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 . . . . . . . . . . . . . . . . . . .. ”” ”” ””. ”.. ”s””””3 

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 

FY 1992 nonprofit private 

[53%)	 organizations to assist in the 

planning, development, and 

delivery of comprehensive � rl—f”’——’ 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,

(33%)	 while Washington has only 

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 11‘options 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, HRSA’S 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 President’s 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 HRSA’S 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 TheRyanWhiteCAREActdoesnot placeanyceilingon the percentageof fundsthat emaortiamayspendon 

administration,and planningand evaluation.In addition,readersshouldnote thatsomeStateadefine“administration”and 

“planningand evaluation”morebroadlythan the RyanWhiteCAREAct. 

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 Categoty I Spent I % 

consortia during FY 1992. Most 

Alabama Title II consortia funds were MediealCare ! $14,478 ~ 26.4 

spent on medical care and case CaseManagement $14,180 25.8 

management. 2 Alabama’s report did 

not describe specific consortia activities. Housing&sistance 

I 

$6,712 12.2 

Pharmaceuticals ! $4,601 8.4 

I

Alabama requested technical assistance Planningand Evaluation $3,S63 6.5 

to help implement the Uniform 

Reporting System. They requested that Transportation $2,645 4.8 

HRSA staff make periodic site visits to MentalHealth $~316 4.2 

help Alabama discuss its progress Treatmen~erapy/Counaelirrg 

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 In thisreport,we use the term“most”to meanmorethan50 percent, 

4 
---

-----

Spent % 

Alaska ($121,737) sewed approximately 4-:-1- E .egory 

rtla wnwn 325 people through 2 conso]. “ . Ii LaXMalla&. .,.-,.”,a”..=”t $36,696 30.1 

u.... 

cover the State. The majority 01 II $20,710 17.0 

Alaska’s consortia funding contributes to Continuationof HealthInsumnm 

$15,513 12.7 

case management, continuation of health I pharmaceutical


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


Alaska report identifies continuation of Trexment~eWY/~unSefing


health insurance coverage as a growing’ Administration $8,577 7.1 

need. Although this service is expensive, $8,577 7.1 

h allows Alaska to save on medical care Planning& Evaluation 

$8,244 6.8 

costs over time by decreasing the Edu@io@isk Reduction 

number of clients who have their health MedicalCare $7,445 6.1 

care paid by Medicaid or other public DentalCare $3,522 2.9 

payers. One consotiium conducted a $1,727 1.4 

study 

They found that 35 percent of clients Total $121,738 100 

had been homeless at some point, 58 

percent had a history of substance abuse, 

and 22 percent had mental illness or 

dementia. 

looking at characteristics of clients. Transportation 

Arizona ($484,227) has two consortia Category Spent % 

and allocates additional Title II consortia CMManagement $165,300 34.1 

funds to rural Arizona counties. Arizona 

HomeHealthCare $113,600 23.5 

spent most of its consortia funds on case 

$65,300 13.5 

management and home health care. DentalCare 

Arizona’s report described how the Dh.mnlm-lwtics-- als S63,300 13.1 , 1,-. 

consortia will solicit public and 1}ClientAdVWXY 

SYMIOtI -.-, — I 11.0 I 

communi~ input to identify the sefices ‘1 

most needed. I Administration $17,727 

I .

3.7=! 

Arizona identified the need for technical l~=jj=j=[ assistance regarding data collection 

under the Uniform Repotiing System, II Day/Respitecafe 

and how to promote sefices a ma‘ ,. 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


funding on pharmaceuticals. The report Category I Spent 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


Managed Care Program to serve clients CaseManagement $58,928 12.8


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:
 Transportation I $9,230 2,0 r II � making arrangements with Education/RiskReduction I $4,195 I 0.9 

physicians for primary care; Total $460,713 100 

II

�	 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


In California, the Office of AIDS Tranqxxtation $311,667 41


contracted with an organization to assist MentalHealth


in development of consortia. The five Treatmen~erapy/Counseling $300,321 40


major activities for the contractor Feed Bank/HomeDeliveredMeals $274,507 3.6


include: HealthInsurance& Miscellaneous $258,533 3.4 

� facilitating and training consortia ClientAdwx3cy $240,137 3.2 

members; Buddy/CompanionSemite $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 

OtherCounseling/Not � providing peer support by Health Mental $52,578 (): 

developing, linking and In-HomeHospiceCare $22,681 ill


distributing models of consortia


organizational and operational Education/RiskReduction $22,598 03


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


procedures; DurableMedkd Equipment $10,268 01 

�	 training for the Health Insurance ResidentialHospiceCare $6,826 0 1 

Premium Payment pilot program Total* $7,581,155 1(M) 

and reimbursement of � Thistotaldoesnot include$26,101,spent bytwoconscmM administrative costs; and, whohadnotsubmitteda reportof expenditures. 

