MaineCare Section 21 · CMS 0159.R08.00
Effective July 1, 2025 through June 30, 2030 · Last reviewed October 7, 2026
Provides community support, home support (1/4 hour), per diem home support, work support-group, assistive technology, career planning, communication aids, consultation, crisis assessment, crisis intervention, employment specialist services, home accessibility adaptations, home support-remote support, home support-residential habilitation-family centered support, non-traditional communication consultation, non-medical transportation, non-traditional communication assessment, occupational therapy…
Intellectual Disability or Developmental Disability, or Both Autism 18 Developmental Disability Intellectual Disability 18 Mental Illness Mental Illness Serious Emotional Disturbance The state further specifies its target group(s) as follows: b.
Evaluation/Reevaluation of Level of Care As specified in 42 CFR § 441.302(c), the state provides for an evaluation (and periodic reevaluations) of the need for the level(s) of care specified for this waiver, when there is a reasonable indication that an individual may need such services in the near future (one month or less), but for the availability of home and community-based waiver services. Reasonable Indication of Need for Services. In order for an individual to be determined to need waiver services, an individual must require: (a) the provision of at least one waiver service, as documen…
State classification: Section 1634 State Miller Trust State: No Other specified Medicaid eligibility groups served in the waiver: • Foster Care Children as specified in §435.150; -Children Aged 19 and 20 as specified in §435.222; and -Adult Group as specified in §435.119. Furnishes waiver services to individuals in the special home and community-based waiver group under 42 CFR § 435.217. Special income level: 300% of the SSI Federal Benefit Rate (FBR).
Limits: Assistive Technology Services are not covered under this waiver if they are available under another MaineCare program. The components above are subject to the following limits: 1. Assistive Technology- Assessments are subject to a limit of 32 units, per state fiscal year. 2. Assistive Technology- Devices and services are subject to a combined limit $6988.33 annually, per state fiscal year. 3. Ass…
Providers: OADS Provider Agency
Limits: Career Planning is limited to sixty (60) hours to be delivered in a six-month period. No two six-month periods may be provided consecutively. Career Planning may not be provided at the same time as Community Support, Home Support, Work Support, or Employment Specialist Services. Career planning furnished under the waiver may not include services available under a program funded under section 110…
Providers: OADS Provider Agency
Limits: For Communication Aids costing more than five hundred dollars ($500), the Participant must obtain documentation from a licensed speech-language pathologist, Licensed Audiologist or a Certified Assistive Technology Professional (ATP) assuring that the purchase is appropriate to meet the Participant’s need and assuring the medical necessity of the devices or services. Only Communication Aids that c…
Providers: Independent Practitioners, Speech and Hearing Agencies and Home Health Care Agencies
Providers: OADS Approved Provider Agency
Limits: Reimbursement for this service is limited to those providers not already reimbursed for consultation as part of another service. Personnel who provide services under targeted case management may not be reimbursed for Consultation Services. Consultation is limited to sixty-six (66) units or sixteen and a half (16.5) hours annually, per type of consultation (Occupational Therapy, Physical Therapy,…
Providers: Home Health Agency Application for 1915(c) HCBS Waiver: ME.0159.R08.00 - Jul 01, 2025 of 275 06/26/2025, Individual Practitioner
Limits: Crisis Assessment Services are limited to one (1) assessment in a three-year (3) period, with a maximum allowance of $2,555.71, and includes all related follow-up activities.
Limits: Crisis Intervention Services may only be provided by staff employed or contracted by an approved provider enrolled in MaineCare. Crisis intervention Services may be authorized in an emergency situation for a period not to exceed two weeks by OADS personnel. Outside of regular business hours, a secondary designated DHHS representative may authorize Crisis Intervention until the next business day o…
Providers: OADS Approved Provider Agency or Mental Health Agency
Limits: Employment Specialist Services are provided on an intermittent basis with a maximum of 10 hours each month. Employment Specialist Services cannot be provided at the same time as Work Support-Group or Work Support-Individual. Administrative tasks and indirect supports are included in the rate for the specified service and are not separately billable.
