BEHAVIORAL HEALTH SERVICES PROVIDER IN MAINE

PROMOTING MENTAL WELLNESS, STABILITY, AND RECOVERY THROUGH THERAPEUTIC SUPPORT AND INTEGRATED COMMUNITY CARE

Behavioral Health Services in Maine address the mental health and substance use needs of children, adults, and families. These services include diagnostic evaluations, therapy, crisis intervention, case management, and peer recovery support. Behavioral health programs are covered under MaineCare (Medicaid), and often coordinated through Section 13 Targeted Case Management, Section 17 Community Support Services, Section 28 and 65 for children, and OBH grants for uninsured or underserved populations.

1. GOVERNING AGENCIES

Agency: Maine Department of Health and Human Services (DHHS) — Office of Behavioral Health (OBH)

Role: Oversees behavioral health program standards, licensing, and service quality

Agency: Maine DHHS — Office of MaineCare Services (OMS)

Role: Manages provider enrollment, Medicaid reimbursement, and utilization review

Agency: Maine DHHS — Division of Licensing and Certification

Role: Issues mental health and substance use treatment licenses for outpatient providers and residential programs

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures Medicaid-funded behavioral health services comply with federal standards and parity regulations

2. BEHAVIORAL HEALTH SERVICE OVERVIEW

Behavioral Health Services include clinical and rehabilitative supports aimed at improving functioning, promoting recovery, and reducing institutional or emergency-based care.

Approved services may include:

• Psychiatric assessments and diagnosis

• Individual, group, or family counseling

• Medication management and psychiatric consultation

• Case management and service coordination

• Crisis intervention and mobile response

• Skills development and psychosocial rehabilitation

• Substance use counseling and MAT (Medication-Assisted Treatment)

• Peer support and recovery coaching

Services must align with the participant’s Individualized Treatment Plan (ITP) and comply with documentation, licensing, and credentialing standards.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Maine Secretary of State

• Obtain IRS EIN and Type 2 NPI

• Apply for a Mental Health Agency License or Substance Use Treatment Certification via the Division of Licensing and Certification

• Enroll as a MaineCare Behavioral Health Provider (based on Section 13, 17, 28, 65, or 92 eligibility)

• Maintain general liability, malpractice, and workers’ comp insurance

• Employ licensed behavioral health professionals (LCPC, LCSW, LMFT, CADC, etc.)

• Develop a Behavioral Health Policy & Procedure Manual

• Ensure HIPAA compliance and behavioral health documentation protocols

4. PROVIDER ENROLLMENT PROCESS

Step 1: Licensure through DHHS Division of Licensing and Certification

• Apply for agency or outpatient clinic licensure

• Submit staffing plan, clinical oversight, emergency procedures, and service descriptions

Step 2: MaineCare Provider Enrollment

• Register at https://mainecare.maine.gov under relevant program sections

• Submit credentials, license, policies, and billing information

Step 3: Staff Credentialing and Onboarding

• Hire licensed mental health or substance use professionals

• Maintain supervision logs, credential files, and continuing education records

Step 4: Clinical Operations Launch

• Accept referrals from primary care, schools, hospitals, or case managers

• Begin assessment, treatment planning, and service delivery

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or DBA filing

• IRS EIN and NPI confirmation

• Maine behavioral health agency license or SUD certification

• Insurance certificates and facility safety documentation

• Behavioral Health Policy & Procedure Manual, including:

  • Intake and assessment forms

  • Individualized Treatment Plan (ITP) templates

  • Progress notes and contact logs

  • Incident and crisis documentation procedures

  • Staff licensure tracking and supervision logs

  • Client rights, informed consent, and HIPAA policies

  • Utilization review and clinical outcome tracking templates

6. STAFFING REQUIREMENTS

Role: Licensed Mental Health Clinician (LCSW, LCPC, LMFT)

Requirements: Active Maine license; experience with diagnostic and therapeutic services

Role: Psychiatric Nurse Practitioner / Psychiatrist

Requirements: State licensure and prescriptive authority; responsible for evaluation and medication management

Role: Behavioral Health Case Manager

Requirements: Bachelor’s degree in human services; experience in care coordination and documentation

Role (optional): Peer Support Specialist / Recovery Coach

Requirements: OBH-certified peer training; lived experience with recovery or mental illness

Training Requirements:

• HIPAA, confidentiality, and client rights

• Suicide prevention and trauma-informed care

• Cultural competence and crisis de-escalation

• Mandatory reporting and abuse prevention

• Documentation standards and audit preparedness

7. MAINECARE PROGRAMS & COVERAGE

Behavioral Health Services are reimbursed through:

• Section 13 — Targeted Case Management

• Section 17 — Community Support Services for adults with SPMI

• Section 28 — Rehabilitative and Community Services for children

• Section 65 — Outpatient Therapy, Psychiatry, Crisis, and MAT services

• Section 92 — Behavioral Health Home Organizations (BHHOs)

• OBH General Fund Contracts — for uninsured or underinsured populations

• Money Follows the Person (MFP) — transitional support with behavioral needs

Services may be delivered:

• In-office, in-home, or via telehealth

• In collaboration with schools, hospitals, or community settings

• Through integrated care models with medical providers

8. TIMELINE TO LAUNCH

Phase: Business Registration and Licensure

Timeline: 2–3 months

Phase: Policy Manual, Facility Setup, and Staff Hiring

Timeline: 30–60 days

Phase: MaineCare Enrollment

Timeline: 60–90 days

Phase: Referral Network Development and Clinical Launch

Timeline: Rolling, based on contracts and provider capacity

9. CONTACT INFORMATION

Maine DHHS – Office of Behavioral Health (OBH)

Website: https://www.maine.gov/dhhs/obh

MaineCare Provider Enrollment Portal

Website: https://mainecare.maine.gov

Division of Licensing and Certification (Behavioral Health Licensing)

Website: https://www.maine.gov/dhhs/dlc

Maine Board of Licensure for Mental Health Counselors and Social Workers

Website: https://www.maine.gov/pfr/professionallicensing

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MAINE BEHAVIORAL HEALTH SERVICES PROVIDER

WCG supports mental health professionals, clinics, and behavioral health organizations in launching MaineCare-approved programs that meet all licensing and compliance requirements.

Scope of Work:

• Behavioral Health licensing and MaineCare enrollment

• Policy & Procedure Manual development

• Staff credentialing checklists and onboarding tools

• Clinical documentation templates and audit guides

• Referral network development with schools, hospitals, and OBH programs

• Medicaid billing and utilization tracking support

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.