Duplication of Services related to Health Homes, Behavioral Health Homes, and Existing Section 17 and Section 13 Services
June 10, 2014
Mental health providers should always check Health Home eligibility before providing services. If a member is enrolled in a Health Home, providers need to contact MaineCare in order to avoid potential duplication of services.
Health Home and Behavioral Health Home services may not be delivered concurrently with the following MaineCare services:
Services to adults:
- Sections 17.04-1 (Community Integration Services)
17.04-2 (Community Rehabilitation Services)
17.04-3 (Intensive Case Management Services)
17.04-4 (Assertive Community Treatment)
Section 13 (Targeted Case Management)
Services to children:
- Section 13 (Targeted Case Management)
To prevent the duplication in the delivery of services, providers of the services listed above should verify a member’s Health Home status as part of their eligibility verification process before requesting prior authorization or delivering any of these services.
As a reminder, to verify a member’s eligibility, providers have two options:
- Call the AVR line at 1-866-690-5585.
- Log into the MIHMS Health PAS Online Portal as a Trading Partner and go to Eligibility Verification.
If a member has Health Home eligibility listed, the provider should contact Valerie Hooper at (207) 624-4039 or via email at Valerie.firstname.lastname@example.org before delivering any of the services listed above (providers must always use encrypted or password protected email if transmitting Protected Health Information). MaineCare will review, and may change, the member’s Health Home status in order to avoid duplication of services:
For MaineCare members that receive Community Care Team services through the Health Home, MaineCare will notify both the Section 17/Section 13 providers and the Community Care Team. These providers, together with the member, will jointly determine which service is most appropriate for that member and develop a transition plan, as necessary.
Members enrolled in Health Homes but not receiving Community Care Team services will be removed from the Health Home program and can then be enrolled in a case management or community integration service.