The Agency is responsible to provide and invoice for each contracted service based on the specific service definitions.

Ryan White Part A Service Definitions

For each funded service, a definition has been developed based on guidelines provided by HRSA, the intent of the local Planning Council and standards of practice determined by the grantee. Unless other agreements are made, proposals should reflect, and service contracts will be written, to reimburse providers for the services as they are defined herein.

Please note: The Ryan White Part A Program is the “payer of last resort.” This means providers must make reasonable efforts to identify and secure other funding sources outside of Ryan White legislation funds, whenever possible. Part A funds are intended to be “the payer of last resort” for the provision of care. Providers are responsible for verifying an individual’s eligibility by

investigating and eliminating all other potential billing sources for each service, including public insurance programs, or private insurance. Part A funds may not be used to supplant partial reimbursements from other sources to make up any un-reimbursed portion of the cost of such services.

The Agency is responsible to provide and invoice for each contracted service based on the specific service definitions.

Service Unit:

Unless otherwise noted, a unit of service is defined as direct client contact or service in a defined unit of time that may be billed in fractions thereof. In the case of medications, specific medical/dental procedures and/or lab tests, the unit cost is the cost for that item or service.

CORE SERVICES:

AIDS Pharmaceutical Assistance

Definition: Local pharmacy assistance program for the provision of prescription drugs to prolong life or prevent the deterioration of health directly related to an individual’s HIV condition. Medication Assistance provided based on guidelines set by the Ryan White Part A Program. Individuals MUST be documented as ineligible for permanent and temporary sources of coverage (e.g., ADAP, Medicaid, Medicare, patient assistance programs, or private payer). Medications provided must be listed on the ADAP formulary.

Providers proposing pharmacy services under the RW Act are required to participate in Public Health Service 340 B pricing and/or accept this pricing as reimbursement in full from Part A. A letter stating provider participation in the PHS340B program is required to be submitted with the proposal.

Service Unit: A unit of service is the prescription written per medication per client. Medication should be billed at 340 B pricing plus any dispensing fees charged by the pharmacy.

Early Intervention Services

Definition: Counseling individuals with respect to HIV/AIDS; testing (including tests to confirm the presence of the disease, tests to diagnose to extent of immune deficiency, tests to provide

information on appropriate therapeutic measures); referrals; other clinical and diagnostic services regarding HIV/AIDS; periodic medical evaluations for individuals with HIV/AIDS; and

providing therapeutic measures.

*The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health treatment programs,

detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV disease counseling and testing sites, health care points of entry specified by eligible areas, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to services by maintaining referral relationships.

Must include the following components:

 Testing – not funded through Ryan White Part A – should detail coordination through other funding sources or agencies

 Referral Services

 Linkage agreements to work with key points of entry  Relationship and trust building

 Assessment of immediate need/attitude/knowledge/behaviors/beliefs regarding care

 Health Literacy/Health Education (counseling)  Include strategies for peer involvement

 Access to Linkage and Care

Services should be targeted to the following populations:  Newly diagnosed

 Receiving other HIV/AIDS services but not in primary care  Formerly in care – dropped out

 Never in care

 Unaware of HIV status

Early Intervention Services (EIS) will lead the efforts of EIIHA. EIS must address coordination with prevention services, counseling and testing centers, as well as RW Part A providers.

Service Unit: A unit of service is defined as a client that received a referral service, health literacy/health education service, access to care, or received medical care. Information should be collected and submitted regarding the total number of clients that received each service as well as whether or not they connected or re-connected to medical care.

Services for this category are reimbursed based on a FTE model covering the salary, fringes, supplies and administrative costs for the position. Any time not spent directly on Ryan White services is not reimbursable. Therefore, no more than 95% of salary can be reimbursed. It should be invoiced at 1/12 the budget each month and have supporting documentation for all costs.

Health Insurance Premium Payments – SERVICE NOT OFFERED IN 2012

Definition: Provision of financial assistance for eligible individuals living with HIV/AIDS to maintain a continuity of health insurance or to receive medical benefits under a health insurance program. This includes premium payments, risk pools, co-payments, and deductibles.

Funds may be used as the payer-of-last-resort to cover the cost of public or private health insurance premiums, as well as the insurance deductible and co-payments. The exception is that Ryan White HIV/AIDS Program funds may NOT be used to cover a client’s Medicare Part D “true out-of-pocket” (i.e., TrOOP or donut hole) costs.

Must have process for payment of insurance premiums, deductibles, and co-payments as well as prescription co-payments that includes the following:

 Documenting cost/benefit analysis of insurance plan

 Verifying health insurance coverage includes medical treatment and

medication for HIV/AIDS that is reasonably comparable to coverage and costs funded by the Ryan White Part A services

 Verifying payer-of-last resort

 Determining client eligibility and verifying ineligibility of other funded programs

 Accounting system to ensure timely payments of premiums to avoid policy cancellations

 Process to update eligibility every six months

 Process to determine when established limits of funds and time have been met for each client

 Process to ensure policy and payments are paid on behalf of client only Service Unit: One unit equals a single payment for health insurance premiums, co-pays, or deductibles. *Maximum amounts and lengths of time for all payments to be established by the Ryan White Part A program.

Services for this category are cost reimbursed based on actual payments plus salary, fringes, supplies and administrative costs for the position responsible for the service. Any time not spent directly on Ryan White services is not reimbursable. Therefore, no more than 95% of salary can be reimbursed.

Home and Community - Based Health Services

Definition: Therapeutic, nursing, supportive and/or compensatory health services provided by a licensed/certified home health agency in a home/residential setting in accordance with a written, individualized plan of care established by a case management team that includes appropriate health care professionals. The case management team must document the appropriateness of in-home care and determine the client to be ineligible for or on the waiting list for the State of Ohio home health waiver program.

Services include durable medical equipment; home health aide services and personal care services in the home; day treatment or other partial hospitalization services; home intravenous and aerosolized drug therapy (including prescription drugs administered as part of such therapy);

routine diagnostics testing administered in the home; and appropriate mental health,

developmental, and rehabilitation services. Inpatient hospital services, nursing home and other long term care facilities are NOT included.

Service Unit: A unit of service shall be the cost of 1 hour of professional or paraprofessional service. A fee schedule listing the type of durable medical equipment and other equipment proposed and the corresponding fee must be included with the proposal.

Home Health Care

Definition: The provision of services in the home by licensed health care workers such as nurses including post hospital release care or other skilled nursing, physical therapy, speech therapy and the administration of intravenous and aerosolized treatment, parenteral feeding, diagnostic testing, and other medical therapies provided by a licensed/certified home health agency in a home/residential setting. Services require a medical referral stating the need for home health services and the expected length of care.

Service Unit: A unit of service shall be the cost of 1 hour of professional service. Hospice Care

Definition: Room, board, nursing care, counseling, physician service and palliative therapeutics provided by agencies licensed within the State. Services may be provided in a home or

residential setting, including a non-acute care section of a hospital that has been designated and staffed to provide hospice care to terminal patients. A physician must certify that a patient is terminal, defined under Medicaid hospice regulations as having a life expectancy of six (6) months or less. Supplemental payment for services to Medicaid eligible clients is not permitted. Service Unit: A unit of Hospice Care is defined as one day of care. Providers shall submit the cost of one day of care for both in-home and/or residential facility based services as well as a comprehensive narrative of what specific services are included and excluded in such care. Medical Case Management

Definition: Provision that link clients with health care, psychosocial, and other services. The coordination and follow-up of medical treatments is a key component of medical case management. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the client’s and other key family members’ needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication. Medical case management services are more complex than community case management services and require ongoing, coordinated case management processes. Individuals providing medical case management are expected to have specialized training in medical case

management models, and to have appropriate educational and professional qualifications

required to conduct this advanced case management service. Medical case management services follows the professional guidelines and standards of the National Association of Social Workers (NASW).

All Case Management must include:

 Intake interview, eligibility determination (every six months) and whether case management is appropriate,

 Semi-annual comprehensive assessment of psychosocial/medical/practical support needs,

 Signed semi-annual Individual Service Plan, outlining goals, objectives and activities,  Implementation of plan through referral, linkages and follow-up,

 Case notes documenting all interventions towards plan goals and all billed services,  Transportation assistance based on eligibility and need of client,

 Monitoring and reassessment of the plan including transfer and/or terminating service.

