Texas DSHS HIV/STD Program - HIV Medical and Support Service Categories

The service categories below are fundable though Ryan White HIV/AIDS Program (RWHAP) Part B grant, DSHS State Services, and HOPWA formula funds awarded to the State only. Listed service categories may not fully reflect services fundable through other RWHAP Parts, direct HOPWA, or other funding sources. Certain services listed in Section 2 and all services listed in Section 3 are fundable only through DSHS State Service funds.

Each service at the subcategory level will allow entry of a total cost amount that is the result of the agency’s unit cost calculation outside the AIDS Regional Information and Evaluation System (ARIES) data system.

The service categories are subject to revision as new information, requirements, and/or guidance is received from the Health Resources and Services Administration (HRSA), U.S. Public Health Service (USPHS), the State of Texas, and/or DSHS.

Significant/Material and Non-Significant Revisions and Updates to DSHS HIV Standards of Care (SOC) and Monitoring Tools

Examples of Significant/Material Revisions:

Changes that add non-HRSA or USPHS-required language (e.g., DSHS requirements, Texas Administrative Code (TAC) requirements)
Revisions that impact minimum requirements
Revisions that add requirements
Changes substantial enough to trigger Statewide SOC Workgroup or HIV Care Services Physician Panel review (e.g. complete re-write of one or SOC)

Examples of Non-Significant Revisions:

DSHS will update and maintain the SOC and tools with current HRSA requirements and relevant new and revised Policy Clarification Notices (PCNs). These changes are required and will be made as soon as the current monitoring cycle is complete. For example, 2019 monitoring was completed in November 2019. Additional updates were made in December 2019 and finalized February 1, 2020. The updates were based on HRSA PCN 16-02 requirements (that HRSA revised October 2018) and are in place for the 2020 monitoring year.
Updates made to USPHS will follow the above rule
Revisions to clarify language but not add new requirements

Section 1. Core Medical Services
Section 2. Support Services
Section 3. Support Services (State Services Funds Only)
Section 4. Health Insurance Program (HIP)
Section 5. HOPWA
Section 6. Universal Standards – Monitoring Tools – Templates

**Section 1. Core Medical Services**
Service Category	Subcategories	ARIES Service Units
Early Intervention Services (Part B) - Revised 7/2/2018 Early Intervention Services (EIS) includes identification of individuals at points of entry and access to services with the provision of: HIV Testing and Targeted counseling Referral services Linkage to care Health education and literacy training that enable clients to navigate the HIV system of care Early Intervention Services Standard	Early Intervention Service	Per encounter with client previously unlinked to care
Health Insurance Premium and Cost Sharing Assistance - Revised 2/1/2020 Health Insurance Premium and Cost Sharing Assistance (Health Insurance Assistance or HIA) provides financial assistance for eligible clients living with HIV to maintain continuity of health and/or dental insurance or to receive medical and pharmacy benefits under a health care coverage program. This includes out-of-pocket costs such as premium payments, co-payments, coinsurance, and deductibles for health and dental insurance plans. Health Insurance Premium and Cost Sharing Assistance Service Standards	All health insurance payments should be reported in ARIES under the CARE/HIPP or SS/HIPP Programs. See Section 4.
Home and Community-Based Health Services - Revised 2/1/2020 Home and Community-Based Health Services is defined as skilled health services furnished in the home of an HIV-infected individual, based on a written plan of care prepared by a case management team that includes appropriate health care professionals. This definition also includes non-medical, non-nursing assistance with cooking and cleaning activities to help clients with disabilities remain in their homes. Home and Community-Based Health Services Standards of Care	Professional	Per visit
	Professional	Per visit
	Durable Medical Conditions	Per unit
Home Health Care - Revised 2/1/2020 Home Health Care is defined as support provided in the patient’s home by licensed health care workers such as nurses. Home Health Care Standards of Care	Home Health Care	Per visit
Hospice Services - Revised 2/1/2020 Provision of Hospice Care provided by licensed hospice care providers to clients in the terminal stages of illness, in a home or other residential setting, including a non-acute-care section of a hospital that has been designated and staffed to provide hospice care for terminal patients. Hospice Standards of Care	Hospice Care – Facility-based	Per day
	Hospice Care – Facility-based	Per day
Local AIDS Pharmaceutical Assistance (LPAP) - Revised 8/30/2017 The purpose of a Local AIDS Pharmaceutical Assistance Program (LPAP) is to provide therapeutics to treat HIV/AIDS or to prevent the serious deterioration of health arising from HIV/AIDS in eligible individuals, including measures for prevention and treatment of opportunistic infections. An LPAP is a program to ensure that clients receive medications when other means to procure medications are unavailable or insufficient. As such, LPAPs are meant to serve as an ongoing means of providing medications for a period of time. Local AIDS Pharmaceutical Assistance (LPAP) Standards	Local Drug Reimbursement	Per prescription (not pill or dose)
Medical Case Management - Revised 2/1/2020 Medical Case Management (MCM) is a proactive case management category intended to serve persons living with HIV with multiple complex health-related needs that focuses on maintaining HIV-infected persons in systems of primary medical care to improve HIV-related health outcomes. Medical Case Management Standards Medical Case Management Frequently Asked Questions	Medical Case Management	Per 15 minutes
Medical Nutritional Therapy - Revised 2/1/2020 Support for Medical Nutrition Therapy (MNT) services including nutritional supplements provided outside of a primary care visit by a licensed Registered Dietitian; may include food provided pursuant to a physician’s recommendation and based on a nutritional plan developed by a licensed Registered Dietitian. Medical Nutrition Therapy Standards of Care	Medical Nutrition Therapy - Counseling	Per 15 minutes
	Medical Nutrition Therapy - Supplements [1]	Per transaction
Mental Health Services - Revised 2/1/2020 Mental Health Services are the provision of outpatient psychological and psychiatric screening, assessment, diagnosis, treatment, and counseling services offered to clients living with HIV. Services are based on a treatment plan, conducted in an outpatient group or individual session, and provided by a mental health professional licensed or authorized with the state to render such services. Such professionals typically include psychiatrists, psychologists, and licensed clinical social workers Mental Health Services Standards of Care Mental Health Services Frequently Asked Questions	Mental Health Services – Individual	Per visit
	Mental Health Services - Group	Per visit
	Mental Health Services – Psychiatric Evaluation	Per visit
	Mental Health Services – Psychiatric Follow-up	Per visit
Oral Health Services - Revised 7/2/2018 Support for Oral Health Services including diagnostic, preventive, and therapeutic dental care that is in compliance with dental practice laws, includes evidence-based clinical decisions that are informed by the American Dental Association Dental Practice Parameters, is based on an oral health treatment plan, adheres to specified service caps, and is provided by licensed and certified dental professionals. Oral Health Services Standard	Oral Health Care - Routine Treatment	Per visit
	Oral Health Care - Prophylaxis	Per visit
	Oral Health Care - Specialty	Per visit
Outpatient/Ambulatory Health Services - Revised 2/1/2020 Outpatient/Ambulatory Health Services are diagnostic and therapeutic services provided directly to a client by a licensed healthcare provider in an outpatient medical setting. Outpatient medical settings include clinics, medical offices, and mobile vans where clients do not stay overnight. Outpatient/Ambulatory Health Services Standards of Care Outpatient/Ambulatory Health Services Frequently Asked Questions	Outpatient/Ambulatory Health Services	Per visit
	Dermatology	Per visit
	Infectious Disease	Per visit
	Neurology	Per visit
	Ob/Gyn	Per visit
	Oncology	Per visit
	Ophthalmology	Per visit
	Other Specialty	Per visit
	Radiology	Per visit
	Laboratory - Service (and test except CD4 and VRLD)	Per test
	CD-4 T-Cell Count	Per test
	Viral Load Test	Per test
Substance Abuse Outpatient Care - Revised 7/26/2017 Substance Abuse Outpatient Care is the provision of outpatient services for the treatment of drug or alcohol use disorders. Substance Abuse Outpatient Care Standards of Care	Substance Abuse Services – Outpatient-Individual Counseling	Per visit
	Substance Abuse Services – Outpatient-Group Counseling	Per visit
	Substance Abuse – Intake Includes but not limited to intake into methadone or other medication-assisted treatment. May include substance abuse assessments (SASSI) by appropriately qualified personnel, although technically, a person is not in outpatient or any form of treatment at the time of the assessment.	Per visit
	Medication-Assisted Detox Includes medications such as Methadone, Subut (buprenorphine hydrochloride) and Suboxone (buprenorphine hydrochloride and naloxone hydrochloride), ORLAAM, etc.	Per visit
	Substance Abuse Medication Maintenance	Per visit

