Non-Medical Case Management Service Standards

 

Approved on May 7, 2019









Prepared by

Service Standards and Integrated Care Committee of the 

Middlesex-Hunterdon-Somerset HIV Health Services Planning Council

Non Medical Case Management Definition:  

Those services which include the provision of advice and assistance in obtaining medical, social, community, legal, financial, and other  needed services.  It does not include coordination and follow up of medical treatment. 

(US Dept. of Health and Human Services, Health Resources and Services Administration, (HRSA), HIV/AIDS Bureau (HAB). 2009 Ryan White HIV/AIDS Treatment Modernization Act-2006)

 

The goal of non-medical case management services is to enhance access to and retention in medical care for eligible people living with HIV through a range of client centered services. This is a human service approach that supports engagement and retention into medical care. This approach emphasizes community linkages to bio-psychosocial supports for reducing real or perceived barriers to medical care. 

 

The objectives are to: 

  • Decrease barriers to medical and support services; 
  • Increase consumer’s awareness of treatment options; 
  • Build/strengthen relationships between the consumer and case manager; 
  • Foster consumer self sufficiency through specific advocacy and services; 



Additional TGA Requirements:

Case management includes all types of case management encounters, including face to face, phone contact, and any other form of communication.  To ensure that non-medical case management services address unmet needs in the community, services must be located outside the medical setting. All (100%) of non-medical case management staff should possess an associate’s degree and one year of related field or two years equivalent experience. 




Staff Service Standards

(Non-Medical Case Management)

Policy
Number
Activity/IssueMinimum Acceptable Threshold of ServiceAccountability Mechanism
1.1Staff hiringStaff will have necessary skills and experience determined by
*Written application
*Resume
*References
*Personal interview
Application, resume, and communication with personal references are documented in personnel files.
1.2(a)Staff qualifications
Non-medical Case Manager

Non-medical case management staff should possess an associate’s degree and one year of related field or two years equivalent experience.

Appropriate diploma, certificate, or license (if appropriate) or experience is documented in 100% of personnel files.

1.2(b)Staff qualifications
Peer Navigator

A member of the peer community living with HIV/AIDS with a high school diploma or GED, plus two years of social service experience. Peer must demonstrate understanding of HIV services and healthcare service navigation.

100% of staff possess a diploma/GED with the required experience documented in the personnel file.



1.3Staff job descriptionsStaff will be given written job descriptions.

100% of staff have job descriptions documented in personnel files.

1.4Staff trainingStaff are trained and knowledgeable on:
*HIV/AIDS and the affected community including disease process, co-*morbidities and psychosocial effects of the disease
*Cultural humility
*Entitlement programs, benefits to clients, and community resources/support services
*Client confidentiality, client rights, agency grievance procedures

Training is documented in 100% in personnel files.

1.5Staff continuing educationStaff participate in at least one continuing education training per year that is available and appropriate.

Training is documented in 100% of personnel files.

1.6(a)Staff supervision
Non-medical case manager

Case managers will receive (at minimum) one hour supervision per week.

Supervision is documented in personnel files.

1.6(b)Staff supervision
Peer Navigator
Peer navigators will receive (at minimum) one hour supervision per week to include patient case conference, peer navigator job performance, and skill development.

Supervision is documented in personnel files.

1.7Policies and procedures

Staff agrees to follow agency policies and procedures (See 1.9a-c).

Signed form is documented in the personnel file.

1.8Staff evaluationStaff is evaluated on their performance annually.

Staff evaluations are documented in personnel files.

1.9Service coordinationCase managers are required to attend monthly case management meetings. A 75% attendance record is required.
(i.e. case managers should not miss more than 4 out of 12 meetings)

Attendance at case manager meetings is documented in the personnel file.

1.10DocumentationStaff will keep written documents of contact with clients and client progress in accordance with agency data collection procedures (See 1.10).

All contacts and client progress are documented in client files and CAREWare.

Client Service Standards

(Non-Medical Case Management)

Policy
Number
Activity/IssueMinimum Acceptable Threshold of Service

Accountability Mechanism

2.1Initial contactCase managers call clients within 24 business hours of client’s call.



90% of return calls are documented in the client's file.

2.2Client Intake/
Assessment
Intake form completed within two weeks of initial referral that includes (but is not limited to):
*Signed releases of information
*Confidentiality and grievance policies
*Client rights and responsibilities
*Description of Ryan White CARE Act, non-medical case management services and other available services.
*Medical history
*Current health status including (but not limited to) substance use status and emotional/mental health status
*Needs assessment that includes (but is not limited to): Available financial resources (including insurance status), food, shelter, transportation, family and other support system, legal assistance
*Initial service plan
*Release of Information Form
Intake form is documented in the client's file.

A description of Ryan White Care Act services will be signed and dated at the time of intake by the consumer in 90% of consumer charts.

A copy of the agency’s grievance policy notification is signed and dated at the time of intake by the consumer in 90% of consumer charts.

A copy of the agency’s privacy and confidentiality policy is signed and dated at the time of intake in 90% of consumer charts.

A signed copy shall be included in the consumer’s file in 100% of charts where a referral was made.
2.3Service plan development

Develop an individual service plan with clients that includes (but is not limited to):
*Short-term needs
*Long-term needs
*Plans to meet needs
*Client goals
*Frequency of visits/appointments
*Explanation of client/case manager contract

85% signed and dated service plan is documented in the client's file.
2.4Client contact (return calls)

Case managers will return client calls within 24 business hours; 48-72 hours for calls on weekends.

85% of return calls are documented in the client's file.

2.5Ongoing service planInitially the case manager should contact the consumer once a week for the first six weeks, and then as needed but not less than monthly. As a result of this contact, the following is noted and recorded in the ISP and/or progress note:
*Effectiveness of the services and individual service plan (ISP).
*Changes, additions, or deletions to current services, including the need for continued contact and for case management services.
85% of contact dates and types are documented in the client's file.

2.6Discharge from case managementClients will be discharged from case management if:
*Client requests discharge.
*Client is referred to a different nonmedical case management program.
*Case manager is unable to make contact with the client in a period of three to four months.
*Client moved out of the catchment area and does not intend to return for services within the next three months.
*All client needs have been met.
100% of discharges are documented in the client's file, including a reason for discharge.

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