Depafiment  of  Health  and Human  Sefices 
OFFICE  OF 
INSPECTOR  GENEML 
THE  RYAN WHITE  CARE ACT: 
CONSORTIA  ACTIVITIES 
I  OFFICE  OF INSPECTOR  GENERAL 
The  mission  of the  Office of Inspector  General  (OIG),  as mandated  by Public  Law 95-452, as 
amended,  is to protect  the  integrity  of the Department  of Health  and Human  Services (HHS) 
programs  as well as the  health  and welfare  of beneficiaries  served  by those  programs.  This 
statutory  mission  is carried  out  through  a nationwide  network  of audits,  investigations,  and 
inspections  conducted  by three  OIG  operating  components:  the  Office of Audit  Services,  the 
Office of Investigations,  and the  Office of Evaluation  and Inspections.  The OIG also informs 
the Secretary  of HHS  of program  and management  problems  and recommends  courses  to 
correct  them. 
OFFICE  OF AUDIT  SERVICES 
The  OIGS  Office of Audit  Services  (OAS)  provides  all auditing  services for HHS,  either  by 
conducting  audits with  its own audit  resources  or by overseeing  audit  work done  by others. 
Audits  examine  the  performance  of HHS  programs  and/or  its grantees  and contractors  in 
carrying out  their  respective  responsibilities  and are intended  to provide  independent 
assessments  of HHS  programs  and operations  in order  to reduce  waste,  abuse,  and 
mismanagement  and to promote  economy  and efficiency  throughout  the  Department. 
OFFICE  OF INVESTIGATIONS 
The  OIGS  Office of Investigations  (01)  conducts  criminal,  civil, and administrative

investigations  of allegations  of wrongdoing  in HHS  programs  or to HHS  beneficiaries  and of

unjust  enrichment  by providers.  The  investigative  efforts  of 01  lead to criminal  convictions,

administrative  sanctions,  or civil money  penalties.  The  01  also oversees  State  Medicaid  fraud

control  units which investigate  and prosecute  fraud  and patient  abuse  in the  Medicaid  program.

OFFICE  OF EVALUATION  AND INSPECTIONS 
The  OIGS  Office of Evaluation  and Inspections  (OEI)  conducts  short-term  management  and

program  evaluations  (called  inspections)  that  focus on issues of concern  to the  Department,

the  Congress,  and the  public.  The  findings  and recommendations  contained  in these  inspection

reports  generate  rapid,  accurate,  and up-to-date  information  on the  efficiency, vulnerability,

and effectiveness  of departmental  programs.

This report  was prepared  under  the  direction  of William C. Moran,  Regional  Inspector

General,  and Natalie  Coen,  Deputy  Regional  Inspector  General,  Office of Evaluation  and

Inspections,  Region  V.  Participating  in this project  were:

REGION  V  HEADQUARTERS

Joseph  L. Penkrot  (Project  Leader)  Alan  S. Levine

Ellen  R. Meara  (Lead  Analyst)

Barbara  Butz

Heather  Robertson

For  a copy of this report,  please  call (312) 353-4124.
 Depatiment  of  Health  and Human  Sefices 
OFFICE  OF 
INSPECTOR  GENERAL 
THE  RYAN WHITE  CARE ACT: 
CONSORTIA  ACTIVITIES  TABLE  OF  CONTENTS 
PAGE 
INTRODUCTION  . . . . . . . . ...0....  . . . . . . . . . ..       .,.  1 
CONSORTIA  ACrMTIES  . . . . . . . . . . . . . . . . ........      . . . . . .
 3

Collected  . . . . . . . . . . . . . . . . . . ..    .  ..  s3 
State  Title  IIConsortia  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..*o.  oQ04 
APPENDIX

k  HIV-Related  Categories  . . . . . . . . . . . . . . . . ......o.co..o..oA-l
 INTRODUCTION 
PURPOSE 
This  inspection  will describe  how consortia  spent  Ryan  White  funds  in fiscal year  (FY) 
1992, any unique  activities  undertaken,  and  any barriers  they face  in accomplishing 
their  missions. 
BACKGROUND 
Title  II of the  Ryan  White  Comprehensive  AIDS  Resources  Emergency  (CARE)  Act 
of 1990 provides  formula  grants  to States  and  Territories  to improve  the  quality, 
availability,  and  organization  of health  care  and  support  services  for individuals  and 
families  with Human  Immunodeficiency  Virus  (HIV)  infection.  The  Ryan  White 
CARE  Act is administered  by the  Health  Resources  Administration  (HRSA)  within 
the  Public  Health  Sefice.  One  major  goal of Title  11funding  is to establish 
community-based,  coordinated,  continuums  of care  to which  everyone  with HIV  would 
have  access.  States  have  the  option  of using Title  II funds  in one  or more  ways. 
However,  States  that  report  1 percent  or more  of all AIDS  cases nationally  must  use 
at least  50 percent  of their 
funds  to operate  consortia. 
The  consortia  option  allows 
States  to establish  consortia
Title  II Expenditures 
consisting  of public  and 
nonprofit  private 
FY 1992 
organizations  to assist in the 
[53%)	
planning,  development,  and 
(   delivery  of comprehensive
rlf 
outpatient  health  and 
Eh--- 
support  services.  States  have
Esb= 
considerable  leeway  in 
 
 
contracting  with  these 
organizations  to provide 
services.  For  example, 
California  has  26 consortia,
while  Washington  has  only 
(33%)	
one  consortium. 
In FY  1992, 43 States  received  Title  II funding  for consortia.  Consortia  spent  a total 
of $51,970,653  in FY  1992, or 53 percent  of all Title  II expenditures.  The  chart  above 
shows the breakdown  of spending-for  each  of the Title  11options  and  also shows the 
percentage  of Title  11funds  spent  for  admintstratton. 
1
 SCOPE  AND  METHODOLOGY 
All analysis  for this report  comes  from  data  included  in FY  1992 year-end  reports 
from  the  States,  and  from  data  collected  for related  Ryan  White  reports.  In addition. 
we asked  States  to identi@ how they  spent  FY  1992 Title  II consortia  and  home  and 
community  based  funds  for  each  service  catego~.  The  HRSA  defined  Ryan  White 
service  categories  for States  in their  FY  1992 Application  Guidance. 
However,  when  explaining  how grantees  must  report  their  use  of Ryan  White  Title  11 
funds,  HRSAS Application  Guidance  offers  information  that  may appear  unclear  to 
grantees.  As a result,  States  reported  consortia  data  in different  ways, making 
comparisons  difficult. 
In addition,  year-end  reports  were  not  available  for many  States.  States  often 
submitted  no year-end  report,  or submitted  either  fourth  quarter  FY  1992 reports  (Jr 
first quarter  FY  1993 reports  as if this should  meet  the  requirement  for  a year-end 
report.  For  the  purposes  of this report,  we assume  that  States  with missing  reports 
have  not  submitted  a year-end  report  at this time.  &  a result,  there  is very little  data 
for  11 States,  more  than  one-fourth  of the  States  with  consortia. 
When  collecting  data  for The Ryan  White  Act:  FY  1992 Title  I and  Title  11 
Expenditures,  we found  that  very few States  included  the  aggregate  funding 
information  required  of grantees  in their  year-end  reports.  As a result,  we had  to 
solicit funding  information  from  each  State.  Expenditure  figures  reported  to us often 
differed  from  the  total  grant  amounts  received  by States. 
This  study is not  an evaluation  of the  Ryan  White  program  or any individual  grantee. 
We  did not  ask for explanations  of why funds were  spent  as they were,  or obtain  any 
description  of the  services  grantees  provided,  including  their  quality  or effectiveness. 
Nor  did we independently  verify the  consortia  expenditures  States  reported  to us. 
This  study is one  in a series  of studies  on the  implementation  of the  Ryan  White 
CARE  Act.  The  other  reports  are: 
.  Funding  Formulas  (OEI-05-93-O0330); 
o  FY  1992 Title  I and  Title  11Expenditures  (OEI-05-93-00331); 
.	 FY  1992 Special  Projects  of National  Significance  - Expenditures  by Semite 
(OEI-05-93-O0332);  and, 
.  Technical  Report  of 1992 Expenditures  (OEI-05-93-O0334). 
This  inspection  was conducted  in accordance  with  the  Standards for Inspections  issued 
by the  Presidents  Council  on Integrity  and  Efficiency. 
2
 CONSORTIA  ACTIVITIES 
OVERVIEW  OF THE  DATA  COLLECTED 
Based  on State  year-end  reports  and  the  funding  information  States  provided,  there 
are  common  elements  in many  of the  States  consortia  activities.  Most  States  spent 
the  largest  portion  of their  FY  1992 consortia  funds  on case  management  or medical 
care.  Thirty-three  percent  of all consortia  funds were  spent  on case  management,  and 
15 percent  were  spent  on medical  care.  States  also used  substantial  portions  of their 
consortia  funds  for a variety  of activities  ranging  from  pharmaceuticals  to client 
advocacy.  These  HIV-related  activities  are  defined  by HRSAS service  categories, 
which  are  shown  in Appendix  A. 
Another  area  where  States  spent  a significant  percentage  of funds  is administration, 
and  planning  and  evaluation. 1  We  found  that  18 States  spent  more  than  10 percent 
of their  FY  1992 consortia  dollars  on administration,  and  planning  and  evaluation.  Six 
States  spent  over  20 percent  of their  consortia  dollars  on administration,  and  planning 
and  evaluation,  with  one  State  spending  100 percent  of its consortia  funds  on planning 
and  evaluation. 
In addition,  many  States  described  considerable  efforts  in planning,  developing,  or 
refining  management  information  systems  to facilitate  data  collection  and  meet  HRSA 
requirements.  Because  these  descriptions  are  similar,  we do not  discuss management 
information  systems  in the  State  summaries  of consortia  activities. 
Many  States  listed  similar  barriers  to providing  consortia  services.  The  most  common 
barrier  mentioned  is lack  of funds.  Eight  States  described  barriers  to funding  specific 
consortia  activities.  Another  common  barrier  was the  difficulty  recruiting  providers  to 
serve  persons  with HIV.  Some  primary  care  providers  and  dental  providers  do not 
want  to accept  HIV  positive  clients.  Some  providers  who are  willing to serve  these 
clients,  do not want  to be  identified  in HIV  service  provider  directories  developed  by 
consortia  because  they  fear  the  stigma  of being  an AIDS  provider.  Five States 
mentioned  specific  problems  collecting  and  reporting  data  about  their  consortia 
activities.  These  were  the  most  common  barriers,  but  States  described  a long list of 
obstacles  ranging  from  concerns  about  conflict  of interest  within  consortia  to difficulty 
in reaching  more  clients  eligible  for services. 
1 TheRyanWhiteCAREActdoesnotplaceanyceilingonthepercentageoffundsthatemaortiamayspendon 
administrationa,ndplanningandevaluation.Inaddition,readersshouldnotethatsomeStateadefineadministrationand 
planningandevaluationmorebroadlythantheRyanWhiteCAREAct. 
3  STATE  TITLE  II CONSORTIA 
A table  for each  State  follows showing how Title  II consortia  funds  were  spent,  a 
narrative  describing  individual  consortia  activities,  and  any barriers  they  face  in 
accomplishing  their  missions.  Due  to rounding,  figures  shown  in the  tables  may differ 
slightly from  what  States  reported,  and  percentages  may not  total  100.  The 
expenditures  are  shown  in rank  order  in the  tables. 
Alabama  ($54,869)  established  four 
consortia  during  FY  1992.  Most  Categoty  I  Spent  I  % 
Alabama  Title  II consortia  funds were  MediealCare  !  $14,478  ~  26.4 
spent  on medical  care  and  case 
CaseManagement  $14,180  25.8 
management.  2  Alabamas  report  did 
Housing&sistance  $6,712  12.2 
not  describe  specific  consortia  activities. 
I 
Pharmaceuticals  $4,601  8.4 
! 
I
Alabama  requested  technical  assistance  Planningand Evaluation  $3,S63  6.5 
to help  implement  the  Uniform 
Transportation  $2,645  4.8 
Reporting  System.  They  requested  that 
HRSA  staff make  periodic  site visits to  MentalHealth  $~316  4.2 
Treatmen~erapy/Counaelirrg 
help  Alabama  discuss  its progress 
towards  goals  they  have  set.  Administration  I  $1,931  3.5 
I 
FoodBank/HomeDeliveredMeals  $1,872  3.4 
Education/RiikReduction  $718  1.3 
PersonalHygiene/COBRA 
$684  1.3
Payments  I  I 
ComputerSupplies  $650  1.2 
!  ! 
DurableMedicalEquipment  I  $368  I  0.7 
DentalCare  $150  0.3 
Total  $54,868  100 
2 
Inthisreport,weusethetermmosttomeanmorethan50percent, 
4  Spent  % 
Alaska  ($121,737)  sewed  approxim4a-t:e-1ly- E  .egory 
325 people  through  2 conso]r. tla   w. nwn Ii L---aX.M,a.l-l,a.&u...,..a ..=t  $36,696  30.1 
cover  the  State.  The  majority  01  II  $20,710  17.0 
Continuationof HealthInsumnm 
Alaskas  consortia  funding  contributes  to 
$15,513  12.7 
case  management,  continuation  of health  pharmaceutical

I 
insurance,  and  pharmaceuticals.  The  MentalHealth  $10,727  8.8

Alaska  report  identifies  continuation  of  Trexment~eWY/~unSefing

health  insurance  coverage  as a growing  $8,577  7.1 
Administration 
need.  Although  this  service  is  expensive,  $8,577  7.1 
Planning& Evaluation 
h  allows Alaska  to save  on medical  care 
$8,244  6.8 
costs over  time  by decreasing  the  Edu@io@isk Reduction 
$7,445  6.1 
number  of  clients  who  have  their  health  MedicalCare 
care  paid  by  Medicaid  or  other  public  $3,522  2.9 
DentalCare 
payers.  One  consotiium  conducted  a 
$1,727  1.4 
study looking  at characteristics  of clients.  Transportation 
$121,738  100 
They  found  that  35 percent  of clients  Total 
had  been  homeless  at  some  point,  58 
percent  had  a history  of substance  abuse, 
and  22 percent  had  mental  illness  or 
dementia. 
Spent  % 
Arizona  ($484,227)  has two consortia  Category 
and  allocates  additional  Title  II consortia  $165,300  34.1 
CMManagement 
funds  to rural  Arizona  counties.  Arizona  $113,600  23.5 
HomeHealthCare 
spent  most  of  its  consortia  funds  on  case 
$65,300  13.5 
management  and  home  health  care.  DentalCare 
Arizonas  report  described  how  the  D, h1.m,-n.-l m---l-w-tics--als  S63,300  13.1  I 
consortia  will  solicit  public  and  1} S-.Y-, MIOtI I  11.0 
ClientAdVWXY  =! 
communi~  input  to identify  the  sefices  $17,727  .31.7 
most  needed.  I  Administration  I 
l~=jj=j=[
Arizona  identified  the  need  for technical 
assistance  regarding  data  collection 
under  the  Uniform  Repotiing  System,  II Day/Respitecafe 
and  how  to  promote  sefices  am a  ,.  1~  I  s484,227  I  100 
identify  cases  in rural  Arizona  counties.  IL---
They  had  some  difficulties  with  a 
contractor  who was providing  home 
health  services.  Due  to delays  in service,  they  discontinued  the  contract. 
5
 Arkansas  ($460,713)  has  five consortia.

Arkansas  spent  most  of its consortia

Category  Spent % 
funding  on pharmaceuticals.  The  report  I  I  l\

highlighted  a variety  of setice  related  Pharmaceuticals  !  $242,065  I  52.5  I

activities.  Two  consortia  established  HomeHealthCare  I  $65,000  14.1

! 
written  agreements  with Jefferson  I

CaseManagement  $58,928  12.8

Managed  Care  Program  to serve  clients 
in their  area.  This freed  up  consortia  Administration  $45,892  10.0

funds  to serve  other  clients.  Consortia  IIMedicalCare  I  $35,403  I  7,7  I

also have  been  involved  in:

IITransportation  $9,230  2,0  II
I 
r 
  making  arrangements  with  Education/RiskReduction  I  $4,195  I  0.9 
physicians  for primary  care; 
Total  $460,713  100 
	 negotiating  contracts  for 
pharmaceuticals; 
	 developing  agreements  with State  and  Federal  agencies  to decrease  the  amount 
of time  it takes  for  eligibility  determination  for all types  of public  assistance; 
  setting  up  support  groups  and  in-semice  training; 
	 developing  brochures  to help  clients  understand  entitlement  programs  in their 
counties; 
  negotiating  contracts  for AIDS  related  blood  testing  and, 
  arranging  transportation. 
In  addition  to  these  activities,  one  consortium  has  increased  access  to  case 
management  services  by  allowing  clients  to  contact  the  case  manager  through  a 24 
hour  toll-free  pager  system. 
Specific  administrative  activities  include: 
	 planning  for  a computerized  Local  Area  Network,  to  allow  case  managers  to 
track  client  progress  more  easily,  and  m  collect  data  for  reports  more  easily; 
  using  a needs  assessment  to  expand  the  mix  of services  offered;  and, 
	 developing  protocols  for  treating  patients  depending  on  what  criteria  the 
patient  meets. 
6
 The  report  mentions  two  administrative  barriers  to  consortia  activities  for  the  year. 
First,  their  peer  review  efforts  have  not  gotten  off the  ground.  Second,  a 
computerized  data  system  was  not  ready  because  the  consortia  could  not  order  the 
needed  equipment  until  April  of 1993. 
Cdifomia  ($7,581,153)  served  58 local 
Category  Spent  70

counties  and  1 city through  42 consortia.

They  added  four  new consortia  in FY  case  Management  $3,320,935  43.8

1992.  The  consortia  spent  most  of their  MedicalCare  $716,380  95

funds  on case  management  and  medical 
HomeHeaIthCare  $400,601  53

care.  California  references  its first year-

end  report  for description  of ongoing  HousingAssistance  $397,287  5.2

activities.  The  second  year  report  Emergenq FinancialAssistance  $368,599  49

centers  around  new consortia  activities. 
Administration  S325,269  43

Tranqxxtation  $311,667  41

In California,  the  Office  of AIDS 
contracted  with  an organization  to  assist  MentalHealth

$300,321  40

in development  of consortia.  The  five  Treatmen~erapy/Counseling 
major  activities  for the  contractor  Feed Bank/HomeDeliveredMeals  $274,507  3.6

include: 
HealthInsurance& Miscellaneous  $258,533  3.4 
ClientAdwx3cy  $240,137  3.2 
  facilitating  and  training  consortia 
members;  Buddy/CompanioSnemite  $227,582  30
Pharmaceuticals  $138,227  I.s 
  developing  strategies  to recruit 
and  maintain  membership  and  to  DentalCare  $100,511  [3 
clarify consortia/fiscal  agent  roles;  Day/RespiteCare  $72,937  10 
OtherCounseling/NoMt ental  $52,578  (): 
  providing  peer  support  by  Health 
developing,  linking  and 
In-HomeHospiceCare  $22,681  ill

distributing  models  of consortia

Education/RiskReduction  $22,598  03

organizational  and  operational 
structures,  functions  and  SubstanceAbuseTreatment  $12,711  ():

