The Big Picture - July 2013

This post is part of a monthly series. It provides an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and HIV Prevention Planning Group. To view meeting materials and presentations, please visit www.hivphilly.org.

Ryan White Planning Council (RWPC)

The Ryan White Planning Council had an action (item)-packed meeting in July.  They started off the meeting by approving their allocations (budget) for the fiscal year, since the eligible metropolitan area (EMA) finally received its grant award - even though the fiscal year started on March 1.  Their first order of business was to approve budgets for the rest of the year.  Then they updated a couple of formal processes, starting with the resource allocation process.  The RWPC used to make advance plans in case the EMA got level funding, a 5% decrease, or a 10% increase.  But, given everything happening in Washington, D.C., they decided to stop planning for a 10% increase, and starting planning for a 10% decrease instead.  They also changed their reallocation process, which is what they use when a service can't spend all of its budgeted money.  The AIDS Activities Coordinating Office (AACO) has to follow the budget set by the RWPC, but they've always been able to move up to 5% of the money in a service in or out without clearing it first.  In July, the RWPC increased this to 10%, since there are so many changes happening.  Then, after all of that, the RWPC voted on the draft list of service priorities that was created by the Comprehensive Planning Committee.  The RWPC approved the list, but there were still some questions about the priority setting tool.  Everyone agreed to talk about the list again at a future meeting.

Most of the work at the committee level in July was spent preparing for that one busy RWPC meeting.  The Comprehensive Planning Committee met to go over their priority setting list and process; the Finance Committee voted on FY2013 allocations and updated the two process documents that they presented to the RWPC.  The Finance Committee also talked about the upcoming regional allocations meetings to plan for FY2014 - more information on the decisions from those meetings can be found below.  The Needs Assessment Committee didn't meet, and the Positive Committee got an update on everything happening at the RWPC meetings.  They also learned more about the allocations process so they could better participate in those meetings.

 

Allocations Meetings

Every summer, the RWPC hosts three regional allocations meetings.  The Philadelphia EMA is made up of nine counties - four suburban PA Counties (Delaware, Chester, Montgomery, and Bucks), four New Jersey Counties (Gloucester, Salem, Camden, and Burlington), and Philadelphia itself.  The RWPC knows that each of these three regions has different needs, so they all budget separately.  These allocations meetings are held far in advance - the July 2013 meetings were for planning for the fiscal year starting on March 1, 2014.  This way, when the EMA finds out how much money they're actually getting from the federal government, there's already a plan in place.

This year, each region planned for what they would do if the EMA received level funding (the same amount as last year), a 5% decrease, or a 10% decrease.  They also have the option to provide instructions to the grantee (AACO).  The RWPC will vote on these plans and any instructions at their August 8, 2013 meeting.  The decisions from the meetings are here:

Philadelphia
Level-funding budget: Philadelphia chose to fund services at the same level under a level-funding budget.

5% decrease budget: Philadelphia chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% decrease budget: Philadelphia chose to fund supportive services at the same level as the 5% decrease budget, spreading the decrease proportionally across all other service categories.

Instructions to the grantee: Philadelphia would like the grantee to investigate the non-Part A funding streams available to each service category.

PA Suburban Counties
Level-funding budget: Due to funding shifts within the EMA, the PA Counties would receive an increase if the EMA received level funding.  The PA suburban counties chose to spread the increase proportionally across all service categories.

5% decrease budget: The PA suburban counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% decrease budget: The PA suburban counties chose to spread a 10% decrease proportionally across all service categories (based on their level-funding budget).

Instructions to the grantee: None.

New Jersey Counties
Level-funding budget: The New Jersey counties chose to keep all services funded at the same levels in the case of level funding, with the exception of medical case management.  Due to funding shifts within the EMA, New Jersey would receive an additional $43,463 if the EMA received level funding.  The New Jersey counties agreed to place the entire amount of this increase in medical case management.

5% decrease budget: The New Jersey counties chose to spread a 5% decrease proportionally across all service categories (based on their level-funding budget).

10% decrease budget: The New Jersey counties chose to spread a 10% decrease proportionally across all service categories, with the exception of legal services, which would not receive a reduction (based on their level-funding budget).

Instructions to the grantee: None.

