This rule change removes the requirement for ADAP clients to have a prescription for an antiretroviral and clarifies or provides new requirements for ADAP clients receiving ADAP insurance benefits.

 

DEPARTMENT OF HEALTH

Division of Disease Control

RULE NO.:RULE TITLE:

64D-4.007AIDS Drug Assistance Program (ADAP)

PURPOSE AND EFFECT: This rule change removes the requirement for ADAP clients to have a prescription for an antiretroviral and clarifies or provides new requirements for ADAP clients receiving ADAP insurance benefits.

SUMMARY: The rule change removes the requirement for ADAP clients to have a prescription for an antiretroviral to enter the program; adds that for a client to be enrolled in the ADAP insurance program, payment for insurance cannot reasonably expect to be made by another source; requires those in the insurance program to use the ADAP insurance benefits manager; and details specific requirements of program enrollees.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: Based on the SERC checklist, this rulemaking will not have an adverse impact on regulatory costs in excess of $1 million within five years as established in s.120.541(2)(a), F.S.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 381.0011(2), 381.003(2), FS

LAW IMPLEMENTED: 381.011, 381.003(1)(b), FS

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Amber Pepe at [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

64D-4.007AIDS Drug Assistance Program (ADAP)

(1) To participate in The program requirements for the AIDS Drug Assistance Program are that an individual must be :

(a) Be determined eligible as defined in Rule 64D-4.003, F.A.C., and

(b) Have a prescription for at least one antiretroviral.

(2) To receive ADAP Premium Plus Insurance Program benefits, participants must be deemed eligible according to In addition to the requirements listed in subsection (1), above, and an individual must meet the following requirements for the ADAP Premium Plus Insurance Program:

(a) Use the ADAP contracted insurance benefits manager to enroll Enrollment in an ADAP approved plan to receive insurance premium assistance.

(b) Need insurance policy pharmaceutical coverage to the extent that payment cannot be made or cannot reasonably be expected to be made by another payer source.

(c) (b) Use an ADAP contracted pharmacy(ies) to receive premium assistance, medications co-payment and/or deductible.

(c) Need prescription coverage to the extent that payment cannot be made, or cannot reasonably be expected to be made, by another payer source.

(3) To receive ADAP insurance benefits for plans purchased through the federally facilitated Marketplace, participants must be deemed eligible according to subsection (1) above; meet the ADAP Premium Plus Insurance Program requirements in subsection (2) above; and comply with the following requirements:

(a) Determination of available subsidies must be requested when submitting a Marketplace application. If an individual qualifies for a premium tax credit, the individual must select the advanced premium tax credit that is paid directly to the insurance provider.

(b) All supporting documentation submitted to the Marketplace as part of the application and/or enrollment process must also be submitted to ADAP.

Rulemaking Authority 381.0011(2), 381.003(2) FS. Law Implemented 381.0011, 381.003(1)(b) FS. History–New 7-4-16, Amended 4-5-21,____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Mara Michniewicz, Interim HIV/AIDS Section Administrator

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Joseph A. Ladapo, MD, PhD, State Surgeon General

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 18, 2022

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 17, 2021