was born April 1, 1989, and his mother s name is Lyanna. His social security number is Lyanna (client s mother) is coded as LYA, the client's date of birth is coded as , and the last four digits of the social security number are coded as The complete Client Code is LYA L Y A HIV/AIDS Services Division, Boston Public Health Commission

27 HRSA Unique Client Identifier (UCI) The Unique Client Identifier (UCI) is an 11-character alphanumeric code. The code is derived from the first and third letters of the client s first name (first two boxes). The first and third letters of the client s last name (following two boxes). The client s date of birth in MMDDYY format (following six boxes). A 1 for male clients, a 2 for female clients, a 3 for transgender clients, or a 9 for clients whose gender is unknown (last box). Example: The client is Jon Snow. She was born April 1, Jon Snow is coded as JNSO the client's date of birth is coded as , and his gender is 1. The complete Client Code is JNSO J N S O Additional guidelines: The client s legal name should be used to develop the UCI. Do not use nicknames or abbreviations (e.g., do not use Bill if the client s full name is William). If the first or last name is an initial only and the initial is not an abbreviation of a longer name, count that as a character. Please also count the period as a character. For example, if a client s name was T. Walter Smith and T is not an abbreviation for a longer name, you would count the T as the first character, the period as the second character and the space as the third character Remember, if a symbol or space is the first or third character of the name, enter the number 9 in the appropriate space of the UCI. In this case, the client code is T9SI, assuming that T. Walter was the client s first name. When individuals have more than one first or last name (e.g., Mary Anne, Peters-Smith), start with the first name in the sequence to determine the first and third characters for the UCI. When a client only has two letters in the first or last name (e.g., Phuong Do, Yi Chen), enter a 9 in the appropriate space in the UCI. FY 2016 Ryan White Part A Provider Manual 19

28 Instructions for Completing the HIV/AIDS Client Information Form For FY16, a number of changes have been made to the Joint HIV/AIDS Client Information Form. What is now known simply as the HIV/AIDS Client Information Form features a number of revisions to preexisting fields, in addition to an entirely new section designed for Medical Case Management programs only. This new section, which is titled Medical Case Management and Medical Supplement, features a number of new medical variables that Medical Case Management programs are required to begin reporting on during FY16. The HIV/ AIDS Client Information Form can be thought of as being composed of three distinct sections. The first section is at the very top of the form (outlined by a black box), and consists of all the client information that is used to create a client s Client Code and Unique Client Identifier. Below this, is a section of general client information that spans items 1 19 on the HIV/AIDS Client Information Form. The third section is the aforementioned Medical Case Management and Medical Supplement, and spans items (for Medical Case Management programs only). Great effort was made to make the new HIV/AIDS Client Information Form as user-friendly and unambiguous as possible, but that is not to presume that questions will not arise. Please see below for a detailed explanation of what information each field on the HIV/AIDS Client Information Form is asking for. Client Code/Unique Client Identifier Information Last 4 Digits of SSN Birth Date Enter the last 4 digits of the client s Social Security Number. If this is unknown, please enter Enter the client s date of birth in mm/dd/yy format. Street Address, City, State (optional) Zip Code Enter the client s street address, city, and state of residence. Enter the client s 5-digit zip code. Do not enter If the client s housing is unstable, enter the zip code where the client spends the most time or returns to regularly and/or can receive messages and be contacted. Mother s First Name Enter the first name of the client s mother. If this is unknown, please enter XXX. Sex at Birth & Current Gender Indicate the client s sex at birth (male or female) and also indicate the client s current gender (male, female, transgender, or unknown/unreported). If the client s current gender is transgender, please indicate whether the transition was from male to female, female to male, unspecified, or if the client declined giving this information. 20 HIV/AIDS Services Division, Boston Public Health Commission

