standards of care hiv
TRANSCRIPT
TABLE OF CONTENTS
BENEFITS SPECIALTY SERVICES
Executive Summary 2
Service Introduction 5
Service/Organizational Licensure Category 6
Definitions and Descriptions 6
How Service Relates to HIV 7
Service Components 7 Outreach 8 Intake 9 BenefitsAssessment 10 BenefitsManagement 11 BenefitsServicePlan(BSP) 11 ApplicationorRecertificationAssistance 12 AppealsCounselingandFacilitation 13 ClientRetention 13 CaseClosure 14
Staffing Requirements and Qualifications 15
Units of Service 16
References 17
Acronyms 17
STANDARDS OF CARELos Angeles County Commission on
HIV
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STANDARDS OF CARELos Angeles County Commission on
HIV
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BENEFITS SPECIALTY SERVICES
EXECUTIVE SUMMARY
SERVICE INTRODUCTION
Benefitsspecialtyservicesfacilitateaclient’saccesstopublic/privatehealthanddisabilitybenefitsandprograms.BenefitsspecialtyservicesworktomaximizepublicfundingbyhelpingclientsidentifyallavailablehealthanddisabilitybenefitssupportedbyfundingstreamsotherthantheRyanWhitePartAfunds.
Theseservicesaredesignedto:◆◆ Assistaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram
◆◆ EducatepeoplelivingwithHIVaboutpublicandprivatebenefitsandentitlementprogramsandprovideassistanceinaccessingandsecuringthesebenefits
Benefitsspecialtyservicescaninclude:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Assistanceandmanagementofbenefitsissuesforclientswhoareenrolledinhealthanddisabilityprograms
ThegoalofbenefitsspecialtyservicesistoensurethatpeoplelivingwithHIVarereceivingalloftheaidfromvariousbenefitandentitlementprogramsforwhichtheyareeligibleandentitled.
SERVICE/ORGANIZATIONAL LICENSURE CATEGORY
Benefitsspecialtyservicesareunlicensed.AllbenefitsspecialtyserviceswillbeprovidedinaccordancewithCommissiononHIVguidelinesandprocedures,andlocallawsandregulations.
SERVICE CONSIDERATIONS
General Considerations:BenefitsspecialtyserviceswillrespecttheinherentdignityofeachpersonlivingwithHIVtheyserve.Serviceswillbeclient-driven,aimingtoincreaseaclient’ssenseofempowermentandself-advocacy.Allbenefitsspecialtyserviceswillbelinguisticallyandculturallyappropriatetothetargetpopulation.
Outreach:ProgramsprovidingbenefitsspecialtyserviceswillconductoutreachactivitiestopotentialclientsandHIVserviceproviderstopromotetheavailabilityofandaccesstobenefitsspecialtyservices.ProgramswillcollaboratewithHIVprimaryhealthcareandsupportservicesproviders,aswellasHIVtestingsites.
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BENEFITS SPECIALTY SERVICES
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Services include appeals counseling and facilitation.
Intake:Clientintakedetermineseligibilityandincludesdemographicdata,emergencycontactinformation,nextofkinandeligibilitydocumentation.Whenpossible,clientintakewillbecompletedinthefirstcontactwiththepotentialclient.
Benefits Assessment:Benefitsassessmentsarecompletedinacooperative,interactive,face-to-faceinterviewprocesswheneverpossibleandareconductedto:◆◆ Determineaclient’sneedforbenefitsadvocacy◆◆ Educateaclientaboutavailablebenefitsandentitlements◆◆ Identifyappropriatebenefitsandentitlementswiththeclient◆◆ Preliminarilyassessaclient’seligibilityforbenefitsandentitlements◆◆ Providenecessaryreferrals,formsandinstructions,asindicated◆◆ Identifyanybenefits-relatedbarrierstheclientisexperiencing◆◆ Determinewhethertheclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits
Benefits Management:Benefitsmanagementreferstothebenefitcounselingneedsthatmanyclientshaveoncetheyareenrolledinvarioushealthanddisabilitybenefitsprograms.
Benefits Service Plan (BSP):Abenefitsserviceplanisdevelopedinconjunctionwiththeclienttodeterminethebenefitsandentitlementsforwhichtheclientwillbereferredtoapplyortheplanthatthespecialistwilldeveloptohelptheclientresolvehisorhercurrentbenefitsissue(s).Thebenefitsspecialistisresponsibleforprovidingadvocacy.
Application or Recertification Assistance: Clientswithsignificantfunctionalbarrierswillbegivenanappointmentwithintwoweeksofassessmenttoassistinthecompletionofrelevantapplicationsorrecertifications.Thisassistancewillbeprovidedinaone-on-onemeetingwiththesamebenefitsspecialistthatcompletedtheclient’sassessmentwheneverpossible.
Appeals Counseling and Facilitation:Clientsdeniedabenefitormedicalservicewillbeofferedindividualappealscounselingandfacilitationservices.Specialistswilleducateandadviseclientsonmethodstoaddressappeals,and,whenindicated,accompanythemtotheappealinafacilitativerole(notasalegalrepresentative).
Client Retention:Programswillstrivetoretainclientsinbenefitsspecialtyservices.Toensurecontinuityofserviceandretentionofclients,programswillberequiredtoestablishabrokenappointmentpolicy.
