The objective of this application is to identify qualified and interested behavioral health providers to deliver Behavioral Health Home (BHH) services in partnership with Health Home and non-Health Home primary care practices. Approved BHH providers from this application process will have a start date of the 21st of the month after all materials are received. This application does not obligate the Department or any provider to enter into a contract or to deliver or pay for any services. Applications will be followed by a formal approval and confirmation process.

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 also 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.
 
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.  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)
  • A signed Contract or Memorandum of Agreement with at least one Health Home Practice. 
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 Value-Based Purchasing Team 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.

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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? MaineCare Benefits Manual, Chapter II, Section 92.02-1(A).

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