RSR Frequently Asked Questions
RSR Frequently Asked Questions
Can I report date of notification for 'death date'?
No. If you cannot report the client's actual full date of death, you should leave that item "blank" or report the item as "unknown". If you know the year of death but not the day, you should report "01" for the month and day in accordance with the instructions provided in the Data Dictionary. The date of notification should not be reported for this data element.
Does 'first date of service' in the Client Report mean the first HIV-related service?
Not necessarily. The date of first service visit is the date the client first received a service at your agency, regardless of the reason. It may or may not be the client's first HIV-related visit or their first Ryan White Program-funded visit. The client's date of first service visit DOES NOT change.
How is a visit different from a unit of service?
The difference between a unit of service and a visit depends upon how agencies are reimbursed. In some cases, a visit may be comprised of several units of service (e.g., an oral health visit may include multiple units of service – a dental examination, a cleaning, a filling, x-rays, and a fluoride treatment).
How do I report 'AIDS diagnosis year' if the data element is not in our current system?
HAB is discussing a policy change regarding 'AIDS diagnosis year.' Therefore, this data element is not part of HAB's data quality improvement efforts for 2009 submission. Stay posted for updates.
How do I report 'death date' if we do not capture that information?
Death date is a required data element for providers that render outpatient/ambulatory care, medical case management, and/or non-medical case management. However, you are not expected to resort to unreasonable measures to locate this information. If you cannot report the client's actual full date of death, you should leave that item "blank" or report the item as "unknown". If you know the year of death but not the day, you should report "01" for the month and day in accordance with the instructions provided in the Data Dictionary.
How do I report 'first date of service' if the data element is not in our current system?
As stated on page 31 of the Instruction Manual v2.0 (available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf), you are not expected to resort to unreasonable measures to locate this information in your files. If you are unable to identify the first date of service, please report the earliest date available in your records. The same rule applies for 'first date of ambulatory care visit'.
How do I report "undetectable" viral loads when the RSR only accepts numeric values?
Many providers' systems use the value "undetectable" for viral loads that are less than 50. However, the RSR does not allow this value; values must be numeric. In these situations, for the annual 2009 submission, you should replace "undetectable" with the cutoff point under which "undetectable" is assigned. For example, if the viral load is "undetectable" if less than or equal to 50, you will input 50 into that field. However, if you receive lab results from multiple providers that have different cutoff points, use the number "1" or "0". This may not be a permanent solution, so keep your eye out for a 2010 policy change.
What are the guidelines for determining if a client is lost to care?
Each individual agency must determine its own guidelines for classifying a client as "lost to care."
What is the definition of client's household income (data element 9)?
The Federal poverty guidelines by definition consider household income by household size. HAB does not require grantees and providers to adopt specific definitions of "household" or "income." Grantees and providers should use the definitions that best match their eligibility requirements and apply those consistently across clients. Table 1 presents the Federal poverty guidelines for 2009. For more information regarding Federal poverty guidelines, please visit the Department of Health and Human Services website: http://aspe.hhs.gov/poverty/08poverty.shtml.
|Table 1: 2009 Federal Poverty Guidelines|
|Persons in Family or Household||48 Contiguous States and the District of Columbia||Alaska||Hawaii|
|For families with more than 8 persons, add for each additional person||$3,740||$4,680||$4,300|
Are providers with whom we have no formal contracts required to submit data?
For the purpose of the RSR, "contracts" include formal contracts, memorandum of understanding, or other agreements. Data must be reported for all providers that receive Ryan White funding.
Can I submit multiple client-level data files for the RSR and if yes, how is the data handled?
Yes. When HAB receives more than one client-level data file from a provider, the files are combined.
Data elements that can have multiple responses are added in. New information on medical insurance, race, risk factors, and core and support services are added to the pre-existing data. Note that "unknown" records for these data elements are not deleted.
Data elements that can take only one response can be overwritten. The previous response will be replaced by a new response if:
- The previous response is missing
- The previous response is unknown
- The previous response is a more recent date. For example, if one client-level data file says the client was first diagnosed in 2008 and the second says 2000, then 2000 is stored
- The previous response has a lower priority
Responses on clinical questions are assigned priorities with the following order (where 1 has the highest priority):
- Not medically indicated
- Not applicable
- Refused to answer
Do I have to submit the Client Report in 2009?
For 2009, if you are a service provider offering outpatient/ambulatory medical care or case management (medical or non-medical) services, you are required to submit a client-level data file. The client-level data file will contain one record for each client that receives a Ryan White Program-funded service.
