Ryan White HIV/AIDS Program Parts C and D Stakeholders Call

July 26, 2018

Mahyar Mofidi, DMD, PhDCaptain, United States Public Health ServiceDirector, Division of Community HIV/AIDS Programs (DCHAP)HIV/AIDS Bureau (HAB)Health Resources and Services Administration (HRSA)

Agenda

• HRSA HAB DCHAP Overview

• Program Updates

• 2018 National Ryan White Conference on HIV Care and Treatment

• Ryan White HIV/AIDS Program (RWHAP) Recipient Program Income Presentations

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Health Resources and Services Administration (HRSA)Overview

Supports more than 90 programs that provide health care to people who are geographically isolated, economically, or medically challenged

HRSA does this through grants and cooperative agreements to more than 3,000 awardees, including community and faith-based organizations, colleges and universities, hospitals, state, local, and tribal governments, and private entities

Every year, HRSA programs serve tens of millions of people, including people living with HIV/AIDS, pregnant women, mothers and their families, and those otherwise unable to access quality health care

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Ryan White HIV/AIDS Program

• Provides comprehensive system of HIV primary medical care, medications, and essential support services for low-income people living with HIV

• More than half of people living with diagnosed HIV in the United States –more than 500,000 people – receive care through the Ryan White HIV/AIDS Program (RWHAP)

• Funds grants to states, cities/counties, and local community based organizations

• Recipients determine service delivery and funding priorities based on local needs and planning process

• Payor of last resort statutory provision: RWHAP funds may not be used for services if another state or federal payer is available

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Ryan White HIV/AIDS Program

• Public health approach to providing a comprehensive system of care

• Ensure low-income people living with HIV (PLWH) receive optimal care and treatment

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HIV/AIDS Bureau Vision & Mission

VisionOptimal HIV/AIDS care and treatment for all.

MissionProvide leadership and resources to assure access to

and retention in high quality, integrated care, and treatment services for vulnerable people living with

HIV/AIDS and their families.

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DCHAP Mission and Core Values

MissionProvide leadership and resources to assure access to

and retention in high quality, comprehensive HIV care and treatment services for vulnerable people living with HIV/AIDS, their families and providers

within our nation’s communities.

Core Values Communication ∙ Integrity ∙ Professionalism

Accountability ∙ Consistency ∙ Respect.

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HAB Strategic Priorities

• National Goals to End the HIV Epidemic/PEPFAR 3.0: Maximize HRSA HAB expertise and resources to operationalize National Goals to End the HIV Epidemic and PEPFAR 3.0.

• Leadership: Enhance and lead national and international HIV care and treatment through evidence-informed innovations, policy development, health workforce development, and program implementation.

• Partnerships: Enhance and develop strategic domestic and international partnerships internally and externally.

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HAB Strategic Priorities

• Integration: Integrate HIV prevention, care, and treatment in an evolving health care environment by maximizing opportunities provided by the health care system for preventing infections, increasing access to quality HIV care, and reducing HIV-related health disparities.

• Data Utilization: Use data from program reporting systems, surveillance, modeling, and other programs, as well as results from evaluation and special projects efforts to target, prioritize, and improve policies, programs, and service delivery.

• Operations: Strengthen HAB administrative and programmatic processes through Bureau-wide knowledge management, innovation, and collaboration.

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2017 NHAS Progress Report Released

• Important progress in reducing new HIV infections, improving health outcomes among people living with HIV, and reducing some of the most difficult and long standing HIV-related disparities. • The number of new HIV diagnoses decreased by nearly 5% from 41,985 in 2011

to 39,876 in 2015

• The percentage of persons living with diagnosed HIV who had a suppressed HIV viral load increased from 46.0% in 2010 to 57.9% in 2014

• Progress has not been equal for all populations and regions. There are still large disparities in HIV risk and diagnoses for gay and bisexual men, HIV diagnoses in the Southern United States, and stable housing among people living with HIV.

• The 2017 Progress Report for the National HIV/AIDS Strategy discusses potential next steps to consider in how our nation’s response might change to address the opportunities and challenges that may exist in 2021 and beyond.

