HRSA Policy Updates NASTAD AIDS Drug Assistance Program (ADAP) Technical Assistance Meeting

1. Heather Hauck, DirectorDivision of State HIV/AIDS Programs (DSHAP)HIV/AIDS BureauHealth Resources and Services Administration HRSA Policy Updates NASTAD AIDS Drug Assistance Program (ADAP) Technical Assistance Meeting July 31, 2014

2. HIV/AIDS Bureau’s Framework

3. HIV/AIDS Bureau’s Framework Zero New Infections The Ryan White HIV/AIDS Program (RWHAP) supports the goals of the National HIV/AIDS Strategy (NHAS) by: • Funding a comprehensive care systems for low-income people living with HIV (PLWH) that: • Reduces new HIV infections • Improves health outcomes and increases quality of life for PLWH • Decreases HIV-related health disparities • Including PLWH in the planning of services • Employing a public health approach to care and treatment

4. Division of State HIV/AIDS Program (DSHAP) Mission: To provide leadership and support to States/Territories for developing and ensuring access to quality HIV prevention, health care, and support services. DSHAP Vision: Optimal HIV/AIDS prevention, care, and treatment for all. DSHAP Mission and Vision

5. HIV/AIDS Bureau (HAB) Initiatives

6. Improved Availability of Ryan White HIV/AIDS Program (RWHAP) Data: HAB Initiatives • RSR- moving from a 12-18 month cleaning-to-dissemination process to a 6-9 month process • ADR– moved to new calendar year data collection period; 3-6 month cleaning-to-dissemination process • State Profiles – eliminating the backlog of data (currently 2011 data is posted on the HAB website); 2012 data will available in fall 2014

7. Innovative Uses of Data to Improve Prevention and Care Outcomes HAB Initiatives • HAB continues to work with CDC/DHAP on the Continuum of Care initiatives (e.g., CAPUS, SMAIF, communication campaigns) • HAB continues to invest in health information technology initiatives through the Special Projects of National Significance (SPNS) (e.g., facilitate exchange, examine staffing) • HAB and CDC/DHAP worked with NASTAD to convene a meeting to discuss opportunities and challenges for surveillance and program data integration and utilization to improve continuum of care analysis and related activities

8. HIV Care Continuum Cross-Part Collaborative HAB Initiatives A quality collaborative of 5 states involving RWHAP grantees to increase access to HIV care and viral load suppression. Aim 1: Build regional capacity for closing gaps across the HIV Care Continuum to ultimately increase viral load suppression rates for individuals living with HIV Aim 2: Align quality management goals across all Ryan White HIV/AIDS Program Parts to jointly meet legislative quality management mandates Aim 3: Implement joint quality improvement activities to advance the quality of care for people living with HIV within a state and to coordinate HIV services seamlessly across Parts All grantees within the state form a team. • Arkansas • Mississippi • Missouri • New Jersey • Ohio

9. HAB Initiatives Black MSM Cooperative Agreement (14-106) Black MSM in the Ryan White HIV/AIDS Program: • Black MSM: 32.4% of all MSM • 29.4% are ages 45-54 • Represent 66.4% of the MSM are ages 13-18 • Represent 61% of the MSM are ages 19-24 • 68.5% of Black MSM are 100% below FPL • 48.7% of Black MSM had no insurance at some time during the year Source: 2012 RSR (preliminary)

10. MSM & IDU Retained in Care & Virally Suppressed HAB Initiatives Retained in care: had at least one OAMC visit before September 1, 2012, and had at least 2 visits 90 days or more apart Viral suppression: had at least one OAMC visit, at least one viral load count, and last viral load test <200 Source: 2012 RSR data (preliminary)

11. HAB Initiatives Black MSM Cooperative Agreement (14-106) Purpose of Cooperative Agreement Compiling, distributing, and replicating effective models for HIV clinical care and treatment for adult and young Black Men who have Sex with Men (Black MSM). Specifically, the intent of this cooperative agreement program is: • For Year 1: To inventory existing evidence-based interventions for HIV care and prevention strategies • For Year 2: To identify and disseminate best practices and effective models of care for Black men who have sex with men (Black MSM), including young Black MSM ages 13-24

