Resolve, To Save Lives by Establishing a Homeless Opioid Users Service Engagement Pilot Project within the Department of Health and Human Services
Maine Legislature, Session 128, LD 1711
Committee Amendment CA_A_H737 (House)

COMMITTEE AMENDMENT "A" to H.P. 1191, L.D. 1711, "Resolve, To Save 
Lives by Establishing a Homeless Opioid Users Service Engagement Pilot Project within 
the Department of Health and Human Services" 
Amend the resolve by striking out everything after the title and before the summary 
and inserting the following: 
'Sec. 1. 
Homeless opioid users service engagement pilot project. 
Resolved: 
That there is established within the Department of Health and Human 
Services a homeless opioid users service engagement pilot project to provide 50 opioid 
users who are among the most vulnerable and unstable in the State rapid access to 
low-barrier treatment for substance use disorders and stable housing to support their 
recovery. 
1. Definitions. For purposes of this resolve, the following terms have the following 
meanings. 
A. "Department" means the Department of Health and Human Services. 
B. "Housing assistance fund" means the fund described in section 2, subsection 3, 
paragraph C. 
C. "Individuals who are experiencing homelessness" means adults, unaccompanied 
youth and families with children who lack a fixed, regular and adequate nighttime 
residence or who are at risk of imminently losing their primary nighttime residence 
including those who are sharing another person's dwelling on a temporary basis under 
which permission to remain is contingent upon the hospitality of the primary 
leaseholder or owner and can be rescinded at any time without notice. "Individuals 
who are experiencing homelessness" includes individuals and families who are 
fleeing or attempting to flee domestic violence, dating violence, sexual assault, 
stalking or another dangerous or life-threatening situation involving violence against 
the individual or a member of the family. 
"Individuals who are experiencing 
homelessness" also includes individuals who are exiting an institution where the 
individual resided for 90 or fewer days and who resided in an emergency shelter or 
place not meant for human habitation immediately before entering the institution. 
COMMITTEE AMENDMENT 
COMMITTEEAMENDMENT"A "toH.P.1191,L.D.1711 
D. "Lead provider" means a social service or health care provider that is selected by 
the department and that executes a social service contract with the department to 
implement the pilot project. 
E. 
"Medication-assisted treatment" means the evidence-based, whole-patient 
approach to the treatment of substance use disorder that combines counseling and 
behavioral therapies with medications approved by the federal Food and Drug 
Administration for the treatment of substance use disorder, such as buprenorphine 
and naloxone combination drugs, methadone or naltrexone. 
F. "Partner provider" means a social service or health care provider with expertise in 
all or a portion of the services provided in the pilot project and that executes a 
subcontract with a lead provider to provide those services. 
G. "Pilot project" means the homeless opioid users service engagement pilot project 
established in this section. 
H. "Recovery" means a process of change through which an individual improves the 
individual's health and wellness, lives a self-directed life and strives to reach the 
individual's full potential. 
2. Duration of pilot project. The department shall issue a request for proposals and 
implement the pilot project through social service contracts no later than September 1, 
2018. The pilot project must operate for a minimum of 12 months. 
3. Pilot project location. The pilot project must provide services in both an urban 
area and a rural area of the State where social service and health care providers who can 
successfully implement the pilot project are located. In selecting the areas of the State, 
the department shall determine which areas of the State have the greatest need based upon 
the geographic location of opioid users who are experiencing homelessness and the extent 
of emergency services use by those individuals. The department may select one lead 
provider to implement the pilot project in both the urban area and the rural area or it may 
select separate lead providers for the urban area and the rural area. 
4. Lead providers. The lead provider or providers with whom the department 
executes social service contracts are responsible for implementing the pilot project and 
accounting for pilot project funds. To qualify for selection by the department as a lead 
provider, a social service or health care provider must demonstrate the ability to 
implement all aspects of the pilot project successfully. A lead provider may subcontract 
with partner providers to implement a portion of the pilot project services that are within 
the partner providers' expertise. 
At a minimum, the lead provider and its partner 
providers shall demonstrate successful experience in the following activities: 
A. 
