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- Health Coverage
The health care insurance coverage landscape has seen rapid changes in recent years. Ryan White HIV/AIDS Program (RWHAP) care providers work with public and private payers to secure inclusion in their networks and reimbursement for services not covered by grants. RWHAP staff also serve as counselors/navigators to help clients make wise choices on health insurance coverage.
- Eligibility
Eligibility determination is a process of collecting information from an individual in order to provide access to appropriate sources of health insurance, services, and other benefits. Such determinations take place at initial intake but also at periodic intervals (recertification) to verify any changes in eligibility status. Ryan White HIV/AIDS Program eligibility determination and enrollment processes help ensure:
- Alignment of individuals with appropriate services and benefits under public and private health insurance and other service programs (e.g., substance abuse treatment, housing, social services).
- Coordination of benefits to maximize coverage while avoiding inappropriate coverage and payments.
- Compliance with program requirements (e.g., income eligibility, health status eligibility, Ryan White payer of last resort).
The Ryan White eligibility determination processes contain a collection of information on multiple criteria:
- HIV status
- Income (set as a percentage of federal poverty guidelines)
- Residency, and eligibility/enrollment in other health insurance programs
The Eligibility Determination processes are being enhanced via online systems that interface with insurance Marketplace systems established under the Affordable Care Act.
- Medical & Support Services
A sampling of HIV clinical training resources (e.g., guidelines, clinical tools) are featured here. For more, see the AIDS Education and Training Center's (AETC) National Coordinating Resource Center (NCRC) for training (e.g., National HIV Curriculum, webinars); consultations (e.g., National Clinician Consultation Center, access to regional experts); library (e.g., guidelines, training tools, and more, organized by topic); and community (e.g., newsletters).
The AETC Program is the clinical training arm of HRSA's Ryan White HIV/AIDS Program.
- Enrolling & Accessing Health Coverage
The Access, Care, and Engagement (ACE) TA Center is building Ryan White agency capacity to enroll clients in health coverage. See also Enrollment Resources for Consumers.
- Assessing Plans for RWHAP Clients & ADAP
Resources for Ryan White programs in assessing Qualified Health Plans (QHPs) in relation to the needs of people living with HIV/AIDS.
- Billing & Reimbursement
Collection of tools on third-party billing and reimbursement and calculating the cost of care.
- Enrollment Resources for Consumers
Videos for your waiting room or website, posters, fact sheets, and other resources developed to educate and inform RWHAP clients about health care and insurance.
- Program Income
Agencies can fiscally benefit by generating program income through contracts with public and private payers and efficient billing systems.
- Linkage to Care
Linkage services are critical to helping people living with HIV find and stay in care. For newly diagnosed people, rapid (same day) linkage is becoming a standard. Patients undergoing life transitions (moving, loss of insurance, release from jail or prison) need linkage services that are sensitive to their situations.
- Achieving Viral Suppression
When HIV is suppressed, or controlled by medications and other care, people are protected from HIV-related illnesses, and are much less likely to pass the virus to their sexual partners or unborn children. Another word for "viral suppression" is "undetectable" meaning the levels of HIV in a person's blood (viral load) are so low that the laboratory test cannot measure them.
- HIV Care Continuum
The HIV care continuum is a representation of the extent to which individuals living with HIV are diagnosed, engaged in care and benefiting from antiretroviral therapy in terms of full viral suppression (undetectable lab values). The value of the continuum in managing the HIV epidemic is compelling: individuals engaged in care can manage HIV as a chronic condition and simultaneously reduce the risk of transmitting the virus to others.
- Stigma/Legal
HIV-related stigma compromises the well-being of people with the disease. Stigmatized individuals may suffer discrimination that can lead to loss of employment and housing, estrangement from family and society, and increased risk of violence. HIV-related stigma can also drive new HIV infections because it can deter people from getting tested for the disease, make them less likely to acknowledge their risk of infection, and discourage those who are HIV-positive from discussing their HIV status with their partners and families.
- Aging / Older (50+)
Nearly half of Ryan White HIV/AIDS Program (RWHAP) clients are aged 50 years and older. As with the overall RWHAP population, the majority of older Ryan White clients are from racial and ethnic minority populations and have lower incomes. Their viral suppression rates, across key populations, are slightly above the overall RWHAP rate, with the exception of those with unstable housing. Care for older people can be challenging if they are being treated for multiple conditions as they may need support to manage (and pay for) complicated treatment regimens.
- Performance Measurement
The HRSA HIV/AIDS Bureau's performance measure portfolio is a set of standardized measures aligned with milestones along the HIV care continuum. Ryan White HIV/AIDS Program recipients are encouraged to use them, including the core performance measures, which completed the rigorous National Quality Forum infectious disease endorsement process.
- Completeness
HAB’s RSR data quality goal is for all providers to have at least 90% known values – that is valid data excluding missing or unknown values – for five client-level data elements: health insurance status, housing status, federal poverty level, viral load, and prescribed ART. These data elements are required to both establish Ryan White eligibility and demonstrate critical HIV health outcomes.
- COVID-19 Data Report (CDR)
To support federal requirements to monitor and report on funds distributed under the CARES Act, the HRSA HIV/AIDS Bureau (HAB) created a new data reporting module – the COVID-19 Data Report (CDR) – to collect information on CARES Act funded activities. The CDR will collect monthly, aggregate data on the types of services provided and number of people served for the treatment or prevention of COVID-19 among RWHAP-eligible clients. Completion of the CDR is required for all providers (regardless of whether they are recipients or subrecipients) who receive CARES Act funding.
Access the COVID-19 Data Report.
- Estimating Unmet Need
Update to the Unmet Need framework for Ryan White HIV/AIDS Program (RWHAP) Part A and Part B recipients, by HRSA's HIV/AIDS Bureau. RWHAP Part A and Part B recipients will be required to submit Unmet Need estimates using the updated methodology in FY 2022 as part of their applications. Listed resources are to assist recipients with the successful implementation of the new methodology, which was developed given improvements in the availability and quality of data used to estimate unmet need.
- Methodology for Estimating Unmet Need: Instruction Manual and accompanying materials that focus on various aspects of the unmet need methodology
- The latest Estimating Unmet Need: Required Reporting Templates and Optional Calculation Tables Package
- Go beyond the basics with various webinars and training
- Employment Support for People with HIV
HIV agencies often focus on employment services--for people with HIV as well as their staff. For patients/consumers, employment support is increasingly crucial given the disproportionate impact of HIV on lower income individuals, who are living long and hopefully productive lives given the effectiveness of HIV treatment and care. Support may include, for example, job training, hiring of peers to work with clients (e.g., peer educators, peer navigators), and support for individuals transitioning from correctional facilities.
See Program Management and the AETC NCRC Library for resources on workforce support on conducting services in new and innovative ways (e.g., via practice transformation training).
- Service Models
This website is in the process of consolidating HIV care delivery service models within a unified database. In the interim, see the following service models, HIV Care Innovations: Replication Resources and Best Practices Compilation.