EMERGENCY FINANCIAL ASSISTANCE

Transcription

1 I. DEFINITION OF SERICE EMERGENCY FINANCIAL ASSISTANCE Emergency Financial Assistance is the provision of short-term payments to agencies or establishment of voucher programs to assist with emergency expenses related to essential utilities, such as heat, electricity, water/sewer, and telephone service. These short-term payments must be carefully monitored to assure limited amounts, limited use, and for limited periods of time. Note: Direct cash payments to are not permitted II. HRSA DEFINITION Support for Emergency Financial Assistance (EFA) for essential services including utilities, housing, food (including groceries, food vouchers and food stamps), or medications, provided to with limited frequency and for limited periods of time, through either: Short-term payments to agencies Establishment of voucher programs. Note: Direct cash payments to are not permitted III. DESCRIPTION OF SERVICE SERVICE Support for Emergency Financial Assistance (EFA) for essential services including utilities, housing, food (including groceries, food vouchers, and food stamps), or medications, provided to with limited frequency and for limited periods of time through either: Short-term payments to agencies Establishment of voucher programs NOTE: Direct cash payments to are not permitted PERFORMANCE MEASURE/METHOD Documentation of services and payments to verify that: 1. EFA to individual is provided with limited frequency and for limited periods of time, with frequency and duration of assistance specified by the grantee 2. Assistance is provided only for the following essential services: utilities, housing, food (including groceries, food vouchers, and Food Stamps), or medications 3. Payments are made either through a voucher program or short-term payments to the service entity, with no direct payments to 4. Emergency funds are allocated, tracked, and reported by type of assistance 5. Ryan White is the payer of last resort MONITORING STANDARD I. Maintain client records that document for each client: 1. Client eligibility and need for EFA 2. Types of EFA provided 3. Date(s) EFA was provided 4. Method of providing EFA II. Maintain and make available to the grantee program documentation of assistance provided including: 1. Number of and amount expended for each type of EFA 2. Summary of number of EFA services received by client 3. Methods used to provide EFA (e.g., payments to agencies, vouchers) III. Provide assurance to the grantee that all EFA: 1. Was for allowable types of assistance 2. Was used only in cases where Ryan White was the payer of last resort 3. Met grantee-specified limitations on amount and frequency of assistance to an individual client 4. Was provided through allowable payment methods LIMITATIONS Direct cash payments to are not permitted 1

2 IV. NATIONAL FISCAL MONITORING STANDARDS (HRSA issued April 2013): SERVICE PERFORMANCE MEASURE/METHOD MONITORING STANDARDS LIMITATIONS SECTION D: Imposition & Assessment of Client Charges 1. Ensure grantee and subgrantee policies and procedures require a publicly posted schedule of charges (e.g. sliding fee scale) to for services, which may include a documented decision to impose only a nominal charge 2. No charges imposed on with incomes below 100% of the Federal Poverty Level (FPL) 3. Charges to with incomes greater than 100% of poverty are determined by the schedule of charges. Annual limitations on amounts of charge (i.e. cap on charges) for RW services are based on the percent of client s annual income, as follows: 5% for with incomes between 100% and 200% of FPL 7% for with incomes between 200% and 300% of FPL 10% for with incomes greater than 300% of FPL Review of subgrantee policies and procedures, to determine: Existence of a provider policy for a schedule of charges. A publicly posted schedule of charges based on current Federal Poverty Level (FPL) including cap on charges Client eligibility for imposition of charges based on the schedule Track client charges mad and payments received How accounting systems are used for tracking charges, payments, and adjustments Review of provider policy for schedule of charges to ensure with incomes below 100% of the FPL are not charged for services Review of policy for schedule of charges and cap on charges Review of accounting system for tracking patient charges and payments Review of charges and payments to ensure that charges are discontinued once the client has reached his/her annual cap. Establish, document and have available for review: Policy for a schedule of charges Current schedule of charges Client eligibility determination in client records Fees charged by the provider and the payments made to that provider by Process for obtaining, and documenting client charges and payments through an accounting system, manual or electronic Document that: Policy for schedule of charges does not allow below 100% of FPL to be charged for services Personnel are aware of and consistently following the policy for schedule of charges. Policy for schedule of charges must be publicly posted. Establish and maintain a schedule of charges and policy that includes a cap on charges and the following: Responsibility for client eligibility determination to establish individual fees and caps Tracking of Part A charges or medical expenses inclusive of enrollment fees, deductibles, co-payments, etc. A process for alerting the billing system that the client has reached the cap and should not be further charged for the remainder of the year Personnel are aware and consistently following the policy for schedule of charges and cap on charges. 2

