Department of Health and Human Services Health Resources and Services Administration HIVAIDS Bureau Preparing for 2014 Overview of Ryan White Program Policy Updates amp Guidance Todays Presentation Will ID: 385286
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August 14, 2013Department of Health and Human ServicesHealth Resources and Services AdministrationHIV/AIDS Bureau
Preparing for 2014:Overview of Ryan White Program Policy Updates & GuidanceSlide2
Today’s Presentation WillProvide an overview of recently released HIV/AIDS Bureau (HAB) policies and guidance, including:
Two new policy clarification notices, one on Medicaid eligibility, and another on client eligibility Joint Centers for Medicare & Medicaid Services (CMS)/Health Resources & Services Administration (HRSA) letter on coordination between Medicaid and the Ryan White HIV/AIDS Program (RWHAP)Letter on outlining allowable uses of RWHAP funds for outreach and enrollment activitiesRevised Core Medical Service Waiver policySlide3
Upcoming WebcastAn upcoming webcast,
to be scheduled shortly, will provide an overview of additional HAB policies, including:13-03: RWHAP Client Eligibility Determinations: Considerations Post-Implementation of the Affordable Care Act13-04: Clarifications Regarding Clients Eligible for Private Health Insurance and Coverage of Services by RWHAP13-05:Clarifications Regarding Use of RWHAP Funds for Premium and Cost- Sharing Assistance for Private Health Insurance13-06: Clarifications Regarding Use of RWHAP Funds for Premium and Cost-Sharing Assistance for MedicaidSlide4
Policy Clarification Notice 13-01
Clarifications Regarding Medicaid-Eligible Clients and Coverage of Services by Ryan White HIV/AIDS ProgramSlide5
13-01: DetailsThis policy clarification reiterates HRSA policy regarding RWHAP clients
who are currently eligible for Medicaid or will become eligible for Medicaid beginning on or after January 1, 2014.Grantees must make every effort to enroll individuals in Medicaid if eligible - including individuals newly eligible for Medicaid under the Affordable Care Act.The RWHAP will
continue to
be the payer of last resort and will continue to pay for Ryan White
HIV/AIDS Program
services not covered or partially covered by Medicaid.Slide6
13-01: Retroactive Medicaid EligibilityMedicaid coverage may start retroactively up to three months
prior to the client’s application date. Grantees must back-bill Medicaid for services provided during this time.Slide7
Policy Clarification Notice 13-02Clarifications
on Ryan White Program Client Eligibility Determinations and Recertifications Requirements Slide8
13-02: Initial Eligibility Reiterates current client eligibility requirements to receive RWHAP funded services. Clients must be:
HIV positiveLow-income, as defined by the granteeGrantees have the option of narrowing eligibility requirements; however, requirements may not be broadened. Slide9
13-02: RecertificationGrantees must ensure that clients continue to meet eligibility requirements by verifying:
Residency, income, and insurance statusClients must be recertified no less than every six months. Grantees must conduct an in-depth recertification at least once every 12 months.
Self-attestation can be used for one of
the two
required certifications;
the other
must be full recertification
Appropriate documentation
is required
for any changesSlide10
13-02: Summary of Documentation
Eligibility Criteria
Initial Eligibility Determination & Once a Year/12 Month Period Recertification
Recertification (minimum of every six months)
HIV Status
Required for Initial Eligibility Determination
Not required for the once a year/12 month period recertification
No documentation required
Income
Documentation required
Grantee may require:
Full application and associated documentation, or
Self-attestation, with documentation required only if there is a change in income.Slide11
13-02: Summary of Documentation, cont’d
Eligibility CriteriaInitial Eligibility Determination & Once a Year/12 Month Period Recertification
Recertification (minimum of every six months)
Residency
Documentation required
Grantee may require:
Full application and associated documentation, or
Self-attestation, with documentation required only if there is a change in residency.
Insurance Status
Must verify if the applicant is enrolled in other health coverage and document the client’s insurance status
Grantee must verify if the applicant is enrolled in other health coverage.
Self attestation,
with documentation only if there is a change in insurance status.