Providers: OADS Supported Employment Agency
Limits: Home Support (1/4 hour) may not exceed 336 quarter hour units or 84 hours per week. Units of service that were not provided to a Participant in any week cannot be carried over into subsequent weeks. Payment is not made directly, or indirectly, to members of the Participant's immediate family. The Home Support-Quarter Hour service includes transportation furnished by the provider during the course…
Providers: OADS Approved Provider Agency
Limits: .0159.R08.00 - Jul 01, 2025 Home Accessibility Adaptations are limited to a ten thousand-dollar ($10,000.00) limit in a five (5) year period with an additional annual allowance up to three hundred dollars ($300.00) for repairs and replacement per year. Home Accessibility Adaptions that exceed five hundred dollars ($500) require documentatio…
Providers: Independent Service Provider
Limits: Home Support-Remote Support is limited to forty-eight (48) units (12 hours) per day. Home Support-Remote Support can be in delivered concurrently with Home Support-Quarter Hour, as long as the service is not duplicative.
Providers: OADS approved provider agency
Limits: Payment is not made for the cost of room and board, including the cost of building maintenance, upkeep and improvement. The method by which the costs of room and board are excluded from payment for residential habilitation is specified in Appendix I-5. Cost of room and board is paid for separately by a combination of Participant funds (e.g. SSI) and other state contracted funds. Payment is not ma…
Limits: Services must be coordinated through a broker.
Providers: Broker
Limits: Non-Traditional Communication Assessments are limited to forty (40) quarter-hour units annually.
Providers: Individual Practitioner
Limits: The service allows up to 60 hours of Communication Consultation annually.
Providers: Individual Practitioner
Limits: Evaluative and rehabilitative Occupational Therapy is included in the state plan and is not covered as a component of maintenance therapy. The service is not available for individuals under age 21, as it is covered under EPSDT. Services are limited to 12 hours/year for an OT and 10 hours/year for a COTA.
Providers: Home Health Agency, Individual Practitioner
Limits: The service may be provided to up to three (3) Participants at once. When the service is provided to a group, the appropriate group rate must be billed. Services related to activities for the general good and welfare of Participants, e.g., general exercises to promote overall fitness and flexibility and activities to provide diversional or general motivation, do not constitute physical or occupat…
Providers: Home Health Agency, Individual Practitioner
Limits: Payments are not made for room and board, the cost of facility maintenance, upkeep, or improvement. The cost of transportation is included in the rate for Per Diem Home Support. Per Diem Home Support placements will only be approved at provider managed settings where a minimum of two (2) Participants resides. Administrative tasks and indirect supports are included in the rate for the specified se…
Providers: OADS Approved Provider Agency
Limits: Respite for Shared Living is a component of the rate paid to the AOA and therefore not a separately billable service. Services provided directly or indirectly by the legal guardian will not be reimbursed unless the legal guardian is the Member’s parent, sibling or other biological family member. This rule will not be avoided by adult adoption.
Providers: OADS Provider Agency
Limits: All items in excess of $500 require documentation from physician or other appropriate professional such as OT, PT or Speech therapist that purchase is appropriate to meet the individuals need. Medically necessary adaptive aids that cannot be obtained as a covered service under any other MaineCare benefit can be reimbursed under this section.
Providers: Businesses specializing in Durable Medical Equipment (DME)
Limits: Evaluative and rehabilitative Speech Therapy is included in the state plan and is not covered as a component of maintenance therapy. The service is not available for individuals under age 21, as it is covered under EPSDT.
Providers: Individual Practitioner, Speech and Hearing Agency
Limits: The combination of Work Support-Group, Work Support-Individual and Community Support may not exceed $52,693.87 annually. Documentation is maintained in the file of each Participant receiving this service that the service is not available under a program funded under section 110 of the Rehabilitation Act of 1973 or the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.). The cost…
Providers: OADS Supported Employment Agency
Limits: The combination of Work Support-Group, Work Support-Individual and Community Support may not exceed $52,693.87 annually. Work Support-Individual services are limited to one DSP per participant at a time. Administrative tasks and indirect supports are included in the rate for the specified service and are not separately billable.
Providers: OADS Approved Supported Employment Agency
May be Medicare certified, but not required under this waiver.
Home Health Agency .0159.R08.00 - Jul 01, 2025 — provider organization (Consultation)
.0159.R08.00 - Jul 01, 2025
OADS Approved Provider Agency — provider organization (Habilitation)
Licensed as a Home Health Agency in Maine
Home Health Agency .0159.R08.00 - Jul 01, 2025 — provider organization (Consultation)
Occupational Therapist Speech Language Pathologist
OADS Provider Agency — provider organization (Assistive Technology)
The driver must have valid driver's license, registration and insurance.
