Attachment 1
Ryan White Part B Subcontract
A.SERVICES TO BE PROVIDED
1.Definition of Terms
a.Contract Terms
(1)“Corrective Action Plan”means a written plan of action that details how the provider will correct findings noted in a written monitoring report. This plan includes time frames for completion.
(2)“Findings” mean a significant issues regarding compliance with contract terms and conditions and quality of service delivery identified in a monitoring report that require corrective action.
(3)“Recommendation” means a suggestion made by the department in a monitoring report for the purpose of improving contract compliance or quality of service provision to which the provider must respond in writing.
b.Program or Service Specific Terms
(1)“Allowable Services” mean the HIV/AIDS patient care services listed in the current federal Glossary of Services as referenced by the Health Resources and Services Administration in the Ryan White CARE Act Title II Manual (2002); the eligible activities as stated in Task List, and, the list of HIV/AIDS patient care services administered by the Department of Health, Bureau of HIV/AIDS, all of which are incorporated by reference and available upon request from the Department of Health, Bureau of HIV/AIDS at 4052 Bald Cypress Way, Bin A09, Tallahassee, FL 32399-1715. The allowable services actually delivered are based on availability, accessibility and funding of the service.
(2)“APR” means Annual Progress Report.
(3)“Beneficiary” means any individual who received HOPWA housing assistance during the operating year and includes all members of the household receiving assistance. Ryan White and PCN Beneficiary mean any individual who received direct and/or supportive services during the operating year.
(4)“Bureau” means the Department of Health, Bureau of HIV/AIDS.
(5)"Business hours" means 8 A.M. to 5 P.M. Eastern Daylight Time Monday through Friday.
(6)"Calendar days" counts all days, including weekends and holidays.
(7)“CAPER” means Consolidated Annual Performance and Evaluation Report.
(8)“CAREWare” means free software provided by the DOH for managing and monitoring HIV/AIDS patient care services.
(9)“Consortia” meansan association of one or more public, and one or more nonprofit private, (or private for-profit providers or organizations if such entities are the only available providers of quality HIV care in the area) health care and support service providers and community-based organizations. Consortia act in an advisory capacity to the state for the purpose of planning and prioritizing the use of Part B (and other patient care) funds; provide a forum for the infected and affected communities, providers and others; and facilitate the provision of coordinated, comprehensive health and support services to people infected and affected by HIV/AIDS.
(10)“Department,”“DOH” or “Buyer” means Department of Health and may be used interchangeably.
(11)“Eligible Person” means an applicant who meets all of the criteria under Rule 64D-4, F.A.C.
(12)“General Revenue Patient Care Network (PCN)” means funding allocated by the state legislature and distributed through the Bureau of HIV/AIDS.
(13)“Grantee” means the person or legal entity to which a grant is awarded and that is accountable for the use of the funds provided.
(14) “HRSA” means Health Resources and Services Administration which is the federal grantor for Ryan White funding.
(15)“Lead Agency” meansany organization that receives funds under the contract with the grantee to carry out eligible activities under the Ryan White Treatment Modernization Act of 2009.
(16)“Low Income” means a person whose household income is at or below the maximum allowable amount as defined in Rule 64D-4, F.A.C.
(17)“Medicaid” meansa joint Federal and state program that helps with medical costs for some people with low incomes and limited resources.
(18)“Part B Grantee” means the Florida Department of Health.
(19)“RSR” means Ryan White Service Report which collects information on programs and clients served during the program year.
(20)“Ryan White HIV/AIDS Treatment Extension Act of 2009” also known as “Ryan White”, means a federal program to provide HIV/AIDS care to people with HIV/AIDS who have no health insurance or who have insufficient health care coverage.
