241.001 Administrative Agency Roles and Responsibilities

1.0 Purpose

This policy establishes the roles and responsibilities required of an administrative agency (AA) under contract with the state to assure the development of a comprehensive plan for the delivery of HIV core medical support services and the implementation of that plan. This policy serves as guidance for AAs to meet the Health Resources and Services Administration HIV/AIDS Bureau’s (HRSA’s) Ryan White HIV/AIDS Program (RWHAP) requirements and minimum DSHS expectations, as authorized (see Section 3.0).
 

2.0 Background

The Texas Department of State Health Services (DSHS), HIV/STD Care and Medications Unit (the State), coordinates all federal and state funds for HIV client services through selected AAs. AAs administer and disburse funds to various providers and provide administrative services, including planning, data management, contract and financial management, and quality assurance and management.
 

3.0 Authority

RWHAP, Title XXVI of the Public Health Service (PHS) Act, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87, October 30, 2009); Office of Management and Budget (OMB) Uniform Guidance: Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Guidance), 2 Code of Federal Regulations (CFR) Part 200; 45 CFR Part 75—Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards; General Provisions for Texas Department of State Health Services Grant Contracts; Texas Grant Management Standards (TxGMS); Uniform Grant Management Standards (UGMS).
 

4.0 Definitions

Administrative Agency (AA) – Community-based organizations, governmental entities, and other organizations located within Texas and specifically deemed eligible in the state’s request for proposals (RFP) responsible for ensuring a comprehensive continuum of care exists in their funded HIV Administrative Service Area. The AA accomplishes this through the management, distribution, and oversight of federal and state funds, and under contractual agreement with the Texas Department of State Health Services (DSHS). AAs disburse funds from DSHS through a subcontractor system to provide comprehensive services to people living with HIV (PLWH) and those affected within the service planning area.

HIV Administrative Service Area (HASA) – DSHS divides Texas into six HASAs, with each HASA containing one or more HIV Service Delivery Areas. An AA is responsible for providing administrative and planning services for the entire HASA they cover.

HIV Service Delivery Area (HSDA) – A geographic service area set by the Department of State Health Services for the purposes of allocating federal and state funds for HIV core medical and support services.

Planning Council – The Chief Elected Official for the Eligible Metropolitan Area (EMA) or Transitional Grant Area (TGA) appoints the Ryan White Part A Planning Councils. Planning Councils do needs assessments and set HIV-related service priorities for the EMA or TGA funds based on identified needs. 

Reallocation – Movement of funds from one service priority to a different service priority (e.g., food pantry to outpatient medical care).

Redistribution – Movement of funds from one contract to another within the same service priority (e.g., housing agency A to housing agency B).

Stakeholders – Stakeholders include PLWH, affected communities, organizations serving PLWH, allied service providers, public health agencies, and RWHAP Parts A, C, and D grantees located in the HSDA.
 

5.0 Administrative Agency Roles and Responsibilities

The functions listed below are required of the Administrative Agency.
 

5.1 General

• Prepare grant applications and proposals for funding in response to all DSHS HIV client service requests for proposals (RFP) or renewal applications.
• Develop and implement an unbiased process to select subcontractors to provide HIV-related client services in accordance with HIV/STD Policy 241.003 Subcontracting HIV Health and Support Services. Ensure various RFP distribution channels with the goal of reaching a diverse audience.
• Agencies functioning in a dual role as an AA and as a service provider agency have a formal, internal structure separating AA responsibilities from those of the service provider to eliminate conflict of interest. In addition, the AA ensures the provider agency does not have a competitive advantage in the selection or monitoring process.
• Make available to state and federal officials the time, staff, and information necessary to evaluate compliance with contractual attachments.
   

5.2 Contract management

• Ensure subcontractors have adequate organizational and fiscal accountability systems in place before initiating a contract.
• Develop and execute subcontracts with providers following HSDA-level priorities and allocations.
• Monitor and evaluate contracts, including the financial and programmatic performance of subcontractors, using an approved monitoring and evaluation tool approved by the state, and report those outcomes to the state.
• Provide technical assistance and training to providers on issues related to financial and programmatic performance, including training and assistance in the estimation of unit costs of services.
• Ensure funding follows locally established Service Standards (e.g., service category limits such as federal poverty level (FPL), emergency financial assistance caps) and reevaluate as needed.
   

