New Mexico
AIDS
InfoNet Fact
Sheet Number 351
in Care
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NM 87106 (505) 272-2554 |
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2211 Lomas Blvd. NE Albuquerque,|
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PrintWHAT IS THE RYAN WHITE PARTNERS IN CARE (RW/PIC) PROGRAM?
The Partners in Care Program is funded by Title III of the Public
Health Service, allowing University Hospital to provide primary
health care services to enrolled HIV-positive individuals who
reside in New Mexico.
WHAT IS CONSIDERED A PRIMARY CARE SERVICE?
For purposes of reimbursement through this program, primary care
services include doctor/ clinic visits, HIV+ related laboratory
tests, x-rays, vaccinations, certain medications and various specialized
procedures. For a complete list of covered services, contact the
RW/PIC Program.
WHO DETERMINES WHICH SERVICES ARE COVERED?
University Hospital and the Ryan White/ Partners in Care Medical
Director determine which services are covered based on recommendations
from both a Community Advisory Board and a Medical Advisory Board.
WILL RW/PIC PAY FOR MY MEDICATIONS?
Only if the medications are covered by the program, and you are
not eligible for the state medication program.
WILL RW/PIC PAY FOR ALL MY HEALTH CARE?
No, only certain services are covered, and there is a maximum
level for reimbursements. Emergency services and inpatient care
are not covered.
WHAT IF I HAVE HEALTH INSURANCE?
The RW/PIC program is a “payor of last resort.” This
means that if you have insurance of any kind, it must be billed
first. RW/PIC will then review and reimburse the provider, according
to the program’s fee schedule, for services denied by insurance.
The program will not pay outstanding balances unpaid by insurance.
WHAT ARE THE COSTS TO ME?
At the time of enrollment, your income will be reviewed in order
to determine a monthly co-payment, according to federal poverty
guide’ lines. Depending on your income you may or may not have
to pay a co-payment for services.
IF I DO HAVE A CO-PAYMENT, HOW DO I PAY IT?
Your monthly co-payment should be made to your provider at the
time you first receive services in any given month. The RW/PIC
Program cannot accept co-payments.
CAN YOU BE DENIED ENROLLMENT BASED ON INCOME?
No, there is no requirement regarding your earned income. If your
income is above poverty guidelines you will be assessed a co-payment.
MAY I CONTINUE TO SEE MY OWN DOCTOR/HEALTH CARE PROFESSIONALS?
The RW/PIC Program may only reimburse providers who have contracted
with the program. Currently, 60 clinical providers in 22 New Mexico
counties have contracted with the RW/PIC Program. Laboratories
and Pharmacies serve all counties statewide. Providers are added
on a continuing basis. You may call the office to confirm the
status of your providers.
CAN I BE REIMBURSED DIRECTLY?
No, if you receive your care from a contracted provider, there
will be no reason for you to pay for your health care services,
provided these services are covered by the program. At the time
of enrollment, you will be given a letter confirming your enrollment
in the program which may be presented to your health care provider.
There should be no out~of~pocket costs to you, other than your
co-payment, if you have one.
HOW DO YOU SELECT PROVIDERS FOR THE PROGRAM?
Providers are selected through a number of avenues. Some contact
us directly, others are referred by public and private agencies
and many become providers at the request of clients.
WHO IS ELIGIBLE FOR THIS PROGRAM?
Any resident of New Mexico who is HIV+.
HOW DO I ENROLL?
You need to complete a New Mexico A.C.C.E.S.S. form and provide
proof of income. You may obtain these forms from RW/PIC Program
staff, or your case manager. From the date we receive all necessary
information, you will be covered through the program. The dates
of the coverage will be stated in your authorization letter.
ONCE I ENROLL HOW LONG WILL I BE COVERED?
For one year. You must re-enroll each year, providing up-to-date
income verification. Program staff will notify both yourself and
your case manager when re-enrollment is necessary.
HOW MANY CLIENTS ARE SERVED BY THE RW/PIC PROGRAM?
During 1997, 829 total clients were served through this program.
IF I HAVE QUESTIONS, WHO DO I CALL?
The RW/PIC office is open from 8 AM to 5 PM, Monday through Friday.
The phone number is 272-2554. After hours, you may leave
a voice message, and someone will return your call the next business
day.
Revised March 30, 1998
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and the New Mexico Department of Health