Ryan White CARE Act: The History

Title II Services in Kansas

The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act is Federal legislation that addresses the unmet health needs of persons living with HIV disease (PLWH) by funding primary health care and support services that enhance access to and retention in care. First enacted by Congress in 1990, it was amended and reauthorized in 1996 and again in 2000. The CARE Act reaches over 500,000 individuals each year, making it the Federal Government's largest program specifically for people living with HIV disease.

Like many health problems, HIV disease disproportionately strikes people in poverty, racial/ethnic populations, and others who are underserved by healthcare and prevention systems. HIV often leads to poverty due to costly healthcare or an inability to work that is often accompanied by a loss of employer-related health insurance. CARE Act-funded programs are the "payer of last resort." They fill gaps in care not covered by other resources. Most likely users of CARE Act services include people with no other source of healthcare and those with Medicaid or private insurance whose care needs are not being met.

CARE Act services are intended to reduce the use of more costly inpatient care, increase access to care for underserved populations, and improve the quality of life for those affected by the epidemic. The CARE Act works toward these goals by funding local and State programs that provide primary medical care and support services; healthcare provider training; and technical assistance to help funded programs address implementation and emerging HIV care issues.

The CARE Act provides for significant local and State control of HIV/AIDS healthcare planning and service delivery. This has led to many innovative and practical approaches to the delivery of care for PLWH.

The HIV/AIDS Bureau (HAB) of the Health Resources and Services Administration (HRSA) was formed in August 1997 to consolidate all programs funded under the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The CARE Act was signed into law on August 15, 1990 to improve the quality and availability of care for people with HIV/AIDS and their families. Amended and reauthorized in May 1996, and November 2000 the Act is named after the Indiana teenager, Ryan White, who became an active public educator on HIV/AIDS after he contracted the syndrome. He died the same year the legislation was passed.

In serving people and families affected by HIV/AIDS, the Bureau, headed by HRSA Associate Administrator Deborah Parham, Ph.D., RN, has identified four factors that have significant implications for HIV/AIDS care, services and treatment:

1. The HIV/AIDS epidemic is growing among traditionally underserved and hard-to-reach populations.
2. The quality of emerging HIV/AIDS therapies can make a difference in the lives of people living with HIV.
3. Changes in the economics of health care are affecting the HIV/AIDS care network.
4. Policy and funding increasingly are determined by outcomes.

The CARE Act addresses the health needs of persons living with HIV disease (PLWH) by funding primary health care and support services that enhance access to and retention in care. The following principles were crafted by HAB to guide CARE Act programs in implementing CARE Act provisions and emerging challenges in HIV/AIDS care:

• Revise care systems to meet emerging needs. The CARE Act stresses the role of local planning and decision making-with broad community involvement-to determine how to best meet HIV/AIDS care needs. This requires assessing the shifting demographics of new HIV/AIDS cases and revising care systems (e.g., capacity development to expand available services) to meet the needs of emerging communities and populations. A priority focus is on meeting the needs of traditionally underserved populations hardest hit by the epidemic, particularly PLWH who know their HIV status and are not in care. This entails outreach, early intervention services (EIS), and other needed services to ensure that clients receive primary health care and supportive services-directly or though appropriate linkages.

 
• Ensure access to quality HIV/AIDS care. The quality of HIV/AIDS medical care-including combination antiretroviral therapies and prophylaxis/treatment for opportunistic infections-can make a difference in the lives of PLWH. Programs should use quality management programs to ensure that available treatments are accessible and delivered according to established HIV-related treatment guidelines.

 
• Coordinate CARE Act services with other health care delivery systems. Programs need to use CARE Act services to fill gaps in care. This requires coordination across CARE Act programs and with other Federal/State/local programs. Such coordination can help maximize efficient use of resources, enhance systems of care, and ensure coverage of HIV/AIDS-related services within managed care plans (particularly Medicaid managed care).

 
• Evaluate the impact of CARE Act funds and make needed improvements. Federal policy and funding decisions are increasingly determined by outcomes. Programs need to document the impact of CARE Act funds on improving access to quality care/treatment along with areas of continued need. Programs also need to have in place quality assurance and evaluation mechanisms that assess the effects of CARE Act resources on the health outcomes of clients

State of Kansas Title II CARE Program . . .

