Appendix B:
Service Category Definitions  TOP

Health Care Services  TOP

Ambulatory/Outpatient Medical Care. Provision of professional, diagnostic and therapeutic services rendered by a physician, physician’s assistant, clinical nurse specialist, or nurse practitioner in an outpatient, community-based, and/or office-based setting. This includes diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, care of minor injuries, education and counseling on health and nutritional issues, minor surgery and assisting at surgery, well-baby care, continuing care and management of chronic conditions, and referral to and provision of specialty care.

Primary Medical Care for the Treatment of HIV Infection includes the provision of care that is consistent with Public Health Service guidelines. Such care must include access to antiretrovirals and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies.

Drug Reimbursement Program. Ongoing service/program to pay for approved pharmaceuticals and or medications for persons with no other payment source. Subcategories include:

1. State-Administered AIDS Drug Assistance Program (ADAP). Title II CARE Act-funded and administered program or other state-funded Drug Reimbursement Program.
   
2. Local/Consortium Drug Reimbursement Program. A program established, operated, and funded locally by a Title I EMA or a consortium to expand the number of covered medications available to low-income patients and/or to broaden eligibility beyond that established by a State-operated Title II or other State-funded Drug Reimbursement Program.
   
3. Medications include prescription drugs provided through ADAP to prolong life or prevent the deterioration of health. The definition does not include medications that are dispensed or administered during the course of a regular medical visit or that are considered part of the services provided during that visit. If medications are paid for and dispensed as part of an Emergency Financial Assistance Program, they should be reported as such.

Health Insurance. A program of financial assistance for eligible individuals with HIV disease to maintain a continuity of health insurance or to receive medical benefits under a health-insurance program, including risk pools.

Home Health Care. Therapeutic, nursing, supportive and/or compensatory health services provided by a licensed/certified home-health agency in a home/residential setting in accordance with a written, individualized plan of care established by a case-management team that includes appropriate health-care professionals. Component services include:

• Durable medical equipment
  
• Homemaker or home-health aide services and personal care services
  
• Day treatment or other partial hospitalization services
  
• Intravenous and aerosolized drug therapy, including related prescription drugs
  
• Routine diagnostic testing administered in the home of the individual
  
• Appropriate mental health, developmental, and rehabilitation services

Home- and community-based care does not include inpatient hospital services or nursing home and other long-term care facilities.

Oral Health. Diagnostic, prophylactic, and therapeutic services rendered by dentists, dental hygienists, and similar professional practitioners.

Hospice Services.

1. Home-Based Hospice Care. Nursing care, counseling, physician services, and palliative therapeutics provided by a hospice program to patients in the terminal stages of illness in their home setting.
   
2. Residential Hospice Care. Room, board, nursing care, counseling, physician services, and palliative therapeutics provided to patients in the terminal stages of illness in a residential setting, including a non-acute care section of a hospital that has been designated and staffed to provide hospice services for terminal patients.

In-Patient Personnel Costs. Within the limitations of the legislation, up to ten percent of the total award is allowable for such costs, if it has been determined by the planning council that a shortage of inpatient personnel exists which has in turn resulted in inappropriate utilization of inpatient services.

Mental Health Services. Psychological and psychiatric treatment and counseling services, including individual and group counseling, provided by a mental-health professional who is licensed or authorized within the State, including psychiatrists, psychologists, clinical-nurse specialists, social workers, and counselors.

Nutritional Counseling. Provision of nutrition education and/or counseling provided by a licensed/registered dietitian outside of a primary care visit. Nutritional Counseling provided by other than a licensed/registered dietician should be provided under Psychosocial support services. Provision of food, meals, or nutritional supplements should be reported as a part of the subcategory, Food and/Home-Delivered Meals/Nutritional Supplements, under Support Services.

Rehabilitation Services. Services provided by a licensed or authorized professional in accordance with an individualized plan of care which is intended to improve or maintain a client’s quality of life and optimal capacity for self-care. This definition includes physical therapy, speech pathology, and low-vision training services.

Substance Abuse Services. Provision of treatment and/or counseling to address substance-abuse issues (including alcohol, legal and illegal drugs), provided in an outpatient or residential health service setting.

