PURPOSE: This rule establishes the requirements for assistance from the HIV/AIDS Medications Program.

1. (1) Clients may be admitted to the program at any stage of human immunodeficiency virus
2. (HIV) infection. Participation is voluntary.

3. (2) Individuals will be enrolled in the medications program only pursuant to available funding, as delineated in 19 CSR 40-13.020. Pursuant to these restrictions, an individual may be eligible if s/he meets the following criteria:

   1. (A) Is a Missouri resident;
   2. (B) Is not incarcerated nor an inpatient in a licensed heath care facility;
   3. (C) Is HIV infected and has provided written medical evidence of HIV status to a service coordinator;
   4. (D) Is enrolled in the service coordination program, which includes: providing documentation of his/her income, signing the department*s Health Service Coordination Evaluation/Assessment form, signing a Release of Information form for medical records, and granting the department permission to use his/her name in discussing the case with a physician, pharmacist, service provider, social or case worker, or other person or agency involved in the case;
   5. (E) Has an income at or below one hundred eighty-five percent (185%) of the federal poverty standard published annually in the Federal Register by the U.S. Department of Health and Human Services; and
   6. (F) Is ineligible for medications assistance from other sources such as private insurance or Medicaid. Medicaid spenddown clients may enroll in the general medications program, but not the specialty medications programs.

4. (3) Individuals will be enrolled in specialty medication programs only pursuant to available funding as delineated in 19 CSR 40- 13.020. Pursuant to these restrictions, an individual may be eligible for specialty medications if s/he meets the following criteria:

   1. (A) All eligibility requirements as stated under 19 CSR 40-13.030(2).
   2. (B) Has submitted a completed physician referral form and a client participation agreement, as supplied by the department.
5. (4) Individuals may be automatically eligible for general or specialty medications programs if they meet all eligibility requirements as specified in 19 CSR 40-13.030(2) and currently receive the applicable medications pursuant to a benefit package under a Ryan White Title II Consortium.

AUTHORITY: sections 191.650–191.698, 192.006, 192.020, 192.025 and Chapter 213, RSMo (1994) and (Cum. Supp. 1996).* Emergency rule filed Nov. 21, 1996, effective Dec. 1, 1996, expired May 29, 1997. Original rule filed Dec. 10, 1996, effective May 30, 1997. *Original authority: 191.650–191.698 see Missouri Revised Statutes 1994 and Cum. Supp. 1996; 192.006, RSMo (1993), amended 1995; 192.020, RSMo (1939), amended 1945, 1951; 192.025, RSMo (1951); and Chapter 213, see Missouri Revised Statutes 1994 and Cum. Supp. 1966.