12. HAB Initiatives Collaborating Across Federal Government • RWHAP legislation specifically references coordination across U.S. Department of Health and Human Services • NHAS/HIV Care Continuum: http://hab.hrsa.gov/nationalstrategy/index.html • Collaborate and coordinate to: • Align across Federal programs to reduce reporting burden on grantees • Partner to advance evidence base and develop interventions to improve care and treatment across the HIV Care Continuum • Share resources and expertise to build capacity at the grantee level

13. ACA-Related Updates

14. FFR Overview PCN 14-01 New Policy Clarification Notice (PCN) 14-01 on reconciliation of advance premium tax credits • On June 6th, HRSA released PCN 14-01, which clarifies HRSA policy regarding the use of Ryan White HIV/AIDS Program funds to purchase health insurance for clients in the Marketplace and the reconciliation of advance premium tax credits • RWHAP grantees and sub-grantees must vigorously pursue any excess premium tax credit a client receives from the Internal Revenue Service (IRS) upon submission of the client’s tax return • Collect excess premium tax credit attributed to individual client

15. FFR Overview PCN 14-01 PCN 14-01 continued • HRSA is considering allowing RWHAP grantees and sub-grantees to use RWHAP funds to pay the IRS any additional income tax liability a client may owe to the IRS solely based on reconciliation of the premium tax credit. • A Federal Register Notice was published on July 14, 2014 in which HRSA seeks comments from the public regarding this proposed policy, with a closing date of August 13, 2014. The Federal Register Notice can be found at: http://www.gpo.gov/fdsys/pkg/FR-2014-07-14/pdf/2014-16406.pdf

16. ACA Technical Assistance HAB currently has three cooperative agreements that provide technical assistance to grantees regarding the Affordable Care Act: • Engaging in Marketplace Insurance Plans under the Affordable Care Act (CicatelliAssociates) • Establishing AIDS Service Organization (ASO) Service Models (Fenway Community Health) • Supporting the Continuum of Care: Building Ryan White Program Grantee Capacity to Enroll Eligible Clients in ACA Health Coverage Programs (ACE Project)(John Snow, Inc.) 17

17. Affordable Care Enrollment (ACE) TA Center ACE Outreach & Enrollment Survey • 231 Ryan White HIV/AIDS Program Part A, B, C, and D grantees were surveyed in fall 2013 to determine grantee needs to facilitate outreach and enrollment assistance to minority clients seeking private insurance through the Marketplace • About a third of respondents (31%) received resources other than RWHAP grant funds to support outreach and enrollment efforts • Just over half of respondents (51%) reported that they have staff with outreach and enrollment certifications within their organizations

18. ACE TA Center Outreach & Enrollment Survey Key Findings • Limited Knowledge and Experience • Many direct service providers faced general outreach and enrollment challenges related to lack of knowledge of new coverage options • Communication and Coordination • RWHAP grantees and providers want more local guidance about policies and best practices. Gaps in coordination may have implications for how clients experience care 193

19. ACE TA Center Outreach & Enrollment Survey Key Findings • Barriers to Care • RWHAP providers are working with minority clients who have historically faced barriers to accessing care and who may not be comfortable enrolling in new ACA coverage options • Clients are particularly concerned about plan affordability, as well as the possibility of needing to change providers • Both outreach and enrollment capacity and cultural competency are critical to enrolling and retaining minority RWHAP clients in ACA coverage options 193

20. July Webinar Series ACE TA Center The ACE TA Center is presenting a series of webinars to introduce practical new tools and resources to support culturally competent enrollment of RWHAP clients in health insurance • July 10: Introducing new tools and resources to help enroll people of color living with HIV in health care coverage • July 17: Ready for the next open enrollment period? A new Online Resource Guide to help enroll PLWH in health insurance • July 24: Are we speaking the same language? Tools to assist with complicated conversations about enrolling in health insurance • July 31: Trouble keeping track of your clients in the enrollment process? A worksheet to assist them through every step The webinars and presentation slides are archived on the TARGET Center website

