A MaineCare provider bulletin dated July 30, 2026 states that "On April 29, 2026, the Department adopted 10-144 C.M.R. Chapter 101, MaineCare Benefits Manual (MBM), Chapter II, Section 28, Adaptive Behavior Services. This rule defines school-related services, distinguishes between school providers and community providers, and specifies applicable provider requirements" (MaineCare provider bulletin, 2026-07-30). The adopted rule text itself was not read, because the rule files and the Department's adoption notice returned HTTP 403. Facts below that describe coverage before April 29, 2026 come from a January 2026 federal Office of Inspector General audit hosted on the Maine Legislature's site and describe the rule in effect during the audit period.
Section 28 was rewritten and re-adopted on April 29, 2026, and an emergency rule added a Level of Care gate on January 30, 2026. Items below labeled as the earlier rule describe the audit period and may no longer apply. Confirm current eligibility, authorization, provider requirements, and rates in the adopted rule and the MaineCare fee schedule.
The reimbursement criteria at a glance
- Is ABA covered by MaineCare
- Who is eligible
- Billing code and rate structure
- Place of service
- Prior authorization
- Provider qualifications
- The commercial mandate
- Practices with in-house diagnostics versus ABA-only practices
- How this connects to the rest of your compliance stack
- Getting set up to bill MaineCare: the sequence
- What this guide could not verify
- Maine reimbursement variables at a glance
- Frequently asked questions
- Where professional advice is essential
Is ABA covered by MaineCare
Yes. The federal audit describes the earlier arrangement: "The State agency began covering RCS services for the treatment of autism on April 1, 2010," and ABA services "are typically delivered as a specialized RCS service" (HHS Office of Inspector General audit A-01-24-00006, hosted at legislature.maine.gov/doc/12360). The Maine autism report states that the Medicaid EPSDT benefit "supports access to medically necessary services designed to correct or ameliorate conditions discovered, including evidence-based models such as Applied Behavior Analysis" (2025 Biennial Report: Autism Spectrum Disorder, April 2025). The adopted April 29, 2026 Section 28 replaced the prior section titled "Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations."
Who is eligible
Under the January 30, 2026 emergency rule, the purpose was "to establish for Section 28 services, other than services delivered by a School and prescribed on an individualized education plan or individualized family service plan, an eligibility requirement of a Level 3 or higher score on the age-appropriate Level of Care/Service Intensity Tool and to require that eligibility for such services be determined through the Single Assessment process" (MaineCare rulemaking notice, effective January 30, 2026). Under the earlier rule, "MaineCare covers RCS services for children who are under 21 years of age and have a behavioral health diagnosis, including a diagnosis of autism" (OIG audit, citing MBM chapter 2, 28.02(C)). The age range, diagnosis, and referral rules in the April 29, 2026 adopted text were not read.
Billing code and rate structure
A MaineCare billing bulletin states that "providers should only bill HCPCS H2021 for the time the BHP delivers direct services," and that "the reimbursement rates that providers receive by billing HCPCS code H2021 for the Behavioral Health Professional (BHP) direct services include reimbursement for the full cost of the BCBA. This means providers cannot bill any code, including HCPCS G9007 and HCPCS H2021, for any time the BCBA spends delivering services" (MaineCare bulletin, updated billing guidance for Section 28 providers, 2025-03-03). No rate for H2021 or any 9715x code was retrieved, because the MaineCare fee schedule page returned an empty reply.
Place of service
The July 30, 2026 bulletin sets the allowable member ages by school provider type: public school ages 3 through 20, special purpose private school ages 4 through 20, intermediate education unit birth through age 6, and private early childhood special education program ages 3 through 6. School providers "must enroll with MaineCare under the provider type that corresponds to the educational program they operate," with a separate enrollment for each type (MaineCare provider bulletin, 2026-07-30). Under the earlier rule, services "are provided in a child's home or school or in community settings" (OIG audit). Telehealth rules for Section 28 were not verified.
