• DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    E-mail the HIV/STD Program

    E-mail data requests to HIV/STD Program - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

Referral for Health Care and Support Services

Service Standard

Print version (PDF : 231 kB)

HRSA Definition:

Referral for Health Care and Support Services directs a client to needed core medical or support services in person or through telephone, written, or other type of communication. This service may include referrals to assist 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).

 

Limitations:

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

 

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 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.

 

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 590.000, Section 5.3)

 

Service Standard and Performance Measure

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

Standards
Standard Performance 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, Health Insurance Assistance (HIA), Medicaid, Medicare, Private, ACA/Marketplace) 
  • SNAP
  • Pharmaceutical Patient Assistance Programs (PAPS) 
  • Social Security Programs (SSI, SSDI, SDI)
  • 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 provided assistance 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 synapsis 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.

 

References

HRSA/HAB Division of Metropolitan HIV/AIDS Programs Program Monitoring Standards – Part A April 2013. p. 43-44.

HRSA/HAB Division of State HIV/AIDS Programs National Monitoring Standards – Program Part B April, 2013. p. 42-43.

Virginia Department of Health, Division of Disease Prevention, HIV Care Services Referral for Health Care/Supportive Services (PDF) 

HRSA/HAB Ryan White & Global HIV/AIDS Programs, Program & Grants Management, Policy Notices and Program Letters, Policy Clarification Notice 16-02

DSHS Policy 591.000, Section 5.3 regarding Transitional Social Service linkage.


Last updated July 5, 2018