FY 2011 Case Management and Medication Assistance Terms and Conditions

1. FY 2011Case Management and Medication Assistance Terms and Conditions HIV Care Services Virginia Department of Health http://www.vdh.virginia.gov/epidemiology/DiseasePrevention/HCS

2. Why • Increased need • New Clients • Reengaging Clients • Level or decreased funds • Access is more complex • RW as Payor of Last Resort

3. FY 11 Case Management Terms and Conditions Contractor will ensure that case management services (both medical and non-medical) funded through Ryan White Part B funds (either contracted or subcontracted) support medication access for case managed clients, including enrollment and maintenance in manufacturer Pharmaceutical Assistance Programs when appropriate.  Ryan White Part B-funded case managers are required to:

4. Case Management Terms and Conditions (cont.) • Assess and document medication access for clients at every assessment and reassessment at appropriate time intervals directed in the HIV/AIDS Case Management Standards. • Initiate, coordinate and complete enrollment and re-enrollment requirements for medication access systems for case managed clients, including manufacturer Pharmaceutical Assistance Programs.

5. Case Management Terms and Conditions (cont.) • Serve as the primary contact for medical providers seeking medication access for their case managed clients. • Provide medication access resource information and education to clients and providers.

6. Case Management Terms and Conditions (cont.) • Document all activity related to medication access activity for clients in client charts, clearly noted on Assessments, Reassessments, Individual Service Plans and Issues Lists.  This is subject to review by funder at any time. • Report activities related to these terms on a monthly basis as part of the contractually required monthly progress reports.

7. Additional Considerations/Guidance • Review time expectations of case managers.  One contractor requires at least 75% of funded time is spent with “direct” patient intervention, and no more than 25% of time is spent on “administrative” (charts, individual service plans) or training.  • Evaluate instances where case management intervention can be consolidated if there are duplicative efforts being made by funded staff (i.e., nurses and social workers).

8. Additional Considerations/Guidance • Evaluate efficiency, benefits or challenges of co-locating case management to medical sites versus stand alone sites. • Contact the Virginia Healthcare Foundation for support, coordination with funded sites, or to evaluate the appropriateness of using software to support this effort (Pharmacy Connection).  Purchase of this software will be considered an allowable cost during Ryan White Part B Fiscal Year 2011. 

9. FY 11 Medication Assistance Terms and Conditions The contractor is responsible for ensuring that Ryan White Part B (RWB)-funded copayment assistance provided by the contractor (or subcontractors) for antiretroviral medications (ARVs) occurs only after all alternative methods of payment, including Copayment Patient Assistance Programs (Copay PAPs), have been attempted. Activities related to these terms must be reported as part of the contractually required monthly progress reports to VDH.

10. Questions? • Lenore Drewry, HIV Services Coordinator Supervisor • Lenore.Drewry@vdh.virginia.gov, or (804) 864-8022 • Or your specific Contract Monitor • Lisa Laurier, Mary Browder, Hunter Robertson, Ann Verdine-Lewis, Phyllis Morris