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

Last reviewed: 2026-09-10

Effective April 13, 2026, the Maine Office of Aging and Disability Services (OADS) is temporarily pausing the acceptance and review of all initial applications for entities seeking to become approved waiver providers under MaineCare Benefits Manual Sections 18, 20, 21, and 29. Maine does not license or cover a distinct service named "Adult Companion Services"; instead, non-medical supervision, socialization, and assistance that allow an adult to remain safely in the community are authorized as "Home Support" or "Community Support" under these specific MaineCare waivers.

Prospective agencies must first navigate the OADS online application portal to become a qualified waiver provider before seeking applicable licensure through the Division of Licensing and Certification (DLC) and enrolling in MaineCare. The process requires strict adherence to the federal HCBS Settings Rule, evidenced by a mandatory HCBS Settings Compliance Attestation Form, ensuring that all service locations integrate members fully into the greater community.

1. Service Definition and Scope

Because Maine does not utilize the standalone billing term "Adult Companion Services," providers deliver non-medical supervision and socialization through "Home Support" or "Community Support" services under MaineCare Benefits Manual (MBM) Chapter II, Sections 18, 20, 21, and 29. These services are designed to assist members with intellectual disabilities, autism, or brain injuries in acquiring, retaining, or improving the self-help, socialization, and adaptive skills necessary to reside successfully in home and community-based settings.

Home Support involves direct assistance and supervision in the member's residence, while Community Support focuses on integration and socialization in community settings. Both services strictly prohibit the provision of medical or nursing care by the support staff, focusing entirely on habilitation, safety, and community inclusion as dictated by the member's Person-Centered Service Plan.

• Service Equivalent: Maine covers companion-like supervision under Home Support and Community Support within MBM Sections 18, 20, 21, and 29.
• Scope of Home Support: Provides direct assistance, supervision, and habilitation in the member's home to ensure safety and skill retention.
• Scope of Community Support: Facilitates socialization, community integration, and adaptive skill building outside the member's residence.
• Medical Exclusion: Staff providing these supports are prohibited from delivering skilled nursing or medical care.
• Service Authorization: All support hours must be explicitly detailed and justified in the member's Person-Centered Service Plan.
• Setting Requirements: Services must be delivered in settings that comply with the Global HCBS Waiver Person-Centered Planning and Settings Rule (MBM Ch. I, Section 6).

2. Regulatory and Oversight Agencies

The Maine Department of Health and Human Services (DHHS) oversees all Medicaid waiver services through several specialized divisions. The Office of Aging and Disability Services (OADS) acts as the primary programmatic gatekeeper, reviewing initial provider applications and ensuring compliance with waiver standards.

The Division of Licensing and Certification (DLC) handles the physical licensure of agencies, such as Personal Care Agencies, while the Office of MaineCare Services (OMS) manages the financial and enrollment aspects of the Medicaid program through the Health PAS Online Portal.

• Maine Department of Health and Human Services (DHHS): The umbrella agency responsible for Medicaid and public health in Maine (https://www.maine.gov/dhhs).
• Office of Aging and Disability Services (OADS): The division that qualifies waiver providers and manages Sections 18, 20, 21, and 29 (https://www.maine.gov/dhhs/oads).
• Division of Licensing and Certification (DLC): The regulatory body that issues licenses for Personal Care Agencies and assisted housing (https://www.maine.gov/dhhs/dlc).
• Office of MaineCare Services (OMS): The state Medicaid agency responsible for provider enrollment and policy (https://www.maine.gov/dhhs/oms).
• Health PAS Online Portal: The MMIS and provider enrollment system used for MaineCare billing and credentialing (https://mainecare.maine.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

The most definitive structural precondition for new providers in Maine is the OADS application moratorium. Effective April 13, 2026, OADS implemented a temporary pause on accepting and reviewing initial applications for entities seeking to become approved waiver providers under MBM Sections 18, 20, 21, and 29. Applications submitted on or after this date will not be accepted or processed until the pause is lifted.

When the application window is open, providers must first secure OADS approval through their online application portal before they can apply for MaineCare enrollment. There is no standalone enrollment for these services without prior OADS qualification.

