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<regulation prefix="Regulation" num=".10" citation="COMAR 10.67.04.10" title_num="10" subtitle_num="67" chapter_num="04" heading="Special Needs Populations — Individuals with HIV/AIDS.">
  <paragraph num="A.">
    <text>An MCO shall meet the standards set forth in this regulation for treating individuals with HIV/AIDS.</text>
  </paragraph>
  <paragraph num="B.">
    <text>HIV/AIDS Specialist.</text>
    <paragraph num="(1)">
      <text>An MCO shall allow an enrollee with HIV/AIDS to choose an HIV/AIDS specialist for treatment and coordination of primary and specialty care.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To qualify as an HIV/AIDS specialist, a health care provider shall be board certified in the field of infectious diseases by a member board of the American Board of Medical Specialties or:</text>
      <paragraph num="(a)">
        <text>Hold a current, valid, unrevoked, and unsuspended Maryland license or certification as a:</text>
        <paragraph num="(i)">
          <text>Doctor of medicine;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Doctor of osteopathy;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Nurse practitioner; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Physician's assistant being supervised by a medical doctor;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Have provided direct, continuous, ongoing care for at least 20 patients with HIV over the past 2 years; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Have completed one of the following requirements:</text>
        <paragraph num="(i)">
          <text>If a medical doctor, certified physician's assistant being supervised by a medical doctor, or doctor of osteopathy, at least 30 hours of HIV-related continuing medical education category I credits over the past 2 years;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>If a nurse practitioner, at least 30 hours of HIV-related continuing education units over the past 2 years;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>If a medical doctor, certified physician's assistant being supervised by a medical doctor, doctor of osteopathy, or a nurse practitioner, an accredited training program over the past year; or</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>If a medical doctor, certified physician's assistant being supervised by a medical doctor, doctor of osteopathy, or a nurse practitioner, has completed the American Academy of HIV Medicine (AAHIVM) credentialing examination.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>AIDS Case Management Services.</text>
    <paragraph num="(1)">
      <text>An MCO shall ensure that an enrollee with HIV/AIDS receives case management services that:</text>
      <paragraph num="(a)">
        <text>Link the enrollee with the full range of available benefits;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Link the enrollee with any additional needed services including:</text>
        <paragraph num="(i)">
          <text>Mental health services;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Substance abuse services;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Medical services;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Social services;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Financial services;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Counseling services;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Educational services;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Housing services; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Other required support services;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(c)">
        <text>Ensure timely and coordinated access to medically necessary levels of care that support continuity of care across the continuum of service providers;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Are performed by licensed physicians, physician assistants, advanced practice nurses, registered nurses, social workers, or other individuals who are appropriately trained, experienced, and supervised by a licensed practitioner; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Include, but are not limited to:</text>
        <paragraph num="(i)">
          <text>Initial and ongoing assessment of the enrollee's needs and personal support systems, including the MCO offering an enrollee one face-to-face meeting during the initial assessment and documenting the enrollee's acceptance or declination of the face to face meeting;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Development of a comprehensive, individualized service plan, using a multidisciplinary approach;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Coordination of the services required to implement the plan;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Periodic reevaluation and adaptation of the plan as necessary over the life of the enrollee;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Development of an outreach system for the enrollee and family by which the case manager and primary care provider track services received, clinical outcomes, and the need for additional follow-up; and</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Serving as an effective enrollee advocate to resolve differences between the enrollee and providers of care pertaining to the course or content of therapeutic interventions.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>An enrollee diagnosed with HIV/AIDS shall be offered case management services by the MCO at any time after diagnosis. An enrollee who has previously refused these services may request case management from the MCO at any time.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>Diagnostic Evaluation Service (DES) Assessment.</text>
    <paragraph num="(1)">
      <text>An MCO shall offer a diagnostic evaluation service (DES) assessment annually and document the enrollee's acceptance or declination.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The DES shall consist of a comprehensive medical and psychosocial assessment.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>A DES provider shall use assessment and care plan forms used by the Department for adult and pediatric assessments.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>An individual shall select a DES provider from an approved list of sites, and may select a DES provider which is not part of the individual's MCO if so desired.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>An MCO and other qualified institutions may become DES providers as provided in COMAR 10.09.32.03C.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>An individual with HIV/AIDS who has a substance use disorder shall be referred to the behavioral health ASO for substance abuse treatment within 24 hours of request.</text>
  </paragraph>
  <paragraph num="F.">
    <text>Clinical Trials.</text>
    <paragraph num="(1)">
      <text>An MCO may refer enrollees who are individuals with HIV/AIDS to facilities or organizations that can provide the enrollees' access to clinical trials.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>An MCO shall provide enrollees with HIV/AIDS access to clinical trials in accordance with COMAR 10.67.06.26-1.</text>
    </paragraph>
  </paragraph>
</regulation>