This Maine MaineCare regulation governs coverage and provider requirements for three core crisis services: crisis residential services (short-term supervised residential stabilization), mobile crisis intervention response services (rapid community-based outreach teams), and site-based crisis stabilization services (walk-in crisis receiving centers and emergency department-based crisis services). Providers must meet specific licensing, staffing, assessment, treatment planning, and documentation standards, including 24/7 availability, use of approved crisis assessment tools, peer support integration, and trauma-informed care. The rule also establishes reimbursement principles and billing instructions for these MaineCare-covered services.
View official sourceTABLE OF CONTENTS 66.01 INTRODUCTION1 66.02 DEFINITIONS1 66.02-1 Adult Peer Support1 66.02-2 Certified Intentional Peer Support Specialist1 66.02-3 Child1 66.02-4 Clinicians1 66.02-5 Crisis1 66.02-6 Crisis Peer Support Staff2 66.02-7 Crisis Plan2 66.02-8 Family2 66.02-9 Family Peer Support2 66.02-10 Harm Reduction2 66.02-11 Lethal Means2 66.02-12 Member2 66.02-13 Trauma Informed Care2 66.02-14 Youth Peer Support3 66.03 ELIGIBILITY FOR CARE3 66.03-1 General Eligibility3 66.03-2 Specific Service Eligibility3 66.04 PROVIDER REQUIREMENTS3 66.04-1 Crisis Residential Services3 66.04-2 Mobile Crisis Intervention Response Services5 66.04-3 Site-Based Crisis Stabilization Services9 66.04-4 Referrals for Behavioral Health Services10 66.05 COVERED SERVICES10 66.05-1 Crisis Residential Services10 66.05-2 Mobile Crisis Intervention Response Services13 66.05-3 Site-Based Crisis Stabilization Services19 66.06 REPORTING REQUIREMENTS20 66.07 DOCUMENTATIONS AND CONFIDENTIALITY20 66.08 REIMBURSEMENT 20 66.08-1 Reimbursement Principles20 66.08-2 Performance-Driven Reconciliation Payments for Mobile Crisis Intervention Response Services 21 66.08-3 Cost-of-Living Adjustment23 66.08-4 Comparable or Duplicative Services23 66.09 BILLING INSTRUCTIONS23 66.01 INTRODUCTION This section describes coverage for MaineCare’s core continuum of crisis services for adults and children, including crisis residential, mobile crisis intervention response, and site-based crisis stabilization services. Additional crisis services and supports are embedded throughout the MaineCare Benefits Manual (MBM). MaineCare will cover Mobile Crisis Intervention Response Services and Site-Based Crisis Stabilization Services starting on July 1, 2026. Thus, all provisions related to these services have a future effective date of July 1, 2026. 66.02 DEFINITIONS 66.02-1 Adult Peer Support means an individual with lived experience who is a Certified Intentional Peer Support Specialist – Crisis Service Provider (CIPSS-CSP) and who also is fully or provisionally certified in formal Department of Health and Human Services (DHHS)-approved crisis response training. Peer support is founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful to promote recovery and resiliency. 66.02-2 Certified Intentional Peer Support Specialist (CIPSS) means an individual who has completed the DHHS, Office of Behavioral Health (OBH) curriculum for CIPSS and maintains certification. Peer support is founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful to promote recovery and resiliency. 66.02-3 Child means a person who is twenty (20) years of age or younger. 66.02-4 Clinicians are individuals appropriately licensed or certified, practicing within the scope of that licensure or certification, who are qualified to deliver treatment under this section. A Clinician includes the following: Licensed Clinical Professional Counselor (LCPC); Licensed Clinical Professional Counselor-Conditional (LCPC-C); Licensed Clinical Social Worker (LCSW); Licensed Master Social Worker- Conditional Clinical (LMSW-CC); Licensed Marriage and Family Therapist (LMFT); Licensed Marriage and Family Therapist-Conditional (LMFT-C); Licensed Alcohol and Drug Counselors (LADC); Certified Alcohol and Drug Counselors (CADC); physician; psychiatrist; Advanced Practice Registered Nurse Psychiatric and Mental Health Practitioner (APRN-PMH-NP); Advanced Practice Registered Nurse Psychiatric and Mental Health Clinical Nurse Specialist (APRN-PMH-CNS); psychological examiner; Physician Assistant (PA); Registered Nurse (RN); or licensed clinical psychologist. 66.02-5 Crisis means any experience of stress, emotional, or behavioral symptoms, difficulties with substance use, or a traumatic event that compromises or has the ability to negatively impact an individual’s wellbeing, safety, and/or the ability to function within their current family or caregiver environment, living situation, school, workplace, or community, as defined by the individual experiencing the Crisis or by a parent, caregiver, guardian, or designee of the individual as appropriate. 66.02-6 Crisis Peer Support Staff for the purposes of mobile crisis intervention response services means an Adult Peer Support, Family Peer Support, or Youth Peer Support under supervision from a supervisor who has received DHHS-approved training for appropriate Crisis Peer Support Staff supervision. 66.02-7 Crisis Plan means an individualized plan collaboratively designed and developed by a member receiving crisis services, the respective crisis services team, and community support(s) to include immediate, actionable items to promote safety and mitigate the current or a future Crisis. Crisis Planning is the process of empowering an individual in crisis and coordinating with immediate supports to evaluate and consider factors that contributed to the current crisis episode, mitigate and/or resolve the current crisis, and develop or update planning tools featuring strategies to prevent or manage future crises. 66.02-8 Family, unless otherwise defined in this section, means the primary caregiver(s) in a member's daily life, and may include a biological or adoptive parent, foster parent, legal guardian or designee, sibling, stepparent, stepbrother or stepsister, brother-in-law, sister-in-law, grandparent, spouse or partner, grandparent or grandchild, a person who provides kinship care, or any person sharing a common abode as part of a single-family unit. 66.02-9 Family Peer Support means a person who assists individuals with children with serious mental illness or serious emotional disturbance and who has lived experience providing this type of assistance as a family member or primary caregiver. Family Peer Supports must have full or provisional certification in formal DHHS-approved crisis response training to deliver services. Family Peer Supports work in alignment with the key principles of respect, shared responsibility, and mutual agreement of what is helpful to promote recovery and resiliency. 66.02-10 Harm Reduction means a philosophy of hope and healing that avoids assumptions when an individual shares information about self-injury, drug use, or any other “maladaptive” coping practice. The focus is on strategies to reduce harm from high-risk behavior rather than insisting on abstinence. This approach emphasizes utilizing those with lived experience in the management of harm reduction services. 66.02-11 Lethal Means means methods that may be used by individuals experiencing a crisis for lethal purposes, including guns, medications, alcohol, opioids, other substances, ropes, cords, or sharp objects. 