Treatment Adherence Services. Provision of counseling or special programs to ensure readiness for and adherence to complex HIV/AIDS treatments.

Support Services  TOP

Child Care Services. The provision of care for the children of HIV positive clients while the clients are attending medical or other appointments. This does not include daycare while the client is at work.

Child Welfare Services. Assistance in placing children younger than 20 in temporary (foster care) or permanent (adoption) homes because their parents have died or are unable to care for them due to HIV-related illness.

Buddy/Companion Services. Activities provided by peers or volunteers to assist a client in performing household or personal tasks. Buddies also provide mental and social support to combat loneliness and isolation.

Case Management. A range of client-centered services that links clients with primary medical care, psychosocial and other services to insure timely, coordinated access to medically-appropriate levels of health and support services, continuity of care, ongoing assessment of the client’s and other family members’ needs and personal support systems, and inpatient case-management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities. Key activities include initial comprehensive assessment of the client’s needs and personal support systems; development of a comprehensive, individualized service plan; coordination of the services required to implement the plan; client monitoring to assess the efficacy of the plan; and periodic reevaluation and revision of the plan as necessary over the life of the client. May include client-specific advocacy and/or review of utilization of services.

Client Advocacy. Assessment of individual need, provision of advice and assistance in obtaining medical, social, community, legal, financial, and other needed services. Advocacy does not involve coordination and follow-up on medical treatments.

Day or Respite Care. Home- or community-based non-medical assistance designed to relieve the primary caregiver responsible for providing day-to-day care of client or client’s child.

Early Intervention Services (EIS). Counseling, testing, and referral services to PLWH who know their status but are not in primary medical care or who are recently diagnosed and are not in primary medical care for the purpose of facilitating access to HIV-related health services.

Emergency Financial Assistance. Provision of short-term payments for transportation, food, essential utilities, or medication assistance, which planning councils, Title II grantees, and consortia may allocate. These short-term payments must be carefully monitored to assure limited amounts, limited use, and for limited periods of time. Expenditures must be reported under the relevant service category.

Food Bank/Home Delivered Meals/Nutritional Supplements. Provision of food, meals, or nutritional supplements.

Health Education/Risk Reduction. (1) Provision of information, including the dissemination about medical and psychosocial support services and counseling or (2) preparation/distribution of materials in the context of medical and psychosocial support services to educate clients with HIV about methods to reduce the spread of HIV.

Housing Assistance. This assistance is limited to short-term or emergency financial assistance to support temporary and/or transitional housing to enable the individual or family to gain and/or maintain medical care. Use of Titles I, II and IV funds for short-term or emergency housing must be linked to medical and/or health-care services or be certified as essential to a client’s ability to gain or maintain access to HIV-related medical care or treatment.

Housing Related Services. Includes assessment, search, placement, and advocacy services provided by professionals who possess an extensive knowledge of local, State and Federal housing programs and how they can be accessed.

Legal Services. Legal services directly necessitated by a person’s HIV status including: preparation of Powers of Attorney, Do Not Resuscitate Orders, wills, trusts, bankruptcy proceedings, and interventions necessary to ensure access to eligible benefits, including discrimination or breach of confi dentiality litigation as it relates to services eligible for funding under the CARE Act. See also, Permanency Planning and Child Welfare Services.

Outreach Services. Programs which have as their principal purpose identifying people with HIV disease, particularly those who know their HIV status so that they may become aware of and may be enrolled in ongoing HIV primary care and treatment. Outreach activities must be planned and delivered in coordination with State and local HIV-prevention outreach activities to avoid duplication of effort and to address a specific service need category identified through State and local needs assessment processes. Activities must be conducted in such a manner as to reach those known to have delayed seeking care. Outreach services should be continually reviewed and evaluated in order to maximize the probability of reaching individuals who do not know their HIV status or know their HIV status but are not actively in treatment. Broad activities that market the availability of health-care services for PLWH are not considered appropriate Title I outreach services.

