Scope
The standards described in this document apply to the HIV/AIDS case management services funded by the AIDS Institute through state and/or federal grants. In addition, the standards apply to case management services reimbursed by Medicaid, either on a fee-for service basis or bundled with other services required for an enhanced Medicaid reimbursement rate. Services covered by these standards may be provided in a variety of settings, including community health centers, hospitals, or community-based organizations.
Case Management services provided under the following AIDS Institute initiatives are covered by these Case Management Standards:
- AIDS Day Health Care Program (ADHCP)
- Centers of Excellence in Pediatric HIV Care
- COBRA Community Follow-Up Program
- Community-Based HIV Primary Care and Prevention Services
- Community Service Programs (CSP)
- Designated AIDS Centers (DACS)
- Family-Centered Health Care Services
- HIV Primary Care and Prevention Services for Substance Users
- HIV Services for HIV-Infected Women and Their Families
- Multiple Service Agencies (MSA)
- Ryan White Part B Case Management Programs
- Supported Housing Programs
- Youth-Oriented Health Care Programs (Special Care Centers)
Exempt Programs
Exempt from the standards are programs funded by the AIDS Institute to provide HIV prevention case management (now known as Comprehensive Risk Counseling and Services), transitional planning (in criminal justice settings), transitional case management (Youth Access Programs), or supportive services (please see glossary for definition of terms).
Designated AIDS Centers (DACS)
Designated AIDS Centers (DACS) are responsible for providing medical care coordination (see below), as well as supportive case management. DACS are also responsible for referring patients assessed as needing comprehensive case management to community providers, unless recognized as providing comprehensive case management. Consult DAC-specific case management standards for additional information.
About Medical Care Coordination
Medical care coordination is an essential component of HIV primary care. It is distinct from case management as defined in these standards, although overlap between the two roles often exists.
The medical care coordinator focuses on the clinical services of HIV primary care, and ensures that an HIV+ patient enrolled in primary care receives associated services such as nutritional assessments, substance use and mental health interventions, treatment adherence support, prevention education, and partner notification. Core functions include coordination of inpatient and outpatient care, referrals to specialists, follow-up for referrals and missed appointments, and conferencing between clinical staff and community-based case managers.
