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-89 - MaineMOM Services and Reimbursement › Subsection 144-101-II-89.02 - DEFINITIONS

Current through 2024-29, July 17, 2024
89.02-1
American Society of
					 Addiction Medicine
(ASAM
)
Criteria
Level of
					 care criteria that establish what services are medically necessary for a
					 member.
89.02-2
Authorized
					 Entity
is an organization authorized by the Department of Health and
					 Human Services (DHHS) to perform specified functions pursuant to a signed
					 contract or other approved signed agreement.
89.02-3
Behavioral and Physical Health
					 Integration
is the care a member experiences as a result of a team of
					 primary care and behavioral health providers, working together with members and
					 families, using a systematic and cost-effective approach to provide
					 patient-centered care for a defined population (based on the definition of
					 "Integrated Behavioral Health Care" from the Agency for Healthcare Research and
					 Quality).
89.02-4
Care
					 Plan
is a patient-centered plan that describes, coordinates, and
					 integrates a member's clinical information, to include all clinical and
					 non-clinical health care-related needs and services.
89.02-5
Community Health Worker
					 (CHW)
is a trained health worker 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). CHWs apply their
					 unique understanding of the community's experience, socio-economic needs,
					 language and/or culture to advocate for individual and community needs and acts
					 as a bridge between providers and individuals to promote health, reduce
					 disparities, and improve service delivery. CHWs are distinguished from other
					 health professionals in that they are hired primarily for their understanding
					 of the populations and communities they serve, conduct outreach a significant
					 portion of the time, and have experience providing services in community
					 settings.
89.02-6
Co-occurring Capable Providers
are organized to welcome, identify,
					 engage, and serve members with co-occurring mental health and Substance Use
					 Disorders (SUDs), and to incorporate attention to these issues into all aspects
					 of co-occurring services including linkage with other providers, staff
					 competency and training.
89.02-7
Diagnostic and Statistical Manual of Mental Health
					 Disorders
(DSM)
is the most current version published by the
					 American Psychiatric Association. The DSM is used to classify mental health
					 diagnoses and provide standard categories for definition of mental health
					 disorders.
89.02-8
Eat,
					 Sleep, Console (ESC)
is an Evidence-Based Practice of care using a
					 non-pharmacological care model and treatment of Neonatal Opioid Withdrawal
					 Syndrome (NOWS) for newborn infants in the hospital setting. ESC focuses on
					 keeping parent and infant together, monitoring feeding, sleeping, and ability
					 to be consoled as measures of infant functioning.
89.02-9
Electronic Health Record
					 (EHR)
is a systematic collection of electronic health information about
					 individual MaineCare members. It is a record in digital format that is capable
					 of being shared across different health care settings by a
					 Department-designated Health Information Exchange(s) (HIE), a
					 Department-designated network connected enterprise-wide information system(s),
					 and other information networks or exchanges. An EHR supports clinical EHR
					 functions, such as intake, clinical care, task management, and case management
					 where appropriate, and has Health Level Seven (HL7) interoperability
					 capabilities to support the electronic sharing of portions of the patient's
					 record.
89.02-10
Intrapartum
					 Care
are the health services provided to members and their infant(s)
					 during labor and delivery, including vaginal delivery and cesarean
					 section.
89.02-11
Opioid Use
					 Disorder (OUD)
means SUD, Opioid, defined by the DSM.
89.02-12
Perinatal Care
are the
					 health services provided to a member and their infant(s) during the perinatal
					 period, which begins at conception and extends through twelve (12) months
					 following the end of pregnancy, and includes Prenatal, Intrapartum and
					 Postpartum Care.
89.02-13
Plan of Safe Care
is a written document, prepared by health care
					 or community providers in consultation with the parents of substance exposed
					 infants in accordance with
					 22 M.R.S.
					 §4004-B(5).
89.02-14
Postpartum Care
are the
					 health services provided to a member following the end of pregnancy, including
					 but not limited to routine Postpartum Care and family planning
					 education.
89.02-15
Prenatal
					 Care
are the health services provided to a member during pregnancy
					 including physical examinations, recording of weight, blood pressure, fetal
					 heart tones, maternity counseling, etc.