Presentation is loading. Please wait.

Presentation is loading. Please wait.

P S PB COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE SPECIAL PHARMACEUTICAL BENEFITS PROGRAM.

Published byPhilomena Boyd Modified over 8 years ago

Similar presentations

Presentation on theme: "P S PB COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE SPECIAL PHARMACEUTICAL BENEFITS PROGRAM."— Presentation transcript:

1

2 P S PB COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE SPECIAL PHARMACEUTICAL BENEFITS PROGRAM

3 What is the SPBP? A state and federally funded drug assistance program for low and moderate income individuals and families that pays for specific drug therapies for the treatment of persons living with HIV/AIDS or a DSM IV diagnosis for schizophrenia.

4 S PECIAL P HARMACEUTICAL B ENEFITS P ROGRAM S P B P SPBP/ADAP ADAP/SPBP REMEMBER IN MOST OTHER STATES THIS PROGRAM IS CALLED AIDS DRUG ASSISTANCE PROGRAM ADAP IN PENNSYLVANIA IT IS CALLED THE SPECIAL PHARMACEUTICAL BENEFITS PROGRAM SPBP COVERS DRUGS FOR HIV/AIDS AND SCHIZOPHRENIA

5 Recent Developments Annual Re-Certification Current vs New Process Medicare Part D Pennsylvania Participating Plans

6 WHAT ARE THE CRITERIA FOR RE-CERTIFICATION TO SPBP? RESIDENCE APPLICANTS MUST BE A RESIDENT OF THE COMMONWEALTH NOT INSTITUTIONALIZED INCOME THE CURRENT CEILING IS $30k WITH A FAMILY ALLOWANCE SOCIAL SECURITY NUMBER CLIENT INFO ALREADY ON FILE NOT NECESSARY MEDICAL NEED APPLICANTS DIAGNOSIS CONFIRMED IN PAST

7 SUPPORTING DOCUMENTATION EACH APPLICATION MUST INCLUDE SUPPORTING DOCUMENTATION. CLIENTS ARE RESPONSIBLE FOR PROVIDING CLEAR and LEGIBLE PHOTOCOPIES OF SUPPORTING DOCUMENTS FOR THE CRITERIA

8 RESIDENCE APPLICANTS MUST PROVIDE DOCUMENTATION SHOWING PROOF OF RESIDENCY IN PENNSYLVANIA EXAMPLES OF SUPPORTING DOCUMENTATION: UTILITY BILLS CABLE TV BILLS DRIVER’S LICENSE BANK STATEMENT SOCIAL SECURITY OR UNEMPLOYMENT AWARD LETTERS WRITTEN VERIFICATION FROM FAMILY MEMBERS, PARTNERS, HOMELESS SHELTERS, ETC. THE ADDRESS ON SUPPORTING DOCUMENTATION MUST MATCH THE ADDRESS ON THE APPLICATION

9 INCOME APPLICANTS MUST PROVIDE DOCUMENTATION SHOWING PROOF OF INCOME. INCOME CRITERIA IS BASED ON GROSS AMOUNT. CURRENTLY, THE CEILING IS $30,000 FOR INDIVIDUALS AND AN ALLOWANCE OF $2,480 FOR APPLICABLE FAMILY MEMBERS. FAMILY is defined on the application. EXAMPLES OF SUPPORTING DOCUMENTATION CURRENT PAY STUBS A LETTER FROM EMPLOYER(S) SOCIAL SECURITY OR UMEMPLOYMENT AWARD LETTER LEDGER SHEETS FROM AN ACCOUNTANT IN SOME CASES, INCOME TAX RECORDS SELF EMPLOYEED INDIVIDUALS MUST PROVIDE FINANCIAL INFORMATION THAT INCLUDES INCOME RECORDS 90 DAYS PRIOR TO THE DATE OF APPLICATION TO THE SPBP

10 WHAT IF THERE IS $0 INCOME ? The application will be determined pending and the applicant will be sent a letter to provide SPBP staff with a letter detailing how daily needs are being met. For example, if a client’s friends, family, partner or homeless shelter is providing support, that information should be indicated in a letter sent with the application.

11 STATUS APPROVED: CLIENT IS SENT A LETTER WITH AN ELEGIBILITY CARD ATTACHED PENDING: CLIENT IS SENT A LETTER WITH INSTRUCTIONS TO SUBMIT MISSING DOCUMENTATION DENIED: CLIENT IS SENT A LETTER EXPLAINING WHY THE APPLICATION IS DENIED AND INSTRUCTED TO REAPPLY IF CIRCUMSTANCES CHANGE NOTE: CASE MANAGERS, SOCIAL WORKERS, ET AL. DO NOT RECEIVE COPIES OF THIS INFORMATION (PLEASE ASK YOUR CLIENT)

12 ABILIFY CLOZARIL GEODON RISPERDAL SEROQUEL ZYPREXA SPBP MH Covered Drugs

13 Client Name and SPBP ID Number

14

15 Medicare PART D Plans 12 Plans 1.AmeriHealth Advantage 2.First Health Premier 3.Humana Standard 4.Humana Enhanced 5.Highmark BlueRX Plus 6.Memberhealth Comm Care RX Basic 7.Ovations United Health RX Basic 8.Ovations AARP Medicare RX Saver 9.Ovations AARP Medicare RX 10.Elder Health Bravo RX II 11.Geisinger Gold RX 12.UPMC for Life PDP Participating Plans are those that have made special agreements with the state of PA to accept payment of premiums for clients that are enrolled in PA servicing programs, i.e. SPBP and PACE clients Partnering Plans are also referred to as PA Participating Plans Why 12 Specific Plans??? Cost Effectiveness Monitoring is More Manageable Controlled # of Plans Ensures Seamless Coordination of Benefits for Clients

