Chapter 32. Targeted Case Management for HIV-Infected Individuals

Has been diagnosed as HIV-infected or is a child less than 2 years old born to a woman diagnosed as HIV-infected;

Elects, or has a legally authorized representative elect in the recipient's behalf, to receive the services available under these regulations; and

Is not receiving the same case management services under the Social Security Act, §1915(b), 1915(c), or 1915(g).

Date and subject of contact;

Person contacted;

Person making the contact;

Nature, extent, and unit or units of service provided; and

Place of service; and

Participate as a member of the multidisciplinary team;

Assist with performance of the bio-psychosocial assessment;

Assist with the development and revision of the plan of care; and

Monitor the participant’s need for a revised bio-psychosocial assessment.

The participant;

The participant’s legally authorized representative or representatives;

Any additional representatives chosen by the participant, if desired;

A representative from the HIV diagnostic evaluation services provider which may include any of the following as necessary and appropriate:

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.

Recommendations for the plan of care in the bio-psychosocial assessment; and

Availability of needed services.

With any entity approved as an HIV diagnostic evaluation services provider from whom the ongoing case management provider is accepting referrals, and

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;

Are assessed by an HIV diagnostic evaluation services provider;

Are recommended for HIV ongoing case management services in the plan of care; and

Elect to receive ongoing case management services;

A review of relevant medical and other records, with the participant’s or legal representative’s written consent;

A consult with the participant’s attending physician and current providers of medical, social, or other support services, as appropriate;

A face-to-face assessment of the participant, preferably at the participant’s residence, to determine:

A consult, as appropriate, with the participant or the participant’s legally authorized representative or representatives; and

All areas listed on the Department’s approved sample bio-psychosocial assessment form.

Be participant-centered and goal-oriented;

Be developed and written in collaboration with the participant and other members of the multidisciplinary team;

Incorporate findings from the bio-psychosocial assessment;

Incorporate findings and recommendations from the multidisciplinary team;

Establish a plan for after-hours crises, including medical and social crises, and other emergency situations;

Document the proposed frequency of contact with a minimum of 1 face-to-face meeting every 6 months; and

Address all areas listed on the Department’s approved sample plan of care form.

Conducting a face-to-face assessment of the participant’s psychosocial status and health care needs and briefing the multidisciplinary team on the findings;

Participating in the development or revision of an individualized plan of care for the participant;

Encouraging the participant’s and representative’s participation in the multidisciplinary team process; and

Linking the participant with any services needed on an emergency basis before the plan of care or revision is finalized.

Participates as a member of the multidisciplinary team convened by the HIV diagnostic evaluation services provider;

Assumes responsibility for providing case management services to the participant;

Acts as a point of contact for the case; and

Implements and monitors the plan of care recommended by the HIV diagnostic evaluation services provider’s multidisciplinary team and approved by the participant.

Are recommended in the plan of care as needing case management; and

Who elect to receive case management services.

The case manager shall make initial contact with the participant to assure that medical and support referrals were completed and followed-up on;

The case manager shall maintain regular contact that will occur at intervals agreed on by the participant and case manager in the plan of care;

The case manager or HIV ongoing case management provider, when necessary, shall respond to participant-initiated non-emergency contact within 2 working days;

The participant or the participant’s representative or representatives shall be offered a copy of the plan of care;

The case manager shall document every direct and indirect contact, including assessing the progress of implementation of the plan of care in the participant’s record;

The case manager shall assist the participant with each action plan to reach the goals outlined in the plan of care;

The case manager shall advise the participant about available services and service providers, by making referrals to and arrangements with service providers selected by the participant, and by assisting the participant in gaining access to services for which the participant is eligible and which the participant chooses, to include:

The case manager shall provide the participant with any necessary counseling concerning:

The case manager shall follow up with referral sources; and

The case manager shall examine the actual service delivery against the plan of care.

Review and check the status of each activity outlined in the plan of care;

Modify the action plan or goals to accommodate the participant’s changing needs or changes in service availability;

Monitor the plan of care at regular intervals that have been predetermined at the time of the plan of care or more often depending on participant need;

Evaluate the plan of care, in collaboration with the participant, at least every 6 months, with input from any members of a multidisciplinary team who have been involved with the participant’s care.

Participant notification, including date of closure, reason, and explanation of closure;

Participant’s notification of right to re-enter services at a later time;

Documentation of coordination and referral to a new provider if desired by the participant; and

Documentation of a participant’s non-response to case manager attempts to reach the participant over a 6-month period of time with at least 3 attempts to contact the participant.

The Rare and Expensive Case Management Program, as defined in COMAR 10.09.69; or

Under another Program authority.

Date or dates of service;

Participant's name and Medical Assistance number;

Provider's name, identification number, and location; and

Nature, procedure code or codes, and unit or units of covered service provided.

For the completion of a bio-psychosocial assessment and development or revision of the plan of care performed by an HIV diagnostic evaluation services provider — $200;

For the participation by the case manager in the completion of the bio-psychosocial assessment and development or revision of the plan of care, as specified in Regulation .04B of this chapter up to 6 units of service at a rate of $17.86 per unit of service

For HIV ongoing case management, up to 96 units of service, at a rate of $17.86 per unit of service, may be reimbursed per year following completion of the bio-psychosocial assessment and development or revision of the plan of care by a qualified provider of HIV diagnostic evaluation services.