Md. Code Regs. 10.09.32.01

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.32.01 - Definitions

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.

Md. Code Regs. 10.09.32.01

Regulations .01 amended as an emergency provision effective December 26, 1988 (15:27 Md. R. 3123); adopted permanently effective April 25, 1989 (16:7 Md. R. 811)
Regulations .01 amended as an emergency provision effective August 28, 1990 (17:19 Md. R. 2318); emergency status expired November 11, 1990; amended permanently effective November 26, 1990 (17:23 Md. R. 2732)
Regulation .01B amended effective August 27, 2007 (34:17 Md. R. 1507); April 2, 2012 (39:6 Md. R. 408)