66.02-12 Member is a MaineCare member. 66.02-13 Trauma Informed Care means the provision of health services which realizes the widespread impact of trauma and understands potential paths for recovery, recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system, responds by fully integrating knowledge about trauma into policies, procedures, and practices, and which seeks to actively resist re-traumatization. 66.02-14 Youth Peer Support means an individual at least eighteen (18) years of age but no older than thirty (30) years of age with lived experience who provides support and facilitation for case planning, models positive self-advocacy, and provides guided support in recovery for youth and helps them navigate their system of care. Youth Peer Supports must have full or provisional certification in formal DHHS-approved crisis response training to deliver services. Youth Peer Supports work in alignment with the key principles of respect, shared responsibility, and mutual agreement of what is helpful to promote recovery and resiliency. 66.03 ELIGIBILITY FOR CARE 66.03-1 General Eligibility Individuals must meet the MaineCare eligibility criteria as set forth in the MaineCare Eligibility Manual. Some Members may have restrictions on the type and amount of services they are eligible to receive. Once an individual in Crisis is stabilized, the provider is responsible for verifying a MaineCare Member's enrollment status, as described in MaineCare Benefits Manual, Chapter I, Section 1. 66.03-2 Specific Service Eligibility Additional specific eligibility criteria are set forth for each service. 66.04 PROVIDER REQUIREMENTS 66.04-1 Crisis Residential Services * *The Department will submit to the Centers for Medicare & Medicaid Services (CMS) and anticipates receiving approval of a State Plan Amendment related to these provisions. Crisis residential providers shall: Maintain a current and valid license for the provision of mental health services issued by the Division of Licensing and Certification pursuant to 34-B MRS §1203-A and comply with all applicable requirements in 10-144 C.M.R. ch. 123, Behavioral Health Organizations Licensing Rule; Children’s crisis residential service providers must comply with residential child care facility requirements as stated in 10-148 C.M.R. ch. 35, Children’s Residential Care Facilities Licensing Rule. Comply with 14-193 C.M.R. ch. 1, Rights of Recipients of Mental Health Services, and 14-472 C.M.R. ch. 1, Rights of Recipients of Mental Health Services Who are Children in Need of Treatment, or successor versions of these regulations; D. Operate the crisis residential facility twenty-four (24) hours per day, seven (7) days per week; E. Comply with the following staffing requirements: Ensure that an independently licensed Clinician acting within their scope of practice is available to provide psychiatric consultation, twenty-four (24) hours per day, seven (7) days per week. This licensed Clinician cannot be a licensed Clinician who is actively working a shift at the crisis residential facility as in 66.04-1(E)(3); Ensure that there is at least one (1) Mental Health and Rehabilitation Technician (MHRT) staffed for every two (2) beds during the day and at least one (1) MHRT for every three (3) beds at night, between the hours of seven (7) p.m. to seven (7) a.m.; Ensure that at least one (1) licensed Clinician is on staff and available for every six (6) beds twenty-four (24) hours per day, seven (7) days per week; 4. Ensure all staff utilize the most current version of the Federal Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 2025 National Guidelines for a Behavioral Health Coordinated System of Crisis Care. See: https://library.samhsa.gov/sites/default/files/national-guidelines-crisis-care-pep24-01-037.pdf; 5. Determine the most appropriate, least restrictive, and most effective support and intervention using a strength-based approach; and 6. Educate all staff in Harm Reduction practices. Use the Columbia Suicide Severity Rating Scale (C-SSRS) or a similar DHHS-approved tool to determine the level of risk for harm for each Member and provide immediate crisis interventions services if there is an imminent risk of suicide. Providers shall use the National Suicide Prevention Lifeline’s 988 Suicide and Crisis Lifeline Suicide Safety Policy when staff are unclear about the level of safety after performing the C-SSRS screening tool or similar DHHS-approved tool. See: https://988lifeline.org/wp-content/uploads/2023/02/FINAL_988_Suicide_and_Crisis_Lifeline_Suicide_Safety_Policy_-3.pdf; G. Review all referrals for Members for crisis residential services. Crisis residential service providers must accept DHHS referrals that meet eligibility criteria, provided there is bed availability. When crisis residential service providers deny Members placement, the providers shall document there was not bed availability; and H. Develop and implement an operations manual detailing all policies and standard operating procedures. Providers shall make the manual available to DHHS upon request. 66.04-2 Mobile Crisis Intervention Response Services * *The Department will submit to CMS and anticipates receiving approval of a State Plan Amendment related to these provisions. Mobile crisis intervention response services providers shall: Hold a current and valid contract for mobile crisis intervention response services with OBH and perform all services and maintain all standards and requirements for services included in the contract; Maintain a current and valid license for the provision of mental health services issued by the Division of Licensing and Certification pursuant to 34-B M.R.S. §1203-A and comply with all applicable requirements in 10-144 C.M.R. Ch. 123. Providers are encouraged to also be licensed for the provision of substance use disorder services; Be co-occurring capable, meaning that the organization is structured to welcome, identify, engage, and serve Members with co-occurring substance use and mental health disorders and to incorporate attention to these issues into Member services. D. Comply with 14-193 C.M.R. ch. 1, Rights of Recipients of Mental Health Services and 14-472 C.M.R. ch. 1, Rights of Recipients of Mental Health Services Who are Children in Need of Treatment, or successor versions of these regulations; E. Complete crisis assessment and planning which includes the minimum assessment components found in section 66.05-3(A)(3), and complete and submit, as necessary, required documentation to DHHS; F. Be available to respond to Members in Crisis twenty-four (24) hours a day, seven (7) days a week and, in response to calls and walk-ins, conduct initial encounters, as described in Section 66.05-2(A), to all Members in Crisis; G. Accept walk-ins in at least one (1) publicly accessible location in each crisis district they serve from, at a minimum, 8 a.m. through 5 p.m.; H. Initiate and maintain relationships with relevant community partners to support referrals and care coordination, such as behavioral health providers, housing service providers, certified community behavioral health clinics, tribal crisis response providers, regional domestic violence and sexual response programs, partners who support the cultural and linguistic needs of Members served, legal