**Section 2. Support Services**
Some services listed here may not be funded with Ryan White Part B funds.
Service Category	Subcategories	ARIES Service Units
Child Care Services - Revised 2/1/2020 Child care services are care for the children of clients who are HIV positive while the clients are attending medical or other appointments, or RWHAP-related meetings, groups, or training. Funds may be used to support informal child care provided by a neighbor, family member, or other person if there is an understanding that existing Federal restrictions prohibit giving cash to clients or primary caregivers to pay for these services. Child Care Services Standards	Child Care Services [2]	Per hour
Emergency Financial Assistance (EFA) - Revised 2/1/2020 Support for Emergency Financial Assistance (EFA) for essential services including utilities, housing, food (including groceries and food vouchers), or prescriptions provided to clients with limited frequency and for a limited period of time. The intent of these funds are to support a client for a short duration. Emergency Financial Assistance (EFA) Standards	Emergency Assistance - Prescription	Per prescription
	Emergency Assistance – Utilities	Per transaction
	Emergency Assistance – Food	Per visit
Food Bank / Home-Delivered Meals - Revised 7/23/2018 Funding for Food Bank/Home Delivered Meals may include: The provision of actual food items Provision of hot meals A voucher program to purchase food Food Bank/Home Delivered Meals Standards Food Bank/Home Delivered Meals Frequently Asked Questions	Food Pantry/Voucher Visit Without Nutritional Supplements	Per visit
	Food Pantry/Voucher Visit with Nutritional Supplements [3]	Per visit
	Meals - Home-Delivered	Per person per meal
	Meals - Congregate	Per person per meal
Health Education / Risk Reduction (HE/RR) - Revised 9/26/2017 The provision of information; including information dissemination about medical and psychosocial support services and counseling to help clients with HIV improve their health status. HE/RR Standards	HE/RR - Prevention Case Management for HIV positives – Individual Intervention	Per 15 minutes
	HE/RR – Group-level Intervention	Per 15 minutes
Housing Services - Revised 2/1/2020 Housing Services consists of the provision of short-term assistance to support emergency, temporary, or transitional housing to enable an individual or family to gain or maintain medical care. Housing Services Standards	Housing Assistance – Short-Term Housing assistance is limited to short-term assistance to support temporary and/or transitional housing to enable the individual or family to gain and/or maintain medical care. Use of Ryan White Program funds for short-term or emergency housing must be linked to medical and/or healthcare or be certified as essential to a client’s ability to gain or maintain access to HIV-related medical care or treatment.	Per day
	Housing Assistance – Emergency Housing assistance is limited to emergency financial assistance to support temporary and/or transitional housing to enable the individual or family to gain and/or maintain medical care. Use of Ryan White Program funds for short-term or emergency housing must be linked to medical and/or healthcare or be certified as essential to a client’s ability to gain or maintain access to HIV-related medical care or treatment.	Per day
	Housing Referral/Housing Related Services Housing related services include assessment, search, placement, and advocacy services provided by professionals who possess an extensive knowledge of local, State and Federal housing programs and how they can be accessed.	Per 15 minutes
Legal Services (Obsolete - see Other Professional Services) Legal Services is provided to for an HIV-infected person to address legal matters directly necessitated by the individual’s HIV status. Legal Services Standards	Legal Services	Per hour
Linguistic Services - Revised 2/1/2020 Support for Linguistic Services includes interpretation (oral) and translation (written) services, provided by qualified individuals as a component of HIV service delivery between the provider and the client, when such services are necessary to facilitate communication between the provider and client and/or support delivery of Ryan White-eligible services. Linguistic Services Standards	Translation/Interpretation - Interpersonal	Per 15 minutes
	Translation/Interpretation - Document	Per transaction