Medical Case Management includes all provisions listed above and requires a patient whose acuity level requires the case manager also manage their medical care, schedule and monitor medical appointments, lab work, medication treatment adherence, other indicated services including dietician, mental health and substance abuse screenings/ treatment and other supports. If the Part A Case Manager is not the Primary Case Manager, the case manager must coordinate all activities with the Primary Case Manager.

Service Unit: One hour of direct client or client-specific advocacy service, either face-to-face or over the telephone. Proposals should identify the amount of staff time allocated to direct service, number of clients in staff caseloads and units of service estimated per client. The clients’ case records must document the substantive treatment purpose of each call.

Services for this category are reimbursed based on a FTE model for client direct and client-specific advocacy assistance. Proposals should identify the amount of staff time allocated to this service, number of clients in staff caseloads. The clients’ case record must document all direct service as well as any service provided on behalf of the clients. Medical case management covers the salary, fringes, and administrative costs for the position. Any time not spent directly on Ryan White services is not reimbursable. Therefore, no more than 95% of salary can be reimbursed. It should be invoiced at 1/12 the budget each month and have supporting documentation for all costs.

Medical Nutrition Therapy

Definition: The provision of nutritional counseling services provided by a licensed registered dietician outside of a primary care visit and includes the provision of nutritional supplements. Service Unit: A unit of Nutritional/Dietary Counseling shall be the cost of one in-person

visit/appointment between the patient and the licensed nutritionist. In an effort to allow as many consumers as possible receive dietician services, reimbursement will be limited to four

appointments per year per patient unless documentation from an M.D. justifies the need for additional counseling.

Mental Health Services (Professional Mental Health Counseling)

Definition: Provision of psychological and psychiatric treatment and counseling services offered to individuals with a diagnosed mental illness, conducted in a group or individual setting, and provided by a mental health professional licensed or authorized within the State to render such services. This includes individual or group counseling services provided by a mental health professional, licensed by and practicing under the guidelines and standards established by the Ohio Counselor and Social Work Board and/or the Ohio Department of Mental Health at an agency certified by the Ohio Department of Mental Health or Medicaid. Services funded under this category require a mental health diagnosis. Group Counseling Services may be offered if the persons in the group meet the Ryan White eligibility criteria and participation in such a group meets the therapy protocols for the individual clients’ diagnosis. Provider agencies may only bill for services for which there is no other third party reimbursement in whole or in part.

Service Unit: One hour of group or individual counseling session Oral Health Services

Definition: The provision of diagnostic, preventative and therapeutic services provided by general dental practitioners, dental specialists, dental hygienists and auxiliaries, and other trained primary care providers.

Service Unit: A unit of dental service is the specific dental service, procedure or appliance

provided for the patient. Dental services should be billed at the per service cost normally charged by the provider for that specific dental service.

A fee schedule listing the type of dental services and appliances offered/proposed and the current corresponding fee must be included with the proposal. Providers may choose to submit current Medicaid rates as the fee schedule for reimbursement of dental services.

Outpatient/Ambulatory Medical Care

A. Primary Care, Medical Sub-Specialty Care and RN Care Coordination:

Definition: Provision of professional diagnosis and therapeutic services rendered by a physician, physician’s assistant, clinical nurse specialist or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not considered outpatient settings. Services include diagnostic testing (see separate definition), early intervention and risk assessment, preventative care and screening, practitioner

examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, care of minor injuries, education and counseling on health issues, well-baby care, continuing care and

management of chronic conditions, and referral to and provision of sub-specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the Public Health Service’s

guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies. Proposals should demonstrate interaction with mental health providers, dental providers, substance abuse treatment providers, dieticians and home health providers to ensure coordination of care. A referral of medical necessity is required for clients to receive Ryan White funded nutritional counseling, home delivered meals, transitional housing assistance, home health care and hospice services. Such referrals should indicate the reasons why such care is necessary and the anticipated length of time service is expected. Referrals must be renewed at various intervals depending on the service.

Service Unit: A unit of service is defined as an hour of time the client is seen by the doctor or if the provider chooses to use Medicaid rates, a patient visit. RN hourly unit costs may be billed in five-minute increments for in-person client office visits or medically necessary phone consultation between the nurse and the client if such consultation is both more cost effective for the provider and more convenient for the client. Nurse Care Coordination phone contact is limited to a maximum of 15 minutes per client per day and must be with the client directly and not collateral on the clients’ behalf. Calls to patients for appointment reminders or prescription pick-ups are not reimbursable. Client records must reflect the specific treatment given on the phone.

