Policy
Notice - 07-04, The Use of Ryan White HIV/AIDS
Program Funds for Transitional Social Support
and Primary Care Services for Incarcerated
Persons
DATE:
September 28, 2007
TO:
All Ryan White HIV/AIDS Program Grantees
Attached
is the HIV/AIDS Bureau (HAB) updated policy
describing the use of Ryan White HIV/AIDS
Program funds for transitional social support
and primary care services for incarcerated
persons. This policy was previously published
as "Policy Notice 01-01." This
updated policy reflects the changes in Title
XXVI of the Public Health Service Act as
amended by the Ryan White HIV/AIDS Treatment
Modernization Act of 2006 (Ryan White HIV/AIDS
Program) and establishes updated guidelines
for the use of Ryan White HIV/AIDS Program
funds for transitional social support and
primary care services for incarcerated persons
for Parts A through D of the Ryan White
HIV/AIDS Program.
The attached policy supports the use of
Ryan White HIV/AIDS Program funds for incarcerated
persons as they prepare to exit the correctional
system as part of effective discharge planning
or when they are in the correctional system
for a brief period, which would not include
any discharge planning.
If
you have any questions regarding the content
of the HAB Policy Notice, please contact
your project officer. Thank you for your
attention to this important matter.
Deborah Parham Hopson, Ph.D., R.N.
Assistant Surgeon General
Associate Administrator
Overview
The
following policy establishes guidelines for
allowable expenditures under the Ryan White
HIV/AIDS Program for incarcerated persons
when they: (a) prepare to exit the correctional
system as part of effective discharge planning;
or (b) are in the correctional system for
a brief period, which would not include any
type of discharge planning. 'Incarcerated
person' refers to an individual involuntarily
confined in association with an allegation
or finding of behavior that is subject to
criminal prosecution. Thus, the policy applies
to individuals who are involuntarily living
in the secure custody of law enforcement,
judicial, or penal authorities. Furthermore,
this includes individuals who reside in a
community setting (which is not part of the
institutional setting of the prison system
such as a pre-release residential half-way
house) if the individual is still involuntarily
confined to those settings.
The
intent of all Ryan White HIV/AIDS Program
funds is to ensure that eligible HIV-infected
persons gain or maintain access to HIV-related
care and treatment. This policy recognizes
that many incarcerated persons will ultimately
be the responsibility of the Ryan White
HIV/AIDS Program, so early detection, entry
into care, and access to and continuity
of care are important reasons to use Ryan
White HIV/AIDS Program funds for incarcerated
persons who meet the qualifications specified
above.
The
purpose of this policy is to provide grantees
flexibility in providing necessary, and
otherwise unavailable, transitional primary
care and social support services to incarcerated
persons in the custody of a local, State,
or Federal correctional system who are either
nearing release or whose incarceration is
of short duration. Grantees who want to
develop these linkages should become familiar
with local prisons or jails and the State
and Federal correctional facilities as well
as the procedures established to prepare
inmates for release into the community.
These systems could vary greatly across
localities and regions. Grantees should
work with the appropriate corrections administrators
to determine what health services are legally
expected to be provided within the correctional
system and how, and whether, the correctional
system addresses the discharge planning
needs, continuity of treatment, and community
linkages for inmates infected with HIV/AIDS.
We
envision grantees who establish transitional
social services will link the inmate to
HIV/AIDS care and treatment and transitional
primary care services. These services could
be provided in the correctional facility
prior to release as part of discharge planning.
In the case of a short term facility, like
a local jail, which does not provide discharge
planning, services would be outside of the
facility. In either situation, these services
are not covered by the correctional system.
Transitional primary care services can also
be provided on a short term basis in an
outpatient setting. Working with the correctional
system, grantees must determine 1) What
the release date of the inmate is; 2) what
health care services are provided by the
correctional system; and 3) what services
the Ryan White HIV/AIDS Program funds can
provide.
