The Michelle P. Waiver (MPW) is recognized in Kentucky Medicaid as a Supports for Community (SCL) Waiver provider. They are recognized in Kentucky Medicaid as Provider Type (33) and may bill Kentucky Medicaid using this provider type number. In order for any MPW service provider to provide services to a Medicaid beneficiary, it must:
- be licensed
- be enrolled as a Kentucky Medicaid provider
What are MPW Services? The MPW is a home- and community-based waiver program of the Kentucky Medicaid program developed as an alternative to institutional care for people with intellectual or developmental disabilities. The waiver allows individuals to remain in their homes with services and supports.
MPW offers a variety of services to support an individual's goals, choices, and priorities including but not limited to:
- Behavioral Supports: Help to identify and reduce behaviors that interfere with activities of daily living, social interaction, or work
- Day Training: Services designed to help an individual participate in meaningful, daily routines within the community
- Environmental and Minor Home Adaptation: Changes to a person's home that ensure their health, safety, and welfare, increase independence, and allow them to continue to live in the community
- Personal Care: Help with tasks a person cannot do on his or her own due to an intellectual or developmental disability including bathing, dressing, grooming, light housework, laundry, and meal planning and preparation
- Occupational, Physical, and Speech Therapy: These services are only offered to individuals older than 21.
- Respite: Provides a short term break for a person's primary, unpaid caregiver.
Currently, there is a waiting list for MPW services and supports. Placement on the waiting list is determined by the date your completed application is received.
To view a full listing of the available supports and services, visit the Division of Developmental and Intellectual Disabilities(DDID) SCL website.
A MPW service provider must meet the coverage provisions and requirements set forth in
907 KAR 1:835. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow Kentucky Medicaid regulations for which it participates. All services must be medically necessary.
Reimbursement: Reimbursement for MPW services is in accordance with
907 KAR 1:835.
HCBS Waiver services requiring prior authorization must contact
Service Authorization Changes: Effective Nov. 25, 2019, Carewise Health will no longer approve person-centered service plans (PCSPs) for 1915(c) HCBS waivers. Case managers will take over this task for most services. Today, DMS notified case managers of several upcoming deadlines related to this change. We have included a copy of the notice in this email to make all stakeholders aware as the deadlines could affect re-certifications or emergency modifications to PCSPs.
Read the Service Authorization Deadlines Memo.
Kentucky Medicaid currently contracts with DXC to process the Kentucky Medicaid fee for service (FFS) claims.
Coding: Kentucky Medicaid utilizes the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15) Kentucky Medicaid requires the use of CMS 1500 billing forms. (eff: 02/12) Providers will need to bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied FFS claims must be submitted to DXC. The request must include the reason for the request along with a hard copy claim.
Timely Filing: Claims must be received within 12 months from the date of service (DOS) or 6 months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - DXC
- (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - CareWise
- (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085KyHealth.net
- (800) 205-4696