​​​​​​​​​​The Acquired Brain Injury (AB​I) and Acquired Brain Injury Long Term Care (ABI LTC) waivers are Kentucky Medicaid provider type 17. To bill Kentucky Medicaid, ABI and ABI LTC providers must:

• meet the provider participation requirements in 907 KAR 3:090 for the ABI waiver and/or 907 KAR 3:210 for the ABI LTC waiver.
  
• be enrolled as a Kentucky Medicaid provider.​​
  

Covered Services

The Acquired Brain Injury Branch operates two waivers that provide services to adults with an acquired brain injury.

• The ABI waiver is for adults with acquired brain injury who can benefit from intensive rehabilitation services designed to help them reenter the community.
  
• The ABI LTC waiver is for adults with an acquired brain injury who have reached a plateau in their rehabilitation level and require maintenance services to live safely in the community. 
  

Services include individual and group counseling, behavior supports, companion/community living supports, and residential supports. ABI and ABI LTC services help individuals live in the community as independently as possible. 

An ABI waiver provider must meet the coverage provisions and requirements of 907 KAR 3:090 and 907 KAR 3:100. An ABI LTC waiver provider must meet the coverage provisions and requirements of 907 KAR 3:​210. Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations. All services must be medically necessary. ​

Eligibility

Reimbursement

ABI waiver services are reimbursed per 907 KAR 3:100 . ABI LTC waiver services are reimbursed per 907 KAR 3:210. Current reimbursement rates for both waivers are available on the DMS Fee and Rate Schedule webpage. 

Duplication of Service

Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the service is covered during the same period.

Service Authorization

Case managers approve most 1915(c) HCBS services. Carewise Health reviews requests for high-cost or high-skill services as part of the Kentucky Medicaid Utilization Management (UM) Program. If you have questions about service authorization, please contact the UM Call Center at (800) 292-2392.   

Claims Submission

Kentucky Medicaid currently contracts with Gainwell Technologies to process the Kentucky Medicaid fee-for-service claims. 

Find FFS Provider Billing Instructions​

Coding: Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals: Appeal requests made on denied fee-for-service claims must be submitted to Gainwell Technologies. The request must include the reason for the request along with a hard-copy claim.

Timely Filing: Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.

Regulations

907 KAR - Cabinet for Health and Family Services DMS Title Page
907 KAR 7:005 - Certified waiver provider requirements
907 KAR 3:090 - ABI waiver
907 KAR 3:100 - Reimbursement for ABI waiver
907 KAR 3:210 - ABI LTC waiver and reimbursement
907 KAR 1:022​ - Nursing facility level of care 

Provider Resources

MAP Forms
MAP-10: Waiver Services Physician's Recommendations
MAP-115: Application Intake, Participant Authorization
MAP-116: Service Plan, Participant Authorization
MAP-351: Medicaid Waiver Assessment
MAP-531: Conflict-Free Case Management Exception
Search for all MAP forms 

Helpful Links​
Search for Provider Letters
ABI and ABI LTC Waiver Information
ABI Waiver Provider Summary
Electronic Visit Verificati​​on
Medicaid Waiver Management Application (MWMA) Guides and Information
Incident Reporting: Instructional Guide and FAQ
Service Authorization Crosswalks, Training and Resources​

ABI Training and Education
Brain Injury 101
Case Management for the Acquired Brain Injury​
Community Inclusion
Road to ABI
Person-Centered Principles
Rancho Levels

If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions -Gainwell Technologies - (800) 807-1232
ABI Waiver Policy Questions - (844) 784-5614
Service Authorization - (800) 292-2392
Provider Enrollment or Revalidation​ - (877) 838-5085
KyHealth-Net assistance - Gainwell Technologies - (800) 205-4696
MWMA Technical Support - (844) 784-5614, option 1 
Report Fraud and Abuse - (800) 372-2970

For more specific inquiries, view the 1915(c) waiver "Who To Call" listing.