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

1.0 Purpose

To provide guidance on administering allowable Ryan White HIV/AIDS Program (RWHAP) and State Services (SS) services and funds to incarcerated people living with HIV (PLWH), recently released, or otherwise involved in justice in Texas.
 

2.0 Background

The Texas Department of State Health Services (DSHS) receives federal grant funds through the RWHAP and state general revenue funds to provide RWHAP Core and Support Services to low-income residents of Texas. RWHAP policy prohibits the use of RWHAP funds for payment of RWHAP Core and Support Services where Texas law requires another entity to provide or pay for such treatment. These laws and policies govern who is eligible for RWHAP Core and Support Services. This includes laws and policies governing PLWH incarcerated or otherwise involved in the Texas Criminal Justice System.
 

3.0 Authority

Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87); Health Resources and Services Administration (HRSA) Policy Clarification Notice (PCN) #18-02; Code of Federal Regulations (CFR) Title 28, §§ 549.10-549.15; Federal Bureau of Prisons Program Statement 6190.04; Texas Code of Criminal Procedure, Article 104.002; Texas Government Code, §501.054; §507.023; Texas Health and Safety Code, §85.003, §85.012, §§85.112-85.114, §85.141, §85.142; §§614.015-017; Texas Local Government Code, §351.101, §361.901; 25 and 25 Texas Administrative Code (TAC) §3.31; 37 TAC, §273.1, §343.322, §343.326. 
 

4.0 Definitions

Correctional Facility – A facility providing involuntary confinement of an individual under arrest or detention or held or convicted by a criminal justice agency or court. This includes federal prisons, state prisons, state jails, county jails, municipal jails, private prisons and jails, substance abuse felony punishment facilities, intermediate sanction facilities, and juvenile detention facilities.

HIV Service Provider – An organization with a contractual agreement with an administrative agency to provide RWHAP Core and Support Services to PLWH, as defined in the HIV Services Taxonomy, and paid for with RWHAP Part B, SS Funds, or both through DSHS.

Incarceration – Involuntary confinement of an individual in connection with an alleged crime. It includes involuntary confinement, occurring either upon a decided sentence or while an individual awaits case adjudication. In Texas, a correctional facility detains an incarcerated person.

Judicially Involved PLWH – PLWH, not incarcerated or recently released from incarceration, involved in the criminal justice system in other ways. This may include supervision under probation or parole, residence in a correctional community facility or halfway house, participation in a court-ordered class or service such as substance use therapy, parenting education, sex offender therapy, domestic violence classes, DWI or DUI classes, community and volunteer services, or monitoring by the courts through equipment such as an ankle monitor or a vehicle alcohol ignition interlock breathalyzer device.

Recently Released Individual – An individual released from a correctional facility to the community within the last 180 days.

RWHAP Core and Support Services – HIV care, treatment, and essential services to eligible PLWH through the RWHAP. For a complete list of services, see HIV Medical and Support Service Categories.

Transitional and Short-Term Basis – The time-limited provision of RWHAP Core and Support Services for the purpose of ensuring linkage to and continuity of care for incarcerated PLWH who are eligible for HRSA RWHAP services upon release when such release is imminent. The HRSA HIV/AIDS Bureau (HAB) defers to recipients or subrecipients for a determination of the time limitation, 180 days or fewer. HRSA HAB recognizes, in some instances, the time limitation is commensurate with the duration of incarceration. RWHAP Core and Support Services must comply with RWHAP payor of last resort (POLR) requirements.

Transitional Discharge Planning – Development of a plan with an incarcerated PLWH on how the PLWH enrolls in RWHAP and plans to obtain HIV medication and medical care in the community. Transitional discharge planning can begin 180 days before the incarcerated individual’s release to the community and extend through 180 days post-release from incarceration.
 

5.0 Policy

HIV Service Providers bill third-party payors before charging services to Ryan White and state services funds for RWHAP Core and Support Services. Ryan White or state services funds cannot pay for RWHAP Core and Support Services payable or chargeable to another billable source. Ryan White funds are not billable for a service where another payor is available. See HIV/STD Section Policy 590.001, DSHS Funds as Payor of Last Resort (PoLR).

5.1 Payor of Last Resort (PoLR) for Incarcerated Individuals

In providing medical treatment for incarcerated PLWH residing in a Texas correctional facility, federal and Texas laws mandate the correctional facility is liable for expenses incurred in the safekeeping of incarcerated individuals. Under the laws, the correctional facility is responsible for providing and paying for necessary medication and medical treatment for incarcerated individuals held in the facility. This includes HIV treatment and medication for PLWH.

Federal law and RWHAP PoLR policy prohibit the use of federal RWHAP and SS funds for payment of treatment and care services where Texas law requires another entity to provide or pay for such treatment. Under this rule, RWHAP cannot provide RWHAP Core or Support Services to incarcerated PLWH during their incarceration.
 

5.2 Transitional and Short-Term Services

The only exception to the PoLR policy is transitional discharge planning. On a transitional and short-term basis, incarcerated PLWH scheduled for release from custody within 180 days are eligible to engage with an HIV service provider to plan how the individual enrolls in RWHAP and obtains HIV medication and medical care in the community upon release. The HIV service provider coordinates with the correctional facility to ensure there is no duplication of services. Transitional discharge planning can include services such as completing an application for medication assistance through the Texas HIV Medication Program, scheduling community HIV medical and support service appointments, completing referrals for other needs (such as housing), and educating the individual about HIV and navigating HIV services in the community.

Recently released PWLH are eligible for qualified RWHAP Core and Support Services and assistance with the Transitional Discharge Plan. Assistance with the Transitional Discharge Plan encourages recently released PLWH to enroll and stay in RWHAP while they adjust from incarceration to living in the community. Recently released PLWH can receive up to 180 days of Transitional Discharge Plan assistance from the HIV service provider.
 

5.3 Judicially Involved PLWH

PLWH who are judicially involved and meet the RWHAP eligibility requirements can enroll in RWHAP Core and Support Services.
The exception to the service eligibility for judicially involved PLWH is if their court-ordered requirements duplicate RWHAP Core or Support services. In this instance, RWHAP is not the PoLR.
 

6.0 Revision History

7.0 Associated Policies