LA HAP FAQS Updated
Contents
1. LA HAP Frequently Asked Questions updated Health Access 3 5 1 5 Program Newest and most recently updated FAQs appear highlighted LA HAP services and eligibility What s the difference between LA HAP HIP L DAP and ADAP LA HAP the Louisiana Health Access Program is a healthcare cost assistance program divided into two parts the Louisiana Drug Access program L DAP which pays for drug costs for uninsured clients or drug copays and coinsurance for insured clients and the Health Insurance Program HIP which pays for medical cost shares for insured clients Another way of looking at it an insured client who requests full assistance is both a HIP and an L DAP client and an uninsured client who requests full assistance which for uninsured clients means only medication services is only an L DAP client Both L DAP and HIP clients are LA HAP clients ADAP stands for AIDS Drug Assistance Program Every state has their own ADAP Louisiana no longer uses the name ADAP and now calls their program LA HAP which covers all of the old ADAP services and more Can a client sign up for HIP before having insurance No In order to be approved for HIP a person either has to have active insurance or be newly signed up for insurance and requesting an initial premium payment from HIP Typically insurance plans including all Marketplace plans will allow someone to sign up for insurance but pay their first premium at a later date So a cli2. behalf HIPAA regulations prohibit Ramsell and LA HAP from offering general or all agency access to client profiles Keep in mind that this is a privacy and ethics consideration sharing medical information on a strictly need to Billing and Mailing If a co pay is due at the time of my doctor s visit prescription pickup how do make sure that HIP gets billed and not me This will be different depending on what provider clinic vendor you are seeing Some providers are familiar with HIP and will when you show them your HIP approval letter bill HIP directly or give you an invoice at the time of your visit to send to HIP Other providers will require payment at the time of services so you should always check with your provider before your visit to see what their HIP procedure is If the provider is not already familiar with HIP HIP can contact the provider to introduce the program and explain the services offered The best contact at HIP to explain the program to providers is Katie Dearman who can be reached at 225 927 1269 All of this should be cleared with the provider BEFORE the day of the visit to ensure the provider knows NOT to bill the client Ultimately it is the provider s choice to accept or refuse payment from HIP on the client s behalf HIP cannot reimburse clients for anything they pay the doctor themselves Click here for a list of the pharmacies in Louisiana which already work with LA HAP Do insurance companies s
3. include common law spouses girlfriends boyfriends partners or significant others A legally married couple that are separated and are not living together will be considered separate households Domestic partners and roommates should not be included Same sex partners should also not be included since Louisiana doesn t recognize the legality of same sex marriage This definition of household is applied both to Step 4 on Page 2 and Step 6 on Page 3 of the application My client has Medicare Parts A B and D but only is requesting assistance for Part D Do we need to fill in their Part A and B insurance information in the LA HAP application It s not necessary to enter the Medicare Part A and B information in the insurance section of the application if the client is only applying for help with Part D But there is no problem if it has already been filled out LA HAP will accept the application either way How do know the status of an application If you or your agency have access to the Ramsell system you can check the application status under the eligibility tab of your client s profile If you do not have access to Ramsell you may call LA HAP for a status update If an incomplete application is received a follow up fax requesting the missing information or documentation will be sent back to the provider who sent the application Priority Review Requests My priority review request was rejected because LA HAP sai
4. DAP The term ADAP refers to a specific funding source from HRSA the federal Health Resources and Services Administration ADAP funds from HRSA can be used to provide both medications to uninsured clients as well as insurance services to clients who have insurance To reduce confusion we changed the name of our programs in 2013 L DAP the Louisiana Drug Assistance Program now covers both insured and uninsured drug services Our Health Insurance Program HIP covers premium costs and medical cost share To apply for any or all of these services you would complete a LA HAP application Didn t the HIP office use to be in Baton Rouge Has it moved Although the Louisiana Office of Public Health runs LA HAP and processes enrollment for all services at their office in New Orleans they contract with two organizations to help manage the different components of their program Ramsell is the Pharmacy Benefits Manager for L DAP clients HAART Inc a community based organization in Baton Rouge houses HIP Their office manages premium and cost share payments for clients If you have questions about HIP enrollment they should be directed to LA HAP in New Orleans but any questions about billing should go to HIP in Baton Rouge Completing the LA HAP application I ve been told by LA HAP that I need another document in order for my client s application to be complete but my client will be out of medication soon Will my client have to wait until the a
5. all remember that HIP can only share cost with the insurance company so if a client accesses a service that their insurance company doesn t cover HIP cannot cover that cost The insurance company must pay at least part of the claim in order for HIP to pick up the rest What medications are covered by L DAP What is covered by L DAP depends on your insurance status For uninsured members everything on the LA HAP uninsured formulary is covered If a member is insured LA HAP can cover the cost of all medication covered by your insurance EXCEPT those categorically excluded by HRSA which are e All over the counter OTC drugs e Erectile Dysfunction ED drugs e Nutritional Supplements e Prescriptions used for cosmetic purposes If I m a HIP client can I see any doctor want Not necessarily There are a couple important things to keep in mind first your doctor needs to be in the insurance company s network You can find that out by going to your insurance company s website and searching for your doctor s name calling your insurance company or calling your doctor Second you need to make sure that your doctor is aware of HIP and has agreed to work with them It is every provider s choice whether or not they want to work with HIP Remember that HIP cannot reimburse you for anything that you pay out of your own pocket so it is VERY IMPORTANT that you inform your doctor about HIP well before your visit so they can agree
6. d from a merging of data from the ADAP database HIP databases and CAREWare All updates to client data in the Ramsell system are made by LA HAP staff Can case managers clients make any changes via the Ramsell Edit Profile button or should the changes be directed back to LA HAP Only LA HAP staff can make edits to client data in the Ramsell system If there is client data that needs to be updated please provide it to LA HAP staff You can use the Insurance Add Change form or the general Information Change form located under Forms and Applications on this site The Edit Profile button at the top of the Ramsell screen links to your user profile and you should be able to click on the button to update your own profile information In the Ramsell system you can also click on the Help button at the top of the screen This will bring up 3 tabs FAQ User Manual and Help Desk In the User Manual tab you should find the EW User Guide which also contains helpful information about how to navigate the system If a client has a record in the Ramsell system does it automatically mean they are eligible for medication assistance No the Ramsell system houses enrollment information for all LA HAP applicants regardless of status or service selection including those who only applied for HIP services and not medication assistance To determine if a member is eligible for services refer to the Application Status on the Eligibility tab The optio
7. d my client isn t treatment adherent but they ARE treatment adherent What s going on When they receive a priority review request form LA HAP staff check its eligibility first by checking whether the client has accessed services in the past 2 months Sometimes from the records it may look like the client is not treatment adherent Some examples e Your client is a Medicare client who went through the Part D donut hole and Medicare is now paying 100 of their drug costs meaning that when LA HAP checks your client in the system it looks like they haven t been using their L DAP services e Your client is taking medication that they received from a friend In instances like these the application can still be eligible for priority approval but you MUST use the comment field in the Medication Access History part of the form to explain where and HOW the client has been accessing medication No further external documentation is needed submitted a LA HAP application on time for my client but it hasn t been processed by the LA HAP office yet Now my client is in danger of running out of medication What should do If treatment interruption within 48 hours is a possibility you may fill out a Priority Review Request Form which will be looked at within that 48 hour span The situations where a priority review request can be used are e when a treatment experienced client one who has been compliant with HIV medication for at leas
8. eceives Client enrollment can also be checked in the Ramsell system haven t received a HIP letter yet for my client What s going on First check the Ramsell system to see if the application has been approved for your client Then make sure you have sent the Member ID policy number and Group number to LA HAP after you receive it from the insurance company LA HAP does not require a copy of the insurance card but you may send a copy of the insurance card to LA HAP as a way of providing the Member ID policy number and Group number to LA HAP LA HAP will not send HIP letters until they have this information If you have already done both these things you can call LA HAP to see where the HIP letter is The Ramsell System am a case manager who signed up a client for L DAP services and then transferred them to a different case manager to enroll in insurance coverage and HIP Now I ve lost access to their record in Ramsell to see if they ve been successfully transferred LA HAP has discussed this issue with Ramsell and each client record is now able to be linked to two different case managers simultaneously At the moment this doesn t work 100 of the time because it is a new feature with Ramsell but it should get better over time If it continues to be a problem for you please report it to LA HAP so they can continue to work with Ramsell Who puts information to the Ramsell system The initial data in the Ramsell system was loade
