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

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.