Chapter 2
State Direct Services  TOP

Introduction

State direct services allow States—under certain circumstances—to directly fund services normally provided through consortia. This category was added to the original four Title II program categories in the 1996 Amendments. The others include: consortia; home- and community-based programs; continuity of health insurance; and treatments.

The purpose of State direct services is to allow States to contract directly with providers and then to use their own State programs to deliver services in those cases where it is more effective to do so. Services that may be funded through State direct services are the same as those outlined for consortia.

Legislative Background  TOP

State Direct Services Category

Section 2612(a) of the CARE Act defines Title II programs, including State direct services and—relatedly—consortia, stating that a " State may use amounts provided under grants made under this part:

(1) to provide the services described in section 2604(b)(1) for individuals with HIV disease;

(2) to establish and operate HIV care consortia within areas most affected by HIV disease that shall be designed to provide a comprehensive continuum of care to individuals and families with HIV disease in accordance with section 2613;

Services described in paragraph (1) shall be delivered through consortia as described in paragraph (2), where such consortia exist, unless the State demonstrates to the Secretary that delivery of such services would be more effective when other delivery mechanisms are used. In making a determination regarding the delivery of services, the State shall consult with appropriate representatives of service providers and recipients of services who would be affected by such determination, and shall include in its demonstration to the Secretary the findings of the State regarding such consultation."

Eligible Services

Services that can be funded under State direct services are defined under Section 2604(b)(1) and Section 2612(b) as follows:

Section 2604(b)(1)(C) Inpatient case management services that prevent unnecessary hospitalization or that expedite discharge, as medically appropriate, from inpatient facilities.

Section 2612(b) (1) Outpatient and ambulatory support services under section 2611(a) (including case management) to the extent that such services facilitate, enhance, support, or sustain the delivery, continuity, or benefits of health services for individuals and families with HIV disease.

Section 2612(b)(2) Outreach activities that are intended to identify individuals with HIV disease who know their HIV status and are not receiving HIV-related services, and that are:

(A) necessary to implement the strategy under section 2617(b)(4)(B), including activities facilitating the access of such individuals to HIV-related primary care services at entities described in subsection (c)(1);

(B) conducted in a manner consistent with the requirement under section 2617(b)(6)(G) and 2651(b)(2); and

(C) supplement, and do not supplant, such activities that are carried out with amounts appropriated under section 317.

Section 2612(c) Early Intervention Services:

(1) In General.—The purposes for which a grant under this part may be used include providing to individuals with HIV disease early intervention services described in section 2651(b)(2), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the services to HIV-related health services. The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV disease counseling and testing sites, health care points of entry specified by States or eligible areas, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to services by maintaining referral relationships.

(2) Conditions.—With respect to an entity that proposes to provide early intervention services under paragraph (1), such paragraph applies only if the entity demonstrates to the satisfaction of the State involved that—

(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and

(B) the entity will expend funds pursuant to such paragraph to supplement and not supplant other funds available to the entity for the provision of early intervention services for the fiscal year involved.

HAB/DSS Expectations  TOP

States may provide HIV-related services directly or through contract. States must deliver these services through consortia where consortia exist, unless the state demonstrates to the Secretary that the delivery of such services would be more effective when other service delivery mechanisms are used. As part of the justification for the other service delivery mechanism, States with consortia must furnish the results of their consultation with appropriate representatives of service providers and recipients of services in those areas where a change of service delivery mechanism is proposed.