Do I have to collect and report every data item (element) in the Client Report?
No. The client-level data elements reported for each client depends upon the type of service(s) the client received. To determine the client-level data elements that must be reported for each client, review the Required Client-level Data Elements for RWHAP Eligible Services matrix in RSR Instruction Manual available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf.
Do case managers and other non-clinical providers submit client-level clinical data?
No. HAB does not expect non-medical providers, such as case managers, to submit client-level clinical data. In 2009, outpatient/ambulatory medical care providers are the only providers to submit this data. The chart in Appendix A of the Instruction Manual v2.0 (available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf) lists the client-level data elements required from each type of service provider.
Do grantees and providers funded through multiple Ryan White Parts submit reports for each part?
For 2009, each grantee will complete a separate Grantee Report for each RWHAP grant it receives from HRSA (Part A, Part B, Part C, Part D, Part A MAI, or Part B MAI). However, service providers (including grantees that also provide services) submit only one Provider Report whether they are funded through only one or through multiple Parts. Service providers that provide outpatient/ambulatory medical care or case management (medical or non-medical) upload one client-level data file for all Ryan White funded clients, regardless of which Part is funding the services.
Do I report the services my client receives from my agency only, or do I report all Ryan White-funded services that are part of my client's care plan?
When reporting for the Core Services Data Elements (Items 16-27) and/or the Support Services Data Elements (Items 17-45), each agency is only responsible for reporting the Ryan White services that the client received at its agency and were funded by Ryan White. HAB does not expect providers to report services received by clients at other agencies and/or services that were not funded by the Ryan White HIV/AIDS Program.
If complete information cannot be reported by the deadline, will I have the opportunity to submit amended information later?
Yes and No. Grantees will submit two Ryan White Services Reports for each reporting (calendar) year:
- An interim report for the period January 1 through June 30; and
- An annual report for the period January 1 through December 31
Information that was not available when the first report—or interim report—was submitted may be included in the annual report. However, grantees and providers will not be able to amend data submitted in the annual report.
If I do not provide outpatient/ambulatory medical care or case management (medical or non-medical), am I required to submit the RSR?
Yes. If you are a grantee of record, you are required to submit a Grantee Report for each of your Ryan White HIV/AIDS Program grants. If you are a service provider, you will complete a Service Provider Report. However, if for the first and second reporting periods (January-June 2009 and January-December 2009), you were not funded to provide outpatient/ambulatory medical care services and/or case management services (medical or non-medical), you will NOT be required to submit a Client Report.
If Medicaid or another funding source is paying for the visit, should it be reported in the RSR?
When reporting for the Core Services Data Elements (Items 16-27) and/or the Support Services Data Elements (Items 17-45), you are only responsible for reporting the services that the client received at your agency and were funded by Ryan White. HAB does not expect you to report services received by clients at other agencies and/or services that were not funded by the Ryan White HIV/AIDS Program.
If Ryan White funding only covers provider salaries, should I report the services rendered by those providers in the Client Report?
HAB is considering a policy change, but for now, the answer is no. You should report those salaries in the Provider Report. You should not report any services in the client-level data file unless they were directly covered by Ryan White funding.
If we don't count medical visits reimbursed by Medicaid or another funding source, won't we be underreporting?
It is true that when you are reporting for the Core Services Data Elements (Items 16-27) and/or the Support Services Data Elements (Items 17-45), you are only responsible for reporting the services that the client received at your agency and that were funded by Ryan White. However, this doesn't mean you are underreporting, because for those two sets of data elements, HAB is simply accounting for how Ryan White money is spent. HAB won't be using those two sets of data elements as a measure of comprehensive care or quality of care. Keep in mind that if you are a medical care provider and have Ryan White-funded HIV positive outpatient/ambulatory clients, then you will be reporting on ALL of the clinical data elements (Items #46-66) for those clients, regardless of who paid for or delivered those clinical services. Therefore, you won't be undercounting to HAB these important clinical outcome measures. Also keep in mind that HAB will not be comparing the kind of client/visit counts you'll be collecting with the RSR to the kind of counts that are collected using the RDR. It wouldn't make sense because the RSR and the RDR count things differently.
I provide Ryan White-funded outpatient/ambulatory medical care. When I report the clinical information data elements (#45-66) for my outpatient/ambulatory medical care clients, do I report only Ryan White-funded outpatient/ambulatory medical care services?
