TABLE OF CONTENTS

BENEFITS SPECIALTY SERVICES

Executive Summary 2

Service Introduction 5

Service/Organizational Licensure Category 6

Definitions and Descriptions 6

How Service Relates to HIV 7

Service Components 7 Outreach 8 Intake 9 BenefitsAssessment 10 BenefitsManagement 11 BenefitsServicePlan(BSP) 11 ApplicationorRecertificationAssistance 12 AppealsCounselingandFacilitation 13 ClientRetention 13 CaseClosure 14

Staffing Requirements and Qualifications 15

Units of Service 16

References 17

Acronyms 17

STANDARDS OF CARELos Angeles County Commission on

HIV

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STANDARDS OF CARELos Angeles County Commission on

HIV

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BENEFITS SPECIALTY SERVICES

EXECUTIVE SUMMARY

SERVICE INTRODUCTION

Benefitsspecialtyservicesfacilitateaclient’saccesstopublic/privatehealthanddisabilitybenefitsandprograms.BenefitsspecialtyservicesworktomaximizepublicfundingbyhelpingclientsidentifyallavailablehealthanddisabilitybenefitssupportedbyfundingstreamsotherthantheRyanWhitePartAfunds.

Theseservicesaredesignedto:◆◆ Assistaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram

◆◆ EducatepeoplelivingwithHIVaboutpublicandprivatebenefitsandentitlementprogramsandprovideassistanceinaccessingandsecuringthesebenefits

Benefitsspecialtyservicescaninclude:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Assistanceandmanagementofbenefitsissuesforclientswhoareenrolledinhealthanddisabilityprograms

ThegoalofbenefitsspecialtyservicesistoensurethatpeoplelivingwithHIVarereceivingalloftheaidfromvariousbenefitandentitlementprogramsforwhichtheyareeligibleandentitled.

SERVICE/ORGANIZATIONAL LICENSURE CATEGORY

Benefitsspecialtyservicesareunlicensed.AllbenefitsspecialtyserviceswillbeprovidedinaccordancewithCommissiononHIVguidelinesandprocedures,andlocallawsandregulations.

SERVICE CONSIDERATIONS

General Considerations:BenefitsspecialtyserviceswillrespecttheinherentdignityofeachpersonlivingwithHIVtheyserve.Serviceswillbeclient-driven,aimingtoincreaseaclient’ssenseofempowermentandself-advocacy.Allbenefitsspecialtyserviceswillbelinguisticallyandculturallyappropriatetothetargetpopulation.

Outreach:ProgramsprovidingbenefitsspecialtyserviceswillconductoutreachactivitiestopotentialclientsandHIVserviceproviderstopromotetheavailabilityofandaccesstobenefitsspecialtyservices.ProgramswillcollaboratewithHIVprimaryhealthcareandsupportservicesproviders,aswellasHIVtestingsites.

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BENEFITS SPECIALTY SERVICES

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Services include appeals counseling and facilitation.

Intake:Clientintakedetermineseligibilityandincludesdemographicdata,emergencycontactinformation,nextofkinandeligibilitydocumentation.Whenpossible,clientintakewillbecompletedinthefirstcontactwiththepotentialclient.

Benefits Assessment:Benefitsassessmentsarecompletedinacooperative,interactive,face-to-faceinterviewprocesswheneverpossibleandareconductedto:◆◆ Determineaclient’sneedforbenefitsadvocacy◆◆ Educateaclientaboutavailablebenefitsandentitlements◆◆ Identifyappropriatebenefitsandentitlementswiththeclient◆◆ Preliminarilyassessaclient’seligibilityforbenefitsandentitlements◆◆ Providenecessaryreferrals,formsandinstructions,asindicated◆◆ Identifyanybenefits-relatedbarrierstheclientisexperiencing◆◆ Determinewhethertheclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits

Benefits Management:Benefitsmanagementreferstothebenefitcounselingneedsthatmanyclientshaveoncetheyareenrolledinvarioushealthanddisabilitybenefitsprograms.

Benefits Service Plan (BSP):Abenefitsserviceplanisdevelopedinconjunctionwiththeclienttodeterminethebenefitsandentitlementsforwhichtheclientwillbereferredtoapplyortheplanthatthespecialistwilldeveloptohelptheclientresolvehisorhercurrentbenefitsissue(s).Thebenefitsspecialistisresponsibleforprovidingadvocacy.

Application or Recertification Assistance: Clientswithsignificantfunctionalbarrierswillbegivenanappointmentwithintwoweeksofassessmenttoassistinthecompletionofrelevantapplicationsorrecertifications.Thisassistancewillbeprovidedinaone-on-onemeetingwiththesamebenefitsspecialistthatcompletedtheclient’sassessmentwheneverpossible.

Appeals Counseling and Facilitation:Clientsdeniedabenefitormedicalservicewillbeofferedindividualappealscounselingandfacilitationservices.Specialistswilleducateandadviseclientsonmethodstoaddressappeals,and,whenindicated,accompanythemtotheappealinafacilitativerole(notasalegalrepresentative).

Client Retention:Programswillstrivetoretainclientsinbenefitsspecialtyservices.Toensurecontinuityofserviceandretentionofclients,programswillberequiredtoestablishabrokenappointmentpolicy.

Case Closure:Caseclosureisasystematicprocessfordisenrollingclients/familiesfromactivebenefitsspecialtyservices.Theprocessincludesformallynotifyingclients/familiesofpendingcaseclosureandcompletingacaseclosuresummarytobekeptonfileintheclientchart.

