Maine pays no 97153 or 97155. Its new Section 28 rule folds supervisor cost into the technician rate, allows an RBT pathway and resets who qualifies for ABA.
Key Takeaways
- No CPT codes, one bundled rate. MaineCare bills all children’s ABA under HCPCS H2021, and its $27.87 one-to-one community rate covers the full cost of supervision, which providers cannot bill separately.
- A rule shaped by a contested settlement. The new Section 28, effective April 29, was written partly to comply with Maine’s DOJ settlement, which the state and DOJ are appealing after a judge refused to weaken it.
- Deadlines landed in late October. A 180-day grace period for children who no longer qualify ended around October 26, and some direct care staff faced an October 29 deadline for BHP certification.
- Watch CMS and January. The new staff qualifications, including an RBT option, are tied to a pending State Plan Amendment, and the rule’s COLA formula will decide whether rates follow Maine’s roughly 4 percent minimum wage increase in 2027.
Maine’s Medicaid program does not pay for applied behavior analysis (ABA) under CPT codes 97153 or 97155. Its Section 28 benefit bills every children’s ABA service under a single HCPCS code, H2021, and sorts service type, setting and group size with modifiers. One-to-one ABA delivered in the home or community pays $27.87 per 15-minute unit on the Section 28 fee schedule that runs from April 30 through December 31, 2026.
That figure is not a technician rate in the sense most states use the term. Under the rewritten Section 28 rule, reimbursement for direct care staff accounts “for the full cost of the supervisor,” and providers may bill supervisor time only when a supervisor fills in for absent direct care staff. Supervision by a Board Certified Behavior Analyst (BCBA) or licensed psychologist is priced into the unit rather than billed on its own code.
The rule took effect April 29 as part of a broader rebuild of Maine’s children’s behavioral health system. MaineCare’s adoption notice says the Department of Health and Human Services (DHHS) replaced the old Section 28 to simplify it, change the service names, describe its reimbursement methodology and, in part, assure compliance with the state’s settlement with the U.S. Department of Justice. Two of the rule’s transition deadlines landed in the last week of October.
How MaineCare Pays for ABA Under Section 28
Section 28, now titled Adaptive Behavior Services for Children, covers two services. Adaptive Skills Training builds daily living, social, communication and self-care skills. ABA is the more specialized service, aimed at building adaptive skills and reducing challenging behaviors. The rule treats the two as duplicative, so a child cannot receive both at the same time.
Each service carries community and school-related rates. One-to-one ABA pays $27.87 per unit in the community and $23.43 when a school delivers it under an individualized education program (IEP) or individualized family service plan (IFSP). One-to-one Adaptive Skills Training pays $20.51 and $17.36. Group rates step down with size; a two-member ABA group pays $15.19 per unit in the community. One staff member may serve up to four children at once, and at least two staff may serve up to eight.
At four units an hour, community ABA works out to $111.48. Section 28 rates also received a 1 percent cost-of-living adjustment on January 1, 2026, under a MaineCare bulletin that covered 16 sections of the benefits manual.
[Chart placeholder: Insert the original MaineCare Section 28 one-to-one rates chart here. File: Maine-Section-28-Original-Rate-Chart.png]
Figure 1. MaineCare Section 28 one-to-one rates per 15-minute unit, effective April 30 through December 31, 2026. This series’ standard comparison charts, built on the MediRate platform, track CPT 97153 and 97155 across neighboring states. Maine bills neither code, so a cross-state chart would leave Maine off entirely. Acuity instead compiled this chart directly from the state’s Section 28 fee schedule, obtained through MediRate’s state document library, using the one-to-one rate for each service and setting. All four rates bill under HCPCS H2021 and, under the rule, include the full cost of supervision, so they are not directly comparable to other states’ 97153 rates. Source: MaineCare Section 28 fee schedule (updated June 4, 2026), via MediRate.
Credentialing: BHP Certification, an RBT Option and BCBA Supervision
Direct care staff must be at least 18 and hold a high school diploma or equivalent. For ABA, staff must hold Behavioral Health Professional (BHP) certification at hire, begin BHP training within 30 days and complete it within six months, or hold Registered Behavior Technician (RBT) certification from the Behavior Analyst Certification Board at hire. The rule notes that DHHS is seeking federal approval of a State Plan Amendment related to those staffing provisions.
The rule also set a deadline for current workers. Staff employed as of April 28 who were hired on or after April 30, 2025, and who lacked full BHP certification had until October 29, 2026, or one year from hire, whichever came first, to obtain it.
Supervisors of ABA staff must be BCBAs or licensed psychologists with training or experience in behavior analysis. Staff who deliver 20 or more direct hours a week must receive at least four hours of supervision a month, with a prorated amount and a one-hour minimum for staff working fewer hours. Functional behavior assessments, care coordination and analysis of progress data may be delivered only by a supervisor, and supervisors may deliver functional behavior assessments, parent training and staff oversight by telehealth. The comprehensive assessment that opens each case must be completed in person.
Section 28 Eligibility Now Runs Through the Single Assessment
Except for school-related services, eligibility for Section 28 is determined through the Single Assessment process set out in Maine’s new Children’s Behavioral Health Services Global Rule. Children must be under 21, score Level 2 or higher on the age-appropriate Level of Care/Service Intensity Tool and meet service-specific criteria.
For ABA, a physician or psychologist with experience diagnosing neurodevelopmental disorders must document autism spectrum disorder or Rett syndrome. Kansas has adopted a similar gate, accepting autism diagnoses for ABA only from doctoral psychologists and physicians beginning November 1. The child also needs an Adaptive Behavior Assessment System or Vineland score from the past 12 months showing significant impairment, generally a composite two standard deviations below average. Children with other neurodevelopmental conditions can qualify if less intensive interventions have not worked and a physician or psychologist explains why ABA should, an issue CMS has raised nationally.
