POPS Chapter 17 - Health Insurance Program Standards
Reference: HIV/STD Policy No. 260.002
17.1 Service Assembly
- The agency has documentation to show that the Assembly allocated funds to the health insurance program, according to the local needs assessment identification.
- The agency has documentation of any eligibility criteria developed by the Assembly in addition to DSHS’s.
The agency has a procedure on file for paying health insurance providers while protecting the client’s confidentiality with regard to HIV status.
17.3 Case Management
- The case file has documentation that client meets eligibility criteria required by the DSHS
- The case file has documentation that the client meets Assembly eligibility criteria, if any
- The case file has documentation that the case manager assessed the client’s health insurance coverage and eligibility for the health insurance program at the time of the intake
- The case file has documentation that the client knows of the responsibility to report changes in income, insurance status, or other relevant information (e.g., change of insurance carrier, premium rates)
- The case file has documentation that the case manager re-evaluates the client’s needs on a periodic basis
- The case file contains the necessary information about the insurance provider (payee, address, verified premium amount), the amount of assistance for which the client is eligible and when payments were made.