Policy
Notice - 07-06
October
16, 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 outreach services.
This policy was previously published as
"Policy Notice 02-01." 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 allowable expenditures for outreach
services for all of the Parts, except for
the Special Projects of National Significance
Program.
If you have any questions regarding the
content of this 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
This policy reflects the provisions in the
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 replaces "The Use of Ryan
White CARE Act Funds for Outreach Services
and Q & A, May 16, 2002" (formerly
Policy No. 02-01), which replaced the "Division
of Service Systems (DSS) Program Policy Guidance
No. 3: Outreach, June 1, 2000" (formerly
Policy No. 97-03, March 31, 1997). It also
establishes updated guidelines for allowable
expenditures for outreach services.
The purpose of all Ryan White HIV/AIDS Program
funds is to address the unmet care and treatment
needs of persons living with HIV/AIDS who
are uninsured or underinsured and therefore
unable to pay for HIV/AIDS health care and
vital health-related supportive services.
In the Ryan White Comprehensive AIDS Resources
Emergency (CARE) Act Amendments of 2000, new
requirements gave grantees increased flexibility
in providing outreach services that were designed
to identify persons at high risk for HIV,
to bring HIV-infected persons into care, and
for the purpose of early treatment in order
to provide an array of early intervention
and prevention services. Outreach services
include services to both HIV-infected persons
who know their status and are not in care
and HIV-infected persons who do not know their
status and are not in care.
Outreach services are and have always been
considered to be support services under the
Ryan White HIV/AIDS legislation. As such,
with the advent of the amended Ryan White
HIV/AIDS Program legislation, Parts A, B and
C grantees are required to limit their expenditures
for all support services to 25 percent of
their grant award. Conversely, these grantees
are required to expend 75 percent of their
grant dollars on core medical services, placing
the emphasis of Ryan White HIV/AIDS Program
funding on life-saving and life-extending
services.
New Outreach Service Guidance for Grantees
All Ryan White HIV/AIDS Program Grantees may
continue to use funds to pay for HIV counseling
and testing, outreach, and referral services,
as provided in the Ryan White CARE Act Amendments
of 2000. However, Parts A, B and C Grantees
are limited to the percentage of grant funds
that may be expended for outreach and other
support services. As such, these Grantees
are expected to prioritize the support services
most appropriate for their geographical area
and client needs and fund those services first.
Grantees may continue to target and identify
individuals who may or may not know their
HIV status and are not in care, have not returned
for treatment services or do not adhere with
treatment requirements, if they determine
that these services are needed for the populations
they serve.
Policy Notice 07-06: The Use of Ryan White
HIV/AIDS Program Funds for Outreach Services
Federal funds received under the Ryan White
HIV/AIDS Program may continue to be used for
outreach activities which have as their principal
purpose targeting activities, under specific
needs assessment-based service categories,
that can identify individuals with HIV disease.
This includes those who know their HIV status
and are not in care as well as those individuals
whose HIV status is unknown, so that they
become aware of the availability of HIV-related
services and enroll in primary care, AIDS
Drug Assistance Programs, and support services
that enable them to remain in care.
I. Goal of Outreach Services
The goal of outreach services continues to
be to link individuals into care that would
ultimately result in ongoing primary care
and increased adherence to medication regimens.
Outcome measures need to be defined by grantees
that reflect the goal to evaluate the success
of outreach activities. Broad activities such
as providing "leaflets at a subway stop"
or "a poster at a bus shelter" would
not meet the intent of the law. This policy
continues to give CARE Act grantees flexibility
to target and identify individuals who may
or may not know their HIV status and are not
in care, have not returned for treatment services
or do not adhere with treatment requirements;
however, HAB encourages grantees to coordinate
outreach activities with the Centers for Disease
Control and Prevention(CDC)funded providers
where there is a greater emphasis on outreach
and case finding than the Health Resources
and Services Administration (HRSA).
II. Appropriate Support Services
An outreach component is not a requirement
for Ryan White HIV/AIDS Program-funded grantees.
Each individual Ryan White HIV/AIDS Program
under Parts A, B, C, D and F (except SPNS
programs) should identify if outreach services
are an appropriate support service for their
service area. As noted above, Parts A, B,
and C grantees of the Ryan White HIV/AIDS
Program must expend 75 percent of their grant
funds on core medical services for their clients.
