Background and Purpose
This toolkit is intended to support the Health Resources and Services Administration’s (HRSA) Ryan White HIV/AIDS Program (RWHAP) Part B recipients and RWHAP AIDS Drug Assistance Programs (ADAPs) as they work to ensure they have systems and processes for eligibility determination and recertification that are client-centered, efficient, and timely. It was developed to reflect many of the areas for which NASTAD receives requests for technical assistance and/or peer exchange. It also provides links to HRSA HIV/AIDS Bureau (HAB) guidance relevant to eligibility determination and/or recertification as well as practical, tangible examples from RWHAP Part B recipients and RWHAP ADAPs. These examples are intended to provide jurisdictions with a variety of strategies for meeting HRSA HAB eligibility determination and recertification guidance, as well as ways to maximize the effectiveness of these processes. They were also selected to reflect the diversity of program structures, capacities, and operating environments.
Of note, this resource specifically focuses on assessing initial and ongoing eligibility for RWHAP Part B and/or ADAP services funded by and allowable under the RWHAP legislation and does not include eligibility for services provided as part of the federal Ending the HIV Epidemic: A Plan for America. RWHAP Part B recipients funded for an Ending the HIV Epidemic (EHE) Initiative cooperative agreement have greater flexibility in terms of client eligibility and recertification and may deliver services beyond the scope allowable under RWHAP service categories.
The toolkit includes the following sections: (1) eligibility determination/recertification-related infrastructure; (2) initial application and recertification documentation and communication; and (3) strategies to streamline eligibility determination/recertification. Each section presents a menu of options for RWHAP Part B recipients and ADAPs to improve their eligibility and recertification processes. RWHAP Part B recipients and ADAPs should review and utilize those section(s) that address the areas of concern or inefficiency they identify within their own programs, adapting those recommendations or examples that meet the unique needs of their clients and programs.
The following HRSA HAB resources address RWHAP eligibility determination and/or recertification. While this list is not exhaustive, it is intended to represent the resources most relevant to these topics. As these policies and other resources are subject to change, we recommend that readers refer back to any original source documents that may be available from HRSA HAB directly.
- HRSA HAB policy clarification notice (PCN) 13-02 - Clarifications on Ryan White Program Client Eligibility Determinations and Recertification Requirements: Outlines the HRSA RWHAP expectations for client eligibility assessment and clarifies the recertification requirements.
- HRSA HAB program letter - Rapid eligibility determinations and Ryan White HIV/AIDS Program: Released in May 2019, this letter describes how PCN 13-02 has been updated to reflect the allowability of rapid eligibility determination within RWHAP services, including RWHAP Part B and/or ADAP.
- HRSA HAB performance measures for ADAPs: Details suggested performance measures HRSA HAB identifies for ADAPs, including measures specific to application determination and recertification.
- HRSA HAB National Monitoring Standards for RWHAP Parts A and B grantees: Section B of these monitoring standards reflect HRSA HAB expectations for eligibility determination and recertification for RWHAP Parts A and B, including the role of recipients and sub-recipients in verifying and documenting client eligibility. Additionally, these monitoring standards describe expectations regarding the vigorous pursuit of other payer coverage for clients.
While RWHAP Part B recipients and ADAPs must implement eligibility determination and recertification processes consistent with HRSA HAB guidance and other applicable states/local policy, they have flexibility in how they do so as long as it does not create additional barriers to care for their clients. RWHAP Part B recipients and/or ADAPs should consider strategies that may streamline and strengthen their systems, including but not limited to:
- Leveraging data systems and self-attestation at six-month recertification to reduce the reporting burden on staff and clients
- Utilizing timely and effective communications to staff and clients regarding upcoming recertification
- Continuously monitoring the eligibility determination and recertification process, including the rate of success and the timeliness
These strategies have frequently been used by RWHAP Part Bs and ADAPs to bolster rates of successful eligibility determination and recertification while reducing challenges faced by clients and providers who assist them (e.g., case managers). Throughout this Toolkit, NASTAD highlights areas in which RWHAP Part B recipients and ADAPs may customize their approach to best meet their situational needs for clients and staff.