Routine screening and confirmatory testing for syphilis, HIV, hepatitis C virus that is otherwise not covered by a third-party payor or patient can be covered by this funding. Specifically, the following tests would be covered:

• Syphilis: TPA, TPPA, TPHA, FTA-ABS, EIA, CIA, and RPR
• HIV: HIV 1&2 antigen/antibody tests, HIV 1&2 antibody tests (aka HIV 1&2 differentiation tests) and HIV NAAT and/or HIV Viral load by RNA PCR, HIV genotype testing
• Hepatitis C: HCV antibody, HCV RNA (quantitative or qualitative), HCV genotype testing

Coverage policies may vary by payer, patient demographics, symptoms, risk factors, and state and federal law. EDs implementing opt-out testing for syphilis, HIV and/or HCV have typically been able to get opt-out screening covered by patient insurance. CDPH and PHI/Bridge may be able to provide Technical Assistance on these questions to funded grantees as needed. 

USPSTF recommendations on frequency of routine testing are sometimes helpful to guide EDs, but there is no consensus from USPSTF, CDC, or other entities on frequency of routine screening. Most EDs have to make a decision based on local incidence and population at risk. Implementing an EHR screening algorithm that identifies folks (in part based on last available test in the EHR system) can simplify identification of individuals for screening.

These tests will be billed to third party payors based on your hospital’s billing protocol (i.e., to the third-party payor, or to the patient who then has to submit to their insurance). Grant funds may be used for unrecoverable costs of tests including for patients who are under or uninsured.

The FAQ Use of Funds section states funds may be used to defray unrecoverable costs of tests; tests will be authorized and performed at the independent medical discretion of the site. Unrecoverable costs of tests are the costs that the site incurs in the administration of tests and treatment that cannot be reasonably paid by the patient, insurance, or a responsible third party.

A budget is not required for this application or this program. As a fixed-price deliverables-based agreement, PHI/Bridge does not require a budget. It is up to the hospital to ensure they use the funding to meet the milestones and deliverables of the agreement.

This is a fixed-price deliverables-based agreement. PHI/Bridge does not limit the indirect cost rate. It is the responsibility of the hospital to ensure they use the funding to meet the deliverables of the agreement. 

No, EDSP funding cannot be used to support HIV test counselor certification. 

Yes, the FAQ Use of Funds section lists personnel (salary and benefits) under allowable expenses. Funds can support expenses necessary for the hospital to meet EDSP deliverables as long as they are allowable, including members of the team and laboratory supporting the program. 

Navigator Supplemental Funding is for an additional 1.0 FTE navigator over the grant period and can be used to expand patient navigation hours and/or coverage. Hospitals should request supplemental funds only if they cannot implement the program without this additional capacity and do not have another funding source to cover additional navigator(s).

Per recent guidance from CDPH, funds cannot be used for out of state travel. In-state travel is only allowable if it supports the deliverables of the agreement.

PHI/Bridge is retaining 12.5% or $1.875M of the total $15M allocation for program operations, which includes development and management of the RFA, application, and application process support. In addition, PHI/Bridge will oversee agreement development and management with the awarded hospitals, deliverables tracking, and payment processing over the 30-month period. PHI/Bridge will also provide training and technical assistance to selected hospitals. Of the $1.875M retained for program operations, $850K will be for training and technical assistance and the remaining $1.025M will be for other operations activities and PHI indirect cost rate.

EDs implementing opt-out testing for syphilis, HIV and/or HCV have very rarely reported any issues with insurance denials on these tests. In fact, some hospital labs have shared they generate income when they perform and bill for these routine tests. However, routine screening and confirmatory testing for syphilis, HIV, and HCV that is otherwise not covered by a third-party payor or patient can be covered by this funding. See the Use of Funds FAQ section for more information. 

In terms of capitated billing rates, some EDs have reached out to their Medicaid Managed Care Plan to explore options to negotiate their capitated case rate agreement.

Ultimately, implementing a syphilis, HIV, and HCV screening program can be a cost-effective strategy to increase patient participation in care, decrease care barriers, and increase receipt of appropriate treatment, thereby reducing morbidity, mortality, disease progression, and ED utilization.