CD4/Viral
Load
Discretion
of the grantee
Discretion of the granteeSlide12
13-02: Other ConsiderationsRe-verification of HIV diagnosis is not required.
CD4/viral load is not required by HAB.PO Boxes can be used for mailing addresses; however, clients must verify addresses via another means.Slide13
13-02: Other Considerations, cont’dGrantees may use data-sharing agreements with other grantees and/or sub-grantees for recertification.
In states that have multi-tiered continuous residency, income, and insurance verification processes:No six month recertification is requiredMust be applied consistently to all clientsMust be approved by HABPart C, D, and F grantees are encouraged to coordinate with Part A and B grantees.Slide14
Outreach and EnrollmentRWHAP grantees and planning bodies are encouraged to review their Fiscal Year 2013/2014
HIV service priorities, allocations, contracts and budgets and consider utilization of RWHAP resources to support Affordable Care Act related outreach and enrollment activities. In March 2013, the HRSA HIV/AIDS Bureau posted recommendations for RWHAP grantees
on uses of existing funding to complete activities in the following three areas:
outreach education
,
enrollment
and
benefits counseling
. Slide15
Outreach and Enrollment cont’dRyan White Program Parts A & B
Early Intervention Services funding may be used for benefits counseling, enrollment and
outreach education
.
Medical Case Management Services
funding
may be used for
benefits counseling
and
enrollment
.
Non-Medical Case Management Services
funding
may be used for
benefits counseling
and
enrollment
.Slide16
Outreach and Enrollment cont’d
Ryan White Program Parts A & B Health Education/Risk Reduction Services funding may be used for Affordable Care Act outreach education. Outreach Services
funding, which is generally
used
for identifying new
HIV
cases, HIV testing
and
linkage to care; or to re-engage individuals who have
fallen out of medical
care may be used
for
Affordable Care Act
outreach education
.
Referral for Health Care/Supportive Services
funding
may be used for
benefits counseling
,
enrollment
and
outreach education
, as the Affordable Care Act is considered a
benefit to
people living with HIV/AIDS.Slide17
Outreach and Enrollment cont’d
Ryan White Program Minority AIDS Initiative - Part BMinority AIDS Initiative funding may be used for outreach education, benefits counseling and
enrollment
. Slide18
Outreach and Enrollment cont’dRyan White Program
Part CMedical Case Management Services funding may be used for benefits counseling and enrollment.
Non-Medical Case Management Services
funding may be used for
benefits counseling
and
enrollment
.
Outreach
Services
generally
used for identifying new HIV cases, HIV testing and linkage to care; or to re-engage individuals who have fallen out of medical care may be used for Affordable Care Act
outreach education
. Slide19
Outreach and Enrollment cont’dRyan White Program Part
DMedical Case Management Services funding may be used for benefits counseling and enrollment.Non-Medical Case Management Services
funding may be used for
benefits counseling
and
enrollment
. Slide20
Joint HRSA/CMS Informational BulletinIssued to promote a seamless transition of care into 2014
Outlines Federal coordination between HRSA and CMSIdentifies key resources at both agenciesEncourages coordination between Medicaid and the RWHAP AIDS Drug Assistance Program (ADAP)Slide21
Core Medical Services WaiverFederal Register Notice With Opportunity for Comments Published May 24, 2013
This draft policy Outlines the application process for Part A, B, and C grantees to apply for a waiver of the requirement that 75% of funds be spent on core medical servicesClarifies documentation requirementsProvides more flexibility in the timeframe for grantees to apply for a waiverSlide22
Core Medical Services Waiver, Cont’d Comment period closed on June
24, 2013HRSA is currently reviewing comments and will make decisions shortly on next steps.As is, the policy goes into effect on September 23, 2013.Slide23
Next StepsVisit the HAB webpage, “
Ryan White & the Affordable Care Act: What You Need to Know” : http://www.hab.hrsa.gov/affordablecareact/index.htmlOn this page you may:Sign up for updates
View and download slides from HAB’s recent webcasts
Email Ryan White Program/Affordable Care Act questions to:
RWP-ACAQuestions@hrsa.gov