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DCHAP – New Deputy Director

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Stephanie M. Yun, MPH, CHES

Senior Public Health Analyst: Ralph Brisueno

Branch ChiefMindy Golatt

DirectorMahyar Mofidi

Deputy DirectorStephanie Yun

Western BranchAK, AZ, CA, CO, HI, ID, MT, ND, NV,

OR, SD, UT, WA, WY

Midwest BranchIA, IL, IN, KY, MI MN, NE, OH, PA,

WI

Central BranchAL, AR, KS, LA, MO, MS, NM, OK,

TN, TX

Southern BranchFL, GA, NC, SC

Northeastern BranchCT, DC, DE, MA, MD, ME, NH, PR, RI,

VA, VI, VT, WV

Senior Program Advisor Makeva Rhoden

Administrative AssociatesMenina Reyes

Michael Eggleston

Public Health Analysts

Lillian BellRanjodh Gill

Barbara KosogofNichelle Lewis

Nkem OsianAngela Smith

Kristin WilliamsElise Young

Atlantic Branch NJ, NY

Branch ChiefMonique Hitch

Branch ChiefStephanie Bogan

Branch ChiefHanna Endale

Branch ChiefShaun Chapman

Public Health Analysts

Folasayo AdunolaWendy Cousino

Stephanie FelderFabrine FloydIndira Harris

Catishia Mosley (Data)

Ijeamaka OkoyeCecilia Yin

Public Health Analysts

Rishelle AnthonyBrian FitzsimmonsTanya GrandisonTamika Martin

S. Nicole VaughnL. Andrea Zeigler

VacantVacant

Public Health Analysts

Latham AveryKaren Beckham

Michael CarriganCypriana Fowell

Tracey GanttTyranny Smith-Bullock

Keith WellsVacant

Public Health Analysts

Jessica FoxStephanie Pehoua

Akil PierreMonica SivillsDiane Tanman

Renata ThompsonTina Trombley

Vacant

Public Health Analysts

Alex CalvoJohn Eaton

Karen GoodenRuby Neville

Viven Walker-MarableWhitney Weber

Vacant

Senior Public Health Analyst: Gail Kelly

Branch ChiefMarinna Banks-Shields

Senior Policy Advisor Vacant

Chief Nurse Consultant Vacant

Health Resources and Services AdministrationHIV/AIDS Bureau – Division of Community HIV/AIDS Programs

Revised 7-9-2018

HAB Vision: Optimal HIV/AIDS care and treatment for all. DCHAP Mission: To provide leadership and resources to assure access to and retention in high quality, comprehensive HIV care

and treatment services for vulnerable people living with HIV/AIDS, their families and providers within our nation’s communities.

DCHAP’s CORE

VALUES: Communication

Respect

Accountability

Consistency

Integrity

Professionalism

Senior Program Advisor Vacant

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Program Updates

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Notice of Award (NoA)

• RWHAP Part C - Balance of Awards• HRSA HAB is processing the balance of awards based on FY 2018

appropriations.

• RWHAP Part D Supplemental (HRSA-18-044)• HRSA HAB is proceeding with the release of funding for RWHAP Part D

Supplemental awards.

• RWHAP Part C Capacity Development (HRSA-18-051)• HRSA HAB is proceeding with the release of funding for the RWHAP Part C

Capacity Development awards.

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Important Dates: Upcoming FFR Deadlines

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RWHAP Part CBudget period ends… FY 17 FFR

Due date

April Start 3/31/2018 7/30/2018

May Start 4/30/2018 7/30/2018

RWHAP Part DBudget period ends… FY17 FFR

Due date

August Start 7/31/2018 10/30/2018

RWHAP FY18 Parts C and D Allocation Report

• RWHAP Part C and D Allocation reports are available in the GCMS on August 16, 2018

• RWHAP Part C and D Allocation Webinar training will be held on August 23, 2018

• RWHAP Part C and D Allocation Report is due on October 31, 2018

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Please work with your PO if you received a revised budget condition of award before starting the FY 18 RWHAP Allocation report.

EHB Updates and Helpful Links

• Site Visit Action Plan (Corrective Action Plan)• The Electronic Handbook (EHB) now allows HRSA staff to collaboratively plan a

Corrective Action Plan with grantees/recipients.

• All information related to the Corrective Action Plan will be entered through the EHB.

