Maine - Behavioral Health Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maine Department of Health and Human Services (DHHS) Division of Licensing and Certification (DLC) licenses Behavioral Health Organizations to deliver mental health and substance use disorder treatments under statutory authorities 34-B MRS §3601 and 5 MRS §20005(6). Providers operate under the MaineCare Benefits Manual (MBM) Chapter II, Section 65, which governs covered behavioral health services, staffing credentials, and utilization review.

Approval to bill MaineCare for these services requires an applicant to first secure a Mental Health Agency or Substance Use Disorder Treatment Agency license, as Maine does not currently issue integrated behavioral health licenses. An agency must submit separate applications, undergo a DLC survey, secure an approved physical site, and prove sufficient first-year funding before the MaineCare Provider Enrollment application is accepted.

1. Service Definition and Scope

Behavioral Health Services in Maine encompass a continuum of care designed to treat mental health conditions, neurodevelopmental disorders, and substance use disorders. The service framework is defined by the MaineCare Benefits Manual (MBM) Chapter II, Section 65.

Covered modalities include outpatient therapy, psychological testing, Multisystemic Therapy (MST), Home and Community Based Treatment (HCT), and Crisis Residential Services. Services require clinical assessments and individualized treatment planning to establish medical necessity.

• Service Authority: MaineCare Benefits Manual, Chapter II, Section 65.
• Covered Modalities: Outpatient therapy, psychological testing, Multisystemic Therapy (MST), and crisis response.
• Target Population: Children and adults with mental health diagnoses, neurodevelopmental disorders, or substance use disorders.
• Assessment Tool: LOCUS score required for adult members to determine the appropriate level of care.
• Treatment Planning: Individual Treatment Plan required within 30 days of beginning standard services.

2. Regulatory and Oversight Agencies

The DHHS Division of Licensing and Certification (DLC) is the primary regulatory body responsible for surveying and licensing behavioral health facilities and agencies in Maine.

The DHHS Office of MaineCare Services manages Medicaid provider enrollment, policy rulemaking, and reimbursement structures for Section 65 services.

• Licensing Agency: Maine DHHS Division of Licensing and Certification (https://www.maine.gov/dhhs/dlc/licensing-certification/behavioral-health).
• Medicaid Authority: DHHS Office of MaineCare Services (https://www.maine.gov/dhhs/oms).
• Rulemaking Division: DHHS Division of Policy (https://www.maine.gov/dhhs/about/rulemaking).
• Provider Enrollment: MaineCare Provider Enrollment Portal (https://mainecare.maine.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine requires agencies to be fully licensed by the DLC before any MaineCare enrollment application can be processed. Applicants must establish a physical presence and demonstrate financial viability.

Because Maine does not offer an integrated behavioral health license, agencies intending to provide both mental health and substance use disorder services must navigate two parallel but distinct licensing gates.

• Corporate Status: Applicant must be incorporated and authorized to deliver mental health or SUD services in Maine.
• Financial Solvency: Applicant must demonstrate the ability to secure sufficient funds for the first year of operation prior to licensure.
• Site Approval: Must have a physical site in Maine that is approved for occupancy before the license is granted.
• Separate Licensure: Mental Health and Substance Use Disorder programs require distinct, separate applications and licenses; they cannot be combined.
• Water Testing: Sites utilizing a private well must complete a Basic Safety Test prior to approval.

4. Licensure and Certification Requirements

Licensure is governed by the Behavioral Health Organization Licensing Rule. Applicants must download the specific fillable PDF application for either Mental Health or Substance Use Disorder from the DLC website.

The application process requires submitting supporting documentation via email while mailing the first page of the application along with the required fee to the state treasurer.

• Mental Health Authority: 34-B MRS §3601 and §3603.
• SUD Authority: 5 MRS §20005(6) and 22 MRS §8002.
• Application Form: Mental Health Agency Initial, Renewal, and Change Application (Rev 7/2026) or SUD equivalent.
• Submission Method: Email supporting documents to [email protected] and mail the first page with the fee.
• Fee Payee: Check or money order made out to Treasurer, State of Maine.
• Survey Requirement: A physical survey by DLC is required for initial licensure and subsequent renewals.

5. Medicaid Provider Enrollment

Once licensed by the DLC, agencies must enroll through the MaineCare Provider Enrollment portal to bill for Section 65 services.

Providers must maintain active licensure matching their enrolled provider type and complete revalidation every five years.