Case Closure:Caseclosureisasystematicprocessfordisenrollingclients/familiesfromactivebenefitsspecialtyservices.Theprocessincludesformallynotifyingclients/familiesofpendingcaseclosureandcompletingacaseclosuresummarytobekeptonfileintheclientchart.
STAFFING REQUIREMENTS AND QUALIFICATIONS
BenefitsspecialistswillholdaBachelor’sdegreeinanareaofhumanservicesand/orcertificationinself-insuranceliability;ahighschooldiploma(orgeneraleducationdevelopment(GED)equivalent)andhaveatleastoneyear’sexperienceworkingasanHIVcasemanagerorHIVpolicyadvocate,oratleastthreeyears’experienceworkingwithinarelatedhealthservicesfield.
BenefitsspecialistswillbeknowledgeableabouttheHIVdiseaseprocessandthe
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BENEFITS SPECIALTY SERVICES psychologicaleffectsoflivingwithHIV,aswellastheco-morbiditiesofsubstanceabuseand
mentalillnessandtheireffectsonthemanagementofHIVillness.
Further,benefitsspecialistswillhave:◆◆ Effectiveinterviewingandassessmentskills◆◆ Abilitytoappropriatelyinteractandcollaboratewithothers◆◆ Effectivewritten/verbalcommunicationskills◆◆ Abilitytoworkindependently◆◆ Effectiveproblem-solvingskills◆◆ Abilitytorespondappropriatelyincrisissituations◆◆ Effectiveorganizationalskills
AllbenefitsspecialistswillsuccessfullycompletetheDivisionofHIVandSTDPrograms(DHSP)—formerlyreferredtoastheOfficeofAIDSProgramsandPolicy(OAPP)—BenefitsSpecialtyCertificationTrainingwithinthreemonthsofbeinghired.Inaddition,specialistswillsuccessfullycompletecertificationinRyanWhite/HealthInsurancePremiumPaymentProgram(HIPP)andAIDSDrugAssistanceProgram(ADAP)withinsixmonthsofbeinghired,aswellasanyrequisitetraining(asappropriate).
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STANDARDS OF CARELos Angeles County Commission on
HIV
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BENEFITS SPECIALTY SERVICES
Specialists can assist with benefit paperwork.
SERVICE INTRODUCTION
Benefitsspecialtyservicesfacilitateaclient’saccesstopublic/privatehealthanddisabilitybenefitsandprograms.BenefitsspecialtyservicesworktomaximizepublicfundingbyhelpingclientsidentifyallavailablehealthanddisabilitybenefitssupportedbyfundingstreamsotherthantheRyanWhitePartAfunds.
Theseservicesaredesignedto:◆◆ Assistaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram
◆◆ EducatepeoplelivingwithHIVaboutpublicandprivatebenefitsandentitlementprogramsandtoprovideassistanceinaccessingandsecuringthesebenefits
Benefitsspecialtyservicescaninclude:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Appealscounselingandfacilitation◆◆ Assistanceandmanagementofbenefitsissuesforclientswhoareenrolledinhealthanddisabilityprograms
Allprogramswilluseavailablestandardsofcaretoinformclientsofservicesandwillprovideservicesinaccordancewithlegalandethicalstandards.Maintainingconfidentialityiscriticalanditsimportancecannotbeoverstated.AllprogramsmustcomplywiththeHealthInsurancePortabilityandAccountabilityAct(HIPAA).
ThegoalofbenefitsspecialtyservicesistoensurethatpeoplelivingwithHIVarereceivingalloftheaidfromvariousbenefitandentitlementprogramsforwhichtheyareeligibleandentitled.
Recurringthemesinthisstandardinclude:◆◆ Benefitsspecialtyserviceswillrespectthedignityandselfdeterminationofclients.◆◆ Benefitsspecialistswilltailortheirinterventionstothefunctionalabilitiesoftheirclients.
◆◆ Benefitsspecialistswillfollowupwiththeirclientsthroughoutthebenefitsprocess.◆◆ Benefitsspecialistswillberequiredtohavespecializedtrainingandexpertiseinbenefitsandentitlements.
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BENEFITS SPECIALTY SERVICES ◆◆ Benefitsspecialistswillestablishcollaborativerelationshipswithkeybenefitspartners
(SocialSecurity,DepartmentofPublicSocialService,CaliforniaDepartmentofPublicHealth(CDPH),DivisionofHIVandSTDPrograms(DHSP)—formerlyreferredtoastheOfficeofAIDSProgramsandPolicy(OAPP),ADAPandRyanWhite/HIPP,othergrantees).
TheLosAngelesCountyCommissiononHIVandDHSPhavedevelopedthisstandardofcaretosetminimumqualityexpectationsforserviceprovisionandtoguaranteeclientsconsistentcare,regardlessofwheretheyreceiveservicesintheCounty.
Thisdocumentrepresentsasynthesisofpublishedstandardsandresearch,including:◆◆ ProBenefit$ Handbook,AIDSProjectLosAngeles◆◆ Program Policies and Procedures for Benefits Specialty Services,AIDSProjectLosAngeles
◆◆ Client Advocacy Definitions,CommissiononHIV◆◆ StandardsofcaredevelopedbyseveralotherRyanWhiteTitle1PlanningCouncils—mostvaluableinthedraftingofthisstandardwasBaltimore,2004
SERVICE/ORGANIZATIONAL LICENSURE CATEGORY
Benefitsspecialtyservicesareunlicensed.AllbenefitsspecialtyserviceswillbeprovidedinaccordancewithCommissiononHIVguidelinesandprocedures,andlocallawsandregulations.
