HIV Resource & Training Center

HIV Resource & Training Center

Ryan White Client Resources

Ryan White & ADAP Eligibility Qualifications

1. Provide documentation of HIV positive status
2. Provide documentation of income at or below 300% of the Federal Poverty level.
   (Click Here for table)
3. Have no health insurance or lack there of including Medicaid and Medicare.

General Restrictions

1. All Services must be HIV-related
2. In patient services cannot be covered
3. Payment for services requiring preauthorization is not guaranteed
4. Payments for services cannot be made to the consumer
5. All services are subject to the availability of funds
6. Insurance deductibles & co-payments are covered in most cases
7. Services not covered by insurance may be covered

Services Covered by Ryan White Part B

• Intake/Eligibility
• Outpatient Health Services
• Lab Services
• Medication Assistance
• Dental Care
• Case Management
• Counseling
• Substances Abuse
• Transportation

*All services are subject to availability of funds and may not be offered through all providers.
Click Here to find a service provider

Ryan White Part B Medication Services

AIDS Pharmaceutical Assistance: Includes medications associated with HIV and related conditions as set forth in the Virginia Department of Health Non-ADAP Drug Formulary (Full and Co-payment assistance) and ADAP Formulary (Co-payment assistance only).

VDH Policy on Non-ADAP Drug Formulary: Part B policy requires that all services provided using Ryan White dollars be explicitly related to the client’s HIV diagnosis. Medications are used for a variety of purposes and determining how the use of each drug prescribed is related to HIV diagnosis can be difficult. In order to ensure that basic drugs needed to treat HIV-related conditions are available in all areas of the state, VDH has developed a Part B non-ADAP formulary.

Definition of how a medication is HIV related – Medications are considered HIV-related if one of the following is true:

1. It is used to treat HIV infection.
2. It is used to treat opportunistic infections.
3. It is used to treat immediate and/or long term side effects of medications used to treat HIV or opportunistic infections with the following considerations:
   1. The side effect is known and documented from a reliable clinical source.
   2. The medication causing the side effect must be currently in use or recently discontinued. In the case of a recently discontinued medication, the side effect condition must be monitored to ensure that the treatment continues to be appropriate.
   3. Pre-existing conditions may be treated if there is documentation of an increased side effect after the initiation of therapy.

Click Here for a list of Ryan White Part B covered medications

Client Rights and Responsibilities

All services under Title II of the Ryan White CARE Act are subject to the availability of funds by the Consortium. Any client presenting him or herself for services is considered entitled to the following rights and responsibilities:

1. The right to treatment with dignity and respect in a non-judgmental manner, regardless of his or her personal identification. No provider offering Ryan White Title II services shall discriminate on the basis of race, ethnicity, religion, age, country of origin, sexual orientation, or sexual identification. In addition, their rights for federally funded services are protected under any other statures provided for in federal laws, guidelines, regulations, and procedures.
2. The right to complete confidentiality. Information will be withheld from all inquirers, including family member, friends, spouse/lover and medical or law enforcement personnel except in cases of life-threatening situations, child abuse or with the written request/permission of the client.
3. The right to be seen privately. This includes the following services, if applicable: intake, assessment of needs, case management, and individual counseling. Exceptions to this right include enrollment in a group session provided in association with any program.
4. The right to refuse or discontinue services at any time for any reason. This includes the right to request services from another provider.
5. The right to full information about the services offered in association with Ryan White or any other program a provider may offer.
6. The right to inspect all client-specific documents. This includes all intake forms, notes, assessment forms and notes, case notes and any other documents pertaining to the client only.
7. The right to information pertaining to the grievance and appeals process in the event(s) he/she has a dispute with a provider or subcontractor.
8. The right to know what rules and regulations any provider, subcontractor or the SW/Piedmont HIV Care Consortium has established in regard to inappropriate client conduct and what penalties and/or consequences may result.
9. The right to present problems with another client(s), his/her subcontractor or the consortium. The client can expect to be heard, be provided with a response and be notified of final determination/resolution.
10. The right to be protected from: sexual and physical harassment; solicitation for favors, labor or money; discharge without due cause, notice and/or process from staff of providers, subcontractors and the consortium.
11. The right to receive services from their choice of provider, subcontractor or consortium. Clients may enroll in services with more than one Ryan White subcontractor; however, clients may not enroll in the same service at more than on subcontractor simultaneously.
12. The right to input in any and all medical and case management plans of care.
13. The responsibility to be honest and accurate on all reported information. Purposeful falsification or omission of information is grounds for removal from services.
14. The responsibility for their actions. Clients may be removed form services by a provider or subcontractor for actions and statements deemed abusive, threatening or harassing with notice.
15. The responsibility to keep appointments. Clients who miss three scheduled appointments without notifying the services provider may be restricted from receiving that service in the future with notice.
16. The responsibility to comply with medical and case management care plans. Clients who fail to comply with agreed upon goals may be discharged from services with notice.
17. The responsibility to submit HIV related healthcare bills in a timely manner. A client should never assume that any bills have been paid. Some bills may go directly to the subcontractor; others (especially insurance copayments) may not. Any late notices for bills should be forwarded immediately to the subcontractor. Subcontractors have a final invoice date of May 15th after the end of the fiscal year to submit bills for payment. All bills must be submitted by the Lead Agency to VDH by May 30th . Once the final bill is invoiced to VDH, no further bills will be accepted. Bills may not be carried over from the previous year. The term of the fiscal year is April 1st to March 31st.

Click Here for a copy of the Client and Responsibilities Statement.

Grievance Policy and Procedure

Each subcontractor must have a grievance procedure. This policy may be used or subcontractors can develop their own as long as it includes the same elements as this one. Each client must be given a written copy of the Grievance Procedure at his/her initial Ryan White eligibility appointment. These policies must be explained and clients must be given an opportunity to ask questions at this time and at their yearly eligibility appointments. A form signed by the client, must be included in his/her chart stating that she/he has received copies of the Grievance Procedure. Subcontractors may use their own form or use the example form included in this manual. This can be on a separate form, included with a list of other policies received by the client, or included with the consent for services signed. This form must be signed each year.

SOUTHWEST/PIEDMONT HIV CARE CONSORTIUM GRIEVANCE POLICY AND PROCEDURE

Clients may file a grievance if a request for services offered under the Ryan White Part B Program is denied or if they have any complaint or concern about the services received through their service provider or the Consortium. Clients have 90 days from the date of denial of services or complaint about the services received to file a grievance. This policy only applies to services provided by the Southwest/Piedmont HIV Care Consortium funded under Part B of the Ryan White Program. Issues arising from services provided with funds other than Ryan White Part B may not be addressed through this process. This includes prevention services, Ryan White Part A, C, or D services, Housing Opportunities for Persons with AIDS (HOPWA), or any other services not funded by the Southwest Piedmont HIV Care Consortium. Situations in which a grievance may be filed:

• Denial of Services: A client is denied a service typically offered under the Ryan White Part B Program. A list of services offered with descriptions is in Chapter 3 of the S/PHCC Policy and Procedures Manual.
• Unfair or Unequal Treatment: Having a complaint or concern about a service received is when a client believes she/he has been treated unfairly or has received poor treatment by a service provider or by the consortium.
• Breach of Confidentiality: If a subcontractor discloses any information about a client without written consent.
• Involuntary Discharge from Any or All Services: Clients may be discharged with cause and notice. Clients must be made aware of any issues that may lead to an involuntary discharge in writing prior to being discharged.

Situations in which a grievance may not be filed:

• Virginia Medication Formularies: Being denied a mediation that is not on either the Virginia ADAP or Non-ADAP Formularies. The process for adding medications is listed under chapter 3, medications.
• Billing Deadlines: The Ryan White Part B year begins on April 1 and ends on March 31 of each year. ALL billing must be submitted to VDH by May 30 of each year. Bills cannot be carried over from year to year.
• Availability of Funds: Denial of services or being placed on a waiting list due to a shortage of funds.
• Subcontractor Personnel Issues: The Council of Community Services as the Lead Agency of the Southwest/Piedmont HIV Care Consortium has no authority to reprimand any individual employee of any subcontractor or service provider.

Grievance Process:

1. This process begins AFTER a client has discussed the issue with the Ryan White Part B subcontractor and has been unable to resolve the situation in question.
2. Clients wishing to file a grievance must complete the Grievance Form. Copies are available from each service provider or from the Council of Community Services. Clients are welcome to contact the Council prior to filing a grievance by phone or email; however, without a signed form allowing the Council to begin an investigation into the complaint, the Council may take no action on the behalf of the client. Clients will receive a confirmation of receipt of the grievance within 7 days.
3. A representative from the Council of Community services will contact all parties and begin gathering information. The representative will attempt to resolve the issue between the parties within 15 days of receipt of the grievance form.
4. Failing to reach a resolution, the Council will convene a panel consisting of a client representative, a subcontractor representative and a lead agency representative within 30 days. No members of the panel will be an employee or a recipient of services form the subcontractor named in the grievance.
5. After the panel makes a decision on the grievance, the lead agency will issue the result in writing to all parties. The decision of the panel is final.

Grievance Forms must be mailed to: The Council of Community Services, c/o Robert Morrow, P.O. Box 598, Roanoke, VA 24004-0598. Please mark all such correspondence confidential on both sides of the envelope.

Click Here for a printable PDF version of the grievance form.

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