Model II Waiver (MIIW) Services

Program Update
Private Duty Nursing (PDN)

August 2011

The Department for Medicaid Services (DMS) identified the need for additional access to providers who can provide high-skill PDN for MllW recipients. The Centers for Medicare and Medicaid Service and DMS have approved PDN agencies to provide services for MllW.

The provider type for the MllW is 41. Providers who wish to enroll may refer to the Enrollment Requirements and Enrollment forms.

MIIW services are community-based, in-home waiver services for ventilator-dependent individuals. These services are provided to an individual who is dependent on a ventilator at least 12 hours per day and would otherwise require nursing facility level of care in a hospital-based nursing facility as defined by 907 KAR 1:022.

An individual enrolled in MIIW may receive up to 16 hours of PDN services per day from a registered nurse, licensed practical nurse or respiratory therapist as determined by assessment, individual needs and provider staffing.

To be eligible for MIIW Services,

• An individual is considered ventilator (respiration stimulating mechanism) dependent if he/she requires mechanical support for 12 or more hours per day as defined by 907 KAR 1:022 Section 7(2)(a).
• Meets the income and resource limitations required by the program.

• A physician order is required to request a PDN agency or a home health (HH) agency to assess the person's condition to determine individual needs for appropriateness of MIIW services.
• A physician's statement is required for validating that an individual is ventilator dependent for at least 12 hours per day.
• The PDN or HH agency contacts the QIO to provide required information for the level of care determination.
• The QIO sends the determination within five working days by means of confirmation notice or adverse action form.
• If QIO gives approval (confirmation notice), the MIIW provider completes the comprehensive assessment process by:
  • Developing an individual plan of care
  • Advise the patient (caregiver) go to the local local Department for Community Based Services (DCBS) Office to apply for Medicaid
  • Advise the patient (caregiver) about freedom of choice
  • Submit MAP-109 (MIIW) - Requesting specific services
• Reevaluation for MIIW services is required every 60 days.
• Level of care determination is required every six months.