9. end EOBs Explanation of Benefits to clients directly or to HIP EOBs will go directly to the client It is then the client s responsibility to get their invoices and EOBs to HIP if they need want assistance with a medical claim cost share What is the deadline for sending bills to HIP for payment HIP can pay bills up to 90 days after claim adjudication this means 90 days after the insurance company paid the provider After you or your client receives a service or visits a provider an Explanation of Benefits EOB will be sent to them detailing what the insurance company paid to the provider check the date on this EOB to know when the 90 days began Where should bills and EOBs be sent All bills and EOBs should be sent to the HIP office in Baton Rouge While SHP processes enrollment for HIP from their New Orleans office they contract with HAART in Baton Rouge for processing of HIP billing Send to HAART Attn HIP PO Box 66913 Baton Rouge LA 70896 or fax to 225 927 1267 Attn HIP Accessing Healthcare Will HIP pay for clients to see an out of network provider It depends on the circumstances In order for HIP to provide payment assistance the insurance company must pay on the claim That means that the insurance company partially covers the cost of the service or visit Some insurance companies allow their clients to see out of network providers and still cover a portion of those services for example 50 In this examp
10. ent can sign up for insurance and then fill out the LA HAP insurance add change form to apply for HIP premium and cost share assistance If approved HIP can pay the initial premium and future premiums directly to the insurer Use this chart to make sure you re submitting the correct paperwork when you apply Remember that HIP cannot directly reimburse the client for any money they may pay to the insurance company Can a client sign up for any LA HAP services if they don t have insurance Yes In Step 1 Question 1 of the LA HAP application a person can select the type of assistance they need LAHAP provides 4 types of assistance 1 insurance premium assistance 2 insurance medical copay and deductible assistance 3 insurance drug copay and deductible assistance 4 medication assistance only The first three services are only available to people with insurance The 4 option is for uninsured clients Unlike insured clients who can get assistance with their health care costs including services unrelated to HIV uninsured clients can ONLY have assistance with HIV medication costs Use this chart to make sure you re submitting the correct paperwork when you apply What if just want to fill out an ADAP application for my client Use the LA HAP application An important thing to remember is that we have had both name and programmatic changes over the last few years The first change in that we no longer have a program call A
11. ion LA HAP does not have this form publically available but will automatically send you this form when it is time to recertify How soon before their recertification date can submit my client s LA HAP application Applications for recertification can be accepted starting at 6 weeks prior to the recertification date If you submit earlier than this 6 week period LA HAP will e Set aside your application to be reviewed on the first eligible date if recertification date is less than 3 months away and send you a fax to indicate this OR e Send you a fax indicating that the application was not accepted and must be re submitted at the correct time if recertification date is more than 3 months away Is there a grace period after eligibility ends No Per HRSA no grace period may be allowed once a client s eligibility ends However provided there is no cap on enrollment an individual may reapply at any time if their eligibility expires REMEMBER charges incurred during the time that an individual is not actively enrolled for LA HAP may NOT be back billed to or repaid by LA HAP HIP or LDAP Important documents LA HAP cards and HIP letters What is a LA HAP card and who gets one The LA HAP card sometimes called a Ramsell card as it is sent to the client by Ramsell LA HAP s Pharmacy Benefits Manager provides pharmacies with information for a client s drug services A client will receive a LA HAP card if they are e Uni
12. le HIP CAN help with costs because the insurance company pays on the claim Other insurance companies may refuse to cover any services if their client goes out of network leaving the client responsible for 100 of their services costs In this case HIP CANNOT help with costs The Schedule or Summary of Benefits should tell you whether or not the insurance company covers services from Out of Network providers Remember that HIP is for cost sharing and or premium assistance So there must be costs shared with the insurance company in order for HIP to be able to pay HIP cannot pay for any service that is not covered by the insurance company s policy at all What services will HIP NOT cover The most important thing to remember is that per our HRSA guidelines HIP funds can ONLY be used for outpatient cost shares This mean that services such as hospitalization and surgeries cannot be covered by HIP If a procedure can be performed on an outpatient basis it s a good idea to ask your provider if this is an option we can assist with those costs Although HIP is able to pay premiums for dental insurance they CANNOT cover dental cost shares co pays coinsurance and deductibles HIP can cover vision premiums and cost shares IF they are part of a larger general health plan HIP CANNOT pay for premiums on a standalone vision plan although they can pay cost shares if the client chooses to pay their own premiums for a standalone plan Over
