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Ryan Whitecontent relevant to the Ryan White
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Questions and Answers for Policy Notice 07-01 Links RWCA Provisions Ryan White Program and Services for American Indians and Alaskan NativesQuestions and Answers for Policy Notice 07-01
Yes. AIs/ANs can claim Ryan White Program services for which they are eligible where they choose, regardless of the availability of other services that may also be available to them (e.g., through Indian Health Service (IHS), tribal, or urban Indian health programs and services).
Persons infected with the Human Immunodeficiency Virus (HIV) and those who have clinically defined Acquired Immune Deficiency Syndrome (AIDS) are eligible. Some States/Territories may require additional financial, residential, and medical criteria to establish eligibility. Non-infected individuals, in limited situations, may be eligible for services but only if these services have at least an indirect benefit to a person with HIV infection.
Yes. ADAP provides funding for medications for the treatment of HIV disease. Each State and territory establishes its own eligibility criteria. All require that individuals document their HIV status and meet established income eligibility criteria. ADAPs operate under either a pharmacy reimbursement model similar to Medicaid or may directly purchase and distribute drugs for and to enrollees. Clients can enroll in ADAP in one of two ways depending on the state of enrollment; either by applying directly through state ADAP offices or submitting applications through their case manager, physician, nurse, or other service provider.
There are no restrictions that prohibit clients from tailoring their health care program utilizing various providers and services for which they are eligible to meet their individual health care needs.
Ryan White Program services cannot be denied to clients who are not AIs/ANs. By IHS law, IHS and tribal facilities who receive Ryan White Program funds, however, are not required to provide individuals whom are not AI/AN access to existing resources that are meant for AIs/ANs. As the Ryan White Program and IHS eligibility for services are separate health care programs, clients presenting for care are eligible for care/services as prescribed by each individual programs’ existing eligibility rules. Those clients, who are not AI/AN, who receive services not covered by the Ryan White program from IHS-operated, 638 contract, or Urban Indian Health Programs should follow the facilities’ established procedures for determining health care coverage and payment for these services.
Ryan White Program services must not supplant (replace a service already offered and available) other funded services but may be used to supplement services which are unavailable for clients who require the service.
No. The IHS is not obligated to reimburse a Ryan White Program grantee or provider for services provided to an AI or AN who requests those services. IHS services are a separate entitlement from Ryan White Program services. IHS facilities are also exempt from the “Payer of Last Resort” restriction for Parts A, B, and C.
Ryan White Program funds cover the cost of the care. With the exception of programs administered by or providing services of the IHS under Parts A, B, and C, - who are exempt from payer of last resort restrictions - if a patient is eligible or has other health service coverage, e.g., Medicaid, the grantee or provider must seek payment from that payer first and should follow established procedures to determine health care coverage as it usually does under the payer of last resort program.
The Ryan White Program can cover the cost of an array of HIV/AIDS health and related supportive services. Health services can include primary health care, including the ADAP, early intervention services, and dental services. In addition, the Ryan White Program covers critical health related support services needed for individuals with HIV/AIDS to achieve their medical outcomes. Support services might include respite care for persons caring for individuals with HIV/AIDS, outreach services, medical transportation, linguistic services, and referrals for health care and support services. Payment for these services must be sought from all other sources, Medicaid, private insurance, and other third party reimbursement plans, prior to grantees seeking reimbursement from the Ryan White Program. With the exception of programs administered by or providing services of the IHS under Parts A, B, and C, - who are exempt from payer of last resort restrictions - Ryan White Program funding is the payer of last resort. Grantees must be capable of providing the HIV/AIDS Bureau (HAB) with documentation related to the use of funds as payer of last resort and the coordination of such funds with the tribes and with the IHS as applicable and other sources of payment (e.g., Medicaid, Medicare, Department of Veterans Affairs, State funded programs, etc.).
A 638 facility is operated by a tribal organization that is recognized by the Federal government, under a funding agreement with IHS
Facilities, Tribes, and Urban Indian Health programs interested in applying as a direct grantee should periodically check http://www.grants.gov/ as all program guidances are released and applicants must apply electronically via this site. Interested programs should also review the necessary steps on http://www.grants.gov/ to apply for grants and use the information provided to prepare themselves as a competitive applicant.
Subcontractors can include hospitals (including Department of Veterans Affairs' facilities), community-based organizations, hospices, ambulatory care facilities, community health centers, migrant health centers, rural health centers, homeless health centers, substance abuse treatment programs, faith based organizations, and mental health programs that can provide HIV related services. Private for-profit entities may provide services as a subcontractor if they are the only available provider of quality HIV care in the specified area. Facilities and/or organizations interested in providing services as a subcontractor, should directly contact Ryan White Grantees. For a list of current grantees under Parts A, B, C, and D, see the grantee lists at http://hab.hrsa.gov/programs.htm
Find
a Ryan White Care Act Title I and Title II grantee Ryan White Target Center Ryan White Program Fact Sheet (PDF
- 179KB) Ryan
White AIDS Drug Assistance Program (ADAP) Fact Sheet (PDF
- 980KB) The Ryan White CARE
Act (RWCA) was reauthorized (12/19/2006) as the “Ryan
White HIV/AIDS Treatment Modernization Act of 2006 (RWMA)” (PDF
- 2MB) The following RWCA provisions in the reauthorization affect the IHS and AI/AN population:
We are working diligently with leadership from HRSA to discuss ramifications and implementation of this language and to disseminate the message of these changes to help with care of our AI/AN persons at risk and living with HIV/AIDS. Additionally, we hope to focus current and future initiatives and collaborations with HRSA around efficient models and linkages of care between our clients, I/T/U facilities, and Ryan White grantees, service providers, and services (i.e. RWCA Titles I, II (which includes the AIDS Drug Assistance Program), III, IV, etc.). Although I/T/U sites are eligible for Titles III and IV, this does not mean I/T/U sites are automatically grantees; they must go through the application and approval process. For now, you may visit http://www.grants.gov/ for more information. Given these new provisions, it is imperative that all AI/AN clients and facilities eligible for these provisions are made aware and assisted in removing any barriers to effective and seamless access and care. It may be advisable for each health facility to contact a RWMA grantee in your respective area/state to link this new language to an action plan and discuss potential linkages or improve existing ones. |