DEFINITIONS AND DESCRIPTIONS
Benefits assessmentisacooperativeandinteractiveface-to-faceinterviewprocessduringwhichtheclient’sknowledgeaboutandaccesstopublicandprivatebenefitsareidentifiedandevaluated.
Benefits management referstobenefitsspecialtyservicesprovidedtoindividualswhoareenrolledinvarioushealthanddisabilityprograms.Thegoalofbenefitsmanagementistoprovideadvocacythathelpstheindividualmaintainhisorherbenefits.
Case closureisasystematicprocessofdisenrollingclientsfromactivebenefitsspecialtyservices.
Client intakeisaprocessthatdeterminesaperson’seligibilityforbenefitsspecialtyservices.
Entitlement programsarebenefitsthatrequirefinancialcontributionintotheprogrampriortocollectingfromtheprogram(e.g.,StateDisabilityInsurance(SDI)andSocialSecurityDisabilityInsurance(SSDI)).
Legal representationdefinesaprocessthroughwhichaconsumerisrepresentedbyanattorney,paralegaland/orlicensed/certifiedinsuranceadjustor.(PleaseseeLegal Assistance Standard of Care.)
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BENEFITS SPECIALTY SERVICESOutreachpromotestheavailabilityofandaccesstobenefitsspecialtyservicestopotential
clientsandserviceproviders.
Public benefitsdescribeallfinancialandmedicalassistanceprogramsfundedbygovernmentalsources.
HOW SERVICE RELATES TO HIV
Attheendof2013,approximately60,050peoplewereestimatedtobelivingwithHIVinfectioninLosAngelesCounty.LosAngelesCountycomprises40%ofthetotalAIDScasesintheStateofCalifornia(EpidemiologicProfileofHIVinLosAngelesCounty,2013).
Linkingclientstoresourcescanbetime-consumingandcomplex,ofteninvolvingamixofadvocacyandmediation(Chernesky&Grube,2000).A2002NewYorkCitystudyonformalclientassessment,foundthedevelopmentofacareplanandassistanceinsecuringpublicbenefitstobekeyfactorsinasignificantlyincreasedlikelihoodofaclient’senteringandmaintainingmedicalcare(Messerietal.,2002).
Otherstudieshaveshownthatthereceiptofancillaryservices(includingclientadvocacy)hasbeensignificantlyassociatedwithincreaseduseofprimarymedicalcare(Ashman,Conviser&Pounds,2002).Thisfindingmaysuggestthathelpingclientstosolveproblemsnotdirectlyrelatedtoprimarycaremayempowerthemtoseekandobtainit(Ashman,Conviser&Pounds,2002).
SERVICE COMPONENTS
Benefitsspecialtyservicesareclient-centeredactivitiesthatfacilitateaclient’saccesstopublicmaintenanceofhealthanddisabilitybenefitsandservices.Benefitsspecialtyservicesfocusonassistingaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram.
Specialistsareresponsiblefor:◆◆ Ensuringthattheirclientsarereceivingallthebenefitsandentitlementsforwhichtheyare
eligible◆◆ Educatingclientsaboutavailablebenefitandentitlementprogramsandassessingtheireligibilityforthem
◆◆ Assistingclientswithapplications,providingadvocacywithappealsanddenials◆◆ Assistingwithrecertifications,providingadvocacyinotherareasrelevanttomaintainingbenefits
Specialistswillexploreaspossibleoptionsfortheirclientsthefollowingbenefits(atminimum):◆◆ AIDSDrugAssistanceProgram(ADAP)◆◆ AbilitytoPayPrograms(ATP)◆◆ Cal-WORKs◆◆ CARE/HealthInsurancePremiumPayment(CARE/HIPP)◆◆ FoodStamps◆◆ GeneralRelief/GeneralReliefOpportunitiestoWork(GROW)◆◆ InHomeSupportiveServices(IHSS)
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BENEFITS SPECIALTY SERVICES ◆◆ InsuranceContinuation(COBRA,OBRA,HIPAA)
◆◆ HealthyFamiliesProgram◆◆ MajorRiskMedicalInsuranceProgram(MRMIP)◆◆ ManagedCareSystems◆◆ Medicaid/Medi-Cal◆◆ Medi-Cal/HealthInsurancePremiumPaymentProgram(Medi-Cal/HIPP)◆◆ Medicare◆◆ MedicareSavingsPrograms◆◆ PharmaceuticalPatientAssistancePrograms(PAPs)◆◆ PrivateInsurance◆◆ SocialSecurityPrograms◆◆ SocialSecurityDisabilityInsurance(SSDI)◆◆ SupplementalSecurityIncome(SSI)◆◆ SocialSecurityRetirement◆◆ StateDisabilityInsurance(SDI)◆◆ TemporaryAidtoNeedyFamilies(TANF)◆◆ UnemploymentInsurance(UI)◆◆ Veteran’sAdministrationBenefits(VA)◆◆ Women,InfantsandChildren(WIC)◆◆ Worker’scompensation◆◆ Otherpublic/privatebenefitsprograms
Inadditiontoassessingeligibilityfortheprogramslistedabove,specialistswilladdresstheuniquebenefitsneedsofspecificpopulationsincluding(butnotlimitedto):◆◆ Immigrants◆◆ Veterans◆◆ Individualswhohaverecentlybeenincarcerated◆◆ Familiesandchildren◆◆ BenefitsspecialtyserviceswillrespecttheinherentdignityofeachpersonlivingwithHIVtheyserve.Serviceswillbeclient-driven,aimingtoincreaseaclient’ssenseofempowermentandself-advocacy.AllHIVbenefitsspecialtyserviceswillbelinguisticallyandculturallyappropriatetothetargetpopulation.(SeeProgramRequirementsandGuidelinesintheStandardsofCareIntroduction)
BenefitsspecialistswillusetrainingandresourcematerialsprovidedbytheDHSP,aswellasotherrelevanttrainingandeducationalmaterials.