� facilitating meetings throughout 

the year. 

California’s report also described some highlights of service-related consortia activities. 

During FY 1992, consortia became eligibl~ o~ganizations to apply for and receive 

7 

10 
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. 

California’s 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 Treatmentfierapy/Counseling $35,497 6.4 

management. MedicalCare $31,947 5.8 

Although Colorado’s 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 

estimated 400 unduplicated clients in 65 Categoty Spent % 

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 

communities, pediatric AIDS projects, Other Cmmaeling/Not

Health 

Mental $6,000 1.0 

and persons discharged from 

correctional facilities. The funds also FoodBanWHomeDeliveredMeals $5,000 0.8 

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 

up of 44 members. They spend most of 

their money on support services, mental 

health services, and substance abuse 

treatment. Delaware’s report gave little 

detail about activities except that they 

hope to expand the consortium to 

include all who provide services to 

persons infected with HIV. 

The District of Columbia ($684,970) 

served 739 persons through one 

consortium. The consortium spent most 

of its funds on case management. 

Among its case management activities, 

the consortium funded organizations to 

provide targeted case management for 

women, children, and other special 

populations such as homeless and 

substance abusers. The consortium 

developed protocols for case 

management of women and children. 

Category Spent % 

SupportSerncea” S18,500 34.4 

MentalHealth 

TreatmenVI’hemPY/GunseIing $8,000 14.9 

SubstanceAbuseTreatment $6,300 11.7 

EmergencyFinancialAssistance $16,000 29.7 

Administration $5,000 9.3 

Total $53,800 100 

� Tlds includesbuddy/companionseMces,clientadvocacy 

aeMcea,non-mentalhealthcounseling,foodbankservic=~and 

transportation. 

Category Spent % 

CaseManagement $409,196 59.7 

Planningand Evaluation $137,ss7 20.1 

Administration $92,240 13.5 

HousingAssistance $45,647 6.7 

Total $6s4,970 100 1. 

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 

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 

account for 4 percent. 

Pharmaceutiak 

Administration 

! $861,504 

I $590,063 

I 

I 

14.8 

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. 

Case managers must meet daily, wee~y, 

and monthly semice goals, and consortia 

HousingAssistance 

Transportation 

$190,485 ! 

I $181,292 \ 

3.3 

3.1 

believe they served more clients because 

of this. Florida used rollover money to 

MentalHealth 

Treatment~empy/tiunseling $151,479 2.6 

provide dental awareness education and Other Counseling/NotMental $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 

1 

L6 

care. One consortium created a ClientOutreachandVolunteer $67,992 1.2 

comprehensive service directory in Setices 

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,so the moncvamounrspresentedhereexceedwhatwasspenton consortia 

alone. 

11

Georgia ($1,482,554) spent most of its 

consortia funds on pharmaceuticals. 

Georgia did not submit a year-end 

report. ~ 

Guam has no consortia. 

Hawaii ($175,884) serves clients through 

one consortium. A year-end report is 

not available for Hawaii, but they did 

file a final quarterly report with some 

information about program activities. 

Hawaii spent most of its consortia funds 

on administration, housing assistance, 

and case management. One unique use 

of funds in Hawaii was that the 

consortium used funds for emergency 

supplies and housing assistance following 

Hurricane Iniki. 

, ‘~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 

Category 

Administration 

HousingAssistance 

CaseManagement 

MedicalCare 

DentalCare 

Other(EmergencyItems,Housing 

Aaaistamx,Acupuncture& 

MassageTherapy) 

MentalHealth 

Treatment/I’herapy/Counseling 

FoodBank/HomeDeliveredMeals 

Pharmaceuticals 

Transportation 

Adoption/FosterCare 

HomeHealth(Me 

Total 

Spent % 

$40,884 232 

$36,939 21() 

$19,912 113 

$16,166 92 

$16,166 92 

$12,742 72 

$10,568 bt) 

$7,854 ‘is 

$5,575 \2 

$3,192 18 

$3,115 18 

$2,770 lb 

$175,883 1()() 

12

-.. . ldaho has no consortia. 

Illinois ($1,860,633) served clients 

through 4 consortia. The consortia spent 

most of their funds on administration 

and case management. Although the 

State filed no year-end report, it 

submitted a final quarterly report. 

The consortia met most of their goals 

regarding sencices such as case 

management, housing assistance, 

substitute care, and in-home services. 

