School Health-Related Services
This webpage provides information and important updates about policy and billing changes to MaineCare-covered services that are provided in an educational setting.
New MaineCare in Education Online Courses!
The Office of MaineCare Services is excited to share new resources where you can learn more about how MaineCare Covered Services are delivered in Maine schools. All courses may be accessed using a desktop, tablet, or mobile device.
To access the online courses, just click on the title below.
- For Parents and Guardians
This online course was created with parents and guardians in mind. It provides an overview of what MaineCare is and how students can get MaineCare services in schools. This course takes about forty-five (45) minutes to complete.
- For School Administrators, MaineCare Providers, and Other Stakeholders
School Administrators, MaineCare Providers, and Other Stakeholders, please be sure to take the courses in order, starting with MaineCare 100. At the end of each course, you will be asked to submit contact information to receive a certificate of completion for each course.
This course presents an overview of the MaineCare program. Participants will learn about the purpose of the program, basic eligibility requirements, the application process, member responsibilities, and what resources are available for MaineCare members. This course takes about forty-five (45) minutes to complete.
Sometimes students need to access health services in school settings. Since there are separate federal and state regulations and authorities providing guidance for Medicaid and education programs, it is critical to understand how the two systems work together to support students. This course provides foundational information to explain the basis for Medicaid reimbursement in school settings. Participants will learn about what covered services enrolled MaineCare providers can deliver in school settings, and how the services are accesed by student MaineCare members. This course takes about forty-five (45) minutes to complete.
*Prerequiste Required: Completion of MaineCare 100 Introduction to MaineCare.
MaineCare providers must ensure they understand the full scope of requirements related to delivery of MaineCare covered services. This course provides an opportunity for participants to expand on the information presented in MaineCare 100 and 101 related to the delivery of School Health-Related Services. This course takes about two (2) hours to complete.
*Prerequistes Required: Completion of MaineCare 100 Introduction to MaineCare and MaineCare 101 Introduction to School Health-Related Services.
Through this course participants will have the opportunity to gain a greater understanding of how Private Duty Nursing (PDN) services may be delivered in Maine schools. As with other School Health-Related services, schools have the option of delivering services directly, or contracting with an enrolled MaineCare provider.
*Prerequistes Required: Completion of MaineCare 100 Introduction to MaineCare, MaineCare 101 Introduction to School Health-Related Services, and MaineCare 102 Advanced School Health-Related Services for Providers.
Additional Resources for School Administrators and other Providers
- MaineCare Member Count by Zip Code (PDF) - This is a listing of the number of enrolled MaineCare members by zip code and age, updated quarterly. This resource will assist SAUs in planning for MaineCare reimbursement.
- Private Duty Nursing (PDN) Services FAQ - October 5, 2023
- Secondary Authorization Forms Required for Schools Providing PDN Services:
- Frequently Asked Question (FAQs) for School Health-Related Service Providers Related to OMS' Restraint Guidance - April 24, 2023.
- MaineCare in Education 2023 School Health-Related Services Billing Guide (PDF) - This guide is for anyone involved in the provision of Medicaid services.
MaineCare and Maine Department of Education Joint Training Resources
- Joint Guidance on MaineCare Reimbursement when Restraint is Utilized in Outpatient Behavioral Health Settings - March 6, 2023.
- Guidance on IEP Documentation (PDF) - May 2021
- IEP Documentation Training One Video - June 2, 2021
- Presentation Slides (PDF)
Development of a New School Health-Related Services Rule
The DHHS Office of MaineCare Services (OMS) is drafting a new section of the MaineCare Benefits Manual, Section 106, which will contain requirements for the provision of School Health-Related Services. School Health-Related Services are MaineCare-covered services, delivered in school settings, to MaineCare members by enrolled and qualified MaineCare providers.
Additional resources will be available here as MaineCare proceeds with the rulemaking process.
In January 2022 stakeholder sessions were held with preliminary information regarding the development of the new rule. You can access the Stakeholder Presentation and one of the recorded sessions here.
Virtual Meetings and Trainings
All providers who deliver MaineCare services in schools are encouraged to sign up to be part of the "MaineCare in Education Sessions" team. You will receive information and resources about School Health Related Services through virtual meetings and training opportunities. Complete the online form to register.