Ryan White Part B Documents

Universal Eligibility and Enrollment Forms

• 18-04a Universal Eligibility Application- Brand New Client Packet (PDF)
• 18-04a Universal Eligibility Application- Brand New Client Packet Español (Cliente Completamente Nuevo) (PDF)
• 18-05a Universal Eligibility Application- Annual Client Packet (PDF)
• 18-05a Universal Eligibility Application- Annual Client Packet Español (Revisión del Cliente Annual (PDF)
• 18-06a Universal Six Month Self-Attestation Packet (PDF)
• 18-06a Universal Six Month Self Attestation- Español (Auto‐Afirmación de Seis Meses) (PDF)
• 19-08 Dental Insurance Form (PDF)
• 19-08A Dental Enrollment Primer (PDF)
• 21-01 Dental Insurance Referral Procedure (PDF)

Common Guidance

• 16-04 Profit and Loss Statement Proof of Income (PDF)
• 16-08 Primer on CAREWare Notes (PDF)
• 16-11 Payer of Last Resort Exemptions (PDF)
• 17-05 Primer on Labs (PDF)
• 17-06 Grievance Protocol Guidance (PDF)
• 18-01 Nevada Ryan White Part B Guidelines – Federal Poverty Level (PDF)
  • 2022 Federal Poverty Level 
  • Prior HHS Federal Poverty Levels
• 19-02 Referrals for Medication or Insurance Assistance (PDF)
• 20-20 Payer of Last Resort Policy (PDF)
• Universal Eligibility Manual 2021 (PDF)
• 22-01 Vital Status Request Policy (PDF)
  • Vital Status Request Form (PDF)
• Universal Eligibility PowerPoint 2022 (PPTX)

Service Standards

• 15-04 SS Early Intervention Services (PDF)
• 15-06 SS Medical Case Management (PDF)
• 15-07 SS Non-Medical Case Management (PDF)
• 15-08 SS Health Education/Risk Reduction (PDF)
• 15-10 SS Legal Services (PDF)
• 15-11 SS Medical Transportation Services (PDF)
• 15-11 SS Addendum – Medical Transportation Services (PDF)
• 15-13 SS Psychosocial Support Services (PDF)
• 15-15 SS Referral to Healthcare and Support Services (PDF)
• 15-16 SS Mental Health Services (PDF)
• 16-23 SS Service Standards Approval (PDF)
• 17-11 SS Housing Services (PDF)
• 19-03 SS Medical Nutritional Therapy Service Standards (PDF)
• 19-04 SS Addendum – Food Bank/Home Delivered Meals (PDF)

Sub-Recipient List

• GY22-23 Sub-Recipient List – April 1, 2022 through March 31, 2023 (PDF)

Monitoring Visit Information

• • 17-12 Annual Site Visit Policy (PDF)
  • 17-13 Site Visit Cover Page (PDF)
  • Programmatic, Administrative and Fiscal Policies Checklist
  • Programmatic, Administrative and Fiscal Policies Checklist FAQ
  • 17-18 Site Visit Corrective Action Plan Form (PDF)
  • 17-19 Technical Assistance Request Form (PDF)

Service Taxonomies

• April 1, 2021 – March 31, 2022 (XLSX)

Ryan White Part B Archives

• 2021 RSR Subrecipient Timeline (PPTX)
• 2020 RSR Subrecipient Timeline (PDF)
• 17-XX Site Visit Survey
  • Retired 01/21/2021 14 – Programmatic (PDF)
  • Retired 01/21/2021 15 – Quality Management (PDF)
  • Retired 01/21/2021 16 – Administrative (PDF)