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pdf2016 ADR Manual Addendum
Changes made to the ADR Manual
Version 2: November 3, 2016
Client Report:
9. Health Insurance. (See pages 20-21)
Guidance on reporting client health insurance when Ryan White funds are used to pay for premiums,
copays, and/or deductibles has changed to include both response options, “private” AND “no insurance”.
AIDS DRUG ASSISTANCE PROGRAM
DATA REPORT (ADR)
INSTRUCTION MANUAL
2016
Release Date: September 26, 2016
Version 2 : N o v e m b e r 3 , 2 0 1 6
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a
collection of information unless it displays a currently valid OMB control number. The OMB control number for
this project is 0915-0345, with an expiration date of 10/31/2017. Public reporting burden for this collection of
information is estimated to average 36.5 hours per response, including the time for reviewing instructions,
searching existing data sources, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to: HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10C-031, Rockville, MD
20857.
HIV/AIDS Bureau
Division of Policy and Data
Health Resources and Services Administration
U.S. Department of Health and Human Services 5600
Fishers Lane, Room 7C-07
Rockville, MD 20857
Table of Contents
Introduction................................................................................................................................................................. 2
What’s New ................................................................................................................................................................... 3
About the ADAP Report ............................................................................................................................................... 3
Who is an ADAP client?......................................................................................................................................... 3
What are ADAP services? ...................................................................................................................................... 3
Medication Assistance Services............................................................................................................................... 4
Health Insurance Assistance Services ................................................................................................................ 4
Services Provided under the ADAP Flexibility Policy ...................................................................................... 4
How is the ADR submitted to HAB?...................................................................................................................... 4
Who submits the ADR? ................................................................................................................................................ 4
What are the reporting periods? .............................................................................................................................. 5
Important Dates to Note ..................................................................................................................................... 5
The Grantee Report ..................................................................................................................................................... 6
Cover Page ............................................................................................................................................................. 6
Figure 1. ADR Grantee Report Online Form: Cover Page..................................................................................... 6
Programmatic Summary Submission...................................................................................................................... 7
Figure 2. ADR Grantee Report Online Form: Screenshot of the Programmatic Summary
Submission: Q #1-3 ........................................................................................................................................ 8
Figure 3. ADR Grantee Report Online Form: Screenshot of the Programmatic Summary
Submission: Q #4 ......................................................................................................................................... 10
Figure 4. ADR Grantee Report Online Form: Screenshot of the Programmatic Summary
Submission: Q #5 ......................................................................................................................................... 11
Figure 5. ADR Grantee Report Online Form: Screenshot the Programmatic Summary
Submission: #6 ............................................................................................................................................. 12
Figure 6. ADR Grantee Report Online Form: Screenshot of the Programmatic Summary
Submission: Example List of Medications ................................................................................................... 13
Next Step: Upload Your Client-Level Data .......................................................................................................... 14
The Client Report...................................................................................................................................................... 15
Reporting Client-level Data .................................................................................................................................. 15
Submitting Client-level Data to HAB ........................................................................................................................ 15
Client-level Data Fields .............................................................................................................................................. 15
Encrypted Unique Client Identifier .................................................................................................................. 16
Guidelines for Collecting and Recording Client Names ................................................................................. 16
Client Demographics ............................................................................................................................................ 17
Reporting Client Race and Ethnicity................................................................................................................ 17
Enrollment and Certification............................................................................................................................ 22
ADAP Services............................................................................................................................................................ 24
ADAP Health Insurance Services ......................................................................................................................... 24
Drugs and Drug Expenditures.......................................................................................................................... 25
Clinical Information ............................................................................................................................................. 27
Importing the XML Client File............................................................................................................................. 29
Reviewing your Client Report .............................................................................................................................. 29
Report Validation ................................................................................................................................................. 29
Submitting Your Report ....................................................................................................................................... 30
Appendix A: Required Client-level Data Elements ....................................................................................................... 31
Appendix B: Frequently Asked Program Questions from the Field.......................................................................... 32
Appendix C: Calculating Client Income as a Percent of the Federal Poverty Measure Using HHS
Federal Poverty Guidelines................................................................................................................................... 34
Appendix D: Glossary............................................................................................................................................... 35
ADAP Manual Index ....................................................................................................................................................... 40
2016 ADAP Data Report (ADR) Instruction Manual
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Icons Used in this Document
In addition to the content updates, icons are also featured throughout the text to alert you to particularly important
and/or useful information. You will find the following icons in this document:
The Note icon highlights information that you should know when completing your ADR.
The Tip icon points out recommendations and suggestions that may make completing the ADR easier.
The question mark icon points out common questions that we have received from ADAPs and may help
you to complete the ADR.
2016 ADAP Data Report (ADR) Instruction Manual
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Introduction
The Ryan White HIV/AIDS Treatment Extension Act of 2009 (Public Law 111-87, October 30, 2009) provides the
Federal HIV/AIDS programs in the Public Health Service (PHS) Act under Title XXVI flexibility to respond
effectively to the changing epidemic. Its emphasis is on providing life-saving and life-extending services for people
living with HIV/AIDS across the country and on providing resources to targeted areas with the greatest need.
All Program Parts of the Ryan White HIV/AIDS Program (RWHAP) specify the Health Resources and Services
Administration’s (HRSA’s) responsibilities in the allocation and administration of grant funds, as well as the
evaluation of programs for the population served, and the improvement of the quality of care. Accurate records of
the recipients of RWHAP funding, the services provided, and the clients served continue to be critical to the
implementation of the legislation and thus are necessary for HRSA to fulfill its responsibilities.
The RWHAP legislation authorizes a portion of Part B funds to be designated for the AIDS Drug Assistance
Program (ADAP), which primarily provides medications for the treatment of HIV disease. ADAP funds may also be
used to provide access to medications through the purchase of health insurance for eligible clients and for services that
enhance access, adherence, and monitoring of drug treatments. All 50 States and Territories and the District of
Columbia receive ADAP grants.
The HIV/AIDS Bureau (HAB) requires all ADAPs report client-level data using the ADAP Data Report (ADR).
The ADR was developed and implemented in 2013. The ADR enables HAB to evaluate the impact of the ADAP
program on a national level and allows HAB to characterize the individuals using the program, describe the
ADAP-funded services being used, and delineate the costs associated with these services. The ADAP client-level
data submitted will be used to:
•
•
•
•
•
monitor the clinical outcomes of clients receiving care and treatment through ADAP
monitor the use of ADAP funds in addressing the HIV/AIDS epidemic in the United States
monitor the support provided by ADAP to the most vulnerable communities, especially minorities
address the data needs of Congress and the Department of Health and Human Services (HHS) concerning
the HIV/AIDS epidemic and the RWHAP
monitor progress towards the goals of the National HIV/AIDS Strategy
HAB uses an encrypted Unique Client Identifier (eUCI) to ensure client confidentiality and limits data
collection to only that information reasonably necessary to accomplish the purpose of the ADR.
Technical support for the ADR is available to ADAPs through the HAB Web site at
http://hab.hrsa.gov/manageyourgrant/index.html or the Target Center Web site at
https://careacttarget.org/library/data-technical-assistance.
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What’s New
There have been no revisions to the reporting requirements for the 2016 ADR. Please review the manual for added
clarification on existing requirements.
About the ADAP Report
The ADR includes two components: (1) the Grantee Report, and (2) the Client Report. All ADAPs are required to
submit both reports.
The Grantee Report is a collection of basic information about recipient characteristics and policies.
The Client Report (or client-level data) is a collection of records (one record for each client enrolled in the ADAP)
which includes the client’s encrypted unique identifier, basic demographic data, and enrollment and certification
information. A client’s record may also include data about the ADAP-funded insurance and medication received,
including the costs of these services, as well as HIV clinical information.
ADAPs are required to submit the ADR annually.
The 2016 ADR is due on June 5, 2017.
Who is an ADAP client?
An ADAP client is any individual who is certified as eligible to receive ADAP services, regardless of whether the
individual used ADAP services during the reporting period.
During the reporting period, an ADAP client may have:
•
•
•
•
received medications and/or insurance assistance
been placed on a waiting list
been disenrolled
been eligible, but did not receive any services
What are ADAP services?
The ADAP is a state-administered program authorized under Part B of the RWHAP to provide FDA-approved
medications to low-income clients with HIV disease who have no coverage or limited health care coverage. ADAPs
may also use program funds to purchase health insurance for eligible clients and for services that enhance access to,
adherence to, and monitoring of antiretroviral therapy.
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Medication Assistance Services
Medication assistance services are the purchases of U.S. Food and Drug Administration (FDA) approved medications
for the treatment of HIV disease and the prevention and treatment of opportunistic infections. These medications
are purchased with ADAP funds on behalf of a client.
Health Insurance Assistance Services
Health insurance assistance services are the provisions of financial assistance for clients to maintain continuity of
health insurance or to receive medical benefits under a health insurance program. This includes premium payments
(partial or full), Medicare Part D co-insurance, deductibles, true out-of-pocket costs (TrOOP), and co-insurance
under catastrophic coverage. Co-pays and deductibles for medications are also considered health insurance
assistance services, not medication assistance services, and should be reported in this section, not in the Drug and
Drug Expenditures section.
