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All e-mail addresses, web links, telephone numbers, and addresses noted in this manual were correct as of
the revision date (see footer); however, each is subject to change without prior notice.
ALABAMA DEPARTMENT OF PUBLIC HEALTH
PROVIDER (EXTERNAL)
AIDS DRUG ASSISTANCE PROGRAM (ADAP)
POLICY AND PROCEDURES MANUAL
Last Updated
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: January 2024
Last edited: 1/19/24
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TABLE OF CONTENTS
SECTION ONE: Glossary _________________________________________________________________ 3
Alabama ADAP programs and sub-programs _________________________________________________ 4
SECTION TWO: Program Overview _________________________________________________________ 5
Statement of Use _______________________________________________________________________ 5
What is ADAP? ________________________________________________________________________ 5
SECTION THREE: Eligibility and Application ________________________________________________ 12
Payor of Last Resort ___________________________________________________________________ 12
Eligibility Criteria _______________________________________________________________________ 12
Individuals who are Underinsured _________________________________________________________ 14
Individuals who are Incarcerated __________________________________________________________ 15
Adult Child on Parent Insurance __________________________________________________________ 15
Application Process ____________________________________________________________________ 16
Enrollment and Effective Dates ___________________________________________________________ 18
Program Transitions ____________________________________________________________________ 20
Recertification Receipt and Processing _____________________________________________________ 21
Open Enrollment and Special Enrollment ___________________________________________________ 21
Factors That Delay or Prevent Eligibility Determination _________________________________________ 22
Denials and Termination ________________________________________________________________ 23
Policy Exceptions ______________________________________________________________________ 23
Client Rights and Responsibilities _________________________________________________________ 24
Confidentiality _________________________________________________________________________ 24
SECTION FOUR: Emergency Preparedness _________________________________________________ 25
Emergency Assistance to Neighboring States ________________________________________________ 25
SECTION FIVE: Additional Documentation __________________________________________________ 28
Ryan White Part B and ADAP Provider Locations _____________________________________________ 28
ServicePoint User Manual _______________________________________________________________ 28
CAREWare User Manual ________________________________________________________________ 28
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SECTION ONE: GLOSSARY
TERM
ACRONYM
DEFINITION/DESCRIPTION
AIDS Drug
Assistance Program
ADAP
A part of the Ryan White HIV/AIDS Program (RWHAP) that provides
funding to states to purchase HIV drugs and other medications for
people with HIV. ADAP may also help people with HIV pay insurance
premiums and copayments.
The AIDS Drug Assistance Program (ADAP) provides three forms of
assistance through three programs – AIDS Drug Assistance
Prescription Program (ADAP-Rx), HealthPlus Alabama (HPAL), and
the Medicare Part D Cost Assistance Program (MEDCAP, Blue Rx
Enhanced Plus).
AIDS Drug
Assistance
Prescription Program
ADAP-Rx
The AIDS Drug Assistance Prescription Program (ADAP-Rx) is a
program that reimburses enrolled pharmacies the ADAP-Rx allowable
cost of ADAP formulary medications for eligible low-income people
with HIV.
Co-payment
Co-payments are set dollar amounts charged to clients for medical or
prescription drug services. For example, a client may have a co-
payment of $25 per prescription regardless of the actual cost of the
prescription. ADAP will pay co-payments for ADAP formulary
medications on behalf of eligible clients.
Deductibles
Deductibles are set dollar amounts charged to clients for covered
health care services before an insurance plan starts to pay. After
deductibles are paid, co-payment or co-insurance may be charged for
covered services and the insurance company pays the rest. ADAP will
pay deductibles, co-payments, and coinsurance for eligible clients with
certain types of public and/or private health insurance.
Dental Plus Alabama DPAL
Dental Plus Alabama is a sub-program of HPAL and pays the full cost
of the dental insurance premium, deductibles, and $2,000 annual
allotment.
HealthPlus Alabama
AIAP,
HPAL
HealthPlus Alabama pays the cost of premiums, deductibles, and co-
payments for specific health insurance policies for eligible people living
with HIV.
Medicaid
Medicaid provides health coverage to millions of Americans, including
eligible low-income adults, children, pregnant women, elderly adults,
and people with diverse abilities. Medicaid is administered by states,
according to federal requirements, and is funded jointly by states and
the federal government.
Medicare
Part A: Hospital Stays—ADAP does not provide any coverage.
Part B: Physician Services—ADAP does not provide any coverage.
Part C: Medicare Advantage Plans—ADAP does not provide
coverage.
Part D: Prescription Drug Plans— ADAP does not provide coverage.
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Medicare Part D Cost
Assistance Program
MEDCAP
The MEDCAP program pays the cost of premiums, deductibles, and
co-payments for the Blue Rx Enhanced Plus (Medicare Part D) plan
for eligible people living with HIV.
Pharmacy Benefits
Manager
PBM
An organization that provides administrative services in processing
and adjudicating prescription claims for pharmacy benefit programs.
In Alabama, Ramsell Corporation serves as the PBM.
Premium
A monthly payment made to the insurer to obtain insurance coverage.
Premiums can be paid by employers, unions, employees, or
individuals or shared among different payers (e.g., ADAP).
Qualifying life event
A major change in your life that impacts your health coverage needs or
your options for getting coverage. If you have a qualifying life event,
you can enroll in coverage or switch plans during a special enrollment
period. If you do not qualify for a special enrollment period, you must
wait until the open enrollment period that occurs once per year.
Getting married and having a baby or moving to another part of the
country are examples of qualifying life events. In addition, loss of other
health coverage that results from other life changes, such as divorce
or death of a family member or losing a job, is also a qualifying event.
Recertification
Recertification requires that clients and/or case managers complete a
program application each year to remain eligible for ADAP services.
Special enrollment
period
SEP
An additional enrollment period available if you have special
circumstances in your life, such as divorce, a spouse’s death or
unemployment or the birth of a child that affect your eligibility for health
insurance. If eligible for a special enrollment period, you may enroll or
switch plans without waiting until the next open enrollment period.
ALABAMA ADAP PROGRAMS AND SUB-PROGRAMS
ADAP
ADAP-Rx HPAL
DPAL
MEDCAP
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SECTION TWO: PROGRAM OVERVIEW
STATEMENT OF USE
It is the expectation of ADPH that all policies and procedures outlined in this Manual are to be followed by staff.
If any policy or procedures outlined in this Manual is not demonstrative of efficient program operations, the
Acting ADAP Branch Manager should be notified in writing immediately. The Manual will be reviewed
annually.
The purpose of this document is to outline core standards for the administration of the Alabama ADAP.
