Non-Medical Case Management

Service Standard

Non-Medical Case Management Service Standard print version

Subcategories	Service Units
Case Management – Non Medical	Per 15 minutes

Health Resources & Services Administration (HRSA) Description:

Non-Medical Case Management Services (NMCM) is the provision of a range of client-centered activities focused on improving access to and retention in needed core medical and support services. NMCM provides coordination, guidance, and assistance in accessing medical, social, community, legal, financial, employment, vocational, and/or other needed services. NMCM services may also include assisting eligible clients to obtain access to other public and private programs for which they may be eligible, such as Medicaid, Children’s Health Insurance Program, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, Department of Labor or Education-funded services, other state or local health care and supportive services, or private health care coverage plans. health insurance Marketplace plans. NMCM Services includes all types of case management encounters (e.g., face-to-face, telehealth, phone contact, and any other forms of communication).

Program Guidance:

NMCM Services have as their objective providing coordination, guidance and assistance in improving access to and retention in needed medical and support services to mitigate and eliminate barriers to HIV care services, whereas Medical Case Management Services have as their objective improving health care outcomes.

Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services.

Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services.

All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations’ planning and operations.

Limitations:

Non-Medical Case Management services do not involve coordination and follow up of medical treatments.

Non-Medical Case Management is a service based on need, and is not appropriate or necessary for every client accessing services. Non-Medical Case Management is designed to serve individuals who are unable to access, and maintain in, systems of care on their own (medical and social). Non-Medical Case Management should not be used as the only access point for medical care and other agency services. Clients who do not need guidance and assistance in improving/gaining access to needed services should not be enrolled in NMCM services. When clients can maintain their care, clients should be graduated. Clients with ongoing existing needs due to impaired cognitive functioning, legal issues, or other documented concerns meet the criteria for NMCM services.

Non-Medical Case Management Services have as their objective providing guidance and assistance in improving access to needed services whereas Medical Case Management services have as their objective improving health care outcomes.

Services:

Non-Medical Case Management services provide guidance and assistance to clients to help them to access needed services (medical, social, community, legal, financial, and other needed services), but may not analyze the services to enhance their care toward improving their health outcomes.

Key activities include:

Initial assessment of service needs
Development of a comprehensive, individualized care plan
Timely and coordinated access to medically appropriate levels of health and support services and continuity of care
Client-specific advocacy and/or review of utilization of services
Continuous client monitoring to assess the efficacy of the care plan
Re-evaluation of the care plan at least every six (6) months with adaptations as necessary
Ongoing assessment of the client’s and other key family members’ needs and personal support systems

In addition to providing the psychosocial services above, Non-Medical Case Management may also provide benefits counseling by assisting eligible clients in obtaining access to other public and private programs for which they may be eligible (e.g., Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services, and insurance plans through the health insurance Marketplaces/Exchanges).

Telehealth and Telemedicine is an alternative modality to provide most Ryan White Part B and State Services funded services. For the Ryan White Part B/SS funded providers and Administrative Agencies, telehealth and telemedicine services are to be provided in real-time via audio and video communication technology which can include videoconferencing software.

DSHS HIV Care Services requires that for Ryan White Part B or SS funded services providers must use features to protect ePHI transmission between client and providers. RW Providers must use a telehealth vendor that provides assurances to protect ePHI that includes the vendor signing a business associate agreement (BAA). Ryan White Providers using telehealth must also follow DSHS HIV Care Services guidelines for telehealth and telemedicine outlined in DSHS Telemedicine Guidance.

