Ryan White Program

The following documents are for the updated Out of Network/Non-Certified (OON) Referral process; only for clients who are NOT receiving medical case management from the local Part A/MAI Program.

The first two documents listed below are fillable online. However, they need to be printed and signed (referral form only) by the client. Then, the client gives these forms to the agency where services are needed. See the OON Registration Contact Information list below. Supporting documentation, as shown on the checklist, must be attached to the referral.

The Part A/MAI Program is the payer of last resort. Attach to the referral proof that the service or procedure was not covered by any other source.

• Out of Network (OON) / Non-Certified Referral (Final 04/23/18)
• Out of Network (OON) / Non-Certified Referral Demographics (Revised 4/29/19)
• Client Eligibility Documentation Checklist Summary (Effective 06/01/23)
• Client Eligibility Documentation Checklist Detail (Effective 06/01/23)
• Out of Network (OON) Referral Registration Contact Information (Revised 05/01/19)
• 2023 Federal Poverty Guidelines Transmittal Letter
• 2023 Federal Poverty Guidelines 

Federal legislation for the Ryan White Program requires Recipients such as Miami-Dade County to establish a clinical quality management (CQM) program to ensure services are: (1) consistent with the most recent Public Health Service (PHS) guidelines for the treatment of HIV disease and related opportunistic infections; and (2) consistent with HRSA guidelines for improving access to, quality of, and client satisfaction with HIV health services.

• Miami-Dade County Ryan White Part A/MAI Program’s current CQM Plan

Service providers apply for program funding through a request for proposal (RFP).

For direct client services, the RFP is developed for an initial 1-year term with up to five 1-year options to renew. The current cycle ends on Feb. 28, 2026.

County staff provides administrative support to contracted service providers, including:

• Assisting agency personnel under contract with establishing budgets and overall program guidance
• Assisting with monitoring visits and meeting national monitoring standards and guidelines

Food bank assistance is provided on a temporary as needed basis to eligible HIV+ clients to help maintain their health by providing groceries, including personal hygiene products, when available.

Providers must offer nutritional counseling to all clients through qualified staff supervised by a licensed dietitian or nutritionist.

Letter of Medical Necessity

• Ryan White Service Provider Letter Regarding Changes to Food Bank
• Nutritional Assessment Letter (Revised 10/28/16)

Federal funds come from Part A of the Ryan White HIV/AIDS Treatment Extension Act of 2009 from the U.S. Department of Health and Human Services, Health Resources and Services Administration.

Funding is also received under the Ryan White Minority AIDS Initiative Program. Which aims to reduce disparities and improve health outcomes for racial/ethnic minorities with HIV or AIDS.

Funds are awarded on an annual basis. The grant/budget period runs from March 1 through Feb. 28.

Funding allocations by Fiscal Year include:

• FY 2018 Part A and MAI Final Allocations and Expenditures
• FY 2017 Part A and MAI Final Allocations and Expenditures

These standards, posted in Section III of the Service Delivery Guidelines portion of this page, are an essential component of the Ryan White Quality Management Program and form the basis for on-going monitoring and evaluation of Ryan White Program-funded medical case management agencies.
 
Areas of evaluation include:

• Staff qualifications
• Training
• Access to care
• Eligibility and financial assessment
• Initial client health assessment
• Plan of care development and monitoring
• Adherence to treatment regimen
• Referrals and follow-up
• Updates to client records
• Standards for documentation
• Quality assurance and performance improvement
• Compliance with requirements related to the Ryan White Program Service Delivery Information System (SDIS)
• Permanency planning / Advance Directives
• Case closure and case transfers
• Program specific operating requirements

Performance Improvement Plan
This plan provides a systematic approach to quality assessment and performance improvement, concentrating on four key areas:

• Improved access to and retention in care for HIV positive individuals
• Quality of services and related outcomes
• Linkage of social support services to medical services
• Elimination of disparities in care

Read the complete Performance Improvement Plan:

• Flowchart
• Executive Summary
• Performance Improvement Plan Summary
• Performance Improvement Plan

Comprehensive Site Visit
On-site visits to contracted service providers are conducted for monitoring. A comprehensive monitoring instrument is used to assess compliance with fiscal, programmatic and administrative requirements.

• Comprehensive Monitoring Instrument
• Site Visit Required Documentation Checklist

Record Review Tools
Monitoring activities conducted by the Ryan White Program include on-site record reviews to assess service providers’ compliance with standards of care and specific requirements established for each service area, including outpatient medical care, medical case management, oral health care, outreach services, substance abuse treatment, etc.

