Q&A
(from 12.11.15, 2.3.16, and 2.17.16 meetings with providers)
Reordered By Category – 3/4/16
COMMENTS FROM HRSA
In a conference call with providers on February 3 and 17, HRSA Program Officers made comments
regarding the eHARS to CAREWare project including:
This is great work – and innovative – many jurisdictions are just thinking of how to approach this
type of project. Data is becoming more and more important to coordinate. Good data helps you to
look at your care continuum and find gaps and opportunities. We are making funding decisions
based on data and knowing what the ‘unmet need’ is in the jurisdiction. We find that jurisdictions
are offering more and more support services that aren’t covered under insurance (such as housing).
We need to know what the health outcomes are related to the services (using collected data) to
better fund those services.
There is a nation-wide trend of putting resources into medical case management. Medical case
managers are the link to getting people into care and keeping them virally suppressed. We
recognize them as a key public health intervention for greatly improving health outcomes through
their work. Thank you again for taking on this project!
SUMMARY CONTEXT
In December 2014, MDH, DHS, and Hennepin County launched a pilot project with 7 Ryan White
service providers. The purpose was to pilot ways to connect the HIV/AIDS Surveillance System or
eHARS (enhanced HIV/AIDS Reporting System) with CAREWare. The experience of pilot providers
helped to inform and improve the process to the point that grantees decided to ask for full
implementation of the project as of March 1, 2016 among all Ryan White service providers. The
purpose of this effort is to ensure that a system is in place that provides better data for improving
care for the HIV community. The way to make this system work is to have all clients sign a release
of information (ROI) form so that the pertinent data can be compiled and used in determining
statewide statistics. The ROI is required because government security officers have determined
that we have to have an agreement from the client to share data.
Providers can also serve their clients better with this shared limited surveillance data (for those
clients who give consent). Case management and primary care are the logical points for having an
ROI signed. A signed ROI means provider staff can view:
• HIV diagnosis date/AIDS diagnosis date/HIV status
• Vital status and date of death
• All CD4counts (date, type of test, result)
• All viral load labs (date, type of test, result)
Note: All CD4 counts and viral load labs (date, type of test, result) can only be viewed by
case managers and clinical staff in provider domains that serve the client.
Also, if each provider is able to get 90% of their clients to sign an ROI, grantees will review the
possibility of eliminating Form 1.
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The following are questions asked (and answers given) in 3 meetings with providers
(December – February 2016) and presented in general themes.
RELEASE OF INFORMATION (ROI) FORMS
 We have many clients we don’t often see face-to-face for services. Won’t it be very difficult for us to
ask all of these clients to fill out these ROIs and track them?
o Break it down. This will happen over time as you interact with clients whether face to
face or not.
o For those you see at least once a year:
 At the regular recertification of income, insurance, or residency (anytime you
need to meet with clients for recertification), add the ROI into those regular
signing opportunities
 When an ROI is signed and you submit the form, MDH will enter the client in the
system
o For those clients you don’t see face to face:
 Use the same process that you currently use to recertify them to have them sign
the ROI. Also, the ROI will be presented to clients at other agencies as well – any
program can access a list of clients who have signed an ROI
o We will follow a phased process:
 In 2016, MDH will quarterly provide a list of clients who have not yet signed an
ROI
 In 2017 and beyond, providers will run their report on their own
 Providers need to go into CAREWare to get this data
 If providers need assistance, MDH can provide emails with screen shots
to show people how to run the report

If a client transfers to another agency, will they have to sign another ROI?
o The ROI is client based and the new agency will be able to see that they already have a
signed ROI
o Right now you can generate a report that shows all people who have signed an ROI but
we are looking into being able to create a report that shows those who don’t have one
o DHS is going to send out this form to their clients on Program HH
o Already from the pilot project, we have 13% (600) ROI’s already signed

We have clients who won’t sign anything – what should we do?
o This is up to them; they just won’t be in the system

What is available to community based providers after getting the client to sign the ROI?
o Providers should be able to run a report to show who has signed an ROI
o If you are a CM or Clinical Provider, you will be able to see their labs,
o Call CAREWare help desk if you need help with running the reports

Asking clients to sign again in five years would require more tracking on our part. How can we
know when the ROI needs to be resigned?
o Providers can run a report that tells them when the ROI expires.
o This affects providers only in December 2018 or 2019 so the burden is not that great.
o Let’s see how it goes in 6-12 months – grantees can better respond to any problems or
barriers at that time

What if half of my clients sign the ROI and half do not, do I need to be doing Form 1 for the half of
my clients who do not?
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o
Once we reach the 90% participation threshold for each provider, we will consider
retiring Form 1 for all providers. Until that time, Form 1 must be filled out whether an
ROI is signed or not.

Will the 600 ROI’s already in place due to the pilot be included in the quarterly report?
o Yes

Does this mean that clients in the pilot won’t have to sign again?
o They won’t have to sign again for 5 years

What happens if the client decides to revoke the ROI?
o The data already in the system will remain in the system, but new data will not be
loaded.

