---
title: "MaineCare ABA coverage: the intake guide."
url: "https://carelu.com/payers/maine-medicaid"
markdown_url: "https://carelu.com/payers/maine-medicaid.md"
state: ME (Maine)
payer: MaineCare (Maine Medicaid)
kind: State Medicaid program
description: "How MaineCare covers ABA: the April 2026 Section 28 Adaptive Behavior Services rule for children under 21, the Single Assessment run by Acentra, prior authorization, H2021 U1 HK billing, EVV, supervision and telehealth limits, and no state behavior-analyst license."
last_reviewed: October 2026
---

# MaineCare ABA coverage: the intake guide.

_Payer Guide · MaineCare · Last updated October 2026 · 15 primary sources_

> MaineCare is fee-for-service: ABA is a Section 28 benefit under 21, gated by Acentra’s Single Assessment and prior auth, billed H2021 U1 HK.

MaineCare, Maine’s Medicaid program run by the DHHS Office of MaineCare Services, has no risk-based managed care plans for ABA: the state authorizes and pays providers directly. ABA lives in Chapter II, Section 28 of the MaineCare Benefits Manual, which was rewritten from scratch effective April 29, 2026 as "Adaptive Behavior Services for Children." The old Section 28 ("Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations") and its Chapter III rate section were repealed the same day, so older guidance that cites them is out of date.

Two gates come before any ABA hour is paid. The child must qualify through the Single Assessment, a statewide eligibility review for medium- and high-intensity children’s behavioral health services that Acentra Health’s licensed clinicians complete for MaineCare, and the provider must then get prior authorization through Acentra. Acentra is the state’s administrative services organization, not a health plan: the card, the rules and the payment are all MaineCare’s.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: There is no separate assessment code to authorize: Section 28 bills ABA only as H2021 U1 HK and lists no 97151–97158 codes. Eligibility comes first from the state’s Single Assessment (completed by Acentra’s clinicians for MaineCare), and the BCBA’s in-person comprehensive assessment is due within 30 days after the provider receives the initial service authorization [1][3][4][5]
- **Prior auth for treatment**: Yes. "All services in this Section require prior authorization by the Department or its Authorized Entity"; Acentra’s July 2026 grid lists Section 28 ABA for prior-authorization review with a 90-day initial authorization and continued-stay periods of up to 180 days [1][5]
- **Autism diagnosis required?**: Yes for the standard path: ASD (DSM criteria) or Rett syndrome diagnosed by a licensed physician or psychologist experienced in neurodevelopmental disorders, plus a significant functional impairment on the ABAS or Vineland within 12 months. Section 28 also has a path for other neurodevelopmental conditions after less intensive treatment has failed, and an at-risk path for children under 6 [1]

## At a glance

- **Covers ABA?:** Yes: Section 28 Adaptive Behavior Services for members under 21
- **Structure:** Fee-for-service; no MCOs. Acentra Health (ASO) runs the Single Assessment and prior authorization
- **Rule:** MBM Ch. II § 28, Adaptive Behavior Services for Children (eff. 4/29/2026); Ch. III § 28 repealed
- **Eligibility:** Under 21 + Level 2 or higher on ECSII/CALOCUS-CASII/LOCUS + ASD or Rett dx + ABAS/Vineland impairment within 12 months
- **Billing code:** H2021 U1 HK per 15 min (group: add UN/UP/UQ); school-related ABA H2021 U2 HK
- **Rates:** On the MaineCare fee schedule (not retrieved); +1.0% COLA from 1/1/2026
- **Who may deliver:** Direct care staff with BHP certification or the RBT credential, supervised by a BCBA or licensed psychologist
- **EVV:** Required for community providers
- **Licensure:** None: Maine does not license behavior analysts

## Where ABA sits: Section 28, not a health plan

MaineCare’s ABA benefit is Section 28, Adaptive Behavior Services for Children, adopted effective April 29, 2026. It covers two services: Adaptive Skills Training and Applied Behavior Analysis, which "are duplicative of each other and cannot be delivered concurrently to a Member." ABA is "an evidence-based treatment service … based on the principles of behavior analysis," and may include discrete trial training, behavioral skills training, incidental teaching, functional communication training and parent training (which "cannot be the primary focus"). Functional behavior assessments, care coordination with other providers and analysis of progress data "may only be delivered by a supervisor." The adoption notice says the Department repealed the old Section 28 and the Chapter III Section 28 allowances because they "contain outdated, ambiguous, and inaccurate provisions," and wrote the new rule partly to comply with Maine’s settlement agreement with the U.S. Department of Justice. [1][2][6][10]