Benefitsspecialtyservicesarecomprisedof:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Appealscounseling,facilitationandreferral
OUTREACH
ProgramsprovidingbenefitsspecialtyserviceswillconductoutreachactivitiestopotentialclientsandHIVserviceproviderstopromotetheavailabilityofandaccesstobenefitsspecialtyservices.ProgramswillcollaboratewithHIVprimaryhealthcareandsupportservicesproviders,aswellasHIVtestingsites.
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BENEFITS SPECIALTY SERVICESSTANDARD MEASURE
Benefitsspecialtyprogramswilloutreachtopotentialclients/familiesandproviders.
Outreachplanonfileatprovideragency.
Benefitsspecialtyprogramswillcollaboratewithprimaryhealthcareandsupportiveserviceproviders.
MemorandaofUnderstandingonfileattheprovideragency.
INTAKE
Clientintakedetermineseligibilityandincludesdemographicdata,emergencycontactinformation,nextofkinandeligibilitydocumentation.Whenpossible,clientintakewillbecompletedinthefirstcontactwiththepotentialclient.Thecompleteintakeprocess,includingregistrationandeligibility,isrequiredforeveryclientathisorherpointofentryintotheservicesystem.Ifanagencyorotherfundedentityhastherequiredinformationanddocumentationonfileintheagencyrecordforthatclientorinthecountywidedatamanagementsystem,furtherintakeisnotrequired.
Intheintakeprocessandthroughoutbenefitsspecialtyservicedelivery,clientconfidentialitywillbestrictlymaintainedandenforced.AllprogramswillfollowHIPAAguidelinesandregulationsforconfidentiality.Asneeded,ReleaseofInformationformswillbegathered.Theseformsdetailthespecificperson/soragenciestoorfromwhominformationwillbereleasedaswellasthespecifickindofinformationtobereleased.NewformsmustbeaddedforindividualsnotlistedonthemostcurrentReleaseofInformation(specificationshouldindicatethetypeofinformationthatcanbereleased).
Aspartoftheintakeprocess,theclientfilewillincludethefollowinginformation(atminimum):◆◆ WrittendocumentationofHIVstatus◆◆ ProofofLosAngelesCountyresidencyorAffidavitofHomelessness◆◆ Verificationoffinancialeligibilityforservices◆◆ Dateofintake◆◆ Clientname,homeaddress,mailingaddressandtelephonenumber◆◆ Emergencyand/ornextofkincontactname,homeaddressandtelephonenumber
Required Forms:Programsmustdevelopthefollowingformsinaccordancewithstateandlocalguidelines.
Completedformsarerequiredforeachclient:◆◆ ReleaseofInformation(mustbeupdatedannually).NewformsmustbeaddedforthoseindividualsnotlistedontheexistingReleaseofInformation(specificationshouldbemadeaboutwhattypeofinformationcanbereleased).
◆◆ LimitsofConfidentiality(confidentialitypolicy)◆◆ ConsenttoReceiveServices◆◆ ClientRightsandResponsibilities◆◆ ClientGrievanceProcedures◆◆ DisclosureorDutyStatementfromclientthatinformsthebenefitsspecialistwhenclienthasretainedotherlegalrepresentation
◆◆ ProgramDisclaimerthatbenefitsspecialtyservicesdonotconstitutelegaladviceorrepresentationandthatthereisnoguaranteeofsuccessinobtainingbenefits.
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BENEFITS SPECIALTY SERVICES STANDARD MEASURE
Theintakeprocesswillbeginduringfirstcontactwithclient.
Intaketoolinclientfiletoinclude(atminimum):• DocumentationofHIVstatus• ProofofLACountyresidencyorAffidavitof
Homelessness• Verificationoffinancialeligibility• Dateofintake• Clientname,homeaddress,mailingaddressand
telephonenumber• Emergencyand/ornextofkincontactname,home
addressandtelephonenumber
ConfidentialitypolicyandReleaseofInformationwillbediscussedandcompleted.
ReleaseofInformationsignedanddatedbyclientonfileandupdatedannually.
ConsentforServiceswillbecompleted. SignedanddatedConsentinclientfile.
ClientwillbeinformedofRightsandResponsibilityandGrievanceProcedures.
Signedanddatedformsinclientfile.
Whenindicated,theclientwillprovideDisclosureorDutyStatement.
SignedanddatedDisclosureorDutyStatementinclientfile.
ClientwillbeinformedoflimitationsofbenefitsspecialtyservicesthroughDisclaimerform.
SignedanddatedDisclaimerinclientfile.
