Sexually Transmitted Diseases
Ryan White Program
The State of Tennessee provides drug and medical services for eligible Tennessee residents. To be eligible for coverage by the Ryan White Part B Medical Services Program, the Insurance Assistance Program, and the HIV Drug Assistance Program, a recipient must meet the following criteria and then see a Medical Case Manager:
- The recipient must be a resident as evidenced by one of the following:
- Valid driver’s license or State Identification Card;
- Mortgage or rental lease in recipient's name;
- Tennessee utility bills in recipient's name;
- Letter of identification and verification of residency from a verifiable homeless shelter or community center serving homeless individuals;
- Mail postmarked within the last 30 days and delivered to recipient's address.
- The recipient must meet the income guidelines established by the programs:
- Maximum gross monthly income less than or equal to 300% of current federal poverty level;
- Household resources value less than or equal to $8,000. (Resources include cash on hand, money in checking and/or savings accounts, or resources that can be quickly converted into cash, such as stocks, bonds, or certificates of deposit, etc.).
- The recipient must have a medical diagnosis of HIV as demonstrated by:
- A positive screening test for HIV antibody. The HIV sero-status must be confirmed by a more specific confirmatory test (either the Western blot assay or Indirect immunoflourescence assay [IFA] before being considered definitive for confirming HIV infection);
- Detectable HIV RNA by PCR (Viral Load) test results.
The Ryan White Part B Medical Services Program serves eligible Tennessee residents with HIV/AIDS. This program covers Part B clients that do not have any form of health insurance. A Medical Case Manager will assess each client’s eligibility for this program when they apply for Part B coverage. The program primarily covers procedures directly or indirectly associated with HIV/AIDS and related illnesses. A fee schedule of covered procedures and the amounts paid is updated each year and sent to all authorized providers. For a health care provider to be authorized by program, they must complete and submit a state “Authorization to Vendor Form” each year, and agree to accept the Fee Schedule amount as payment in full.
The program does not cover emergency room charges or inpatient costs. The payment of any uncovered services is the responsibility of the patient.
The Ryan White Part B Insurance Assistance Program (IAP) began in 2000. This program assists Ryan White-eligible HIV/AIDS clients in Tennessee with health insurance premiums, co-pays and deductibles, and should not be considered an entitlement. Benefits of the Ryan White Part B Insurance Assistance Program are subject to periodic adjustment based on available funds and program expenditures.
- Medical Case Managers assist clients with applying for the program, which is administered by a fiscal agent contracted by the state.
- Funds from the program may be used to pay for the "out of pocket" health insurance premium (for a policy already in effect) as well as deductibles and/or co-pays.
- Eligibility for IAP is the same criteria used by Medical Case Managers to qualify a patient for the Medical Services Program and HIV Drug Assistance Program (HDAP).
- If you think you might be eligible, please contact the Medical Case Manager for your area. If you are unsure whom you should call, you may contact the State Of Tennessee IAP coordinator for assistance at (615) 532-2392.
Tennessee HIV Drug Assistance Program (HDAP)
The Drug Assistance Program is funded through Ryan White Part B. The program is designed to assist with the purchase of specific drugs for eligible, low-income individuals with HIV who have no other source of health coverage.
HDAP Information for the Physician/Medical Case Manager
- Medical Case Managers must ensure that the application is completed, signed, and dated. The application is then transferred to the State HDAP via File Transfer Protocol (FTP).
- A client recertification is required every 6 months. An updated application must be submitted within 30 days of recertification or the client will be terminated from the program.
- All applicants must have an attending physician who agrees to prescribe the drug(s) approved under this program and medically monitor the applicant in accordance with federal guidelines for use of the drug(s) in the treatment of HIV disease.
- Clients must inform their Medical Case Manager if they are transferring to another physician's care and follow-up, or if they are approved for TennCare or any other source of health insurance with prescription coverage (at that time HDAP benefits will cease, but they may qualify for the Insurance Assistance Program).
- Per the T.C.A. 68-10-101 and "Notifiable Disease Reporting Regulations of the Tennessee Department Of Health, health care providers diagnosing, treating, or prescribing for a person with HIV and/or AIDS must report this to the designated regional health department surveillance personnel. For information about how to report a case, call (615) 741-7500.
HIV Drug Assistance Program (HDAP) Formulary
HIV Centers of Excellence (COE)