Shelley Taylor-Donahue, MPH HIV Health Services Planner

1. VIRGINIA DEPARTMENT OF HEALTH RFP# 6010508CLHVIRGINIA AIDS DRUG ASSISTANCE PROGRAM (ADAP)CENTRALIZED ELIGIBILITY & ENROLLMENT (CEEP)PRELIMINARY FOCUS GROUP FINDINGS May 21, 2008 Pre-Bid Conference Shelley Taylor-Donahue, MPH HIV Health Services Planner

2. AIDS Drug Assistance Program (ADAP)Centralized Eligibility and Enrollment (CEEP)Focus Groups • Preliminary findings are reported in this presentation, with a more detailed final report to be released/disseminated in June or July • Groups were held in all 5 health regions of the state over a 7 week period: • 11 provider groups/90 providers • 3 consumer groups/20 consumers

3. Goal of Focus Groups • The goal of the focus groups was to utilize feedback to determine: • Best methods for communicating in an appropriate manner with consumers and providers (including culturally, linguistically, and with regard to differences in physical and cognitive abilities) • Best methods for communicating with diverse consumers and providers throughout a geographically diverse state • Best methods for establishing helpful relationships with service providers • Best methods for providing a consistent eligibility determination experience for all consumers • Best methods of ensuring that there is no disruption to client services during the transition to a centralized process

4. How CEEP will impact/improve ADAP services(Some of these issues are addressed in Section II of the RFP) • Participants felt that a new eligibility process/agency will confuse consumers who are already confused about all of the different eligibilities they are being required to do (e.g. Medicaid, Ryan White (RW), Health Department) • Participants also felt that having to go through another agency, separate from the Health Department (HD), will be another hoop for consumers to jump through • The greatest concern was that this (CEEP) will delay patients getting their medications as they are currently able to access medications within 1-3 days • Some participants felt that semi-annual eligibility may bring people back into care or keep them in care if they are required to do eligibility every 6 months • However, some participants thought that we may lose clients who feel overwhelmed by the semi-annual eligibility requirement • Most participants felt that having a consistent eligibility experience will be helpful

5. Barriers for consumers to access CEEP • The primary issues identified by participants included clients’ lack of understanding that this is not the same as their RW eligibility, concern that consumers can’t afford postage, lack of transportation, lack of phone access, homelessness/move around a lot, substance abuse, mental health issues, inability to read/write, stigma, trust issues with an unknown entity • Participants also voiced concerns about those clients who do not have a Case Manager (CM)/AIDS Service Organization (ASO) to help them through the new process, falling out of care

6. Barriers for providers/health departments to access CEEP(Some of these issues are addressed inSections II and III of the RFP) • The primary barrier identified by participants was confusion about who is responsible for what (e.g. labs, prescriptions) • Some participants stated that local HDs have developed relationships with their clients and are hesitant to let them go • Some participants voiced the concern that providers (especially medical providers) will not want to deal with an additional agency to get patients their medications • Once again, participants were concerned that there will be disruption in medications if eligibility is not 100% complete

7. How cultural, linguistic, cognitive and physical differences issues could be addressed by CEEP(Some of these issues are addressed inSections II and IV of the RFP) • Participants noted that HDs are currently using the language line &/or staff to interpret for foreign languages and TTY for deaf clients. It was suggested that CEEP have access to multiple foreign languages and have capability to work with deaf and blind consumers • Participants also suggested that CEEP staff go out to consumers’ homes for those who are unable to read, write, &/or travel • Participants suggested that all eligibility documents be translated/available in Spanish, and that CEEP could possibly use peer educators/advocates to assist clients with completing eligibility documents

8. Assistance/tools that could facilitate/maximize client access to ADAP medication(Some of these issues are addressed inSections II and III of the RFP) • Participants suggested that it would be helpful to have a standardized package of forms/info that could be given to ASOs, CMs, local HD, so that they can give to consumers or help consumers fill out • Participants also felt that it would be very helpful if RW and ADAP eligibility dates coincided so that HD, CM, or others could collect the information and pass it on to CEEP • Participants suggested that CEEP develop brochure(s) and other marketing information that could be sent/given to clients explaining the program and how to enroll • Participants recommended that first contact with consumers should be face-to-face (especially for newly diagnosed persons)