STAFFING REQUIREMENTS AND QUALIFICATIONS

BenefitsspecialistswillholdaBachelor’sdegreeinanareaofhumanservicesand/orcertificationinself-insuranceliability;ahighschooldiploma(orgeneraleducationdevelopment(GED)equivalent)andhaveatleastoneyear’sexperienceworkingasanHIVcasemanagerorHIVpolicyadvocate,oratleastthreeyears’experienceworkingwithinarelatedhealthservicesfield.

BenefitsspecialistswillbeknowledgeableabouttheHIVdiseaseprocessandthe

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BENEFITS SPECIALTY SERVICES psychologicaleffectsoflivingwithHIV,aswellastheco-morbiditiesofsubstanceabuseand

mentalillnessandtheireffectsonthemanagementofHIVillness.

Further,benefitsspecialistswillhave:◆◆ Effectiveinterviewingandassessmentskills◆◆ Abilitytoappropriatelyinteractandcollaboratewithothers◆◆ Effectivewritten/verbalcommunicationskills◆◆ Abilitytoworkindependently◆◆ Effectiveproblem-solvingskills◆◆ Abilitytorespondappropriatelyincrisissituations◆◆ Effectiveorganizationalskills

AllbenefitsspecialistswillsuccessfullycompletetheDivisionofHIVandSTDPrograms(DHSP)—formerlyreferredtoastheOfficeofAIDSProgramsandPolicy(OAPP)—BenefitsSpecialtyCertificationTrainingwithinthreemonthsofbeinghired.Inaddition,specialistswillsuccessfullycompletecertificationinRyanWhite/HealthInsurancePremiumPaymentProgram(HIPP)andAIDSDrugAssistanceProgram(ADAP)withinsixmonthsofbeinghired,aswellasanyrequisitetraining(asappropriate).

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STANDARDS OF CARELos Angeles County Commission on

HIV

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BENEFITS SPECIALTY SERVICES

Specialists can assist with benefit paperwork.

SERVICE INTRODUCTION

Benefitsspecialtyservicesfacilitateaclient’saccesstopublic/privatehealthanddisabilitybenefitsandprograms.BenefitsspecialtyservicesworktomaximizepublicfundingbyhelpingclientsidentifyallavailablehealthanddisabilitybenefitssupportedbyfundingstreamsotherthantheRyanWhitePartAfunds.

Theseservicesaredesignedto:◆◆ Assistaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram

◆◆ EducatepeoplelivingwithHIVaboutpublicandprivatebenefitsandentitlementprogramsandtoprovideassistanceinaccessingandsecuringthesebenefits

Benefitsspecialtyservicescaninclude:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Appealscounselingandfacilitation◆◆ Assistanceandmanagementofbenefitsissuesforclientswhoareenrolledinhealthanddisabilityprograms

Allprogramswilluseavailablestandardsofcaretoinformclientsofservicesandwillprovideservicesinaccordancewithlegalandethicalstandards.Maintainingconfidentialityiscriticalanditsimportancecannotbeoverstated.AllprogramsmustcomplywiththeHealthInsurancePortabilityandAccountabilityAct(HIPAA).

ThegoalofbenefitsspecialtyservicesistoensurethatpeoplelivingwithHIVarereceivingalloftheaidfromvariousbenefitandentitlementprogramsforwhichtheyareeligibleandentitled.

Recurringthemesinthisstandardinclude:◆◆ Benefitsspecialtyserviceswillrespectthedignityandselfdeterminationofclients.◆◆ Benefitsspecialistswilltailortheirinterventionstothefunctionalabilitiesoftheirclients.

◆◆ Benefitsspecialistswillfollowupwiththeirclientsthroughoutthebenefitsprocess.◆◆ Benefitsspecialistswillberequiredtohavespecializedtrainingandexpertiseinbenefitsandentitlements.

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BENEFITS SPECIALTY SERVICES ◆◆ Benefitsspecialistswillestablishcollaborativerelationshipswithkeybenefitspartners

(SocialSecurity,DepartmentofPublicSocialService,CaliforniaDepartmentofPublicHealth(CDPH),DivisionofHIVandSTDPrograms(DHSP)—formerlyreferredtoastheOfficeofAIDSProgramsandPolicy(OAPP),ADAPandRyanWhite/HIPP,othergrantees).

TheLosAngelesCountyCommissiononHIVandDHSPhavedevelopedthisstandardofcaretosetminimumqualityexpectationsforserviceprovisionandtoguaranteeclientsconsistentcare,regardlessofwheretheyreceiveservicesintheCounty.

Thisdocumentrepresentsasynthesisofpublishedstandardsandresearch,including:◆◆ ProBenefit$ Handbook,AIDSProjectLosAngeles◆◆ Program Policies and Procedures for Benefits Specialty Services,AIDSProjectLosAngeles

◆◆ Client Advocacy Definitions,CommissiononHIV◆◆ StandardsofcaredevelopedbyseveralotherRyanWhiteTitle1PlanningCouncils—mostvaluableinthedraftingofthisstandardwasBaltimore,2004

SERVICE/ORGANIZATIONAL LICENSURE CATEGORY

Benefitsspecialtyservicesareunlicensed.AllbenefitsspecialtyserviceswillbeprovidedinaccordancewithCommissiononHIVguidelinesandprocedures,andlocallawsandregulations.