Support services may be funded out of the
remaining 25 percent of grant funds and may
include in addition to outreach services,
such services as: respite care for persons
caring for individuals with HIV/AIDS, medical
transportation, linguistic services, and referrals
for health care and support services. This
is not an all inclusive list of support services
and grantees must determine which of the support
services they will implement based on services
that are needed for individuals with HIV/AIDS
to achieve their medical outcomes.
III. Outreach activities supported with
Ryan White HIV/AIDS Program funds must continue
to be:
A. Planned and delivered in coordination with
State and local HIV prevention outreach activities
to avoid duplication of efforts and to address
a specific service need category identified
through State and local needs assessment processes;
B. Directed to populations known, through
local epidemiological data or through review
of service data, to be at disproportionate
risk for HIV infection;
C. Conducted in such a manner, (i.e., time
of day, month, events, sites, method, cultural
appropriateness) among those known to have
delayed seeking care relative to other populations,
etc., and continually reviewed and evaluated
in order to maximize the probability of reaching
individuals infected with HIV who do not know
their serostatus or know their status but
are not actively in treatment;
D. Designed to:
- Establish
and maintain an association with entities
that have effective contact with persons
found to be disproportionately impacted
by HIV or disproportionately differ in
local access to care, e.g., prisons, homeless
shelters, substance abuse treatment centers,
etc.
- Direct
individuals to early intervention services
(EIS) or primary care (HIV counseling
and testing, diagnostic, and clinical
ongoing prevention counseling services
with appropriate providers of health and
support services).
- Include
appropriately trained and experienced
workers to deliver the message when applicable.
E. Designed to provide quantifiable outcome
measures such as the number of individuals
reached of previously unknown HIV status
who now know they are positive, and/or
the number of HIV positive individuals
not in care who are now in care; and
F. Determined to be a priority service
by Part A planning bodies and Part B consortia
or State planning bodies, and be necessary
to implement the Eligible Metropolitan
Areas or State wide comprehensive plan
and associated strategies.
IV.
Points of Entry
If
and when Part A, Part B, and Part C Grantees
determine that outreach services are appropriate
and should be funded with allotted support
service funds, the points of entry and early
intervention services are still applicable.
Ryan White HIV/AIDS Program Parts A and
B grantees are still allowed to fund outreach
services to link persons with HIV disease
into care. The 2000 Amendments introduced
language such as "key points of entry"
(such as emergency rooms, substance abuse
treatment programs, detoxification centers,
adult and juvenile detention facilities,
sexually transmitted disease clinics, HIV
counseling and testing sites, mental health
program and homeless shelters) and "early
intervention services" (HIV counseling
and testing, diagnostic, and clinical ongoing
prevention counseling services with appropriate
providers of health and support services)
where persons with HIV disease can be identified,
referred, and maintained in health care
and related supportive services. Grantees
should coordinate outreach services such
that they include key points of entry as
sites where targeted outreach activities
are conducted.
V. Early Intervention Services (EIS):
The grantee can use outreach to identify
and refer individuals to new and existing
early intervention services. Early intervention
services stress the importance of bringing
persons into care earlier in HIV disease
progression. Outreach services are aimed
at 1) identifying persons with HIV who may
or may not know their status and are not
in care; and 2) providing HIV counseling
and testing, diagnostic, and clinical ongoing
prevention counseling services with appropriate
providers of health and support services.
These early intervention services are now
eligible for all Parts under the Ryan White
HIV/AIDS Program.
VI. Prohibited Use of Funds
A. Funds awarded under the Ryan White HIV/AIDS
Program may not be used for outreach activities
that exclusively promote HIV prevention
education. Broad scope awareness activities
that address the general public (poster
campaigns for display on public transit,
billboards, TV or radio announcements, etc.)
may be funded provided that they are targeted
and contain HIV information with explicit
and clear links to health care services.
B. Outreach activities should supplement,
and not supplant, such activities that are
carried out with amounts appropriated under
Section 317 of the Public Health Service
Act, "Project Grants for Preventive
Health Services" administered by the
CDC or with other Federal, State or local
funds.
VII. Payer of Last Resort
The grantee must ensure that Ryan White
HIV/AIDS Program funds remain the payer
of last resort.
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