B. Diagnostic Laboratory Testing:

Definition: This includes all indicated medical diagnostic testing including all tests considered integral to treatment of HIV and related complications (e.g. Viral Load, CD4 counts and genotype assays). Funded tests must meet the following conditions:

 Tests must be consistent with medical and laboratory standards as established by scientific evidence and supported by professionals, panels, associations or organizations; and

 Tests must be (1) approved by the FDA, when required under the FDA medical Devices Act and/or (2) performed in an approved Clinical Laboratory

Improvement Amendments of 1988 (CLIA) certified laboratory or State exempt laboratory; and

 Tests must be (1) ordered by a registered, certified or licensed medical provider and (2) necessary and appropriate based on established clinical practice standards and professional clinical judgment.

Service Unit: A unit of service is defined as the cost per individual test that the testing facility/lab charges for such tests. It is expected that costs will vary for different tests. Testing providers will not be reimbursed separately for staffing, record keeping, reporting, supplies, overhead, administration or invoicing of testing services. A fee schedule listing the type of test(s) proposed and the corresponding fee must be included with the proposal.

Note: For both physician visits and lab tests, the provider may choose to submit the current Medicaid rates for these services as a fee schedule in lieu of calculating unit cost reimbursement rates.

Substance Abuse Treatment Services – Outpatient (Core Service) and Residential (Support Service)

Definition: Provision of professional level outpatient counseling and treatment services to address substance abuse problems, to non-Medicaid Ryan White eligible persons living with HIV/AIDS, or related services not covered by Medicaid to Ryan White eligible persons living with HIV/AIDS. Providers must be licensed by the State of Ohio and maintain current

certification from the Ohio Department of Alcohol and Drug Addiction Services. Staff providing the services shall hold the appropriate licensure and credentials as determined by the State Board. Provider agencies may only bill for services for which there is no other third party reimbursement in whole or in part.

A. Outpatient (core service)- provision of medical or other treatment and/or counseling to address substance abuse problems (i.e., alcohol and/or legal and illegal drugs) in an outpatient setting, rendered by a physician or under the supervision of a physician, or by other qualified personnel.

B. Residential (support service) - comprehensive treatment in a facility based treatment center. The following limitations apply to use of Ryan White HIV/AIDS Program funds for residential services:

Because of the Ryan White HIV/AIDS Program limitation on inpatient hospital care, funds may not be used for inpatient detoxification in a hospital setting. However, if detoxification is offered in a separate licensed residential setting (including a separately-licensed detoxification facility within the walls of a hospital), Ryan White HIV/AIDS Program funds may be used for this activity. If the residential treatment service is in a facility that primarily provides inpatient medical or psychiatric care, the component providing the drug and/or alcohol treatment must be separately licensed for that purpose.

Service Unit: One hour of outpatient or one day of residential service. Proposals must provide narrative and budget separately for outpatient and residential.

SUPPORT SERVICES

Definition: The temporary provision of prepared home delivered meals (or home delivered groceries in communities where no prepared meal delivery service is available) for persons living with HIV/AIDS eligible for such services funded by Ryan White Part A due to:

 Medical emergency or condition rendering patient home-bound unable to shop for food, or

All home delivered meals require a written medical referral documenting the delivery as a medical necessity including the diagnosis (the reason why the patient is unable to shop, prepare or eat on his/her own or) and the length of time the physician expects the patient will require this special diet or meal service. A physician referral is valid for a maximum of 90 days. After the original 90 days a new referral stating the reason for the special diet and length of time expected is required A client signature for every meal delivery is required to be in the clients’ file. Clients are required to also see a licensed dietician to assist in the maintenance of a healthy diet. All foods provided must be consistent with nutritional needs of persons living with AIDS and/or special needs, re: low cholesterol diet, diabetic meals, etc. Providers are not permitted to give clients cash or vouchers to purchase meals or groceries. In the case of groceries, the list of food items generally purchased is required to be on file with Part A and receipts reflecting the general shopping menu should be on file for audit purposes. For home delivered meals, the delivery driver must obtain a client signature for each delivery and these signed receipts must be maintained in the client’s case file for review during the program fiscal audit.

