Model Ryan White HIVAIDS Program RWHAPPart A Planning

Model Ryan White HIV/AIDS Program (RWHAP)Part A Planning Council Orientation [Designed for 1½-2 Days; Choose Slides for a Shorter Session] Updated April 2017 Emily Gantz Mc. Kay and Hila Berl This model training session was prepared and updated over many years by Emily Gantz Mc. Kay and Hila Berl. It was designed for planning councils, based on their legislative responsibilities, but can be adjusted for use with a planning body. The 2017 update was supported under Task Order TA 00311, through MSCG/Ryan White Technical Assistance Contract. From: Compendium of Materials for Planning Council Support Staff. EGM Consulting, LLC. 2018. Available at: www. target. HIV. org/planning-chatt/pcs-compendium 1

Get-Acquainted Activity: Expectations and Concerns: 1. At your table, choose: A facilitator, to coordinate the work of your group and participate A recorder/reporter, to take notes summarizing the discussion in your small group and present your group and its expectations to the full group 2. Share: Your name and up to 2 major “affiliations” or activities Length of time involved with the Planning Council/Body Most important expectation for the training Most important concern about the training 3. Be prepared to introduce your small group to the full group 2

Training Issues and Challenges Diversity of Ryan White experience: new and veteran members New members: learn the Ryan White program as it now exists Veteran members and staff: learn the new legislation and make good space for the new members Everyone: learn, become a team, and commit to using sound practices 3

Objectives 1. 2. 3. 4. 5. 6. 7. To understand the size, scope, & key trends in the local HIV/AIDS epidemic To become familiar with the Ryan White Treatment Extension Act of 2009 To describe the roles and responsibilities of a RWHAP Part A Planning Councils (PCs) To differentiate Planning Council and recipient/ administrative agency roles To describe the challenges and key priorities for this Planning Council and EMA/TGA To understand the structure and operations of this Planning Council To be ready to serve as an active PC member 4

Suggested Groundrules 1. 2. 3. 4. 5. 6. 7. 8. Focus on our shared purpose: the best possible care for people living with HIV (PLWH) in the metro area Ask questions that help clarify the information presented View this as an opportunity to get updated information on federal and local expectations for Ryan White HIV/AIDS Program (RWHAP) planning councils and members Wait to speak until recognized Treat everyone with respect Try to identify practical solutions as well as problems Recognize that the facilitator may have to limit discussion to move the agenda Both follow and help enforce these groundrules 5

Agenda Why We are Here: The Local HIV/AIDS Epidemic Ryan White Legislation: What Every Planning Council Member should Know Legislative Context: Facts and Factors Important to Planning Councils Roles and Responsibilities of Planning Councils: An Overview The Annual Planning Cycle Planning Council Operations How This Planning Council Operates Looking Ahead Sum Up and Assessment 6

Why We are Here: The Local HIV Epidemic 7

Epidemiologic Overview [Provide an overview – brief and focused – of the epidemic in this EMA/TGA – 3 -4 key slides – to remind people why there is a Ryan White Program and why the Planning Council is important] 8

Ryan White Legislation: What Every Planning Council Member should Know 9

Ryan White Treatment Extension Act Largest Federal government program specifically designed to provide services for people living with HIV/AIDS – $2. 32 billion in funding in FY 2016 Third largest Federal program serving people living with HIV/AIDS – after Medicaid and Medicare Enacted as the Ryan White Comprehensive AIDS Resources Emergency Act in 1990 Amended in 1996, 2000, 2006, 2009 – no longer an “emergency” act 10

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Total Ryan White and RWHAP Part A Appropriations, FY 2010 - FY 2016 $2 500 000 Total $ Thousands $2 000 Part A Part B Total ADAP Only $1 500 000 Part C Part D Part F $1 000 $500 000 $0 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 12

Importance of Ryan White HIV/AIDS Program (RWHAP) About 1. 2 million people in the U. S. are living with HIV or AIDS About 13% (1 in 8) do not know their status About half of PLWH who know their status receive at least one medical, health, or related support service from a Ryan White HIV/AIDS Program provider – 533, 036 in 2015 RWHAP is the provider/payer of last resort for lowincome, uninsured, and underinsured people living with HIV/AIDS Continues to play a critical role under health care reform 13

Revised Purpose of Ryan White Legislation No longer “emergency relief” for overburdened health care systems Now “Revise and extend the program for providing life-saving care for those with HIV/AIDS” “Address the unmet care and treatment needs of persons living with HIV/AIDS by funding primary health care and support services that enhance access to and retention in care” 14

Ryan White Programs: RWHAP Part A Funding for 52 eligible metropolitan areas (EMAs) and Transitional Grant Areas (TGAs) that are severely & disproportionately affected by the HIV epidemic – 24 EMAs (≥ 2, 000 cases of AIDS reported in past 5 years and ≥ 3, 000 living cases) – 28 TGAs – (1, 000 -1, 999 cases reported in past 5 years and ≥ 1, 500 living cases) Administered by the Division of Metropolitan HIV/AIDS Programs (DMHAP) 15

Ryan White Programs: Part B Grants to all 50 States, DC, Puerto Rico, territories and jurisdictions: –Base Award –Supplemental (competitive) Award –AIDS Drug Assistance Program (ADAP) –Supplemental ADAP Award –Grants to Emerging Communities (500 -999 new cases in past 5 years) Administered by the Division of State HIV/AIDS Programs (DSHAP) 16

Parts C & D and Part F Dental Services Part C: – Funding to local community-based organizations, community health centers, health departments, and hospitals to support comprehensive primary health care and support services in an outpatient setting – Planning grants and capacity development grants to more effectively deliver HIV care and services Part D: family-centered HIV primary medical and support services for women, infants, children, and youth living with HIV and their affected family members Part F: Dental Reimbursement Programs and Community Based Dental Partnership Administered by the Division of Community HIV/AIDS Programs (DCHAP) 17

Part F Minority AIDS Initiative (MAI) Congress authorized MAI in 1999 to improve access to HIV care and health outcomes for disproportionately affected minority populations Allowable uses of MAI funds vary by Part RWHAP Part A programs receive MAI formula grants to use for core medical and related support services designed to improve access and reduce disparities in health outcomes Formula is based on the number of racial and ethnic minority individuals with HIV/AIDS in the jurisdiction 18

Other Part F Programs Special Projects of National Significance (SPNS): supports the development of innovative models of care and effective delivery systems for HIV care, and the dissemination of successful models HIV/AIDS Education and Training Centers (AETCs): supports a network of regional centers that conduct targeted, multidisciplinary education and training programs for health care providers serving PLWH Administered by the Office of HIV/AIDS Training and Capacity Development (OHATCD) 19

Quiz: What’s My “Part”? Individually answer the 10 questions provided in the Quizzes Handout, using the following lettered responses (some may be used more than once, some not at all) – then share at your table. A = Part A B = Part B C = Part C D = Part D E = All Parts F = Part F G = Parts A and B H = Parts C and D I = None of the Parts 20

Legislative Context: Facts and Factors Important to Planning Councils/Bodies 21

Factors Affecting HIV/AIDS Services Nationally 1. 2. 3. 4. 5. Epidemic continues, especially among traditionally underserved and hard-to-reach populations – but important progress in prevention Because of available and emerging therapies, people with HIV/AIDS can live long and productive lives Treatment IS prevention – virally suppressed PLWH rarely infect other people – which means an increased focus on coordination and collaboration between prevention and care Changes in the larger health care system and financing affect HIV services Policy and funding increasingly are determined by clinical outcomes 22

Medical Model Major focus on core medical services (medical model) 75% of funds must be spent on core medical services (waiver available) Support services must contribute to positive clinical outcomes Refinements to service categories and definitions in 2016 (PCN #16 -02) 23

Core Medical Services: Parts A & B 1. 2. 3. 4. AIDS Drug Assistance Program (ADAP) Treatments Local AIDS Pharmaceutical Assistance Program (LPAP) Early Intervention Services (EIS) Health Insurance Premium and Cost Sharing Assistance for Low-Income Individuals 5. Home and Community-Based Health Services 6. Home Health Care 7. Hospice Services 8. Medical Case Management, including Treatment Adherence Services 9. Medical Nutrition Therapy 10. Mental Health Services 11. Oral Health Care 12. Outpatient/Ambulatory Health Services 13. Substance Abuse Outpatient Care 24