Record review tools used for this purpose include:

• CM Record Review Instrument
• Oral Health Care Record Review
• Psychosocial Support Services Record Review Tool
• Substance Abuse Record Review & Guideline

Dental services provided to eligible persons include:

• Routine dental exams, prophylaxis and dental cleanings
• X-rays
• Fillings
• Replacements
• Treatment of gum disease
• Oral surgery
• Dental Implants (limited services; restrictions apply; medical necessity only)

Only dental procedures included in the most current Oral Health Care Formulary can be performed under this service category.

• Oral Health Care Formulary - summary letter (07/05/23)
• Summary of  Available Dental Care Procedures (03/01/23)
• Letter of Medical Necessity - Dental Implant Codes (03/01/23)
• Letter of Medical Necessity - Dental Implant Codes - fillable (03/01/23)
• Tobacco Cessation Counseling Protocol
• Oral Health Care Formulary Review Request Form (Revised 07/20/20)

Health and support services are measured throughout the year to determine their effect on the health status and well-being of the person living with HIV disease.
 
Current Ryan White Program outcome measures:

• Part A and MAI Client-level Outcomes for FY 2018

Medications are available to improve the health of persons living with HIV by gaining access to life-sustaining medications.

This service is available to persons ineligible to receive medications under any other source, including but not limited to Medicare, Medicaid, the State AIDS Drug Assistance Program (ADAP), private insurance, etc.

Only medications included in the most current Ryan White Program Prescription Drug Formulary can be accessed through the Ryan White Program.

Prescription Drug Formulary

• Prescription Drug Formulary Transmittal Letter (Revised 08/30/21)
• Attachment A – Notations/Comments (Revised 08/30/2021)
• Attachment B – Consumable Medical Supplies List (Revised 04/05/21)
• Prescription Drug Formulary - Sorted by Brand Name (Revised 08/30/21)
• Prescription Drug Formulary - Sorted by Generic Name (Revised 08/30/21)
• Prescription Drug Formulary - Sorted by Pharmacy Classification (Revised 08/30/21)
• Prescription Drug Formulary - Sorted by RW Miami Pharma-Code (Revised 08/30/21)
• Prescription Drug Formulary - Sorted by Therapeutic Classification (Revised 08/30/21)
• Department of Health Memo (Complera)
• Department of Health Memo (Descovy)
• Department of Health Memo (Edurant)
• Department of Health Memo (Etravirine)
• Department of Health Memo (Evotaz)
• Department of Health Email (Juluca)
• Department of Health Memo (Odefsey)
• Department of Health Memo (Prezcobix)
• Department of Health Memo (Tybost)
• Department of Health Memo (Stribild)
• Department of Health Email (Symtuza and Dovato)
• Department of Health Memo (Tivicay)
• Department of Health E-mail (Triumeq)
• Letter to OMC Providers
• Stribild Info Key Points
• Gilead Sciences-Stribild Indications Warnings

Letters of Medical Necessity (LOMN)

• Letter of Medical Necessity Changes for RWP (Part A) Transmittal (7/20/21)
• Neupogen (revised 4/12/21)
• Procrit or Epogen (revised 4/12/21)
• Roxycodone (Oxycodone) (revised 4/12/21)
• Standards for Use of Controlled Substances - for use with Oxycodone LOMN (2/21/19)
• Highly Sensitive Tropism Assay required to prescribe Maraviroc (Selzentry)  (revised 4/12/21)

Request to add or delete medication

• Prescription Drug Formulary Request

This section includes the most current descriptions, rules, and guidance related to the delivery of services to clients in the local Ryan White Part A/Minority AIDS Initiative (MAI) Program.