13. ns you will see in the Application Status field are e Applied Pending an application has been submitted but the person is not yet eligible for services e Applied Denied an application has been submitted but the person did not meet eligibility criteria e Enrolled Eligible an application has been approved and the person is eligible to receive services e Ineligible information has been provided specifying that the person is ineligible for services Do I have to be at my own computer to pull up the Ramsell system The Ramsell system is a web based system meaning you can access it from anywhere you have internet access However since this system does contain confidential person health information the system should never be accessed from a non secure network such as wifi and the information contained should never be shared with anyone other than your client service staff who have signed your agency s confidentiality waiver I am a LA HAP client who manages my own care and I don t have a case manager Do I have access to the Ramsell system At the moment only case managers have access to the Ramsell system If you need information from your profile such as the last time you filled medication you can call your pharmacy or LA HAP and they will help you over the phone I can t always be near a computer to check Ramsell Is it possible for my coworkers to have access to a client s Ramsell profile so they can check it on my
14. nsured and enrolled in LA HAP for full medication assistance or e Insured and enrolled in LA HAP for medication copay and deductible assistance previously provided through HIP CDAP What is a HIP letter and who gets one If a LA HAP client is enrolled in HIP for premium assistance and or medical copay and deductible assistance they will receive a HIP letter If a client is enrolled in LA HAP for drug services as well as premium assistance and or medical co pay and deductible assistance they will receive both a LA HAP card and a HIP letter Here s a visual to help Louisiana Health Access Program LA HAP ind mer appicca PL guideline LA HAP CARD J HIP LETTER a Louisiana Drug Assistance Program Louisiana Health Insurance Program LDAP HiP Drug costs for uninsured members insurance plan premiums as well as and drug copays coinsurances amp NON drug copays coinsurances amp deductibles for insured members deductibles for insured members Managed through Ramsell Managed through HAART Please note that clients will not get a copy of this HIP letter unless they are self referred to LA HAP Otherwise HIP letters will be faxed to the referring agency Also note that HIP letters won t be sent until LA HAP has received the Member ID Policy Number and Group Number of the client s insurance plan Will the referring agency get a copy of the LA HAP card No but the agency can make a copy of the card the client r
15. pplication is approved to get their medication Yes Please do your best to make sure the application is complete when submitted to avoid treatment interruption and call LA HAP staff if you have questions about completeness If any of my client s personal information changes and they submit the Information Add Change form to LA HAP do they also need to contact HIP separately and let them know No All enrollment information including changes and updates are processed by the LA HAP staff at SHP in New Orleans LA HAP staff then relay insurance information to the HIP office in Baton Rouge as needed Do I need to attach the entire Summary or Schedule of Benefits to my application NO LA HAP no longer needs a copy of the SOB in your application unless they specifically ask for it LA HAP will not ask unless it is a very unusual or unique plan for which they don t already have the plan SOB on file Please remember that you should still use the SOB for your own purposes in filling out step 8 of the application as completely as possible When the application asks for household income is that to include the ENTIRE household income including domestic partnerships or roommates or only those persons related by blood or marriage If you look at Step 4 on page 2 you will see that Household is considered all persons related by blood state defined legal marriage and or legal adoption living in the same dwelling Household size does not
16. t one month will run out of medication within 48 hours AND o has moved from another state OR o lost health insurance OR o had their LA HAP enrollment expire OR e when a treatment naive client has a request from a clinician that they begin HIV medication within 48 hours Important dates and deadlines When does enrollment for LA HAP expire Enrollment expiration for all LA HAP services both HIP and L DAP is the same and is based on the client s month of birth and 6 months from the client s month of birth Clients or their case managers must complete the LA HAP application every 6 months in order to recertify their eligibility for LA HAP and stay enrolled in the program Note that eligibility is based on the client s month not date of birth So if your birthday is September 3 you must recertify each year by March 31 and September 30 not March 3 and September 3 My client was approved for LA HAP services in February and their birthday is in March Do they have to recertify for LA HAP services already Can they wait until September 6 months after their birth month HRSA guidelines stipulate that recertification must take place every 6 months so you cannot wait until September as it is more than 6 months past your client s enrollment date However in instances where the client s birthday falls within 3 months of their enrollment date you can complete a one page Self Attestation form in lieu of the full LA HAP applicat
17. to send any bill for your copay coinsurance or deductible to HIP The best contact at HIP to explain the program to providers is Katie Dearman who can be reached at 225 927 1269
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