Review of the CLDv4

[Moderator]
Welcome to today’s webcast: Review of the ADR Client Level Data: Update on Q&A from the Field. Thank you so much for joining us today!
My name is Michael Costa of Abt Associates. I am a member of the DART Team, one of several groups engaged by HAB to provide training and technical assistance to state ADAPs during the implementation of the ADR. Today’s Webcast is presented by Imogen Fua of the WRMA/CSR Data Support Team. Imogen will provide step‐by‐
step instructions for completing the submission of the ADR, including the reviewing your client‐level data using the online tools. At any time during the presentation, you’ll be able to send us questions using the “Question” function on your control panel on the right‐hand side of the screen. You’ll also be able to ask questions directly “live” at the end of the presentation. You can do by clicking the “raise hand” button (on your control panel) and my colleague, Titi, will conference you in. You can also click the “telephone” button and you’ll see a dial‐in number and code. We hope you consider asking questions “live,” because we really like hearing voices other than our own.
Now I’ll turn this over to our presenter. Imogen?
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Hi Everyone. I’m glad that you could join us here today. We are just less than a couple of weeks before the deadline to submit the first client level data report for ADAP. We know that all of you have been working hard in sorting out the requirements and getting your data prepared. From all the webinars we’ve conducted since last year, we have been collecting your questions and today, we will be reviewing some of those questions regarding the client‐level data elements.
I know that many of you are already familiar with the client level data elements, but please do bear with me as I will go over all of them in order to give new webcast participants the complete picture. I will however, quickly review the items that seem to be straightforward to you, meaning that you haven’t posed any questions regarding them and will spend more time on the items that received questions and requests for clarifications.
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First of all, let’s quickly review WHO and WHAT you will be reporting.
For the ADR Client Report, you will be reporting data on all clients who were enrolled in your ADAP during the reporting period, even if they did not receive services. So if you have a person who is enrolled in ADAP but is not receiving services for some reason ‐‐ you will report data for this client. Demographics and enrollment data are required of all clients. The insurance section are required for clients who receive insurance services. And finally, the medication section and clinical data are required for clients who received medication services. 3
Let’s talk about the system variables which are the first items in the ADR Client Report. First is the reporting period, which, for this submission, is October 1, 2012 to March 31, 2013.
Second, you will enter the client’s encrypted Unique Client Indentifier or eUCI. If you don’t know what the eUCI is, see the resources shown on the slide. The user guide and webinar will provide information on how the eUCI is generated. The third link is the eUCI application for those of you who will need to generate the eUCI. One note for CAREWare and RxRex users, you don’t need to worry about downloading this application because the eUCIs for your clients will be automatically generated for you by those software applications. Lastly, you’ll enter the ADAP number that HAB has assigned to your ADAP. If you do not know what this number is, contact Data Support and we’ll be happy to look it up for you. For those of you who have downloaded the RxRex
Manual, a list of ADAPs with their ADAP number is also listed in the appendix.
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Now, we’ll review the data elements under Client Demographics which describe the characteristics of your clients. The Client Demographics is going to tell HAB who you are serving. Again, Client Demographics are required for all clients even if they did NOT receive services during the reporting period. Lastly, these data should be collected through self‐report.
Let’s quickly go over these data elements. Under ethnicity, you report only one. Is your client Hispanic/Latino, non‐Hispanic or unknown?
Then for race, you should report all that apply. There is also an unknown option.
Under gender, transgender is a choice as a response in addition to male, female and unknown.
If you choose the transgender option, you must also report the transgender status – is the person male to female or female to male or unknown?
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Item 8 is Pregnancy status which should be reported for women only. Again, demographic data are collected through self‐report, so you don’t need clinical verification.
Next, we ask for the client’s birth year. Then we ask for the client’s HIV/AIDS status, as of the end of the reporting period. Again, this is through self‐
report.
Next is the client’s poverty level which is the client’s household income as a percent of the Federal Poverty Level. You should calculate this percent in a manner that is consistent with the federal guidelines and consistent for all clients. You should also use the latest information on file for each client, for example, you can use information from their recertification documents. 6
We also ask you to report whether the client was in a high risk insurance pool at any time during the reporting period. This is a health insurance program for individuals denied or prevented from purchasing coverage. This also includes the pre‐existing condition insurance plans (PCIPs) as many of you have asked. The responses for this Item is yes, no or unknown.
Finally, you will report ALL sources of health insurance that the client was enrolled in during the reporting period: Medicare Part A/B, Medicare D, Medicaid, private, other public insurance, no insurance, and Other. These options are defined in the ADR manual.
