Purpose, Definitions, Eligibility and Documentation Requirements, Determined Eligible or Ineligible, Re-Determination and Continued Eligibility, Rights and Responsibilities, AIDS Drug Assistance Program (ADAP)
RULE NO.: RULE TITLE:
64D-4.001 Purpose
64D-4.002 Definitions
64D-4.003 Eligibility and Documentation Requirements
64D-4.004 Determined Eligible or Ineligible
64D-4.005 Re-Determination and Continued Eligibility
64D-4.006 Rights and Responsibilities
64D-4.007 AIDS Drug Assistance Program (ADAP)
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 41 No. 7, January 12, 2015 issue of the Florida Administrative Register.
64D-4.001 Purpose
No change.
64D-4.002 Definitions.
For the purpose of this chapter, the words and phrases below are defined as follows:
(1) “ADAP Approved Plans” – insurance plans that will, at minimum, include pharmaceutical benefits for HIV antiretroviral medications; have at least one drug from each class of core antiretroviral; and are assessed for cost effectiveness. Cost effective is defined as the aggregate cost of paying for the health insurance option versus paying for the full cost for medications.
(1) “AIDS Drug Assistance Program (ADAP)” –The Ryan White HIV program codified by Title XXVI of the Public Health Services Act, as amended by the Ryan White HIV/AIDS Treatment Extension Act of 2009. ADAP provides HIV/AIDS medications to persons in need by either providing the medications directly, providing access through pharmacies, or providing health insurance continuation support for policies that include coverage for HIV/AIDS drugs.
(2) “ADAP Premium Plus Insurance Program (APPIP)” – a component of ADAP designed to assist eligible clients who have insurance and need assistance with premiums, copays, and/or deductibles.
(2)(3) “Federal Poverty Level” - the poverty income guidelines (January 2015 2014) as published by the U.S. Department of Health and Human Services, Federal Office of Management and Budget, which is incorporated by reference. The federal poverty guidelines are available at or can be obtained at any Florida county health department.
(3)(4) “Household Income” - income from all sources received by the applicant, the applicant’s spouse (if married), and other adult persons living in the home, if they are included in the household size as defined in subsection (4)(5) below.
(4)(5) No change.
(5)(6) “HIV/AIDS Patient Care Programs”:
(a) Ryan White Part B Consortia Program, a program authorized by 42 U.S.C. § 300ff-23, that assesses the service needs of persons living with HIV/AIDS in an area that received Ryan White Part B funding, and secures providers to deliver the needed core medical and support services based on available funding.
(b) Ryan White Part B AIDS Drug Assistance Program, a program that provides medications to uninsured or underinsured individuals living with HIV/AIDS disease, authorized under 42 U.S.C. § 300ff-26. Services are provided through the distribution of medications directly to eligible clients or by the purchase of health insurance that includes coverage for HIV/AIDS medications,
(c) ADAP Premium Plus Insurance Program, a component of ADAP designed to assist eligible clients, as defined in Rule 64D-4.007, who have insurance and need assistance with premiums, copays, and/or deductibles,
(d) State Housing Opportunities for Persons with AIDS (HOPWA) Program, as defined by 24 C.F.R. Part 574 (04/01/13), a housing program, funded by the U.S. Department of Housing and Urban Development and administered by the state, that is intended to prevent the condition of homelessness from occurring to individuals or families living with HIV/AIDS; or if already homeless, to transition the individuals or families back into stable housing as soon as possible, as well as to create a strategy for long-term housing stability for persons living with HIV/AIDS. The program funds short-term rent, mortgage and utility assistance, permanent housing placement, transitional housing, resource identification and case management, and
(e) HIV/AIDS patient care programs provided by the patient care networks, as defined in Rule 64D-2.001, and county health departments as administered by the Florida Department of Health, Bureau of Communicable Diseases.
