Chapter 4
Statewide Coordinated Statement of Need  TOP

Introduction

The Statewide Coordinated Statement of Need (SCSN) is a mechanism for addressing key HIV/AIDS care issues and enhancing coordination across CARE Act programs and titles. The State Title II program is responsible for coordinating the SCSN, but all titles and grantees are expected to participate.

Legislative Background  TOP

The SCSN has been a requirement of the CARE Act since the 1996 reauthorization. The State Title II program is responsible for convening the SCSN for all CARE Act grantees under the following provisions:

Section 2617(b)(4)(F) requires the State’s Title II application to “provide 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.”

Section 2617(b)(5) requires “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 of this title, providers, and public agency representatives for the purpose of developing a statewide coordinated statement of need.”

Title II programs are required to participate in the SCSN process, and use its findings, under the following provisions:

Section 2617(B)(4)(c) requires States to “develop a comprehensive plan for the organization and delivery of health and support services” to be funded under Title II that, in part— “(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….”

Section 2617(b)(5) requires States to submit an application for funding that contains, in part, “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;”

HAB/DSS Expectations  TOP

Definition

The SCSN is both a process and the written product emerging from that process. It is a mechanism to collaboratively identify significant issues related to the needs of people living with HIV disease (PLWH) in the State and to maximize coordination across the CARE Act titles. Based on that mechanism, a written SCSN is prepared and submitted to HRSA’s HIV/AIDS Bureau, Division of Service Systems (HAB/DSS).

The SCSN must reflect, without replicating, existing needs assessments. The SCSN process 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. The SCSN must identify broad goals, cross-cutting issues, and critical gaps in services for PLWH throughout the State.

Process

The SCSN is convened by the State Title II program for all CARE Act grantees. HAB/DSS does not endorse any single approach but encourages States to develop models that meet their particular needs. The mechanism for developing an SCSN can be a statewide meeting or some other locally developed collaborative process. The chosen process, along with a list of participants, must be submitted to HAB/DSS by the State, along with the SCSN document.

HAB/DSS has the following additional expectations about the SCSN:

• The SCSN is an activity of equal responsibility and partnership. Title II grantees are responsible for convening a meeting or using another method to develop an SCSN. However, all programs have equal responsibility for developing and participating in the process as well as reviewing and approving the SCSN.
• The SCSN should be based on existing information. The SCSN is not a comprehensive needs assessment requirement nor is it a requirement for a comprehensive plan for HIV/AIDS care. For example, existing needs assessments carried out for different titles should be used in identifying service gaps and issues. There is no expectation of additional research or data collection.
• The SCSN must identify cross-cutting service delivery gaps. It is helpful to collapse information from various needs assessments to identify where gaps exist. Gaps in service delivery may be found according to population groups, types of service, geographic areas, or other highlighted issues. The SCSN can assist CARE Act programs in facing new HIV/AIDS challenges such as ensuring access to care for underserved populations increasingly affected by the epidemic and identifying HIV-positive individuals who know their status but are not in care.
• The SCSN must identify broad goals. Goals should not be prioritized but should be reviewed to assess the potential impact of collective program efforts. Examples of cross-cutting issues that might yield broad goals include managed care, bringing people into care, access to medications, targeting specific populations, and addressing the needs of underserved areas or populations.
• The SCSN is not intended to supersede local program-specific planning and priority setting. HAB encourages grantees to use the SCSN to support statewide HIV/AIDS planning.
• Physical meetings are not required. Participants can develop a mechanism other than a physical meeting (e.g., a teleconference) to conduct an SCSN process, so long as it provides an opportunity for involvement and discussion by all the required participants.
• All CARE Act grantees are permitted to use administrative dollars to support travel and other aspects of the SCSN process. Each State should develop its own process for determining how expenses will be paid, with all parties deciding what resources (e.g., travel, lodging) are needed to support the SCSN process.
• Consistency is critical. Each Title's grant application guidance includes instructions on how each grantee’s application is expected to reflect issues addressed in its State’s SCSN. For example, Title II grantees are required to demonstrate how the proposed services described in their supplemental grant application are consistent with the SCSN.

