Go to Kentucky.gov home page
Kentucky Cabinet for Health and Family Services (Banner Imagery) - Go to home page

Intermediate Care Facilities for Individuals with Intellectual Disabilities or Developmental Disabilities

Medicaid covers services to individuals with intellectual disabilities and/or developmental disabilities (IID/DD) who require a planned program of active treatment on an inpatient basis and who meet patient status criteria of ICF/IID/DD participating in the Medicaid program.

Click below to view:

Who is eligible

An individual shall meet ICF/IID/DD criteria if the individual requires physical or environmental management or rehabilitation for moderate to severe retardation and meets the following criteria:

  • The individual has significant developmental disabilities or significantly subaverage intellectual functioning and requires a planned program of active treatment to attain or maintain the individual's optimal level of functioning, but does not necessarily require nursing facility or nursing facility with waiver services;
  • The individual requires a protected environment while overcoming the effects of developmental disabilities and subaverage intellectual functioning while:
    • Learning fundamental living skills;
    • Learning to live happily and safely within his own limitations;
    • Obtaining educational experiences that will be useful in self-supporting activities; or
    • Increasing his awareness of his environment; or
  • The individual has a psychiatric primary diagnosis or if:
    • The mental care needs are adequately handled in a supportive environment (i.e., ICF/IID/DD) and
    • The individual does not require psychiatric inpatient treatment.

Return to the top of the page.

Are there Exclusions?

Individuals shall be specifically excluded from coverage in the following situations:

  • If the individual case is a combination of care needs beyond the capability of the facility or placement in the facility is inappropriate due to potential danger to the health and welfare of the individual, other residents, or staff of the facility; and
  • If the individual does not meet the preadmission screening and resident review criteria specified in 42 U.S.C. 1396r and 907 KAR 1:755 for entering or remaining in a facility

An individual who does not require a planned program of active treatment to attain or maintain the individual's optimal level of functioning shall not meet ICF/IID/DD patient status.

An individual shall not be denied for ICF/IID/DD services solely due to advanced age, or length of stay in an institution, or history of previous institutionalization, if the individual qualifies for ICF/ID/DD services on the basis of all other factors.

Excluding an individual with intellectual or a developmental disability to qualify for ICF/IID/DD services, the disability shall have manifested itself prior to the individual's 22nd birthday.

Return to the top of the page.

How do I apply?

An application for Medicaid may be filed at your local Department for Community Based Services Office.

At the time of application, an individual or family should bring proof of:

  • Social Security Number
  • Proof of identity (drivers license)
  • Proof of citizenship (birth certificate)
  • Health insurance
  • Medical bills
  • Income
  • Resources
  • Life insurance policies or burial reserves

A Medicaid application is more likely to be processed sooner if the individual or family provides the above information.

Return to the top of the page.

What if I want to stay in my home?

There are Medicaid Waiver programs that can provide Medicaid coverage for many different services that help you stay in your home. For more information, click here.

Return to the top of the page.

 

Regulations, Policy Information, Provider Letters, Billing Information, Forms and Directories
 

Regulations
907 KAR 1:022
907 KAR 1:065
907 KAR 1:755

Policy Information
Nursing Facility Services Manual

Provider Letters

To view a copy of the most current provider letters, go to the Provider Letter page.

Billing Information
Provider Billing Instructions

Forms

  • Map 350NF - Certification Form and Instructions (03/09)
  • Map 409 - Pre-Admission Screening and Resident Review(PASRR) Nursing Facility Identification Screen (LEVEL I)
  • Map 4092 - Exempted Hospital Discharge Physician Certification of Need for Nursing Facility Service
  • Map 4093 - Provisional Admission To A Nursing Facility
  • Map 4094 - Notification of Intent To Refer For LEVEL II PASRR
  • Map 4095 - PASRR Significant Change/Discharge Data
  • Map -726A- Nursing Level of Care Request for Admission (Rev. 09/03)

Directories
Intermediate Care Facilities

 

Contact Information:
 

For policy questions, contact:
Division of Policy and Operations
Benefits Branch
275 E. Main St.
6W-D
Frankfort, KY 40621
(502) 564-6890

Contact us by email:
CHFS DMS Webmaster

For Nurse Aid Registry Information, contact:
Kentucky Board of Nursing
312 Whittington Pky
Suite 300
Louisville, KY 40222
Phone:
Local : (502) 429-3347
Toll free: (888) 530-1919
Fax: (502) 696-3957

For billing questions, contact
(800) 807-1232

For information regarding programs and services, refer to Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID) Web site.

 

Last Updated 10/31/2013
Privacy | Security | Disclaimer | Accessibility Statement