assistance programs, peer support and recovery centers, and the criminal justice system; Assess the family unit when Families of Children request mobile crisis intervention response services for the Child, in addition to determining if the Child identifies as in Crisis; Determine the appropriateness of including the parents or caregivers when Children request services for themselves; K. Render culturally affirming care, regardless of co-occurring conditions or complexity of crisis, which requires providers to: 1. Be inclusive and humble in responding to all Members with unconditional positive regard; 2. Examine, explore, and understand assumptions about people who present in Crisis before they lead to pathologizing or valuing certain behaviors over others; 3. Appreciate diversity. No two individuals are the same despite outwardly presenting as similar; 4. Train and appreciate the uncomfortable, particularly the discomfort of working with people who are in Crisis and where the solution may not be easy or obvious, before seeking the comfortable; 5. Reflect how primary language, housing status, markers of limited access to food, housing, transportation, and/or employment, microaggressions, overt racism, historical racism, and the legacy of inherited privileges for some groups may have contributed to unintended traumatization that precipitated the Crisis, including experiences in past or current Crises and routine behavioral health service delivery; 6. Monitor for and address differential treatment of certain groups in the community, such as differential involvement of law enforcement or incarceration for community Members of color; and 7. Include a method to work with staff on any identified biases and measure the impact of this method; L. Ensure that all mobile crisis intervention response services staff and supervisors obtain and meet the following requirements: Full certification through the DHHS-approved crisis response training within six (6) months of becoming provisionally certified. When approved by DHHS, staff may receive a waiver for parts of the crisis response training if they have already completed relevant training; DHHS-designated continuing education and crisis response training recertification requirements; 3. Training in how to administer naloxone and recognize the signs and symptoms of overdose. M. Call the Office of Aging and Disability Services Crisis Prevention and Intervention Services or other DHHS-designated specialized crisis response teams so they can respond to Members with an intellectual or developmental disability, an acquired brain injury, or autism spectrum disorder who are in Crisis; N. Ensure that all crisis responder staff carry naloxone. Staff are not responsible for obtaining naloxone. It is the provider’s responsibility to acquire and maintain an adequate supply of naloxone; O. Offer Members in Crisis the option to speak to appropriate Peer Support Staff during engagement. When possible, providers must also offer an appropriate peer response to each person associated with the Member in Crisis. This includes offering Family Peer Support or Youth Peer Support for Families or Children and Adult Peer Support for adults. Peer Support Services should be offered as soon as possible and periodically thereafter; P. Furnish mobile crisis intervention response services with a multidisciplinary team of crisis supervisors, dispatch coordinators, and crisis responders. One (1) team member may not fulfill multiple roles at the same time. Crisis Supervisor. The crisis supervisor must be a psychiatrist, psychologist, LCPC, LCSW, LMFT, APRN-PMH-NP, APRN-PMH-CNS, or another appropriately qualified professional. Conditional licensure as an LCPC, LCSW, or LMFT is considered appropriately qualified. In addition, the crisis supervisor must be fully or provisionally certified as a Mental Health and Rehabilitation Technician - Crisis Service Provider (MHRT/CSP). At least one (1) crisis supervisor must be on call twenty-four (24) hours per day, seven (7) days per week. A crisis supervisor may respond in-person to a Member in Crisis, but an in-person response to a Member in Crisis does not require a crisis supervisor. The crisis supervisor shall oversee services and support for other provider staff. This skilled supervisor participates in program development and maintenance, as well as collaboration with community partners. The crisis supervisor shall be responsible for program and facility upkeep. The crisis supervisor shall coordinate with other staff throughout service delivery, providing input on services, synthesizing relevant biopsychosocial information in collaboration with crisis responders, and managing day-to-day logistics. Crisis supervisor duties include planning and supervising crisis related behavioral health projects and documenting quality improvement. Crisis supervisor duties also include planning policy and workflow development. Dispatch Coordinator. Dispatch coordinators must be fully or provisionally certified MHRT/CSPs. At least one (1) dispatch coordinator must be on call twenty-four (24) hours per day, seven (7) days per week. The dispatch coordinator shall: a. Ensure immediate referral to crisis responders, following protocol as determined by DHHS; Manage incoming calls requesting crisis intervention or assistance; As needed, provide services via telehealth to stabilize Members in Crisis while crisis responders travel to the Member to deliver an initial encounter. Use DHHS-approved protocols and tools to determine and coordinate dispatch of appropriate mobile crisis intervention response services; and Make best efforts to ensure the safety of mobile crisis intervention response service staff in the field, using real-time location tracking and facilitating clinical and peer support consultation, as appropriate, to assist mobile crisis intervention response service workers before, during, and after response to a Crisis episode. 3. Crisis Responders. Crisis responders are fully or provisionally certified MHRT/CSPs or Crisis Peer Support Staff deployed to Members in Crisis. The primary role of crisis responders is working directly with the Member in Crisis. Crisis responders are responsible for delivering mobile crisis intervention response service components. Crisis responders are responsible for coordinating services with the crisis supervisor and the dispatch coordinator. Crisis responders may work alongside relevant community partners. The preferred model for delivering mobile crisis intervention response services is a two-person response of one (1) fully certified MHRT/CSP and one (1) fully certified Crisis Peer Support Staff deployed to the Member in Crisis. The initial crisis response must consist of at least one (1) fully certified MHRT/CSP. MHRT/CSPs and Crisis Peer Support Staff may only deliver services that are within their respective scopes of practice. Q. Practice with a specific goal of diversion from unnecessary engagement with the criminal justice and hospital systems. Providers must have protocols for monitoring which crisis resources local law enforcement agencies have and how to request them. If requesting law enforcement involvement, staff must request a response from law enforcement with relevant crisis training whenever appropriate, such as crisis intervention team officer(s) or behavioral health liaison(s); R. Ensure that Crisis Peer Support Staff have adequate supervision from an appropriately trained supervisor; S. Have round-the-clock on-call access to a psychiatrist, APRN-PMH-NP, or APRN-PMH-CNS for psychiatric consultation. The psychiatric consultant is not required to complete the DHHS-designated crisis training; T. Develop and implement an operations manual detailing all policies and standard operating procedures. Providers shall make the manual available to DHHS upon request. 