Throughout the document, “ADAP” refers to assistance through three programs—the AIDS Drug Assistance
Prescription Program (ADAP-Rx), HealthPlus of Alabama (HPAL, AIAP), and the Medicare Part D Cost
Assistance Program (MEDCAP, Blue Rx Enhanced Plus).
WHAT IS ADAP?
The Alabama AIDS Drug Assistance Program (ADAP) provides working class individuals living with HIV in
Alabama access to medical services and medications. ADAP comprises three programs:
1. The AIDS Drug Assistance Prescription Program (ADAP-Rx) covers the cost of antiretroviral and other
HIV-related medications.
2. HealthPlus Alabama (AIAP or HPAL) covers the full cost of health insurance premiums and medication
and medical co-payments and/deductibles for eligible clients. This program also includes dental
insurance (DPAL), which covers the full cost of dental insurance premiums and medication and medical
co-payments and/or deductibles for eligible clients.
3. The Medicare Part D Program (MEDCAP, Blue Rx Enhanced Plus) covers the full cost of health
insurance premiums and medication and medical co-payments and/or deductibles for eligible clients.
ADAP is funded through:
Federal RWHAP Part B funds administered by the Health Resources and Services Administration
(HRSA), including ADAP earmark, supplemental, and emergency relief funds.
340B rebates from drug manufacturers.
Supplemental rebates negotiated on behalf of the Alabama ADAP by the ADAP Crisis Task Force.
Staff within the Alabama Office of HIV Prevention and Care, in coordination with the Alabama Department of
Public Health (ADPH), are responsible for administration of the ADAP. This includes the development of
policies and procedures that are in accordance with relevant state statutes, federal RWHAP legislation, and
other federal requirements.
The AIDS Drug Assistance Prescription Program (ADAP-Rx) is designed to maintain the health and
independence of low-income individuals living with HIV in Alabama by paying for antiretroviral and other HIV-
related prescriptions. The following information pertains to clients who are currently enrolled in ADAP-Rx, or
those applying for the program. This information is also important for individuals assisting clients with
enrollment in ADAP-Rx, such as case managers and linkage to care specialists.
Covered Medications: ADAP-Rx has a medication formulary that outlines the specific drugs that are
covered. In accordance with RWHAP legislation, the formulary includes at least one drug from each
class of HIV antiretroviral medications, only medications approved by the FDA and the devices needed
to administer them, is consistent with the most recent Adolescent and Adult HIV/AIDS Treatment
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Guidelines published by the Department of Health and Human Services, and equally and consistently
available to all eligible enrolled individuals throughout the state/territory. The ADAP-Rx Formulary is
located on the Alabama ADAP website. Only medications listed in ADAP-Rx formulary will be covered.
Clients can request a 90-day supply of medication if traveling.
Coverage for Individuals without Health Insurance: ADAP-Rx will cover the entire ADAP-Rx
allowable cost of formulary medications for individuals who do not have health insurance and meet all
ADAP-Rx eligibility requirements. If an individual who was previously uninsured acquires health
insurance at any time during the year, they are required to contact ADAP-Rx staff and inform them of
the change in insurance status.
Designated Pharmacies: Clients enrolled in ADAP-Rx are required to use a pharmacy that is enrolled
as an ADAP-RX in-network pharmacy. Clients are responsible for updating ADPH ADAP eligibility staff
and their pharmacy with any changes in insurance coverage or status. Clients and case managers can
locate ADAP-Rx enrolled pharmacy providers using the Alabama Ramsell website:
Alabama AIDS Drug
Assistance Program | Ramsell (ramsellcorp.com). ADAP-Rx is not responsible for paying claims to
pharmacies that are not enrolled as ADAP-Rx providers.
HealthPlus Alabama (AIAP or HPAL) is designed to maintain the health and independence of people living
with HIV in Alabama by covering the full cost of their monthly health insurance premium, deductibles, and co-
payments. HPAL will not pay the cost of a family health insurance policy. The following policies apply
specifically to HPAL and are in accordance with federal legislation and federal funding requirements.
Blue Cross Blue Shield open enrollment period: November 1-December 15
Anyone who is eligible for HPAL must apply, be determined eligible, and enroll during the ADPH ADAP
open enrollment period which runs from November 1 to October 31 annually.
Types of Health Insurance Premiums Covered: In accordance with federal regulations, HPAL uses
RWHAP funds to cover the cost of premiums for insurance plans that:
1. At minimum, include at least one drug in each class of the core antiretroviral therapeutics from
the U.S. Department of Health and Human Services (HHS) Clinical Guidelines and Treatment of
HIV/AIDS as well as appropriate primary care services;
2. And are cost-effective per HRSA’s definition (HIV/AIDS Bureau (HAB) Policy Notice 07-05).
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The following is a list of the specific types of insurance plans for which HPAL will cover the full cost of
premiums for eligible clients.
TYPE OF
INSURANCE
GENERAL INFORMATION WHAT WILL ADAP COVER?
Private, individual
insurance
(purchased through
the marketplace)
Individuals who are legally present in the
United States and do not have access to
affordable employer-sponsored insurance
or health coverage through public
programs (Medicare, Medicaid) are able to
purchase individual health insurance
through the federal Health Insurance
Marketplace.
Blue Cross Blue Shield of
Alabama Blue Value Gold plan.
HPAL will cover monthly health
insurance premiums, prescription
deductibles, and/or co-payments,
and certain medical co-payments
and deductibles.
Employer-
sponsored health
insurance
for individuals who qualify for
employer-sponsored health
insurance.
COBRA
COBRA provides the option to continue
group health benefits provided by their
previous employers’ group health plan for
up to 18 months, or 29 months if
determined disabled by the SSA, after
initial enrollment.
Who is eligible?
Employees, and their families, who lose
their health insurance, due to voluntary or
involuntary job loss, reduction in the hours
worked, transition between jobs, death,
divorce, and/or other life events.
for individuals who qualify for
COBRA.
Dental Insurance
Oral health care is an important part of
overall health for all people, and insurance
can help cover costs of dental care,
including preventative care.
People living with HIV experience a high
rate of common oral health problems, as
well as oral health problems that are
directly related to HIV infection.
in the Blue Cross Blue Shield of
Alabama Dental Blue Select plan.
HPAL does not cover the cost of premiums for other types of insurance that are not listed above.
Coverage for Individuals with Health Insurance: HPAL will cover the cost of deductibles and/or co-
payments for formulary medications for individuals who meet all ADAP eligibility requirements. Case
managers and/or clients are required to provide ADAP staff with information on their health insurance
policy, as well as changes to their insurance coverage/status, to ensure that RWHAP funds are utilized
as the payer of last resort (PHS Act Section 2617(b)(7)(F); HAB Policy Notice 07-03).
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Covered Medications: clients enrolled in HPAL may have access to broader formularies, as included
in their insurance plan. ADAP will pay for any medications included on the HPAL formulary for those
clients. Clients can request a 90-day supply of medication if traveling.
Payment of Insurance Premiums: for HPAL to make premium payments on behalf of eligible clients,
the case manager must complete the HPAL application for the client. Upon eligibility determination and
enrollment, United Way of Central Alabama (UWCA) will enroll the client in HPAL and make the
premium payment on behalf of ADPH ADAP.
Dental Plus Alabama (DPAL): DPAL is designed to maintain the health and independence of people
living with HIV in Alabama by covering the full cost of their monthly dental insurance premium,
deductibles, and $2,000 annual allotment. DPAL is only available for individuals enrolled in HPAL and
clients must see only in-network dental providers.
Benefits Cards: UWCA acts as the insurance benefits manager for HPAL and DPAL clients managing
insurance enrollment and payment of all associated premiums and medical co-payments, and/or
deductibles. Ramsell acts as the insurance benefits manager for HPAL and DPAL clients managing
payment of medication co-payments and/or deductibles.
Clients successfully enrolled in HPAL will receive:
1. A health insurance card from Blue Cross Blue Shield of Alabama that covers certain medical
and mental health copayments and deductibles.
2. A benefits card from Ramsell to cover prescription co-payments and/or deductibles.
Clients successfully enrolled in DPAL will receive:
1. A dental insurance card from Blue Cross Blue Shield of Alabama
2. A DPAL benefits card from UWCA to cover dental deductibles and co-payments.
Clients must present both cards to any participating in-network pharmacy, health, and/or dental
provider to ensure full payment. The HPAL/DPAL benefits card will ensure ADAP is billed for the client
portion of the co-payments and/or deductibles.
The Medicare Part D Cost Assistance Program (MEDCAP or Blue Rx Enhanced Plus) is designed to
maintain the health and independence of people living with HIV in Alabama who are eligible for Medicare Part
D by covering the full cost of their monthly Medicare Part D insurance premium and co-payments. The
following policies apply specifically to Blue Rx Enhanced Plus and are in accordance with federal legislation
and federal funding requirements.
Open enrollment period: October 15-December 7
Anyone who is eligible for Medicare Part D must apply, be determined eligible, and enroll during the
open enrollment period to have their premiums paid for by ADPH ADAP beginning January 1. Until
which time an individual is fully enrolled in Medicare Part D, ADPH ADAP will not support the payment
of premiums and is unable to back-pay unpaid premiums for the plan.
Types of Health Insurance Premiums Covered: In accordance with federal regulations, MEDCAP
uses RWHAP funds to cover the cost of premiums for insurance plans that:
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1. At minimum, include at least one drug in each class of the core antiretroviral therapeutics from
the U.S. Department of Health and Human Services (HHS) Clinical Guidelines and Treatment of
HIV/AIDS as well as appropriate primary care services;
2. And are cost-effective per HRSA’s definition (HIV/AIDS Bureau (HAB) Policy Notice 07-05).
The following is a list of the specific types of insurance plans for which MEDCAP will cover the full cost
of premiums for eligible clients.
TYPE OF
INSURANCE
GENERAL INFORMATION WHAT WILL ADAP COVER?
Medicaid
for individuals who qualify for
Medicaid.
Medicare and
Medicare dual-
eligible individuals
for individuals who qualify for
Medicaid.
Medicare Part A
and B
Many Medicare recipients obtain
additional coverage through private
Medicare Supplement Policies to help
lower their out-of-pocket expenses.
Who is eligible?
Individuals who are determined to be
disabled by the Social Security
Administration become eligible for
Medicare after 24 months of disability, and
individuals age 65 and older are also
eligible for Medicare.
Medicare Part A or B plans.
Medicare Part C
(with drug
coverage)
Medicare Advantage offers people
enrolled in Medicare Part A and Part B
another option for obtaining health
insurance through the Medicare program.
All Medicare Advantage plans must
provide at least the same benefits as
Original Medicare.
Medicare Advantage plans are offered by
private companies approved by Medicare.
Medicare Part C plans.
Medicare Part D
Medicare Part D provides coverage for
prescription drugs.
Who is eligible?
Individuals who are determined to be
disabled by the Social Security
Administration become eligible for
Medicare after 24 months of disability, and
the Blue Cross Blue Shield of
Alabama Blue Rx Enhanced Plus
(Medicare Part D) plan.
MEDCAP will cover monthly
Medicare Part D prescription
insurance premiums and all
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individuals age 65 and older are also
eligible for Medicare.
prescription medications.
MEDCAP clients must apply for
Low Income Subsidy (Extra Help)
during initial program application
and during each annual
certification and submit a letter of
denial for Low Income Subsidy
Assistance from the SSA.
Individuals who are eligible for
MEDCAP and chose not to enroll
will be terminated from ADAP.
MEDCAP does not cover the cost of premiums for other types of insurance that are not listed above.
Application for Low Income Subsidy: individuals eligible for MEDCAP must apply for Low Income
Subsidy Assistance (Extra Help) during initial program application and each annual recertification.
Individuals who are eligible for Low Income Subsidy (Extra Help) are not eligible for ADAP services;
those individuals may be eligible for other Part B services. Upon application, submit the letter of denial
for Low Income Subsidy Assistance (Extra Help) from the SSA for the new enrollment year and
annually thereafter during the annual recertification.
To apply for the Low Income Subsidy Assistance (Extra Help), contact the Social Security
Administration (SSA) at 1-800-722-1213 or by visiting the Social Security website at www.ssa.gov.
Coverage for Individuals with Health Insurance: MEDCAP will cover the cost of co-payments for
formulary medications for individuals who meet all ADAP eligibility requirements. Clients are required to
provide ADAP staff with information on their health insurance policy, as well as changes to their
insurance coverage/status, to ensure that RWHAP funds are utilized as the payer of last resort (PHS
Act Section 2617(b)(7)(F); HAB Policy Notice 07-03).
Covered Medications: clients enrolled in MEDCAP may have access to broader formularies, as
included in their insurance plan. ADAP will pay for any medications included on the Blue Rx Enhanced
Plus formulary for those clients. Clients can request a 90-day supply of medication if traveling.