3 V. EFA SERVICE COMPONENTS Program Outcomes: Clients stabilized at three- and six-month intervals that do NOT have future EFA requests 75 % of will show improved and or stabilized living situation as result of accessing EFA at six months and twelve months Indicator: Number of stabilized (determined by decreased need for EFA, stable housing, reduced number of requests) Service Unit(s): Successful processing of payment Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark I. Structure Provider adheres to the Planning Council written guidelines that list the criteria, including allowable extenuating circumstances to determine if a client is eligible for Agency provides orientation for staff members and follows written guidelines, without exception. Agency has documented criteria to determine eligibility for s document adherence to guidelines Number of agencies with guidelines charts that adhered to guidelines Number of contracted agencies for EFA Agency files Policy & Procedure Manual 100% of agencies have documented criteria to determine eligibility for document adherence to guidelines Services are made available to all individuals who meet EFA program eligibility requirements. II. Process Provider will establish collaborative relationships with other Emergency Financial Assistance providers. Eligibility criteria include 30 days or more past due bill notice, inability to pay bill (lack of employment, no other source of funds, or no other funding program) Letter of collaboration in place between providers/case management agencies. Number of charts with documented eligibility Number of providers with documented meetings/ correspondence with alternate funding stream providers Number of total client files for EFA Number of contracted agencies for EFA Document on file 100% charts document eligibility criteria All providers have letter of collaboration in place between providers/case management agencies. 3

4 Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark Service provider assists client in seeking at least 3 alternate funding sources. Planning sessions occur with regarding alternate funding source investigation (min. 3) Number of charts with alternate funding sessions (min. 3 alternate sources) 90% of charts document planning sessions with client regarding alternate funding source Provider stays within the emergency financial Assistance cap per directives or will inform case managers when the cap will be exceeded. III. Outcome Provider agency pays routine requests for payment within 7 days. Provider agency pays emergency requests for payment within 48 hours. Agencies stay within the emergency financial assistance cap or inform the case managers when it will be exceeded. Clients receive payment within 7 days Client receive emergency payment within 48 hours within cap or informed when exceeded receive payment w/in 7 days receive emergency payment within 48 hours CAREWare investigation (min. 3) All Agencies stay within the emergency financial assist-ance cap or informs the CM when it will be exceeded. show payment within 7 days. document emergency payment within 48 hours VI. DATA REPORTING Part A service providers are responsible for documenting and keeping accurate records of Ryan White Program Data/Client information, units of service, and client health outcomes. Reporting units of service are a component of each agency s approved workplan. Please refer to the most current workplan, including any amendments, for guidance regarding units of service. Summaries of service statistics by priority will be made available to the Planning Council by the Grantee for priority setting, resource allocation and evaluation purposes. The Chart Audit Tool for Emergency Financial Assistance (EFA) is attached on the next page 4

5 Standard of Care Emergency Fina Emergency Financial Assistance Tool STRUCTURE ( WHO ) 1 Staff Verification Documentation of supervision Staff & Chart Monitoring HIV Education Staff meet minimum requirements annual HIV education Recordkeeping Requirements Chart is properly stored & secure; chart is clearly organized; entries legible Staff has Knowledge of Eligibility Guidelines Staff follows written eligibility guidelines for client eligibility for EFA Services are Available Services are available to those who meet guidelines; type of EFA is documented with date and method of providing EFA Sliding Fee Scale Provider maintains current sliding fee scale in accordance with HRSA mandate PROCESS ( How ) 7 Client Demographics/Eligibility Age, ethnicity, gender, risk/exposure documented; client eligibility documented at least 2x per year (every 6 months minimally) Documentation & Process for EFA Distribution Collaboration with Other EFA providers letter of collaboration between providers and CM agencies Alternate Funding Sources Provider assists in seeking at least 3 alternate funding sources; documentation of RW funds used as payer of last resort EFA Cap Provider stays within EFA cap or informs CM when the cap will be exceeded; summary is documented of EFA services received by client and methods used to provide EFA OUTCOME ("What Impact") Outcome Payments Routine requests for payment are made within 7 days Emergency Requests Emergency requests for payment are made within 48 hours