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In addition, many of you have asked us how to report high risk insurance and PCIPs under the insurance data element, Item 13. Here is the guidance on that.
• If the client is paying the premium for the insurance, then that insurance should be reported as private. (ADAP may be paying the co‐pays, deductibles or paying medications in FULL not covered by private insurance)
• If the Federal or State government is paying, then report the insurance as “other public” (ADAP may be paying the co‐pays, deductibles or paying medications in FULL not covered by private insurance)
• If you are using Ryan White funds to pay for the premium, we want you to report this as “no insurance”. One important note, if you report that Ryan White funds were used, you should answer Yes to the data element, Item 20 (which we will go over later), that asks if the client received ADAP insurance assistance and then enter the dollar amounts for the premium and any other dollar amounts for copays and deductibles. 8
Next we move on to the Enrollment and Certification section which will tell HAB about client enrollment patterns and recertification processes. The first data element under enrollment and certification asks whether the client is a new or existing client. A new client is defined as someone who has applied to ADAP for the very first time and has met your state or jurisdiction’s eligibility requirement.
An existing client is someone who was enrolled in a previous reporting period and is again enrolled in the current reporting period. For example, a client who was enrolled in your State ADAP 10 years ago is an existing client. They could have been disenrolled for any reason and has now become eligible to receive services. So an existing client is someone who was ever previously enrolled in your ADAP.
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Next you will report for all new clients ‐ the date that their application was received and the date that the application was approved.
We’ve received many questions and scenarios from ADAPs on how to determine these dates. You all have many different processes and even your own eligibility requirements that can determine these dates. Each ADAP can decide when an application is completed and approved and then apply it consistently to all applicants. 10
Next under Enrollment and Certification, you will report the most recent date of recertification for all clients. Of course, for a new client, date of recertification would obviously not yet be required to collect.
Then you will report the enrollment status of all clients as of the end of the reporting period. Are they receiving services, are they on a wait list, have they been disenrolled?
If the client’s enrollment status is Disenrolled, you will also report the reasons or reasons for disenrollment. We received a lot of questions and scenarios on how you should determine a client’s disenrollment status. The list of reasons offered under this Item are actually what grantees agreed upon during the vetting of the Client Report. Just to go over them quickly, they are: ineligible due to a change in the ADAP’s Federal Poverty Level requirements, ineligible because they are now eligible for Medicaid, ineligible for other reason, the person did not recertify, did not fill their prescription, is deceased, or dropped out, and finally, Other/Unknown. You can report all that apply and your program should determine which reason or reasons best applies to the client. This could be another area where your ADAP can set policies as how to determine disenrollment reasons for certain circumstances.
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Now we move on to reporting requirements for ADAP services. These are medication and insurance services, which were paid with ADAP funds. Services that your client received during the reporting period need to be reported in these sections.
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First we’ll go over the ADAP Insurance Services section. This section will tell HAB about your insurance services and expenses.
After you indicate Yes, that the client did receive insurance services during the reporting period, you will enter the amounts that were paid. If you answer, NO, you will skip this section. For Premiums, you should include all premiums paid during the reporting period, regardless of the time frame the premium covers. We’ve received questions on which date to use for these paid premiums – again there are many different scenarios across ADAPs and your program should determine which date to use and apply it all clients.
The next data element is the total months of coverage for which the insurance premium was paid. It doesn’t matter if the months are outside of the reporting period, you want to report all the months of coverage.
Then the next data element is the total amount paid for co‐pays and deductibles during the reporting period. The last data element is the total amount of payments towards Medicare Part D which includes co‐insurance, or co‐
payment, or donut hole coverage. Any payments towards Medicare Part D are all captured in this data element. You should not include any payments towards Medicare Part D in the previous data elements, specifically Items 21 and 23. 13
Next we move on to Drugs and Drug Expenditures services. These data are required for clients who received medication assistance. The purpose of this section is to gather data on ADAP‐funded medications that were dispensed as well as their costs. In the Grantee Report, you were required to list ARVs, Hep B and Hep C medications, and A1‐OIs. Under this section, HAB only requires you to list the ARVs, Hep B and Hep C medications.
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After you indicate yes, that the client did receive medication services during the reporting period, you will enter each ADAP‐funded medication that your client received using the 5 digit drug code. Again, you will report only medications that were dispensed to the client during the reporting period and regardless of whether the supply extended beyond the reporting period. If you answer, No to Item 25, the client did not receive medication services, you will skip this section. In April, we had a webinar that talked about the available tools to report your medications. On the slide is the link to the webinar which talks about how to use CAREWare, RxRex, the Multum lookup tables and the NDC/D‐Code Crosswalk.