DEFINITIONS AND DESCRIPTIONS

Benefits assessmentisacooperativeandinteractiveface-to-faceinterviewprocessduringwhichtheclient’sknowledgeaboutandaccesstopublicandprivatebenefitsareidentifiedandevaluated.

Benefits management referstobenefitsspecialtyservicesprovidedtoindividualswhoareenrolledinvarioushealthanddisabilityprograms.Thegoalofbenefitsmanagementistoprovideadvocacythathelpstheindividualmaintainhisorherbenefits.

Case closureisasystematicprocessofdisenrollingclientsfromactivebenefitsspecialtyservices.

Client intakeisaprocessthatdeterminesaperson’seligibilityforbenefitsspecialtyservices.

Entitlement programsarebenefitsthatrequirefinancialcontributionintotheprogrampriortocollectingfromtheprogram(e.g.,StateDisabilityInsurance(SDI)andSocialSecurityDisabilityInsurance(SSDI)).

Legal representationdefinesaprocessthroughwhichaconsumerisrepresentedbyanattorney,paralegaland/orlicensed/certifiedinsuranceadjustor.(PleaseseeLegal Assistance Standard of Care.)

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BENEFITS SPECIALTY SERVICESOutreachpromotestheavailabilityofandaccesstobenefitsspecialtyservicestopotential

clientsandserviceproviders.

Public benefitsdescribeallfinancialandmedicalassistanceprogramsfundedbygovernmentalsources.

HOW SERVICE RELATES TO HIV

Attheendof2013,approximately60,050peoplewereestimatedtobelivingwithHIVinfectioninLosAngelesCounty.LosAngelesCountycomprises40%ofthetotalAIDScasesintheStateofCalifornia(EpidemiologicProfileofHIVinLosAngelesCounty,2013).

Linkingclientstoresourcescanbetime-consumingandcomplex,ofteninvolvingamixofadvocacyandmediation(Chernesky&Grube,2000).A2002NewYorkCitystudyonformalclientassessment,foundthedevelopmentofacareplanandassistanceinsecuringpublicbenefitstobekeyfactorsinasignificantlyincreasedlikelihoodofaclient’senteringandmaintainingmedicalcare(Messerietal.,2002).

Otherstudieshaveshownthatthereceiptofancillaryservices(includingclientadvocacy)hasbeensignificantlyassociatedwithincreaseduseofprimarymedicalcare(Ashman,Conviser&Pounds,2002).Thisfindingmaysuggestthathelpingclientstosolveproblemsnotdirectlyrelatedtoprimarycaremayempowerthemtoseekandobtainit(Ashman,Conviser&Pounds,2002).

SERVICE COMPONENTS

Benefitsspecialtyservicesareclient-centeredactivitiesthatfacilitateaclient’saccesstopublicmaintenanceofhealthanddisabilitybenefitsandservices.Benefitsspecialtyservicesfocusonassistingaclient’sentryintoandmovementthroughcareservicesystemsoutsideoftheservicedeliverynetworkfundedbytheRyanWhiteProgram.

Specialistsareresponsiblefor:◆◆ Ensuringthattheirclientsarereceivingallthebenefitsandentitlementsforwhichtheyare

eligible◆◆ Educatingclientsaboutavailablebenefitandentitlementprogramsandassessingtheireligibilityforthem

◆◆ Assistingclientswithapplications,providingadvocacywithappealsanddenials◆◆ Assistingwithrecertifications,providingadvocacyinotherareasrelevanttomaintainingbenefits

Specialistswillexploreaspossibleoptionsfortheirclientsthefollowingbenefits(atminimum):◆◆ AIDSDrugAssistanceProgram(ADAP)◆◆ AbilitytoPayPrograms(ATP)◆◆ Cal-WORKs◆◆ CARE/HealthInsurancePremiumPayment(CARE/HIPP)◆◆ FoodStamps◆◆ GeneralRelief/GeneralReliefOpportunitiestoWork(GROW)◆◆ InHomeSupportiveServices(IHSS)

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BENEFITS SPECIALTY SERVICES ◆◆ InsuranceContinuation(COBRA,OBRA,HIPAA)

◆◆ HealthyFamiliesProgram◆◆ MajorRiskMedicalInsuranceProgram(MRMIP)◆◆ ManagedCareSystems◆◆ Medicaid/Medi-Cal◆◆ Medi-Cal/HealthInsurancePremiumPaymentProgram(Medi-Cal/HIPP)◆◆ Medicare◆◆ MedicareSavingsPrograms◆◆ PharmaceuticalPatientAssistancePrograms(PAPs)◆◆ PrivateInsurance◆◆ SocialSecurityPrograms◆◆ SocialSecurityDisabilityInsurance(SSDI)◆◆ SupplementalSecurityIncome(SSI)◆◆ SocialSecurityRetirement◆◆ StateDisabilityInsurance(SDI)◆◆ TemporaryAidtoNeedyFamilies(TANF)◆◆ UnemploymentInsurance(UI)◆◆ Veteran’sAdministrationBenefits(VA)◆◆ Women,InfantsandChildren(WIC)◆◆ Worker’scompensation◆◆ Otherpublic/privatebenefitsprograms

Inadditiontoassessingeligibilityfortheprogramslistedabove,specialistswilladdresstheuniquebenefitsneedsofspecificpopulationsincluding(butnotlimitedto):◆◆ Immigrants◆◆ Veterans◆◆ Individualswhohaverecentlybeenincarcerated◆◆ Familiesandchildren◆◆ BenefitsspecialtyserviceswillrespecttheinherentdignityofeachpersonlivingwithHIVtheyserve.Serviceswillbeclient-driven,aimingtoincreaseaclient’ssenseofempowermentandself-advocacy.AllHIVbenefitsspecialtyserviceswillbelinguisticallyandculturallyappropriatetothetargetpopulation.(SeeProgramRequirementsandGuidelinesintheStandardsofCareIntroduction)

BenefitsspecialistswillusetrainingandresourcematerialsprovidedbytheDHSP,aswellasotherrelevanttrainingandeducationalmaterials.

