THMP Recertification Becky Ruiz, BSW Katherine Wells, MPH

2April 3, 2009 THMP Recertification Purpose: To ensure that the information within our files is current and accurate, and that all program clients continue to meet the established eligibility criteria as required by our funding sources Recertification was requested by community advocates as a way to control ADAP costs. The proposal was presented to the Texas Board of Health, they agreed and recertification was added to the program rules In 2005, HRSA made recertification a condition of our federal ADAP grant award

3April 3, 2009 Recertification Process Clients are required to recertify every 2 to 3 years 3 years for ADAP 2 years for SPAP The recertification date is based on the client’s last THMP approval date The THMP will notify clients by mail when it is time to recertify During this process clients are eligible to order medications as long as they meet the recertification deadlines

4April 3, 2009 Recertification Process Approximately 250 clients are notified each month Recertification Packets are mailed on the first of the month and include an Introductory letter Application & Instructions Spanish Insert Applications are due back to the THMP within 45 days If the application is not received by the due date the client’s medications will be put on HOLD

5April 3, 2009 Recertification Process The recertification application is very similar to the original THMP application. The application must be completely filled out and include proof of income, insurance and household information. A medical certification form is not required. If the application is incomplete or if additional information is needed the client will be notified by phone or mail If the “pending” information is not returned within the specified time period the client’s medications will be placed on HOLD

6April 3, 2009 What to do when a client is on HOLD When a client is on hold, the THMP will not ship medications for the client If on hold, the client needs to call the THMP recertification staff at We can usually grant a 14 to 30 day extension depending on the situation – this will allow the pharmacy to order a one month supply of medications If a client knows they need an extension they should call the THMP before the due date

7April 3, 2009 Recertification Determinations Approvals – Client is sent an approval letter Denials – Most common reasons: income and/or insurance w/Rx coverage Client is contacted about denial and told the reason for the denial and given the date they will be dropped from the program Client is encouraged to contact their doctors office and/or local service agency about accessing other types of medication assistance programs A formal letter is mailed to the client

8April 3, 2009 Common Problems Returned Mail Application not returned to THMP Questions left blank, application not signed Income documentation not submitted Missing Insurance documentation Changes in marital status not reported

9April 3, 2009 SPAP Recertification SPAP recertification is only done once a year Recertification packets are sent in the fall (Sept/Oct) Clients are recertifying for the next Medicare Part D plan year The recertification must be completed before December 31 Clients will be dropped from the SPAP if they do not complete the process

10April 3, 2009 Recertification What you can do to help: Inform clients that it is their responsibility to notify the THMP at any point to any changes in: Residential and mailing address Household information/composition, such as marriage, divorce, changes in dependents Household income changes: such as returning to work, receiving Social Security or other benefits Insurance benefit changes: obtaining health insurance or any changes in your prescription coverage

11April 3, 2009 THMP Contact Information Phone: or Website: StaffExtensionArea of Expertise Becky3006Case Management, Eligibility, Medicare Christine3003Recertification Lead Juliet3004SPAP Coordinator Jack3012Incarcerated Populations Katherine3008SPAP Kelley3011Order Processing Lead Krystal3009Eligibility Stacy3007Eligibility