text:
Историята на Хърватия от идването на хърватите на Балканския полуостров до края на Първата световна война, може условно да се раздели на четири основни периода.
 Първи период
 Първият период започва през 7 век с идването на хърватите по днешните си земи и завършва през 1102 година със сключването на т.нар. „Pacta conventa“. В продължение на повече от 450 години хърватите водят успешни отбранителни войни срещу франките, венетите, арабите, маджарите, българите и византийците.
 Заселване на хърватите на Балканския полуостров
 Византийският император Константин VII Багренородни (912 – 959) в труда си „За управлението на империята“ пише за идването на хърватите в Далмация, Илирия и Панония, за покоряването на аварите, част от които биват асимилирани от хърватите. В този труд се посочва още, че хърватите идват в сегашната си родина като съюзници на византийския император Ираклий в борбата му срещу аварите. След победата над аварите хърватите, вместо да се върнат по старите си земи, остават в новата си родина. Тя включва шест географски области които биват плътно заселени с хървати: Кроация (или Централна Хърватия), Далмация, Истрия, Славония, Босна и Херцеговина.
 Още през 7 век Светият престол осъществява първите си контакти с хърватите, което е отразено в папския летопис „Liber pontificalis“, където е записано, че папа Йоан IV (640 – 642) изпраща в Далмация и Истрия своя абат Мартин да плати откуп за пленници и за костите на стари християнски мъченици.
 Хърватите, скоро след заселването си на Балканския полуостров, приемат християнството, благодарение на гъвкавата политика на Светия престол, който прилага правилата на папа Григорий I за прилагане на християнските принципи към езическите обичаи и храмове на новопокръстените народи (постепенно покръстване).
 Хърватски княжества
 През първите три века след заселването на хърватите на Балканския полуостров, обществения и политическия им живот се развива в три хърватски княжества: в Далмация, в Панония и по поречието на река Неретва.
 Най-известният княз на Панонска Хърватия е Людевит (ок. 810 – 823), който води редица успешни битки срещу франките. Други князе на панонското хърватско княжество са: Войномир (791 – ок. 810), Ратимир (829 – 838) Браслав (880 – 897).
 Като първи княз на Далматинска Хърватия се споменава Порга, който управлява през втората половина на 7 век. През втората половина на 8 и началото на 9 век, княз Вишеслав воюва срещу франките. От времето на неговото царуване е запазен кръщелен купел от катедрала в Нин. След княз Вишеслав, начело на далматинското княжество застава княз Борна (ок. 810 – 821), който воюва заедно с франките срещу Византия и срещу далматинския княз Людевит. Борна е наследен от племенника си Владислав (821 – 835). Тогава започва столетният конфликт между хърватите и венецианците за Адриатическо море. По времето на княз Мислав (ок. 835 – 845) и княз Търпимир (ок. 845 – 864), далматинското княжество става все по-силно. Княз Търпимир воюва с венецианците, византийците и българите. Наследява го княз Домагой (ок. 864 – 876), който води успешни войни срещу арабите, венецианците и византийците, както и тежка седемгодишна война с франките, в която хърватите успяват да извоюват независимостта си. Синовете на Домагой управляват от 876 до 878 година. Княз Здеслав (878 – 879), с помощта на Византия ги прогонва, но го сполетява подобна съдба, след като народът се разбунтува, недоволен от политиката му. На престола тогава се възкачва княз Бранимир (879 – ок. 892), който спечелва благоразположението на папа Йоан VIII. След Бранимир на престола идва княз Мунцимир, баща на последния хърватски княз и първия хърватски крал Томислав (910 – 928).
 Хърватско кралство
 Папа Йоан X, в писмо от 925 година, провъзгласява княз Томислав за хърватски крал и тази година се смята за начало на хърватското кралство. По времето на крал Томислав Хърватия се нарежда сред силните държави в Европа и води войни с българския цар Симеон I в защита на сръбските племена, покорени от България.
 Наследниците на крал Томислав, неговият по-малък брат, Търпимир II, и след него Крешимир I, успяват да запазят хърватското кралство. Обаче след ранната смърт на крал Крешимир I, бан Прибин предизвиква вътрешни размирици в борба за престола, при които бива убит наследникът на престола, Мирослав. Хърватската войска и флота намаляват значително, а границите на кралството се свиват. Крал Михайло Крешимир II се заема да възстанови отслабеното кралство, задача, която продължава успешно впоследствие и неговият син, Стефан Държислав, който по време на 28-годишното си управление връща мощта на кралството. След неговата смърт обаче тримата му сина Светослав Суроня, Крешимир III и Гоислав започват междуособици, които нанасят най-тежкия удар на хърватската държава и повличат след себе си и дългогодишни войни с Венеция за Далмация.
 След Крешимир III на престола сяда неговият племенник Стефан I Крешимирович, който започва обновяване на хърватското кралство. През 1058 г. го наследява синът му, крал Петър Крешимир IV, при когото Хърватия достига най-голямото си могъщество като дори успява да присъедини далматинските градове и острови. От 1075 до 1089 г. на хърватския престол е крал Димитър Звонимир, който провежда сериозни реформи в икономическия и обществен живот. Установява също така здрави връзки с папа Григорий VII, чийто легат го коронясва през 1075 г. за крал на Хърватия и Далмация, укрепва църковното единство, допринася много за налагането на глаголицата в писмеността, за което свидетелства най-важния паметник на хърватската глаголическа писменост, Башчанската плоча.
 След Звонимир на престола се качва за две години последният крал от династията Търпимировичи, Стефан II, а след неговата смърт в началото на 1091 г. в Хърватия настъпват големи безредици, оказали се фатални за хърватската държава. Последният хърватски крал от хърватски произход, крал Петър, загива в бой на планината Гвозд, носеща днес неговото име, Петрова гора. Съпругата на крал Звонимир, Елена Унгарска, сестра на унгарския крал Ласло I помага на брат си да стане хърватски владетел.
 Втори период
 Вторият период, през който хърватите имат общ крал с унгарците, обхваща периода от 1102 до 1526 г. През този период хърватите отблъскват татарите, успешно воюват с Венеция и Византия, а по-късно с Османската империя, за Далмация и за оцеляване. Непрекъснатите войни все повече утвърждават хърватско-унгарските връзки, олицетворявани отначало само от кралската особа.
 Pacta Conventa
 Смъртта на крал Петър през 1097 г. не оказва негативно влияние върху военната мощ на хърватите, които задържат хърватско-унгарската граница по река Драва. При тези обстоятелства през 1102 г. се стига до сключване на съглашение между хърватите и унгарския крал Калман, известно като „Pacta Conventa“, според което унгарският крал става общ крал на хървати и унгарци, като двете държави запазват самостоятелността си. Има много причини, довели до това фатално съглашение, но една от тях е тайното споразумение на хърватските аристократи с унгарския крал.
 В Биоград на Мору Калман бива коронясан за крал на Хърватия и Далмация, а той обещава всички държавни права на Хърватското кралство, като признава на хърватската аристокрация и допълнителни привилегии. Срещу това хърватските аристократи се задължават да подкрепят краля по време на война.
 Всички владетелски права на хърватския крал преминават в ръцете на Калман и неговите наследници, а именно: да назначават банове, да дават привилегии и дарения, да ратифицират приетите от Сабора закони, да събират данъци и мита, да ползват кралските земи на някогашната хърватска династия, върховно командване на хърватската войска и определяне на външната политика. По този начин Хърватия на практика губи своята независимост, но спомага за вътрешна консолидация.
 Antemurale Christianitatis
 През 1453 г. турците превземат Константинопол и папа Каликст III призовава всички християнски народи на кръстоносна война. В тази война участват и много хървати. Един от тях е Иван Капистран, францискански монах, предвождащ хърватските бойци в битката край Белград през 1456 г., обявен по-късно за светец.
 Вековете 16 и 17 са наречени в хърватската история „два века на плач“, поради жестоките битки, които хърватите водят с многократно по-многобройната турска армия. Тежък удар е загубата на повече от 10000 хърватски войници, загинали през 1493 г. в битката на Кърбавското поле. През 1519 г. Хърватия получава от папа Лъв X почетното название „Antemurale Christianitatis“ („авангард на християнството“).
 През почти 400-годишния период на войни срещу завоевателите се прославят множество знайни и незнайни хърватски войници.
 Трети период
 Третият период започва с битката на битката на Мохачкото поле през 1526 г., а завършва със смъртта на крал Йосиф II през 1790 г. През този период хърватите успяват трайно да отблъснат турците. След победата край Сисак през 1593 г., хърватите започват да си възвръщат изгубените територии, обаче голяма част от териториите им е безвъзвратно изгубена. Същевременно, хърватите водят борба и за правата си, които все повече са застрашени от плановете на Виенския двор за централизация на властта и за германизация на всички народи в Хабсбургската монархия. През този период стават големи етнически промени по хърватските земи – заселват се голям брой сърби в Срем, Славония и хърватската военна погранична област.
 Хърватите избират Хабсбургите за свои крале
 Тъй като край Мохач загива последният Ягело, Людвиг II, крал на Унгария и Хърватия, а на Хабсбургите вече е обещана короната, и те са единствената реална сила, която може да организира отбраната на Хърватско, естествено е хърватите да ги изберат за свои владетели. Освен това, Хабсбургите помагат и преди това за защитата на Хърватско, защото през нея минава пътят към наследените територии Щирия, Каринтия и Крайна.
 Поради тези причини, хърватите, независимо от унгарците, избират през 1527 за свой крал Фердинанд I, но при условие да помогне за отбраната на Хърватско и да уважава всички нейни стари права и свободи. По този начин потвърждават елементите на държавността си и статута на свободно кралство. Обаче част от славонската и унгарската аристокрация избират за свой крал граф Ян Заполски, което води до избухване на гражданска война, продължила до смъртта на Заполя през 1540 г. През това време турците постоянно нападат от Босна и през 1528 г. превземат град Яйце, който е на най-предната линия на отбраната на Хърватско, а през 1532 г. тръгват с основната си армия към Виена. Хърватите, начело с Никола Юришич успяват да спрат турското напредване към Виена, но постепенно една след друга падат непревземаеми хърватски крепости: през 1536 г. пада Пожега, главният стълб на отбраната на Славония, а през 1537 година – Клис в Далмация.
 Селско въстание
 През 1573 година, след като напразно се оплакват на краля и бана от престъпленията, извършвани от чужди благородници, селяните, в знак на протест престават да плащат нереално високите данъци. Един от най-жестоките аристократи, Ференц Тахи, изпраща въоръжените си наемници да съберат данъците, но селяните ги посрещат също с оръжие. Заради тази съпротива хърватският Сабор обявява селяните за предатели, на което те отговарят с всеобщо въстание. За водач на въстанието бива избран Амброз Губец, по-късно наречен Матия Губец от Горня Стубица. Селското въстание е характерно най-вече с това, че има програма за установяване на селска власт, която да води сметка за данъците и другите налози за отбраната на Хърватско от турците.