• HRSA staff (PO) will enter the initial information in the EHB and send the Corrective Action Plan to the recipient to enter “resolve action plan” tasks.

• The Corrective Action Plan must be sent back to the HRSA staff (PO) for review and approval before the recipient can begin working on resolving the issues.

• Only after all site visit findings, included in the plan, have been resolved can the Corrective Action Plan be closed by the PO.

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The Site Visit Action Plan EHB Help Page: https://help.hrsa.gov/x/jYCZAwTier 2 Support: 301-443-2112

Clarifications Regarding the Use of RWHAP Funds for Health Care Coverage Premium and Cost Sharing Assistance

Policy Clarification Notice (PCN) 18-01

• Simplifies and replaces three previous PCNs: #07-05; #13-05; #13-06.

• Details the requirements for using RWHAP funds for premium and cost sharing assistance associated with:

• Private health insurance

• Medicaid

• RWHAP funds can be used to pay for premiums and cost sharing for Medicare, in certain situations.

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Allowable Use of RWHAP Funds for Health Care Coverage

• Recipients may only use RWHAP funds to pay for health care coverage that includes:

• at least one U.S. Food and Drug Administration (FDA) approved medicine in each drug class of core antiretroviral medicines outlined in the U.S. Department of Health and Human Services’ Clinical Guidelines for the Treatment of HIV, AND

• appropriate HIV outpatient/ambulatory health services

• Recipients may only use RWHAP funds to pay for health care coverage if they can demonstrate upon request that the cost of paying for the health care coverage is cost-effective.

• Recipients may still consider providing their health insurance premiums and cost sharing resource allocation to their state RWHAP AIDS Drug Assistance Program.

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Allowable Use of RWHAP Funds for Health Care Coverage Resources

PCN 18-01 can be accessed at:

https://hab.hrsa.gov/sites/default/files/hab/program-grants-management/18-01-use-of-rwhap-funds-for-premium-and-cost-sharing-assistance.pdf

Overview of Eligible Service Reporting Changes for the 2019 Ryan White Services Report (RSR)

• Currently, eligible scope reporting requires recipients to report client level data for all eligible clients who receive a Ryan White HIV/AIDS Program (RWHAP) service from a recipient/sub-recipient who is funded to provide that service.

• Recipients do not report information on services that are fully funded by other RWHAP-related funding, such as rebate dollars or program income.

• Under eligible scope, RWHAP and recipients cannot measure the full investment and impact of the RWHAP at state and local levels.

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Overview of ChangesProposed Change to Eligible Services Reporting

• Proposal: Recipients and subrecipients submit client level data for RWHAP eligible clients that received an allowable service funded through any RWHAP and RWHAP-related expenditures.

• RWHAP-related funding would include:• RWHAP related Program Income

• RWHAP Rebate funds

• This would not include:• Other federal funding

• State or local funds

• Other sources of funding received by the sub-recipient

• Implemented with 2019 RSR reporting (March 2020)

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Building Futures with Youth Contract

New Webinars For Ryan White HIV/AIDS Program Providers Serving Youth:

• AUGUST 9, 2018 (Thursday, 2-3:30 p.m. EDT) • Infrastructure development, including staff recruitment and retention, improving communication

with youth, and LGBTQ-friendly policies. https://attendee.gototraining.com/r/5229862633115966722

• AUGUST 16, 2018 (Thursday, 2-3:30 p.m. EDT) • Informing program development, including gathering feedback from youth and data-driven

programming. https://attendee.gototraining.com/r/7662540905704223489

• AUGUST 23, 2018 (Thursday, 2-3:30 p.m. EDT)

• Wraparound services, including youth support groups, support service needs, and re-engaging youth lost to care. https://attendee.gototraining.com/r/1644932458584048385

• AUGUST 30, 2018 (Thursday, 2-3:30 p.m. EDT) • Clinical service models, including youth-centered services and interdisciplinary care teams.

https://attendee.gototraining.com/r/8606182466592024577

Sessions will be recorded and available through the TARGET Center

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2018 National Ryan White Conference on HIV Care and

Treatment

National Ryan White Conference on HIV Care & Treatment

Date: December 11-14, 2018

Theme: Catalyzing Success: Advancing Innovation. Leveraging Data. Ending the HIV Epidemic.

