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-93.04 - POLICIES AND PROCEDURES FOR MEMBER IDENTIFICATION AND ENROLLMENT

Universal Citation: 10 ME Code Rules ยง 144-101-II-93.04

Current through 2024-38, September 18, 2024

93.04-1 Member Identification

The OHH provider shall identify members who are potentially eligible for OHH services based on the eligibility criteria for OHH Services. The OHH provider will submit potentially eligible members through a certification process to approve services.

93.04-2 Enrollment and Duplication of Services

A. Enrollment. The OHH Provider shall identify members for OHH based on the OHH eligibility criteria. Potentially eligible members shall be given information about the benefits of participating in an OHH. The member can choose to be part of OHH 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 OHH provider or the Department's authorized entity for certifications of OHH services.

B. Duplication of Services. The Department will not reimburse for duplicative services for members as set forth in the Reimbursement provision of this rule. 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.

The Department's authorized entity will notify members that they cannot receive duplicative services and will keep a record of documentation as to the members' choice of service.

C. Requests and Referrals. Members may request OHH services or be referred for OHH 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.

D. Consent Forms. OHH providers must retain a signed consent form for all OHH members in the member record. Consent documentation must, at a minimum:
1. Indicate that the individual has received information in writing, and verbally as appropriate, explaining the OHH purpose and the services provided; and

2. Indicate that the individual has consented in writing, and verbally as appropriate, to receive the OHH services and understand their right to choose, change, or disenroll from their OHH provider at any time.

93.04-3 ASAM Criteria

Members must be assessed for appropriateness of OHH services in alignment with the ASAM Criteria. Members must meet ASAM Level 0.5 or Level I for individual, family or group outpatient services. Members must meet ASAM Level II.1 or II.5 for Intensive Outpatient Services Level of Care.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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