 Въстанието избухва в края на януари 1573 г. и бързо обхваща голяма част от Хърватско и Словения. Обаче армията бързо го потушава. На 5 февруари 1573 словенските селяни са разбити край Кръшко, а на следващия ден е разбита и селската войска край Керестинце. Малко по-дълго имат успех единствено бунтовниците на Губец в хърватското Загорие. На 9 февруари 1573 г. се води последният бой между бунтовниците на Губец и войската, ръководена от Гашпар Алапич. След като селяните почти спечелват тази битка, идва подкрепление за Алапич и бунтовниците са разгромени. Матия Губец е заловен и на 14 февруари 1573 г. е екзекутиран на площад Марков търг в Загреб.
 Възникване на пограничните военни области
 За отбраната на Хърватия и Славония от постоянните турски набези в Сен, Огулин, Бихач, Храстовица, Жумберак, Иванич, Крижевци и Копривница се организират т.нар. „капитании“, военни окръзи, които покриват територията от Адриатическо море до Драва. Хърватите укрепяват Сисак за отбрана, а Хабсбургите за тази цел изграждат крепостта Карловац (1579). Скоро всички капитании в Хърватско биват обединени в Карловачката (Хърватската) погранична военна област, а в Славония – във Вараждинската погранична военна област. Тяхното управление и финансиране е директно от Хабсбургите, като техните генерали управляват тези области от Грац, а по-късно – от Виена. Създадена е система военни укрепления и наблюдателни кули, които имат както отбранителни, така и съобщителни функции.
 Между Хърватската и Славонската погранична област, в Покупле е оставен пояс от укрепления под прякото командване на хърватския бан, поради което е наречен Банска погранична област или Бановина. По-късно тук се образуват т.нар. „регименти“ (укрепени пунктове) Глина и Петриня. Основен проблем на пограничните военни области е финансирането, въоръжаването и заселването на пустеещите райони. Поради това че хърватският Сабор и бан нямат власт върху по-голямата част от тези области, в края на 16 и през целия 17 век биват заселени власи, като по този начин се променя етническият състав на населението по тези земи.
 Поражение на турците край Сисак през 1593 г.
 Беят на Босненския санджак, Ферхад паша, започва да завладява земите между реките Уна и Купа и по поречието на Глина. От 1575 до 1577 г. превзема много хърватски крепости. През 1580 г. Босна става пашалък. През 1592 г. Хасан паша Предоевич решава да превземе Сисак, но през 1593 г. претърпява поражение от хърватския бан Тома Ердьоди. По този начин е спряно настъплението на турците към Загреб и централната част на Хърватско.
 Зринско-франкопанската завера
 След поражението на турците край Сисак започва дългогодишна война между Хабсбургите и Османската империя. Тя завършва през 1606 г. и на хърватите биват върнати част от изгубените територии. През 1618 г. започва нова, 30-годишна война с турците. В нея се изявяват братя Зрински, тогава най-влиятелните хърватски аристократи.
 През 1664 войската на Хабсбургите разбива турците край унгарското село Санкт Готхард, но Леополд I (1657 – 1705) не се възползва от победата, а сключва неизгоден мирен договор с турците, които запазват завладените хърватски и унгарски земи. Хърватите и унгарците не се съгласяват с условията на този договор, който нарушава правата им, и се вдигат на бунт, оглавяван от хърватския бан Никола VII Зрински. Бунтовниците водят преговори с френския крал Луи XIV, който е в конфликт с Виенския двор, заради европейската му политика. Преговорите не постигат резултат, а на 18 ноември 1664 г. Никола Зрински нелепо загива по време на лов. Мястото му заема по-младият му брат, Петър Зрински, който продължава борбата за правата на хърватите заедно с Фран Кръсто Франкопан и унгарски благородници. Обаче съюзът с унгарците се разпада през 1667 г., след смъртта на водача им Ференц Вешелейни. Скоро след това, чрез измама, са заловени Петър Зрински и Фран Кръсто Франкопан, както и унгарските водачи на бунта. На 30 април 1671 г. Зрински и Франкопан са екзекутирани и погребани тайно. Последва разграбване на имуществото им и унищожаване на семействата им. Гробовете на Зрински и Франкопан са открити чак през 1907 г., а през 1919 г. посмъртните им останки са пренесени в Загребската катедрала. На надгробната им плоча е изсечен стих от Фран Кръсто Франкопан, който е и известен хърватски поет: „Navik on živi ki zgine pošteno“ (Тоз, който загине с чест, живее навеки).
 „Съживена Хърватия“ и Карловицкият мирен договор
 През 1683 г. турците за последен път обсаждат Виена, но претърпяват поражение. Окуражени от това, хърватите започват война за освобождение на завладените от турците земи. За 15 години си възвръщат цяла Славония, Бановина, Лика и др. През 1699 г. турците са принудени да сключат в Сремски Карловци мирен договор с Хабсбургската монархия и се изтеглят напълно от Унгария и голяма част от хърватските територии. Този период в хърватската история бива наречен от известния хърватски учен от онова време Павел Ритер-Витезович „Croatia rediviva“ (Съживена Хърватия), макар че Венеция успява да завладее доста територии, населени с хървати.
 „Прагматичната санкция“ от 1712 и абсолютизмът
 Тъй като Карл VI Хабсбург няма мъжки наследник, съществува възможност за поделяне на държавата му. С желание да предотврати това, той се стреми да осигури престола на дъщеря си Мария Тереза. Хърватският Сабор помага, като приема през 1712 т.нар. Прагматична санкция, с която, независимо от Унгария, признават женската линия на династията. С този акт за пореден път (както през 1102 и 1527) Хърватско се изявява като самостоятелно кралство и по своя воля си избира владетел. Унгарците се възпротивяват, но все пак през 1715 г. унгарският парламент признава, че не може да се меси в работата на хърватския.
 Мария Тереза води първо война с Прусия, а след това участва в Седемгодишната война. Поради заслугите на редица хървати в тези войни, Мария Тереза връща през 1745 г. на хърватския Сабор и бан управлението върху Славония и възстановява древната система на жупаниите, а през 1746 г. реформира хърватско-славонската военна погранична област.
 На практика обаче, Мария Тереза налага абсолютизма, не свиква нито хърватския, нито унгарския парламент и провежда политика на насилствена централизация, като управлява чрез издаване на патенти и временни укази. В областта на образованието и икономиката, обаче, се осъществяват редица реформи, въвеждат се облекчения на феодалните задължения на селяните. Тази политика на т.нар. „просветèн абсолютизъм“ бива продължена и от сина на Мария Тереза – Йосиф II Хабсбург (1780 – 1790).
 Четвърти период
 През четвъртия период, който продължава от 1790 до 1918 г., хърватите водят борба за териториален суверенитет и независимост. В началото на този период Венеция губи Далмация, която след кратко френско управление (1815), става австрийска област. Поради стремежите на Унгария да заграби хърватските територии, през 1848 г. се стига до война с Унгария. Поради непрестанните безредици и конфликти между католици и мюсюлмани в Босна, Австро-Унгария я завладява през 1878 г., като по този начин целият хърватски народ се оказва в една държава.
 Съюз с Унгария 1790
 След десетгодишното управление на Йосиф II, по време на което всички права на хървати и унгарци са премахнати, през 1790 година хърватският Сабор приема решение за съюз с Унгария за общ отпор срещу абсолютизма на Виенския двор. В резултат на това е образувано общо хърватско-унгарско правителство. Това е само временна мярка, но в Унгария се възползват от това и се опитват да наложат своите език, закони и управление и в Хърватия. Оттогава хърватите започват борба на два фронта – срещу унгарския хегемонизъм и срещу австрийския централизъм и германизация.
 Войните на Наполеон
 След Френската революция започват войните на Наполеон, които засягат и Хърватско. През 1797 г. престава да съществува Венецианската държава, а териториите ѝ в Далмация са завладени от Австрия. През 1805 г. французите отнемат от Австрия тези земи, а след нова война през 1809 г. завладяват още хърватски и някои западни словенски земи и образуват т.нар. Илирски провинции, които просъществуват до 1813 г. Армията на Наполеон влиза през 1806 г. в Дубровник, а през 1808 е обявен краят на Дубровнишката република. След поражението на Наполеон всички хърватски земи под негова власт попадат под австрийско управление.
 Хърватско народно възраждане
 Периодът от 1830 до 1848 г. в хърватската история е известен като „Хърватско народно възраждане“, което възниква под влияние на френската революция и поради силния натиск за германизация и маджаризация, както и вследствие на засиленото икономическо и културно развитие. Благодарение усилията на редица хърватски интелектуалци, като напр. Людевит Гай, Янко Драшкович, както и трудовете на загребския епископ Максимилиян Върховац, се оформя хърватският книжовен език, започват да се издават вестници и списания, учредяват се национални институции. От 1847 г. в Хърватско престава да се използва латинският като официален език, като за тази цел започва да се използва само хърватският. Хърватското възраждане ражда движението на илиризма, което има за цел обединението на всички южни славяни. На практика обаче тази идея не се осъществява.
 Революцията от 1848 – 1849 г.
 През 1848 г. избухва революция в Хабсбургската монархия. Хърватите издигат политическа програма под формата на Искания към Виенския двор, а народното събрание избира полковник Йосип Йелачич за бан. Той прекратява всички отношения с Унгария, отхвърля решението от 1790 г. за общо правителство, премахва крепостничеството, образува самостоятелно хърватско правителство. При последвалите заплахи от унгарска страна, бан Йелачич заема отбрана на Хърватско. На практика бан Йелачич контролира всички хърватски територии: той е хърватски бан, управител на пограничните области, както и на Риека и Далмация.
 Избухналата в Унгария революция не признава хърватите за отделен народ и заплашва Хърватско с оръжие. Въпреки стремежа на бан Йелачич да не се стига до война, като води неуспешни преговори, войната между унгарци и хървати избухва. Виенският двор, който се нуждае от защита – революцията е обхванала и Виена, подкрепя бан Йелачич. Той води няколко успешни битки и разбива унгарската войска край Виена.
 След като Унгарската революция е потушена, новият владетел Франц Йосиф I налага абсолютизма както върху всички наследствени австрийски земи, така и върху земите на хърватите, които помагат на Хабсбургите, така и на унгарците, които вдигат революция. Обаче по време на абсолютизма Йелачич остава бан и продължава да полага усилия за икономическото развитие на Хърватско. Освен това, хърватската католическа епископия се отделя от унгарската. В този период град Загреб се утвърждава като хърватска столица.
 Край на абсолютизма – хърватско-унгарско споразумение от 1868 г.
 След поражението на Австрия в Италия през 1859 г., монархът е принуден да премахне абсолютизма, да възстанови конституционното управление, а в самата монархия все повече се дискутира върху въпросите за централизма и федерализма. През 1861 г. е свикан хърватският Сабор, който настоява за обединение на всички хърватски земи: Далмация, Хърватско и Славония, а освен това отказва да влезе във виенския Императорски съвет, като по този начин отхвърля възможността за споразумение с Австрия. Последва ново сближаване с Унгария, но този път при условие да бъде призната териториалната цялост и равноправното положение на Хърватско. Тогава за пръв път в Хърватско се появяват политически партии от съвременен тип и за пръв път се издига идеята за независима хърватска държава.
