Chapter 1
Planning Council Duties  TOP

Introduction

Use of Title I CARE Act funds is guided by planning, which takes place through the Title I planning council established by the chief elected official (CEO) of each Title I eligible metropolitan area (EMA). The planning council is not advisory. It has legislative authority to carry out its assigned tasks, along with roles recommended by HRSA’s HIV/AIDS Bureau (HAB), Division of Service Systems (DSS).

The planning council takes the lead in conducting many of its responsibilities and shares duties with the grantee in some areas. To guarantee that a broad range of ideas are heard, the planning council membership must reflect specific areas of expertise as well as disproportionately affected and historically underserved populations.

Each planning council’s responsibilities are to:

• Establish operations to make planning tasks function smoothly. Examples include procedures for membership (e.g., nominations procedures to secure new members), decision making (e.g., open meeting processes, grievance procedures related to funding decisions, conflict of interest), and other tasks.
  

• Assess the EMA’s HIV/AIDS service needs. In particular this includes assessing the biggest gaps in care by determining the needs of those who know their HIV status but are not in care, as well as disparities in access to care across affected groups. This assessment must include a public process to obtain community input on needs and priorities.
  

• Establish priorities for the allocation of funds. Decisions are to be based on a needs assessment; the cost effectiveness and outcome effectiveness of purchasing specific services; priorities in HIV-infected communities within the EMA; and the availability of other governmental and nongovernmental resources.
  

• Develop a comprehensive plan for the organization and delivery of HIV services that is compatible with existing State and local plans. As part of the plan, the EMA must coordinate use of CARE Act dollars with other programs, including prevention and substance abuse services. Part of this is done through participation in the development of a Statewide Coordinated Statement of Need (SCSN), which is a mechanism CARE Act programs use to address HIV/AIDS care issues and enhance coordination.
  

• Assess the efficiency of the administering agency in rapidly allocating funds to areas of greatest need. The planning council may also, at their discretion, assess how well services that are funded by the grantee address the planning council’s priorities, allocations, and instructions for addressing these priorities. (Relatedly, evaluation of how well services are being delivered and the cost effectiveness of such services, are to be undertaken separately under the leadership of the grantee.)

Legislative Background  TOP

The CARE Act specifies the following mandated activities that planning councils must accomplish.

Planning Body Operations

Section 2602(b)(5)(A) prohibits the planning council from being "directly involved in the administration of a grant" under Title I and does not permit it to "designate (or otherwise be involved in the selection of) particular entities as recipients" of Title I funds.

Section 2602(b)(6) requires the planning council to "develop procedures for addressing grievances with respect to funding," and to describe these procedures in its bylaws.

Section 2602(b)(7)(A) prohibits the planning council from being "chaired solely by an employee of the grantee."

Section 2602(b)(7)(B) states that:

1. "The meetings of the council shall be open to the public and shall be held only after adequate notice to the public.

2. The records, reports, transcripts, minutes, agenda, or other documents which were made available to or prepared for or by the council shall be available for public inspection and copying at a single location.

3. Detailed minutes of each meeting of the council shall be kept. The accuracy of all minutes shall be certified to by the chair of the council.

4. This subparagraph does not apply to any disclosure of information of a personal nature that would constitute a clearly unwarranted invasion of personal privacy, including any disclosure of medical information or personnel matters."

Needs Assessment

Section 2602(b)(4) requires the planning council to:

1. "determine the size and demographics of the population of individuals with HIV disease;

2. "determine the needs of such population, with particular attention to:

   1. individuals with HIV disease who know their HIV status and are not receiving HIV-related services; and

   2. disparities in access and services among affected subpopulations and historically underserved communities."

2602(b)(4)(G) requires planning councils to "establish methods for obtaining input on community needs and priorities which may include public meetings…conducting focus groups, and convening ad-hoc panels."

Priority Setting and Resource Allocation

2602(b)(4)(C) requires planning councils to "establish priorities for the allocation of funds within the eligible area, including how best to meet each such priority and additional factors that a grantee should consider in allocating funds under a grant based on the:

1. size and demographics of the population of individuals with HIV disease (as determined under subparagraph (A)) and the needs of such population (as determined under subparagraph (B));

2. demonstrated (or probable) cost effectiveness and outcome effectiveness of proposed strategies and interventions, to the extent that data are reasonably available;

3. priorities of the communities with HIV disease for whom the services are intended;

4. coordination in the provision of services to such individuals with programs for HIV prevention and for the prevention and treatment of substance abuse, including programs that provide comprehensive treatment for such abuse;

5. availability of other governmental and nongovernmental resources, including the State Medicaid plan under Title XIX of the Social Security Act and the State Children’s Health Insurance Program under Title XXI of such Act to cover health care costs of eligible individuals and families with HIV disease; and

6. capacity development needs resulting from disparities in the availability of HIV-related services in historically underserved communities…."