Benefitsspecialtyservicesarecomprisedof:◆◆ Assessmentofbenefitneedandeligibility◆◆ Assistancewithcompletingbenefitpaperwork◆◆ Appealscounseling,facilitationandreferral

OUTREACH

ProgramsprovidingbenefitsspecialtyserviceswillconductoutreachactivitiestopotentialclientsandHIVserviceproviderstopromotetheavailabilityofandaccesstobenefitsspecialtyservices.ProgramswillcollaboratewithHIVprimaryhealthcareandsupportservicesproviders,aswellasHIVtestingsites.

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BENEFITS SPECIALTY SERVICESSTANDARD MEASURE

Benefitsspecialtyprogramswilloutreachtopotentialclients/familiesandproviders.

Outreachplanonfileatprovideragency.

Benefitsspecialtyprogramswillcollaboratewithprimaryhealthcareandsupportiveserviceproviders.

MemorandaofUnderstandingonfileattheprovideragency.

INTAKE

Clientintakedetermineseligibilityandincludesdemographicdata,emergencycontactinformation,nextofkinandeligibilitydocumentation.Whenpossible,clientintakewillbecompletedinthefirstcontactwiththepotentialclient.Thecompleteintakeprocess,includingregistrationandeligibility,isrequiredforeveryclientathisorherpointofentryintotheservicesystem.Ifanagencyorotherfundedentityhastherequiredinformationanddocumentationonfileintheagencyrecordforthatclientorinthecountywidedatamanagementsystem,furtherintakeisnotrequired.

Intheintakeprocessandthroughoutbenefitsspecialtyservicedelivery,clientconfidentialitywillbestrictlymaintainedandenforced.AllprogramswillfollowHIPAAguidelinesandregulationsforconfidentiality.Asneeded,ReleaseofInformationformswillbegathered.Theseformsdetailthespecificperson/soragenciestoorfromwhominformationwillbereleasedaswellasthespecifickindofinformationtobereleased.NewformsmustbeaddedforindividualsnotlistedonthemostcurrentReleaseofInformation(specificationshouldindicatethetypeofinformationthatcanbereleased).

Aspartoftheintakeprocess,theclientfilewillincludethefollowinginformation(atminimum):◆◆ WrittendocumentationofHIVstatus◆◆ ProofofLosAngelesCountyresidencyorAffidavitofHomelessness◆◆ Verificationoffinancialeligibilityforservices◆◆ Dateofintake◆◆ Clientname,homeaddress,mailingaddressandtelephonenumber◆◆ Emergencyand/ornextofkincontactname,homeaddressandtelephonenumber

Required Forms:Programsmustdevelopthefollowingformsinaccordancewithstateandlocalguidelines.

Completedformsarerequiredforeachclient:◆◆ ReleaseofInformation(mustbeupdatedannually).NewformsmustbeaddedforthoseindividualsnotlistedontheexistingReleaseofInformation(specificationshouldbemadeaboutwhattypeofinformationcanbereleased).

◆◆ LimitsofConfidentiality(confidentialitypolicy)◆◆ ConsenttoReceiveServices◆◆ ClientRightsandResponsibilities◆◆ ClientGrievanceProcedures◆◆ DisclosureorDutyStatementfromclientthatinformsthebenefitsspecialistwhenclienthasretainedotherlegalrepresentation

◆◆ ProgramDisclaimerthatbenefitsspecialtyservicesdonotconstitutelegaladviceorrepresentationandthatthereisnoguaranteeofsuccessinobtainingbenefits.

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BENEFITS SPECIALTY SERVICES STANDARD MEASURE

Theintakeprocesswillbeginduringfirstcontactwithclient.

Intaketoolinclientfiletoinclude(atminimum):• DocumentationofHIVstatus• ProofofLACountyresidencyorAffidavitof

Homelessness• Verificationoffinancialeligibility• Dateofintake• Clientname,homeaddress,mailingaddressand

telephonenumber• Emergencyand/ornextofkincontactname,home

addressandtelephonenumber

ConfidentialitypolicyandReleaseofInformationwillbediscussedandcompleted.

ReleaseofInformationsignedanddatedbyclientonfileandupdatedannually.

ConsentforServiceswillbecompleted. SignedanddatedConsentinclientfile.

ClientwillbeinformedofRightsandResponsibilityandGrievanceProcedures.

Signedanddatedformsinclientfile.

Whenindicated,theclientwillprovideDisclosureorDutyStatement.

SignedanddatedDisclosureorDutyStatementinclientfile.

ClientwillbeinformedoflimitationsofbenefitsspecialtyservicesthroughDisclaimerform.

SignedanddatedDisclaimerinclientfile.

