 |
Utah Administrative Code (Current through November 1, 2019) |
 |
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 |
|
Latest version.
|
|
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 |
|
Latest version.
|
|
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 |
|
Latest version.
|
|
(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 |
|
Latest version.
|
|
The Department reimburses only providers who contract with the Department to provide services under the program. |
| R388-805-5. Reimbursement |
|
Latest version.
|
|
(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 |
|
Latest version.
|
|
(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. (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. (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. (5) Clients must re-certify semi-annually in order to continue program participation. |