Allocation of Funds to Services for Infants, Children, Youth, and Women

Section 2604(b)(4) specifies that "[f]or the purpose of providing health and support services to infants, children, youth, and women with HIV disease, including treatment measures to prevent the perinatal transmission of HIV, the chief elected official of an eligible area, in accordance with the established priorities of the planning council, shall for each of such populations in the eligible area use, from the grants made for the area under section 2601(a) for a fiscal year, not less than the percentage constituted by the ratio of the population involved (infants, children, youth, or women in such area) with acquired immune deficiency syndrome to the general population in such area of individuals with such syndrome."

This provision does not require planning councils to create a special priority for services to these populations. A waiver to this provision can be granted when EMAs can demonstrate that the needs of each population or combination of these populations is being met through other programs such as Medicaid, State Children’s Health Insurance Program (SCHIP), or other CARE Act titles.

Comprehensive Planning

2602(b)(4)(D) requires the planning council to "develop a comprehensive plan for the organization and delivery of health and support services described in section 2604 that:

1. "includes a strategy for identifying individuals who know their HIV status and are not receiving such services and for informing the individuals of and enabling the individuals to utilize the services, giving particular attention to eliminating disparities in access and services among affected subpopulations and historically underserved communities, and including discrete goals, a timetable, and an appropriate allocation of funds;

2. includes a strategy to coordinate the provision of such services with programs for HIV prevention (including outreach and early intervention) and for the prevention and treatment of substance abuse (including programs that provide comprehensive treatment services for such abuse); and

3. is compatible with any State or local plan for the provision of services to individuals with HIV disease…."

Coordination

Section 2602(b)(4)(F) calls for the planning council and grantee to "participate in the development of the statewide coordinated statement of need initiated by the State public health agency responsible for administering grants" under Title II.

Section 2602(b)(4)(H) requires the planning council to "coordinate with Federal grantees that provide HIV-related services within the eligible area."

Assessment of the Administrative Mechanism and Effectiveness of Services

2602(b)(4)(E) requires planning councils to "assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area, and at the discretion of the planning council, assess the effectiveness, either directly or through contractual arrangements, of the services offered in meeting the identified needs."

HAB/DSS Expectations  TOP

Fulfilling Planning Council Duties  TOP

Planning Council Operations

• Planning councils must set up planning council operations to help the planning council to operate smoothly and fairly. This includes such features as bylaws, open meetings, grievance procedures, and conflict of interest standards. (See below and chapters on Grievance Procedures and conflict of Interest.)

Open Meetings. Section 2602(b)(7)(B) of the CARE Act requires that planning council deliberations be public.

Council Chair. The legislation specifies that an employee of the Title I grantee may not be the only chair of a planning council. An employee of the grantee may serve as a co-chair, provided the bylaws of the planning council permit or specify that arrangement.

Meetings and Minutes. To comply with legislative requirements around open meetings and public access to minutes and other planning council documents, planning councils must:

• Ensure that meetings are open to all members of the general public and maintain a system that provides for public written notice of all council meetings. This includes publication of the meeting notices in local print media and through other forums accessible to the disabled (i.e., the hearing- or speech-impaired).
  

• Have a summary of the minutes certified by the chair of the planning council available for public inspection. The complete transcript of minutes should be available within six weeks after the meeting date.
  

• Have a publicly accessible location where minutes and other legislatively required information can be inspected and copied if requested.
  

• Take appropriate steps to guard against disclosure of personal information that would constitute an invasion of privacy.
  

• Make available for public inspection records of the recommendations made by committees or other subgroups to the planning council, as well as the subsequent actions taken by the planning council.
  

• Where local, county, or State regulations, ordinances, or statutes are more stringent than the CARE Act requirements, follow these more stringent requirements.

Needs Assessment

• The main planning task for the planning council is to conduct a needs assessment to find out what services are needed and what populations need care. (See Needs Assessment chapter.)

Priority Setting and Resource Allocation

• Based upon the results of the needs assessment, and other information, the planning council sets priorities for the allocation of funds. (See Priority Setting and Resource Allocation chapter.)

Comprehensive Planning

• The planning council then develops a comprehensive plan on how to provide these services. (See Comprehensive Planning chapter.)

Coordination

• The planning council also looks for ways that Title I services work to fill gaps in care with other CARE Act programs through the Statewide Coordinated Statement of Need (SCSN); special attention to early intervention services, HIV prevention, and substance abuse prevention and treatment; and ongoing coordination with other services like Medicaid. (See chapters on Title I and II Coordination, Care/Prevention Collaborative Planning, SCSN, and Managed Care and HIV Disease.)