Support Services Must be: – ≤ 25% of total service expenditures – Approved by the Secretary of HHS – Needed to achieve medical outcomes Medical outcomes = outcomes affecting the HIVrelated clinical status of an individual with HIV/AIDS Planning Councils need to know allowable service categories and service definitions Recipient and Planning Council need to be able to link funded support services to positive medical outcomes 25

Support Services: Parts A & B 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Child Care Services Emergency Financial Assistance Food Bank/Home Delivered Meals Health Education/Risk Reduction Housing Linguistic Services Medical Transportation Non-Medical Case Management Services Other Professional Services [e. g. , Legal Services and Permanency Planning] Outreach Services Psychosocial Support Services Referral for Health Care and Support Services Rehabilitation Services Respite Care Substance Abuse Services (residential) 26

Focus on National HIV/AIDS Strategy (NHAS) Goals and HIV Care Continuum NHAS 2020 Goals: 1. Reducing new HIV infections 2. Increasing access to care and improving health outcomes for people living with HIV (PLWH) 3. Reducing HIV-related disparities and health inequities 4. Achieving a more coordinated national response to the HIV epidemic 27

National HIV Care Continuum 28

Ryan White HIV Care Continuum In 2015: 533, 036 people received at least 1 service paid for by the RWHAP 81% of clients were retained in care (at least 2 medical visits 90 days apart) 83% of clients were virally suppressed 29

EMA/TGA HIV Care Continuum [Insert your latest HIV Care Continuum, or perhaps both the overall continuum and the continuum for Ryan White clients if you have both – and include definitions] 30

Prevention-Care Cooperation 7 Unified Planning Body for HIV Prevention, Care, Other Programs (HOPWA, STDs) 6 Unified Prevention-Care Planning Body Integrated Committee of a Larger Planning Body [or Linked to Prev & Care 5 Bodies]* 4 Integrated Prevention and Care Plan [often Parts A-B]* 3 Joint Projects or Activities (e. g. , Information Gathering, Data Analysis)* 2 Cross Representation* 1 Information Sharing* * Also Cross-part Cooperation Source: Integrated HIV Prevention-Care Planning Activities, EGM Consulting for HRSA/HAB through the Ryan White Technical Assistance Contract, 2014. 31

Limits on Non-Service Funding Focus: maximize funding for direct services 10% administrative cap for administrative costs, including Planning Council support costs 32

Flow of RWHAP Part A Decision Making & Funds Planning Council sets priorities, allocates resources, and gives directives to recipient on how best to meet these priorities 33

Sum Up: Key Facts about RWHAP Part A Planning Council is not advisory Ryan White services are not an entitlement Ryan White is the payer of last resort Key role for consumers of RWHAP Part A services 34

Roles and Responsibilities of Planning Councils: An Overview 35

Recipient and Planning Council Roles and Responsibilities Recipient and Planning Council = two independent entities, both with legislative authority and roles Some roles belong to one entity and some are shared Effectiveness requires clear understanding of the roles and responsibilities of each entity, plus: – Communications, information sharing, and collaboration between the recipient, Planning Council, and Planning Council support (PCS) staff – Ongoing consumer and community involvement 36

Planning Council, Recipient, and CEO Roles & Responsibilities Task CEO Recipient Planning Council Carry Out Needs Assessment Do Comprehensive Planning Set Priorities* Allocate Resources* Manage Procurement X X X Monitor Contracts Evaluate Effectiveness of Planning Activities Evaluate Effectiveness of Care Strategies X X Do Quality Management X Determine Planning Body X Establish Planning Body X X X [Care Standards & Committee Involvement] Assess the Efficiency of the Administrative Mechanism* * Sole responsibility of RWHAP Part A Planning Councils X 37