66.04-3 Site-Based Crisis Stabilization Services * *The Department will submit to CMS and anticipates receiving approval of a State Plan Amendment related to these provisions. Site-based crisis stabilization providers shall: Be approved by DHHS to deliver site-based crisis stabilization services; B. Be either: 1. An appropriately licensed behavioral health organization delivering site-based crisis stabilization services in emergency departments; or 2. A crisis receiving center, meaning a center providing walk-in access to crisis services to Members experiencing behavioral health, mental health, and substance use challenges. C. Maintain a current and valid license for the provision of mental health services issued by the Division of Licensing and Certification pursuant to 34-B M.R.S. §1203-A and comply with all applicable requirements in 10-144 C.M.R. ch. 123; D. Comply with 14-193 C.M.R. ch. 1, Rights of Recipients of Mental Health Services and 14-472 C.M.R. ch. 1, Rights of Recipients of Mental Health Services Who are Children in Need of Treatment, or successor versions of these regulations; Practice Trauma Informed and culturally sensitive care in accordance with section 66.04-2(J); and Develop and implement an operations manual detailing all policies and standard operating procedures. Providers shall make the manual available to DHHS upon request; and Ensure that all site-based crisis stabilization services staff complete the training, education, and recertification requirements in section 66.04-2(L). Furnish site-based crisis stabilization services with a team of at least one (1) MHRT/CSP and one (1) Clinician. The Clinician must be available twenty-four (24) hours per day, seven (7) days per week for supervision and consultation. Call the Office of Aging and Disability Services Crisis Prevention and Intervention Services or other DHHS-designated specialized crisis response teams so they can respond to Members with an intellectual or developmental disability, an acquired brain injury, or autism spectrum disorder who are in Crisis 66.04-4 Referrals for Behavioral Health Services In accordance with the Settlement Agreement between the United States of America and the state of Maine (U.S. Dist. Ct. (D. Me.), Case No. 1:24-cv-00315-SDN), all providers that deliver covered services under this Section to Members under twenty-one (21) years of age must offer to those Members and, if appropriate, the Members’ Families to refer the Members to DHHS for an assessment to determine any behavioral health services for which they are eligible. 66.05 COVERED SERVICES 66.05-1 Crisis Residential Services Crisis residential services are short-term, highly supportive services delivered in a supervised residential setting, which provide individualized therapeutic interventions to address mental health and/or co-occurring mental health and substance use conditions for a time-limited, post-crisis period to stabilize the Member’s condition. Components of crisis residential services include assessment; development of a Crisis Plan; monitoring behavior and the Member’s response to therapeutic interventions; participating and assisting in planning for and implementing crisis and post-crisis stabilization activities; and supervising the Member to assure personal safety. Services include all components of screening, assessment, evaluation, intervention, and disposition, meaning determining the most appropriate care for the Member, commonly considered appropriate for the provision of emergency and crisis mental health care. Providers must obtain prior authorization for crisis residential services from DHHS or its authorized entity. Prior authorizations are limited to a stay of up to seven (7) consecutive days, beginning with the date of admission. Providers may submit requests to DHHS or its authorized entity to approve additional time. DHHS or its authorized entity may approve additional time based on a variety of factors, including, but not limited to, whether the Member is in Crisis, progress made toward stabilization and short-term treatment plan goals, and if crisis residential services is the most appropriate level of care to meet the Member’s needs. A. Admission and Assessment Crisis residential providers shall comply with the following admission and assessment requirements: The independently licensed Clinician shall determine the most appropriate level of care for the Member and, if applicable, assist in the admission process to the crisis residential facility. A mobile crisis intervention response service assessment can be utilized to meet this requirement; Perform an initial safety assessment within two (2) hours after admission, including evaluating the Member’s ability to care for self and risk of causing harm to self, others, and property. In the event the provider determines that the Member is suicidal and/or a danger to others, the provider shall deliver immediate interventions, including referral to first responders (e.g. police, ambulance, etc.) and/or other immediate response as appropriate. Providers shall approach initial safety assessments as a supportive dialogue with the Members and shall involve others as applicable, including community support workers, case managers, residential providers, Family Members, and/or other treatment providers. A MHRT may perform the initial safety assessment instead of the supervising clinician, but it must be reviewed and signed by the supervising Clinician; If a comprehensive crisis assessment was not completed within twenty-four (24) hours prior to admission, perform a comprehensive crisis assessment within the first seventy-two hours (72) hours of admission to the crisis residential facility. Each comprehensive crisis assessment shall be reviewed and signed by a supervising licensed Clinician; and Develop and maintain records of the above comprehensive crisis assessment, which shall include each of the following: Demographic and diagnostic information; Risk of harm to self and others (including current and history of suicidal/homicidal impulses, thoughts and behaviors, trauma history, risk of victimization, and/or abuse or neglect, physically and/or sexually aggressive impulses or behaviors, and ability for self-care); Functional status (including self-care/hygiene, ability to maintain social/interpersonal relationships, changes/disturbances in biologic functioning such as sleep, eating, activity level, and school, and/or work performance); Evidence of co-occurring medical, substance use, developmental, and psychiatric conditions that may have a potential impact on the course and/or treatment of the presenting condition(s); Environmental stressors, including transitions and losses; current living situation/home environment, serious illness and/or injury of the Member or a relative; exposure