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Care and Services, Dept of Veterans Affairs

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Assess and evaluate claims and, if in order, make disability compensation or pension payments to eligible veterans with HIV-related illnesses.

1. Implement published final regulatory criteria effective March 24, 1992, for evaluating manifestations of HIV-related illnesses.
2. Publish amendment to portion of Schedule for Rating Disabilities.

Assist Departmental training programs to ensure widespread awareness of VA policies related to HIV/AIDS.

Expand outreach efforts to increase awareness of the VA's HIV/AIDS programs.

Include information on the VA's HIV/AIDS-related policies and accomplishments at external presentations, i.e., service organization meetings, town meetings.

Provide HIV testing and counseling to high risk groups of patients and/or patients who request testing.

1. Provide HIV testing and make counseling services available at every VA medical center and/or VA outpatient clinic throughout the system;
2. Train professional health-care staff to serve as HIV counselors and patient educators on HIV prevention and transmission;
3. Establish quality laboratory standards for HIV testing, including ELISA and Western Blot; and Ensure implementation of policy prohibiting routine involuntary screening.

Protect patients' rights to information and self- determination in HIV testing process.

1. Ensure that HIV testing is performed only with written informed consent, utilizing standardized written informed consent form, by law and policy.
2. Provide counseling and patient education on prevention and transmission performed by trained health-care professionals.
3. Ensure that patient education pamphlets explaining how to obtain an HIV test in a VA facility is available.

Protect patients' rights to confidentiality in HIV testing and/or infection.

1. Ensure that medical records of veteran tested for or infected with HIV are subject to additional confidentiality (beyond Privacy Act), by law, regulation and policy.
2. Implement safeguards to assure that: veteran HIV testing or status is released only with patient's written authorization with exceptions to disclosure (public health agencies, spouse, sexual partners) only under specified conditions;
3. VA staff's access to medical records only on "need to know" basis; and legal, clinical and administrative staff are trained in confidentiality regulations and policy.

Protect patient's rights to non-discrimination in admission to or treatment in VA health-care facilities.

1. Ensure non-discrimination in admission and treatment on the basis of HIV status, established by law and policy.
2. Implement safeguards to assure that: access to medical treatment based on clinical judgment, not HIV status; legal, clinical and administrative staff are trained in regulations and policy with periodic updates and consultation available; and patient representatives and clinical staff are available in all facilities for patient grievances.

Provide state-of-the-art medical treatment for patients with HIV infection or AIDS given by professional health-care staff educated and current in state-of-the-art HIV/AIDS treatment and make available of appropriate pharmaceuticals and therapeutics at health-care facilities.

1. Provide FDA approved pharmaceuticals and therapies at local medical centers, outpatient clinics or health-care facilities or referral medical centers in VHA networks.
2. Provide compassionate use of therapies under research protocols at referral or other medical centers and facilities throughout system.
3. Promote integration of clinical treatment and research in HIV/AIDS. Establish and maintain "Centers of Excellence" for the care of HIV/AIDS patients utilizing multidisciplinary models of care.
4. Facilitate physician and other clinician participation in local and national educational programs, professional societies, local, and state and national advisory groups.
5. Support on-going education and training of health-care and support staff throughout system.
6. Encourage establishment of formal and informal physician and clinician networks for treatment advice.

Provide a full range of medical and psychosocial services to meet veteran's comprehensive care needs.

1. Provide specialty and subspecialty care in medicine, surgery, psychiatry, psychology, rehabilitation in medical centers and/or networks.
2. At the medical center level, provide comprehensive social services and counseling including family, housing and community referrals.

Provide consultation on legal, clinical and policy issues related to the care of HIV-infected patients.

1. Address and/or refer to the appropriate individuals, questions and inquiries from external agencies, field staff, and veterans on issues related to HIV infection and AIDS.
2. Maintain and establish, as needed, special advisory groups of interdisciplinary field experts to address problems or issues requiring national focus.
3. Include veterans in deliberations, as appropriate.
4. Implement, through policy, guidelines and recommendations of CDC, PHS, OSHA and other Federal agencies specific to HIV/AIDS and bloodborne pathogens.

Assess the impact of the HIV/AIDS epidemic on VA health-care system for resource utilization and planning purposes.

1. Maintain confidential HIV/AIDS Registry of all patients treated in VA health-care facilities. Evaluate workload distribution by medical center to determine geographical distribution.
2. Utilize workload information as validation tool in resource allocation process.
3. Include special field advisory group in resource planning and management in the allocation process for HIV/AIDS care.

Participate in interagency planning on issues related to HIV/AIDS. Provide expertise, when requested, on special issues.

1. Cooperate and collaborate with other agencies such as CDC on special issues such as HIV-infected health-care workers, when requested.
2. Provide expertise from field. Involve other agencies, as appropriate, on special issues in HIV/AIDS.
3. Utilize OSHA, HHS, CDC, FDA expertise on specific issues, as necessary.

Ensure that Federal, State, County and local officials are aware of Department policies and procedures concerning treatment of personnel and veterans with HIV/AIDS.

1. Monitor status of pending legislation for State, County and local officials.
2. Serve on committees that develop and review Department policies when requested.

Ensure Department policies and procedures comply with Federal law.

Interpret Federal laws that impact on VA's HIV/AIDS program. Provide legal advice and counsel to program officials. Serve on committees that develop and review Department policies when requested. Review new and updated policy directive on HIV/AIDS.

Description

Medical care and services.

* Resources for HIV/AIDS care are derived from the general Medical Care Budget. FY 1995 figures are reported expenditures. FY 1996 and FY 1997 are based on the projected number of patients by category or stage of disease and estimated resources required, as reported in the President's budget.

Eligible HIV positive veterans.

Eligible veterans through local medical centers and facilities.

Appendix C: Care & Services

Housing and Urban Development - Appendix C: Care & Services

Substance Abuse & Mental Health Services Administration - Appendix C: Care & Services

Department of Justice

Department of Defense

Agency for Health Care Policy & Research

Social Security Administration

Corporation for National Service

Health Care Financing Administration

Health Resources & Services Administration

Office of Personnel Management

Indian Health Service

Care and Services, Dept of Veterans Affairs