BENEFITS ASSESSMENT

Benefitsassessmentsarecompletedinacooperative,interactive,face-to-faceinterviewprocesswheneverpossibleandareconductedto:◆◆ Determineaclient’sneedforpublicbenefitsadvocacy◆◆ Educateaclientaboutavailablebenefitsandentitlements◆◆ Identifyappropriatebenefitsandentitlementswiththeclient◆◆ Preliminarilyassessaclient’seligibilityforbenefitsandentitlements◆◆ Providenecessaryreferrals,formsandinstructions,asindicated◆◆ Identifyanybenefits-relatedbarrierstheclientisexperiencing◆◆ Determinewhethertheclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits

Benefitsassessmentsalsohelpthespecialistassessaclient’sfunctionalabilitytofollowthroughwithcomplicatedenrollmentandapplicationprocedures.Thisinformalfunctionalassessmentwillhelpguidetheadvocateinmakingdecisionsaboutthelevelofassistancerequiredtoensurethatagivenclientissuccessfulinthebenefitapplicationprocess.

Examplesoffunctionalbarriersmayinclude(butnotbelimitedto):◆◆ Literacy◆◆ Englishproficiency◆◆ Mentalillness◆◆ Substanceabuse◆◆ Learningdisabilities◆◆ Homelessness◆◆ Stigma◆◆ Transportationchallenges◆◆ Poorphysicalhealthandmedicationsideeffects

Benefitsassessmentswillbecompletedduringthefirstappointmentafterreferralorcompletionofintake.Ifaclient,duetophysicalimpairmentorillness,isunabletocometoanagencyappointment,anadvocatewillbedispatchedtohisorherplaceofresidencetocompletetheassessmentandrequisitefollow-up.

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BENEFITS SPECIALTY SERVICESWhilemostclientswilllikelycometobenefitsspecialtyservicesthroughdirectreferralfrom

casemanagers,benefitsspecialistsmustensureaccessandreferraltocasemanagementservicesforanyclientsnotalreadyconnectedtosuchservices.

Benefitsassessmentsrequirethattheclientchartonfilecontainthefollowingdocumentation(atminimum):◆◆ Dateofassessment◆◆ Signatureandtitleofstaffpersoncompletingtheassessment◆◆ CompletedAssessment/Informationform◆◆ Notationoffunctionalbarriers◆◆ Briefnotationofrelevantbenefitsandentitlementsandrecordofformsprovided◆◆ Benefitsserviceplan

STANDARD MEASURE

Benefitsassessmentswillbecompletedduringfirstappointment.

Benefitsassessmentinclientchartonfiletoinclude:• Dateofassessment• Signatureandtitleofstaffperson• CompletedAssessment/Informationform• Functionalbarriers• Notationofrelevantbenefitsandentitlementsand

recordofformsprovided• Benefitsserviceplan

BENEFITS MANAGEMENT

Benefitsmanagementreferstothebenefitcounselingneedsthatmanyclientshaveoncetheyareenrolledinvarioushealthanddisabilitybenefitsprograms.

Clientsmayrequirebenefitsmanagementassistanceforanyofthefollowingreasons:◆◆ Healthorlifestylechanges◆◆ Programrecertificationorreenrollment◆◆ Treatment/servicedenials◆◆ Return-to-workissues◆◆ Legislativeorbudgetrelatedchangestobenefits

STANDARD MEASURE

Benefitsmanagementserviceswillbeprovidedtoclientswhoareenrolledinbenefitsprogramsandrequireadvocacytomaintaintheirbenefits.

Benefitsassessmentonfileinclientcharttoinclude:• Date• Signatureandtitleofstaffperson• Notationofrelevantbenefitsandpresentingissue(s)• Benefitsserviceplantoaddressidentifiesbenefits

issue(s)

BENEFITS SERVICE PLAN (BSP)

ABSPisdevelopedinconjunctionwiththeclienttodeterminethebenefitsandentitlementsforwhichtheclientwillbereferredtoapplyortheplanthatthespecialistwilldeveloptohelptheclientresolvehisorhercurrentbenefitsissue(s).Thebenefitsspecialistisresponsibleforprovidingadvocacy,referralsandotherassistancenecessarytocarryouttheBSPafterdeterminingwhetherthepersonhassoughtlegalrepresentation.Throughofficevisits,homevisitand/orphonecalls,theadvocatewillworkwiththeclienttoobtaintheservicesorinformationnecessarytocompletethebenefit/entitlementprocessorto

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BENEFITS SPECIALTY SERVICES resolvethependingbenefitissue.

IncludedintheBSPistheleveloffacilitationexpectedfromtheadvocate.◆◆ Clients with insignificant or no apparent functional barrierswillbeprovidedwithnecessaryformsandinstructions.Specialistswillfollowupwithintwoweekstocheckclient’sprogressincompletingandapplyingforbenefitsandentitlements.

◆◆ Clients with significant functional barrierswillbeprovidedwithnecessaryformsandinstructionsandgivenanappointmenttoreturnwithintwoweekstoassistincompletingforms.

Attheconclusionofthebenefitsassessment,BSPswillbecompletedforeachclient.BSPswillbeupdatedasneededandwillincludethefollowing(atminimum):◆◆ Name,dateandsignatureofclientandadvocate◆◆ Notationofbenefitsandentitlementstowhichtheclientwillapply◆◆ Notationoffunctionalbarriersstatusandrequisitenextsteps◆◆ Dispositionoftheapplicationforeachbenefitorentitlementasitiscompleted,changedordeterminedtobeunattainable

STANDARD MEASURE

BSPswillbedevelopedinconjunctionwiththeclientatthecompletionofthebenefitsassessment.

