Maine - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-15

In Maine, the state does not license or enroll providers under the distinct, standalone title of "Adult Companion Services." Instead, non-medical supervision, socialization, and community integration services are authorized and billed under the broader umbrellas of Community Support Services (for individuals with intellectual disabilities or autism under MaineCare Sections 21 and 29) or Personal Care/Attendant Services (for the elderly and disabled under Section 19). Providers seeking to offer these companion-like services must apply through these established waiver categories.

The single biggest structural barrier to entry for this service in Maine is the strict sequencing of approvals: an applicant cannot even submit a MaineCare provider enrollment application until they have first obtained a Home and Community Support Service Agency (HCSS) or Personal Care Agency license from the Department of Health and Human Services (DHHS) Division of Licensing and Certification (DLC), and subsequently secured program approval from the Office of Aging and Disability Services (OADS).

1. Service Definition and Scope

Because Maine does not utilize a standalone "Adult Companion" waiver service, the non-medical supervision and socialization required to keep an adult safely in the community are integrated into existing Home and Community-Based Services (HCBS) waivers. For adults with intellectual disabilities or autism, these activities are defined as Community Support Services under MaineCare Sections 21 and 29. For elderly adults or those with physical disabilities, similar supports fall under Section 19 Personal Care Services.

These services are designed to help individuals live more independently, develop essential life skills, and participate in their communities. They must be delivered in strict accordance with the individual's Person-Centered Plan (PCP) and cannot duplicate services billed under other categories.

• Service Umbrella: Billed as Community Support Services (Sections 21/29) or Personal Care Services (Section 19) rather than Adult Companion Services.
• Target Population: Adults with intellectual disabilities, autism, or age-related disabilities who meet nursing facility level of care and are at risk of institutionalization.
• Covered Activities: Non-medical supervision, socialization, community integration, and assistance with activities of daily living (ADLs).
• Excluded Activities: Medical or nursing care, and simultaneous billing for transportation unless specifically authorized as a separate service on the same day.

2. Regulatory and Oversight Agencies

The Maine Department of Health and Human Services (DHHS) is the overarching authority for all Medicaid and licensing functions in the state. Within DHHS, responsibilities are divided among specialized offices that handle licensing, waiver administration, and Medicaid billing.

Providers must interact with three distinct DHHS divisions in a specific sequence to achieve full operational status and billing privileges.

• Maine Department of Health and Human Services (DHHS): The umbrella state agency governing health regulations and the MaineCare (Medicaid) program.
• Division of Licensing and Certification (DLC): The regulatory body responsible for surveying and issuing the required Home and Community Support Service Agency (HCSS) or Personal Care Agency licenses.
• Office of Aging and Disability Services (OADS): Administers the Section 19, 21, and 29 HCBS waivers, reviews program descriptions, and authorizes individual Person-Centered Plans.
• Office of MaineCare Services (OMS): Manages Medicaid provider enrollment, claims processing, and operates the Health PAS Online Portal.

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine does not require a Certificate of Need (CON) for non-medical HCBS agencies, nor does it restrict entry through closed-network Requests for Proposals (RFPs) or moratoria for these specific waiver services. However, there are absolute structural preconditions that block an applicant from enrolling in MaineCare.

The primary gatekeeper is the state licensure requirement. A provider's MaineCare enrollment application will be immediately rejected if they do not already possess an active license from the DLC and a program approval letter from OADS.

• Licensure Prerequisite: Applicants must hold an active Home and Community Support Service Agency (HCSS) or Personal Care Agency license from DHHS DLC before applying to MaineCare.
• OADS Program Approval: Providers must submit program descriptions, staff credentials, and community engagement goals to OADS for Section 21/29 approval prior to enrollment.
• Business Registration: The operating entity must be registered and in good standing with the Maine Secretary of State.
• NPI Requirement: The agency must obtain a Type 2 National Provider Identifier (NPI) and an Employer Identification Number (EIN) before initiating the state application process.

4. Licensure and Certification Requirements

To obtain the prerequisite license, agencies must apply directly to the DHHS Division of Licensing and Certification (DLC). This process requires the submission of comprehensive operational policies, procedures, and organizational documentation.

The DLC will conduct an initial review and survey to ensure the agency meets state health and safety standards, including strict adherence to worker standards and client rights.

• License Type: Home and Community Support Service Agency (HCSS) or Personal Care Agency.
• Governing Rule: Regulated under the Code of Maine Rules (CMR) 10-144, which dictates operational, health, and safety standards for HCBS programs.
• Policy Manual Requirements: Must include detailed policies on person-centered service delivery, illness exclusion, medication administration, and emergency protocols.
• Facility Exemption: No separate facility license is required unless the services are delivered in a licensed site-based setting (e.g., a day program facility).

5. Medicaid Provider Enrollment

Once licensed by DLC and approved by OADS, the agency must enroll as a MaineCare provider to bill for services. This is completed entirely online through the state's designated Medicaid Management Information System portal.

Enrollment grants the provider the right to bill Maine DHHS for MaineCare claims, provided they maintain their DLC licensure and comply with all federal Medicaid screening rules.

• Enrollment System: Applications must be submitted through the Health PAS Online Portal ([C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, subsec. 144-101 ...](https://www.law.cornell.edu/regulations/maine/C-M-R-10-144-ch-101-ch-I-SS-144-101-I-1-subsec-144-101-I-1.03)).
• Waiver Selection: Providers must specifically apply to become a MaineCare provider under Section 19, Section 21, and/or Section 29.
• Application Fee: Subject to the standard federal Medicaid institutional application fee (approximately $709), unless waived by prior Medicare enrollment.
• Provider Agreement: Must sign and upload the MaineCare Provider Agreement acknowledging compliance with state and federal regulations.
• Revalidation: Providers are required to revalidate their enrollment every 3 to 5 years through the Health PAS portal.

