1. Becky Ruiz, BSW Katherine Wells, MPH
THMP Recertification
Becky Ruiz, BSW
Katherine Wells, MPH

2. 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
April 3, 2009

3. 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
April 3, 2009

4. 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
April 3, 2009

5. 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
April 3, 2009

6. 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
April 3, 2009

7. 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
April 3, 2009

8. 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
April 3, 2009

9. 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
April 3, 2009

10. 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
April 3, 2009

11. THMP Contact Information
Phone: or
Website:
Staff
Extension
Area of Expertise
Becky
3006
Case Management, Eligibility, Medicare
Christine
3003
Recertification Lead
Juliet
3004
SPAP Coordinator
Jack
3012
Incarcerated Populations
Katherine
3008
SPAP
Kelley
3011
Order Processing Lead
Krystal
3009
Eligibility
Stacy
3007
April 3, 2009