BSPonfileinclientchartthatincludes:• Name,dateandsignatureofclientandcasemanager• Benefits/entitlementsforwhichtobeapplied• Functionalbarriersstatusandnextsteps• Dispositionforeachbenefit/entitlementand/or

referral

APPLICATION OR RECERTIFICATION ASSISTANCE

Clientswithsignificantfunctionalbarrierswillbegivenanappointmentwithintwoweeksofassessmenttoassistinthecompletionofrelevantapplicationsorrecertifications.Thisassistancewillbeprovidedinaone-on-onemeetingwiththesamebenefitsspecialistthatcompletedtheclient’sassessmentwheneverpossible.

Clientswithinsignificantornofunctionalbarrierswillbeofferedindividualapplicationassistanceif,atthetimeoffollow-up,theyexpressaneedforthisservice.

Itisthespecialist’sresponsibilitytoensurethattheapplicationsarecompleteandthattheclienthasclearinstructionsaboutthenextstepsrequiredtofinalizetheapplicationprocess(e.g.,settingappointmentsatbenefitsoffices,mailinginstructions,etc.).

Documentationforapplicationassistanceserviceswillbekeptintheformofaprogressnoteandshouldinclude(atminimum):◆◆ Date◆◆ Determinationwhetherclienthasalreadysoughtlegalrecourserelatedtoservicesforwhichheorsheisseekingbenefits

◆◆ Descriptionofapplicationscompleted◆◆ Timespentwith,oronbehalfof,theclient◆◆ Specialist’ssignatureandtitle

Ifaclientdoesnotattendascheduledappointment,specialistswillattempttofollowupwithinonebusinessday.

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BENEFITS SPECIALTY SERVICESSTANDARD MEASURE

Specialistswillassistclientswithsignificantfunctionalbarriersorwhorequireadditionalhelpincompletingbenefitpaperwork.

Signed,datedprogressnotesonfilethatdetail(atminimum):• Determinationoflegalcounsel• Descriptionofpaperworkcompleted• Timespent

Specialistswillattempttofollowupmissedappointmentswithinonebusinessday.

Progressnoteonfileinclientchartdetailingfollow-upattempt.

APPEALS COUNSELING AND FACILITATION

Clientsdeniedabenefitormedicalservicewillbeofferedindividualappealscounselingandfacilitationservices.Specialistswilleducateandadviseclientsonmethodstoaddressappeals,and,whenindicated,accompanythemtotheappealinafacilitativerole(notasalegalrepresentative).

Whenaspecialistdeemsthatfurtherlegalassistanceisrequiredtosuccessfullynegotiateanappeal,clientswillbereferredtoalegalserviceprovider.

Documentationforappealscounselingandfacilitationserviceswillbekeptintheformofaprogressnoteandshouldinclude(atminimum):◆◆ Date◆◆ Briefdescriptionofcounselingprovided◆◆ Timespentwith,oronbehalfof,theclient◆◆ Legalreferrals(asindicated)◆◆ Specialist’ssignatureandtitle

Ifaclientdoesnotattendascheduledappealscounselingappointment,specialistswillattempttofollowupwithinonebusinessday.

STANDARD MEASURE

Asnecessary,specialistswillassistclientswithappealscounselingandfacilitation.CasesthatrequirefurtherlegalassistancewillbereferredtoRyanWhiteProgram-fundedorotherlegalserviceprovider.

Signed,datedprogressnotesonfilethatdetail(atminimum):• Briefdescriptionofcounselingprovided• Timespentwith,oronbehalfof,theclient• Legalreferrals(asindicated)

Specialistswillattempttofollowupmissedappointmentswithinonebusinessday.

Progressnoteonfileinclientchartdetailingfollow-upattempt.

CLIENT RETENTION

Programswillstrivetoretainclientsinbenefitsspecialtyservices.Toensurecontinuityofserviceandretentionofclients,programswillberequiredtoestablishabrokenappoint-mentpolicy.Follow-upstrivestomaintainaclient’sparticipationincareandcanincludetelephonecalls,writtencorrespondenceand/ordirectcontact.Sucheffortswillbedocu-mentedintheprogressnoteswithintheclientrecord.Inaddition,programswilldevelopandimplementacontactpolicyandproceduretoensurethatclientswhoarehomelessorreportnocontactinformationarenotlosttofollow-up.

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BENEFITS SPECIALTY SERVICES STANDARD MEASURE

Programswilldevelopabrokenappointmentpolicytoensurecontinuityofserviceandretentionofclients.

Writtenpolicyonfileatprovideragency.

Programswillprovideregularfollow-upprocedurestoencourageandhelpmaintainaclientinbenefitsspecialtyservices.

Documentationofattemptstocontactinsigned,datedprogressnotes.Follow-upmayinclude:• Telephonecalls• Writtencorrespondence• Directcontact

Programswilldevelopandimplementaclientcontactpolicyandprocedureforhomelessclientsandthosewithnocontactinformation.

Contactpolicyonfileatprovideragency.Programreviewandmonitoringtoconfirm.

CASE CLOSURE

Caseclosureisasystematicprocessfordisenrollingclients/familiesfromactivebenefitsspecialtyservices.Theprocessincludesformallynotifyingclients/familiesofpendingcaseclosureandcompletingacaseclosuresummarytobekeptonfileintheclientchart.Allattemptstocontacttheclientandnotificationsaboutcaseclosurewillbedocumentedintheclientfile,alongwiththereasonforcaseclosure.