Service Standard and Measure

The following Standards and Measures are guides to improving healthcare outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard	Measure
Initial Assessment: The Initial Assessment is required for clients who are enrolled in Non-Medical Case Management (N-MCM) services. It expands upon the information gathered during the intake phase to provide the broader base of knowledge needed to address complex, longer-standing access and/or barriers to medical and/or psychosocial needs. The 30 day completion time permits the initiation of case management activities to meet immediate needs and allows for a more thorough collection of assessment information: Client’s support service status and needs related to: Nutrition/Food bank Financial resources and entitlements Housing Transportation Support systems Partner services and HIV disclosure Identification of vulnerable populations in the home (i.e., children, elderly and/or disabled) and assessment of need (e.g., food, shelter, education, medical, safety (Texas Department of Family Protective Services (TDFPS) Child Protective Services CPS/ TDFPS Adult Protective Services (APS) referral as indicated) Family violence Legal needs (ex. Health care proxy, living will, guardianship arrangements, landlord/tenant disputes, Social Security Disability Insurance (SSDI)/Supplemental Security Income (SSI) applications) Linguistic services, including interpretation and translation needs Activities of daily living Knowledge, attitudes and beliefs about HIV disease Sexual health assessment and sexual health promotion Employment/Education Additional information Client strengths and resources Other agencies that serve client and household Brief narrative summary of assessment session(s)	Percentage of clients who access N-MCM services that have a completed assessment within 30 calendar days of the first appointment to access N-MCM services and includes all required documentation. Percentage of clients that received at least one face-to-face meeting with the N-MCM staff that conducted the initial assessment. Percentage of clients who have a documented initial assessment in the primary client record system.
Care Planning: The client and the case manager will actively work together to develop and implement the care plan. Care plans include at a minimum: Problem Statement (Need) Goal(s) – suggest no more than three goals Intervention Task(s) Assistance in accessing services (types of assistance) Service Deliveries Individuals responsible for the activity (case management staff, client, other team member, family) Anticipated time for each task Client acknowledgment *The care plan is updated with outcomes and revised or amended in response to changes in access to care and services at a minimum every six (6) months.* Tasks, types of assistance in accessing services, and services should be updated as they are identified or completed – not at set intervals.	Percentage of non-medical case management clients, regardless of age, with a diagnosis of HIV who had a non-medical case management care plan developed and/or updated two or more times in the measurement year. *(DSHS Performance Measure)* Percentage of client records with documented follow up for issues presented in the care plan. Percentage of Care Plans documented in the primary client record system.
Assistance in Accessing Services and Follow-Up: Case management staff will work with the client to determine barriers to accessing services and will aid in accessing needed services. Case management staff will ensure that clients are accessing needed services, and will identify and resolve any barriers clients may have in following through with their Care Plan. When clients are aided with services elsewhere (outside of the agency providing NMCM services), case notes include documentation of follow-up.	Percentage of N-MCM clients with documented types of assistance provided that was initiated upon identification of client needs and with the agreement of the client. Assistance denied by the client should also be documented in the primary client record system. Percentage of N-MCM clients with assistance provided have documentation of follow up to the type of assistance provided.
Case Closure/Graduation: Clients who are no longer engaged in active case management services should have their cases closed based on the criteria and protocol outlined below. Common reasons for case closure include: Client no longer needs non-medical case management services Client is referred to another case management program Client relocates outside of service area Client chooses to terminate services Client is no longer eligible for services due to not meeting eligibility requirements Client is lost to care or does not engage in service Client incarceration greater than six (6) months in a correctional facility Provider initiated termination due to behavioral violations Client death Graduation criteria: Client completed case management goals for increased access to services/care needs Client is no longer in need of case management services (e.g., client can resolve needs independent of case management assistance) Client is considered non-adherent with care if three (3) attempts to contact client (via phone, email and/or written correspondence) are unsuccessful and the client has been given 30 days from initial contact to respond. Discharge proceedings should be initiated by agency 30 days following the 3rd attempt. Make sure appropriate Releases of Information and consents are signed by the client and meet requirements of HB 300 regarding electronic dissemination of protected health information (PHI). Staff should utilize multiple methods of contact (phone, text, email, certified letter) when trying to re-engage a client, as appropriate. Agencies must ensure that they have releases of information and consent forms that meet the requirements of HB 300 regarding the electronic dissemination of protected health information (PHI).	Percentage of N-MCM clients with closed cases includes documentation stating the reason for closure and a closure summary (brief narrative in progress notes and formal discharge summary). Percentage of closed cases with documentation of supervisor signature/approval on closure summary (electronic review is acceptable). Percentage of clients notified (through face-to-face meeting, telephone conversation, or letter) of plans to discharge the client from case management services. Percentage of clients with written documentation explaining the reason(s) for discharge and the process to be followed if client elects to appeal the discharge from service. Percentage of clients with information about reestablishment shared with the client and documented in primary client record system. Percentage of clients provided with contact information and process for reestablishment as documented in primary client record system. Percentage of clients with documented Case Closure/Graduation in the primary client record system.

Standard

Measure

Initial Assessment: The Initial Assessment is required for clients who are enrolled in Non-Medical Case Management (N-MCM) services. It expands upon the information gathered during the intake phase to provide the broader base of knowledge needed to address complex, longer-standing access and/or barriers to medical and/or psychosocial needs.

