Maine - Home Health Service — 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 Home Health Care Services under 10-144 C.M.R. Chapter 119 to deliver intermittent skilled nursing, physical therapy, and home health aide services.

Agencies seeking MaineCare reimbursement under the MaineCare Benefits Manual Chapter II, Section 40 must first obtain Medicare certification (Title XVIII) and secure a surety bond before submitting an enrollment application through the Maine Integrated Health Management Solution (MIHMS) portal.

1. Service Definition and Scope

In Maine, Home Health Care Services provide intermittent skilled nursing, physical, occupational, and speech therapy, and home health aide services to individuals in their residences. These services are governed by 10-144 C.M.R. Chapter 119 for licensure and the MaineCare Benefits Manual (MBM) Chapter II, Section 40 for Medicaid reimbursement.

Care must be delivered under a systematic, individualized written plan of care developed by professional staff in conjunction with the patient and ordered by a physician.

• Skilled Nursing: Provided by a registered nurse (RN) or licensed practical nurse (LPN) under RN supervision for observation, assessment, and complex care.
• Physical Therapy: Restorative therapy provided by a Maine-licensed physical therapist authorized by Title 32 MRSA §3111.
• Home Health Aide: Delegated personal care and nursing tasks performed by a Certified Nursing Assistant (CNA) listed on the Maine Registry.
• Plan of Care: A systematic, individualized written plan updated as the patient's needs change, detailing the activities provided to meet those needs.
• Preventive Services: Services provided in the home by health care professionals or paraprofessionals designed to promote health so illnesses will not occur.
• Branch Offices: Locations sharing administration with the parent agency, permitted under Chapter 119 without a separate license if sufficiently close.

2. Regulatory and Oversight Agencies

Maine divides the oversight of home health agencies between state licensing bodies, the state Medicaid agency, and federal certification authorities.

Providers must interact with multiple portals and divisions to maintain compliance, bill claims, and update their enrollment records.

• Division of Licensing and Certification (DLC): Issues the state Home Health Care Services license and conducts regulatory surveys (https://www.maine.gov/dhhs/dlc).
• Office of MaineCare Services (OMS): Sets Medicaid policy, service limits, and reimbursement rates under MBM Section 40 (https://www.maine.gov/dhhs/oms).
• Health PAS Online Portal: The MIHMS provider enrollment and claims system operated by Gainwell Technologies for MaineCare (https://mainecare.maine.gov).
• Centers for Medicare & Medicaid Services (CMS): Grants the federal Medicare certification required for MaineCare HHA enrollment (https://www.cms.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine does not require a Certificate of Need (CON) for new Home Health Agencies, as the state repealed this requirement for this specific service category. However, strict financial and federal certification prerequisites block MaineCare enrollment until met.

An agency cannot simply obtain a state license and immediately bill MaineCare; it must first navigate the federal certification process and secure specific financial guarantees.

• Certificate of Need: None exists; Maine explicitly repealed the CON requirement for home health agencies.
• Medicare Certification: A mandatory precondition for MaineCare enrollment as a Home Health Agency under MBM Section 40.
• Surety Bond: A mandatory financial prerequisite for all new, revalidating, or expanding Home Health Agencies enrolling in MaineCare.
• Application Fee: A required institutional provider enrollment fee paid during the MIHMS application process, varying annually based on CMS rates.
• NPI Registration: Applicants must obtain an organizational Type 2 National Provider Identifier (NPI) via NPPES before initiating the state enrollment process.

4. Licensure and Certification Requirements

Agencies must apply for a Home Health Care Services license from the DLC under 10-144 C.M.R. Chapter 119. The process involves a detailed application, policy review, and an initial survey.

Because MaineCare requires Medicare certification, most agencies utilize a national accrediting organization to achieve deemed status for both federal certification and state licensure compliance.

• Licensure Rule: Governed by 10-144 C.M.R. Chapter 119 Regulations Governing the Licensing and Functioning of Home Health Care Services.
• Application Form: Submitted to DLC with ownership disclosures, organizational charts, and the required licensing fee.
• Deemed Status: Maine DLC may accept accreditation from CHAP, ACHC, or The Joint Commission in lieu of a standard state survey.
• Medicare Tie-In: The agency must undergo a CMS initial certification survey to receive a CMS Certification Number (CCN).
• Branch Approval: Branch offices must be approved by DLC to ensure they are sufficiently close to share administration and supervision.

5. Medicaid Provider Enrollment

Once licensed and Medicare-certified, the agency enrolls in MaineCare via the MIHMS Health PAS Online Portal. This process links the agency's NPI and CCN to the state's claims system.

Enrollment requires uploading proof of licensure, federal certification, and the mandatory surety bond.

