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SECTION V ATTACHMENT 5 RYAN WHITE PART A PROGRAM CASE MANAGEMENT SERVICES This Attachment consists of the Scope of Work, Budget and Schedule of Deliverables. For provision of Case Management Services. This portion of the Intergovernmental Agreement shall be a cost re-imbursement fee methodology. Index of Attachments Attachment 5-A: Service Definition and Scope of Work Attachment 5-B: Service Budget and Schedule of Deliverables SECTION V ATTACHMENT 5 RYAN WHITE PART A PROGRAM Attachment 5-A 1.0 Service Definition Medical and Non-Medical Case Management Services: Medical Case Management Services: The United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAD) defines Medical Case Management Services (including treatment adherence) as a range of client- centered services designed to ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, provided by trained professionals, including both medically credentialed and other health care staff who are part of the clinical care team, through all types of encounters including face-to-face, phone contact, and any other form of communication. Activities that include at least the following: • Initial assessment of service needs • Development of a comprehensive, individualized care plan • Coordination of services required to implement the plan • Continuous client monitoring to assess the efficacy of the plan • Periodic re-evaluation and adaptation of the plan at least every 6 months, as necessary Service components that may include: • A range of client-centered services that link clients with health care, psychosocial, and other services, including benefits/ entitlement counseling and referral activities assisting them to access other public and private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturers' Patient Assistance Programs, and other State or local health care and supportive services) • Coordination and follow up of medical treatments • Ongoing assessment of the client's and other key family members' needs and personal support systems • Treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments • Client-specific advocacy and/or review of utilization of services Non-Medical Case Management Services: The United States Department of Health and Human Services, Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB) defines Non-Medical Case Management as the provision of advice and assistance to clients in obtaining medical, social, community, legal, financial, and other needed services. Non-medical case management does not involve coordination and follow-up of medical treatments, as medical case management does. May include: • Benefits/entitlement counseling and referral activities to assist eligible clients to obtain access to public and private programs for which they may be eligible • All types of case management encounters and communications (face-to-face, telephone contact, other) • Transitional case management for incarcerated persons as they prepare to exit the correctional system Medical and Non-medical Case Management Contractors will administer Ryan White Part A Financial Assistance funds as allocated to the Contractor. These funds may include Health Insurance Premium and Cost Sharing Assistance, and other client financial assistance programs approved and funded according to the directives of the Planning Council. Health Insurance Premium and Cost Sharing includes providing a cost-effective alternative to ADAP by: • Purchasing health insurance that provides comprehensive primary care and pharmacy benefits for low income clients that provide a full range of HIV medications • Paying co-pays (including co-pays for prescription eyewear for conditions related to HIV infection) and deductibles on behalf of the client • Providing funds to contribute to a client's Medicare Part D true out-of-pocked (TrOOP) costs SECTION V ATTACHMENT 5 RYAN WHITE PART A PROGRAM Medical and Non-medical Case Management Contractors are considered Contractors for Minority AIDS Initiative NO funding if the Contractor and County identify the need for the Contractor to serve 1-IIV/AIDS positive minorities as defined by the current MAI implementation plan. 2.0 Scope of Work The Contractor may provide Case Management Services, which may include Medical Case Management or Non- Medical Case Management Services including treatment adherence to clients receiving medical services at MINS. a. The Contractor is responsible for ensuring that patients receiving services from MtHS utilizing Ran White Part A Program funds have been properly screened for financial clearance. Obtains and maintains referrals for specific patients to ensure authorized services are received and provide the basis for maximum reimbursement. b. The Contractor shall provide thorough documentation and information entered into the Star system and provides assistance to patients inquiring about their hospital statements. This position ensures that all compliance policies are monitored and followed. As well as registers patients while ensuring accurate and timely processing of all accounts. This position obtains necessary verification of insurance and other eligibility programs. Initiates and assists patients in completing the AHCCCS application. Tracks and monitors the completion of the AHCCCS application. Performs Quality checks on all eligibility/AHCCCS applications initiated in the department and ensures they are processed on every self-pay or unverifiable payer source. Also performs Quality Assurance Checks on the AHCCCS application program and works with management and other staff to Identify and resolve issues that threaten billing and reimbursement. SECTION V ATTACHMENT S RYAN WHITE PART A PROGRAM Attachment 5-6 Budget MIHS - Eligibility Specialist Ryan White Part A Grant Year 2014-16 Salary Hourly Rate Hourly Ravi Salary 1/1115 - Total Yearly Start Date 3/1114 - 12/31114 111116 2128114 FM 311114 - 12/31114 208116 Salary Personnel Ebgibity SpeciaIst 31112014 $16.72 $17.22 1.00 $28,981 $5,970 $34,951 Subtotal Salary $16.72 $1722 1.00 $28,981 $6,970 $341961 ERE Hourly Rate Hourty Rate ERE 111/15. Total Yearly Sbut Data 3/1114 - 12/31114 1/1115-2/28/14 F1E% NU -12131114 2/28/16 ERE EREs RCA - 6.20% 31112014 $16.72 $17.22 1.00 $1,797 $370 $2161 Medicare- 1.45% 31112014 $16.72 $17.22 1 00 $420 $87 $507 ASRS Retirement & LTD. 11.54% 3/1/2014 $1612 $17.22 1.00 $3,344 $689 $4,033 HealthlDerrlallife Insurance 46.3% 311/2014 1 00 $13,490 $2,698 $16188 Subtotal ERE $16.72 $1722 1.00 $19,052 $3,844 $22,895 Total Direct $48,033 $9,813 $67,846 10% Indirect $4,803 $981 $5,785 Total Budget $52,836 $10,794 $63,631 'Hourly rate for the period 1/1115 - 2128/15 reflects a three percent merit increase. SECTION V ATTACHMENT 5 RYAN WHITE PART A PROGRAM Maricopa Integrated Health System Budget Justification Personnel Year !: S34,951 Personnel costs reflect a three percent merit increase (from $16.72 per hour to $17.22 per hour) for a two month period. January—February 2015. Position Title Hourly Salary Number of Months Total Amount Requested Assigned to Program Eligibility Specialist— 1.0 FTE S16.72 12 $34,951 Employee Related Expenses (ERE) Year I: $22,895 MIHS has approved the following Fringe Benefits rates for FY14: FICA 6.20% Medicare 1.45% ASRS Retirement & Long-term Disability (LTD) 11.54% Health/Dentallife Based on employee's elected coverage (46.3%) Name of FICA Medicare ASRS Retirement & ' HeallbiDentel /Life Told Employee LID Laurance Benda Eligibility $2,167 $507 $4,033 16,188 $22895 Specialist Total Salary and ERE Expenses: $57,846 10% Indirect Expe_. $5,785 Total Budget: $63,631