Maine - Skilled Nursing Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Maine Department of Health and Human Services (DHHS) Office of Aging and Disability Services (OADS) and the Division of Licensing and Certification (DLC) jointly approve providers to deliver in-home Skilled Nursing Services under MaineCare Benefits Manual Sections 18, 20, 21, and 29. Providers must secure a Home Health Agency license from DLC before enrolling to bill MaineCare for RN and LPN services delivered in the home.

Effective April 13, 2026, OADS instituted a temporary pause on all initial provider applications for Sections 18, 20, 21, and 29, halting new approvals for waiver-funded skilled nursing until the moratorium is lifted. When the window is open, applicants must hold the appropriate DLC license, post a surety bond, and enroll through the Maine Integrated Health Management Solution (MIHMS) portal.

1. Service Definition and Scope

In Maine, Skilled Nursing Services under HCBS waivers consist of nursing tasks delivered in the member's home by a Registered Nurse (RN) or Licensed Practical Nurse (LPN). These services must be ordered by a physician and included in the member's Person-Centered Service Plan.

The scope of practice includes comprehensive assessments, medication administration, wound care, and other skilled treatments that exceed the scope of personal care or direct support professionals.

• Service Name: Skilled Nursing Services (often billed under Home Health or Private Duty Nursing depending on the specific MaineCare section).
• Delivery Setting: The member's private residence or approved community setting.
• Practitioner Qualifications: Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensed by the Maine State Board of Nursing.
• Authorization: Requires a written physician's order and formal inclusion in the OADS-approved service plan.
• Covered Waivers: MaineCare Benefits Manual Sections 18, 20, 21, and 29.

2. Regulatory and Oversight Agencies

Multiple divisions within the Maine Department of Health and Human Services (DHHS) oversee the licensing, approval, and enrollment of skilled nursing providers.

Professional licensure for individual nurses is managed by a separate state board outside of DHHS.

• Maine Division of Licensing and Certification (DLC): Issues Home Health Agency licenses and conducts surveys (https://www.maine.gov/dhhs/dlc).
• Office of Aging and Disability Services (OADS): Approves waiver provider applications and manages the HCBS programs (https://www.maine.gov/dhhs/oads).
• Office of MaineCare Services (OMS): Manages Medicaid provider enrollment, policy, and the MIHMS system (https://www.maine.gov/dhhs/oms).
• Maine State Board of Nursing: Licenses individual RNs and LPNs (http://www.maine.gov/boardofnursing).
• Health PAS Online Portal: Hosts the MIHMS enrollment system and billing resources (https://mainecare.maine.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine imposes strict structural preconditions on entities seeking to provide waiver-funded skilled nursing services. The most immediate precondition is an active moratorium on new waiver provider applications.

Additionally, Maine does not enroll independent nursing agencies for these services without formal state licensure as a Home Health Agency.

• OADS Application Pause: Effective April 13, 2026, OADS is not accepting or processing initial applications for Sections 18, 20, 21, and 29.
• Licensure Prerequisite: An applicant must hold an active State-licensed Home Health Agency license from DLC before applying to bill MaineCare for skilled nursing.
• Surety Bond: Home Health Agencies must secure and provide a surety bond when enrolling as a new provider or adding a service location.
• Trading Partner Account: Required to access the MIHMS enrollment portal; an application cannot be started without it.

4. Licensure and Certification Requirements

To provide skilled nursing in the home, an agency must be licensed by the DLC Medical Facilities Unit as a Home Health Agency. Maine licenses both State-licensed-only home health agencies and federally certified agencies.

The licensure process involves submitting an application, policies, and procedures to DLC, followed by a state licensure investigation to determine compliance with state regulations.

• License Type: State-licensed Home Health Agency or Federally Certified Home Health Agency.
• Issuing Authority: DLC Medical Facilities Unit.
• Survey Requirement: DLC conducts state licensure investigations to determine compliance with minimum standards.
• Federal Certification: Optional but required if the agency intends to bill Medicare in addition to MaineCare.

5. Medicaid Provider Enrollment

Once licensed and approved by OADS, providers must enroll in MaineCare through the Maine Integrated Health Management Solution (MIHMS).