5.3 Financial

• Provide sufficient bookkeeping and accounting functions through qualified staff or contracted services.
• Provide financial management using generally accepted accounting procedures.
• Centralize all financial reporting and record-keeping.
• Request, receive, and disburse funds to subcontractors in a timely and responsible manner.
• Review and process invoices and requests for reimbursement, purchase vouchers, financial status reports, and other financial information. Ensure expenditures conform to the approved budget attached to the state contract and to the contract between the AA and subcontractor.
• Prepare and submit invoices, financial information, and fiscal reports promptly, as required by the state.
• Adjust subcontractor budgets and redistribute funds when necessary to meet a service priority. The redistribution of funds within a single service priority does not require prior approval from the state. Reallocation of funds across service priorities requires state approval; see Policy 241.006 Reallocation of HIV Client Services Funds.
• Make reallocations as appropriate and as directed by the HSDA-based level priorities set by the planning process. This ensures efficient use of funds and meets the needs of clients within the area. The reallocation of funds, even within a single subcontract, requires prior approval of the state, and the AA makes reallocations to categories that serve critical needs. Once the state approves, the AA may distribute reallocated funds across HSDAs to meet critical needs.
• Ensure that the reallocation and redistribution of funds conform to state contract regulations.
   

5.4 Planning

• Consult with relevant stakeholders as required and directed in HIV/STD Policy 241.004, Administrative Agency Requirements for Community Input.
• Produce an integrated, comprehensive HIV service delivery plan to meet the needs of people with HIV in the HASA. The AA comprehensive plan must align with and support the goals of the State Integrated HIV Plan. The AA must update the plan annually.
• Evaluate the effectiveness of the integrated comprehensive plan in meeting the stated goals and objectives.
• Ensure coordination with Ryan White Part A Planning Councils in HSDAs that include a Part A EMA or TGA. The AA coordinates with the Planning Council and Part A Administrative Agent to ensure the use of Part B and State Services funds within the EMA or TGA is consonant with the priorities and needs discussed in the Part A plan for the EMA or TGA. Part A Planning Councils set recommended priorities and allocations for Part B and State Services funds for any HSDA containing an EMA or TGA.
• Allocate DSHS funds available to each HSDA to prioritized service categories. The state considers allocations as recommendations until it explicitly approves them.
• Routinely assess the need for reallocations to ensure the efficient and appropriate expenditure of funds in coordination with financial management, data and program management, the Planning Council, and clinical quality management (CQM).
• Make reallocations, as appropriate, to ensure efficient use of funds to meet the needs of clients within the area. Ensure planners and those involved with planning activities receive timely communications about the reallocations. The state considers allocations as recommendations until it explicitly approves them.  Once the state approves, the AA may distribute reallocated funds across HSDAs to meet critical needs.
• Complete a comprehensive assessment of the needs of PLWH every three years. The assessment collects information on the needs for core medical and support services and includes an inventory of available resources within each HSDA of the HASA to identify service needs, gaps, and barriers among focused populations. If the area contains an EMA or TGA, the AA is responsible for ensuring representation of the outlying counties within the HSDA in the needs assessment. The triennial needs assessment is not the only assessment conducted; AAs explore research questions, which arise between the assessment years through smaller assessments.
• Coordinate with other RWHAP activities and services, including participating in the Statewide Coordinated Statement of Need (SCSN) and ensuring coordinated use of RWHAP funds with other funding services and with other healthcare systems and services to ensure RWHAP status as the payor of last resort.
• Participate in statewide integrated HIV prevention and care planning bodies, activities, and processes.
• Participate in the development of the statewide Service Standards. Develop local standards which, at minimum, meet the statewide Service Standards.
   

5.5 Records and Reports

• Submit all programmatic information and reports required by the state within established timelines.
• Maintain records as specified in the uniform terms and conditions for DSHS Contracts. AAs keep records in good order and make them available for inspection by state and federal officials upon request.
• Provide, at minimum, quarterly reports to the state and to stakeholders on the status of the comprehensive HIV service plan, including current expenditure and client utilization data per contract service category, not subcontractor.
   

5.6 Evaluation and Quality Assurance

• Evaluate success in 1) implementing the HIV service delivery plan and 2) designing cost-effective mechanisms to deliver comprehensive care.
• Provide a formal process to solicit information on client satisfaction, apply the findings to improve the delivery of services, and make the findings available to stakeholders and the state.
• Meet the HRSA’s and the state’s contract requirements for CQM systems.
• Ensure client services comply with the DSHS HIV Medical and Support Service Categories Service Standards, the Federally Approved Clinical Practice Guidelines for HIV/AIDS care, and the assessment of the quality of support services. The actions of the CQM committee require and substantiate efforts toward continuous improvement of client health outcomes and the service delivery system.
   

5.7 Data

• Collect and report program data as required by HRSA and the state. 231.002 TakeChargeTexas (TCT) Administrative Agency Data Managers’ Core Competencies.
• Comply with and fulfill all requirements of the uniform reporting system (URS) and attend computer systems training supported by the state.
• Fulfill data management activities consistent with the performance standards developed by the state.
• Provide technical training on the URS at least semi-annually to subcontractors.
   

5.8 Policies and procedures

• Ensure that subcontractor contractual requirements, policies, procedures, or expenses do not create barriers for subcontractors to deliver services to clients or place an undue burden upon the administrative, fiscal, or programmatic structures.
• Establish a written policy or procedure on the process used to receive, review, respond to, and resolve client and provider complaints and subcontractor selection grievances.
   

6.0 Associated Policies

7.0 Revision History