No. Outpatient/ambulatory medical care providers should report all of the clinical information for each of their Ryan White HIV-positive or -indeterminate clients who received outpatient/ambulatory medical care services, regardless of who paid for or delivered those clinical services.
One of my providers receives ADAP funds only. Will this provider submit an RSR?
No. This provider is not required to submit an RSR. When a contract is created for a provider, at least one service must be specified. ADAP was not included in the services list. Please ask grantees to exclude providers (and/or provider contracts) that are exclusively funded by ADAP from their grantee reports.
One of my providers receives both ADAP funds and base funds in a single contract. Do I report the ADAP funds in the total contract amount?
No. In cases like this, it is okay for providers to subtract ADAP funds from the total contract amount and report only base funds for the contract amount.
Our organization contributes Part A EMA/TGA funds and/or Part B Base Funds for ADAP. Should I include a contract with the state (or its ADAP contractor) on my contract list?
No. Please do not include contracts with the state (or its ADAP contractor) on your contract list. The funding provided by your organization will be reported by the Part B grantee in its ADAP Quarterly Report.
What about "small" providers that don't see many patients or submit only vouchers or only serve clients on a 'fee-for-service basis or only get a small amount of funding? Are they exempt from submitting provider and client data?
At the grantee's discretion, it may decide to exempt a provider from reporting its own data, but the grantee then assumes the responsibility of reporting the provider and client data for the exempt provider. See the instruction manual for reporting rules and guidelines for deciding if a grantee may exempt a provider from self-reporting.
What are Completeness Reports?
HAB wants to provide you with feedback on the quality of your providers' and your client-level data. The Completeness Report, which can be generated from the RSR System within the EHB, is a tool HAB created to do that. Currently, the Completeness Report can only be generated for past data collection periods. For each data element, the Completeness Report contains:
- Number of clients for whom you reported the data element
- Number of clients who were required for reporting
- Number of required clients with missing data
- Number of required clients with Unknown
- And finally, percent reported – which is the number of clients with non-missing values, including Unknowns, divided by the number of required clients. This final column is referred to as the Completeness Rate
For more information on Completeness Reports, please review the related webcast: http://www.careacttarget.org/webcasts.asp#rsr.
What are fiscal intermediaries?
Fiscal intermediaries are typically first-level providers, which distribute funding to second-level providers. In order to be defined as a fiscal intermediary, the agency must take an active role in helping the grantee manage providers. Some activities that fiscal intermediaries perform are sending out RFPs to potential providers, reviewing proposals and selecting the providers, distributing funding, supervising provider performance, and managing provider reporting. The one activity that is required of fiscal intermediaries is that they distribute funding.
For more information on fiscal intermediaries, please review the related webcast: http://careacttarget.org/webcasts.asp#rsr.
What are the deadlines for the RSR?
The Grantee Report must be certified by February 1, 2010. The providers need to submit their reports for grantees' review by March 15, 2010. Grantees must review all provider reports and return any for changes to the provider by April 12, 2010. All reports must be in submitted/accepted status by April 26, 2010.
What is included in Local AIDS Pharmaceutical Assistance?
Local AIDS pharmaceutical assistance (Local APA, not ADAP) includes local pharmacy assistance programs implemented by Part A or Part B Grantees to provide HIV/AIDS medications to clients. This assistance can be funded with Part A grant funds and/or Part B base award funds. These organizations may or may not provide other services (e.g., primary care, case management) to the clients that they serve through a Ryan White HIV/AIDS Program contract with their grantee or other funding sources.
Programs are considered a local APA if they provide HIV/AIDS medications to clients and meet all of the criteria listed below:
- Have a client enrollment process;
- Have uniform benefits for all enrolled clients;
- Have a record system for distributed medications; and
- Have a drug distribution system.
Programs are not local APAs if they dispense medications in one of the following situations:
- Medications are dispensed to a client as a result or as a component of a primary medical visit;
- Medications are dispensed to a client on an emergency basis (an emergency basis is defined as a single occurrence of short duration); or
- Money or cash vouchers are given to a client to procure medications.
See part 2804 of the legislation for further information.
Reporting: Service Provision
If a medical service is provided by a nurse instead of a physician, is it still considered a medical visit?
As stated in the Instruction Manual v2.1 (available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf) on page 5: " Core medical services are a set of essential, direct health care services provided to persons living with HIV/AIDS and specified in the Ryan White HIV/AIDS Treatment Modernization Act. Outpatient/ambulatory medical care includes the provision of professional diagnostic and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, nurse practitioner, or other health care professional who is certified in his or her jurisdiction to prescribe antiretroviral (ARV) therapy in an outpatient setting."
