DAR File No. 42328

Health, Disease Control and Prevention; HIV/AIDS, Tuberculosis Control/Refugee Health

Rule R388-805

Ryan White Part B Program

Notice of Proposed Rule

(Amendment)

DAR File No.: 42328
Filed: 11/15/2017 10:29:55 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to remove the asset test, to restrict case management services to clients at or below 500% of the federal poverty level (FPL) limit to align eligibility requirements with HRSA guidelines, and to reduce barriers to accessing care.

Summary of the rule or change:

The changes remove eligibility asset limit of owning no more than one home and one car, and implement a 500% FPL limit for case management services.

Statutory or constitutional authorization for this rule:

• Section 26-1-18
• Section 26-1-5
• Section 26-1-15
• Subsection 26-1-30(2)(b)
• Subsection 26-1-30(2)(a)
• Subsection 26-1-30(2)(g)
• Subsection 26-1-30(2)(c)

Anticipated cost or savings to:

the state budget:

There are minimal anticipated savings to the Ryan White Part P Program (Program) by implementing a 500% FPL limit for case management services. It is difficult to predict exact savings based on client enrollment, however, it is anticipated that this change will save the Program approximately $1,500 annually. This is a federally-funded program that provides services to people living with HIV/AIDS. The majority of the population served (60%) has no assets. Removing the asset test is not anticipated to increase Program utilization but rather reduce barriers to accessing care and determining eligibility.

local governments:

There are no anticipated costs or savings to local governments because the program governed by this rule neither requires action from nor provides benefits to local governments.

small businesses:

There are no anticipated costs or savings to small businesses because the program governed by this rule neither requires action from nor provides benefits to small businesses.

persons other than small businesses, businesses, or local governmental entities:

These rule changes will affect individuals that are over the 500% FPL and clients that own more than one car or home. It is anticipated that there will be no significant impact to the budget as the majority of individuals enrolled in the Program do not own more than one car or home and implementing the 500% FPL limit will restrict enrollment in case management services. In the last 12 months, only 9 clients were over 500% FPL. Clients who are no longer eligible for case management services through the Part B Program will still receive services free of cost, however, their services will no longer be eligible for reimbursement through the Program. These costs will be absorbed by the case management agency at an anticipated annual cost of $1,500.

Compliance costs for affected persons:

There are no compliance costs for affected persons as the Program incurs all costs associated with these changes.

Comments by the department head on the fiscal impact the rule may have on businesses:

The proposed amendments remove the asset test, restrict case management services to clients at or below 500% FPL limit to align eligibility requirements with HRSA guidelines, and reduce barriers to access care. It is anticipated that these changes will result in a lost of approximately $1,500 to non-small businesses currently contracted with the Department of Health including the University of Utah Clinic 1A and the Utah Aids Foundation. The amendments will have a slight negative fiscal impact on non-small business providers who contract with the Department through a loss of some funding due to eligibility requirements for clients in this program.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Disease Control and Prevention; HIV/AIDS, Tuberculosis Control/Refugee Health
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Amelia Self at the above address, by phone at 801-538-6221, by FAX at 801-538-9913, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

01/02/2018

This rule may become effective on:

01/09/2018

Authorized by:

Joseph Miner, Executive Director

Appendix: Regulatory Impact Analysis for Small and Non - Small Businesses

	FY 2018	FY 2019	FY 2020
Fiscal Costs
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$1,500	$1,500	$1,500
Other Persons	$0	$0	$0
Total Fiscal Costs:	$1,500	$1,500	$1,500
Fiscal Benefits
State Government	$1,500	$1,500	$1,500
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$1,500	$1,500	$1,500
Net Fiscal Benefits:	$0	$0	$0

 

The total fiscal costs is the sum of all the fiscal costs.

The total fiscal benefits is the sum of all the fiscal benefits.

The net fiscal benefits is total fiscal benefits minus total fiscal costs.

 

Fiscal costs to non-small businesses include the loss of Program funded case management services to clients exceeding the 500% Federal Poverty Limit, which is an estimated $1,500 annually. The agencies currently contracted with UDOH include University of Utah, Clinic 1A and the Utah AIDS Foundation.

 

 

R388. Health, Disease Control and Prevention; HIV/AIDS, Tuberculosis Control/Refugee Health.

R388-805. Ryan White Part B Program.

R388-805-1. Authority and Purpose.

This rule governs program eligibility, benefits, and administration by the Department for the Ryan White HIV/AIDS Treatment Extension Act of 2009 Part B Program (Ryan White Part B Program). It is authorized by Section 26-1-5; Section 26-1-15; Section 26-1-18; and Section 26-1-30(2)(a), (b), (c), and (g).

 

R388-805-2. Definitions.

The following definitions apply to this rule:

(1) "HIV" means Human Immunodeficiency Virus.

(2) "Department" means the Utah Department of Health.

(3) "Client" means an individual who meets the eligibility criteria and is enrolled in the Ryan White Part B Program pursuant to the provisions of this rule.

 

R388-805-3. Nature of Program and Benefits.

(1) The Ryan White Part B Program provides reimbursement to providers for services rendered to HIV positive individuals who meet the eligibility requirements. The Ryan White Part B Program provides limited services as described in this rule. The Department provides reimbursement coverage under the program only for services for each program:

(a) as provided in law governing the Ryan White HIV/AIDS Treatment Extension Act of 2009;

(b) to the extent that it has agreed to reimburse providers with whom it contracts to provide services; and

(c) as limited in its agreements or contracts with providers.

(2) Within available funding, the Department provides Core Medical and Supportive Services as allowable under the legislation;

(a) The AIDS Drug Assistance Program (ADAP) provides HIV related medications, health insurance premium, and cost-sharing assistance.

(b) Supportive Services Program provides a variety of supportive services that enable the client to access medical care as well as to retain the client in medical care.

(3) The Department may adjust the services available to meet current needs and fluctuations in available funding.

(4) The Ryan White Part B Program is not health insurance. A relationship with the Department as the insurer and the client as the insured is not created under this program.

 

R388-805-4. Providers.

The Department reimburses only providers who contract with the Department to provide services under the program.

 

R388-805-5. Reimbursement.

(1) The Department shall reimburse only for services as limited in its agreements or contracts with providers.

(2) The Department shall reimburse providers according to the fee schedule or budgets that are made part of its agreements or contracts with providers.

(3) The Ryan White Part B Program is the payer of last resort. The Department does not pay for services under the Ryan White Part B Program for which an individual is eligible to receive under any other primary payer source.

 

R388-805-6. Ryan White Part B Program Eligibility.

(1) To receive services under the Ryan White Part B Program, an individual must physically reside in Utah, and must have a medical diagnosis of HIV infection as verified by the individual's physician. [, and may not own more than one home and one registered vehicle.]

(2) To receive Core Medical and Supportive Services, excluding Case Management services, an individual must not have gross annual household income exceeding 250% of the federal poverty level.

(3) To receive Case Management services, an individual must not have gross annual household income exceeding 500% of the federal poverty level.

[(3)](4) To be eligible to receive assistance from the AIDS Drug Assistance Program, including health insurance premium and cost-sharing assistance an individual must have a prescription for the medication requested.

[(4)] (5) Clients must re-certify semi-annually in order to continue program participation.

 

KEY: treatment and care, HIV/AIDS, ADAP, Ryan White Part B Program

Date of Enactment or Last Substantive Amendment: [November 30, 2016]2018

Notice of Continuation: September 30, 2016

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-1-15; 26-1-18; 26-1-30(2)(a), (b), (c), (g)