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-92 - Behavioral Health Home Services › Subsection 144-101-II-92.04 - POLICIES AND PROCEDURES FOR MEMBER IDENTIFICATION AND ENROLLMENT

Current through 2024-29, July 17, 2024
92.04-1
Member Identification
The Department shall seek and anticipates receiving
						approval of this Section.
Pending approval, the BHH provider shall
						identify members who are potentially eligible for BHH services based on the
						eligibility criteria for BHH Services. The BHH provider will submit potentially
						eligible members through a certification process to approve
						services.
92.04-2
Enrollment and Freedom of Choice
A.
Enrollment. The Department shall
					 seek and anticipates receiving CMS approval of this Section.
Pending
					 approval, the BHH Provider will identify members for BHH based on the BHH
					 eligibility criteria. Potentially eligible members will be given information
					 about the benefits of participating in a BHH. The member can choose to be part
					 of BHH once confirmed eligible. They must be approved through a certification
					 process, with the certification effective the earliest date without risk of
					 duplicative services. The member can choose to not participate at any time by
					 notifying their BHH provider or the Department's authorized entity.
B.
Requests and Referrals
.Members may request BHH services or be referred for BHH services by another
					 MaineCare provider. The Department or its authorized entity shall approve or
					 deny the enrollment of such members within three (3) business days of a request
					 for services.
C.
Selection of
					 a primary care practice
.Upon entry of enrollment with a BHHO, the BHHO
					 will work with the member to identify an HHP or other primary care
					 provider.
D.
Duplication and
					 Freedom of Choice.
A member may not receive services under this Section
					 at the same time the member is receiving services under Section
					 13, Targeted Case Management
					 Services; Section
					 17, Community Support Services;
					 Section
					 91, Health Home Services; or,
					 Section
					 93, Opioid Health Home Services.
					 If, through the certification process, the member is determined to be receiving
					 a duplicative service, the member must choose which service they want to
					 receive, and such choice must be clearly documented in the member's record.
A member may opt out of BHH services at any time, and may
						choose to receive services from any qualified BHHO, by providing notice to the
						BHHO provider. The choice to switch providers shall be effective on the
						21stday of the following month, or the first
						available date when a duplication of service does not exist. Members who switch
						providers shall be removed from the member list for that provider. BHHO
						providers must transfer all the member's clinical documentation to the
						appropriate provider(s) within ten (10) business days of notification that a
						member shall transfer to a new BHHO provider.
Providers that offer Section
						13, Section
						17, Section
						91, and/or Section
						93 services and also Section
						92 services must be able to
						demonstrate that members are provided with information regarding choice of
						Section
						13, Section
						17, Section
						91, Section
						93 and Section
						92 services for which the member
						is eligible and which the provider offers.