Ryan White recertification

[sovereign1]

Here's a question for any of you with expertise in this area:
 
If a client meets all the basic requirements for Ryan White coverage (i.e., residency, income, HIV status, insurance, etc.), can they be denied recertification solely on the basis of not taking their HIV meds?  It seems this is an issue to be addressed between the client and their HIV doctor.

Also, is recertification generally determined by the local/state agency that receives the federal Ryan White funding, or perhaps directly through HRSA?

Thanks in advance for any information you can provide!

[Jim Allen]

Hi

Are you the client? Or are you asking for a client of yours?

Jim

[sovereign1]

I am the client.

[J.R.E.]

Hey,..

First question I'd like to ask, is why you are not taking your medication as prescribed by you doctor ?

Ray

[J.R.E.]

I also found this in the Ryan White handbook.  I am also not certain if this has been revised: NOTE THIRD POINT.

III. RESPONSIBILITIES
You are responsible for assisting your case manager in developing your Individualized Service Plan.

You are responsible for keeping scheduled appointments and accepting offered and necessary services.

You are responsible for adhering to patient care treatment, including medical provider appointments and
pharmaceuticals.

You are responsible for demonstrating behavior that is cooperative, assertive, and respectful of others.

You are responsible for notifying your case manager when you have problems in obtaining services or
when you are dissatisfied with your care.

You are responsible for following health care instructions to the best of your ability.
If you are designated a minimal co-payment based on the department's respective sliding fee scale you are
responsible for making all co-payments as instructed prior to receiving services.
My rights and responsibilities have been explained to me and I will agree to the conditions established."

Ray

[J.R.E.]

Also This: ( Notice last Point )

Purpose: The purpose of this policy is to identify the circumstances where services may be
denied and/or terminated for individuals utilizing Ryan White Part B funded services.


a. Ryan White Part B funded services may be denied to individuals for the following
reasons:

1. Individual is not eligible for services in accordance with the Ryan White Part B
Program Policy “Client Eligibility.”

2. Individual fails to substantiate an HIV medically related need for Ryan White Part
B funded services in accordance with the Ryan White Part B Program Policy
“Direct Emergency Assistance” and the HRSA National Monitoring Standards
(see link above).

3. Individual fails to maintain measurable progress or to follow their individual
service plan as documented by individual’s case manager.  

4. Lack of available federal, state, or private funding utilized for the provision and
delivery of Ryan White Part B services.

5. Programmatic decisions made by NDHHS Ryan White Program which changes,
reduces, or eliminates a currently provided service.

b. Ryan White Part B funded services may be terminated (defined by documentation and
closure of client file terminating the relationship with the serving agency) for individuals
currently eligible for Ryan White Part B funded services for the following reasons:
1. Client has violated the Ryan White Part B Program Policy “Waste, Fraud, and
Abuse of Ryan White Part B funding.”

 Continual failure to maintain measurable progress on an individual’s service plan may lead to termination.