AIDS PHARMACEUTICAL ASSISTANCE (LOCAL)

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1 AIDS PHARMACEUTICAL ASSISTANCE (LOCAL) I. DEFINITION OF SERVICE Implementation of a Local AIDS Pharmaceutical Assistance Program (LPAP) for the provision of HIV/AIDS using a drug distribution system that has: A client enrollment and eligibility process Uniform benefits for all enrolled clients throughout the EMA A drug formulary approved by the local advisory committee/board A recordkeeping system for distributed A drug distribution system A system for drug therapy management An LPAP that does not dispense as: A result or component of a primary medical visit A single occurrence of short duration (an emergency) Vouchers to clients on an emergency basis A Program that is: Consistent with the most current Coordinated with the State s Part B AIDS Drug Assistance Program II. DESCRIPTION OF SERVICE SERVICE Implementation of a Local AIDS Pharmaceutical Assistance Program (LPAP) for the provision of HIV/AIDS using a drug distribution system that has: A client enrollment and eligibility process Uniform benefits for all enrolled clients throughout the EMA A drug formulary approved by the local Planning Council/Grantee A recordkeeping system for distributed A drug distribution system A system for drug therapy management PERFORMANCE MEASURE/METHOD Documentation that the LPAP program s drug distribution system has: 1. A client enrollment and eligibility process 2. Uniform benefits for all enrolled clients throughout the EMA 3. A recordkeeping system for distributed 4. A drug distribution system that includes a drug formulary approved by the local Planning Council/Grantee 5. A system for drug therapy management MONITORING STANDARDS 1. Documentation that the LPAP program meets HRSA/HAB requirements 2. Maintain documentation in client files of proof of client LPAP eligibility that includes HIV status, residency, medical necessity, and low income status as defined by the EMA based on a specified percent of the Federal Poverty Level (FPL) 3. Provide reports to the Part A program of the number of individuals served and the provided LIMITATIONS For an LPAP program that does NOT dispense Documentation that the LPAP is NOT 1. Documentation that the LPAP program Collaborative Research, LLC Updated March P age

2 as: A result or component of a primary medical visit A single occurrence of short duration (an emergency) Vouchers to clients on an emergency basis The LPAP Program is: Consistent with the most current Coordinated with the State s Part B AIDS Drug Assistance Program dispensing as: 1. A result or component of a primary medical visit 2. A single occurrence of short duration (an emergency) without arrangements for longer term access to medication 3. Vouchers to clients on a single occurrence without arrangements for longer-term access to Documentation that the LPAP Program is: 1. Consistent with the most current 2. Coordinated with the State s Part B AIDS Drug Assistance Program meets HRSA/HAB requirements 2. Maintain documentation in client files of proof of client LPAP eligibility that includes HIV status, residency, medical necessity, and low income status as defined by the EMA based on a specified percent of the Federal Poverty Level (FPL) 3. Provide reports to the Part A program of the number of individuals provided single occurrence of short duration and/or vouchers to clients on an emergency basis 1. Documentation that the LPAP Program is consistent with the most current 2. Documentation in client file of coordination efforts with the State s Part B AIDS Drug Assistance Program (i.e. ADAP application, denial letter from ADAP) III. CARE SERVICE COMPONENTS Program Outcomes: successfully transferring to a sustainable funding source as result of accessing Drug Reimbursement at 6 months & 12 months Indicator: who report an improved health status as measured by virologic suppression (HIV RNA Viral Load). Service Unit(s): Successful completed application request utilizing local ADAP funds Filled prescriptions using local ADAP (enumerate by script) Collaborative Research, LLC Updated March P age

3 Standard of Care Outcome Measure Numerator Denominator Data Source Goal/Benchmark I. Process The client is assessed for eligibility of AIDS Drug Assistance Program (ADAP) Wait for approval of ADAP application following ADAP receipt of complete application. Provider will utilize the most affordable/cost efficient form of medication accessible. A copy of the client s prescription from a medical provider is on file. III. Outcomes Clients are offered counseling on medication adherence. Prescriptions are in to pharmacy within 48 hours of ADAP Assistance provider receipt of prescription No barriers exist to access & utilization Applications approved for ADAP within 2 weeks of ADAP receipt of complete application. Prescriptions filled are the most cost-efficient provided Charts document prescriptions with: Name of the client Date of birth Medication Dose Prescribing medical provider Clients are screened for medication adherence and counseled if not adherent. Clients are provided medication within 48 hours of prescription given to ADAP Assistance provider assessed for ADAP Number of applications approved for ADAP within 2 weeks of completed application Number of charts with most cost-efficient Number of prescriptions with information listed screened for adherence Number of screened clients are counseled with prescription provided within 48 hours on ADAP Total number of applications Ryan White Office Utilization Report Client chart ADAP Program Report 100% of client charts document assessment for eligibility of ADAP 100% of applications approved for ADAP within 2 weeks of ADAP completed application Number of charts Client chart 85% of prescriptions are filled are the most cost-efficient provided Number of prescriptions Number of screened clients with prescriptions Client charts Client chart 100% of charts document prescriptions with: Name of the client Date of birth Medication Dose Prescribing medical provider 100% of clients are screened for medication adherence 80% of clients screened to have adherence issues are counseled. Clients are provided medication within 48 hours of prescription given to ADAP Assistance provider Collaborative Research, LLC Updated March P age

4 IV. DATA REPORTING Part A service providers are responsible for documenting and keeping accurate records of Ryan White Program Data/Client information, units of service, and client health outcomes. Reporting units of service are a component of each agency s approved workplan. Please refer to the most current workplan, including any amendments, for guidance regarding units of service. Summaries of service statistics by priority will be made available to the Planning Council by the Grantee for priority setting, resource allocation and evaluation purposes. The Chart Audit Tool for Local AIDS Pharmaceutical Assistance is attached on the next page Collaborative Research, LLC Updated March P age

5 LOCAL ADAP PROGRAM SITE: REVIEWER(S): CHART #s: AUDIT DATE: STRUCTRE ( Who ) Enrollment Process 1 Written enrollment and eligibility processes are available for clients to review Uniform Access 2 Documentation of uniform benefits for all enrolled clients throughout the EMA 3 Drug Formulary Provider utilizes approved drug formulary CHARTING & MONITORING Recordkeeping Requirements 4 Provider has recordkeeping system for distributed, to include program reporting of number of individuals served and the provided Distribution System 5 Provider has documented evidence of a drug distribution system that includes a drug formulary approved by the EMA Eligibility Documentation in client file supporting eligibility requirements 6 for RW funding; includes proof of HIV status, residency, medical necessity, and low income status as defined by the EMA based on FPL CARE STATUS Documentation of clients assessed for eligibility of State ADAP assistance Documentation of State ADAP application in clients files; ADAP application approved within 2 weeks of submitting LPAP Prescriptions filled with LPAP funds are documented at the most cost efficient price point (evidence of 340B pricing where applicable Prescriptions Client file shows evidence of prescription with: client name, date of birth, medication, dosage, and prescribing medical provider Medication Adherence Documentation in clients files of screening for medication adherence; if adherence issue is identified med adherence counseling documented Medication Clients receive medication assistance within 48 hours of receipt of prescription New addition Program Monitoring Standards HAB Measures Indicates National HIV/AIDS Strategy Goal Refers to Scope of Services Outcome Collaborative Research, LLC Updated March P age

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