Planning Council Formation and Membership Council established by Chief Elected Official (CEO) – Mayor appoints all members Membership must meet legislated requirements: – Representation (legislatively required categories) – 33% unaffiliated consumers of RWHAP Part A services – Reflectiveness (of the epidemic in the EMA/TGA) Must use an open nominations process Recipient has no role in membership selection Bylaws may call for a recipient representative on the Council The Planning Council may not be chaired solely by an employee of the recipient 38

Applying Knowledge The Planning Council has had a lot of trouble finding someone from a health planning agency to serve as a member. So when someone in that category sends an application to Planning Council support staff, the Council votes to recommend her to the Mayor without the usual review by the Membership Committee. Is this OK? Why or why not? 39

Data Needs for Ryan White Planning Needs Assessment Data Service Expenditure Data Client Characteristics & Utilization (RSR) Data Note: Some data types overlap Epi Profile Data Performance & Clinical Outcomes Data HIV Care Continuum Data Testing and Unmet Need Data Clinical Quality Management Data 40

Expectations: Needs Assessment Determine what services are needed, what services are being provided, and what service gaps exist, overall & for particular populations, in & out of care – includes obtaining PLWH input on service needs and gaps 41

Components of Needs Assessment 1. Epi profile of HIV & AIDS cases and trends 2. Estimate & assessment of unmet need and undiagnosed – PLWH who know their status but are not in care and PLWH who do not know their status 3. Service needs of PLWH in & out of care 4. Existing services, including a resource inventory & provider capacity/capability (availability, accessibility & appropriateness overall and for specific populations) 5. Barriers to testing and care 6. Service gaps for those in and out of care 7. Disparities in access to services for subpopulations 42

Needs Assessment Planning Council has primary responsibility and “ownership” – design, direct work or oversight of consultants or volunteers Recipient provides support – data, procurement if a consultant is needed, staff assistance Need active community involvement – especially consumers and providers Need multi-year plan for assessing needs of PLWH in and out of care Findings go in user-friendly formats as input to decision making, especially priority setting and resource allocation 43

Purpose of the Planning Cycle: Putting the Pieces Together Knowing who needs the services and how to reach them Knowing who, where, what and to whom services are now provided Making data driven decisions about which services are most needed and for whom 44

Applying Knowledge The EMA has done a lot of needs assessment activities, but not a comprehensive needs assessment, including all components. Several members of the Committee want to do a comprehensive needs assessment next program year. Others say no, it is best to do it in a three-year cycle. Which is the better idea? Why? 45

Comprehensive Planning Legislation requires RWHAP Part A and Part B programs to prepare comprehensive plans that set goals and objectives and guide the work of the program All Parts expected to participate in the Statewide Coordinated Statement of Need (SCSN) process In 2016, RWHAP Part A and Part B recipients prepared integrated plans based on a combined guidance from CDC and HRSA to submit 5 -year Integrated HIV Prevention and Care Plans, including the SCSN – Plans for 2017 -2022 were submitted in September 2016 and are now being implemented 46

Comprehensive Plan, Cont. Combined guidance designed to help reach the goals of the National HIV/AIDS Strategy (NHAS) and improve performance along the HIV Care Continuum (HCC)/Treatment Cascade Programs expected to regularly review Plan progress and refine objectives and strategies as needed – plan should be a living document that guides the annual planning cycle Collaborative implementation and monitoring of the plan between prevention and care (and between RWHAP Part A and Part B) encouraged 47

Priority Setting and Resource Allocations The most important legislative responsibility of Planning Councils – should involve all members Priority setting: deciding what service categories are most important for PLWH in the EMA or TGA Resource allocations: deciding how much RWHAP Part A funding to provide for each service priority (best done in both dollars and percent) – including separate allocation of RWHAP Part A and RWHAP Part A MAI funds Directives to the recipient on how best to meet these priorities – e. g. , what service models for what populations in what geographic areas Reallocation of funds during the program year so all funds are expended on needed services 48

Priority Setting Planning Council responsibility Means determining what service categories are most important for PLWH in the EMA or TGA – unrelated to who provides the funding for these services Recipient provides information – especially service utilization data – and advice, but has no decisionmaking role Council must establish a sound, fair process for priority setting and ensure that decisions are data based Important to prioritize needed service categories even if there may not be enough money to fund them all, in case the PC is able to reallocate some funds into a previously unfunded category during the program year 49