 След ново поражение във войната срещу Италия и Прусия през 1866, Австрия е принудена от централистична държава да се преобразува в двойна монархия: да се раздели на Австрия и Унгария, наречена официално Австро-Унгария. През 1868 година между Унгария и Хърватско се сключва отделен договор, хърватско-унгарско споразумение, според което на хърватите се признава държавна и юридическа обособеност и автономия в управлението, правосъдието, образованието, както и църковна самостоятелност. Освен това, Хърватско има собствен държавен символ и войска. Макар че хърватите не са доволни от това, такъв статут няма никой друг народ в рамките на Австро-Унгария (напр. чехи, поляци и др.).
 Присъединяване на пограничните военни области към Хърватско през 1881 г.
 Въпреки че хърватско-унгарското споразумение не е много изгодно за хърватите, особено в икономическата област и данъците, Хърватско се развива бързо, особено в периода на управление на бана реформатор Иван Мажуранич (1873 – 1880).
 През 1881 година са премахнати пограничните военни области и управлението им е върнато на Хърватия. Обаче Далмация, Бока Которска и Истрия остават под директно австрийско управление, а Риека и Меджимурие – под унгарско управление, въпреки усилията на хърватския Сабор да обедини всички хърватски земи.
 Първи политически партии в Хърватско
 След хърватското народно възраждане възникват и първите политически партии в Хърватско, от която най-силна е Народната партия на епископ Йосип Юрай Щросмайер, известен в България като Йосиф Щросмайер. Идеите на тази партия са за просветно и културно издигане на Хърватско и обединение на всички южни славяни (т.нар. „южнославянска идея“). От 1861 г. съществува и Партия на правото, която се обявява за независима хърватска държава и е против съглашения с Австрия, Унгария или Сърбия.
 В края на 19 и началото на 20 век в Хърватско се заражда движение срещу унгарското влияние, а по-късно – и срещу сръбския национализъм. През 1883 в Загреб и Централна Хърватия биват свалени всички унгарски гербове и надписи и антиунгарското движение се разраства дотолкова, че се намесва войската. През 1895 година загребските студенти палят унгарски трибагреници, които за тях са символи на маджаризацията.
 През 1902 година в Загреб избухват антисръбски демонстрации, след като местните сърби публикуват във вестника си „Сърбобран“ памфлет, в който обявяват на хърватите война до изтребление. През 1903 година се надига и второ антиунгарско движение.
 Нови политически тенденции от 1903 г.
 Второто народно движение от 1903 година повдига нерешения хърватски въпрос в Австро-Унгария. Към това движение се присъединяват и хърватите от Далмация и Истрия. Подкрепят го и други славянски народи от Австро-Унгария. През 1905 г. двама далматински политици- Франо Супило и Анте Трумбич, поставят начало на т.нар. „политика на нов курс“, която има за цел обединяване на всички опозиционни партии на народите, населяващи Австро-Унгария. Към края на 1905 г. в Хърватско се оформя хърватско-сръбска коалиция, която печели мнозинство на изборите през 1906 година.
 Първа световна война и разпадане на Австро-Унгария
 След Сараевския атентат през 1914 г. започва Първата световна война. Повечето от опозиционните хърватски политици избягват от Австро-Унгария и основават т.нар. „Южнославянски комитет“ за освобождение на южните славяни в Австро-Унгария и за сътрудничество със Сърбия. Обаче Франо Супило, който е един от учредителите му, го напуска, защото другите членове не са привърженици на федерализма в една бъдеща държава на южните славяни или са колебливи в мнението си.
 Австро-Унгария, съставена от множество народи, се разпада, след като изгубва войната през 1918 г. и на нейната бивша територия изникват нови държави.
 Хърватия след 1918
 Вижте също
 Югославия между двете световни войни
 Външни препратки
 Кратка политическа и културна история на Хърватско
 общи страници в историята на прабългари и прахървати – Иван Танев Иванов


type: other

text:
Bedrijfsopvolging en onroerend goed - Jongbloed Fiscaal Juristen
 U bevindt zich hier : Kennisbank Bedrijfsopvolging Bedrijfsopvolging en onroerend goed
 In een B.V. zit veel onroerend goed. De eigenaar van de B.V. (de DGA) komt te overlijden. De aandelen gaan over naar de heer X en de broer van de overleden DGA. De vraag is of in de B.V. een materiële onderneming is ondergebracht. Als dit zo zou zijn, dan gaan de aandelen vrijwel zonder heffing over naar de erfgenamen. De Rechtbank is van mening dat er sprake is van een echte onderneming (materiële onderneming), het Gerechtshof is het niet met de Rechtbank eens (geen onderneming). De Hoge Raad verwijst de zaak naar een ander Gerechtshof omdat er volgens de Hoge Raad wel sprake is van een onderneming.
 Ontwikkelingsactiviteiten vormen onderneming voor BOF
 De heer X, zijn broer en hun vader zijn aandeelhouder in Y B.V. In deze B.V. zit veel onroerend goed en wordt ook onroerend goed ontwikkeld. De aandelen vererven aan de heer X en zijn broer. Het Gerechtshof was van mening dat de omvang van de ontwikkelingsactiviteiten t.o.v. de overige activiteiten in de B.V. te beperkt is voor een materiële onderneming. De Hoge Raad is dit niet met het Gerechtshof eens. Er moet worden gekeken of de ontwikkelingsactiviteiten op zichzelf bezien kunnen worden aangemerkt als onderneming. De zaak wordt verwezen naar het Gerechtshof in Amsterdam voor nader onderzoek.
 Grote portefeuille is onderneming voor BOF
 In een BV zit voor ruim 7 miljoen aan onroerende zaken (winkelcentra, kantoren en hallen). Zowel de Rechtbank Den Haag (ECLI:NL:RBDHA:2016:17102) als het Gerechtshof Den Haag (ECLI:NL:GHDHA:2018:794) zijn van mening dat er sprake is van een onderneming (en dus kan de bedrijfsopvolgingingsfaciliteit worden toegepast). Belangrijkste redenen:
 omvang van de onroerend goed portefeuille
 voortdurend inschakelen van externe deskundigen (zoals makelaars en juristen)
 werkzaamheden gericht tot behalen hoger rendement dan normaal (gemiddeld 6% en in deze casus 9%)
 Bedrijfsopvolging is fiscaal erg aantrekkelijk geworden. Voor ondernemers die van plan zijn hun eenmanszaak, VOF of B.V. eerdaags voor een aantrekkelijk prijsje aan één van hun kinderen over te doen, kan de bedrijfsopvolgingsfaciliteit van belang zijn. Veel klanten van ons kantoor vinden het prettig dat hun kinderen de zaak voortzetten. Begrijpelijke emotie noem ik dit. Door de onderneming tegen een lagere prijs dan de werkelijke waarde te verkopen of door de koopsom geheel of gedeeltelijk kwijt te schelden, willen zij hun kinderen steunen. De Successiewet merkt dit als schenking aan, belasting betalen dus. Sinds 2010 is deze faciliteit verder uitgebreid. Onder bepaalde voorwaarden wordt over de eerste € 1.000.000 aan geschonken ondernemingsvermogen in het geheel geen schenkbelasting meer geheven. Het daarboven geschonken ondernemingsvermogen is voor 83% vrijgesteld van heffing van schenkbelasting. De belangrijkste voorwaarde is dat er sprake is van een echte onderneming, een materiële onderneming zoals de fiscale wet dit omschrijft. Bij onroerende zaken is er vaak discussie over dit onderwerp. De laatste jaren schuift de jurisprudentie langzaam op richting "ook stenen kunnen een bedrijf vormen". Laat u wel voordien goed adviseren en doe dit tijdig (6 jaar voor de opvolging).
 Bron bedrijfsopvolging
 Hoge Raad d.d. 10 maart 2017 (ECLI:NL:HR:2017:396).
 Gerechtshof Den Haag d.d. 1 juli 2016 (ECLI:NL:GHDHA:2016:2167).
 Rechtbank Den Haag d.d. 3 juni 2014 (ECLI:NL:RBDHA:2014:16718).
 Vragen over de bedrijfsopvolgingsfaciliteit
 Meer weten van bedrijfsopvolging en onroerend goed
 Auteur(s) van bedrijfsopvolging en onroerend goed
 Artikel datum : 14-03-2017 | Artikel laatst gewijzigd : 06-06-2018


jurisdiction: US

text: b" Department of Health and Human Services\n\n OFFICE OF\n INSPECTOR GENERAL\n\n\n\n\nRYAN WHITE EVALUATION SYSTEMS\n\n Title II: Grants to the States\n\n\n\n\n JUNE GIBBS BROWN\n Inspector General\n\n AUGUST 1999\n OEI-05-98-00393\n\x0c OFFICE OF INSPECTOR GENERAL\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to\nprotect the integrity of the Department of Health and Human Services programs as well as the\nhealth and welfare of beneficiaries served by them. This statutory mission is carried out through a\nnationwide program of audits, investigations, inspections, sanctions, and fraud alerts. The\nInspector General informs the Secretary of program and management problems and recommends\nlegislative, regulatory, and operational approaches to correct them.\n\n Office of Evaluation and Inspections\n\nThe Office of Evaluation and Inspections (OEI) is one of several components of the Office of\nInspector General. It conducts short-term management and program evaluations (called\ninspections) that focus on issues of concern to the Department, the Congress, and the public. The\ninspection reports provide findings and recommendations on the efficiency, vulnerability, and\neffectiveness of departmental programs.\n\nOEI's Chicago Regional Office prepared this report under the direction of William Moran,\nRegional Inspector General. Principal OEI staff included:\n\nREGION HEADQUARTERS\n\nWilliam Moran, Project Leader\n Elise Stein, Program Specialist\nAnn Maxwell, Lead Analyst\n Rada Spencer, Program Specialist\nVictoria Jacobs, Analyst\n Alan Levine, Program Specialist\nNora Leibowitz, Analyst\n\nVince Greiber, New York Regional Office\n\n\n\n\n\n To obtain copies of this report, please call the Chicago Regional Office at (312) 353-9867.\n Reports are also available on the World Wide Web at our home page address:\n\n http://www.dhhs.gov/progorg/oei\n\x0c EXECUTIVE SUMMARY\n\nPURPOSE\n\n To examine the evaluation systems used by Title II Ryan White grantees to monitor the\n compliance, measure the outcomes and measure the overall effectiveness of the programs\n they fund.\n\nBACKGROUND\n\n In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency\n (CARE) Act as a comprehensive response to the HIV epidemic and its impact on\n individuals, families, communities, cities, and States. The Ryan White CARE Act was re-\n authorized in fiscal year (FY) 1996 through FY 2000. Title II of the Act provides grants\n to States to improve the quality, availability and organization of health care and support\n services for individuals and families with HIV disease. In FY 1999, the States received\n $710 million in Title II funds. Most grantees disburse a portion of these funds to service\n providers through regional fiscal agents called lead agencies and planning bodies called\n consortia.\n\n The Ryan White CARE Act will be considered for its second re-authorization in 2000. As\n Congress debates this re-authorization, questions are certain to be asked about the\n effectiveness and impact of the programs funded. This inspection examines the capacity of\n Title II Ryan White grantees to answer those questions.\n\n Through an extensive documentation review and on-site interviews, we examined the\n evaluation mechanisms used in 8 States, 12 consortia/lead agencies and 5 consortia\n responsible for planning only. The eight States visited represent 61 percent of FY 1998\n Ryan White Title II funds and 68 percent of reported AIDS cases in FY 1997.\n\nFINDINGS\n\nIn Most Sampled States, Program and Fiscal Compliance of Service Providers Is\nMonitored Through Fiscal Intermediaries; Intermediaries Have Monitoring\nMechanisms in Place\n\n In the eight States we visited, seven of the grantees use regionally based lead agencies to\n serve as fiscal agents for the service providers. In six of the States, the lead agencies have\n primary responsibility for monitoring the program and fiscal compliance of the service\n providers. The lead agencies receive regular program and fiscal reports from the\n providers and conduct frequent site visits to providers. Likewise, the grantees receive\n\n\nRyan White Evaluation Systems: Title II 1 OEI-05-98-00393\n\x0c regular program and fiscal reports from the lead agencies and conduct periodic site visits\n to them. Most of the grantees and lead agencies have mechanisms in place to ensure that\n Ryan White funds are used only for eligible clients and as the payor of last resort.\n\nFew Grantees or Lead Agencies Currently Require Outcome Measurement of\nTheir Service Providers; Most Are in the Early Stages of Discussion Regarding\nOutcome Measures\n\n Currently, only 1 of the 8 State grantees and 1 of the 12 lead agencies we visited, require\n client outcomes to be measured. The majority of grantees and lead agencies are in the\n early stages of planning for outcome measurement. Concerns regarding outcomes\n measures and a desire for technical assistance from the Health Resources and Services\n Administration (HRSA) were expressed by over half of the grantees and lead agencies.\n\nGrantees Rely on Consortia to Assess Needs; Most Consortia Routinely Assess\nthe Needs of Clients but Not of Persons Outside of HIV/AIDS Care\n\n All of the State grantees we visited rely on regional consortia to assess the needs of\n persons with HIV/AIDS and require them to do so on a routine basis. Slightly over half\n of the grantees require the consortia to submit the needs assessment results as part of the\n consortium\xe2\x80\x99s annual application for funds.\n\n Most of the consortia or local planning bodies use both qualitative and quantitative data\n sources in their needs assessment work, including public health data, consumer and\n provider surveys, focus groups and public forums. Outside of the public health data,\n information on the needs of infected individuals not receiving HIV/AIDS care is typically\n not obtained. Of the 17 planning bodies we interviewed, only 3 reported that they have\n successfully solicited needs information from persons with HIV/AIDS not in care.\n\nRECOMMENDATIONS\n\nThe HRSA Should Implement a Multi-year Outcomes Initiative\n\n The HRSA should build upon their efforts to promote outcome measurement by\n establishing a multi-year implementation plan. Outcome measurement should start on the\n provider level and lead through subsequent steps to consortia-wide analysis of client\n outcomes by the responsible fiscal agent. Outcome measurement would foster program\n improvements and greater accountability for expenditures and promote the achievements\n of the Ryan White programs.\n\n\n\n\nRyan White Evaluation Systems: Title II 2 OEI-05-98-00393\n\x0cThe HRSA Should Provide Technical Assistance to Improve the Ability of\nGrantees and Consortia to Estimate the Needs of Infected Persons Not in\nHIV/AIDS Care\n\n The HRSA currently requires grantees to estimate unmet need of persons not in\n HIV/AIDS care by comparing service utilization data to the HIV epidemic in their area.\n The HRSA should require the grantees and consortia to improve their knowledge of\n unmet need by soliciting information directly from persons not in HIV/AIDS care.\n\n Grantee solicitation of the input of persons unconnected to HIV/AIDS care would assist\n the grantees in complying with the re-authorized CARE Act\xe2\x80\x99s directive to prioritize a\n portion of funds for emerging populations. Grantee solicitation of this input would also\n contribute to the Department\xe2\x80\x99s efforts to address the greater burden of HIV/AIDS on\n racial and ethnic minorities.\n\n Several respondents indicated a need for technical assistance on using outreach strategies\n to solicit information from persons not in HIV/AIDS care. The HRSA could provide the\n grantees and consortia with a technical assistance document detailing effective outreach\n strategies. Particular attention should also be paid to reaching persons who receive\n HIV/AIDS services but may not be receiving primary health care services.\n\nAGENCY COMMENTS\n\n While HRSA concurred with the findings and recommendations in our draft report, they\n offered suggestions for clarifying the report. Where appropriate, we changed the report to\n reflect their comments. The HRSA\xe2\x80\x99s complete comments can be found in Appendix B.\n\n The HRSA briefly described a few activities in support of our recommendation to\n implement a multi-year outcomes initiative. We commend HRSA on these activities and\n plans. Despite their efforts in this area, HRSA expressed a few concerns regarding data\n limitations, funding limitations, and confidentiality concerns.\n\n We do not expect the outcomes initiative to lead to rigorous scientific evaluations\n conducted by every grantee. By examining the client-level impact of the services they\n fund, the grantees can assess in general terms the effectiveness of these services.\n\n Although we expect the costs involved to be minimized by emphasizing the use of data\n resources already available to the providers, many grantees may need additional financial\n resources to develop an outcomes system. We recommend that HRSA work with the\n Department to secure funds for these initiatives. The FY 2000 re-authorization of the\n CARE Act provides an optimal opportunity to consider funding for infrastructure\n development vital to ensuring efficient and effective service delivery in the future.\n The HRSA\xe2\x80\x99s third area of concern - assuring client confidentiality, can be addressed by\n using unique identifiers and staff confidentiality agreements.\n\nRyan White Evaluation Systems: Title II 3 OEI-05-98-00393\n\x0c TABLE OF CONTENTS\n\nEXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1\n\n\nINTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5\n\n\nFINDINGS\n\n Fiscal Intermediaries Perform Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9\n\n\n Few Require Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11\n\n\n Adequately Assessing Client Needs, Not Those Outside of Care . . . . . . . . . . . . . . . 14\n\n\nRECOMMENDATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16\n\n\nAGENCY COMMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20\n\n\nAPPENDICES\n A: Title II Administrative Structure by State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21\n\n\n B: Agency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24\n\n\n C: Related Office of Inspector General Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32\n\n\n\n\n\nRyan White Evaluation Systems: Title II 4 OEI-05-98-00393\n\x0c INTRODUCTION\n\nPURPOSE\n\n To examine the evaluation systems used by Title II Ryan White grantees to monitor the\n compliance, measure the outcomes and measure the overall effectiveness of the programs\n they fund.\n\nBACKGROUND\n\n This study complements our reports entitled, Ryan White Evaluation Systems, Title I:\n Grants to Metropolitan Areas (OEI-05-98-00392) and Ryan White Evaluation Systems,\n AIDS Drug Assistance Programs (OEI-05-98-00390).\n\nThe Ryan White CARE Act\n\n In 1990, Congress passed the Ryan White Comprehensive AIDS Resources Emergency\n (CARE) Act as a response to the HIV epidemic and its impact on individuals, families,\n communities, cities and States. The Ryan White programs provide health and support\n services to persons with HIV/AIDS who would otherwise not have access to care. The\n Ryan White programs constitute slightly over $1 billion of the $6.8 billion in HIV/AIDS\n expenditures in the U.S. Department of Health and Human Services\xe2\x80\x99 Fiscal Year (FY)\n 1998 budget.\n\n The Ryan White CARE Act was re-authorized in FY 1996 through FY 2000. Changes to\n the Act included a directive to Title II grantees to prioritize a portion of their funds for\n emerging populations.\n\n The Health Resources and Services Administration (HRSA) directs Ryan White resources\n to various local entities through the Act's four titles and Part F and allows grantees\n maximum flexibility in the use of funds. In FY 1998, nearly 90 percent of the Act\xe2\x80\x99s funds\n were awarded to Title I and Title II grantees.\n\nTitle II of the Ryan White CARE Act\n\n Title II provides grants to States to improve the quality, availability and organization of\n health care and support services for individuals and families with HIV disease. Grants are\n awarded to States in accordance with the number of living AIDS cases in the State or\n territory and the estimated number of living AIDS cases outside of Title I funded eligible\n metropolitan areas. In addition to the base award, States receive earmarked funds for the\n\n\n\nRyan White Evaluation Systems: Title II 5 OEI-05-98-00393\n\x0c AIDS Drug Assistance Programs (ADAPs) through which States provide medications to\n low-income individuals with HIV disease with no or limited insurance coverage.\n\n Outside of the earmarked funds, States can use Title II funds to support home and\n community based health and support services, continuation of health insurance coverage,\n pharmaceutical treatments through the ADAP, HIV care consortia, and direct health and\n support services. This inspection focuses on evaluation mechanisms within the consortia\n program, as this program receives the largest share of Title II non-ADAP funds.