1. 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

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

3. 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

4. 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.

5. 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.

6. 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.

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

8. Proof of Income
Income Calculation Worksheet

9. 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

10. 9/23/2019

11. 9/23/2019

12. 9/23/2019

13. Texas HIV Medication Program
/meds/

14. 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.”
( qualitymanagement/adapmanual.pdf)
9/23/2019

15. 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.

16. 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

17. 6 month SA R

18. 6 month SA R

19. 6 month SA

20. 6 month SA R

21. 6 month SA R

22. 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

23. 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.

24. 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

25. 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

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

27. 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

28. 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.

29. 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

30. 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

31. Thank you
THMP