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CARE
Act Title II Manual - 2003 Version |
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Chapter
1
Planning Body Duties
TOP
Introduction
Title II funds
are awarded to the State agency designated by the Governor to administer
Title II, usually the State health department. States provide Title
II services directly as well as through consortia, which are groups
comprised of providers, consumers, and others who perform a planning
and advisory function to regions, or the entire State, in determining
needs and delivering essential health and support services. Regardless
of the mechanism used, planning and other duties are part of determining
how to use limited Title II funds to ensure the CARE Act is the
payer of last resort and to manage their use.
Both the State
(as the Title II grantee) and consortia have designated responsibilities
in the areas of planning and delivery of CARE Act services. Duties
can occur through Title II planning bodies, Statewide or regional,
as well as through consortia or other planning groups established
by the State. Regardless of the set-up, planning requires broad
membership involvement in order to bring diverse experience and
input into such tasks as needs assessment and developing a comprehensive
plan. Ensuring smooth operation of planning bodies also requires
them to have in place conflict of interest and grievance procedures
to guide their decision making
Beyond their
planning duties, consortia have duties that are prescribed in the
legislation. Others are delegated by the State, and still others
are assumed by the consortium in response to needs in its service
area. In some cases, they actually deliver services, while other
consortia do so through funding agreements.
Legislative
Background
TOP
State Requirements
Section 2617(a)
requires States to submit Title II applications that contain requirements
outlined in the legislation and the annual program guidance. Section
2617(b) requires applications to contain:
(1) a
detailed description of the HIV-related services provided in the
State to individuals and families with HIV disease during the year
preceding the year for which the grant is requested, and the number
of individuals and families receiving such services, that shall
include
(A) a description
of the types of programs operated or funded by the State for the
provision of HIV-related services during the year preceding the
year for which the grant is requested and the methods utilized
by the State to finance such programs;
(B) an accounting
of the amount of funds that the State has expended for such services
and programs during the year preceding the year for which the
grant is requested; and
(C) information
concerning
(i) the
number of individuals to be served with assistance provided
under the grant;
(ii) demographic
data on the population of the individuals to be served;
(iii)
the average cost of providing each category of HIV-related health
services and the extent to which such cost is paid by third-party
payors; and
(iv) the
aggregate amounts expended for each such category of services;
(2) a determination
of the size and demographics of the population of individuals with
HIV disease in the State;
(3) a determination
of the needs of such population, with particular attention to
(A) individuals
with HIV disease who know their HIV status and are not receiving
HIV-related services; and
(B) disparities
in access and services among affected subpopulations and historically
underserved communities;
(4) a comprehensive
plan that describes the organization and delivery of HIV health
care and support services to be funded with assistance received
under this part that shall include a description of the purposes
for which the State intends to use such assistance, and that
(A) establishes
priorities for the allocation of funds within the State based
on
(i) size
and demographics of the population of individuals with HIV disease
(as determined under paragraph (2)) and the needs of such population
(as determined under paragraph (3));
(ii) availability
of other governmental and non-governmental resources, including
the State medicaid plan under title XIX of the Social Security
Act and the State Childrens Health Insurance Program under
title XXI of such Act to cover health care costs of eligible
individuals and families with HIV disease;
(iii)
capacity development needs resulting from disparities in the
availability of HIV-related services in historically underserved
communities and rural communities; and
(iv) the
efficiency of the administrative mechanism of the State for
rapidly allocating funds to the areas of greatest need within
the State;
(B) 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;
(C) 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);
(D) describes
the services and activities to be provided and an explanation
of the manner in which the elements of the program to be implemented
by the State with such assistance will maximize the quality of
health and support services available to individuals with HIV
disease throughout the State;
(E) provides
a description of the manner in which services funded with assistance
provided under this part will be coordinated with other available
related services for individuals with HIV disease; and
(F) 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 this title; and
