Current through Register Vol. 46, No. 39, September 25, 2024
(a)
Consistent with generally accepted standards of clinical care, the program
shall provide directly onsite or through referral arrangements a full range of
clinical services appropriate for the continuous care of patients. For the
purposes of this Part, the provision of services through referral arrangements
shall entail the establishment of linkages with qualified service providers and
the development of a mechanism to track the delivery of such services.
(1) The CAHP shall provide the following core
diagnostic, treatment and monitoring services onsite as clinically appropriate:
age appropriate, confidential HIV counseling and testing, initial and annual
comprehensive medical evaluation including substance use history and mental
health assessments, cognitive function testing ongoing clinical HIV disease
monitoring, HIV-specific therapies and prophylactic treatments, routine
gynecological care and follow-up (including reproductive counseling, pelvic
examination and pap smears), case management, patient health education
including HIV risk reduction, and nutrition screening and counseling.
(2) The CAHP shall provide onsite if
authorized or arrange through written referral agreements with other health
care providers the provision of the following services:
(i) consultations by specialists in
infectious diseases. If not provided onsite, formal linkages with local
resources of infectious disease expertise such as designated AIDS centers as
defined in section
405.22(g) of this
Title shall be developed to promote the timely delivery of these essential
consultative services;
(ii) core
diagnostic and therapeutic services: laboratory, including early diagnostic
methods to establish the infection status of children; radiology, including
MRI; dental services; mental health services, to include clinical social work,
clinical psychology and psychiatry as clinically appropriate;
(iii) other primary care, specialty and
subspecialty services: obstetrics; pediatrics, adolescent medicine and
pediatric subspecialties; ophthalmology; dermatology; neurology; outpatient
surgery; clinical pharmacy; subspecialties of internal medicine including
gastroenterology, hematology, pulmonology and oncology;
(iv) acute inpatient care where required;
and
(v) chronic care aervices where
required.
(b)
A primary care pracitioner shall be assigned principal responsibility for the
continuous care and coordination of care for each patient.
(1) Program staff shall assist all patients
with arrangements for all off-site medical services, facilitate receipt of
those services, monitor reported results of these off-site services and
integrate results into patient records.
(2) In those instances where the primary care
practitioner does not have hospital admitting privaleges, the CAHP shall have
backup arrangements with hospitals for prompt hospital admission of patients
and transfer of information between the hospital and the program.
(c) A CAHP shall provide patients
prompt access on a 24-hour basis to a clinical staff member who can respond to
emergencies.
(d) Comprehensive
ambulatory care services for women, including gynecological specialty care,
shall be provided directly onsite or through referral arrangements.
(1) Core services to be provided onsite
include:
(i) routine gynecological care and
follow-up including pelvic examinations and pap smears; and
(ii) routine family planning services
including pregnancy testing and reproductive counseling.
(2) Services to be provided either onsite or
through referral arrangements with other health care providers shall include:
(i) special diagnostic and treatment
procedures for HIV-related gynecological conditions such as cervical
dysplasia;
(ii) obstetrical care
for pregnant women that addresses the HIV-related needs of both the mothers and
their fetuses during pregnancy; and
(iii) health education for pregnant and
postpartum women to include the latest generally accepted recommendations
regarding breastfeeding.
(e) consistent with generally accepted
standards of medical care for these age groups, the special needs of HIV
exposed infants and HIV infected infants, children and adolesents shall be
addressed by the CAHP with services provided either directly onsite or through
referral arrangements. Such programs shall provide or arrange for comprehensive
services that address the unique medical, psycological and developmental needs
of these age groups.
(1) For children,
comprehensive ambulatory health care shall combine HIV-related comprehensive
evaluations and follow-up monitoring, routine pediatric care, care for acute
illnesses, and continuous care for chronic conditions, incorporating the
following special considerations:
(i) Routine
pediatric care shall be provided for HIV antibody positive infants and children
in accordance with generally established standards of medical care and shall
include immunizations, monitoring of growth and development, routine screening,
health education and guidance to help parents anticipate normal changes and
problems associated with growth and development.
(ii) For HIV infected children, the following
shall be provided directly onsite or through referral arrangement as clinically
indicated:
(a) comprehensive developmental
assessment;
(b) early intervention
services including physical, speech and occupational therapies;
(c) access to intravenous infusions;
and
(d) referral to clinical
trials.
(2)
For adolescents, providers shall tailor individual care to puberty status,
adolescent health benefits, education level, HIV-related knowledge base, living
situation and compliance patterns. Providers of care to adolescents, including
HIV counselors and case managers, shall have training and/or experience
regarding adolescent development and methods of effective communication with
this age group.
(f) A
CAHP shall provide each eligible patient, with the patient's written consent,
case management services either onsite or through referral arrangements with
other case management providers, including at a minimum a comprehensive
age-appropriate assessment of medical, social and psychological needs and a
plan for appropriate follow-up services, coordinated by a desigbated case
manager and developed in consultation with the patient and/or patient designee
or family and the patient's primary care practitioner or team. Such services
shall include:
(1)
intake/assessmentl
(2) coordination
of services;
(3) service plan
development, implementation, monitoring and periodic reassessment;
and
(4) crisis intervention, which
must be provided onsite.
(g) Substance use assessment and referral for
treatment as clinically appropriate shall be provided and integrated into
treatment planning.
(1) Comprehensive
substance use assessment services to be provided onsite shall include:
(i) substance use history and referral for
laboratory screening as appropriate;
(ii) crisis intervention; and
(iii) referral to the available treatment
modality appropriate to the patient's needs.
(2) Services to be provided either onsite or
through referral arrangements with other qualified service providers shall
include:
(i) substance use
counseling;
(ii) support group
programs;
(iii) inpatient drug and
alcohol detoxification;
(iv)
methadone maintenance treatment programs;
(v) residential drug or alcohol treatment
programs;
(vi) work rehabilitation
programs; and
(vii) harm reduction,
recovery readiness and needle exchange services.
(h) Dental services, including
preventative care, peridontics, oral surgery and pediatric dentistry shall be
provided directly or through referral arrangements.
(1) Such routine services shall be provided
onsite to the extent that they are currently offered to all other patients
treated by the facility.
(2)
Specialty services shall be readily available with referral arrangements
developed to promote their timely delivery.
(i) Mental health services shall be provided
directly or through referral arrangements.
(1) A mental health assessment shall be
completed in conjunction with the medical and social history to establish a
baseline for further care, including psychiatric diagnosis and treatment and to
monitor changes in mental health status.
(2) For children, services to help them cope
with progressive disease and/or the loss of a parent or other family members
shall be made available.
(3) Mental
health services for adolescents shall deal with issues of emerging sexuality,
identity consolidation, experimentation with drugs, violence, school, family
relationships and responses to authority.
(j) The CAHP shall provide onsite nutrition
screening and counseling including a baseline nutritional evaluation and
continuing nutrition risk assessment.
(1)
Screening for specific nutrition risk conditions shall begin at the initial
visit with continuing reassessment as needed.
(2) Proffesional nutrition counseling shall
be available, either onsite or though referral arrangement, to all patients at
nutritional risk.
(3) A consultant
in clinical nutrition, qualified by training and experience, shall serve as an
information resource to staff, patients and their families regarding the
nutritional aspects of managing HIV infection.
(k) A CAHP shall facilitate access to
clinical research programs, including those for investigational new drugs
(IND's). Programs shall have policies for managing patients on protocols,
including notification of the investigator.