2.General Description
a.Authority
The provider must comply with all applicable Federal laws, regulations, action transmittals, program instructions, review guides and similar documentation related to the following:
The Bureau of HIV/AIDS is governed by Chapter 381, Florida Statutes, entitled Public Health and more specifically Section 381.003, Florida Statutes, entitled Communicable Disease and AIDS Prevention and Control. Additionally, portions of this program are also governed by Florida Administrative Code 64D-4, entitled “Eligibility Requirements for HIV/AIDS Programs.”
b.Scope of Service
(1)The Ryan White Treatment Extension Act of 2009 (federal) program provides patient care services to individuals with HIV/AIDS who have no or insufficient health insurance.
c. Major Program Goals
(1)The intent of Ryan White Services is to provide allowable services to eligible persons through:
- Proper fiscal management
- Proper eligibility determination
- Proper service access
- Proper documentation
- Utilization of the State CAREWare database
- Prompt linkage to care post diagnosis or referral
- Proper medical treatment
- Proper laboratory monitoring
- Proper medication adherence
3.Clients To Be Served
a.General Description
“Ryan White” is defined as any individual who identifies as positive with HIV/AIDS and meets the criteria in Rule 64D-4 and who is seeking patient care services.
b.Client Determination
(1)All clients requesting patient care services shall be determined eligible based on Chapter 64D-4, Florida Administrative Code. All providers are required to enter eligibility information on every client into the eligibility module in the state of Florida, CAREWare database.
(2)In the event of any disputes regarding the eligibility of the clients, determination made by the Department is final and binding to all parties.
c.Contract Limits
(1)The total contract amount paid to the provider under this contract shall not exceed
- $XX,XXX Case Management
- $XX,XXX Medical
(2)The estimated number of clients to be served:XXX
(Note: the number of clients to be served is planning estimates only and the lead agency reserves the right to alter and/or adjust the number of affected clients by any amount.)
(3)Case Management contracts are cost reimbursement and only cover payroll costs (salary and fringe are included). The medical (outpatient/ambulatory) contract amount includes payments for primary care, specialty care, procedures, and labs. Payments for primary care will not exceed $200 per doctor visit or $50 per nurse visit and are subject to funds remaining after payments to the provider or on the provider’s behalf for specialty care, procedures, & labs.
B.MANNER OF SERVICE PROVISION
1.Task List
a.Objectives: The provider shall provide and/or procure direct patient care services, and support services to HIV/AIDS infected individuals to improve quality, availability, and facilitate collaboration of HIV/AIDS services within the designated area to improve the overall health of individuals living with HIV/AIDS.
b. Activities shall include:
(1)Adhere to the Florida Ryan White Part B/General Revenue Patient Care Network Administrative Guidelines. .
(2)Adhere to the Florida HIV/AIDS Patient Care Eligibility Procedures Manual
(3)Adhere to Florida HIV/AIDS Case Management Operating Guidelines
(4)Entering defined data variables in state CAREWare for each client as described in the Ryan White HIV/AIDS Program Services Report Instruction Manual ( the Florida Bureau of HIV/AIDS Eligibility Procedures Manual, the HRSA monograph, using data to measure public health performance (
(5)Administer needs assessments as required including review of current needs assessment data which can be found at .
(6)Ensure client satisfaction surveys are conducted and sent to Lead Agency.
(7)Facilitate the use of state CAREWare for all clients accessing services.
2.Deliverables
a.The provider shall provide the following services for Ryan White:
____X_____Outpatient/ambulatory medical care
____X_____Medical case management
____X______Case management (non-medical)
3.Staffing Requirements
a.Staffing Levels
The provider shall maintain an adequate administrative organizational structure and support staff sufficient to discharge its contractual responsibilities.
b.Professional Qualification
The provider will ensure case managers possess sufficient education, knowledge, and skills to provide effective services to clients. Supervisors of case managers must have related experience in providing case management services; provide routine reviews of case management records to facilitate case management duties; provide routine support and supervision; provide interim staff for vacancies and staff on leave. Supervisory experience is preferred but not required.
c.Staffing Changes
The provider shall notify the lead agency in writing of any changes to the staff paid under this contract. The provider will supply the lead agency with proof of the required credentials for all new case managers and supervisors.
