HIV Resource & Training Center

Southwest/Piedmont HIV Care Consortium

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.
   
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

 

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

Grievance Policy and Procedure

 

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 15 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:

 

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

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