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Referral for Health Care and Support Services

Service Standard

Referral for Health Care and Support Services Service Standard print version

Texas Department of State Health Services, HIV Care Services Group – HIV/STD Program

Subcategories Service Units
Application     Per application
Referral for Healthcare/Supportive Services Per referral

Health Resources and Services Administration (HRSA) Description

Referral for Health Care and Support Services (RHCS) directs a client to needed core medical or support services in person or through telephone, written, or other type of communication. Activities provided under this service category may include referrals to assist HRSA Ryan White HIV/AIDS Program (RWHAP) eligible clients to obtain access to public or private programs for which they may be eligible.

Program Guidance

Agencies should report referrals for health care and support services provided by Outpatient/Ambulatory Health Services professionals under the Outpatient/Ambulatory Health Services (OAHS) category.

Agencies should report referrals for health care and support services provided during a Medical Case Management (MCM) or Non-Medical Case Management (NMCM) visit in the appropriate case management service category (i.e., MCM or NMCM). Agencies can report referral services an MCM or NMCM–enrolled client receives under RHCS only if someone other than the client’s case manager provided services outside a case management visit. Agencies should take steps to ensure they do not report services in duplicate across different service categories.

Recipients can use RWHAP Part B and State Services (RW and SS) funds to provide transitional social services to establish or reestablish linkages to the community. Referral services that link a soon-to-be-released incarcerated person with primary care are an example of appropriate transitional social services. Transitional social services may not exceed 180 days, per DSHS Policy 591.000 The Use of Ryan White Part B Funds for Incarcerated People Living with HIV (PLWH), Recently Released, or Otherwise Judicially Involved in Texas, Section 5.3.

Limitations

Recipients cannot use RHCS funds to duplicate services provided through other service categories. 

Services

Referrals for Core Medical and Support Services provide clients with assistance in accessing medical and support services to improve engagement in the health care system and the HIV continuum of care. Referral for Health Care and Support Services includes application assistance, benefits and entitlement counseling, and referral to medical and support services. 

RHCS providers may assist RWHAP-eligible clients with obtaining needed HIV Care Services medical or support services, and services available through the Texas HIV Medication Program (THMP) including:

  • AIDS Drug Assistance Program (ADAP)
  • State Pharmaceutical Assistance Program (SPAP)
  • Texas Insurance Assistance Program (TIAP)

Benefits counseling services facilitate a client’s access to public or private health and disability benefits and programs. This service category works to maximize public funding by assisting clients in identifying available health and disability benefits supported by funding streams other than RW and SS funds. Agencies educate clients about and assist with accessing and securing available public and private benefits and entitlement programs.

Referrals may include benefits counseling and application assistance programs for Marketplace plans, health insurance, Medicaid, Medicare, and medication payment plans or programs. These services focus on assisting a client’s entry into and movement through the care service delivery network such that RW and SS funds are the payer of last resort.

Universal Standards

Service providers for Referral for Healthcare and Support Services follow HRSA and DSHS Universal Standards 1-52 and 184-186.

Service Standards and Measures

The following standards and measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard Measure

Application Assistance and Benefits Counseling: Staff will educate clients about available benefit programs, assess eligibility, assist with applications, provide advocacy with appeals and denials, assist with re-certifications, and provide advocacy in other areas relevant to maintaining these benefits and resources.

Staff will assist clients with the following, as appropriate: 
  1. Percentage of clients with documented education provided on applicable public or private benefit programs.
     
  2. Percentage of clients with applicable public or private benefit applications completed within 14 business days of the eligibility determination date.
     
  3. Percentage of clients with documentation of follow-up and results within 90 days of a completed benefit application.

Referrals for Core Medical and Support Services: Staff will assist clients with accessing health care and support services to support their engagement in the health care system and the HIV continuum of care through the referral process.

Staff may assist clients with referrals to the following, as applicable:

Staff must complete follow-ups for clients. 

If staff give a client a referral to self-complete, RHCS staff will follow up with the client within 15 business days to determine the outcome and further assistance needed.

If staff assisted the client with scheduling an appointment for a referral at the time of service, RHCS staff will follow up with the client within 10 business days of the scheduled appointment to determine the outcome and further assistance needed.
  1. Percentage of clients who received a referral to core or support service who have documentation that they received education on how to access these services.
     
  2. Percentage of clients who received a referral to core or support services that had documentation of a follow-up within 15 business days of a referral given to the client to self-complete OR 10 business days from the scheduled appointment if an appointment was set at time of referral.

References:

Division of Metropolitan HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part A Recipients. Health Resources and Services Administration, June 2023.

Division of State HIV/AIDS Programs, HIV/AIDS Bureau (HAB). Ryan White HIV/AIDS Program (RWHAP) National Monitoring Standards for RWHAP Part B Recipients. Health Resources and Services Administration, June 2023.

Ryan White HIV/AIDS Program. Policy Notice 16-02: Eligible Individuals & Allowable Uses of Funds. Health Resources and Services Administration, October 22, 2018.

Texas Department of State Health Services. HIV/STD Policy 591.000 The Use of Ryan White Part B Funds for Incarcerated People Living with HIV (PLWH), Recently Released, or Otherwise Judicially Involved in Texas. May 28, 2024.

HIV/STD Program

HIV/STD Program

HIV Medical and Support Service Categories