Provider Forms and Links

Kepro:

Kepro Forms and Instructions can be found at www.qualitycareforme.com

Kepro Provider Relations can answer questions at 1-866-521-0027, Option 1 or via email at providerrelationsme@kepro.com

Enterprise Information System (EIS):
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• EIS

Rehabilitative and Community Services (RCS) (MaineCare Section 28):

• Comprehensive Assessment: Guide to Conversation
   

Individual Planning Funds (IPF):

• Form (Word)
• Parent/Guardian Liability/Acknowledgment Form (Word)

Intensive Temporary Residential Treatment (ITRT):

• CBHS Provider Application and PNMI ITRT Supplement (Word)
• Kepro Residential Treatment Consultation Guide (PDF)
• Educational Planning and Notification Guide (Word)
• Children’s Residential Standards (Word)
• Children’s Residential Treatment Decision Letter (Word)
• Out of State Quick Application (for providers outside of Maine) (Word)

Co-Occurring Disorders (Mental Health, Trauma-Related Mental Health and Substance Use Disorders)

• AC-OK COD Adolescent Screening Tool (PDF)
• AC-OK COD Adult Screening Tool (PDF)