Backup — original pdf

Backup

Planning Council Directive to the Grantee Directive # 01-2015 Creation Date: February 24, 2015 Directive regarding compliance with HRSA requirement (Policy Clarification 13-04) to evaluate consumer eligibility for insurance under the Affordable Care Act (ACA) The Austin Area HIV Planning Council hereby directs the Grantee to ensure that all uninsured consumers receiving services under Part A/MAI are assessed for insurance coverage available through the ACA Marketplace. Specific activities related to this Directive include the following: 1. Evaluate all existing Silver insurance plans available through the federal Marketplace to determine which plans provide adequate coverage for HIV/AIDS care and treatment. Identify all consumers receiving core medical services under Ryan White Part A/MAI who are eligible to enroll in accordance with the provisions of the Affordable Care Act. 2. 3. Work with each eligible consumer to determine total cost to the consumer, including the cost of the premium, co-payment and deductible. 4. On an individual consumer basis, determine if it is cost effective for the Ryan White Program for the consumer to transition to ACA insurance. It is recommended that the Grantee utilize the methodology prescribed by the Texas Department of State Health Services (DSHS) for Part B Administrative Agents in accordance with the DSHS instructions contained in: Interim Guidance to Texas Administrative Agents on Health Insurance Assistance Services. 5. Ensure that each consumer eligible for insurance under ACA be fully educated about the benefits of ACA insurance as well as the potential consequences of not obtaining insurance. Consumer education must include apprising the consumer of the Payer of Last Resort policy and potential federal income tax liability. The Austin Area HIV Planning Council also directs the Grantee to provide quarterly updates to the Planning Council regarding the progress made in compliance with this directive. The report shall include (but not limited to) the following: 1. The number of consumers who are insured broken down by the following (add additional categories as appropriate): Insurance purchased through the ACA Marketplace • • Other private insurance including group insurance through employer • Medicare • Medicaid • Veterans Administration Note: This Directive is provided to the Grantee in accordance with the Ryan White HIV/AIDS Program Part A Manual, Section XI, Chapter 4 and Policy#2 (Guidance) of the Austin Area HIV Planning Council  Directive # 01-2015 Page 2 2. The impact of insurance in terms of quality and continuity of care: • How ACA insurance has benefited the consumer? For example: o Has the consumer received preventative services beyond what Ryan White would have provided? o Has the consumer received care for medical conditions not associated with HIV (outside the scope of Ryan White)? • How has ACA insurance coverage impacted continuity of care? For example: o Has any consumer cancelled an appointment because they did not have their co- payment or had not yet met their deductible? o Have policy limitations such as need for prior approval or annual limits on test or procedures impacted scope or quality of care? 3. Service utilization metrics: • Units of service billed to Ryan White for each core service and the number of units of service paid for by ACA policies. • Number of consumers who received assistance under the Insurance Continuation service category (specifically for insurance purchased under ACA). 4. Is ACA insurance cost effective for the Ryan White Program? (Compare average OAMC expenditures to the health insurance expenditure). 5. Any other information that will provide the Planning Council a better understanding of the impact(s) and experiences of the transition to ACA insurance coverage. Note: This Directive is provided to the Grantee in accordance with the Ryan White HIV/AIDS Program Part A Manual, Section XI, Chapter 4 and Policy#2 (Guidance) of the Austin Area HIV Planning Council