Revisions to the Standards for the Designated AIDS Centers: DOHM AI 08-01

This Memorandum supersedes the following Department of Health communications regarding the Designated AIDS Centers:

  1. DOHM 86-32 - Request for Applications for Designated AIDS Centers
  2. DOHM 89-95 - Pediatric and Maternal Human Immunodeficiency Virus (HIV) Services in Hospitals
  3. DOHM 93-25 - Supplement to DOH Memorandum 86-32 Update of Program Standards For Designated AIDS Center Hospitals
  4. Issuance of Revised AIDS Center Program Standard 17-Case Management

Background

The Designated AIDS Center program was established more than 20 years ago as part of the New York State Department of Health's first response to the AIDS epidemic. The standards for Designated AIDS Centers (DACs), last updated in 1993, do not fully reflect the current programmatic and organizational complexities of providing high quality HIV/AIDS care in today's health care environment.

The disease burden of HIV has shifted the paradigm of HIV health care from an acute to a chronic diseases medical model, with patients living longer, healthier lives. There is a need for basic, integrated primary care and preventive services and the availability and accessibility of subspecialty care for disease conditions associated with aging, and long term ARV therapy.

The financial environment for hospitals has also changed. Medicaid Managed Care, including HIV Special Needs Plans, has become the primary payor for Medicaid for many health care organizations. Increasing, hospitals will be negotiating rates rather than depending on the traditional fee for service methods.

Facilitated by the New York Commission on Health Care Facilities in the 21st Century, health care systems are in the process of rightsizing. Many HIV programs will be faced with reorganization or relocation out of the hospital setting and into off-site clinics, removing the HIV programs from the set of on-site services traditionally required, further complicating the delivery of the expanded set of services needed.

The AIDS Center program was developed and remains a patient-centered program model that can evolve with the needs of the patient in the changing health care environment.

AIDS Centers provide a primary care home for the person with HIV. Patient outcomes improve when care is seamless, coordinated by a care manager utilizing multi-agency, multi-disciplinary health care teams. The most effective care model is patient-centered and is simple to navigate for the needed services. AIDS Centers must enhance coordination with their community-based partners to identify patients at risk, help patients access and remain in care, and understand and adhere to their complicated regimens.

The new emphasis for the AIDS Centers should be on developing integrated care networks, supported by various funding streams, including State, Ryan White and Medicaid. These networks should encompass community-based providers offering COBRA case management, services agencies funded by Ryan White, Medicaid Managed Care Plans including the HIV Special Needs Plans, Adult Day Care and treatment education and adherence programs. All contribute to a comprehensive service package needed by the patient.

Enhancement of our collective capacity and use of health information technology to identify and reach those persons in the community most at risk for HIV and not yet diagnosed is critical. This includes normalizing and streamlining HIV testing and the attendant linkages to care for the newly diagnosed.

Summary of Significant Changes

  • Revised and streamlined Standards outline a comprehensive, collaborative, integrated system of service provision that embraces new priorities;
  • Developing systems to improve early diagnosis by reaching out to populations at risk and not yet diagnosed;
  • Developing mechanisms that assure consumer input in to program planning, implementation and quality management;
  • Strengthening Statewide and community-based efforts to increase patient engagement and retention in care;
  • Enhancing the coordination with CBOs for extended support to help patients navigate the health care system and remain in care;
  • Providing adherence support and treatment education as an integral part of engagement and retention;
  • Promoting wellness, health education and health maintenance with an increased focus on risk factors for major chronic diseases, including harm reduction interventions for HIV-infected individuals, education and primary care, to reduce preventable causes of illness and to improve health outcomes;
  • Assuring the availability and accessibility of subspecialty care for non HIV-associated medical conditions; and
  • Expanding the use of health information technology (electronic data systems) to support quality improvement, evaluation, communication among care providers and cost containment.

Thank you for your participation in the AIDS Center Program. If you have any questions about these Standards, please contact:

Ellen Tanner, Director
Bureau of HIV Program Review & Systems Development
Division of HIV Health Care
NYS Department of Health AIDS Institute
Empire State Plaza, Corning Tower, Rm. 372
Albany, NY 12237
(518) 486-1383

Humberto Cruz, MS
Director, AIDS Institute
New York State Department of Health

The Revised Standards