Ryan White Part B and THMP Eligibility Changes & Updates Jessica Conly, Care Services Consultant Desty Muturi, MPH, Care Services Trainer Imelda Majalca, MSW, THMP Trainer February 22, 2018

What’s changed? Timelines Language Proof of Positivity Proof of Residency Proof of Income Income Cap

Timelines THMP and Ryan White Part B have aligned eligibility processing dates to a ‘birth month’ and ‘1/2 birth month’ timeline Effective 10/1/17 for THMP Effective 4/1/18 for RW Part B and SS Removing ‘Determination Period’ from policy

Language Alignment Recertification vs Certification vs Self-Attestation New Eligibility: new enrollment into services, or re- enrollment after a break in services. Recertification: annual process of submitting a full THMP application, and complete proof of eligibility for RW Part B (income, insurance verification, and residency). This process occurs by the last day of the clients birth month. Self-Attestation: process of a client confirming no change in previous eligibility declaration and documentation. This process occurs by the last day of the month, six months after the clients birth month.

Proof of Positivity Prescribing Authority Clarified language regarding signed statements from clinicians to prove HIV status. Signed statements proving HIV status must be from a clinician with prescribing authority for HIV medication/care.

Proof of Residency More aligning.. Social Security, Medicaid/Medicare, or SNAP/TANF benefit award letter; IRS Tax Return Transcript, Verification of Non-Filing, W2, or 1099; Official State Mail; Current Employment Records (pay stub) and; Post Office Records.

Income Cap 500% FPL All Ryan White and State Services - funded services must have an FPL limit not to exceed 500% of FPL

Proof of Income Income Calculation Worksheet

THMP & RW Merged Income Form (April 1) *Individual income will still be used to determine individual FPL for RW eligibility, along with calculations for sliding fee scales. Purpose: To assist in merging THMP & RW eligibility process and decrease barriers for clients accessing services Income eligibility will not change Merged form to replace the MAGI/Mock MAGI forms Individual FPL (RW) Household FPL (THMP) 9/23/2019

9/23/2019

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9/23/2019

Texas HIV Medication Program 1-800-255-1090 https://www.dshs.texas.gov/hivstd /meds/

Recertification Timeline October 1, 2017 ADAP programs are prohibited from “presumptive eligibility” activity, which is defined as “providing services before a client has been determined to meet the ADAP’s eligibility criteria”. Furthermore, ADAP programs are prohibited from providing “grace periods.” This means that it is “unallowable for a client to receive ADAP service after their 6 month eligibility period has expired and before they recertify their eligibility.” (https://hab.hrsa.gov/sites/default/files/hab/clinical- qualitymanagement/adapmanual.pdf) 9/23/2019

Grace Period March 1st July 31st Approved Aug 25th Update Address Mail 2nd app New due date Aug 31st. 1 more fill March 1st July 31st Approved Aug 25th Self Attestation due on July 31st We don’t know if the client is eligible from July 31st-Aug 25th but they got a 30 day supply. Grace Period.

Recertification Calendar Birthdate Month Self-Attestation 6 months Recertification 12 months January July 31st January 31st February August 31st February 28th/29th March September 30th March 31st April October 31st April 30th May November 30th May 31st June December 31st June 30th July January 31st July 31st

6 month SA R

6 month SA R

6 month SA

6 month SA R

6 month SA R

Medications never close UNLESS the client misses a due date. No Grace Period Medications never close UNLESS the client misses a due date. March 1st Aug 31st March 1st Aug 31st Sept 1st Feb 28/29th Dropped immediately if… Client moves out of state Client is now over scale THMP is no longer payer of last resort

