ADAP Client Report

AIDS Drug Assistance Program (ADAP) Data Report

Client-Level Data Elements

ADAP Client Report

OMB: 0915-0345

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ADAP Data Report: Client Report

Revised Client-Level Variables

2014



Summary of 2014 Changes

ADAP Data Report: Client Report

The following changes to the ADAP Data Report (ADR) will apply to 2014 ADR reporting due Monday June 8th, 2015.

For the Client Report, ADAPs report client data based on the calendar year, January 1 – December 31, 2014, for clients enrolled during this period.

System Variables

Deletions/Modifications

  • Field #1: Reporting period – DELETED

  • Field #3: ADAP number – DELETED

Client Demographics

Deletions/Modifications

  • Field #4: Ethnicity – Unknown deleted as a response option

  • Field #5: Race – Unknown deleted as a response option

  • Field #8: Pregnancy status – DELETED

  • Field #10: HIV/AIDS status – Unknown deleted as a response option

  • Field #11: Poverty level – Response options were changed; unknown deleted as a response option

  • Field #13: Health insurance coverage – Response options were changed

Additions

  • Field #68: Hispanic/Latino(a) breakdown – If a client is reported as Hispanic/Latino, this additional information will now be required

  • Field #69: Asian breakdown – If a client is reported as Asian, this additional information will now be required

  • Field #70 : Native Hawaiian/Pacific Islander breakdown – If a client is reported as Native Hawaiian/Pacific Islander, this additional information will now be required

  • Field #71: Sex at birth - The biological sex assigned to the client at birth has been added


Note – Where Unknown is deleted, clients with no information will show as missing.

Enrollment and Certification

Deletions/Modifications

  • Field #14: Change wording and skip pattern to accommodate new 12 month reporting period

  • Field #16: Change wording, logic to allow data for both #16 and element #17

  • Field #17: Recertification dates – More than one date will now be accepted

  • Field #19: Reasons for disenrollment – Response options were modified

ADAP Insurance Services Received

Deletions/Modifications

  • Field #21: Premium paid changed to include Medicare Part D

  • Field #23: Copays/deductibles changed to include Medicare Part D co-insurance, copays or donut hole coverage

  • Field #24: Medicare Part D co-insurance, copays or donut hole coverage – DELETED

Additions

  • Field #67: Type of insurance assistance provided – Specified insurance assistance service(s) provided to client during the reporting period.


Drugs and Drug Expenditures

Deletions/Modifications

  • Field #30: Separate dispensing fees collected – DELETED

  • Field #31: Total cost of dispensing fees – DELETED

Additions

  • Section now includes A1-OI medications






System Variables

Field #

Variable Description

Variable definition

Allowed Values

Rationale

2

Encrypted UCI

The encrypted, unique client identifier generated by the HAB UCI generation utilities.

41-character string


Client Variables

Client Demographics: To describe the socio-demographic characteristics of all clients enrolled in the ADAP, whether or not they received services.

4

Ethnicity

Client’s ethnicity.

OMB-approved categories are used.

  • Hispanic/Latino(a)

  • Non-Hispanic

Description of clients served

5

Race

Client’s race.

Select all that apply.

OMB-approved categories are used.

  • White

  • Black or African American

  • Asian

  • Native Hawaiian/Pacific Islander

  • American Indian or Alaska Native

Description of clients served

68

New Variable

Hispanic/Latino breakdown

For clients who reported Hispanic/Latino, the subgroup(s) with which they identify. Select all that apply.

  • Mexican, Mexican American, Chicano/a

  • Puerto Rican

  • Cuban

  • Another Hispanic, Latino/a or Spanish origin

To meet OMB requirements as determined by the Office of Civil Rights

69

New Variable

Asian race breakdown

For clients who reported Asian, the subgroup(s) with which they identify. Select all that apply.

  • Asian Indian

  • Chinese

  • Filipino

  • Japanese

  • Korean

  • Vietnamese

  • Other Asian

To meet OMB requirements as determined by the Office of Civil Rights

70

New Variable

NH/PI breakdown

For clients who reported Native Hawaiian or Pacific Islander, the subgroup(s) with which they identify. Select all that apply.

  • Native Hawaiian

  • Guamanian or Chamorro

  • Samoan

  • Other Pacific Islander

To meet OMB requirements as determined by the Office of Civil Rights

6

Gender

Client’s current gender

  • Male

  • Female

  • Transgender

  • Unknown

Description of clients served

Field #

Variable Description

Variable definition

Allowed Values

Rationale

Client Demographics: To describe the socio-demographic characteristics of all clients enrolled in the ADAP, whether or not they received services.

