Utah Department of Administrative Services Office of Administrative Rules

Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since January 1, 2017, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


R388. Health, Disease Control and Prevention; HIV/AIDS, Tuberculosis Control/Refugee Health.

Rule R388-805. Ryan White Part B Program.

As in effect on January 1, 2017

Table of Contents

R388-805-1. Authority and Purpose.

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.

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.

(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.

The Department reimburses only providers who contract with the Department to provide services under the program.

R388-805-5. Reimbursement.

(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.

(1) To receive services under the Ryan White Part B Program, an individual must physically reside in Utah, must have a medical diagnosis of HIV infection as verified by the individual's physician, and may not own more than one home and one registered vehicle.

(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 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.

(4) Clients must re-certify semi-annually in order to continue program participation.

KEY

treatment and care, HIV/AIDS, ADAP, Ryan White Part B Program

Date of Enactment or Last Substantive Amendment

November 30, 2016

Notice of Continuation

September 30, 2016

Authorizing, Implemented, or Interpreted Law

26-1-5; 26-1-15; 26-1-18; 26-1-30(2)(a), (b), (c), (g)


Additional Information

Contact

For questions regarding the content or application of rules under Title R388, please contact the promulgating agency (Health, Disease Control and Prevention; HIV/AIDS, Tuberculosis Control/Refugee Health). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.