Thursday, November 21, 2024
11/21/2024
In 2017, Maine had the eighth highest drug overdose death rate in the country, totaling 34.4 deaths per 100,000 total population. Maine also has one of the highest rates of infants born drug affected – peaking at 1,013 during 2015, a 77% increase from 2010, and 952 babies in 2017. Maine experienced the second highest annual change in incidence rate of NAS in the country from 1999 to 2013, 3%, resulting in 30.4 babies with NAS per 1,000 live births in 2012. Yet Maine lacks a statewide system of care for the treatment of pregnant and postpartum women with Opioid Use Disorder (OUD), or a strategy to address the disproportionate impact of the opioid epidemic on Maine’s many rural communities. Maine is a unique testing ground for CMMI and a Maine Maternal Opioid Model (MaineMOM). Newly elected Governor Janet Mills has expanded MaineCare, the State’s Medicaid program, which will provide coverage for 66,000 Mainers by the end of 2019. She also issued an executive order to “Implement Immediate Response to Maine’s Opioid Epidemic,” which highlights the impact of the opioid epidemic and prioritizes the need for reducing stigma, expanding access to evidence-based treatment and recovery supports, securing non-tax based resources to further state goals, and improving connections to timely care and community resources. Maine does not have Medicaid Managed Care. Maine has pioneers in the research and delivery of evidence-based care for pregnant women with OUD, but we lack a statewide system and consistent models, and need investment in convening, capacity-building, and adaptation to scale. Two of our care-delivery partners (CDPs), MaineGeneral Health and Penobscot Community Health Care, will help lead this work. Maine is a very large rural state; 66 areas are health care Health Professional Shortage Areas (HPSA), and 51 HPSA designations for mental health care, most in rural areas. To assure statewide reach, additional CDPs were recruited, including MaineHealth, MidCoast Parkview Hospital, Northern Light Healthcare, and Pines. The MaineMOM model will utilize funding to develop and deploy a system to offer: 1) A “no-wrong-door”, coordinated referral and screening system; 2) Same-day access with a “medications-first” model; 3) Increased capacity of integrated care teams to deliver evidence-based care; 4) Integrated care model w/MAT and group clinics available to MaineMOM participants, no matter where they live, with a goal of co-located pregnancy and OUD care; 4a) Strengthening of existing Opioid Health Homes (OHH) capacity to serve the unique needs of pregnant/postpartum women with OUD; 4b) Warm hand-offs to- and coordination with- home visiting and community supports; 5) Heightened coordination with home visiting and community supports through streamlined communication, shared training, and shared data; 6) Effective and person-centered planning for the perinatal period; 7) Use of the Eat, Sleep, Console (ESC) approach in all hospitals statewide; 8) Early conversations about the safety and effectiveness of Long-Acting Reversible Contraceptives inserted in the immediate postpartum period and increased planning and communication around pain management during delivery; 9) Care through 12 months postpartum with a focus on both mother and infant wellness; 10) Payment model that fills gaps in MaineCare funding to cover care for this population. Implementation funds will be used for program management, outreach, and CDP expenses to participate in planning and subsequent deployment of the model. Transition year funding will be used to pay for allowable services. Milestone funding will be used to enhance the ability of CDPs to engage women with OUD and to support development of additional Sites. The goal of this proposal is to develop and sustain a high-quality care delivery system, statewide, for pregnant women with OUD and their infants.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