BENEFITS ASSESSMENT
Benefitsassessmentsarecompletedinacooperative,interactive,face-to-faceinterviewprocesswheneverpossibleandareconductedto:◆◆ Determineaclient’sneedforpublicbenefitsadvocacy◆◆ Educateaclientaboutavailablebenefitsandentitlements◆◆ Identifyappropriatebenefitsandentitlementswiththeclient◆◆ Preliminarilyassessaclient’seligibilityforbenefitsandentitlements◆◆ Providenecessaryreferrals,formsandinstructions,asindicated◆◆ Identifyanybenefits-relatedbarrierstheclientisexperiencing◆◆ Determinewhethertheclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits
Benefitsassessmentsalsohelpthespecialistassessaclient’sfunctionalabilitytofollowthroughwithcomplicatedenrollmentandapplicationprocedures.Thisinformalfunctionalassessmentwillhelpguidetheadvocateinmakingdecisionsaboutthelevelofassistancerequiredtoensurethatagivenclientissuccessfulinthebenefitapplicationprocess.
Examplesoffunctionalbarriersmayinclude(butnotbelimitedto):◆◆ Literacy◆◆ Englishproficiency◆◆ Mentalillness◆◆ Substanceabuse◆◆ Learningdisabilities◆◆ Homelessness◆◆ Stigma◆◆ Transportationchallenges◆◆ Poorphysicalhealthandmedicationsideeffects
Benefitsassessmentswillbecompletedduringthefirstappointmentafterreferralorcompletionofintake.Ifaclient,duetophysicalimpairmentorillness,isunabletocometoanagencyappointment,anadvocatewillbedispatchedtohisorherplaceofresidencetocompletetheassessmentandrequisitefollow-up.
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BENEFITS SPECIALTY SERVICESWhilemostclientswilllikelycometobenefitsspecialtyservicesthroughdirectreferralfrom
casemanagers,benefitsspecialistsmustensureaccessandreferraltocasemanagementservicesforanyclientsnotalreadyconnectedtosuchservices.
Benefitsassessmentsrequirethattheclientchartonfilecontainthefollowingdocumentation(atminimum):◆◆ Dateofassessment◆◆ Signatureandtitleofstaffpersoncompletingtheassessment◆◆ CompletedAssessment/Informationform◆◆ Notationoffunctionalbarriers◆◆ Briefnotationofrelevantbenefitsandentitlementsandrecordofformsprovided◆◆ Benefitsserviceplan
STANDARD MEASURE
Benefitsassessmentswillbecompletedduringfirstappointment.
Benefitsassessmentinclientchartonfiletoinclude:• Dateofassessment• Signatureandtitleofstaffperson• CompletedAssessment/Informationform• Functionalbarriers• Notationofrelevantbenefitsandentitlementsand
recordofformsprovided• Benefitsserviceplan
BENEFITS MANAGEMENT
Benefitsmanagementreferstothebenefitcounselingneedsthatmanyclientshaveoncetheyareenrolledinvarioushealthanddisabilitybenefitsprograms.
Clientsmayrequirebenefitsmanagementassistanceforanyofthefollowingreasons:◆◆ Healthorlifestylechanges◆◆ Programrecertificationorreenrollment◆◆ Treatment/servicedenials◆◆ Return-to-workissues◆◆ Legislativeorbudgetrelatedchangestobenefits
STANDARD MEASURE
Benefitsmanagementserviceswillbeprovidedtoclientswhoareenrolledinbenefitsprogramsandrequireadvocacytomaintaintheirbenefits.
Benefitsassessmentonfileinclientcharttoinclude:• Date• Signatureandtitleofstaffperson• Notationofrelevantbenefitsandpresentingissue(s)• Benefitsserviceplantoaddressidentifiesbenefits
issue(s)
BENEFITS SERVICE PLAN (BSP)
ABSPisdevelopedinconjunctionwiththeclienttodeterminethebenefitsandentitlementsforwhichtheclientwillbereferredtoapplyortheplanthatthespecialistwilldeveloptohelptheclientresolvehisorhercurrentbenefitsissue(s).Thebenefitsspecialistisresponsibleforprovidingadvocacy,referralsandotherassistancenecessarytocarryouttheBSPafterdeterminingwhetherthepersonhassoughtlegalrepresentation.Throughofficevisits,homevisitand/orphonecalls,theadvocatewillworkwiththeclienttoobtaintheservicesorinformationnecessarytocompletethebenefit/entitlementprocessorto
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BENEFITS SPECIALTY SERVICES resolvethependingbenefitissue.
IncludedintheBSPistheleveloffacilitationexpectedfromtheadvocate.◆◆ Clients with insignificant or no apparent functional barrierswillbeprovidedwithnecessaryformsandinstructions.Specialistswillfollowupwithintwoweekstocheckclient’sprogressincompletingandapplyingforbenefitsandentitlements.
◆◆ Clients with significant functional barrierswillbeprovidedwithnecessaryformsandinstructionsandgivenanappointmenttoreturnwithintwoweekstoassistincompletingforms.
Attheconclusionofthebenefitsassessment,BSPswillbecompletedforeachclient.BSPswillbeupdatedasneededandwillincludethefollowing(atminimum):◆◆ Name,dateandsignatureofclientandadvocate◆◆ Notationofbenefitsandentitlementstowhichtheclientwillapply◆◆ Notationoffunctionalbarriersstatusandrequisitenextsteps◆◆ Dispositionoftheapplicationforeachbenefitorentitlementasitiscompleted,changedordeterminedtobeunattainable
STANDARD MEASURE
BSPswillbedevelopedinconjunctionwiththeclientatthecompletionofthebenefitsassessment.