procedures; 
DurableMedkd Equipment  $10,268  01 
ResidentialHospiceCare  $6,826  0 1 
	 training  for the  Health  Insurance 
Premium  Payment  pilot  program  Total*  $7,581,155  1(M) 
and  reimbursement  of 
Thistotaldoesnotinclude$26,101s,pentbytwoconscmM
administrative  costs;  and,   
whohadnotsubmitteda reportofexpenditures. 
  facilitating  meetings  throughout 
the  year. 
Californias  report  also  described  some  highlights  of service-related  consortia  activities. 
During  FY  1992, consortia  became  eligibl~ o~ganizations  to apply  for  and  receive 
7  formula-based  allocations  for  the  Housing  Opportunities  for Persons  With  AIDS 
Program.  Another  unique  aspect  of the  California  consortia  istheir  role  in 
tuberculosis  (TB)  prevention.  The  Office  of AIDS  has  required  the  local  TB 
Controller  or designee  to be  a member  of the  local  consortia  by the  start  of the  third 
year  of Title  II funding.  The  goal of involving  the  TB controller  is to foster  an 
environment  that  promotes  treatment  compliance. 
California  reported  that  its biggest  challenge  regarding  delivering  services  through 
consortia  is that  they  do not  have  enough  funds  to hire  staff.  To  fill in the  gaps, 
consortia  use  in-kind  support  and volunteers. 
Californias  report  also described  administrative  activities  for the  year.  In addition  to 
routine  administrative  activities,  consortia  representatives  attended  the  Title  11CARE 
Act Rural  Capacity  Building  Conference  for consortia,  service  providers,  fiscal agents, 
people  with HIV,  and  at-risk  populations  in California.  This  conference  led  to the 
organization  of participants  into  the  California  Rural  HIV/AIDS  Association. 
Colorado  ($552,830)  served  over  1,000 
Catego~  I  Spent  70 
clients  through  four  consortia.  The 
, 1 
majority  of clients  are  served  through  CaseManagement  $423,634  76.6 
the  Metro  Denver  AIDS  Services 
Administration  $49,532  9.0 
Consortium.  The  consortia  spent  more 
MentalHealth
than  three-fourths  of their  funds  on case  $35,497  6.4 
Treatmentfierapy/Counseling 
management. 
MedicalCare  $31,947  5.8 
Although  Colorados  report  gave  little  In-HomeHospiceCare  !  $7,690  1.4 
I  II
detail  about  specific  services,  it described  DentalCare  $4,530  0.8 
some  of the  barriers  to  providing 
Total  $552.830  100
semices  through  consortia.  There  is a 
need  for  more  case  management  for 
rural  residents.  One  consortium  had 
difficulty  meeting  its  objectives  because  it had  to  remove  funding  and  change  the  lead 
agency  from  a community  based  organization  to  the  local  county  health  department. 
This  caused  another  community  based  organization  to  leave  the  consortium. 
8
 Colorado  devoted  most  of its year-end  report  to describing  administrative  activities. 
Specific  administrative  activities  include: 
  meeting  with consortia  members; 

 establishing  quality  assurance  programs  within  each  consortium  using  means 
such  as site visits, surveys and  peer  review  and, 

 investigating  a response  to needs  for long term  care  housing,  and  the  need  for a 
medical  management  clinic. 
Comecticut  ($597,171)  sewed  an 
Categoty  Spent  % 
estimated  400 unduplicated  clients  in 65 
towns in the  State  through  five consortia.  CaseManagement  $3S1,578  63.9 
Consortia  spent  nearly  two-thirds  of their 
Administration  $61,4S6  10.3 
funds  on case  management. 
MedicalCare  $59,432  10.0 
Consortia  used  second  year  funding  to  Transportation  $46,675  7.8 
add  case  management  positions  that  HomeHealthCare  $34,000  5.7 
target  populations  such  as Latino 
Other Cmmaeling/NoMtental 
communities,  pediatric  AIDS  projects,  $6,000  1.0 
Health 
and  persons  discharged  from 
FoodBanWHomeDeliveredMeals  $5,000  0.8 
correctional  facilities.  The  funds  also 
contributed  to semices  such  as  InsurancePremiumPayments  $3,000  0.5 
physicians  services,  laboratory  services, 
Total  $597,171  100

out-patient  treatment,  prescription  drugs,

nursing  services,  dental  care,  diagnostic

screening  and  home  health.  Consortia

added  support  services  such as dietary  counseling,  food  delivery,  health  insurance

assistance,  and  expanded  transportation.  They  are  in the  process  of developing  a

quality  assurance/retiew  process,  and  recruiting  more  persons  with  HIV/AIDS  to be

members  of consortia.

Connecticut  mentioned  several  challenges  consortia  face.  Consortia  are  having

difficulty  meeting  the  great  financial  demands  for transportation  services.  Also, there

are  questions  about  who  has liability when  subcontractors  provide  these  support

services.

9
 Delaware  ($53,800)  served  262 persons 
through  one  State-tide  consortium  made  Category  Spent  % 
up  of 44 members.  They  spend  most  of 
SupportSerncea  S18,500  34.4 
their  money  on support  services,  mental 
health  services,  and  substance  abuse  MentalHealth  $8,000  14.9 
TreatmenVIhemPY/GunseIing 
treatment.  Delawares  report  gave little 
detail  about  activities  except  that  they  SubstanceAbuseTreatment  $6,300  11.7 
hope  to expand  the  consortium  to  EmergencyFinancialAssistance  $16,000  29.7 
include  all who  provide  services  to 
Administration  $5,000  9.3 
persons  infected  with HIV. 
Total  $53,800  100 
Tlds includesbuddy/companiosneMces,clientadvocacy 
 
aeMcea,non-mentalhealthcounselingf,oodbankservic=~and 
transportation. 
The  District  of Columbia  ($684,970) 
served  739 persons  through  one  Category  Spent  % 
consortium.  The  consortium  spent  most 
CaseManagement  $409,196  59.7 
of its funds  on case  management. 
Among  its case  management  activities,  Planningand Evaluation  $137,ss7  20.1 
the  consortium  funded  organizations  to 
Administration  $92,240  13.5 
provide  targeted  case  management  for 
HousingAssistance  $45,647  6.7 
women,  children,  and  other  special 
populations  such  as homeless  and  Total  $6s4,970  100 
1. 
substance  abusers.  The  consortium 
developed  protocols  for case 
management  of women  and  children. 
The  consortium  conducted  a variety  of other  service-related  activities.  It received  a 
grant  to coordinate  an early  intervention  program  for persons  with HIV  in particular 
areas  of the  District.  This will include  testing  with  pre  and  post  counseling,  primary 
care,  and  psychosocial  services.  The  consortium  also funded  a housing  coordinator  to 
administer  the  Tenant  Assistance  Program.  The  housing  coordinator  also established 
agreements  with  rental  agencies,  coordinated  municipal  funds  to help  persons  with 
HIV,  and  applied  for additional  grant  funds  from  other  sources.  The  housing 
coordinator  created  a database  of available  housing  that  is now being  adapted  to be 
used  in conjunction  with  the  case  managers  information  system. 
The  District  of Columbia  report  mentioned  several  obstacles  to the  success  of service 
related  activities.  The  consortium  experienced  problems  due  to the  discontinuation  of 
some  matching  funds  it was using for  one  demonstration  site,  and  difficulty  filling a 
case  manager  aide  position.  Another  barrier  was that  the  timetable  for processing 
Title  11 applications  made  it difficult  to complete  a competitive  grant  making  process. 
The  District  of Columbia  consortium  also feels  that  minority  HIV/AIDS  semice 
providers  have  trouble  competing  for and  managing  funds  available  in the  District. 
10  Within  the  housing  area,  some  District  of Columbia  administrative  difficulties  delayed 
implementation  of the  city-wide  Supported  Assisted  Housing  Program. 
Florida  ($5,833,059)3 has  10 regional 
consortia.  Florida  spent  most  of its Title  Category  I  Spent  % 
I 
II funds  on case  management,  medical 
care,  and  pharmaceuticals.  Women  bse Management  !  $1,715,444 [  29.4 
represent  25 percent  of those  receiving  kfediealCare  \  $899,156  I  15.4 
care  through  the  consortia.  Children  Pharmaceutiak  !  $861,504  14.8 
account  for 4 percent.  I 
Administration  I  $590,063  I  10.1 
The  consortia  provide  a wide range  of  DentalCare  $355,137  6.1 
services  from  direct  medical  care  to bi- HomeHealthCare  $260,898  4.5 
monthly  infectious  disease  consultations. 
HousingAssistance  $190,485  !  3.3 
Case  managers  must  meet  daily, wee~y, 
and  monthly  semice  goals, and  consortia  Transportation  I  $181,292  \  3.1 
believe  they  served  more  clients  because  MentalHealth 
$151,479  2.6 
of this.  Florida  used  rollover  money  to  Treatment~empy/tiunseling 
provide  dental  awareness  education  and  Other Counseling/NoMt ental  I 
$147,778  L5 
mental  health  services  through  a mental  Health 
I I 
health  therapist.  At least  one  [nsursnceContinuation  I  $137,884  2.4 
consortium  used  funds  for insurance 
FoodBank/HomeDeliveredMeals I  $135,423  I  2.3 
coverage.  Also, money  for 
transportation  has  increased  access  to  SubstanceAbuseTreatment  !  $95,935  L6 
1 
care.  One  consortium  created  a  ClientOutreachandVolunteer 
$67,992  1.2 
Setices 
comprehensive  service  directory  in 
English,  Spanish,  and  Creole.  The  DusableMedicalEquipment  $34,065  0.6 
directory  is being  distributed  county 
Day/RespiteCare  $5,890  0.1 
wide. 
RehabilitationCarp  !  S2.633  I  0.1 
While  conducting  a recent  review,  a peer  Total  I $5,833,058  too 
 
