This document is intended to assist grant recipients/subrecipients and planning bodies with developing local service standards. Please use this resource when developing service standards and monitoring the delivery of health services across your local continuum of care. If you have any questions regarding service standards, please consult your HRSA HIV/AIDS Bureau Project Officer.
What are Service Standards? | What Should be Addressed in Service Standards? | How are Service Standards Developed? | Why are Service Standards Important? | How Often Should Service Standards be Reviewed for Accuracy and Relevance? | How are Service Standards Used? | What Resources Exist When Developing Service Standards?
Service Standards outline the elements and expectations a Ryan White HIV/AIDS Program (RWHAP) service provider follows when implementing a specific service category. The purpose of service standards are to ensure that all RWHAP service providers offer the same fundamental components of the given service category across a service area. Service standards establish the minimal level of service or care that a RWHAP funded agency or provider may offer within a state, territory or jurisdiction.
Service Standards applies to “standards of care’ in RWHAP Parts A and B manuals. Outside of RWHAP services, “standard of care” has been used to refer to acceptable levels of medical care and treatment rendered. Therefore, the term “service standards” is used to encompass services offered through RWHAP funding.
Service standards must be consistent with applicable clinical and/or professional guidelines, state and local regulations and licensure requirements. The variability in state/local regulations and requirements prevents the adoption of national service standards for the RWHAP, and thus they must be set at the grantee level. Medical care service standards must be consistent with U.S. Department of Health and Human Services (HHS) care and treatment guidelines as well as other clinical and professional standards. For non-clinical services, service standards may be developed using evidence-based best practices, the Part A and B National Monitoring Standards, and guidelines developed by the state and local government. As a result, service standards are essential in defining and ensuring that consistent quality care is offered to all clients.
Service standards set a benchmark by which services are monitored, and subrecipient contracts are developed. Each funded service category must have a unique set of service standards. There may be some overlap of service standards among two or more service categories (e.g., medical case management and non-medical case management may both assist with enrolling clients in insurance assistance programs).
Each categorical specific service standard should include:
- Service Category Definition
- Intake and Eligibility
- Key Services Components and Activities
- Personnel Qualifications (including licensure)
- Assessment and Service Plan*
- Transition and Discharge
- Case Closure Protocol
- Client Rights and Responsibilities
- Grievance Process
- Cultural and Linguistic Competency
- Privacy and Confidentiality (including securing records)
- Recertification Requirements*
* Where Applicable
It is ultimately the responsibility of the grantee to ensure that service standards are in place for all funded service categories.
For RWHAP Part A grant recipients, developing service standards is a shared responsibility, typically led by the Planning Council. For Part B grant recipients, advisory committees and grantees are encouraged to obtain public input in the development of the service standards. Often this is done through a committee or workgroup body.
For Part A and B grant recipients, the development of service standards is a shared responsibility of the grant recipient and the planning body. Grant recipients and planning bodies may determine the order in which they are developed based on various criteria including: funding allocation level, service category prioritization, service utilization and changes in the national and local health service delivery systems. In addition, grant recipients and planning bodies should obtain input from providers, consumers and experts when developing standards to provide technical input and recommendations for service delivery, and to ensure that full consideration and diverse perspectives are included in service specific service standards. The roles and development process may vary for each jurisdiction.
For Parts A and B, service standards should, at minimum, also follow the programmatic and fiscal management requirements outlined in the Part A and B National Monitoring Standards. For Parts C and D, medical care standards should be based on the latest HHS HIV guidelines.
For Part C and D grant recipients, the development of service standards are done on the organizational or agency level and are often referred to as “Policies and Procedures.” Each Part C and D grant recipient is expected to have policies and procedures in place on patient eligibility, enrollment, available services, as well as a patient grievance and discharge procedure. In addition, clinics and health care agencies are further guided by accrediting organizations (e.g., The Joint Commission) and regulations and guidance (e.g., Medicare Fee-For-Service Payment Regulations). All applicable standards and policies should be vetted by the legally responsible authority of the agency, usually the Board of Directors. Part C and D grant recipients are encouraged to refer to the most recent funding opportunity announcement for additional guidance on recommended policies and procedures.
Why are Service Standards Important?
Service standards are important to various stakeholders, with the goal to improve client and public health outcomes.
- Consumers - Service standards ensure the minimal expectation for consumers accessing or receiving RWHAP funded services within a state, territory or jurisdiction.
- Service Providers - Service standards define the core components of a service category to be included in the model of service delivery for each funded service category.
- Grant Recipients - Grant recipients are responsible for ensuring the development, distribution, and use of the service standards. Service standards are important to ensure that services are provided to clients in a consistent manner across service providers.
- Quality Managers - Service standards are the foundation for the clinical quality management program, and provide the framework and service provision from which processes and outcomes are measured.
- Planning Bodies - Service standards assist planning bodies with understanding what activities are being provided
Service standards must be reviewed regularly and updated to reflect the most current nationally recognized guidelines in HIV care and treatment and local requirements. Therefore, planning bodies and grant recipients should build into their annual work plan a time to review existing standards. Service standards should be publicly accessible so clients and providers can become familiar with them.
For Parts A and B grant recipients, service standards should be included in Requests for Proposals when service categories are competitively bid as the service standards outline the key components of each service category, guide the implementation of each service category, and form the basis for monitoring service delivery, including site visits and chart reviews. Grant recipients should use service standards when conducting programmatic site visits, chart reviews, and routine monitoring of subrecipients to determine if service providers are meeting the minimal expectations and adhering to service standards.
For Parts C and D grant recipients, service standards can be used in establishing definitions for services in Memorandum of Understanding or contracts. In addition, Service Standards can be used in policies and procedures to define elements for monitoring in quality improvement activities and to implement change activities for service and clinical improvement.
- RWHAP National Monitoring Standards - The National Monitoring Standards are designed to help RWHAP Part A and B (including AIDS Drug Assistance Program) grant recipients meet federal requirements for program and fiscal management, monitoring, and reporting to improve program efficiency and responsiveness.
- HRSA HIV/AIDS Bureau TA website - Has samples of ‘standards of care’ established by various grantees within the RWHAP, which may be adapted to other jurisdictions.
- HHS Clinical Guidelines for the Treatment of HIV/AIDS - HHS issues a series of guidelines to help clinicians treat people with HIV in the United States. Clinical guidelines outline the science and recommendations for treatment of HIV disease (e.g., antiretroviral therapy, opportunistic infection treatment and prophylaxis) as well as guidelines for conducting HIV testing and counseling. Developed by various panels of clinical experts, these are frequently updated and should be accessed at Clinical Info.HIV.gov.