Transcript HRSA Policy Updates

HRSA Policy Updates
NASTAD AIDS Drug Assistance Program
(ADAP) Technical Assistance Meeting
July 31, 2014
Heather Hauck, Director
Division of State HIV/AIDS Programs (DSHAP)
HIV/AIDS Bureau
Health Resources and Services Administration
HIV/AIDS Bureau’s Framework
HIV/AIDS Bureau’s Framework
Zero New
Infections
The Ryan White HIV/AIDS Program (RWHAP) supports the
goals of the National HIV/AIDS Strategy (NHAS) by:
• Funding a comprehensive care systems for low-income people
living with HIV (PLWH) that:
o Reduces new HIV infections
o Improves health outcomes and increases quality of life for PLWH
o Decreases HIV-related health disparities
• Including PLWH in the planning of services
• Employing a public health approach to care and treatment
DSHAP Mission and Vision
Division of State HIV/AIDS Program (DSHAP)
Mission: To provide leadership and support to
States/Territories for developing and ensuring
access to quality HIV prevention, health care,
and support services.
DSHAP Vision: Optimal HIV/AIDS prevention,
care, and treatment for all.
HIV/AIDS Bureau (HAB)
Initiatives
HAB Initiatives
Improved Availability of Ryan White HIV/AIDS
Program (RWHAP) Data:
• RSR- moving from a 12-18 month cleaning-todissemination process to a 6-9 month process
• ADR – moved to new calendar year data collection
period; 3-6 month cleaning-to-dissemination process
• State Profiles – eliminating the backlog of data (currently
2011 data is posted on the HAB website); 2012 data will
available in fall 2014
HAB Initiatives
Innovative Uses of Data to Improve Prevention
and Care Outcomes
• HAB continues to work with CDC/DHAP on the Continuum of
Care initiatives (e.g., CAPUS, SMAIF, communication
campaigns)
• HAB continues to invest in health information technology
initiatives through the Special Projects of National
Significance (SPNS) (e.g., facilitate exchange, examine
staffing)
• HAB and CDC/DHAP worked with NASTAD to convene a
meeting to discuss opportunities and challenges for
surveillance and program data integration and utilization to
improve continuum of care analysis and related activities
HAB Initiatives
HIV Care Continuum Cross-Part Collaborative
A quality collaborative of 5 states involving RWHAP grantees to increase access to
HIV care and viral load suppression.
All grantees within the
state form a team.
• Arkansas
• Mississippi
• Missouri
• New Jersey
• Ohio
Aim 1: Build regional capacity for closing
gaps across the HIV Care Continuum to
ultimately increase viral load suppression
rates for individuals living with HIV
Aim 2: Align quality management goals
across all Ryan White HIV/AIDS Program
Parts to jointly meet legislative quality
management mandates
Aim 3: Implement joint quality improvement
activities to advance the quality of care for
people living with HIV within a state and to
coordinate HIV services seamlessly across
Parts
HAB Initiatives
Black MSM Cooperative Agreement (14-106)
Black MSM in the Ryan White HIV/AIDS Program:
• Black MSM: 32.4% of all MSM
o 29.4% are ages 45-54
o Represent 66.4% of the MSM are ages 13-18
o Represent 61% of the MSM are ages 19-24
• 68.5% of Black MSM are 100% below FPL
• 48.7% of Black MSM had no insurance at some time
during the year
Source: 2012 RSR (preliminary)
HAB Initiatives
MSM & IDU Retained in Care & Virally Suppressed
100%
90%
80%
82%
82.05%
79.6%
74.4%
70%
81.30%
75.10%
76.39%
67.8%
74.50%
All RSR clients
60%
52.9%
50%
MSM
40%
Black MSM
30%
Young (13-24) MSM
20%
IDU
10%
0%
Retained in care
Virally suppressed
Retained in care: had at least one OAMC visit before September 1, 2012, and had at least 2 visits 90 days or more apart
Viral suppression: had at least one OAMC visit, at least one viral load count, and last viral load test <200
Source: 2012 RSR data (preliminary)
HAB Initiatives
Black MSM Cooperative Agreement (14-106)
Purpose of Cooperative Agreement
Compiling, distributing, and replicating effective models for HIV
clinical care and treatment for adult and young Black Men who have
Sex with Men (Black MSM). Specifically, the intent of this cooperative
agreement program is:
• For Year 1: To inventory existing evidence-based interventions for
HIV care and prevention strategies
• For Year 2: To identify and disseminate best practices and
effective models of care for Black men who have sex with men
(Black MSM), including young Black MSM ages 13-24
HAB Initiatives
Collaborating Across Federal Government
• RWHAP legislation specifically references coordination across
U.S. Department of Health and Human Services
• NHAS/HIV Care Continuum:
http://hab.hrsa.gov/nationalstrategy/index.html
• Collaborate and coordinate to:
o Align across Federal programs to reduce reporting burden on
grantees
o Partner to advance evidence base and develop interventions
to improve care and treatment across the HIV Care Continuum
o Share resources and expertise to build capacity at the grantee
level
ACA-Related Updates
PCN 14-01
New Policy Clarification Notice (PCN) 14-01 on
reconciliation of advance premium tax credits
• On June 6th, HRSA released PCN 14-01, which clarifies
HRSA policy regarding the use of Ryan White HIV/AIDS
Program funds to purchase health insurance for clients in
the Marketplace and the reconciliation of advance
premium tax credits
• RWHAP grantees and sub-grantees must vigorously
pursue any excess premium tax credit a client receives
from the Internal Revenue Service (IRS) upon submission
of the client’s tax return
• Collect excess premium tax credit attributed to individual client
FFR Overview
PCN 14-01
PCN 14-01 continued
• HRSA is considering allowing RWHAP grantees and subgrantees to use RWHAP funds to pay the IRS any additional
income tax liability a client may owe to the IRS solely based
on reconciliation of the premium tax credit.