What is the best way to ask a client to sign an ROI form
o Simplify your explanation – Just explain how this form will allow other organizations to
get and share information– ‘it’s an easier way and will reduce the number of forms you
will have to sign’

This form is at a high reading level – is it possible to simplify it?
o It had to go through 3 legal teams, so probably not
o This is the main reason why it has to be presented to the client instead of just handing
the form to the client
o We have created a FAQ to help with explaining terms
IMPLEMENTATION PLANS
 What are the ways that providers can get help from the grantees?
o Use the MDH website as the first place to look for guidance and answers
o Contact the Help Desk which will triage the type of problem and then send it to the
appropriate staff to answer
o When many providers identify similar issues or areas of concern, grantees will do one
or more of the following:
 send out a clarifying email or notice
 send out revised procedures
 hold a meeting/training
o We will hold one to two provider CAREWare meetings annually to review results and
address any questions

Have you considered listing someone as a Liaison for clients to call to ask questions or learn more
about this?
o Jonathan Hanft will be the contact person to trouble-shoot and respond to client
questions.

How does this affect our clients who don’t have data? (e.g., Tribal communities who are not
required to report to surveillance)
o We are only asking that clients sign an ROI. If there is no lab reported to MDH, then we
have no data to report. A small percentage of Ryan White clients (less than 1%) are not
in eHARS.

Is it possible to run ROI reports for PDI providers?
o Yes – here are several options
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MDH can run reports and xport the report into WINSCP. The provider can then
retrieve from the CAREWare server
Providers can run them themselves
We are hoping jPROG will enable us soon to have a box on the front screen that
shows whether the client has an ROI signed
PROVIDER AND GRANTEE ROLES & RESPONSIBILITIES
 Is provider agency funding contingent on participation in this program? Is it required to
participate?
o The answer is ‘No’ in the short term but ‘possibly’ in the long term. It is clear that HRSA
has a strong focus on data so they can continue funding services. Because the data is
used to evaluate the program, if we don’t have outcomes to review, it could affect
funding. We need to measure the effectiveness of the programs so we can be good
stewards of funding. It will be part of the criterion we use to select providers to fund in
the future.

What is expected of provider agencies participating in this project?
o Providers will ask all clients who have not signed an ROI to sign an ROI (this is written
into the contract). This will be easier than it may sound:
 Clients may be getting the ROI signed at another provider
 Program HH is sending this form in its recertification packet
 12% of all clients already have an ROI
o Providers will use the information gained to improve your services; this will be
considered as you work on your QI goals
o Looking for each provider to have 90% of clients signed ROI – if this happens, we may
eliminate Form 1 For this to happen all providers would need to achieve 90%.
HOW WILL THE DATA BE USED AND PROTECTED
 How will individual follow-up with clients out of care occur?
o The data will be used in aggregate and not associated with individual clients. The
aggregate data can be used to help providers improve overall agency outcomesThis
process should only be for helping us at population levels.
o Independent of signing an ROI, when public health agencies (MDH and Hennepin
County) see that someone is out of care based on CD4 counts and viral loads in eHARS,
a CareLink Navigator will reach out to an individual who is out of care. When clinics and
case management agencies have this information, they can reach out to their clients
more quickly. Hennepin County and DHS expect that all funded providers will actively
reach out to clients who are not retained in medical care.

Our clients aren’t confident that the data will continue to be private; they want it to be in a
vacuum; how can we ensure the security of the data?
o CD4 and Viral Load data is only seen for your clients
o Access is restricted by permissions and the staff’s role
o We follow CDC guidelines for security – participating agencies have completed a
security assessment
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ADMINISTRATION & MANAGEMENT
 Can we get reimbursed for the work to get ROI’s signed?
o If the provider gets reimbursed on a unit rate contract, this can be billed the same as any
recertification work.
o For cost reimbursement contracts, this activity will fall under programmatic costs.

Can we get a report on a client’s CD4 count?
o Not a report, but you can see it in the individual client record (clinical tab)
o We are looking for a way to give you a report on this
o Might already be able to get an alert for CD4 count
o For those with stable suppression, most clinicians are not ordering CD4 counts and
Ryan White is most interested in the viral load for overall suppression views

What will the delay be on seeing the data?
o About a 3 month delay depending on whether the data comes in a paper form to MDH or
there is delayed entry by the clinic staff

We had a client who came from HCMC who wasn’t in the CAREWare system – why not?
o If the client was not getting service funded by Part A or Part B they won’t be in the
system, or
o If they were relatively new to the system, their data probably hadn’t gotten through the
system yet

As a case manager, how do I explain the larger picture and the surveillance piece?
o Explain to clients that it will help other agencies (such as Aliveness providing their
meals)
o Speak to the broader public health piece – help the client understand that it not only
promotes their own good health but also helps to prevent new infections within the
community – everyone’s health is improved
o Especially for the clinical programs, perhaps we can get clinical staff together to draft
something that spells it out for their settings
RELATIONSHIP TO PROGRAM HH - DHS
 Couldn’t DHS send this ROI out as a program HH mailing?
o DHS is sending out ROIs as a part of the program HH mailing
 Would it be possible to remove the CD4 and viral load questions from the program HH application,
especially if we will be doing eHARS to CAREWare?
o DHS is in the process of determining if these can be changed on the application and will
follow up on this with eligibility specialists.
 Will the client still have to sign Program HH forms?
o Yes at the moment, the form is still required for this year, but this may change as we go
forward
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