Maine - Respite Care Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maine Department of Health and Human Services (DHHS), through the Office of Aging and Disability Services (OADS) and the Office of MaineCare Services (OMS), funds Respite Care Services under MaineCare waiver Sections 19, 20, 21, and 29. This service provides short-term relief to primary caregivers of individuals with disabilities, chronic illnesses, or age-related conditions, allowing families to take scheduled breaks while ensuring continuous care.

Providers seeking to offer out-of-home or facility-based respite must first obtain facility licensure through the Maine Division of Licensing and Certification before they can enroll in MaineCare. Agencies providing in-home respite must register their business, obtain an NPI, and enroll directly through the MaineCare Provider Enrollment Portal as a waiver provider.

1. Service Definition and Scope

Respite Care in Maine offers temporary substitute care provided by trained staff to give relief to a family or unpaid caregiver. Services are tailored to the participant's support needs and must be included in their approved Plan of Care.

The scope includes in-home care, out-of-home care at licensed day programs or residential settings, and emergency respite for unexpected caregiver disruptions.

• In-Home Respite: Short-term caregiving delivered directly in the participant's private residence.
• Out-of-Home Respite: Care provided at a licensed day program or residential setting.
• Emergency Respite: Immediate short-term care authorized when caregivers face health or family emergencies.
• Overnight Care: Extended respite coverage authorized specifically within the participant's Plan of Care.

2. Regulatory and Oversight Agencies

Multiple divisions within the Maine Department of Health and Human Services (DHHS) oversee respite care, depending on the population served and the setting of the care.

Licensing, Medicaid enrollment, and waiver administration are divided among these specific state offices.

• Office of Aging and Disability Services (OADS): Oversees waiver-based respite care for aging adults and individuals with intellectual/developmental disabilities (https://www.maine.gov/dhhs/oads).
• Office of MaineCare Services (OMS): Administers Medicaid waiver programs, provider enrollment, and billing policies (https://www.maine.gov/dhhs/oms).
• Division of Licensing and Certification (DLC): Issues facility licenses required for out-of-home respite settings (https://www.maine.gov/dhhs/dlc).
• Office of Child and Family Services (OCFS): Approves non-school providers for children's behavioral health services (https://www.maine.gov/dhhs/ocfs).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine imposes specific structural prerequisites depending on the type of respite care an agency intends to provide. There is no universal Certificate of Need for basic in-home respite, but facility-based services face strict gating.

Providers must clear these hurdles before submitting a MaineCare enrollment application.

• Facility Licensure Prerequisite: Agencies providing out-of-home, day-based, or overnight respite must hold an active facility license from the Division of Licensing and Certification before MaineCare enrollment.
• OCFS Approval: Non-school providers delivering services to children with cognitive impairments must be approved by the Office of Child and Family Services (OCFS) prior to enrollment.
• Business Registration: Applicants must be registered with the Maine Secretary of State and possess an IRS EIN.
• NPI Requirement: Agencies must obtain a Type 2 National Provider Identifier (NPI) specific to their organizational entity.

4. Licensure and Certification Requirements

In-home respite care does not require a distinct home care license in Maine, but providers must meet the certification standards of the specific MaineCare waiver they operate under.

Out-of-home respite requires formal facility licensure, which involves physical plant inspections and life safety code compliance.

• Out-of-Home Licensure: Required through the Division of Licensing and Certification for any facility-based respite delivery.
• Waiver Certification: Providers must meet the specific standards outlined in the MaineCare Benefits Manual for Sections 19, 20, 21, or 29.
• Insurance Requirements: Agencies must maintain general liability and workers' compensation insurance.
• Policy Manual: Providers must develop and maintain a comprehensive Respite Care Policy and Procedure Manual.

5. Medicaid Provider Enrollment

All respite providers must enroll through the MaineCare Provider Enrollment Portal. The process requires selecting the appropriate waiver section based on the target population.

Enrollment cannot be finalized until all prerequisite facility licenses or OCFS approvals are uploaded to the portal.