Services Provided under the ADAP Flexibility Policy
HAB Policy Notice 07-03 allows recipients greater flexibility in the use of ADAP funds and permits expenditures of
ADAP funds for services that improve access to medications, increase adherence to medication regimens, and help
clients monitor their progress in taking HIV-related medications. To use ADAP dollars for services under the ADAP
Flexibility Policy, recipients must request approval annually in their grant application or through the prior approval
process in the EHB. ADAP dollars used for services under the ADAP Flexibility Policy are not reported on the ADR.
How is the ADR submitted to HAB?
The ADR is submitted online using HAB’s ADR Web Application. Recipients access the ADR Web Application
via the HRSA Electronic Handbooks for Applicants/Recipients (EHBs), a Web-based grants administration
system. The EHBs are located at https://grants.hrsa.gov/webexternal.
If you need help navigating the EHBs, contact the HRSA Contact Center at 1-877-464-4772.
The ADR Grantee Report is completed by filling out the online forms in the ADR Web Application. After
completing the Grantee Report, recipients upload the Client Report as an XML (eXtensible Mark-up Language) file
from within the Grantee Report. For additional information, see the Submitting Client- Level Data to HAB section
on page 15 of this manual.
Who submits the ADR?
The submission of the ADR is a condition of the RWHAP Part B grant award. Each Part B recipient of record must
complete both components of the ADR. The recipient of record (formerly referred to as the grantee of record) is the
agency that receives ADAP funding directly from HRSA.
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What are the reporting periods?
The Grantee Report and the Client Report have different reporting periods.
For the Grantee Report, ADAPs report data based on the grant year reporting period, April 1, 2016 to March 31,
2017.
For the Client Report, ADAPs report client-level data for clients enrolled during the calendar year reporting period,
January 1, 2016 to December 31, 2016.
Important Dates to Note
Date
Client XML File
Grantee Report
Monday, February 6,
2017
2016 ADR Test Your XML and Data
Quality Feature Opens
-----
Thursday, April 6, 2017
Monday, April 24, 2017
Monday, June 5, 2017
2016 ADR Web System opens for 2016 data collection
Target upload date for all 2016 ADR
client-level data files
-----
ADRs must in be “Submitted” status by 6:00 PM ET
Please make sure to visit the HAB Web site: http://hab.hrsa.gov/manageyourgrant/adr.html at the
beginning of the report submission period to obtain up-to-date information regarding the reporting
deadlines.
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The Grantee Report
For the Grantee Report, ADAPs will be reporting data based on the grant year reporting period, April 1, 2016 to
March 31, 2017. Each ADAP completes the Grantee Report.
The first section of the Grantee Report is the Cover Page (see Figure 1) which contains basic recipient information.
Recipients must update, enter, and/or verify the following recipient information.
Cover Page
1. Recipient name (display only): The recipient name must match the organization name on the Notice of
Award (NoA). There should be no abbreviations or acronyms unless they are also used in the NoA.
2. Grant number (display only): This is the grant number displayed on your NoA.
Figure 1. ADR Grantee Report Online Form: Cover Page
3. DUNS number (display only): This number, assigned by Dun & Bradstreet, indicates the recipient’s credit
worthiness.
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4. Recipient address (display only): This address should match the mailing address of the recipient of record.
There should be no abbreviations or acronyms unless they are also used in the NoA.
5. Contact information of person completing the Grantee Report: Enter name, title, email, telephone number, and
FAX number. You must complete this required data.
The Cover Page items displayed on your screen reflect the information on the recipient of record that
is stored in the EHBs. If the information is not correct for items 1-4, please contact the HRSA
Contact Center to make corrections. For item 5, you may edit the contact information directly on
your screen.
Once you’ve updated, entered, and/or verified the data on the Recipient Contact Information page, click Save to save
the data and to also be advanced to the next section, Programmatic Summary Submission.
Programmatic Summary Submission
The next section is the Programmatic Summary Submission consisting of sub sections A through E, numbers 1-7. It
should be completed for the grant year reporting period, April 1, 2015 to March 31, 2016.
Note the Navigation menu on the left side of the ADR Web application in Figure 1. Under Data Entry,
you can navigate through the Grantee Report by clicking on the question number.
You will not be able to save a page with missing data (a blank entry). To avoid losing data, you
may enter “0” (zero) as a placeholder for any unknown data and return at a later time to enter the
known data.
A. Program Administration
1. ADAP Limits: Indicate whether your program has adopted any of the following limits in order to control
costs. You may check more than one box if applicable (see Figure 2).
a. Waiting list—A list of clients who have been certified as eligible and have been enrolled to receive
ADAP services, but are not receiving ADAP services due to caps on service enrollment or other
cost-containment strategies.
b. Enrollment cap—A limit on the maximum number of people who can be enrolled in your program
and receive services at any given time. If your ADAP has capped enrollment, enter the maximum
number of enrollees.
c. Capped number of prescriptions per month―A limit on the number of prescriptions allowed per
month. If your ADAP has capped prescriptions per month, enter the number per month.
d. Capped expenditure—A limit on the maximum amount of dollars that can be spent per client.
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If your ADAP has capped expenditures, enter the monetary cap per client and whether the cap applies
monthly or annually.
e. Drug-specific enrollment caps for ARVs or Hepatitis B & C medications—A limit on the maximum
number of clients who can receive a specific medication at any given time.
If your ADAP has adopted drug-specific enrollment caps, indicate the medications for which you have
enrollment caps.
f.
Formulary reduction―A change in your ADAP formulary that reduced the number of medications
that are available to your clients.
g. Decrease in financial eligibility criteria― A change in your income eligibility requirement that
decreased the Federal Poverty Level (FPL) criteria for participation in your ADAP.
h. None of these limits were applied to the ADAP during the reporting period―If your ADAP did not
apply any limits, check this box as your only response to this question.
Figure 2. ADR Grantee Report Online Form:
Screenshot of the Programmatic Summary Submission: Q #1-3
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If you select Enrollment Cap, Capped prescriptions or Capped expenditure, you must enter the
maximum limit for that option. For the Drug-specific enrollment caps, you must indicate the specific
medication.
2. ADAP income eligibility: Enter the maximum income eligibility cap for participation in your State ADAP
that was in place as of the end of the grant year. (see Figure 2). This should be expressed as a percentage of
the FPL. For example, individuals living with HIV who have an income of 200 percent of the FPL or
lower, may be eligible to participate. See Appendix C for additional information on how to calculate FPL.
Which FPL eligibility requirement should we report if we have different requirements for our
medication and health insurance assistance services?
Answer: ADAPs should report their FPL requirement for medication services.
3. Clinical criteria required to access ADAP: Check all of the clinical eligibility criteria that are required (in
addition to HIV positive status) for enrolling in the ADAP in your state or territory (see Figure 2).
a. CD4— Indicate the threshold number in the space provided
b. Viral load — Indicate the threshold number in the space provided
c. Other - Indicate each criterion used and any corresponding threshold number
d. No clinical eligibility is required to enroll in the ADAP― only check if your ADAP does not
require clinical eligibility criteria. Do not check any other options.
Click on the Save button before navigating to the next page or your data will be lost.
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Figure 3. ADR Grantee Report Online Form:
Screenshot of the Programmatic Summary Submission: Q #4
Note: This screenshot will be revised for the 2016 ADR System. Response options, “340B Dual (i.e. Hybrid) and
“None of these apply to our Drug Pricing Program” have been eliminated. See below, B. Purchasing
Mechanisms, for the updated 2016 response options.
B. Purchasing Mechanisms
4. Drug pricing cost-saving strategies: Check all items that apply to your drug pricing program (see Figure
3). For complete definitions of the cost-saving strategies below, see Glossary.
If your ADAP participates in the 340B Drug Pricing Program that requires drug manufacturers to provide
outpatient drugs to eligible health care organizations/covered entities at significantly reduced prices, please
select the mechanism(s) through which your program has implemented the program:
a. 340B Rebate - A prescription drug purchasing model in which ADAPs reimburse a network of
retail pharmacies for costs associated with filling prescriptions for eligible clients. ADAPs submit
340B rebate claims to drug manufacturers.
b. 340B Direct Purchase - A prescription drug purchasing model in which ADAPs purchase drugs
directly from a manufacturer or wholesaler at the 340B pricing schedule.
1. If your ADAP participates in the Prime Vendor Program that handles price negotiation
and drug distribution responsibilities for members, please check, “Prime Vendor”
If your ADAP participates in the following:
c. Department of Defense: pharmaceutical cost-saving strategy administered by the Department
of Defense.
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Figure 4. ADR Grantee Report Online Form:
Screenshot of the Programmatic Summary Submission: Q #5
C. Funding
5. ADAP funding received during the reporting period: Enter the amount of funding your program
received, not awarded, from the sources listed during the reporting period (see Figure 4). Enter 0 if your
ADAP did not receive funding from any given source during the period. Do not leave any boxes blank.
When you ask for Part B Base Funding, are you also asking us to include ADAP base funding in
that total?
Answer: The term, Part B Base Funding, refers to any of your Ryan White Part B Base award that is
used for ADAP services. Do not include your ADAP Base funding (formerly referred to as
“earmark” funds) in this total.
We did not receive any new funding during the report period, am I permitted to enter zero in Item
#5?
Answer: Report all funding received during the reporting period, not just new funding. You may enter
“0” if you did not receive any funding from the list of sources.
