280.001 Sub-Contracting HIV Core and Support Services by an Administrative Agency

Policy Number  280.001
Effective Date  September 1, 2015
Revision Date  September 1, 2015
Subject Matter Expert HIV/STD Care Services Group Manager
Approval Authority  HIV/STD Prevention and Care Branch Manager
Signed by Shelley Lucas, M.P.H.

1.0 Purpose

The purpose is to establish contracting expectations by the Administrative Agency for the provision of HIV Core and Support Services at the local level.

2.0 Authority

Texas Health and Safety Code, Chapter 85, §§85.003, 85.013, 85.014 - 85.03; Ryan White Treatment Extension Act 2009; HRSA Policy Notice 10-02. 

3.0 Policy

Administrative Agencies will have the capacity to contract with agencies to provide comprehensive outpatient core and support services to meet the prioritized needs of people with HIV disease and their affected families in the service delivery area.

4.0 Definitions

Administrative Agency (AA) – Entity responsible for ensuring a comprehensive continuum of care exists in their funded areas. This is accomplished through the management, distribution, and oversight of federal and state funds, and under contractual agreement with the Department of State Health Services (DSHS).

Client – Anyone who has completed the eligibility process and is receiving any agency services, whether or not the service is funded by Ryan White or State Services.

Contractor – The entity with whom the Department of State Health Services has contracted to provide services. The contractor is the responsible entity even if there is a subcontractor who actually provides the services. Contractor is also referred to as either a subrecipient or a vendor.

Department of State Health Services (DSHS) – The agency responsible for administering physical and mental health-related prevention, treatment, and regulatory programs for the State of Texas.

Human Immunodeficiency Virus (HIV) – HIV infection destroys some types of white blood cells and is transmitted through blood or bodily secretions such as semen.

HIV Services – Any of the core or supportive services defined in the HIV Core and Support Services Taxonomy paid for with Ryan White Part B and/or State Services funding streams disseminated through DSHS.

Provider – A local organization, individual clinician, or group of clinicians who provide services to HIV-positive clients and their affected families.

Subcontractor – A provider who contracts with the Administrative Agency to provide services to HIV-positive clients and their affected families.

Sub of Subcontract – A contract established between a subcontractor and another provider to deliver specific services outlined in the subcontractor’s contract with the Administrative Agency.

Subrecipient – See “Contractor”

Vendor – See “Contractor”

5.0 Persons Affected

  • DSHS HIV Care Services staff
  • Administrative Agencies (Contractors)
  • Providers (Subcontractors)
  • Clients

6.0 Responsibilities

6.1 DSHS HIV Care Services Branch

Ensure that systems are in place to provide care and services to Texans who are eligible to receive these through Ryan White Part B, and State Services. Staff will assure that Administrative Agencies appropriately monitor subcontractors for quality assurance.

6.2 Administrative Agency

Develop contracts with entities to deliver services. The contracts must delineate services to be provided and address quality assurance mechanisms.

6.3 Contractor and Provider

Develop policies and procedures to implement Standards of Care for HIV services.

7.0 Requirements

7.1 Subcontractors with Providers

A key strategy in the National HIV/AIDS Strategy (2010) is to increase access to care and improve health outcomes for people living with HIV. To accomplish this vision, the Administrative Agency must take deliberate steps to increase the number and diversity of available providers of clinical care and related services for people living with HIV.

The Administrative Agency may enter into a contracting relationship (known as subcontract) with providers within their service area to deliver direct services for Core and Support Services. In establishing and monitoring subcontracts, the Administrative Agency will adhere to HIV Program and Operating Procedures Chapter 13; 13.5 Standards for Capacity to Subcontract and Monitor located at: dshs.texas.gov/hivstd/pops/

Subcontractors may not subcontract (also known as sub of subcontracting) with another provider for services that they are contracted to deliver under the Administrative Agency’s contract.

However, the Administrative Agency must have and maintain resources for the provision of relevant client services and assure that subcontractors have and maintain contract, Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA) with other service providers in the area. These must exist between service providers for clients to receive a large array of services such as HIV prevention, mental health, substance abuse, home health, medical transportation, etc. Contracts/MOU/MOAs must be renewed annually within 30-60 days of contract initiation.

7.1.1 Exceptions to Sub of Subcontracting

Pharmacy and laboratory testing are exempt from this policy.

For all service categories: if a contract cannot be established directly with a provider or there are other extenuating circumstances, the Administrative Agency may request a waiver so that a provider may subcontract for limited services with another provider. An annual waiver request must be submitted and approved by DSHS prior to establishing subcontracts. The waiver must describe why the Administrative Agency cannot directly contract with the provider and the business need for a provider to establish a subcontract. The waiver must include the proposed contract between the provider and another provider. Request for waiver must be submitted no later than thirty (30) days prior the beginning of the contract year. DSHS will respond to waiver requests within ten (10) business days.

Administrative Agency must monitor the sub of subcontractor for quality assurance by annually reviewing client records/documents as outlined by DSHS upon approval of the waiver. Service Category Standards of Care and monitoring requirements are located at dshs.texas.gov/hivstd/taxonomy/.

8.0 Additional Resources

Form 280.001A - Subcontracting Waiver Request Form


9.0 Revision History

Date Action Section
9/1/2015 New policy All