The Title II CARE Program in the State of Kansas has been assisting Kansans living with HIV before the enactment of the CARE Act in 1990. These resources included private donations, community-based organizations throughout the state and federal funding for a statewide ADAP (1987). Since this time, the Title II CARE Program has received federal and state funding for assistance with:

• Medications through the statewide AIDS Drug Assistance Program (ADAP);
• Case Management;
• Primary Care services;
• Dental Care services;
• Mental Health (MH) services; and
• Substance Abuse (SA) services.

The State of Kansas, the Kansas Ryan White Title II CARE Program and the Kansas Title II Advisory Consortia, as defined that the purpose of these funds is to provide care for persons living with HIV infection who are not covered by public or private sources. They also assure that all Kansans living with HIV infection throughout the state have access to the resources to monitor, adhere, and treat infection, in order to achieve the highest quality of life possible.

The services described in this manual are supported by a federal grant available through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act from the Human Resources and Services Administration (HRSA) and a prevention grant through the Centers for Disease Control (CDC). The Kansas Department of Health and Environment HIV/STD Section Ryan White Title II CARE Program is responsible for administration of Title II programs.

Title II funds are to be accessed only when no other support is available, serving as payor of last resort. It should also be noted that services might not be available for the entire year if funds become limited.

These responsibilities were created in to assist in the empowerment of medication adherence by encompassing all asspects of care into the process. It is hoped that by exercising these few keys, the client and case manager can ensure continual coverage of medications and adhere to a prescribed regimen.

General Program Eligibility and Reimbursement

The services described throughout this manual will have varying eligibility and reimbursement criteria. Below are listed an overall set of guidelines that apply to all services administered by the Kansas Ryan White Title II CARE Program. Most items may be reiterated upon throughout the manual. This is done to reflect the process of the varying programs and emphasize the basis of the guideline/procedure.

1. Title II funds are to be accessed only when no other support is available, serving as payor of last resort. It should also be noted that services might not be available for the entire year if funds become limited

 
2. The rate of reimbursement shall be the rate established by Medicaid or varying rate established contractually between the program and the provider;

 
3. The client will be allowed to choose among eligible providers;

 
4. Prior to providing services , providers shall assure that the client has been authorized by the Title II CARE Program to receive services. The program will not reimburse providers for services that are provided prior to authorization;

 
5. The Title II CARE Program will not make payment for any item or service to the extent that payment has been made, or can reasonably be expected, through the following:

 
• Under any federal or state health benefits program (i.e., Medicaid, Medicare, MediKan, Healthwave and/or Veteran’s Assistance (VA));
• Under a group/individual private compensation program/insurance policy; and/or
• By an entity that provides health services on a prepaid basis.

 
6. When clients are approved retroactively for any state administered benefits program, such as Medicaid, providers will be required to invoice that program back to the first of the month that status had been approved;

 
7. The program has the authority to review client records and provider invoices to assure that program guidelines are being followed;

 
8. The program reserves the right to verify and confirm eligibility of all enrolled clients applying for services recognizing;

 
9. The program and its contractors recognize and work to abide by state and federal statutes relating to a person’s confidentiality, including but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA); in addition

 
10. The program shall be conducted in accordance with all state and federal nondiscrimination requirements. The standards for eligibility and participation in these programs shall be the same for all persons regardless of race, ethnicity, creed, color, national origin, handicap, sexual orientation or gender.

 

Client Eligibility

All Clients requesting assistance with services outside of case management services must submit completed Client and Medical Eligibility Forms. The following requirements must apply:

• Reside in Kansas;

 
• Have proof of HIV infection (i.e., signed Medical Eligibility Form, medical records) and copies of recent labs;

 
• Documentation noting family income is at or below 300% of Federal poverty guidelines (i.e., paystub, unemployment check, Social Security award letter, W-2 form or income tax return);

 
• Not be institutionalized or living within a facility that is primarily responsible for medical and health care services; and

 
• Provide updated information through a bi-annual (every six month) renewal process with their Ryan White Title II Case Manger. Any changes prior to this renewal process (i.e., income, address, insurability, etc.) must be reported immediately to their Ryan White Title II Case Manager.