Do we include funding that we used for services under the ADAP Flexibility Policy, or just
funding for medication and health insurance services?
Answer: Services funded through the ADAP Flexibility Policy are not reported on the ADR.
Where do we report State matches for ADAP?
Answer: State funds used in ADAP to meet the recipient’s match requirement should be included in
f. State general fund contributions.
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Figure 5. ADR Grantee Report Online Form:
Screenshot the Programmatic Summary Submission: #6
Note: This screenshot will be revised for the 2016 ADR System. Response options, “a. Pharmaceuticals” has
been changed to “a. Full pay medication assistance” and “d. Insurance coverage” has been changed to “d.
Health insurance assistance.” See below, D. Expenditures for the updated 2016 response options.
D. Expenditures
6. Expenditures: Enter the total expenditures for pharmaceuticals, dispensing and other administrative costs,
and health insurance coverage (including co-pays, deductibles and premiums) for the reporting period (see
Figure 5). The total expenditures for the reporting period will be calculated automatically.
a. Full pay medication assistance: Report ALL drugs fully-paid for by ADAP. If a drug is only partially paid for
by ADAP, it must be reported as health insurance assistance and reported in d. Health insurance coverage
below.
b. Dispensing costs: fees paid by ADAP to distribute medications.
c. Other administrative costs: all other fees excluding dispensing costs paid by ADAP that are related to
purchasing and distributing medication such as shipping and handling and other bulk order fees. Do not
include the general administrative costs of the ADAP (e.g. staffing costs) here.
d. Health insurance assistance: any health insurance assistance, including co-pays, deductibles, and premiums,
provided to ADAP clients paid by ADAP
E. ADAP Medication Formulary
7. ADAP Medication Formulary: A list of (a) ARVs, (b) A1-OI’s, and (c) Hepatitis medications will be
provided separately (see Figure 6 for ARVs as an example page). The medication’s generic name appears
first, followed by the brand name and then its D-code number.
For each list of medications, check the box on the left if your ADAP currently includes the medication in
the formulary.
If the medication was added to the formulary during the reporting period, check the box provided in the
“Med Added” column and enter the date that the medication was added in the “Date Added” column.
The list of medications will automatically generate previous data (i.e. from your ADAP’s last ADR
submission). You will need to review the list again and enter any changes that were made during the
current reporting period.
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The columns can also be sorted to easily locate medications on your formulary.
Figure 6. ADR Grantee Report Online Form:
Screenshot of the Programmatic Summary Submission: Example List of Medications
Do recipients have to report historical start dates in the formulary?
Answer: Recipients only need to include the “date added” for medications added to the formulary within
the fiscal year reporting period. Recipients do not need to enter the “date added” if the medication was
added prior to the fiscal year reporting period.
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Next Step: Upload Your Client-Level Data
Once you are satisfied that your Grantee Reports is complete and correct, upload your client-level data.
The Grantee Report cannot be submitted until the Client Report is uploaded into the ADR Web Application. The
Client Report is a collection of ADAP client records that must be submitted in one or more properly formatted
client-level data XML files. For more explanations on the client-level data elements, see the section, The Client
Report on page 15. To learn how to upload the client-level data XML file, see the section Importing the XML Client
File on page 29.
If you need help on completing the Grantee Report, contact Data Support at 1-888-640-9356 or e-mail
RyanWhiteDataSupport@wrma.com.
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The Client Report
For the Client Report, ADAPs should report client-level data for clients enrolled during the calendar year
reporting period, January 1, 2016 to December 31, 2016.
Reporting Client-level Data
The Client Report should contain one record (“row” of data in a database) for each client enrolled in the ADAP
during the reporting period. An enrolled client is an individual who is certified as eligible to receive services,
whether or not the individual actually received ADAP services during the reporting period. For all enrolled
clients, ADAPs must report client demographics and enrollment and certification data. For clients who received
services, ADAPs must report whether they received health insurance services and/or medications services and
their related data. Note that clinical data is only required for clients who received medication services. See
appendix A: Required Client-Level Data Elements to determine the client-level data elements required to be
reported for an enrolled client.
Submitting Client-level Data to HAB
The Client Report (i.e., client-level data set) must be uploaded in one or more properly formatted XML file(s).
XML is a standard, simple, and widely adopted method of formatting text and data so that it can be exchanged
across different computer platforms, languages, and applications. To learn how to upload the client-level data
XML file, see the section Importing the XML Client File on page 29.
ADAPs need to extract the client-level data elements from their systems into the proper XML format before they
can be uploaded to the HAB server. If your ADAP uses an ADR Ready System such as CAREWare, eCOMPAS
or Provide Enterprise, no special action will be required to generate the XML file. These ADR Ready Systems are
able to export the data in the required XML format.
Be sure you are using the latest version of your ADR Ready System.
If you do not use an ADR Ready System, you will need to use a program that extracts the data from your system and
inserts it into an XML file that conforms to the rules of the ADR XML schema. The schema and related documents
are available at https://careacttarget.org/library/adap-data-report-adr-download-package. HAB has also created the
tool, TRAX to help ADAPs create their XML file. To download the application and manual, go to
https://careacttarget.org/library/trax-adr.
If you need assistance in creating your XML file(s), contact DART at Data.TA@caiglobal.org.
Client-level Data Fields
The Client-level Data Fields section outlines the data fields required to be submitted in the client-level data XML
file. Due to the new and deleted data elements implemented in the past years, the numbering is not sequential, but
rather is consistent with the unique identifier (ID number) in the ADR XML Schema as referenced above. For
common program questions from recipients, see appendix B: Frequently Asked Program Questions from the Field.
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Encrypted Unique Client Identifier
The XML file will contain one system field: encrypted Unique Client Identifier (eUCI). To protect client
information, an eUCI is used for reporting Ryan White client data.
A Unique Client Identifier (UCI) is a unique 11-character alphanumeric code that is the same for the client across all
provider settings. The UCI is derived from the first and third characters of a client’s first and last name, his or her
date of birth (MM/DD/YY), and a code for gender (1=male, 2=female, 3=transgender, 9=unknown).
An eUCI is a 40-character alphanumeric code created when SHA-1, a one- way hashing algorithm that meets the
highest privacy and security standards, encrypts the client’s UCI. SHA-1 is a trap door algorithm, meaning that the
original UCI is unrecoverable from the eUCI. The resulting alphanumeric code, the eUCI, is used to distinguish one
Ryan White client from all others in a region.
It is possible that different clients have identical 40-digit eUCIs. Therefore, ADAPs must add a 41st character at the
end of the eUCI to provide additional distinction. If only one client within the ADAP data system has a given UCI,
the suffix should be U for unique. If more than one client has the same UCI, the final character of the first client’s
eUCI needs to be A, the final character of the next client’s eUCI needs to be B, and so on. The suffix prevents
multiple clients from having the same eUCI.
The UCI must be encrypted with SHA-1 at the provider site BEFORE the data are submitted to HAB.
To learn more about the eUCI, view the resources available on the TARGET Center Web site at
https://careacttarget.org/library/euci-and-adr-0.
Guidelines for Collecting and Recording Client Names
Recipients should develop business rules/operating procedures outlining the method by which client names should
be collected and recorded, for example:
•
•
•
•
Enter the client’s entire name as it normally appears on documentation such as a driver’s license, birth
certificate, passport, or social security card.
Follow the naming patterns, practices, and customs of the local community or region (i.e., for Hispanic
clients living in Puerto Rico, record both surnames in the appropriate order).
Avoid the use of nicknames (i.e., do not use Becca if the client’s full name is Rebecca).
Avoid using initials.
Recipients should instruct their staff on the correct entry of client names. Client names must be entered in the same
way every time in order to avoid false duplicates.
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Client Demographics
The purpose of the Client Demographics section is to describe the socio-demographic characteristics of all clients
enrolled in the ADAP, regardless of whether they received services.
Reporting Client Race and Ethnicity
The Office of Management and Budget (OMB) Revisions to the Standards for the Classification of Federal Data on
Race and Ethnicity provides a minimum standard for maintaining, collecting, and presenting data on race and
ethnicity for all federal reporting purposes. The standards were developed to provide a common language for
uniformity and comparability in the collection and use of data on race and ethnicity by federal agencies.
The standards have five categories for data on race: American Indian or Alaska Native; Asian; Black or African
American; Native Hawaiian or Other Pacific Islander; and White. There are two categories for data on ethnicity:
Hispanic or Latino and Not Hispanic or Latino. Identification of ethnic and racial subgroups is required for the
categories of Hispanic/Latino, Asian, and Native Hawaiian/Pacific Islander. The racial category descriptions
defined in October 1997 are required for all federal reporting, as mandated by the OMB. For more information, go
to: http://aspe.hhs.gov/datacncl/standards/aca/4302/index.pdf.
HAB is required to use the OMB reporting standard for race and ethnicity. However, ADAPs can choose to collect
race and ethnicity data in greater detail. If the agency chooses to use a more detailed collection system, the data
collected should be organized so that any new categories can be aggregated into the standard OMB breakdown.
Recipients are required to report race and ethnicity for each client based on each client’s self-report.
Self-identification is the preferred means of obtaining this information. Recipients should not establish
criteria or qualifications to determine a particular individual's racial or ethnic classification, nor specify
how someone should classify himself or herself.