Participation in the Development of the SCSN

The SCSN must be developed with input from a variety of participants, including the following:

• Representatives of all CARE Act Titles funded in the State. Title I should include representatives from both grantees and planning councils, and Title II should include grantee and statewide planning body and/or consortium representatives. Also participating should be representatives of Title III and Title IV programs, as well as any AIDS Education and Training Center (AETC), Dental Reimbursement Program, and Special Projects of National Significance (SPNS) programs operating in the State.
• PLWH. People living with HIV disease must participate in the SCSN process, and the grantee application must describe their participation (i.e., what form the participation took and how many PLWH were involved as a percentage of the total number of SCSN participants).
• Providers. A provider is defined as any individual or institution either receiving CARE Act funds or generally involved in the provision of health care and/or support services for PLWH.
• Public agency representatives. Public agency representatives are to be chosen at the discretion of the State. Agencies represented may include, but need not be limited to, Maternal and Child Health (MCH) Title V programs, substance abuse prevention/treatment agencies, mental health agencies, local/county public health departments, Medicaid programs, and health centers.

Participation in More than One SCSN

EMAs that cross State boundaries may choose to work with more than one SCSN process.

Grantees that provide services in an area that straddles State boundaries or are located in one State but with satellite and subcontract sites in other States can choose to participate in the SCSN that most appropriately applies to their population based on the epidemiologic profile of that entity. As a practical matter, such grantees should participate in an SCSN process in the State whose profile is most consistent with their epidemic, geographic area, and treatment patterns.

Funding for the SCSN Process

The legislation makes no specific reference to funding the SCSN process. The Congressional Conference Report accompanying the Ryan White CARE Act of 1996 “strongly encourages grantees under part B (i.e., Title II) to provide the funds necessary to assure adequate and broad statewide participation of people living with HIV/AIDS and other representatives of historically underserved communities and subpopulations in the SCSN process.”

The use of CARE Act funds to assure participation in the SCSN must be consistent with each Title or program’s individual guidance. SCSN expenses are a legitimate administrative cost for which Titles I and II funds may be used. Title I planning councils may use planning council support funds to pay for expenses related to participation in SCSN development if this activity has been identified as a planning council priority. Similarly, all CARE Act grantees may use administrative dollars to support travel and other aspects of the SCSN process if such funds are required.

Each State should develop its own process for determining how expenses will be paid. In some States, State-appropriated dollars pay all expenses; in other States, Title II funds pay; in still others, expenses are shared across programs. As long as all parties participate in reaching a decision on the resources needed to support the SCSN process, HAB/DSS has no preference as to how SCSN expenses should be covered.

Timetable

The SCSN should be reviewed and updated as appropriate and must be updated at least every three years. Title II grantees are required to submit a copy of the SCSN with their grant applications.

SCSN Review

HAB reviews each SCSN submitted and provides comments back to the Title II grantee. Review of the SCSN allows HAB/DSS to identify cross-cutting issues across jurisdictions, such as the following:

• Trends in the epidemic, such as increases in the rate of HIV infection among specific populations such as minorities, gay men, and women
• Need for both client-and provider-focused education on new therapies and adherence strategies
• Need for re-employment services for PLWH who return to work
• Need to understand and respond to the impact of managed care on CARE Act programs
• Key issues affecting access to treatment for diverse populations
• Importance of access to affordable and appropriate housing (e.g., transitional housing for incarcerated, rental assistance for PLWH who cannot work, housing that accommodates disabilities)
• Need for services to meet the needs of the multiply diagnosed, and
• The challenge of identifying people who know their status but are not in care—and getting them into care.

References  TOP

Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). Ryan White CARE Act Title I and II Application Guidances.

HRSA, HAB. “Frequently Asked Questions About the SCSN.” 1997.

HRSA, HAB. SCSN Program Guidance. 1997.

HRSA, HAB. “SCSN.” CARE Act Technical Assistance Call Report. Rockville, MD: U.S. Department of Health and Human Services, 1997.