4.Service Location and Equipment
a.Service Delivery Location
The provider must offer services to clients at a minimum of Monday through Friday, excluding state holidays, from one or more service delivery locations. All service delivery locations shall be accessible through public transportation or supplied transportation.
b.Service Times
The provider must offer services to clients at a minimum, 8 am – 5 p.m. excluding state holidays, from one or more service delivery locations.
c.Changes in Location
The provider will notify the Department in writing a minimum of one (1) week prior to making changes in location that will affect the Department’s ability to contact the provider by telephone or facsimile.
d.Equipment
The provider will be responsible for supplying, at their own expense, all equipment necessary to perform under the contract, including but not limited to computers, telephones, copiers, fax machines, maintenance and office supplies.
5.Report Requirements
a.Reports
(1)Where the resulting contract requires the delivery of reports to the LEAD AGENCY, mere receipt by the LEAD AGENCY shall not be construed to mean or imply acceptance of those reports. It is specifically intended by the parties that acceptance of required reports shall constitute a separate act. The LEAD AGENCY reserves the right to reject reports as incomplete, inadequate, or unacceptable according to the parameters set forth in the resulting contract. The LEAD AGENCY, at its option, may allow additional time where the provider may remedy the objections noted by the LEAD AGENCY. The LEAD AGENCY may, after having given the provider a reasonable opportunity to complete, make adequate or acceptable its response, and declare this agreement to be in default.
b.Records and Documentation
NOTE: Paragraph 4.b.3. is not applicable to state agencies or subdivisions, as defined in §768.28, FS.
(1)To the extent that information is utilized in the performance of the resulting contract or generated as a result of it, and to the extent that information meets the definition of “public record” as defined in subsection 119.011(1), F.S., said information is hereby declared to be and is hereby recognized by the parties to be a public record and absent a provision of law or administrative rule or regulation requiring otherwise, shall be made available for inspection and copying by any person upon request as provided in Art. I, Sec. 24, Fla. Constitution and Chapter 119, F.S. It is expressly understood that any state contractor’s refusal to comply with these provisions of law shall constitute an immediate breach of the contract entitling the LEAD AGENCY to unilaterally terminate the contract. The provider will be required to notify the Department of any requests made for public records.
(2)Unless a greater retention period is required by state or federal law, all documents pertaining to the program shall be retained by the provider for a period of six years after the termination of the resulting contract or longer as may be required by any renewal or extension of the contract. During this period, the provider shall provide any documents requested by the LEAD AGENCY in its standard word processing format (currently Microsoft Word 6.0). If this standard should change, the provider shall adopt the new standard at no cost to the LEAD AGENCY. Data files will be provided in a format directed by the LEAD AGENCY.
(3)The provider agrees to maintain the confidentiality of all records required by law or administrative rule to be protected from disclosure. The provider further agrees to hold the LEAD AGENCY harmless from any claim or damage including reasonable attorney’s fees and costs or from any fine or penalty imposed as a result of failure to comply with the public records law or an improper disclosure of confidential information and promises to defend the LEAD AGENCY against the same at its expense.
6.Performance Specifications
a.Outcome
Consistent assessment of HIV/AIDS patient care services and measuring desired outcomes is essential to theLEAD AGENCY and measuring desired outcomes is essential for quality measurement and improvement. The Bureau of HIV/AIDS will monitor the use of CAREWare for accuracy and completeness of data collection as described in the Ryan White HIV/AIDS Program Services Report Instruction Manual ( the Florida Bureau of HIV/AIDS Eligibility Procedures Manual, the HRSA monograph, using data to measure public health performance
The provider will be required to use state CAREWare to capture clinical information. The Bureau of HIV/AIDS will develop and make available reports from the CAREWare database that will assist providers to remain in compliance with federal and state requirements.
b.Outputs
Over the course of the contract, the provider will be required to complete and provide at a minimum, an acceptable performance and compliance for the following performance measures:
(1)Providers funding Ambulatory/Outpatient Medical Care and/or Medical Case Management must capture the clinical information necessary for the Bureau of HIV/AIDS to monitor HRSA’s Group One Clinical measures, either through CAREWare or manually.