BSPonfileinclientchartthatincludes:• Name,dateandsignatureofclientandcasemanager• Benefits/entitlementsforwhichtobeapplied• Functionalbarriersstatusandnextsteps• Dispositionforeachbenefit/entitlementand/or
referral
APPLICATION OR RECERTIFICATION ASSISTANCE
Clientswithsignificantfunctionalbarrierswillbegivenanappointmentwithintwoweeksofassessmenttoassistinthecompletionofrelevantapplicationsorrecertifications.Thisassistancewillbeprovidedinaone-on-onemeetingwiththesamebenefitsspecialistthatcompletedtheclient’sassessmentwheneverpossible.
Clientswithinsignificantornofunctionalbarrierswillbeofferedindividualapplicationassistanceif,atthetimeoffollow-up,theyexpressaneedforthisservice.
Itisthespecialist’sresponsibilitytoensurethattheapplicationsarecompleteandthattheclienthasclearinstructionsaboutthenextstepsrequiredtofinalizetheapplicationprocess(e.g.,settingappointmentsatbenefitsoffices,mailinginstructions,etc.).
Documentationforapplicationassistanceserviceswillbekeptintheformofaprogressnoteandshouldinclude(atminimum):◆◆ Date◆◆ Determinationwhetherclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits
◆◆ Descriptionofapplicationscompleted◆◆ Timespentwith,oronbehalfof,theclient◆◆ Specialist’ssignatureandtitle
Ifaclientdoesnotattendascheduledappointment,specialistswillattempttofollowupwithinonebusinessday.
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BENEFITS SPECIALTY SERVICESSTANDARD MEASURE
Specialistswillassistclientswithsignificantfunctionalbarriersorwhorequireadditionalhelpincompletingbenefitpaperwork.
Signed,datedprogressnotesonfilethatdetail(atminimum):• Determinationoflegalcounsel• Descriptionofpaperworkcompleted• Timespent
Specialistswillattempttofollowupmissedappointmentswithinonebusinessday.
Progressnoteonfileinclientchartdetailingfollow-upattempt.
APPEALS COUNSELING AND FACILITATION
Clientsdeniedabenefitormedicalservicewillbeofferedindividualappealscounselingandfacilitationservices.Specialistswilleducateandadviseclientsonmethodstoaddressappeals,and,whenindicated,accompanythemtotheappealinafacilitativerole(notasalegalrepresentative).
Whenaspecialistdeemsthatfurtherlegalassistanceisrequiredtosuccessfullynegotiateanappeal,clientswillbereferredtoalegalserviceprovider.
Documentationforappealscounselingandfacilitationserviceswillbekeptintheformofaprogressnoteandshouldinclude(atminimum):◆◆ Date◆◆ Briefdescriptionofcounselingprovided◆◆ Timespentwith,oronbehalfof,theclient◆◆ Legalreferrals(asindicated)◆◆ Specialist’ssignatureandtitle
Ifaclientdoesnotattendascheduledappealscounselingappointment,specialistswillattempttofollowupwithinonebusinessday.
STANDARD MEASURE
Asnecessary,specialistswillassistclientswithappealscounselingandfacilitation.CasesthatrequirefurtherlegalassistancewillbereferredtoRyanWhiteProgram-fundedorotherlegalserviceprovider.
Signed,datedprogressnotesonfilethatdetail(atminimum):• Briefdescriptionofcounselingprovided• Timespentwith,oronbehalfof,theclient• Legalreferrals(asindicated)
Specialistswillattempttofollowupmissedappointmentswithinonebusinessday.
Progressnoteonfileinclientchartdetailingfollow-upattempt.
CLIENT RETENTION
Programswillstrivetoretainclientsinbenefitsspecialtyservices.Toensurecontinuityofserviceandretentionofclients,programswillberequiredtoestablishabrokenappoint-mentpolicy.Follow-upstrivestomaintainaclient’sparticipationincareandcanincludetelephonecalls,writtencorrespondenceand/ordirectcontact.Sucheffortswillbedocu-mentedintheprogressnoteswithintheclientrecord.Inaddition,programswilldevelopandimplementacontactpolicyandproceduretoensurethatclientswhoarehomelessorreportnocontactinformationarenotlosttofollow-up.
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BENEFITS SPECIALTY SERVICES STANDARD MEASURE
Programswilldevelopabrokenappointmentpolicytoensurecontinuityofserviceandretentionofclients.
Writtenpolicyonfileatprovideragency.
Programswillprovideregularfollow-upprocedurestoencourageandhelpmaintainaclientinbenefitsspecialtyservices.
Documentationofattemptstocontactinsigned,datedprogressnotes.Follow-upmayinclude:• Telephonecalls• Writtencorrespondence• Directcontact
Programswilldevelopandimplementaclientcontactpolicyandprocedureforhomelessclientsandthosewithnocontactinformation.
Contactpolicyonfileatprovideragency.Programreviewandmonitoringtoconfirm.
CASE CLOSURE
Caseclosureisasystematicprocessfordisenrollingclients/familiesfromactivebenefitsspecialtyservices.Theprocessincludesformallynotifyingclients/familiesofpendingcaseclosureandcompletingacaseclosuresummarytobekeptonfileintheclientchart.Allattemptstocontacttheclientandnotificationsaboutcaseclosurewillbedocumentedintheclientfile,alongwiththereasonforcaseclosure.
