Attachment 2

AIDS Institute’s Cross Sector Collaborations Requirements

(Components A, B, C and E ONLY)

Applicants are required to establish collaboration agreements (e.g., memorandum of understanding [MOU], memorandum of agreement [MOA], service agreements) with a comprehensive network of medical providers, community based organizations, and State and local health departments to ensure adequate coverage of HIV/STD/HCV prevention and care services for clients of the priority population(s). The goal of the network is to encourage collaboration, facilitate information exchange, reduce duplication of efforts, and to facilitate timely client-centered linkages. Signed Authorization for Release of Health Information and Confidential HIV-Related Information (DOH-2557) forms must be signed by clients to authorize the release of health information including HIV-related information between medical providers and community based organizations. NYSDOH AIDS Institute encourages that releases be made valid for a period of two (2) years or based on the client’s request for a shorter timeframe.

When establishing collaboration agreements, consider the following

  1. Proximity and accessibility of the medical provider and/or community based organization within your service area(s); ​
  2. The medical provider’s capacity and history as it relates to care and treatment of HIV positive persons, STD and HCV services, and priority population; and ​
  3. The community based organization’s capacity and history of providing supportive services to the priority population, HIV positive persons, and those of unknown HIV status (e.g., housing, substance abuse services, counseling, mental health services, treatment adherence, etc.).

Establish collaboration agreements that include, but are not limited to, the following:

  1. Name and address of the provider(s);
  2. Name, title, and contact information for the primary point of contact for the provider;
  3. Description of the services provided at the agency and/or medical provider;
  4. Description of reimbursement mechanisms;
  5. Specific linkage procedures;
  6. Description of the exchange of patient identifying health information;
  7. Description of how agencies will obtain results regarding the outcome of the linkage;
  8. Medical Care: Description of the agreed-upon processes that will be used to link newly diagnosed and out-of-care HIV positive individuals to HIV medical carewith CD4 or viral load tests performedwithin 30 days of date of diagnosis and client’s readiness to reengaging in HIV medical care; ​ and
  9. Essential Supportive Services: Description of the agreed-upon processes that will be used to deliver supporting services pending client’s readiness to engage in services.