Broker — provider organization (Non-Medical Transportation)
Other standard: Transportation services are managed through a 1915 (b) waiver run concurrently with this waiver and managed through a broker. The qualified broker, as selected through a request for proposal process, must maintain documentation of liability insurance, ability to obtain payment and performance bonds, and meet other specifications as detailed in the request for proposal. The State verifies the broker’s…
Broker — provider organization (Non-Medical Transportation)
State licensure, if applicable. .0159.R08.00 - Jul 01, 2025
Businesses specializing in Durable Medical Equipment (DME) — provider organization (Specialized Medical Equipment and Supplies)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. Minimum requirements may include compliance with: Local and state codes Underwriters Laborat…
Businesses specializing in Durable Medical Equipment (DME) — provider organization (Specialized Medical Equipment and Supplies)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS.
Home Health Agency .0159.R08.00 - Jul 01, 2025 — provider organization (Consultation)
The provider of this service must be a Registered Physical Therapist (RPT) for Physical Therapy Maintenance.
Home Health Agency — provider organization (Physical Therapy (Maintenance))
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS.
Home Health Agency — provider organization (Physical Therapy (Maintenance))
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS.
Home Health Agency — provider organization (Occupational Therapy (Maintenance))
Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement.
Independent Practitioners (Communication Aids)
The provider agency/individual must have completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. Enrollment includes MaineCare Provider Agreement, Program Integrity Unit review, license verification. Minimum requirements may include compliance with: Local and state building codes, Un…
Independent Service Provider (Home Accessibility Adaptations)
Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement.
Individual Practitioner (Occupational Therapy (Maintenance))
Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. .0159.R08.00 - Jul 01, 2025
Individual Practitioner (Non-traditional Communication Assessment)
Received approval from OADS for provision of waiver services as required in MIHMS. The provider agency must ensure all personnel are acting with the scope of their individual license or certification.
Individual Practitioner (Non Traditional Communication Consultation)
The agency must have a current Mental Health license issued by DHHS Division of Licensing and Certification (DLC). The agency must attest that individual practitioners (employees or contractors) are licensed in accordance with state regulation.
OADS Approved Provider Agency or Mental Health Agency — provider organization (Crisis Intervention)
A DSP who provides Crisis Intervention Services must have behavioral intervention training on approved behavioral interventions procedures (e.g., MANDT) in addition to the following: a) DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS’s approved Assessment of Prior Learning, or has successfully completed the Maine Col…
OADS Approved Provider Agency or Mental Health Agency — provider organization (Crisis Intervention)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. The Provider Agency must attest to and retain documentation of completion of the following r…
OADS Approved Provider Agency or Mental Health Agency — provider organization (Crisis Intervention)
DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS’s approved Assessment of Prior Learning, or has successfully completed the Maine College of Direct Support within six (6) months of date of hire. DSPs must have current CPR and First Aid Certification and may not work alone with the Participant until such time as the st…
OADS approved provider agency — provider organization (Home Support-Remote Support)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. The Provider Agency must attest to and retain documentation of completion of the following r…
OADS approved provider agency — provider organization (Home Support-Remote Support)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. 3. Effective through June 30, 2024, an agency may be reimbursed for Per Diem Home Support if…
OADS Approved Provider Agency — provider organization (Residential Habilitation)
DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS’s approved Assessment of Prior Learning, or has successfully completed the Maine College of Direct Support within six (6) months of date of hire. DSPs must have current CPR and First Aid Certification and may not work alone with the Participant until such time as the st…
OADS Approved Supported Employment Agency — provider organization (Work Support-Individual)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. The Provider Agency must attest to and retain documentation of completion of the following r…
OADS Approved Supported Employment Agency — provider organization (Work Support-Individual)
DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS, or demonstrated proficiency through DHHS’s approved Assessment of Prior Learning, or has successfully completed the Maine College of Direct Support within six (6) months of date of hire. DSPs must have current CPR and First Aid Certification and may not work alone with the Participant until such time as the st…
OADS Provider Agency — provider organization (Shared Living)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. The Provider Agency must attest to and retain documentation of completion of the following r…
OADS Provider Agency — provider organization (Shared Living)
Other standard: Minimum requirements for equipment may include compliance with: • Local and state codes • Underwriters Laboratories • FCC • NFPA Life Safety Code • ADA The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from…
OADS Provider Agency — provider organization (Assistive Technology)
DSPs must successfully complete the Direct Support Professional curriculum as adopted by DHHS or demonstrated proficiency through DHHS’s approved Assessment of Prior Learning, or has successfully completed the Maine College of Direct Support within six (6) months of date of hire. DSPs must have current CPR and First Aid Certification and may not work alone with the Participant until such time as the sta…
OADS Supported Employment Agency — provider organization (Employment Specialist Services)
Other standard: .0159.R08.00 - Jul 01, 2025 The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS. The Pro…
OADS Supported Employment Agency — provider organization (Employment Specialist Services)
Speech Language Pathologist(CCC-SLP) for agency employees Assistive Technology Professional(ATP)from the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA)
Speech and Hearing Agencies and Home Health Care Agencies — provider organization (Communication Aids)
Other standard: The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS.
