Ryan White HIV/AIDS Program Part A Manual

The purpose of the Statewide Coordinated Statement of Need (SCSN) is to provide a collaborative mechanism to identify and address significant HIV/AIDS care issues related to the needs of people living with HIV/AIDS (PLWHA), and to maximize co or dination, integration, and effective linkages across the Ryan White HIV/AIDS Program Parts. In addition, the SCSN process is expected to result in a document that reflects the input and approval of all Ryan White HIV/AIDS Program Parts. The State Part B program is responsible for coordinating the SCSN, but all Parts and grantees are expected to participate.

Section 2617(b)(6) requires grantees to conduct activities to enhance co or dination across Ryan White HIV/AIDS Program Parts by mandating participation in the development of an SCSN.

The State Part B program is responsible for convening the SCSN for all Ryan White grantees under the following provisions:

Section 2617(b)(6) states that "the public health agency administering the grant for the State will periodically convene a meeting of individuals with HIV/AIDS , members of a Federally recognized Indian tribe as represented in the State, representatives of grantees under each part under this title, providers, and public agency representatives for the purpose of developing a statewide coordinated statement of need….”

Section 2617(b)(5)(F) requires the State’s Part B application to include a comprehensive plan that “provides a description of how the allocation and utilization of resources are consistent with the statewide coordinated statement of need (including traditionally underserved populations and subpopulations) developed in partnership with other grantees in the State that receive funding" under Ryan White.

Part A programs are required to participate in the SCSN process, and use its fi ndings, under the following provisions:

Section 2602(b)(4)(F) requires the planning council to “participate in the development of the statewide coordinated statement of need initiated by the State public health agency responsible for administering grants under Part B.”

Section 2603(b)(1)(G) requires the Part A application for supplemental funding to “demonstrate the manner in which the proposed services are consistent with the local needs assessment and the statewide coordinated statement of need….”

Section 2605(a)(8) requires an assurance as part of the Part A application to ensure “that the applicant has participated, or will agree to participate, in the statewide coordinated statement of need process where it has been initiated by the State public health agency responsible for administering grants under Part B, and ensure that the services provided under the comprehensive plan are consistent with the statewide coordinated statement of need.”

Definition

The Statewide Coordinated Statement of Need (SCSN) is a written statement of need developed through a locally chosen collaborative process with other Parts of the Ryan White HIV/AIDS Program. The SCSN must reflect, without replicating, a discussion of existing needs assessments and should include a brief overview of epidemiologic data, existing quantitative and qualitative information, and emerging trends/issues affecting HIV/AIDS care and service delivery in the State. Important elements in assessing need include a determination of the population with unmet need, a full understanding of primary care and treatment in the State, and a consideration of all available resources. The SCSN process should consider total Ryan White HIV/AIDS Program resources in the State, both the amount of funds and what services the funds are supporting. For example, the number of full-time case managers funded with Ryan White HIV/AIDS Program funds, the total spent for core services, and the total amount spent f or medications. Where possible, the value of non-Ryan White HIV/AIDS Program resources in the State should be considered in determining need. A consideration of the numbers of persons who know their HIV status but are not in care should be included.The SCSN must identify broad goals and critical gaps in life-extending care needed by people living with HIV/AIDS (PLWHA) both in and out of care.

In developing a SCSN, States are expected to use needs assessments and comprehensive plans completed by other parts of the Ryan White HIV/AIDS Program in an effort to identify cross-cutting issues in the State. The cross-cutting issues and goals identified by this process will form the basis of the SCSN. The issues and goals identified in the SCSN should not be prioritized, but assessed equally. Some examples of cross-cutting issues and/or broad goals may include access to medications, increasing the number and percentage of cervical cancer screenings provided to women living with HIV/AIDS, developing and evaluating a clinical quality management program, and decreasing unmet need.

The Health Resources and Services Administration ( HRSA ) strongly encourage grantees to use the SCSN to support Statewide HIV/AIDS planning. This could include using the goals outlined in the SCSN to set measurable objectives, inform resource allocation decisions, create a Statewide plan, as well as conduct other activities to enhance HIV care and service delivery Statewide. The SCSN cannot supplant local needs assessment, planning, and priority setting processes.

Contents of the SCSN

At a minimum, the SCSN should contain:

• The most recent State HIV/AIDS epidemiology profile
• A description of the process used to develop the SCSN
• A list of participants in the process
• A description of identified gaps and/or overlaps in services
• A list of priorities identified, including addressing Unmet Need and gaps in Core Medical Services, and
• A description of priorities addressing identified barriers to care for underserved populations in the State.

Process

The Ryan White HIV/AIDS Program assigns Part B Grantees the responsibility for periodically convening a meeting for the purpose of developing a SCSN and submitting the SCSN to the HRSA , HIV/AIDS Bureau, Division of Service Systems. However, HRSA views all Ryan White HIV/AIDS Program Parts equally responsible for the development of the process, their organization's participation, and the development and approval of a collaborative SCSN. The mechanism for developing the SCSN can be a series of Statewide meetings, meetings organized based on epidemiologic data or some other locally developed process, as long as the criteria described in the Definition and Participation Sections are met. The mechanism must ensure participation of all other Parts.

Participation in the Development of the SCSN

The SCSN must be developed with input from: (1) representatives of all Ryan White HIV/AIDS Programs, including administrators of the AIDS Education and Training Centers , the Dental Reimbursement Program and Special Projects of National Significance Demonstration Grants operating in the State; (2) PLWHAs; (3) providers; and (4) public agency representatives. Part A representation should include grantee and Planning Council representatives. Part B should have Consortia, direct care providers, and grantee administrators. In cases where there are multiple grantees from a Ryan White HIV/AIDS Program, such as a State with multiple Part C programs, the State in concert with those grantees, should determine a mechanism of representation allowing a variety of interests and views to be fairly represented in the SCSN process.

For the purpose of this guidance “provider” is defined as any individual or institution either receiving Ryan White HIV/AIDS Program funds or generally involved in the provision of health care and/or support services to PLWHA

In addition to Ryan White HIV/AIDS Program representation, States are also encouraged to include representation from other major providers or funders of services needed by PLWHA such as substance abuse, mental health, Medicaid, Medicare, HRSA -funded Health Centers, and Veteran's Affairs.

Special Considerations

Part A – In instances where the eligible metropolitan area (EMA) or transitional grant area (TGA) crosses a State border, the Part A applicant will be given the option to use the SCSN that most appropriately applies to their population based on the epidemiological profile of that area.

Part B – States with only Part B funds will be required to develop a SCSN with participation from PLWHA, providers, and public agency representatives. The final document should reflect efforts made to meet new legislative requirements.

Funding for the SCSN Process

The use of Ryan White funds to assure participation in the SCSN must be consistent with each individual program’s requirements with regard to program expenditures.

Timetable

The SCSN should be reviewed and updated at least every three years and submitted to HRSA.

SCSN Review

HAB reviews each SCSN submitted and provides comments back to the Part B grantee. Review of the SCSN allows HAB/DSS to identify cross-cutting issues across jurisdictions.