Patient Care Eligibility

(a) Ryan White Part B Consortia Program.

(b) Ryan White Part B AIDS Drug Assistance Program.

(c) Ryan White Part B AIDS Insurance Continuation Program.

(d) State Housing Opportunities for Persons with AIDS Program, and

(e) HIV/AIDS Patient Care Programs provided by the patient care networks and county health departments as administered by the Department of Health, HIV/AIDS and Hepatitis Program.

The Federal Poverty Guidelines provide a measure of poverty. They are updated annually in the Federal Register by the Department of Health and Human Services. The guidelines are a simplification of the poverty thresholds when determining financial eligibility for certain federal programs. The Federal Poverty Level (FPL) is used by the HIV/AIDS and Hepatitis Program to determine the maximum amount of income allowed for eligibility.

For general questions about the FPL, visit http://aspe.hhs.gov/poverty.

(A) The Eligibility Requirements(.doc,24KB)
List of the eligibility requirements for all of the HIV/AIDS Patient Care Programs as required by Chapter 64D-4 Florida Administrative Code (F.A.C.).
    For programmatic qualifications for enrollments, please select one of the following links.

Ryan White Part B AIDS Drug Assistance Program
Ryan White AIDS Insurance Continuation Program
State Housing Opportunities for Persons with AIDS Program

(B) Eligibility Brochure (pdf, 1.0 MB)
Official eligibility information brochure. This brochure was prepared especially for applicants and explains the eligibility requirements and procedures in question and answer format. This brochure which also includes the application can be found at any county health department.

(C) Eligibility Application(pdf,585 KB)
Official application completed by an applicant or with help from eligibility staff. The application is a part of the brochure and can be found at any county health department.

(D) Eligibility Rule Text (pdf,29.7KB)

Entire rule text of Chapter 64D-4 Eligibility Requirements for HIV/AIDS Patient Care Programs.

(E) Eligibility Determining Procedure's Manual(pdf, 2.3MB)
Determining Eligibility Staffs Procedure Manual. This document contains the procedures and requirements for determining eligibility in conjunction with Chapter 64D-4 F.A.C.

(F) Technical Assistance/Eligibility Questions/Answers (pdf,117KB)

Eligibility questions raised during the implementation of the eligibility rule and the responses. These responses should be used by eligibility staff and included with the Determining Eligibility Staff Procedures Manual

(G) Implementation Memo (pdf,893KB)

Implementation of the Eligibility Rule interoffice memorandum disseminated statewide after the adoption of Chapter 64D-4 F.A.C.

(H) Attachment Rule 64D-4 memo (pdf,893KB)

Attachments

Attachment to Eligibility Manual A through F
All files are .PDF format and under 5mb in size all files open in a new window

Attachment	Name	Requirement
List of Attachments	Attachment Summary	N/A
Attachment A	Ryan White Program Service Definitions	N/A
Attachment B	DH 1120 Computer Use and Confidentiality Agreement	A version is required Check with local area
Attachment C	DH 3204 Initiation of Services	A version is required Check with local area
Attachment D	Notice of Privacy Practices	A version is required Check with local area
Attachment E	DH 3203 Authorization to Disclose Confidential Information	A version is required Check with local area
Attachment F	DH 2116 Consent to Fax	Not Required Check with local area
Attachment G	Brochure and Application	Required
Attachment H	Eligibility Staff Assessment Worksheet	Required
Attachment I	Six Month Re-certification Review Form	Required
Attachment J	Notice of Eligibility	Required
Attachment K	Notice of Ineligibility	Required
Attachment L	Notice of Rights	Required
Attachment M	Insurance Waiver Form	Required
Attachment N	Federal Poverty Guidelines	N/A
Attachment O	Self Employment Tracking Sheet	Required
Attachment P	Request for Exception s	Required

This page was last modified on: 02/18/2013 02:52:07

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