Maine - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

MaineCare funds Community Transition Services—the state's nomenclature for transitional assistance—through the Office of Aging and Disability Services (OADS) under the Section 18, 19, and 20 Home and Community-Based Services (HCBS) waivers. This service reimburses the one-time, non-recurring set-up expenses required to move an eligible MaineCare member from a nursing facility or intermediate care facility into a private community residence.

Approval to bill for these institutional discharge expenses requires enrollment through the Maine Integrated Health Management Solution (MIHMS) portal as an atypical provider. Applicants must first secure a direct service authorization or contract from OADS or a designated Care Coordination agency, as standalone independent enrollment without an existing OADS relationship or waiver service authorization is not permitted.

1. Service Definition and Scope

In Maine, Transitional Assistance is formally defined in the MaineCare Benefits Manual (MBM) as Community Transition Services. It covers the essential, one-time expenses necessary to establish a basic household when a member transitions from an institutional setting to a community setting.

The service is strictly limited to concrete goods and deposits, rather than ongoing coordination time, which is billed separately under Care Coordination or Case Management.

• Covered Expenses: Security deposits, utility set-up fees, essential furnishings, and moving expenses.
• Excluded Items: Monthly rental or mortgage payments, food, regular utility charges, and recreational items like televisions.
• Funding Cap: Expenditures are strictly capped per transition, typically up to $1,500 or as specified in the member's authorized Person-Centered Service Plan.
• Setting Requirement: The destination must be a private residence, not another licensed residential care facility.

2. Regulatory and Oversight Agencies

The Maine Department of Health and Human Services (DHHS) holds ultimate authority over the Medicaid program. Within DHHS, two distinct offices manage the programmatic and financial aspects of Community Transition Services.

The Office of Aging and Disability Services (OADS) manages the waiver programs and authorizes the services, while the Office of MaineCare Services (OMS) handles provider enrollment and claims processing.

• Maine Department of Health and Human Services (DHHS): Oversees all health and human services in the state (https://www.maine.gov/dhhs).
• Office of Aging and Disability Services (OADS): Administers the Section 18, 19, 20, 21, and 29 waivers and authorizes transition plans (https://www.maine.gov/dhhs/oads).
• Office of MaineCare Services (OMS): Manages Medicaid policy, provider enrollment, and reimbursement (https://www.maine.gov/dhhs/oms).
• Health PAS Online Portal: The official MIHMS system for provider enrollment and claims submission (https://mainecare.maine.gov).

3. Gatekeeping Prerequisites: Who Can Even Apply

Maine does not permit entities to enroll in MaineCare solely as independent "transition brokers" without prior programmatic authorization. The structural precondition for this service is an existing relationship with OADS or a designated Care Coordination agency.

Providers must be authorized to deliver the service as part of an approved member's Person-Centered Service Plan before an application to bill for Community Transition Services is accepted.

• OADS Authorization: Providers must receive a service authorization from an OADS Care Coordinator or Case Manager before delivering goods.
• Entity Type: Typically restricted to established Community Action Agencies, Area Agencies on Aging, or existing enrolled HCBS providers.
• Atypical Provider Status: Applicants must qualify to enroll as atypical (non-medical) providers in the MIHMS system.
• Waiver Capacity: The service is only available to members who have successfully secured a funded slot in an applicable HCBS waiver.

4. Licensure and Certification Requirements

Maine does not issue a specific facility or occupational license for Community Transition Services. Because the service consists of purchasing goods and paying deposits rather than providing direct physical care, standard business licensure applies.

Providers must maintain good standing as a business entity in Maine and comply with general HCBS provider requirements, though they are exempt from the clinical licensure required for direct-care agencies.

• Business Registration: Must be registered and in good standing with the Maine Secretary of State.
• HCBS Settings Attestation: Providers must comply with the Global HCBS Waiver Rule (10-144 C.M.R. ch. 101) ensuring the destination setting is integrated.
• Tax Identification: Must possess a valid Employer Identification Number (EIN) or Social Security Number for sole proprietors.
• OADS Qualification: Must meet the specific provider qualifications outlined in the respective waiver appendix (e.g., Section 19).

5. Medicaid Provider Enrollment

Enrollment is conducted entirely online through the Maine Integrated Health Management Solution (MIHMS) via the Health PAS Online Portal. Providers of Community Transition Services enroll as Atypical providers.

Because they do not provide medical services, they are not required to obtain a National Provider Identifier (NPI), but must complete the MaineCare Provider Agreement.

