Subsection 144-101-II-92.04 - POLICIES AND PROCEDURES FOR MEMBER IDENTIFICATION AND ENROLLMENT92.04-1Member IdentificationThe 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.
92.04-2Enrollment and Freedom of ChoiceA.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.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-92, subsec. 144-101-II-92.04