Housing Services

Service Standard

Housing Services Service Standard print version

Subcategories	Service Units
Housing Assistance – Short-Term - Housing assistance is limited to short-term assistance to support temporary and/or transitional housing to enable the individual or family to gain and/or maintain medical care. Use of Ryan White Program funds for short-term or emergency housing must be linked to medical and/or healthcare or be certified as essential to a client’s ability to gain or maintain access to HIV-related medical care or treatment.	Per day
Housing Assistance – Emergency - Housing assistance is limited to 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 Ryan White Program funds for short-term or emergency housing must be linked to medical and/or healthcare or be certified as essential to a client’s ability to gain or maintain access to HIV-related medical care or treatment.	Per day
Housing Referral/Housing Related Service - Housing related services include 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.	Per 15 minutes

Health Resources & Services Administration (HRSA) Description:

Housing provides transitional, short-term, or emergency housing assistance to enable a client or family to gain or maintain outpatient/ambulatory health services and treatment, including temporary assistance necessary to prevent experiencing homelessness and to gain or maintain access to medical care. Activities within the Housing category must also include the development of an individualized housing plan, updated annually, to guide the client’s linkage to permanent housing. Housing may provide some type of core medical (e.g., mental health services) or support services (e.g., residential substance use disorder services).

Housing activities also include housing referral services, including assessment, search, placement, and housing advocacy services on behalf of the eligible client, as well as fees associated with these activities.

Program Guidance:

HRSA Ryan White HIV/AIDS Program (RWHAP) recipients and subrecipients that use funds to provide Housing must have mechanisms in place to assess and document the housing status and housing service needs of new clients, and at least annually for existing clients.

HRSA RWHAP recipients and subrecipients, along with local decision-making planning bodies, are strongly encouraged to institute duration limits to housing activities. HRSA HIV/AIDS Bureau (HAB) recommends recipients and subrecipients align duration limits with those definitions used by other housing programs, such as those administered by the Department of Housing and Urban Development (HUD), which currently uses 24 months for transitional housing.

Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services.

Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services.

All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations’ planning and operations.

Limitations:

Housing services cannot be in the form of direct cash payments to clients and cannot be used for mortgage payments or rental deposits. [1] These may be allowable costs under HUD Housing Opportunities for Persons with AIDS grant awards.

Services:

Eligible housing may include housing that:

Provides some type of core medical (e.g. mental health services) or support services (such as residential substance use disorder services or mental health services, residential foster care, or assisted living residential services); or
Does not provide direct core medical or support services but is essential for a client or family to gain or maintain access to and adherence with HIV-related medical care and treatment.

Funds received under this category may be used for the following housing related expenditures:

Housing referral services provided by a housing case manager or other professional to include assessment, search, placement, and advocacy services, who possess a comprehensive knowledge of local, state, and federal housing programs and how these programs can be accessed.
Emergency housing defined as an unforeseen event that jeopardizes a household’s ability to pay housing costs. Assistance is limited to one (1) month of rental/utility assistance within a contract year. The maximum amount of emergency housing assistance shall be uniform throughout each HIV Service Delivery Area (HSDA) and be determined by: 1) planning councils (PCs) in areas where the PC determines recommended allocations for Ryan White Part B (RW/B) and State Services funds; or 2) by the Administrative Agency (AA) based on consumer input/planning processes in RW/B-only HSDAs.
Transitional housing is defined as support for a person experiencing homelessness and to gain or maintain access to medical care. Funds may be used for rental and/or application fees; however, funds cannot be used for rental deposits. Funds may also be used for transitional residential housing that provides some type of core medical or support services such as residential substance use disorder services or mental health services, residential foster care, or assisted living residential services. Transitional housing assistance is based on need and available resources and is limited to no more than (6) continuous months of funding within a contract year. The maximum amount of transitional housing assistance shall be uniform throughout each HSDA and be determined by 1) PCs in areas where the PC determines recommended allocations for RW/B and State Services funds; or 2) by the AA based on consumer input/planning processes in RW/B-only HSDAs.
Short-term assistance defined as support for a person currently in housing but needing financial support for rent and/or utilities to gain or maintain medical care. The maximum amount of short-term assistance shall be uniform throughout each HSDA and be determined by: 1) PCs in areas where PCs determine recommended allocations for RW/B and State Services funds; or 2) by the AA based on consumer input/planning processes in RW/B-only HSDAs.

Telehealth and Telemedicine is an alternative modality to provide most Ryan White Part B and State Services funded services. For the Ryan White Part B/SS funded providers and Administrative Agencies, telehealth and telemedicine services are to be provided in real-time via audio and video communication technology which can include videoconferencing software.

DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance.