Medical Transportation Services - Revised 7/2/2018 Medical Transportation Services enable an eligible individual to access HIV-related health and support services, including services needed to maintain the client in HIV medical care, either through direct transportation services, vouchers, or tokens. Medical Transportation Services Standard Medical Transportation Services Frequently Asked Questions	Medical Transportation Services	Per one way trip
Non-Medical Case Management - Revised 6/8/2017 Non-Medical Case Management (N-MCM) model is responsive to the immediate needs of a person living with HIV and includes the provision of advice and assistance in obtaining medical, social, community, legal, financial, entitlements, housing, and other needed services. Non-Medical Case Management Standards Case Management Frequently Asked Questions	Case Management – Non Medical	Per 15 minutes
Other Professional Services - Revised 7/17/2017 Other Professional Services allow for the provision of professional and consultant services rendered by members of particular professions licensed and/or qualified to offer such services by local governing authorities. Other Professional Services Standards	Legal Services	Per hour
	Permanency Planning	Per hour (new)
	Income Tax Preparation	Per hour (new)
Outreach Services - Revised 2/1/2020 Support for Outreach Services is designed to identify individuals who do not know their HIV status and/or individuals who know their status and are not in care and help them to learn their status and enter care. Outreach Services Standards	Outreach Services (Outreach for linkage to services)	Per encounter with client previously unlinked to care
Psychosocial Support Services - Revised 7/17/2017 Support for Psychosocial Support Services that may include: Support and counseling services Child abuse and neglect counseling HIV support groups Pastoral Care/counseling Caregiver support Bereavement counseling Nutrition counseling provided by a non-registered dietitian Psychosocial Support Services Standards Psychosocial Support Services Frequently Asked Questions	Other Counseling – Individual	Per 15 minutes
	Other Counseling - Support Group	Per 15 minutes
	Other Counseling - Nutritional [4]	Per 15 minutes
Referral For Health Care and Support Services - Revised 7/2/2018 Direct a client to a service in person or through telephone, written, or other types of communication, including management of such services where they are not provided as part of Ambulatory Outpatient Medical Care or Case Management Services. Referral for Health Care and Support Services Standard	Referral to health care/supportive services	Per referral
Rehabilitation Services - Revised 9/18/2017 Rehabilitation services are provided by a licensed or authorized professional in accordance with an individualized plan of care intended to improve or maintain a client’s quality of life and optimal capacity for self-care. These include physical and occupational therapy, speech pathology, and low-vision training. Rehabilitation Services Standards	Rehabilitative Services – Physical Therapy	Per visit
	Rehabilitative Services – Occupational Therapy	Per visit
	Rehabilitative Services – Speech Therapy	Per visit
	Rehabilitative Services – Low vision training services	Per visit
Respite Care - Revised 10/18/2017 Respite Care services includes non-medical assistance for an HIV-infected client, provided in community or home-based settings, and designed to relieve the primary caregiver responsible for the day-to-day care of an adult or minor living with HIV/AIDS. Respite Care Standards	Day Care – Infected Child (under 13)	Per hour
	Day Care – Infected Adult	Per hour
	Respite Care Sporadic relief of the caregiver of any aged, infected client.	Per hour
Substance Abuse Services (Residential) - Revised 7/26/2017 Substance Abuse Services (Residential) is the provision of services for the treatment of drug or alcohol use disorders in a residential setting to include screening, assessment, diagnosis, and treatment of substance use disorder Substance Abuse Services (Residential) Standards	Substance Abuse Services (Residential) - Detox	Per day
	Substance Abuse Services (Residential) - Treatment	Per day
Treatment Adherence Counseling (Non Medical) (obsolete – See Medical Case Management and Health Education/Risk Reduction) Treatment adherence counseling is the provision of counseling or special programs to ensure readiness for and adherence to complex HIV/AIDS treatment, provided by non-medical personnel outside of the Medical Case Management and clinical setting. Treatment Adherence Counseling Standards	Treatment Adherence Counseling	Per 15 minutes