9. Best way for CEEP to communicate with consumers and providers(Some of these issues are addressed inSections II, III, and IV of the RFP) • Participants identified a number of possible means of communication between CEEP, local HD, Central Pharmacy, medical providers and consumers - phone, fax, mail (concern that this will slow things down, though), email, secured website to check for eligibility and to exchange updated information (e.g. new address, new phone number) for enrollees • Participants felt that different clients/providers will have different needs with regard to modes of contact. Many clients may need face-to-face contact (could have set days/times to be in each area of the state on a monthly schedule; for example: will be at LHD from 1pm-4pm on the first Thursday of the month), while others can communicate via mail, phone and fax • Participants suggested that CEEP provide reminder memos to the Central Pharmacy so that they can put them in consumer’s medication bags starting 2 months prior to implementation date to let them know when CEEP is going into effect • Participants felt very strongly that both consumers and providers want to be able to speak with a person and not a voice mail system. It would be preferable for consumers and providers to have a specific CEEP contact person so that they can build rapport with that person and have consistency

10. Best way for CEEP to communicate with consumers and providers(Some of these issues are addressed inSections II, III, and IV of the RFP) • Participants felt that CEEP could coordinate with CM appointments, medication pickup &/or Dr’s appointments to meet clients to get eligibility documentation and to educate consumers/providers about the new system and how the process will work • Participants suggested that the VDH HIV/STD/Viral Hepatitis Hotline have information about CEEP and be able to direct consumers to the right place • Participants thought that it would be helpful to include a Self Addressed Stamped Envelope (SASE) when sending forms out for consumers to complete and return to CEEP

11. How semi-annual ADAP recertification could be handled(Some of these issues are addressed inSections II and III of the RFP) • Participants felt it would be helpful for CEEP to notify the consumer’s medical provider (&/or CM/ASO) when that consumer needed new prescriptions, labs and eligibility • Participants also thought that it would be helpful if CEEP could notify the local HD when a consumer’s eligibility is coming up so that they can remind consumer when they come to pick up medications • Again, participants suggested that CEEP provide Central Pharmacy with eligibility reminders that could be put in consumer’s medication bags starting 2 months before eligibility is due • Participants felt that streamlining the paperwork required for recertification would help consumer’s through the process (e.g. things such as date of birth, social security number, race/ethnicity stay the same, but address, phone number, income could change within 6 months)

12. Best way to preserve client confidentiality while sharing information with local ADAP Coordinators(These issues are addressed in Sections III, IX and Attachment 8 of the RFP) • Participants suggested having one universal release of information so that information can be shared between all parties (medical provider, RW provider(s), local ADAP Coordinators, VDH, CEEP) • Participants suggested using unique identifiers when transmitting information about consumers • Participants suggested using letterhead/envelopes that do not identify HIV-relatedness

13. Qualities the CEEP contractor might possess(Some of these issues are addressed inSections II and IV of the RFP) • Participants felt that the following attributes/skills would be helpful for the CEEP staff to possess: • Knowledge about HIV/AIDS (e.g. HIV 101) • CM, social services or outreach background • Knowledge/understanding of confidentiality and HIPAA regulations • Should be culturally and linguistically competent • Should be compassionate • Should know about medications on the ADAP formulary • Should know other resources available if client identifies other needs or is not eligible for ADAP • Should have excellent customer service skills • Should be flexible and accessible (after 5pm and weekend hours) • Should have ability to communicate with people of different education/cognitive levels

14. Best way for CEEP to share/transfer client data(Some of these issues are addressed inSections II, III and Attachment 8 of the RFP) • Overwhelmingly, participants indicated that their preference was to have a secured website where local HD could check eligibility and where providers could alert CEEP if there is an address/phone or other change to consumer’s information • If the above is not possible, participants suggested that they would like to have a regular (e.g. weekly?) list of eligible clients transmitted via fax or email (only if secured) to local HD so that they can keep on top of eligibility when ordering medications • Participants suggested having a toll-free “hotline” number for providers/HD to call to check eligibility