Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-65 - Behavioral Health Service
Subsection 144-101-II-65.02 - PROVIDER QUALIFICATIONS
Current through 2024-38, September 18, 2024
The following providers are qualified to provide Behavioral Health Services as listed in 65.13 Appendix I.
65.02-1 Independent Practitioner is a Licensed Psychologist, Psychological Examiner, Licensed Clinical Professional Counselor (LCPC), Licensed Clinical Social Worker (LCSW) or Licensed Marriage and Family Therapist (LMFT) who practices independently, has a Provider Agreement with DHHS, is Co-occurring Capable, knowledgeable in Trauma Informed Care, practices within the scope of his or her licensure and adheres to all state and federal rules and regulations concerning confidentiality and the Americans with Disabilities Act.
65.02-2 Mental Health Agencies are providers licensed by the Division of Licensing and Certification pursuant to 34-B MRSA § 1203- A, contracted by DHHS, and enrolled as MaineCare Providers. Mental Health Agencies provide covered adult and/or children's mental health, substance use, or co-occurring mental health and substance use services. In order for these agencies to provide adult mental health services or children's mental health services, including Trauma Informed Care services, they must have a current contract with DHHS, Office of Behavioral Health (OBH) or Office of Child and Family Services (OCFS) to provide covered adult mental health services or with co-occurring mental health and substance abuse diagnosis. Agencies must adhere to the Rights of Recipients of Mental Health Services (14-193 C.M.R. Ch. 1) and the Rights of Recipients of Mental Health Services Who are Children in Need of Treatment (14-472 C.M.R. Ch. 1). Providers must maintain all appropriate Licensing and Credentialing and must notify DHHS, including the Office of MaineCare Services, OCFS and/or OBH of any changes in Licensing or Credentialing status.
Only Mental Health Agencies that have a contract for specific covered services may provide covered mental health services for members in the care or custody of DHHS, Office of Child and Family Services. Providers of Functional Family Therapy (FFT) for members served by the Department of Corrections, Juvenile Services, must have a contract with the Department of Corrections, as described in Home and Community Based Treatment. Those agencies licensed by DHHS as an ambulatory health care unit, allied health care facility, or as a residential childcare facility must also have a mental health agency license to be reimbursable under this Section.
65.02-3 Substance Use Agencies are providers who are licensed by the Division of Licensing and Certification, who hold a current contract with DHHS, the Office of Behavioral Health (OBH), and who are enrolled as MaineCare Providers. Only providers who hold a valid contract to deliver covered services to adults as described under this Section will be enrolled or continue to be enrolled as MaineCare providers. Substance use agency providers deliver substance use treatment services including services for members with co-occurring mental health and substance use disorder diagnoses. OBH will contract with any licensed provider willing to contract and able to meet standard OBH contract requirements for substance use treatment services. Providers must maintain all appropriate Licensing and Credentialing and must notify DHHS, including the Office of MaineCare Services, OCFS and/or OBH of any changes in Licensing or Credentialing status.
65.02-4 School is a program that has been approved by the Department of Education, as either a Special Purpose Private School or a Regular Education Public School Program under 05-071 C.M.R., Chapter 101, § XII and 20-A MRSA § 7204(4), 7252-A and 7253, and 05-071 C.M.R., Chapter 101, § 12, or a program operated or contracted by the Child Development Services System 20-A MRSA § 7001 (1-A) that has enrolled as a provider and entered into a provider agreement, as required by MaineCare. For the purposes of this rule, a school may provide the following services:
All services must be provided by qualified staff, as described in the corresponding sections of this policy.
