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-93.05 - COVERED SERVICES

Current through 2024-29, July 17, 2024
OHHs shall provide the following six (6) covered services
						in accordance with the requirements in their respective subsections. For
						clarity, each member in the IOP, Induction, Stabilization, and Maintenance
						Levels of Care receives each covered service. For members in the Medication
						Plus Level of Care, which does not require counseling, OHHs shall provide each
						covered service except for 93.05-4, Counseling Addressing Opioid Dependency.
						For members in the Methadone Level of Care who receive methadone treatment
						services under
MBM, Section
						65
, OHHs shall only
						provide 93.05-1, Health Home Services.
OHH services may be delivered, face-to-face, via phone or
						other media, in any community location where confidentiality can be maintained,
						as clinically appropriate. Not all aspects of OHH covered services require
						direct member involvement; however, all covered services require that provider
						activities be directly related to an individual member, are member-informed,
						and pursuant to the member's Plan of Care/ITP.
93.05-1
Health Home Services
The OHH shall provide at least one of the following
						Health Home Services to each OHH member within the reporting month, pursuant to
						the member's Plan of Care/ITP.
A.
Comprehensive Care Management
Comprehensive care management is provided for members,
						with the involvement of the member's family or other support system, if desired
						by the member, in order to assist the member to implement a whole-person care
						plan and monitor the member's success in achieving goals. The OHH shall review
						all discharge plans, monitor and review medication and lab results, and
						regularly communicate about these efforts with the multi-disciplinary team.
						Levels of care management may change according to member needs over time.
The OHH will establish and maintain relationships with
						the multidisciplinary team through outreach, planning, and communication in
						formulating and facilitating treatment recommendations.
B.
Care Coordination
The OHH shall provide intensive and comprehensive care
						coordination to address the complex needs of OHH members and help OHH members
						overcome any barriers to care by providing access to all clinical and
						non-clinical health-related social needs and services as appropriate to meet
						the individual member's treatment needs.
Forms of care coordination may include but are not
						limited to the following, if medically indicated:
1. Assistance in accessing health care and
					 follow-up care;
2. Assessing
					 housing needs and providing assistance to access and maintain safe/affordable
					 housing;
3. Assessing employment
					 needs and providing assistance to access and maintaining employment;
4. Conducting outreach to family members and
					 others to support connections to services and expand social networks;
5. Assistance in locating community social,
					 legal, medical, behavioral healthcare and transportation services; and
6.  Maintaining frequent
					 communication with other team providers to monitor health status, medical
					 conditions, medications, and medication side effects.
C.
Health Promotion
The OHH shall provide health promotion services to
						encourage and support healthy behaviors and encourage self-management of
						health. OHH providers must provide and document efforts to connect each OHH
						member to a primary care provider. OHH health promotion activities may also
						include, but are not limited to the following:
1. Health education specific to opioid
					 dependence and treatment;
2.
					 Relapse prevention plans;
3. Health
					 education and referral support regarding a member's other chronic conditions or
					 health-related risk factors (e.g. oral health, contraceptive counseling,
					 screenings);
4. Development of
					 self-management plans;
5.
					 Behavioral techniques to promote healthy lifestyles;
6. Supports for managing chronic
					 pain;
7. Smoking cessation and
					 reduction in use of alcohol and other drugs
8. Nutritional counseling; and
9.  Promotion of increased physical
					 activity
D.
Comprehensive Transitional Care
Comprehensive Transitional Care services are designed to
						ensure continuity and coordination of care and prevent the unnecessary use of
						the ED and hospitals.
1. When possible,
					 the OHH shall collaborate with hospital EDs, discharge planners, long-term care
					 facilities, corrections, probation and parole staff, residential treatment
					 programs, primary care and specialty mental health and substance use disorder
					 treatment services to provide transitional services. The OHH shall attempt to
					 follow up with each member following an inpatient hospitalization, use of
					 crisis services, incarceration, or out-of-home placement. As clinically
					 appropriate, the OHH shall work with the member to ensure that the member
					 remains engaged or re-engages in an appropriate level of care for OUD following
					 an absence in treatment from the OHH. As clinically appropriate, the OHH shall
					 work with discharge planners to schedule follow-up appointments with primary or
					 specialty care providers within seven (7) days of discharge and work with
					 members to ensure attendance at scheduled appointments.
2. The OHH shall assist the member and
					 family, guardian(s), or caregivers, as appropriate, with the discharge process,
					 including outreach in order to assist the member with returning to treatment
					 for OUD in the community, transition planning, and work to prevent avoidable
					 readmissions after discharge.
3.
					 The OHH shall assist the member in exploration of less restrictive alternatives
					 to hospitalization/ institutionalization.
4. As allowed by law, the OHH shall provide
					 timely and appropriate follow up communications on behalf of transitioning
					 members, which includes a clinical hand off, timely transmission and receipt of
					 the transition/discharge plan, review of the discharge records, and
					 coordination of medication reconciliation related to the member's OHH
					 treatment.
E.
Individual and Family Support Services
Individual and Family Support Services is a required
						service for all OHH members. This service may be provided by any member of the
						multi-disciplinary OHH team.
Individual and family support services promote recovery
						by supporting participation in treatment. Support may involve families,
						communities, and other individuals or entities identified by the member as an
						integral to their recovery process.
The OHH shall employ approaches which may include but are
						not limited to supports, support groups, and self-care programs. These
						approaches shall be designed to increase member and family/support knowledge
						about an individual's chronic condition(s), promote member engagement and
						self-management capabilities, and help the member maintain their
						recovery.
The OHH shall provide assessment of individual and family
						strengths and needs, provide information about services and education about
						health conditions, assistance with navigating the health and human services
						systems, opioid use disorder supports and outreach to key caregivers, and
						assistance with adhering to treatment plans.
F.
Referral to Community and Social
					 Support Services
Referrals will be made through telephone or in person and
						may include electronic transmission of requested data. The OHH shall follow
						through on referrals to encourage the member to connect with the services.
The OHH shall refer members to community, social support
						and recovery services including but not limited to resources and agencies that
						provide transportation, housing, and career planning/employment based upon
						individual needs identified through assessment and treatment planning
						processes.