Y22-115_Exhibit_3_Orlando_EMA_Ryan_White_Program_Allowable_Medical_Conditions_List.pdf

Ryan White Part A Program Service Delivery Guidelines Fiscal

Year 2021 - 2022

Allowable Medical Conditions List

Orlando Eligible Metropolitan Area

Effective August 2018

Orlando EMA Ryan White Program Allowable Medical Conditions List

These conditions are related to or exacerbated by HIV, comorbidities related to HIV, and complications of HIV treatment.

This list is intended to address the federal Health Resources and Services Administration’s requirement that services provided through outpatient medical care be related to an individual’s HIV status. This list was created to assist medical providers with specialty care referrals and to emphasize the importance of documenting the link between an individual’s HIV status and the specialty care service to which a client is referred. This list is a guideline to be used in the Orlando EMA’s Ryan White Part A/Minority AIDS Initiative Program of the most common conditions exacerbated or caused by HIV or its treatment.

Routine medical diagnostic testing (e.g., Pap smear, mammogram, bone density test, colonoscopy, colorectal cancer screening, and ophthalmologic screening) is allowable as long as such testing follows established medical guidelines, such as U.S. Public Health Services (PHS), American Medical Association, Health Resources and Services Administration (HRSA), or other local guidelines, as a standard of care.

When provided in an outpatient setting, labs, diagnostics and treatments related to HIV, as indicated above, including complications of HIV treatment related to the following conditions may be covered:

CARDIOLOGY:

Atherosclerosis Coronary artery disease (angina, myocardial infarction) Hyperlipidemia Arrhythmias Endocarditis Congestive Heart Failure

CHIROPRACTIC/PHYSICAL MEDICINE:

Peripheral neuropathy Rheumatic diseases Osteopenia/osteoporosis Avascular necrosis (Stage 1 or 2 only) Chronic myopathy/myalgia, HIV related Chronic arthralgia, HIV related IMPORTANT NOTE: According to CDC, chronic pain is defined as pain having duration of at least three months. Chronic pain is considered a co-morbidity of HIV. This may also contribute to the depression with pain comorbidity complex (DPC). Treatment of acute pain is not covered.

COLORECTAL:

Abnormal anal Pap smears Anal cancers Fistulas Hernias Anal Condylomas Anal fissure Proctitis

DENTAL (ORAL HEALTH CARE):

Human papillomavirus associated oral lesions Giant aphthous ulcers Oral cancers Dental cancers

DERMATOLOGY:

Skin conditions and symptoms, including skin appendages and oral mucosa Dermatitis (including tinea infections) Eczema/seborrheic dermatitis Eosinophilic folliculitis Herpes simplex virus Herpes Zoster Kaposi’s sarcoma Molluscum contagiosum Onychomycosis Photodermatitis Pruritus (as a symptom of undiagnosed xerosis, psoriasis, scabies, lymphoma, etc.)

Psoriasis Abscess Skin cancers (squamous cell carcinoma, etc.)

Warts Lymphadenitis

EAR, NOSE AND THROAT (ENT)/OTOLARYNGOLOGY:

Chronic sinusitis Oral human papillomavirus Oral Cancers Dental cancers Hearing loss/tinnitus HPV lesions on vocal cords

ENDOCRINOLOGY:

Hypothyroidism Hyperthyroidism Hyperparathyroidism Diabetes Hypogonadism Adrenal Insufficiency

GASTROINTESTINAL:

Colitis (Syphilitic colitis- very rare) Diarrhea Esophageal candidiasis Nausea/vomiting HIV related malabsorption syndrome

GENITOURINARY (GU)/ GYNECOLOGY (GYN):

Abnormal Pap smear Cervical human papillomavirus Erectile dysfunction (IMPORTANT NOTE: the local Ryan White Part A/MAI Program will only pay for evaluation and diagnostics of erectile dysfunction; but the treatment of erectile dysfunction is not covered by the local Ryan White Part A/MAI Program.)

Hematuria (related to neoplasms) Tinea cruris (jock itch) or scrotal candidiasis Vaginal candidiasis Gynecological cancers Orchitis Epididymitis Prostatitis GU Condylomas Hematospermia Circumcision

HEMATOLOGY/ONCOLOGY:

Anemia Kaposi’s sarcoma Lymphoma Polycythemia vera Thrombocytopenia Neutropenia Leukopenia

INFECTIOUS DISEASE:

Herpes simples infections (1 and especially type 2), varicella zoster infections, non-tuberculous Mycobacterial infections Histoplasmosis Leishmaniasis Syphilis Tuberculosis Viral hepatitis (hepatitis B and C) Cryptococcal infection Coccidiomycosis Aspergillosis Cytomegalovirus Toxoplasmosis Bartonella Infection

NEPHROLOGY:

Human immunodeficiency virus-associated nephropathy Renal failure (may be related to coronary artery disease induced by HIV or diabetes mellitus induced by HIV, etc.)

HAART therapy induced nephropathies

NEUROLOGY:

Delirium HIV associated neurocognitive disorder (HAND)1 HIV related encephalopathy Neurosyphilis Neuropathy Primary CNS Lymphoma Organic Brain Syndrome HIV Related Dementia

NUTRITION:

Lipodystrophy Wasting Weight gain Weight loss

OPHTHALMOLOGY/OPTOMETRY:

IMPORTANT NOTE: The local Ryan White Part A/MAI Program will only pay for evaluation and diagnosis for HIV-related eye problems/complications and limited corrective lenses. Referrals must indicate a condition attempting to rule out complications of HIV. The Ryan White Program will not pay for contact lenses exam or contact lenses. Please contact the local Ryan White Part A Program office for a detailed list of covered frames and lenses.

Conjunctivitis Retinitis Choroiditis Uvietis Ocular Herpes Zoster Retinopathies

ORTHOPEDICS/RHEUMATOLOGY:

Avascular necrosis of hip, knee, etc.

Osteopenia/osteoporosis HIV- related myopathy/myalgia HIV- related rheumatic diseases

PODIATRY:

Foot and ankle (IMPORTANT NOTE: The local Ryan White Part A/MAI Program will only pay for diagnostic evaluation of foot and ankle pain. Conditions such as hammer toes, bunions, heels spurs may be covered if related to neuropathies. Sprains or fractures are not covered unless a direct connection to neuropathies is present.)

Diabetic foot care Onychomycosis

PULMONARY:

Mycobacterium Pneumocystis pneumonia Recurrent pneumonia Tuberculosis

RADIOLOGY:

Radiology would be approved as pertaining to the conditions listed on the guidelines and must be related to HIV diagnosis or co-morbidity.