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: Health and Human Services
Sponsors: GATTINE, SANBORN, CRAVEN, DUNPHY, HYMANSON, JORGENSEN, MADIGAN
Amends: 22 MRSA §2354

Legislative Document
No. 1337
H.P. 965
House of Representatives, March 21, 2019
An Act To Save Lives by Establishing a Homeless Opioid Users 
Service Engagement Program within the Department of Health and 
Human Services
Reference to the Committee on Health and Human Services suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative GATTINE of Westbrook.
Cosponsored by Senator SANBORN, L. of Cumberland and
Representatives: CRAVEN of Lewiston, DUNPHY of Old Town, HYMANSON of York, 
JORGENSEN of Portland, MADIGAN of Waterville.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §2354 is enacted to read:
§2354.  Homeless opioid users service engagement program
There is established within the department a homeless opioid users service 
engagement program 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 disorder and 
stable housing to support their recovery.
1.  Definitions.  For purposes of this section, the following terms have the following 
meanings.
A.  "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leaseholder or owner and can be rescinded at any time without notice.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.
B.  "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 program.
C.  "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.
D.  "Partner provider" means a social service or health care provider with expertise in 
all or a portion of the services provided in the program and that executes a 
subcontract with a lead provider to provide those services.
E.  "Program" means the homeless opioid users service engagement program 
established in this section.
F.  "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 program through social service contracts.
3.  Service location.  The program 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 program 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 program 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 program and 
accounting for program 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 program successfully.  A lead provider may subcontract with 
partner providers to implement portions of the program 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.  Program design and implementation.  To the extent permitted by resources 
allocated to the program, the program must be designed and implemented as described in 
this subsection.
A.  The program must assist participants in attaining and sustaining recovery, 
minimize the risk of opiate poisoning among participants and decrease the likelihood 
of diversion of buprenorphine 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 program, 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 program must give priority to individuals who are being discharged from 
incarceration or long-term hospitalization due to complications related to substance 
use disorder.
The program must include intensive outreach using a collaborative team case review 
approach to identify and recruit participants.  An individual selected for the program 
who chooses to participate in the program shall sign a written agreement that explains 
the requirements for program participation and authorizes initiation of case 
management and treatment services as well as a release authorizing members of the 
program 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 program to meet the 
needs of the rural area or urban area it serves, the program must include medication-
assisted treatment, intensive case management and immediate access to stable 
housing as described in this paragraph.
(1)  The program must provide participants with medication-assisted treatment in 
accordance with this subparagraph that is initiated within 48 hours of each 
participant's enrollment in the program.  The program must 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 
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 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)  Random drug testing of participants;
(d)  Ongoing evaluations of participants to optimize treatment, including 
assessments of psychosocial needs and referrals for psychiatric assessments 
or treatment as necessary; and
(e)  Treatment of participants' concomitant psychiatric disorders that either 
complicate the participants' substance use disorder or act as triggers for 
relapse.
(2)  The program 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 
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)  Improving 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 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 program 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 program 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, 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.  The intensive case management 
team shall collaborate with local housing authorities, affordable housing 
developers, municipal general assistance offices and housing voucher 
administrators to provide program participants with priority in accessing these 
placements.
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 program participants 
with 5 months of rent 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 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 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 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 program at any time.  The lead provider or a 
partner provider shall reevaluate each participant's enrollment in the program every 
month.  A participant may receive services from the program for the length of time 
necessary for the participant to successfully complete the program or to transition to a 
less intensive model of treatment when considered clinically appropriate.  In 
determining whether a participant has successfully completed the program 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 program if the lead provider 
or a partner provider determines that the program is unable to provide appropriate 
services due to the participant's physical or mental health or continued illegal 
substance use.
6.  Program evaluation.  Annually the lead provider shall contract with an 
independent entity to conduct a rigorous evaluation of the program 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 program voluntarily, who 
were discharged after successful completion of the program and who were discharged 
because the program could no longer provide appropriate services.
7.  Report.  The department shall report to the joint standing committee of the 
Legislature having jurisdiction over health and human services matters regarding the 
program by March 15, 2020 and each year thereafter.  The joint standing committee may 
submit legislation regarding the program, including legislation to continue or expand the 
program.
Sec. 2.  Authority to submit legislation.  The joint standing committee of the 
Legislature having jurisdiction over health and human services matters may submit 
legislation regarding the homeless opioid users service engagement program established 
in the Maine Revised Statutes, Title 22, section 2354 to the Second Regular Session of 
the 129th Legislature.
SUMMARY
This bill establishes within the Department of Health and Human Services a program 
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.  The bill details the program objectives, 
eligibility criteria for program 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 bill requires an independent evaluation of the program 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 program by 
March 15, 2020 and annually thereafter.  The joint standing committee is authorized to 
submit legislation regarding the program.