Transcript Paying for Reproductive Health Services for PLWHA

Paying for Sexual and
Reproductive Health Services
for PLWHA
Jennifer Marshall Pepper
Program & Quality Manager, Ryan White Part A Program
Shelby County Government
Memphis, TN
Ryan White Parts A, B, C, D
 Part A funded services are available to residents of Crittenden
County, AR
 Part B funded services are available to all Arkansas state
residents
 Part C Grantees:
 East Arkansas Family Health Center, West Memphis, AR
 ARCare, Batesville, Conway, Jonesboro, and Kensett, AR
 Jefferson Comprehensive Care Systems, Inc., Pine Bluff, AR
 Part D Grantees:
 ARCare, Batesville, Conway, Jonesboro, and Kensett, AR
 Jefferson Comprehensive Care Systems, Inc., Pine Bluff, AR
Ryan White Parts A, B, C, D
 Outpatient/Ambulatory medical care = the provision of
professional diagnostic and therapeutic services rendered by a
physician, physician's assistant, clinical nurse specialist, or nurse
practitioner in an outpatient setting…. referral to and provision
of specialty care (includes all medical subspecialties).
 Health Insurance Premium & Cost Sharing Assistance = the
provision of financial assistance for eligible individuals living with
HIV to maintain a continuity of health insurance or to receive
medical benefits under a health insurance program. This includes
premium payments, risk pools, copayments, and deductibles.
Ryan White Parts A, B, C, D
 AIDS Drug Assistance Program (ADAP treatments) = Stateadministered program under Part B provides FDAapproved medications
 Resource:
http://www.healthy.arkansas.gov/programsServices/infecti
ousDisease/hivStdHepatitisC/Documents/ADAPDrugFormul
ary.pdf
 AIDS Pharmaceutical Assistance (local) = local pharmacy
assistance programs implemented by Part A or Part B to
provide HIV/AIDS medications to clients.
Title X Family Planning
 Title X Grantee is Arkansas Department of Health,
Women’s Health Services
 Contraception
 STI Testing and Treatment
 Preconception Counseling
 Anyone, male or female, needing family planning services
can be seen at any local health unit.
 All services are private and confidential.
 No one will be refused services because they do not have
money to pay.
Arkansas Medicaid: Women’s Health
Waiver
 Women who have a family income at or below 200 percent
of the federal poverty guidelines and who are of
childbearing age.
 The target population is women aged 14 to 44, but all women at
risk of unplanned pregnancy may apply.
 Enrollees are Medicaid-covered for family planning services
only.
 Women must be re-evaluated annually to continue receiving
benefits.
Arkansas Medicaid: Women’s Health
Waiver
 FREE pelvic exams, pap tests, and mammograms for all ages
 Includes coverage of Implanon® and IUD insertions and
removals and sterilization procedures
 Resource:
http://mmcs.afmc.org/Portals/3/Documents/WomensHealth
Waiver_ProvBrochure.pdf
Affordable Care Act
 There are Essential Health Benefits of every Qualified
Health Plan, including:
 Sexually Transmitted Infections counseling for sexually active
women and men, including Syphilis Screening
 HAV, HBV, and HPV vaccinations
 Breast Cancer Mammography screenings every 1 to 2 years for
women over 40
 Breastfeeding comprehensive support and counseling from
trained providers, and access to breastfeeding supplies, for
pregnant and nursing women
 Cervical Cancer screening for sexually active women
Affordable Care Act
 There are Essential Health Benefits of every Qualified
Health Plan, including:
 HIV screening and counseling for sexually active women and
men
 Domestic and interpersonal violence screening and
counseling for all women
 Human Papillomavirus (HPV) DNA Test every 3 years for
women with normal cytology results who are 30 or older
 Tobacco Use screening and interventions for all women, and
expanded counseling for pregnant tobacco users
 Well-woman visits to get recommended services for women
under 65
Affordable Care Act
 Plans in the Health Insurance Marketplace must cover
contraceptive methods and counseling for all women, as
prescribed by a health care provider.
 These plans must cover the services without charging a
copayment or coinsurance when they’re provided by an innetwork provider.
 Health plans sponsored by certain exempt “religious
employers,” like churches and other houses of worship, don’t
have to cover contraceptive methods and counseling.
Affordable Care Act
 All Food and Drug Administration-approved contraceptive
methods prescribed by a woman’s doctor are covered, including:
 Barrier methods (used during intercourse), like diaphragms and
sponges
 Hormonal methods, like birth control pills and vaginal rings
 Implanted devices, like intrauterine devices (IUDs)
 Emergency contraception, like Plan B® and ella®
 Sterilization procedures
 Patient education and counseling
 Plans aren’t required to cover:
 Drugs to induce abortions
 Services related to a man’s reproductive capacity, like vasectomies
Patient Assistance Programs
 Mirena® and Skyla®
 http://www.archpatientassistance.com/
 Paragard®
 http://www.paragard.com/What-it-costs.aspx
 PrEP
 http://www.gilead.com/responsibility/us-patientaccess/truvada%20for%20prep%20medication%20assistan
ce%20program