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                        What is Case HIV Case Management?

 

HIV/AIDS case management provides a system of case management based on the changing needs of enrolled clients. Medical and Non-Medical Case management in the Metropolitan Area inclusive of the District of Columbia, Maryland, Virginia, and West Virginia is available statewide through Ryan White HIV/AIDS Programs that receive federal funds from the Health Resources and Services Administration (HRSA). Case managers provide referrals to support services such as transportation, housing, food banks, etc. Clients who receive any Ryan White Part B funded service should be enrolled in Case Management. The purpose of  HIV/AIDS Case Management Standards is to guide funded agencies and case managers that will assist in fulfilling the Ryan White Part B Office of HIV/AIDS minimum expectations for case management. These Standards are not meant to replace or override existing, more detailed standards that provider agencies may already have in place. If any agency is unable to meet case management standards, there must be documentation explaining why they were unable to meet the standards. The Standards are intended to assist the agency and case managers in fulfilling the following goals of case management:  

To increase the quality of care and quality of life for persons living with HIV/AIDS:

• To improve service coordination, access, and delivery

• To reduce the cost of care through coordinated services that keep persons living with HIV/AIDS out of urgent care centers, emergency rooms, and hospitals

• To provide client advocacy and crisis intervention services Background The HIV services system provides several types of coordination, referral, and follow-up services that eliminate barriers and help people with HIV get connected and stay in care.

 

Medical Case Management (MCM) is the backbone of the HIV services delivery system and the primary way of ensuring that people with HIV access, receive, and stay in primary medical care. MCM assesses the primary and immediate needs of people with HIV, coordinates referrals, and follows up with critical core medical and support services to ensure people with HIV remain in medical care. The services that are provided are in alignment with the National HIV/AIDS Strategy and focus on entry into care, retention in care, and viral load suppression. The continuum of interventions that begins with outreach and testing, and concludes with HIV viral load suppression is generally referred to as the HIV Care Continuum or the HIV Treatment Cascade. The HIV Care Continuum includes the diagnosis of HIV, linkage to primary care, lifelong retention in primary care, appropriate prescription of antiretroviral therapy (ART), and ultimately HIV viral load suppression

What is Non-Medical Case Management?

 

Non-Medical Case Management Services (NMCM) is a variety of client-centered initiatives aimed at enhancing retention in essential core medical and support services. Accessing medical, social, community, legal, financial, job, vocational, and/or other necessary services is facilitated by NMCM through coordination, direction, and help. The provision of NMCM services may also entail helping eligible clients gain entry to other public and private programs for which they may qualify, including Medicaid, the Children's Health Insurance Program, Medicare Part D, state pharmacy assistance programs, pharmaceutical manufacturer patient assistance programs, Department of Labor or Education-funded services, other state or local health care and supportive services, or private health insurance plans. All case management interactions, including in-person, over the phone, through telemedicine, and otherwise, are included in NMCM Services.

 

Services:

Key activities of NMCM include:

  • Initial assessment of service needs

  • Development of a comprehensive, individualized care plan

  • Timely and coordinated access to medically appropriate levels of health and support services

  • Client-specific advocacy and/or review of utilization of services

  • Continuous client monitoring to assess the efficacy of the care plan

  • Re-evaluation of the care plan at least every six (6) months with adaptations as necessary

  • Ongoing assessment of the client’s needs and available resources to support those needs

In addition, NMCM may also provide benefits counseling by assisting eligible clients in obtaining access to other public and private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, state pharmacy assistance programs, pharmaceutical manufacturer’s patient assistance programs, other state or local health care and supportive services, or Marketplace insurance plans).

 

 

What is Medical Case Management? 

In order to support the HIV care continuum, Medical Case Management offers a variety of customer-centered services aimed at enhancing health outcomes. An interprofessional team that includes additional specialist care professionals may recommend certain activities. Any type of case management interaction, including face-to-face, telephone, and other modes of communication, falls under the umbrella of medical case management. Initial evaluation of service demands is among the service objectives. 

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