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The following questions were taken from Planning Council meeting evaluations. Due to the interest of time, these questions were not able to be answered at the general meetings. Please feel free to email any comments and questions to Cara Mathews at cmathews@bphc.org.
Q.1. What is the purpose of the Grantee leeway?
Since the funding scenarios are made one year in advance, the Grantee leeway allows the Grantee to make relatively minor adjustments to the service category allocations based on changes that may occur between the time the funding scenarios are created and when the award is actually received. This is different from the “sweeps process” that happens during the fiscal year. With the higher level of unknowns – such as the impact of State and/or Federal Budget changes, and uncertainty around Dental and Drug services – the leeway is critical.
Additionally, when individual agency budgets are created, the total amount of money allocated to agencies within each service category does not always equal exactly what the Council’s plan included. This may happen for such reasons as historical under spending by one agency or an agency getting a new source of funds, hence having less of a need for Part A dollars. As a result, there may be one agency that gets reduced and that money could be potentially moved to another category. The leeway allows for this level of adjustment to be made.
In the past, the Grantee leeway awarded by the Planning Council has varied between 10-20%. Depending on the year, the Grantee has exercised the leeway anywhere from 1-16% per service category in accordance with the intent of the Planning Council.
Q.2. Does the Red Cross give out any HIV education to people that give blood?
The Red Cross does provide specific information about HIV/AIDS as part of their donation process. They also make it clear that donating blood should not be used to test for HIV/AIDS. The Red Cross’ donation eligibility criteria worksheet (http://www.redcrossblood.org/donating-blood/eligibility-requirements/eligibility-criteria-alphabetical-listing) includes information on identifying risk for HIV/AIDS and also potential signs and symptoms for HIV/AIDS.
Q.3. Why does Boston EMA Part A money go to the AIDS Drug Assistance Program (ADAP)?
The AIDS Drug Assistance Program (ADAP), otherwise known at the HIV Drug Assistance Program (HDAP) in MA, provides access to medications for people living with HIV (PLWH). ADAP can pay for medications and drug co-pays, private non-group health insurance premiums and premium co-pays, HIV resistance testing, and post-exposure prophylaxis (PEP). These services are essential for PLWH who would otherwise be unable to obtain these medications.
For FY11, Part A anticipates contributing almost $2 million to ADAP in MA and NH (74% to MA and 26% to NH). In conjunction with the Part A contribution, as well as funding from the states of MA and NH, and Ryan White Part B, neither MA nor NH have an ADAP waiting list. Currently, 13 states have ADAP waiting lists. Historically, the Planning Council has been cognizant of the potential shortfalls that ADAP could experience, that could result in leaving PLWH without needed medications, and has recommended allocating under-expended funds and unexpended funds to the ADAP service category.
Q.4. How do I access Planning Council reports?
All Planning Council reports (ex. Needs Assessment, Funding Streams, etc) are located on the Planning Council website under the "Publications" tab (http://bostonplanningcouncil.org/publications.htm).
All Grantee (BPHC) reports can be found on the BPHC website (http://www.bphc.org/aids).
Q.5. What is the importance of name-based reporting?
Names-based reporting refers to the state managed HIV/AIDS surveillance system. Name-based reporting is important for two reasons: 1) it provides more accurate data collection on HIV/AIDS cases, and 2) the number of cases determines the formula funds allocated to EMAs' Part A and States' Part B programs. For these reasons, MA is in the process of transitioning from a code-based to a names-based reporting system.
1) The Center for Disease Control and Prevention (CDC) is responsible for the national HIV/AIDS surveillance system, which is the nation's key source of information used to track the epidemic. Since 1999, states have been advised to conduct HIV reporting using a confidential name-based approach, such as what is currently in place for AIDS case reporting. There are currently 43 states that use this type of confidential names-based case reporting. From a public health perspective, the names-based data collection method is preferred by CDC because it routinely achieves high levels of accuracy and reliability when it comes to case counting. According to the CDC, other HIV surveillance (e.g. coded patient identifiers, which is used in MA) has not been shown to routinely produce equally accurate, timely, or complete data compared to using confidential, name-based surveillance methods.
2) Furthermore, HRSA uses the CDC HIV/AIDS surveillance data to determine funding allocations for EMAs and TGAs covered by the Ryan White Act. HRSA's formula dollars are a result of the number of HIV/AIDS cases in the EMA; therefore, name-based reporting is critically important because it provides the most accurate data of the number of current HIV/AIDS cases in the area, which thereafter determines the amount of funding distributed. Currently, the CDC will only certify cases from states with names-based reporting systems. However, under the Ryan White legislation HRSA is allowed to accept code-based data only from thoses states with an approved transition plan.
http://www.cdc.gov/Washington/testimony/2006/t20060427.htm
http://www.hhs.gov/asl/testify/2009/09/t20090909a.html
Q.6. What is the current federal poverty level (FPL)?
