MEDICAL CASE MANAGEMENT

Medical Case Management is the provision of a range of client–centered services that link clients with health care, psychosocial, and other services that improve overall health. An essential component of Medical Case Management includes the coordination and follow-up of medical treatment, as well as treatment adherence counseling.

The primary goal of medical case management is to work with the primary care provider to assist a client to maintain and improve health status, which is reflected in a client’s health indicators. Client empowerment and monitoring of service utilization (including medical appointment adherence) and health indicators are crucial elements of the medical case management.

Enrollment in Medical Case Management may not be permanent; a client’s level of need may change over time and require a different level of service to fit their present circumstances. 

SERVICES

Key activities include: (1) completion of comprehensive assessment of service needs, (2) development of a comprehensive, individualized service plan, (3) coordination of services required to implement the plan (service linkage), (4) client monitoring to assess the efficacy of the plan, and (5) periodic re–evaluation and adaptation of the plan as necessary over the duration of the client’s case (reassessment), (6) case closure or transfer as appropriate.

Non-Medical Case Management

This service provides advice and assistance to empower clients to access a variety of necessary services (including medical, social, community, legal and financial) that support medically related outcome measurements.

Some clients may demonstrate a low level of need and would therefore benefit from Non-medical Case Management.

Enrollment in either medical case management (active) or non-medical case management (direct services only) is not permanent; a client may move from one type of case management to the other depending on current circumstances. On-going and frequent assessment by a non-medical case manager and a medical case management supervisor occur to ensure that clients receive the level of care that is appropriate.

SERVICES

Non-medical Case Management Key activities include: (1) completion of comprehensive assessment of service needs conducted by a nonmedical case manager meeting the same qualifications as a medical case manager, (2) coordination of services required to support health outcomes, and (3) periodic reevaluation of client needs.

This may include client–specific advocacy and/or review of utilization of services.

Transportation

These direct or vouched conveyance services provide transportation to a client so that he or she may access health care services. Services are provided routinely or on an emergency basis.

Medical Transportation Services include conveyance services provided, directly or through voucher, to a client so that he or she may access health care services. Services may be provided routinely or on an emergency basis.

SERVICES

This category offers transportation services is available for patients and accompanying essential caregiver and/or child(ren) to access health care services, including routine and emergency rides and destinations as supported by client need.

Services may include the following modes of transportation: distribution of vouchers, such as public transit tokens and/or passes, gasoline vouchers, van and taxi services.

Early Intervention Services

(EIS) are a combination of services that include the following related to HIV/AIDS and Hepatitis C: Counseling, testing, referrals, and other clinical and diagnostic services designed to bring individuals with HIV and/or Hepatitis C disease into care. These services focus on expanding key points of entry and documentation of referrals.

HIV Specialty Care

Outreach services are intended to identify individuals living with HIV who know their status or those of unknown status so that they may become aware of the availability services and access care and treatment.

Individual outreach is defined as activities aimed at locating individuals who are aware of their HIV status so that they may be successfully linked into Primary Medical Care. Individuals who are not aware of their HIV status will be linked to Early Intervention Services (EIS).

SERVICES

Outreach services include both case finding and consumer recruitment through community outreach. Community outreach activities are designed to find individuals who are at high risk of HIV and to refer those individuals into care and treatment services (such as Early Intervention Services (EIS), Primary Medical Care (PMC) and Medical Case Management (MCM).

Outreach services are provided in collaboration with State and local prevention programs.