Completed Medical Eligibility Form is not necessary for bi-annual submission unless client has been inactive from Title II CARE and/or ADAP services for more than 90-days.

Client Eligibility Requirements (PDF)
| Enrollment and Biannual Certification (PDF)
| 2006 Federal Poverty Guidelines (PDF)

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Provider Enrollment and Eligibility

In addition to those criteria listed above under General Program Eligibility and Reimbursement, clients must also ensure that the clinic or person is a provider actively enrolled in the Kansas Ryan White Title II CARE Program.

It is through the provider eligibility that the differences between the services can vary. Below are listed the criteria necessary for basic enrollment:

• Current license within the State of Kansas or comparable licensure board;

 
• Approved Kansas Ryan White Title II CARE Program provider;

 
• Approved Kansas Medicaid provider;

 
• In good standing with comparable regulatory board (such as the Behavioral Sciences Regulatory Board [BSRB]); and

 
• Willing to accept reibursment rates as deemed by the Kansas Ryan White Title II CARE Program.

 

To be a provider, please complete the below attachment (in PDF), contact the Title II CARE Program offices at (785) 368-6567 or email Melissa Romo.

Reimbursement Pages (PDF)
| Provider Agreement Form (PDF)

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AIDS Drug Assistance Program (ADAP)

The Kansas AIDS Drug Assistance Program (ADAP) is a statewide program that assists eligible clients obtain medications for the treatment of HIV/AIDS. The Kansas ADAP works collaboratively with KansasSocial and Rehabilitation Services (SRS) Program, also referred to as the state’s Medicaid Program. Through this partnership state agency’s, the Kansas Ryan White Title II CARE Program maintains all the eligibility of the ADAP while the Medicaid Program oversees all the claims processing of the program.

The Kansas ADAP is funded through a variety of sources. Although a majority of funding is received through the Human Resources and Services Administration (HRSA), the program also receives funding from the State of Kansas, the Kansas City Ryan White Title I EMA and rebates through pharmaceutical companies. Those clients identified through the Kansas ADAP and the Kansas Medically Needy program (Medicaid) with an unmet spenddown are additionally benefited through these funding sources. State funds are used for claims on these individuals in order to meet a spenddown even though the client is not obligated for the expense. Those clients accessing ADAP services and have Medicaid Medically Needy are automatically eligible for spenddown assistance.

Services

Services are available to all enrolled clients within the Kansas Ryan White Title II CARE Program. These services provide reimbursement for medications listed on the Kansas ADAP Medication Formulary. This formulary currently includes all FDA-approved medications for the treatment of HIV infection, including other medications that are utilized for prevention and treatment of secondary infections. Persons also eligible for other benefit plan coverage, such as Medicaid, Medically Needy (Spenddown) or MediKan will have covered services under the particular benefit plan.

Clients accessing ADAP services are exempt from copy requirements while covered under ADAP. Those eligible for other benefit plans will not be exempt from co-pays. These other benefit plans include, but are not exclusive to, Medicaid, Medically Needy, MediKan, Healthwave, Medicare Part D, private insurance, etc.

AIDS Drug Assistance Program (ADAP) (PDF)
| Ryan White Title II Medication Formulary (PDF)

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Dental Care Services

The Kansas Ryan White Title II CARE Program Dental Care Program assists clients in preventative oral hygiene and infection control that can pose a greater burden on the immune system. As health care professionals, dentists have the moral, ethical and legal obligation to attend to the oral health needs of all patients.

The "healthy" HIV infected patient with a CD-4 count above 200 can usually receive routine dental treatment in the office of a general practitioner. No special procedures -- only universal precautions -- are required. Individuals HIV-status should be obtained in every health history, but it must not be used as a "barrier" to access to dental care. It is privileged information and must not be disclosed by the dentist or office staff.

The Dental Care Provider Network is made up of limited providers throughout the State of Kansas that are willing to provide these services.