Permanency Planning. The provision of social service counseling or legal counsel regarding:

• The drafting of wills or delegating powers of attorney
  
• The preparation for custody options for legal dependents including standby guardianship, joint custody, or adoption

Psychosocial Support Services. Individual and/or group counseling, other than mental-health counseling, provided to clients, family, and/or friends by non-licensed counselors. May include psychosocial providers, peer counseling/support group services, caregiver support/bereavement counseling, drop-in counseling, benefits counseling, and/or nutritional counseling, or education.

Referral. The act of directing a person to a service in-person or through telephone, written, or other forms of communication. Referral may be made formally from one clinical provider to another, within a case-management system by professional case managers, informally through support staff or as part of an outreach services program.

Transportation. Conveyance services provided to a client in order to access primary medical care or psychosocial support services. May be provided routinely or on an emergency basis.

Other Support Services. Direct support services not listed above, such as translation/ interpretation services.

Other Planning Council Priorities  TOP

Planning Council Support. Provision of support for the planning council, including the following:

a. Costs associated with conducting a needs assessment and other methods for obtaining input on community needs and priorities, such as public meetings, focus groups, and adhoc panels, for the purpose of assisting the planning council in setting service priorities.

b. Staff support (clerical and professional expenses required by the planning council for performance of required planning council activities, including routine planning council administrative activities.

c. Costs incurred by planning council members as a result of their participation on the planning council and in the conduct of their required planning council activities, in accordance with Chapter 7, Generally Allowable/Unallowable Costs, pp. 7-6 to 7-7 of the Public Health Service (PHS) Grants Policy Statement, which covers such items as reimbursement of reasonable and actual out-of-pocket costs incurred solely as a result of attending a scheduled meeting, including transportation, meals, babysitting fees, and lost wages.

d. Costs associated with the development of the comprehensive plan for the organization and delivery of HIV-related services.

e. Costs associated with assessing the effi ciency of the administrative mechanism in rapidly allocating funds within the EMA.

f. Costs associated with participation in development of the Statewide Coordinated Statement of Need (SCSN).

g. Marketing activities associated with publicizing the planning council’s activities and programs for HIV-affected/infected populations and sub-populations, and efforts to substantively enhance community participation in planning council activities.

h. Development and implementation of planning council grievance procedures for decisions related to priorities and allocations.

Program Support. Activities that are not service oriented or administrative in nature but contribute to improved service delivery. Such activities may include capacity building, technical assistance, program evaluation (including outcome assessment), quality assurance, and assessment of service delivery patterns.

Grantee Administration  TOP

Grantee Administrative Costs. Include funds to be used by the grantee for routine grant administration and monitoring activities, which shall include the development of this application under Title II, the receipt and disbursal of program funds, the development and establishment of reimbursement and accounting systems, the preparation of routine programmatic and fi nancial reports and compliance with grant conditions and audit requirements. Grantee administrative costs also cover all activities associated with the grantee’s contract award procedures, including the development of requests for proposals, contract proposal review activities, negotiation and awarding of contracts, development and implementation of grievance procedures, monitoring of contracts through telephone consultation, written documentation or on-site visits, reporting on contracts, and funding reallocation activities. Title II grantees may not spend more than 10 percent of their grant on planning and evaluation activities, not more than 10 percent of their grant on administration and, when combined, not more than 15 percent of their grant on planning, evaluation and administration. An exception is allowed for those States that receive a minimum allotment under the CARE Act Title II formula; they are limited to spending “not more than the amount required to support one full-time equivalent employee.”

Beginning in FY 2002 grantees are allowed to allocate fi ve percent of the total grant award or $3,000,000 (whichever is less) for quality management activities.

Quality Management  TOP

Quality management programs, as set forth in the reauthorization language should accomplish a three-fold purpose:

1. Assist direct service medical providers in assuring that funded services adhere to established HIV clinical practice standards and Public Health Services (PHS) guidelines.
   
2. Ensure that strategies for improvements to quality medical care include vital health-related support services in achieving appropriate access and adherence with HIV medical care.
   
3. Ensure that available demographic, clinical and primary medical care utilization information is used to monitor HIV-related illnesses and trends in the local epidemic.

For policies regarding the use of Title II funds for specific services, see the policies section of this manual. For new HAB Policies and DSS Program Policy Guidances, see the HAB web site Law and Policy page.