10-144 C.M.R. ch. 101, II-93.02
The OHH must meet the following requirements. OHH providers must maintain documentation of all processes and procedures described below in an operating manual that is available for review by the Department upon request.
All team members shall contribute to delivery of integrated and coordinated, whole-person care through a team-based approach.
The Clinical Team Lead shall coordinate the care management activities across the OHH, ensure that there is a current Plan of Care/ITP for each member, and ensure that there is appropriate supervision of the Recovery Coach.
The Clinical Team Lead role may be filled by an individual also serving in one of the other roles below, as long as the individual also meets the qualifications described above.
OHH MOUD prescribers provide services for the chronic condition of opioid dependence through an office-based opioid treatment setting and shall be trained and authorized to prescribe buprenorphine, buprenorphine derivatives, and naltrexone for opioid dependence.
OHH MOUD prescribers must have completed any applicable federally required training and hold the appropriate X-DEA license to prescribe buprenorphine in an office-based setting. They are required to adhere to Maine's Office of Substance Abuse and Mental Health Services, 14-118 C.M.R. Chapter 11, Rules Governing the Controlled Substances Prescription Monitoring Program and Prescription of Opioid Medications.
For members in the Methadone Level of Care who receive OHH services from an OTP, this role may be filled by a practitioner licensed under state and federal law to order, administer, or dispense opioid agonist treatment medications.
For members in the Methadone Level of Care who receive OHH services from a non-OTP OHH, the MOUD Prescriber must coordinate with the OTP.
All MOUD prescribers must be involved in the services described under Section 93.05-1. Activities may include, but are not limited to, participating in team meetings, assisting with the coordination of care across specialty and primary care providers, assessing risk of and discussing with the member potential medication interactions, and providing assistance and guidance in ensuring physical and behavioral health issues are addressed through screening, care coordination, and health promotion.
The Nurse Care Manager shall contribute to implementation, coordination, and oversight of each OHH member's Plan of Care/ITP, assist in the coordination of care with outside providers, and communicate barriers to adherence as appropriate to the team, including the Clinical Team Lead.
The Nurse Care Manager position may be filled by another appropriate licensed medical professional on the OHH team, as long as the individual also meets the qualifications described above.
The Clinical Counselor training must be documented and records must be kept on file for review by the Department upon request.
The Clinical Counselor provides counseling related to opioid dependency and individual or group substance use disorder outpatient therapy for members receiving counseling. For all members, the Clinical Counselor provides behavioral health expertise and contributes to care planning, assessment of individual care needs, and identification of and connection to behavioral health services, as part of the services described in 93.05-1.
The Patient Navigator shall work with the member to collaborate with other health care, mental health, social service, and community providers to guide the member in accessing additional services and supports that will help the member in their recovery.
Recovery Coaches who are themselves in long-term recovery are encouraged and preferred, as their life experiences and recovery allow them to provide recovery support in such a way that others can benefit from their experiences.
*The Department shall seek and anticipates receiving approval for this section from the Centers for Medicare and Medicaid Services (CMS). Pending approval, covered services will be provided as described in this policy.
*The Department shall seek and anticipates receiving approval for this section from the CMS. Pending approval, covered services will be provided as described in this policy.
The OHH must demonstrate how it will meet the following Core Standards prior to approval to provide services. Within the first three (3) months following the start of the OHH's participation, the OHH shall participate in an on-site assessment initiated by the Department, or its authorized agent, to establish a baseline in meeting the Core Standards and identify the OHH's training and educational needs. For the remainder of the first year of participation, the OHH must submit quarterly reports on sustained implementation of the Core Standards. After the first year, the OHH may request the Department's approval to submit the Core Standard progress report annually instead of quarterly.
The Core Standards are:
The Clinical Team Lead shall work with other providers and staff in the OHH to build a team-based approach to care, continually examine processes and structures to improve care, and assist with the review of data on the quality performance of the practice.
The OHH utilizes non-physician and non-licensed staff to improve access and efficiency of the practice team in specific ways, including one or more of the following:
"Adverse outcomes," for purposes of this provision, means a negative clinical outcome and/or avoidable use of healthcare services such as hospital admissions, ED visits, or non-evidence-based use of diagnostic testing or procedures.
Care management staff shall have clear roles and responsibilities, be integrated into the practice team, and receive explicit training to provide care management services.
Care management staff shall have processes for tracking outcomes for patients receiving care management services.
The OHH shall have processes in place to routinely refer patients and families to local community resources and social support services, including those that provide self-management support to assist members in overcoming barriers to care and meeting health goals.
The system must be used to support member care, including one or more of the following:
10-144 C.M.R. ch. 101, II-93.02