​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Supports for Community (SCL) is Kentucky Medicaid provider type 33. To bill Kentucky Medicaid, an SCL waiver provider must be:  

• Certified and meet the provider participation requirements in 907 KAR 12:010.
  
• Enrolled as a Kentucky Medicaid provider. 
  

Covered Services

The SCL and MPW waivers provide services traditional Medicaid does not cover to adults and children with intellectual or developmental disabilities. Services include behavior supports, personal assistance/community living supports, and residential support services (SCL only). SCL and MPW services help individuals live in the community as independently as possible. 

An SCL service provider must meet the coverage provisions and requirements in 907 KAR 12:010  and 907 KAR 12:020. An MPW service provider must meet the coverage provisions and requirements in 907 KAR 1:835. 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

Verify eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System. 

​ 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. ​

​Reimbursement

SCL waiver services are reimbursed per 907 KAR 12:020 and Provider Letter #A-53. MPW waiver services are reimbursed per 907 KAR 1:835. Current reimbursement rates for SCL and MPW are available on the DMS Fee and Rate Schedule webpage​. 

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 Ke​ntucky 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 Medicaid fee-for-service claims.

Find FFS Provider Billing Instructions

Coding: Kentucky Medicaid utilizes the National Correct Coding Initiative edits and 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 and 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 from 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 1:022​ - Nursing facility and intermediate care facility level of care
907 KAR 12:010 - SCL waiver
907 KAR 12:020 - Reimbursement for SCL waiver services
907 KAR 1:835​ - MPW waiver and reimbursement

Provider Resources

​ MAP Forms
MAP-351: Medicaid Waiver Assessment (MPW) 
MPW/SCL Employment Services PA Request Form​
Search all MAP forms​​

Provider Letters
MPW Assessment Team Qualifications
MPW Assessment Guidance​
Search all Provider Letters ​

Helpful Links
SCL Waiver Information
MPW Waiver Information
SCL Provider Summary
SCL Exceptional Supports Process Information
Electronic Visit Verification 
Medicaid Waiver Management Application (MWMA) Guides and Information
Incident Reporting: Instructional Guide and FAQ​
Service Authorization Crosswalks, Training and Resources​​

If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - Gainwell Technologies - (800) 807-1232
MPW and SCL Policy Questions - Contact Your DBHDID Quality Administrator