4. Ethnicity
Indicate the client’s ethnicity based on his or her self-report.
•
•
Hispanic/Latino(a)—A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race. The term “Spanish origin” can be synonymous with
“Hispanic or Latino.” If a client identifies as Hispanic/Latino, go to Item 68 below and choose all
Hispanic subgroups that apply.
Non-Hispanic—A person who does not identify his or her ethnicity as Hispanic or Latino.
68. Hispanic/Latino Subgroup
Indicate the client’s Hispanic/Latino subgroup based on his or her self-report.
•
•
•
•
Mexican, Mexican American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, Latino/a or Spanish origin
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5. Race (Select one or more)
Indicate the client’s race based on his or her self-report.
•
•
•
•
•
American Indian or Alaska Native—A person having origins in any of the original peoples of North and
South America (including Central America), and who maintains tribal affiliation or community
attachment.
Asian—A person having origins in any of the original peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan,
the Philippine Islands, Thailand, and Vietnam. If a client identifies as Asian, go to Item 69 below and
choose all Asian subgroups that apply.
Black or African American—A person having origins in any of the black racial groups of Africa.
Native Hawaiian or Other Pacific Islander—A person having origins in any of the original peoples of
Hawaii, Guam, Samoa, or other Pacific Islands. If a client identifies as Native Hawaiian/Pacific
Islander, go to Item 70 below and choose all Native Hawaiian/Pacific Islander subgroups that apply.
White—A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
“Unknown” is not a response option for the race and ethnicity subgroups. If you do not have these data for a
given client, leave blank and the data will be missing. For additional assistance on how to deal with
“unknown” responses in your data, please contact DART.
69. Asian Subgroup (Select one or more)
Indicate the client’s Asian subgroup based on his or her self-report.
•
•
•
•
•
•
•
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
70. Native Hawaiian/Pacific Islander Subgroup (Select one or more)
Indicate the client’s Native Hawaiian/Pacific Islander subgroup based on his or her self-report.
•
•
•
•
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
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6. Current Gender
Indicate the client’s current gender (the socially and psychologically constructed, understood, and interpreted
set of characteristics that describe the current sexual identity of an individual) based on his or her self-report.
Gender cannot be missing; one of the options below must be reported for current gender.
• Male—An individual with strong and persistent identification with the male sex.
• Female—An individual with strong and persistent identification with the female sex.
• Transgender—An individual whose gender identity is not congruent with his or her biological gender,
regardless of the status of surgical and hormonal gender reassignment processes. Sometimes the term is
used as an umbrella term encompassing transsexuals, transvestites, cross-dressers, and others. The term
transgender refers to a continuum of gender expressions, identities, and roles, which expand the current
dominant cultural values of what it means to be male or female.
7. Transgender
If the client is reported as Transgender in Item 6, indicate the following:
•
•
•
Male-to–Female
Female-to–Male
Unknown
71. Sex at Birth
Indicate the biological sex assigned to the client at birth.
•
•
Male
Female
Sex at Birth should be completed for all clients.
9. Year of Birth
Indicate the client’s birth year in the form YYYY. This data element is required.
Even though only the year of birth will be reported to HAB, ADAPs should collect the client’s full date
of birth. The client’s birth month, day, and year are used to generate the UCI.
10. HIV/AIDS Status
Indicate the HIV/AIDS status of the client at the end of the reporting period.
•
HIV-positive, not AIDS—Client has been diagnosed with HIV but has not been diagnosed with AIDS.
2016 ADAP Data Report (ADR) Instruction Manual
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•
HIV-positive, AIDS status unknown—Client has been diagnosed with HIV. It is not known whether the
client has been diagnosed with AIDS.
CDC-defined AIDS—Client is an HIV-infected individual who meets the CDC AIDS case definition for
an adult or child.
•
11. Poverty Level
Report the client’s annual household income as a percent of the Federal poverty measure as of the end of the
reporting period. See appendix D: Calculating Client Income Percentage of the Federal Poverty Measure Using
HHS Federal Poverty Guidelines. Report information from the most recent certification/recertification for
each client.
•
•
•
•
•
•
•
Below 100% of the Federal poverty level
100 – 138% of the Federal poverty level
139 – 200% of the Federal poverty level
201 – 250% of the Federal poverty level
251 – 400% of the Federal poverty level
401 – 500% of the Federal poverty level
More than 500% of the Federal poverty level
There are two slightly different versions of the Federal poverty measure—the poverty thresholds
(updated annually by the U.S. Bureau of the Census) and the poverty guidelines (updated annually by
HHS.) If your agency already uses one of these measures, use that to report this data item. Otherwise,
HAB recommends and prefers that your organization use the HHS poverty guidelines to collect and
report it. For more information on poverty measures and to see the 2016 HHS Poverty Guidelines, go to
https://aspe.hhs.gov/poverty-guidelines.
12. High Risk Insurance
Indicate whether the client was in a High Risk Insurance Pool at any time during the reporting period. A High
Risk Insurance Pool is a state or federal health insurance program that provides coverage for individuals who
are denied coverage due to a preexisting condition or who have health conditions that would normally prevent
them from purchasing insurance coverage in the private market.
•
•
•
No
Yes
Unknown
13. Health Insurance
Report all sources of health insurance the client had for any part of the reporting period, regardless of
whether the ADAP paid for it. If the client did not have health insurance at some time during the reporting
period, report No insurance as well. (Select one or more).
2016 ADAP Data Report (ADR) Instruction Manual
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•
Private – Employer is private health insurance such as BlueCross/BlueShield, Kaiser Permanente and
Aetna and is paid by an employer.
•
Private – Individual is private health insurance such as BlueCross/BlueShield, Kaiser Permanente and
Aetna and is paid by the client and/or RWHAP funds.
•
Medicare Part A/B is a public health insurance program for people 65 years of age and older, some
disabled people under 65 years of age, and people with End-Stage Renal Disease (permanent kidney
failure treated with dialysis or a transplant). Part A (hospital insurance) covers inpatient care in hospitals
and hospice and home health care. Part B (medical insurance) covers medically necessary services and
supplies provided by Medicare such as outpatient care, doctor's services, physical or occupational
therapists, and additional home health care.
•
Medicare Part D is a stand-alone prescription drug coverage insurance.
•
Medicaid, Children’s Health Insurance Program (CHIP), or other public plan. Medicaid is a jointly
funded, federal-state health insurance program for people with limited income and resources. CHIP
provides health coverage to children in families who do not qualify for Medicaid. Other public plan is
any federal or state-funded health insurance plan.
•
VA, Tricare or other military health care. VA is health coverage for eligible Veterans. Tricare and other
military health care are health care programs for uniformed service members, retirees and their families.
•
Indian Health Services (IHS) provides health services to American Indians and Alaska Natives.
•
Other plan means the client has an insurance type other than those listed above.
•
No insurance/uninsured means the client did not have health insurance at some time during the
reporting period. HAB classifies clients who have no way to pay for medical expenses other
than with RWHAP funds as uninsured.
In general, insurance should be reported based on who pays for the insurance premium. If a client or
employer pays for the premium, select private. If Ryan White funds are used to pay for premiums,
copays or deductibles, select both private AND no insurance. For state or federally funded health
insurance, select Medicaid, Children’s Health Insurance Program (CHIP) or other public plan”.
How do I report Medicare Advantage as a type of
insurance?
Answer: Medicare Advantage is an alternative to private health insurance for Medicare beneficiaries. Report
Medicare Advantage under Medicare Part A/B.
2016 ADAP Data Report (ADR) Instruction Manual
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Enrollment and Certification
The purpose of the Enrollment and Certification section is to describe client enrollment patterns and certification
processes. Report the applicable data elements in this section for all clients who were enrolled in the ADAP during
the reporting period, whether or not they received services.
14. Was the client a new or existing client?
Report whether the client was new during the reporting period, even if the client was disenrolled at the end of
the period.
•
New client refers to individuals who meet all of the following criteria:
• applied to your state ADAP for the first time ever
• met the financial and medical eligibility criteria of the ADAP during the period for which you
are reporting data
Examples of clients who should NOT be included as a new client are the following:
• clients who have been recertified as eligible or clients who have been re-enrolled after a period
of having been decertified/disenrolled
• clients who have moved out of the state and then returned
• clients who move on and off ADAP because of fluctuations in eligibility for a Medicaid/
Medically Needy program, based on whether they met spend-down requirements.
•
Existing client refers to individuals who meet the following criteria:
• enrolled in your ADAP in a previous reporting period
• are enrolled in the current reporting period, regardless of whether they ever used ADAP
services
An individual enrolled in ADAP (new or existing client) may or may not use services. Use of services is
not required to be an enrolled client.
15. Date Completed Application Received (Complete if client is a new client.)
For all new clients, report the date that the completed application was received by the ADAP program. Each
ADAP should have a policy of when an application is considered completed and approved and apply it
consistently to all applicants. Indicate this date in the form MM/DD/YYYY.
16. Date Application Approved (Complete if client is a new client.)
For all new clients, report the date that the client was first approved to begin receiving ADAP services. For
those ADAPs who may have two different application processes for medication or health insurance services
or if a client applies to the program more than once within the reporting period, enter the first date a client
is approved for any ADAP service. Indicate this date in the form MM/DD/YYYY. The date should be within
the reporting period.