review  committee  found  that  the  State 
had  difficulty  coordinating  Title  I 
planning  councils  and  Title  II consortia.  This  group  recommended  developing  data 
collection  for  consortia  to facilitate  coordinatmn.  Other  challenges  for  Florida  are  that 
spending  of  consortia  dollars  is behind  prt~jectlons,  and  consortia  also  face  obstacles 
identifying  providers  such  as  dentists. 
3 FloridalumpedtogetherallTMe11funding,sothemoncvamounrspresentedhereexceedwhatwasspentonconsortia 
alone. 
11
 Georgia  ($1,482,554)  spent  most  of its 
consortia  funds  on pharmaceuticals. 
Georgia  did not  submit  a year-end 
report. 
~  ,  ~7  3 
CaseManagement  $513,638  347 
DurableMedkalEquipment  $125,427  8.5 
Administration  $49,375  33 
Transportation  $37,853  2.6 
Other  $10,794  07 
Total  $1,482,554  100 
Guam  has no consortia. 
Hawaii  ($175,884)  serves  clients  through 
one  consortium.  A year-end  report  is 
Category  Spent  % 
not  available  for Hawaii,  but  they  did 
file a final  quarterly  report  with some  Administration  $40,884  232 
information  about  program  activities.  HousingAssistance  $36,939  21() 
Hawaii  spent  most  of its consortia  funds 
CaseManagement  $19,912  113 
on administration,  housing  assistance, 
MedicalCare  $16,166  92 
and  case  management.  One  unique  use 
of funds  in Hawaii  was that  the  DentalCare  $16,166  92 
consortium  used  funds  for  emergency 
Other(EmergencyItems,Housing 
supplies  and  housing  assistance  following  AaaistamxA, cupuncture&  $12,742  72 
MassageTherapy) 
Hurricane  Iniki. 
MentalHealth 
$10,568  bt) 
Treatment/Iherapy/Counseling 
FoodBank/HomeDeliveredMeals  $7,854  is 
Pharmaceuticals  $5,575  \2 
Transportation  $3,192  18 
Adoption/FosteCr are  $3,115  18 
HomeHealth(Me  $2,770  lb 
Total  $175,883  1()() 
12
 -..  .
ldaho  has  no consortia. 
Illinois  ($1,860,633)  served  clients  1 
Category  Spent  % 
through  4 consortia.  The  consortia  spent 
most  of their  funds  on administration  Administration  $515,635  27.7 
and  case  management.  Although  the 
CaseManagement  $451,714  24.3 
State  filed no year-end  report,  it 
MedicalCare  $360,345  19.4 
submitted  a final  quarterly  report. 
Housingksistance  $231,598  12.5 
The  consortia  met  most  of their  goals 
Food Bank/HomeDeliveti M~ls  $.176,770  9.5 
regarding  sencices such  as case 
support seMees  S74,525  4.0 
management,  housing  assistance, 
substitute  care,  and  in-home  services.  ClientAdvocacy  $12,000  0.6 
They  also improved  transportation  for  MentalHealth 
$10,345  0.6 
clients.  Treatment~em~/~unsehng 
Transportation  $10,187  0.6 
One  service  Illinois  consortia  hope  to 
LegalSerw@a  $9,918  0.5 
improve  is providing  dental  care.  They 
have  difficulty  recruiting  dentists.  One  DentalCare  $5,553  0.3 
consortium  also had  difficulty  recruiting  HomeHealthCare  $2,043  0.1 
primary  care  physicians  to seine  persons 
Total  S1,860,633  100 
with HIV. 
Illinois  consortia  also concentrated  on a 
variety  of administrative  activities  such  as improving  quality  assurance,  developing 
minimum  standards  of case  management,  and  impro~rtg  data  collection  capabili~ 
through  new software  or data  collection  forms. 
One  consortium  created  a newsletter  and  established  an advisory  board  with a peer 
review  subcommittee.  Some  consortia  members  appeared  at public  hearings  and 
media  conferences. 
Indiana  ($309,194)  served  417  HIV

infected  individuals  through  one 
Category  I  Spent  I  %
 II 
statewide  consortium.  The  consortium

spent  almost  of its  money  on  medical  MedicalCare  I  $173,549  I  56.1
 II 
care  and  administration,  56 percent  and  Administration  $134,643  43.6  !

!  ~ 
43 percent  respectively.  The  consortium 
DentalCare  $865  0.3

placed  a special  emphasis  on  targeting

MentalHealth  <0.1

women  and  children  for  setices,  $137 
T~tment~emw/Gll~gelin@
recruiting  dentists,  and  recruiting 
primary  care  physicians.  Service  IITotal  I  $309,194  100  [ 
providers  have  been  able  to  serve  all 
women  and  children  who  have  requested 
service,  but  they believe  that  man~ women  postpone  testing  for  HIV. 
13
 ~erepofi  described  several  obstacles  tosefice-related  consortium  activities.  The 
consortium  had  difficulty  recruiting  dentists,  and  one  area  of the  State  still has  a 
shortage  of primary  care  physicians.  Also,  although  the  Indiana  consortium  reports  it 
has no trouble  targeting  semices  to all the women  and  children  requesting  help,  many 
other  people  who wanted  services  remained  on the waiting  list because  Title  II funds 
were  insufficient  to provide  the  needed  services. 
Indiana  conducted  a variety  of administrative  activities  with  consortia,  including  an 
evaluation  of its activities  through  needs  assessments,  suxveys of clients  and  providers, 
and  public  hearings.  Indianas  report  also includes  a detailed  list describing  monthly 
activities  such  as meetings  and  conferences  attended,  promotional  activities, 
publications,  and  similar  activities. 
r 
Iowa  ($90,000)  served  an estimated 
Category  spent  %
1,120 clients  through  3 consortia.  I 
Consortia  spent  nearly  half  of their  funds  CaseManagement  $43,555  4s.4 
on  case  management.  Medical  care 
MedicalCare  $16,04S  17.8 
constituted  another  large  expenditure  for 
Emergenq Fhancial Assistance  $8,744  9.7 
lowa  consortia.  About  25 percent  of the 
services  provided  through  the  consortia  Administration/Planning/Evaluation  $6,009  6.7 
included  assistance  to  women,  children  Transportation  $5,9s4  6.7 
and  families.  One  consortium  hosted 
DentalCare  $5,039  5.6 
events  to  raise  money  and  public 
awareness  about  AIDS.  Another  way  Day/RespiteCare  $1,969  2.2 
consortia  have  worked  to  increase  Other Counseling/NoMt ental 
$1,706  1.9 
awareness  was through  a newsletter.  Health 
Pharmaceuticals  $946  1.0 
The  biggest  barrier  faced  by  Iowa 
Total  $90,000  100 
consortia  is the  growing  number  of  J 
clients  with limited  funds.  The  report 
describes  Iowas desire  to open  a new 
consortium  in the  western  part  of the  State  where  the  need  is great.  Iowa  also hopes 
to improve  accuracy  of reporting  for  consortia  services. 
Kansas  has no consortia. 
Kentucky  has no  consortia. 
14
 Louisiana  ($1, 124,648)  submitted  no 
report  on  the  number  of consortia  or  Category  Spent  % 
their  specific  activities.  Most  Louisiana 
ConsortiaDevelopment/  $343,991  30.6 
Title  II consortia  funds  were  spent  on 
VolunteerServices 
consortia  development  and  volunteer 
case Management  $304,517  27.0 
services,  and  case  management. 
MedicalCare  $135,276  12.0 
1 
EmergencyFinancialAssistance  $118,418  10.5 
ClientAdvocacy  $84,182  7,5 
1 
ResidentialHospiceCare  $73,005  6.5 
Transportation  $59,099  5.3 
Administration  $6,160  0.6 
TotaI  S1,124,648  100 
Maine  ($163,401)  has four  consortia  but

submitted  no  report  on their  specific

Category  Spent  % 
activities.  All Maine  Title  11consortia
 I 
funds  were  spent  on  case  management.
 CaseManagement  $163,401  100 
Statewide,  Maine  consortia  provided

over  400  encounters  with  295  clients.

Maryland  ($1,828,532)  has four

Category  Spent  % 
consortia.  Most  Maryland  Title  II

consortia  funds  were  spent  on medical
 MedicalCare  $686,680  37.5 
care  and  case  management.  In  1992,
 CaseManagement  $458,770  25.1 
1,555 clients  were  served  by Maryland

Administration  .$202,747  11.1 
consortia.  Marylands  annual  report

EmergencyFinancialAssistance  $153,800  8.4 
covers  the  period  7/1/92 to 6/30/93.

DentalCare  $142,000  7.8 
Maryland  also  described  consortia

MentalHealthTreatment/  $84,136  4.6 
activities,  including  public  hearings  on
 Therapy/Counseling 
the  needs  of people  with HIV/AIDS  and

HousingAssistance  $67,501  3.7 
the  proposed  use  of Title  II funds,
 1 
Outreach  I  $32,898  !  1.8 
consulting  with  service  providers

regarding  funding  priorities  and
 Tota[  $1,828,532  100 
I 
activities,  and  publishing  a newsletter  for

local  medical  providers,  clients  and

religious  leaders.

15
 Massachusetts  ($1,195,000)  has  16

consortia.  Most  Massachusetts  Title  II
 Category  I  Spent  70 
I  jl 
consortia  funds  were  spent  on  case

CaseManagement  S657,250  55 
management  (including  client  advocacy,

and  which  may  include  outreach,  buddy/
 Transportation  $167,300  14 
> 
companion  services,  non-mental  health

Administration  !  $131,450  I  11  II 
counseling  and  education/  risk

MentalHealthTreatment/  ]  $71,700  I  6  II 
reduction).  Statewide,  consortia  served

Therapy/Counseling 
1,545 clients.  The  Massachusetts
 I  I  II 
FoodBankiHomeDeliveredM=ds  $59,750  5 
Department  of Public  Health  conducted

a meeting  to discuss implementation  of
 HousingAssistance  $35,850  3 
HIV  Care  Consortia  programs.  This

Planningand Evaluation  $23,900  2 
meeting  addressed  both  service  providers

EmergencyFinancialAssistance  $23,900  2 
and  consumers.  Local  consortia  also

held  meetings  to educate  and  engage
 Phartnaceutieals  I  $11,950  I  I
I 
providers  and  clients  in consortia
 Acupuncture/Massage  $11,950  1 
activities.
 NutritionalCounseling 
I 
-rOtal  I $1,195,000  1(h) 
The  Massachusetts  consortia  treat  a

diverse  group  of clients.  While  one

consortium  mainly  serves  intravenous

drug  users,  another  focuses  on  children  with  HIV  and  their  families.  As  a result, 
Massachusetts  consortia  developed  several  initiatives  to  meet  the  needs  of their  clients 
and  to  respond  to  problems  they  face.  Among  the  consortia  initiatives  are: 
  hiring  bilingual/bicultural  staff  to serve  Haitian,  Latino,  and  Cape  Verdean 
populations; 
  developing  a volunteer  program  to provide  practical  supports  and  buddy 
services; 
  providing  support  for  entire  families  by using family-centered  case  manage me n(, 
and  holding  support  groups  for children  both  infected  and  affected  by AIDS: 
  co-sponsoring  a conference  on  women,  substance  abuse  and  HIV,  and 
establishing  a support  group  for  women:  and, 
  working  in conjunction  with a local  church  to expand  a frozen  meals  program. 
Specific  problems  faced  by Massachusetts  consortia  include: 
	 overcoming  the  overall  lack  of resources  and  institutional  supports  to  fully 
develop  the  needed  continuum  of semices; 
	 defining  the  appropriate  roles  of  the  lead  agencies,  contracted  agencies, 
consortium  leaders,  and  commit  tee  structures  in consortia  activities;  and, 
16
 	 integrating  consumer  advisory  boards  into  the  operation  of consortia.  A new 
State  requirement  mandates  25 percent  representation  on the  consortia 
governing  body. 
Michigan  ($912,929)  has five consortia.

The  summary  expenditure  report 
Category  Spent

indicates  almost  all Michigan  Title  11

consortia  funds  were  spent  on case

management.  Michigan  monitors

consortia  through  site visits and  quality

~  ,::,

assurance  activities.  Michigans 
Continuum  of Care  Coordinator  Total  $912,929  1(M)

provides  technical  assistance  to

consortia.

