An Act To Save Lives by Establishing a Homeless Opioid Users Service Engagement Program within the Department of Health and Human Services
Sec. 1. 22 MRSA §2354 is enacted to read:
§ 2354. Homeless opioid users service engagement program
There is established within the department a homeless opioid users service engagement program to provide 50 opioid users who are among the most vulnerable and unstable in the State rapid access to low-barrier treatment for substance use disorder and stable housing to support their recovery.
The program must include intensive outreach using a collaborative team case review approach to identify and recruit participants. An individual selected for the program who chooses to participate in the program shall sign a written agreement that explains the requirements for program participation and authorizes initiation of case management and treatment services as well as a release authorizing members of the program team to share information regularly regarding the participant's progress in recovery and in attaining individual goals. Participants shall also complete initial assessments regarding substance use disorder, physical health and psychosocial and psychiatric needs as soon as possible.
(1) The program must provide participants with medication-assisted treatment in accordance with this subparagraph that is initiated within 48 hours of each participant's enrollment in the program. The program must seek reimbursement from the MaineCare program for medication-assisted treatment services whenever possible. The lead provider or partner provider shall employ a medical professional authorized to prescribe for each participant a medication approved by the federal Food and Drug Administration for the treatment of substance use disorder that, in the professional's opinion, is most appropriate given the participant's current medications, substance use and medical history. The authorized prescriber shall take primary responsibility for managing and refilling the prescription.
The lead provider or partner provider shall establish a collaborative, interagency staffing model of medication-assisted treatment that includes, to the extent resources permit, the authorized prescriber, a nurse care manager, a licensed clinical social worker or licensed alcohol and drug counselor, a certified psychiatric mental health nurse practitioner and a peer support specialist who meet regularly to plan participant services, review participant progress and implement reenrollment strategies when necessary. The lead provider or partner provider shall use a shared medical appointment model for medication-assisted treatment that supports participants in decreasing the use of illegal drugs and drugs that are not prescribed to the participant by delivering the following:
(a) Office-based, daily observed medication administration to participants;
(b) The opportunity to participate in individual and group psychotherapy, pharmacotherapy and support groups;
(c) Random drug testing of participants;
(d) Ongoing evaluations of participants to optimize treatment, including assessments of psychosocial needs and referrals for psychiatric assessments or treatment as necessary; and
(e) Treatment of participants' concomitant psychiatric disorders that either complicate the participants' substance use disorder or act as triggers for relapse.
(2) The program must provide participants with intensive case management designed to provide an intensive, comprehensive range of community-based services to address the physical and behavioral health needs of participants and support their compliance with medication-assisted treatment and other services necessary to recovery.
The lead provider or partner provider shall establish an intensive case management team that includes, to the extent resources permit, an intensive case management team supervisor, case managers, a housing liaison, a transition liaison and peer support specialists. The intensive case management team shall provide intensive outreach, assessment, care coordination, advocacy, support, planning and facilitation of services to meet each participant's comprehensive mental health, medical and dental health needs while reducing redundant services and supporting participants in achieving the following goals:
(a) Acquiring medical care and material resources, including, but not limited to, food, shelter and clothing;
(b) Improving psychosocial functioning and developing greater autonomy;
(c) Developing coping and problem-solving skills;
(d) Developing a community support system to help participants meet the demands of community life; and
(e) Accessing benefits and services for which participants may qualify, including, but not limited to, housing, medical, behavioral health, employment, education, supplemental income, transportation, utility and community and family integration services.
The peer support specialist shall serve as a role model and shall provide one-on-one peer support services to assist participants in reducing harmful behaviors, to identify participants' strengths and skills that can help reduce illegal substance use and to develop participants' recovery goals. The peer support specialist shall also coordinate and facilitate peer recovery groups.
The transition liaison shall assist participants who are transitioning out of incarceration or hospitalization. The transition liaison shall recruit individuals who are incarcerated or hospitalized and who expect to be discharged soon for participation in the program and assist those individuals with the enrollment process. The transition liaison also shall coordinate with staff from the correctional or medical facility to facilitate participants' smooth transition from the facility. To the extent practicable, the transition liaison shall ensure that participants have access to housing immediately upon discharge from a correctional or medical facility.
(3) The program shall provide participants with immediate and continued access to stable housing that promotes recovery, independence and harm reduction. The intensive case management team shall identify appropriate housing placements for participants, which may include, but are not limited to, housing first developments, which are developments prioritizing providing permanent housing to individuals experiencing homelessness, recovery residences, private nonmedical institutions and private apartments. The intensive case management team shall collaborate with local housing authorities, affordable housing developers, municipal general assistance offices and housing voucher administrators to provide program participants with priority in accessing these placements.
The lead provider or a partner provider shall administer a housing assistance fund to provide participants with immediate access to stable housing. The housing assistance fund must contain sufficient capital to provide all program participants with 5 months of rent at fair market value based on the location of the housing. The lead provider or partner provider may provide a participant with more or less than 5 months of financial assistance from the housing assistance fund, depending on the participant's individual need for financial assistance to achieve housing stability.
While participants receive financial assistance from the housing assistance fund, the intensive case management team shall assist participants in securing an alternative financial resource or resources for housing, including but not limited to employment, general assistance, the Bridging Rental Assistance Program established in Title 34-B, section 3011, the federal shelter plus care program authorized by the federal McKinney-Vento Homeless Assistance Act, Public Law 100-77, as amended by the federal Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009, Public Law 111-22, Division B (2009) and housing choice vouchers under Section 8 of the United States Housing Act of 1937, Public Law 75-412, 50 Stat. 888, as amended.
Alternatively, a participant may be discharged from the program if the lead provider or a partner provider determines that the program is unable to provide appropriate services due to the participant's physical or mental health or continued illegal substance use.
Sec. 2. Authority to submit legislation. The joint standing committee of the Legislature having jurisdiction over health and human services matters may submit legislation regarding the homeless opioid users service engagement program established in the Maine Revised Statutes, Title 22, section 2354 to the Second Regular Session of the 129th Legislature.
This bill establishes within the Department of Health and Human Services a program to provide rapid access to low-barrier treatment for substance use disorders and stable housing to support recovery and create stability for 50 opioid users who are among the most vulnerable and unstable in the State. The bill details the program objectives, eligibility criteria for program participants and services that must be provided to those participants, including medication-assisted treatment, intensive case management services and financial and case management assistance to ensure immediate and continued access to stable housing. The bill requires an independent evaluation of the program and directs the department to submit a report to the joint standing committee of the Legislature having jurisdiction over health and human services matters regarding the program by March 15, 2020 and annually thereafter. The joint standing committee is authorized to submit legislation regarding the program.