2016 ADAP Data Report (ADR) Instruction Manual
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If a client is initially ineligible for ADAP and is declined and then 2 months later reapplies and is
eligible, which date should be used for the completed application?
Answer: You should report the application date under which the client was approved.
If a new client application is approved in January but the application was received before
(outside) the reporting period, what date should be reported for the application date?
Answer: You should report the actual date of the application received, even if outside the
reporting period.
17. Date of Recertification (Complete if client has been enrolled for 6 or more months.)
All clients enrolled for more than 6 months or existing clients who were re-enrolled to receive services
during the reporting period should have recertification dates. Report the date(s) the client was determined to
be eligible to continue receiving ADAP services. Indicate date(s) in the form MM/DD/YYYY. Dates should
be within the reporting period.
If a client fails to recertify one week after the 6-month anniversary of certification, is the client
automatically disenrolled?
Answer: The recipient must ensure that eligibility is verified every 6 months, but are given flexibility as
to whether they recertify all clients at the same time or have a rolling recertification based on some
other factor (e.g. original enrollment date, birthdate, etc.). If a client does not recertify by the date
specified by the recipient, the client is ineligible for the program as of that date; there is no grace period
or cushion.
What should we report if we have more than 2 recertification dates?
Answer: HAB reviews these data to determine compliance with the policy of recertification of clients
at least every 6 months. You should report the 2 dates that would meet this criteria.”
All individuals enrolled in ADAP, regardless of whether or not they receive services, must be recertified
every 6 months. This includes clients on a waiting list. Information on client eligibility determinations
and recertification requirements can be found at
http://hab.hrsa.gov/manageyourgrant/pinspals/pcn1302clienteligibility.pdf
18. Enrollment Status
Indicate the enrollment status of the client at the end of the reporting period.
•
•
•
•
The client is enrolled in ADAP but did not need/request any services
The client is enrolled in ADAP but is on a waiting list
The client is enrolled in ADAP and received ADAP-funded medications or health insurance services
during the reporting period
The client was disenrolled from ADAP
If the client is currently enrolled, skip to Item 20.
2016 ADAP Data Report (ADR) Instruction Manual
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19. Reason(s) for Disenrollment
Indicate all reasons for disenrollment/discharge. Choose the best reason(s) that apply to your ADAP’s
disenrollment policies. If the reason is unknown, please report under Other/unknown.
•
•
•
•
•
•
The client is ineligible due to change in ADAP eligibility criteria
The client is ineligible for ADAP due to no longer meeting ADAP eligibility criteria
The client did not recertify
The client did not fill prescription as required by program
The client is deceased
Other
If a new client application is approved but the first service is not received during the reporting
year, what data should be reported for this client?
Answer: You should report Date Completed Application Received (Item #15) and Date Application
Approved (Item #16) and for Item #18, report the option of “enrolled, but did not need/request any
services.”
ADAP Services
ADAP services are health insurance assistance and medication assistance services provided to enrolled clients in
the ADAP program. ADAP funds, regardless of its source (state funds, Ryan White Part B ADAP, Ryan White
Part B formula, Part B Supplemental Funding, ADAP Emergency Relief Fund, Part A contributions, 340B
rebates, ADAP Crisis Task Force Rebates, etc.) were used to provide these services. All ADAP services that a
client received during the reporting period should be reported in these sections. Additional definitions for ADAP
services can be found in the “What are ADAP Services?” section on page 3 of this manual.
ADAP Health Insurance Services
The purpose of the ADAP Health Insurance Services section is to describe ADAP-funded health insurance
assistance services and expenditures. ADAP-funded health insurance assistance includes premiums (partial or
full), Medicare Part D co-insurance, deductibles, TrOOP, and co-insurance under catastrophic coverage. Co- pays
and deductibles for medications are also considered health insurance assistance services, not medication services,
and should be reported in this section, not in the Drugs and Drug Expenditures section. Lastly, report the ADAPfunded health insurance services your clients received during the reporting period based on when the premiums,
deductibles, co-pays, etc. were paid, not according to the coverage period.
A full premium payment is 100% of the premium paid for by the ADAP. This is common when an ADAP is
purchasing insurance on behalf of the client.
A partial premium payment is when a portion of the premium (i.e. less than 100%) is paid for by the ADAP.
Examples include if the ADAP is paying the employee-share of a premium or the non-subsidy part of an
insurance premium.
20. Receipt of Health Insurance Services
Indicate whether the client received ADAP-funded health insurance assistance during the reporting period
including premiums (partial or full), Medicare Part D co-insurance, deductibles, TrOOP, and co- insurance
under catastrophic coverage. Co-pays and deductibles for medications are also considered health insurance
2016 ADAP Data Report (ADR) Instruction Manual
24
assistance services and should be reported in this section, not in the Drugs and Drug Expenditures section.
•
•
Yes (If the response is Yes, complete Items 67, 21, 22 and 23)
No (If the response is No, skip to Item 25)
67. Type of Health Insurance Assistance Received
Indicate the types of health insurance service(s) that the client received during the reporting period. Choose
all that apply.
• Full premium payment is 100% of the premium paid for by the ADAP.
• Partial premium payment is when a portion of the premium (i.e. less than 100%) is paid for by the ADAP.
• Copay/deductible including Medicare Part D co-insurance, co-payment or donut hole coverage
21. Amount Paid for Premiums
Indicate the total amount ($0 to $100,000) of insurance premiums, including premiums paid for Medicare
Part D, paid on behalf of the client during the reporting period. This includes any premium paid (partial or full)
during the reporting period, regardless of the time frame that the premium covers (i.e., if the time frame covered
extends outside the reporting period).
If an amount was entered, complete Item 22.
22. Months Coverage of Premiums Paid
Indicate the total number of months (0 to 12) of coverage for which the insurance premium in Item 21 was
paid. Include all months, even if they fall outside of the reporting period. If ADAP pays part of the
premium, report the full coverage period of the policy. ADAPs do not need to prorate the months based on
the portion of the premium paid.
23. Amount Paid for Co-pays and Deductible
Indicate the total amount ($0 to $100,000) of medication deductibles and co-pays paid on behalf of the client
including Medicare Part D deductibles and co-pays or donut hole coverage during the reporting period. This
includes any medication deductibles and co-pays paid during the reporting period, regardless of when the
services were delivered.
Drugs and Drug Expenditures
The purpose of the Drugs and Drug Expenditures section is to describe the ARVs, Hepatitis B, Hepatitis C and
A1-OI medications paid for in full by ADAP and dispensed to clients during the reporting period. This section
also describes the total expenditures for those medications. Please note that this section is only for clients who
were dispensed medications that were paid for in full by ADAP.
ADAP payments for medication co-pays or deductibles are considered health insurance assistance
services and should be reported in the Health Insurance Services section.
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25. Receipt of Medication Services
Indicate whether ADAP-funded medications were dispensed to this client during this reporting period. Only
report ARVs, Hepatitis B, Hepatitis C and A1-OI medications included in your ADAP formulary that were
paid for in full with ADAP funds.
•
Yes (If the response is Yes, complete Items 26, 27, 28 and 29)
•
No (If No, this is the end of this client’s record)
26. Medication(s) Dispensed
Report each ADAP-funded medication dispensed to the client during the reporting period. Do not report
medications other than ARVs, Hepatitis B and C and A1- OI medications. Use the five-digit drug
code (d-xxxxx) of the medication. Drug codes (d-codes) are unique 5-digit codes assigned by the Multum
Drug Database.
You may be able to get d-codes from your pharmacy, PBM or other provider. If you use CAREWare,
d-codes are already built into the system. You may also make a request to HAB to access the Multum
Database via https://careacttarget.org/library/hab-grantee-request-form-multum-medicationinformation.
For more information on how to report medications using d-codes, go to Tools for Reporting Client
Medications at https://careacttarget.org/library/adr-tools-reporting-client-medications.
27. Medication Dispensed Date
Report the date each ADAP-funded medication listed in Item 26 was dispensed. Indicate this date in the form
MM/DD/YYYY.
28. Day(s) Supply of Medication
Indicate the number of days for which each medication listed in Item 26 was dispensed to the client during the
reporting period. Report the number of days in 30-day increments (1 through 30, 60, 90, …360) Anything less
than 30 days should be reported as the actual number of days supplied (e. g. 14 days).
29. Amount Paid for Medication
Indicate the total cost of each ADAP-funded medication ($0 to $100,000) listed in Item 26 that was dispensed
to the client during the reporting period. Cost should be reported per medication dispensed. Include the total
costs paid for each prescription that is dispensed, even if the medication prescription period extended beyond
the reporting period. See example below.
Example of Medication Data
ClientId
1
MedicationId
d05847
MedicationStartDate
11/5/2016
2016 ADAP Data Report (ADR) Instruction Manual
MedicationDays
7
MedicationCost
$1,948
26
ClientId
1
MedicationId
d05847
2
d03984
2
d04774
MedicationStartDate
11/14/2016
MedicationDays
90
MedicationCost
$2,598
10/5/2016
180
$100
10/5/2016
180
$1,413
May recipients report medications for health insurance assistance clients?
Answer: No, medications not paid in full under ADAP should not be reported in the Drugs and Drug
Expenditures section of the Client-level Report. Amounts paid for co-pays and deductibles for
medications should be reported in the Health Insurance Service section under Amount Paid for Co-pays
and Deductibles.
