Performance Measure: Enrollment in Health Care Coverage (Including Medicaid, Medicare Part D, and Private Health Insurance)

National Quality Forum #: None

Description: Percentage of clients who receive at least one ADAP service who are eligible for and enrolled in health care coverage (including Medicaid, Medicare Part D and private health insurance) in the measurement year

Numerator: Number of clients in the denominator who are enrolled in health care coverage (including Medicaid, Medicare Part D and private health insurance) in the measurement year

Denominator: Number of clients who receive at least one ADAP service who are eligible for health care coverage

Exclusions: Clients who are ineligible¹ for health care coverage in service area

Data Elements: Does the client, regardless of age, have a diagnosis of HIV? (Y/N)

1. If yes, did the client receive at least one ADAP service in the measurement year? (Y/N)
   
   1. If yes, is the client eligible for non-RWHAP health care coverage (including Medicaid, Medicare Part D and private health insurance) in the measurement year?
      
      1. If yes, was the client enrolled in non-RWHAP health care coverage during the measurement year?

Data Sources: Recipient's ADAP data system

National goals, targets, or benchmarks for comparison

The HIV Quality Measures (HIVQM) Module is a tool within the RSR portal that allows recipients to enter aggregate data specific to the HRSA HAB Performance Measures. The HIVQM Module allows recipients to conduct point-in-time benchmarking across Ryan White HIV/AIDS Programs that use the module.

Basis for selection

The Ryan White HIV Treatment Modernization Act of 2006 (P.L. 109-415) requires that the Ryan White HIV/AIDS Program (RWHAP) be the payor of last resort. HIV/AIDS Bureau, Policy Clarification Notice 21-02: Determining Client Eligibility and Payor of Last Resort in the Ryan White HIV/AIDS Program (PDF - 68 KB) specifies that "RWHAP recipients and subrecipients should conduct periodic checks to identify any potential changes to clients' healthcare coverage that may affect whether the RWHAP remains the payor of last resort, and require clients to report any such changes."

Department of Health and Human Services Clinical Practice Guidelines

None

References/notes

¹ For the purposes of this measure, ineligible means those clients who are ineligible for any health care coverage outside of the RWHAP.