An Act To Save Lives by Establishing a Homeless Opioid Users Service Engagement Program within the Department of Health and Human Services
Maine Legislature, Session 129, LD 1337
Committee Amendment CA_A_H429 (House)

COMMITTEE AMENDMENT "A" to H.P. 965, L.D. 1337, Bill, "An Act To Save 
Lives by Establishing a Homeless Opioid Users Service Engagement Program within the 
Department of Health and Human Services" 
Amend the bill by striking out the title and substituting the following: 
'Resolve, To Save Lives by Establishing a Homeless Opioid Users Service 
Engagement Pilot Project within the Department of Health and Human Services' 
Amend the bill by striking out everything after the title 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-banier 
treatment for substance use disorders and stable housing to support their recovery. 
1. Definitions. As used in this resolve, the following terms have the following 
meanings. 
A. "Department" means the Department of Health and Human Services. 
B. "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leaseholder or owner and can be rescinded at any time without notice.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. 
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C. "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. 
D. 
"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. 
E. "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. 
F. "Pilot project" means the homeless opioid users service engagement pilot project 
established in this section. 
G. "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. Social service contracts. The department shall issue a request for proposals and 
implement the pilot project through social service contracts. 
3. Service 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 individuals 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 which 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 portions 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; 
B. Administering medication-assisted treatment to vulnerable populations; and 
C. 
Providing housing support services to individuals who are experiencing 
homelessness. 
5. Pilot project design and implementation. To the extent permitted by resources 
allocated to the pilot project, the pilot project must be designed and implemented as 
described in this subsection. 
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COMMITTEE AMENDMENT "/J" to H.P. 965, L.D. 1337 
A. The pilot project must assist participants in attaining and sustaining recovery, 
minimize the risk of overdosing 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. 
B. 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 who chooses to participate in 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. 
C. 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 paragraph. 
(1) 
The pilot project must provide participants with medication-assisted 
treatment in accordance with this subparagraph that is initiated within 48 hours of 
each participant's emollment in the pilot project. The lead provider shall seek 
reimbursement from the MaineCare program 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 
staffmg 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 supp01t specialist who 
meet regularly to plan participant services, review participant progress and 
implement reemollment strategies when necessary. The lead provider or partner 
provider shall use a shared medical appointment model for medication-assisted 
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R. • '!, 
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treatment that supports participants in decreasing the use of illegal drugs and 
drugs that are not prescribed to the participant by delivering the following: 
(a) Office-based, daily observed medication administration to participants; 
(b) The opportunity to participate in individual and group psychotherapy, 
pharmacotherapy and support groups; 
( c) Ongoing evaluations of participants to optimize treatment, including 
assessments of psychosocial needs and referrals for psychiatric assessments 
or treatment as necessaty; and 
( d) Treatment of participants' concomitant psychiatric disorders that either 
complicate the participants' substance use disorder or act as triggers for 
relapse. 
(2) 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 
necessaty 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 
and supporting participants in achieving the following goals: 
(a) Acquiring medical care and material resources, including, but not limited 
to, food, shelter and clothing; 
(b) hnproving psychosocial functioning and developing greater autonomy; 
( c) Developing coping and problem-solving skills; 
( d) Developing a community support system to help participants meet the 
demands of community life; and 
(e) 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 ai·e 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 
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COMMITTEE AMENDMENT /I-" to H.P. 965, L.D. 1337 
participation in the pilot project and assist those individuals with the enrollment 
process. The transition liaison also shall coordinate with staff from the 
correctional or medical 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. 
(3) The pilot project shall provide participants with immediate and continued 
access to stable housing that promotes recovery, independence and hatm 
reduction. The intensive case management team shall identify appropriate 
housing placements for participants, which may include, but are not limited to, 
housing first developments, which are developments prioritizing providing 
permanent housing to individuals experiencing homelessness, recovery 
residences, private nonmedical institutions and private apartments leased either 
directly by the individual or by the provider through a master lease agreement. 
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 placements and maximizing the availability of any 
housing assistance, subsidies or vouchers. 
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 18 months ofrent at fair market value based on the location of 
the housing. The lead provider or partner provider may provide a participant with 
more or less than 18 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 participants 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. 
D. 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 pilot project or to 
transition to a less intensive model of treatment when considered clinically 
appropriate. In determining whether a participant has successfully completed the pilot 
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 
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COMMITTEE AMENDMENT ,"'1,, to H.P. 965, L.D. 1337 
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. 
6. Duration of pilot project. The department shall issue a request for proposals to 
implement the pilot project through social service contracts no later than the effective 
date of this resolve. The pilot project must operate for 24 months from the date all of the 
social service contracts have been awarded. 
7. Evaluation of pilot project. The lead provider shall contract with an independent 
entity each year of the pilot project 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 consider, at a minimum, 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 evaluation period as compared to the year before the evaluation period 
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. 
8. Federal funds. To the maximum extent possible, the department shall use state 
funds received for the pilot project to maximize its receipt of federal funds to be used for 
the pilot project and the department shall seek federal fund~g for the pilot project, if 
available. 
9. Report. 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 December 15, 2020 and at the conclusion of the pilot project. The joint 
standing committee may submit legislation to the first regular session of the l 30th 
Legislature regarding the pilot project, including legislation to continue or expand the 
pilot project. 
Sec. 2. Appropriations and allocations. Resolved: 
That the following 
appropriations and allocations are made. 
HEALTH AND HUMAN SERVICES, DEPARTMENT OF 
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COMMITTEE AMENDMENT.;; .. to H.P. 965, L.D. 1337 
Office of Substance Abuse and Mental Health Services Z199 
Initiative: Provides one-time funding for a 24-month 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 
2019-20 
$752,421 
$752,421 
2020-21 
$1,504,842 
$1,504,842 
This amendment changes the bill into a resolve. The bill established a homeless 
opioid users service engagement program. The amendment changes it to a pilot project 
that operates for 24 months. 
The amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/26/19 Mae.. 
LD 1337 
LR 1261(02) 
An Act To Save Lives by Establishing a Homeless Opioid Users Service Engagement Program within 
the Department of Health and Human Services 
Q \ 
Fiscal Note for Bill as Amended by Committee Amendment A• ( /1-'f :J.J 
Committee: Health and Human Services 
Net Cost (Savings) 
General Fund 
Appropriations/ Allocations 
General Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY2019-20 
FY 2020-21 
$752,421 
$1,504,842 
$752,421 
$1,504,842 
Projections 
FY2021-22 
$752,421 
$752,421 
Projections 
FY2022-23 
$0 
$0 
The bill includes General Fund appropriations to the Department of Health and Human Services of $752,421 in fiscal 
year 2019-20 and $1,504,842 in fiscal year 2020-21 for a 24 month 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. 
LR1261(02) - Fiscal Note - Page 1 of 1