HIV Prevention Planning Group (HPG)

The new HIV Prevention Planning Group (HPG) met for the first time in July.  Welcome to the first twelve members!  The HPG took the place of the PPG, and will focus on gathering community input on Philadelphia's plan for HIV prevention.  For their first meeting, the new HPG got a presentation on Philadelphia's HIV prevention plan from AACO's Coleman Terrell.  Jen Chapman also talked about the concurrence process, explaining that the HPG would have to vote to either concur with the plan, concur with reservations, or not concur at all.  The HPG also voted to keep former PPG community co-chair Jen Chapman in her position on the new HPG.

Points of Integration Workgroup

Members from both the care and prevention planning bodies come together for the Points of Integration Workgroup.   In July, they continued their conversation about how to improve linkage to HIV care for those newly diagnosed with HIV.  They talked about programs in other areas, including Washington state and Lousiania, which were addressed in a webinar by the HIV Prevention Justice Alliance.  They also talked about the Anti-Retroviral Treatment and Access to Services (ARTAS) model.  One of the major points from the meeting was a need to develop clear and consistent messages so that people being tested for HIV would know that they could access free care at their choice of provider if they found out they were positive.



This is a great time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved. If you have questions, you can also call us at 215-574-6760.

Health Reform Resources: Enrollment Support and Marketplaces

As the start of open enrollment (October 1, 2013) draws closer, there has been a flurry of resources concerning how to help consumers screen for eligibility and enroll in Marketplace plans and Medicaid. Below you will find several new resources relevant to the Philadelphia region. Community-based providers and AIDS service organizations are encouraged to explore all the resources and opportunities available to assist with the transition to the era of health reform and new coverage options. You can explore our

other blog posts about health reform here.

Stakeholder Call with HHS and CMS about the Health Insurance Marketplace in PA - July 31, 2013

This second in a series of three calls is intended specifically for stakeholders in Pennsylvania. HHS and CMS regional officials will give brief updates on the operational execution of the Marketplace including systems readiness; consumer support and outreach.   

Certified Application Counselor Organizations

There are going to be opportunities for organizations to be trained and certified to provide counseling to enrollees. As a CAC organization, your staff and volunteers will help people understand, apply, and enroll  for health coverage through the Marketplace. There are three official trainings on how to become a Certified Application Counselor Organization over the next couple of weeks. Register at the links below.

Date	Time	Webinar Link
July 31, 2013	1:30 – 3:00 pm ET	https://goto.webcasts.com/starthere.jsp?ei=1020077
August 6, 2013	1:30 – 3:00 pm ET	https://goto.webcasts.com/starthere.jsp?ei=1020167
August 7, 2013	1:30 – 3:00 pm ET	https://goto.webcasts.com/starthere.jsp?ei=1020171

Kaiser Family Foundation Issue Brief -- Helping people with HIV Navigate the Transition to ACA Coverage.

This issue brief is a summary of a roundtable discussion convened by Kaiser Family Foundation in March 2013 concerning planning for the coverage transition, helping people with HIV choose and enroll in coverage and troubleshooting during coverage transitions.
Key passages:
Pg. 5 - HIV community needs to plan for changes in the role of the Ryan White HIV/AIDS Program 
Pg. 5 - HIV community stakeholders need to be aware of their state's organizational structure and work to inform state policymakers about the needs of people with HIV and standards for HIV care.
Pg. 6 - HIV service providers may need to consider business re-design options to maximize their engagement with the health system.
Pg. 6 - Best practices and lessons learned from states and organizations that have begun navigating through HIV-related policy changes will help inform how to better plan for challenges that may occur
Pg. 8 - It may be important to differentiate between types of HIV enrollees in ACA coverage
Pg. 9 - While HIV providers and clinic staff are poised to play a central role in supporting coverage transitions, they may require specific training and support

Insurance Marketplace Pre-screening Tools and other Resources at HIVhealthreform.org

There are too many great resources on hivhealthreform.org to list here. One of the most interesting is the pre-screening tools (for both Medicaid-expansion states and those not currently expanding Medicaid coverage) from Duke Law Project.

Health Reform To-Do List

This presentation was designed specifically for people living with HIV/AIDS (PLWHA) who are uninsured or in need of affordable insurance options. Most of the information is general to PLWHA in the US, but some Pennsylvania information is included because the state is not expanding Medicaid coverage to low income adults (not at this time anyway). These slides are adapted from content developed by the Target Center. I highly recommend providers and consumers of Ryan White services check out the Target Center for great resources about Health Reform and so much more.

