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Centralized ADAP Eligibility

In Virginia, ADAP eligibility has been conducted primarily through local health departments, of which there are over 100 across the Commonwealth. These sites also serve as ADAP medication distribution sites. In 2008, to ensure that Ryan White is the payor of last resort, and to reduce the program burden at the local level, the Virginia Department of Health (VDH) solicited and reviewed proposals through a competitive process to select a contractor to implement and conduct centralized eligibility determinations and enrollment for individuals who apply for Virginia ADAP.
Through this process Patient Services Inc. (PSI) was selected. PSI is a 501(c) (3) non-profit, charitable organization located in Midlothian, Virginia. For nearly two decades, PSI has helped people who live with certain chronic illnesses or conditions locate suitable health insurance coverage and co-payments. PSI also manages the Virginia State Pharmaceutical Assistance Program (SPAP), which pays Medicare Part D costs for people who get medicines through Virginia ADAP.

Centralized ADAP eligibility will be phased in first in select sites and then regionally. The first site was launched in June 2009. To date, centralized ADAP eligibility has been launched in the following health districts: Prince William, Central Virginia, Peninsula, Hampton, Henrico, Arlington, Norfolk, Central Shenadoah, VA Beach, and Fairfax.
Several weeks prior to a districtwide launch of centralized eligibility, clients will receive information and notification through the mail, medication bag inserts, and counsel from the local ADAP coordinators regarding the new process and PSI.

The application process was designed to minimize client burden and provide excellent customer care. Each client is assigned a PSI representative to manage the application. The representative will work directly with the client to complete the application process successfully.
Visit the ADAP eligibility page for all eligibility requirements.
PSI’s direct toll-free ADAP number will be available to clients to allow them to contact their representative should they have any questions about the process or their eligibility.
Clients have two options to complete an application: (1) over the phone, with the completed application mailed to client to be returned with a signature and income documentation or (2) complete the entire application by mail and/or fax to PSI’s toll-free fax line.
When appropriate and approved by the client, PSI will use identified client advocates (case managers, local ADAP coordinators, social workers) to expedite and assist with the application. PSI will also make site visits to health districts to reach out to clients who can’t be reached through mail and phone efforts.
Clients will be required to complete the application process annually, with an abbreviated recertification every six months. Every effort will be made to ensure a client’s successful application.

Clients will continue to utilize the health department to drop-off and pick-up prescriptions in statewide, even if centralized eligibility has been launched in an area or for an approved applicant.
Medications will be dispensed for clients who have been determined eligible for the program.
Client eligibility for ADAP will continue to be determined at the local health departments where centralized ADAP eligibility has not been launched.
PSI will communicate with the local ADAP coordinator to ensure medications are ordered for eligible clients; however, valid prescriptions must be provided to the local health department for medications to be dispensed.
VCH-HS Financial Services will continue to manage ADAP eligibility for clients obtaining ADAP medications through ACC Pharmacy and Hayes Willis.

APPLICATION PAPERWORK
Referral:	Send this document to PSI to refer a client to begin an application
Application:	Send this complete document to PSI to submit an application (English/Spanish)
Provider's Statement :	This document is completed by the provider.
	1- 866-392-1309 PSI Toll Free #
	1-877-251-0415 PSI Toll Free Fax

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Last Updated: 02-10-2012

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