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For each medication dispensed that ADAP fully paid for, you will report the start date, days of supply, and the amount paid for each prescription. We’ve received a lot of clarification questions on the start date. This start date refers to a date during the reporting period when the client started taking the medication that was dispensed to them. So we’re not asking for when they ever started the medication – we are looking for the start date of the prescription that ADAP paid for during the reporting period.
Under days supply, you will need to report the number of days the medication was dispensed. We’ve also been told that some ADAPs only collect the quantity of the medication and not the days supply. You can calculate the days supply by dividing the known dosage into the quantity to get days supply as illustrated here on the slide.
Lastly, for amount paid for medication, the ADR system will only allow 0‐20,000. The system will not allow for negative numbers. We are not looking for you to report medication reversals. Only report medications that were actually picked up by the client.
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Also, you should not report medications that your ADAP purchased and were later reimbursed by insurance. This expense should be reported in the insurance section.
You also should not report medications where ADAP funds were used to pay for co‐pays and deductibles. These expenses should also be reported in the insurance section.
Again, only report medications that were fully funded by ADAP.
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Finally the last two data elements of this section have to do with dispensing fees. You will report whether your ADAP paid for dispensing fees for the client ‐‐ separate from other fees, such as administrative fees. This is a yes/no response item. The second data element asks for the amount paid. This amount should be the total costs for all medication dispensing fees for this client during the reporting period. The ADR system will only allow values 0‐
1,000. Again, you cannot report a negative number for dispensing fees. 18
The final section of the Client Report is the clinical data. It describes the clinical characteristics of ADAP clients who receive medication services. It is only required of clients who received medication services. These data must come from a lab report or similar document or from your state surveillance program.
For clinical data, you will report the most recent CD4 Count and Viral Load Count test dates and values. Values will be accepted as long as they occur within the 12 months preceding the end of the reporting period. So, for example, this first reporting period ends on March 31, 2013; so the CD4 and Viral Load tests must have occurred no earlier than March 31, 2012. Some of you have asked about how to report undetectable viral load values. In you data dictionary, there is guidance to make sure your developers use the “is dectable” attribute. They should set that attribute to “false” and report the lower test limit for the viral load, if available. Otherwise, you can simply report “0”.
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Finally, there will be no validations checks for your ADR client level data for this submission. We will begin validations in the next submission. HAB is only looking that you have a properly formatted XML file.
However, we ask that you do your best in completing the client level data elements. And take this great opportunity to learn about what data issues you have that will prevent you from submitting the data requirements; so that then you can resolve or begin to resolve them in time for the next submission.
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Finally, I want to remind you that your ADR report is due June 17, 2013. 21
I want to wrap up this webcast with a few reminders. Be sure to take advantage of the many technical assistance resources that are available to you on the TARGET Center Web site and the 2012 ADR Instruction Manual, and the Frequently Asked Questions.
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The last webinar for this reporting period is June 26th which is an ADR Town Hall. You can register at the Target website.
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And, if you still need help after reviewing the information online, you can contact any of these TA resources listed here. With that, I’m going to turn things back over to Michael. Thank you for joining us today!
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[Moderator]
Thank you Imogen! Before we take your questions, we’d like your feedback on this webcast presentation. On your screen you will see two poll questions appear. Please take a moment to respond to each poll by clicking on the appropriate box. We will pause for a moment to give you time to do this. [Titi will load poll question 1, pause, then load poll question 2]. [Poll question 1: Was this web conference informative?]. [Poll question 2: Was the web conference content presented clearly and concisely?] Thank you for your assistance. As a reminder, one final evaluation question will appear on your screen as you exit this webcast, to help us understand what other information you would have liked included. We appreciate your feedback very much, and use this information to plan future webcasts. Thank you! We will now take questions. As a reminder, you can send us questions using the “Question” function on your control panel on the right hand side of the screen. You can also ask questions directly “live.” You can do this by clicking the raise hand button (on your control panel). If you are using a headset with a microphone, my colleague, Titi, will conference you in; or, you can click the telephone button and you will see a dial in number and code. We hope you consider asking questions “live”, we really like hearing voices other than our own.
We do want to get all of your questions answered, and we do not usually run over an hour. If you have submitted your question in the question box and we cannot respond to your question today, we will contact you to follow up. We often need to explore your question in order to give you the most appropriate answer.
[Moderator reads questions from the log while Organizers “assign” these to appropriate panelists and presenters].
[Reminder]: As you exit this webcast, please complete the evaluation question that appears on your screen. This will help us understand what other information you would have liked included. We appreciate your feedback very much, and use this information to plan future webcasts. Thank you for joining us today! 25