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10.52.08.00.htm 10.52.08.00. Title 10 MARYLAND DEPARTMENT OF HEALTH Subtitle 52 PREVENTIVE MEDICINE Chapter 08 Maryland HIV Prevention Case Management Program Authority: Health-General Article, §2-104(b) and (j) 2-105(a) and 18-102(a) Annotated Code of Maryland
10.52.08.01.htm 10.52.08.01. 01 Purpose.. The purpose of the Maryland HIV Prevention Case Management Program is to:. A. Provide community-based prevention services for individuals at elevated risk for acquiring human immunodeficiency syndrome (HIV) including:1) Routine testing;. 2) Risk reduction counseling; and. 3) Pre-exposure prophylaxis (PrEP) and. B. Address the needs of recipients that would otherwise present barriers to accessing prevention services including:1) Housing;. 2) Transportation;. 3) Food;.
10.52.08.02.htm 10.52.08.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) “Acquired immunodeficiency syndrome (AIDS) means the medical condition caused by the human immunodeficiency virus.2) Agent.. a) “Agent” means an individual who assists an applicant in submitting an application for prevention services and is employed by an organization that has received funding from the Department under the Maryland HIV Prevention Case Management Program.
10.52.08.03.htm 10.52.08.03. 03 Program Funding.. A. The Department may provide funding to a CBO or a local health department approved to establish and operate a navigation program.B. Funding may cover:. 1) Case management services provided by an agent at a local health department or CBO;. 2) The estimated cost for a local health department or CBO to directly provide covered services to recipients; and3) The estimated cost for a local health department or CBO to provide payments to external organizat
10.52.08.04.htm 10.52.08.04. 04 Application for Funding from the Department.. A. A CBO or local health department that applies to receive funding from the Department to establish a navigation program:1) Shall submit an application to the Department that includes:. a) Responses to all applicable questions; and. b) Any supporting documentation indicated on the application;. 2) May voluntarily withdraw an application at any time; and. 3) May submit a new application at any time.. B. The Department shall:.
10.52.08.05.htm 10.52.08.05. 05 Navigation Program Design and Operation.. The grantee approved to operate a navigation program:. A. Shall ensure that all navigation program staff have:. 1) Appropriate levels of expertise in working with individuals who are members of vulnerable populations such as people of color, members of the LGBTQIA+ community, and people who use drugs;2) Knowledge of harm reduction strategies; and. 3) Skills in implementing harm reduction strategies;. B. Shall ensure that all
10.52.08.06.htm 10.52.08.06. 06 Recipient Eligibility for Program Services.. A. To be eligible for prevention program benefits, an individual shall meet the following criteria:. 1) Be a resident;. 2) Have one of the following factors for increased risk of acquisition of HIV:. a) A recently diagnosed STI;. b) A partner known to be living with HIV, if the partner:. i) Is not prescribed ART; or. ii) Takes ART inconsistently;. c) Sharing of injection drug equipment;.
10.52.08.07.htm 10.52.08.07. 07 Recipient Screening, Care Plan, Application, and Enrollment into the Program.. A. Screening.. 1) The agent shall complete a needs assessment and a sexual health screening for the applicant or recipient during each visit.2) The needs assessed shall include but are not limited to:. a) Housing;. b) Access to food;. c) Employment;. d) Job readiness;. e) Educational or vocational needs;. f) Behavioral health;. g) Medical needs;. h) Transportation;. i) Linguistic needs;.
10.52.08.08.htm 10.52.08.08. 08 Covered Services.. A. If a recipient is enrolled with a payor that provides some of the services provided by the Prevention Program, the Prevention Program shall be billed only for services not covered by the payor.B. The grantee:. 1) May provide covered program services directly; and. 2) May refer recipients to an outside organization and pay for the services on behalf of the recipient.C. The agent employed by the grantee shall obtain and keep on file document
10.52.08.09.htm 10.52.08.09. 09 Recovery of Payments.. A. If benefits have been incorrectly paid or another payor has been identified, the Department shall seek recovery of the amount of those payments.B. A grantee shall inform the Department if benefits have been incorrectly paid or another payor has been identified.
10.52.08.10.htm 10.52.08.10. 10 Fraud.. A. The Department shall pursue cases of suspected misrepresentation or fraud pursuant to Criminal Law Article, §8-503, Annotated Code of Maryland, or any other applicable statutory provision.B. A grantee shall inform the Department of suspected misrepresentation or fraud that may be pursued under the Criminal Law Article, §8-503, Annotated Code of Maryland, or any other applicable statutory provision.
10.52.08.11.htm 10.52.08.11. 11 Confidentiality.. Except when otherwise authorized by law, the agent of an applicant, the agent of a recipient, the grantee, and the Department:A. Shall keep all applicant and recipient personal information confidential;. B. May not disclose personal information kept on an applicant or recipient without written consent of the:1) Applicant;. 2) Recipient;. 3) Applicant’s parent or legal guardian; or. 4) Recipient’s parent or legal guardian;. C. Shall comply with the
10.52.08.12.htm 10.52.08.12. 12 Availability of Funding and Program Termination.. A. If sufficient monies are not available to fund the Prevention Program, the Department shall take the action necessary to eliminate a deficit which may include program termination or restricting eligibility for the program.B. If the program is terminated, the Department shall continue to provide benefits for each currently enrolled recipient through the earlier of:1) The end of the recipient’s 12-month enrollment period; or.
10.52.08.13.htm 10.52.08.13. 13 Changes in Eligibility and Disenrollment.. A. A recipient shall notify the agent or Department within 60 business days of a change in:. 1) Availability of third-party or insurance payment for covered services;. 2) Gross income; or. 3) Address.. B. If the agent or Department determines that a change reported in §A of this regulation results in the recipient no longer qualifying for Prevention Program services, the agent or the Department shall disenroll the recipient.
10.52.08.14.htm 10.52.08.14. 14 Reconsideration and Appeal.. A. An applicant or recipient who has been notified by the Department or grantee of ineligibility for or disenrollment from Prevention Program benefits may request reconsideration of the decision by submitting a letter of reconsideration with additional supporting documentation or information to the agent or Department within 30 business days of the notification.B. If an applicant or recipient submits a letter of reconsideration within
10.52.08.15.htm 10.52.08.15. 15 Payment Procedures.. A. The grantee shall:. 1) Pay for covered services directly to the vendor on behalf of the recipient; and. 2) Report amounts paid for services in the expenditure reports required by the Department.. B. The agent shall obtain documentation of payments due to outside organizations and receipt of payment made on behalf of the recipient.C. Payment for services, other than gift cards for the purchase of food, may not be provided directly to the recipient.
10.52.08.16.htm 10.52.08.16. 16 Cause for Suspension or Removal, and Imposition of Sanctions.. A. If the Department determines that a service provider or service provider’s employee, or both, has failed to comply with federal or State laws and regulations or has engaged in fraud or abuse, the Department may:1) Suspend the service provider from receiving payments from Prevention Program funds;. 2) Withhold payment to the service provider; or. 3) Permanently ban the service provider from recei
10.52.08.9999.htm 10.52.08.9999. Administrative History Effective date: May 20, 2019 (46:10 Md. R. 490).
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