Engaging with individuals who are experiencing homelessness and who use 
opioids in the State; 
8 
B. Administering medication-assisted treatment to vulnerable populations; and 
C. 
Providing housing support services to individuals who are experiencing 
homelessness; and be it further 
Sec. 2. Pilot project design and implementation. Resolved: That, to the 
extent permitted by resources allocated to the pilot project, the pilot project must be 
designed and implemented as described in this section. 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"A"toH.P.1191,L.D.1711 
1. Pilot project objectives. The pilot project must assist participants in attaining 
and sustaining recovery, minimize the risk of opiate poisoning among participants and 
decrease the likelihood of diversion ofbuprenorphine by increasing participants' access to 
stable and supportive housing, connecting participants with the recovery community and 
its resources and providing participants with a safe environment in which the participants 
can identify individualized short-term and long-term goals and develop new skills to 
support their recovery. 
2. Participant eligibility and recruitment. To participate in the pilot project, an 
individual must be an individual who is experiencing homelessness, have a history of 
drug overdose and meet the criteria for physiological dependence on opioids in the 
Diagnostic and Statistical Manual of Mental Disorders, 5th edition, published by the 
American Psychiatric Association. The pilot project must give priority to individuals 
who are being discharged from incarceration or long-term hospitalization due to 
complications related to substance use disorder. 
The pilot project must include intensive outreach using a collaborative team case review 
approach to identify and recruit participants. An individual selected for the pilot project 
shall sign a written agreement that explains the requirements for pilot project 
participation and authorizes initiation of case management and treatment services as well 
as a release authorizing members of the pilot project team to share information regularly 
regarding the participant's progress in recovery and in attaining individual goals. 
Participants shall also complete initial assessments regarding substance use disorder, 
physical health and psychosocial and psychiatric needs as soon as possible. 
3. Pilot project components. Although a lead provider may adapt the structure of 
the pilot project to meet the needs of the rural area or urban area it serves, the pilot 
project must include medication-assisted treatment, intensive case management and 
immediate access to stable housing as described in this subsection. 
A. The pilot project must provide participants with medication-assisted treatment in 
accordance with this paragraph that is initiated within 48 hours of each participant's 
enrollment in the pilot project. The pilot project must seek reimbursement from 
MaineCare for medication-assisted treatment services whenever possible. The lead 
provider or partner provider shall employ a medical professional authorized to 
prescribe for each participant a medication approved by the federal Food and Drug 
Administration for the treatment of substance use disorder that, in the professional's 
opinion, is most appropriate given the participant's current medications, substance use 
and medical history. The authorized prescriber shall take primary responsibility for 
managing and refilling the prescription. 
The lead provider or partner provider shall establish a collaborative, interagency 
staffing model of medication-assisted treatment that includes, to the extent resources 
permit, the authorized prescriber, a nurse care manager, a licensed clinical social 
worker or licensed alcohol and drug counselor, a certified psychiatric mental health 
nurse practitioner and a peer support specialist who meet regularly to plan participant 
services, review participant progress and implement reenrollment strategies when 
necessary. 
The lead provider or partner provider shall use a shared medical 
appointment model for medication-assisted treatment that supports participants in 
decreasing the use of illegal and nonprescribed drugs by delivering the following: 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ·11" to H.P. 1191, L.D. 1711 
(1) Office-based, daily observed medication administration to participants; 
(2) 
The opportunity to participate in individual and group psychotherapy, 
pharmacotherapy and support groups; 
(3) Random drug screening of participants; 
(4) 
Ongoing evaluations of participants to optimize treatment, including 
assessments of psychosocial needs and referrals for psychiatric assessments or 
treatment as necessary; and 
(5) 
Treatment of participants' concomitant psychiatric disorders that either 
complicate the participants' substance use disorder or act as triggers for relapse. 
B. The pilot project must provide participants with intensive case management 
designed to provide an intensive, comprehensive range of community-based services 
to address the physical and behavioral health needs of participants and support their 
compliance with medication-assisted treatment and other services necessary to 
recovery. 
