Preparing for 2014: Overview of Ryan White Program Policy Updates & Guidance

1. Preparing for 2014:Overview of Ryan White Program Policy Updates & Guidance August 14, 2013 Department of Health and Human Services Health Resources and Services Administration HIV/AIDS Bureau

2. Today’s Presentation Will • Provide 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 activities • Revised Core Medical Service Waiver policy

3. Upcoming Webcast • An 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 Act • 13-04: Clarifications Regarding Clients Eligible for Private Health Insurance and Coverage of Services by RWHAP • 13-05:Clarifications Regarding Use of RWHAP Funds for Premium and Cost- Sharing Assistance for Private Health Insurance • 13-06: Clarifications Regarding Use of RWHAP Funds for Premium and Cost-Sharing Assistance for Medicaid

4. Policy Clarification Notice 13-01 Clarifications Regarding Medicaid-Eligible Clients and Coverage of Services by Ryan White HIV/AIDS Program

5. 13-01: Details • This 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.

6. 13-01: Retroactive Medicaid Eligibility • Medicaid coverage may start retroactively up to three monthsprior to the client’s application date. • Grantees must back-bill Medicaid for services provided during this time.

7. Policy Clarification Notice 13-02 Clarifications on Ryan White Program Client Eligibility Determinations and Recertifications Requirements

8. 13-02: Initial Eligibility • Reiterates current client eligibility requirements to receive RWHAP funded services. Clients must be: • HIV positive • Low-income, as defined by the grantee • Grantees have the option of narrowing eligibility requirements; however, requirements may not be broadened.

9. 13-02: Recertification • Grantees must ensure that clients continue to meet eligibility requirements by verifying: • Residency, income, and insurance status • Clients 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 changes

10. 13-02: Summary of Documentation

11. 13-02: Summary of Documentation, cont’d

12. 13-02: Other Considerations • Re-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.

13. 13-02: Other Considerations, cont’d • Grantees 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 required • Must be applied consistently to all clients • Must be approved by HAB • Part C, D, and F grantees are encouraged to coordinate with Part A and B grantees.

14. Outreach and Enrollment • RWHAP grantees and planning bodies are encouraged to review their Fiscal Year 2013/2014HIV 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.

15. Outreach and Enrollment cont’d Ryan White Program Parts A & B • Early Intervention Services fundingmay be used for benefits counseling, enrollment and outreach education. • Medical Case Management Services fundingmay be used for benefits counseling and enrollment. • Non-Medical Case Management Servicesfunding may be used for benefits counseling and enrollment.

16. 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 Servicesfunding, 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 fundingmay be used for benefits counseling, enrollment and outreach education, as the Affordable Care Act is considered a benefit to people living with HIV/AIDS.

17. Outreach and Enrollment cont’d Ryan White Program Minority AIDS Initiative - Part B • Minority AIDS Initiative funding may be used for outreach education, benefits counseling and enrollment.

18. Outreach and Enrollment cont’d Ryan White Program Part C • 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. • Outreach Servicesgenerally 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.

19. Outreach and Enrollment cont’d Ryan White Program Part D • 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.

20. Joint HRSA/CMS Informational Bulletin • Issued to promote a seamless transition of care into 2014 • Outlines Federal coordination between HRSA and CMS • Identifies key resources at both agencies • Encourages coordination between Medicaid and the RWHAP AIDS Drug Assistance Program (ADAP)

21. Core Medical Services Waiver • Federal 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 services • Clarifies documentation requirements • Provides more flexibility in the timeframe for grantees to apply for a waiver

22. Core Medical Services Waiver, Cont’d • Comment period closed on June 24, 2013 • HRSA is currently reviewing comments and will make decisions shortly on next steps. • As is, the policy goes into effect on September 23, 2013.

23. Next Steps • Visit the HAB webpage, “Ryan White & the Affordable Care Act: What You Need to Know” : http://www.hab.hrsa.gov/affordablecareact/index.html • On 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