• Application Moratorium: Effective April 13, 2026, OADS paused all initial provider applications for Sections 18, 20, 21, and 29.
• OADS Qualification Requirement: Providers must be formally approved by OADS before applying for MaineCare enrollment.
• Online Portal Mandate: OADS no longer accepts paper or email applications; all submissions must go through the Maine HCBS Compliance online portal (https://maine.hcbscompliance.com).
• Licensure Prerequisite: If the specific service delivery model requires it, the agency must obtain a Personal Care Agency license from DLC after OADS approval but before MaineCare enrollment.
• HCBS Settings Compliance: Providers must attest to meeting all federal HCBS Settings Rule requirements prior to location enrollment.

4. Licensure and Certification Requirements

Depending on the exact structure of the agency and the services provided, entities delivering Home Support may need to be licensed by the Division of Licensing and Certification (DLC) as a Personal Care Agency. This license ensures the agency meets state standards for administrative oversight, consumer rights, and basic safety.

Agencies must also maintain their OADS approval status by adhering to the programmatic rules outlined in the MaineCare Benefits Manual. This includes passing desk-level reviews and maintaining compliance with the Global HCBS Waiver Rule.

• Personal Care Agency License: Required by DLC for agencies providing direct in-home personal support services, depending on the business model.
• OADS Provider Approval: The foundational certification required to operate as a waiver provider for Sections 18, 20, 21, and 29.
• HCBS Settings Attestation: A mandatory form certifying that the provider's settings comply with community integration standards.
• Policy Manual Submission: Applicants must submit comprehensive agency policies and procedures during the OADS review process.
• Formal Interview: OADS conducts a formal interview with the applicant if all documentary requirements are met during the initial review.

5. Medicaid Provider Enrollment

Once OADS approval and any necessary DLC licenses are secured, the agency must enroll as a MaineCare provider through the Office of MaineCare Services (OMS). This process is conducted entirely online via the Health PAS Online Portal.

Providers must sign a MaineCare Provider Agreement, which binds them to the General Administrative Policies and Procedures found in MBM Chapter I, Section 1. Following enrollment, providers must use the portal to define specific service locations before they can receive authorizations for waiver members.

• Health PAS Online Portal: The mandatory system for submitting MaineCare provider enrollment applications (https://mainecare.maine.gov).
• MaineCare Provider Agreement: The legally binding contract requiring adherence to MBM Chapter I, Section 1.
• OADS Onboarding Meeting: A required step post-approval where OADS reviews expectations and provides direction before the provider accepts members.
• Service Location Definition: Providers must log into the Health PAS Portal to register specific service locations for prior authorization routing.
• Revalidation: Enrolled MaineCare providers must complete periodic revalidation through the Health PAS portal to maintain active billing status.

6. Staffing, Training and Background Checks

Staff delivering Home Support or Community Support in Maine are typically classified as Direct Support Professionals (DSPs). Maine requires DSPs to complete a standardized training curriculum approved by DHHS to ensure they are equipped to support individuals with intellectual disabilities or autism.

Agencies are strictly responsible for conducting comprehensive background checks on all staff prior to employment. This includes criminal history checks and registry verifications to ensure the safety of vulnerable waiver members.

• Direct Support Professional (DSP) Certification: Required training for staff delivering Section 21 and 29 waiver services.
• Background Checks: Agencies must conduct state criminal history checks on all prospective employees.
• Registry Verifications: Staff must be checked against the Maine Registry of Certified Nursing Assistants and Direct Care Workers.
• First Aid and CPR: Direct care staff must maintain current certification in basic First Aid and CPR.
• Ongoing Training: Agencies must provide and document annual continuing education for all direct support staff.

7. Documentation, Policies and Records

Maine places a heavy emphasis on documentation that proves compliance with the federal HCBS Settings Rule. Providers must complete the HCBS Settings Compliance Attestation Form for each setting, verifying that members have full access to the greater community and control over their personal resources.

Additionally, all services delivered must be meticulously documented in alignment with the member's Person-Centered Service Plan. Any modifications to the HCBS settings requirements (such as restrictions for safety) must be justified by a specific assessed need and documented with informed consent.