A client was enrolled in ADAP and then was eligible for Medicaid. Medicaid granted retroactive
eligibility and ADAP was back billed for services paid by ADAP. How do we report this client?
Answer: Data for these clients should be reported in the Client Report. ADAP services that are
retroactively paid for by Medicaid (i.e., back billing) should be reported. ADAPs are not required to go
back into their data system and delete services for which they back billed Medicaid and received
reimbursement.
Clinical Information
The purpose of the Clinical Information section is to describe the clinical characteristics of ADAP clients who
received medications paid in full by ADAP (ARVs, Hepatitis B, Hepatitis C and A1-OI medications only). Clinical
information is required to be reported for each client who was dispensed ADAP-funded medications (as reported in
Item 25) during the reporting period.
Clinical information must come from labs, other clinical sources or from the State Surveillance
Program, not from client self-report.
Some clients may switch from receiving ADAP-funded medications to receiving health insurance
services within the same reporting period. Is there a minimum amount of time during which a
client must receive ADAP-funded medications for the clinical data to be required?
Answer: Clinical data must be reported on all clients who received ADAP funded-medications at any
time during the reporting period.
32. CD4 Count Date
Report the date of the most recent CD4 count test administered to the client during the data collection period.
The date must be in the form MM/DD/YYYY. The CD4 cell count measures the number of T- helper
lymphocytes per cubic millimeter of blood. It is a good predictor of immunity. As CD4 cell count declines, the
risk of developing opportunistic infections increases. The test date is the date the client’s blood sample is
taken.
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33. CD4 Count Value
Indicate the value (0 and 100,000,000) of the most recent CD4 count test for the client during this reporting
period.
34. Viral Load Date
Report the date of the most recent viral load test administered to the client during the data collection
period. The date must be in the form MM/DD/YYYY. Viral load is the quantity of HIV RNA in the blood and is a
predictor of disease progression. Test results are expressed as the number of copies per milliliter of blood plasma.
The test date is the date the client’s blood sample is taken.
35. Viral Load Value
Indicate the value (0 and 100,000, 000) of the most recent viral load test for the client during this reporting
period. If a test result is undetectable, report the lower test limit for the viral load value which should be
available from a clinical data source. If the test limit is not available, report zero (0).
A client is disenrolled before receiving a Viral Load and/or CD4 test during the reporting period.
What should I report?
Answer: There are times when you do not have these data for all clients. You may use the comment box
that will appear after you’ve submitted your ADR to explain the missing data. You will also find these
missing data reflected in your Confirmation Report.
This is the end of the Client Report.
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Importing the XML Client File
To upload a client-level data XML file, open your ADR Grantee Report in the EHB. From within the ADR
Grantee Report, click the Client Upload link in the ADR Navigation menu. This will open another window.
You can continue to follow the on-screen instructions to upload your XML file.
Recipients may upload more than one client-level data file to “build” the Client Report. Before uploading
multiple client-level data XML files, recipients should understand the ADR Web Application’s data
merge rules. To learn more about the ADR Web Application merge rules, see
https://careacttarget.org/library/adr-merge-rules-30.
Reviewing your Client Report
ADAPs should generate and review a Client-level Data Upload Confirmation and Data Completeness Reports
before they submit their ADR to ensure quality data. The Confirmation Report is an aggregate report that can be
used to verify that the counts and totals reported in your Client Report match data stored in your source
system(s) (i.e., the correct number of clients, services, medications, and expenditures are being reported). The
Completeness Report provides details on the completeness of your client level data and show gaps where
data is not reported. Both reports are available only after you have uploaded client-level data into the ADR Web
application. To run these reports, select the respective links in the ADR Navigation menu on the left hand side of
the ADR Web page.
Report XML
After completing the ADR Grantee Report and uploading the client-level data XML file, you must validate your
report. To validate your report, click Validate in the ADR Navigation menu. The validation process checks to
make sure that your data are complete and correct. If your report has some potential data issues, you will receive
errors, warnings or alerts. To address these data issues, you must:
•
•
•
Correct data that received errors.
Correct data that received warnings or write a comment for each uncorrected warning in order to
submit your report. To write a comment, click the “Add Comment” link next to the warning
message.
Review alerts and correct them, if applicable. However, you are not required to fix or comment on
alerts to submit your report.
Before uploading a new or corrected client-level data file, you must clear all previous client records by clicking on
the Clear Clients link on the Navigation Menu or selecting the “Clear Client Records” box in the file upload
window.
After you have addressed these data issues, you can re-upload your client XML file by clicking on the Client
Upload link.
2016 ADAP Data Report (ADR) Instruction Manual
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Submitting Your Report
When your report is complete, submit the Grantee and Client Reports by clicking on Submit in the ADR
Navigation menu and following the instructions on your screen.
If you need help on completing the ADR, contact Data Support at 1-888-640-9356 or e-mail
RyanWhiteDataSupport@wrma.com
2016 ADAP Data Report (ADR) Instruction Manual
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Appendix A: Required Client-level Data Elements
Report this data element
Field
#
2
4
68
5
69
70
6
7
71
9
10
11
12
13
14
15
16
17
18
19
20
67
21
22
23
25
26
27
28
29
32
33
34
35
Type of Client, by Services Received
All Enrolled
Health
Medication
Client-Level Data Elements
Clients
Insurance
Services
Services
System Variables
Encrypted UCI
Client Demographics
Ethnicity
Hispanic/Latino Subgroup
Race
Asian Subgroup
Native American/Pacific Islander Subgroup
Gender
Transgender
Sex at Birth
Year of Birth
HIV/AIDS Status
Poverty Level
High Risk Insurance
Health Insurance
Enrollment and Certification
New or Existing Client
Date Completed Application Received (new
client only)
Date Application Approved (new client only)
Date of Recertification
Enrollment Status
Reason(s) for Disenrollment
ADAP Health Insurance Services
Receipt of Health Insurance Services
ADAP-funded health insurance assistance
Amount Paid for Premiums
Months Coverage of Premiums Paid
Amount Paid for Co-pays and Deductibles
Drugs and Drug Expenditures
Receipt of Medication Services
Medications Dispensed
Dispense Date for Medication
Days Supply of Medication
Amount Paid for Medication
Clinical Information
CD4 Count Date
CD4 Count Value
Viral Load Date
Viral Load Value
2015 ADAP Data Report (ADR) Instruction Manual
31
Appendix B: Frequently Asked Program Questions from the Field
1. Does the certification and recertification process count as an ADAP service that should be
reported?
Certification and recertification is not an ADAP medication or health insurance service, and
therefore should not be reported in the ADR.
2. Should ADAPs stop reporting after the donut hole (Medicare)?
After leaving the donut hole, a Medicare Part D beneficiary enters the Catastrophic Coverage period. If
ADAP pays the client’s copayments during Catastrophic Coverage period, it should continue to report amounts
under Amount Paid for Co-pays and Deductibles.
3. Where do I report copays for medical visits in the ADR?
ADAP funds cannot be used to pay for medical visit co-pays. You should only report co-pays for medication
co-pays in Items 67 and 23.
4. What does the eUCI generator do? Does it create the UCI and then encrypt it?
The eUCI generator can both create the UCI and then convert the 12 character UCI into a 40-character
string using the SHA-1 hashing algorithm. The SHA-1 is a trap door algorithm, meaning that the original
UCI is unrecoverable from the eUCI and therefore meets the highest privacy and security standards. When
using an ADR-Ready System such as CAREWare and TRAX, the eUCI is generated directly from the raw
data elements when the XML file is created. For more information, see “the Encrypted Unique Client
Identifier (eUCI): Application and User Guide” at https://careacttarget.org/library/encrypted-unique-clientidentifier-euci-application-and-user-guide
5. May ADAPs provide services to a client before eligibility has been determined? What if it is an
emergency?
It is not allowable for an ADAP to provide services before a client has been determined to meet that ADAP’s
eligibility criteria (i.e., presumptive eligibility). Expedited enrollment (i.e., emergency enrollment) is
allowed if the process ensures that clients have been determined eligible prior to services being provided.
Providing temporary assistance to ADAP-eligible clients while eligibility is determined for Medicaid or
other insurance (i.e., provisional status) is allowed, with the clear understanding that Medicaid is back-billed
if Medicaid is awarded retroactively. Data for these clients should be reported in the ADR Client report.
ADAP services that are retroactively paid for by Medicaid (i.e. back billing) should be reported. ADAPs are
not required to go back into their data system and delete services for which they back billed Medicaid and
received reimbursement.
6. Is it permissible for ADAPs to purchase medications through their 340B program and bill
insurance for their insurance clients?
It is allowable for a recipient to use ADAP funds to purchase medications at 340B pricing and to then bill
the medication to insurance for ADAP-eligible clients with insurance, so long as they: (1) do not pass on
the 340B pricing to the insurance company, and (2) treat the difference between the 340B price and the
insurance payment as program income. ADAPs that purchase medications through 340B and then bill
insurance are considered to be providing a health insurance service to the client, not a medication service. A
2015 ADAP Data Report (ADR) Instruction Manual
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health insurance service is paying for a co-pay, deductible, insurance premium or Medicare Part D service. If
an ADAP is not paying for any of these health insurance services, the client is not considered an ADAP
client.
7. Our program uses federal as well as non-federal funding for our ADAP clients. For the clients
served with non-federal funds (such as state), can we use a different set of certification or reporting
rules?
All funds that go into the ADAP program are considered ADAP funds and therefore must align with the
ADAP guidelines (i.e., ‘same program/same rules’); and all data should therefore be reported in the ADR. If,
however, a state chooses to establish a separate program funded by non-ADAP funds, the state could choose
to have different rules for that program and data for that program would not be reported on the ADR. The
state needs to be aware that 340B pricing would not be available to the separate, non-ADAP-funded
program unless the state is a 340B covered entity outside of the ADAP.
8. Are ADAPs allowed to dispense more than a 30-day supply of medication?
Each state has the authority to determine its own policy on the maximum day supply of medication for its
ADAP clients.
9. Is an ADAP permitted to pay health insurance premiums for in-patient care?
ADAPs are allowed to pay health insurance premiums for plans that cover inpatient care. However, Ryan
White funds may not be used to pay co-pays or deductibles for inpatient care.
10. For reporting the medication cost, are we permitted to approximate the cost of ADAP medications
purchased in bulk? Are there other ways to calculate the cost purchased in bulk?
ADAPs should not approximate cost for the purchase of medications. Each purchase includes quantity and
price that would allow the ADAP to provide a specific cost for the medication. If the ADAP carries stock
from one reporting period to the next, the ADAP should prorate the cost for the period for which they are
reporting. The amount of medication cost reported in Item #29 must be the actual price calculated from the
quantity purchased and the total price.
11. Is HAB considering an alternative method of completing the ADR Grantee Report other than filling
in the online forms (i.e., an ADR Grantee Report XML upload)?
HAB is exploring this possibility.
2015 ADAP Data Report (ADR) Instruction Manual
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Appendix C: Calculating Client Income as a Percent of the Federal
Poverty Measure Using HHS Federal Poverty Guidelines
Calculation Steps
Here are five easy steps you can use to determine a client’s income as a percent of the Federal poverty measure
using the U.S. Department of Health and Human Services Federal poverty guidelines (FPG):
1.
2.
3.
4.
Count the client’s family size.
Add up the family income.
Look up the FPG for the family size, year, and geographic location.
Calculate the family income as a percent of the family FPG:
family income / guideline * 100 = % family FPG
5. Use the percent of the family FPG to report the client percent of the Federal poverty measure for Item
12 of your ADR Client Report.
Background, Definitions, and Notes
To find the Poverty Guidelines and more information on poverty measurement, go to the HHS Poverty
Guidelines, Research, and Measurement Web page at http://aspe.hhs.gov/POVERTY/index.cfm
The Federal poverty guidelines are dollar amounts that vary according to family size and are used to determine
poverty status. HHS issues them each year in the Federal Register.
There are separate guidelines for the contiguous 48 States, Alaska, and Hawaii.
For example, an ADAP can define family size is the number of family members who live together. An individual
living alone (or with only non-relatives) counts as a family of one.
Family income is the sum of income of all family members who live together.
•
It includes pre-tax money (or “cash”) income (earnings; unemployment compensation; Social
Security; public assistance; veterans’ payments; survivor benefits; pension or retirement income;
interest; dividends; rents; royalties; income from estates, trusts, educational assistance, alimony,
child support, assistance from outside the household, and other miscellaneous sources)
•
It excludes non-cash benefits (e.g., food stamps, housing subsidies) and capital gains (or losses)
All family members have the same poverty status; thus all family members have the same income as a percent of the
Federal poverty measure.
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Appendix D: Glossary
ADAP
ADAP client
ADAP Base Funds
ADAP
Flexibility
Policy
ADAP
Supplemental
Drug Treatment
Grant Award
ADR
Web application
Administrative costs
AIDS
ARV
Capped expenditure
CAREWare
CDC
AIDS Drug Assistance Program—A state-administered program authorized
under Part B of the RWHAP to provide FDA-approved medications to lowincome clients with HIV disease who have no coverage or limited health care
coverage. ADAPs may also use program funds to purchase health insurance for
eligible clients and for services that enhance access to, adherence to, and
monitoring of antiretroviral therapy.
An ADAP client is any individual who is enrolled in the ADAP, (i.e.,
certified as eligible to receive ADAP services, regardless of whether the
individual used ADAP services during the reporting period).
Federal funds specifically designated to be used for the State/Territory ADAP.
HIV/AIDS Bureau’s (HAB) Policy Notice 07-03 provides recipients greater
flexibility in the use of ADAP funds and permits expenditures of ADAP funds for
services that improve access to medications, increase adherence to medication
regimens, and help clients monitor their progress in taking HIV-related
medications. Please note that to use ADAP dollars for services under the ADAP
flexibility policy, recipients must request approval annually, in their grant
application or through the prior approvals process in EHB.
Federal funds awarded to an ADAP with demonstrated severe need based
on established criteria, in addition to the ADAP Base funds.
HAB’s online ADR Web Application is where recipients submit their ADR.
Grantees access the ADR Web Application via the HRSA Electronic
Handbooks for Applicants/Grantees (EHBs), a Web-based grants
administration system.
Administrative costs for medication purchases include items such as
shipping and handling, and other bulk order fees.
Acquired Immune Deficiency Syndrome—A disease caused by the
human immunodeficiency virus.
Antiretroviral. A drug that interferes with the ability of a retrovirus, such
as HIV, to make more copies of itself.
A limit on the amount of money to be spent on one service or client per
month or per year.
CAREWare is a free, scalable software used for managing and monitoring
HIV clinical and supportive care and producing reports.
Centers for Disease Control and Prevention. The U.S. Department of Health
and Human Services agency that administers HIV/AIDS prevention programs,
including the HIV Prevention Community Planning process, among others.
The CDC is responsible for monitoring and reporting infectious diseases,
administers HIV surveillance grants, and publishes epidemiologic reports
such as the HIV/AIDS Surveillance Report.
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CD4 or CD4+ cells
CD4 cell count
Combination
therapy
Confidential
information
Coordinated
benefits
Co-insurance
Co-payment
Deductible
Department of
Defense Drug
Pricing Program
Dispensing fees
Dispensing of
pharmaceuticals
Direct Purchase
Donut hole coverage
Drug formulary
Drug pricing cost
strategies
Dual Application
D-Codes
Also known as helper T-cells, these cells are responsible for coordinating much
of the immune response. HIV’s preferred targets are cells that have a docking
molecule called “cluster designation 4” (CD4) on their surfaces. Cells with this
molecule are known as CD4-positive (CD4+) cells. Destruction of CD4+
lymphocytes is the major cause of the immunodeficiency observed in AIDS,
and decreasing CD4 levels appear to be the best indicator for developing
opportunistic infections.
The number of T-helper lymphocytes per cubic millimeter of blood. The CD4
count is a good predictor of immunity. As the CD4 cell count decreases, the
risk of developing opportunistic infections increases. The normal range for
CD4 cell counts is 500 to 1,500 per cubic millimeter of blood. CD4 counts
should be rechecked at least every 6 to 12 months if CD4 counts are greater
than 500/mm3. If the count is lower, testing every 3 months is advised. A CD4
count of 200 or less indicates AIDS.
Two or more drugs or treatments used together to achieve optimum results
against HIV infection and/or AIDS. For more information on treatment
guidelines, visit http://www.aidsinfo.nih.gov/
Information that is collected on the client and whose unauthorized disclosure
could cause the client unwelcome exposure, discrimination, and /or abuse.
The provision of services in such a way that clients do not receive duplicated
services from multiple providers or payers.
A form of medical cost sharing in a health insurance plan that requires an
insured person to pay a percentage of medical expenses received.
A fee charged to an individual per visit or per prescription.
An annual fixed dollar amount that an insured person pays before the health
insurance starts to reimburse or make payments for covered medical services.
Drug pricing cost-saving strategy administered by the Department of Defense
The cost to pharmacies to dispense drugs which is then transferred as a fee to
the buyer.
The provision of prescription drugs to prolong life or prevent the deterioration
of health.
A prescription drug purchasing model in which State ADAPs purchase drugs
directly from a manufacturer or wholesaler at the 340B pricing schedule.
ADAPs then distribute the drugs using a centralized State system or through
their own pharmacies.
The coverage gap of the Medicare Part D plan where, after a certain point, the
beneficiary is 100% responsible for the costs of the medication.
A list of pharmaceuticals that can be or should be preferentially prescribed
within a reimbursement (insurance) program.
See 340B, direct purchase, prime vendor and Alternative Method
Demonstration Project.
One application form for assistance that is used by both the ADAP and
Medicaid, such that clients only need apply once and may receive services from
both ADAP and Medicaid.
A five-digit drug identification number developed by Multum Cerner® to
identify groups of medications. D-codes have the format d#####, and may also
be referred to as ‘d-codes’ or ‘HRSA codes.’
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Electronic
Handbook (EHB)
Eligibility criteria
Epidemic
Fee-for-service
Fiscal Year
Fixed co-payment
Recipient of record
HAART
HIP
HRSA
Hybrid/Dual
Manufacturers’
rebates
Medicaid
Medicaid/Medically
Needy Program
Medication Protocol
The HRSA Electronic Handbooks for Applicants/Grantees (EHBs) is a Webbased grants administration system. The EHBs are located at
https://grants.hrsa.gov/webexternal.
