HIV Case Management

HIV Case Management is a client-focused strategy that provides cost-effective, medically necessary services to enhance beneficiary health status and level of functioning.

The goals of HIV case management are to:

  • Improve an eligible beneficiary’s access to a wide range of appropriate services
  • Promote continuity of care by coordinating service delivery arrangements
  • Enhance a beneficiary’s health status and level of functioning
  • Promote efficiency by reducing or containing the overall cost of services

HIV case management is not intended to be an ongoing service. It is a short-term, goal-oriented service tailored to meeting the specific immediate needs of the beneficiary. It is designed to empower clients through education, referrals and facilitating access to care, assisting clients to gain the tools needed to be their own advocates and navigate the health care and social services systems to improve health outcomes.

HIV case management core components include:

  • Assessment
  • Care planning
  • Resource development
  • Service coordination
  • Monitoring
  • Reassessment
  • Discharge

Eligibility

  • Receiving Medicaid
  • Diagnosed with HIV or seropositivity
  • Not a resident of a non-covered institution

Fee Schedules

Clinical Coverage Policy 12B

HIV Case Management Stakeholder

Join the HIV Case Management Stakeholder Group, find meeting information and request a topic for discussion. 

Training

Within the first 90 days of hire, new Case Manager or supervisor will request the HIV CM Basic Training via email at HIV_CaseMgt@dhhs.nc.gov with subject line : HIV Basic Training Request. Within 24 hours, DMA will email the HIV CM Basic Training PDF.

Note: Per policy, new hires must complete this process within 90 days of hire and cannot bill Medicaid for services provided prior to successful completion of assessment.

Forms

Visit the Medicaid Forms web page for a complete list of required HIV Case Management Forms.

Resources

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

Contacts

DMA Clinical Policy and Programs
Phone: 919-855-4360
Fax: 919-715-0102
Email: HIV_CaseMgt@dhhs.nc.gov