7

Transgender

Client’s current transgender status. To be completed only if the response is “Transgender” in Item #6

  • Male-to-Female

  • Female-to-Male

  • Unknown

Description of clients served

71

Sex at birth

The biological sex assigned to the client at birth

  • Male

  • Female

To meet OMB requirements as determined by the Office of Civil Rights

9

Client’s year of birth

The year in which the client was born

YYYY Must be < current year

Description of clients served

10

HIV/AIDS status

Client’s HIV/AIDS status as of the end of the reporting period

  • HIV positive, not-AIDS

  • HIV positive, AIDS status unknown

  • CDC-defined AIDS

Description of clients served

11

Poverty level

Client’s annual household income as a percent of the Federal Poverty Level (FPL) at the end of the reporting period.

  • 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

Description of clients served

12

High Risk Insurance

Indicate if the client was in a High Risk Insurance Pool at any time during the reporting period.

  • No

  • Yes

  • Unknown

Description of clients served

13

Client’s health insurance coverage during the reporting period

Indicate all sources of client’s health insurance during the reporting period (Regardless of who paid for the health insurance).

Report all that apply.

  • Private – Employer

  • Private - Individual

  • Medicare Part A/B

  • Medicare Part D

  • Medicaid, CHIP, or other public plan

  • VA, Tricare, or other military health care

  • IHS

  • Other plan

  • No Insurance/uninsured

Description of clients served





Field #

Variable Description

Variable definition

Allowed Values

Rationale

Enrollment and Certification: To describe client enrollment patterns and certification processes

14

Was the individual a new or existing client?


Newly enrolled clients in ADAP this reporting period refers to individuals who meet all of the following criteria:

  • applied to 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 in this number 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, and

  • 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.


An existing ADAP client is a client who meets the following criteria:

  • enrolled in ADAP in a previous reporting period and;

  • continues to be enrolled in the current reporting period, regardless of whether they used ADAP services in either reporting period.


Note:

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.


  • Newly enrolled client

  • Existing Client (skip to Item #17)

HAB ADAP Performance Measures

Field #

Variable Description

Variable definition

Allowed Values

Rationale

Enrollment and Certification: To describe client enrollment patterns and certification processes

15

What was the date of receipt of the completed client ADAP application?

The date that the completed application was received by the ADAP program. This is reported only for new clients.

MM/DD/YYYY

HAB ADAP Performance Measures

16

What was the date of approval of this client’s ADAP application?

The date that the client was approved to begin to receive ADAP services. This is when the client was first enrolled in the ADAP program. This is reported only for new clients.

(Also, if 16 <07/01/YYYY, accept an additional value in 17.)

MM/DD/YYYY

HAB ADAP Performance Measures

17

What was this client’s recertification dates

during this reporting period?

The dates on which a client was determined to be eligible to continue to receive ADAP services. This is reported for all clients.


Note: All individuals enrolled in ADAP, regardless of whether or not they receive services, must be recertified every six months. This includes clients on a waiting list.

MM/DD/YYYY

Accept up to 2 values





HAB ADAP Performance Measures

18

What was the client’s enrollment status as of the end of the reporting period?

The status of an individual in the ADAP program as of the end of the reporting period. There are four possible options which are:

  • The individual is enrolled in ADAP but did not need/request any services

  • The individual is enrolled in ADAP but is on a waiting list

  • The individual is enrolled in ADAP and received either ADAP-funded medications or insurance services during the reporting period

  • The individual was disenrolled from ADAP

  • Enrolled, receiving services (skip to Item #20)

  • Enrolled, on waiting list (skip to Item #20)

  • Enrolled, services not requested (skip to Item #20)

  • Disenrolled

Description of clients served











Field #

Variable Description

Variable definition

Allowed Values

Rationale

Enrollment and Certification: To describe client enrollment patterns and certification processes

19

What was/were the reason(s) for disenrollment?

Please note the reasons for disenrollment/discharge. Select all that apply. If the reason is unknown, please report under “other”.

  • Ineligible due to change in ADAP eligibility criteria

  • Ineligible for ADAP, no longer meets ADAP eligibility criteria

  • Did not recertify

  • Did not fill prescription, as required by program

  • Deceased

  • Dropped out, no reason given

  • Other/Unknown

To determine service utilization

ADAP Insurance Services Received: To describe ADAP-funded insurance assistance services and expenditures. ADAP-funded insurance assistance includes premiums, co-payments and deductibles.

20

Did this client receive any ADAP-funded insurance assistance during this reporting period, including Medicare Part D premiums?

This includes premiums, deductibles and co-payments for which ADAP funds were used.


  • No (skip to Item #25)

  • Yes

To describe service utilization

67

New Variable

What type of ADAP-funded insurance assistance did the client receive?