• Provider Type: Mental Health Agency (MHA) or Substance Abuse Agency (SAA).
• Enrollment System: MaineCare Provider Enrollment portal (https://mainecare.maine.gov).
• Prerequisite: Active DHHS DLC license matching the specific services to be billed.
• Revalidation Cycle: Every five years, or as requested by the Department.
• Support Contact: Provider Services Call Center at 1-866-690-5585, Option 2.

6. Staffing, Training and Background Checks

Staffing qualifications are strictly defined in MBM Chapter II, Section 65. Clinical services must be delivered by licensed professionals practicing within their scope.

Unlicensed staff providing direct support or crisis intervention must hold specific state-recognized certifications before delivering billable services.

• Crisis Services Staff: Must hold a Mental Health Rehabilitation Technician (MHRT) Certification at the level appropriate for the services delivered.
• Clinical Supervisors: Must be licensed clinicians practicing within the scope of their Maine licensure.
• Multisystemic Therapy (MST): Requires a monthly average minimum of two contacts per week by qualified staff.
• Direct Support Professionals: Must meet training requirements specified in the MaineCare Benefits Manual.

7. Documentation, Policies and Records

Agencies must maintain clinical records that justify the level of care, including formal assessments and individualized treatment plans.

Crisis services have accelerated documentation timelines to ensure immediate safety and stabilization needs are met and documented.

• Initial Assessment: Must include a written opinion from a clinician based on a face-to-face evaluation.
• Standard Treatment Plan: Individual Treatment Plan must be developed within 30 days of beginning services.
• Crisis Documentation: Crisis Residential Services require a treatment plan within 24 hours of admission.
• Crisis Review: Crisis plans must be reviewed on the seventh day and every two days thereafter if extended.
• Financial Audits: Governing body must conduct periodic financial reviews and annual audits by a CPA.

8. Billing, Rates and Claims

Reimbursement rules and service limitations are detailed in MBM Chapter II, Section 65. Certain intensive services require prior authorization or utilization review by an Authorized Entity.

Effective April 28, 2026, Maine repealed MBM Chapter III, Section 65, moving all rates to published rate schedules on the DHHS website in accordance with state law.

• Rate Authority: 22 M.R.S. § 3173-J.
• Rate Location: Published on the DHHS website rate schedules, following the repeal of MBM Chapter III, Section 65.
• Prior Authorization: Crisis Residential Services require prior authorization, initially limited to 7 days.
• Utilization Review: Authorized Entities perform utilization review for specific services like Home and Community Based Treatment.
• Co-occurring Services: Billed as integrated services when a member has both a mental health and a substance abuse diagnosis.

9. Approval Sequence and Timeline

The approval process is sequential, beginning with facility readiness and culminating in MaineCare enrollment.

Agencies cannot bypass the DLC licensing survey, and MaineCare will not backdate enrollment prior to the effective date of the DLC license.

• Step 1: Secure a physical location in Maine and pass occupancy and water safety tests.
• Step 2: Submit the Mental Health or SUD Agency Initial Application to DLC with the required fee.
• Step 3: Undergo the initial DLC licensing survey to verify compliance with core standards.
• Step 4: Receive the Behavioral Health Organization license, which is valid for two years.
• Step 5: Submit the MaineCare Provider Enrollment application with the active license.

10. Common Denials and Survey Findings

DLC monitors compliance with core standards and can shorten license durations or deny renewals for noncompliance.

MaineCare enrollment applications are frequently delayed or denied if the applicant attempts to enroll for services not explicitly covered by their DLC license.

• Commingled Applications: Submitting a single application for both MH and SUD services, which is rejected because licenses are not integrated.
• Staff Credentialing: Allowing staff without active MHRT certification to deliver crisis services.
• Treatment Plan Delays: Failing to complete the Individual Treatment Plan within the 30-day or 24-hour crisis window.
• Financial Insufficiency: Inability to prove sufficient funds for the first year of operation during the initial DLC application.

11. Key Contacts and Resources

Providers should direct licensing inquiries to the DLC Behavioral Health Program and enrollment questions to MaineCare Provider Services.

Official rulemaking notices and application forms are maintained on the DHHS website.

• DLC Behavioral Health Program: [email protected], 41 Anthony Ave, Augusta, ME 04330.
• MaineCare Provider Services: 1-866-690-5585, Option 2.
• DHHS Rulemaking Notices: https://www.maine.gov/dhhs/about/rulemaking
• DLC Behavioral Health Page: https://www.maine.gov/dhhs/dlc/licensing-certification/behavioral-health

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