The 30 day completion time permits the initiation of case management activities to meet immediate needs and allows for a more thorough collection of assessment information:

Client’s support service status and needs related to:
- Nutrition/Food bank
- Financial resources and entitlements
- Housing
- Transportation
- Support systems
- Partner services and HIV disclosure
- Identification of vulnerable populations in the home (i.e., children, elderly and/or disabled) and assessment of need (e.g., food, shelter, education, medical, safety (Texas Department of Family Protective Services (TDFPS) Child Protective Services CPS/ TDFPS Adult Protective Services (APS) referral as indicated)
- Family violence
- Legal needs (ex. Health care proxy, living will, guardianship arrangements, landlord/tenant disputes, Social Security Disability Insurance (SSDI)/Supplemental Security Income (SSI) applications)
- Linguistic services, including interpretation and translation needs
- Activities of daily living
- Knowledge, attitudes and beliefs about HIV disease
- Sexual health assessment and sexual health promotion
- Employment/Education
Additional information
- Client strengths and resources
- Other agencies that serve client and household
- Brief narrative summary of assessment session(s)

Percentage of clients who access N-MCM services that have a completed assessment within 30 calendar days of the first appointment to access N-MCM services and includes all required documentation.

Percentage of clients that received at least one face-to-face meeting with the N-MCM staff that conducted the initial assessment.

Percentage of clients who have a documented initial assessment in the primary client record system.

Care Planning: The client and the case manager will actively work together to develop and implement the care plan. Care plans include at a minimum:

Problem Statement (Need)
Goal(s) – suggest no more than three goals
Intervention
- Task(s)
- Assistance in accessing services (types of assistance)
- Service Deliveries
Individuals responsible for the activity (case management staff, client, other team member, family)
Anticipated time for each task
Client acknowledgment

The care plan is updated with outcomes and revised or amended in response to changes in access to care and services at a minimum every six (6) months. Tasks, types of assistance in accessing services, and services should be updated as they are identified or completed – not at set intervals.

Percentage of non-medical case management clients, regardless of age, with a diagnosis of HIV who had a non-medical case management care plan developed and/or updated two or more times in the measurement year. (DSHS Performance Measure)

Percentage of client records with documented follow up for issues presented in the care plan.

Percentage of Care Plans documented in the primary client record system.

Assistance in Accessing Services and Follow-Up: Case management staff will work with the client to determine barriers to accessing services and will aid in accessing needed services.

Case management staff will ensure that clients are accessing needed services, and will identify and resolve any barriers clients may have in following through with their Care Plan.

When clients are aided with services elsewhere (outside of the agency providing NMCM services), case notes include documentation of follow-up.

Percentage of N-MCM clients with documented types of assistance provided that was initiated upon identification of client needs and with the agreement of the client. Assistance denied by the client should also be documented in the primary client record system.

Percentage of N-MCM clients with assistance provided have documentation of follow up to the type of assistance provided.

Case Closure/Graduation: Clients who are no longer engaged in active case management services should have their cases closed based on the criteria and protocol outlined below.

Common reasons for case closure include:

Client no longer needs non-medical case management services
Client is referred to another case management program
Client relocates outside of service area
Client chooses to terminate services
Client is no longer eligible for services due to not meeting eligibility requirements
Client is lost to care or does not engage in service
Client incarceration greater than six (6) months in a correctional facility
Provider initiated termination due to behavioral violations
Client death

Graduation criteria:

Client completed case management goals for increased access to services/care needs
Client is no longer in need of case management services (e.g., client can resolve needs independent of case management assistance)

Client is considered non-adherent with care if three (3) attempts to contact client (via phone, email and/or written correspondence) are unsuccessful and the client has been given 30 days from initial contact to respond. Discharge proceedings should be initiated by agency 30 days following the 3rd attempt. Make sure appropriate Releases of Information and consents are signed by the client and meet requirements of HB 300 regarding electronic dissemination of protected health information (PHI).

Staff should utilize multiple methods of contact (phone, text, email, certified letter) when trying to re-engage a client, as appropriate. Agencies must ensure that they have releases of information and consent forms that meet the requirements of HB 300 regarding the electronic dissemination of protected health information (PHI).

Percentage of N-MCM clients with closed cases includes documentation stating the reason for closure and a closure summary (brief narrative in progress notes and formal discharge summary).

Percentage of closed cases with documentation of supervisor signature/approval on closure summary (electronic review is acceptable).

Percentage of clients notified (through face-to-face meeting, telephone conversation, or letter) of plans to discharge the client from case management services.

Percentage of clients with written documentation explaining the reason(s) for discharge and the process to be followed if client elects to appeal the discharge from service.

Percentage of clients with information about reestablishment shared with the client and documented in primary client record system.

Percentage of clients provided with contact information and process for reestablishment as documented in primary client record system.

Percentage of clients with documented Case Closure/Graduation in the primary client record system.