Casesmaybeclosedwhentheclient:◆◆ Successfullycompletesbenefitandentitlementapplications◆◆ Resolvesbenefitsissue◆◆ Seekslegalrepresentationforbenefits◆◆ Relocatesoutoftheservicearea◆◆ Hashadnodirectprogramcontactinthepastsixmonths◆◆ Isineligiblefortheservice◆◆ Nolongerneedstheservice◆◆ Discontinuestheservice◆◆ Isincarceratedlongterm◆◆ Usestheserviceimproperlyorhasnotcompliedwiththeclientservicesagreement◆◆ Hasdied

Benefitsspecialistswillcompleteacaseclosuresummarytoinclude:◆◆ Dateandsignatureofbenefitsspecialist◆◆ Dateofcaseclosure◆◆ StatusoftheBSP◆◆ Reasonsforcaseclosure

STANDARD MEASURE

Clientswillbeformallynotifiedofpendingcaseclosure.

Contactattemptsandnotificationaboutcaseclosureonfileinclientchart.

Benefitscasesmaybeclosedwhentheclient:• Successfullycompletesbenefitandentitlement

applications• Seekslegalrepresentationforbenefits• Relocatesoutoftheservicearea• Hashadnodirectprogramcontactinthepastsix

months• Isineligiblefortheservice• Nolongerneedstheservice• Discontinuestheservice• Isincarceratedlongterm• Usestheserviceimproperlyorhasnotcomplied

withtheclientservicesagreement• Hasdied

Caseclosuresummaryonfileinclientcharttoinclude:• Dateandsignatureofbenefitsspecialist• Dateofcaseclosure• StatusoftheBSP• Reasonsforcaseclosure

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BENEFITS SPECIALTY SERVICESSTAFFING REQUIREMENTS AND QUALIFICATIONS

Atminimum,allbenefitsspecialistswillbeabletoprovidelinguisticallyandculturallyappropriatecaretopeoplelivingwithHIVandcompletedocumentationasrequiredbytheirpositions.Benefitsspecialistswillcompleteanagency-basedorientationbeforeprovidingservices.BenefitsspecialistswillalsobetrainedandorientedregardingclientconfidentialityandHIPAAregulations.

BenefitsspecialistswillholdaBachelor’sdegreeinanareaofhumanservicesand/orcertificationinself-insuranceliability;ahighschooldiploma(orgeneraleducationdevelopment(GED)equivalent)andhaveatleastoneyear’sexperienceworkingasanHIVcasemanagerorHIVpolicyadvocate,oratleastthreeyears’experienceworkingwithinarelatedhealthservicesfield.

BenefitsspecialistswillbeknowledgeableabouttheHIVdiseaseprocessandthepsychologicaleffectsoflivingwithHIV,aswellastheco-morbiditiesofsubstanceabuseandmentalillnessandtheireffectsonthemanagementofHIVillness.

Further,benefitsspecialistswillhave:◆◆ Effectiveinterviewingandassessmentskills◆◆ Abilitytoappropriatelyinteractandcollaboratewithothers◆◆ Effectivewritten/verbalcommunicationskills◆◆ Abilitytoworkindependently◆◆ Effectiveproblem-solvingskills◆◆ Abilitytorespondappropriatelyincrisissituations◆◆ Effectiveorganizationalskills

AllbenefitsspecialistswillsuccessfullycompletetheDHSPBenefitsSpecialtyCertificationTrainingwithinthreemonthsofbeinghired.Inaddition,specialistswillsuccessfullycompletecertificationinRyanWhite/HIPPandADAPwithinsixmonthsofbeinghired,aswellasanyrequisitetraining(asappropriate).

SupervisionforbenefitsspecialtyserviceswillbeprovidedbyaMaster’sdegree-levelprofessional(orBachelor’sdegree-levelwithequivalentexperience)withhealthanddisabilitypolicyexperience,staffmanagementandadministrationexperience.Thebenefitsspecialtysupervisorisrequiredtocompleteallbenefitandentitlement-relatedtrainingasnotedabove.

Benefitsspecialistswillperformtheirdutiesaccordingtogenerallyacceptedethicalstandards,including:◆◆ Strivingtomaintainandimproveprofessionalknowledge,skillsandabilities◆◆ Basingallservicesonatruthfulassessmentofaclient’ssituation◆◆ Providingclientswithacleardescriptionofservices,timelinesandpossibleoutcomesattheinitiationofservices

◆◆ Safeguardingaclient’srightstoconfidentialitywithinthelimitsofthelaw◆◆ Evaluatingaclient’sprogressonacontinuousbasistoguideservicedelivery◆◆ Referringclientsforthoseservicesthatthebenefitsspecialistisunabletoprovide◆◆ Respectingattorney/clientprivilege

SUPERVISION

Supervisionisrequiredofallbenefitsspecialiststoprovideguidanceandsupport.Supervisionwillbeprovidedforallbenefitsspecialistsataminimumoffourhourspermonth

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BENEFITS SPECIALTY SERVICES inindividualand/orgroupformats.Supervisionwillassistinproblem-solvingrelatedto

clients’progresstowardsgoalsdetailedintheBSPandtoensurethathigh-qualitybenefitsspecialtyservicesarebeingprovided.Inadditiontoprovidingdirectsupervisiontocasemanagers,supervisorsareresponsibleformonitoringtheworkofbenefitsspecialiststhroughrecordreviewtoensurethatdocumentationisappropriateandadequatelycompleted.