Section 65 (Behavioral Health Services) is not the ABA benefit, but it carries a related program: the Developmental Disability and Behavioral Health Intensive Outpatient Program (DD/BH-IOP) for children and adults with ASD or an intellectual disability and serious problem behaviors. It must "utilize Applied Behavior Analysis (ABA) principles," including an FBA completed by a BCBA and a positive behavior support plan, at a minimum of three hours a day, three days a week, delivered in person with prior authorization. [1][2][6][10]

## The front door: Single Assessment, then prior authorization through Acentra

Eligibility for Section 28 community services "is determined through the Single Assessment" under the Children’s Behavioral Health Services Global Rule (Ch. I, Section 7). The Single Assessment combines the age-appropriate level-of-care tool (ECSII for ages 0–5, CALOCUS-CASII for 6–18, LOCUS for 18–20), a review of diagnoses and past treatment records, an interview with the child and family, and, where needed, a diagnostic evaluation or functional assessment. Section 28 then requires a score of Level 2 or higher on that tool, plus the service-specific criteria. MaineCare launched the process on February 2, 2026: "referrals submitted through the external link go to Acentra. Acentra’s licensed clinicians complete the assessment and determine eligibility on behalf of OMS." Providers already on Acentra’s Atrezzo portal, and case managers, submit Single Assessment requests there; others use the Single Assessment Referral Link. Questions go to Agreement.CBHS@maine.gov or Acentra at 866-521-0027, option 3. [1][3][4][5]

Referrals come through "a Department-approved referral form from healthcare providers, school staff, and responsible state employees"; families can ask any of them to refer, and "Children may self-direct themselves to a Single Assessment." After the family chooses a service, the case manager (or the Department or Acentra) refers to the provider of the family’s choice, and the Department or Acentra "will approve prior authorizations for any service a Child is found eligible for following the Single Assessment." The rule also bars denying behavioral health services because of complex needs, significant medical needs, or a need for services up to 24 hours a day. School-related ABA delivered by a school under an IEP or IFSP needs no Single Assessment, but its prior-authorization request must include the IEP or IFSP. [1][3][4][5]

## Staffing, supervision, documentation and EVV

Community providers need MaineCare enrollment, program approval from the Office of Behavioral Health, and a current behavioral health organization license under 10-144 C.M.R. ch. 123. ABA direct care staff must be 18 or older with a high school diploma and either hold Behavioral Health Professional (BHP) certification (or earn it within six months of hire) or "Have Registered Behavior Technician (RBT) certification through the Behavior Analyst Certification Board at the time of hire." Supervisors of ABA staff must be "A BCBA; or A duly licensed psychologist with training and/or experience in behavioral analytic principles." Staff delivering 20 or more hours a week get at least four hours of supervision a month; fewer hours are prorated, with a one-hour monthly minimum. [1]

The supervisor completes an in-person comprehensive assessment within 30 days of the initial service authorization and updates it at least annually. The individual treatment plan is due within 30 days of the start of services, reviewed "at least every ninety (90) days," signed and dated by each staff member involved and by the legal guardian, and copied to the family within 10 days of signature. Every progress note must carry the name, signature and credentials of a staff member who delivered the service, the date, time, location and staff-to-member ratio, family participation, interventions and the child’s response. Community providers must use electronic visit verification (the state system is free, or a compatible system of their own) under the 21st Century Cures Act. Services between 8 p.m. and 6 a.m. are not covered without Department or Acentra approval. [1]

## Billing, rates and claims

Section 28 is paid fee-for-service in 15-minute units. Community ABA bills H2021 with modifiers U1 HK (individual), adding UN for a group of two, UP for three and UQ for four to eight; school-related ABA bills H2021 U2 HK with the same group modifiers. "Providers may only bill for the time that direct care staff spend delivering covered services": the rate "account[s] for the full cost of the supervisor," and supervisor time is billable only when the supervisor is standing in as direct care staff. The specific rates are on the MaineCare provider fee schedule on the Health PAS portal, not in the rule; each January 1 the Department applies a cost-of-living adjustment tied to the Maine minimum wage, and MaineCare’s bulletin set the January 1, 2026 COLA for Section 28 at 1.0%. We could not open the fee schedule this month, so no dollar rate is quoted here. [1][9][8]