Prior authorization
Under the earlier rule, a provider "must obtain prior authorization from the State agency prior to the start of all services," and the state "contracts with an outside administrative services organization to review and process requests for prior authorizations for behavioral health services" (OIG audit, citing MBM chapter 2, 28.08-1(B)). The vendor name, hour limits, and process under the April 29, 2026 rule were not verified.
Provider qualifications
Under the earlier rule, "to provide specialized RCS services, BHPs must be under the supervision of a licensed psychologist or a BCBA or equivalent," and a Behavioral Health Professional is 18 or older with a high school diploma or equivalent (OIG audit). The credential requirements for BCBAs, BHPs, and RBTs under the adopted rule, and community provider enrollment steps, were not verified.
The commercial mandate
Individual policies under 24-A M.R.S. 2768 must cover autism spectrum disorders "for an individual covered under a policy or contract who is 10 years of age or under," and "the policy or contract may limit coverage for applied behavior analysis to $36,000 per year." Applied behavior analysis "must be provided by a person professionally certified by a national board of behavior analysts or performed under the supervision of" one, and treatment is covered when "it is determined by a licensed physician or licensed psychologist that the treatment is medically necessary health care." The group (2847-T) and health maintenance organization (4259) sections use the same provider language (Maine Revised Statutes; section history ends PL 2013, c. 597). The Maine Licensing page covers the credential question.
Practices with in-house diagnostics versus ABA-only practices
The earlier rule allowed BHP services under the supervision of a licensed psychologist or a BCBA, so a practice with a psychologist on staff had a supervision route that an ABA-only practice did not. Whether the adopted 2026 rule keeps that structure was not verified. The commercial mandate's medical necessity determination comes from a physician or psychologist.
How this connects to the rest of your compliance stack
See the Maine Licensing page for the credential posture and the Maine entity page for the structure analysis.
Getting set up to bill MaineCare: the sequence
- Read the adopted Section 28. It was adopted April 29, 2026, and this guide could not read its text.
- Check the Level of Care gate. Non-school services require a Level 3 or higher score determined through the Single Assessment process.
- Bill H2021 for BHP direct time only. BCBA time is built into the rate and is not separately billable.
- Enroll under the correct provider type. School providers enroll by the educational program they operate.
What this guide could not verify
- The text of the April 29, 2026 Section 28 rule and its CMS state plan authority.
- Age range, diagnosis, and referral rules, prior authorization vendor and hour limits, and provider credentials under the adopted rule.
- Any Section 28 rate, including H2021, and any 9715x codes.
- Telehealth rules for Section 28.
Maine reimbursement variables at a glance
| Variable | Maine value |
|---|---|
| ABA covered by Medicaid? | Yes, MBM Chapter II, Section 28; rewritten April 29, 2026 |
| Eligibility gate | Level 3 or higher on the Level of Care/Service Intensity Tool for non-school services, effective January 30, 2026 |
| Billing | H2021 for BHP direct service time; BCBA time not separately billable |
| Rates | Not verified |
| Commercial mandate | 24-A M.R.S. 2768: age 10 and under; $36,000 per year limit allowed; certified by a national board |
Frequently asked questions
When did MaineCare rewrite Section 28?
Can I bill for BCBA time?
What is the Level of Care gate?
What does the commercial mandate cover?
Where professional advice is essential, not optional
MaineCare's ABA rules were rewritten in 2026 and this guide could not read the adopted text, so Maine is the page where the current rule matters most. Bring in a billing specialist to read the adopted Section 28 and the fee schedule before you model revenue.
The governing authorities to know are MBM Chapter II, Section 28 and 24-A M.R.S. 2768, 2847-T, and 4259.
This page describes rules read from MaineCare provider bulletins, a federal audit hosted by the Maine Legislature, and the Maine Revised Statutes. The adopted Section 28 text and the fee schedule could not be read. The Department of Health and Human Services, the state insurance regulator, and each payor provide current requirements. Do not rely on this page or any secondary source in place of direct verification.