Service Standard and Measure

The following Standards and Measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard	Measure
Emergency Housing Assistance: Agency staff will initiate an intake within three (3) business days’ onset of the emergency housing need. Assessment of client housing status and housing service needs must be documented. Reason(s) for emergency assistance may include but are not limited to: Client is unable to pay rent due to: recent job loss; unpaid medical leave of absence; exhausted all leave balances Client is unable to work due to recent hospitalization Client had to recently purchase unexpected costly HIV medications or to pay for unexpected HIV-related medical expenses out of pocket Assessment that the household need is: Actual costs to avoid eviction Other resources are not reasonably available to address the unmet housing need Client will maintain and/or have stable housing as a result of housing assistance Staff will contact the client at the end of the month to determine if the housing emergency has been resolved. If not resolved and the client needs additional assistance, the client may be assessed for short-term housing assistance.	Percentage of client charts with documented evidence of emergency housing need assessed. Percentage of client charts that have a documented assessment of other resources reviewed and determined not available to assist client in housing emergency. Percentage of client charts with documented evidence of follow up to housing need with resolution of housing emergency. Percentage of clients with an HIV diagnosis, with a lack of housing or unstably housed, in the 12-month measurement period. *(HAB Performance Measure)* Percentage of client charts accessing housing assistance, with stabilized housing documented as a result of the assistance provided.
Housing Plan for Transitional (temporary) and Short-Term Housing: All clients receiving assistance for transitional and/or short-term housing must have a Housing Plan documented within the client files that includes: Housing status; Reason for housing service need; Other resources screened for housing assistance. Plans must detail the on-going housing stability goal with a focus on access to medical treatment and supportive services. The plan must include: Sustainable short-term and long-term goals for alleviating risks of a lack of housing, establishing affordable permanent housing stability, and improving access to health care and supportive services. Identification of barriers to sustainable housing; Steps to address housing needs; Referral(s) to available housing support services; and Budget and money management skills building, if indicated. Documentation in the client’s primary record/progress notes that the housing plan is reviewed at least monthly.	Percentage of client charts with a documented housing plan developed. Percentage of client charts with documented evidence of monthly updated housing plans with progress toward goals identified.
Housing Referral Services: Housing-related referrals provided by housing assistance/referral providers include housing assessment, search, placement, and advocacy services to seek housing (application to funding sources, visits to court systems). [1] Staff will document in the client’s primary record all activity to assist client in securing housing and outcome of the assistance.	Percentage of client charts with documented evidence of housing referral services provided, as applicable, including all elements as indicated. Percentage of clients who received housing referral services that obtained secure, stable housing because of the assistance provided.

Standard

Measure

Emergency Housing Assistance: Agency staff will initiate an intake within three (3) business days’ onset of the emergency housing need. Assessment of client housing status and housing service needs must be documented. Reason(s) for emergency assistance may include but are not limited to:

Client is unable to pay rent due to: recent job loss; unpaid medical leave of absence; exhausted all leave balances
Client is unable to work due to recent hospitalization
Client had to recently purchase unexpected costly HIV medications or to pay for unexpected HIV-related medical expenses out of pocket

Assessment that the household need is:

Actual costs to avoid eviction
Other resources are not reasonably available to address the unmet housing need
Client will maintain and/or have stable housing as a result of housing assistance

Staff will contact the client at the end of the month to determine if the housing emergency has been resolved. If not resolved and the client needs additional assistance, the client may be assessed for short-term housing assistance.

Percentage of client charts with documented evidence of emergency housing need assessed.

Percentage of client charts that have a documented assessment of other resources reviewed and determined not available to assist client in housing emergency.

Percentage of client charts with documented evidence of follow up to housing need with resolution of housing emergency.

Percentage of clients with an HIV diagnosis, with a lack of housing or unstably housed, in the 12-month measurement period. (HAB Performance Measure)

Percentage of client charts accessing housing assistance, with stabilized housing documented as a result of the assistance provided.

Housing Plan for Transitional (temporary) and Short-Term Housing: All clients receiving assistance for transitional and/or short-term housing must have a Housing Plan documented within the client files that includes:

Housing status;
Reason for housing service need;
Other resources screened for housing assistance.

Plans must detail the on-going housing stability goal with a focus on access to medical treatment and supportive services. The plan must include:

Sustainable short-term and long-term goals for alleviating risks of a lack of housing, establishing affordable permanent housing stability, and improving access to health care and supportive services.
Identification of barriers to sustainable housing;
Steps to address housing needs;
Referral(s) to available housing support services; and
Budget and money management skills building, if indicated.

Documentation in the client’s primary record/progress notes that the housing plan is reviewed at least monthly.

Percentage of client charts with a documented housing plan developed.

Percentage of client charts with documented evidence of monthly updated housing plans with progress toward goals identified.

Housing Referral Services: Housing-related referrals provided by housing assistance/referral providers include housing assessment, search, placement, and advocacy services to seek housing (application to funding sources, visits to court systems). [1]

Staff will document in the client’s primary record all activity to assist client in securing housing and outcome of the assistance.

Percentage of client charts with documented evidence of housing referral services provided, as applicable, including all elements as indicated.

Percentage of clients who received housing referral services that obtained secure, stable housing because of the assistance provided.

Notes

1. Housing referral activities performed by Ryan White-funded case managers (NMCM or MCM) are reported under the respective Case Management service category. Referral services provided by Ryan White-funded housing specialists are reported under the Housing service category.