(2)Providers must maintain documentation that clients are eligible, as defined by the State, at the time services are rendered
(3)Maintain a quality management plan and procedure consistent with the local comprehensive plan
(4)Notify the lead agency when a written complaint is filed related to any services.
Acceptable performance and completion of additional performance measures may be required by the department.
c.Monitoring and Evaluation Methodology
(1)By execution of this contract the provider hereby acknowledges and agrees that its performance: (a) must meet the standards set forth in this contract, and (b) will be bound by the conditions set forth. If the provider fails to meet these standards, the LEAD AGENCY, at its exclusive option, may allow up to six (6) months for the provider to achieve compliance with the standards. If the LEAD AGENCY affords the provider an opportunity to achieve compliance, and the provider fails to achieve compliance within the specified time frame, in the absence of any extenuating or mitigating circumstances, the LEAD AGENCY will terminate the contract. The determination of the extenuating or mitigating circumstances is the exclusive decision of the LEAD AGENCY.
(2)TheLEAD AGENCY will conduct on-site visits and perform desk reviews by utilizing fiscal-compliance records produced by the provider.
(3)TheLEAD AGENCY will conduct on-site monitoring of the programmatic performance of the provider as stated in the Task List. TheLEAD AGENCY will monitor the provider for contractual compliance once annually or as deemed necessary by the Bureau of HIV/AIDS. This monitoring will include at a minimum review of client files, monthly reports, and physical security of the database and corresponding paper files. If the provider fails to meet established standards and goals, a follow-up review will be conducted within sixty (60) calendar days of the initial monitoring.
(4)If corrective action is still necessary as a result of the initial on-site monitoring and the follow-up monitoring visit by the department, failure to correct deficiencies within forty-five (45) calendar days of notification by the department to the provider shall result in termination of contract.
(5)It is the responsibility of the LEAD AGENCY to monitor all subcontracts. At a minimum, this monitoring will include a monitoring tool developed by the provider and approved by the department’s contract manager.
7.Provider Responsibilities
a.Provider Unique Activities
The provider is solely and uniquely responsible for the satisfactory performance of the tasks described in Section B Task List. By execution of the resulting contract the provider recognizes its singular responsibility for the tasks, activities, and deliverables described therein and warrants that it has fully informed itself of all relevant factors affecting accomplishment of the tasks, activities, and deliverables and agrees to be fully accountable for the performance thereof.
b.Coordination with other Entities
The provider will be required to coordinate all patient care services with the local county health departments, community based organizations, AIDS services organizations, other Ryan White grantees, other HOPWA grantees, the local HIV/AIDS consortia, the local Medicaid office and any other local agency providing similar services. Specific failure of other entities does not alleviate the provider from any accountability for tasks or services the provider is obligated to perform pursuant to the contract.
8.LEAD AGENCY Responsibilities
a.Lead Agency Obligations
The LEAD AGENCY may provide technical support and assistance to the provider within the resources of the Department to assist the provider in meeting the required tasks in Section B Task List. The support and assistance, or lack thereof shall not relieve the provider from full performance of contract requirements.
b.LEAD AGENCY Determinations
The LEAD AGENCY reserves the exclusive right to make certain determinations in these specifications. The absence of the LEAD AGENCY setting forth a specific reservation of rights does not mean that all other areas of the resulting contract are subject to mutual agreement.
C.FINANCIAL SPECIFICATIONS
a.This contract is funded through the Health Resources and Services Administration (HRSA).