DCHAP Business Meeting: December 11

Clinical Conference: December 9-11

Location: Gaylord National Harbor Hotel and Convention Center

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https://ryanwhite2018.hrsa.gov/

National Ryan White Conference on HIV Care & Treatment

• DCHAP Business meeting:• Tuesday, December 11• 8:30a.m.-2:30p.m. (lunch on your own)

Required Attendance

• Who should attend:• All RWHAP staff who receive Part C/D/F-Dental funding

• Topic areas (examples): • Program Income• CQM/Data Utilization• Oral Health • HIV & Aging• Grant Process• Behavioral Health and Primary Care Integration• PLWH Consumer Involvement

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National Ryan White Conference on HIV Care & Treatment (NRWC)

• Registration still open: https://ryanwhite2018.hrsa.gov• Closes September 28 or when 4500 registrations have been accepted

• Registration for the Clinical Conference and for the NRWC are separate

• Maximum number of attendees per grant: RWHAP Part C (4), RWHAP Part D (4), and RWHAP Part F Dental (2)

• Encouraged to bring sub-recipient and/or PLWH consumer

• Link for hotel reservations can be found within the conference confirmation email

• If you have not received a confirmation email, contact your PO

• Overflow hotels will be announced once the Gaylord has reached capacity

• Additional registration slots are available for PLWH consumers and sub-recipients; decisions will be made in July 2018

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National Ryan White Conference on HIV Care & Treatment

Tracks:• Increasing Access, Engagement, and Retention in HIV Care and Treatment

• Data Utilization

• Leveraging Innovative Practices to Improve Outcomes and Address Emerging Priorities

• Clinical Quality Management and Clinical Improvement

• Ryan White HIV/AIDS Program Planning and Resource Allocation: Collaborative Partnerships and Community Engagement

• Ryan White HIV/AIDS Program Fiscal and Grant Management Boot Camp

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National Ryan White Conference on HIV Care & Treatment

• December 10 - Check-in

• December 11 - Business Meetings; Opening plenary (Federal staff presenting)

• December 12 & 13 - Plenary sessions (Leveraging Data & Innovation; Planning & Resource Allocation)

• December 11 through 13 - evening Auxiliary meetings (hosted by Federal Staff)

• December 14 - Closing plenary

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National Ryan White Conference on HIV Care & Treatment

Parking: • On-site parking, fee: $12 USD hourly; $30 USD daily

• Valet parking, fee: $45 USD daily

• Metro rail- Yellow and Blue lines at King Street station

• Bus

*Going green- the app will be available in November 2018

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Questions

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Program Income

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Program Income

Per 45 CFR §75.2, Program Income: Program income means gross income earned by the non-Federal entity that is directly generated by a supported activity or earned as a result of the Federal award during the period of performance except as provided on 45 CFR §75.307(f). Program income includes but is not limited to income from fees for services performed, the use or rental of [sic.] real or personal property acquired under Federal awards, the sale of commodities or items fabricated under a Federal award, license fees and royalties on patents and copyrights, and principal and interest on loans made with Federal award funds. Interest earned on advances of Federal funds is not program income. Except as otherwise provided in Federal statutes, regulation, or the terms and conditions of the Federal award, program income does not include rebates, credits, discounts, and interest earned on any of them.

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Program Income

Background

• Since 2016 DCHAP has provided focused technical assistance (TA) on recipients’ use of program income (tracking, allocating, and spending)

• Dual Focus of TA:

1) Ensuring recipients spend program income in in accordance with the parameters of the RWHAP statute and the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards (45 CFR Part 75).

2) Educating recipients about ways to maximize program income spending, with a goal of expanding the reach of RWHAP Part C and D by funding innovative services that are within the scope of allowable RWHAP Part C and D activities.

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Program Income

Use of Program Income – RHWAP Part C

To support comprehensive primary health care and support services in an outpatient setting for low income, uninsured, and underserved people living with HIV (PLWH).

Early Intervention Services

Core Medical Services

Support Services

Administrative expenses

Clinical quality management activities

Not subject to statutory distribution requirements (i.e., 10% administration)

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Program Income

Use of Program Income – RWHAP Part D

To support a comprehensive system of family-centered care for low-income women, infants, children, and youth affected by or living with HIV.