\n\n Consortia are community-based regional planning entities established by Title II grantees.\n The consortia plan and prioritize Title II funds in their area, promote coordination of\n services and serve as a community forum. Representatives of local public and non-profit\n health and support service providers serve as consortium members. Incorporated\n consortium may serve as the local fiscal agent for Title II funds. In other cases,\n consortium designate a member agency to be the \xe2\x80\x9clead agency,\xe2\x80\x9d responsible for grants\n administration and provider monitoring of Title II funds in the region. In some areas, the\n lead agency is the same agency that is responsible for the administration of Title I funds.\n (See Appendix A for a description of the consortia/lead agency structure in visited States)\n\nOIG Evaluation Recommendations in 1995\n\n In a June 1995 Office of Inspector General (OIG) report, \xe2\x80\x9cThe Ryan White CARE Act:\n Local Implementation Issues\xe2\x80\x9d(OEI-05-93-00336), the OIG found an absence of program\n outcome evaluation to measure the CARE Act\xe2\x80\x99s impact. Beyond surveys of client\n satisfaction undertaken by providers at the local level, grantees and consortia were not\n assessing the impact of CARE Act funds on their service area.\n\n The OIG recommended that the Health Resources and Services Administration and the\n Assistant Secretary for Planning and Evaluation (ASPE) fund appropriate studies to assess\n the overall effectiveness of the Ryan White programs. The OIG also recommended that\n HRSA ensure grantees evaluate their own programs. The OIG suggested local\n evaluations include provider compliance reviews, outcome measure studies and overall\n program effectiveness reviews. The OIG asked HRSA to provide grantees with technical\n assistance and evaluation instruments that guarantee consistency in data collection and\n evaluation.\n\n The ASPE did not conduct any evaluations of the Ryan White program as recommended\n in the 1995 OIG report. However, ASPE is currently funding the HIV Costs and Services\n Utilization Study (HCSUS) with HRSA and the Agency for Health Care Policy and\n Research (AHCPR). The HCSUS examines who is treated for HIV, the health services\n HIV patients receive, the costs of the services and means of payment. The ASPE and\n AHCPR are also sponsoring a related study on the impact of health care financing\n arrangements on access to and use of new and emerging HIV therapies.\n\n\n\nRyan White Evaluation Systems: Title II 6 OEI-05-98-00393\n\x0c The Office of Science and Epidemiology, within the HIV/AIDS Bureau of HRSA, has a\n national Ryan White evaluation agenda which includes client-level data studies, links with\n secondary data sets, topic specific evaluations and the aggregate reporting system. The\n office is focusing on evaluating the following areas: 1) Enrolling under-served populations;\n 2) Providing clients with care equal to that received by the insured;\n 3) Providing services that remove barriers to receiving primary care; 4) Reducing\n morbidity, including opportunistic infections and perinatal transmission, and maintaining or\n increasing CD4 levels; 5) Reducing mortality; and 6) Adapting to a changing service and\n cost environment.\n\nHRSA\xe2\x80\x99s Current Evaluation Requirements\n\n In recent years, HRSA\xe2\x80\x99s Grant Application Guidances have placed a growing emphasis on\n the ability of grantees to document and quantify the impact of the services they fund. The\n FY 1999 application guidance asks grantees to begin developing outcome measures in\n relation to four program principles: responding to the needs of the underserved and hard-\n to-serve, assuring access to emerging therapies, adapting to changes in the health care\n market, and documenting client-level outcomes. Suggested client-level outcomes include:\n decreased viral load, declines in perinatal transmission of HIV, and morbidity and\n mortality reductions. In the absence of defined outcome measures, the grantee is asked to\n describe activities they will undertake to measure impact in these areas.\n\n The FY 1999 Application Guidance instructs applicants to estimate unmet need for those\n in care and those not currently in the system of care in terms of their demographics,\n geographic variation across the State and their unmet need. Applicants are also instructed\n to provide quantitative data on co-morbidities, poverty status and insurance status of the\n State\xe2\x80\x99s living HIV/AIDS cases.\n\n The FY 1999 Application Guidance asks the grantees for more information on unmet need\n to be obtained through comparisons of HIV prevalence and service utilization data. The\n Guidance emphasizes the importance of documenting unmet need and indicates future\n HRSA plans to work with the States in this endeavor.\n\nHRSA\xe2\x80\x99s Technical Assistance on Evaluation\n\n The HRSA has provided technical assistance to Title II grantees on conducting\n evaluations through a variety of means including: self assessment protocols, meetings to\n share evaluation strategies, and a series of monograph reports on evaluation and\n assessment. The most recent report emphasizes the importance of outcome measurement\n and provides some guidance to grantees on how to approach it. The report does not\n suggest outcomes to measure or steps to develop outcome measures. More recently,\n HRSA has suggested grantees focus on primary health care outcomes and will soon\n disseminate a publication focusing on primary health care outcome measures.\n\n\nRyan White Evaluation Systems: Title II 7 OEI-05-98-00393\n\x0cRe-authorization in 2000\n\n The Ryan White CARE Act will be considered for its second re-authorization in 2000. As\n Congress debates this re-authorization, questions are certain to be asked about the\n effectiveness and impact of the programs funded. This inspection examines the capacity of\n Title II Ryan White grantees to answer those questions.\n\nSCOPE AND METHODOLOGY\n\n In this inspection, we examined the mechanisms Title II grantees use to monitor\n sub-grantee program and fiscal compliance, measure the outcomes of the programs they\n fund and assess their effectiveness in meeting the evolving needs of the affected\n population. This evaluation does not judge the compliance, measure the outcomes or\n assess the effectiveness of the Title II grantees, but rather judges whether the grantees\n have and appropriately utilize the tools to perform these evaluation functions. We did not\n review HRSA\xe2\x80\x99s evaluation of the grantees.\n\n For the purposes of this analysis, we define compliance as serving the population,\n providing the services and spending the resources as agreed to in return for the award of\n program funds. Outcomes are defined as measures of the benefits clients derive as a result\n of the program. Finally, we define overall effectiveness as how well the mix of services\n meets the evolving needs of the population affected by the epidemic.\n\n We conducted an on-site examination of these evaluation mechanisms in eight States: New\n York, New Jersey, Maryland, Florida, Illinois, Texas, California and the District of\n Columbia. We selected these States as a purposive sample representative of\n comparatively high rates of incidence through intravenous drug use transmission,\n comparatively high rates of infections among minority populations, and regional diversity.\n In addition, our selected States contain 68 percent of the living AIDS cases reported in\n 1997 and 61 percent of the Title II funding for FY 1998.\n\n We conducted an extensive review of documentation provided by the grantees, consortia\n and providers. We examined States\xe2\x80\x99 FY 1998 Title II grant applications, service provider\n contracts, samples of all program, fiscal, outcome and needs assessment reports, site visit\n protocols and additional evaluation materials.\n\n We supplemented the documentation review with on-site interviews from October through\n December 1998. In each State we interviewed: the Title II grantee, the Title II\n consortia/lead agency in up to three different regions, and at least 10 percent of the Title II\n providers. The number of providers interviewed ranged from 4 to 15. They were chosen\n to represent various program sizes, service delivery purposes and locations.\n\n We conducted our review in accordance with the Quality Standards for Inspections issued\n by the President\xe2\x80\x99s Council on Integrity and Efficiency.\n\nRyan White Evaluation Systems: Title II 8 OEI-05-98-00393\n\x0c FINDINGS\n\nIn most sampled States, program and fiscal compliance of\nservice providers is monitored through fiscal intermediaries;\nintermediaries have monitoring mechanisms in place\n In the eight States we visited, seven of the grantees use regionally based lead agencies to\n serve as fiscal agents for the service providers. The grantees monitor the lead agencies\n and the lead agencies monitor the providers. The lead agencies determine funding awards\n in accordance with a service plan developed by the regional consortium or planning body.\n In six of the States, the lead agencies have primary responsibility for monitoring the\n program and fiscal compliance of the service providers. In two of these six States, the\n grantees keep abreast of individual provider performance by reviewing the reports\n providers submit to the lead agency or by accompanying the lead agency on site visits. In\n the other four States, the grantees leave all provider monitoring responsibilities to the lead\n agencies.\n\nGrantees receive regular program and fiscal reports from lead agencies and most\nconduct periodic site visits to lead agencies\n\n All of the grantees we visited receive monthly or quarterly program and fiscal reports from\n the lead agencies. Program reports typically contain compiled program data, such as the\n units of service provided and the number and demographics of clients served, as well as a\n narrative section on program accomplishments and barriers. Fiscal reports are typically\n expense vouchers or invoices of line item costs.\n\n Most of the grantees we visited reimburse the lead agencies based on a line item budget.\n A couple of the grantees reimburse lead agencies on a fee-for-service or unit cost basis.\n Some grantees advance the lead agencies a portion of their funds to facilitate the flow of\n the grant making process. All but one of the grantees requires the lead agencies to have\n an independent audit performed. The majority of grantees require the audits to be\n submitted for review on an annual basis.\n\n Most of the grantees conduct formal site visits to the lead agencies at least once every 2\n years. Two of the grantees have not routinely visited lead agencies but plan to conduct\n routine visits in the future. One of these grantees plans to visit lead agencies once every\n 3 years.\n\n\n\n\nRyan White Evaluation Systems: Title II 9 OEI-05-98-00393\n\x0cLead agencies receive regular program and fiscal reports from providers and\nconduct frequent site visits to providers\n\n All of the lead agencies we visited receive monthly or quarterly program and fiscal reports\n from their service providers. The program and fiscal reports contain similar information to\n that which the lead agencies report to the grantees. While most of the grantees reimburse\n lead agencies based on a line item budget, the majority of lead agencies reimburse\n providers on a fee-for-service or unit cost basis or have plans to do so. Nearly all of the\n lead agencies require and review annual audits of the providers.\n\n The majority of sampled lead agencies conduct formal site visits to service providers at\n least once a year and as often as quarterly. Site visits typically include a review of a\n sample of client files, financial records and other support documentation used for\n reporting. Most of the lead agencies also informally monitor providers through ongoing\n communication and individualized technical assistance.\n\nMost grantees and lead agencies have mechanisms to ensure that Ryan White\nfunds are used only for eligible clients and as the payor of last resort\n\n All of the grantees and lead agencies have mechanisms in place to ensure that providers\n verify client eligibility for Ryan White services. Six of the eight grantees and most of the\n lead agencies also have mechanisms to ensure that providers use Ryan White funding as\n the payor of last resort. The grantees and lead agencies include eligibility and payor\n requirements in written policy and procedural manuals and check relevant documentation\n on site visits. A few lead agencies do not routinely verify provider use of Ryan White\n funds as the payor of last resort. These lead agencies indicated awareness of the need to\n devote more attention to this area in the future.\n\n Most of the service providers we visited have mechanisms in place to ensure that they use\n Ryan White funds as the payor of last resort, such as documenting Medicaid and private\n insurance coverage in client files and billing accordingly. However, a few of the ancillary\n service providers we visited appeared unaware of the rules or their responsibility in this\n area. A few also appeared to be unclear of the services paid for by Medicaid in their\n State. In addition, service providers have varying capacity to check Medicaid eligibility.