Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.32 - Targeted Case Management for HIV-Infected Individuals › Section 10.09.32.01 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. The following
				  terms have the meanings indicated.
B. Terms Defined.
(1) "Case management" means services which
				  will assist participants in gaining access to the full range of Medical
				  Assistance services, as well as to any additional needed medical, social,
				  housing, financial, counseling, and other support services.
(2) "Case manager" means a physician, nurse,
				  or social worker (refer to Regulation .02 of this chapter) employed by the HIV
				  ongoing case management provider and chosen by the participant or the
				  participant's legally authorized representative.
(3) "Department" means Department as defined
				  in COMAR 10.09.36.01A.
(4) "Entity" means a facility,
				  agency, organization, department, office, corporation, partnership, group or
				  individual.
(5) "HIV diagnostic
				  evaluation services" means a bio-psychosocial assessment of a participant and
				  development or revision of an individualized plan of care by a
				  multidisciplinary team convened by an approved HIV diagnostic evaluation
				  services provider.
(6) "HIV
				  diagnostic evaluation services provider" means an entity approved by the
				  Department as a provider of HIV diagnostic evaluation services, as defined in
				  Regulation .03 of this chapter.
(7)
				  "HIV-infected individual" means a person determined as positive for human
				  immunodeficiency virus (HIV) infection by the enzyme-linked immunosorbent assay
				  (ELISA) and confirmed by the Western Blot, or another generally accepted
				  diagnostic testing algorithm for HIV infection.
(8) "HIV ongoing case management" means the
				  activities involved in developing, revising, implementing, and monitoring the
				  plan of care, as performed by a case manager through an approved HIV ongoing
				  case management provider.
(9) "HIV
				  ongoing case management provider" means an entity, as defined in Regulation .03
				  of this chapter, approved by the Department as a provider of ongoing case
				  management services to participants.
(10) "HIV-targeted case management" means the
				  provision of HIV diagnostic evaluation services and HIV ongoing case
				  management.
(11) "Medical
				  Assistance Program" means the Medical Assistance Program as defined in COMAR
				  10.09.36.01A.
(12) "Medically necessary" has the
				  meaning stated in COMAR
				  10.09.36.01A.
(13) "Multidisciplinary team"
				  means the members convened by the HIV diagnostic evaluation services provider
				  to perform a bio-psychosocial assessment of the participant and develop or
				  revise an individualized plan of care.
(14) "Nurse" means a person who is licensed
				  as a registered nurse in the jurisdiction in which services are
				  provided.
(15) "Ongoing case
				  management" means the activities involved in developing, revising,
				  implementing, and monitoring the plan of care, as performed by a case manager
				  through an approved HIV ongoing case management provider.
(16) "Participant" means a recipient who:
(a) Has been diagnosed as HIV-infected or is
				  a child less than 2 years old born to a woman diagnosed as
				  HIV-infected;
(b) Elects, or has a
				  legally authorized representative elect in the recipient's behalf, to receive
				  the services available under these regulations; and
(c) Is not receiving the same case management
				  services under the Social Security Act, § 1915(b), 1915(c), or
				  1915(g).
(17)
				  "Physician" means a doctor of medicine or osteopathy who is licensed to
				  practice medicine in the jurisdiction in which services are rendered.
(18) "Plan of Care" means a goal-directed
				  treatment plan developed and revised by the HIV diagnostic evaluation service
				  provider's multidisciplinary team that is based on the bio-psychosocial
				  assessment.
(19) "Program" means
				  the Program as defined in COMAR
				  10.09.36.01A.
(20) "Provider" means the HIV
				  diagnostic evaluation services provider or HIV ongoing case management
				  provider, which offers covered case management services to participants through
				  a provider agreement signed with the Department and which is identified as a
				  Program provider by issuance of an individual account number.
(21) "Provider agreement" means a contract
				  between the Department and the provider.
(22) "Recipient" means recipient as defined
				  in COMAR 10.09.36.01A.
(23) "Social worker" means a
				  person who is in compliance with the social work licensing requirements of the
				  jurisdiction in which services are provided.