Policy
Notice - 07-05
September
19, 2007
TO:
All Ryan White HIV/AIDS Program Grantees
Attached is the HIV/AIDS Bureau (HAB) updated
policy describing the use of Ryan White
HIV/AIDS Program Part B AIDS Drug Assistance
Program (ADAP) funds to purchase health
insurance. This policy was previously published
as "Policy Notice 99-01." This
updated policy reflects the technical changes
in Title XXVI of the Public Health Service
Act as amended by the Ryan White HIV/AIDS
Treatment Modernization Act of 2006 (Ryan
White HIV/AIDS Program) and establishes
updated guidelines for the use of Ryan White
HIV/AIDS Program Part B ADAP funds for the
purchase of health insurance. In essence,
the previous policy has not undergone any
substantive changes and is being re-issued
to reflect the technical changes as a result
of the newly reauthorized Ryan White HIV/AIDS
Program.
Funds designated to carry out the provisions
of Section 2616 of the Public Health Service
Act may be used to purchase health insurance
whose coverage includes HIV treatments and
access to comprehensive primary care services,
subject to specific conditions.
If you have any questions regarding the
content of the HAB Policy Notice, please
contact your project officer. Thank you
for your attention to this important matter.
Deborah Parham Hopson, Ph.D., R.N.
Assistant Surgeon General
Associate Administrator
Policy Notice 07-05: The Use of Ryan White
HIV/AIDS Program Part B AIDS Drug Assistance
Program (ADAP) Funds to Purchase Health
Insurance
The
following HIV/AIDS Bureau (HAB) policy is
being issued to support individual States
in the management of their HIV/AIDS programs
and to ensure that ADAPs are the payers
of last resort.
A.
Funds designated to carry out the provisions
of Section 2616 of the Public Health Service
Act may be used to purchase health insurance
whose coverage includes the full range of
HIV treatments and access to comprehensive
primary care services, subject to the conditions
below:
- Funds
must continue to be managed as part of
the established ADAP Program.
- ADAP
programs must be able to account for and
report on funds used to purchase and maintain
insurance policies for eligible clients
including covering any costs associated
with these policies.
- Funds
may only be used to purchase premiums
from health insurance plans that at a
minimum provide prescription coverage
equivalent to the Ryan White HIV/AIDS
Program Part B formulary.
- The
total annual amount spent on insurance
premiums can not be greater than the annual
cost of maintaining that same population
on the existing ADAP program.
- Funds
may be used to cover any costs associated
with the health insurance policy, including
co-payments, deductibles, or premiums
to purchase or maintain insurance policies
- Current
client eligibility guidelines, set under
Section 2616(b) of the Public Health Service
Act, must be followed.
- The
States must maintain their contributions
to their HIV/AIDS care programs as required
under Section 2617(b)(7)(E).
- Ryan
White HIV/AIDS Program funds must be the
payers of last resort for pharmaceuticals.
- The
State must assure that ADAP funds will
not be used to purchase health insurance
deemed inadequate by the State in its
provision of comprehensive primary care
services.
B.
Prior to the use of ADAP funds for the purchase
of health insurance, States must provide
the HIV/AIDS Bureau with the methodology
used by the State to:
-
Assure that they are buying health insurance
that at a minimum includes pharmaceutical
benefits equivalent to the Ryan White
HIV/AIDS Program Part B ADAP formulary
(refer to A.3.), and
- Assess
and compare the costs of providing medications
through the health insurance option versus
the existing ADAP program (refer to A.4.).
- If
the use of ADAP funds for buying insurance
is initiated within a grant cycle, the
State ADAP will provide notification of
intent with the aforementioned assurances
to the Grants Management Officer.
C.
Nothing in the above policy may be interpreted
or construed to change existing requirements,
authorized by law or policy guidelines, regarding,
but not limited to: client eligibility, statewide
parity for client eligibility, and statewide
parity for treatments available in the ADAP
formulary. |