Applying Knowledge The Planning Council is setting priorities. Members have agreed to make decisions based on hard data indicating what services are most needed by PLWH in the EMA/TGA. Two members want to add another factor: how much funding is available from other sources. They say that it doesn’t make sense to give a service category high priority under RWHAP Part A if it has enough funding through other sources. Are they right or wrong? Why? 50

Directives Planning Council role Providing guidance to recipient on how best to meet the priorities and other factors to consider in procurement Often specify use or non-use of a particular service model, or address geographic access to services, language issues, or specific target populations Must not have the effect of limiting open procurement by making only 1 -2 providers eligible Planning Council needs to be aware of cost implications Recipient must follow Council directives in procurement and contracting (but cannot always guarantee full success) 51

Examples of Directives Funded primary care services must be available in each of the major jurisdictions Providers must have bilingual staff in positions with direct client contact, including clinical staff At least one substance abuse treatment provider must offer services appropriate for women with young children and pregnant women 52

Applying Knowledge The Planning Council is concerned about the lack of access to Ryan White-funded primary care in the evening and on weekends. So it develops a directive that says that primary care providers must be open at least six hours a month for evening or weekend care. Is this an appropriate directive? Why or why not? 53

Resource Allocation Planning Council responsibility Process of deciding how much funding to allocate to each priority service category or sub-category ≥ 75% of service dollars must go to core services (unless program has a waiver) ≤ 25% to support services needed for achieving medical outcomes Recipient provides data and advice, but has no decisionmaking role Need a fair, data-based process that controls conflict of interest Consider other funding streams, cost per client, plans for bringing people into care – so some highly ranked service categories may receive little or no funding Often use three funding scenarios in order to adjust when funding is received – flat, increase, decrease 54

Non-Service Funds Recipient may take 10% for administrative costs and up to 5% for clinical quality management (QM) activities Planning Council support (PCS) budget comes out of 10% administrative costs – Amount for Planning Council must be negotiated with the recipient – Then Council budgets those funds to meet legislative requirements Planning Council has no say in the amount or use of other administrative or QM funds 55

Unobligated Funds If an EMA or TGA has more than 5% of its formula grant unspent at the end of the program year (as determined when Financial Status Report is submitted): – Amount over 5% is deducted from the grant awarded the following fiscal year – EMA/TGA cannot compete for supplemental funds in the next application cycle – Recipient can apply for carryover, and funds must be used the next year – Means if funds left in FY 2018, no supplemental funding and a deduction from formula funds in FY 2020 56

Reallocation Planning Council role: must approve any reallocation of funds among service categories Reallocation usually means moving funds: – From underspent providers to those in the same service category spending at a higher level [recipient decision], or – From underspent service categories to different service categories spending at a higher level or with additional need [PC must approve] Recipient provides expenditure data by service category to PC, usually monthly, and requests permission for reallocations as needed Some recipients do regular “sweeps” or request reallocation permission at set times each year – rapid reallocations process very important to avoid unobligated funds and ensure funds are used to address priority service needs 57

Coordination of Services Shared responsibility of recipient and Planning Council Focus on ensuring that RWHAP Part A funds fill gaps, do not duplicate other services, and make Ryan White the payer of last resort Involves coordination in planning, funding, and service delivery Council reviews other funding streams as input to resource allocation Recipient ensures that providers have linkage agreements and use other funding where possible – for example, help clients apply for entitlements like Medicaid 58

Procurement Recipient role No Planning Council involvement Involves: – Publicizing the availability of funds – Writing Requests for Proposals (RFPs) – Using a fair and impartial review process to choose providers – Contracting with providers – and requiring that they follow standards of care (SOC) and meet reporting and quality management (QM) requirements Contract amounts by service category or sub-category must be consistent with Planning Council allocations and directives 59

Contract Monitoring Recipient role No Planning Council involvement, except that standards of care [approved by Planning Council] are typically included in contracts and therefore a basis for monitoring Involves site visits and document review for monitoring of – Program quality and quantity of services – Finances/fiscal management, including expenditure patterns and adherence to HRSA/HAB and municipal regulations in use of funds Aggregate findings (by service category or across categories) shared with the Planning Council as input to decision making 60