Payment of Insurance Premiums: for MEDCAP to make premium payments on behalf of eligible
clients, the case manager must complete the Blue Rx Enhanced Plus application for the client. Upon
eligibility determination and enrollment, UWCA will enroll the client in Blue Rx Enhanced Plus and make
the premium payment on behalf of ADPH ADAP.
Benefits Cards: UWCA acts as the insurance benefits manager for MEDCAP clients managing
insurance enrollment and payment of all associated premiums. Ramsell acts as the insurance benefits
manager for MEDCAP clients managing payment of medication co-payments.
Clients successfully enrolled in MEDCAP will receive:
1. A prescription insurance card from Blue Cross Blue Shield of Alabama.
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2. A MEDCAP benefits card from Ramsell Corporation to cover all client prescription costs.
Clients must present both cards to any participating in-network pharmacy provider to ensure full
payment. The MEDCAP benefits card will ensure ADAP is billed for the client portion of the co-
payments.
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SECTION THREE: ELIGIBILITY AND APPLICATION
PAYOR OF LAST RESORT
In accord with federal regulations, all RWHAP funds used to support the Alabama ADAP are used as payer of
last resort. RWHAP funds are not used “for any item or service to the extent that payment has been made, or
can reasonably be expected to be made…” by another payment source. To ensure compliance with the payer
of last resort requirement, ADAP staff and agencies funded by ADPH must:
1. Vigorously pursue client enrollment into health care coverage for which clients may be eligible (e.g.,
Medicaid, CHIP, Medicare, state-funded HIV/AIDS programs, employer-sponsored insurance,
and/or private health insurance).
2. Ensure that clients are enrolled in health care coverage whenever possible or applicable, and are
informed about the consequences of not enrolling.
ELIGIBILITY CRITERIA
All applicants and clients seeking services to be provided by Alabama ADAP must meet the following criteria:
1. Diagnosis of HIV
2. Reside in Alabama
3. Have an individual gross income not exceeding 400% of the Federal Poverty Level (FPL)
4. Be ineligible for third-party payors, including but not limited to employer-sponsored insurance, COBRA,
and Alabama Medicaid.
To complete eligibility determination, all applications must complete the ADPH Release of Information.
The following provides further detail regarding ADAP eligibility criteria.
CRITERIA
JUSTIFICATION
VERIFICATION
Diagnosis of HIV and is
under the care of a
physician licensed in
the United States of
America
Note: only required for
new application
To be eligible for the Alabama ADAP,
applicants must be living with HIV. This
must be documented.
Documentation requirements include
one of the following:
1. Confirmatory HIV test (Western
Blot)
2. Clinician statement documenting
diagnosis
ES reviews document submitted to
determine if the documentation
submitted is for the individual seeking
services and denotes that the individual
is living with HIV.
If yes, individual could be eligible for the
program if he/she meets other eligibility
criteria.
If no, individual is not eligible for the
program.
Resides in Alabama
To be eligible for the Alabama ADAP,
applicants must be living within the
geographic boundaries of the state of
Alabama, with an intent to continue to
physically reside within those
ES reviews document submitted to
determine if the documentation
submitted is for the individual seeking
services, that the documentation
submitted is valid as of the date of
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boundaries at the time of application.
This residency must be documented.
Documentation requirements include
one of the following:
1. Alabama Driver’s License (must
have a future expiration date).
2. Alabama non-driver ID (must have a
future expiration date).
3. Utility Bill (electricity, water, or gas
bill dates) dated within 90 days of
submission date of application.
4. Mortgage or lease/rental agreement.
5. Confirmation by case manager of
incarceration.
6. Copy of Social Security benefits
notification letter dated within 90
days of application submission.
review and denotes that the individual is
living in Alabama.
If yes, individual could be eligible for the
program if he/she meets other eligibility
criteria.
If no, individual is not eligible for the
program.
Individual gross
income
2
not exceeding
400% FPL
Documentation requirements include
any of the following:
1. Copy of signed federal tax return for
the most recent prior tax year (i.e.,
1040 or 1040 EZ, including the
Schedule C; acceptable for business
owners only).
2. Copy of most recent pay stub
showing at least 30 days of earnings
and the employer’s name and
address; earnings must be dated
within 90 days of submission date of
application.
3. Copy of current Social Security
benefits notification letter.
4. Letter from employer on company
letterhead detailing pay frequency,
hours worked, and hourly wage.
ES reviews document submitted to
determine if the individual has a gross
income at or below 400% FPL.
If yes, individual could be eligible for the
program if he/she meets other eligibility
criteria.
If no, individual is not eligible for the
program.
2
Gross income is defined as the sum of all wages before any deductions or taxes (i.e., income tax, Social Security tax, etc.)
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Ineligible
3
for third-
party payors, including
but not limited to
employer-sponsored
insurance, COBRA,
and Alabama
Medicaid.
Documentation requirements include
any of the following (as applicable):
1. Copy of letter detailing ineligible
for/unavailable employer sponsored
insurance
2. Copy of letter detailing waiting
period for employer sponsored
insurance
3. Copy of denial letter for COBRA
access.
4. Copy of denial letter from Alabama
Medicaid
ES reviews document submitted to
determine if the individual in ineligible
for third-party insurance.
If yes, individual could be eligible for the
program if he/she meets other eligibility
criteria.
If no, individual is not eligible for the
program.
Alabama ADAP will not deny services to an individual receiving benefits through Veterans Affairs (VA) or the
Indian Health Service, tribal, or urban Indian health programs, even if they can obtain medications through
these agencies. Eligibility determination will be made regardless of immigration status.
INDIVIDUALS WHO ARE UNDERINSURED
Uninsured is defined as the individual not being eligible for nor receiving services from any private or public
insurance (employer-sponsored, COBRA, Medicare, Medicaid) at the time of eligibility determination.
Underinsured is defined as the individual having an existing private insurance policy (private (not purchased
by ADPH), employer-sponsored, COBRA) that covers less than 50% of their prescription costs. To document
that an individual is underinsured, the case manager must provide ADPH with:
1. A copy of the individuals insurance card
2. A copy of the individuals insurance booklet containing their full prescription coverage and benefit
All documents must be uploaded to ServicePoint.
ADPH will review the prescription coverage to determine if the person is underinsured (their policy covers less
than 50% of their prescription costs). If the policy covers more than 50% of their prescription costs, the
individual is not considered underinsured and will not be eligible for ADAP. If the policy covers less than 50%
of their prescription costs, the person would be considered underinsured and eligible for ADAP if they meet all
other eligibility criteria.
3
Ineligible is defined as the individual being denied access to or ineligible for third-party insurance (i.e., employer-sponsored
insurance). An individual cannot “opt-out” of third-party insurance for which they are eligible and be determined eligible for ADAP.
