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					Administrative   Overview

Ryan White HIV/AIDS Program
                  Part A    Part B

The AIDS Drug Assistance Program

 Kerry Hill, MSW, Project Officer
 HRSA, DSS, Northeastern/Central Services Branch
 For the Feb 5-7, 2008 Administrative Overview

1. Overview
2. Funding
3. Financial Eligibility and Formulary coverage
4. ADAP Supplemental Award
5. Insurance
6. Flexibility Policy
7. Quality Management
8. Waiting List
Part B of the Ryan White Program

   Part B is administered by the Division of Service
    Systems, within the HIV/AIDS Bureau, HRSA

   Part B grants are awarded on a formula basis to States
    and Territories to provide health care and support
    services for people living with HIV disease

   Pharmaceutical treatments, through an AIDS Drug
    Assistance Program (ADAP), is one of the Part B
    eligible services
Purpose of ADAPs

 … to provide therapeutics to treat
  HIV disease or prevent the
  serious deterioration of health
  arising from HIV disease in
  eligible individuals, including
  measures for the prevention
  and treatment of opportunistic
Overview of ADAPs

 ADAP provides medications for the treatment of HIV disease

 ADAP funds may be used to purchase health insurance for eligible

 ADAP funds also may be used to pay for services that enhance
  access, adherence, and monitoring of drug treatment

 ADAPs are required to have at least one drug from each class of
  Public Health Service approved Antiretrovirals on their formulary
ADAPs National Overview
   59 ADAPs, including all 50 States, the District of
    Columbia, Puerto Rico, Virgin Islands, Guam, American
    Samoa, Northern Mariana Islands, Republic of Palau,
    Federated States of Micronesia and the Republic of
    Marshall Islands

   Wide variation in program characteristics due to
    individual State administration of each ADAP and
    HIV/AIDS prevalence in each State

   Differences most pronounced in areas of funding,
    eligibility criteria, formulary size, and cost-saving
History of the ADAP Earmark
           1996        $52 million
           1997        $167 million
           1998       $285.5 million
           1999        $461 million
           2000        $528 million
           2001        $589 million
           2002        $639 million
           2003        $714 million
           2004        $748 million
           2005       $787.5 million
           2006      $789.005 million
           2007      $789.546 million
Financial Eligibility Criteria: June 2007

  Income threshold as % of    Number of                 List of States
  Federal Poverty Level (FPL) State ADAPs
  101-200% of FPL                            12 ADAPs   GU, IA, ID, LA, NC, NE,
                                                        OK, OR, PR, TX, VI,
  201-300% of FPL                            19 ADAPs   AK, AR, AL, AZ, FL,
                                                        GA, IN, KS, KY, MN,
                                                        MO, NH, SC, SD, TN,
                                                        VA, WA, WI, WV
  Over 301% of FPL                           23 ADAPs   CA, CO, CT, DC, DE,
                                                        HI, IL, ME, MD, MA,
                                                        MI, MS, MT, ND, NM,
                                                        NV, NJ, NY, OH, PA,
                                                        RI, UT, WY

  Territories did not submit ADAP Profiles
Formulary Coverage: June 2007
 Number of Drugs   Number of States   List of States
 11-50                     9          AL, GU, IA, ID, LA, TX,
                                      UT, VI, WV

 51-100                    24         AK, AR, CO, DC, FL,GA
                                      IL, IN, KS, KY, MS, NC,
                                      ND, NM, NV, OH, OK,
                                      RI, SD, TN, SC, VA, WI,
 101-200                   12         AZ, CA, HI, MD, MA,
                                      MN, MT, NE, OR, PR,VT,
 201+                      9          CT, DE, ME, MI, MO,
                                      NH, NJ, NY, PA
Supplemental Treatment Drug Grants

   5 percent of FY 2007 ADAP Earmark funds are
    reserved for supplemental grants to ADAPs in States
    exhibiting severe need to increase access to HIV/AIDS-
    related medications

   States/Territories are eligible to apply for program
    funding, based on program limitation (i.e. enrollment
    cap, waiting list and capped expenditures) reported in
    the ADAP Quarterly Report (December 31, 2006).
Supplemental Treatment Drug Grants

Funding available to States/Territories based on:
   Financial requirement of Federal Poverty Level (FPL)
    <200 percent;

   Limited formulary compositions for all core classes of
    antiretroviral medications;

   Waiting list, capped enrollment or expenditures; and

   An unanticipated increase of eligible individuals with
ADAP Insurance

   HAB Policy Notice 07-05

   Allows States and Territories to use ADAP
    funds to purchase health insurance.

   Allows for the use of Part B ADAP funds to
    purchase health insurance services that include
    the full range of HIV treatments as well as
    access to comprehensive primary care services
ADAP Insurance (cont.)

   States have utilized High Risk Health Insurance
    Pools, State-sponsored health insurance,
    COBRA, and private insurance policies

ADAP Flexibility Policy

    HAB Policy Notice 07-03

    Purpose: Fund support services directly tied to:

        gaining “Access” to Medications,
        increasing “Adherence” to medication
         regimens, and
        “Monitoring” client’s progress in taking HIV-
         related medication
ADAP Flexibility Policy

Quality Management

   Best Practices - How do you communicate and
    promote the PHS Guidelines to providers (AETC)

   Advisory Body - By-laws, formulary approval and
    revisions, consumer input and participation, budget

   Data - How is data used to improve service delivery

   Client Perception - satisfaction, access, formulary,
    grievance procedures, application and approval
    process, timeliness
Public Health Service Guidelines

   Adult and Adolescent Guidelines

   Pediatric Guidelines

   Management of HIV Complications

   HIV Testing

   Web-link:

Waiting List

   Two types of waiting list: “First Come, First Serve”
    or “client’s health status”

   Patient Assistance Programs (train providers and
    case managers)

   Reporting- weekly update to HRSA PO

   Process for removing clients from waiting list (for
    what reasons, how often, when, by whom)
Waiting List-Cost Saving Strategies

   Reducing formulary                Bi-annual recertification
   Capping the number                Medicaid database
    individuals on the State           matching for eligibility
    ADAP enrollment

   Capping the dollar amount
                                      Cost Share
    of clients on a per month or
    annual basis
                                      Back-billing Medicaid

                                      Creation of waiting list
Medicare Part D Audio Slides
Contact Information

   Kerry Hill, MSW
   Project Officer, HIV/AIDS Bureau
   DSS, Northeastern Central Services Branch
   5600 Fishers Lane, Room 7A-55
   Rockville, MD 20857

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