Update to HIV Case Management Program

<p>This article covers: Clinical Coverage Policy 12B and State Plan Amendment, 2018 Recertification Process, Stakeholder Engagement and, History and Purpose of HIV&nbsp;Case Management Services.</p>

Author: HIV Case Management Section

Clinical Coverage Policy 12B and State Plan Amendment

Clinical Coverage Policy 12B, HIV Case Management, and the related State Plan Amendment (SPA) is revised to include clarifying updates to policy and program improvements, and increase beneficiary access to services. Amendments to the SPA and policy are currently undergoing the review process and will tentatively be effective early Spring of 2018.

2018 Recertification Process

North Carolina Medicaid has initiated the 2018 HIV Case Management (CM) recertification process for providers with current certifications expiring on June 30, 2018.

Beginning January 2018, Medicaid will:

  • Notify providers of recertification process initiation via e-mail and mail
  • Post the Recertification Application Packet on the North Carolina Medicaid HIV Case Management Forms web page. The completed packet is due by March 31, 2018.
  • Schedule site visits upon approval of completed Recertification Application Packets
  • Conduct a desk audit review. The documentation requested for review and instructions can be found in the Notice of Certification Expiration letter.

Beginning April 2018, Medicaid will:

  • Conduct site visits
  • Issue recertification letters

Stakeholder Engagement

The next stakeholder meeting will be held March 8, 2018. The agenda is expected to include a discussion of managed care and its impact on HIV case management, as well as other pertinent topics including the 2018 Recertification Process. In-person attendance is required for stakeholder meetings; however, the agenda and meeting minutes will be available for review on the DMA HIV Case Management web page.

Medicaid began involving HIV CM stakeholders in November 2016, and continues holding quarterly stakeholder meetings. A separate policy/training work group convened to focus on necessary policy changes.

History and Purpose of HIV Case Management Services

HIV CM is a client-focused strategy that provides cost-effective, medically necessary services to enhance beneficiary health status and level of functioning. The goals of HIV case management are to:

  • Improve an eligible beneficiary’s access to a wide range of appropriate services, including medical, social, and educational needs
  • Promote continuity of care by coordinating service delivery arrangements
  • Enhance a beneficiary’s health status and level of functioning
  • Promote efficiency by reducing or containing the overall cost of services

Since 2013, the NC Division of Medical Assistance (DMA) has administered the program. In late 2016, DMA began engaging stakeholders, amending the policy and SPA and expanding the program to ensure statewide coverage.

Those with questions regarding the HIV CM program may contact the Medicaid’s HIV CM Section at 919-855-4360 or send an email to HIV_CaseMgt@dhhs.nc.gov.

HIV Case Management Section
DMA, 919-855-4360

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