Maine is continuing its work to strengthen the children's behavioral health system so that children and families can access the right care, at the right time, and in the right setting.
This work is grounded in one goal: ensuring children receive timely, appropriate, community-based supports whenever possible, with services coordinated around each child's individual needs.
In November 2024, the State of Maine and the United States Department of Justice (DOJ) entered into a Settlement Agreement focused on improving Children's Behavioral Health Services. Prior to and since execution of the Settlement Agreement, the Maine Department of Health and Human Services (the Department) has been implementing a broad set of reforms designed to improve access to care, strengthen accountability, modernize service delivery, and create a clearer path for families seeking help.
Many of these changes required updates to MaineCare rules. Understanding why those changes were necessary, how they were developed, and what they mean for children, families, providers, and communities moving forward is an important part of this work.
Why Rule Changes Were Necessary
A foundational part of the Department's reform is reflected in the new Children's Behavioral Health Services Global Rule (Chapter I, Section 7).
The Global Rule was developed to support a more coordinated and consistent behavioral health system for children statewide. Among other improvements, it establishes a standardized Single Assessment process that will be used across programs to better understand a child's strengths and needs, identify what behavioral health services may be appropriate, and improve consistency in access to care.
The rule identifies providers that must offer referrals to the Single Assessment process, helping families connect to services more efficiently and ensuring better coordination across programs. These changes are intended to help ensure that:
- Children receive the right services at the right time
- Families experience a system that is clearer and easier to navigate
- Access to care is more consistent across Maine
- Children can remain safely supported in their homes and communities whenever appropriate
In addition to the Global Rule, the Department updated six Sections of the MaineCare Benefits Manual ("MBM"):
- Targeted Case Management Services, 10-144, C.M.R. Chapter 101, MBM, Chapter II, Section 13
- Rehabilitative and Community Support Services for Children with Cognitive Impairments and Functional Limitations, 10-144 C.M.R. Chapter 101, MBM, Chapter II, Section 28
- Behavioral Health Services, 10-144 C.M.R. Chapter 101, MBM, Chapter II, Section 65
- Crisis Services, 10-144 C.M.R. Chapter 101, MBM, Chapter II, Section 66
- Principles of Reimbursement for Behavioral Health Home Services, 10-144 C.M.R. Chapter 101, MBM, Chapter II, Section 92
- Private Non-Medical Institution Services, 10-144 C.M.R. Chapter 101, MBM, Chapter II, Section 97
Some changes, as with the Global Rule, directly support the DOJ Settlement Agreement. Other improvements were many years in the making, such as introducing a new Mobile Crisis service model in Section 66 that aims to improve services and align with federal opportunities.
Why Some Changes Were Implemented Quickly
The DOJ Settlement Agreement established clear implementation timelines and some changes needed to be put in place promptly.
To meet those timelines, the Department adopted certain rules on an emergency basis, as allowed under the Maine Administrative Procedure Act (MAPA). Emergency rules are temporary and effective for 90 days.
These emergency adoptions helped launch several important components of the broader reform effort, including:
- The statewide Single Assessment process
- High fidelity wraparound services
- Other operational changes required under the Settlement Agreement
Using emergency rulemaking allowed Maine to move critical improvements forward while simultaneously beginning the permanent rulemaking process.
How Permanent Rules Are Finalized
Immediately after emergency rules were adopted, the Department initiated regular rulemaking pursuant to the process set forth under MAPA. That process includes:
- Public notice of proposed rules
- Public hearings
- Opportunities for written public comment
- Review of and response to all feedback before final adoption
This process is important because it promotes transparency, consistency, and meaningful public participation.
Why Public Discussion of Open Rules Is Limited During Rulemaking
Some stakeholders asked why the Department did not publicly respond to specific comments, questions or proposed rules prior to rule adoption. Under the MAPA process, state agencies are advised not to discuss the substance of open rule proposals outside the formal comment process. This helps preserve the integrity and legal validity of rulemaking, ensures all voices are heard through the same official channels, and reduces confusion while proposals are actively under review.
At the same time, the Department continued communicating with providers and partners regarding operational matters such as training opportunities, implementation timelines, and readiness for the Single Assessment process.
Public Input Meaningfully Improved the Final Rules
The Department received a significant volume of comments from families, providers, advocates, and community members regarding proposed rules. That feedback was valuable and carefully reviewed. Input from the public helped identify areas needing clarification, potential unintended consequences, and opportunities to strengthen final policy.
As a result, the Department made a number of changes, including:
- Modified eligibility criteria to help ensure children do not lose access to medically necessary services
- Extended the required frequency of certain provider activities to better align with standard practice and reduce unnecessary administrative burden
- Removed unnecessary requirements and clarified unclear provisions
- Allowed additional provider types to serve in certain roles
- Clarified in-person and telehealth expectations
The rulemaking process also extended opportunity for public engagement beyond minimum requirements through two rounds of public hearings and an extended public comment period for Sections 13, 28, and 97. These actions reflect an important principle: public engagement strengthens policy.
Modernizing Systems That Had Not Been Updated in Years
Many of these rulemakings involved more than isolated technical edits. Some sections of policy had not been significantly updated in five to ten years. At the same time, Maine was working to implement new service models, improve care coordination, respond to the DOJ Settlement Agreement, and modernize provider expectations. This meant that many proposals were inevitably comprehensive and interconnected.
Updates included:
- Modernizing outdated requirements
- Aligning services with current best practices
- Improving assessment and eligibility pathways
- Strengthening provider accountability and clarity
- Expanding and better organizing the continuum of care
- Supporting more coordinated delivery of services statewide
While significant system change can be complex, modernization is necessary to ensure children and families are served by a system designed for today's realities.
What the Final Rules Deliver for Maine Families
Through this process, Maine has adopted rules that strengthen Children's Behavioral Health Services in meaningful ways, including:
- Better Access to Care: Several new or strengthened service options help better match supports to each child's level of need.
- Clearer Pathways to Services: Improved assessment and eligibility processes make it easier for families to understand where to begin and how to access appropriate supports.
- Stronger Quality Standards: Clear expectations for providers support consistency, accountability, and high-quality care delivery.
- Greater Focus on Community-Based Care: The overall system is designed to help children receive services in home and community settings whenever appropriate and safe.
Ongoing Support and Communication
The public can find all comments and response documents attached to the adopted rule packets on the Department's rulemaking webpage.
Adopting final rules is an important milestone, but implementation continues. The Department remains committed to ongoing communication, technical assistance, and provider support to help families, providers, and community partners understand the updated system and navigate changes successfully.
Looking Ahead
This work reflects a continued commitment to improving behavioral health services for Maine children and families. The Department appreciates the many families, advocates, providers, and community members who participated in the rulemaking process and helped strengthen the final result.
By combining system modernization, public input, and a focus on community-based care, Maine is building a stronger behavioral health system that better serves children today and into the future.