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INDIVIDUALS WHO ARE INCARCERATED
4
At which time an ADAP enrollee is in a city or county jail that does not contract with a healthcare provider to
provide medication services, the individual will continue to be eligible to receive ADAP medication services.
To ensure the Ryan White HIV/AIDS Program remains payer of last resort for medication services, the
city or county jail must provide written documentation to the ADPH ADAP Central Office that the city or
county jail does not contract with a health care provider to pay for medication services for individuals
with HIV. Documentation must be submitted for each client.
ADAP medications will continue to be shipped by the Pharmacy Benefits Manager to the incarcerated
ADAP enrollee’s clinic for the clinic to provide to the enrollee while in the city or county jail.
This policy applies to persons who are in county or city “work release” programs as they are still under
the care and custody of a city or county jail.
Case managers for any applicant or current client who is incarcerated in a city/county jail must complete the
ADPH ADAP Form: Individuals who are Incarcerated in City/County Jails. Completion of this form will ensure
that applicants/clients are able to continue to receive services.
If the ADAP Enrollee is transferred to a state or federal prison, the clinic must notify the ADAP central office
immediately and follow the guidelines outlined below.
At which time an ADAP enrollee is incarcerated in a state or federal prison, the individual is no longer
eligible for ADAP medication services.
The clinic must notify the ADPH ADAP Central Office immediately when an ADAP enrollee is
incarcerated by noting the enrollment revision “due to incarceration” on the Assessment tab under
Disenrollment application in ServicePoint.
The incarcerated enrollee will be placed on “Terminated ADAP enrollment” status, and the Pharmacy
Benefits Manager will be notified to stop all further medication shipments.
The incarcerated client may reapply as a new applicant once released.
Persons who are on probation, parole, or house arrest, may apply for ADAP enrollment because they are
living in the community and are not in the care or custody of a jail or prison system, although they may be
reporting to a parole or probation officer.
ADULT CHILD ON PARENT INSURANCE
In the case of security and confidentially concerns, adult children enrolled in a parent’s insurance plan who do
not wish to disclose their HIV status can be enrolled in the ADAP-Rx program. Fear of involuntary disclosure of
HIV status (i.e., though an explanation of benefits letter issued to the parental insurance plan owner) is a valid
security and confidentiality concern creating a barrier to care. Any related HIV services can be funded through
Part B (e.g., office visits, labs, and other Ryan White core and support services). When requesting ADAP-Rx
services for these clients, other payment sources must be vigorously pursued and rigorously documented.
Vigorously pursued means that other forms of payment (i.e., insurance) must be sought out and the applicant
4
HRSA Policy Notice 18-02: https://ryanwhite.hrsa.gov/sites/default/files/ryanwhite/grants/pcn-18-02-people-who-are-incarcerated.pdf;
Opinion 2004-17 dated October 28, 2003 to Chambers County Attorney Claud E. McCoy, Jr. Section 14-6-22 Code. Costs and
Expenses – Prisons and Prisoners – Medial Expenses and Municipalities – County Jails.
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must be counseled on the benefits of sharing his or her HIV status with the parent, as self-disclosure would
remove the security and confidentiality concern. Rigorously documented means that the security and
confidentiality concern, as well as all other actions taken to ensure the RWHAP remains the payer of last
resort, must be documented to record why enrollment in ADAP-Rx must be pursued.
APPLICATION PROCESS
All individuals who wish to have their eligibility determined for ADAP must submit the required application.
RWHAP Part B and ADAP utilize a shared eligibility system for all new, returning, and recertifying applications:
ServicePoint. An application is defined as completion of all eligible questions electronically in ServicePoint; a
hard copy of the application is not available. Information provided on the application must be complete and
accurate.
Individuals who are uninsured are expected to apply for Medicaid before applying for ADAP. Individuals may
be enrolled in ADAP (assuming all other eligibility requirements are met) while awaiting a decision on pending
applications for Medicaid.
After initial application and enrollment, ADAP clients must complete recertification every year during their birth
month to verify continued eligibility for the program.
It is the expectation of ADPH that case managers work with clients to compile required documentation, detailed
as “Eligibility Criteria.” Case managers should screen all individuals for all third-party payors prior to ADAP
application.
If an individual is eligible for Medicaid, the individual should be enrolled in Medicaid and is not eligible
for ADAP; the individual should be referred to Alabama RWHAP Part B services.
If an individual is eligible for employer-sponsored or other third-party insurance, the individual
should be enrolled in employer-sponsored or other third-party insurance and is not eligible for
ADAP; the individual should be referred to Alabama RWHAP Part B services.
The case manager initiates an application for all other individuals considering support from ADAP, regardless
of perceived eligibility. ADPH will make the determination if an individual is eligible for ADAP and, if so, for
which program the individual is eligible. The case manager completes the ServicePoint application in
coordination with the individual seeking services.
ADPH ADAP eligibility staff will review all submitted applications for completeness prior to making an eligibility
determination. Applications are reviewed to ensure completeness within three (3) business days by ADPH
ADAP eligibility staff. Application is complete if full application and supporting documentation are uploaded
and legible (all information that would be necessary to determine eligibility is included on the uploaded
document and able to be clearly read). Only confirming that an upload file exists is not satisfactory review for
completion.
a. If application is complete, ADPH ADAP eligibility staff will make an eligibility determination.
b. I
f application is incomplete, ADPH ADAP eligibility staff will notify the case manager via
ServicePoint and require completion within five (5) business days or the application will be removed
from the queue. If they are removed from the queue, the case manager will be required to resubmit
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a new application for each individual seeking services.
Complete applications are reviewed for eligibility standards and verification by the ADPH ADAP eligibility staff
as follows.
CRITERIA
VERIFICATION
Diagnosis of HIV and is
under the care of a
physician licensed in the
United States of America
Note: only required for
new application
ADPH ADAP eligibility staff reviews document submitted to determine if the
documentation submitted is for the individual seeking services and denotes
that the individual is living with HIV.
If yes, individual could be eligible for the program if he/she meets other
eligibility criteria.
If
no
, individual is not eligible for the program.
Resides in Alabama
ADPH ADAP eligibility staff reviews document submitted to determine if the
documentation submitted is for the individual seeking services, that the
documentation submitted is valid as of the date of review, and denotes that
the individual is living in Alabama.
If yes, individual could be eligible for the program if he/she meets other
eligibility criteria.
If no, individual is not eligible for the program.
Individual income not
exceeding 400% FPL
ADPH ADAP eligibility staff reviews document submitted to determine if the
documentation submitted is for the individual seeking services and the
individual has an income at or below 400% FPL.