They also improved transportation for 

clients. 

One service Illinois consortia hope to 

improve is providing dental care. They 

have difficulty recruiting dentists. One 

consortium also had difficulty recruiting 

primary care physicians to seine persons 

with HIV. 

Illinois consortia also concentrated on a 

Category Spent % 

Administration $515,635 27.7 

CaseManagement $451,714 24.3 

MedicalCare $360,345 19.4 

Housingksistance $231,598 12.5 

Food Bank/HomeDeliveti M~ls $.176,770 9.5 

support seMees S74,525 4.0 

ClientAdvocacy $12,000 0.6 

MentalHealth 

Treatment~em~/~unsehng $10,345 0.6 

Transportation $10,187 0.6 

LegalSerw@a $9,918 0.5 

DentalCare $5,553 0.3 

HomeHealthCare $2,043 0.1 

Total S1,860,633 100 

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 %


statewide consortium. The consortium


1 

II 

spent almost of its money on medical MedicalCare I $173,549 I 56.1


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


women and children for setices, MentalHealth $137 <0.1


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


II 
~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. Indiana’s report also includes a detailed list describing monthly 

activities such as meetings and conferences attended, promotional activities, 

publications, and similar activities. 

Iowa ($90,000) served an estimated r 

Category I spent % 1,120 clients through 3 consortia. 

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 

lowa consortia. About 25 percent of the Emergenq Fhancial Assistance $8,744 9.7 

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/NotMental $1,706 1.9 

awareness was through a newsletter. Health 

Pharmaceuticals $946 1.0 

The biggest barrier faced by Iowa 

consortia is the growing number of Total $90,000 100 J 

clients with limited funds. The report 

describes Iowa’s 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 

their specific activities. Most Louisiana 

Title II consortia funds were spent on 

consortia development and volunteer 

services, and case management. 

Maine ($163,401) has four consortia but


submitted no report on their specific


activities. All Maine Title 11consortia


funds were spent on case management.


Statewide, Maine consortia provided


over 400 encounters with 295 clients.


Maryland ($1,828,532) has four


consortia. Most Maryland Title II


consortia funds were spent on medical


care and case management. In 1992,


1,555 clients were served by Maryland


consortia. Maryland’s annual report


covers the period 7/1/92 to 6/30/93.


Maryland also described consortia


activities, including public hearings on


the needs of people with HIV/AIDS and


the proposed use of Title II funds,


consulting with service providers


regarding funding priorities and


activities, and publishing a newsletter for


local medical providers, clients and


religious leaders.


Category 

ConsortiaDevelopment/ 

VolunteerServices 

case Management 

MedicalCare 

EmergencyFinancialAssistance 

ClientAdvocacy 

ResidentialHospiceCare 

Transportation 

Administration 

TotaI 

Spent % 

$343,991 30.6 

$304,517 27.0 

$135,276 12.0 1 

$118,418 10.5 

$84,182 7,5 

1 

$73,005 6.5 

$59,099 5.3 

$6,160 0.6 

S1,124,648 100 

Category I Spent % 

CaseManagement $163,401 100 

Category Spent % 

MedicalCare $686,680 37.5 

CaseManagement $458,770 25.1 

Administration .$202,747 11.1 

EmergencyFinancialAssistance $153,800 8.4 

DentalCare $142,000 7.8 

MentalHealthTreatment/ $84,136 4.6 

Therapy/Counseling 

HousingAssistance $67,501 3.7 

1 

Outreach I $32,898 ! 1.8 

Tota[ I $1,828,532 100 

15

� 

� 

� 

� 

� 

Massachusetts ($1,195,000) has 16


consortia. Most Massachusetts Title II


consortia funds were spent on case


management (including client advocacy,


and which may include outreach, buddy/


companion services, non-mental health


counseling and education/ risk


reduction). Statewide, consortia served


1,545 clients. The Massachusetts


Department of Public Health conducted


a meeting to discuss implementation of


HIV Care Consortia programs. This


meeting addressed both service providers


and consumers. Local consortia also


held meetings to educate and engage


providers and clients in consortia


activities.


