Updated MaineCare in Education 2022 Guide

May 16, 2022

Please review and download the MaineCare in Education 2022 School Health-Related Services Billing Guide. The guide is available on the School Health Related Services webpage. 

We have updated the guide to provide additional clarification on the provision of services and further detail on School Health Center services. There have been no recent changes to the MaineCare Benefits Manual regarding the provision of School Health-Related Services.

As a reminder, all services categorized as Individuals with Disabilities Education Act (IDEA) services must be:

1. Medically necessary;
2. Ordered, prescribed, or recommended by a physician or other licensed practitioner;
3. Included in the member’s Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP) according to the posted Joint Guidance; and
4. Medical in nature (rather than academic).

It is the provider’s responsibility to verify a member’s eligibility for MaineCare prior to providing services, as described in Chapter I, Section 1 of the MaineCare Benefits Manual.

Please direction questions about the provision of School Health-Related Services to the MaineCare In Education email box.