Maine - Medical Supply Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maine Department of Health and Human Services (DHHS), Office of MaineCare Services (OMS), reimburses Medical Supply and Durable Medical Equipment (DME) services under the MaineCare Benefits Manual Chapter II, Section 60. Providers furnish, fit, and service durable medical equipment and disposable supplies for eligible MaineCare members, including waiver participants.

Approval requires providers to secure a surety bond and complete enrollment through the Maine Integrated Health Management Solution (MIHMS) portal. Providers must also maintain compliance with federal Medicare accreditation standards where applicable and revalidate their enrollment every three years.

1. Service Definition and Scope

Medical Supplies and Durable Medical Equipment (DME) in Maine encompass items that are primarily and customarily used to serve a medical purpose and can withstand repeated use.

These services are governed by the MaineCare Benefits Manual and include both rental and purchase of equipment, as well as disposable medical supplies required for waiver participants.

• Rule Citation: MaineCare Benefits Manual (MBM) Chapter II, Section 60
• Covered Items: durable medical equipment, prosthetics, orthotics, and disposable medical supplies
• Service Delivery: furnished, fitted, and serviced for MaineCare members
• Exclusions: items that are primarily for comfort or convenience are not covered

2. Regulatory and Oversight Agencies

The Office of MaineCare Services (OMS) is the primary agency responsible for provider enrollment, rate setting, and policy administration for DME.

The Division of Licensing and Certification (DLC) oversees healthcare facilities, though DME providers primarily interact with OMS for enrollment rather than DLC for facility licensure.

• Office of MaineCare Services (OMS): administers the MaineCare program and provider enrollment (https://www.maine.gov/dhhs/oms)
• Division of Licensing and Certification (DLC): oversees state healthcare facility licensing (https://www.maine.gov/dhhs/dlc)
• Centers for Medicare and Medicaid Services (CMS): sets federal accreditation and application fee standards (https://www.cms.gov)
• Maine Integrated Health Management Solution (MIHMS): the state's Medicaid portal for enrollment and claims (https://mainecare.maine.gov)

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine requires DME providers to meet specific financial and federal prerequisites before an enrollment application is accepted.

Providers must secure a surety bond and, in most cases, hold Medicare enrollment and accreditation from a CMS-approved accrediting organization.

• Surety Bond: Home Health Agencies and DME providers must provide a surety bond when enrolling, revalidating, or adding a location
• Medicare Enrollment: providers typically must be enrolled in Medicare as a DMEPOS supplier
• Accreditation: must hold accreditation from a CMS-approved organization such as ACHC or The Joint Commission
• National Provider Identifier (NPI): required prior to beginning the MaineCare enrollment process

4. Licensure and Certification Requirements

Maine does not issue a distinct state-level facility license specifically for DME and Medical Supply providers.

Instead, the state relies on federal Medicare DMEPOS accreditation, local business licensing, and MaineCare provider enrollment agreements to authorize service delivery.

• State Licensure: Maine does not have a specific DME facility license category
• Federal Certification: relies on Medicare DMEPOS supplier standards
• Business Registration: must be registered to do business in the State of Maine
• Out-of-State Providers: must meet the licensing requirements of their home state if located outside Maine

5. Medicaid Provider Enrollment

Providers must enroll through the Maine Integrated Health Management Solution (MIHMS) portal.

The process requires payment of an application fee and submission of the surety bond, with a strict revalidation schedule.

• Enrollment Portal: MIHMS Provider Portal (https://mainecare.maine.gov)
• Application Fee: required for newly enrolling, revalidating, or adding locations (fee varies annually based on CMS limits)
• Revalidation Cycle: DME providers must revalidate their information with MaineCare every 3 years
• Required Form: MaineCare Provider Agreement

6. Staffing, Training and Background Checks

DME providers must ensure that all staff fitting or servicing equipment meet applicable professional standards.

Owners and managing employees are subject to mandatory federal and state background checks during enrollment.

• Background Checks: required for all owners with 5% or more interest and managing employees
• Exclusions Screening: must screen staff monthly against the OIG LEIE and MaineCare exclusion lists
• Professional Licensing: staff providing specialized fittings (e.g., orthotics) must hold appropriate credentials
• Training: staff must be trained on equipment operation and safety protocols

7. Documentation, Policies and Records

Providers must maintain comprehensive records for all dispensed supplies and equipment.

This includes valid prescriptions, certificates of medical necessity, and proof of delivery.

• Prescriptions: a valid prescription from an enrolled MaineCare provider is required for all items
• Proof of Delivery: must maintain signed delivery slips or shipping tracking documents
• Record Retention: records must be kept for a minimum of five years
• Prior Authorization: documentation must support requests for items requiring prior approval under Section 60

8. Billing, Rates and Claims

Reimbursement for DME and medical supplies is based on the MaineCare Usual Customary and Reasonable (UCR) Fee Schedule.

Recent methodology changes align MaineCare rental periods and rates more closely with Medicare standards, including rural and non-rural modifiers.

• Fee Schedule: MaineCare UCR Report available on the Rate Setting Website
• Billing System: claims are submitted via the MIHMS portal
• Modifiers: specific modifiers are required for rental vs. purchase and rural vs. non-rural rates
• Manual Pricing: items without a set rate may be priced 'By Invoice' requiring submission of manufacturer invoices

9. Approval Sequence and Timeline

The enrollment process follows a sequential path starting with federal prerequisites.

Providers should expect the process to take several months from obtaining a surety bond to final MIHMS approval.

• Step 1: Obtain NPI and Medicare DMEPOS accreditation
• Step 2: Secure the required surety bond
• Step 3: Submit the enrollment application and fee via MIHMS
• Step 4: Respond to any OMS requests for additional information within 30 days

10. Common Denials and Survey Findings

Enrollment applications and claims are frequently delayed or denied due to missing documentation.

Failure to maintain the surety bond or active Medicare accreditation will result in termination.

• Missing Bond: failure to upload a valid surety bond during MIHMS enrollment
• Fee Omission: not paying the required application fee
• Lapsed Accreditation: failure to maintain CMS-approved DMEPOS accreditation
• Invalid Prescribing Provider: prescriptions from providers not enrolled in MaineCare (NOPR requirement)

11. Key Contacts and Resources

Providers should utilize the official MaineCare resources for the most current manuals and fee schedules.

The Provider Relations team is available to assist with billing and enrollment questions.

• Office of MaineCare Services: https://www.maine.gov/dhhs/oms
• MIHMS Provider Portal: https://mainecare.maine.gov
• Provider Enrollment Guide: https://www.maine.gov/dhhs/oms/providers/provider-enrollment-revalidation
• MaineCare Benefits Manual: https://www.maine.gov/sos/cec/rules/10/ch101.htm

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