Performance Measure: Loss of AIDS Drug Assistance Program (ADAP) Services Due to Failure to Confirm Eligibility

National Quality Forum #: None

Description: Percentage of clients who experienced a loss¹ of ADAP services² in the measurement year due to failure to confirm continued ADAP eligibility based on the ADAP's requirements

Numerator: Number of clients from the denominator who experienced a loss¹ in ADAP services² in the measurement year due to failure to confirm continued eligibility as required by the ADAP

Denominator Number of clients receiving at least one ADAP service² in the measurement year

Exclusions: Clients who died or became ineligible³ for ADAP services in the measurement year

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, did the client experience a loss in ADAP services in the measurement year? (Y/N)
      
      1. If yes, was the loss due to failure to confirm continued eligibility and
      2. The loss resulted in an ADAP service interruption of at least one month?

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 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 must conduct timely eligibility confirmations, in accordance with their policies and procedures, to assess if the client's income and/or residency status has changed."

Department of Health and Human Services Clinical Practice Guidelines

None

References/notes

¹ Loss of ADAP services means an interruption of at least one month in the provision of ADAP services due to the failure of a client to meet the eligibility confirmation requirements of the ADAP.

² ADAP service includes health insurance assistance (including premium payment and medication copays), and full-pay medication assistance.

³ For the purposes of this measure, ineligible means those clients who are ineligible for ADAP services due to no longer meeting eligibility standards for the ADAP (e.g., moving out of state or the client's income exceeding the income cap).