clarifications on client eligibility assessment and recertification … · 2017-07-14 ·...
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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
Division of State HIV/AIDS Programs (DSHAP) 4
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
5 Division of State HIV/AIDS Programs (DSHAP)
HRSA Expectations for Eligibility Assessment and Recertification
Division of State HIV/AIDS Programs (DSHAP)
8 3/26/2013
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: [email protected] Visit Our Webpage: www.idph.state.il.us
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General Questions and Answers
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
Heather Hauck, MSW, LICSW Director, Division of State HIV/AIDS Programs
HIV/AIDS Bureau Phone: (301) 443-3613
E-mail: [email protected] Website: www.hab.hrsa.gov
26 Division of State HIV/AIDS Programs (DSHAP)