Barriers  faced  by  consortia  include  maintaining  the  required  provider-type

representation  in  the  consortia,  eliminating  potential  conflicts  of  interest  by  consort  la

members  since  they  possibly  stand  to  profit  by  consortia  activities,  and  encouraging

HIV  advocacy  groups  to  provide  input  to  consortia  planning  and  activities.

Minnesota  ($199,399)  has  21 consortia.

Most  Minnesota  Title  11consortia  funds 
Category  Spent  % 
I  I  II

were  spent  on case  management,

CaseManagement  $47,000  216

administration,  and  mental  health 
services.  Administration  $30,033  1s 1

4 
Minnesota  consortia  have  responded  to

clients needs  in innovative  ways.  One

consortium  provides  a dental  voucher

program.  They  have  entered  into  an  Counselingand Support  ~  W3,545  119  II

I 
agreement  with Delta  Dental  of  Med@lCare  $16,833  lit

I

Minnesota  to ensure  dental  care  for low  ClientAdvocacy  $16,585  8.3 
income  persons  with HIV  disease.  This 
Dental  $.7,974  4()  II

contract  has  led  to an increase  in the  ! 
I

number  of dental  care  providers  skilled  Transportation  $4,429  2:

in treating  HIV  infected  individuals. 
Total  $199,399  100

Other  consortia  addressed  the  need  for

short  term  education  and  support

programs  for persons  newly diagnosed

.-
with HIV  disease.  Five  diverse community-based  agencies  provide  these  services. 
Barriers  still remain  in providing  transportation  sefices  outside  the  Twin  Cities  area. 
Because  Minnesota  Medicaid  covers  transportation  services,  they  are  not  reimbursable 
by the  consortia.  However,  the  consortia  report  barriers  to using Medicaid 
transportation  services. 
17
 Mississippi has no consortia. 
Missouri  ($636,442)  has  one  consotiium.  Spent  % 
Category 
The  summa~  expenditure  repofi 
$351,178  55.2 
indicates  most  Missoufi  Title  11  HomeHealthare 
consotiium  funds were  spent  on home  $87,582  13.8 
Mdkal Care 
health  care.  The  consofiium  is  $75,787  11.9 
TmnspO~tiOn 
organized  into  three  branches:  St. Louis, 
$43,635  6.9 
Kansas  City, and  Outstate,  which	 MentalHealthTreatment 
~empy/Counseling
includes  the  rest  of the  State.  Statetide, 
$37,982  5.9 
the  consofiium  seined  1,070 clients.  HousingAsais~n@ 
$36,842  5.7 
FoodBanwome DeliveredMeals 
Most  consofiium  services  are  delivered  $3,436  0.5 
Dentalam 
on a fee-for-sefice  basis with  303 health 
$636,442   100 
setice  agencies  and  81 physicians  under  Total  A 
contract  to provide  medical  services. 
Montana  ($57,970)  has five consotiia.  Spent  % 
Categoty 
Most  Montana  Title  11 consofiia  funds 
$16,270  28.1 
were  spent  on medical  care,  Mexlkdore 
administration,  and  case  management.  $11,800  20.4 
Administratiotl 
Statewide,  the  consotiia  seined  87  $8,400  14.5 
~  Management 
clients. 
$4,700  8.1 
phamaceutids 
Four  of the  Montana  consortia  are  local  $3,200  5.5 
Dentalcare 
health  depafiments,  who  contracted  with  $3,100  5.3 
MentalHealthTreatment/
the  State.  These  consotiia  submitted 
~empy/Counwling 
bills to the  State  for sefices  from  $2,800  4.8 
Housing  ASSiS~ltCe 
providers;  their  administrative  costs were 
$2,600  4.5 
a fixed amount  specified  under  the  MiscellanmmItemsand Sefi= 
(e.g.,linen,monitoringequipment,
contract  with  the  State. 
g~t-iea,  etc.) 
$1,800  3.1 
HomeHe.dth~m 
The  fifth  consofiium,  a community-based 
$1,700  2.9 
organization,  was awarded  funds  Educatiofiisk Reduction 
separately.  Since it was not  covered  by  -is  $900  1.5 
FoodBank/HomeDeliveredM
the  State  contract  with the  other  $600  1.0 
Tmnqxxtation 
consofiia,  it processed  and  tracked  its 
$100  0.2 
expenditures.  Like  the  other  consortia,  ClientAdv@W 
it repofis  details  of expenditures  to the  $57,970  100 
Total 
State,  but  is reimbursed  for actual  IL 
expenses,  rather  than  a fixed, contracted 
amount. 
18
 Nebraska  ($15,592)  has  one  consortium. 
Most  Nebraska  Title  II consortium  funds 
Categoty  Spent 
I  I  70 
were  spent  on case  management, 
CaseManagement  $6,990  44.9 
equipment  and vision  care.  The 
consortium  served  15 clients  in the  Tri- Equipmentand Vkion Care  $2,075  13.3 
City area  of Grand  Island,  Hastings  and 
Transportation  $1,3s1  8.9 
Kearney,  located  in central  Nebraska. 
DentalCare  $1,2s0  8.0 
The  consortium  has hired  a Care  Phatmaeeutida  $1,22s  7.9 
Coordinator  to continue  building  the  Outreach  $s00  5.1 
consortium.  The  Care  Coordinator,  in 
ClientAdvocacy  $711  4.6 
addition  to case  management 
responsibilities,  contacted  physicians,  Administration  $535  3.4 
dentists,  psychologists,  counselors,  drug  FoodBank/I-IomDeeliveredMeals  $230  1.5 
treatment  agencies,  faith  communities, 
HousingAssistamx  $203  1.3 
and  local  health  departments.  The  Care 
Planningand Evaluation  $192  1.2 
Coordinator  facilitated  a meeting, 
bringing  together  drug/  alcohol  treatment  Total  $15,592  100 
center  providers,  mental  health  agencies, 
HIV/Sexually  Transmitted  Disease 
(STD)  representatives,  and  family planning  staff members.  This  meeting  led to  a 
cross-training  conference  and  fostered  collaboration  between  these  entities. 
Nevada  has no  consortia. 
New Hampshire  has no consortia. 
New Jersey  ($2,407,708)  had  six consortia  in the  FY  1992 reporting  period,  and  has 
added  a seventh  consortium  since  then.  Most  New Jersey  Title  II funds  for the  six 
consortia  were  spent  on case  management,  medical  care,  and  dental  care.  (See  table 
next  page.)  Statewide,  five consortia  report  providing  more  than  15,000 services 
during  the  year.  The  sixth consortium  reports  serving  nearly  1,000 clients. 
Some  specific  New Jersey  consortia  activities  include: 
	 supporting  alternative  methods  of medical  care  such  as acupuncture, 
chiropractic  and  nutritional  programs; 
	 publishing  a tri-county  resource  guide  to services  for people  with HIV,  and  a 
guide  to entitlement  programs; 
  placing  case  managers  at  community  support  service  agencies; 
	 instituting  an experimental  retinal  photography  program  to detect 
cytomegalovirus  retinitis; 
19
 New Jersey  (Continued) 
Categoty  Spent  % 
I  1 II 
	 installing  special  phone  lines for 
CaseManagement  $577,500  24.0 
hearing-impaired  clients;  and, 
MedhxICl are  $509,992  21.2 
c	 integrating  early intemention 
DentalCare  $198,361  8.2 
primary  care  medical  services  into 
Administration  $187,105  7.8 
methadone  maintenance 
programs.  Transportation  !  $177,431  I  7.4 
II 
Planningand Evaluation  $152,109  6.3 
!  ! 
The  consortia  cite  the  reluctance  of  II 
MentalHealthTreatment/  .$128,823  5.4 
county  and  local  hospitals  to provide 
Therapy/Counseling 
primary  care  services  for clients  with 
HIV/AIDS  as a continuing  barrier  to  SubataneeAbuseTreatment  I  $93,678  [  3.9  I 
treatment.  Outreach  I  $89,043  I  3.7  1] 
Day/RespiteCare  $69,270  2.9 
Title  II reporting  requirements  present 
Food BanWIomeDeliveredMeals  $37,682  1.6 
some  difficulties  for consortia  as well. 
ParalegalSeMea  $36,222  1.5 
The  consortia  directors  fear  that  the 
complexity  of reporting  may discourage  HomeHealthCare  $27,892  1.2 
some  individual  service  providers  from 
Pharmaceuticals  $27,646  1.2 
participating.  Likewise,  large  providers, 
Education/RiskReduction  $26,183  1.1 
like hospitals,  may not  wish to provide 
considerable  detail  about  these  Other Counseling/NoMt ental  $25,098  1.0 
Health 
expenditures,  since  they  receive  a very 
small  part  of their  total  funding  from  ClientAdvocaq  $18,375  0.8 
Ryan  White  funds.  In-HomeHoapieeCare  $18,000  0.8 
HousingAaaNance  $5,798  0.2 
I 1 
RehabilitationCare  I  $1.500  I  0.1  II 
I
Total  $2,407,708 I  100 
II 
20
 % 
New Mexico  ($63,000)  has one  1!  Catego~  I  Spent  I
consortium.  Most  New Mexico  Title  II  1 
IIClientMvoeacy  I  $22,0W  34.9 
consortium  funds  were  spent  on client 
I  II 
advocacy,  and  outreach.  Statewide,  the  IOutreach  $19,000  30.1 
consortium  served  750 clients. 
Transportation  $17,000  27,0 
r  , 
EmergencyFhancialAssistance  $3,000  4.8 
Although  New Mexico  did not  submit  a 
~~ 
year-end  report  for FY  1992, their  Administration  $2,000 
I
fourth  quarter  report  for N  1992 
ITotal  I  $63,000  100 
I  1[
described  several  consortium  activities. 
The  consortium  emphasized  services  to 
women  and  children  by holding  a 
Women  with AIDS, workshop  and  a Families  with AIDS  workshop.  In addition, 
150 consumers  and  providers  attended  a statewide  HIV/AIDS  symposium,  with 
workshops  focusing  on treatment  issues,  systems  advocacy,  prevention  strategies  in 
rural  areas,  and  rural  and  cultural  barriers  to semice  delivery. 
New York  ($8,179,779)  has  16 consortia.  Most  New York  Title  II consortia  funds 
were  spent  on case  management,  home  health  care,  and  sewice  planning  and 
coordination.  (See  table  next  page.) 
Some  New York  consortia  activities  include: 
	 establishing  an HIV/AIDS  Network  for the  Deaf  committee,  which will develop 
educational  materials  and brochures,  and  work  toward  coordination  among 
agencies  seting  this population; 
	 making  presentations  on topics  such as HIV/STD,  tuberculosis  (TB)  control, 
hepatitis&UV  and  behavior  modification  in the  gay community; 
c	 sponsoring  a TB/HIV  community  conference,  targeting  community  members, 
clergy, legislators,  school  officials,  and  service  providers; 
  developing  a training  outline  on Native  Americans  and  HIV; 
	 developing  a program  for the  county  prison  to provide  adequate  HIV/AIDS 
training  for  corrections  officers; 
	 fostering  linkages  between  hemophiliac  centers,  the  Designated  AIDS  Center, 
medical  centers  and  Community  Based  Organizations; 
	 working  to open  a residential  facility  that  will offer  comprehensive  services  to 
women  with AIDS  and  their  families; 
21
 New York  (Continued) 
Categoty  Spent  % 
	 facilitating  expansion  of 
CaseManagement  $2,263,633  277 
transportation  services  for all the 
I 
networks  counties; 
	 developing  a resource  directory  of 
community-based  agencies, 
organizations,  support  groups,  OtherCounseling/NoMt ental  $576,256  7.0
Health 
primary  care  providers, 
homeopathic  and  allopathic  Outreach  !  $547,799  67  II
[ 
providers;  Information  $439,792  54 
DentalCare  $406,807  <O 
	 sponsoring  a Speak-out  where 
persons  lfing  &th  AIDS  will  Transportatim  $395,812  4,3 
voice  their  needs  and  identify  HousingAssistance  $264,522  1: 
barriers  to care  to an audience  of 
elected  officials  and  service 
providers;  and, 
	 advocating  against  the  closing of  TechnicalAssistanceto Providers  I  $109,301  I  1.3  II
test  sites.  IIFoodBanM1-IomDeeliieredMmls  $109,301  1.3 
I 
1 1 
ClientAdvocacy  $64,028  03 
!  ! 
New York  consortia  cite the  following  II 
LegalSemites  $39,452  ()5 
barriers  to providing  services: 
Buddy/CompanioSnefi- $33,631  {)J
	 overcoming  special  semice  needs  - ProviderTrainingon ClinicalCare  $20,696  02  II
I  I 
including  counseling  and  testing  Iwlea 
services,  services  for inmates,  RecreationalActivities  $10,995  01 
dental  services,  womens  services, 
In-HomeHospictCam  I  $9,701  I  01  II 
Spanish-speaking  providers,  and 
mental  health  semices  for HIV- Day/RespiteCare  $9,701  01 
positive  people  who  are  Total  $8,179,777  100 
a 
recovering  from  substance  abuse; 
making  mental  health/psychotherapy  services  part  of the  continuum  of serviccs: 
increasing  the  number  of physicians  who provide  early  intervention  and  prima v 
care,  particularly  in rural  areas; 
surmounting  the  obstacle  of physicians  who  are  willing to provide  semices  to 
HIV-infected  individuals  but  who  do not wish to be  identified; 
guaranteeing  anonymous  HIV  counseling  to those  who want  confidentiality; 
providing  local TB diagnostic  testing; 
22    addressing  concerns  relating  to  HIV-infected  senior  citizens;  and, 
	 securing  adequate  representation  from  minorities  and  persons  living with AIDS 
on the  network. 
North  Carolina  ($947,421)  has  11 
Category  Spent 
%0
consortia  but  submitted  no report  of

