ATTENTION Section 92, Section 13, and Section 17 Providers: Passthrough process now required if organizations jointly serve an Opioid Health Home (OHH) Member   

 

Please see changes below that apply when a Section 92 Behavioral Health Home, Section 13 Targeted Case Management, or Section 17 Community Integration provider delivers services to members enrolled with an Opioid Health Home (OHH). 

  • Effective August 21, 2022, in order for a Section 92, Section 13, or Section 17 provider to jointly serve an OHH member, they will need to be part of the OHH team.   

  • In these limited and clinically-appropriate scenarios, fb88Care payment will only be made to the OHH provider and will include a pass-through payment of $394.40 when eligible members chooses to receive additional provider support. Providers will need to establish contracts to make the appropriate pass-through payments. &²Ô²ú²õ±è;

  • In these scenarios, the Section 92, Section 13, or Section 17 provider will not bill via claims or through the Value-Based Management system for their additional provider support. &²Ô²ú²õ±è;

  • Providers will need to be authorized through Kepro and use the following codes when authorizing additional provider support for OHH members:    

    • For Section 13, Opioid Health Home (OHH) providers will use the following codes with modifiers for their authorization: T1017 HG-TCM HIV, T1017 U5 HG-TCM Homeless, T1017 UC HG- TCM Children.    

    • For Section 92, OHH providers will use the following codes with modifiers for their authorization: T2022 HA HG-BHH Children, T2022 HB HG- BHH Adult.    

    • For Section 17, OHH providers will use the following codes with modifiers for their authorization: H2015 HG- Community Integration. &²Ô²ú²õ±è;

This updated payment process will begin with the September payment month, for services provided between 8/21/2022 and 9/20/2022. These changes are a result of federal guidance and changes to the Opioid Health Home policy, found in fb88Care Benefits Manual, Chapter II, Section 93, Opioid Health Home Services. &²Ô²ú²õ±è;

For questions regarding this update, please contact HH-BHH-Services@maine.gov.