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-93.01 - DEFINITIONS

Current through 2024-29, July 17, 2024
93.01-1
American Society of Addiction
					 Medicine (ASAM) Criteria
- Level of care criteria that establish what
					 services are medically necessary for a member.
93.01-2
Community Health Worker
					 (CHW)
- A trained (as described in 93.02-1(E)(5)) health worker who
					 applies their unique understanding of the 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 because 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 (adapted from the Maine State Innovation Model definition).
93.01-3
Medication Plan
- An
					 individualized medication-related treatment plan developed by the Medication
					 for Opioid Use Disorder (MOUD) prescriber specifically for the member based on
					 the results of the Comprehensive Biopsychosocial Assessment, diagnoses, level
					 of care required, and treatment priorities.
93.01-4
Electronic Health Record
					 (EHR)
- An EHR means 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 HL7 interoperability capabilities to support the
					 electronic sharing of portions of the patient's record.
93.01-5
Integrated Medication Assisted
					 Treatment (IMAT)
- Acombination of medication approved by the federal
					 Food and Drug Administration for the treatment of substance use disorder with
					 counseling, urine drug screening, and behavioral therapy that has proven
					 effective in treating substance use disorder.
93.01-6
Intensive Outpatient Services
					 (IOP) Level of Care
- This level of care includes members in the
					 induction phase of treatment who require OHH sites that operate an IOP in
					 accordance with
MaineCare Benefits Manual (MBM), Ch. II, Section
					 65.06-5
. This Level of Care is expected to last no more than sixty
					 (60) days per induction and shall not exceed six (6) months in a twelve
					 (12)-month period.
93.01-7
Induction Level of Care
- This level of care includes members in
					 the induction phase of treatment who do not require the IOP Level of Care. This
					 Level of Care is expected to last no more than sixty (60) days per induction
					 and shall not exceed six (6) months in a twelve (12)-month period.
93.01-8
Maintenance Level of
					 Care
- This level of care includes members in the maintenance phase of
					 treatment.
93.01-9
Medication Plus Level of Care
- This level of care includes members in
					 any phase of clinical treatment who only receive the services described in
					 93.05-1, 93.05-2, 93.05-3, 93.05-5, and 93.05-6.
93.01-10
Methadone Level of Care -
This level of care includes members who are receiving methadone
					 treatment services under
MBM, Section
					 65
and who are also
					 receiving the services described in 93.05-1, Health Home Services, from an OHH
					 provider.
93.01-11
Opioid
					 Health Home (OHH)
- A group of providers that furnishes IMAT and MOUD
					 services based on an integrated care delivery model focused on whole-person
					 treatment which may include, but is not limited to, counseling, care
					 coordination, MOUD, recovery coach support, urine drug screening, and medical
					 consultation for individuals who have been diagnosed with an opioid dependency.
					 An OHH is a team of providers that has completed an application and been
					 approved by the Department to provide OHH services.
93.01-12
Opioid Treatment Program
					 (OTP)
- An accredited treatment program with Substance Abuse and Mental
					 Health Services Administration (SAMHSA) certification and Drug Enforcement
					 Agency (DEA) registration to administer and dispense opioid agonist medications
					 that are approved by Federal Drug Administration to treat opioid
					 addiction.
93.01-13
Plan of
					 Care/Individual Treatment Plan (ITP)
- The Plan of Care/ITP is a care
					 plan that describes, coordinates and integrates a member's clinical data, as
					 well as clinical and non-clinical health care-related needs and services. The
					 Plan of Care/ITP shall also include member health goals, and the services and
					 supports necessary to achieve those goals, with particular focus on the
					 member's opioid dependency. The Plan of Care/ITP may exist within the member's
					 Electronic Health Record (EHR).
93.01-14
Stabilization Level of
					 Care
- This level of care includes members who have discontinued or
					 greatly reduced their substance use, no longer have cravings, and have few or
					 no side effects.