Management  $391,494  41.3

individual  consortia  activities.  Most  case 
# 
North  Carolina  Title  II consortia  funds  HomeHealthCare  I  $231,508  I  24.4  ]]

were  spent  on case  management  and 
EmergencyFinancialAssistance  $114,719  12.1

home  health  care.

Transportation  $51,513  5.4 
Challenges  facing  consortia  were  ClientAdvocacy  $44,504  4.7 
outlined  at the  March  1993 statewide 
Administration  $30,857  3.3 
leadership  conference,  TIM Impact  of 
MentalHealthTreatment/  $28,190  3.0
AIDS  in North  Carolina.  To  date,  most 
Therapy/Counseling 
North  Carolina  consortia  have  struggled 
with issues  relating  to providing  services  Medical Care  $18,145  1.9 
and  managing  funds,  without  the  benefit  Other SupportSetiees  $15,627  1.6 
of significant  planning  and  development.  Pharrnaceutieals  $12,675  1.3 
Administrative  and  development 
DentalCare  $3,932  0.4 
limitations  of the  funds  have  prevented 
most  consortia  from  hiring  full-time  DurableMedicalEquipment  $3,235  0.3 
development  and  administrative  staff.  Day/RespiteCare  $806  0.1 
RehabilitationCare  $216  <.01 
Total  S947,421  100 
23
 North  Dakota  ($90,000)  has  one 
consortium  but  submitted  no report  of  II  Categoty  I  Spent  I  % II

consortium  activities.  All North  Dakota 
Pharmaceuticals  $58,500  65.0 
Title  II consortia  funds  were  spent  on 
pharmaceuticals  and  medical  care.  MedicalC-are  $31,500  35.0 
r 
1 
1! I  $Wm I 
Total  100  II 
Ohio  ($703,929)  has nine  consortia. 
More  than  two-thirds  of Ohio  Title  II  Categoty  Spent  % 
consortia  funds  were  spent  on housing 
HousingAmistance  $492,736  70.0 
assistance.  Statewide,  the  consortia 
served  2,023 clients.  Food Bank/HomeDeliered Mm~  $67,913  9.6 
MediealCare  $43,751  6.2 
Ohio  contracted  with Nationwide 
Transportation  $28,777  4.1 
Insurance  Company  as its third  party 
administrator  to develop  a  ThirdPartyAdministrator  $20,935  3.0 
reimbursement  system  for providers  of  DentalQme  $13,200  1.9 
services  to persons  and  families  with 
EmergencyJ3nancialAsaiitance  $10,497  1.5 
HIV  disease. 
MentalHealthTreatment/  $6,086  0.9 
Therapy/Counseling 
Ohio  consortia  face  several  challenges. 
Because  of funding  shortfalls,  Ohio  RehabditationCare  $3,809  0.5 
consortia  reduced  yearly  State- BereavemenStervi@a  $3,673  0.5 
established  limits  to between  $250-$500 
Pharmaw.uticala  $3,654  0.5 
per  individual  in order  to provide 
ChildCare  $2,560  0.4 
coverage  throughout  the  program  year 
without  interruption.  Peer  review  SubstanceAbuseTreatment  $2,300  0.3 
processes  need  to be  developed  for 
DurableMedkalEquipment  $2,013  0.3 
consortia  as well. 
HomeHeahh Care  $1,600  0.2 
ClientAdvocacy  $425  0.1 
Total  $703,929  100 
 lWa includes$5,053in interestearnedon the amountset aside 
($698,876)for consortia. 
24  Oklahoma  ($160,000)  has  two consortia. 
Nearly  equal  amounts  of Oklahoma  Title 
Category  Spent  % 
11consortia  funds were  spent  on 
Pharmaceuticals  $29,000  18.1 
pharmaceuticals,  substance  abuse 
I i 
treatments,  administration,  planning  and  SubstanceAbuseTreatment  $21,000  13.1 
evaluation,  client  advocacy  and  outreach. 
Adminiatration  $20,328  12.7 
Planningand Evaluation  $20,328  127 
Oklahoma  did not  submit  a year-end 
report  detailing  specific  activities.  ClientAdvocaq  $20,328  12.7 
Outreach  $20,328  12.7 
Oregon  ($280,323)  served  clients  through 
Catego~  Spent  % 
seven  consortia  organized  by regions 
around  the  State.  Consortia  spent  most  CaaeManagement  $130,000  46.4 
of their  funds  on case  management  and 
HomeHealthCare  $37,000  13.2 
home  health  care. 
AdoptionlFoateCrare  $25,000  8.9 
Some  consortia  used  a unique  approach  Day/RespiteCare  $20,000  7.1 
to increase  clients  access  to services. 
ClientAdvoeacY  $15,000  5.4 
They  distributed  vouchers  to clients  to 
MedicalCare  $15,000  5.4 
help  connect  them  with medical  care. 
Participating  pharmacies  and  care  Emergenq FinancialAaaiitance  $10,OOO  3.6 
facilities  agree  to accept  vouchers  as  DentalCare  $8,000  2.9 
payment  from  clients  for HIV-related 
Transportation  $6,323  2.3 
services.  Each  consortium  has 
conducted  a variety  of outreach  FoodBanIdHomeDeliieredMeala  $6,000  2.1 
activities,  with  one  county  in particular  HousingAaaiatance  $5,000  1.8 
targeting  the  Native  American 
Pharmaceuticals  S3,000  1.1 
population. 
Total  $280,323  10Q 
25
 Pennsylvania  ($1,495,668)  served  over 
4,000 clients  through  7 consortia. 
Category  Spent  70 
Consortia  spent  most  of their  funds  on 
the  following  activities:  case  Caae  Management  $365,220  24.4 
management,  family home  workers,  FamilyHomeWorkem,Volunteer 
volunteer  training,  professional  training>  Training,ProfessionaTlraining,  $224,097  15.0 
and HIV Chmaeling& Testing 
HIV  counseling,  HIV  testing,  and 
emergency  financial  assistance.  Emergency13nanciaAl aaiatance  I  $218,421  I  14.6 
Administration(includingsome 
$187,137  12.5
Pennsylvania  increased  minority  PlanningandEvaluation) 
participation  in consortia  and  the  State  MedicalCare  $166,064  11.1 
wide  HIV  Adviso~  Council.  Each 
PlanningandEvaluation  $118,717  7.9 
consortium  is represented  on the  State 
Buddy/CompanioSnervices  S44,256  3.0 
HIV  Advisory  Council. 
Tranapotition  $42,233  2.8 
I  I 
The  consortia  representatives 
Mentalhealth 
$41,787  2.8
contributed  to the  Advisory  Councils  TreatmentAlerapy/Coun=ling 
work  toward  housing  needs  assessments, 
Outreach  S27,648  1.9 
and  other  service  needs  assessments. 
HousingAskance  $19,494  1.3 
They  also worked  to develop 
consolidated  data  collection  that  would  HomeHealthCare  $11,070  0.7 
meet  Federal  and  State  reporting  Education/RiskReduction  $10,143  0.7 
requirements. 
SubstanceAbuseTreatment  $9,579  0.6 
Barriers  Pennsylvania  mentioned  include  DentalCare  $9,098  0.6 
contracting  and  program  reporting.  ClientAdvocacy $704  0.1 
+ 
Some  of the  consortia  contracts  were 
Total  I S1,495,668  100 
delayed  due  to State  regulations  about 
how money  must  be  allocated  by State 
agencies.  Also,  timely  reporting  of data 
was a problem.  How&er:  the  S~ate hopes  to improve  this through  its new client  level 
data  reporting  system  and  through  a newly established  statistical  position  for someone 
to monitor  and  coordinate  data  collection.  Puerto  Rico  ($2,840,858)  seined  its  % 
clients  through  seven  consortia.  Puerto  Categoty  1  Spent  I
Rico  spent  between  10 and  20 percent  CaseManagement  $528,839  18.6 
!  ! 
of its consortia  funding  on the  following 
Pharmaceuticals  !  $366,869  !  12.9 
categories:  case  management, 
pharmaceuticals,  home  health  care,  and  HomeHealthCare  I  $363,061  I  12.8 
residential  hospice  care.  Puerto  Rico  ResidentialHospiceCare  $299,983  10.6 
did not  submit  a year-end  report.  MedicalCare  $265,762  94 
Puerto  Rico  spent  money  on some  1 
Spentbut not documentedby  I  I 
innovative  services  such as nutritional  $264,222  93
subeontrsctots 
supplements,  legal  services,  a respiratory 
Administration  I  $206,538 !  73 
therapist,  and  childrens  summer  camp.  I 
HousingAaaktanee  $112,310  ~o  I 
~ 
I 
Approximately  nine  percent  of Puerto  NutritionalSupplements  I  $106,366  %7  41
Ricos Title  II funding,  or $264,222 has  I 
EmergencyFinancialAssistance  I  $81,846  2.9  I 
been  spent  but  has  not  been 
I 
documented  by subcontractors.  MentalHeahltAherapy/CcwtaelingI  $74,119  I  ~b  Ii 
IIDay/RespiteCare  I	 $41,215  I  1.5 
nTransportation  ~
 $37,759  I  13
IIDentalCare  I  $32,544  I  1.2