Medications remain open during this time as long as due dates are met. January Birthday Transition effect for timeline, slide 1 (Basic) Tip: This transition works well for graphics that horizontally span more than one slide. To reproduce the shape effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Home tab, in the Drawing group, click Shapes, and then under Block Arrows, click Chevron (second row, eighth option from the left). On the slide, drag to draw a long, horizontal chevron shape. Select the chevron. Under Drawing Tools, on the Format tab, in the Size group, do the following: In the Shape Width box, enter 9.48”. In the Shape Height box, enter 0.7”. Drag the chevron so that the right end is beyond the right edge of the slide, and the left end of the chevron is approximately one inch to the right of the left edge of the slide. Select the chevron. Under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. Click the button next to Direction, and then click Linear Up (second row, second option from the left). Under Gradient stops, click Add gradient stop or Remove gradient stop until a total of four gradient stops appear in the slider. Also under Gradient stops, customize the gradient stops as follows: Select the first stop in the slider, and then do the following: Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left) In the Position box, enter 0%. Select the next stop in the slider, and then do the following: In the Position box, enter 36%. Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 213, Green: 219, Blue: 221. In the Position box, enter 73%. Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 178, Green: 190, Blue: 194. Select the last stop in the slider, and then do the following: In the Position box, enter 100%. Also in the Format Shape dialog box, click Line Color in the left pane, and then select No line in the Line Color pane. Also in the Format Shape dialog box, click Shadow in the left pane, and then do the following in the Shadow pane: Click the button next to Presets, and then under Outer click Offset Bottom (first row, second option from the left). In the Transparency box, enter 60%. In the Size box, enter 100%. In the Blur box, enter 4 pt. In the Angle box, enter 90°. Also in the Format Shape dialog box, click 3-D Format in the left pane. In the 3-D Format pane, under Bevel, click the button next to Top, and then under Bevel click Circle (first row, first option from the left). Next to Top, in the Width box, enter 4 pt, and in the Height box, enter 4 pt. In the Distance box, enter 3 pt. On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box. Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Gill Sans MT Condensed from the Font list, enter 26 in the Font Size box, click Bold, click the arrow next to Font Color, and then under Theme Colors click White, Background 1, Darker 50% (sixth row, first option from the left). On the Home tab, in the Paragraph group, click Center to center the text in the text box. Select the text box. On the Home tab, in the Clipboard group, click the arrow to the right of Copy, and then click Duplicate. Repeat this process to create a total of three text boxes. Click in each of the two duplicate text boxes, and then edit the text. Drag the text boxes onto the chevron shape to form a row. Press CTRL+A to select all the objects on the slide. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following: Click Align Middle. Click Align to Slide. Press and hold SHIFT, and then select all three text boxes. On the Home tab, in the Drawing group, click Arrange, and under Position Objects, point to Align, and then do the following: Click Distribute Horizontally. To reproduce the animation effects on this slide, do the following: On the Transitions tab, in the Transition to This Slide group, click More, and then under Subtle click Push. Also on the Transitions tab, in the Transitions to This Slide group, click Effect Options and then click From Right. Also on the Transitions tab, in the Timing group, in the Duration box, enter 1.00. Client is approved for the first time. Medications remain open during this time as long as due dates are met. Eligibility Ends. May 5th June 1st July 31st August 31st Mail out Self-Attestation 60 days before it’s due. Self-Attestation is due Complete processing of Self-Attestation by Aug 31st.

Medications remain open during this time as long as due dates are met. January Birthday Transition effect for timeline, slide 2 (Basic) Tip: This slide is the second slide in a three-slide sequence. To reproduce the effects on this slide, do the following: In the Slides and Outline pane, right-click the previous slide (“Transition effect for timeline, slide 1”) and click Duplicate Slide. Select each of the three text boxes on the slide and change the text. Select the chevron shape on the slide. Drag the left sizing handle to the left so that the chevron shape extends past the left edge of the slide. Medications remain open during this time as long as due dates are met. New Eligibility Begins Eligibility Ends September 1st Dec 1st Jan 31st February 28/29th Complete processing of Recert by Feb 28/29th Mail out Recert Apps Recert App due for Jan Bdays