Core Medical Services

Support Services

Administrative expenses

Clinical quality management activities

Not subject to statutory distribution requirements (i.e., 10% admin)

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Program Income

Expenditure of Program Income

• To the extent available, recipients and sub-recipients must disburse funds available from program income, rebates, refunds, contract settlements, audit recoveries and interest earned on such funds before requesting additional cash payments (45 CFR §75.305(b)(5)).

• Estimate accrued program income and determine RWHAP funds that will be needed during the current performance period.

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HAB/OFAM Program Income Initiative

• Program Income Initiative• Collaboration between HRSA HAB/DCHAP and the HRSA Office of Federal

Assistance Management (OFAM)

• Goals:

1. Identify recipients who have established appropriate processes and procedures related to program income (tracking, allocating, spending, and reporting)

2. Disseminate information about these processes and procedures

• Recipient presentations • Presenting examples of program income policies and procedures.

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Recipient Program Income Presentations:

Strategic Planning and Spending

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340B Program Income-Strategic Planning and Spending

Mary Bergeron

Kathy Gaddis

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History and Overview of HIV Program

1988 – University Teaching Hospital Clinic was founded

1997 – First awarded Ryan White Part C grant

2010 – Registered as a 340B entity

2011 – Contracted with external 340B pharmacy

2013 – Contracted with internal 340B pharmacy

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Health Outcomes• HIV Viral Load

• 91 % ≤ 1000

• 88% ≤ 200

• Retention Rate - 82 %

• 2 visits within a year period separated by 3 months

Service Area• Clinic population 3,457

• Majority live in Alabama

• Target area is Birmingham and 7 surrounding

counties

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Gender and Race

Male , 2618, 75%

Female, 839, 24%

Transgender, 25, 1%Gender

Male Female Transgender

African American, 2358, 66%

Caucasian, 1102, 31%

Other, 103, 3%

RACE

African American Caucasian Other

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Income and Insurance

89% have income below 100 % of the Federal Poverty Level

26% have private insurance independently

35% have Medicare or Medicaid

24% have private health insurance through the Alabama

Department of Public Health

15% have no insurance

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Services Provided

• Ambulatory HIV primary, specialty medical and

oral health care

• Medical case management

• Mental health counseling including addiction

• Nutrition Counseling – Nutritionist

• Medication Adherence Counseling

• Clinical and Behavioral Research

• Education and training for healthcare workers

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Needs Assessment

• Reviewing quality measures and collectively thinking about gaps in services

• Looking at current resources and staff

• Evaluating current systems

• Conducting client surveys

• Talking to clinic staff who have a direct line of communication with patients, listen to what they identify as gaps in services.

• Nurses, social workers, medical providers, receptionists, peer mentors, etc.

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How are Needs Identified?With the enactment of the 340B program, the 1917 Clinic leadership & staff implemented initiatives that were a direct result of an ongoing assessment process.

Comprehensive Quality

Management Program

Patient Communication

& Patient Surveys

Communication with Medical

Providers

Communication with Clinic Staff

Consumer Advisory Groups &

Community Need

Assessments

Look at Patient Staffing Ratios

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Initial Expansion of Ryan White HIV/AIDS

Program Services Funded by Program

Income Included the Following:

Hiring of additional clinic staff

Development of a web based system to

operationalize social worker activities

The establishment of an offsite call center for patient

management

Expansion of oral health care

Expansion of specialty care

Contractual agreements with external providers

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Once able to fully meet the needs of our patients that fell under

the allowable Ryan White HIV/AIDS Program service definitions,

we expanded to areas that improved outcomes including:

Hiring of full time tech support specialist

FTE support of additional data analysts for ongoing CQI

efforts

Minor Upgrade of facilities

Provision of additional security

Additional parking options

Enhanced staff training

Expanded our outreach and linkage program

Additional Areas of Improvement

funded through use of Program Income

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Collaborations and Benefits

Collaborations

1. Housing and stabilization initiatives with area ASOs

2. Nutrition program with area ASO

3. Residential substance abuse program with area ASO

4. Residential Comprehensive Nutritional Health and

Wellness program for those dually diagnosed with

serious mental illness and HIV

Once “internal needs” were met, we began a process to

further expand services related to patient support & care

by working with AIDS Services Organizations (ASOs).