to substance use and its effects; and danger or threat in the home or community, etc.; Environmental supports, including ability to take advantage of community and professional resources and social and emotional support from friends or relatives, etc.; Current and past experience with treatment and services, including response to treatment, ability to manage recovery, ability to engage in the treatment process, history of psychiatric hospitalization, history of involvement with crisis services, resiliency following setbacks, etc.; and h. Pertinent medical history including medications and/or prescriptions, current use of medications and prescriptions, and medication issues. When a crisis assessment reveals medication issues that need to be addressed, crisis staff shall request a psychiatric consultation. B. Treatment Plan and Services Crisis residential providers shall comply with the following treatment plan and service requirements: Provide observation, supervision, and stabilization to achieve the following: Reduce the likelihood the Member will be placed in more restrictive settings, including emergency departments, psychiatric hospitals, residential treatment, and incarceration facilities; and Prepare the Member to return to the community; Use a strength-based approach that includes immediate action steps to mitigate the Crisis to provide support and coping strategies for: Managing the Crisis; Teaching the Member skills to cope with the Crisis; Supervising prescribed medication; and As appropriate, involving Family and/or friends with stabilization; The provider shall develop and implement a treatment plan that includes: Steps to restore the Member to a level of functioning that requires a less restrictive level of care; and Recommended interventions that will assist the Member reenter and stay in a community environment. If the Member is homeless and does not have community services in place, the provider shall assist the Member with completing and submitting appropriate housing applications; If the Member is a veteran and does not have community-based services, the provider shall assist the Member with completing and submitting applications to an agency that specializes in case management for veterans; Develop a discharge plan for the Member upon recommendation for discharge. Each discharge plan shall be kept in the Member’s record and shall include the following: Recommendations for ongoing peer support; All completed referrals to outpatient assessment and treatment, community support systems, health home, community service worker, other treatment providers, housing resources, routine care, and other resources; Support and involvement by Family Members and other natural supports; and A follow-up plan, including information about contacting other providers and resources. Make referrals to and provide support to Members and/or parents/guardians in successfully accessing resources in the community and community-based providers that would benefit Members based on their needs as identified in the individualized service/treatment plan; Provide information to the Member through discussion, sharing of pamphlets, written resources, and a written version of the discharge plan throughout the Member’s stay in the crisis residential facility and upon discharge; If there is an existing treatment/service plan or advanced directive, contact the provider that developed the plan and request additional information to formulate an outcome recommendation; and Collaboratively develop a Crisis Plan or review/revise an existing Crisis Plan with the Member. 66.05-2 Mobile Crisis Intervention Response Services * *The Department will submit to CMS and anticipates receiving approval of a State Plan Amendment related to these provisions. MaineCare will provide this Mobile Crisis Intervention Response Service starting on July 1, 2026. Until that time, MaineCare will continue to cover mobile crisis services through crisis resolution under MBM Chapter II, Section 65, § 65.05-1. Mobile crisis intervention response services are rapid, on-demand, community-based, individualized and therapeutic behavioral health intervention response services available twenty-four (24) hours a day seven (7) days a week. Services are delivered to the Member and the Member’s parent or guardian or adult Member’s guardian (in support of care for the Member). Services can be provided in an office or on scene. "On scene" can mean a variety of locations such as a home, school, street, emergency shelter, emergency department (for aftercare only), or the mobile crisis intervention response service provider’s office. Services may not be delivered to Members in inpatient care. Initial encounters may not be delivered to Members in emergency departments. Aftercare may be delivered to Members in emergency departments only for the limited purpose of providing continuity of care in order to transition the Member to new provider services or otherwise safe discharge, i.e. making a “warm handoff” as required under Section 66.05-2(B)(5). Mobile crisis intervention response service teams may be dispatched to an incident as a secondary response after the police have responded and determined crisis intervention is appropriate. Mobile crisis intervention response services consist of initial encounters and aftercare. A. Initial Encounter An initial encounter is triggered by a Crisis event. The initial encounter spans engagement through crisis planning and acute intervention, including the initial follow-up on the precipitating Crisis event and generally covering the first twenty-four to forty-eight (24-48) hours after successful contact with the Member in Crisis. Members may subsequently have another Crisis that warrants another initial encounter. Providers must make reasonable efforts to deliver responses involving at least two (2) crisis responders for all initial encounters, which preferably include at least one (1) MHRT/CSP and one (1) Crisis Peer Support Staff. Provisionally certified MHRT/CSPs and Crisis Peer Support Staff may not conduct initial encounters without a fully certified crisis responder MHRT/CSP. When, despite making reasonable efforts, the provider cannot deliver a two-person response, a one-person response may be furnished by a fully certified crisis responder MHRT/CSP. The initial encounter must always include an in-person response from a fully certified crisis responder MHRT/CSP. A second crisis responder responding via telehealth may comprise a two-person response. When responding to Members seventeen (17) years of age and younger, the crisis responder joining the in-person response via telehealth must use real-time, interactive video and audio, not audio only. Initial encounters have response times standards of one (1) hour in urban areas and two (2) hours in rural areas. OBH shall specify in provider contracts for this service which areas are subject to the urban and rural area standards, and shall establish a timeline for achieving compliance with service response time standards. Initial encounters include the following components (1-5). Providers delivering an initial encounter shall deliver all service components to Members in Crisis, except any components that the provider determines is/are not clinically appropriate. 