• Enrollment Portal: Applications must be submitted via the Health PAS Online Portal (https://mainecare.maine.gov).
• Provider Type: Must select the Atypical provider classification during the MIHMS enrollment process.
• Application Fee: Atypical HCBS providers are generally exempt from the standard Medicaid institutional application fee.
• Provider Agreement: Must sign and upload the standard MaineCare Provider Agreement binding the entity to state billing rules.

6. Staffing, Training and Background Checks

While Community Transition Services do not involve direct medical care, any staff interacting with vulnerable adults or managing their transition funds must pass state-mandated background checks.

There are no specific clinical degree requirements for staff purchasing goods or paying deposits, but they must complete mandatory reporting training.

• Criminal Background Check: Required through the Maine State Bureau of Identification (SBI) for all staff interacting with members.
• Registry Checks: Must clear the Maine Adult Protective Services (APS) and Child Protective Services (CPS) registries.
• Mandated Reporter Training: Staff must complete Maine's mandated reporter training for elder and vulnerable adult abuse.
• OIG Exclusion List: Agencies must verify staff are not on the federal LEIE (List of Excluded Individuals/Entities).

7. Documentation, Policies and Records

The core compliance requirement for Community Transition Services is strict financial documentation. Providers are reimbursed at actual cost, meaning every billed dollar must be backed by an original receipt or invoice.

Records must clearly link the purchased items to the authorized transition plan and demonstrate that the goods were delivered to the member's new community residence.

• Original Receipts: Must maintain original, itemized receipts for all purchased goods, deposits, and services.
• Transition Plan: The specific items purchased must match the approved list in the member's Person-Centered Service Plan.
• Proof of Delivery: Documentation, often including the member's signature, verifying that the items were received at the community home.
• Record Retention: All financial and service records must be retained for a minimum of five years per MaineCare rules.

8. Billing, Rates and Claims

Community Transition Services are billed to MaineCare through the Health PAS Online Portal using specific HCPCS codes. Reimbursement is strictly for the actual cost of the items or deposits, up to the waiver's lifetime or per-transition cap.

Providers cannot mark up the cost of goods or charge administrative overhead to this specific service code.

• Procedure Code: Typically billed using T2038 (Community Transition, waiver) as specified in the MaineCare provider fee schedule.
• Reimbursement Rate: Paid at actual cost, requiring providers to bill the exact amount shown on the receipts.
• Prior Authorization: Claims will deny if the service was not prior-authorized in MIHMS by the Care Coordinator.
• Claim Format: Submitted via direct data entry on the Health PAS portal or via an 837P electronic transaction.

9. Approval Sequence and Timeline

The approval process begins with the member's Care Coordinator identifying the need for transition services. The provider cannot initiate enrollment for this service without this triggering event.

Once authorized by OADS, the MIHMS enrollment process for an atypical provider typically takes 30 to 60 days, provided all background checks and agreements are submitted accurately.

• Step 1: Member is allocated a waiver slot and Care Coordinator develops the transition plan.
• Step 2: Provider agrees to procure the items and receives OADS authorization.
• Step 3: Provider submits the Atypical enrollment application via the Health PAS Online Portal.
• Step 4: OMS screens the application and issues a MaineCare Provider ID (typically 30-60 days).

10. Common Denials and Survey Findings

Financial audits of Community Transition Services frequently target missing documentation and unallowable purchases. Because the service is capped and highly specific, deviations from the approved plan result in immediate recoupment.

Providers most often face claim denials at the time of billing due to missing prior authorizations in the MIHMS system.

• Unallowable Purchases: Recoupment for buying excluded items like televisions, cable installation, or monthly rent.
• Missing Receipts: Total denial of claims if the provider cannot produce the original, itemized receipt for the purchase.
• Exceeding the Cap: Claims denying because the total billed amount exceeds the $1,500 (or applicable) waiver limit.
• No Prior Authorization: Claims rejecting in MIHMS because the Care Coordinator failed to enter the authorization before the purchase date.

11. Key Contacts and Resources

Providers should direct enrollment and portal questions to the MaineCare Provider Services Call Center. Programmatic questions regarding allowable purchases or waiver rules should be directed to OADS.

The Health PAS Online Portal is the central hub for all billing, enrollment, and policy manual access.

• MaineCare Provider Enrollment Portal: Health PAS Online Portal (https://mainecare.maine.gov).
• Provider Services Call Center: 1-866-690-5585, Option 2 for Enrollment Questions.
• OADS HCBS Waiver Team: Email for waiver application and programmatic materials at [email protected].
• MaineCare Benefits Manual: Available via the Secretary of State or DHHS policy pages for Chapter II, Sections 18, 19, 20, and 21 rules (https://www.maine.gov/dhhs/oms).

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