The Massachusetts consortia treat a


diverse group of clients. While one


consortium mainly serves intravenous


Category I Spent I 70 jl 

CaseManagement S657,250 55 

Transportation $167,300 14 

> 

Administration ! $131,450 I 11 II 

MentalHealthTreatment/ ] $71,700 I 6 II 

Therapy/Counseling I I II 

FoodBankiHomeDeliveredM=ds $59,750 5 

HousingAssistance $35,850 3 

Planningand Evaluation $23,900 2 

EmergencyFinancialAssistance $23,900 2 

Phartnaceutieals I $11,950 I 

I I

Acupuncture/Massage $11,950 1 

NutritionalCounseling 

I 

-rOtal I $1,195,000 1(h) 

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. Michigan’s ~ ,::,


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 I Spent I % II


were spent on case management,


administration, and mental health CaseManagement $47,000 216


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 I 

119 II


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


Minnesota to ensure dental care for low ClientAdvocacy $16,585 8.3 I
 income persons with HIV disease. This 

Dental ! $.7,974 4() 

contract has led to an increase in the I
 II


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. Category Spent % 

The summa~ expenditure repofi 

indicates most Missoufi Title 11 HomeHealthare $351,178 55.2 

consotiium funds were spent on home Mdkal Care $87,582 13.8 

health care. The consofiium is TmnspO~tiOn $75,787 11.9 

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 Dentalam $3,436 0.5 

on a fee-for-sefice basis with 303 health 2 

setice agencies and 81 physicians under Total $636,44 100 A 

contract to provide medical services. 

Montana ($57,970) has five consotiia. 

Most Montana Title 11 consofiia funds 

were spent on medical care, 

Categoty 

Mexlkdore 

Spent 

$16,270 

% 

28.1 

administration, and case management. Administratiotl $11,800 20.4 

Statewide, the consotiia seined 87 

clients. ~ Management $8,400 

$4,700 

14.5 

8.1 

phamaceutids 

Four of the Montana consortia are local Dentalcare $3,200 5.5 

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 

a fixed amount specified under the MiscellanmmItemsand Sefi= $2,600 4.5 

(e.g.,linen,monitoringequipment, contract with the State. g~t-iea, etc.) 

HomeHe.dth~m $1,800 3.1 

The fifth consofiium, a community-based 

organization, was awarded funds Educatiofiisk Reduction $1,700 2.9 

separately. Since’ it was not covered by FoodBank/HomeDeliveredM-is $900 1.5 

the State contract with the other $600 1.0 

consofiia, it processed and tracked its 

expenditures. Like the other consortia, ClientAdv@W $100 0.2 

it repofis details of expenditures to the 

State, but is reimbursed for actual 

Total 

IL 

$57,970 100 

expenses, rather than a fixed, contracted 

amount. 

Tmnqxxtation 

18

Nebraska ($15,592) has one consortium. 

Most Nebraska Title II consortium funds 

were spent on case management, 

equipment and vision care. The 

consortium served 15 clients in the TriCity area of Grand Island, Hastings and 

Kearney, located in central Nebraska. 

The consortium has hired a Care 

Coordinator to continue building the 

consortium. The Care Coordinator, in 

addition to case management 

responsibilities, contacted physicians, 

dentists, psychologists, counselors, drug 

treatment agencies, faith communities, 

and local health departments. The Care 

Coordinator facilitated a meeting, 

bringing together drug/ alcohol treatment 

center providers, mental health agencies, 

HIV/Sexually Transmitted Disease 

Categoty I Spent I 70 

CaseManagement $6,990 44.9 

Equipmentand Vkion Care $2,075 13.3 

Transportation $1,3s1 8.9 

DentalCare $1,2s0 8.0 

Phatmaeeutida $1,22s 7.9 

Outreach $s00 5.1 

ClientAdvocacy $711 4.6 

Administration $535 3.4 

Food DeliveredMeals $230 1.5 

HousingAssistamx $203 1.3 

Planningand Evaluation $192 1.2 

Total $15,592 100 

Bank/I-Iome

(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) 

�	 installing special phone lines for 

hearing-impaired clients; and, 

c	 integrating early intemention 

primary care medical services into 

methadone maintenance 

programs. 

The consortia cite the reluctance of 

county and local hospitals to provide 

primary care services for clients with 

HIV/AIDS as a continuing barrier to 

treatment. 

Title II reporting requirements present 

some difficulties for consortia as well. 

The consortia directors fear that the 

complexity of reporting may discourage 

some individual service providers from 

participating. Likewise, large providers, 

like hospitals, may not wish to provide 

considerable detail about these 

expenditures, since they receive a very 

small part of their total funding from 

Ryan White funds. 

