In November 2024, the State of Maine and the United States Department of Justice (DOJ) entered into a Settlement Agreement focused on Children’s Behavioral Health Services.
At its core, the Agreement strengthens and expands the focus on early identification, standardized assessment, coordinated service planning, and ongoing monitoring of outcomes. This is supported by changes in MaineCare rules which focus on ensuring children receive appropriate community-based services before more restrictive options are considered.
The Role of the Global Rule
A foundational component of this work is the Children’s Behavioral Health Services Global Rule, Chapter I, Section 7 (Global Rule). Among other things, the Global Rule was developed to implement a standardized Single Assessment process that will be used across programs to better understand a child’s needs and determine appropriate service intensity. The Global Rule also identifies which providers are required to offer referrals to the Single Assessment, helping ensure consistent access and coordination across the system.
The Global Rule serves as the backbone for the broader changes underway, connecting multiple service areas under a shared framework and supporting more consistent, child-centered decision-making.
How These Changes Affect Children’s Behavioral Health Services in Maine
MaineCare is adopting a series of rules through emergency rulemaking to effectuate some of the requirements of the Agreement. Rules adopted through emergency rulemaking are effective for 90 days. This will allow the Department to implement required changes quickly, while long-term updates move through the regular rulemaking process, including public notice and comment.
These changes affect multiple MaineCare service areas and focus on:
- Implementing the Single Assessment across Children’s Behavioral Health Services
- Aligning eligibility and service intensity with standardized assessment tools
- Strengthening care coordination and case management requirements
- Expanding and clarifying community-based behavioral health services
- Adding higher-intensity service options within existing service frameworks
For the Office of Behavioral Health, these updates reinforce a coordinated, assessment-driven system that emphasizes early intervention, family-centered planning, and services delivered in home and community settings whenever appropriate.
Looking Ahead
Additional services, including Therapeutic Intensive Homes, are intended to be addressed through future proposed rulemaking.
Collectively, these changes will strengthen and expand assessment, service coordination, and oversight across Children’s Behavioral Health Services, while reinforcing the Department’s commitment to serving children in the most appropriate, least restrictive settings.