MaineCare replaced its prior Section 28 rules with Chapter II, Section 28, Adaptive Behavior Services for Children, effective April 29, 2026. The adoption notice and adopted rule change eligibility, service names, provider and staff requirements, and ABA components. They also change prior authorization, records, EVV, group services, two-to-one staffing, telehealth, reimbursement, and billing. Providers need a service-date migration that covers the substantive changes behind the new terminology.

MaineCare Section 28 Adaptive Behavior Services rule 2026

The MaineCare Section 28 Adaptive Behavior Services rule 2026 replaced the former Chapter II and Chapter III Section 28 rules with one Chapter II rule. Preserve the pre-April 29 configuration for older services, claims, corrections, appeals, and audits. Build the new configuration from the adopted PDF, effective date, service and provider scope, transition provisions, and later official bulletins. A renamed service can also carry changed eligibility, staffing, documentation, and billing requirements.

Reassess eligibility and protect the transition

For most community services, the rule adds Single Assessment and level-of-care or service-intensity requirements and updates ABA eligibility pathways. Members receiving Section 28 immediately before the effective date who no longer meet the new criteria receive a 180-day transition period. Record the prior eligibility, new assessment, determination, transition start and end, notice, appeal, continuity work, and responsible clinical and administrative owners.

Build a person-level transition register from the member's actual pre-effective-date service, current eligibility evidence, determination date, and notice. Calculate the transition period from the controlling event defined by the rule or notice, then preserve the calculation and source. Keep pending assessments, appeals, network searches, and clinical transitions visible. A bulk calendar date should not replace the member-specific facts needed to determine the operative period.

Explain each state in accessible language. The family should be able to see which requirement changed, who made the clinical and coverage decisions, what service continues during the transition, and which question belongs with MaineCare, Acentra, the provider, or another authority. Record interpreter and AAC access, consent and assent when applicable, and the person's own priorities for continuity.

Map community and school provider requirements

The rule distinguishes community providers, school providers, and school-related services. Community providers need the specified behavioral-health-organization licensing route, while school providers follow their educational-program and enrollment requirements. Verify the entity, site, provider type, program approval, staff, service, setting, member age, and payer evidence. A school location does not make a community provider a school provider.

Update direct-care and supervision records

The adopted change shortens the Behavioral Health Professional certification period to six months after hire, adds RBTs as allowable direct-care staff for ABA, and clarifies supervision. It also identifies supervisor-only ABA components. Record qualification, hire date, certification deadline, role, assigned service, supervisor, observation, direction, training, and current evidence. Certification alone does not establish MaineCare enrollment, service assignment, or billing authority.

Rebuild the covered-service map

The rule renames prior treatment services as Adaptive Skills Training and names specialized services as Applied Behavior Analysis. It incorporates former BCBA service components into ABA reimbursement and says they are not separately billable. It also addresses parent training, service locations, family-participation barriers, noncovered respite or custodial work, and duplicative services. Qualified clinicians determine the individualized plan; billing staff apply the current service and claim source.

Crosswalk old and new services at the activity level. Record the actual work, person served, goal, qualified role, setting, direct or indirect status, time, former service, new service candidate, bundled component, authorization state, and coding source. Keep an unresolved activity on hold until the clinical, service-definition, and billing owners agree on its treatment. A name similarity is not enough to support a claim conversion.

Implement the record and delivery controls

Section 28 now addresses prior authorization and utilization review, annual functional-assessment scores for specified cohorts, comprehensive assessment, ITP, progress notes, treatment-team meetings, EVV for community providers, group delivery, prior authorization for two-to-one staffing, and telehealth. Build one test per applicable requirement. Keep IEP or IFSP evidence and school exceptions in the school-related route.

Create a release matrix by service, provider type, setting, staffing pattern, and service date. A row should identify the required assessment, plan, authorization, staff and supervisor, note, EVV state when applicable, telehealth condition, unit, claim mapping, and evidence location. Test valid and invalid boundary cases, including a transition date, a two-to-one request without approval, a group with a missing participant-level record, and a community service missing an EVV element.

Collect only the information required for the active delivery rule. EVV, school records, personnel evidence, and clinical notes have different custodians and access needs. Preserve the person's communication tools and an accessible way to pause or raise a concern during service. Technology evidence cannot replace clinical documentation or the person's participation.

A fictional rule-migration audit

Wren's MaineCare transition team locks 36 controls across eligibility, 180-day transitions, provider types, licenses, staff deadlines, ABA and AST services, noncovered work, authorization, records, EVV, groups, two-to-one staffing, telehealth, reimbursement, and billing. Twenty-eight have a source, owner, effective state, test, and evidence location. Readiness is 28 of 36, or 77.8%. Eight remain held. The measure does not establish member eligibility, clinical fit, authorization, claim acceptance, or payment.

Use a Section 28 release checklist

Verify member age and eligibility route, transition state, provider classification, entity and site authority, staff role and deadline, supervisor, service, location, family and communication access, assessment, ITP, authorization, functional score, record, EVV, group or two-to-one conditions, telehealth, code, unit, reimbursement version, and claim evidence. Monitor MaineCare bulletins for implementation clarifications without overriding the adopted rule.

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