• Medicare Part D  Effective 4/1/10
• Pharmacy Policy Effective 4/1/10
• ADAP Formulary and HPCSWF Formulary (in addition to ADAP Formulary)
• Health Insurance Policy  Effective 4/1/10
• Authorization Request  and Services Matrix  
• Dental Policy and Fee Schedule Effective 4/1/10
• Exceptions Policy  Effective 4/1/10
• End of the Year Policy  Effective 4/1/10
• Mental Health Policy  Effective 4/1/10
• Substance Abuse Policy Effective 4/1/10
• Transportation Policy 
• Food Policy and Food Referral Form  Effective 4/1/10
• Ambulatory Medical and Case Management Policy 
• Invoicing Process 
• AICP Process Policy 
• RW and HOPWA Reporting Policy 
• HOPWA Payment Policy 
• State HOPWA Program Guidelines (Guidelines Section Only) 
• Local HOPWA Implementation Policies 
• HUD - Fair Market Rent Values
• 2008/2009 Poverty Guidelines 

Forms & Reports
The following are forms and reporting tools for the medical and housing assistance programs:

• MIP Assignment/Update Form Effective 4/1/10
• Request for Authorization Form
• Case Management FTE Verification 
• HOPWA Request for Assistance 
• Landlord / Mortgage Holder Agreement  
• FTTY Report (blank in MS Excel with calculations)
• Quarterly Scorecard - Updated
• IRS W-9 form for all vendors to be paid by HPCSWF
• Enhanced W-9 Form 
• 2009 AICP Application Packet - Effective May 2009
• AICP Special Services Application - Effective May 2009
• AICP Application Checklist - Effective May 2009
• AICP Memo of Confidentiality - Effective May 2009
• AICP Client's Rights and Responsibilities - Effective May 2009
• AICP Assignment of Pro Rata Refund - Effective May 2009
• AICP Fax Consent - Effective May 2009
• AICP Medicaid Release - Effective May 2009
• AICP Physician Form - Effective May 2009
• AICP Data Collection Form - Effective May 2009
• AICP Decision Path - Effective May 2009
• Notice of RW Eligibility Rule for AICP   (all in one PDF file)
• AWAPP Application 
• HOPWA Utility/Rent Deposit Agreement 
• HOPWA Shelter Verification Form
• HUD/HOPWA Fair Market Values 2009

 
 New Florida HIV/AIDS Patient Care Program Eligibility Forms

• Applicant Survey 
• Amended Rule 64D-4 Memo
• Eligibility Assessment Worksheet 
• No Change Certification 
• Notice of Eligibility 
• Notice of Ineligibility 
• Notice of Rights
• Redetermination Notice of Eligibility 
• Redetermination Notice of Ineligibility 
• Request for Exception   
• Electronic Application Form, Form Instructions, and PDF Application 
• 2008/2009 Poverty Levels 
• Six-Month Recertification Review Form 
• Summary of Operational Procedures for Eligibilty Determination 
• DH 3204 Initiation of Services
• DH 3204 Instruction Sheet
• DH 3203 Authorization To Disclose Confidential Information 
  

Other forms will be added as they are reviewed, updated and approved.

Surveys  

There is a client satisfaction requirement for all RWII and HOPWA providers. The policy for administrating, returning and reporting the surveys is attached along with the survey tools

• Client Satisfaction Policy 

   
• HOPWA Client Satisfaction Survey 
• RW Medical Satisfaction Survey  New
• RW Case Management Satisfaction Survey  New
• RW General Satisfaction Survey    New
  
  2010 Florida Ryan White Anonymous Needs Survey: