HIV Care Services and the Ryan White Part B Program

1. HIV Care Services and the Ryan White Part B Program Tessa McKenzie HIV Service Planner Virginia Department of Health February 25, 2014

2. Overview • Receives Ryan White Part B (RWPB) funding annually from the Health Resources and Services Administration (HRSA). • VDH receives funds and administers the RWPB funds statewide • AIDS Drug Assistance Program (ADAP) • At least 75% of funds for Part B must be spent on core medical services • The remaining 25% can be spent on other supportive services

3. Ryan White Part B • Ryan White Part B funding provides several options for people living with HIV/AIDS for accessing medical care and other services in Virginia. Locations vary statewide: • Academic Medical Centers • Community-Based/AIDS Service Organizations • Community Health Centers • Hospitals /Health Systems • Private Medical Practices • Public Health Clinics

4. HIV Care Services Our mission: • HIV Care Services is committed to meeting the current and emerging needs of those infected and affected by HIV/AIDS in Virginia through the coordinated delivery of quality care and support programs.

5. Ryan White Service Planning • The Virginia Department of Health (VDH) conducts annual public hearings as part of its planning process to improve delivery of HIV Care and Prevention Services. • Winchester, Lynchburg, Petersburg • Public hearings and local meetings are one component of planning services for HIV-positive individuals in Virginia (in addition to epidemiological data, performance indicators, regional needs assessment, feedback from providers and people living with HIV/AIDS, local or national regulatory changes, among others)

6. Ryan White Service Planning • RW Part B programs create and implement comprehensive plans for the state every 3 years and performs ongoing needs assessments. • Virginia completed its Statewide Coordinated Statement of Need (SCSN) and Statewide Comprehensive Plan for HIV Services (SCP) in 2012. Next SCSN completed 2015. SCP updated in 2014. • During grant year 2012, one finding from the SCSN was the need for increased oral health services. VDH subsequently increased oral health funding and service availability across Virginia through Part B.

7. Ryan White Service Planning • RW Part B consortia: • Conduct a needs assessment • Develop a strategic plan and set service priorities • Promote coordination and integration of community resources • Assure the provision of comprehensive core and support services • Work with subcontractors to provide direct services • RW Part B direct contractors (about 19) • Contract with VDH directly to provide services

8. AIDS Drug Assistance Program (ADAP) • ADAP provides life sustaining medications to low income individuals with HIV. • Eligibility and applications are managed centrally through VDH • VDH Medication Eligibility Hotline • Tollfree-855-362-0658 • VDH Website and ADAP updates • www.vdh.virginia.gov/ADAP

9. Programs under ADAP • Direct ADAP- If a client does not have any other coverage for their HIV/AIDS medications (such as insurance or Medicare Part D), medications can be picked up at any Local Health Department (LHD) or at Virginia Commonwealth University Health System (VCUHS) or INOVA, if they receive services at those sites. • VDH pays for: • Medications on ADAP formulary. • Health Insurance Marketplace Assistance Program (HIMAP)-  VDH ispurchasing insurance for clients enrolling into specific VDH approved plans via the Marketplace.   Clients will obtain medications through in-network retail pharmacies. • VDH pays for: • Monthly premiums for VDH approved ACA plans. • Medication copays for medications approved by primary insurance. • Pre-Existing Condition Insurance Plan (PCIP) – This insurance plan was implemented due to the Affordable Care Act (ACA) for clients who were eligible due to a pre-existing condition and inability to obtain other means of insurance coverage. This plan was originally supposed to end on 12/31/13 but has been extended to 3/31/14. VDH has made it a priority to transition these clients to approved Health Insurance Marketplace plans.

10. PROGRAMS UNDER ADAP • Medicare Part D Assistance Program (MPAP) - MPAP clients are helped with monthly premiums and cost shares. Cost shares are medication deductibles and medication copayments. MPAP clients can pick up medications at any pharmacy that accepts their Medicare Part D plan. • VDH pays for: • Monthly premiums for Part D plan. • Medication copays for medications approved by primary insurance (Part D plan). • Insurance Continuation Assistance Program (ICAP)- Individuals with certain private insurance with medication benefits are eligible for ADAP assistance with their medication copayments and deductibles if all other qualifications are met. This service allows ADAP to assist those with limited income access medications at a retail pharmacy. At any point in time a client loses insurance, the client can access medications through Direct ADAP if the client continues to meet ADAP eligibility criteria. • VDH pays for: • Medication copays for medications on ADAP formulary AND Ryan White Part B formulary.

11. ADAP-approved ACA insurance plans

12. ADAP ENROLLMENT UPDATES • OPEN ENROLLMENT ENDS: MARCH 31, 2014 • NUMBER OF ENROLLED ADAP CLIENTS • GOALS • NEXT STEPS

13. Minority AIDS Initiative (MAI) • Linking low-income, ethnic minority individuals with HIV/AIDS who are newly diagnosed, lost to care, or at risk of falling out of care to needed care and services. • The primary goal of the program is to locate and link eligible individuals to HIV-related medication access services such as Virginia ADAP, and also assists with access to Outpatient Medical Care, Medical Case Management Services, Mental Health and Substance Abuse Services as needed. • Funded in Southwest and Northern regions

14. Special Projects of National Significance (SPNS) • VDH received special additional funding to develop strategies to: • Help clients get linked to HIV care faster • Help clients stay in HIV care over time • Evaluate the effectiveness of these strategies by measuring improvement in HIV linkage, retention, and viral suppression rates over time • Funding received for 4 years (2011-2015)

15. Special Projects of National Significance (SPNS) • 4 main strategies were developed over the past 2 years to accomplish these goals: • Active Referral: Creation of a new process for DIS to help link patients to care within 90 days of HIV diagnosis (Statewide) • Patient Navigation: Patient Navigators help clients link and retain in care by addressing barriers and working with patients (Central and Southwest regions) • Care Coordination: Creation of an improved process to link patients to HIV care and medication after being released from jails and prison (statewide) • Mental Health: Creation of a new screening and referral process to address the mental health barriers that keep patients from linking or staying in HIV care (Central and Northwest)

16. Special Projects of National Significance (SPNS) • Implementation of these strategies is currently underway across the state. • VDH will be working to evaluate the effectiveness of these strategies over the next 2 years. • Next steps: • Development of strategy manuals for replication other settings • Evaluation and analysis of outcome data • Dissemination of findings across the state and in national forums

17. Current planning efforts for 2014 • Affordable Care Act (ACA) transition • ACA Informational Forums • Open Enrollment preparedness: Nov 15, 2014 • Integrating HIV Prevention and Care planning and activities • Statewide Needs Assessment • Weekly communication to clients and stakeholders • …and Public Hearings!

18. Contact us: • Tessa McKenzie (HIV Care Services Planner) tessa.mckenzie@vdh.virginia.gov • VDH Medication Eligibility Hotline • Tollfree-855-362-0658 • VDH Website and ADAP updates • www.vdh.virginia.gov/ADAP