(5) an assurance
that the public health agency administering the grant for the State
will periodically convene a meeting of individuals with HIV disease,
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; and
(6) an assurance
by the State that
(A) the
public health agency that is administering the grant for the State
engages in a public advisory planning process, including public
hearings, that includes the participants under paragraph (5),
and the types of entities described in section 2602(b)(2), in
developing the comprehensive plan under paragraph (4) and commenting
on the implementation of such plan;
(B) the
State will
(i) to
the maximum extent practicable, ensure that HIV-related health
care and support services delivered pursuant to a program established
with assistance provided under this part will be provided without
regard to the ability of the individual to pay for such services
and without regard to the current or past health condition of
the individual with HIV disease;
(ii) ensure
that such services will be provided in a setting that is accessible
to low-income individuals with HIV disease;
(iii)
provide outreach to low-income individuals with HIV disease
to inform such individuals of the services available under this
part; and
(iv) in
the case of a State that intends to use amounts provided under
the grant for purposes described in 26151, submit a plan to
the Secretary that demonstrates that the State has established
a program that assures that
(I)
such amounts will be targeted to individuals who would not
otherwise be able to afford health insurance coverage; and
(II)
income, asset, and medical expense criteria will be established
and applied by the State to identify those individuals who
qualify for assistance under such program, and information
concerning such criteria shall be made available to the public;
(C) the
State will provide for periodic independent peer review to assess
the quality and appropriateness of health and support services
provided by entities that receive funds from the State under this
part;
(D) the
State will permit and cooperate with any Federal investigations
undertaken regarding programs conducted under this part;
(E) the
State will maintain HIV-related activities at a level that is
equal to not less than the level of such expenditures by the State
for the 1-year period preceding the fiscal year for which the
State is applying to receive a grant under this part;
(F) the
State will ensure that grant funds are not utilized to make payments
for any item or service to the extent that payment has been made,
or can reasonably be expected to be made, with respect to that
item or service
(i) under
any State compensation program, under an insurance policy, or
under any Federal or State health benefits program; or
(ii) by
an entity that provides health services on a prepaid basis;
and
(G) entities
within areas in which activities under the grant are carried out
will maintain appropriate relationships with entities in the area
served that constitute key points of access to the health care
system for individuals with HIV disease (including emergency rooms,
substance abuse treatment programs, detoxification centers, adult
and juvenile detention facilities, sexually transmitted disease
clinics, HIV counseling and testing sites, mental health programs,
and homeless shelters), and other entities under section 2612(c)
and 2652(a), for the purposes of facilitating early intervention
for individuals newly diagnosed with HIV disease and individuals
knowledgeable of their HIV status but not in care.
Consortium
Requirements
Section 2613(a)(1)
of the CARE Act defines a consortium as an association of
one or more public, and one or more nonprofit private, (or private
for-profit providers or organizations if such entities are the only
available providers of quality HIV care in the area) health care
and support service providers and community based organizations
operating within areas determined by the State to be most affected
by HIV disease;
Section 2613(a)(2)
states that consortia must agree to use such assistance for
the planning, development and delivery, through the direct provision
of services or through entering into agreements with other entities
for the provision of such services, of comprehensive outpatient
health and support services for individuals with HIV disease;
Section 2613(b)(1)
states that consortia, in order to receive Title II funding from
the State, must provide the State with assurances stating, [in part]
that:
(A)
within any locality in which such consortium is to operate, the
populations and subpopulations of individuals and families with
HIV disease have been identified by the consortium, particularly
those experiencing disparities in access and services and those
who reside in historically underserved communities;
(B) the
service plan established under subsection (c)(2) by such consortium
is consistent with the comprehensive plan under section 2617(b)(4)
and addresses the special care and service needs of the populations
and subpopulations identified under subparagraph (A); and
(C) except
as provided in paragraph (2), the consortium will be a single
coordinating entity that will integrate the delivery of services
among the populations and subpopulations identified under subparagraph
(A).