21. ACE TA Center Additional Assistance for Grantees • Subscribeto the ACE TA Center list for updates about strategies, tools and training, and to get a copy of the Needs Assessment report:http://eepurl.com/JPUVj • Contact the ACE TA Center with questions: acetacenter@jsi.com • Look for the ACE TA Center on the TARGET Center website, which will include new resources and existing tools that are tailored, adapted, and translated for RWHAP providers (https://careacttarget.org/ace)

22. HAB’s ACA-Related Studies

23. ACA Post-Enrollment Role of HRSA • Continue to engage with colleagues in CMS and CCIIO on key issues such as monitoring third party payment, mail order pharmacy, prior authorization, and ECP implementation • Develop and co-host webinars to relevant topics, including best practices http://hab.hrsa.gov/affordablecareact/webinars/index.html • Respond to and post FAQs http://hab.hrsa.gov/affordablecareact/faqs.html

24. Role of Grantees ACA Post-Enrollment • Assist clients in applying for and enrolling in health care coverage • Role of assisters: http://marketplace.cms.gov/help-us/assisters-after-enrollment.pdf • Educate patients about what it means to have health insurance • Coverage to Care: http://marketplace.cms.gov/help-us/c2c-roadmap.pdf

25. Role of Grantees (cont.) ACA Post-Enrollment • Get “in-network” with Qualified Health Plans and Medicaid Managed Care Organizations as soon as possible • TARGET Center Provider Network Resources: https://careacttarget.org/library/contracting-health-plans-and-provider-networks • “Answers About Health Plan Contracting” Webinar Archive: http://www.fpntc.org/training-and-resources/webinar-recording-answers-about-health-plan-contracting

26. FFR Overview CMS Final Rule Final Rule for Exchange/Insurance Market Standards for 2015 and Beyond • On May 16, the Department of Health and Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS), issued the final rule for Exchange/Insurance Market Standards for 2015 and Beyond • The rule promotes affordability, transparency and takes the first step toward providing additional quality related tools for consumers shopping in the Health Insurance Marketplace

27. CMS Final Rule Highlight: Consumer Assistance • “…in specific circumstances, certified application counselor (CAC) designated organizations can serve target populations without violating the broad non-discrimination requirement related to Exchange functions” • RWHAP providers may offer CAC services exclusively to their client populations (e.g., enrollment assistance, post-enrollment assistance, outreach and education about getting covered), so long as they do not discriminate based on race, color, national origin, disability, age sex or other prohibited factors

28. FFR Overview CMS Final Rule Highlight: 24 hour expedited review of formulary requests • Qualified Health Plans (QHPs) must have an expedited exceptions process for beneficiaries with exigent circumstances to seek a medication not covered under a plan • Exigent circumstances exist when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a non-formulary drug • QHPs must decide within 24 hours of receiving the request • QHPs must provide coverage of any drug obtained through this expedited exceptions process for the duration of the exigency

29. Integrated Planning

30. Integrated Planning with CDC • HAB and DHAP released a joint letter indicating our ongoing support for integrated planning and the alignment of the RWHAP Comprehensive Plan/Statewide Coordinated Statement of Need and the HIV Jurisdictional Prevention Plan due dates • HAB and DHAP are continuing to work on the guidance(s) for these plans and anticipate releasing guidance in 2015

31. Other HAB Updates

32. ADR • Thanks for all the hard work that went into the CY 2013 ADR submission • 41 States/Territories were able to submit on time • Data contractors worked with the remaining States/Territories to successfully submit • CY 2014 ADR • The 2014 ADR Client Data Dictionary is now available on the TARGET Center website as part of the ADAP Data Report (ADR) Download Package. This resource has been updated to reflect reporting requirements for the 2014 ADAP Data Report (ADR)

33. ADR CY 2014 ADR (cont.) • Thank-you to ADAPs that submitted comments on the draft 2014 ADR Manual. The manual will be posted on TARGET in early August • DART is planning a webinar with ADAPs on August 20 at 2 pm ET to go over the 2014 ADR changes. Check the Events tab on the TARGET Center website to register

34. Contact Information Heather Hauck Phone: (301) 443-3613 Email: HHauck@hrsa.gov Glenn Clark Phone: (301) 443-3692 Email: GLClark@hrsa.gov