Applying Knowledge A recipient staff member is participating in a Planning Committee meeting on needs assessment. The committee is reviewing information on the continuum of care and provider capacity within the EMA, and one member says she would like to know more about the Ryan White providers. She asks the recipient representative to provide “copies of information from provider proposals so we can better understand their capabilities. ” How should the recipient staff member respond? Why? 61

Clinical Quality Management Recipient plays primary role Involves ensuring that: – Services meet clinical guidelines and local standards of care – Supportive services are linked to positive medical outcomes – Demographic, clinical, and utilization data are used to understand address the local epidemic Recipient requires providers to develop QM plans, monitors providers based on quality standards, and recommends improvements Council establishes standards of care for use in QM Recipient reports to Council on QM findings by service category or across categories for use in decision making 62

Applying Knowledge At its most recent Town Hall meeting to hear about PLWH service needs, the Planning Council received a lot of complaints about long waiting times for primary care appointments. Two specific providers are mentioned. At the next Planning Council meeting, one member asks the recipient to “check this out when you do your QM and contract monitoring visits, and tell us what you find. ” Is this appropriate? Why or why not? 63

Cost-Effectiveness and Outcomes Evaluation Planning Council has the option of assessing the effectiveness of services offered – usually best done in coordination with QM Recipient monitors performance, clinical outcomes, and cost effectiveness of services as part of QM Major focus on HIV Care Continuum Findings used by recipient in selecting and monitoring providers Findings used by Planning Council in priority setting, resource allocation, and development of directives on service models 64

Assessment of the Efficiency of the Administrative Mechanism Planning Council responsibility Legislation requires PC to “assess the efficiency of the administrative mechanism in rapidly allocating funds to the areas of greatest need within the eligible area” Should be done annually – directly or through a consultant Involves assessing how efficiently the recipient does procurement, disburses funds, supports the Council’s planning process, and adheres to Council priorities and allocations Written report goes to recipient, which indicates what action it will take to address any identified problem areas 65

Managing Conflict of Interest Planning Council must have and enforce conflict of interest policies including disclosure Conflict of interest occurs when a Planning Council member has a monetary, personal, or professional interest in a decision or vote – through being an employee, consultant, or officer/director of a RWHAP Part A service provider Being a consumer of a specific provider is not considered a conflict of interest Planning Council should not discuss particular providers and members should not advocate for providers – discussion should focus on service categories 66

How Planning Councils Manage Conflict of Interest (COI) Each member must: Sign a Disclosure Form every year Update the form if affiliations change Declare any COI before discussion begins In decision making about priorities and allocations: answer questions but not initiate discussion about service categories for which they have a COI Not vote on priorities or allocations for categories where there is a real or perceived conflict of interest Not vote on other matters where there is a conflict (e. g. , hiring of consultants) 67

COI Policies and Disclosure [Explain your COI policies, pass out COI Disclosure Forms, and get them completed and signed by new members and by veteran members for the new year] 68

Applying Knowledge The Planning Council is doing allocations. As the allocation for outpatient substance abuse treatment is being discussed, a funded substance abuse treatment provider makes a passionate plea for more funding for this service category. Members ask him questions. He answers the questions and asks several clients who are in the room to support his statements. But he doesn’t vote on the allocation because of his conflict of interest. Is this process appropriate? Why or why not? 69

Members as Advocates and Planners Members often come as Advocates: – Bring passion – Provide a voice for their communities or for populations their organization serves – Also learn to advocate on behalf of other subpopulations that may be underrepresented in PC deliberations Need to know when/how to be Planners: – Consider the entire community – Seek Win-Win versus Win-Lose – Listen to others/ask questions – Come prepared – review data and reports; ask questions – Use data to make decisions – not “impassioned pleas” – Understand boundaries 70