(2) Exception.Subparagraph
(C) of paragraph (1) shall not apply to any applicant consortium
that the State determines will operate in a community or locality
in which it has been demonstrated by the applicant consortium that
(A) subpopulations
exist within the community to be served that have unique service
requirements; and
(B) such
unique service requirements cannot be adequately and efficiently
addressed by a single consortium serving the entire community
or locality.
Section 2613(c)
requires a consortium to submit an application to the State that
[in part]:
(A)
demonstrates that the consortium includes agencies and community-based
organizations
(i) with
a record of service to populations and subpopulations with HIV
disease requiring care within the community to be served; and
(ii) that
are representative of populations and subpopulations reflecting
the local incidence of HIV and that are located in areas in
which such populations reside;
(B) demonstrates
that the consortium has carried out an assessment of service needs
within the geographic area to be served and, after consultation
with the entities described in paragraph (2), has established
a plan to ensure the delivery of services to meet such identified
needs that shall include
(i) assurances
that service needs will be addressed through the coordination
and expansion of existing programs before new programs are created;
(ii) assurances
that, in metropolitan areas, the geographic area to be served
by the consortium corresponds to the geographic boundaries of
local health and support services delivery systems to the extent
practicable;
(iii)
assurances that, in the case of services for individuals residing
in rural areas, the applicant consortium shall deliver case
management services that link available community support services
to appropriate specialized medical services; and
(iv) assurances
that the assessment of service needs and the planning of the
delivery of services will include participation by individuals
with HIV disease;
(C) demonstrates
that adequate planning has occurred to meet the special needs
of families with HIV disease, including family centered and youth
centered care;
(D) demonstrates
that the consortium has created a mechanism to evaluate periodically
(i) the
success of the consortium in responding to identified needs;
and
(ii) the
cost-effectiveness of the mechanisms employed by the consortium
to deliver comprehensive care;
(E) demonstrates
that the consortium will report to the State the results of the
evaluations described in subparagraph (D) and shall make available
to the State or the Secretary, on request, such data and information
on the program methodology that may be required to perform an
independent evaluation; and
(F) demonstrates
that adequate planning occurred to address disparities in access
and services and historically underserved communities.
(2)
Consultation.In establishing the plan required under paragraph
(1)(B), the consortium shall consult with
(A)(i) the
public health agency that provides or supports ambulatory and
outpatient HIV-related health care services within the geographic
area to be served; or
(ii) in
the case of a public health agency that does not directly provide
such HIV-related health care services such agency shall consult
with an entity or entities that directly provide ambulatory
and outpatient HIV-related health care services within the geographic
area to be served;
(B) not
less than one community-based organization that is organized solely
for the purpose of providing HIV-related support services to individuals
with HIV disease;
(C) grantees
under section 2671, or, if none are operating in the area, representatives
in the area of organizations with a history of serving children,
youth, women, and families living with HIV; and
(D) the
types of entities described in section 2602(b)(2).
The organization
to be consulted under subparagraph (B) shall be at the discretion
of the applicant consortium.
(e)
Priority.In providing assistance under subsection (a), the
State shall, among applicants that meet the requirements of this
section, give priority
(1) first
to consortia that are receiving assistance from the Health Resources
and Services Administration for adult and pediatric HIV-related
care demonstration projects; and then
(2) to any
other existing HIV care consortia.
HAB/DSS
Expectations
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Consortia
and State Planning and Service Delivery Activities
The CARE Act
contains planning and related duties for both consortia and States.
-
Consortia. Section 2613 of the CARE Act requires each Title
II consortium to complete various planning and other tasks and
submit an application to the State assuring that it has carried
out required activities. Duties are also often required by the
State in its annual consortium application process or even in
the consortiums mission statement.
Consortia
responsibilities require efficient and effective operations that
help the consortium fulfill its duties. They may require a consortium
to take on roles beyond what is required by CARE Act legislation
or by the State/grantee. While additional roles may be agreed
upon by a consortium membership in response to factors such as
consortium structure, service area, and/or funding level, other
consortia in very rural areas or areas with very limited service
provider networks may be unable to take on additional functions.
