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
Focus
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
infections
Overview of ADAPs
ADAP provides medications for the treatment of HIV disease
ADAP funds may be used to purchase health insurance for eligible
clients
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
strategies
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,
VT
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,
WY
101-200 12 AZ, CA, HI, MD, MA,
MN, MT, NE, OR, PR,VT,
WA
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
HIV/AIDS.
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
http://hab.hrsa.gov/law.htm
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
http://hab.hrsa.gov/law/0703.htm
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
projections
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:
http://aidsinfo.nih.gov/Guidelines
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
TARGET Center http://careacttarget.org
Contact Information
Kerry Hill, MSW
Project Officer, HIV/AIDS Bureau
DSS, Northeastern Central Services Branch
5600 Fishers Lane, Room 7A-55
Rockville, MD 20857
301-443-0583
kerry.hill@hrsa.hhs.gov