Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter II - Specific Policies By Service › Section 144-101-II-93 - Opioid Health Home Services › Subsection 144-101-II-93.02 - PROVIDER REQUIREMENTS

Current through 2024-29, July 17, 2024
The OHH must meet the following requirements. OHH
						providers must maintain documentation of all processes and procedures described
						below in an operating manual that is available for review by the Department
						upon request.
93.02-1
Opioid
					 Health Home (OHH) Requirements
A. The
					 OHH must execute a MaineCare Provider Agreement. The OHH is subject to
					 applicable state and federal Medicaid law, including but not limited to the
					 MBM, Chapter I, Section 1.
B. The
					 OHH must be approved as an OHH by the Department through the OHH application
					 process.
C. The OHH is encouraged
					 to utilize an EHR system and create an EHR for each member. Lack of an EHR
					 system will not be a determining factor in approving an OHH provider
					 application.
D. The OHH must be
					 co-occurring capable, meaning that the organization is structured to welcome,
					 identify, engage, and serve individuals with co-occurring substance use and
					 mental health disorders and to incorporate attention to these issues into
					 member services.
E. The OHH must be
					 a community-based provider located within the state of Maine. The OHH delivers
					 a team-based model of care through a team of employed or contracted personnel.
					 The team must include at least the personnel identified in this sub-section.
					 Unless otherwise specified, each role must be filled by a different individual;
					 the Department reserves the right to waive this requirement based on team
					 member professional experience and training. If there is a lapse in fulfillment
					 of team member roles of greater than thirty (30) continuous days, the OHH must
					 notify the Department in writing and maintain records of active recruitment to
					 fill the position(s).
All team members shall contribute to delivery of
						integrated and coordinated, whole-person care through a team-based
						approach.
1.
Clinical Team
					 Lead
- A licensed clinical professional with significant experience
					 treating individuals with substance use disorders, who may be a physician,
					 physician's assistant, psychologist, Licensed Clinical Social Worker (LCSW),
					 Licensed Clinical Professional Counselor (LCPC), Licensed Alcohol and Drug
					 Counselor - Certified Clinical Supervisor (LADC-CCS) or Advanced Practice
					 Registered Nurse (APRN).
The Clinical Team Lead shall coordinate the care
						management activities across the OHH, ensure that there is a current Plan of
						Care/ITP for each member, and ensure that there is appropriate supervision of
						the Recovery Coach.
The Clinical Team Lead role may be filled by an
						individual also serving in one of the other roles below, as long as the
						individual also meets the qualifications described above.
2.
MOUD prescriber
- A licensed
					 health care professional with authority to prescribe buprenorphine.
OHH MOUD prescribers provide services for the chronic
						condition of opioid dependence through an office-based opioid treatment setting
						and shall be trained and authorized to prescribe buprenorphine, buprenorphine
						derivatives, and naltrexone for opioid dependence.
OHH MOUD prescribers must have completed any applicable
						federally required training and hold the appropriate X-DEA license to prescribe
						buprenorphine in an office-based setting. They are required to adhere to
						Maine's Office of Substance Abuse and Mental Health Services, 14-118 C.M.R.
						Chapter 11,
Rules Governing the Controlled Substances Prescription
						Monitoring Program and Prescription of Opioid Medications
.
For members in the Methadone Level of Care who receive
						OHH services from an OTP, this role may be filled by a practitioner licensed
						under state and federal law to order, administer, or dispense opioid agonist
						treatment medications.
For members in the Methadone Level of Care who receive
						OHH services from a non-OTP OHH, the MOUD Prescriber must coordinate with the
						OTP.
All MOUD prescribers must be involved in the services
						described under Section 93.05-1. Activities may include, but are not limited
						to, participating in team meetings, assisting with the coordination of care
						across specialty and primary care providers, assessing risk of and discussing
						with the member potential medication interactions, and providing assistance and
						guidance in ensuring physical and behavioral health issues are addressed
						through screening, care coordination, and health promotion.
3.
Nurse Care Manager
- The
					 Nurse Care Manager must be either:
a. A
					 registered nurse, psychiatric nurse licensed as a registered professional nurse
					 and certified by the American Nurses Credentialing Center (ANCC) as a
					 psychiatric and mental health nurse (PMHN), APRN (as defined by the Maine State
					 Board of Nursing), or a Licensed Practical Nurse (LPN) who completes the SAMHSA
					 required training for an X-DEA license (i.e. SAMHSA approved eight-hour
					 training for Buprenorphine prescribing by physicians) within six (6) months of
					 initiating service delivery for OHH members. These providers may not continue
					 functioning as a Nurse Care Manager for more than six (6) months without
					 completing the appropriate training; or
b. An APRN who holds their X-DEA license.
The Nurse Care Manager shall contribute to
						implementation, coordination, and oversight of each OHH member's Plan of
						Care/ITP, assist in the coordination of care with outside providers, and
						communicate barriers to adherence as appropriate to the team, including the
						Clinical Team Lead.