-
States. For States, planning requirements are outlined
in Section 2617 and include submission of an application for Title
II funding describing current services, PLWH being served, and
information about services to be provided. These duties imply
planning responsibilities, which are in fact explicitly outlined
in Section 2617 to include needs assessment, priority setting
for the allocation of funds, development of a comprehensive plan,
and service delivery and coordination. These tasks are in addition
to Title II grantee responsibility to manage the funds.
Following
are planning body and service duties. Those required by the legislation
are so noted. Those that represent sound practices and HAB/DSS expectations
are also presented. More information about a number of these requirements
are covered in greater detail in other chapters in this manual (e.g.,
needs assessment, comprehensive plan, priority setting and resource
allocation, coordination).
Planning
Body Membership
States.
Planning body requirements for States are outlined in Section 2617(b)(6).
States are required to engage in a public advisory planning
process to secure broad input in the development and implementation
of the comprehensive plan from PLWH, providers, other CARE Act entities,
and other agencies, similar to those outlined for Title I planning
councils.
Consortia.
Title II planning body requirements are also outlined for consortia.
Section 2613 requires the consortium membership to be inclusive
in terms of (1) agencies with experience in HIV/AIDS service delivery
and (2) populations and subpopulations of persons living with HIV
disease (PLWH), who are reflective of the local incidence of HIV.
Such consortia are also to be located in areas where such populations
reside.
Section 2613(c)(2)
also provides for additional involvement by diverse perspectives
by requiring consortia, in establishing their service plans, to
demonstrate that they have consulted with PLWH, the public health
agency or other entity(ies) providing HIV-related health care in
the area, at least one community-based AIDS service provider, Title
II grantee, Title IV grantees or organizations with a history of
serving children, youth, women, and families with HIV, and entities
such as those required to be represented on Title I planning councils.
Consortia
are expected to actively recruit and develop programs to retain
the membership of persons living with HIV disease (PLWH). PLWH bring
the perspective of those most important to the CARE Act planning
processthe people who need the services. PLWH can help to
orient, train, and mentor other PLWH and monitor the consortiums
activities to assure its responsiveness to PLWH needs. Consortium
activities should include PLWH input, and PLWH should be mentored
and developed to undertake leadership positions. For more information
on meeting this requirement, see PLWH Participation
in this manual.
Planning
Body Operations
States
and Consortia. Implementing membership and planning body functioning
requires organizational development activities to create a planning
group that can perform the tasks mandated by the CARE Act, the State,
and the consortiums mission. This includes development of
policies and procedures, meeting rules, rules of interaction, committee
structure, and leadership/membership duties.
The potential
for conflict of interest is one area that requires specific attention
in running planning bodies that engage in decisions about how to
use funds. Conflicts of interest increase when consortia have responsibilities
for procuring services. Because the CARE Act requires that providers
be part of consortia, decision makers within consortia are frequently
employees, board members, or clients of the agencies seeking resources
to provide services. Close attention must be paid to conflict of
interest in all phases of resource allocation. Policies and procedures
must be in place to minimize this problem.
Needs Assessment
Both States
and their consortia have needs assessment requirements. Specific
requirements for needs assessment are outlined in the needs assessment
chapter of this manual.
States.
Section 2617(b) outlines State Title II requirements, which entail
determining the size and demographics of the population of PLWH
in the State and determining their needs, with particular attention
to PLWH who know their status and not are receiving HIV-related
services and disparities in access and services among affected subpopulations
and historically underserved communities.
Consortia.
Section 2613(c)(1)(B) requires consortia to conduct a needs assessment
within the geographic area served. The assessment must be done in
collaboration with public health and community-based providers of
HIV-related services and with the participation of people living
with HIV disease (PLWH).
