... the District of Columbia, Puerto Rico, Virgin Islands,

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The AIDS Drug Assistance Program
Kerry Hill, MSW, Project Officer
HRSA, DSS, Northeastern/Central Services Branch
For the Feb 5-7, 2008 Administrative Overview

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Focus

• Overview
• Funding
• Financial Eligibility and Formulary coverage
• ADAP Supplemental Award
• Insurance
• Flexibility Policy
• Quality Management
• Waiting List

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Part B of the Ryan White Program

• Part B is administered by the Division of Service
  Systems, within the HIV/AIDS Bureau, HRSA
  
• Part B grants are awarded on a formula basis to
  States and Territories to provide health care and
  support services for people living with HIV
  disease
• Pharmaceutical treatments, through an AIDS Drug
  Assistance Program (ADAP), is one of the Part B
  eligible services
  

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Purpose of ADAPs

• to provide therapeutics to treat HIV disease
  or prevent the serious deterioration of health
  arising from HIV disease in eligible individuals,
  including measures for the prevention and
  treatment of opportunistic infections

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Overview of ADAPs

• ADAP provides medications for the treatment of
  HIV disease
  
• ADAP funds may be used to purchase health
  insurance for eligible clients
  
• ADAP funds also may be used to pay for services
  that enhance access, adherence, and monitoring of
  drug treatment
  
• ADAPs are required to have at least one drug from
  each class of Public Health Service approved
  Antiretrovirals on their formulary

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ADAPs National Overview

• 59 ADAPs, including all 50 States, the District
  of Columbia, Puerto Rico, Virgin Islands, Guam,
  American Samoa, Northern Mariana Islands,
  Republic of Palau, Federated States of Micronesia
  and the Republic of Marshall Islands
• Wide variation in program characteristics due to
  individual State administration of each ADAP and
  HIV/AIDS prevalence in each State
  
• Differences most pronounced in areas of funding,
  eligibility criteria, formulary size, and
  cost-saving strategies

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History of the ADAP Earmark
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Financial Eligibility Criteria June 2007
Territories did not submit ADAP Profiles
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Formulary Coverage June 2007
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Supplemental Treatment Drug Grants

• 5 percent of FY 2007 ADAP Earmark funds are
  reserved for supplemental grants to ADAPs in
  States exhibiting severe need to increase access
  to HIV/AIDS-related medications
• States/Territories are eligible to apply for
  program funding, based on program limitation
  (i.e. enrollment cap, waiting list and capped
  expenditures) reported in the ADAP Quarterly
  Report (December 31, 2006).

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Supplemental Treatment Drug Grants

• Funding available to States/Territories based
  on
  
• Financial requirement of Federal Poverty Level
  (FPL)
• Limited formulary compositions for all core
  classes of antiretroviral medications
  
• Waiting list, capped enrollment or expenditures
  and
  
• An unanticipated increase of eligible individuals
  with HIV/AIDS.

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ADAP Insurance

• HAB Policy Notice 07-05
• Allows States and Territories to use ADAP funds
  to purchase health insurance.
  
• Allows for the use of Part B ADAP funds to
  purchase health insurance services that include
  the full range of HIV treatments as well as
  access to comprehensive primary care services

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ADAP Insurance (cont.)

• States have utilized High Risk Health Insurance
  Pools, State-sponsored health insurance, COBRA,
  and private insurance policies
  
• http//hab.hrsa.gov/law.htm

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ADAP Flexibility Policy

• HAB Policy Notice 07-03
• Purpose Fund support services directly tied to
• gaining Access to Medications,
• increasing Adherence to medication regimens,
  and
  
• Monitoring clients progress in taking
  HIV-related medication

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ADAP Flexibility Policy

• http//hab.hrsa.gov/law/0703.htm

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Quality Management

• Best Practices - How do you communicate and
  promote the PHS Guidelines to providers (AETC)
  
• Advisory Body - By-laws, formulary approval and
  revisions, consumer input and participation,
  budget projections
  
• Data - How is data used to improve service
  delivery
  
• Client Perception - satisfaction, access,
  formulary, grievance procedures, application and
  approval process, timeliness

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Public Health Service Guidelines

• Adult and Adolescent Guidelines
• Pediatric Guidelines
• Management of HIV Complications
• HIV Testing
• Web-link
• http//aidsinfo.nih.gov/Guidelines

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Waiting List

• Two types of waiting list First Come, First
  Serve or clients health status
  
• Patient Assistance Programs (train providers and
  case managers)
  
• Reporting- weekly update to HRSA PO
• Process for removing clients from waiting list
  (for what reasons, how often, when, by whom)
  

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Waiting List-Cost Saving Strategies

• Reducing formulary
• Capping the number individuals on the State ADAP
  enrollment
  
• Capping the dollar amount of clients on a per
  month or annual basis
  

• Bi-annual recertification
• Medicaid database matching for eligibility
• Cost Share
• Back-billing Medicaid
• Creation of waiting list

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Medicare Part D Audio SlidesTARGET Center
http//careacttarget.org
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Contact Information

• Kerry Hill, MSW
• Project Officer, HIV/AIDS Bureau
• DSS, Northeastern Central Services Branch
• 5600 Fishers Lane, Room 7A-55
• Rockville, MD 20857
• 301-443-0583
• kerry.hill_at_hrsa.hhs.gov

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