The lead provider or partner provider shall establish an intensive case management 
team that includes, to the extent resources permit, an intensive case management 
team supervisor, case managers, a housing liaison, a transition liaison and peer 
support specialists. The intensive case management team shall provide intensive 
outreach, assessment, care coordination, advocacy, support, planning and facilitation 
of services to meet each participant's comprehensive mental health, medical and 
dental health needs while reducing redundant services as well as to support 
participants in achieving the following goals: 
(1) Acquiring material resources, including, but not limited to, food, shelter, 
clothing and medical care; 
(2) Improving psychosocial functioning and developing greater autonomy; 
(3) Developing coping and problem-solving skills; 
(4) 
Developing a community support system to help participants meet the 
demands of community life; and 
(5) 
Accessing benefits and services for which participants may qualify, 
including, but not limited to, housing, medical, behavioral health, employment, 
education, supplemental income, transportation, utility and community and 
family integration services. 
The peer support specialist shall serve as a role model and shall provide one-on-one 
peer support services to assist participants in reducing harmful behaviors, to identify 
participants' strengths and skills that can help reduce illegal substance use and to 
develop participants' recovery goals. The peer support specialist shall also coordinate 
and facilitate peer recovery groups. 
The transition liaison shall assist participants who are transitioning out of 
incarceration or hospitalization. The transition liaison shall recruit individuals who 
are incarcerated or hospitalized and who expect to be discharged soon for 
participation in the project and assist those individuals with the enrollment process. 
The transition liaison shall also coordinate with staff from the correctional or medical 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"4 "toH.P.1191,L.D.1711 
facility to facilitate participants' smooth transition from the facility. To the extent 
practicable, the transition liaison shall ensure that participants have access to housing 
immediately upon discharge from a correctional or medical facility. 
C. The pilot project shall provide participants with immediate and continued access 
to stable housing that promotes recovery, independence and harm reduction. The 
intensive case management team shall identify appropriate housing placements for 
participants that may include, but are not limited to, housing first developments, 
recovery residences, private nonmedical institutions and private apartments. The 
intensive case management team shall collaborate with local housing authorities, 
affordable housing developers, municipal general assistance offices and housing 
voucher administrators to provide pilot project participants with priority in accessing 
these programs. 
The lead provider or a partner provider shall administer a housing assistance fund to 
provide participants with immediate access to stable housing. The housing assistance 
fund must contain sufficient capital to provide all pilot project participants with 5 
months of rent at fair market value based on the location of the pilot project. The 
lead provider or partner provider may provide a participant with more or less than 5 
months of financial assistance from the housing assistance fund, depending on the 
participant's individual need for financial assistance to achieve housing stability. 
While participants receive financial assistance from the housing assistance fund, the 
intensive case management team shall assist pa1ticipants in securing an alternative 
financial resource or resources for housing, including but not limited to employment, 
general assistance, the Bridging Rental Assistance Program established in the Maine 
Revised Statutes, Title 34-B, section 3011, the federal shelter plus care program 
authorized by the federal McKinney-Vento Homeless Assistance Act, Public Law 
100-77, as amended by the federal Homeless Emergency Assistance and Rapid 
Transition to Housing Act of 2009, Public Law 111-22, Division B (2009) and 
housing choice vouchers under Section 8 of the United States Housing Act of 1937, 
Public Law 75-412, 50 Stat. 888, as amended. 
4. 
Participant discharge criteria. A participant may withdraw from the pilot 
project at any time. 
The lead provider or a partner provider shall reevaluate each 
participant's enrollment in the pilot project every month. A participant may receive 
services from the pilot project for the length of time necessary for the participant to 
successfully complete the project or to transition to a less intensive model of treatment 
when considered clinically appropriate. 
In determining whether a participant has 
successfully completed the project or may transition to a less intensive model of 
treatment, the lead provider or partner provider shall consider the participant's sustained 
abstinence from illegal substance and alcohol use, employment or involvement in other 
meaningful community activities, psychosocial supports and willingness to participate in 
further treatment to maintain recovery. 