Needs assessment
activities happen throughout the annual cycle of planning and help
capture information about met and unmet needs. A comprehensive,
formal needs assessment does not need to be completed every year.
Consortia should undertake periodic needs assessment updating activities
(e.g., a client survey or an update of the resource inventory) to
stay informed about changing needs. Epidemiologic data should be
updated each year.
Priority
Setting
States.
Section 2617(b) requires States to establish priorities for
the allocation of funds within the State. Factors to consider
in setting priorities include: size and demographics of the population
of individuals with HIV disease and the needs of such population
(with a focus on PLWH who know their status and are not in care
and on disparities in access and services among affected subpopulations
and historically underserved communities); availability of other
governmental and non-governmental resources, including the State
Medicaid plan and the State Childrens Health Insurance Program
to cover health care costs of eligible individuals and families
with HIV disease; capacity development needs resulting from disparities
in the availability of HIV-related services in historically underserved
communities and rural communities; and efficiency of the administrative
mechanism of the State for rapidly allocating funds to the areas
of greatest need within the State. Completing an annual priority
setting process weighs needs against available resources and uses
results to inform the resource allocation process.
Consortia.
For consortia, the legislation does not explicitly outline priority
setting but does imply its importance in language requiring consortia
to ensure that services address identified needs. Clearly, this
indicates that needs assessment results must be used in determining
service priorities.
Comprehensive
Planning
States
and Consortia. Both the State and their consortia are required
to develop a plan to meet identified service needs. Specific requirements
are outlined in greater detail in the comprehensive planning chapter
in this manual.
The comprehensive
plan must demonstrate that adequate planning occurred to address
multiple areas. They include: disparities in access and services
to historically underserved communities; the needs of those who
know their HIV status and are not in care and the needs of those
who are currently in the care system; and coordination of services
with other services, including HIV prevention programs (including
outreach and early intervention services) and substance abuse prevention
and treatment programs
A comprehensive
plan should include data from local needs assessments and/or statewide
needs assessments to meet legislative requirements. Many Title II
areas have conducted an assessment process, enabling them to update
their Statewide Coordinated Statement of Need. This information
may play a valuable part in the development of a comprehensive plan.
Those needs identified should be an impetus in the development of
the comprehensive plan that includes goals and measurable objectives
for use in guiding resource allocation decisions.
Consortia.
In establishing service plans, consortia must demonstrate that they
have consulted with PLWH, the public health agency or other entity(ies)
providing HIV-related health care in the area, at least one community-based
AIDS service provider, Title II grantee, Title IV grantees or organizations
with a history of serving children, youth, women, and families with
HIV, and entities such as those required to be represented on Title
I planning councils.
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DEVELOP
A BALANCED WORKPLAN
Some
consortia spend the bulk of their meeting time dealing only
with organizational issues and concerns and then find they
have just a couple of months before they apply to the State
for funding to complete planning activities such as needs
assessment, prioritization, the comprehensive plan, and evaluation.
A balance must be established. During some times of the year,
the consortium will focus on planning tasks and on organizational
activities. At other junctures the consortium can revisit
its mission and annual workplan or develop and implement a
new membership recruitment plan. A key is to develop an annual
workplan that specifies who is responsible for what activities
by when, on a month-by-month basis. The workplan should include
the following, with timelines:
- Activities
due for the annual State application
- Activities
required for planning and resource allocation
- Activities
required to keep the organization healthy and strong, and
- Any
other special projects.
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Coordination
Coordination
requirements exist for both States and their consortia. Some are
outlined above under comprehensive planning, wherein the plan must
coordinate services with HIV prevention programs (including outreach
and early intervention services) and substance abuse prevention
and treatment programs. Coordination is also discussed in the early
intervention chapter and coordination chapters in this manual, with
the latter covering working with other payers, programs, and planning
bodies.
States.