29 Screenshots of e2boston This entire section highlights the necessary data elements we need in a client s record. However, we encourage you to fill in as much information as possible, such as Client s Primary Language or Country of Birth. When you create a client, you fist enter information into the Client Intake page. This information is used to create a Unique Client Identifier (UCI) and a Client Code. e2boston also uses this information to check if the client already exists in your system. Once you verify the client is new, you can move to Client Demographics. How to Create New Client in e2boston All pages in the client record, including Demographics, use red asterisks to indicate mandatory fields. On any given page, you must fill in all asterisked fields before you can save the information. Date client first received services Referral Source Activity Status & Reason for Discharge (if inactive) Race (select all that apply) Hispanic or Latino/a (select one) Ethnic Sub-group Enter the date that the client first received HIV services at your agency in mm/dd/yy format. Indicate the way in which the client was initially referred to your agency for HIV services. If you choose other, please specify what the means of referral was. Indicate whether the client is an active client at your agency. If they are inactive, please indicate the reason for their discharge is known (please select only one and include the date of death in mm/dd/yy format if they are deceased.) Please select the racial categories that the client identifies as. The Unknown category includes Latinos who do not identify with any race). Please indicate whether the client is Hispanic or Latino/a. If a client is Hispanic, Asian or Native America, an option will appear to mark their Ethnic Subgroup. Please fill this out as it is now part of RSR Reporting. FY 2016 Ryan White Part A Provider Manual 21

30 How to Create New Client in e2boston Diagnostic information This page contains info about the client s HIV status, as well as original exposure category. Multiple exposure categories can be reported per client. The HIV status should be updated if the client s status changes, i.e. is diagnosed with AIDS. Diagnostic Information (select one) Current HIV/AIDS Medical Provider (if HIV positive) Exposure category (if HIV positive) (select all that apply) Please indicate the client s current HIV status by selecting one of the available options. If AIDS, CDC defined is selected, please provide the year of AIDS diagnosis in yyyy format. Important: HIV verification is required for any HIV positive clients Please indicate whether the client, if they are HIV positive, currently has an HIV/AIDS medical provider. Also, please provide the date on which this information was updated. If the client is HIV positive, please indicate all applicable exposure categories. Housing and Insurance This section of the client records contains one of the main components of Ryan White Eligibility: income information. This section must be updated each time a client is reassessed for eligibility. Once you have filled in income, income type, and family size, use the Calculate FPL button for e2boston to calculate the client s FPL for you. This FPL number can be used on the Income Verification sheet so you don t need to calculate it yourself. Housing Status (select one) & Housing type (if permanently housed) Source of Primary Medical Insurance (select one) & Source of other Medical Insurance Please indicate the client s housing status and provide the date on which this information was updated. If Permanent housing is selected, move to item 17 and indicate whether or not the housing is owned or rented. If it is rented, also indicate whether it is subsidized. Please indicate the client s source of primary medical insurance. If the client has more than one source of insurance, select all applicable sources. Also, please indicate the date on which this information was updated. 22 HIV/AIDS Services Division, Boston Public Health Commission

31 Client Utilization reporting is used as a means to collect and review client activity within each funded program. Using the client code and the unique client identifier, BPHC is able to link those activities with a specific client that has been entered in the Demographics tab of the e2boston Data System. In addition to submitting an overview of utilization data with the quarterly reports, all programs must regularly upload/import utilization data into e2boston. Client utilization data are entered or uploaded at least monthly for review and submitted quarterly for programs with cost reimbursement budgets. Likewise, client utilization data are submitted at least monthly for programs with unit rate budgets. Reporting Requirements * Cost Reimbursement: Programs with cost reimbursement budgets will submit client utilization data quarterly, incorporating data from e2boston. * Unit Rate: Programs with unit rate budgets will submit a combined fiscal and data report consisting of a Fiscal Invoice and Client Utilization Data on a monthly basis. The monthly client utilization data will serve as fiscal backup documentation for units billed. Unit rate programs are encouraged to create and submit their own spreadsheet or submit a print out from the e2boston data system as their client utilization data fiscal backup. The submission should include the following: agency name, service category, client code in alphanumerical order, service code, date of service, number of units, rate, and total cost. Programs should not submit duplicate versions of the same data. Refer to page 27 for a sample submission. Instructions e2boston - Client Utilization Form While the reporting deadlines and requirements vary for cost reimbursement and unit rate programs, client activity itself is reported on similarly for both types of programs. Client activity is recorded in one of three ways: by amount of time of service provided, upon completion of service, and by units of service provided. 1. Time-based Units of Service: If a client activity is measured in hours, it can be broken down into quarterunits. Examples: * If a client meets face-to-face with his Case Manager for 30 minutes, the visit is recorded as 0.5 hours. * If a mental health clinician holds an individual psychosocial support session with a client for 90 minutes in her office, the visit is recorded as 1.5 hours. 2. Completion of Service: Not all units of client activity correspond to hours of time. Instead, they are reported as one (1) unit when the activity is completed, regardless of how long the activity took to complete. Examples: * Phone calls that provide client-centered assistance are recorded as one (1) unit regardless of the length of the phone call. * Case Management intakes are recorded as one (1) unit when they are completed. Supported Referrals are recorded as one (1) unit when they are completed. 3. Units of Service: Some client activities are recorded in units of service provided. The units may be in the form of discrete service units provided (e.g., meals, bed days). In some cases, they are client activities which are defined as units. Examples: FY 2016 Ryan White Part A Provider Manual 23