Service Unit: A unit of meal service shall be the cost of one home delivered meal, or where no prepared home delivered meal program is available, the cost of one week’s groceries required to prepare meals. No reimbursement will be made for shopping, preparation, delivering or

administering meal services. These costs should be figured into the unit cost of the meals/groceries being delivered.

Housing Services (Transitional Housing Assistance)

Definition: The planning council has determined local housing assistance dollars are to be used for temporary rental subsidies as allowable under the federal Part A guidelines. Temporary rental subsidies are available for under-housed persons living with HIV/AIDS for the purpose of maintaining access to medical care. The program is transitional in nature to assist persons in maintaining current housing while actively looking to move an individual and/or family into a less expensive permanent stable living environment (that would no longer require Part A

assistance dollars.) Temporary Rental Assistance is limited to two years (24 months) maximum, with no exceptions. Previous exceptions for ex-felons and consumers in substance abuse

treatment are no longer permitted under federal guidelines.

Providers shall conduct an on-site visit to an individual’s apartment by a case manager to conduct an initial assessment of clients’ housing situation and housing needs. Providers are required to investigate all other alternatives to reduce risk for homelessness before granting rental subsidies. Eligibility for housing assistance must be re-evaluated every six months and the plan for transition must be updated at least every six months.

A housing record must be maintained for each client, including a copy of the client’s lease, documenting the date of the visit, location, findings, and recommendations of the review as well as a plan and regular activities to secure permanent housing free of the Ryan White subsidy. Eligibility for rental subsidies:

 Clients must be homeless or documented to be at risk for homelessness,  Household income must be insufficient to meet the client’s needs,

 Household income cannot exceed 200% of federal poverty guidelines,

 Persons participating in other low income subsidized housing programs such as Housing Choice Voucher, Famicos, CMHA, Shelter Plus Care are ineligible for services,

 Eligibility for services is limited to persons who are disabled due to HIV disease as documented by a letter from Social Security or an assessment by a physician, and  Documentation must include a physician statement confirming housing is necessary

to maintain medical treatment. To remain in the program, there must be documentation of continued access to medical care as defined by HRSA including annual physician visits, viral load, CD-4 and anti-retroviral therapies when indicated. Service Unit: A unit cost should be developed for the administration of housing assistance including client needs assessments, eligibility determination, actual home visit, plans for transition, and processing rental subsidies. These costs should be reflected in the cost of the client site visit.

Medical Transportation Services

Definition: Provision to provide transportation for eligible clients to access HIV-related health services, including services needed to maintain client in HIV/AIDS medical care. The service covers Ryan White Part A prioritized and funded core medical and support services. Ryan White Part B and C clients can access transportation assistance. Ryan White is the payer of last resort and used when clients are in need of funding assistance for transportation and are not eligible for this service through any other funding source. Medical Transportation is approved and

distributed by the client’s primary case manager.

Includes travel between the funded providers for services as well as transportation assistance to government agencies or medical facilities required by any of the services eligibility requirements (i.e., local job and family service agency for Medicaid assistance).

All Clients requesting transportation assistance for the approved core medical and support must not be eligible for this service through any other funding source.

Eligibility guidelines:

 Current Ohio residency;  Documentation of HIV status;

 Family income is at or below 300% of Federal poverty guidelines;

 Documentation of CD4 and viral load tests performed in the last twelve months A. Transportation Provider

An agency proposing to be a transportation provider must provide round trip ride service to and from the core medical or support service appointments in an agency-owned or staff authorized vehicle at a set Service Unit for 1) one-way, 2) round-trip, or 3) one mile driven. Agencies submitting proposals to become a transportation provider must provide services to any eligible client to any Ryan White funded care appointment even if that client is not receiving other services at that agency or if the Ryan White care appointment

is at another Ryan White funded agency. Proof of insurance is required to contract with the County for transportation services.

Any provider offering transportation must verify that the client is too ill to transport themselves or take public transportation. Receipts signed by the transportation provider and client noting date, time, pick up and drop off address are required to be kept in the client’s file/agency transportation file for review during a program audit, for any reimbursement to be made. Transportation providers must provide receipt of travel to other Ryan White providers that are Primary case managers for those clients receiving the transportation service.

