1. Ryan White Part B Eligibility and Beyond
Changes & Updates
Jessica Conly, Care Services Consultant
August 23, 2018

2. Quick Recap Timeline - Birth Month/Half Birth Month
Eligibility timeline alignment with THMP went into effect 4/1/18
Language: consistent with THMP. Example: recertification, attestation, etc.
Proof of Positivity: clarified prescribing authority
Proof of Residency – expanded to allow more source documents
Proof of Income - expanded to allow more source documents and implemented new Income Calculation Worksheet
Income Cap – All Part B and SS funded services must have an income limit not to exceed 500% of the FPL
Timeline - Birth Month/Half Birth Month
Language - Aligned with THMP
Proof of Positivity - Prescribing authority
Proof of Residency - Aligned with THMP
Proof of Income - Aligned with THMP
Income Calculation Worksheet – Replaces MAGI and Mock MAGI forms
Income Cap - ≤500% FPL

3. What’s Back
You may get a question re: “alternative funding sources.” That is really up to the Subrecipient for figure out.
The policy states the longstanding general rule that RW cannot pay for services provided to an HIV-negative individual. In other words, the agency eats the cost for this in so far DSHS care services funding. Maybe nobody pays for it….but regardless, RWB/SS cannot.
Section 7.1.2
In an effort to facilitate rapid linkage to care, DSHS permits a 30-day Initial Eligibility Determination Period
Alternative source of funding should an applicant be found to be ineligible
Note: The Initial Determination Period is not applicable to clients applying to any THMP program.

4. What’s New Income Calculation Worksheet
Revisions to the income calculation worksheet in response to feedback from the field:
Client Name
Agency Name
Client ID#
Agency Worker Name
Client DOB
Date

5. Proof of Status
Exposed infants of HIV positive mothers can be served with documentation of the mother’s HIV positive status up to the age of 12 months
Children older than 12 months must meet the same criteria for proof of HIV as listed in the policy to continue services
7/12/2019

6. Beyond
SB 805
Third Party Payor Verification
7/12/2019

7. SB 805 : Veterans Language on HOPWA & Ryan White Applications
Stress that Subrecipients must still respect the longstanding RWHAP policy that allows Veterans to utilize RWHAP services even if eligible for Veterans Benefits including VA medical care.
Senate Bill 805 requires the state to improve veterans’ awareness of their eligibility for federal and state veteran benefits and services.
To meet the intent of SB 805, the following language must be included on all HOPWA and Ryan White applications and/or intake forms:
“Important Information for Former Military Services Members:
Women and men who served in any branch of the United States Armed Forces, including Army, Navy, Marines, Air Force, Coast Guard, Reserves, or National Guard may be eligible for additional benefits and services. For more information please visit the Texas Veterans Portal at
Must be implemented by 9/1/2018
7/12/2019

8. Third Party Payer Verification
With respect to “verification at every visit” if the audience has a question about clients who access a service several times in a single month (e.g. for MH group or individual sessions), I suggest recommending that AAs consider adding a policy that allows Subrecipients to implement a P&P that requiring 3rd party coverage verification at every visit or monthly, whichever is less frequent. This may mitigate concerns over the burden on clients and providers. Run this by your folks before suggesting.
Payer of Last Resort – 8.0
Must verify 3rd party coverage for eligible services at every visit
Providers of 3rd party reimbursable services must have an effective electronic health benefits verification system in place for all contracts beginning 4/1/18
7/12/2019

9. Local Implementation
Round table update by AA
7/12/2019

10. Resources
What is needed is a system that can 1) verify coverage based on information provided by the client (e.g. their insurance card) and/or 2) identify coverage for clients who may not disclose their coverage (e.g. fear of their status being disclosed, job loss, etc.). Ideally at the AA level, but it is essential at the Subrecipient level.
These are for-profit companies who want to sell a service, thus pricing information is usually proprietary. Contact them and negotiate the best price for the service(s) you need. They want customers.
Many of your Subrecipients (clinics, hospital systems) may have already have this capability or the capability is available as an add-on to their existing Electronic Health Record (EHR) system.
Remind AAs it is their responsibility to enforce the requirement. It is the Subs responsibility to comply…these example resources are intended to assist AAs but ultimately the requirement must be met.
Availity/RTE (Real-Time Eligibility):
NANTHealth/Navinet:
Change Healthcare (Emdeon): overage-insight
EPIC/Coverage Eligibility System – a component of the EPIC EHR suite:
7/12/2019

11. Thank you