Sec. 10.09.32.03. Conditions for Participation

A. General requirements for participation in the Medical Assistance Program are that providers shall meet all the conditions for participation as set forth in COMAR 10.09.36.03.

B. Specific requirements for participation in the Program as a provider of services covered under this chapter are that the provider shall maintain a record on each participant which meets the Program’s requirements and which includes:

(1) Verification of the participant’s HIV-infected status;

(2) Verification of the participant’s eligibility for services;

(3) A signed consent form by the participant to participate in HIV ongoing case management;

(4) The completed bio-psychosocial assessment;

(5) The completed plan of care signed by all members of the multidisciplinary team;

(6) Documentation for each contact made by the case manager including:

(a) Date and subject of contact;

(b) Person contacted;

(c) Person making the contact;

(d) Nature, extent, and unit or units of service provided; and

(e) Place of service; and

(7) A signed case closure form when HIV ongoing case management services are ended.

C. Specific requirements for participation in the Program as an HIV diagnostic evaluation services provider are that the provider shall:

(1) Be a physician or a health or social services entity which employs or has a written agreement with physicians, nurses, or social workers for provision of its diagnostic evaluation services who are experienced or trained in the provision of services to HIV-infected individuals;

(2) Have a written plan for the implementation of HIV diagnostic evaluation services;

(3) Be available to participants at least 8 hours a day, 5 days a week, except on State holidays;

(4) Have existing policies and procedures concerning the performance of HIV diagnostic evaluation services;

(5) Develop procedures to expedite bio-psychosocial assessments when necessary;

(6) Have access to specialty physicians experienced and trained in the provision of services to HIV-infected individuals for consultation, as necessary, concerning a participant’s medical assessment and the medical services recommended in the plan of care.

(7) Present a qualified recipient with the option of receiving HIV diagnostic evaluation services and HIV ongoing case management services. If the recipient elects to receive HIV ongoing case management, the provider shall ask the recipient to select from a list of qualified HIV ongoing case management providers.

(8) Establish a written agreement with any entity approved as an HIV ongoing case management provider which a participant selects as his or her case manager and agrees to allow the case manager chosen by the participant to:

(a) Participate as a member of the multidisciplinary team;

(b) Assist with performance of the bio-psychosocial assessment;

(c) Assist with the development and revision of the plan of care; and

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

(9) Convene a multidisciplinary team for each participant, to perform the bio-psychosocial assessment and develop or revise an individualized plan of care. The team shall be composed of:

(a) The participant;

(b) The participant’s legally authorized representative or representatives;

(c) Any additional representatives chosen by the participant, if desired;

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

(i) The participant’s primary care physician;

(ii) Nurse;

(iii) Current service provider or providers;

(iv) Specialty physician; or

(v) Social worker; and

(e) 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.

(10) Inform the participant or the participant’s legally authorized representative or representatives of:

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

(b) Availability of needed services.

(11) Have the capacity to conduct, at minimum, an annual bio-psychosocial assessment of the participant, unless an earlier assessment is recommended by the case manager or multidisciplinary team.

D. Specific requirements for participation in the Program as an HIV ongoing case management provider are that the provider shall:

(1) Be a health or social services entity employing registered nurses, social workers, or physicians, who are trained and have at least 1 year experience in the provision of services as a case manager. Experience may have been acquired as volunteer work or field placement;

(2) Have a written agreement:

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

(b) 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;

(3) Have a written plan for the implementation of HIV ongoing case management services;

(4) Have existing policies and procedures concerning the performance of HIV ongoing case management;

(5) Provide HIV ongoing case management services to participants who:

(a) Are assessed by an HIV diagnostic evaluation services provider;

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

(c) Elect to receive ongoing case management services;

(6) Be available to participants at least 8 hours a day, 5 days a week, except on State holidays;

(7) Have established alternatives for managing participants’ medical and social crises during off-hours that will be specified in participants’ individualized plans of care;

(8) Have the capacity to meet with the participant face-to-face;

(9) Be knowledgeable of the eligibility requirements and application procedures of applicable federal, State, and local government assistance programs; and

(10) Maintain a current listing of medical, social, housing assistance, mental health, financial assistance, counseling, and other support services available to HIV-infected individuals.