Attention Providers of Sections 17, 65, and 92 Adult Behavioral Health Services: Service Termination Approval Requirements

Apr 24, 2023

This notice provides clarification to providers of Sections 17, 65, and 92 Adult Behavioral Health Services regarding service termination approval requirements for adults receiving behavioral health services. *There are no changes for Section 97 service termination requests. Section 97 providers should follow the existing process.*   

The MaineCare Benefits Manual requires service providers to request approval from the Department’s authorized agent, Kepro, to discharge members with Serious and Persistent Mental Illness (SPMI) prior to the actual discharge.     

Section 65 Clubhouse and Specialized Group Services   

Section 65 Clubhouse and Specialized Group Services eligibility requires a LOCUS score of 17 or greater. This requirement is also embedded in Section 17 eligibility. Given this requirement, providers must complete a Serious Mental Illness (SMI) termination request prior to discontinuing services with a member. To access training materials for completing the SMI termination request process, please visit the Kepro website.   

Section 17, 65, 92 SMI Termination Process Updated Guidance   

Once a SMI termination request has been approved through Kepro, service providers must send a 30-day notice to members prior to the actual discharge. The Department acknowledges that there are scenarios where the notification letter is not practical; in those instances, the 30-day notice requirement is waived. The following list provides Department-approved examples of when a termination letter may not be warranted:  

• The member is in hospice care. 

• The member is incarcerated.  

• The member has relocated out of state.    

For members experiencing homelessness, providers must send SMI termination letters to the last known address or to last shelter at which the member is known to have stayed.    

If an agency termination request has been denied, providers are expected to reach out to the member and attempt additional engagement. If contact is unsuccessful or if the member accepts an additional appointment and then cancels or does not show for the additional appointment, providers will need to submit a second SMI termination request. In the second SMI termination request, please include the following:  

• A statement that this is the second attempt at receiving approval for termination; and 

• A summary of additional attempt(s) and outcome with dates and method of outreach.    

For questions regarding this notice, please contact Kepro Provider Relations at 1-866-521-0027, Option 3 or via email at ProviderRelationsME@kepro.com.  Additionally, the following DHHS staff can provide support:  

• Clubhouse Services, please contact Heidi.Johnson@maine.gov or Leticia.Huttman@maine.gov.    

• For Section 17 or 65, please contact  Angie.Newhouse@maine.gov or Patrick.D.Bouchard@maine.gov.   

• For Section 92, please contact Kaley.Boucher@maine.gov.