• HCBS Settings Compliance Attestation Form: A mandatory document required prior to location enrollment and service authorization.
• Person-Centered Service Plan: The guiding document that must explicitly identify the member's needs, preferences, and authorized support hours.
• Individual Experience Assessments: OADS reviews these assessments during desk-level audits to verify actual community integration.
• Modification Documentation: Any restriction of HCBS rights must document prior less-intrusive methods, data collection, and informed consent.
• Service Notes: Providers must maintain daily service notes detailing the specific interventions and supports provided during the shift.

8. Billing, Rates and Claims

Reimbursement for Home Support and Community Support is governed by the rate schedules published in the MaineCare Benefits Manual, Chapter III for the respective waiver sections (e.g., Section 21 or 29). Providers submit claims through the Health PAS Online Portal.

Rates are typically established in 15-minute increments for hourly supports or as per diem rates for residential models. Providers must ensure that all billed time is supported by corresponding service documentation and falls within the limits of the prior authorization.

• Rate Schedules: Established by DHHS and published in MBM Chapter III for Sections 18, 20, 21, and 29.
• Billing Increments: Hourly supports are generally billed in 15-minute units using specific HCPCS codes defined in the waiver appendix.
• Claims Submission: All claims must be submitted electronically via the Health PAS Online Portal (https://mainecare.maine.gov).
• Prior Authorization: Claims will be denied if the service is not prior-authorized by OADS for the specific member and location.
• Rate Updates: Providers must monitor MaineCare provider bulletins for periodic rate adjustments and coding changes.

9. Approval Sequence and Timeline

The approval sequence in Maine is strictly linear. An agency must first submit a complete application through the OADS online portal. If the application passes the initial documentary review, OADS conducts a formal interview before issuing an approval.

Following OADS approval, the agency applies for any required DLC licensure. Only after obtaining OADS approval and DLC licensure can the agency submit a MaineCare enrollment application through the Health PAS portal. The entire process is currently impacted by the April 13, 2026 OADS application pause.

• Step 1: OADS Portal Submission: Upload all required policies and documentation to the Maine HCBS Compliance portal.
• Step 2: OADS Review and Interview: OADS reviews the application for completeness and conducts a formal interview.
• Step 3: DLC Licensure: Apply for a Personal Care Agency license through DLC, if applicable to the service model.
• Step 4: MaineCare Enrollment: Submit the provider enrollment application via the Health PAS Online Portal.
• Step 5: Location Setup and Onboarding: Define service locations in Health PAS and complete the OADS onboarding meeting.

10. Common Denials and Survey Findings

Applications to OADS are frequently delayed or denied due to incomplete policy submissions or failure to adequately demonstrate how the agency will meet the specific needs of the waiver population. During the current pause, any initial application submitted after April 13, 2026, is automatically rejected.

For enrolled providers, OADS desk-level reviews often uncover deficiencies related to the HCBS Settings Rule. Common findings include a lack of evidence that members have true access to the community or failure to properly document necessary modifications to the settings requirements in the Person-Centered Service Plan.

• Moratorium Rejections: Initial applications submitted on or after April 13, 2026, are not accepted.
• Incomplete Policies: OADS denies applications that lack comprehensive, Maine-specific operating procedures.
• HCBS Settings Failures: Desk reviews frequently cite providers for failing to prove members have full access to the greater community.
• Undocumented Restrictions: Surveyors cite agencies for implementing safety restrictions without documenting less-intrusive methods or informed consent.
• Lapsed Training: DLC and OADS audits commonly find missing or expired DSP certifications or CPR/First Aid credentials.

11. Key Contacts and Resources

Prospective providers should rely on the official DHHS division websites for the most current manuals, forms, and announcements. The Office of Aging and Disability Services (OADS) is the primary point of contact for waiver program questions and application status.

For technical assistance with Medicaid enrollment or billing, providers must utilize the Health PAS Online Portal resources or contact the Provider Services Call Center.

• OADS Provider Inquiries: Email [email protected] for questions regarding waiver applications and the current pause.
• OADS Website: Official program information and updates (https://www.maine.gov/dhhs/oads).
• Health PAS Online Portal: For MaineCare enrollment, revalidation, and claims (https://mainecare.maine.gov).
• Division of Licensing and Certification (DLC): For questions regarding Personal Care Agency licensure (https://www.maine.gov/dhhs/dlc).
• MaineCare Provider Services Call Center: 1-866-690-5585, Option 2 for enrollment questions.

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