Claims must be filed correctly within one year of the date of service (or one year from the other carrier’s EOB, or from the date eligibility was granted). A provider aggrieved by a MaineCare decision may request an informal review "within sixty (60) calendar days from the date of receipt of that decision," before any administrative hearing; a member must request a hearing within 60 calendar days of the notice. [1][9][8]

Corrections and payment, from Chapter I, Section 1: a rejected claim must be corrected and resubmitted within the same one-year limit; a provider who disputes what MaineCare paid "must request a review of payments, using the MaineCare Adjustment Request form, within one hundred and twenty (120) days of the remittance statement date or waive any right to a review." The Office of the State Treasurer issues all payments, by EFT unless the provider cannot accept it, and "A Remittance Advice (RA) is generated with each payment." Providers bill other insurance, including Medicare, first. Section 1 publishes no weekly payment day or submission cut-off. [1][9][8]

## Can a BCBA licensed in another state treat a MaineCare member, including by telehealth?

Maine has no behavior-analyst license, so there is no Maine license to obtain; the BACB’s licensure table does not list Maine and Title 32 has no behavior-analyst chapter. The gates are MaineCare’s own: the agency must be an enrolled MaineCare provider, and a community provider needs Office of Behavioral Health program approval and a Maine behavioral health organization license before delivering Section 28 services. ABA supervision must come from a BCBA or a licensed psychologist. On telehealth, Section 28 is narrow: direct care staff "must deliver services in-person," except when "unforeseen and uncontrollable circumstances prevent in-person service delivery, such as unplanned Member travel, Family illness, and inclement weather"; supervisors of ABA "may deliver Functional Behavior Assessments, Parent Training, and supervision and oversight of direct care staff" by telehealth; treatment team meetings may be remote. The supervisor’s comprehensive assessment must be in person. Under Ch. I, Section 4 the member’s site "must be physically located in the United States," and interactive telehealth claims carry modifier GT (93 for telephonic). [1][7][11][12]

## Intake gates

The questions that decide whether a family can start with MaineCare (Maine Medicaid), and what they have to bring.

- **Age limit**: Under 21. Section 28 eligibility requires members "be under the age of twenty-one (21)," and the Global Rule defines a Child as a MaineCare member under 21. [1][3]
- **Diagnosis recency**: No expiry on the diagnosis itself, but the ABAS or Vineland functional assessment must be from "within the past twelve (12) months," and providers must re-administer the same type of functional assessment annually for utilization review. [1]
- **Who may diagnose**: A "duly licensed physician or psychologist with experience in diagnosing neurodevelopmental disorders" for ASD or Rett syndrome. The alternative path (another neurodevelopmental condition) needs a licensed physician or psychologist to document the condition and find ABA medically necessary; the under-6 at-risk path needs a licensed physician. [1]
- **Diagnostic tools required**: No ASD diagnostic instrument is named. Section 28 requires the current Adaptive Behavior Assessment System or Vineland Adaptive Behavior Scale, administered per its publisher’s guidelines, showing a composite at least 2 SD below average, or 1.5 SD below with a 2 SD communication or social domain score. The Single Assessment uses ECSII (0–5), CALOCUS-CASII (6–18) or LOCUS (18–20), and Section 28 needs Level 2 or higher. [1][3]
- **Referral required?**: Yes, to the Single Assessment: referrals come through "a Department-approved referral form from healthcare providers, school staff, and responsible state employees," families can ask any of them to refer, and children may self-direct to the assessment. Medical providers without Atrezzo use the Single Assessment Referral Link; Atrezzo users and case managers submit in Atrezzo. No physician prescription is required by Section 28. School-related services need the IEP or IFSP instead. [3][4][1]
- **Telehealth**: Limited. Direct care staff "must deliver services in-person," except when "unforeseen and uncontrollable circumstances prevent in-person service delivery, such as unplanned Member travel, Family illness, and inclement weather." Supervisors of ABA may deliver functional behavior assessments, parent training, and supervision and oversight of direct care staff by telehealth, and treatment team meetings may be remote; the supervisor’s comprehensive assessment must be in person. Telehealth follows Ch. I, Section 4: bill the underlying service with modifier GT (interactive) or 93 (telephonic), with the member located in the United States. [1][7]
- **Prior-auth decision time**: MaineCare’s own rule: absent urgency, the Department or its Authorized Entity "will make a decision to authorize or deny the request for PA within thirty (30) days of the receipt of the completed request … or services will be considered authorized," and a PA may run up to 12 months. Federal law is now stricter: since January 1, 2026 the state agency must decide a standard request "in no case later than 7 calendar days after receiving the request" (extendable by up to 14 days) and an expedited one within 72 hours. Acentra’s grid sets a 90-day initial authorization for community ABA. [8][13][5]
- **Other insurance (who pays first)**: "MaineCare is the payer of last resort." Providers must pursue any third-party resource first, show the other carrier’s EOB, and "If a claim has been denied by a member’s third party payer for services deemed as not medically necessary, the provider must appeal the decision of the third party payer before billing MaineCare," then submit the denial and appeal result. Claims involving other insurance must be filed within one year of the other carrier’s EOB; if the family will not cooperate, MaineCare may be billed after 90 days. [8][14]

