Coordinating HIE Participation Within OMS Programs

Overview

Participation in the statewide Health Information Exchange (HIE) is required and/or incentivized in varying ways for many of the programs offered by the Office of MaineCare Services (OMS). For organizations interested in joining an OMS program, it is important to simultaneously understand and inquire about relevant conditions and/or considerations of HIE participation.

For questions about OMS programs' conditions and/or considerations of HIE participation, please contact HealthInfoNet’s Client Engagement team (clientengagement@hinfonet.org).

Conditions & Considerations

Accountable Communities

The Accountable Communities (AC) program is designed to help reduce costs while improving quality and outcomes for the state’s eligible Medicaid members. Similar to the Accountable Care Organization (ACO) initiative managed by the U.S. Centers for Medicare and Medicaid Services (CMS), the AC program contracts with groups of providers who volunteer to participate in the shared-savings model.

For more information about the AC program, visit the following OMS webpage: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/accountable-communities

OMS AC program email address: AccountableCommunities.DHHS@maine.gov

HIE Participation Conditions & Considerations

Health Homes

Health Home services include care coordination, case management, individual and family support, and health promotion/education. OMS currently offers three health home programs.

Community Care Teams

The Community Care Teams (CCT) program consist of organizations that partner with primary care practices and community-based providers to support the state’s eligible Medicaid members with chronic conditions who are at greater risk of poor health outcomes and/or higher utilization of healthcare services. Within the CCT program are a specialized group of providers, the Housing Outreach and Member Engagement (HOME) providers, which provide housing outreach and member engagement services for eligible members with long-term homelessness.

For more information about the CCT program, visit the following OMS webpage: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/health-homes

OMS CCT program email address: HH-BHH-Services.DHHS@maine.gov

HIE Participation Conditions & Considerations

Behavioral Health Homes

The Behavioral Health Home (BHH) program supports care teams within licensed community mental health agencies that manage the physical and behavioral health needs of the state’s eligible Medicaid members. 

For more information about the BHH program, visit the following OMS webpage: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/health-homes

OMS BHH program email address: HH-BHH-Services.DHHS@maine.gov

HIE Participation Conditions & Considerations

Opioid Health Homes

The Opioid Health Home (OHH) program delivers team-based treatment of opioid use disorders, including medication, opioid dependency counseling, and comprehensive care management for the state’s eligible Medicaid members and uninsured individuals.

For more information about the OHH program, visit the following OMS webpage: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/health-homes

OMS OHH program email address: HH-BHH-Services.DHHS@maine.gov

HIE Participation Conditions & Considerations

Primary Care Plus

The Primary Care Plus (PCPlus) program offers primary care practices greater flexibility and incentives to support the state’s eligible Medicaid members' healthcare needs. The program transitions away from the traditional fee-for-service payment system toward an approach that provides population-based payments tied to cost- and quality-related outcomes.

For more information about the PCPlus program, visit the following OMS webpage: https://www.maine.gov/dhhs/oms/providers/value-based-purchasing/primary-care

OMS PCPlus program email address: PCP-Network-Services.DHHS@maine.gov

HIE Participation Conditions & Considerations

Dual Eligible Special Needs Plans

The Dual-Eligible Special Needs Plan (D-SNP) program, supported by OMS in collaboration with the Office of Aging and Disability Services (OADS), helps facilitate care coordination among Medicare beneficiaries enrolled in a Medicare Advantage health plan who also have Medicaid coverage (i.e., dually eligible individuals). Although they are overseen and paid for by the federal Medicare program managed by the U.S. Centers for Medicare and Medicaid Services (CMS), Medicare Advantage payers designated as “Dual-Eligible Special Needs Plans” must enter into an agreement with a state’s Medicaid agency in order to offer their health plan(s) in the state. It is then the state’s Medicaid agency’s responsibility to help fulfill and further the requirements defined by CMS among the D-SNP payers and the long-term care (LTC) facilities and service coordinating agency (SCA) providers with which they contract in order to best support the healthcare needs of dually eligible individuals.

For more information about the D-SNP program, visit the following OMS/OADS resource: https://www.maine.gov/dhhs/documents/Aging-LTSS-Reform-2019.pdf

OMS D-SNP program email address: ManagedCare.DHHS@maine.gov

HIE Participation Conditions & Considerations