1. Engagement. This component shall consist of developing a therapeutic relationship with Members in Crisis. Engagement shall utilize the strengths-based process through which Members with mental health conditions form a healing connection with people that support their recovery and wellness within the context of family, culture, and community. 2. De-escalation. This component shall consist of steps to decrease the emotional, behavioral, and mental intensity of a situation and to ensure autonomy, personal choice, and self-directed care whenever possible. De-escalation includes verbal and non-verbal techniques of transferring a sense of calm, genuine interest, and unconditional positive regard towards a person in Crisis. Even in circumstances of service provision to an involuntary Member, crisis teams shall practice with a specific goal of Member diversion from unnecessary interaction with criminal justice and hospital systems. 3. Assessment and Planning. This component shall consist of the provider immediately initiating the gathering of information from available sources (e.g., collateral contacts, the Member in Crisis, an established Crisis Plan when it exists). a. Assessment should not be delayed because the Member in Crisis is too agitated/intoxicated. Assessment shall focus on addressing the most acute issues and attempts to reassess may be needed after primary interventions. This component in the Crisis setting shall be thorough enough to inform decision making and focused enough to work within a fast-paced setting in which only limited information may be available. Assessment of the Member in Crisis should be limited to clinically indicated assessments. An MHRT/CSP must complete a Department-provided assessment which consists of, at minimum, the following elements: i. Obtaining demographic information; ii Determining specific causes or contributing factors leading to the Crisis event; iii. Assessing risk of harm to self and others; iv. Assessing functional status; v. Determining environmental stressors; vi. Determining environmental supports (including ability to take advantage of community and professional resources, social and emotional support from friends or relatives, etc.); vii. Obtaining evidence of co-occurring medical, substance use, developmental, and psychiatric conditions and/or diagnoses that may have a potential impact on the course and/or treatment of the presenting condition(s); vii. Obtaining current and past history with treatment and services; ix. Obtaining pertinent medical history, including medications and/or prescriptions, and current use of medications and prescriptions; and x. Recommending appropriate actions based on the level of need rating identified through the assessment. b. Collecting information from one or more collateral resources (e.g., a Family Member or case manager), whenever possible and within the limits of Member choice and privacy regulations, to gain a more complete picture; c. Addressing medical concerns when appropriate. This shall consist of, at a minimum: Calling 911 and administering naloxone, as indicated, in the event of suspected opioid overdose; and Performing an initial triage to determine the need for more formal medical clearance prior to providing an assessment. Only Members whose triage indicates a reasonable need for an emergency medical evaluation should be required to go to an emergency department for medical clearance prior to being seen by mobile crisis intervention response services staff. Examples of conditions that would require medical screening or clearance include: (i) Altered mental status of unknown etiology without prior behavioral health symptoms that suggests an underlying medical condition; (ii) Near hanging, strangulation, or suffocation; (iii) Suspected or confirmed overdose; (iv) Based on the Member’s presentation, it is reasonable to suspect foreseeable harm to self or others (v) Meeting criteria for involuntary hospitalization and/or protective custody under Title 34-B §§ 3861-3864 (e.g., assaultive, combative, violent, has a weapon); (vi) Any non‐superficial or significant physical injury; (vii) Difficulty or ineffective breathing; and (viii) Suspected alcohol withdrawal and/or history of withdrawal induced seizure. d. The information gathered during the assessment shall be used to collaboratively develop a Crisis Plan or review/revise an existing Crisis Plan for each Member in Crisis. The Crisis Plan will be informed by previously developed plans as appropriate. Crisis responders are responsible for: i. Entering the Crisis Plan into the electronic Member record and providing copies of the Crisis Plan to the person in Crisis, parent/guardian, emergency first responders, and other appropriate providers when consent to release information is obtained from the Member; and ii. Ensuring that the Crisis Plan contains information regarding other systems involvement (e.g., legal, child welfare, adult protective, etc.) as well as available and applicable community-based resources; 4. Intervention. This component shall be timely and match the Member’s needs as identified in the assessment. This component shall consist of: a. Therapeutic screening, including explicit screening for suicidality; b. Developing a safety plan through the clinical process of listening to, empathizing with, and engaging the patient in the development of a prioritized written list of coping strategies and sources of support. Members can use these strategies before or during a suicidal crisis. The plan is brief, is in the patient’s own words, and is easy to read; c. Developing a Lethal Means safety plan, as needed; and d. Transporting the Member to the provider that will deliver the next appropriate level of care if needed and safe for transport. If a provider determines a Member is unsafe for transport, the provider must document why the Member is unsafe for transport. When appropriate, transportation for a voluntary examination should be done by a crisis responder in a civilian vehicle, not in an ambulance or a police vehicle. 5. Disposition. This component consists of determining the Member’s disposition, meaning determining the most appropriate care for the Member, and making initial referrals for that care. The disposition is based off the assessment and any other available information obtained during the initial encounter. Providers must return a disposition statement to the statewide crisis hotline within twenty-four (24) hours of completion of the on-scene encounter. When delivering an initial encounter, the provider must complete this component prior to delivering aftercare to the Member. Examples of a disposition include, but are not limited to: Member can be supported in the community and provider submits referral for behavioral health services; Admission to a crisis residential provider; Stabilization and referral to the Member’s current provider for appropriate continuation of care; or Psychiatric hospitalization. B. Aftercare Aftercare services are delivered following the initial encounter, though an initial encounter is not required to deliver aftercare. Aftercare services may be delivered by any fully or provisionally credentialed MHRT/CSP or Crisis Peer Support Staff. Aftercare may be delivered via telehealth. Aftercare includes the below coordination and referral services and may also include, as appropriate, any