• Enrollment Portal: Applications must be submitted via the Health PAS-OnLine portal (https://mainecare.maine.gov).
• Waiver Selection: Applicants must specify enrollment under Section 19, 20, 21, or 29 during the application process.
• Provider Agreement: Agencies must sign the standard MaineCare Provider Agreement binding them to state billing rules.
• Application Fee: Providers may be subject to the federal Medicaid application fee unless enrolled in Medicare or another state's Medicaid program.

6. Staffing, Training and Background Checks

Maine requires respite care staff to meet minimum educational and training standards before providing direct care. Agencies are responsible for maintaining personnel files that prove compliance.

Background checks are mandatory for all staff interacting with vulnerable populations.

• Basic Qualifications: Direct Support Professionals (DSPs) or respite workers must have a High school diploma or GED.
• Background Checks: Mandatory criminal history and registry checks for all direct care staff prior to client contact.
• Certifications: Staff must hold current CPR and First Aid certifications.
• Required Training: Staff must complete training on HIPAA, elder/disability abuse prevention, ADL support, and emergency procedures.

7. Documentation, Policies and Records

Providers must maintain strict documentation to support MaineCare billing and survive state audits. All services must tie directly back to the participant's authorized Plan of Care.

Electronic or paper records must be kept securely and in compliance with HIPAA regulations.

• Plan of Care Alignment: All delivered respite hours must be documented and match the authorized Plan of Care.
• Time Tracking: Agencies must utilize HIPAA-compliant documentation and time tracking systems for all shifts.
• Incident Reporting: Providers must have policies for documenting and reporting critical incidents to DHHS.
• Record Retention: Personnel and client records must be retained according to MaineCare Benefits Manual requirements.

8. Billing, Rates and Claims

Respite services are billed to MaineCare using specific procedure codes tied to the authorized waiver section. Rates are established by the Office of MaineCare Services.

Prior authorization is strictly required before any services can be delivered or billed.

• Prior Authorization: Must be obtained through DHHS or its Authorized Agent prior to the start of all services.
• Billing System: Claims are submitted through the MaineCare Health PAS-OnLine system.
• Service Units: Billed in hourly or daily increments depending on the specific waiver authorization.
• Rate Schedules: Current reimbursement rates are published in the MaineCare Benefits Manual fee schedules.

9. Approval Sequence and Timeline

The timeline to become a fully approved respite provider in Maine depends heavily on whether facility licensure is required. In-home providers move faster than out-of-home providers.

Agencies should expect a multi-month process from initial business setup to first billable claim.

• Business Setup: Entity formation and policy manual development typically takes 1 to 2 months.
• Facility Licensure: If applicable, obtaining a license from DLC adds significant time for inspections.
• MaineCare Enrollment: Processing through the Health PAS-OnLine portal generally takes 60 to 90 days.
• Staff Onboarding: Hiring and credentialing staff usually requires 3 to 4 weeks prior to launch.

10. Common Denials and Survey Findings

Applications and ongoing operations frequently face delays or sanctions due to incomplete documentation or failure to adhere to waiver-specific rules.

State surveyors focus heavily on staff qualifications and the alignment of billed services with the Plan of Care.

• Missing Prerequisites: MaineCare applications denied because the provider lacks the required DLC facility license or OCFS approval.
• Background Check Failures: Citations for allowing staff to provide care before background checks are fully cleared.
• Training Deficiencies: Personnel files lacking proof of required CPR, First Aid, or abuse prevention training.
• Billing Discrepancies: Recoupment of funds when billed respite hours exceed the limits authorized in the Plan of Care.

11. Key Contacts and Resources

Providers should rely on official Maine DHHS portals and division websites for the most current regulations, fee schedules, and application materials.

The Provider Services Call Center is the primary point of contact for enrollment status inquiries.

• MaineCare Provider Enrollment Portal: Health PAS-OnLine (https://mainecare.maine.gov).
• Office of Aging and Disability Services (OADS): Waiver program administration (https://www.maine.gov/dhhs/oads).
• Division of Licensing and Certification (DLC): Facility licensure (https://www.maine.gov/dhhs/dlc).
• Provider Services Call Center: 1-866-690-5585, Option 2 for Enrollment Questions.

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