IIBuddy/CompanioSnervieea  !  $27,620  1  1.0

DurableMediealEquipment  $8,846  03 
ClientAdvoeaey  $6,000  0.2 
I 
II Respiratotyllterapist  I  $5,950  I  02 
IiMedicalSuppIies  $3,276  0.1 
!  I 
PharmacistAssistant  $2,657  01 
ChildrenSummerCamp  $2,240  0.1 
r I 
IILegal Serviee  ]  $1,998  I  0.1 
[! Outreach  I  $840  I  <0.1 
Total  $2,840,860  lwt 
I  * 
Rhode  Island  has no consortia. 
27
 South  Carolina  ($297,252)  seined  an 
Category  Spent  % 
estimated  378 individuals  through  3 
consortia  around  the  State.  South  MexiieaClare  $189,639  63.8 
Carolina  spent  nearly  two-thirds  of  its  Pharmaceuticals  $65,327  22.0 
consortia  money  in medical  care. 
CaseManagement  $34,7s6  11.7 
Specific  consortia  activities  include 
physician  training  on  HIV/AIDS  Other  Counseling/Not  a Mental 
$7,500  2.5 
Health
therapies,  participation  in drug  studies  so 
that  qualified  patients  receive  free  Total  $297,2S2  100 
medications,  establishing  support  groups, 
and  developing  brochures  to  raise  public 
awareness  about  services. 
One  barrier  mentioned  is that  some  clients  are  concerned  about  confidentially  when 
participating  in  support  groups. 
Tennessee  has no  consortia. 
Texas  ($5,650,696)4  served  clients  through  26 consortia.  Texas  spent  most  of its 
consortia  funding  on case  management,  medical  care,  and  food  bank/home  delivered 
meals.  (See  table  next  page.)  Although  they prepared  narrative  quarterly  reports, 
they include  no narrative  with the  year-end  report,  but  simply a statement  of 
objectives  and  goals  and  whether  or not  these  goals have  been  met. 
One  service  related  activity  described  in detail  was the  creation  of a support  group  for 
male  HIV-infected  inmates. 
Specific  administrative  activities  include: 
  organizing  a Lead  Agency  Workshop  where  representatives  from  consortia 
gathered  to prepare  guidelines  for the  HIV  Service  Delivery  Areas  and  discuss 
areas  of concern; 
  making  site visits to consortia  to assure  the  timely  and  skilled  delivery  of 
medical  and  psychosocial  services; 
establishing  and  implementing  a needs  assessment  process  for the  consortia; 
Q 
  coordinating  with State  agencies; 
  implementing  a planning/public  hearing/public  comment  process;  and, 
automating  reporting  from  each  consortia. 
9 
4  Texas included money for the Home and Community-Based  Care Option of Title II in its Consortia  btego~.  This is also 
reflected in the table for Texas Consortia seMces  by category. 
28  Texas  (Continued) 
r 
CAegoty  Spent  % 
Texas  requested  guidance  from  HRSA 
during  the  year  on how Title  II sites  Caae Management  $1,977,648  35.0 
administer  sliding scale  fees  and  in-kind  MedicalCare  $755,740  13.4 
contributions.  One  of its quarterly 
Food Bank/HomeDeliveredMeaIa  $386,048  6.8 
reports  also mentions  that  despite 
repeated  requests,  the  State  cannot  Home Health Care  $355,088  6.3 
obtain  information  about  how Ryan  IIOther Counseling/Not  Mental  I  II 
$310,888 
White  Title  I and  Title  IIIb  funds  are  Health  I  55 
spent  in Texas.  As a result,  Texas  Residential  Hoapiee Care  $298,316  5.3 
officials  cannot  be  sure  that  consortia 
Dental  Care  $259,888  4.6 
semices  are  not  duplicating  services 
In-Home Hoapiee Care  $253,916  4.5 
already  provided  under  these  titles. 
Tranapaation  $203,636  3.6 
Volunteers  S198,648  3.5 
Pharmaceuticals  $149,684  2.7 
Day/respite Care  $144,020  2.6 
Housing Aaaiatanee  $88,020  1.6 
Buddy/Companion  Serwixa  $79,664  1.4 
Education/Riik  Reduetion  $73,404  1.3 
Durable  Medieal Equipment  $52,688  0,9 
Client Advocacy  $51,400  0,9 
Sign Language/Interpretation  $12,000  0.2 
I Total  $5,650,696  100 
I  [ 
29  Utah  ($99,071)  spent  most  of its funds

on mental  health  treatment  and  dental  II  Catezorv  I  Spent  I  %

care.  There  is no year-end  report 
available  for Utah.  IIMental Health  36.9 
$36,553 
Treatmen~erapy/Counseling 
Dental Care  $21,441  21.6 
Client Advocacy  $12,381  12.5 
Education/Risk  Reduction  $10,063  10.2 
Medical Care  $6,657  6.7 
I I 
IIEmergencyFinancialAaaiatance  I  $4,420  I  4.5 
II
Transportation  S2,628  2.7 
! 
I 
II
Substance Abuse Treatment  $2,450  2.5 
!  I 
IFoodBank/HomeDeliveredMeala  $1,5s6  1.6 
Pharmaceutical  $s8s  0.9 
IITotal  $99,067  100  II 
I  I 
Vermont  ($30,000)  has  one  consortium.

All Vermont  Title  II consortium  funds

C3tegory
 Spent  % 
were  spent  on plaming  and  evaluation. 
The  consortium  conducted  a statewide  Planning and Evaluation
 $30,000  100 
needs  assessment,  and  as a result,  is

developing  a resource  guide  to HIV-

related  services  in Vermont.

Virginia  ($871,219)  has  five consortia.  The  summary  expenditure  report  indicates  that 
most  Virginia  Title  II consortia  funds  were  spent  on case  management  and  medical 
care,  (See  table  next  page.) 
Virginia  cites  the  potential  conflict  of interest  as a constant  struggle  for consortia, 
noting  it is difficult  to assure  that  those  who will profit  from  the  funds  do not  make 
the  decisions  about  awarding  them.  In many  areas,  the  only agencies  that  are 
interested  in belonging  to the  consortium  are  those  that  expect  to get financial 
benefits. 
30
 Virginia  (Continued) 
Category  Spent  % 
Other  barriers  faced  by  Virginia 
consortia  include:  Case Management  $270,269  31.0  I 
J 
Medkzd Care  $250,000  28.7 
(cid:31) finding  an objective  committee 
Administration  $87,122  10.0  ~ 
with  the  time  to  conduct  peer 
Planning and Evaluation  $43,560  5.0 
reviews; 
Mental Health Treatment/  $30,000  3.4 
Therapy/Camaeiing 
(cid:31) determining  the  needs  of clients 
through  organized  and  scientific  Pharmaceuticals  $26,768  3.1 
needs  assessments; 
Emergency Fhtancial Asaiitance  $26,000  3.0 
Dental Care  $25,000  2.9 
(cid:31) restricting  administrative  funds 
available  to consortia  and  Outreach  $25,000  2.9 
subcontractors;  and,  Other  Counseliss@Not Mental  $15,000  1.7 
Heakh 
(cid:31) the  regulation  prohibiting  Transportation  $15,000  1.7 
payments  of physician  consultant 
Day/Respite  Care  $15,000  1.7 
fees when  the  patient  had  to be 
hospitalized.  Home Health (kc  $10,OOO  1.2 
Client Advocacy  $7,000  0.8 
Housing Assistance  $6,000  0.7 
FoodBank/HomeDeliveredM~ls  $5,000  0.6 
Adoption/FosteCrare  $4,000  0.5 
Eduation/RiskReduction  $3,000  0.3 
ResidentialHospiceCare  $2@O0  0.2 
DurabteMedicalEquipment  $2,000  0.2 
SubstanceAbuse Treatment  $1,500  0.2 
Buddy/Companion Semi=  $1,000  0.1 
Rehabilitation  Care  $l,oact  0.1 
 