Categoty I Spent 1 % II 

CaseManagement $577,500 24.0 

MedhxIlCare $509,992 21.2 

DentalCare $198,361 8.2 

Administration $187,105 7.8 

Transportation ! $177,431 I 7.4 

II 

Planningand Evaluation ! $152,109 ! 6.3 

II 

MentalHealthTreatment/ .$128,823 5.4 

Therapy/Counseling 

SubataneeAbuseTreatment I $93,678 [ 3.9 I 

Outreach I $89,043 I 3.7 1] 

Day/RespiteCare $69,270 2.9 

Food BanWIomeDeliveredMeals $37,682 1.6 

ParalegalSeMea $36,222 1.5 

HomeHealthCare $27,892 1.2 

Pharmaceuticals $27,646 1.2 

Education/RiskReduction $26,183 1.1 

Other Counseling/NotMental $25,098 1.0 

Health 

ClientAdvocaq $18,375 0.8 

In-HomeHoapieeCare $18,000 0.8 

HousingAaaNance $5,798 0.2 

I 1 

RehabilitationCare I $1.500 I 0.1 II 

Total I$2,407,708 I 100 II 

20

New Mexico ($63,000) has one 

consortium. Most New Mexico Title II 1! Catego~ I Spent I % 

1 

consortium funds were spent on client IIClientMvoeacy I $22,0W 

I 

34.9 

II 

advocacy, and outreach. Statewide, the Outreach $19,000 30.1 

consortium served 750 clients. Ir 

Transportation $17,000 27,0 , 

Although New Mexico did not submit a EmergencyFhancialAssistance $3,000 4.8 

~~ year-end report for FY 1992, their Administration $2,000 

I fourth quarter report for N 1992 ITotal I $63,000 I 100 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) 

�	 facilitating expansion of 

transportation services for all the 

network’s counties; 

�	 developing a resource directory of 

community-based agencies, 

organizations, support groups, 

primary care providers, 

homeopathic and allopathic 

providers; 

�	 sponsoring a “Speak-out” where 

persons lfing &th AIDS will 

voice their needs and identify 

barriers to care to an audience of 

elected officials and service 

providers; and, 

�	 advocating against the closing of 

test sites. 

New York consortia cite the following 

barriers to providing services: 

�	 overcoming special semice needs -

including counseling and testing 

services, services for inmates, 

dental services, women’s services, 

Spanish-speaking providers, and 

mental health semices for HIVpositive people who are 

recovering from substance abuse; 

making mental health/psychotherapy 

Categoty Spent % 

CaseManagement $2,263,633 277 

I 

OtherCounseling/NotMental $576,256 7.0

Health 

Outreach ! $547,799 67 

[ II

Information $439,792 54 

DentalCare $406,807 <O 

Transportatim $395,812 4,3 

HousingAssistance $264,522 1: 

II

TechnicalAssistanceto Providers I $109,301 I 1.3 II

FoodBanM1-IomeDeliieredMmls I $109,301 1.3 

1 1 

ClientAdvocacy ! $64,028 ! 03 

II 

LegalSemites $39,452 ()5 

Buddy/CompanionSefi- $33,631 {)J

ProviderTrainingon ClinicalCare I $20,696 I 02 II Iwlea 

RecreationalActivities $10,995 01 

In-HomeHospictCam I $9,701 I 01 II 

Day/RespiteCare $9,701 01 

Total $8,179,777 100 

a 

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


individual consortia activities. Most case Management # 

$391,494 41.3


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 

consortium activities. All North Dakota 

Title II consortia funds were spent on 

pharmaceuticals and medical care. 

Ohio ($703,929) has nine consortia. 

More than two-thirds of Ohio Title II 

consortia funds were spent on housing 

assistance. Statewide, the consortia 

served 2,023 clients. 

Ohio contracted with Nationwide 

Insurance Company as its third party 

administrator to develop a 

reimbursement system for providers of 

services to persons and families with 

HIV disease. 

Ohio consortia face several challenges. 

Because of funding shortfalls, Ohio 

consortia reduced yearly Stateestablished limits to between $250-$500 

per individual in order to provide 

coverage throughout the program year 

without interruption. Peer review 

processes need to be developed for 

consortia as well. 

Categoty I Spent I %

II II


Pharmaceuticals $58,500 65.0 

MedicalC-are $31,500 35.0 

r 1 

1!Total I $Wm I 100 II 

Categoty Spent % 

HousingAmistance $492,736 70.0 

Food Bank/HomeDeliered Mm~ $67,913 9.6 

MediealCare $43,751 6.2 

Transportation $28,777 4.1 

ThirdPartyAdministrator $20,935 3.0 

DentalQme $13,200 1.9 

EmergencyJ3nancialAsaiitance $10,497 1.5 

MentalHealthTreatment/ $6,086 0.9 

Therapy/Counseling 

RehabditationCare $3,809 0.5 

BereavementServi@a $3,673 0.5 

Pharmaw.uticala $3,654 0.5 

ChildCare $2,560 0.4 

SubstanceAbuseTreatment $2,300 0.3 

DurableMedkalEquipment $2,013 0.3 

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 

11consortia funds were spent on 

pharmaceuticals, substance abuse 

treatments, administration, planning and 

evaluation, client advocacy and outreach. 

