THMP Recertification

1. THMP Recertification Becky Ruiz, BSW Katherine Wells, MPH

2. THMP Recertification • Purpose: To ensure that the information within our files is current and accurate, and that all program clients continue to meet the established eligibility criteria as required by our funding sources • Recertification was requested by community advocates as a way to control ADAP costs. The proposal was presented to the Texas Board of Health, they agreed and recertification was added to the program rules • In 2005, HRSA made recertification a condition of our federal ADAP grant award

3. Recertification Process • Clients are required to recertify every 2 to 3 years • 3 years for ADAP • 2 years for SPAP • The recertification date is based on the client’s last THMP approval date • The THMP will notify clients by mail when it is time to recertify • During this process clients are eligible to order medications as long as they meet the recertification deadlines

4. Recertification Process • Approximately 250 clients are notified each month • Recertification Packets are mailed on the first of the month and include an • Introductory letter • Application & Instructions • Spanish Insert • Applications are due back to the THMP within 45 days • If the application is not received by the due date the client’s medications will be put on HOLD

5. Recertification Process • The recertification application is very similar to the original THMP application. • The application must be completely filled out and include proof of income, insurance and household information. • A medical certification form is not required. • If the application is incomplete or if additional information is needed the client will be notified by phone or mail • If the “pending” information is not returned within the specified time period the client’s medications will be placed on HOLD

6. What to do when a client is on HOLD • When a client is on hold, the THMP will not ship medications for the client • If on hold, the client needs to call the THMP recertification staff at 1-800-255-1090 • We can usually grant a 14 to 30 day extension depending on the situation – this will allow the pharmacy to order a one month supply of medications • If a client knows they need an extension they should call the THMP before the due date

7. Recertification Determinations • Approvals – Client is sent an approval letter • Denials – • Most common reasons: income and/or insurance w/Rx coverage • Client is contacted about denial and told the reason for the denial and given the date they will be dropped from the program • Client is encouraged to contact their doctors office and/or local service agency about accessing other types of medication assistance programs • A formal letter is mailed to the client

8. Common Problems • Returned Mail • Application not returned to THMP • Questions left blank, application not signed • Income documentation not submitted • Missing Insurance documentation • Changes in marital status not reported

9. SPAP Recertification • SPAP recertification is only done once a year • Recertification packets are sent in the fall (Sept/Oct) • Clients are recertifying for the next Medicare Part D plan year • The recertification must be completed before December 31 • Clients will be dropped from the SPAP if they do not complete the process

10. Recertification • What you can do to help: Inform clients that it is their responsibility to notify the THMP at any point to any changes in: • Residential and mailing address • Household information/composition, such as marriage, divorce, changes in dependents • Household income changes: such as returning to work, receiving Social Security or other benefits • Insurance benefit changes: obtaining health insurance or any changes in your prescription coverage

11. THMP Contact Information Phone: 1-800-255-1090 or 512-533-3000 Website: www.dshs.state.tx.us/hivstd/meds