Grievance Procedures Both Planning Council and recipient must have HRSA/HAB-approved grievance procedures [should be attached to PC Bylaws] Council must have procedures to handle grievances related to funding – usually involving deviations from its priority-setting and resource-allocation procedures; may also cover other policies and processes Recipient must have procedures to handle grievances related to: – The procurement and contract award process – Deviations from Planning Council priorities and allocations in contracts and awards or changes in them 71

Review: PC, Recipient, and CEO Roles & Responsibilities Task CEO Recipient Planning Council Determine Planning Body Establish Planning Body Carry Out Needs Assessment Do Comprehensive Planning Set Priorities Allocate Resources Manage Procurement Monitor Contracts Evaluate Effectiveness of Planning Activities Evaluate Effectiveness of Care Strategies Do Quality Management Assess the Efficiency of the Administrative Mechanism 72

Summary Planning Council has clearly defined legislative responsibilities Planning Council decisions must be data-based, using the best available data Responsibilities are interrelated – emphasizing the importance of committee work Many functions best in collaboration with the Recipient 73

The Annual Planning Cycle 74

Updated Annual Planning Cycle Core responsibility of a Planning Council: carry out community planning to establish and maintain the best possible system of care for PLWH in the jurisdiction – through a welldefined and fully-implemented planning cycle Centrality of the comprehensive/integrated plan Importance of needs assessment – identified as a weakness in the 2016 PC/B assessment Critical need for access to many types of data for decision making 75

Updated Annual Planning Cycle Comp Plan Review/Updates Evaluation & Planning Outcomes Annual Plan to Plan Epi Profile & Needs Assessment Data Review & Reallocation Priority Setting & Resource Allocation Review of All Data 76

Feedback Loop Includes obtaining input from stakeholders, analyzing that information, using it for decision making, and reporting back to the community Input Analysis Decision Making Report Back 77

Planning Council Operations 78

Planning Council Operations Must develop Bylaws, policies and procedures to ensure fair, efficient operations Must have grievance procedures Must manage conflict of interest (COI) Major attention to new member recruitment including an open nominations process, orientation, and training PCs expected to provide training for members at least annually Much of work done by committees Assisted by Planning Council support staff 79

Role of Planning Council Support (PCS) Staff Assist the Planning Council to carry out its legislative responsibilities and to operate effectively as an independent planning body Staff committees and Planning Council meetings Provide expert advice on Ryan White legislative requirements and HRSA/HAB regulations and expectations Oversee a training program for members Encourage member involvement and retention, with special focus on consumers Serve as liaison with the recipient Help the PC manage its budget Be involved only with supporting RWHAP Part A-related activities 80

Recipient Staff Roles with Planning Council Attend and make a recipient report at Planning Council meetings Regularly provide agreed-upon reports and data (e. g. , costs and service utilization) Provide advice on areas of expertise without unduly influencing discussions or decisions Assign staff to attend most committees regularly Collaborate on shared roles Carry out joint efforts such as task forces and special analyses consistent with roles and resources 81

How This Planning Council Operates Add local slides that describe how your PC operates. For example: 1. Committee structure 2. Slide on expectations for committee membership/engagement 3. Process for signing up for a committee (maybe have presentations from Committee Chairs and a form for sign-up? 4. Policies and procedures around attendance 5. Expense reimbursement 6. Asking for help 7. Mentoring or other help to new members 82

Looking Ahead 83

Discussion – What We are Working Towards: Envisioning a System of Care Why did you join the Planning Council? What is your vision for HIV/AIDS care in the EMA/TGA? What will make you feel your work on the Planning Council has been worthwhile – what do you most want to help accomplish? 84

Challenges for the EMA/TGA and Planning Council [List key challenges for this EMA/TGA and Planning Council for the coming year and discuss – ideally, have leadership lead the discussion – break into small groups if you have time, using the following slide] 85

Describing and Addressing Challenges Work with the small group at your table. Choose a facilitator and a recorder/reporter. Consider one key challenge from the list generated, and be prepared to share with the full group: –What are the key issues? –What can the Planning Council do to help address them? 86

Sum Up and Assessment 87

Sum Up [Have a PC leader go around the room, asking each participant to identify one important thing learned today, then have leader add any key points] 88

Session Assessment + - What You Liked D – What you would like to change 90