The 2010 Health and Human Services Poverty Guidelines are as follows:
|
Size of family
unit |
100 Percent
of Poverty |
150 Percent
of Poverty |
175 Percent
of Poverty |
200 Percent
of Poverty |
300 Percent of Poverty |
400 Percent of Poverty |
|
1 |
$10,830 |
$16,245 |
$18,953 |
$21,660 |
$32,490 |
$43,320 |
|
2 |
$14,570 |
$21,855 |
$25,498 |
$29,140 |
$43,710 |
$58,280 |
|
3 |
$18,310 |
$27,465 |
$32,043 |
$36,620 |
$54,930 |
$73,240 |
|
4 |
$22,050 |
$33,075 |
$38,588 |
$44,100 |
$66,150 |
$88,200 |
|
5 |
$25,790 |
$38,685 |
$45,133 |
$51,580 |
$77,370 |
$103,160 |
|
6 |
$29,530 |
$44,295 |
$51,678 |
$59,060 |
$88,590 |
$118,120 |
|
7 |
$33,270 |
$49,905 |
$58,223 |
$66,540 |
$99,810 |
$133,080 |
|
8 |
$37,010 |
$55,515 |
$64,768 |
$74,020 |
$111,030 |
$148,040 |
*For family units of more than 8 members, add $3,740 for each additional member.
Source: http://www.cms.gov
Q.7. What is meant by supportive housing?
Supportive housing is defined as a combination of affordable housing with services that help people live more stable, productive lives. In the Boston EMA, Part A money is used to fund supportive services offered to residents of AIDS Housing Programs. These services include wrap around care coordination, specialized substance abuse and mental health counseling, congregate housing, scattered site housing, and transitional housing. A list of Part A funded programs for Housing Services can be found at http://www.bphc.org/aids.
Q.8. How will national health care reform affect PLWH?
The impact of national health care reform on PLWH is a topic that is being followed by the Policy Committee, and other professional and community groups. Updates will be provided to the Planning Council as they are available. At this point, most of the pieces of national health care reform will not be implemented until 2014. On November 4, 2010, Robert Greenwald presented to the Planning Council and Consumer Committee on the potential impacts of national health care reform on PLWH and on Massachusetts. The minutes from these meetings can be accessed on the Planning Council website (www.bostonplanningcouncil.org). For more information on national health care reform, please visit the following websites.
http://www.mass.gov/nationalhealthreform
http://healthreform.kff.org/timeline/aspx
Q.9. What is the status of HIV/AIDS Drug Assistance Programs across the country (HDAP/ADAP)?
As of December 2010, there are nine states that have a HDAP/ADAP waiting list. The total number of people on an HDAP/ADAP waiting list in the United States is 4,732 (Source: Kaiser Family Foundation).
At the January 13, 2011 Planning Council meeting, presentations were given on HDAP/ADAP programs in Massachusetts and New Hampshire. These presentations are available on the Planning Council website (www.bostonplanningcouncil.org).
Q.10. What is PrEP?
PrEP (Pre-Exposure Prophylaxis) is a HIV/AIDS prevention method that is currently undergoing various research trials, including one in Boston at Fenway Community Health Center. In PrEP studies, HIV negative people who are at high risk, take antiretroviral medication in order to try to lower their chances of becoming infected with HIV if they are exposed to it. According to the CDC, PrEP has only been shown to reduce HIV transmission among gay and bisexual men. There is currently no data on heterosexuals or injection drug users. There are currently no CDC guidelines for PrEP, but initial safety precautions are available on the CDC website. For more information on PrEP, please visit the following websites.
http://www.cdc.gov/hiv/prep/
http://www.fenwayhealth.org
Q.11. What Ryan White and Housing Opportunities for People with AIDS (HOPWA) services/agencies specifically serve people with sex offenses?
Unfortunately, this information is not tracked, so it is unknown who in the Boston EMA may fall into that category.
Q.12. Is there information on visiting nurses and case managers that go to clients that are housbound and need medications, or help with other issues?
Concerning medical care, the Boston EMA Part A funding does not cover the service category home health services, which is defined by HRSA as "the provision of services in the home by licensed health care workers such as nurses and the administration of intravenous and aerosolized treatment, parenteral feeding, diagnostic testing, and other medical therapies." The state of Massachusetts and New Hampshire fund limited HIV specific home health medical services. The reason for the limited funding is due to the availability of Home Health services that are reimbursable by third party payors.
While both Part A and the states of MA and NH have supported the ability of case managers to engage clients in their homes, the most recent joint Request for Responses (RFR) issued by BPHC and MDPH calls for the expanded utilization of mobile case management and other services that can be provided in a range of settings including the home.
Q.13. Does JSI present the data in the Annual Outcomes Report to provider agencies?
Individualized outcome reports are prepared for each agency based on their own data. All providers are encouraged to use the BPHC website to download the full report.
Additionally, at the annual Grantee Provider Training, there is a Quality Management session in which data from the Outcome reports and other studies are shared.
Q.14. As part of federal healthcare reform, the government will pay 50% back in name-brand drugs. How will this affect the HIV Drug Assistance Program/AIDS Drug Assistance Program (HDAP/ADAP)?
Once this component of national healthcare reform goes into effect, this policy should save money for HDAP/ADAP. Theoretically, it will cost half as much to get individuals through the "doughnut hole" now that HDAP/ADAP costs count toward true out-of-pocket costs (TrOOP).
Q.15. What is the percentage of concurrent HIV/AIDS diagnoses in NH?
The concurrent diagnosis percentages for the past three years are 49% for both 2009 and 2008, and 34% for 2007.
Source: NHDHHS
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