initial encounter service components. Providers delivering aftercare shall: Use in-home crisis-related supports and care coordination following an acute Crisis event, post discharge from a more restrictive care environment, or as a preventive measure to reduce the likelihood of decompensation until the Member is successfully connected to routine community-based services; 2. Stabilize the Member, if applicable; 3. Ensure that support is delivered to the Member’s “natural supports,” such as their Family, environment, etc., including peer/recovery support for the person’s emergency contacts, their entire Family, or other relevant group of natural supports involved; 4. Contact any treatment provider(s) identified by the Member to obtain additional information; Provide a warm handoff to the appropriate provider for follow up with the Member. Alone, referring the Member for appropriate services is not a warm handoff. A warm handoff shall include: Introducing the Member to the new provider or service directly, either face-to-face or via telehealth; Involving the Member and, when appropriate, the Member’s Family in the communication between service providers in a manner which permits the Member access (e.g., the Member is on the phone call or the communication is done in front of the Member); Providing the Member with the opportunity to ask questions, clarify, or correct information about their care; Contacting the Member to remind the Member of initial appointments, unless this is specifically declined by the Member; and Contacting the referred providers to confirm the Member attended their initial appointment. The mobile crisis intervention response service provider must render the appropriate level of home and community-based aftercare services until such time as another clinically-indicated support is sufficiently integrated or until these home and community-based aftercare services are no longer required, or as stated by the Member. 66.05-3 Site-Based Crisis Stabilization Services MaineCare will provide this Site-Based Crisis Stabilization Service starting on July 1, 2026. Until that time, crisis resolution services will continue to be available under MBM Chapter II, Section 65, § 65.05-1. A. Site-based crisis stabilization services are immediate Crisis-oriented services provided to a Member with a serious problem of disturbed thought, behavior, mood or social relationships, and/or crises originating from problems associated with an intellectual disability, autism, or other related condition. Site-based crisis stabilization services are oriented toward the amelioration and stabilization of these acute emotional disturbances to ensure the safety of a Member or society. Site-based crisis stabilization services include all components of screening, assessment and planning, evaluation, intervention, and disposition commonly considered appropriate for the provision of care for Crises, including, but not limited to, Crises caused by co-occurring mental health and substance use conditions. Site-based crisis stabilization services shall include collaboratively developing a Crisis Plan, or reviewing and revising an existing Crisis Plan with the Member. Services also include a warm handoff as described in subsection 65.05-2(B)(5) and appropriate coordination and referral follow-up. B. Site-based crisis stabilization services must be delivered at the Department-approved site. However, site-based crisis stabilization services may include telehealth contacts with both the Member and, with the Member’s consent as applicable, the Member’s parent or guardian, or with only the adult Member’s guardian when at least one in-person contact is made with the Member within seven (7) days prior to the telehealth contact. The substance of the telehealth contact(s) must be such that the Member is the focus of the service, and the need for communication with the parent or guardian without the Member present must be documented in the Member’s record. C. Providers may deliver site-based crisis stabilization services on-site for up to sixty (60) days after the first face-to-face visit. Whenever possible, providers delivering site-based crisis stabilization services shall seek to transition Members to the least restrictive setting appropriate, including through referral to mobile crisis intervention response services. D. MaineCare will reimburse more than one (1) provider for delivering site-based crisis stabilization services to the same Member at the same time if it is necessary to ensure the Member receives the necessary services. Both providers must maintain documentation of the necessity of this treatment. 66.06 REPORTING REQUIREMENTS All providers delivering services under this section shall: A. Submit data requested by DHHS to any DHHS-designated crisis management system; B. If applicable, submit data necessary to report on compliance with performance measures set forth in subsection 66.08-2; and C. Follow critical incident requirements in 10-144 C.M.R. ch. 123, Behavioral Health Organizations Licensing Rule. 66.07 DOCUMENTATION AND CONFIDENTIALITY All providers shall maintain the confidentiality of information regarding Members in accordance with Chapter I, Section I, of the MaineCare Benefits Manual, 42 C.F.R. §§ 431.301-306, 22 M.R.S. §1711-C, and with all other applicable sections of state and federal laws and regulations. 66.08 REIMBURSEMENT * *The Department will submit to CMS and anticipated receiving approval of a State Plan Amendment related to these provisions. 66.08-1 Reimbursement Principles Specific reimbursement rates are listed on the MaineCare provider fee schedule, which is posted on the DHHS website in accordance with 22 M.R.S. § 3173-J(7), at https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx. There are no Member cost sharing requirements, such as co-insurance or co-pay, for crisis services. The table below includes the codes, modifiers, and unit of service for each covered service as of the effective date of this Section. Updated codes and modifiers for services can be found on the fee schedule linked above. Covered Service Code Modifier Unit Crisis Residential Crisis Residential H0018 Per Diem Crisis Residential – Children H0018 HA Per Diem Mobile Crisis Intervention Response Services * Initial Encounter – One-Person Response S9485 HK Per Unit Initial Encounter – Two-Person Response S9485 HE Per Unit Initial Encounter – One-Person Response (Enhanced Match) S9485 HK CG Per Unit Initial Encounter – Two-Person Response (Enhanced Match) S9485 HE CG Per Unit Aftercare – MHRT/CSP H2011 HK 15 minutes Aftercare – Crisis Peer Support H2011 HE 15 minutes Site-Based Crisis Stabilization Services Site-Based Crisis Stabilization H2011 15 minutes Site-Based Crisis Stabilization – Children H2011 HA 15 minutes 66.08-2 Performance-Driven Reconciliation Payments for Mobile Crisis Intervention Response Services A. Performance Reporting Beginning April 2026, all mobile crisis intervention response service providers, regardless of performance, will receive a quarterly report with a performance assessment, indicating whether they met the performance standards below. The report will contain instructions for the provider to appeal and/or rebut the report’s data if the provider disagrees with the report. DHHS will provide a thirty- (30) day rebuttal