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Model II Waiver (MIIW) Services

MIIW services are community-based, in-home waiver services for an individual who is dependent on a ventilator 12 hours or greater per day, meets High Intensity nursing care services 24 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. Click below to view:

Program Updates

Model II Waiver Update

(October 2012) - MIIW providers shall verify the criteria for the Model ll waiver services are met by accurate and specific assessment and documentation on the MAP-351A (assessment), MAP-109 (MIIW) (Plan of Care) and nursing documentation.

  • Meets Ventilator dependent 12 hours or greater/day/24 hours
  • Recipient possess a permanent tracheostomy;
  • Meets High Intensity nursing care services 24 hour/day; and
  • Physician validates criteria is met.

Providers are required to document the times the recipient is actually on the ventilator on the MAP-351A and the MAP-109 (MWII);

  • Agencies should not provide PDN services when recipient is off the ventilator and determined to have stable respirations.
  • Agencies may provide PDN services when recipient is off the ventilator during physician ordered weaning schedule until it has been determined the recipient has stable respirations.
  • Agencies should not routinely request 16 hours/day.
  • Agencies should assess needs for PDN hours/ units and provide appropriate documentation for requested hours/units.

The MAP-351A documentation should be recipient specific, accurate, and age appropriate which reflect the required nursing care services.

The Map 109 (MWII) should be specific for needs as determined by assessment and utilization of documentation from the MAP-351A assessment.

Required Nursing documentation includes:

  • Indicate time on and off ventilator
  • Nursing care services which are addressed on the Plan of Care with measurable goals/outcomes
  • Concerns, status changes and pertinent information
  • Care needs that are performed by the recipient, and/or caregiver(s)
  • Documentation of caregiver's competence in performance of patient care.

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Private Duty Nursing (PDN) Update

(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.

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MWII Services

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 ventilator dependency needs and provider staffing.

  • Agencies shall assess for PDN hours as needed.
  • Agencies should not routinely request 16 hours/day.

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Eligibility Requirements

To be eligible for MIIW Services,

  • An individual is considered ventilator dependent if he/she requires mechanical support for 12 or more hours per day/24 hours as defined by 907 KAR 1:022 Section 7(2)(a).
  • Recipient possess a permanent tracheostomy (for positive
    pressure ventilation)
  • Meets High Intensity nursing care services 24 hour/day
  • Primary caregivers shall have the ability to accept and understand the purposes, responsibilities, risks, and benefits of home ventilator therapy.
  • The patient's family/primary caregiver must be capable of comprehension and performance of duties and responsibilities relative to ventilator dependent patient care.
  • Adequate family support systems including a primary caregiver and a secondary caregiver.
  • Meets the income and resource limitations required by the program.

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Eligibility Process
  • A physician's 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 12 hours or greater 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:
  • Reevaluation for MIIW services is required every 60 days.
  • Level of care determination is required every six months.

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

Regulations

Policy Information

Provider Letters

To view older provider letters, refer to the Provider Letter page.

Forms

  • MAP-109 (MIIW) - Plan of Care/Prior Authorization for Model II Waiver Services
  • Map-350 (MIIW) - Long Term Care Facilities and Home and Community Based Program Certification Form
  • MAP-351A - Medicaid Waiver Assessment

Billing Information

 

If you have questions
 

Regarding Policy, contact:
Division of Community Alternatives
Home and Community Services Branch
275 East Main St.,
6 W-B
Frankfort, KY 40621
Phone: (502) 564-5560
Email: CHFS DMS Webmaster

Regarding enrolling as a provider, refer to the provider enrollment website.

 

Last Updated 12/5/2012
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