\n\n\n\n\nRyan White Evaluation Systems: Title II 10 OEI-05-98-00393\n\x0cFew Grantees or Lead Agencies Currently Require Outcome\nMeasurement of Their Service Providers; Most Are in the\nEarly Stages of Discussion Regarding Outcome Measures\n\nCurrently, Only One of the Eight State Grantees and One of the Twelve Lead\nAgencies We Visited, Require Client Outcomes to Be Measured\n\n The New York grantee currently requires outcome measures for three service categories,\n primary care, dentistry and case management. Primary care and dentistry are measured\n according to professional clinical guidelines and expected clinical health outcomes. An\n independent peer review organization monitors providers\xe2\x80\x99 performance on a set of core\n indicators such as CD4 count and gynecological health. These are tracked by a common\n software package that aggregates individual level clinical data entered to manage patient\n care. The grantee is also piloting outcomes in case management in the following areas:\n optimal health, financial/entitlements, independent living, adult education/employment,\n family stability, mental health, substance abuse and client empowerment.\n\n The Sacramento County Department of Health and Human Services, the lead agency for\n Title II funds in the Sacramento area, requires providers to report outcome measures on a\n quarterly basis. Since reporting compliance was low in the initial 6 months, the lead\n agency is developing a standard format for outcome reporting. Outcome measures are a\n required component of the provider quarterly reports as of FY 1999.\n\n The rest of the grantees and lead agencies rely on process measures to measure the\n success of service providers. These measures, along with annual goals, are usually\n outlined in the scope of work section of a provider\xe2\x80\x99s contract. The process measures\n typically consist of the number of clients served and the number of service units delivered\n in the contract year. Some contracts require that the measures be broken down by sub-\n population, with a special emphasis on women and children.\n\nA few providers currently report outcomes; many others have client outcomes in case files\n\n A few providers in several localities have developed aggregate outcomes to measure the\n impact of the services they provide. These providers have taken the initiative due to the\n requirements of other funding sources or their own desire for greater program\n accountability. Though they are not required to, these agencies typically submit their\n outcome information to their lead agencies as part of their quarterly or annual progress\n reports.\n\n The outcome measures developed by the Mount Carmel Guild in Mercer County New\n Jersey provide an example of the type of outcome measures some providers are using. The\n\n\nRyan White Evaluation Systems: Title II 11 OEI-05-98-00393\n\x0c Mount Carmel Guild provides nutritional counseling, nutritional food packages and\n personal care packages for HIV infected clients. They have a set of outcome measures\n that are tracked for each client and aggregated to evaluate overall program performance.\n The measures include weight loss, weight gain, weight stabilization, cholesterol level,\n albumin level and routine vitamin intake. The nutritionist routinely tracks progress on\n these outcomes by client and aggregates them annually through a random audit of 50\n client charts. The organization has plans underway to refine this process by analyzing\n outcomes across sub-populations.\n\n Many other providers we visited collect client information which could be used to measure\n program outcomes if aggregated. For example, case managers often establish client goals\n at intake and document progress towards these goals in a client\xe2\x80\x99s case file. Physicians also\n typically record clinical progress in patient charts. In these situations, a client\xe2\x80\x99s progress\n or the progress of the caseload in general may be discussed at organizational meetings, but\n agencies do not aggregate the client outcomes and are not able to compare outcomes\n across client groups, service strategies or over time. Nor do they report outcomes to the\n lead agency or grantee.\n\nThe Majority of Grantees and Lead Agencies We Visited Are in the Early Stages of\nPlanning for Outcome Measurement\n\n Most State grantees are in various stages of planning for outcome measures. Two State\n grantees are discussing the development of outcome measures in the near future. Both are\n planning on developing a core set of outcomes at the State level with provider input. One\n has begun by introducing the concept of outcome measurement to its providers to solicit\n their feedback. The other grantee is setting up a task force to focus on outcome\n measures. This task force is soliciting information from other Ryan White programs and is\n searching for a consultant to help them devise a strategy to develop outcome measures in\n a participatory manner. They are also considering contracting a local university to define\n the measures once they are selected.\n\n Other State grantees, while not yet engaged in outcomes discussions, are laying the\n groundwork for future outcome measurement. A few are developing standards of care. It\n is their belief that this standardization of service provision is necessary in order to hold\n providers accountable to a common set of outcome measures. Several grantees are\n working to improve their databases which will facilitate the collection of outcome\n measures. The improvements include projects such as developing the capacity to collect\n client-level data and devising standard data definitions to assure accurate and reliable\n reporting.\n\n Half of the lead agencies are also engaged in the development of outcome measures. Half\n of these agencies indicated that they are actively engaged in putting outcome measures in\n place by the FY 1999 grant cycle. The other half are in the very early stages of discussion\n surrounding the implementation of outcome measurement.\n\nRyan White Evaluation Systems: Title II 12 OEI-05-98-00393\n\x0c Agencies actively pursuing outcome measures are doing so by formulating a core set of\n outcome measures. One agency has, based on the United Way model1, met with all of the\n providers to assess the data they are collecting and their capacity to aggregate outcome\n measures with minimal additional burden. This information will be used to create a set of\n outcomes for each service category. Another lead agency, already receiving voluntary\n outcome measures from its providers, has compiled a list of all of the outcome measures\n reported and is in the process of selecting a core set of measures. Another agency has\n hired a consultant to develop a set of quality indicators in consultation with staff and\n providers. This agency plans to recommend a set of outcome measures and require that\n providers incorporate a minimum of three outcome measures per service category.\n\n Other lead agencies are aware of the management and accountability benefits of utilizing\n outcome measures, but are still \xe2\x80\x9cfiguring out their approach.\xe2\x80\x9d While they indicate plans to\n have outcomes in place by FY 2000, they have no specific plans underway.\n\nMore than Half of the Grantees and Lead Agencies Expressed Concerns\nRegarding Outcomes Measures\n\n Grantees and lead agencies share a variety of concerns regarding the development of\n outcome measures. Several respondents noted that the administrative cap limits the\n amount of money available to track outcomes. Additional grant funds that can be set\n aside for outcome measurement would be in direct competition with direct service funds.\n There are also capacity concerns. A number of grantees and lead agencies are concerned\n that they do not possess the technical expertise to develop outcome measures that would\n appropriately reflect the diversity of service delivery and which could be attributed solely\n to the infusion of Ryan White funds. Respondents also questioned the ability of planning\n bodies to properly understand and utilize outcome measures. Providers voiced similar\n concerns regarding outcome measures. In particular, they felt that they did not have the\n resources or skills to properly develop or monitor client outcomes.\n\n Respondents also questioned whether the State and local levels are the appropriate place\n to develop and conduct outcome measurement. Many respondents feel that outcome\n measures should be uniform across Ryan White Titles, the State and the country in order\n to reduce the reporting burden and to allow for meaningful comparisons between\n programs. Some also feel that Ryan White outcome measures should relate to the\n outcomes measures of other Federal agencies that support HIV services, such as the\n Department of Housing and Urban Development, and the Public Health Service goals for\n the year 2000. In addition, several respondents suggested that tracking outcomes at the\n national level would be more cost-effective. Respondents indicated that with uniform\n measures HRSA could take advantage of sampling methodologies to reduce the amount of\n\n 1\t\n The United Way approach emphasizes developing outcomes reflective of an agency\xe2\x80\x99s goals and\n recommends using data sources readily available to agencies such as client records and responses\n to routinely administered standardized tests and measurements.\n\n\nRyan White Evaluation Systems: Title II 13 OEI-05-98-00393\n\x0c labor involved. The HRSA could also tap into the capacity and resources that already\n exist in the medical research field.\n\nMajority of grantees desire technical assistance from HRSA on outcome\nmeasurement\n\n Grantees requested that HRSA clearly delineate and communicate the direction they are\n headed with regards to outcome measures. Grantees asked for a definition of what is\n meant by outcome measures and what outcome measures are appropriate for specific\n service categories.\n\n Several grantees also want HRSA to offer guidance on how to design an inclusive process\n of developing outcomes, how to measure service outcomes and how to build\n organizational capacity to interpret and analyze outcomes. They want answers to\n questions such as: How do you create indicators that provide the information you are\n after? How do you track outcome measures over time? How do you get the necessary\n information from the client or their provider? What about confidentiality issues? The\n respondents suggested that the answers to these questions could be provided through\n workshops, dissemination of best practices and national conferences, designed to promote\n information exchange among the grantees.\n\nGrantees rely on consortia to assess needs; most consortia\nroutinely assess the needs of clients but not of persons\noutside of HIV/AIDS care\n All of the State grantees we visited rely on regional consortia to assess the needs of\n persons with HIV/AIDS and require them to conduct periodic assessments. Slightly over\n half of the grantees we visited require the consortia to submit needs assessment results as\n part of the consortium\xe2\x80\x99s annual application for funds. A couple of grantees supplement\n the local needs assessments with limited Statewide assessments of specific issues or sub-\n populations. None of the grantees currently conduct comprehensive assessments of the\n needs of the HIV/AIDS population in their State. However, in compliance with Federal\n law, all of the State grantees review local needs assessments to identify Statewide needs as\n part of the Statewide Coordinated Statement of Need (SCSN) process.2 Building on the\n momentum of the SCSN process, two of the grantees are planning to conduct a\n Statewide needs assessment in FY 1999.\n\n\n\n 2\t\n The 1996 CARE Act legislation requires all Ryan White grantees to participate in a Statewide\n Coordinated Statement of Need (SCSN) process to collaborate in identifying and addressing HIV\n care issues. The SCSN is to be based on existing information from local needs assessments.\n Starting in FY 1998 Title II grantees are required to submit a copy of the SCSN with their grant\n applications and update the SCSN every three years, at a minimum.\n\n\nRyan White Evaluation Systems: Title II 14 OEI-05-98-00393\n\x0cMost grantees do not specify what to include in the needs assessment\n\n Most of the grantees we visited do not specify what the consortia must include in their\n needs assessment or provide a standard tool for conducting the needs assessment. A few\n of the grantees provide some guidance to the consortia on how to conduct the needs\n assessment and on the types of information they are expected to collect. For example, the\n Florida grantee specifies what types of entities and population groups the consortium\n should consult with in the assessment. Lead agencies in Florida are also directed to\n include an epidemiological profile, a demographic survey, focus groups, a resource\n inventory and a profile of provider capacity. Two of the State grantees are in the process\n of developing a standard needs assessment tool for use by their consortium.