What kind of provider can conduct mental health and substance abuse screenings associated with outpatient medical care?
As stated in the Instruction Manual v2.1 (available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf) on page 44: "Mental health screenings include the use of brief structured instruments or commonly used questionnaires to assess potential mental health problems. Screenings are designed to determine whether the client presents signs or symptoms of a mental health problem and if the client should be referred to a mental health professional. Screens are not diagnostic tools and, although typically administered by a mental health professional, may be administered by trained health care professionals in other medical/clinical disciplines."
Should a clinician funded under the outpatient/ambulatory medical core service category report client visits regarding health education?
As stated in the Instruction Manual v2.1 (available at http://www.careacttarget.org/library/RSR_Instruction_Manual.pdf) on page 5, "Outpatient/ambulatory medical care includes the provision of professional diagnostic and therapeutic services rendered by a physician, physician's assistant, clinical nurse specialist, or nurse practitioner in an outpatient setting. Settings include clinics, medical offices, and mobile vans where clients generally do not stay overnight. Emergency room services are not considered outpatient settings. Services include diagnostic testing, early intervention and risk assessment, preventive care and screening, practitioner examination, medical history taking, diagnosis and treatment of common physical and mental conditions, prescribing and managing medication therapy, education and counseling on health issues, well-baby care, continuing care and management of chronic conditions, and referral to and provision of specialty care (includes all medical subspecialties). Primary medical care for the treatment of HIV infection includes the provision of care that is consistent with the PHS's guidelines. Such care must include access to antiretroviral and other drug therapies, including prophylaxis and treatment of opportunistic infections and combination antiretroviral therapies."
Can I Submit my Provider Report with Warnings?
You may submit your provider report with warnings.
How can I tell if my grantee report was certified?
There are two ways to determine whether your grantee report has been certified. If your grantee report has not been certified, it will bring you directly into your grantee report when accessing the RSR through the EHB. The status of your grantee report is listed in the top left which will state "working" or "certified". You can also click on the "grantee report" tab in your inbox, and it will show "certified" under the status column.
How can I tell if my provider report was submitted?
There are three possible statuses for provider reports. If the report is in "working" status, it means that it has not yet been submitted for review or it has been submitted for review and has been returned for changes. "Review" status indicates that not all grantees have accepted the report, but it has been submitted to the grantees for review. "Submitted" status indicates that all grantees have accepted the report.
How do I submit the Client Report?
The Client Report (client-level data set) must be uploaded in the required XML format. XML (eXtensible Markup Language) is a standard, simple, and widely adopted method of formatting text and data so that it can be exchanged across all of the different computer platforms, languages, and applications. Providers need to extract the client-level data elements from their systems and into the proper XML format before they can be uploaded to the HAB server. How this is done depends upon the system you are using.
Vendor-distributed Data Collection Systems
If you use any of the proprietary, vendor-distributed systems listed below to collect data, you will be able to export your data to HAB from the system in the required XML format. No special action will be required by you to develop this export capability. Your vendor will notify you when the system feature to export the client-level data file is available. HAB's Information Technology [IT] contractor is working with representatives from each of these systems to develop this capability as soon as possible.
- Allscripts: Will be ready for the 2010 interim submission
- Casewatch Millennium
- eClinicalWorks: Will be ready for the 2010 interim submission
- Provide Enterprise
If you utilize or are aware of other vendor-distributed systems that are widely used in the field by Ryan White service providers, but that are not listed above, please contact: Stefani Olsen of SAIC, HAB's IT Contractor, at 301-230-4714, [email protected].
Custom Data Collection Systems
If you use a home-grown or custom-built data collection system, you will need to extract the client-level data elements out of your system and into the proper XML format before you can upload it to the HAB server. You or someone familiar (or able to become familiar) with the structure of your database should use the XML schema provided by HAB to write a program that will extract data from your system and place it into the XML schema format. To obtain a copy of the XML schema, please contact: Stefani Olsen of SAIC, HAB's IT Contractor, at 301-230-4714, [email protected].
If your system uses a relational database such as SQL Server, Oracle, or Access to store your data, the most common way to convert the data would be to develop an application in a programming language such as C#, Visual Basic or Java to extract the data from the database and write it to an XML text file that conforms to the published Client-Level Data XML Schema format. (Almost all programming languages today provide some support for managing XML files.)
