<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 10.09.32.03" title_num="10" subtitle_num="09" chapter_num="32" heading="Conditions for Participation.">
  <paragraph num="A.">
    <text>General requirements for participation in the Medical Assistance Program are that providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Specific requirements for participation in the Program as a provider of services covered under this chapter are that the provider shall maintain a record on each participant which meets the Program’s requirements and which includes:</text>
    <paragraph num="(1)">
      <text>Verification of the participant’s HIV-infected status;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Verification of the participant’s eligibility for services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A signed consent form by the participant to participate in HIV ongoing case management;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The completed bio-psychosocial assessment;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The completed plan of care signed by all members of the multidisciplinary team;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Documentation for each contact made by the case manager including:</text>
      <paragraph num="(a)">
        <text>Date and subject of contact;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Person contacted;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Person making the contact;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Nature, extent, and unit or units of service provided; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Place of service; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(7)">
      <text>A signed case closure form when HIV ongoing case management services are ended.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Specific requirements for participation in the Program as an HIV diagnostic evaluation services provider are that the provider shall:</text>
    <paragraph num="(1)">
      <text>Be a physician or a health or social services entity which employs or has a written agreement with physicians, nurses, or social workers for provision of its diagnostic evaluation services who are experienced or trained in the provision of services to HIV-infected individuals;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have a written plan for the implementation of HIV diagnostic evaluation services;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Be available to participants at least 8 hours a day, 5 days a week, except on State holidays;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Have existing policies and procedures concerning the performance of HIV diagnostic evaluation services;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Develop procedures to expedite bio-psychosocial assessments when necessary;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Have access to specialty physicians experienced and trained in the provision of services to HIV-infected individuals for consultation, as necessary, concerning a participant’s medical assessment and the medical services recommended in the plan of care.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Present a qualified recipient with the option of receiving HIV diagnostic evaluation services and HIV ongoing case management services. If the recipient elects to receive HIV ongoing case management, the provider shall ask the recipient to select from a list of qualified HIV ongoing case management providers.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Establish a written agreement with any entity approved as an HIV ongoing case management provider which a participant selects as his or her case manager and agrees to allow the case manager chosen by the participant to:</text>
      <paragraph num="(a)">
        <text>Participate as a member of the multidisciplinary team;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Assist with performance of the bio-psychosocial assessment;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Assist with the development and revision of the plan of care; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Monitor the participant’s need for a revised bio-psychosocial assessment.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(9)">
      <text>Convene a multidisciplinary team for each participant, to perform the bio-psychosocial assessment and develop or revise an individualized plan of care. The team shall be composed of:</text>
      <paragraph num="(a)">
        <text>The participant;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The participant’s legally authorized representative or representatives;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Any additional representatives chosen by the participant, if desired;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A representative from the HIV diagnostic evaluation services provider which may include any of the following as necessary and appropriate:</text>
        <paragraph num="(i)">
          <text>The participant’s primary care physician;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Nurse;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Current service provider or providers;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Specialty physician; or</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Social worker; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(e)">
        <text>The participant’s case manager. If employed by the HIV diagnostic evaluation services provider, the case manager may also act as the representative from the provider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(10)">
      <text>Inform the participant or the participant’s legally authorized representative or representatives of:</text>
      <paragraph num="(a)">
        <text>Recommendations for the plan of care in the bio-psychosocial assessment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Availability of needed services.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(11)">
      <text>Have the capacity to conduct, at minimum, an annual bio-psychosocial assessment of the participant, unless an earlier assessment is recommended by the case manager or multidisciplinary team.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Specific requirements for participation in the Program as an HIV ongoing case management provider are that the provider shall:</text>
    <paragraph num="(1)">
      <text>Be a health or social services entity employing registered nurses, social workers, or physicians, who are trained and have at least 1 year experience in the provision of services as a case manager. Experience may have been acquired as volunteer work or field placement;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Have a written agreement:</text>
      <paragraph num="(a)">
        <text>With any entity approved as an HIV diagnostic evaluation services provider from whom the ongoing case management provider is accepting referrals, and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Which permits the case manager to participate as a member of the multidisciplinary team, to have access to the plan of care, and to request a bio-psychosocial assessment and plan of care revision as necessary;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Have a written plan for the implementation of HIV ongoing case management services;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Have existing policies and procedures concerning the performance of HIV ongoing case management;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provide HIV ongoing case management services to participants who:</text>
      <paragraph num="(a)">
        <text>Are assessed by an HIV diagnostic evaluation services provider;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Are recommended for HIV ongoing case management services in the plan of care; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Elect to receive ongoing case management services;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(6)">
      <text>Be available to participants at least 8 hours a day, 5 days a week, except on State holidays;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Have established alternatives for managing participants’ medical and social crises during off-hours that will be specified in participants’ individualized plans of care;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Have the capacity to meet with the participant face-to-face;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Be knowledgeable of the eligibility requirements and application procedures of applicable federal, State, and local government assistance programs; and</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Maintain a current listing of medical, social, housing assistance, mental health, financial assistance, counseling, and other support services available to HIV-infected individuals.</text>
    </paragraph>
  </paragraph>
</regulation>