Family and Children's Medicaid MA-3540 Medicaid Covered Services
XLiV. CASE MANAGEMENT FOR HIV
Refer to DMA’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm for specific coverage criteria, prior approval requirements, and service limitations.
A. Covered Services
Targeted case management for recipients with HIV is a client-focused plan for coordinating care. It involves assessing a recipient’s need for specific health, psychological, and social services, and facilitating access to services that will address those needs. Services must be provided in accordance with the clinical coverage policy found at: www.dhhs.state.nc.us/dma.
REVISED 08/01/11 – CHANGE NO. 14-11
1. Recipient must have documented HIV disease or HIV seropositivity.
2. HIV case management is not covered as stated below.
a. In a general hospital, psychiatric hospital, nursing facility, or intermediate facility for the mentally retarded;
b. Under Community Alternatives Program services for the children (CAP/C), disabled adults (CAP/DA), CAP/Choice and mentally retarded/developmentally disabled (CAP-MR/DD) ;
c. If receiving at-risk case management services
d. If receiving case management provided through the area mental health program for the chronically mentally ill and developmentally disabled.