Assessment of Administrative Mechanism, Effectiveness of Services in Addressing Priorities

• The planning council assesses the efficiency of the administrative mechanism, which entails evaluation of how efficiently providers are selected and paid and how well their contracts are monitored. This assessment should also review the planning process used by the EMA prior to procurement of services and disbursement of funds. (See attached sample.) In addition, the planning council may also, at their discretion, assess how well services that are funded by the grantee address the planning council’s priorities, allocations, and instructions for addressing these priorities.
  
  Generally, assessments are based on time-framed observations of procurement, expenditure, and reimbursement processes. For example, an evaluation could identify the percent of funds obligated within a certain time period (e.g., 90 days) from the date of grant award. Similarly, reimbursement processes can be tracked from date of service delivery through invoicing to payment, with documentation of any adverse impact on clients or providers related to delayed payments. HAB/DSS will occasionally request information about the assessment or require EMAs to submit a copy of the most recent administrative assessment as part of progress reports or grant applications.
  
  In evaluating the administrative mechanism, communication between the grantee and planning council is essential so that information can be efficiently shared. The planning council and grantee should establish, before the procurement process begins, a memorandum of understanding outlining a process and timeline for sharing data necessary to evaluate the administrative mechanism. The grantee must communicate back to the planning council the results of its procurement process. The planning council may then assess the consistency of the procurement process with its stated service priorities and allocations.
  
  If the council finds that the existing mechanism is not working effectively, it is responsible for making formal recommendations for improvement and change. The grantee or administrative agency then needs to respond to the planning council in writing, informing it of corrective actions to be taken to improve or change the system. The planning council also has the right to bring a formal grievance if the grantee’s disbursement of funds is inconsistent with the planning council’s priorities and resource allocations.*
  
  The planning council also has the option of evaluating the "effectiveness of the services offered in meeting identified need." This means that the planning council can assess whether the services that have been procured by the grantee are consistent with stated planning council priorities, resource allocations, and instructions as to how to meet these priorities. However, assessing the administrative mechanism is not an evaluation of the grantee or individual service providers, which is a grantee responsibility. (See outcomes evaluation and cost-effectiveness chapters in this section of the manual.)

Evaluation

• The planning council and grantee should determine what impact services are having on client health outcomes (outcomes evaluation) and also examine the cost-effectiveness of the services being delivered. (See chapters on Outcomes Evaluation and Cost Effectiveness.)
  
  * For more information, see the chapter on Grievance Procedures in this manual.

Relationships Among Title I Entities  TOP

In order for planning councils to function in the most efficient manner possible, it is important to understand the relationships between and among grantees, planning councils, PLWH, and planning council support staff (including consultants and shared staff of the council and grantee).

Planning Council and the Grantee

The planning council is a legislatively constituted body with clearly defined responsibilities in CARE Act planning and decision making.

Separation of Planning Council and Grantee Roles

While the CEO may designate a specific department within local government to administer the program, it is not appropriate for the grantee to perform duties related to the planning council’s legislative responsibilities. A separation of grantee and planning council roles is necessary to avoid conflicts of interest. For example, Section 2602(b)(7)(A) of the CARE Act prohibits the planning council from being "chaired solely by an employee of the grantee." However, a grantee employee may be a co-chair.

Memorandum of Understanding

To clarify the roles of the planning council and the grantee, and to encourage a collaborative working relationship, HAB/DSS recommends that these two entities develop a written agreement (a Memorandum of Understanding) that identifies the individual and shared responsibilities of both parties and specifies communication mechanisms. The role of planning council staff can also be included. The planning council should establish bylaws and operating procedures that codify this relationship.

A clear delineation of roles and responsibilities will help ensure timely and efficient disbursement of Title I funds and facilitate the development of a continuum of care that addresses the needs of PLWH.

Persons Living with HIV Disease (PLWH)

In fulfilling its roles and responsibilities, a planning council must include PLWH in all its activities. The CARE Act Amendments of 2000 requires that at least 33% of the planning council be individuals who are receiving HIV-related services funded by Ryan White Title I and not officers, employees, or consultants to any entity that receives Title I funds. The individuals who meet the 33% unaligned definition must (like the planning council as a whole) reflect the demographics of the population of individuals with HIV disease in the EMA. *

Inclusion of PLWH brings unique benefits, including a consumer perspective to all decision making and a link between the planning council and the community served. It also presents challenges, such as the need for:

• Training and mentoring to address new member unfamiliarity with the mechanics of the legislation
  

• Flexibility to address changing health status
  

• Methods to channel anger and frustration, and
  

• Especially for representatives with limited incomes, resources to address transportation, child care, and financial burdens.

HAB/DSS strongly recommends that planning councils adopt a variety of strategies to strengthen the effective participation of PLWH. Two HAB/DSS manuals, the Consumer Digest and the Training Guide: Preparing Planning Body Members, provide materials to help address the challenges of recruiting and maintaining the active participation of people living with HIV disease in planning council processes.

