Outpatient/Ambulatory Health Services Standards

Ryan White HIV/AIDS Treatment Extension Act of 2009

Approved March 1, 2022

Prepared by:

Service Standards & Integrated Care Plan Committee

Middlesex-Hunterdon-Somerset HIV/AIDS Health Services Planning Council

Outpatient/Ambulatory Health Services Definition: Outpatient/Ambulatory Health Services provide diagnostic and therapeutic-related activities directly to a client by a licensed healthcare provider in an outpatient medical setting. Outpatient medical settings may include: clinics, medical offices, mobile vans, using telehealth technology, and urgent care facilities for HIV-related visits. Allowable activities include:
  • Medical history taking
  • Physical examination
  • Diagnostic testing (including HIV confirmatory and viral load testing), as well as laboratory testing
  • Treatment and management of physical and behavioral health conditions
  • Behavioral risk assessment, subsequent counseling, and referral
  • Preventive care and screening
  • Pediatric developmental assessment
  • Prescription and management of medication therapy
  • Treatment adherence
  • Education and counseling on health and prevention issues
  • Referral to and provision of specialty care related to HIV diagnosis, including audiology and ophthalmology

Program Guidance:

Treatment adherence activities provided during an Outpatient/Ambulatory Health Service visit are considered Outpatient/Ambulatory Health Services, whereas treatment adherence activities provided during a Medical Case Management visit are considered Medical Case Management services.

Non-HIV related visits to urgent care facilities are not allowable costs within the Outpatient/Ambulatory Health Services Category.

Emergency room visits are not allowable costs within the Outpatient/Ambulatory Health Services Category.

Outpatient/Ambulatory Health Services for the Middlesex, Somerset, Hunterdon TGA includes the above definition of medical care, but also consists of:

  • Referrals to other social service agencies
  • Education on risk reduction for themselves and to prevent disease transmission to others.
  • Assessing, promoting and educating patients on medication adherence

Source: HIV/AIDS Bureau Policy Clarification Notice (PCN) #16-02 (2018)

Staff Service Standards

(Outpatient/Ambulatory Health Services)

Policy
Number
Activity/IssueMinimum Acceptable Threshold of ServiceAccountability Mechanism
1.1Staff hiringStaff will have necessary skills and experience determined by
*Written application
*Resume
*References
*Personal interview
100% of personnel files include documentation of an application, resume, and communication with personal references
1.2 (a)Staff qualificationsStaff have a diploma, certificate
or license (if appropriate) or experience documented in personnel file
100% of staff possesses a diploma/GED or the required experience documented in personnel file
1.2 (b)Staff qualifications
Peer Navigator
A member of the peer community living with HIV with a high school diploma or GED, plus two years of social service experience. Peer must demonstrate understanding of HIV services and healthcare service navigation.100% of staff possesses a diploma/GED with the required experience documented in personnel file
1.3Staff job descriptionsStaff will be given a written job
description. The job description
includes definition of services
100% of staff has job description and service standard documented in personnel file
1.4Staff trainingStaff are trained and knowledgeable on:
*HIV and the affected community including disease process, co-morbidities and psychosocial effects of the disease.
*Cultural humility.
*Entitlement programs, benefits to clients, and community resources/support services
*Client confidentiality, client rights, agency grievance procedures
100% of personnel files have documented training
1.5Staff continuing educationStaff participate in at least one continuing education training per year that is available and appropriate.
100% of personnel files have documented training
1.6 (a)Staff supervisionSupervisors are knowledgeable
about RW HIV services and
procedures including fiscal and
program

Staff will receive (at minimum)
one hour supervision per week to
develop skills
100% of supervisors are knowledgeable about the RW program


Supervision is documented in personnel file

1.6 (b)Staff supervision
Peer Navigator
All peer navigators will receive (at minimum) one hour supervision per week to include patient case conference, peer navigator job performance, and skill development.Supervision is documented in personnel file

1.7Policies and proceduresSigned form is documented in
personnel file.
100% of staff agrees to follow agency policies and procedures

1.8Staff evaluationStaff evaluations are documented in
personnel files.
100% of staff is evaluated on their performance annually

1.9DocumentationStaff will keep written
documents of contact with clients in
accordance with RW data collection
procedures
100% of all contacts are documented in client files

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