• Enrollment Portal: Applications are submitted electronically through the MaineCare Health PAS Online Portal.
• Provider Type: Enrolled specifically as a Home Health Agency to bill MBM Section 40 services.
• Surety Bond Submission: The required HHA surety bond must be uploaded with the enrollment packet.
• Application Fee Payment: The CMS-mandated institutional application fee must be paid or proof of prior payment to Medicare provided.
• Revalidation: MaineCare requires HHAs to revalidate their enrollment and submit an updated surety bond every five years.

6. Staffing, Training and Background Checks

Chapter 119 mandates specific qualifications for administrative and clinical leadership to ensure safe and effective care delivery.

All direct care staff must meet state-specific credentialing requirements and undergo comprehensive background screening.

• Administrator: Must be a physician, RN, or health administrator with at least 1 year of supervisory or administrative experience in home health.
• Director of Nurses: Must be a Maine-licensed RN with 1 year of clinical experience and at least 2 years of supervisory or administrative experience in home health.
• Home Health Aides: Must have completed a Maine State Board of Nursing approved course and be listed on the Maine Registry of Certified Nursing Assistants.
• Therapists: Physical, occupational, and speech therapists must hold current Maine professional licenses.
• Background Checks: Agencies must query the Maine Background Check Center (MBCC) for all direct access workers prior to hire.

7. Documentation, Policies and Records

Agencies must maintain comprehensive clinical records and administrative policies as dictated by Chapter 119 and Medicare Conditions of Participation.

Documentation must clearly link the physician's orders to the specific interventions performed during each visit.

• Plan of Care: Must be written, individualized, updated as the patient's needs change, and signed by the physician.
• Clinical Notes: Must be written, signed, and dated by the clinician for every visit, detailing the services provided.
• Advanced Directives: Policies must comply with the Maine Uniform Rights of the Terminally Ill Act and document patient choices.
• Bylaws: The agency must adopt a formal set of rules governing its operation and administrative structure.
• Electronic Health Record (EHR): Strongly encouraged for the secure collection and sharing of health information across care settings.

8. Billing, Rates and Claims

MaineCare reimburses Home Health Services based on a fee schedule established by the Office of MaineCare Services. Claims are submitted via the MIHMS portal.

Providers must ensure that MaineCare is the payer of last resort, particularly for dually eligible Medicare/Medicaid members.

• Billing System: Claims are submitted electronically to Gainwell Technologies via the Health PAS Online Portal.
• Reimbursement Methodology: Paid according to the MaineCare Fee Schedule for MBM Chapter II, Section 40.
• Prior Authorization: Certain extended or specialized home health visits may require prior authorization from MaineCare's utilization review vendor.
• Coding: Services are billed using standard HCPCS/CPT codes and revenue codes applicable to home health disciplines.
• Duplication of Payment: Agencies must have systems to ensure no duplicate billing occurs between Medicare, MaineCare, and other payers.

9. Approval Sequence and Timeline

The pathway from entity formation to billing MaineCare involves sequential approvals from DLC, CMS or an accreditor, and OMS.

Because Medicare certification is required before MaineCare enrollment, the timeline is significantly longer than for state-only waiver services.

• Step 1: Entity formation and NPI registration via NPPES (1-2 weeks).
• Step 2: Submission of the state license application to DLC and policy review (30-60 days).
• Step 3: Initial state licensure survey or accreditation survey for Medicare deemed status (3-6 months, depending on volume).
• Step 4: Issuance of the Medicare CCN by CMS (30-90 days post-survey).
• Step 5: MaineCare provider enrollment via MIHMS, including surety bond review (30-60 days).

10. Common Denials and Survey Findings

DLC and MaineCare frequently cite agencies for administrative omissions or failure to follow the physician-ordered plan of care.

Financial enrollment denials often stem from missing or incorrectly formatted surety bonds.

• Plan of Care Deviations: Providing services or frequencies not explicitly authorized in the physician-signed plan of care.
• Incomplete Clinical Notes: Missing signatures, dates, or specific details of the interventions performed during a visit.
• Unqualified Personnel: Utilizing aides who have lapsed on the Maine Registry of Certified Nursing Assistants.
• Surety Bond Lapses: Failure to maintain or properly submit the required surety bond during MaineCare enrollment or revalidation.
• Delayed Physician Signatures: Failing to obtain timely physician signatures on orders before billing claims.

11. Key Contacts and Resources

These official state resources provide the applications, manuals, and portals required to establish and maintain a Home Health Agency in Maine.

Providers should monitor these sites for updates to Chapter 119 rules and MaineCare Section 40 billing guidelines.

• Division of Licensing and Certification (DLC): https://www.maine.gov/dhhs/dlc
• Office of MaineCare Services (OMS): https://www.maine.gov/dhhs/oms
• MaineCare Provider Enrollment (Health PAS Portal): https://mainecare.maine.gov
• Maine Background Check Center (MBCC): https://www.maine.gov/dhhs/dlc/background-check-center
• Centers for Medicare & Medicaid Services (CMS): https://www.cms.gov

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