**Section 3. Support Services (State Services Funds Only)**
These services may not be funded with Ryan White Part B funds.
Service Category	Subcategories	ARIES Service Units
Other Services Activities not associated with current HRSA Service Categories to be provided under this service category. Activities must be approved by DSHS prior to allocating State Service funds.	Must be established with DSHS	Must be established with DSHS

**Section 4. Health Insurance Programs (HIP)**
Health insurance payments made with Ryan White CARE Act funds should be reported under the CARE/HIPP; health insurance payments made with State Services funds should be reported under the State Services - Insurance.
Service Category	CARE/HIPP & State Services Insurance	ARIES Service Units
Outpatient / Ambulatory Medical Care - Revised 3/31/2017 Co-payments for Outpatient / Ambulatory Medical Care Services when a client has private insurance.	Ambulatory/Outpatient Medical Care	Per payment
	Dermatology	Per payment
	Infectious Disease	Per payment
	Neurology	Per payment
	Ob/Gyn	Per payment
	Oncology	Per payment
	Opthamaology	Per payment
	Other Specialty	Per payment
	Radiology	Per payment
	Laboratory - Service	Per payment
	CD-4 T-Cell Count	Per payment
	Viral Load Test	Per payment
Insurance – Medical Premium and deductible payments for a client’s medical insurance with a private insurance provider. Do not report payments to public payers (e.g. Medicare/Medicaid) here.	Deductible Payment	Per payment
	Premium Payment	Per month
Oral Health Care Co-payments for Oral Health Care when a client has private dental insurance.	Routine Treatment	Per payment
	Prophylaxis	Per payment
	Specialty	Per payment
Insurance – Oral Health Care Premium and deductible payments to a private insurer for dental insurance.	Deductible Payment	Per payment
	Premium Payment	Per month
AIDS Pharmaceutical Assistance (Local) (not Medicare, Medicaid or Part D) Co-payments for a client’s medications when a client has drug coverage from a private insurer.	Co-Payment	Per prescription
Insurance - Prescription Drugs (not Medicare, Medicaid or Part D) Premium and deductible payments for prescription drug benefits with a private insurer.	Deductible Payment	Per payment
	Premium Payment	Per month
Medicare/Medicaid Supplement Premium, deductible or co-payments to Medicare/Medicaid.	Deductible Payment	Per payment
	Co-Payment	Per payment
	Premium Payment	Per month
	Deductible Payment – Part D	Per payment
	Co-Payment – Part D	Per payment
	Premium Payment – Part D	Per month
Other Health Insurance Premium, deductible or co-payments to other health insurers.	Deductible Payment	Per payment
	Co-Payment	Per payment
	Premium Payment	Per month

**Section 5. HOPWA**
The goals of the DSHS HOPWA Program are to help low-income persons living with HIV and their households establish or maintain affordable and stable housing, reduce their risk of homelessness, and improve their access to health care and supportive services. HOPWA Project Sponsors can visit the DSHS HOPWA Program Homepage for information and resource materials applicable to the activities they are carrying out.

The service categories below are funded through annual formula grants to the State from the U.S. Department of Housing and Urban Development (HUD). They may not reflect services funded through other Ryan White Program Parts, direct HOPWA, or other funding sources. Certain services listed in Section 2 and all services listed in Section 3 are funded only through DSHS State Service funds.

Each service at the subcategory level will allow entry of a total cost amount that is the result of the agency’s unit cost calculation outside the data management system AIDS Regional Information and Evaluation System (ARIES).