Service Unit: A set Unit Cost for 1) round-trip service, 2) one-way service, or 3) one mile driven with an eligible client as passenger. The cost of a service unit can include: personnel, fringe, gasoline, vehicle maintenance, supplies, equipment, and contractual categories.

B. Client/Agency Transportation Reimbursement

Providers within Cuyahoga County contracted for Medical Case Management services will be issued bus passes and gas cards based on estimation of client need through the Ryan White Part A program office. All clients are required to apply for RTA Fixed Route Disability Fare Program to be eligible for disability fares. Clients are issued gas cards if the bus routes are not within one mile of residence or destination or medical documentation shows client is too ill to take public transportation.

Providers outside of Cuyahoga that propose Medical Case Management services may be reimbursed by the grantee for providing transportation assistance to any Ryan White eligible client to and from their facility for a Ryan White service appointment, in the form of gas card, bus pass or cab voucher. Agencies requesting transportation funds for

reimbursement to clients must not be eligible for or receive any special client

transportation vouchers through any other funding source. The agency may pay for the cost of client transportation and invoice the grantee for this service without a separate proposal to become a transportation provider as long as receipts for all reimbursed client travel are kept in the client file and travel corresponds with an appointment at that agency.

Outreach

Definition: Programs that have as their principal purpose identification of people with unknown HIV disease or those who know their status so that they may become aware of, and may be enrolled in care and treatment services (i.e., case finding), not HIV counseling and testing nor HIV prevention education. These services may target high-risk communities or individuals. Outreach programs must be planned and delivered in coordination with local HIV prevention outreach programs to avoid duplication of effort; be targeted to populations known through local epidemiologic data to be a disproportionate risk for HIV infection; be conducted at times and in places where there is high probability that individuals with HIV infection will be reached; and be designed with quantified program reporting that will accommodate local effectiveness

Activities include those that connect clients to medical care, assist clients in coordinated and continuous care, and retain clients in medical care. Include strategies for peer involvement. Services should be targeted for:

Newly Diagnosed

 Tested positive in the past six/twelve months, is aware of his or her status but is not connected to the local continuum of medical care and support services.

 Out of care (HRSA)

 No primary care appointments for over 12 months  No CD4 or viral load test for over 12 months  No antiretroviral therapy for over 12 months At risk of Out of Care/Erratically In Care:

 Erratic (3 or more) appointment non-compliance  Medication adherence issues

Service Unit: A unit of service is defined as a client that received medical care. Information should be collected and submitted regarding the total number of clients that received outreach services whether or not they connected or re-connected to medical care.

Services for this category are reimbursed based on a FTE model covering the salary, fringes, supplies and administrative costs for the position. Any time not spent directly on Ryan White services is not reimbursable. Therefore, no more than 95% of salary can be reimbursed. It should be invoiced at 1/12 the budget each month and have supporting documentation for all costs.

Psychosocial Support Services

Definition: Provision of support and counseling activities, child abuse and neglect counseling, HIV support groups, pastoral care, caregiver support, and bereavement counseling. Includes nutrition counseling provided by a non-registered dietitian but excludes the provision of nutritional supplements.

Allowable activities under this service category include activities to reduce isolation, bereavement counseling, caregiver support, and pastoral care. Services can include affected children and children living with HIV/AIDS and can be delivered in a format conducive to children.

Group facilitators must be licensed nurses, social workers or counselors. Client participation in these support groups does not require a mental health diagnosis and treatment plan. However, the curriculum of the sessions, attendance records and a case file on each client participating in support groups is required by the grantee. Providers submitting proposals for support groups must submit group curriculum and the anticipated number of groups offered, number of

participants in each group and anticipated length of participation by individual clients in groups as part of the proposal narrative. A unit cost for individuals served in the group must be

Service Unit: 1 unit of support group services is defined as one hour for each client participating in a support group session. Groups must be at least one-hour in length, but no longer than two hours in length and individual client reimbursement will be limited to one session per week. *Note: Reimbursement for Support Group sessions will only be made for a minimum of three (3) consumers and up to a maximum of twelve (12) consumers. Unit of services for children can be defined in a half-day, day, or week-long program setting, but must be developed in a per person cost and detailed in a budget.