Casesmaybeclosedwhentheclient:◆◆ Successfullycompletesbenefitandentitlementapplications◆◆ Resolvesbenefitsissue◆◆ Seekslegalrepresentationforbenefits◆◆ Relocatesoutoftheservicearea◆◆ Hashadnodirectprogramcontactinthepastsixmonths◆◆ Isineligiblefortheservice◆◆ Nolongerneedstheservice◆◆ Discontinuestheservice◆◆ Isincarceratedlongterm◆◆ Usestheserviceimproperlyorhasnotcompliedwiththeclientservicesagreement◆◆ Hasdied
Benefitsspecialistswillcompleteacaseclosuresummarytoinclude:◆◆ Dateandsignatureofbenefitsspecialist◆◆ Dateofcaseclosure◆◆ StatusoftheBSP◆◆ Reasonsforcaseclosure
STANDARD MEASURE
Clientswillbeformallynotifiedofpendingcaseclosure.
Contactattemptsandnotificationaboutcaseclosureonfileinclientchart.
Benefitscasesmaybeclosedwhentheclient:• Successfullycompletesbenefitandentitlement
applications• Seekslegalrepresentationforbenefits• Relocatesoutoftheservicearea• Hashadnodirectprogramcontactinthepastsix
months• Isineligiblefortheservice• Nolongerneedstheservice• Discontinuestheservice• Isincarceratedlongterm• Usestheserviceimproperlyorhasnotcomplied
withtheclientservicesagreement• Hasdied
Caseclosuresummaryonfileinclientcharttoinclude:• Dateandsignatureofbenefitsspecialist• Dateofcaseclosure• StatusoftheBSP• Reasonsforcaseclosure
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BENEFITS SPECIALTY SERVICESSTAFFING REQUIREMENTS AND QUALIFICATIONS
Atminimum,allbenefitsspecialistswillbeabletoprovidelinguisticallyandculturallyappropriatecaretopeoplelivingwithHIVandcompletedocumentationasrequiredbytheirpositions.Benefitsspecialistswillcompleteanagency-basedorientationbeforeprovidingservices.BenefitsspecialistswillalsobetrainedandorientedregardingclientconfidentialityandHIPAAregulations.
BenefitsspecialistswillholdaBachelor’sdegreeinanareaofhumanservicesand/orcertificationinself-insuranceliability;ahighschooldiploma(orgeneraleducationdevelopment(GED)equivalent)andhaveatleastoneyear’sexperienceworkingasanHIVcasemanagerorHIVpolicyadvocate,oratleastthreeyears’experienceworkingwithinarelatedhealthservicesfield.
BenefitsspecialistswillbeknowledgeableabouttheHIVdiseaseprocessandthepsychologicaleffectsoflivingwithHIV,aswellastheco-morbiditiesofsubstanceabuseandmentalillnessandtheireffectsonthemanagementofHIVillness.
Further,benefitsspecialistswillhave:◆◆ Effectiveinterviewingandassessmentskills◆◆ Abilitytoappropriatelyinteractandcollaboratewithothers◆◆ Effectivewritten/verbalcommunicationskills◆◆ Abilitytoworkindependently◆◆ Effectiveproblem-solvingskills◆◆ Abilitytorespondappropriatelyincrisissituations◆◆ Effectiveorganizationalskills
AllbenefitsspecialistswillsuccessfullycompletetheDHSPBenefitsSpecialtyCertificationTrainingwithinthreemonthsofbeinghired.Inaddition,specialistswillsuccessfullycompletecertificationinRyanWhite/HIPPandADAPwithinsixmonthsofbeinghired,aswellasanyrequisitetraining(asappropriate).
SupervisionforbenefitsspecialtyserviceswillbeprovidedbyaMaster’sdegree-levelprofessional(orBachelor’sdegree-levelwithequivalentexperience)withhealthanddisabilitypolicyexperience,staffmanagementandadministrationexperience.Thebenefitsspecialtysupervisorisrequiredtocompleteallbenefitandentitlement-relatedtrainingasnotedabove.
Benefitsspecialistswillperformtheirdutiesaccordingtogenerallyacceptedethicalstandards,including:◆◆ Strivingtomaintainandimproveprofessionalknowledge,skillsandabilities◆◆ Basingallservicesonatruthfulassessmentofaclient’ssituation◆◆ Providingclientswithacleardescriptionofservices,timelinesandpossibleoutcomesattheinitiationofservices
◆◆ Safeguardingaclient’srightstoconfidentialitywithinthelimitsofthelaw◆◆ Evaluatingaclient’sprogressonacontinuousbasistoguideservicedelivery◆◆ Referringclientsforthoseservicesthatthebenefitsspecialistisunabletoprovide◆◆ Respectingattorney/clientprivilege
SUPERVISION
Supervisionisrequiredofallbenefitsspecialiststoprovideguidanceandsupport.Supervisionwillbeprovidedforallbenefitsspecialistsataminimumoffourhourspermonth
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BENEFITS SPECIALTY SERVICES inindividualand/orgroupformats.Supervisionwillassistinproblem-solvingrelatedto
clients’progresstowardsgoalsdetailedintheBSPandtoensurethathigh-qualitybenefitsspecialtyservicesarebeingprovided.Inadditiontoprovidingdirectsupervisiontocasemanagers,supervisorsareresponsibleformonitoringtheworkofbenefitsspecialiststhroughrecordreviewtoensurethatdocumentationisappropriateandadequatelycompleted.