Speech and Hearing Agencies and Home Health Care Agencies — provider organization (Communication Aids)
Category 4: Sub-Category 4: .0159.R08.00 - Jul 01, 2025
Speech and Hearing Agency — provider organization (Speech Therapy (Maintenance))
The provider of this service must have a current Certificate of Clinical Competence- Speech Language Pathology (CCC- SLP).
Speech and Hearing Agency — provider organization (Speech Therapy (Maintenance))
Other standard: Other Standard (specify): The provider agency must have: 1. Completed the enrollment process for the "Maine Integrated Health Management Solution" (MIHMS) including the Provider Agreement and additional Developmental Services Rider to said Agreement. 2. Received approval from OADS for provision of waiver services as required in MIHMS.
Speech and Hearing Agency — provider organization (Speech Therapy (Maintenance))
Received approval from OADS for provision of waiver services as required in MIHMS.
Independent Practitioners (Communication Aids)
The provider agency/individual must have:
Independent Practitioners (Communication Aids)
Each year a DSP completes HCBS standards (HCBS 101, 102, or 103 by year), Employment First, and the Person-Centered Planning lessons.
Yes. Criminal history and/or background investigations are required. Specify: (a) the types of positions (e.g., personal assistants, attendants) for which such investigations must be conducted; (b) the scope of such investigations (e.g., state, national); and, (c) the process for ensuring that mandatory investigations have been conducted. State laws, regulations and policies referenced in this description are availa…
Before a DSP works alone with a member: Introduction to Developmental Disabilities, DSP Professionalism, Individual Rights and Choice, Maltreatment, Grievance Process, and HCBS 101. Online lessons and the matching live classroom sessions are both required. Source: Maine College of Direct Support required curriculum, effective 10/1/2022.
Suggested within 60 to 90 days and required within six months: Cultural Competence, Community Inclusion, Safety, Documentation, Communication, Positive Behavior Supports, Human Sexuality, Supporting Healthy Lives, Teaching People with Developmental Disabilities, Home and Community Living, Person-Centered Planning, Working with Families and Support Networks, Behavioral Regulations for DSPs, Adult Protective Investiga…
Provision of Personal Care or Similar Services by Legally Responsible Individuals. A legally responsible individual is any person who has a duty under state law or regulations to care for another person (e.g., the parent (biological or adoptive) of a minor child or the guardian of a minor child who must provide care to the child). At the option of the state and under extraordinary circumstances specified by the stat…
Every 36 months a DSP repeats the Grievance Process module and Individual Rights and Choice.
ME Home and Community Services for Adults with Intellectual Disabilities or Autism Spectrum Disorder Waiver (0159.R08.00)
Intellectual Disability or Developmental Disability, or Both Autism 18 Developmental Disability Intellectual Disability 18 Mental Illness Mental Illness Serious Emotional Disturbance The state further specifies its target group(s) as follows: b.
Assistive Technology, Career Planning, Communication Aids, Community Support, Consultation, Crisis Assessment, Crisis Intervention, Employment Specialist Services, Habilitation, Home Accessibility Adaptations, Home Support-Remote Support, Home Support-Residential Habilitation-Family Centered Support, Non-Medical Transportation, Non-traditional Communication Assessment, Non Traditional Communication Consultation, Occupational Therapy (Maintenance), Physical Therapy (Maintenance), Residential Habilitation, Shared Living, Specialized Medical Equipment and Supplies, Speech Therapy (Maintenance), Supported Employment, Work Support-Individual
Annual HCBS, employment, and person-centered planning training; Criminal background investigation; DSP curriculum before working alone; DSP curriculum within six months; Extraordinary care by legally responsible person; Grievance and rights refresher
The services, eligibility notes, and requirements come from the approved CMS waiver application 0159.R08.00. Last reviewed 2026-10-07.