From HRSA's HIV/AIDS Bureau
Dear Ryan White HIV/AIDS Program Colleagues:
The Health Resources and Services Administration’s (HRSA) HIV/AIDS Bureau (HAB) understands that the COVID-19 public health emergency has had a significant impact on Ryan White HIV/AIDS Program recipients and sub-recipients and your ability to provide HIV care and treatment services to people with HIV. HRSA HAB acknowledges this impact and wants to provide guidance to address your concerns.
In response, today [September 10] we released a new program letter [and below] regarding the COVID-19 public health emergency and its impact on clinical and programmatic operations and workflows and, subsequently, on client services, performance measure data, and health outcomes.
We continue to be inspired by your hard work, particularly during these challenging times. We are proud of our collective ability to work together through these unprecedented times.
Laura Cheever and Heather Hauck
Associate Administrator and Deputy Associate Administrator
HIV/AIDS Bureau, HRSA
September 10, 2020
Dear Ryan White HIV/AIDS Program Colleagues,
The Health Resources and Services Administration (HRSA )HIV/AIDS Bureau (HAB) appreciates the diligent efforts and tireless dedication of Ryan White HIV/AIDS Program (RWHAP) recipients and subrecipients during the Coronavirus 2019 (COVID-19) public health emergency. We understand that RWHAP recipients and subrecipients had to quickly and thoughtfully assess the risks and benefits of current clinical and programmatic operations and workflows, incorporate Department of Health and Human Services (HHS) Interim Guidance for COVID-19 and Persons with HIV, and use the best information available at the time to make difficult decisions about the delivery of services to people with HIV. In response, we ask recipients to:
- Document the changes to clinical and programmatic operations and workflows that may have had an effect on performance measures data, particularly retention and viral suppression.
- Ensure performance measure thresholds and payment models using performance measure thresholds account for any changes in service delivery during this period.
- Address and document the impact COVID-19 has had on health outcomes.
- Continue to follow the HHS HIV medical practice guidelines including the antiretroviral and COVID-19 guidelines.
I have personally heard about changes RWHAP recipients and subrecipients have made in the context of evolving clinical and programmatic shifts. For example, RWHAP recipients and subrecipients have adjusted their workflows to accommodate more acute or sick medical visits and fewer routine or non-urgent medical visits; have rapidly opted for medical visits via telehealth; and delayed ordering routine labs to protect the health and safety of people with HIV. RWHAP recipients and subrecipients will continue to assess the risks and benefits, which may result in the continuation of these changes to clinical and programmatic operations and workflows for the near future.
As a reminder, RHWAP recipients can use the FY 2020 Coronavirus Aid, Relief and Economic Security (CARES) Act funding to address challenges occurring because of the COVID-19 public health emergency. The following list is not exhaustive, but includes suggested uses for CARES Act funds as well as other actions to take during the COVID-19 public health emergency.
- Determine how the healthcare team can screen and address emerging medical and psychosocial issues (e.g., behavioral health effects related to social distancing or isolation).
- Address the range of issues that would support successful implementation of telehealth. The use of telehealth is highly encouraged to promote access to and continuity of care in a safe way during social distancing.
- Review current performance measure definitions, including numerator and denominator descriptions, to ensure they capture information provided in the HHS Interim Guidance for COVID-19 and Persons with HIV (e.g., medical visits delivered via telephone or virtual visits).
- Document and monitor performance measure trends seen during the COVID-19 public health emergency, particularly those trends that vary significantly from what data have shown in prior years for the same time period.
- Note the effects of the COVID-19 public health emergency on clinical and programmatic operations and workflows when reviewing performance measure data for the time period spanning the COVID-19 public health emergency.
- Continue to monitor trends in services and care delivery that may not be evident for this time period, but may show in the future such as increases in substance use or mental health services and their relation to viral suppression and slowing or pausing of quality improvement activities.
- Contact HRSA HAB for guidance on or technical assistance for your clinical quality management activities during the COVID-19 public health emergency at [email protected].
Thank you for your continued commitment to ensuring that the RWHAP provides an optimal, comprehensive system of quality care and treatment for people with HIV. Please contact your project officer if you have any questions and to share any challenges you are facing, or anticipate facing, concerning the COVID-19 public health emergency.
/Laura W. Cheever/
Laura W. Cheever, MD, ScM Associate Administrator