(6)(7) “Low Income” - modified adjusted gross household income at or below 400 percent of the Federal Poverty Level. For HOPWA, low income means 80 percent of a county’s median medium income, as defined by the U.S. Department of Housing and Urban Development, effective July 1, 2014, which is incorporated by reference and is available at which can be found at http://www.huduser.org/portal/datasets/il/il14/index_il2014.html.
Rulemaking Authority 381.0011(2), 381.003(2), FS. Law Implemented 381.001, 381.0011, 381.003(1)(b) FS. History–New 1-23-07, Amended 8-31-07, 3-21-08, 10-27-08, 3-30-09, _________.
64D-4.003 Eligibility and Documentation Requirements.
Only an individual seeking assistance, or their court-appointed representative, legal representative or legal guardian seeking assistance on their behalf, may apply for services.
An applicant for HIV/AIDS Patient Care programs is eligible to be linked to services based on a preliminary positive HIV test result from a test approved by the Food and Drug Administration to determine the presence of HIV infection. For this rule, linkage to service is defined as referring the applicant to eligibility determination and counseling services and the scheduling of medical appointments.
To receive services from an HIV/AIDS patient care program, an applicant:
(1) Must have a positive test result from a test approved by the Food and Drug Administration to confirmation determine the presence of HIV infection.
(2) Must be living in Florida, which may be documented by providing one of the following: current state or local Florida photo identification; utility bill, with name and street address; housing, rental or mortgage agreement in client’s name; recent school records; bank statement, with name and street address; letter from person with whom the client resides; property tax receipt or W-2 form for previous year; unemployment document with street address; current voter registration card; official correspondence, postmarked in last 3 months; prison records, if recently released; current documentation from the Florida Medicaid Managed Information System (FLMMIS) or the Medical Eligibility Verification System (MEVSNET) showing that the client is currently receiving Medicaid or assistance from the Supplemental Nutritional Assistance Program (SNAP), formally known as food stamps; Florida Department of Corrections offender search website photo print out; or a Declaration of Domicile, as per s. 222.17, F.S. If homeless: a statement from the shelter in which the client resides or visits; physical observation of location of residence by eligibility staff; a written statement from the client describing living circumstances may be used, signed and dated by the client. Eligibility staff may provide assistance with writing the statement; or a statement from a social service agency attesting to the homeless status of the client
(3) through (5) No change.
(6) Must not be currently institutionalized in a prison, jail, nursing home, hospital, or other entity that is legally required to provide medical care and prescription medications.
(7) No change.
Rulemaking Authority 381.0011(2), 381.003(2), FS. Law Implemented 381.001, 381.0011, 381.003(1)(b) FS. History–New 1-23-07, Amended 10-27-08,_______.
No change.
64D-4.007 AIDS Drug Assistance Program (ADAP)
(1) The program requirements for the AIDS Drug Assistance Program are that an individual have:
(a) A Must have a current Notice of Eligibility, DH8000-PHSPM-08/2014, which is incorporated by reference and available at [DOS link to be added].
(b) A Must have a prescription for at least one antiretroviral on the ADAP Formulary.
(c) An Must have CD4 and HIV viral load laboratory results that is are less than six months old and an HIV CD4 laboratory result that is less than 12 months old at the time of enrollment or recertification.
(2) In addition to the requirements listed in subsection (1) above, an individual must meet the following requirements for apply to the ADAP Premium Plus Insurance Program:
(a) Enrollment Must be enrolled in an ADAP approved plan which includes pharmaceutical benefits equivalent to the ADAP formulary.
(b) Must Uuse of an ADAP contracted pharmacy(ies) to receive premium assistance, medications co-payment and/or deductible.
(c) Must Need for prescription coverage to the extent that payment cannot be made, or cannot reasonably be expected to be made, by another payer source a primary payor.
Rulemaking Authority 381.0011(2), 381.003(2), FS. Law Implemented 381.001, 381.0011, 381.003(1)(b) FS. History–New __________.