Dental Care Services (PDF)
| Reimbursement Pages (PDF)

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Primary Medical Care Services

The Kansas Ryan White Title II CARE Program Primary Care Services allow clients to access qualified medical professionals throughout the state for treatment of HIV-infection and illnesses related to the progression of the infection. The Primary Care Services Network is one of the cornerstones of HIV care in the State of Kansas. As eligible clients access these services, they can be monitored and treated by physicians with the expertise in treating HIV-infection.

Services

Services are available to eligible Title II CARE Program clients for any service related to the diagnosis, monitoring and treatment of HIV-infection and those disease states or illnesses associated with this infection. These include, but are not limited to:

• Physician and nurse visits;
• Preventive care services; and
• Minor in-office procedures

Services outside of those listed above need to be prior authorized by calling (785) 368-6567 or emailing Melissa Romo.

http://www.kdheks.gov/hiv/ryan_white_care.html

Primary Medical Care Services (PDF)
| Reimbursement Pages (PDF)

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Mental Health Services (MH)

The Kansas Ryan White Title II CARE Program Mental Health services allow clients to address needs and coping mechanisms that not only range from painful emotions that typically accompany an anti-body test result to decision-making in a number of important areas of their lives in which there is a great deal of uncertainty. “This includes uncertainty about medical prognosis, health care options, how best to spend one's time and plan for the future, and how to share the news of being seropositive with others.”

Services

Services are available to all eligible Title II clients. Mental health services provide clients with the means to address issues related to challenges faced with living with HIV-infection. These services include, but are not limited to: individual counseling, pain management, and medication adherence counseling.

Mental Health Services (PDF)
| Reimbursement Pages (PDF)

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Substance Abuse Services (SA)

The Kansas Ryan White Title II CARE Program Substance Abuse services allow clients to address needs and coping mechanisms that may be restricting better health. These coping mechanisms would relate to use of alcohol and drugs (legal or otherwise). While mental health counseling can provide a viable resource for clients, those enduring the addictive results of drug and alcohol dependency may require other means of treatment.

Services

Substance abuse services are available to all eligible Title II clients and are provided as a means of assisting clients address issues related to challenges faced with living with HIV-infection. These services include, but are not limited to: outpatient drug/alcohol treatment, individual counseling, and pain management.

Substance Services (PDF)
| Reimbursement Pages (PDF)

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Kansas Health Insurance Assistance (KHIA) Program

The Kansas Health Insurance Assistance (KHIA) Program is designed to assist clients who are returning to work and/or are currently employed yet do have stability to maintain the financial responsibilities associated with group coverage. An article in the Employment World 2000 states that not only is our culture very preoccupied with work but that what type of work describes who and what we are. The loss of a job and its affects on relations with co-workers, schedules and regular income can alter our perceptions of how we look at ourselves and the environment we are in.

KHIA assist clients by overcoming some of the financial barriers that come with either beginning a new job or dealing with the loss of a current job. Because employment can affect many aspects of a client’s life, KHIA hopes to at least allow clients not worry about those aspects that may also affect their ability to maintain good health and adherence to a good HIV treatment regimen.

KHIA currently assists eligible clients in premiums and/or co-pays directly related to utilization of medications administered through the Kansas AIDS Drug Assistance Program (ADAP).

Eligibility

Eligibility of the program is based on a three-tiered system:

• Those requesting premium assistance only;
• Those requesting co-pay assistance only; and
• Those requesting both premium and co-pay assistance.

Although the initial enrollment and subsequent certification of services for all assistance provided through the KHIA program are the same, the mechanisms by which they are evaluated and delivered to the client are different.

Premium Assistance Program

The KHIA Premium Assistance Program is designed for those clients whom have chosen to extend their current medical/health benefits from a previous employer due to a number of factors (including but not limited to termination, leave of absence, and/or layoffs). The following are NOT allowable expenses of the KHIA Program:

• Payment of premiums directly to clients;
• Premium assistance for clients returning to work by which insurance is provided;
• Assistance for premiums that have not be found cost effective for Title II CARE Program, AIDS Drug Assistance Program and other state and federal; programs that will accessed as a result of lack of coverage; and
• Premiums towards state and federally funded programs (such as Working Healthy).