• A Federal Register Notice was published on July 14, 2014 in
which HRSA seeks comments from the public regarding this
proposed policy, with a closing date of August 13, 2014.
The Federal Register Notice can be found at:
http://www.gpo.gov/fdsys/pkg/FR-2014-07-14/pdf/201416406.pdf
FFR Overview
ACA Technical Assistance
HAB currently has three cooperative agreements that
provide technical assistance to grantees regarding the
Affordable Care Act:
• Engaging in Marketplace Insurance Plans under the
Affordable Care Act (Cicatelli Associates)
• Establishing AIDS Service Organization (ASO) Service
Models (Fenway Community Health)
• Supporting the Continuum of Care: Building Ryan
White Program Grantee Capacity to Enroll Eligible
Clients in ACA Health Coverage Programs (ACE
Project)(John Snow, Inc.)
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Affordable Care Enrollment
(ACE) TA Center
ACE Outreach & Enrollment Survey
• 231 Ryan White HIV/AIDS Program Part A, B, C, and D
grantees were surveyed in fall 2013 to determine grantee
needs to facilitate outreach and enrollment assistance to
minority clients seeking private insurance through the
Marketplace
• About a third of respondents (31%) received resources
other than RWHAP grant funds to support outreach and
enrollment efforts
• Just over half of respondents (51%) reported that they
have staff with outreach and enrollment certifications
within their organizations
ACE TA Center
Outreach & Enrollment Survey Key Findings
• Limited Knowledge and Experience
o Many direct service providers faced general outreach and
enrollment challenges related to lack of knowledge of new
coverage options
• Communication and Coordination
o RWHAP grantees and providers want more local guidance
about policies and best practices. Gaps in coordination
may have implications for how clients experience care
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ACE TA Center
Outreach & Enrollment Survey Key Findings
• Barriers to Care
o RWHAP providers are working with minority clients who
have historically faced barriers to accessing care and who
may not be comfortable enrolling in new ACA coverage
options
o Clients are particularly concerned about plan affordability,
as well as the possibility of needing to change providers
o Both outreach and enrollment capacity and cultural
competency are critical to enrolling and retaining minority
RWHAP clients in ACA coverage options
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ACE TA Center
July Webinar Series
The ACE TA Center is presenting a series of webinars to
introduce practical new tools and resources to support culturally
competent enrollment of RWHAP clients in health insurance
• July 10: Introducing new tools and resources to help enroll people of
color living with HIV in health care coverage
• July 17: Ready for the next open enrollment period? A new Online
Resource Guide to help enroll PLWH in health insurance
• July 24: Are we speaking the same language? Tools to assist with
complicated conversations about enrolling in health insurance
• July 31: Trouble keeping track of your clients in the enrollment
process? A worksheet to assist them through every step
The webinars and presentation slides are archived on the
TARGET Center website
ACE TA Center
Additional Assistance for Grantees
• Subscribe to the ACE TA Center list for updates about
strategies, tools and training, and to get a copy of the
Needs Assessment report: http://eepurl.com/JPUVj
• Contact the ACE TA Center with questions:
[email protected]
• Look for the ACE TA Center on the TARGET Center
website, which will include new resources and existing
tools that are tailored, adapted, and translated for RWHAP
providers (https://careacttarget.org/ace)
HAB’s ACA-Related Studies
Study
Description
Contractor/
Awardee
Emerging Issues Related
to ACA Implementation:
The Future of Ryan White
Services: A Snapshot of
Outpatient Ambulatory
Medical Care
•
Assess current status of Ryan White HIV/AIDS Program
medical services during the first year of ACA
implementation and how well the RWHAP is positioned
to improve clinical outcomes including viral suppression,
retention in care, and linkage to care services in 30 sites
across the country
Abt Associates
Evaluating the Impact of
1115 Medicaid Waivers on
the Ryan White HIV/AIDS
Program and Its Clients
and Providers
•
Understand how Medicaid expansion and the 1115
Medicaid waivers will affect the Ryan White HIV/AIDS
Program as well as PLWH, and how the waivers have
prepared states for implementation of the Affordable
Care Act
JSI
Understanding and
Monitoring Funding
Streams in Ryan White
Clinics
•
Identify the types of medical and support services that
are not covered or not fully covered by Medicaid,
Medicare, and private insurance in RWHAP clinics
Provide information on how grantees monitor changes in
patient healthcare coverage (e.g., payer source, type of
insurance) and the cost of care
Development of a technical assistance tracker to assist
grantees/providers in monitoring and assessing changes
in the mix of funding sources used to pay for client
services as the ACA is fully implemented
Walter R.