The type of insurance service(s) that the client received during the reporting period. Choose all that apply.

  • Full Premium payment

  • Partial premium payment

  • Copay/deductible including Medicare Part D Co-Insurance, Co-Payment or donut hole coverage

To identify which of the possible insurance assistance the client received

21

Total amount of insurance Premium paid on behalf of this client during the reporting period, including Medicare Part D premiums.

The total amount of insurance premium paid on behalf of the client. This pertains to any premium paid during the reporting period, regardless of the time frame that it covers (i.e. if it extends outside the reporting period)

Integer value between 0-100,000

To describe service utilization and to determine annualized costs by type of insurance assistance

22

How many months of coverage were purchased during this reporting period

The total number of months of coverage for which insurance premium in Item #21 was paid. Please report all months even if they fall outside of the reporting period. Do not prorate if you pay part of a client’s premium

Integer value between 0-12

To describe service utilization and to determine annualized costs by medication type

23

Total amount of deductible and co-pays paid on behalf of this client during the reporting period.

The total amount of insurance deductibles and co-pays paid on behalf of the client, including all Medicare Part D deductibles and co-pays. The amount reported should be based on the date that the deductible or co-pay was paid.

Integer value between 0-100,000

To describe service utilization and to determine annualized costs by medication type

Drugs and Drug Expenditures: To describe the ADAP-funded medications dispensed to clients and total expenditures for those services. This section is only for clients who were dispensed ADAP-funded medications paid in full by ADAP (i.e. not clients for whom only the co-pay or deductible was paid). This includes ARVs, Hepatitis B, Hepatitis C and A1-OI medications.

25

Were any ADAP-funded medications dispensed to this client during this reporting period?

Report whether or not ADAP-funded medications were dispensed to this client during this reporting period? ADAP-funded medications include any medication on your ADAP formulary which was paid for in full by ADAP funds.

  • No (skip to end)

  • Yes

To describe service utilization

26

Please list the ADAP-funded medication dispensed to the client during this reporting period.

The specific list of ADAP funded medications that were dispensed to the client during the reporting period. Please use the five-digit drug code (d#####) of the medication. Items #26-29 will be reported for each ADAP-funded medication.

d#####

To describe service utilization and to determine annualized costs by medication type

27

What is the start date of the ADAP-funded medication dispensed to the client during this reporting period?

List the start date for each ADAP funded medication listed in Item #26. HAB defines the start date in this situation as the dispensing date.

MM/DD/YYYY

To describe service utilization and to determine annualized costs by medication type

28

For how many days was the ADAP-funded medication dispensed?

The number of days for which the medication was dispensed for each ADAP funded medication listed in Item #26. Number of days should be reported as the actual number of days supplied

Integer value between 1-360. Any value less than 30, report exact number. Otherwise, report in increments of 30

To describe service utilization and to determine annualized costs by medication type

29

What was the Total cost of the ADAP-funded medication dispensed to the client during the reporting period?

The total cost of each ADAP-funded medication dispensed during the reporting period. Include total costs of each ADAP-funded medication paid during the reporting period, even if the medication prescription period extended beyond the reporting period.

Integer value between 0 and 20,000

To describe service utilization and to determine annualized costs by medication type




Field #

Variable Description

Variable definition

Allowed Values

Rationale

Clinical Information: To describe the clinical characteristics of ADAP clients who received ADAP-funded medications. All clients receiving ADAP-funded medications should have at least one CD4 and one VL in the 12 month reporting period.

32

Report the date of the most recent CD4 count for this client in the last 12 months

Value indicating the date of the most recent CD4 count for this client within the last 12 months preceding the end of the reporting period.

MM/DD/YYYY

To determine the impact of ADAP-funded medications

33

Report the value of the most recent CD4 count for this client in the last 12 months

Value indicating the numerical result of the most recent CD4 count for this client within the last 12 months preceding the end of the reporting period.

Integer value between 0-100,000,000


To determine the impact of ADAP-funded medications

34

Report the date for the most recent Viral load count for this client in the last 12 months

Value indicating the date of the most recent Viral load count for this client within the last 12 months preceding the end of the reporting period.

MM/DD/YYYY

To determine the impact of ADAP-funded medications

35

Report the value of the most recent Viral load count for this client in the last 12 months

Value indicating the numerical result of the most recent Viral load count for this client within the last 12 months preceding the end of the reporting period.

Integer value between 0-100,000,000


To determine the impact of ADAP-funded medications


7/22/2014 Page 8


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleADAP Data ReportProposed Client-Level Data Variables
AuthorDIsenberg
File Modified0000-00-00
File Created2021-01-27

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