The Nurse Care Manager position may be filled by another
						appropriate licensed medical professional on the OHH team, as long as the
						individual also meets the qualifications described
						above.
4.
Clinical Counselor who supports individuals with (OUD)
- The
					 Clinical Counselor must be:
a. A clinical
					 professional with a minimum certification as a Certified Alcohol and Drug
					 Counselor (CADC) or LADC; or
b. A
					 LCSW, Licensed Master Social Worker - Conditional Clinical (LMSW-CC), LCPC,
					 Licensed Clinical Professional Counselor - Conditional (LCPC-C), or Licensed
					 Marriage and Family Therapist (LMFT) or Licensed Marriage and Family Therapist
					 - Conditional (LMFT-C):
i. Who has completed a
					 minimum of sixty (60) hours of alcohol and drug education within the last five
					 (5) years; or
ii. Who, within a
					 maximum of five (5) years of initiating service delivery for OHH services, has
					 completed sixty (60) hours of alcohol and drug education.
The Clinical Counselor training must be documented and
						records must be kept on file for review by the Department upon request.
The Clinical Counselor provides counseling related to
						opioid dependency and individual or group substance use disorder outpatient
						therapy for members receiving counseling. For all members, the Clinical
						Counselor provides behavioral health expertise and contributes to care
						planning, assessment of individual care needs, and identification of and
						connection to behavioral health services, as part of the services described in
						93.05-1.
5.
Patient Navigator
- The
					 Patient Navigator must:
a. Have at least one
					 (1) year of job experience in a health/social services or behavioral health
					 setting and hold an Associate's degree; or
b. Be a Mental Health Rehabilitation
					 Technician/Community (MHRT/C) with at least one (1) year of related work
					 experience; or
c. Have a Bachelor's
					 degree from an accredited four-year institution of higher learning;
					 or
d. Be a medical assistant;
					 or
e. Be an LPN; or
f. Be a registered nurse; or
g. Be the Nurse Care Manager described in
					 93.02-1(E)(3); or
h. Be the Clinical
					 Counselor described in 93.02-1(E)(4); or
i. Be a Community Health Worker (CHW) who has
					 completed a training program with a curriculum approved by the Department, or
					 their designee, that includes both relevant CHW core competencies and training
					 specific to OUD treatment and recovery; or holds a Maine CHW certification or
					 registration (effective the date such a designation becomes active in the State
					 of Maine).
The Patient Navigator shall work with the member to
						collaborate with other health care, mental health, social service, and
						community providers to guide the member in accessing additional services and
						supports that will help the member in their
						recovery.
6.
Recovery Coach
- The Recovery Coach must:
a. Be an individual in long-term recovery or
					 a recovery ally, and
b. Effective
					 upon rule adoption, complete the 30-hour Connecticut Community for Addiction
					 Recovery (CCAR) training, or other Department-approved Recovery Coach training,
					 within six (6) months of the rule adoption date or within six (6) months of
					 beginning to deliver OHH services, whichever is later.
Recovery Coaches who are themselves in long-term recovery
						are encouraged and preferred, as their life experiences and recovery allow them
						to provide recovery support in such a way that others can benefit from their
						experiences.
F. The OHH must adhere to applicable
					 licensing standards regarding documentation of all OHH providers'
					 qualifications in their personnel files. Pursuant to applicable licensing
					 standards, the OHH must have a review process to ensure that employees
					 providing OHH services possess the minimum qualifications set forth
					 above.
G. If an OHH member has a
					 primary care provider, the OHH must establish a relationship with that primary
					 care provider, authorized and evidenced by a signed medical release.* Such a
					 release is not required when the member's primary care provider is also the
					 member's provider within the OHH.
*The Department shall seek and anticipates receiving
						approval for this section from the Centers for Medicare and Medicaid Services
						(CMS). Pending approval, covered services will be provided as described in this
						policy.
H. The OHH shall
					 ensure that it has policies and procedures in place to ensure that the Clinical
					 Team Lead and other team members, as appropriate, can communicate any changes
					 in patient condition that may necessitate treatment change with the member's
					 treating clinicians. This includes the requirement for establishing policies
					 and procedures around coordination, including but not limited to, a signed
					 medical release with the entities listed in 93.08(C) when applicable.
I. The OHH shall have in place
					 processes, procedures, and member referral protocols with local inpatient
					 facilities, Emergency Departments (EDs), residential facilities, crisis
					 services, and corrections for prompt notification of an individual's admission
					 and/or planned discharge to/from one of these facilities or services. The
					 protocols must include coordination and communication on enrolled or
					 potentially eligible members. The OHH shall have systematic follow-up protocols
					 to assure timely access to follow-up care.
J. The OHH must participate in
					 Department-approved OHH technical assistance and educational opportunities. At
					 least one (1) member of the care team must engage in these opportunities.
K. The OHH shall refer members to
					 another OHH or appropriate provider when a member requires treatment or a level
					 of care that the OHH does not offer.*
*The Department shall seek and anticipates receiving
						approval for this section from the CMS. Pending approval, covered services will
						be provided as described in this policy.