## Delivery and billing rules

Coverage decides whether MaineCare (Maine Medicaid) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: ABA direct care staff must be supervised by "A BCBA; or A duly licensed psychologist with training and/or experience in behavioral analytic principles." Staff delivering 20 or more hours of direct service a week must receive at least four hours of supervision a month; staff with fewer hours get a prorated amount, minimum one hour a month. Functional behavior assessments, care coordination and progress-data analysis may be delivered only by a supervisor. [1]
- **Concurrent billing (97153 + 97155)**: Effectively no: "Providers may only bill for the time that direct care staff spend delivering covered services," the direct-care rate "account[s] for the full cost of the supervisor," and supervisor time is billable only when the supervisor is delivering direct services in the absence of the usual staff. Adaptive Skills Training and ABA cannot be delivered concurrently. [1]
- **Daily limits / MUEs**: Section 28 sets no daily or weekly unit cap; hours are set by prior authorization against the treatment plan. Acentra’s grid lists a 90-day initial authorization period and continued-stay periods of up to 180 days for community ABA. Services between 8 p.m. and 6 a.m. are not covered unless a supervisor finds them clinically indicated and the Department or Acentra approves. Two-to-one staffing needs its own prior authorization. [1][5]
- **Session-note signature**: At least one staff member who delivered the service must document a progress note with "Their name, signature, and credentials," the date, time, location and staff-to-member ratio, family participation, interventions and the member’s response. The ITP carries the dated signatures of each staff person who completed it and of the legal guardian; the comprehensive assessment carries the supervisor’s dated signature. Section 28 sets no deadline for signing a session note. [1]
- **Place of service**: Community providers deliver services "in the most clinically appropriate home and community setting," including the member’s home, a provider’s office or a school, but "cannot refuse to deliver services in a Member’s home" without Department approval and "cannot primarily deliver services in a provider’s office or a School." School-related ABA is delivered by an enrolled School Provider under an IEP or IFSP during school hours (H2021 U2 HK) and is not duplicative of community ABA. Section 28 is not available to a member in a residential treatment facility or institution, except school-related services. [1]

## What intake should collect for MaineCare (Maine Medicaid)

- **MaineCare ID:** Confirm active MaineCare on the date of service; there are no health plans to route to.
- **Single Assessment status:** Has the child been referred to, or found eligible through, the Single Assessment (Acentra)? Without it, community Section 28 services cannot be authorized.
- **Diagnostic report:** ASD (or Rett) diagnosis by a licensed physician or psychologist experienced in neurodevelopmental disorders.
- **ABAS or Vineland within 12 months:** Current edition, showing the composite or domain scores Section 28 requires.
- **Other insurance:** MaineCare pays last; a commercial medical-necessity denial must be appealed before MaineCare will consider the claim.
- **IEP or IFSP:** Needed for school-related Section 28 services, and useful to separate school ABA from community ABA (they are not duplicative).

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### How do I correct a MaineCare ABA claim or dispute a payment?

Resubmit a rejected claim within the one-year filing limit; to dispute an amount paid, file the MaineCare Adjustment Request form within 120 days of the remittance statement date. Payments go out by EFT with a remittance advice for each payment; no weekly payment day is published in Section 1.

### Does MaineCare cover ABA therapy?

Yes, for members under 21, under MaineCare Benefits Manual Chapter II, Section 28 (Adaptive Behavior Services for Children, effective April 29, 2026). The child must qualify through the Single Assessment and the provider needs prior authorization.

### Does MaineCare use managed care plans for ABA?

No. MaineCare authorizes and pays ABA directly. Acentra Health is the state’s administrative services organization: its clinicians complete the Single Assessment and it handles prior authorization, but it is not a health plan.