Oklahoma did not submit a year-end 

report detailing specific activities. 

Oregon ($280,323) served clients through 

seven consortia organized by regions 

around the State. Consortia spent most 

of their funds on case management and 

home health care. 

Some consortia used a unique approach 

to increase clients’ access to services. 

They distributed vouchers to clients to 

help connect them with medical care. 

Participating pharmacies and care 

facilities agree to accept vouchers as 

payment from clients for HIV-related 

services. Each consortium has 

conducted a variety of outreach 

activities, with one county in particular 

targeting the Native American 

population. 

Category Spent % 

Pharmaceuticals $29,000 18.1 

I i 

SubstanceAbuseTreatment $21,000 13.1 

Adminiatration $20,328 12.7 

Planningand Evaluation $20,328 127 

ClientAdvocaq’ $20,328 12.7 

Outreach $20,328 12.7 

Catego~ Spent % 

CaaeManagement $130,000 46.4 

HomeHealthCare $37,000 13.2 

AdoptionlFoaterCare $25,000 8.9 

Day/RespiteCare $20,000 7.1 

ClientAdvoeacY $15,000 5.4 

MedicalCare $15,000 5.4 

Emergenq FinancialAaaiitance $10,OOO 3.6 

DentalCare $8,000 2.9 

Transportation $6,323 2.3 

FoodBanIdHomeDeliieredMeala $6,000 2.1 

HousingAaaiatance $5,000 1.8 

Pharmaceuticals S3,000 1.1 

Total $280,323 10Q 

25

Pennsylvania ($1,495,668) served over 

4,000 clients through 7 consortia. 

Consortia spent most of their funds on 

the following activities: case 

management, family home workers, 

volunteer training, professional training> 

HIV counseling, HIV testing, and 

emergency financial assistance. 

Pennsylvania increased minority 

participation in consortia and the State 

wide HIV Adviso~ Council. Each 

consortium is represented on the State 

HIV Advisory Council. 

The consortia representatives 

contributed to the Advisory Council’s 

work toward housing needs assessments, 

and other service needs assessments. 

They also worked to develop 

consolidated data collection that would 

meet Federal and State reporting 

requirements. 

Barriers Pennsylvania mentioned include 

contracting and program reporting. 

Some of the consortia contracts were 

delayed due to State regulations about 

how money must be allocated by State 

agencies. Also, timely reporting of data 

Category Spent 70 

Caae Management $365,220 24.4 

FamilyHomeWorkem,Volunteer 

Training,ProfessionalTraining, $224,097 15.0 

and HIV Chmaeling& Testing 

Emergency13nancialAaaiatance I $218,421 I 14.6 

Administration(includingsome $187,137 12.5 PlanningandEvaluation) 

MedicalCare $166,064 11.1 

PlanningandEvaluation $118,717 7.9 

Buddy/CompanionServices S44,256 3.0 

Tranapotition I $42,233 I 2.8 

Mentalhealth $41,787 2.8 TreatmentAlerapy/Coun=ling 

Outreach S27,648 1.9 

HousingAskance $19,494 1.3 

HomeHealthCare $11,070 0.7 

Education/RiskReduction $10,143 0.7 

SubstanceAbuseTreatment $9,579 0.6 

DentalCare $9,098 0.6 

ClientAdvocacy

+ 

$704 0.1 

Total I S1,495,668 100 

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 

Rico spent between 10 and 20 percent 

of its consortia funding on the following 

categories: case management, 

pharmaceuticals, home health care, and 

residential hospice care. Puerto Rico 

did not submit a year-end report. 

Puerto Rico spent money on some 

innovative services such as nutritional 

supplements, legal services, a respiratory 

therapist, and children’s summer camp. 

Approximately nine percent of Puerto 

Rico’s Title II funding, or $264,222 has 

been spent but has not been 

documented by subcontractors. 

Rhode Island has no consortia. 