There
is an important statutory point of reference
that defines under what circumstances the
Ryan White HIV/AIDS Program-funds can be
used by grantees to provide services for
incarcerated persons. Specifically, the
payer of last resort statutory provision
found in Sections 2605(a)(6), 2617(b)(7)(F),
and 2664(f) of Title XXVI of the Public
Health Service Act requires that funds received
under a Ryan White grant award not be utilized
to make payments for any item or service
to the extent that payment has been made,
or can reasonably be expected to be made.
With respect to such item or service covered
under other programs, these include those
covered under any State's compensation program,
an insurance policy, or under Federal and
State health benefit program (except for
a program administered by or providing the
services of the Indian Health Service).
In 1996, the Office of the Inspector General's
(OIG) audit of a State's Ryan White HIV/AIDS
Part B Program, found Ryan White HIV/AIDS
Program funds were used to provide transitional
services to inmates within 90 days of release,
even though under that State's law inmates
'have a right to medical care and prison
officials have a corresponding duty to provide
such care.' The OIG did not disagree with
the use of Ryan White HIV/AIDS Program funds
to support transitional services for inmates,
but rather in this audit, said that the
State used Ryan White HIV/AIDS Program funds
to support such services when the State
was already paying for transitional services
for other inmates. Under the context described
above, the policy provides for the use of
funds for transitional social services (e.g.,
medical case management and social support
services) to help achieve immediate linkages
to community-based care and treatment services
upon release from custody, where no other
services exist, or where these services
are NOT the responsibility of the correctional
system. The policy also provides for the
use of funds for transitional primary care
services prior to release or during a period
of short-term incarceration where no other
services exist, or where these services
are NOT the responsibility of the correctional
system.
Policy Notice 07-04: The Use of Ryan White
HIV/AIDS Program Funds for Transitional
Social Support and Primary Care Services
for Incarcerated Persons
Federal
funds received under the Ryan White HIV/AIDS
Program, as established in Title XXVI of
the Public Health Service Act, may be used
for short-term, transitional social support,
and primary care services for an incarcerated
person as they prepare to exit the correctional
system as part of effective discharge planning
(or who are incarcerated for a brief period
with no formal discharge planning) and are
otherwise eligible for Ryan White HIV/AIDS
Program services under the following conditions:
I.
Incarcerated Person
'Incarcerated
person' refers to an individual involuntarily
confined in association with an allegation
or finding of behavior that is subject to
criminal prosecution. Thus, the policy applies
to individuals who are involuntarily living
in the secure custody of law enforcement,
judicial, or penal authorities. Furthermore,
this includes individuals who reside in
a community setting (which is not part of
the institutional setting of the prison
system such as a pre-release residential
half-way house) if the individual is still
involuntarily confined to those settings.
II.
Transitional Social Services
A.
Funded transitional social support services
are those services that are needed by incarcerated
persons with HIV/AIDS to establish or re-establish
linkages to HIV/AIDS care and treatment
services in community-based systems of care
in order to achieve their medical outcomes
during the time period as indicated in this
policy. A service, such as case management,
that links the individual with established
primary care is an example of an appropriate
transitional social service
B.
Recognizing that the determination of non-covered
services is unique to each local, State,
and Federal facility, and the grantee is
responsible for assessing the extent to
which such services are or should be covered
by the correctional institution, the grantee
must delineate precisely what services will
be provided by the grantee and ensure that
they are not available from the correctional
system.
C.
The grantee must ensure that these support
services are funded only from the portion
of the grant remaining after reserving amounts
for purposes of providing core medical services,
quality management and covering administrative
expenses specified in statute under Parts
A, B, and C of the Ryan White HIV/AIDS Program.
In addition, the grantee must ensure that
such services supplement, but do not supplant,
existing programs or responsibilities administered
by the correctional system, or other local,
State, or Federal agencies.
III.
Transitional Primary Care Services
A.