Planning Council Support

The planning council is likely to need funding to carry out its responsibilities. HAB/DSS refers to these funds as "planning council support." Title I formula and supplemental grant funds can be used as a source of planning council support, but only if the planning council identifies such support as a priority to be funded, along with specific care services. Planning Council Support funds may be used for such purposes as hiring staff, developing and carrying out needs assessments and estimating unmet need, identifying barriers to access and care, and conducting planning activities. **

Procedures for Selecting Support Staff and Consultants

The procedures to be used in hiring planning council support staff or contracting with consultants need to be agreed upon ahead of time with the grantee. Planning council staff may be employed through the grantee’s payroll system, but measures must be taken to insure that the planning council, not the grantee, directs the work of the planning council’s staff.

A planning council is not permitted to be directly involved in selecting particular entities to receive CARE Act funding for services, but it can be involved with selecting entities and people to carry out activities directly related to planning council functioning and responsibilities. It should be keenly attuned to potential conflicts of interest (real or perceived) in these hiring decisions. The planning council must use an open, public process to contract for Planning Council Support services—preferably a competitive request for proposals (RFP) process under the direction of the grantee. If a planning council’s procedures allow planning council members or the agencies they represent to compete in this process, the planning council must define specific parameters and processes to manage real or perceived conflicts of interest. CARE Act Section 2602(5)(B) requires that a planning council member who has a financial interest in, who is an employee of, or who is a member of an entity that seeks to provide planning council support should not be involved in the selection process.

Shared Staff of Grantee and Planning Council

HAB/DSS discourages the practice of having a single staff person perform administrative work for the grantee and provide support to the planning council. However, sometimes—because of limited funds—this situation is unavoidable. The challenge presented in such situations is to balance that dual role with the legislative intent of the CARE Act to provide the planning council with full authority and autonomy to carry out its mandated responsibilities. Having a single staff member perform dual roles could compromise objectivity. A special complication is the planning council’s responsibility to assess the grantee’s administrative mechanism for distributing and managing Title I CARE Act funds. A single staff member who performs both grantee and planning council support roles may be in the conflicted position of evaluating his/her own work.

To address this challenge, a planning council and grantee sharing a staff member should:

• Define in writing the functions/activities of planning council and grantee staff
  

• Clarify assignments and responsibilities
  

• Cost out time and ensure that resource needs are reflected in the budget justifications for Planning Council Support and Grantee Administration, and
  

• Clearly specify lines of communication and reporting for the staff member so that work performed for the grantee is reported to the grantee contact and Planning Council Support work is reported to the planning council chair, a committee, or the full council.

Program and Fiscal Monitoring  TOP

Program and fiscal monitoring are grantee responsibilities as part of Tile I grant administration. Program and fiscal monitoring are related functions. Program monitoring involves assessing the quality and quantity of the services being provided by a particular contractor. Such monitoring might include reviewing program reports, making site visits, and/or conducting a client satisfaction survey.

Fiscal monitoring involves assessing how quickly and efficiently contractors use CARE Act funds. This type of monitoring includes review and assessment of monthly expenditure patterns for groups of service providers, as well as processes to ensure adherence to Federal, State, and local rules and guidelines on the uses of CARE Act funds.

Planning councils should request that the grantee or administrative agency provide them with aggregate summary reports of the information collected during these site visits. Grantees should not provide and planning councils should not have access to individual provider information. Planning councils can greatly benefit from knowing, for example, the percentage of agencies within a particular service category that have been able to meet established goals for serving specified numbers of clients with regard to race/ethnicity and gender, documenting client health outcomes, implementing quality management programs and documenting system changes associated with those programs, etc.

Site visit information provided by the grantee can also help planning councils evaluate the expenditure patterns of the EMA as a whole as well as service categories. If money is not being spent in an efficient manner, planning councils can know early on and reallocate funds to another service category or direct the grantee to reallocate on a dollar or percentage basis to other agencies within a particular service category.

The planning council must be informed of the changes to service priority allocations that result from any redistribution of program funds by the grantee. As with the initial disbursement of funds, the outcome of the redistribution must be consistent with the priorities and resource allocations of the planning council. Any redistribution of funds by the grantee that is not consistent may lead to a grievance by the planning council.

REFERENCES  TOP

Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB), Division of Service Systems (DSS).   Reauthorization Issues Letter #2: Planning Council Open Meeting Requirements, January 2001.

HRSA, HAB, DSS. Reauthorization Issue Letter #2b: Planning Council Open Meeting Requirements (Addendum), 2001.

Notes

* See chapters in this section on Planning Council Membership, conflict of Interest, and PLWH/Consumer Participation for more information. [Return to Text]

** See the chapter in this manual on administrative costs for further discussion of planning council support. [Return to Text]