Categoty 1 Spent I % 

CaseManagement ! $528,839 ! 18.6 

Pharmaceuticals ! $366,869 ! 12.9 

HomeHealthCare I $363,061 I 12.8 

ResidentialHospiceCare $299,983 10.6 

MedicalCare $265,762 94 

1 

Spentbut not documentedby I $264,222 I 93 subeontrsctots 

Administration I $206,538 ! 73 

I 

HousingAaaktanee ~ $112,310 ~o 

I I 

NutritionalSupplements I $106,366 %7 

I 41

EmergencyFinancialAssistance I $81,846 2.9 

I 

MentalHeahltAherapy/CcwtaelingI $74,119 I ~b Ii 

IIDay/RespiteCare 

nTransportation 

DentalCare 

Buddy/Companion

II

II Servieea 

DurableMediealEquipment 

ClientAdvoeaey 

II Respiratotyllterapist 

IiMedicalSuppIies 

PharmacistAssistant 

ChildrenSummerCamp 

IILegal Serviee 

[! Outreach 

Total 

I	 $41,215 I 1.5 

$37,759 I 13 ~


I $32,544 I 1.2


! $27,620 1 1.0


$8,846 03 

$6,000 0.2 

I 

I $5,950 I 02 

! $3,276 I 0.1 

$2,657 01 

$2,240 0.1 r I 

] $1,998 I 0.1 

I $840 I <0.1 

I $2,840,860 lwt 

* 

27


I 
� 

� 

� 

� 

South 

estimated 378 individuals through 3 Category Spent % 

consortia around the State. South MexiiealCare $189,639 63.8 

Carolina spent nearly two-thirds of its Pharmaceuticals $65,327 22.0 

consortia money in medical care. 

Specific consortia activities include CaseManagement $34,7s6 11.7 

physician training on HIV/AIDS Other Counseling/Not a Mental $7,500 2.5 

Carolina ($297,252) seined an 

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: 

Q 

9 

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; 

coordinating with State agencies; 

implementing a planning/public hearing/public comment process; and, 

automating reporting from each consortia. 

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) 

Texas requested guidance from HRSA 

during the year on how Title II sites 

administer sliding scale fees and in-kind 

contributions. One of its quarterly 

reports also mentions that despite 

repeated requests, the State cannot 

obtain information about how Ryan 

White Title I and Title IIIb funds are 

spent in Texas. As a result, Texas 

officials cannot be sure that consortia 

semices are not duplicating services 

already provided under these titles. 

r 

CAegoty Spent % 

Caae Management $1,977,648 35.0 

MedicalCare $755,740 13.4 

Food Bank/HomeDeliveredMeaIa $386,048 6.8 

Home Health Care 

IIOther Counseling/Not Mental 

Health 

Residential Hoapiee Care 

Dental Care 

In-Home Hoapiee Care 

Tranapaation 

Volunteers 

Pharmaceuticals 

Day/respite Care 

Housing Aaaiatanee 

Buddy/Companion Serwixa 

Education/Riik Reduetion 

Durable Medieal Equipment 

Client Advocacy 

Sign Language/Interpretation 

I Total 

29 

$355,088 6.3 

I $310,888 I 5“5 II 

$298,316 5.3 

$259,888 4.6 

$253,916 4.5 

$203,636 3.6 

S198,648 3.5 

$149,684 2.7 

$144,020 2.6 

$88,020 1.6 

$79,664 1.4 

$73,404 1.3 

$52,688 0,9 

$51,400 0,9 

$12,000 0.2 

I $5,650,696 100 [ 
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 

Treatmen~erapy/Counseling 

Dental Care 

Client Advocacy 

Education/Risk Reduction 

Medical Care 

IIEmergencyFinancialAaaiatance 

IITransportation 

IISubstance Abuse Treatment 

I

FoodBank/HomeDeliveredMeala 

Pharmaceutical 

IITotal 

Vermont ($30,000) has one consortium.


All Vermont Title II consortium funds


were spent on plaming and evaluation. C3tegory


The consortium conducted a statewide Planning and Evaluation


needs assessment, and as a result, is


developing a resource guide to HIV-


related services in Vermont.


36.9 $36,553 

$21,441 21.6 

$12,381 12.5 

$10,063 10.2 

$6,657 6.7 

I I 

I $4,420 I 4.5 

! S2,628 2.7 

I 

! $2,450 I 2.5 

$1,5s6 1.6 

$s8s 0.9 

I $99,067 I 100 II 

Spent % 

$30,000 100 

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) 

Other barriers faced by Virginia 

consortia include: 

� finding an objective committee 

with the time to conduct peer 

reviews; 

� determining the needs of clients 

through organized and scientific 

needs assessments; 

� restricting administrative funds 

available to consortia and 

subcontractors; and, 

� the regulation prohibiting 

payments of physician consultant 

fees when the patient had to be 

hospitalized. 

Virgin Islands have no consortia. 

