C - ADR Client-Level Data Elements 2017

ADAP Data Report: Client Report

2017

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
68	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 ACA/NHAS requirements
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 Unknown	Description of clients served
69	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 ACA/NHAS requirements
70	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 ACA/NHAS requirements
6	Gender	Client’s current gender	Male Female Transgender Male to Female Transgender Female to Male Transgender Other	Description of clients served
7 - delete	Transgender	Client’s current transgender status. To be completed only if the response is “Transgender” in Item #6	Male-to-Female Female-to-Male Transgender Other	Description of clients served
71	Sex at birth	The biological sex assigned to the client at birth	Male Female	To meet ACA/NHAS requirements
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

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.
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 250 – 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
13	Client’s health insurance coverage during the reporting period	Indicate all sources of client’s health insurance during the reporting period. Report all that apply.	Private – Employer Private - Individual Medicare Part A/B Medicare Part D Medicaid, CHIP or other public plan VA, Tricare and 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. The minimum activities for recertification include: Financial Eligibility determination. Ensuring that ADAP is the Payer of Last Resort Appropriate documentation (i.e.: financial/ insurance –or lack thereof/ denial of coverage)	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, change in ADAP eligibility criteria Ineligible for ADAP, no longer meets ADAP eligibility criteria Did not recertify Did not fill prescription 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-pays and deductibles. Co-pays and deductibles for medications should be reported in this section.
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
	What type of ADAP-funded insurance assistance did the client receive? See Field #67
21	Total amount of insurance Premium paid on behalf of this client during the reporting period [including Medicare Part D].	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)	$$$	To describe service utilization and to determine annualized costs by type of insurance assistance
22	For how many months of coverage was this insurance Premium during the reporting period?	The total number of months of coverage for which insurance premium in Item #21 was paid. Please report all months even if they fall outside of the reporting period. Do not prorate if you pay part of a client’s premium	##	To describe service utilization and to determine annualized costs by medication type
Field #	Variable Description	Variable definition	Allowed Values	Rationale
ADAP Insurance Services Received: To describe ADAP-funded insurance assistance services and expenditures. ADAP-funded insurance assistance includes premiums, co-pays and deductibles. Co-pays and deductibles for medications should be reported in this section.
23	Total amount of deductible and co-pays paid on behalf of this client during the reporting period.	The total amount of insurance deductibles and co-pays paid on behalf of the client, including all Medicare Part D deductibles and co-pays. The amount reported should be based on the date that the deductible or co-pay was paid.	$$$	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?	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

Field #	Variable Description	Variable definition	Allowed Values	Rationale
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.
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	##	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.	$$	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.	Value: ####	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.	Value: ####	To determine the impact of ADAP-funded medications

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