Enrollment requires payment of an application fee and adherence to strict ordering and referring provider rules.

• System: Maine Integrated Health Management Solution (MIHMS) accessed via the Health PAS Online Portal.
• Application Fee: Required for newly enrolling or revalidating providers; the fee amount varies annually.
• Revalidation: Providers must revalidate their enrollment information with MaineCare every 5 years.
• NOPR Requirement: Billing providers must provide the NPI of an enrolled MaineCare practitioner who is ordering or referring the service to avoid claim denials.

6. Staffing, Training and Background Checks

Agencies must ensure that all nursing staff hold valid professional licenses and pass comprehensive background checks before providing services to vulnerable Maine citizens.

Background checks are centralized through a state-mandated online system.

• Professional Licensure: RNs and LPNs must hold active, unencumbered licenses from the Maine State Board of Nursing.
• Background Checks: Must be conducted through the Maine Background Check Center (MBCC) for all direct access workers.
• Registry Checks: Agencies must verify staff against the Maine Certified Nursing Assistant (CNA) and Direct Access Worker Registry.
• Supervision: LPNs must practice under the direction and supervision of an RN as dictated by the Board of Nursing.

7. Documentation, Policies and Records

Providers must maintain detailed clinical and administrative records to support the medical necessity and actual delivery of skilled nursing services.

Agencies are also subject to mandatory reporting requirements for critical incidents.

• Physician Orders: Must be signed, dated, and maintained in the client's clinical record.
• Service Plan Alignment: Nursing interventions must directly align with the OADS-approved Person-Centered Service Plan.
• Clinical Notes: Nurses must document each visit, detailing the assessment, interventions performed, and the client's response.
• Sentinel Events: Agencies must report qualifying critical incidents to the DLC Sentinel Events Unit.

8. Billing, Rates and Claims

Claims for skilled nursing services are submitted electronically through the Health PAS Online Portal. Services must be prior-authorized based on the member's service plan.

Rates are standardized and published by the Office of MaineCare Services.

• Billing System: Claims are submitted via the Health PAS Online Portal.
• Procedure Codes: Billed using standard HCPCS codes (e.g., T1002 for RN, T1003 for LPN) as specified in the MaineCare fee schedule.
• Prior Authorization: Required for all waiver-funded nursing services before delivery.
• Rate Publication: Established by OMS and published in the official MaineCare Provider Fee Schedule.

9. Approval Sequence and Timeline

Becoming a skilled nursing provider in Maine is a multi-step process that spans several state agencies. The timeline is currently impacted by the OADS application pause.

Applicants must complete licensure before moving to waiver approval and final Medicaid enrollment.

• Step 1: Apply for and obtain a Home Health Agency license from the DLC Medical Facilities Unit.
• Step 2: Wait for OADS to lift the temporary pause on initial applications (effective April 13, 2026).
• Step 3: Submit the waiver provider application via the OADS online portal (https://maine.hcbscompliance.com).
• Step 4: Establish a Trading Partner Account for MIHMS access.
• Step 5: Submit the MIHMS enrollment application, including the required surety bond and application fee.

10. Common Denials and Survey Findings

Applications are frequently rejected for failing to meet structural prerequisites or missing required documentation.

During surveys, agencies are often cited for documentation and background check failures.

• Moratorium Rejection: Submitting an initial OADS application while the April 2026 pause is still in effect.
• Missing Surety Bond: Failure to attach the required surety bond during the MIHMS enrollment process.
• Incomplete NOPR: Missing the ordering physician's NPI on claims, resulting in automatic denials.
• Background Check Violations: Allowing staff to provide care before completing the MBCC background check process.

11. Key Contacts and Resources

Providers should utilize official state portals and contact specific division helpdesks for guidance on licensure and enrollment.

OADS maintains a dedicated email for waiver provider questions.

• OADS Provider Enrollment: [email protected] (https://www.maine.gov/dhhs/oads).
• DLC Medical Facilities Unit: For Home Health Agency licensing inquiries (https://www.maine.gov/dhhs/dlc).
• MaineCare Provider Services: For MIHMS and Health PAS support (https://mainecare.maine.gov).
• Maine Background Check Center: For direct access worker screening (https://www.maine.gov/dhhs/dlc).

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