The standards set by a State ADAP, usually through an advisory committee, to
determine who receives access to ADAP services. Financial eligibility is usually
determined as a percentage of the Federal Poverty Level (FPL), such as 400
percent FPL. Medical eligibility is most often a positive HIV diagnosis.
Eligibility criteria vary among ADAPs.
A disease that occurs clearly in excess of normal expectation and spreads
rapidly through a demographic segment of the human population. Epidemic
diseases can be spread from person to person or from a contaminated source
such as food or water.
The method of billing for health services whereby a physician or other
health service provider charges the payer (whether it be the patient or his or
her health Insurance plan) separately for each patient encounter or service
rendered.
The Ryan White HIV/AIDS Program Part B grant year of April 1 – March 31.
A set fee charged to all clients per prescription filled.
The official Ryan White HIV/AIDS Program recipient that receives
funding directly from the Federal government (HRSA).
Highly active antiretroviral therapy—An aggressive anti-HIV treatment
including a combination of three or more drugs with activity against HIV whose
purpose is to reduce viral load to undetectable levels. Currently, antiretroviral
therapies include several classes of drugs.
Health Insurance Program. A program of financial assistance for eligible
individuals living with HIV to enable them to maintain continuity of health
insurance or to receive medical benefits under a health insurance program. This
includes premium payments, risk pools, co-payments, and deductibles.
Health Resources and Services Administration—The HHS agency that is
responsible for directing national health programs that improve the Nation’s
health by ensuring equitable access to comprehensive, quality health care for all.
HRSA works to improve and extend life for people living with HIV/AIDS,
provide primary health care to medically underserved people, serve women and
children through State programs, and train a health workforce that is both
diverse and motivated to work in underserved communities. HRSA is also
responsible for administering the Ryan White HIV/AIDS Program.
A prescription drug purchasing model in which State ADAPs utilize both Direct
Purchase and Rebate Models in purchasing and distributing medications under
the 340 pricing schedule.
Dollars received from drug manufacturers, which represent a percentage of the
cost of the drug.
A jointly funded, federal-state health insurance program for certain low-income
and needy people.
The option to have a medically needy program allows States to extend
Medicaid eligibility to additional qualified persons who may have too much
income to qualify under the mandatory or optional categorically needy groups.
This option allows them to spend down to Medicaid eligibility by incurring
medical and/or remedial care expenses to offset their excess income, thereby
reducing it to a level below the maximum allowed by that State's Medicaid plan
A document developed to ensure that medications are prescribed appropriately.
2015 ADAP Data Report (ADR) Instruction Manual
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Monetary cap
NDC
OMB
Online interface
Other negotiated
rebates
Part B
Premium
PHSA
PLWH
Prime Vendor
Prophylaxis
Rebate
Retroactive billing
Retrovirus
RWHAP-funded
service
A limit on the amount of money to be spent on one service or client per month
or per year.
National Drug Code—The identifying drug number maintained by the FDA.
For purposes of the Section 340B Drug Discount Program, the NDC number is
used, including labeler code (assigned by the FDA and identifies the
establishment), product code (identifies the specified product or formulation),
and package size code when reporting requested information.
Office of Management and Budget—The office within the executive branch of
the Federal Government that prepares the President’s annual budget, develops
the Federal Government’s fiscal program, oversees administration of the budget,
and reviews Government regulations.
A shared intranet or Web site between the State’s ADAP and Medicaid
program.
Discounts negotiated between ADAP officials and drug companies on the price
of medications.
The Part of the Ryan White HIV/AIDS Program that authorizes the distribution
of Federal funds to States and Territories to improve the quality, availability,
and organization of health care and support services for individuals with HIV
disease and their families. The Ryan White HIV/AIDS Program emphasizes
that such care and support is part of a continuum of care in which all the needs
of individuals with HIV disease and their families are coordinated. The funds
are distributed among States and Territories based, in part, on the number of
AIDS cases in each State or Territory as a proportion of the number of AIDS
cases reported in the entire United States.
The amount paid for health insurance by an individual and/or plan sponsor such
as an employer.
Public Health Service Act
People living with HIV
A voluntary program of 340B-covered entities in which the prime vendor
handles price negotiation and drug distribution responsibilities for
members. Since the prime vendor has the potential to control a large
volume of pharmaceuticals, it can negotiate favorable prices and develop
a national distribution system that would not be possible for covered
entities to obtain individually.
Treatment to prevent the onset of a particular disease (primary prophylaxis) or
recurrence of symptoms in an existing infection that has been brought under
control (secondary prophylaxis).
A prescription drug purchasing model in which State ADAPs reimburse a broad
network of retail pharmacies for costs associated with filling prescriptions for
eligible clients. ADAPs then submit rebate claims to the manufacturer at the
340B pricing schedule.
Billing for services previously rendered rather than at the time of delivery.
A type of virus that, when not infecting a cell, stores its genetic information on a
single-stranded RNA molecule instead of the more usual double-stranded DNA.
HIV is an example of a retrovirus. After a retrovirus penetrates a cell, it
constructs a DNA version of its genes using a special enzyme, reverse
transcriptase. This DNA then becomes part of the cell’s genetic material.
A service paid for with Ryan White HIV/AIDS Program funds.
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Ryan White
HIV/AIDS Program
(RWHAP)
Section 340B Drug
Discount Program
Sliding scale copayment
State Match for
Supplemental Drug
Treatment Award
XML
Ryan White HIV/AIDS Treatment Extension Act of 2009—The federal
legislation created to address the health care and service needs of people living
with HIV/AIDS (PLWHA) disease and their families in the United States and
its Territories. The Ryan White HIV/AIDS Program was enacted in 1990 (Pub.
L. 101—381), reauthorized in 1996 as the Ryan White CARE Act Amendments
of 1996, in 2000 as the Ryan White CARE Act Amendments of 2000, and in
2006 as the Ryan White HIV/AIDS Treatment Modernization Act of 2006. The
most recent reauthorization was in 2009 as the Ryan White HIV/AIDS
Treatment Extension Act of 2009
Administered by the Office of Pharmacy Affairs, this provision indicates that as
a condition for participation in Medicaid, drug manufacturers must sign a
pharmaceutical pricing agreement with the Secretary of the Department of
Health and Human Services. This agreement States that the price charged for
covered outpatient drugs will not exceed the statutory ceiling price (the average
manufacturers’ price reduced by the Medicaid rebate percentage).
A fee charged to clients for filled prescriptions that varies based on the income
of the client.
Funding and/or resources from the State budget that matches, in part or in
whole, the ADAP Supplemental Drug Treatment Grant Award.
eXtensible Markup Language. A standard, simple, and widely adopted method
of formatting text and data so that it can be exchanged across all of the different
computer platforms, languages, and applications
2015 ADAP Data Report (ADR) Instruction Manual
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ADAP Manual Index
ADAP client, 2, 3, 16, 34, 36
ADAP income eligibility, 10
ADAP Medication, 13
ADAP services, 2, 3, 7, 12, 17, 24, 25, 26, 29, 32, 36,
38
Calculation, 35
Capped expenditure, 8, 10, 36
CD4, 10, 30, 31, 37
client demographics, 17
Client Report, 2, 3, 4, 5, 16, 17, 29, 30, 31, 35
client’s annual household income, 22
Clinical Information, 2, 29, 31
Co-pays, 4, 27, 29, 31, 32
deductibles, 4, 13, 26, 27, 28, 29, 34, 38
Disenrollment, 26, 31
Dispensing fees, 37
Donut hole coverage, 37
Drug Code, 39
Drugs and Drug Expenditures, 2, 26, 27, 29, 31
encrypted Unique Client Identifier, 2, 18
Enrollment and Certification, 2, 24, 31
Enrollment cap, 7
eUCI, 2, 18, 32
Flexibility Policy, 2, 4, 12, 36
2015 ADAP Data Report (ADR) Instruction Manual
Grantee Report, 2, 3, 4, 5, 6, 7, 9, 11, 12, 13, 14, 16, 31,
34
health insurance, 2, 3, 4, 10, 12, 13, 17, 22, 23, 24, 25,
26, 27, 28, 29, 31, 32, 34, 36, 37, 38, 39
High Risk Insurance, 22, 31
HIV/AIDS Status, 21, 31
Medicaid, 23, 24, 29, 32, 37, 38, 39, 40
Medicare Part A/B, 23
Medicare Part D, 4, 23, 26, 27, 32, 34, 37
medication, 3, 4, 9, 10, 12, 13, 14, 17, 24, 26, 27, 28,
32, 34, 36, 37
MULTUM Lexicon drug database, 28
Poverty Level, 10, 22, 31, 38
premiums, 13, 26, 27, 34
Programmatic Summary Submission, 2, 7, 9, 11, 12, 13,
14
Race and Ethnicity, 2, 19
recertification, 22, 25, 32
System Variables, 31
transgender, 18, 21
Validation, 2, 31
Viral Load, 30, 31
waiting list, 3, 25
XML, 2, 4, 5, 16, 17, 18, 31, 32, 34, 40
40
| File Type | application/pdf |
| Author | Imogen Fua |
| File Modified | 2016-11-04 |
| File Created | 2016-11-04 |