Category 

Case Management 

Medkzd Care 

Administration 

Planning and Evaluation 

Mental Health Treatment/ 

Therapy/Camaeiing 

Pharmaceuticals 

Emergency Fhtancial Asaiitance 

Dental Care 

Outreach 

Other Counseliss@Not Mental 

Heakh 

Transportation 

Day/Respite Care 

Home Health (kc 

Client Advocacy 

Housing Assistance 

FoodBank/HomeDeliveredM~ls 

Adoption/FosterCare 

Eduation/RiskReduction 

ResidentialHospiceCare 

DurabteMedicalEquipment 

SubstanceAbuse Treatment 

Buddy/Companion Semi= 

Rehabilitation Care — 

Trd 

— 

Spent % 

$270,269 31.0 I 

J 

$250,000 28.7 

$87,122 10.0 ~ 

$43,560 5.0 

$30,000 3.4 

$26,768 3.1 

$26,000 3.0 

$25,000 2.9 

$25,000 2.9 

$15,000 1.7 

$15,000 1.7 

$15,000 1.7 

$10,OOO 1.2 

$7,000 0.8 

$6,000 0.7 

$5,000 0.6 

$4,000 0.5 

$3,000 0.3 

$2@O0 0.2 

$2,000 0.2 

$1,500 0.2 

$1,000 0.1 

$l,oact 0.1 

$871,219 100 

31

Washington ($712,451) has three 

consortia. The summary expenditure 

report indicates that most Washington 

Title II consortia funds were spent on 

medical care. Washington did not 

submit a year-end report detailing 

specflc consortia activities. 

West Virginia ($109,016) has one 

consortium. Most West Virginia Title II 

consortium funds were spent on case 

management. Case managers are 

serving 245 HIV infected clients. 

The West Virginia consortium is 

compiling a service directo~, but reports 

problems with health care providers not 

wanting publicity. Although these 

providers serve HIV clients, they do not 

wish to be identified in the HIV service 

directoq being developed by the 

consortium. 

Categoty I Spent % 

Care I $433,717 I Medieal 609

Substance Abuse Treatments ! $101,249 I 14.2 

ClientAdvocacy I $61,182 ! 8.6 

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) 

Categoty Spent % 

Caae Management $59,175 54.3 

Housing Aaaiatanee $16,473 151 

Pharmaeeuticala $11,228 103 

Medieal Care $7,671 70 

Administration ! $4,825 

I 

44 

FocalBank/Home Delivered Meala $4,474 41 

Transportation $2,307 2.1 

1 I 

Dental Care ! $1,240 I 11 

Insurance I $905 0.8 

Emergency F!nancial Aaaktanee I $352 0.3 

In-Home Hospice Care $266 02 ~ [ 

Residential Hospice Care I $100 01 

1 

32

Wisccmsin( $480,878) has nine consortia, 

Most Wisconsin Title 11 consortia funds 

were spent on case management and 

medical care. 

Specific consortia activities include: 

� translating English language 

brochures into Hmong to increase 

client outreach; 

� providing SUppOfi group scfices 

for HIV positive clients of the 

Milwaukee Indian Health Center; 

and, 

� developing a transportation 

project. This proj;ct: (1) 

coordinates delivery of food to 

home-bound clients; (2) purchases 

cab service for individuals with 

special needs; (3) subsidizes 

public and private transportation 

for clients capable of using these . 

Category I Spent I % 

~ Management I $165,552 34.4 

Therapy/Cowehg

~

Planning and Evaluation $51,247 10.7 

Administration $39,609 8.2 

Buddy/Companion Servieea I $2s,367 I 5.3 

Health 

Home Health Care $6,000 1.2 

Outreach $5,600 1.2 

Adoption/Foster tire $4,375 0.9 

Client Advocacy $3,637 0.8 

Total $430,878 100 

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 

specific activities. More than two-thirds 

of Wyoming Title 11consortia funds 

were spent on primary medical care. 

Category I Spent I % !I 

PrimaryCare $33,336 68.6 

CaseManagement $8,%2 18.4 

Dental I $1,790 ! 3.7 n I

II MentalHealth Treatment/ I $1,422 I 2.9 II 

Therapy/Counseling I ! 11 II

Food Bank/Home DelNeA M=~ $1,3s4 2.8 

Transportation $1,0s6 2.2 

Home Health Care ! $360 I 0.7 IL II

In-Home Hospice Care S200 0.4 

Day/Respite Care $36 0.1 

Total I $48,576 100 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 semic

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. 

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 client’s 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 client’s 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
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 client’s 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 psychosupport semiccs. May be provided routinely or on an emergency basis. 

m. Other: Support services Not Listed Above 

10. In-Patient Personnel Costs 

A-3