\n\nMost consortia do not assess the needs of infected persons not in HIV/AIDS care\n\n We interviewed 17 planning bodies responsible for conducting local Title II needs\n assessments, including 5 \xe2\x80\x9cHIV/AIDS care networks\xe2\x80\x9d in New York and several Title I\n planning councils who assess needs for both Title I and Title II services. Most of the\n consortia or planning bodies use both qualitative and quantitative data sources in their\n needs assessment work, including public health data, consumer and provider surveys,\n focus groups and public forums.\n\n Outside of the public health data, information on the needs of infected individuals not\n receiving HIV care is usually not obtained. Of the 17 planning bodies interviewed, only 3\n reported that they have successfully solicited needs information from persons with\n HIV/AIDS who are not in care. A few others indicated that they may have obtained needs\n information from infected persons not in care through public forums, but these forums\n were not targeted to this population. Two of the other needs assessment bodies tried to\n solicit information from persons not in HIV/AIDS care through advertising in local\n newspapers and through substance abuse facilities, but were reportedly unsuccessful.\n\n The three consortia successful in obtaining the input of persons not in HIV/AIDS care\n used peers and street outreach to solicit input. Two of the consortia trained persons living\n with HIV to survey infected persons in non-HIV/AIDS provider locations such as shelters\n and community groups. One care network in New York conducted focus groups in\n shooting galleries and crack houses to solicit information on needs from persons outside of\n the HIV/AIDS care system.\n\n\n\n\nRyan White Evaluation Systems: Title II 15 OEI-05-98-00393\n\x0c RECOMMENDATIONS\n\n\nThe HRSA should implement a multi-year outcomes initiative\n\n The HRSA should build upon their efforts to promote outcome measurement by\n establishing a multi-year implementation plan. Outcome measurement should start on the\n provider level and lead through subsequent steps to consortia-wide analysis of client\n outcomes by the responsible lead agency.3 Outcome measurement would foster program\n improvements and greater accountability for expenditures and promote the achievements\n of the Ryan White program.\n\n Here is one option of how HRSA could proceed:\n\n <\t In stage one, HRSA could develop one or more core outcomes for each service\n category and require the grantees to direct the lead agencies of the Title II consortia\n to develop three additional outcomes for each service category. The HRSA\xe2\x80\x99s core\n outcomes could be used for both Title II and Title I grantees and should be aligned\n with the performance goals outlined in HRSA\xe2\x80\x99s annual performance plan. The\n HRSA should urge Title II lead agencies to work with co-located Title I grantees\n and planning bodies in establishing the consortia-level outcome measures, so as to\n avoid imposing a greater measurement burden on providers funded under both\n Titles.\n\n <\t In stage two, HRSA could require the grantees to direct the lead agencies of the\n consortia to collect the established outcome measures from the providers on a\n quarterly basis. The HRSA should also urge the grantees and the lead agencies to\n require providers to report outcome measures as client-level data. These agencies\n will need client-level outcome data in order to analyze client outcomes across the\n region in stage three.\n\n <\t In stage three, HRSA could require the grantees to direct the lead agencies of the\n consortia to analyze the reported outcome measures across services and report\n consortia-wide outcomes to HRSA via the grantees on an annual basis.\n\n In establishing the core outcomes, HRSA should place a greater emphasis on primary\n health care outcomes since the ultimate goal of the Ryan White CARE Act is improved\n\n\n 3\n In States where grantees, rather then regional consortia, have direct oversight over providers, the\n responsibility of developing, collecting and analyzing outcomes would fall to the State.\n\n\nRyan White Evaluation Systems: Title II 16 OEI-05-98-00393\n\x0c health status. However, at least one core outcome should be developed for each support\n service category. The outcomes for the support services should reflect the contribution\n the support services make to improved health status such as facilitating access to primary\n care or creating conditions conducive to following and benefitting from a structured health\n care regimen. Measuring these incremental outcomes would provide valuable information\n on the contribution of these services to health outcomes. This information could be used\n for accountability and program improvement purposes. Confidentiality concerns can be\n overcome using staff confidentiality agreements and unique identification numbers, rather\n than client name, to track clients.\n\n The outcome measurement initiative can serve as a means for HRSA to further promote\n continuous quality improvement (CQI) efforts. Through CQI, information on the\n effectiveness and quality of program delivery is fed back to program managers on a\n continuous basis, serving as a tool for managers to improve program delivery. While\n quality assurance and process indicators are used to gauge the quality of services\n delivered, outcome measures can be used to gauge service effectiveness. The HIV/AIDS\n service providers could use outcome measures along with quality of care indicators to\n improve their performance through program alterations and further self-evaluation under\n CQI.\n\n As the Ryan White CARE Act faces its second decade of providing care to persons\n infected with HIV/AIDS, it is time to ensure that the grantees have the capacity to\n evaluate the outcomes of the services they deliver. Outcome evaluation as a CQI tool is\n vital to strengthening the effectiveness of the services delivered and the efficiency of the\n funds expended to provide the services. This basic need for appropriate funding should be\n addressed in the re-authorization of the CARE Act in FY 2000.\n\n The HRSA should provide the grantees with technical assistance to implement the core\n outcome measures and to develop and implement their own additional outcome measures\n within a CQI framework. The technical assistance could emphasize soliciting provider\n input in the development of the additional outcomes, using the United Way approach.\n\n The United Way approach to outcome measurement emphasizes using outcome measures\n for program improvement purposes. To this end, the United Way emphasizes soliciting\n provider input in the development of outcome measures to make sure that outcome\n measures reflect program goals. The United Way also stresses the importance of\n considering the data resources already available to the providers when developing\n outcome measures so as not to impose too much additional administrative or cost burden.\n\n The United Way\xe2\x80\x99s approach recognizes the limited capacity of health and human service\n providers to engage in rigorous outcome evaluation. Hence, the United Way model\n emphasizes contribution rather than attribution. Using outcome measures, providers can\n determine if clients achieve an expected result after receiving their service intervention.\n While the provider is not able to scientifically prove that the result is due solely to their\n\n\nRyan White Evaluation Systems: Title II 17 OEI-05-98-00393\n\x0c intervention, they can see whether their service is contributing to positive outcomes on a\n regular basis.\n\n In recent years, HRSA\xe2\x80\x99s application guidance to Title II grantees has stressed the\n importance of documenting outcomes and has asked grantees to include outcome data in\n their applications. All of our respondents have received the message from HRSA that\n outcome measures are important and that HRSA expects them to move ahead in this area.\n However, respondents stated that they would like more specificity from HRSA on what\n outcomes they are expected to measure and on HRSA\xe2\x80\x99s implementation plans.\n\n Stronger leadership from HRSA on outcome measurement would help coordinate efforts\n that remain fragmented at various levels of the Title II program. Further, outlining a\n multi-year initiative would provide grantees and the lead agencies with the necessary\n perspective to strategically plan for the future. As HIV/AIDS has evolved from an\n emergency epidemic to a chronic disease in a tight health care market, it is critical that the\n agencies serving infected individuals build the capacity to provide care efficiently and\n effectively through the productive use of outcome and impact studies.\n\nThe HRSA should provide technical assistance to improve\nthe ability of grantees to estimate the needs of infected\npersons not in HIV/AIDS care\n In the FY 1999 Application Guidance, HRSA emphasizes the importance of obtaining\n information on unmet need, acknowledges the difficulty of obtaining this information and\n pledges to work with States to address this area in the future. The HRSA should build on\n this effort by requiring the grantees and consortia to solicit needs information from\n persons not in HIV/AIDS care and by providing technical assistance on how to do this. In\n turn, the grantees should provide the consortia and other Title II planning bodies with\n guidance on needs assessment expectations and on methods to obtain the required\n information.\n\n Currently, grantees are required to use public health data to estimate unmet need in their\n applications to HRSA. This data provides useful information on the needs of infected\n persons. However, the input of persons outside of the care system would add a richness\n of understanding regarding their needs and the barriers to service they encounter.\n\n Grantee solicitation of the input of persons un-connected to HIV/AIDS care would assist\n the grantees in complying with the re-authorized CARE act\xe2\x80\x99s directive to prioritize a\n portion of funds for emerging populations. Grantee solicitation of this input would also\n contribute to the Department\xe2\x80\x99s efforts to address the greater burden of HIV/AIDS on\n racial and ethnic minorities.\n\n\n\n\nRyan White Evaluation Systems: Title II 18 OEI-05-98-00393\n\x0c In their attempt to fulfill the CARE Act\xe2\x80\x99s requirement to prioritize funds for emerging\n populations, HRSA should urge the grantees to strive to reach persons unconnected to\n HIV/AIDS care, in addition to efforts to reach persons who demographically reflect the\n emerging populations. The HRSA should urge the grantees to recognize the complexity\n and disproportionate costs which may be involved in serving persons unconnected to\n HIV/AIDS care. Persons infected by HIV/AIDS are increasingly individuals who are\n traditionally not connected to the health care system for reasons such as poverty and\n historic mistrust of institutional health care. A focused outreach and planning strategy is\n required to address their needs.\n\n The HRSA\xe2\x80\x99s technical assistance materials on conducting needs assessments urge grantees\n to solicit information from persons not in care. The materials suggest avenues for\n soliciting this information, such as substance abuse clinics and homeless shelters. Outside\n of suggesting that consortia provide incentives like food vouchers or use the media to\n solicit participation, the materials do not describe specific outreach strategies. As these\n ideas are discussed only generally, we suggest HRSA provide more detailed information\n on steps to solicit needs information. Several consortia representatives indicated that they\n would like more guidance on how to reach infected persons not in care.\n\n The HRSA could provide the grantees and the consortia with a technical assistance\n document devoted to soliciting needs information from people living with HIV/AIDS who\n are not in HIV/AIDS care, providing steps for conducting outreach and examples of\n effective strategies. The HRSA could highlight outreach strategies which have been used\n by other Ryan White grantees, Centers for Disease Control and Prevention HIV\n prevention community planning groups and service providers in other arenas. Particular\n attention should also be paid to reaching persons who receive HIV/AIDS services but may\n not be receiving primary health care services.\n\n\n\n\nRyan White Evaluation Systems: Title II 19 OEI-05-98-00393\n\x0c AGENCY COMMENTS\n The HRSA provided comments to the draft report. While HRSA concurred with the\n report\xe2\x80\x99s findings and recommendations, they offered suggestions for clarifying the report\n and making other technical changes. Where appropriate, we changed the report to reflect\n their comments. The complete text of HRSA\xe2\x80\x99s comments can be found in Appendix B.