Current through Register Vol. 24-18, September 15, 2024
The medicaid agency provides HIV/AIDS case management to
assist people infected with HIV to: Live as independently as possible; maintain
and improve health; reduce behaviors that put the person and others at risk;
and gain access to needed medical, social, and educational services.
(1) To be eligible for agency-reimbursed
HIV/AIDS case management services, a person must:
(a) Have a current medical diagnosis of HIV
or AIDS;
(b) Be eligible for Title
XIX (medicaid) coverage under either the categorically needy program (CNP) or
the medically needy program (MNP); and
(c) Require:
(i) Assistance to obtain and effectively use
necessary medical, social, and educational services; or
(ii) Ninety days of continued monitoring
under WAC
182-539-0350(2).
(2) The agency has an
interagency agreement with the Washington state department of health (DOH) to
administer the HIV/AIDS case management program for Title XIX (medicaid)
clients.
(3) HIV/AIDS case
management agencies who serve Washington apple health clients must be approved
by HIV client services, DOH.
(4)
HIV/AIDS case management providers must:
(a)
Notify HIV positive people of their statewide choice of available HIV/AIDS case
management providers and document that notification in the client's record.
This notification requirement does not obligate HIV/AIDS case management
providers to accept all clients who request their services.
(b) Have a current, client-signed
authorization form to release and obtain information . The provider must have a
valid authorization on file for the months that case management services are
billed to the agency (see
RCW
70.02.030) . The fee referenced in
RCW
70.02.030 is included in the agency's payment
to providers. Clients must not be charged for services or documents related to
covered services.
(c) Maintain
enough contact to ensure effective, ongoing services under subsection (5) of
this section. The agency requires a minimum of one contact per month between
the HIV/AIDS case manager and the client. However, contact frequency must be
enough to ensure the individual service plan (ISP) is implemented and
maintained.
(5) HIV/AIDS
case management providers must document services as follows:
(a) Providers must start a comprehensive
assessment within two working days of the client's referral to HIV/AIDS case
management services.
(b)Providers
must complete the assessment before billing for ongoing case management
services.
(c) If the assessment
does not meet requirements under this subsection, the provider must document
the reason or reasons for failure to do so.
(d)The assessment must include the following
elements as reported by the client:
(i)
Demographic information for example, age, gender, education, family
composition, housing;
(ii) Physical
status, the client's primary care provider, and current information on the
client's medica-tions and treatments;
(iii) HIV diagnosis (both the documented
diagnosis from the assessment and historical diagnosis information);
(iv) Psychological, social, and cognitive
functioning and mental health history;
(v) Ability to perform daily
activities;
(vi) Financial and
employment status;
(vii) Medical
benefits and insurance coverage;
(viii) Informal support systems for example,
family, friends, and spiritual support);
(ix) Legal status, durable power of attorney,
and any self-reported criminal history; and
(x) Self-reported behaviors that could lead
to HIV transmission or re-infection for example, drug or alcohol
use).
(e) Providers must
develop, monitor, and revise the client's ISP. The ISP identifies and documents
the client's unmet needs and the resources needed to assist in meeting the
client's needs. The case manager and the client must develop the ISP within two
days of the comprehensive assessment, or the provider must document the reason
this is not possible. An ISP must be:
(i)
Signed by the client, documenting that the client is voluntarily requesting and
receiving the agency-reimbursed HIV/AIDS case management services;
and
(ii) Reviewed monthly by the
case manager through in-person or telephone contact with the client. The case
manager must note the review and any changes :
(A)In the case record narrative; or
(B) By entering notations in, initialing, and
dating the ISP.
(f) Providers must maintain ongoing narrative
records and must document case management services provided in each month the
provider bills the agency. Records must:
(i)
Be entered in chronological order and signed by the case manager;
(ii) Document the reason for the case
manager's interaction with the client; and
(iii) Describe the plans in place or to be
developed to meet unmet client needs.
11-14-075, recodified as §182-539-0300, filed 6/30/11,
effective 7/1/11. Statutory Authority:
RCW
74.08.090. 10-19-057, § 388-539-0300,
filed 9/14/10, effective 10/15/10. Statutory Authority:
RCW
74.08.090, 74.09.755,
74.09.800, 42 U.S.C. Section
1915(g). 00-23-070, § 388-539-0300, filed 11/16/00, effective
12/17/00.