If yes, individual could be eligible for the program if he/she meets other
eligibility criteria.
If no, individual is not eligible for the program.
Ineligible for third-party
payors, including but not
limited to employer-
sponsored insurance,
COBRA, and Alabama
Medicaid.
ADPH ADAP eligibility staff reviews document submitted to determine if the
documentation submitted is for the individual seeking services and the
individuals is ineligible for third-party insurance.
If yes, individual could be eligible for the program if he/she meets other
eligibility criteria.
If no, individual is not eligible for the program.
Individuals can be determined eligible for and enrolled in ADAP-Rx while waiting to be enrolled in
private insurance and in the donut hole.
HPAL application requirements: to be enrolled in HPAL, an individual who is determined eligible for ADAP
must provide:
1. A copy of the Blue Cross Blue Shield Authorization for Disclosure form
2. A copy of the Blue Cross Blue Shield Eligibility Coordination of Benefits form
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3. If applying for DPAL, a copy of the Blue Cross Blue Shield Dental Binding Arbitration form
All documents must be uploaded to ServicePoint.
MEDCAP application requirements: to be enrolled in MEDCAP, an individual who is determined eligible for
ADAP must provide:
4. A copy of the front and back of their Medicare Part A and/or B card
5. A copy of their complete and submitted enrollment in the Blue Rx Enhanced Plus (Medicare Part D
drug plan) plan
6. A copy of the front and back of their Blue Rx Enhanced Plus insurance card (Medicare Part D)
7. A copy of the Blue Rx Enhanced Plus billing statement which contains the monthly premium amount
8. A copy of the approval/denial letter from Low Income Subsidy (Extra Help) application
All documents must be uploaded to ServicePoint.
Following eligibility verification, ADPH ADAP eligibility staff makes one of the following determinations based
on the submitted application:
c. Meets eligibility requirements (i.e., eligible): ADPH ADAP eligibility staff reviews application and
supporting documents and determines that the individual meets the eligibility requirements. ADPH
ADAP eligibility staff will complete approval in ServicePoint and proceed with enrolling the individual
in the appropriate program.
d. Requires follow-up on submitted documentation (i.e., additional information necessary): ADPH
ADAP eligibility staff reviews application and supporting documents and has a follow-up question
for the case manager on the information that was submitted (i.e., income is significantly
inconsistent, etc.). Application will be placed within the “Pending” queue in ServicePoint and ADPH
ADAP eligibility staff add notes concerning needed information. Case manager must respond to the
questions within five (5) business days or the application will be removed from the queue. If the
application is removed from the queue, case manager will be required to resubmit a new application
for each individual seeking services.
e. Does not meet eligibility requirements (i.e., denied/not eligible): ADPH ADAP eligibility staff
reviews application and supporting documents and determines that the individual does not meet the
eligibility requirements. Application will be placed in Denied status in ServicePoint.
Programs are prohibited from providing medications to a client through “presumptive eligibility” or
during a “grace period” before or after eligibility has been determined. To prevent delays in receiving
medications, ADAP expects these processes to take place within 14 calendar days of receiving a new,
complete application and that clients have time to recertify within their eligibility period. An application will not
receive final approval until all required components have been submitted and reviewed. If an application is
approved, the effective date of ADAP coverage will be the date the application was approved by ADPH ADAP
eligibility staff.
ENROLLMENT AND EFFECTIVE DATES
Individuals who submit an ADAP application and meet all the eligibility requirements are eligible to be enrolled
in ADAP starting on the date that all application requirements confirmed by ADPH ADAP eligibility staff. ADAP
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staff will determine the plan(s) that each applicant will receive, based on the application information. The plan
enrollment and effective date is determined as follows:
PLAN
GENERAL CRITERIA
EFFECTIVE DATE
ADAP-Rx
Undocumented individuals
Individuals who are eligible for HPAL,
Medicaid, or Medicare and have not yet been
transitioned
Individuals who are eligible for third-party
insurance and are in a waiting period prior to
enrollment
The ADAP-Rx effective date will be equal to
the date the application was processed at
ADPH.
HPAL
Documented US citizens with an income at
or above 138% FPL
No additional private or public insurance
coverage
No disability that would qualify the individual
for Medicare or Medicaid
Not over the age of 65
Not in a waiting period for third-party
insurance
The HPAL effective date will be equal to
January 1 (if enrolled during open
enrollment) or the date defined by a special
enrollment period (if eligible).
MEDCAP
Individuals that are currently enrolled in
Medicare Part D
Individuals over the age of 65
Individuals with qualifying disability
The MEDCAP effective date will be equal to
January 1 (if enrolled during open
enrollment) or the date defined by a special
enrollment period (if eligible).
Medicaid
Individual has an income at or below 76%
FPL
Documented US citizen
While awaiting Medicaid determination,
enrolled in ADAP-Rx. Once Medicaid
determination is made, if enrolled in Medicaid
(full, SOBRA, and QMB-only), they would be
terminated from program.
DPAL
Individuals who are on HPAL only
The DPAL effective date will be equal to
January 1 (if enrolled during open
enrollment) or the date defined by a special
enrollment period (if eligible).
Part B
Individuals who are on ADAP-Rx, HPAL, or
MEDCAP
Individuals who do not qualify for ADAP
The Part B effective date will be equal to the
date the application is processed in
ServicePoint.
Note: This is a federally funded program and serves Alabama residents out of resource allocations made
for this purpose. The funds are judiciously managed and deployed in a balanced manner. To best serve
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those enrolled, it is necessary to limit the number of enrolled clients to a budgeted maximum number
(enrollment cap). This number can vary based on many factors such as funds allocated, funds utilized, etc.
Therefore, the applications received after ADPH reaches its enrollment cap are placed on a waiting list.
PROGRAM TRANSITIONS
It is possible for a client to be enrolled in the ADAP while awaiting eligibility determination for HPAL, Medicaid,
or Blue Rx Enhanced Plus. It is also possible that a client is enrolled in HPAL or Blue Rx Enhanced Plus and
may need to be transitioned from one program to another. The process to transition clients between programs
is as follows:
TRANSITION
FROM
TRANSITION
TO
POLICY/PROCEDURE
ADAP-Rx
HPAL
While awaiting open enrollment or the beginning of a special enrollment
period, enrolled in ADAP. Beginning on January 1 or the start of their
special enrollment period, transitioned to HPAL.
ADAP-Rx
Medicaid
While awaiting Medicaid determination, enrolled in ADAP. Once Medicaid
determination is made, if enrolled in Medicaid (full, SOBRA, and QMB-only),
they would be terminated from program.