The service categories are subject to revision as new information and guidance is received from HUD.
Service Category	Subcategories	ARIES Service Units
Permanent Housing Placement (PHP) Assistance for reasonable security deposits, not to exceed the amount equal to 2 months of rent, and related application fees and credit checks.	Permanent Housing Placement	Per payment
Short-Term Rent, Mortgage and Utility Assistance (STRMU) Housing subsidy for short-term rent, mortgage and utility payments to prevent homelessness of the tenant or mortgagor of a dwelling. This program provides assistance for a period not to exceed 21 weeks (147 days) worth of assistance in any 52 week period. These payments are for eligible individuals and their household beneficiaries who are already in housing and who are at risk of becoming homeless. STRUM was previously known as Emergency Assistance.	Short Term Rental Assistance	Per payment
	Mortgage Assistance	Per payment
	Utility Assistance	Per payment
Supportive Services Assistance for case management, basic telephone service and provision of smoke detectors. May be provided in conjunction with HOPWA housing assistance or as a stand alone service (Supportive Services Only).	Case Management	Per 15 Minutes
	Smoke Detectors	Per payment
	Telephone Service	Per payment
Tenant Based Rental Assistance (TBRA) Housing subsidy for tenant based rental assistance, including assistance for shared housing arrangements. It assists income eligible clients and their beneficiaries with rent and utilities until they are able to secure affordable, stable housing. TBRA was previously known as Rental Assistance.	Tenant Based Rental Assistance	Per payment

**Section 6. Universal Standards – Monitoring Tools – Templates**
Tools
Universal Standards (PDF : 770 kB)
Corrective Action Plan Required Template (Word : 35 kB)
Changes to the 2020 SOC Core Medical Health Insurance Premium and Cost-Sharing Assistance for Low-Income Individuals (PDF : 147 kB) Home and Community-Based Health Services (PDF : 163 kB) Home Health Care (PDF : 152 kB) Hospice Services (PDF : 141 kB) Medical Case Management (PDF : 221 kB) Medical Nutrition Therapy (PDF : 127 kB) Mental Health Services (PDF : 131 kB) Outpatient/Ambulatory Health Services (PDF : 223 kB)
Changes to the 2020 Support Services Child Care (PDF : 71 kB) Emergency Financial Assistance (PDF : 141 kB) Housing Services (PDF : 123 kB) Linguistic Services (PDF : 117 kB) Outreach Services (PDF : 85 kB)
DSHS Master Service Category Monitoring Tools 2020 (Excel: 341 kB) - Effective January 2020
DSHS Master Service Category Monitoring Tools 2019 (Excel : 462 kB) - Effective January 2019
DSHS Master Service Category Monitoring Tools 2018 (Excel : 342 kB) - Effective January 2018
DSHS MAI Monitoring Tools (Excel : 21 kB)
HOPWA Monitoring Tool (Excel : 295 kB)
OAHS Monitoring Tool Crosswalk - Comparison - 2018-2019 (PDF : 213 kB)
OAHS Monitoring Tool Crosswalk - Archived Indicators - 2018-2019 (PDF : 225 kB)
Texas DSHS QA Monitoring Deficiency Response Plan (PDF : 874 kB)

1 - Supplements recommended by someone other than a licensed dietitian should be funded and recorded under Food Pantry/Voucher with Nutritional Supplements.
2 - Ongoing daycare is provided and funded under Respite Care.
3 - Supplements ordered by a licensed dietician should be funded and recorded under Medical Nutritional Therapy.
4 - Nutritional counseling done by a licensed dietician should be funded and recorded under Medical Nutritional Therapy. Supplements ordered from a nutritional counseling visit with someone other than a licensed dietician should be funded and recorded under Food Pantry/Voucher Visit with Nutritional Supplements

HIV Core and Support Service Categories

Significant/Material and Non-Significant Revisions and Updates to DSHS HIV Standards of Care (SOC) and Monitoring Tools