Medical HIV Case Management

The goal of the Statewide Standards for Medical HIV Case Management is to support case managers to help individuals living with HIV to access primary medical care and medications, identify and remove barriers to medical care, and ensure adherence to a prescribed treatment plan.

Medical HIV Case Management is a range of client centered services that ensure timely and coordinated access to primary medical care, medications, and other support services, including treatment adherence, for HIV-positive individuals. Primary activities link a person to primary medical care or services. Secondary activities may be needed for HIV-positive individuals to achieve their medical outcomes and must have a direct relationship to an individual’s HIV clinical outcomes.

The process of case management includes:
1.   Completing a comprehensive bio-psychosocial assessment of the client’s needs,
2.   Developing a comprehensive individualized service plan (ISP),
3.   Monitoring clients to assess the efficiency and success of the ISP,
4.   Reevaluating and revising the ISP as necessary, and
5.   Performing case closure when appropriate.

Title XIX HIV/AIDS Case Management

Title XIX (Medicaid) HIV/AIDS Case Management funded services have been available to Washington State residents since 1987, when the King and Pierce County Health Departments became the first contracted providers of HIV/AIDS case management. Since then, the roster of active Title XIX providers has grown to over 25 organizations including local health jurisdictions, home health agencies, health clinics, mental health clinics, and community-based HIV/AIDS organizations throughout the state.

The Title XIX program allows agencies to provide services that aid eligible individuals to gain access to medical, social, educational, and other services.

System Acuity Measurement

System Acuity Measurement (SAM) is a quality assurance and evaluation system for medical HIV case management providers. SAM is designed to uniformly collect information on a fourteen areas of service and provides a common, standardized language for comparing the differences and similarities in client needs across the full range of case management settings.

Case managers funded with Ryan White Program, Part B, funds for medical HIV case management must monitor and document client level acuity according to the System Acuity Measurement for HIV Case Management guidelines, January 2004.