• Cover, with HIV Care Continuum (Revised 6/29/22)
• Section I - Service Definitions, with Table of Contents (Revised 3/01/22)
• Section II - Cost and Eligibility Summary (10.8 MB) (Revised 3/08/21)
• Section III - Standards (29.5 MB)
  • Cover + System-wide Standards of Care (Revised 4/30/18)
  • Medical Case Management (MCM) Standards (Revised 4/30/18)
  • National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care (Revised 4/30/18) (1.5 MB)
  • HAB HIV Performance Measures (Revised 3/01/18)
  • Primary Medical Care Standards Letter (Revised 10/30/20)
  • Primary Medical Care Standards (Revised 5/15/23)
  • Dear Medical Colleague letter - Viral Load, standing orders
  • Dear Medical Colleague letter - Mental Health Services
  • Gender Affirming Care letter (Revised 4/18/22)
  • Oral Health Care Standards (Final 5/15/23)
  • Treatment Guidelines & Additional Service Delivery Standards
• Section IV - Licensing and Accreditation Requirements
• Section V - Letters of Nutritional Assessment and Medical Necessity (9.6 MB)
  • Letter of Medical Necessity Changes for the Miami-Dade County Ryan White Part A/MAI Program (6/23/23)
  • Letter of Medical Necessity Changes for the Miami-Dade County Ryan White Part A/MAI Program (7/20/21)
  • Oral Health Care Formulary - summary letter (07/05/23)

• Section VI - Client Eligibility (9.3 MB) (Revised 11/25/19)
  • Client Eligibility Documentation Checklist Summary (New 2023)
  • Client Eligibility Documentation Checklist  Detail (New 2023)
  • Letter - RWP Eligibility Reciprocity & Extended Period (New 2023)
  • Memo-Patient Care Eligibility Reciprocity & Extended Eligibility Period (10/17/22)
  • Notice of Eligibility Form- fillable (New 2023)
  • Federal Poverty Guidelines Transmittal Letter (New 2023)
  • Federal Poverty Guidelines (New 2023)
• Section VII - PESN Essential Functions
• Section VIII - Allowable Medical Conditions List  (Revised 9/27/23)
  • Transmittal Letter
  • Transmittal Letter (Revised 3/22/19)
  • Transmittal Letter - OAHS (10/24/23)
  • Transmittal Letter - OAHS (11/10/22)
• Section IX - Local Implementation of the Affordable Care Act Requirements (7.9 MB)
• Section X - Viral Load
• Section XI - Newly Identified Clients (NIC) Protocol
• Section XII - General Revenue (GR) Short-Term Medication Assistance
• Section XIII - Outreach - Linkage to Care Resource Guide
• Section XIV Test and Treat/Rapid Access (TTRA)
  • Test & Treat (T&T) Formulary (Revised 5/21/21)
  • Test & Treat Coverage & Expectations Update (Revised 11/9/22)
  • Test & Treat/Rapid Access Overview for Medical Practitioners (Revised 11/13/23)
• Section XV - Acknowledgement for Medical Transportation
• Service Delivery Guidelines Summary of Updates for FY 2019 (Revised 7/31/19)

Miami-Dade agencies offer health and support services. Referrals are accepted from other providers in the community.

• Service Providers (revised 7/22/19)

Ryan White Program standards of care, posted in Section III of the Service Delivery Guidelines portion of this page, form the basis for:

• On-going monitoring and evaluation of Ryan White and MAI-funded service providers, particularly in the areas of access to care
• Staff qualifications and training
• Quality and completeness of client records and other required documentation
• Quality assurance and performance improvement
• Program operation requirements
• Adherence to confidentiality

• Telehealth (7/13/20)
• Teledentistry (7/13/20)

The Miami-Dade HIV/AIDS Partnership – Miami-Dade County's planning board for HIV/AIDS – obtains input on community needs, sets priorities and allocates funds for Ryan White Part A; plans for services and housing and makes recommendations for Ryan White Part B General Revenue; and Housing Opportunities for people with AIDS. In addition, it may advise the Miami-Dade County mayor and Board of County Commissioners.

Under the Affordable Care Act (ACA), options for health care coverage for people with HIV/AIDS expanded through new private health insurance coverage available through the ACA Health Insurance Marketplace.

Miami-Dade County works with state health officials and local service providers to coordinate efforts to transition eligible Ryan White Part A and AIDS Drug Assistance Program (ADAP) clients into an ACA Marketplace health insurance plan.

These documents provide information for clients eligible to participate in the ACA Marketplace. With guidance from their Ryan White Part A Medical Case Manager, clients who are eligible for the ACA will be responsible for completing the following forms, as applicable see Section IX in Service Delivery Guidelines section above.

Additional ACA Resources (Federal)

• Ryan White Program and the Changing Healthcare Landscape: U.S. Department of Health and Human Services
• Health Insurance Marketplace: Centers for Medicare & Medicare Services
• Healthcare.gov

Note: If you are a Ryan White Part A client and need help with out of pocket costs for health insurance, please contact your Medical Case Manager.