ADAP-Rx
MEDCAP
While awaiting open enrollment or the beginning of a special enrollment
period, enrolled in ADAP. Beginning on January 1 or the start of their
special enrollment period, transitioned to Blue Rx Enhanced Plus.
HPAL
ADAP-Rx
When client has access to alternate third-party private insurance,
prescription coverage is assessed by ADPH ADAP eligibility staff. If the
policy covers more than 50% of their prescription costs, the individual is not
considered underinsured and will be terminated from program. If the policy
covers less than 50% of their prescription costs, the person would be
considered underinsured and eligible for ADAP-Rx if they continue to meet
all other eligibility criteria.
HPAL
MEDCAP
Upon turning 65 years old or developing a qualified disability, transitioned to
Blue Rx Enhanced Plus at the start of their special enrollment period.
HPAL
Medicaid
Once Medicaid determination is made, if enrolled in Medicaid (full, SOBRA,
and QMB-only), they would be terminated from program.
MEDCAP
ADAP-Rx
When no longer having a qualified disability, transitioned to ADAP-Rx until
next open enrollment period.
MEDCAP
Medicaid
Once Medicaid determination is made, if enrolled in Medicaid (full, SOBRA,
and QMB-only), they would be terminated from program.
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RECERTIFICATION RECEIPT AND PROCESSING
Both RWHAP legislation and the Alabama ADAP require that program clients are continued to be determined
eligible on a schedule established by the state. Case managers are responsible for ensuring recertifications
are submitted to ensure no lapse in ADAP eligibility and loss of benefits. ADAP recertifications are based on
client birthday month. Below is the schedule for recertification, based on the client’s birthday month. Case
managers must complete client recertification by close of business on the client’s recertification
deadline.
BIRTH
MONTH
ANNUAL RECERTIFICATION DEADLINE
(BIRTHDAY)
January
January 31
February
February 28-29
March
March 31
April
April 30
May
May 31
June
June 30
July
July 31
August
August 31
September
September 30
October
October 31
November
November 30
December
December 31
To comply with federal guidelines, Alabama ADAP screens each enrollee for Medicaid eligibility and enrollment
on at least a monthly basis. Additionally, each enrollee must complete annual recertification to remain eligible
for any plan of the program. Case managers can generated a ServicePoint report for all upcoming
recertifications for which they are responsible.
OPEN ENROLLMENT AND SPECIAL ENROLLMENT
Open enrollment: Blue Cross Blue Shield open enrollment begins on November 1 and concludes on
December 15 each year. During open enrollment, new applications and recertifications are processed as
outlined above with the following additional requirements.
New applicant: a new applicant will be assessed for eligibility following the process outlined above. If
determined eligible, the individual will be enrolled in the most appropriate program. The individual will
be enrolled in ADAP-Rx pending their enrollment in HPAL on January 1.
Recertifying client not currently on HPAL: a recertifying client will be assessed for eligibility following
the process outlined above. If determined eligible, the individual will be enrolled in or maintained on the
most appropriate program. If eligible for HPAL, the individual will be enrolled in ADAP-Rx pending their
enrollment in HPAL on January 1.
Recertifying client currently on HPAL: a recertifying client will be assessed for eligibility following the
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process outlined above. If determined eligible, the individual will be enrolled in or maintained on the
most appropriate program. The individual will remain on HPAL.
Client who is not in recertification period: a client who is not currently in their recertification period
and is currently enrolled on HPAL will be automatically maintained in HPAL, unless otherwise specified
by his/her case manager.
Special enrollment: if a client or new applicant did not enroll in health insurance during open enrollment, but
appears to be eligible for private health insurance, the client should be considered for a special enrollment
period. Case managers should contact ADPH ADAP eligibility staff if they believe individuals would be eligible
for a special enrollment period.
FACTORS THAT DELAY OR PREVENT ELIGIBILITY DETERMINATION
Submission of an incomplete application will result in a delay, and possible denial, of services. Applicants
must then reapply for the program, which will further delay eligibility determination. The following applications
will be considered incomplete due to missing information:
No permission from the applicant to process the application and complete third-party
verification: application does not have client signature and date within 14 days.
Missing identifying information of who is applying for the program: application does not include
first and last name or date of birth of applicant.
Missing proof of diagnosis of HIV disease: the application is for a new participant and does not
include documentation of diagnosis of HIV disease.
Incomplete proof of income eligibility: accepted income documentation is missing or incomplete for
applicant.
Inadequate proof of residency: accepted residency documentation is missing or incomplete for
applicant.
Applications that require special review: the application appears fraudulent, with paystubs or other
documents that look counterfeit (will go to secondary review, and the applicant may be asked to provide
a higher level of proof of eligibility such as a second proof of residency, an IRS Tax Return Transcript,
IRS Proof of Non-Filing or a divorce decree); the application indicates the applicant may have literacy
or other unique challenges and may not have received appropriate support from assisting agency.
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DENIALS AND TERMINATION
A person may be denied enrollment, denied recertification, and/or have enrollment in the program terminated
for any of the following reasons:
1. The client is ineligible for ADAP due to not/no longer meeting eligibility criteria (i.e., HIV status, income,
residency, or insurance status).
2. The client did not recertify.
3. The client voluntarily withdrawals from the program.
4. The client is deceased.
5. Program funds are exhausted and a waiting list will be established.
6. Other.
ADPH ADAP eligibility staff must process a denial/termination in ServicePoint, noting the denial date (date
denial was determined) or termination date (last date of the month the termination was determined) and the
reason for denial/termination. Program termination is effective as of midnight on the last day of the month the
client was terminated.
POLICY EXCEPTIONS
ADAP may make exceptions to policy in the following circumstances:
Relocation: Clients planning to move out of Alabama will be approved for a 30-day supply of
medications to aid the transition between states. Clients are responsible for enrolling for drug
assistance from the new state and should be aware of any additional program eligibility requirements or
waiting lists in the new state that may result in gaps in access to medications. After clients reside in
another state, Alabama ADAP-Rx is not able to provide medications to clients beyond the 30-day
supply provided at the time of initial relocation.
Medications not on formulary: if an individual needs a medication not on the program’s formulary, the
individual may request access to the medication from the ADAP Manager. The ADAP Manager should
weigh the purpose, cost, and efficacy of the medication when making their decision, consulting with the
Division Nurse for clinical information, as necessary. If approved, the ADAP Manager would notify
Ramsell to process the claims associated with that individual’s medication.
Termination due to ADPH fault: in the event ADPH takes an action that errantly terminates a client
from the program, the individual may be reinstated to the program.
