CASE MANAGEMENT SERVICES PROVIDER IN MAINE

Fatumata Kaba
Aug 12
4 min read

COORDINATING INDIVIDUALIZED SUPPORT PLANS TO ENSURE ACCESS TO CARE, SERVICES, AND COMMUNITY INTEGRATION

Case Management Services in Maine help individuals with disabilities, chronic conditions, or behavioral health needs navigate service systems, connect with resources, and achieve personal goals through person-centered planning. Case Managers play a critical role in developing, monitoring, and adjusting Plans of Care (POC) under both Medicaid-funded Home and Community-Based Services (HCBS) waivers and state programs.

1. GOVERNING AGENCIES

Agency: Maine Department of Health and Human Services (DHHS) — Office of Aging and Disability Services (OADS)

Role: Administers HCBS waiver-based case management for individuals with intellectual/developmental disabilities (IDD), physical disabilities, and seniors

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

Role: Oversees Medicaid billing and provider enrollment

Agency: Maine DHHS — Office of Behavioral Health (OBH)

Role: Manages case management for individuals with serious mental illness (SMI) or substance use disorders (SUD)

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures compliance with HCBS person-centered planning requirements

2. CASE MANAGEMENT SERVICE OVERVIEW

Case Management is a targeted service that assists eligible individuals in identifying their needs, planning supports, and ensuring services are delivered in a timely, coordinated, and effective manner.

Approved functions include:

Comprehensive needs assessments
Development and updates to the Individualized Service Plan (ISP) or Plan of Care (POC)
Resource linkage (waiver services, medical providers, housing, etc.)
Service referrals and authorizations
Crisis planning and monitoring of health and safety
Coordination with interdisciplinary care teams
Documentation of progress, outcomes, and plan revisions

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register business with the Maine Secretary of State
Obtain IRS EIN and Type 2 NPI
Enroll as a MaineCare Case Management Provider
Obtain agency certification or approval from OADS, OBH, or other applicable DHHS divisions
Maintain general liability and professional insurance
Hire qualified Case Managers (Bachelor’s or Master’s degree in human services or related field)
Develop a Case Management Policy & Procedure Manual
Ensure HIPAA compliance and documentation standards

4. PROVIDER ENROLLMENT PROCESS

Step 1: MaineCare Enrollment

Apply via the MaineCare Provider Enrollment Portal at https://mainecare.maine.gov

Step 2: Program-Specific Approval

Section 13 Targeted Case Management (TCM) for Behavioral Health
Section 18, 19, 20, 21, or 29 Waivers for IDD, elder, or medically complex individuals
Submit agency information, staffing plan, policy manual, and documentation samples

Step 3: Staff Credentialing

Hire Case Managers meeting state qualification standards
Complete background checks and required training

Step 4: Referral Network and Service Launch

Coordinate with DHHS case coordinators and service agencies for client assignments

5. REQUIRED DOCUMENTATION

Articles of Incorporation or sole proprietor paperwork
IRS EIN and NPI confirmation
Certificates of liability and malpractice insurance
Case Management Policy & Procedure Manual, including:
- Intake and eligibility verification forms
- Person-centered assessment templates
- Plan of Care/ISP development tools
- Progress notes and contact logs
- Critical incident tracking and resolution protocols
- Grievance, rights, and confidentiality forms
- Training logs, supervision records, and audit checklists

6. STAFFING REQUIREMENTS

Role: Case Manager / Service Coordinator

Requirements: Bachelor’s degree in social work, psychology, rehabilitation, or related field; at least one year of experience; background check; person-centered planning training

Role: Clinical Supervisor (if required by program)

Requirements: Master’s degree or licensure (LCSW, LCPC, RN, etc.); responsible for supervision and plan oversight

Training Requirements for All Staff:

HIPAA and confidentiality
Person-centered planning and service coordination
Abuse, neglect, and mandatory reporting
Documentation and plan monitoring procedures
Cultural competency and trauma-informed care

7. MAINECARE WAIVER & BEHAVIORAL HEALTH PROGRAMS

Case Management is available through:

Section 13 — Targeted Case Management (Behavioral Health)
Section 18 & 20 — Adults with Physical Disabilities and Children with Complex Medical Needs
Section 19 — Elderly and Adults with Disabilities
Section 21 & 29 — Individuals with Intellectual/Developmental Disabilities
Section 28 — Children’s Behavioral Health
Money Follows the Person (MFP) — transition case management after discharge from institutional care

Approved functions include:

Plan development, review, and monitoring
Crisis coordination and advocacy
Interdisciplinary communication and service tracking
Annual or semi-annual reassessments

8. TIMELINE TO LAUNCH

Phase: Business Registration and Policy Manual Development

Timeline: 1–2 months

Phase: MaineCare Enrollment and Program-Specific Approval

Timeline: 60–90 days

Phase: Staff Hiring and Credentialing

Timeline: 3–4 weeks

Phase: Referral Intake and Service Launch

Timeline: Rolling, based on program and waiver needs

9. CONTACT INFORMATION

MaineCare Provider Enrollment Portal

Website: https://mainecare.maine.gov

Maine DHHS — Office of Aging and Disability Services (OADS)

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

Maine DHHS — Office of Behavioral Health (OBH)

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

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.medicaid.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — MAINE CASE MANAGEMENT PROVIDER

WCG supports non-profits, social service agencies, and clinical teams in launching MaineCare-compliant Case Management programs across behavioral health and HCBS waivers.

Scope of Work: