HIV/AIDS Bureau Division of State HIV/AIDS Programs (DSHAP)

Ryan White Part B Technical Assistance Webinar

Clarifications on Client Eligibility Assessment and Recertification

Requirements

March 26, 2013

HAB DSHAP Mission

• Mission: To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care, and support services.

Division of State HIV/AIDS Programs (DSHAP) 2

Presenters

Heather Hauck Director, Division of State HIV/AIDS Programs

Terri Richards

Project Officer, Western Services Branch

Jeffery Maras Illinois Department of Public Health

Holly Hanson

Iowa Department of Public Health Division of State HIV/AIDS Programs (DSHAP) 3

Agenda • Welcome and Opening Remarks

• Ryan White Part B Program Updates

• Reporting Requirements

• Question & Answer Session

• HRSA Expectations for Eligibility Assessment and

Recertification

• Grantee Presentations on Eligibility and Recertification

• Question and Answer Session

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DSHAP Program Updates • Ryan White Part B FY 2013 Awards • Ryan White Part B Administrative Overview June 17-19 • Ryan White & Affordable Care Act Outreach, Enrollment and

Benefits Counseling • HAB New Website with ACA Resources • HRSA/CMS Webinar on ACA and Eligibility: April 5 • NASTAD ADAP Webinar: April 17 • HRSA/HAB Releases Preliminary Data on HIV Care Continuum and

Ryan White Clients • NMS Updates – planned for April release of FAQs and overall NMS • Webcasts on ADAP Data Report: March-June – TARGET • Reporting Requirements Update

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Reporting Requirements

Division of State HIV/AIDS Programs (DSHAP)

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Question & Answer Session

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HRSA Expectations for Eligibility Assessment and Recertification

Division of State HIV/AIDS Programs (DSHAP)

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Question & Answer Session

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Jeffery Maras, Ed. D., MS, LPC Ryan White Part B CARE, ADAP & CHIC Administrator

March 2013

A Flight Plan for the Illinois Ryan White Program

Eligibility Determination

On Time Arrival!

Current Eligibility Criteria for Illinois Ryan White

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• Be diagnosed as having HIV/AIDS – Confirmatory Test Results needed at initial enrollment. – Need current CD4 and Viral Load levels within 6 months

of application date (NEED BOTH LABS) – Surveillance interface began December 2012

• Be a resident of and domiciled in Illinois – Preferred forms of verification of residence are:

• utility bill, • renter’s agreement, • bank statement, or • Letter of Support

Current Eligibility Income

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• Qualify financially [anticipated gross annual income must be at or below 300% (uninsured)/500% (insured) of the current (2013) federal poverty level for the size of the household].

– Required Documents and Common DELAYS: • Do not provide either two most current paystubs (not

older than 90 day), • federal benefit award letter • current federal tax return, or • letter of support. • NO W2s are accepted by IL ADAP.

Payer of Last Resort

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• If eligible for health insurance coverage, the company must be willing to participate with the contracted dispensing pharmacy for coordination purposes.

• Not approved for Medicaid or 1115 Waiver (CountyCare). – Individuals with a financial/medical assistance application pending

or in a spend-down unmet status may participate.

• As of January 1, 2011 Illinois ADAP began to assist with paying client’s Medicare Part D deductible and copayments for drugs on the Illinois ADAP Formulary.

Eligibility Electronic Process

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• Application process is either within the Provide®Enterprise System or via the Web depending on case management delivered from Part A, B, or no case management.

– Care Services are conducted through a medical case

management model and all eligibility determination, needs assessments, and service plans are within the Provide Enterprise System.

– ADAP/Continuation of Health Insurance Coverage (CHIC)

Services are submitted by medical case managers within the Provide Enterprise System or via our interactive WEB APPLICATION.

• Submission of all requested documentation via scan/fax/postal mail.

• Re-application every 6 month – FULL Processes.

Phase 2: Preparation for Affordable Care Act Ryan White Policy Changes Effective 2013

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Single Point of Eligibility Determination: • Merging of CARE and ADAP/CHIC (as well as ADAP/CHIC)

• July 2013 roll out Income Eligibility Determination:

• Modified Adjusted Gross Income (MAGI). • Roll out July 1, 2013

Web User Account:

• Functions as electronic medical records • Email and Texting features for clients

• Roll out December 3, 2013

Jeffrey P. Maras, Ed. D., M.S., LPC Ryan White Part B Administrator

Illinois Department of Public Health

Division of infectious Diseases HIV/AIDS Section

525 West Jefferson Street, First Floor Springfield, IL 62761-0001

Desk Telephone: (217) 524-0506

ADAP Hotline: (800) 825-3518 Work Fax: (217) 785-8013

Email: jeffrey.p.maras@illinois.gov Visit Our Webpage: www.idph.state.il.us

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General Questions and Answers

Eligibility in Iowa ADAP

Holly Hanson, MA, CPM Ryan White Part B Program Manager

March 2013

Similarities between Iowa and Illinois ADAP

• Be diagnosed as having HIV/AIDS

• Be a resident of Iowa

• Qualify financially – [anticipated gross annual income must be at or below 200%

(uninsured)/400% (insured) of the current (2013) federal poverty level for the size of the household].

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Case manager fills out the enrollment

application (with client) and faxes

forms to IA ADAP

Clinician refers client to 1 of 11 Part B Case Managers

for ADAP enrollment

Clinician sends

prescription to pharmacy

IA ADAP approves the application and notifies Part B Agency and Contract Mail Order Pharmacy

Contract Pharmacy dispenses drugs to Client or other designated location

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Iowa ADAP Enrollment Process This image cannot currently be displayed.

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Annual enrollment

–8-page application, –enrollment agreement , and –ALL supporting documentation.

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Six Month Recertification

–1-page Summary Sheet –Supporting documentation

• only Residency, Income, or any change in insurance

If it’s not one thing……. • Medicaid expansion • Medicaid non-expansion • Insurance

– Restrictions (e.g. Mail order only, 30 v. 90 day supplies, 3rd party payment issues, generic only if available, etc.)

– Creditable coverage – Cost neutral in the aggregate vs. individual level

• PBM or not to PBM? • PO Boxes • Self-employed Income Verification

Thank You! Holly Hanson, MA, CPM

Ryan White Part B Program Manager 515-242-5316

Holly.Hanson@idph.iowa.gov

Question & Answer Session

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Thank You

Division of State HIV/AIDS Programs (DSHAP)

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Heather Hauck, MSW, LICSW Director, Division of State HIV/AIDS Programs

HIV/AIDS Bureau Phone: (301) 443-3613

E-mail: hhauck@hrsa.gov Website: www.hab.hrsa.gov

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