In Section 2617, States are required to coordinate use of Title
II funds with other payers and to coordinate with HIV prevention
and substance abuse services. Section 2617(b) also requires States
to assure that funded entities maintain appropriate relationships
with key points of access to facilitate early intervention. This
requires grantees and planning bodies to define such relationships
and establish them with key points of access, as defined in Section
2612(c) (e.g., public health departments, emergency rooms, and sexually
transmitted disease clinics).
Consortia.
Section 2613(c) contains provisions for consortia to develop plans
to promote coordination and integration of community resources.
They require consortia to address service needs through the coordination
and expansion of existing resources before new programs are created.
In the case of services for individuals in rural areas, consortia
must assure access to a continuum of care through case management
services.
Coordination
of services is an important and necessary outgrowth of bringing
together a wide variety of provider organizations and community
representatives into a planning body. An institutional memory develops
of the services being provided by members. Meetings are frequently
used to learn more about those services. Face-to-face relationships
often facilitate referrals between service providers who have not
previously worked together.
Many consortia
have created resource directories of available services to increase
awareness of and access to services. Consortia have worked on approaches
to service coordination goals such as the following:
-
Facilitating referral while protecting confidentiality
-
Reducing paperwork related to intake procedures
-
Minimizing duplication of services, and
-
Assuring access to specific services such as buddy programs, housing,
or legal assistance regardless of a clients entry point
into the system.
Service
Delivery
States.
States are allowed to provide services under five program categories.
(See chapters on these for additional information.)
Consortia.
The CARE Act requires that consortia provide for the delivery of
a broad range of health and support services either by entering
into agreements with existing agencies or by providing services
directly. Most consortia provide services through contracts with
existing service providers. Assuring the provision of health and
support services requires the development and maintenance of a comprehensive
service delivery network and the implementation of a case management
system to ensure that clients have appropriate access to those services.
Enhancing
service delivery can take on other forms, such as:
-
Establishing service standards. Consortia may develop service
or quality of care standards for their providers and may choose
to use these standards as criteria for selecting providers/contractors.
-
Taking a leadership role in assessment and evaluation of service
quality, unit costs, effectiveness, and administrative efficiency,
in cooperation with providers, the lead agency, and the grantee.
-
Educating the community about HIV/AIDS, and advocating for enhanced
AIDS services.
Capacity
Development
States
and Consortia. As part of their needs assessment, priority setting
and resource allocation duties, States and consortia must consider
capacity development needs resulting from disparities in the availability
of HIV-related services in historically underserved communities
and rural communities. In particular is examining needs of PLWH
who know their status and are not in care. If the needs assessment
identifies gaps in the ability of the area to reach and address
the HIV service needs of underserved populations or communities,
capacity development activities must be prioritized. Where there
are no other sources of funding, Title II funds must be allocated
for this activity. Capacity development should be targeted to service
providers located in or with a history of serving communities where
these access or service disparities exist.
The State
and planning bodies can actively participate in recruiting and assisting
with development of increased service provider capacity in a community.
Capacity building can also extend to the provision of technical
assistance to service providers as long as such assistance contributes
to specific capacity development needs that have been identified.
States and
planning bodies may choose to assume responsibility for providing
or coordinating technical assistance to service contractors in organizational
development areas. Examples of eligible areas include training,
equipment, system design, help with planning, and other consultations.
Inappropriate activities include staffing, major construction, and
planning grants.
Consortia.
Consortia with procurement authority may provide technical assistance
on grant application processes to assure applications from a diverse
number of providers. This is particularly important when a consortium
has prioritized services provided by smaller, minority, or rural
organizations lacking experience in applying for and managing Federally
funded programs.
Efficiency
of the Administrative Mechanism
States.
Section 2617 requires States to assess the efficiency of the administrative
mechanism for rapidly allocating funds to areas of greatest need
in the State.
Evaluation
States.
(See outcomes evaluation and cost effectiveness chapters in this
Manual.)
Consortia.
Section 2613 requires consortia to have a mechanism to evaluate
periodically their success in responding to identified needs and
the cost-effectiveness of the mechanisms employed by the consortium
in delivering comprehensive care.