Providing services to evacuees or displaced persons: if an evacuee or displaced individual
presents for services, ADAP will make every effort to provide services. Per HRSA PCN 13-02, the
individual must self-attest, at which time ADAP will grant “temporary residency.” ADAP should obtain
consent from the individual to contact his/her physician as a way of validating HIV status and current
medication regimen. In the event the individual’s physician is not able to be contacted, ADAP may use
the individual’s medication bottles or copies of recent prescriptions to assist the new prescribing
physician in his/her next steps.
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CLIENT RIGHTS AND RESPONSIBILITIES
All individuals applying for and receiving benefits through ADAP are protected against discrimination based on
sex, race, ethnicity, gender, religion, language, age, ability, sexual orientation, and/or national origin.
Providers must comply with all federal laws regarding the protection of health information. An ADAP client has
a right to have personal information safeguarded. The provider is obligated to protect that right. Therefore, use
or disclosure of any information concerning applicants to, and clients of, ADAP for any purpose not connected
with the administration of ADAP is prohibited unless authorized by the client.
Clients are responsible for:
1. Informing their pharmacy that they are receiving benefits under ADAP as well as any current insurance
coverage. Clients cannot use ADAP to avoid using insurance coverage.
2. Giving ADAP and service providers full and accurate information necessary for accurate claims
submission to ADAP.
3. Giving full and accurate information to providers regarding coverage by health insurance carriers,
Medicaid, and any other prescription assistance programs.
4. Informing ADAP within 30 days of any changes in income, household size, address, eligibility, health
insurance coverage, Medicaid or Medicare coverage.
5. Contacting the ADAP and returning any insurance related payments whenever ADAP is providing
premium assistance.
CONFIDENTIALITY
The ADPH policy regarding confidentiality can be found at the following website:
http://adph.org/PROFESSIONAL_SERVICES/assets/component3noquestions.pdf
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SECTION FOUR: EMERGENCY PREPAREDNESS
EMERGENCY ASSISTANCE TO NEIGHBORING STATES
ADPH has established this emergency assistance plan to support continuity of Care for HIV clients that have
evacuated from a neighboring or adjacent state in need of HIV related services. RWHAP core and support
services, including ADAP, are available to meet the needs of our HIV population from neighboring states
during disasters.
ADPH provider locations throughout Alabama have the capacity to offer ADAP and other Part B Core and
Support services for those who are displaced. Provider locations and contact information is available at the
following location: https://www.alabamapublichealth.gov/hiv/provider-locations.html
Each service location can provide needed services such as ADAP/Part B services, housing, food bank, etc. If a
location is affected during a disaster, the provider location network referral system maps to connect with other
locations if needed. Persons needing emergency HIV services can connect with an ASO/CBO to access
RWHAPB services.
ADPH RWHAP has implemented a process to assess emergency ADAP/Part B services throughout the state
and has included a dropdown within the ServicePoint electronic application portal to expedite the application
flow process.
The ServicePoint electronic application portal is used to expedite emergency services and track displaced
eligible clients. Individuals will need to provide demographic information to the provider, including full legal
name, date of birth, Social Security Number, previous ADAP state and Client ID number (if known), permanent
address including state, temporary Alabama address, contact phone number, alternative phone number, and
prescribing physician information from permanent state (if known).
The process using the emergency ServicePoint electronic application flow is as follows: Ramsell and
ServicePoint share the same unique identifier generated in ServicePoint to assess both ServicePoint and
Ramsell. When the ServicePoint electronic emergency, application is saved it will automatically generate a
unique identifier using the “disaster relieve effort-permanent state-ServicePointID” (i.e., SERVICEPointID (ex:
HURIDA-LA-15435)).
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The ServicePoint electronic application’s unique identifier will be utilized to access medication through the
Ramsell PBM portal to access medication services.
The ServicePoint application allows disaster evacuees previously receiving their HIV medications, through
ADAP in their home state, continuity of access to HIV medications in Alabama for up to eight (8) weeks.
Client must meet the eligibility criteria for their permanent state ADAP/Part B (i.e., Louisiana).
Client is responsible to notify Alabama Health Care Provider
(https://www.alabamapublichealth.gov/hiv/provider-locations.html) or contact ADPH ADAP directly at 1-
800-344-1153.
In order to receive emergency HIV medication assistance, clients must authorize the release of medical
information to ADPH ADAP and authorize ADPH ADAP permission to share confidential information
with permanent state ADAP, primary medical professionals, and any referring agency personnel in
Alabama.
Emergency HIV medication assistance has a time limit of eight (8) weeks from the date of approval. At
the end of the eight (8) week temporary emergency period, a new ADAP patient application will need to
be completed using the eligibility requirements of Alabama’s ADAP for continued HIV medication
assistance if needed.
In some instances, state disaster plans include expanding their state’s existing ADAP pharmacy
network to include neighboring states for evacuees to access pharmacy benefits, especially if they are
already using a national chain to provide these benefits. Clients from these ADAPs would continue
receiving their medications from a network pharmacy under their permanent state ADAP.
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Please note, if a client chooses to become an Alabama resident beyond eight (8) weeks, the client will
complete an ADAP application for on-going services. Emergency and all program applications are available via
ServicePoint via a web browser. All emergency assistance prescriptions will be filled and dispensed using
ADAPH current ADAP formulary.
For providers:
Adhere to the emergency plan at each location.
Make sure the sub-recipients are in contact with clients in the service area.
If needed, access to Alabama provider location and contact list for networking.
Be ready to connect with displaced clients to provide services needed (i.e., ADAP, housing, food bank,
etc).
Accept eligibility verification from the impacted state to satisfy enrollment in Alabama.
If the clients do not have eligibility verification from outside of Alabama, a rapid eligibility determination
should be implemented.
Be available to offer and provide services to displaced individuals living with HIV presenting from
surrounding areas.
Keep documents of ADAP/Part B services provided.
Keep fiscal records to potentially re-coup service costs.
Alabama sub-recipients will network with other agencies when needed if an Alabama location is
impacted by disaster.
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SECTION FIVE: ADDITIONAL DOCUMENTATION
RYAN WHITE PART B AND ADAP PROVIDER LOCATIONS
Please refer to the following link for information on current Ryan White Part B and ADAP provider locations:
Ryan White Part B and ADAP Provider Locations | Alabama Department of Public Health (ADPH)
(alabamapublichealth.gov)
SERVICEPOINT USER MANUAL
Please refer to the manual developed and available from UWCA.
CAREWARE USER MANUAL
Please refer to the manual developed and available from HRSA/HAB.