LEVEL 4 LEVEL 3 2 LEVEL 1 of Functioning (4 points) (3 points) (2 points) (1 point) Describes the Client’s need and eligibility for health benefit programs and support services to assist him/her in ACCESS establishing, maintaining, and participating in medical care and treatment services. Client is not engaged in Client has been engaged Client is engaged in Client is engaged in medical care; in medical care for less medical care more than 6 medical care for 12 MEDICAL HOME OR than 6 months; months but less than 12 months or longer; and Client is newly diagnosed OR months; client has had no with HIV and needs Client has had more OR reported ER visits. assistance navigating the than one reported ER Client has had at least system of care; visit in 12 months. one reported ER visit in OR the last 12 months. Client uses the ER as primary care provider. Score: Client is without medical Client needs assistance Client has medical Client is insured with HEALTH INSURANCE/ coverage; to complete applications insurance but insurance is adequate coverage to BENEFITS OR for health benefits inadequate to obtain care; provide access to the full Client is unable to pay for (Medicaid, Alliance, continuum of clinical care OR care through other ADAP, etc.); Client needs assistance in including dental and sources and needs OR meeting deductibles, co- medication services. immediate medical Client needs directions payments and/or Client may only need assistance. and assistance compiling spend-down occasional information or and completing health requirements; periodic review for benefit documentation OR renewal eligibility. or application material; Client needs significant OR active advocacy with Client’s application(s) for insurance representatives health benefits is to resolve billing disputes. pending. Score:
of Functioning LEVEL 4 (4 points) LEVEL 3 (3 points) 2 (2 points) LEVEL 1 (1 point) ACCESS Describes the Client’s need and eligibility for health benefit programs and support services to assist him/her in establishing, maintaining, and participating in medical care and treatment services. MEDICAL HOME Score: Client is not engaged in medical care; OR Client is newly diagnosed with HIV and needs assistance navigating the system of care; OR Client uses the ER as primary care provider. Client has been engaged in medical care for less than 6 months; OR Client has had more than one reported ER visit in 12 months. Client is engaged in medical care more than 6 months but less than 12 months; OR Client has had at least one reported ER visit in the last 12 months. Client is engaged in medical care for 12 months or longer; and client has had no reported ER visits. HEALTH INSURANCE/ BENEFITS Score: Client is without medical coverage; OR Client is unable to pay for care through other sources and needs immediate medical assistance. Client needs assistance to complete applications for health benefits (Medicaid, Alliance, ADAP, etc.); OR Client needs directions and assistance compiling and completing health benefit documentation or application material; OR Client’s application(s) for health benefits is pending. Client has medical insurance but insurance is inadequate to obtain care; OR Client needs assistance in meeting deductibles, co- payments and/or spend-down requirements; OR Client needs significant active advocacy with insurance representatives to resolve billing disputes. Client is insured with adequate coverage to provide access to the full continuum of clinical care including dental and medication services. Client may only need occasional information or periodic review for renewal eligibility.
ELECTRONIC_Standardized_Michigan_HIV_MCM_Acuity_Pilot_Tool_2.2016_517969_7.docx