32 A transitional housing program funded to provide bed days for clients would record each bed day provided for each client as one (1) unit. A meals program funded to provide food bank packages for clients would record each package distributed to clients as one (1) unit. Refer to the Service Code Summary on page 70 for complete service code definitions and reporting instructions. Instructions for Completing Part A Unit Rate Client Utilization Data Fiscal Backup Reminder: Report service utilization only on clients whose services are paid for under Part A contracts. 1. Provider Name 2. Service Category 3. Client Code 4. Unique Client Identifier 5. Unit of Service Code 6. Date 7. Number of Units 8. Unit of Service Description, Optional *All Fields Are Required Unless Otherwise Indicated* Enter the Provider name as indicated on the contract. If desired, the program name may be entered after the Provider name. Enter the service category for which utilization is being reported (e.g., Substance Abuse - Residential). Enter the client code exactly as it was generated from the e2boston Data System. If the client code varies from the e2boston Data System, the client codes will need to be corrected. Enter the UCI exactly as it was generated from the e2boston Data System. If the UCI varies from the e2boston Data System, the UCIs will need to be corrected. Enter the service code for the specific unit of service provided using codes from the Service Code Summary (see page 70). Part A will only recognize codes from the Service Code Summary for which your program is funded. Only submit codes for the service category on which you are reporting. Enter the date the service was provided. Do not include dates that fall in future or past quarters on the Client Utilization Data Fiscal Backup. Enter the number of units of service provided for each service code listed. Each service unit must be recorded using whole or partial units of service as defined in the Service Code Summary. Describe the service provided as indicated in the Service Code Summary. For Cost Reimbursement and unit Rate programs, report utilization using Part A or Part A MAI codes listed in your Scope of Services only, as indicated in e2boston. 24 HIV/AIDS Services Division, Boston Public Health Commission

33 Sample Unit Rate Client Utilization Data, Fiscal Backup Unit rate contracts must submit their client utilization data on a monthly basis via e2boston and as fiscal backup with their unit rate invoice. Below is a sample of a unit rate client utilization data submission that is submitted monthly with the agency s invoice. The submission serves as the fiscal backup documentation. Agencies that have a Substance Abuse - Residential unit rate contract should submit a form like the one below on a monthly basis with their invoice. The form should list client codes in alphabetical order. AIDS Service Organization Ryan White Part A Client Utilization Data, Fiscal Backup Service Category: Substance Abuse - Residential Month: March 2015 Client Code/UCI Dates of service Service Description # Units Rate Total Code LYA / JNSO March 3, 2016 March 31, Bed Day - RRS 29 $75 $2,175 ASH / JMBO March 4, 2016 March 31, Bed Day - TSS 27* $ $3, *Client discharged on March 31, FY 2016 Ryan White Part A Provider Manual 25

34 Screenshot of e2boston How to Add Services to a Client Record 26 HIV/AIDS Services Division, Boston Public Health Commission