Alternatively, a participant may be discharged from the pilot project if the lead provider 
or a partner provider determines that the pilot project is unable to provide appropriate 
services due to the participant's physical or mental health or continued illegal substance 
use; and be it further 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"A "toH.P.1191,L.D.1711 
Sec. 3. Pilot project evaluation. Resolved: 
That the lead provider shall 
contract with an independent entity to conduct a rigorous evaluation of the pilot project 
implemented by that lead provider, including a cost-benefit analysis, in order to inform 
future interventions and provide a model that can be replicated throughout the State. The 
independent entity shall, at a minimum, consider the following information in conducting 
the evaluation: 
A. 
The extent of participant engagement in medication-assisted treatment, 
maintenance of stable housing, achievement of employment or engagement in 
community volunteer positions and reconnection with family; 
B. The number of overdose incidents, the level of involvement with the criminal 
justice system and law enforcement and the extent of use of emergency medical 
services including emergency medical response, crisis intervention services, 
emergency shelter or food resources and inpatient hospital stays for participants 
during the pilot project as compared to the year before the pilot project began; and 
C. The number of participants who withdrew from the pilot project voluntarily, who 
were discharged after successful completion of the pilot project and who were 
discharged because the pilot project could no longer provide appropriate services; and 
be it further 
Sec. 4. Report. Resolved: That the department shall report to the joint standing 
committee of the Legislature having jurisdiction over health and human services matters 
regarding the pilot project by March 15, 2019. The joint standing committee may submit 
legislation regarding the pilot project, including legislation to continue or expand the pilot 
project, to the First Regular Session of the 129th Legislature; and be it further 
Sec. 5. 
Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
Office of Substance Abuse and Mental Health Services Z199 
Initiative: Provides one-time funding for a pilot project to provide rapid access to low-
barrier treatment for substance use disorders and stable housing to support recovery and 
create stability for 50 opioid users who are among the most vulnerable and unstable in the 
State. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
SUMMARY 
2017-18 
$0 
$0 
2018-19 
$2,084,096 
$2,084,096 
This amendment, which is the majority report of the committee, strikes and replaces 
the resolve. Like the resolve, the amendment establishes within the Department of Health 
and Human Services a pilot project to provide rapid access to low-barrier treatment for 
COMMITTEE AMENDMENT 
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COMMITTEEAMENDMENT"A "toH.P.1191,L,D.1711 
substance use disorders and stable housing to support recovery and create stability for 50 
opioid users who are among the most vulnerable and unstable in the State. 
The 
amendment details the pilot project objectives, eligibility criteria for pilot project 
participants and services that must be provided to those participants, including 
medication-assisted treatment, intensive case management services and financial and case 
management assistance to ensure immediate and continued access to stable housing. The 
amendment requires an independent evaluation of the pilot project and directs the 
department to submit a report to the joint standing committee of the Legislature having 
jurisdiction over health and human services matters regarding the pilot project by March 
15, 2019. The joint standing committee is authorized to submit legislation regarding the 
pilot project, including legislation to continue or to expand the pilot project, to the First 
Regular Session of the l 29th Legislature. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 03/19/18 ;t,,/ac 
LD 1711 
LR2744(02) 
Resolve, To Save Lives by Establishing a Homeless Opioid Users Service Engagement Pilot Project 
within the Department of Health and Human Services 
Fiscal Note for Bill as Amended by Committee Amendment •4{ //- 7 3 7) 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2017-18 
FY 2018-19 
$0 
$2,084,096 
$0 
$2,084,096 
Projections 
FY2019-20 
$0 
$0 
Projections 
FY 2020-21 
$0 
$0 
The bill includes a one-time General Fund appropriation to the Department of Health and Human Services of 
$2,084,096 in fiscal year 2018-19 for a pilot project to provide rapid access to low-barrier treatment for substance use 
disorders and stable housing to support recovery and create stability for 50 opioid users who are among the most 
vulnerable and unstable in the State. 
LR2744(02) - Fiscal Note - Page 1 of 1