period. B. Performance Standards There are two performance standards: At least 50% of referrals requiring an in-person intervention result in an in-person initial encounter within two (2) hours of referral receipt. Measure denominator: Members who receive an initial encounter, regardless of setting (using OBH crisis management system data). Measure numerator: Members who receive an in-person initial encounter within two (2) hours of referral receipt. At least 60% of referrals requiring an in-person intervention result in an in-person, in-community initial encounter. Measure denominator: Members who receive an initial encounter, regardless of setting (using OBH crisis management system data). Measure numerator: Members who receive an in-person, in-community initial encounter. C. Reconciliation Payments At least annually, DHHS will calculate the percentage of initial encounters each agency staff delivered compared to the number of initial encounters assumed in the rate model. This assumed number of initial encounters delivered per agency staff varies by the region the provider is located in: For Districts 1 (York County) and 2 (Cumberland County), this is 150 initial encounters annually. For Districts 3 (Androscoggin, Franklin, and Oxford Counties), 4 (Waldo, Lincoln, Knox, and Sagadahoc Counties), and 5 (Somerset and Kennebec Counties), this is 140 initial encounters annually. For Districts 6, (Penobscot and Piscataquis Counties), 7 (Washington and Hancock Counties) and 8 (Aroostook County), this is 120 initial encounters annually. The Department will establish the assumed number of initial encounters per agency staff for the tribal public health district prior to a qualified provider enrolling to deliver these services. DHHS will provide a reconciliation worksheet, and providers must submit the reconciliation worksheet to DHHS, which will calculate this percentage. Based on the percentage and whether the provider met the performance standards below, either DHHS may owe the provider a payment, the provider may owe DHHS a payment, or no payment will be due from either DHHS or the provider. The calculation of the payment due to or from the provider excludes encounters for individuals with other insurance. If a provider meets the performance standards and: a. Delivers fewer than 100% of the initial encounters assumed in the rate model, DHHS will pay the provider the equivalent of the difference between the total reimbursement for the number of initial encounters delivered and what the total reimbursement would be if the provider delivered 100% of the initial encounters assumed in the rate model. b. Delivers between 100% and 110% of the initial encounters assumed in the rate model, no payment will be due from either DHHS or the provider. c. Delivers more than 110% of initial encounters assumed in the rate model, providers must pay DHHS the equivalent of the difference between the total reimbursement for the number of initial encounters delivered and what the total reimbursement would be if the provider delivered 110% of the initial encounters assumed in the rate model. If a provider does not meet the performance standards and: a. Delivers fewer than 96% of the initial encounters assumed in the rate model, DHHS will pay providers the equivalent of the difference between the total reimbursement for the number of initial encounters delivered and what the total reimbursement would be if the provider delivered 96% of the initial encounters assumed in the rate model. b. Delivers between 96% and 100% of the initial encounters assumed in the rate model, no payment will be due from either DHHS or the provider. c. Delivers more than 100% of the initial encounters assumed in the rate model, providers will pay DHHS the equivalent of the difference between the number of initial encounters delivered and 100% of the initial encounters assumed in the rate model. 66.08-3 Cost-of-Living Adjustment Every January 1st, pursuant to 22 M.R.S. § 3173-J, the Department will apply an annual cost of living adjustment equal to the percentage increase in the Maine minimum wage, as determined by the Maine Department of Labor, to all Section 66 services which did not receive a rate adjustment within the previous twelve (12) months. The Maine Department of Labor determines the percentage increase, if any, as of August of the previous year over the level as of August of the year preceding that year in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) for the Northeast Region, as published by the United States Department of Labor, Bureau of Labor Statistics, with the amount of the minimum wage increase rounded to the nearest multiple of 5¢. 66.08-4 Comparable or Duplicative Services Services covered under this section are not covered if the Member is receiving comparable or duplicative services under this or any other section of the MaineCare Benefits Manual. These comparable or duplicative services include, but are not limited to, the following: A. Inpatient care services provided by hospitals or psychiatric residential treatment facilities; B. Crisis residential services, aftercare, and site-based crisis stabilization services are duplicative of assertive community treatment in Chapter II, Section 17, and children’s assertive community treatment in Chapter II, Section 65. 66.09 BILLING INSTRUCTIONS Providers shall bill in accordance with the billing instructions on the DHHS website at: https://mainecare.maine.gov/Billing%20Instructions/Forms/Publication.aspx. Mobile crisis intervention response service providers may bill only for initial encounters and aftercare and must bill in accordance with the below subparts. In accordance with subsection 66.05-2, providers may not bill for any initial encounters delivered in emergency departments; billable crisis services in emergency department settings must be limited to aftercare services. Mobile crisis intervention response providers must bill for the appropriate rates for initial encounters and aftercare which occurs in the geographic districts where the providers are contracted to deliver services as shown in the applicable rate schedule at https://mainecare.maine.gov/Provider%20Fee%20Schedules/Forms/Publication.aspx. A. Initial Encounters Providers may bill for initial encounters when they deliver all clinically appropriate initial encounter service components in section 66.05-2(A) to the Member in Crisis. There are initial encounter rates for two-person and one-person responses: 1. Providers shall bill for a two-person initial encounter when (1) MHRT/CSP and one (1) Crisis Peer Support Staff deliver the initial encounter. 2. Providers shall bill for a one-person initial encounter when one (1) MHRT/CSP delivers the initial encounter. A one-person initial encounter should be the exception, and providers shall document why a two-person initial encounter was not delivered. B. Aftercare There are rates for aftercare delivered by an MHRT/CSP and rates for aftercare delivered by a Crisis Peer Support Staff. Providers shall bill for the appropriate aftercare code that represents the type of crisis responder who delivered the aftercare. STATUTORY AUTHORITY: 42 C.F.R. § 440.170; P.L. 2023, ch. 643; 22 M.R.S. §§ 42, 3173, 3173-J APAO ACCESSIBILITY CHECK (Word): April 28, 2026 ADOPTED (NEW): April 28, 2026 – filing 2026-092