STAFF DEVELOPMENT AND ENHANCEMENT ACTIVITIES

Toensurethatbenefitsspecialistsareprovidingcurrent,accurateinformationandadvocacyservicestoclients,staffwillberequiredtocompleteannualrecertificationtraining.InadditiontoofferingtheDHSPrecertificationtraining,programswillprovideand/orallowaccesstoongoingstaffdevelopmentandtrainingforbenefitsspecialists.Staffdevelopmentandenhancementactivitieswillinclude(butnotbelimitedto)trainingsand/orin-servicesrelatedtobenefitsspecialtyissuesandHIV/AIDS.Benefitsspecialistswillparticipateinatleasteighthoursofjob-relatededucationortrainingannually.

Thefollowingdocumentation,tobekeptintheemployeerecord,isrequiredforstaffdevelopmentandenhancementactivities:◆◆ Documentedcompletionofbenefitsspecialtycertificationtrainingandrecertificationtraining

◆◆ Documentedcompletionofothertrainings◆◆ Staffmember(s)name(s)attendingfunction◆◆ Nameofsponsororprovideroffunction◆◆ Trainingoutline◆◆ Meetingagendaand/orminutes

STANDARD MEASURE

BenefitsspecialtyprogramswillhirestaffthathavetheabilitytoprovidelinguisticallyandculturallyappropriatecaretoclientsinfectedwithandaffectedbyHIV.

Resumeonfileatprovideragencytoconfirm.

Allstaffwillbegivenorientationpriortoprovidingservices.

Recordoforientationinemployeefileatprovideragency.

BenefitsspecialistswillcompleteDHSP’scertificationtrainingwithinthreemonthsofbeinghiredandbecomeADAPandRyanWhite/HIPPcertifiedinsixmonths.

DocumentationofCertificationcompletionmaintainedinemployeefile.

Staffwillcompletebenefitsspecialtyrecertificationtrainingannuallyandwillseekothertrainingopportunitiesasavailable.

Documentationoftrainingmaintainedinemployeefilestoinclude:• Date,timeandlocationoffunction• Functiontype• Staffmembersattending• Sponsororprovideroffunction• Trainingoutline• Meetingagendaand/orminutes

Benefitsspecialistswillpracticeaccordingtogenerallyacceptedethicalstandards.

Programreviewandmonitoringtoconfirm.

Benefitsspecialistswillreceiveaminimumoffourhoursofsupervisionpermonth.

Recordofsupervisiononfileatprovideragency.

UNITS OF SERVICE

Unit of service:Unitsofservicedefinedasreimbursementforbenefitsspecialtyservicesarebasedonservicesprovidedtoeligibleclients.◆◆ Benefits assessment and service plan units:calculatedinnumberofhoursprovided

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BENEFITS SPECIALTY SERVICES◆◆ Application assistance units:calculatedinnumberofhoursprovided

◆◆ Appeals counseling and facilitation units:calculatedinnumberofhoursprovided

Number of clients:Clientnumbersaredocumentedusingthefiguresforunduplicatedclientswithinagivencontractperiod.

REFERENCES

AIDSProjectLosAngeles.Program Policies & Procedures for Benefits Specialty Services & A Comprehensive Directory to HIV/AIDS Services in Los Angeles County,LosAngeles.

AIDSProjectLosAngeles.ProBenefit$ Handbook: A Professional’s Guide to Public Benefits, Private Insurance and Return to Work Issues for People with HIV,BenefitsandWorkServicesDepartment,LosAngeles.

Ashman,J.J.,Conviser,R.,&Pounds,M.B.(2002).AssociationsbetweenHIV-positiveindividuals’receiptofancillaryservicesandmedicalcarereceiptandretention.AIDS Care,14,Supplement1,pp.S109–S118.

Chernesky,R.H.,andGrube,B.(2000).ExaminingtheHIV/AIDScasemanagementprocess.Health & Social Work,25(4),243-253.

CountyofLosAngeles,HIVEpidemiologyProgram(2005).HIV/AIDS Semi-Annual Surveillance Survey (availableonlineathttp://lapublichealth.org/wwwfiles/ph/hae/hiv/Semiannual_Surveillance_Summary_January_2005.pdf).DepartmentofHealthServices,LosAngeles.

Messeri,P.A.,Abramson,D.M.,Aidala,A.A,.etal.(2002).TheimpactofancillaryHIVservicesonengagementinmedicalcareinNewYorkCity.AIDS Care: Psychological and Socio-Medical Aspects of AIDS/HIV,14(Suppl.1),S15-S29.

ACRONYMS

ADAP AIDSDrugAssistanceProgramAIDS AcquiredImmuneDeficiencySyndromeATP AbilitytoPayProgramsBSP BenefitsServicesPlanCDPH CaliforniaDepartmentofPublicHealthCOBRA ConsolidatedOmnibusBudgetReconciliationActDHSP DivisionofHIVandSTDProgramsGROW GeneralReliefOpportunitiestoWorkHIPP HealthInsurancePremiumPaymentProgramHIPAA HealthInsurancePortabilityandAccountabilityActHIV HumanImmunodeficiencyVirusIHSS InHomeSupportiveServicesMRMIP MajorRiskMedicalInsuranceProgramOBRA OmnibusBudgetReconciliationActPAPS PharmaceuticalPatientAssistanceProgramsSDI StateDisabilityInsuranceSSDI SocialSecurityDisabilityInsuranceSSI SupplementalSecurityIncomeSTD SexuallyTransmittedDiseaseTANF TemporaryAIDtoNeedyFamiliesUI UnemploymentInsuranceVA VeteransAdministrationWIC Women,InfantsandChildren