6. Staffing, Training and Background Checks

Direct Support Professionals (DSPs) and personal care staff providing companion-like services must meet rigorous state-mandated background and training standards before they can have unsupervised access to clients.

Maine centralizes its background check process and maintains strict registries to protect vulnerable adults receiving HCBS.

• Background Check System: Comprehensive background checks must be processed and cleared through the Maine Background Check Center (MBCC) prior to unsupervised client contact.
• Registry Verification: Employers must verify the applicant's status on the Maine CNA/direct care worker registry and abuse registry before hire, per 22 M.R.S. § 1717(3) ([Home Care Agency Licensure in Maine (2026) - Vitable Health](https://www.vitablehealth.com/home-care-compliance/maine/licensure)).
• Training Requirements: DSPs must complete the College of Direct Support curriculum or a state-approved equivalent training program.
• Certifications: All direct care staff must hold and maintain current First Aid and CPR certifications.

7. Documentation, Policies and Records

Maine places a heavy emphasis on compliance with the federal HCBS Settings Rule and person-centered planning. Providers must maintain audit-ready records that prove services are delivered exactly as authorized.

OADS conducts routine reviews of a randomly selected sample of person-centered service plans to ensure ongoing compliance with state and federal standards.

• Person-Centered Plan (PCP): All delivered services must strictly align with the individual's OADS-approved PCP and documented goals.
• HCBS Settings Rule Compliance: Policies must demonstrate that individuals have full access to the greater community, privacy, and an experience distinctly different from an institution ([Home and Community Based Services (HCBS) Settings Rule Transition Initiative | Department of Health and Human Services](https://www.maine.gov/dhhs/oads/about-us/initiatives/hcbs)).
• Daily Progress Notes: Staff must document start/stop times, specific activities performed, and progress toward PCP goals for every shift.
• Mandatory Reporting: Agencies must maintain written policies complying with Maine’s Adult Protective Services law for the immediate reporting of suspected abuse, neglect, or exploitation.

8. Billing, Rates and Claims

Billing for Community Support and Personal Care services is managed through the Health PAS Online Portal. Providers must ensure that all billed services have a corresponding prior authorization from OADS.

Rates are standardized by MaineCare and published in the MaineCare Benefits Manual (MBM) fee schedules for the respective waiver sections.

• Billing Portal: Claims are submitted directly via the Health PAS Online Portal or through clearinghouses using standard 837P EDI transactions.
• Prior Authorization: Services cannot be billed unless they are prior-authorized by OADS based on the individual's PCP.
• Fee Schedule: Reimbursement rates are fixed and published by OMS in the MaineCare Benefits Manual for Sections 19, 21, and 29.
• Timely Filing: Claims must generally be submitted within 120 days of the date of service to avoid denial.

9. Approval Sequence and Timeline

Becoming a fully approved provider in Maine is a sequential process that cannot be rushed. Because each step depends on the approval of the previous one, the entire timeline from business formation to active billing status typically takes several months.

Incomplete submissions at the DLC or OADS stages are the leading cause of enrollment delays.

• Step 1: Business Registration & NPI: Register with the Maine Secretary of State and obtain an EIN and Type 2 NPI (1-2 weeks).
• Step 2: DLC Licensure: Submit the HCSS or Personal Care Agency application to DHHS DLC and pass the initial survey (60-90 days).
• Step 3: OADS Approval: Submit program descriptions, staff credentials, and training plans to OADS for waiver approval (30-60 days).
• Step 4: MaineCare Enrollment: Submit the final application through the Health PAS portal ([MaineCare Provider Enrollment Guide: Steps, Requirements & Timeline](https://contractingproviders.com/mainecare-provider-enrollment-guide)) (60-90 days).

10. Common Denials and Survey Findings

Applications and routine surveys frequently fail due to administrative oversights or failure to operationalize federal HCBS requirements. DHHS issues written notices of deficiencies and requires approved corrective action plans for substantial non-compliance.

Providers must be particularly vigilant about background checks and documentation, as these are the most heavily scrutinized areas during OADS and DLC audits.

• Background Check Violations: Allowing staff to have unsupervised access to clients before receiving official clearance from the MBCC.
• Incomplete Portal Submissions: Missing ownership disclosures, unsigned provider agreements, or incomplete policies in the Health PAS portal.
• PCP Non-Compliance: Delivering and billing for services that do not match the authorized Person-Centered Plan or failing to document progress notes.
• Settings Rule Failures: Failing to demonstrate that the service setting integrates the individual into the broader community, violating the federal HCBS Settings Rule.

11. Key Contacts and Resources

Providers should rely on official state resources and portals for the most current regulations, fee schedules, and application materials.

The MaineCare Provider Services Call Center is the primary point of contact for troubleshooting enrollment issues within the Health PAS portal.

• MaineCare Provider Services: Call Center at 1-866-690-5585, Option 2 for enrollment questions ([Online >> Provider Enrollment Resources](https://www.mehca.org/blog_home.asp?display=1457)).
• Health PAS Portal: The official MaineCare portal (mainecare.maine.gov) for enrollment, revalidation, and claims submission.
• DHHS Division of Licensing and Certification (DLC): The regulatory body for HCSS and PCA licensure rules and applications (maine.gov/dhhs/dlc).
• Office of Aging and Disability Services (OADS): The managing office for waiver program requirements, PCP authorizations, and HCBS initiatives (maine.gov/dhhs/oads).

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