35 The Outcome Measurement Report is used to quantify and track the health of each client served. The primary outcome is whether or not a client is virally suppressed. It is not meant as a comprehensive assessment; rather, it is a tool to evaluate the impact of services on key indicators of health and wellness among clients. Outcomes reporting will be based on a Client Clock model; outcomes are assessed for each 6 month period during which the client received services. This model allows each client to have their own custom reporting period, which begins when the client receives a service at a Part A funded agency. Rules for Custom Reporting Periods 1. An outcomes reporting period begins for a given client if the client receives a service at a given agency AND a clock for that reporting period is not already going. 2. Once the outcomes reporting period begins, the provider has exactly 26 weeks (6 months) to complete an outcomes form corresponding to the client. After this 6 month period has elapsed, the provider may no longer submit a form corresponding to that reporting period for that particular client. 3. After the outcomes reporting period ends, regardless of whether or not a corresponding outcomes form was submitted, the next outcomes reporting period starts for a particular client on the first day that they receive a service after the end of the preceding outcomes reporting period. 4. If an outcomes form is completed for a given client at any time during a given outcomes reporting period, the clock does NOT reset. Rather, the clock continues to run for 6 months. After the 6 month period is over, the next service that the client receives at the agency starts a new clock. Reports 1. All reports involving Outcomes data will pull data SUBMITTED during the date range given in the report unless otherwise specified. 2. The Outcomes Completion and Eligibility report will allow providers to track clients that are in each of the 4 submission states, particularly Eligible for Submission and Submission Required. This report will also allow BPHC and providers to track how many missed outcomes reports a provider or a given client has. Outcomes Instructions & Submission Process Resources can be found in the e2boston Resource Center. Outcomes will only be accepted electronically via e2boston. Once an outcome report is missed, there is no way to submit the data to BPHC. It is better to submit an INCOMPLETE outcome report than to submit nothing at all. Contact Information For technical assistance, policy and/or reporting requirement information, please contact BPHC Quality Management Program Coordinator Ben Penningroth or your agency s Program Coordinator at (617) Outcomes Descriptions and Definitions Outcome Measurement Reports Providers should use their professional assessment skills when completing the outcomes reporting forms. While each level for each outcome is defined, please keep in mind the broader status level categories (i.e., in crisis, poor, fair/good, and excellent). CD-4 Count: Choose the level for the most recent test result in the reporting period that you have seen or that FY 2016 Ryan White Part A Provider Manual 27

36 the client has reported. Viral Load: Record the actual value for the most recent test result in the reporting period that you have seen or that the client reported. Primary Medical Care Engagement: Record the month and year in which the client was last seen by his/her HIV medical provider (the provider the client most commonly sees for their HIV medical care). Case Management Status: Record whether or not the client is receiving HIV case management services (social or medical) at any agency. Adherence to Prescribed HIV-related Medical Therapies: Select whether the client always (0 missed doses in the last week), frequently (1-2 missed doses in last week), sometimes (3-4 missed doses in last week) or rarely (>4 missed doses in last week) adheres to prescribed HIV-related medical therapies. Providers can use the criteria that they use in practice to measure adherence. Do not answer this question if the client is not on ART. Severity of Side Effects of HIV-Related Medications: This outcome measure aims to assess the client s subjective experience of side effects from HIV medications. Wherever possible, this measure should be based on the direct report of the client. Do not answer this question if the client is not on ART. Mental Health Status: Use information gathered from clients during intakes, assessments and regular interactions to evaluate client s mental health status. This measure is not to be used as a mental health diagnosis. Access to Support Network: Support Networks may include friends, family, religious groups, or other peer groups from which the client obtains emotional, social, spiritual, or material support. Care Adherence: HIV-related appointments include medical appointments, mental health appointments, peer support, case management, and anything else related to care completion and/or support. Housing Status: This outcome aims to understand a client s stability in housing, regardless of type of housing. 28 HIV/AIDS Services Division, Boston Public Health Commission

37 Screenshots of e2boston How to Add Outcomes to a Client Record FY 2016 Ryan White Part A Provider Manual 29

38 How to Add Outcomes to a Client Record 30 HIV/AIDS Services Division, Boston Public Health Commission

39 How to Add Outcomes to a Client Record FY 2016 Ryan White Part A Provider Manual 31

40 Ryan White HIV/AIDS Services Report (RSR) ALL Ryan White funded providers are required to complete the 2016 RSR, which covers the reporting period from January 1, 2016 to December 31, For FY 2016, agencies will be required to use our new web-based data system, e2boston, to generate the appropriate XML file for their client-level data. Only information for Part A clients can be entered into e2boston, so providers that are funded under multiple Ryan White Parts will have to rely on other systems to track their non-part A clients. There are three components to the RSR: Ryan White HIV/AIDS RSR Reporting Grantee Report to be completed by entities funded DIRECTLY by HRSA, including BPHC as the Part A Grantee, DPH as the Part B Grantee, and all directly funded Part C and D providers. Service Provider Report to be completed by ALL Ryan White funded providers. This report contains information about your agency and the services you provide under Ryan White. Client Report to be completed by ALL Ryan White funded providers. This report contains the Client Level Data (CLD) and is submitted electronically in an XML format with encrypted client identifiers. More information, including instructions for completing the RSR and full Client Level Data compliance, is available at the following HRSA websites: and careacttarget.org/topics/rsr.asp. 32 HIV/AIDS Services Division, Boston Public Health Commission

41 Standards of Care Overview The Ryan White HIV/AIDS Services Planning Council developed the Standards of Care for HIV/AIDS Services for each service category. All Part A and MAI funded programs are expected to comply with these standards. Through site visits and program monitoring, the Boston Public Health Commission will monitor each program s adherence to the Standards of Care. The current operating Standards of Care can be found on the BPHC Quality Management website. During FY 2009, a working group of BPHC and MDPH staff performed a revision of the existing Standards of Care. The development of these revised and expanded standards of care included input and feedback from members of the Planning Council, providers and consumers. The revised Standards of Care were released at the end of FY The Standards of Care will be reviewed by BPHC each year as part of the annual Quality Management Plan. It is BPHC s intention that these standards become increasingly reflective of HRSA s National Monitoring Standards for Ryan White programs. Consequently, our locally-established standards of care are subject to review, and potential revision, throughout the course of the year. However, the Standards of Care for HIV/AIDS Services (2009) remain the most contemporary, and the basis on which programs will be monitored as FY 2015 commences. During FY 2016, BPHC is working on updating the Universal and Service-Specific Standards of Care to more accurately reflect changes to service categories, service definitions, and incorporation of the National Monitoring Standards. Subsequent drafts of the revised standards will be reviewed and presented to various stakeholders, including providers, consumers, community planning bodies, and other funders involved in the service delivery system within the Boston EMA. FY 2016 Ryan White Part A Provider Manual 33

42 In compliance with HRSA National Monitoring Standards, the Boston Public Health Commission conducts annual site visits to ensure that Part A funds are being utilized appropriately, to verify that federal and local requirements are being met, and to offer programmatic and fiscal technical assistance to agency staff. All agencies are monitored during the Part A contract period by BPHC s program and fiscal management teams. Program and fiscal reviews may be conducted simultaneously or on separate dates. Site visit dates are communicated up to one year in advance by BPHC to the Program Manager of the funded agency. While BPHC will attempt to accommodate agencies schedules within the assigned month, BPHC reserves the right to visit a funded program at a time of its choosing and without advance notice. Site Visit Planning Program Visit A BPHC representative leading the program visit will contact the agency about four to six weeks prior to the scheduled visit. (This staff member assigned the visit will not be the same person as the Contract Manager with whom the agency has regular contact.) The Part A-funded agency s Program Manager will receive a packet that includes a confirmation letter, a Monitoring Tool, a Documentation Checklist, the Standards of Care Checklists, a policy summary for client file maintenance, a File Review Summary, and Previous Findings. The Monitoring Tool contains questions that need to be answered by the agency prior to the visit. The agency must submit a completed Monitoring Tool at least two weeks prior to the visit. Agencies that submit documentation prior the visit will benefit from having a shorter review process. The remaining packet documents clarify reporting requirements and previous compliance by the funded program. Questions regarding any of these items may be directed to the site visit coordinator. All programmatic site visits include a comprehensive review of randomly selected client files. Via secure , the agency will receive a list of the client codes between hours prior to the visit. Fiscal Visit The BPHC fiscal coordinator will be in contact with the funded agency s fiscal team and will provide a fiscal Monitoring Tool. This form will need to be completed and submitted back to the BPHC fiscal coordinator at least two weeks prior to the fiscal visit. Day of Site Visit The program visit will focus primarily on reviewing client files. This will take place in the morning and part of the afternoon, and may produce questions for the program s staff. After the file review, BPHC will lead a discussion with agency staff members regarding preliminary findings, reporting requirements, and service coordination. As such, agency staff members are expected to be available during the day of the visit while the Grantee conducts the visit. However, BPHC will do its best to limit the disruption of service delivery to clients seeking support. It is common for a post-review discussion to only require the time of the program manager. Client File Review Site Visit Overview A random sample of up to 40 client files is selected to verify that valid and accurate documentation is present for 34 HIV/AIDS Services Division, Boston Public Health Commission