### What code does MaineCare use for ABA?

H2021 with modifiers U1 HK for community ABA (add UN, UP or UQ for groups of two, three, or four to eight), and H2021 U2 HK for school-related ABA, in 15-minute units. Section 28 lists no 97151–97158 codes.

### What does MaineCare pay for ABA?

The rate is on the MaineCare provider fee schedule (Health PAS portal), not in the rule; Section 28 received a 1.0% cost-of-living increase on January 1, 2026. The rate covers the supervisor’s cost, so supervisor time is not billed separately.

### Can MaineCare ABA be done by telehealth?

Only partly. RBTs and other direct care staff must work in person except in unforeseen circumstances such as illness or bad weather. The supervising BCBA may do functional behavior assessments, parent training and staff supervision by telehealth, but the initial comprehensive assessment must be in person.

### Does a BCBA need a Maine license?

No. Maine does not license behavior analysts. MaineCare requires ABA staff to be supervised by a BCBA or a licensed psychologist, and community agencies need MaineCare enrollment, Office of Behavioral Health approval and a Maine behavioral health organization license.

### Does EVV apply to ABA in Maine?

Yes. Section 28 requires community providers to use electronic visit verification, either the free Maine DHHS system or a compatible system of their own.

## Primary sources

1. [MaineCare Benefits Manual, Ch. II, Section 28 — Adaptive Behavior Services for Children (eff. April 29, 2026, filing 2026-101)](https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c2s028-2026-101%20NEW.docx)
2. [MaineCare Notice of Agency Rulemaking Adoption — Ch. II Section 28 adopted, Ch. II and Ch. III Section 28 repealed (Apr. 29, 2026)](https://www.maine.gov/dhhs/oms/providers/provider-bulletins/mainecare-notice-agency-rulemaking-adoption-mainecare-benefits-manual-chapter-ii-section-28)
3. [MaineCare Benefits Manual, Ch. I, Section 7 — Children’s Behavioral Health Services Global Rule (eff. April 14, 2026, filing 2026-087)](https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c1s007-2026-087%20NEW%20%28Non-EMR%29.docx)
4. [MaineCare provider bulletin — Single Assessment Launch on Feb. 2 (referrals go to Acentra) (Feb. 2, 2026)](https://www.maine.gov/dhhs/oms/providers/provider-bulletins/single-assessment-launch-feb-2-referral-link-non-bh-providers-2026-02-02)
5. [Acentra Health Maine — ASO MaineCare Funded Service Grid (July 1, 2026)](https://me.acentra.com/wp-content/uploads/sites/35/2026/06/MaineCare-Funded-Service-Grid-20260701-1.pdf)
6. [MaineCare Benefits Manual, Ch. II, Section 65 — Behavioral Health Services (eff. April 28, 2026, filing 2026-095; corrections May 2026)](https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c2s065-2026-095-NSC.docx)
7. [MaineCare Benefits Manual, Ch. I, Section 4 — Telehealth Services (amended Nov. 6, 2023; accessibility check July 2025)](https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c1s004%20-%20JUL%202025.docx)
8. [MaineCare Benefits Manual, Ch. I, Section 1 — General Administrative Policies and Procedures (1.07 TPL, 1.10 claims, 1.14 prior authorization, 1.23 provider appeals)](https://www.maine.gov/sos/sites/maine.gov.sos/files/inline-files/c1s001.docx)
9. [MaineCare provider bulletin — Cost-of-Living Adjustments for Sections 2 … 28 … 96, 1.0% eff. Jan. 1, 2026 (Dec. 1, 2025)](https://www.maine.gov/dhhs/oms/providers/provider-bulletins/mainecare-cost-living-adjustments-colas-sections-2-12-13-17-18-19-20-21-26-28-29-60-65-90)
10. [Maine Secretary of State — 10-144 C.M.R. ch. 101, MaineCare Benefits Manual (chapter index)](https://www.maine.gov/sos/cec/rules/10/ch101.htm)
11. [BACB — U.S. Licensure of Behavior Analysts (Maine not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
12. [Maine Revised Statutes, Title 32 (Professions and Occupations) — chapter list (no behavior-analyst chapter; ch. 141 is Professional Land Surveyors)](https://legislature.maine.gov/statutes/32/title32ch0sec0.html)
13. [42 CFR 440.230(e) — State Medicaid agency prior-authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-B/section-440.230)
14. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
15. [MaineCare — MaineCare Bulletins (index of provider e-messages/bulletins)](https://www.maine.gov/dhhs/oms/about-us/mainecare-bulletins)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.