Consortia
can build evaluation of the costs and effectiveness of different
service delivery approaches into the competitive funding award process.
For example, the cost of providing a service can be considered when
awarding contracts to providers.
A consortium
should evaluate how satisfied its members are with consortium processes
and outcomes. Consortia should assess periodically their own administrative
structures and procedures to ensure that they are operating effectively.
Consortium
Administration
TOP
A consortium
should check with its State grantee about any restrictions and specifications
on the administrative cap requirements. An administrative budget
should be developed, either as part of the lead agencys budget
or separately.
Most lead
agencies make in-kind donations to the consortium process
(e.g., allocating staff time and resources such as copying and postage
beyond the funding available for administration). Additionally,
members contribute large amounts of time and resources to the success
of the consortium process. It should never be assumed that the lead
agency or members will automatically donate everything. Consortia
need to develop annual budgets that include an estimation not only
of anticipated costs but also anticipated time and in-kind
donations.
Some consortia
combine resources for more efficient use of their administrative
allocation. For example, a community could pool its
Title II and Centers for Disease Control and Prevention (CDC) Community
Planning Group dollars for a joint needs assessment and evaluation.
Other communities share resources across consortium boundaries by
doing a multi-consortia needs assessment or sharing one staff person
among multiple consortia and splitting that cost. Another solution
to a lack of administrative support is to use other local resources
such as interns from a local university. Many consortia find that
combining planning resources helps financially and enhances community
wide HIV/AIDS planning.
When
Consortia Are Responsible for Selecting Service Providers
TOP
Establishment
of consortia by the State is outlined in the CARE Act legislation.
Various consortium models have emerged in the States, including
the following:
-
Title II consortia are planning entities that become advisory
to the grantee for final decision making regarding the allocation
of funds. In this model, the grantee makes final decisions about
the use of Title II funds based on the advice, input, plans, and
priorities of the consortium. In this arrangement, funds may still
flow through a lead agency. In some cases the funds are allocated
directly to service providers who are reimbursed directly by the
grantee. The contractual relationship is between the grantee and
the service provider.
-
Another model of consortia as advisory planning bodies uses the
lead agency, or an outside organization or group, to procure services.
However, the procurement process and the services procured are
based on the consortium plan and priorities. Consortia influence
the delivery of services through their coordination and planning
functions, but the contractual relationships are between the lead
agency and the direct service delivery organizations.
-
Statewide consortia most frequently act as planning groups and
provide advice about the need for services. They work on an ongoing
basis with the grantee to improve existing services and to identify
the new services most needed to improve the continuum of care.
In at least one State (Delaware), the Statewide consortium is
incorporated and is the decision making body. The State works
in partnership with the consortium. In general, Statewide consortia
are found in States with a relatively low incidence of HIV/AIDS
cases, though a few large States with high incidence use a Statewide
advisory group to assist the State in developing a Statewide comprehensive
plan.
In some States,
the consortia select the service providers who will be providing
the services required by the consortiums comprehensive plan.
Several different processes may be used for allocating funds, including
the following:
- Competitive
Bidding or Grant Application. This approach requires the consortium
to establish a process to issue an RFP (Request for Proposals),
review proposals, determine awardees, grant funds, and oversee
the use of funds. Consortia that are not incorporated do not sign
a contract directly with a subcontractor. This is done by the
lead agency. In this situation, the lead agency is responsible
for monitoring the performance of subcontractors based on the
scope of work or contractual requirements.
- Sole
Source. In this method of subcontracting, a consortia determines
that a needed service is provided only by the sole provider capable
or willing to provide the needed service. This method of contracting
is known as sole source.
- Allocation
Formula. Some consortia use an allocation formula to distribute
funds. This procedure is most common when a consortium is allocating
money to another umbrella organization, such as a county task
force, which may then further subdivide the resources among direct
service providers.
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