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Collaborations and Benefits

Benefits

1. Co-funding of a statewide initiatives with Department of

Public Health and CDC that focus on initiation into care,

treatment adherence and retention

2. Potential long term lease on a new building being

supported by the University Health System.

3. A quality assessment team was built to monitor health

outcomes as a result of these initiatives

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Strengthening Community Partnerships Using Program Income

Identify Need

Identify Established Community

Partners

Initiate Start Up Meeting

Outline Proposal

Requirements

Review Proposal &

Make Modifications

Prepare Contract

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Overcoming challenges with community partners when expanding services funded by Program Income

Challenge

1. Inconsistent expenditure

tracking

2. High volume of referrals

3. Communication barriers or

unclear expectations

Our Solution

Standardized invoicing templates

were developed to be used by all

community partners

Worked with ASOs to increase

contracts for hiring additional FTEs.

Established a housing committee to

vet the referrals.

Community Partners were brought

together for several full day

workgroups to develop consistent

policies.

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Progress to date withProgram Income Funded Community

Initiatives

345

clients

Housing Services

526

clients

Nutritional Support

services

25

clients

Substance

Abuse Services

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Fiscal Oversight of 340B Program Income

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Ensuring Appropriate Use of Program Income

• Program Director approves all new expenditures &

initiatives

• Program Manager, Financial Officer, and

institutional signing official ensure that

expenditures meet HRSA regulations/guidelines

• Review of all invoices for the following:

• Patient is RWHAP Eligible

• Referral of patient is documented and services

match

• Allowability of charges • Use of RW Policy Clarification notices to educate

institutional partners

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Planning for Use of Program Income

• Annual operating budgets are developed based on RWHAP Service Categories and incorporate all funding streams for the program

• 340B program income

• 3rd party payers revenue streams

• RWHAP Part C funding

• Quarterly assessments are done of average revenue vs expenses and operating budgets are adjusted accordingly

• RWHAP Part C funds are spent at a consistent ratio to grant related income

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Monthly Monitoring of Revenue

These variables are monitored because they all

contribute to the calculation of monthly program

income

Number of patients served through 340B pharmacies

Cost of goods sold

Collection from 3rd party payers

Fees for inventory monitoring systems

Co-pays and charity care costs

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Monthly Monitoring of Expense Trends

These variables are monitored to ensure we are

spending per the budgeted plan

FTE’s for clinic staff

Supply costs

External provider costs

External initiative costs (Community partners)

Administrative costs

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Barrier

Differing interpretations of

HRSA policy by

institutional stakeholders

Risk aversion from our

institution

The “too good to be

true” scenario

Our SolutionOngoing and open conversations

with HRSA program officer

Strategic planning to utilize program

income that includes all levels of

institutional leadership

Staff education on the 340B program

and what it means to our clinic staff,

patient population, and community

partners

Sharing availability of 340B funded

opportunities in an appropriate way

Internal Barriers to Engaging in Various Opportunities

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If you don’t know, ask! Have candid conversations to get the most useful information.

→ HRSA 340B Eligibility & Registration

→ HRSA HAB Policy Notices & Program Letters

→ HAB PCN 15-03: Clarifications Regarding the Ryan White

HIV/AIDS Program and Program Income

→ HAB PCN 16-02: Ryan White HIV/AIDS Program Services:

Eligible Individuals & Allowable Uses of Funds

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Contact Information

• Kathy Gaddis –Social Services Director

• kgaddis@uabmc.edu

• Mary Bergeron- Financial Officer III

• mdougher@uab.edu

• James L Raper PhD- Clinic Director/Ryan White PI

• Jlraper@uabmc.edu

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Planning for Growth:

Strategic Planning and Spending Related to RWHAP Part C

Program Income

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Who We Are, What We Do

• Ryan White Part C

• 7 Counties surrounding Charleston, SC

• Rural, coastal South Carolina

• Serve 800 – 900 patients annually

• HIV & Primary Care

• Mental Health

• Medical Case Management

• Housing

• Peer Navigation

• Transportation

• Pharmacy

• Contracted specialty services

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Highlights & Hurdles

High Quality, High Engagement

• 94% Optimally Retained

• 88% Virally Suppressed

• 95% newly enrolled have been fully engaged in care for first year

• 80 PrEP patients since Jan 1, 2015

Physical Barriers & Social Stressors

• Young African American men most likely to be poorly retained and unsuppressed

• Stigma/fear of group settings

• Rural area, poor public transportation

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Funding Sources

• RWHAP Part C (to include Program Income)

• ADAP (Sub-Recipient)

• RWHAP Capacity Grant (FMS)

• HUD (Sub-Recipient)

• MAC AIDS

• Elton John AIDS Foundation

• Private Donations

HIV+ Patient Care

Operations

HIV+ Patient Housing

HIV- Patient Care, PrEP

Annual Operational Budget ~ $3M

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Distribution of Funding

Program

Income

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Program Income Services

• Professional Development

• Peer Navigation

• PrEP*

• Telehealth

• Nutritional Counseling

• Food Pantry

• Pharmacy

• Routine HIV Testing

• Housing FIRST

Strategic

Planning

Strategic

Spending

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Connect to Purpose: Housing FIRST

*Stock photo used to protect anonymity of patient.

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Strategic Planning Framework: Getting to Outcomes (GTO)

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RWWC Planning Cycle

Annual Strategic Planning Meeting

• Feb/Mar

• EDU-tainingAgenda

• Teambuilding

• System Goals

• RWWC Goals

• Team Goals

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RSFH 5 Pillars (by Studor Group)

Service Growth People Finance Quality

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Program Income #trendingtopics

• Evidence-Based Trends in HIV Care

• HRSA HAB Performance Measures• HIV Viral Suppression

• Prescription of HIV Antiretroviral Therapy

• HIV Medical Visit Frequency

• Gap in HIV Medical Visits

• Influenza Immunization

• Waiting Time for Initial Access to Outpatient/Ambulatory Medical Care

• Late HIV Diagnosis

• Linkage to HIV Medical Care

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Hustle & Flow

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Challenges with Planning

• Parent system

• Infrastructure

• Contracting

• HRSA Allowable

• Feasibility

• Capacity

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Modest Beginnings

• Staff Size

• Patient

Population

• Services

Provided

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PI is Available. Now What?

• Status Quo operations

• Creating RWWC Grant Management area with new positions

• Yearly Budget Process• Offset HRSA-budgeted expenses

• New Initiatives:

• Relocation

• Tele Health

• Care Closet

• On-site pharmacy

• Dietician Services

• Expansion of housing services

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Program Income Sources

• Payments received directly from patients for

services, to include co-pays

• Reimbursements received from Medicare,

Medicaid or private insurance providers

• Net amount after the actual purchase price

of a 340B designated drug is deducted from

the third party insurance reimbursement

amount (340B income)

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Monitoring Expenses

Review

Allocate

Authoriz

e

Approve

Audit

Release

Funds

Report

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More Money = More Problems

• 340B Designation

• Increased Patient Population

• Increased Services Needed & Provided

• Increased Staff

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Spending Woes

• Understanding the financial

impact of a 340B designation

Challenges

Obstacles

HRSA Monitoring Site

Visit

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Spending Wows

• Acceptable Expenses

• Mastering the box,

THEN thinking

outside

• Enhancing services

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Call. Email. Tweet. Like.

Kimberly Butler Willis, MPH, CHES

Director

Kimberly.Butler@rsfh.com // 843.402.1067

Keisha Smith, MBA

Grant Accounting Manager

Keisha.Smith@rsfh.com // 843.402.1083

Instagram, Facebook

Ryan White Wellness Center

Twitter

@ryanwhitersfh

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Questions

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2018 Stakeholder Call Schedule

Date Time

Thursday, October 25, 2018 2 pm – 4 pm ET

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Topic: HIV/AIDS and Intimate Partner Violence

Contact Information

Mahyar Mofidi, DMD, PhD

Director, Division of Community HIV/AIDS Programs

HIV/AIDS Bureau (HAB)

Health Resources and Services Administration (HRSA)

Email: Mmofidi@HRSA.gov

Phone: 301-443-2075

Web: hab.hrsa.gov

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