Referral for Health Care and Support Services

Service Standard

Referral for Health Care and Support Services Service Standard print version

Subcategories	Service Units
Referral to health care/supportive services	Per referral

Health Resources & Services Administration (HRSA) Description:

Referral for Health Care and Support Services (RFHC) directs a client to needed core medical or support services in person or through telephone, written, or other type of communication. Activities provided under this service category may include referrals to assist HRSA Ryan White HIV/AIDS Program (RWHAP)-eligible clients to obtain access to other public or private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, and other state or local health care and supportive services, or health insurance Marketplace plans).

Program Guidance:

Referrals for health care and support services provided by outpatient/ambulatory health care professionals should be reported under Outpatient/Ambulatory Health Services (OAHS) category.

Referrals for health care and support services provided by case managers (medical and non-medical) should be reported in the appropriate case management service category (e.g., Medical Case Management (MCM) or Non-Medical Case Management (NMCM)).

RWHAP Part B and State Services funds can be used to provide transitional social services to establish or re-establish linkages to the community. Case management that links a soon-to-be-released inmate with primary care is an example of appropriate transitional social services.

Transitional social services should NOT exceed 180 days. (Source: DSHS Policy 591.00 Limitations on Ryan White and State Service Funds for Incarcerated Persons in Community Facilities, Section 5.3).

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:

Funds cannot be used to duplicate referral services provided through other service categories. Please reference the HRSA Program Guidance above.

Services:

Referral for Health Care and Support Services includes benefits/entitlement counseling and referral to health care services to assist eligible clients to obtain access to other public and private programs for which they may be eligible.

Benefits counseling: Services should facilitate a client’s access to public/private health and disability benefits and programs. This service category works to maximize public funding by assisting clients in identifying all available health and disability benefits supported by funding streams other than RWHAP Part B and/or State Services funds. Clients should be educated about and assisted with accessing and securing all available public and private benefits and entitlement programs.

Health care services: Clients should be provided assistance in accessing health insurance or Marketplace health insurance plans to assist with engagement in the health care system and HIV Continuum of Care, including medication payment plans or programs. Services focus on assisting client’s entry into and movement through the care service delivery network such that RWHAP and/or State Services funds are payer of last resort.

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
Benefits Counseling: Activities should be client-centered facilitating access to and maintenance of health and disability benefits and services. It is the primary responsibility of staff to ensure clients are receiving all needed public and/or private benefits and/or resources for which they are eligible. Staff will educate clients about available benefit programs, assess eligibility, assist with applications, provide advocacy with appeals and denials, assist with re-certifications, and provide advocacy in other areas relevant to maintaining benefits/resources. Staff will explore the following as possible options for clients, as appropriate: AIDS Drug Assistance Program (ADAP) Health Insurance Plans/Payment Options (CARE/ HIPP, COBRA, OBRA, State Health Insurance Assistance Plans (SHIPs), Medicaid, Medicare, Private, ACA/Marketplace) SNAP Pharmaceutical Patient Assistance Programs (PAPS) Social Security Programs (Social Security Income (SSI), Social Security Disability Insurance (SSDI)) Temporary Aid to Needy Families (TANF) Veteran's Administration Benefits (VA) Women, Infants and Children (WIC) Other public/private benefits programs Other professional services Staff will assist eligible clients with completion of benefits application(s) as appropriate within 14 business days of the eligibility determination date. Conduct a follow-up within 90 days of completed application to determine if additional and/or ongoing needs are present.	Percentage of clients with documented evidence of education provided on other public and/or private benefit programs in the primary client record. Percentage of clients with documented evidence of other public and/or private benefit applications completed as appropriate within 14 business days of the eligibility determination date in the primary client record. Percentage of eligible clients with documented evidence of the follow-up and result(s) to a completed benefit application in the primary client record.
Health Care Services: Clients should be assisted in accessing health insurance or Marketplace plans to assist with engagement in the health care system and HIV Continuum of Care, including medication payment plans or programs. Eligible clients are referred to Health Insurance Premium and Cost-Sharing Assistance (HIA) to assist clients in accessing health insurance or Marketplace plans within one (1) week of the referral for health care and support services intake. Eligible clients are referred to other core services (outside of a medical, MCM, or NMCM appointment), as applicable to the client’s needs, with education provided to the client on how to access these services. Eligible clients are referred to additional support services (outside of a medical, MCM, NMCM appointment), as applicable to the client’s needs, with education provided to the client on how to access these services. Staff will follow-up within 10 business days of a referral provided to HIA to determine if the client accessed HIA services. Staff will follow-up within 10 business days of a referral provided to any core services to ensure the client accessed the service. Staff will follow up within 10 business days of a referral provided to support services to ensure the client accessed the service.	Percentage of clients with documented evidence of assistance provided to access health insurance or Marketplace plans in the primary client record. Percentage of clients who received a referral for other core services who have documented evidence of the education provided to the client on how to access these services in the primary client record. Percentage of clients who received a referral for other support services who have documented evidence of the education provided to the client on how to access these services in the primary client record. Percentage of clients with documented evidence of referrals provided for HIA assistance that had follow-up documentation within 10 business days of the referral in the primary client record. Percentage of clients with documented evidence of referrals provided to any core services that had follow-up documentation within 10 business days of the referral in the primary client record. Percentage of clients with documented evidence of referrals provided to any support services that had follow-up documentation within 10 business days of the referral in the primary client record.
Case Closure Summary: Clients who are no longer in need of assistance through Referral for Health Care and Support Services must have their cases closed with a case closure summary narrative documented in the client primary record. The case closure summary must include a brief synopsis of all services provided and the result of those services documented as ‘completed’ and/or ‘not completed.’ A supervisor must sign the case closure summary.	Percentage of clients who are no longer in need of assistance through Referral for Health Care and Support Services that have a documented case closure summary in the primary client record.