I created this interactive presentation in an effort to help more people understand how the Affordable Care Act, or "Obama Care" may affect them. It's intended to be used as a starting-off point to explore resources to help you make the best decisions for yourself and your family. Anything that is underlined is a link to something to help you understand your options or help plan for your new coverage in 2014. Please take time and explore the links.

If you have questions or comments, please be sure to leave comment here or email me. I will do my best to answer your question or lead you to a good resource.

Summer 2013 Update: Priorities and Funding

I shared this Prezi with the Positive Committee at their July 8, 2013 meeting, to give them an update on the Planning Council's activities over the last couple of months. A couple things for you to know/consider before viewing the Prezi:

• You can read more about the priority setting process, including the factors and scoring process here. The Comprehensive Planning Committee is responsible for facilitating the priority setting process at lest once every three years, or whenever there is a need to update the list due to policy or other changes to the care system. Priority setting just means putting the Ryan White care services in order of importance/need according to certain factors, based on information about community need and impact on the continuum of care. 

• The Philadelphia EMA received less of a decrease in the Part A funding than we were told to expect. The grant award was a little more than 6% less than the 2012 award. The Planning Council already developed a plan for a decrease, and this plan is represented by the 2013 pie chart in the Prezi. the 2012 pie chart is how the money was budgeted for last year. You will notice that the most significant differences are in Early Intervention Services and Care Outreach, which were ended as of the first quarter of this grant year (June 30, 2013), due to the funding decreases. Other services will receive less money too, because Early Intervention and Care Outreach Services couldn't absorb all of the cut.

• The Regional Allocations meetings where the community decides how to budget our Ryan White Part A funds will be at the Office of HIV Planning. Everyone is welcome to attend and participate. The Office of HIV Planning plans to provide meeting materials to participants before the meeting. If you would like to attend a meeting, please call 215-574-6760.
• PA Counties (Chester, Bucks, Delaware and Montgomery)- 
• Tuesday, July 23rd from 1-4pm
• NJ Counties (Camden, Burlington, Salem and Glouchester) - 
• Thursday, July 25th from 1-4pm
• Philadelphia - 
• Tuesday, July 30th from 1 - 4pm

Stephen Handlon, OHP Staff Member Introduction

Stephen Handlon, OHP Staff

Tell us about yourself

I recently graduated from Haverford College with a B.A. in History. I have always had an interest in public health and am excited to be the new administrative assistant at the Office of HIV Planning. So far, I have had the opportunity to meet great people and see how policy impacts the lives of those affected by HIV/AIDS. I currently live in Northern Liberties and in my free time, I enjoy exploring new restaurants and hang outs in the city. I have been to Paris, France a few times and am obsessed with French films and almost anything related to the language or culture. Another fun fact is that I’m from Minnesota… and no, I do not have an accent like in the movie Fargo.

What made you get involved in the HIV/AIDS community?

Because of the work that has been done by advocates, community members, policy officials and scientists, those in the gay community in my generation have a greater awareness about issues related to HIV/AIDS than previous generations. However, there is still a lot to be done in terms of erasing the stigma surrounding the illness, providing adequate care to those affected and working towards a cure.

Who do you look up to or admire?

I admire all the hardworking people in the world who are so essential to our everyday activities, but who almost always go unnoticed. I try to remember to thank the driver when I take the trolley to work in the morning.

What do you think is the biggest challenge for people living with HIV/AIDS?

I think some of the biggest challenges are related to larger challenges disproportionately faced by people from marginalized groups, such as stigma and a lack of access to things such as quality food, housing and education. 

Health Reform Resource Update

Over the last few days I have come across a few health reform resources I thought worth sharing. This post is one of a series of blog posts about health reform and the Affordable Care Act. You can read see all the previous posts by clicking on the label "ACA" at the bottom of this post.

Healthcare.gov or  Cuidadodesalud.gov

Want to learn more about the insurance marketplaces and what options are available to you or your clients? The first place you should go is healthcare.gov, the federal website set up to share information about insurance eligibility and enrollment. You can also call 1-800-318-2596 or TTY/TDD 1-855-889-4325 for more information about buying health insurance through the state marketplaces. Enrollment will begin October 1, 2013, but you can call and get your questions answered today. Translation and interpretation services available in 150 languages over the phone.