The threshold moved during rulemaking. A January 30 emergency rule required a Level 3 or higher score; the final rule set it at Level 2. In a May 1 explainer covering Section 28 and five other rewritten sections, DHHS said public comments led it to modify eligibility criteria “to help ensure children do not lose access to medically necessary services.”
Advocates had warned of disruption before the final rule. In April, the Portland Press Herald reported that about 3,500 Maine children use Section 28 services, according to DHHS officials, and that a Sanford nonprofit had told families it would end its Section 28 services in May, citing state-level changes among its reasons. Nancy Cronin, executive director of the Maine Developmental Disabilities Council, told the paper the situation was “a complete mess.” A DHHS spokesperson said then that the rules were not final and that the department could not speak to individual providers’ business decisions.
Children who received services before April 29 but do not meet the new criteria could keep them for 180 days from that date, a window that ended around October 26. Since July 1, an Acentra Health referral process has matched providers with open capacity to the longest-waiting child on the statewide community Section 28 waitlist in their area.
The DOJ Settlement Behind the Section 28 Rewrite, Now on Appeal
The Justice Department sued Maine on September 9, 2024, alleging the state violated Title II of the Americans with Disabilities Act by unnecessarily segregating children with behavioral health disabilities in hospitals, residential facilities and a juvenile detention facility. According to DHHS, a federal court approved the resulting settlement in December 2024; it is designed to keep children under 21 with behavioral health disabilities from unnecessarily entering or remaining in out-of-home placements.
The parties who signed the settlement have since tried to change it. On September 2, 2025, Maine and the Justice Department jointly asked the court to amend it, chiefly by eliminating an independent reviewer charged with reporting on the state’s compliance. They argued the changes would not lessen Maine’s obligations to children and that the state would self-report the data instead. Disability Rights Maine, the ACLU of Maine, GLAD Law and the Center for Public Representation opposed the request as amici.
On November 24, 2025, U.S. District Judge Stacey D. Neumann denied the motion, ruling that the parties had not shown the significant change in circumstances required to modify the agreement. She wrote that there was “no evidence” the changes would help the state comply, and that a change in the government’s legal position alone could not justify modification.
Maine and the Justice Department have appealed. The settlement remains in effect while the First Circuit Court of Appeals considers the case, Maine Public reported on October 28; the ACLU of Maine filed a friend-of-the-court brief opposing the changes on October 26.
The appeal comes as the Justice Department has reversed its reading of the underlying law. A June 18 opinion from its Office of Legal Counsel concluded that neither Title II of the ADA nor Section 504 imposes an integration mandate on states’ treatment of people with mental disabilities. On September 23, a federal court in Texas v. Kennedy vacated the community integration provisions of HHS’s Section 504 rule, approving a resolution the Justice Department proposed, as Acuity has reported. Neither action changed the terms of Maine’s settlement, which remains under court supervision.
How Maine’s ABA Rates Compare and What Comes Next
Because MaineCare bundles supervision into H2021 and bills no 9715x codes, its rates do not line up with its neighbors’ code by code. New Hampshire pays $17.79 for 97153 and $16.43 for 97155, as Acuity has reported, and Connecticut’s $14.00 rate for 97153 trails Massachusetts, New Hampshire and Vermont, according to Acuity’s Connecticut installment. Maine’s $27.87 covers technician time plus supervisor cost, so the figures are not directly comparable. MediRate maintains the underlying rate detail for state Medicaid programs nationwide.
Two open questions will shape 2027. The rule’s cost-of-living provision applies each January 1, tied to the increase in Maine’s minimum wage, but only to services that did not receive a rate adjustment in the prior 12 months. MediRate data show the April schedule left Section 28 rates unchanged from January 1, 2026, so the rewrite itself did not change rates. If Section 28 qualifies for a January COLA, the increase would track Maine’s minimum wage, which rises from $15.10 to $15.70 on January 1, 2027, about 4 percent. The staffing provisions, including the RBT pathway, are also tied to the State Plan Amendment DHHS says it is seeking.
Federal scrutiny of ABA is rising regardless of coding: CMS reported a 421 percent rise in Medicaid and CHIP ABA spending from 2021 to 2025 when it released its state ABA toolkit on August 4. And because Maine does not price 97155, the 2027 CPT split of that code does not touch its fee schedule.
Frequently Asked Questions
What does MaineCare pay for ABA in 2026?
The Section 28 fee schedule effective April 30, 2026, pays $27.87 per 15-minute unit for one-to-one ABA in the community and $23.43 for school-related one-to-one ABA, both under H2021. Group rates are lower, and all rates include the cost of supervision.
Does Maine Medicaid use CPT codes 97153 and 97155?
No. Section 28 bills ABA and Adaptive Skills Training under HCPCS H2021 with modifiers for service type, setting and group size. Supervisor time is not billed separately except when a supervisor stands in for absent direct care staff.
Who can deliver and supervise ABA under Section 28?
ABA direct care staff need BHP certification or RBT certification, under staffing provisions tied to a pending State Plan Amendment. Supervisors must be BCBAs or licensed psychologists with behavior-analytic training, and staff working 20 or more hours a week need at least four hours of supervision a month.
How does a child qualify for Section 28 ABA?
Outside school settings, through the Single Assessment, with a Level 2 or higher score on the Level of Care/Service Intensity Tool, a documented autism or Rett syndrome diagnosis and a qualifying adaptive behavior score. A separate pathway covers other neurodevelopmental conditions.