Co-Pay Assistance Program

The KHIA Co-Pay Assistance Program is designed for those clients who currently have insurance yet find the out-of-pocket expenses for medications a barrier to maintaining medication adherence. Although the insurance plan is offered through an employer or high-risk pool, the prescription benefit plan is designed for individuals who are not “high utilizers” of prescription medications. These types of plans can be very harmful to a client in maintaining their adherence to a multi-drug therapy. The following are NOT allowable expenses to the Co-Pay Assistance Program:

• Payment of co-pays already paid by the clients;
• Co-pays for medications not on the Ryan White Title II ADAP Formulary in place at the time of service; and
• Payment of co-pays where the pharmacy or pharmaceutical company is not contracted with the State of Kansas.

Premium and Co-Pay Assistance Program

The Premium and Co-Pay Assistance Program is designed for those clients who have found that the benefits of all services within the KHIA Program can provide the necessary assistance for maintaining their health and medication compliance. If a client is found eligible for this service, the client must have demonstrated the basic qualifications of all aspects of the KHIA Program.

Kansas Health Insurance Assistance (KHIA) Program (PDF)

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Kansas Ryan White Title II Case Management Services

Ryan White Title II Case Management is a comprehensive service delivery system designed to link individuals with needed care components. Enhancing client self-care, independence and self-determination are the primary goals of this program. Clients are expected to be involved in all aspects of their care, including problem-solving functions to the maximum extent possible. Proactive, coordinated efforts by healthcare providers in community-based organizations will assist clients in obtaining optimum wellness, as well as making the best possible use of available resources. Attention to continuity of care will decrease service inaccessibility and fragmentation.

The role of the Case Manager is multi-faceted. In addition to outreach and intake, the Case Manager is responsible for:

• Assessing the individual's need for services;
• Determining availability and feasibility of services;
• Developing a plan of care that includes home and community-based services appropriate to the individual's medical, social, and financial condition;
• Arranging for service delivery;
• Monitoring service delivery;
• Maintaining confidentiality of client records with the service delivery system; and
• Conducting ongoing evaluation of the effectiveness of the plan of care.

Certification of Case Management Services

As the front line in providing vital service linkages for people living with HIV/AIDS, case managers must be adequately and appropriately experienced and trained. While imposing a statewide standard for the type of experience required of a case manager is not feasible, training and certification of the skills and knowledge case managers must possess are both possible and desirable. To achieve this end, the following will guide the training and certification process:

• Minimum education and/or experience requirements of a case manager shall be:

• An RN with BSN or Social Worker with BSW or other related health or human services degree from an accredited college or university; or
• Related experience in full time service equivalent to two years regardless of education.

• Completion the current KDHE HIV/AIDS testing and counseling certification program, educators certification program and update trainings;
• All case managers must attend all statewide mandatory case managers meeting/education updates provided by KDHE semi-annually, including statewide Advisory Consortia Meetings; and

• Any agency not providing case managers who are not in compliance with the certification guidelines will be in violation of contractual agreements and must resolve the issues with the KDHE HIV/STD Section Director. Non-compliance could result in the termination of the case management contract provided through Kansas Ryan White Title II.

Case Management Services (PDF)

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Regional Case Management Sites

[Region 1] [Region 2] [Region 3] [Region 4] [Region 5] [Region 6] [Region 7] [Region 8] [Region 9]

Regions 1 and 2

Kansas City, Missouri Health Department
2400 Troost, Suite 3100
Kansas City, MO 64108
Phone: (816) 513-8230

For more information: Missouri Department of Health and Senior Services

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Region 3

Douglas County AIDS Project
2518 Ridge Court
Lawrence , KS 66044
Phone: (785) 843-0040
Fax: (785) 843-2669

Kristin Brumm, MNM, Executive Director

Case Managers:

• Shannon Ikerd, Title II Case Manager
• Gerald Downs, Title II Case Manager

For more information:www.douglascountyaidsproject.org

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Region 4

Topeka AIDS Project
708 SW 6th Street
Topeka , KS 66603
Phone: (785) 232-3100
Fax: (785) 232-3186

Debbie Guilbault, Executive Director

Case Managers:

• Ben Whisnant, Title II Case Manager
• Jenny Taylor, Title II Case Manager

For more information: http://www.topekaaidsproject.org/

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Region 5

Crawford County Health Department
410 East Atkinson, Suite A
Pittsburg, KS 66762
Phone: (620) 232-8911
Fax: (620) 232-8913

Janice Goedeke, RN, Executive Director

Case Managers:

• Vicki Brunskill-Stus, RN, Title II Case Manager

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Region 6

Riley County Health Department
2030 Tecumseh Road
Manhattan , KS 66502
Phone: (785) 776-4779 x. 250
FAX: (785) 565-6565

Case Managers:

• Donna Hart, RN, Title II Case Manager

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Region 7

Salina-Saline County Health Department
125 West Elm
Salina , KS 67401
Phone: (785) 826-6600
FAX: (785) 826-6605

Case Managers:

• Diane Pancake, RN, Title II Case Manager
• Maggie Cumberland, Title II Case Manager Assistant

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Region 8

Positive Directions, Inc.
154 North Emporia, Suite 101
Wichita , KS 67202
Phone: (316) 263-2214
FAX: (316) 263-5214

Cody Patton, Executive Director

Case Managers:

• April Lynch, Title II Case Manager
• Leonard McCray, Title II Case Manager
• Angela Henderson, Title II Case Manager
• Mario Gunter, Title II Case Manager
• Jake Petrosky, Title II Case Manager

For more information: http://www.positivedirectionsks.com/

University of Kansas MPA HIV Program
KU Internal Medicine - Midtown
1125 North Topeka
Wichita, KS 67214
Phone: (316) 293-2652
Fax: (316) 293-1882

Renee Crist-Duxler, Program Administrator

Case Managers:

• Jamie Flemming, Title II/III Case Manager
• Teresa Romey, Title II/III Case Manager
• Luis De Lacruz, Title III Outreach Case Manager

For more information: http://www.kumc.edu/

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Region 9

United Methodist Mexican-American Ministries
712 St. John Street
Garden City , KS 67846
Phone: (620) 275-1766 x. 233
Fax: (620) 275-4729

Penney Schwab, Executive Director

Case Managers:

• Irma Velazquez, Title II Case Manager

For more information: http://www.ummam.org/

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Housing Opportunities for People With AIDS (HOPWA)

Kansas Care Through Housing is a HOPWA (Housing Opportunities for People With AIDS) funded program through HUD (Housing and Urban Development). The program sponsor is The University of Kansas School of Medicine - Wichita Medical Practice Association, a non-profit organization. The funds are granted through The Kansas Department of Health and Environment (KDHE). All guidelines established are in compliance with HUD and HOPWA. Assistance is provided regardless of race, religion, color, sex, sexual preference, disability, veteran's status, national origin or ancestry.

Detailed information can be found on the following printable PDF brochure:

• Kansas Care Through Housing

All housing resources can be accessed through Ryan White Title II Case Management Services. Follow this link to find information about case management services in your area:

• Contracted Case Management Sites

Other opportunities and information can be found at:

• Kansas Consolidated Plan

The Consolidated Plan serves as the State's policy guide for the Community Development Block Grant, HOME Investment Partnerships, Emergency Shelter Grant, and Housing Opportunities for Persons with AIDS (HOPWA) programs.

Other Resources

The Kansas HIV/AIDS Hotline at:

The CDC National AIDS Hotline can be reached by calling:
1-800-342-AIDS (2537) or
1-800-342-SIDA (7532) for Spanish

Links:

• Centers for Medicare and Medicaid Services (CMS) (Formerly HCFA)
• Human Resources and Services Administration (HRSA)
• Human Resources and Services Administration (HRSA) HIV/AIDS Services
• State of Missouri HIV/STD Program
• State of Oklahoma HIV/STD Program
• State of Nebraska HIV/STD Program
• State of Colorado STD/HIV Program

For other care needs not addressed through your local health department call a Care Coordination Agency or the Kansas Ryan White Title II Program Office (phone number at the top of this page).

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This AIDS Ribbon was designed
by the
Kansas Capital Area Chapter
of the
American Red Cross
to raise hope and awareness
and support the fight against HIV/AIDS