\n\n The HRSA briefly described a few activities planned or underway in support of our\n recommendation to implement a multi-year outcomes initiative. We commend HRSA on\n these activities and plans. Despite their efforts in this area, HRSA expressed a few\n concerns regarding their ability to carry out this recommendation: 1) limitations on\n accessibility and compatibility of data sets, 2) restrictions on administrative costs\n impacting a Grantee\xe2\x80\x99s ability to use complex data sets for outcome studies, and\n 3) confidentiality concerns.\n\n These limitations are to be expected in a large endeavor but are not insurmountable. For\n this reason we recommend an outcomes approach designed with feasibility as a\n cornerstone. We do not expect the outcomes initiative to lead to rigorous scientific\n evaluations conducted by every grantee. The HRSA is funding such projects on a limited\n basis where the capacity exists. It is not feasible, nor is it necessary, for every grantee to\n participate in this work. What is feasible and necessary for every grantee to undertake is\n an assessment of the effectiveness of the services they fund. By examining the\n contributions made by the services to client outcomes, the grantees can assess, in general\n terms, the effectiveness of these services. We highlight the United Way approach which\n emphasizes contribution, rather than attribution, for this reason.\n\n Although we expect the costs involved to be minimized by emphasizing the use of data\n resources already available to the providers, many grantees may need additional financial\n resources to develop an outcomes system, depending upon the size of their grant and\n competing demands on limited administrative funds. We recommend that HRSA work\n with the Department to secure funds for these initiatives. The FY 2000 re-authorization\n of the CARE Act provides an optimal opportunity to consider funding for infrastructure\n development vital to ensuring efficient and effective service delivery in the future.\n\n The HRSA\xe2\x80\x99s third area of concern - assuring client confidentiality, can be addressed by\n using unique identifiers and staff confidentiality agreements. Grantees collecting client-\n level information have used these measures successfully to address confidentiality\n concerns.\n\n We commend HRSA\xe2\x80\x99s efforts to address our recommendation to improve the ability of\n grantees to estimate the needs of infected persons not in HIV/AIDS care. We urge HRSA\n to disseminate technical assistance information to grantees in this area as soon as possible,\n as the population of infected persons outside of care continues to grow.\n\nRyan White Evaluation Systems: Title II 20 OEI-05-98-00393\n\x0c APPENDIX A\n\n\n Structure of Title II Programs\n\n\nCALIFORNIA\n\n The California Department of Public Health is the Title II grantee agency. Funds are\n dispersed through 37 regionally-based consortium. Each consortium has a lead agency\n which is responsible for the fiscal and administrative functions of the Title II consortia\n program in their region. The State monitors the lead agencies and requires them to\n monitor the programmatic and fiscal compliance of the service providers they fund.\n\n In Eligible Metropolitan Areas, the lead agency is typically the same as the Title I grantee.\n For example, the Los Angeles County Department of Health Services receives Title I\n funds and also acts as the fiscal intermediary for the Title II consortium funds. In these\n situations, a planning council that has merged with the local consortia is responsible for\n advising the lead agency regarding needs and service priorities. In non-EMA areas, the\n lead agencies are counseled by a regional consortia as to the service priorities of that area.\n\nTHE DISTRICT OF COLUMBIA\n\n The District of Columbia Department of Health is the Title II grantee. The Department of\n Health has designated the DC CARE Consortium to be responsible for conducting needs\n assessments, planning service delivery, promoting service coordination and monitoring the\n program and fiscal activities of the service providers. The Department of Health maintains\n some oversight over provider-level activities by reviewing individual provider reports\n submitted to the consortium and by accompanying the consortium on some provider site\n visits.\n\nFLORIDA\n\n The Florida Department of Health is the Title II grantee agency. The Department of\n Health has established 14 regionally based consortia to provide a continuum of care for\n HIV infected persons throughout the State. The consortia plan and prioritize Title II\n funds in their area, promote coordination of services and serve as a community forum.\n\n Each consortium has a lead agency which is responsible for the fiscal and administrative\n functions for the Title II consortia program in their region. In some consortia areas, the\n Department of Health serves as the lead agency for the consortium. In other areas, the\n\n\n\nRyan White Evaluation Systems: Title II 21 OEI-05-98-00393\n\x0c APPENDIX A\n\n Structure of Title II Programs\n\nlocal consortia designate a lead agency. All of the lead agencies in the State act as the fiscal\nconduit and data coordinator for the service providers in their area.\n\nILLINOIS\n\n The Illinois Department of Public Health HIV/AIDS Section administers the Title II\n program in Illinois. The Department relies on 11 lead agencies to disperse the funds\n regionally and to monitor service providers. The State monitors the lead agencies.\n Regional consortium plan and prioritize Title II funds in their area and promote\n coordination of services.\n\nMARYLAND\n\n The Maryland Department of Health and Mental Hygiene AIDS Administration is the Title\n II grantee agency. There are now five lead agencies that disperse the Title II funds\n regionally in accordance with a consortia developed service priority and allocation plan.\n The State has oversight over the lead agency\xe2\x80\x99s funding decisions. The State also retains\n control over monitoring the service providers. Both the lead agencies and service\n providers are required to submit their routine program and fiscal reports to the State\n Title II staff.\n\nNEW YORK\n\n The New York State Department of Health is the designated Title II grantee. The AIDS\n Institute of the Department of Health operates the Title II program. The AIDS Institute\n contracts with 17 Consortia, 16 of which are regionally based and one which is a\n Statewide consortium for special populations. The consortia, otherwise known as \xe2\x80\x9cHIV\n care networks\xe2\x80\x9d are responsible for conducting local needs assessments, identifying local\n service priorities and developing service delivery plans. The AIDS Institute determines\n funding allocations and awards contracts directly to service providers, in accordance with\n the networks\xe2\x80\x99 service delivery plans. The Institute maintains fiscal and administrative\n oversight of the service providers funded through the Title II program, rather than use\n regionally based lead agencies.\n\n\n\n\nRyan White Evaluation Systems: Title II 22 OEI-05-98-00393\n\x0c APPENDIX A\n\n Structure of Title II Programs\n\n\nNEW JERSEY\n\n The New Jersey Department of Health and Senior Services is the Title II grantee. The\n Department allocates its Title II consortia funds to 10 consortia, 9 of which are regionally\n based and one of which is a Statewide network of hospital sites serving HIV-infected\n women and children. New Jersey is in the process of phasing out the six regional\n consortia which are located in Title I EMAs. The New Jersey consortia are responsible\n for planning and coordination activities. Each consortium designates a lead agency to\n handle fiscal and administrative responsibilities for the region. Although monitoring\n responsibilities primarily fall to the lead agencies, the State grantee maintains some\n oversight over the activities of local service providers. The lead agencies determine\n contract awards but provider contracts are subject to the review of the grantee. The\n grantee also conducts annual site visits to all service providers.\n\nTEXAS\n\n The Texas Department of Health is the Title II grantee agency. They allocate funds to 26\n regionally-based lead agencies which are either a local health department or a community\n organization. The State monitors the lead agencies and relies on the lead agencies to\n monitor the programmatic and fiscal compliance of the service providers they fund.\n Funding decisions made at the local level are directed by regional consortia.\n\n The Title II structure in Austin differs from the rest of Texas. In Austin, the Austin/Travis\n County Health and Human Services Department is the lead agency for the Title I funds\n and Title II consortium funds. The local planning council performs the priority setting\n and allocation for both Title I and Title II funds to all 10 counties.\n\n\n\n\nRyan White Evaluation Systems: Title II 23 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 24 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 25 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 26 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 27 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 28 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 29 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 30 OEI-05-98-00393\n\x0c APPENDIX B\n\n\n Agency Comments\n\n\n\n\n\nRyan White Evaluation Systems: Title II 31 OEI-05-98-00393\n\x0c APPENDIX C\n\n\n Related Office of Inspector General Reports\n\n\n\nThe Ryan White CARE Act: Local Implementation Issues (OEI-05-93-00336)\n\n\nThe Ryan White CARE Act: Examples of Local Coordination (OEI-05-93-00335)\n\n\nThe Ryan White CARE Act: Special Projects of National Significance (OEI-05-93-00332)\n\n\nThe Ryan White CARE Act: Technical Report of 1992 Expenditures (OEI-05-93-00334)\n\n\nThe Ryan White CARE Act: Funding Formulas (OEI-05-93-00330)\n\n\nMedicaid Managed Care and HIV/AIDS (OEI-05-97-00210)\n\n\nAudit of State AIDS Drug Assistance Programs\xe2\x80\x99 Use of Drug Price Discounts (A-01-97-01501)\n\n\nReview of Maximizing Drug Discounts Under the Missouri Ryan White Program\n(A-01-97-00926)\n\nAudit of the Ryan White Comprehensive AIDS Resource Emergency Act of 1990, Title II,\nAdministered by the Health Resources and Services Administration (A-01-97-01500)\n\nAudit of Eligibility Under Title I of the Ryan White Comprehensive AIDS Resource Emergency\nAct of 1990, New York Metropolitan Area (A-02-95-02517)\n\nAudit of the Ryan White Comprehensive AIDS Resource Emergency Act of 1990, Title II,\nAdministered by the State of Connecticut (A-01-96-01501)\n\nAudit of the Ryan White Comprehensive AIDS Resource Emergency Act of 1990 in the Boston\nMetropolitan Area for Fiscal Year 1994 (A-01-95-01504)\n\n\n\n\nRyan White Evaluation Systems: Title II 32 OEI-05-98-00393\n\x0c"


type: contracts

jurisdiction: EU

text:
 7.6.2018
 CS
 Úřední věstník Evropské unie
 L 142/7
 ROZHODNUTÍ SMÍŠENÉHO VÝBORU EHP
 č. 108/2017
 ze dne 13. června 2017,
 kterým se mění příloha XX (Životní prostředí) Dohody o EHP [2018/803]
 SMÍŠENÝ VÝBOR EHP,
 s ohledem na Dohodu o Evropském hospodářském prostoru (dále jen „Dohoda o EHP“), a zejména na článek 98 této dohody,
 vzhledem k těmto důvodům:
 (1)
 Rozhodnutí Komise (EU) 2017/175 ze dne 25. ledna 2017 o stanovení kritérií pro ekoznačku EU pro turistické ubytování (1) by mělo být začleněno do Dohody o EHP.
 (2)
 Rozhodnutí Komise (EU) 2017/176 ze dne 25. ledna 2017, kterým se stanoví ekologická kritéria pro udělování ekoznačky EU dřevěným, korkovým a bambusovým podlahovým krytinám (2), by mělo být začleněno do Dohody o EHP.
 (3)
 Rozhodnutím (EU) 2017/175 se zrušují rozhodnutí Komise 2009/564/ES (3) a 2009/578/ES (4), která jsou začleněna do Dohody o EHP, a která by proto měla být v Dohodě o EHP zrušena.
 (4)
 Rozhodnutím (EU) 2017/176 se zrušuje rozhodnutí Komise 2010/18/ES (5), které je začleněno do Dohody o EHP, a které by proto mělo být v Dohodě o EHP zrušeno,
 (5)
 Příloha XX Dohody o EHP by proto měla být odpovídajícím způsobem změněna,
 PŘIJAL TOTO ROZHODNUTÍ:
 Článek 1
 Příloha XX Dohody o EHP se mění takto:
 1)
 Znění bodu 2 m (rozhodnutí Komise 2009/578/ES) se nahrazuje tímto:
 „32017 D 0175: rozhodnutí Komise (EU) 2017/175 ze dne 25. ledna 2017 o stanovení kritérií pro ekoznačku EU pro turistické ubytování (Úř. věst. L 28, 2.2.2017, s. 9).“
 2)
 Znění bodu 2zb (rozhodnutí Komise 2010/18/ES) se nahrazuje tímto:
 „32017 D 0176: rozhodnutí Komise (EU) 2017/176 ze dne 25. ledna 2017, kterým se stanoví ekologická kritéria pro udělování ekoznačky EU dřevěným, korkovým a bambusovým podlahovým krytinám (Úř. věst. L 28, 2.2.2017, s. 44).“
 3)
 Znění bodu 2p (rozhodnutí Komise 2009/564/ES) se zrušuje.
 Článek 2
 Znění rozhodnutí (EU) 2017/175 a (EU) 2017/176 v islandském a norském jazyce, která mají být zveřejněna v dodatku EHP Úředního věstníku Evropské unie, jsou platná.
 Článek 3
 Toto rozhodnutí vstupuje v platnost dnem 14. června 2017 za předpokladu, že jsou učiněna veškerá oznámení podle čl. 103 odst. 1 Dohody o EHP (*1).
 Článek 4
 Toto rozhodnutí bude zveřejněno v oddíle EHP a v dodatku EHP Úředního věstníku Evropské unie.
 V Bruselu dne 13. června 2017.
 Za Smíšený výbor EHP
 předseda
 Claude MAERTEN
 (1) Úř. věst. L 28, 2.2.2017, s. 9.
 (2) Úř. věst. L 28, 2.2.2017, s. 44.
 (3) Úř. věst. L 196, 28.7.2009, s. 36.
 (4) Úř. věst. L 198, 30.7.2009, s. 57.
 (5) Úř. věst. L 8, 13.1.2010, s. 32.
 (*1) Nebyly oznámeny žádné ústavní požadavky.