Medications remain open during this time as long as due dates are met. Transition effect for timeline, slide 1 (Basic) Tip: This transition works well for graphics that horizontally span more than one slide. To reproduce the shape effects on this slide, do the following: On the Home tab, in the Slides group, click Layout, and then click Blank. On the Home tab, in the Drawing group, click Shapes, and then under Block Arrows, click Chevron (second row, eighth option from the left). On the slide, drag to draw a long, horizontal chevron shape. Select the chevron. Under Drawing Tools, on the Format tab, in the Size group, do the following: In the Shape Width box, enter 9.48”. In the Shape Height box, enter 0.7”. Drag the chevron so that the right end is beyond the right edge of the slide, and the left end of the chevron is approximately one inch to the right of the left edge of the slide. Select the chevron. Under Drawing Tools, on the Format tab, in the Shape Styles group, click the arrow next to Shape Fill, point to Gradient, and then click More Gradients. In the Format Shape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following: In the Type list, select Linear. Click the button next to Direction, and then click Linear Up (second row, second option from the left). Under Gradient stops, click Add gradient stop or Remove gradient stop until a total of four gradient stops appear in the slider. Also under Gradient stops, customize the gradient stops as follows: Select the first stop in the slider, and then do the following: Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left) In the Position box, enter 0%. Select the next stop in the slider, and then do the following: In the Position box, enter 36%. Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 213, Green: 219, Blue: 221. In the Position box, enter 73%. Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 178, Green: 190, Blue: 194. Select the last stop in the slider, and then do the following: In the Position box, enter 100%. Also in the Format Shape dialog box, click Line Color in the left pane, and then select No line in the Line Color pane. Also in the Format Shape dialog box, click Shadow in the left pane, and then do the following in the Shadow pane: Click the button next to Presets, and then under Outer click Offset Bottom (first row, second option from the left). In the Transparency box, enter 60%. In the Size box, enter 100%. In the Blur box, enter 4 pt. In the Angle box, enter 90°. Also in the Format Shape dialog box, click 3-D Format in the left pane. In the 3-D Format pane, under Bevel, click the button next to Top, and then under Bevel click Circle (first row, first option from the left). Next to Top, in the Width box, enter 4 pt, and in the Height box, enter 4 pt. In the Distance box, enter 3 pt. On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box. Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Gill Sans MT Condensed from the Font list, enter 26 in the Font Size box, click Bold, click the arrow next to Font Color, and then under Theme Colors click White, Background 1, Darker 50% (sixth row, first option from the left). On the Home tab, in the Paragraph group, click Center to center the text in the text box. Select the text box. On the Home tab, in the Clipboard group, click the arrow to the right of Copy, and then click Duplicate. Repeat this process to create a total of three text boxes. Click in each of the two duplicate text boxes, and then edit the text. Drag the text boxes onto the chevron shape to form a row. Press CTRL+A to select all the objects on the slide. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following: Click Align Middle. Click Align to Slide. Press and hold SHIFT, and then select all three text boxes. On the Home tab, in the Drawing group, click Arrange, and under Position Objects, point to Align, and then do the following: Click Distribute Horizontally. To reproduce the animation effects on this slide, do the following: On the Transitions tab, in the Transition to This Slide group, click More, and then under Subtle click Push. Also on the Transitions tab, in the Transitions to This Slide group, click Effect Options and then click From Right. Also on the Transitions tab, in the Timing group, in the Duration box, enter 1.00. Medications remain open during this time as long as due dates are met. Eligibility Begins Eligibility Ends March 1st June 1st July 31st August 31st Complete processing of Self-Attestation by Aug 31st. Mail out Self-Attestation Self-Attestation is due

Start Early March 1st Elig Starts Aug 31st Elig Ends Ends

Determined eligible thru August 31st No Grace Period Medications never close UNLESS the client misses a due date (or dropped immediately if the client moves out of state, over scale, or now has insurance. March 1st Aug 31st Sept 1st Feb 28/29th March 1st Aug 31st Documentation collection starts on June 1st SA DUE July 31st to be completely processed by Aug 31st for… Documentation collection starts Dec 1st, Recert app DUE Jan 31st to be completely processed by Feb 28/29th for… Determined eligible thru August 31st Determined eligible thru Feb 28/29th

Medications never close UNLESS the client misses a due date. No Grace Period Medications never close UNLESS the client misses a due date. March 1st Aug 31st Sept 1st Feb 28/29th March 1st Aug 31st Documentation collection starts on June 1st, Recert DUE July 31st, to be completed by Aug 31st. Client is dropped by the end of the eligibility date if the due date is missed. Dropped immediately if the client moves out of state , over scale, now has insurance.

Recertification is aligned with the last day of the participant’s birth month. If recertification is completed late, it does not change the due date for self-attestation. Instead, it shortens the eligibility period. Denials for Incomplete applications complete their eligibility period, but denials for over scale, residency, or insurance are immediate. For pending applications, we only need the requested document, not a new application. For incomplete applications, we can accept a new application by fax without the MCF until the application is purged. After an application is purged, the applicant must mail in a new application that includes a medical certification form. Birth Month Mailing Date Recertification Due Date Current Eligibility Period Ends Application Pended-Due Date (This date is the same regardless of when application was received) Application Denied as Incomplete (May Reapply by fax and without MCF until this date) Purge Date Eligibility Period January December 1 January 31 February 28-29 March 3 March 1-August 31 February January 1 March 31 April 3 April 1-September 30 March February 1 April 30 May 3 May 1-October 31 April March 1 May 31 June 3 June 1-November 30 May April 1 June 30 July 3 July 1-December 31 June May 1 July 31 August 3 August 1-January 31 July June 1 August 31 September 3 September 1- February 28-29 August July 1 September 30 October 3 October 1-March 31 September August 1 October 31 November 3 November 1-April 30 October September 1 November 30 December 3 December 1-May 31 November October 1 December 31 January 3 January 1- June 30 December November 1 February 3 February 1-July 31

New eligibility may happen at any time during the year New eligibility may happen at any time during the year. Therefore, the first eligibility period may be shorter than or greater than 6 months. New Eligibility Chart

Thank you THMP 1-800-255-1090