Opioid Health Home Enrollment Documents
To be enrolled and participate in the Opioid Health Home (OHH) program beneficiaries must meet eligibility requirements, including being enrolled in Medicaid or Healthy Michigan Plan and have a diagnosis of an opioid use disorder. To enroll an individual in OHH services through the NMRE, an OHH provider is required to submit the following information.
1) MDHHS 5515 - Consent to Share Behavioral Health Information for Care Coordination Purposes (updated form)
2) NMRE Opioid Health Home Program Enrollment Consent - Clients sign the form to give consent to participate in the program. Admission to health home program is based off the date this form is signed.
3) Individualized Care Plan derived from an evidence-based assessment of need - The care plans should include all the conditions of the client and specify how the OHH provider will coordinate and support clients in addressing their needs. (See care plan requirements in OHH handbook).
4) Treatment Needs Questionnaire screening tool - The tool should be given to clients to complete during their initial OHH visit. It will be used to determine the treatment that is appropriate for the client and to assist the OHH team in developing the care plan.
MDHHS 5515 and Care Plans should be updated annually and uploaded to WSA documents in client file.
C4 Vermont Hub-Spoke Treatment Needs Questionnaire.pdf
C2 NMRE Opioid Health Home Enrollment Consent updated 1.4.20.pdf
C3 OHH Client Care Plan Template (1).pdf
C1 MDHHS 5515 Consent to Share Behavioral Health Information 3.20.pdf
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