Before I explain why Policy Change Notification (PCN) 21-02 compliments Ryan White Integrated Eligibility System (RWISE) I want to provide an overview of the guidance.

In October 2021, the Health Resource and Services Administration (HRSA) HIV/AIDS Bureau (HAB) released Policy Change Notification (PCN) 21-02 which provided guidance for Ryan White HIV/AIDS Program (RWHAP) recipients and subrecipients for determining client eligibility and complying with the payor of last resort requirements.

The PCN said that Ryan White recipients and subrecipients must establish, implement, and monitor policies and procedures to determine client eligibility based on the three eligibility requirements. Those three requirements are HIV diagnosis, income under the State’s poverty level, and be a resident of the State. In addition, the notice said that recipients and subrecipients should conduct periodic checks to identify any potential changes that may impact eligibility. Whenever possible, recipients and subrecipients should use electronic data sources (e.g., Medicaid enrollment, state tax filling or eligibility enrollment information collected by the health care marketplaces) to collect and verify client eligibility. RWHAP recipients and subrecipients can accept a client’s self-attestation from their clients of “no change” when confirming eligibility. Also, HRSA HAB does not recommend that recipients and subrecipients rely solely on client self-attestation indefinitely.

RWISE can do all the above. RWISE is a web-based interface developed by TriYoung, Inc. that uses the CAREWare database to provide an interface for eligibility teams to receive, review and process eligibility for the Ryan White Program. RWISE allows for the scanning and uploading of annual renewal eligibility documents, and they are stored in the referral within CAREWare. Service providers can simply select the link, retrieve supporting documentation for their clients, and view their eligibility status. RWISE collects all the client insurance information with logic to ensure Ryan White is the payor of last resort. The system is customizable to meet programmatic needs and requirements. RWISE has queues that display current renewal applications in process and upcoming renewals for clients. RWISE also calculates the client’s next renewal date to their birthday month. This allows clients to never forget their annual renewal date because it their birthday month.

We use data integration to collect eligibility information from other electronic data sources to assist in determining eligibility. RWISE also facilitates AIDS Drug Assistance Program (ADAP) Enrollment too. RWISE simplifies the Ryan White eligibility process for the grantee, subrecipients and clients which is why it compliments PCN 21-02.

Please reach out to Lisa Fuentes, our Business Development and Data Analyst Specialist, at lisa@triyoung.com to learn more or schedule a demo.  

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