STAFF DEVELOPMENT AND ENHANCEMENT ACTIVITIES
Toensurethatbenefitsspecialistsareprovidingcurrent,accurateinformationandadvocacyservicestoclients,staffwillberequiredtocompleteannualrecertificationtraining.InadditiontoofferingtheDHSPrecertificationtraining,programswillprovideand/orallowaccesstoongoingstaffdevelopmentandtrainingforbenefitsspecialists.Staffdevelopmentandenhancementactivitieswillinclude(butnotbelimitedto)trainingsand/orin-servicesrelatedtobenefitsspecialtyissuesandHIV/AIDS.Benefitsspecialistswillparticipateinatleasteighthoursofjob-relatededucationortrainingannually.
Thefollowingdocumentation,tobekeptintheemployeerecord,isrequiredforstaffdevelopmentandenhancementactivities:◆◆ Documentedcompletionofbenefitsspecialtycertificationtrainingandrecertificationtraining
◆◆ Documentedcompletionofothertrainings◆◆ Staffmember(s)name(s)attendingfunction◆◆ Nameofsponsororprovideroffunction◆◆ Trainingoutline◆◆ Meetingagendaand/orminutes
STANDARD MEASURE
BenefitsspecialtyprogramswillhirestaffthathavetheabilitytoprovidelinguisticallyandculturallyappropriatecaretoclientsinfectedwithandaffectedbyHIV.
Resumeonfileatprovideragencytoconfirm.
Allstaffwillbegivenorientationpriortoprovidingservices.
Recordoforientationinemployeefileatprovideragency.
BenefitsspecialistswillcompleteDHSP’scertificationtrainingwithinthreemonthsofbeinghiredandbecomeADAPandRyanWhite/HIPPcertifiedinsixmonths.
DocumentationofCertificationcompletionmaintainedinemployeefile.
Staffwillcompletebenefitsspecialtyrecertificationtrainingannuallyandwillseekothertrainingopportunitiesasavailable.
Documentationoftrainingmaintainedinemployeefilestoinclude:• Date,timeandlocationoffunction• Functiontype• Staffmembersattending• Sponsororprovideroffunction• Trainingoutline• Meetingagendaand/orminutes
Benefitsspecialistswillpracticeaccordingtogenerallyacceptedethicalstandards.
Programreviewandmonitoringtoconfirm.
Benefitsspecialistswillreceiveaminimumoffourhoursofsupervisionpermonth.
Recordofsupervisiononfileatprovideragency.
UNITS OF SERVICE
Unit of service:Unitsofservicedefinedasreimbursementforbenefitsspecialtyservicesarebasedonservicesprovidedtoeligibleclients.◆◆ Benefits assessment and service plan units:calculatedinnumberofhoursprovided
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BENEFITS SPECIALTY SERVICES◆◆ Application assistance units:calculatedinnumberofhoursprovided
◆◆ Appeals counseling and facilitation units:calculatedinnumberofhoursprovided
Number of clients:Clientnumbersaredocumentedusingthefiguresforunduplicatedclientswithinagivencontractperiod.
REFERENCES
AIDSProjectLosAngeles.Program Policies & Procedures for Benefits Specialty Services & A Comprehensive Directory to HIV/AIDS Services in Los Angeles County,LosAngeles.
AIDSProjectLosAngeles.ProBenefit$ Handbook: A Professional’s Guide to Public Benefits, Private Insurance and Return to Work Issues for People with HIV,BenefitsandWorkServicesDepartment,LosAngeles.
Ashman,J.J.,Conviser,R.,&Pounds,M.B.(2002).AssociationsbetweenHIV-positiveindividuals’receiptofancillaryservicesandmedicalcarereceiptandretention.AIDS Care,14,Supplement1,pp.S109–S118.
Chernesky,R.H.,andGrube,B.(2000).ExaminingtheHIV/AIDScasemanagementprocess.Health & Social Work,25(4),243-253.
CountyofLosAngeles,HIVEpidemiologyProgram(2005).HIV/AIDS Semi-Annual Surveillance Survey (availableonlineathttp://lapublichealth.org/wwwfiles/ph/hae/hiv/Semiannual_Surveillance_Summary_January_2005.pdf).DepartmentofHealthServices,LosAngeles.
Messeri,P.A.,Abramson,D.M.,Aidala,A.A,.etal.(2002).TheimpactofancillaryHIVservicesonengagementinmedicalcareinNewYorkCity.AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV,14(Suppl.1),S15-S29.
ACRONYMS
ADAP AIDSDrugAssistanceProgramAIDS AcquiredImmuneDeficiencySyndromeATP AbilitytoPayProgramsBSP BenefitsServicesPlanCDPH CaliforniaDepartmentofPublicHealthCOBRA ConsolidatedOmnibusBudgetReconciliationActDHSP DivisionofHIVandSTDProgramsGROW GeneralReliefOpportunitiestoWorkHIPP HealthInsurancePremiumPaymentProgramHIPAA HealthInsurancePortabilityandAccountabilityActHIV HumanImmunodeficiencyVirusIHSS InHomeSupportiveServicesMRMIP MajorRiskMedicalInsuranceProgramOBRA OmnibusBudgetReconciliationActPAPS PharmaceuticalPatientAssistanceProgramsSDI StateDisabilityInsuranceSSDI SocialSecurityDisabilityInsuranceSSI SupplementalSecurityIncomeSTD SexuallyTransmittedDiseaseTANF TemporaryAIDtoNeedyFamiliesUI UnemploymentInsuranceVA VeteransAdministrationWIC Women,InfantsandChildren