C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-93, subsec. 144-101-II-93.05
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.
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.
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.
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:
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:
Comprehensive Transitional Care services are designed to ensure continuity and coordination of care and prevent the unnecessary use of the ED and hospitals.
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.
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.
OHHs shall provide this covered service to each OHH member.
At intake and annually thereafter, qualified OHH staff must conduct a comprehensive biopsychosocial assessment to include the following components:
Qualified OHH staff shall conduct biopsychosocial screening and assessment to determine diagnosis, the level of care in which the member should be placed, and to identify treatment priorities for the Plan of Care/ITP. The OHH shall place and maintain a comprehensive assessment report and evidence of the member having had an annual physical exam in the medical record for each OHH member.
The multi-disciplinary OHH team, which must include the member, shall develop and implement a goal-oriented Plan of Care/ITP, which must be available for update and review by all OHH team members.
The Plan of Care/ITP must:
The OHH MOUD prescriber shall meet with each member, except for members in the Methadone Level of Care, at least one time per month. The office visit shall focus on the identified treatment priorities on the most up-to-date Plan of Care/ITP for the member, including, but not limited to, the member's physical health, behavioral health, recovery-oriented goals, and the services and supports necessary to achieve those goals.
*NOTE: The expectation is that counseling will be one hour in duration for each required time period (weekly, biweekly, monthly), but this may be delivered in multiple member contacts, if clinically appropriate and documented in the member's record.
The OHH MOUD prescribers shall provide members, except for members in the Methadone Level of Care, with a prescription for a maximum 30-day supply per billing period of medication to assist in the member's recovery, as medically appropriate. Medications included in the OHH model are buprenorphine, buprenorphine derivatives, naltrexone for opioid use disorder, and methadone. The medication can be provided either directly on site at the OHH, by an outside pharmacy, or by the OTP when a member is receiving methadone.
All prescriptions for buprenorphine, buprenorphine derivatives, and naltrexone must be reported to the Maine Prescription Monitoring Program (PMP) pursuant to the rules established at 14-118 C.M.R. Chapter 11, Rules Governing the Controlled Substances Prescription Monitoring Program and Prescription of Opioid Medications, and other applicable state and federal laws. Please refer to MBM, Chapter II, Section 80, Pharmacy Services and MaineCare's Preferred Drug List at www.mainecarepdl.org for the most current and accurate prescribing criteria for these medications.
OHHs are encouraged to co-prescribe naloxone to members at high-risk for an opioid overdose and/or as clinically appropriate.
For each member, except for members in the Methadone Level of Care, the OHH shall provide, as part of the OHH bundled reimbursement, all appropriate point of care and confirmatory urine drug screening/testing related to OUD treatment. Screenings must be in compliance with Section 55, Laboratory Services and Section 80, Pharmacy Services, of the MBM.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-93, subsec. 144-101-II-93.05