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

Sep 02, 2022

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, MaineCare 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.  

• 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.  

• 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.  

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 MaineCare Benefits Manual, Chapter II, Section 93, Opioid Health Home Services.  

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