Potential Impact of the Affordable Care Act on the Ryan White HIV/AIDS Program

This report from Mathematica provides an in depth look into how the ACA impacts the Ryan White program and Ryan White clients. The report was released in November 2012, but still offers valuable insight and recommendations to Ryan White grantees and providers. 

NASTAD Essential Health Benefits Brief

This issue brief describes the essential health benefits (EHB) and how they impact people living with HIV/AIDS and viral hepatitis. Four of the EHBs are highlighted: preventative services, prescription drugs, mental health and substance abuse services, and chronic care management.

Engaging Safety Net Providers in Expanded Coverage: Tips on Enhancing Billing Capacities

A new fact sheet from NASHP (National Academy for State Health Policy) offers action steps and advice to safety net providers to expand billing options. This fact sheet will be a good companion to my policy updates for providers: here and here.

As I type Kaiser Family Foundation is hosting a briefing on Medicaid Managed Care in the Era of Health Reform. The video should be available this week.

Everyday there are new resources for helping us navigate the new landscape of health reform. I'll keep sharing what I find useful. Please share questions, comments and links in the comments or on our Facebook page.

The Big Picture - June 2013

This post is part of a monthly series published on the fourth Thursday of every month. It provides an overview of themes and topics from the general meetings and committee meetings of the Ryan White Planning Council and HIV Prevention Planning Group each month. To view meeting materials and presentations, please visit www.hivphilly.org.
 

Ryan White Planning Council (RWPC)


Due to a crazy weather situation that never actually happened, the RWPC and RWPC Nominations Committee meetings were both canceled this month.  Three of the RWPC's committees did still meet, though.

RWPC members Lupe, Gary, and Gerry setting priorities

The Comprehensive Planning Committee met to begin its process for setting service priorities for the 2014 fiscal year.  Each service category was scored using five factors: payer of last resort, consumer survey data, impact on the care continuum, unmet need data, and designation as an Essential Health Benefit (EHB) under the Affordable Care Act (ACA).  The group was able to score all of the services in just one meeting.  They'll talk about the draft list at their next meeting at 10 a.m. on Wednesday, July 10 and then present the list to the RWPC for a vote at their July meeting.

Meanwhile, the Finance Committee met to continue discussions on its FY2014 allocations process.  We were joined by AIDS Activities Coordinating Office (AACO) staff, and the group had a lengthy talk about the type of data they would like to consider.  It will be a challenging year for planning allocations, since the fiscal year will coincide with the beginning of most parts of the Affordable Care Act.  They ultimately created a list of data that they planned to look at in order to evaluate the cost-effectiveness of different services.

The Positive Committee had a special presentation from Philadelphia FIGHT in honor of AIDS Education Month.  They discussed HIV myths and facts, and received information on various services.  They also reviewed their new committee brochure.

Prevention Planning Group (PPG)

June marked the last official meeting of the PPG.  They'll be officially replaced by the HIV Prevention Planning Group (HPG) starting on July 1.  This month, a small review panel met to discuss applications for HPG membership.  They recommended a pool of applicants for the new HPG.  After this, the PPG met for the last time.  We were joined by our CDC project officer, Angie Alvarado.  Community co-chair Jen Chapman gave a fantastic overview of HIV prevention planning, including updates from the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS) and a recent HPG Bootcamp.  We thank the PPG members for their service, and look forward to working with the new HPG starting on Wednesday, July 24.

Points of Integration Workgroup

Members from both the care and prevention planning bodies come together for the Points of Integration Workgroup.  Like each of the committees, they've been giving a lot of thought to the treatment cascade and its implications for Philadelphia.  A few months ago, they chose to focus on the "linkage to care" aspect - getting people that test positive for HIV into medical care right away.  They think that having the HIV tester ask questions about "treatment readiness" at the time of the test might help us to get new positives into care.  At their last meeting, the group started to look at different models for these types of assessments, including the Anti-Retroviral Treatment and Access to Services (ARTAS) model.


This is an exciting time to get involved in community planning for the Philadelphia area. To learn more, follow the links in this post, attend one of the meetings listed on our calendar, or email info@hivphilly.org to find out how to get involved. If you have questions, you can also call us at 215-574-6760.