16 Premium Payments SPBP Notification from Clients –Clients need to notify SPBP of what Part D plan they have chosen –SPBP contacts claim processor and claim processor contacts plan –Premium payments paid by SPBP

17 CONTACT US ! SPBP: TOLL FREE IN STATE 1.800.922.9384 SPBP ADDRESS: P.O. BOX 8021 HARRISBURG, PA. 17105-8021 www.dpw.state.pa.us/omapwww.dpw.state.pa.us/omap: Click on HIV/AIDS Information click Special Pharmaceutical Benefits Program (SPBP) HIV Drugs or Clozaril Program Click SPBP Program Application with bolded area Atypical Antipsychotic Medication and printout SPBP Email: spbp@state.pa.us@state.pa.us John Folby, AdminDaneen Williams/Santos Osario, Coordinators Brenda Mitchell, SPBP Assistant Any Office of Medical Assistance Pgm inquiries pamedicaid@state.pa.us@state.pa.us Medicare Questions: 1-800-633-4227www.medicare.govwww.medicare.gov

Download ppt "P S PB COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE SPECIAL PHARMACEUTICAL BENEFITS PROGRAM."

Similar presentations

Illinois Cares Rx What Happens Behind the Scenes.

Illinois Cares Rx What Happens Behind the Scenes.
Merinda Brown. Kentucky Health Insurance Continuation Program Administrator. Mahri Bahati. Kentucky ADAP Coordinator.

Merinda Brown. Kentucky Health Insurance Continuation Program Administrator. Mahri Bahati. Kentucky ADAP Coordinator.
DHS Family and Community Support Center Prevention Assistance Fund Patricia Erwin-Blue Michelle Wylie-Williams John Bowen Rich Kirschner February 2013.

DHS Family and Community Support Center Prevention Assistance Fund Patricia Erwin-Blue Michelle Wylie-Williams John Bowen Rich Kirschner February 2013.
The Health Insurance Portability and Accountability Act of 1996– charged the Department of Health and Human Services (DHHS) with creating health information.

The Health Insurance Portability and Accountability Act of 1996– charged the Department of Health and Human Services (DHHS) with creating health information.
New York State EPIC Program January 2012 Changes.

New York State EPIC Program January 2012 Changes.
Employee Insurance Program Dependent Audit May 1, 2011 Laura Caldwell, Benefits Administrator.

Employee Insurance Program Dependent Audit May 1, 2011 Laura Caldwell, Benefits Administrator.
Presented by: Thomas Murphy Harvard University Employees Credit Union Medical School Loan Repayment & Building Credit PARTNERS OFFICE of RESOURCES for.

Presented by: Thomas Murphy Harvard University Employees Credit Union Medical School Loan Repayment & Building Credit PARTNERS OFFICE of RESOURCES for.
14507PPT(8/09) What they are and how to exercise them at The Standard Future Purchase Options For producer use only. Not for use with consumers.

14507PPT(8/09) What they are and how to exercise them at The Standard Future Purchase Options For producer use only. Not for use with consumers.
1.13.1.G Personal Finance. 1.13.1.G  Almost 31% of an individual’s paycheck is deducted  Taxes are the largest expense most individuals will have 

G Personal Finance G  Almost 31% of an individual’s paycheck is deducted  Taxes are the largest expense most individuals will have 
Welcome to P.A.S.S. People Advantage Self Service March 1, 2007.

Welcome to P.A.S.S. People Advantage Self Service March 1, 2007.
The Evolving Role of States in the Medicare Drug Benefit Thomas M. Snedden, Director Pennsylvania PACE Program The Third National Medicare Congress October.

The Evolving Role of States in the Medicare Drug Benefit Thomas M. Snedden, Director Pennsylvania PACE Program The Third National Medicare Congress October.
Group Name Plan Year : 1/1/11-12/31/11. Find and Replace ( to be edited) Getting Started: Enrollment presentations can be shown to your employees to help.

Group Name Plan Year : 1/1/11-12/31/11. Find and Replace ( to be edited) Getting Started: Enrollment presentations can be shown to your employees to help.
Affordable Housing Production Program Inclusionary Housing.

Affordable Housing Production Program Inclusionary Housing.
Affordable Housing Production Program Inclusionary Housing.

Affordable Housing Production Program Inclusionary Housing.
Paying for college Financial aid overview 2014-2015.

Paying for college Financial aid overview
8/8/2015 Charges for Community Based Services. 8/8/2015 Introduction Purpose is to establish a uniform fee collection policy that: Is equitable Provides.

8/8/2015 Charges for Community Based Services. 8/8/2015 Introduction Purpose is to establish a uniform fee collection policy that: Is equitable Provides.
2009-2010 FINANCIAL AID APPLICATION PROCESS Six Steps to Financial Aid.

FINANCIAL AID APPLICATION PROCESS Six Steps to Financial Aid.
IP Enrollment Process. Insure Oklahoma vs. SoonerCare IO is a limited benefit package. Applicants are responsible for a monthly premium. Premiums range.

IP Enrollment Process. Insure Oklahoma vs. SoonerCare IO is a limited benefit package. Applicants are responsible for a monthly premium. Premiums range.
N EXT S TEPS TO C OMPLETE THE F INANCIAL A ID P ROCESS 2012 Parent Programs.

N EXT S TEPS TO C OMPLETE THE F INANCIAL A ID P ROCESS 2012 Parent Programs.
Florida ranks 3 rd in U.S. for the number of uninsured children. 42% of Florida’s children live in families 200% under FPL 40% of these are uninsured.

Florida ranks 3 rd in U.S. for the number of uninsured children. 42% of Florida’s children live in families 200% under FPL 40% of these are uninsured.

Similar presentations

Ads by Google