Trd  $871,219  100 
 
Virgin  Islands  have  no  consortia. 
31
 Washington  ($712,451)  has  three 
consortia.  The  summary  expenditure  I 
Categoty  Spent  % 
report  indicates  that  most  Washington 
I 
Title  II consortia  funds  were  spent  on  MedieaClare  $433,717  I  609
medical  care.  Washington  did not  Substance Abuse Treatments  $101,249  14.2 
!  I 
submit  a year-end  report  detailing 
ClientAdvocacy  $61,182  8.6 
I  ! 
specflc  consortia  activities. 
Planning and Evaluation  $50,000  7.0 
Administration  $48,762  6.8 
Housing Asaiatance  $14,279  2.0 
!  ! 
Mental Health Treatmettt./  $3,262  05 
Thempy/Gxmaeling 
Total  $712,451  I(n) 
West  Virginia  ($109,016)  has  one 
consortium.  Most  West  Virginia  Title  II 
Categoty  Spent  % 
consortium  funds were  spent  on case 
management.  Case  managers  are  Caae Management  $59,175  54.3 
serving  245 HIV  infected  clients.  Housing Aaaiatanee  $16,473  151 
Pharmaeeuticala  $11,228  103 
The  West  Virginia  consortium  is 
compiling  a service  directo~,  but  reports  Medieal Care  $7,671  70 
problems  with health  care  providers  not  Administration  $4,825  44 
! 
I 
wanting  publicity.  Although  these 
FocalBank/Home Delivered Meala  $4,474  41 
providers  serve  HIV  clients,  they  do not 
Transportation  $2,307  2.1 
wish to be  identified  in the  HIV  service 
1  I 
directoq  being  developed  by the  Dental Care  !  $1,240  I  11 
consortium. 
Insurance  $905  0.8 
I 
Emergency F!nancial Aaaktanee  $352  0.3 
I 
In-Home Hospice Care  $266  ~  02 
[ 
Residential  Hospice Care  $100  01 
I 
1 
32
 Wisccmsin( $480,878)  has nine  consortia, 
Most  Wisconsin  Title  11 consortia  funds 
Category  Spent  % 
I  I 
were  spent  on case  management  and 
~  Management  $165,552  34.4 
medical  care.  I 
Specific  consortia  activities  include: 
Therapy/Cowehg
~
(cid:1) translating  English  language  Planning and Evaluation  $51,247  10.7 
brochures  into  Hmong  to increase 
Administration  $39,609  8.2 
client  outreach; 
I 
Buddy/Companion  Servieea  $2s,367  I  5.3 
(cid:1) providing  SUppOfi  group  scfices 
for  HIV  positive  clients  of  the 
Milwaukee  Indian  Health  Center; 
and, 
Health 
Home Health Care  $6,000  1.2 
(cid:1) developing  a  transportation 
project.  This  proj;ct:  (1)  Outreach  $5,600  1.2 
coordinates  delivery  of food  to 
Adoption/Foster  tire  $4,375  0.9 
home-bound  clients;  (2) purchases 
cab  service  for individuals  with  Client Advocacy  $3,637  0.8 
special  needs;  (3) subsidizes  Total  $430,878  100 
public  and  private  transportation 
for clients  capable  of using these
. 
services  without  volunteer-assistance;  and,  (4) arranges  for volunteers  to 
provide  rides  to patients  for medical  and  mental  health  visits. 
Challenges  faced  by Wisconsin  consortia  include  the  need  for wider  representation  of 
multicultural  communities  within  the  HIV  care  consortia,  the  limited  finding  available 
to meet  the  level  of need  exhibited  by HIV-positive  persons  and  their  families,  the 
lack  of health  and  human  service  providers  willing or able  to provide  HIV-related 
sexvices in many  areas  of the  State,  and  the  need  for communication  with  other 
consortia  in Wisconsin  and  across  the  nation. 
33
 Wyoming  ($48,576)  submitted  no report 
on the  number  of consortia  or their 
Category  I  Spent  I %  !I 
specific  activities.  More  than  two-thirds 
PrimaryCare  $33,336  68.6 
of Wyoming  Title  11consortia  funds 
were  spent  on primary  medical  care.  CaseManagement  $8,%2  18.4 
n
Dental  I  $1,790  3.7  I
! 
II MentalHealth Treatment/  I  $1,422  I  2.9  II 
1T1herapy/Counseling  I  ! 
II
Food Bank/Home DelNeA M=~  $1,3s4  2.8 
Transportation  $1,0s6  2.2 
ILHome Health Care  !  $360  I  0.7  II
In-Home Hospice Care  S200  0.4 
Day/Respite  Care  $36  0.1 
Total  $48,576  100 
I  II 
34  APPENDIX  A 
HIV-RELATIDSERVICE  CATEGORIl= 
A-1  HIV-RELATED  SERWCE  CATEGORIES

1.  primary  f$fedi~l  Care:  provision of routine,  non-emergency,  non-inpatient,  non-specialized  medical  ar 
-?.	 Dental  Care:  Diagnostic  and  therapeutic  services  rendered  by  dentists,  dental  hygienists,  and  sim] 
professional  practitioners. 
3.  Mental  Health  Therapy/Counseling:  Psychological  and  psychiatric  treatment  and  counseling  semice 
including  individual  and group counseling,  provided by a mental heahh professional  licensed or authoriz 
within  the  State,  including  psychiatrists,  psychologists,  clinical  nurse  specialists,  social  Workem.  a 
counselors. 
4.	 Case Management:  Client-centered  service  that links clients  with health care and psychoscmal  sem~ 
in a manner  that  ensures  timely,  coordinated  access  to medically  appropriate  levels  of  care  and  supp 
services,  and continuity  of are.  Key activities  include: assessment of the clients needs and personal supp 
systems;  development  of a comprehensive,  individualized sewice  plan; coordination  of the sm  Ices requl 
to implement  the plan; client  monitoring  to assess  the efficacy of the plan; and periodic  rc-evaluation 
adaptation  of the plan as necessary  over the life of the client. 
5.	 Substance  Abuse  Treatment/Counseling:  Provision  of treatment  and/or  counseling  to address  substa 
abuse  (including  alcohol)  problems. 
6.	 Rehabilitation  Care:  Sexvices provided  by a licensed  or authorized  professional  in aaxxdance  wit! 
individualized  plan of care which is ~intended  to improve  or maintain  a clients quality  of Iife and opt 
capacity  for self-care.  This definition  includes physical therapy, speech pathology,  and low-v ision [rai, 
senices. 
7. Home  Health  Care:  Therapeutic,  nursing,  suppon]ve  and/or compensatory  health sewices  provided 
Iicensedmtified  home  health  agency  in  a  home/restdcntial  setting  in  accordance  w~th  a  w 
individualtid  plan  of care  established  by a case  management  team  that  includes  appropriate  heait h 
professionals.  Component  serviecs  are defined  separately  @ara-professional,  professional  and speci 
care). 
a. Pata- Professional  Care:  homemaker,  home  bith  aide, and personal/attendant  care 
b. Professional  Care:  routine  and skilled  nursm~  rehabilitation  and mental  health 
c.	 Specialized  Care:  intravenous  and  aerosoltzed  medicat Ion treatments,  diagnostic  testmg, 
pa 
feedings  and other  high tech scmiax 
d.	 Durable  medical  equipment:  prosthetics.  dcvias  and quipment  used by clients  in a home/res 
setting,  e.g.,  wheelchairs,  inhalation  therapy  equipment  or hospital  beds. 
8. Home-based  hospice care: numing care, counselin~  physician services, and palliative  therapxutl=  p 
by a hospice  program  to patients  in the terminal  stages  of illness  in their  home setting. 
A-2(cid:31) 9.  Support  se~ices: 
a. Adoption/Foster  Care  Assistance:  assistance  in placing  children  whose  age  is less  than  20 and  ~hc 
parents  are  unable  to care  for them  because  of  l-iIV-related  illness  or death,  in temporary  (foster  care) or 
permanent  (adoption)  homes. 
b.	 Buddy/Companion  Services:  activities  provided  by volunteers/peers  to assist the client  in Performing 
household  or  personal  tasks,  and providing  mental  and social  suppw  to combat  the  negative  effects  of 
loneliness  and isolation. 
c.	 Client  advocacy:  assessment  of individual  need, provision  of advics  and assistance  obtaining  medical, 
social, community,  legal, financial and other needed s.mites.  Advocacy does not involve coordination  and 
follow-up  on medical  treatments. 
d. Counseling:  counseling  serviax  other than mental health therapykounseling  provided to cllents,  family 
andor  friends  by  non-licensed  mental  health  counselors.  May  include  caregivcr  support,  bereavement 
counseling,  drop-in  counseling,  nutrition  counseling  or other support  group  activities. 
e. Day and respite care;  Residential or home-based  non-medical  assistance  designed to rclleve the pnmam 
carcgiver  responsible  for providing  day-to-day  care of client  or clients child. 
f.  Direct  Financial  Assistance:  provision  of  short-term  payments  for  food,  housing,  rent,  utditie 
medications  or other  resources. 
g.  Education/Risk  khction:  counseling  or preparation/distribution  of materials  educate  cl ]ents abo 
methods  to reduce  the spread of HW,  and information  about available  medial  and psycho-soaal  supp~-
Sewiccs.  . 
h. Food bank/Home  Delivered  Meals:  provision  of actual food or meals,  not finances  to purchase  food 
meals. 
i.  Housing  Related  services:  this  includes:  assistance  in l~ting  and  obtaining  suitable,  on-going 
transitional  shelter  (including  costs  associated  with  finding  a  residence  and/or  subsidized  rent),  ~ 
residential  housing  services,  which  arc the provision  of housing  assistance  in a group  home  setting. 
j.	 U@  ksistance:  assistance  provided  to individuals  with respect to wills,  fimeml arrangements,  ma 
related  to protection  of civii  rights,  and other  relevant  legal needs experienced  by clients. 
k. Sign  Language  and  Interpretation  Services:  assistance  provided  to clients  and/or  Carcgivets  Wt 
language  impaired  (sign  language)  or  do  not  speak  English  as  their  primary  language  (in[erprc 
services). 
1.Transportation:  conveyance  scxviccs provided  to a client  in order to acczss  health care or psycho-
support  semiccs.  May be provided  routinely  or on an emergency  basis. 
m. Other:  Support  services  Not Listed  Above 
10.  In-Patient  Personnel  Costs 
A-3