Standard

Measure

Benefits Counseling: Activities should be client-centered facilitating access to and maintenance of health and disability benefits and services. It is the primary responsibility of staff to ensure clients are receiving all needed public and/or private benefits and/or resources for which they are eligible.
Staff will educate clients about available benefit programs, assess eligibility, assist with applications, provide advocacy with appeals and denials, assist with re-certifications, and provide advocacy in other areas relevant to maintaining benefits/resources.

Staff will explore the following as possible options for clients, as appropriate:

AIDS Drug Assistance Program (ADAP)
Health Insurance Plans/Payment Options (CARE/ HIPP, COBRA, OBRA, State Health Insurance Assistance Plans (SHIPs), Medicaid, Medicare, Private, ACA/Marketplace)
SNAP
Pharmaceutical Patient Assistance Programs (PAPS)
Social Security Programs (Social Security Income (SSI), Social Security Disability Insurance (SSDI))
Temporary Aid to Needy Families (TANF)
Veteran's Administration Benefits (VA)
Women, Infants and Children (WIC)
Other public/private benefits programs
Other professional services

Staff will assist eligible clients with completion of benefits application(s) as appropriate within 14 business days of the eligibility determination date.

Conduct a follow-up within 90 days of completed application to determine if additional and/or ongoing needs are present.

Percentage of clients with documented evidence of education provided on other public and/or private benefit programs in the primary client record.

Percentage of clients with documented evidence of other public and/or private benefit applications completed as appropriate within 14 business days of the eligibility determination date in the primary client record.

Percentage of eligible clients with documented evidence of the follow-up and result(s) to a completed benefit application in the primary client record.

Health Care Services: Clients should be assisted in accessing health insurance or Marketplace plans to assist with engagement in the health care system and HIV Continuum of Care, including medication payment plans or programs.

Eligible clients are referred to Health Insurance Premium and Cost-Sharing Assistance (HIA) to assist clients in accessing health insurance or Marketplace plans within one (1) week of the referral for health care and support services intake.

Eligible clients are referred to other core services (outside of a medical, MCM, or NMCM appointment), as applicable to the client’s needs, with education provided to the client on how to access these services.

Eligible clients are referred to additional support services (outside of a medical, MCM, NMCM appointment), as applicable to the client’s needs, with education provided to the client on how to access these services.

Staff will follow-up within 10 business days of a referral provided to HIA to determine if the client accessed HIA services.

Staff will follow-up within 10 business days of a referral provided to any core services to ensure the client accessed the service.

Staff will follow up within 10 business days of a referral provided to support services to ensure the client accessed the service.

Percentage of clients with documented evidence of assistance provided to access health insurance or Marketplace plans in the primary client record.

Percentage of clients who received a referral for other core services who have documented evidence of the education provided to the client on how to access these services in the primary client record.

Percentage of clients who received a referral for other support services who have documented evidence of the education provided to the client on how to access these services in the primary client record.

Percentage of clients with documented evidence of referrals provided for HIA assistance that had follow-up documentation within 10 business days of the referral in the primary client record.

Percentage of clients with documented evidence of referrals provided to any core services that had follow-up documentation within 10 business days of the referral in the primary client record.

Percentage of clients with documented evidence of referrals provided to any support services that had follow-up documentation within 10 business days of the referral in the primary client record.

Case Closure Summary: Clients who are no longer in need of assistance through Referral for Health Care and Support Services must have their cases closed with a case closure summary narrative documented in the client primary record.

The case closure summary must include a brief synopsis of all services provided and the result of those services documented as ‘completed’ and/or ‘not completed.’

A supervisor must sign the case closure summary.

Percentage of clients who are no longer in need of assistance through Referral for Health Care and Support Services that have a documented case closure summary in the primary client record.