Welcome to the Behavioral Health Home Application for MaineCare providers.

The objective of this application is to identify qualified and interested behavioral health providers to deliver Behavioral Health Home (BHH) services.

The BHH program requires providers to deliver services through a team-based model of care, as stated in MaineCare Benefits Manual, Chapter II, Section 92, Behavioral Health Home Services.

Providers may deliver BHH, Community Integration (CI),Targeted Case Management (TCM), and/or Opioid Health Home (OHH) services within the same organization. However, providers may not deliver both services to the same member during the same BHH service month with the exception of OHH services through coordinated care agreements.

Providers may choose to start their BHH program at a single location rather than organization-wide. Within the given location, all eligible MaineCare members must be provided with the opportunity to enroll.

Documentation Requirements

Your organization must provide documentation related to the following requirements to be eligible as a Behavioral Health Home Organization (BHHO):

Due when sending in application:
  • Organization’s most recent Form 990, also known as the Return of Organization Exempt from Income Tax Form, or Form 1120, also known as the U.S. Corporation Income Tax Return Form, dependent on organization type.
Due by the 20th of the month prior to start date:
  • A list of all BHH team members, to include: team role; name; email; phone. If enrolling multiple BHH locations or intending to serve children and adults, a team list must be submitted for each location with your application as per MaineCare Benefit Manual Chapter II, Section 92.02-1 (C) (1-8)
Required documentation is to be sent to: HH-BHH-Services.DHHS@maine.gov.

Additional regulations covering BHH services, including provider qualifications and expectations, can be accessed through the MaineCare Benefits Manual, Chapter II, Section 92, Behavioral Health Home Services.

If your organization would like to meet to discuss BHH services, please feel free to contact the Delivery System Reform Unit by sending an email to HH-BHH-Services.DHHS@maine.gov.

* As a State agency, MaineCare Services is subject to public disclosure requirements per the Maine Freedom of Access Act. Additional information: http://www.maine.gov/foaa/index.htm.
Organization Information

The following questions are regarding the organization where BHH Services will be offered.

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* 1. Please enter your organization's information.

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* 2. Contact information of person completing application:

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* 3. Contact information of Administrative Lead for application questions:

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* 4. Contact information of Clinical Lead for application questions:

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* 5. Is your organization currently a MaineCare provider?

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* 6. Does your organization have expertise in co-occurring disorders as defined in current DHHS contract standards? MaineCare Benefits Manual, Chapter II, Section 92.02-1(E).

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* 7. Does your organization commit to participation in Behavioral Health Home technical assistance opportunities, as offered by the Department? MaineCare Benefits Manual, Chapter II, Section 92.02-1(J)

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* 8. Do you give the Department your consent to publicly share this organization's contact information?

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* 9. Organization Licensure (check all that apply):

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* 10. Do you plan to provide services to (check all that apply):

Site Information

Please enter the following information for each of your organization's sites intending to enroll in BHH.

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* 12. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 13. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 14. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 15. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 16. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 17. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 18. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 19. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 20. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

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* 21. Participating Site Information (*Site NPI is the National Provider Identifier plus 3-digit suffix used in MaineCare site enrollment):

BHH Provider Requirements

The questions below pertain to BHH Core Standards and practice characteristics that are required to qualify as a BHH provider. These requirements can be found in the MaineCare Benefits Manual, Chapter II, Section 92.

Core Standards are required to be met by BHH providers within the first 12 months of implementation of the BHH program. Descriptions of intended compliance to each Core Standard are required. For descriptions of each Core Standard, please refer to MaineCare Benefits Manual, Chapter II, Section 92.02-1(L).

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* 22. Does your agency commit to full implementation of the following Core BHH
expectations within one year of participation in MaineCare Behavioral Health Homes?

  Yes, the organization currently does this. Plans to do this activity prior to BHH implementation. No, the practice does NOT currently meet this requirement. Does not plan to do this under BHH services.
Appoint a Clinical Team Lead to implement and oversee the implementation and execution of required Core Standards. The Clinical Team Lead position will be designed to:
• Work with providers and staff to build a team-based approach to care
• Continually examine processes and structures to improve care
Implement a team-based approach to care delivery that includes expanding the roles of non-licensed team professionals and promote CIPSS as leaders and partners in the provision of care.
Adopt processes to identify patients who are at risk for adverse outcomes or are missing critical preventive services and/or other health screenings.
Ensure BHH members have access to a member of the organization or an authorized entity twenty-four hours a day, seven days a week to address and triage the members’ needs. Also have processes in place to monitor care access.
Implement processes that consumer voice and choice is reflected in Plan of Care development. These processes could include but not limited to:
• Wraparound principles for children with SED and their families.
• Practice guidelines for recovery-oriented care.
Participate regularly in advisory activities representative of MaineCare and/or BHH members, and family members, where appropriate. Member-informed advisory processes will be established to identify patient-centered needs and solutions for improving care in the practice.
Adopt processes to identify and make referrals to local community resources and social support service, including those that provide support in self-management, to assist members in overcoming barriers to care and meeting health and recovery goal
Establish processes to reduce wasteful spending of healthcare resources and improve the cost-effective use of healthcare services as evidenced by at least one improvement initiative that targets waste reduction, such as avoidable hospitalizations; reducing avoidable ED visits; or working with the team to develop new processes and procedures that improve patient experience and quality of care, while reducing inappropriate use of services.
Utilize an electronic data system that includes identifiers and utilization data about members. Member data is used for monitoring, tracking, and indicating levels of care complexity for the purpose of improving member care.

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* 23. Is your organization able to deliver a team-based approach that includes the following components?

Contact information for each member of the BHH team is required within 30 days of completely this application.

For the specific requirements of each position, please refer to: MaineCare Benefits Manual, Chapter II, Section 92.02-1(C)(1-8)

  Yes No
• Psychiatric Consultant
• Nurse Care Manager
• Clinical Team Leader
• Certified Intentional Peer Support Specialist/ Family or Youth Support Specialist
• Health Home Coordinator
• Medical Consultant

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* 24. It is required that BHH providers submit a Behavioral and Physical Health Integration (BHI) Assessment for each practice site. The BHI Assessment will be provided prior to the initial site visit and will guide priorities for the following twelve-month period.

Please note, this will be requested on an annual basis.

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* 25. Virtual Q & A Session

To ensure completeness and accuracy of the application, we ask each organization to participate in a learning session with program staff.

Please list up to three (3) date/times (within 30 days) that you are available for a virtual session.

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