McDonald &
Assoc., Inc.
•
•
Mission
Analytics
ACA Post-Enrollment
Role of HRSA
• Continue to engage with colleagues in CMS and CCIIO on
key issues such as monitoring third party payment, mail
order pharmacy, prior authorization, and ECP
implementation
• Develop and co-host webinars to relevant topics, including
best practices
http://hab.hrsa.gov/affordablecareact/webinars/index.html
• Respond to and post FAQs
http://hab.hrsa.gov/affordablecareact/faqs.html
ACA Post-Enrollment
Role of Grantees
• Assist clients in applying for and enrolling in health care
coverage
o Role of assisters: http://marketplace.cms.gov/help-us/assisters-afterenrollment.pdf
• Educate patients about what it means to have health
insurance
o Coverage to Care: http://marketplace.cms.gov/help-us/c2croadmap.pdf
ACA Post-Enrollment
Role of Grantees (cont.)
• Get “in-network” with Qualified Health Plans and Medicaid
Managed Care Organizations as soon as possible
o TARGET Center Provider Network Resources:
https://careacttarget.org/library/contracting-health-plans-andprovider-networks
o “Answers About Health Plan Contracting” Webinar Archive:
http://www.fpntc.org/training-and-resources/webinar-recordinganswers-about-health-plan-contracting
CMS Final Rule
Final Rule for Exchange/Insurance Market Standards
for 2015 and Beyond
• On May 16, the Department of Health and Human Services
(DHHS), Centers for Medicare & Medicaid Services (CMS),
issued the final rule for Exchange/Insurance Market
Standards for 2015 and Beyond
• The rule promotes affordability, transparency and takes the
first step toward providing additional quality related tools for
consumers shopping in the Health Insurance Marketplace
FFR Overview
CMS Final Rule
Highlight: Consumer Assistance
• “…in specific circumstances, certified application
counselor (CAC) designated organizations can serve
target populations without violating the broad nondiscrimination requirement related to Exchange
functions”
• RWHAP providers may offer CAC services exclusively to
their client populations (e.g., enrollment assistance, postenrollment assistance, outreach and education about
getting covered), so long as they do not discriminate
based on race, color, national origin, disability, age sex
or other prohibited factors
CMS Final Rule
Highlight: 24 hour expedited review
of formulary requests
• Qualified Health Plans (QHPs) must have an expedited exceptions
process for beneficiaries with exigent circumstances to seek a medication
not covered under a plan
• Exigent circumstances exist when an enrollee is suffering from a health
condition that may seriously jeopardize the enrollee's life, health, or ability to
regain maximum function or when an enrollee is undergoing a current course
of treatment using a non-formulary drug
• QHPs must decide within 24 hours of receiving the request
• QHPs must provide coverage of any drug obtained through this expedited
exceptions process for the duration of the exigency
FFR Overview
Integrated Planning
Integrated Planning with CDC
• HAB and DHAP released a joint letter indicating
our ongoing support for integrated planning and
the alignment of the RWHAP Comprehensive
Plan/Statewide Coordinated Statement of Need
and the HIV Jurisdictional Prevention Plan due
dates
• HAB and DHAP are continuing to work on the
guidance(s) for these plans and anticipate
releasing guidance in 2015
Other HAB Updates
ADR
• Thanks for all the hard work that went into the CY
2013 ADR submission
• 41 States/Territories were able to submit on time
• Data contractors worked with the remaining
States/Territories to successfully submit
• CY 2014 ADR
• The 2014 ADR Client Data Dictionary is now available
on the TARGET Center website as part of the ADAP
Data Report (ADR) Download Package. This resource
has been updated to reflect reporting requirements for
the 2014 ADAP Data Report (ADR)
ADR
CY 2014 ADR (cont.)
• Thank-you to ADAPs that submitted comments on the draft
2014 ADR Manual. The manual will be posted on TARGET
in early August
• DART is planning a webinar with ADAPs on August 20 at 2
pm ET to go over the 2014 ADR changes. Check the
Events tab on the TARGET Center website to register
Contact Information
Heather Hauck
Phone: (301) 443-3613
Email: [email protected]
Glenn Clark
Phone: (301) 443-3692
Email: [email protected]