Whether you store your data in a relational database or some other format, technical support will be available to you through the HAB Web site and from your Project Officer.
Paper-based Data Collection Systems
If you currently do not use an electronic client-level data collection system, HAB has made available a version of CAREWare, CAREWare Lite, that will create the required XML upload file. Users will need to manually enter their client data into CAREWare Lite.
What are RSR-Ready Vendors?
RSR-Ready Vendors generate the client-level data XML file, so you do not have to. If you use an RSR-Ready Vendor, you are responsible for accurately inputting the data into the system and ensuring you have the latest build. These vendors include:
- Allscripts: Will be ready for the 2010 interim submission
- Casewatch Millennium
- eClinicalWorks: Will be ready for the 2010 interim submission
- Provide Enterprise
What do I do if I receive an error stating that I am unable to upload my XML?
When you receive an error when attempting to upload an XML into the RSR, this could be due to several reasons. Please call the HCC. Please inform the agent that you are receiving an error message when attempting to upload your XML file into the RSR. Please also be prepared to send the attachment in an email to the HCC as they will probably request it. The HCC will then try to troubleshoot what is causing the error.
What is T-REX?
"T-REX" is a Tool for RSR Export created to assist providers currently not using an RSR-Ready Vendor or the CAREWare Provider Data Import (PDI) in the conversion of their client-level data into an XML format. If consists of an MS Access database that, once populated, can be converted to the client-level data XML file. For more information on T-REX, see the user guide: http://careacttarget.org/library/T_Rex_User_Manual.pdf
What if I receive an unexpected error?
If at any point, you receive an unexpected error, the first thing you should do is closeout of where you are in the system, and start over by trying again. Sometimes the errors resolve themselves with opening up a fresh browser. However, if you still experience the same error, please call the HCC. Please explain to the agent that you are working in the RSR report, provide a grant number or provider name, and the steps in which you are taking when receiving the error.
When will CAREWare be updated to include the new data elements?
CAREWare has been updated to collect all the RSR elements. Grantees should download the latest version. Additional versions to facilitate uploading will be released in an ongoing manner.
For downloads, updates and more information, visit the CAREWare website: http://hab.hrsa.gov/careware.
For more information, contact: John Milberg at [email protected]. For technical questions, contact: the CAREWare helpdesk at [email protected] or 1-877-294-3571.
If a client changes his or her name (especially last name), will their unique client identifier (UCI) change?
Yes. If one of the data elements that makes up the eUCI changes for a given client, the client's eUCI will change. If a client's eUCI changes between two reporting periods, HAB will not be able to link the client's records. Because the de-duplication of client records is a priority for HAB, HAB is creating a process for grantees and providers to inform HAB that a client's eUCI has changed during the reporting period. HAB will provide more information on this process when it is developed. Until such a process is in place, HAB recognizes that this issue will arise, and grantees and providers are not required to make special arrangements to address this problem.
How do I access the UCI creation and encryption algorithm?
Please email your request for the eUCI Application to our TA help desk at[email protected]. A representative will contact you to understand your data system's capabilities and needs. You will then be provided with a user name and password to access the eUCI Application on a secure website.
How Does the eUCI Application Treat Unconventional Data?
Although the eUCI Applicationcan read some unconventional data, other data formats are considered invalid and will not result in a valid eUCI. In the following table, we present how the application interprets unconventional data and what data formats are invalid.
|Missing data||The eUCI will be invalid.|
|First name and last name|
|Name < 3 characters||Third character of the UCI is 9.||First name = TJ; first two characters of
UCI = T9
Spaces are replaced with 9.
|Last name = De Young; third and fourth characters of
UCI = D9
|Apostrophes and hyphens||
Replaced with a 9 with one exception. If name starts with an apostrophe or hyphen, or any other non-letter character, the eUCI will be invalid.
Last name = O'Hagan; third and fourth characters of UCI = OH
Accented letters are replaced with non-accented letters
First and last name = Raúl Grünwald; first four characters of the UCI = RUGU
|Date of birth|
|Incorrect format||If not MM/DD/YYYY or MM/DD/YY, the eUCI will be invalid.|
|Incorrect format||If not 1, 2, 3 or 9, the eUCI will be invalid.|
What if I am missing data elements that compose the UCI?
If you are missing data elements required for the eUCI, you should do everything possible to obtain those data elements. This effort will improve not only the quality of data linking, but also case management and patient care. If you are unable to obtain required data elements, you should use the following placeholder data until they are obtained:
- Month or day of birth: 01
- Year of birth: Best estimate