Documents

Important Early Intervention Program (EIP) documents are listed here alphabetically for your convenience. The Early Intervention Program is also known as the EIP Program and is also the Washington State AIDS Drug Assistance Program (ADAP).

Unless otherwise noted, all materials and forms on this page are in PDF format.

Links to external resources are provided as a public service and do not imply endorsement by the Washington State Department of Health.

Antiretroviral Verification Form
(85KB) Form to verify HIV postitive status and antiretroviral therapy - April 2012.

Antiretroviral Verification Form - Spanish
(72KB) verify HIV postitive status and antiretroviral therapy - April 2012.

Application - English
(84KB) Application for EIP Program - April 2012.

Application - Spanish
(92KB) Application for EIP Program in Spanish - April 2012.

Application ID Card
Instructions and explanation for EIP Medical ID Card.

Application Instructions - English
(93KB) Application instructions for EIP Program - April 2012.

Application Instructions - Spanish
(97KB) Application instructions for EIP Program in Spanish - April 2012.

Billing Code Information
(84KB) Message code (EOB) description and or instruction.

Billing & Claims Frequently Asked Questions
(84KB) Explanation of Some Billing Processes in Question & Answer Format.

Billing Manual for Providers
(40KB) Manual with Instructions, Rules & Procedures for Medical, Laboratory & Dental Billing.

Client Services Quarterly Update - Link to webpage.

Contract for EIP Providers (N18154)
(139KB) Instructions & Paperwork for EIP Provider Contract N18154. October 2011

Contract FAQ for EIP Providers
(31KB) Frequently Asked Questions for EIP Provider Contract.

Cost Share Schedule - Federal Poverty Level- English - 2011
(148KB) Chart Showing 2011 Federal Poverty Level Schedule & Cost Share Information.

Cost Share Schedule- Federal Poverty Level - Spanish - 2011
(148KB) Chart Showing 2011 Federal Poverty Level Schedule & Cost Share Information - in Spanish.

Covered Services for Group 1 EIP Clients
(158KB) Chart of covered services for Group 1 including code, description and maximum payment. Providers must have a contract with DOH prior to services. Clients must be approved fro EIP by DOH prior to services.

Covered Services for Group 2 EIP Clients
(96KB) Chart of covered services for Group 2 including code, description and maximum payment. Providers must have a contract with DOH prior to services. Clients must be approved fro EIP by DOH prior to services.

Covered Services for Group 3 EIP Clients
(71KB) Chart of covered services for Group 3 including code, description and maximum payment. Providers must have a contract with DOH prior to services. Clients must be approved fro EIP by DOH prior to services.

Dental Providers
(39KB) Chart of EIP Dental Providers with Name, Address, Phone Numbers & More.

EIP Medical Provider List 2011
(134KB) EIP Medical Providers with Name, Address, Phone Numbers & More.

Formulary for EIP Clients in Groups 1 & 3 - Link to webpage
Link to PDF document listing preferred generic and brand name drugs for clients in groups 1 & 3.

Formulary for EIP Clients in Group 2 -Link to webpage
Link to PDF document listing preferred generic and brand name drugs for clients in group 2.

Mental Health Providers
(42KB) EIP Mental Health Providers Contact Information.

Letter to Clients - Changes to the EIP Program
(105KB) Effective January 1, 2011.

Letter to Clients - Changes to the EIP Program - Spanish
(107KB) Effective January 1, 2011.

Prescription Spenddown Receipt
(55KB) Form for Client & Pharmacist for Prescription Medication Spendowns.

Ramsell Card
Ramsell Pharmacy Benefit Prescription Drug Card Instructions.

Ryan White Part B Comprehensive Plan 2009-2011
(415KB) Three Year Plan to Continue to Improve Quality & Accountability & Ensure Access to Care for Persons Living with HIV in Washington State.

Statewide Coordinated Statement of Need
(189KB) Report From the Washington State 2008 Workgroup for the Statewide Coordinated Statement of Need.

Statewide Standards for Medical HIV Case Management
(2.5MB) Manual Describing Standards for Medical HIV Case Management for Washington State, 2011.

Steering Committee Meeting Minutes - Link to webpage.

Steering Committee Packets - Link to webpage.

Title XIX (Medicaid) HIV/AIDS Case Management- Link to Department of Health and Social Services document.
(72KB) Department of Health & Department of Social & Health Services Billing Instructions for Title XIX (Medicaid) HIV/AIDS Case Management, 2010.