Transitional primary care services are services
delivered on an outpatient basis or in an
outpatient setting for a brief period of
time until a more permanent health care
provider can be arranged, which includes
a comprehensive continuum of care, such
as, primary medical care and prescription
drugs. These services may also include medical
case management, HIV counseling and testing,
and referral services to obtain health care.
Ryan White HIV/AIDS Program funds may only
be used for these services when other sources
of funds are not available.
B.
This policy does NOT generally permit the
use of Ryan White HIV/AIDS Program funds
in State and Federal prison facilities,
since the State and Federal prison systems
are responsible for providing health care
services to all individuals remanded to
their facility. Such care is the responsibility
of law enforcement, judicial, and penal
authorities in whose secure custody the
individual is held. This limitation, however,
does not apply to State or Federal inmates
about to be released to the community and
who are receiving health-related services
using community resources, when not actually
living in the correctional facility, such
as home detention and half-way house programs.
C.
Grantees wishing to institute a program
of transitional primary care services in
a local, State, or Federal correctional
setting must either deliver these services
directly or through sub-contracts with qualified
HIV/AIDS community-based providers to deliver
primary care services directly to eligible
incarcerated persons to ensure that Ryan
White HIV/AIDS Program funds are properly
expended and only for services not otherwise
available to any incarcerated persons.
D.
Grantees can use Ryan White HIV/AIDS Program
funds to support HIV/AIDS services in local
(e.g., county, city) jails if these institutions
are not legally responsible for meeting
the HIV/AIDS health care and treatment needs
of persons in their custody.
E.
Grantees can use Ryan White HIV/AIDS Program
funds to support primary care services for
incarcerated persons who reside in the community
(e.g., an individual who is not part of
the prison or jail system but resides in
a pre-release facility) ONLY to the extent
to which services are not available or should
not be reasonably expected to be available
to the incarcerated person involuntarily
confined. Furthermore, funding is available
only to support incarcerated persons who
are expected to be eligible for and the
responsibility of the Ryan White HIV/AIDS
Program.
IV.
Timeframe
The
allowable timeframe for the provision of
transitional services requires flexibility
to ensure the effectiveness of our programs.
The determination of the exact amount of
time that is required should be determined
by a collaborative effort between the Ryan
White HIV/AIDS Program project staff who
will be involved in care during and after
release and the correctional institution's
medical and case management staff who are
providing the care while the inmate is in
custody, and based on inmate needs. While
recognizing that the timeframe must be flexible
and determined collaboratively, it is recommended
not to exceed 180 days. The time delineation
must be done in collaboration with HAB's
Ryan White HIV/AIDS Program project officers.
V.
Non-Covered Services
Recognizing
that the determination of non-covered support
or primary care services is unique to each
locality, the grantee is responsible for
assessing the extent to which such services
are or should be covered. The grantee must
delineate precisely what services will be
provided by the grantee and by the correctional
system that are otherwise not available.
VI.
Public Resources
The
grantee must assess the availability of
other public resources for social support
and health-related services and benefits
programs in order to ensure the Ryan White
HIV/AIDS Program funds remain the payer
of last resort.
VII.
Coordination
HAB
expects that grantees will coordinate the
use of funds for prison health services
among publicly funded HIV-related community-based
organizations across the other local, State,
Federal, and public programs, in order to
assure an efficient, seamless, and comprehensive
continuum of HIV/AIDS care for the transition
of incarcerated.
VIII.
Communication
Grantees
must develop methods to ensure that communication
between the correctional system, the grantee,
and/or qualified provider preserve and protect
patient privacy and confidentiality, including
the patient's right not to disclose or to
have disclosed her or his HIV/AIDS status.
Grantees and/or qualified providers must
ensure that only those incarcerated persons
who wish to receive primary care and/or
transitional services are referred for participation.
IX.
Reporting
The
grantee must have a mechanism to report to
HAB on the use of funds to provide transitional
services and social services in correctional
systems, and to include the individuals served
in the same reporting process as other Ryan
White HIV/AIDS Program service recipients
for primary care services. |