Model Waiver II Services

Model Waiver II services are community based in home waiver services for ventilator dependent individuals. These services are provided to an individual who is dependent on a ventilator at least 12 hours per day and would otherwise require nursing facility level of care in a hospital based nursing facility.

An individual who is enrolled in the Model Waiver II program may receive:

• up to 16 hours per day of registered nurse or license practical nurse care or
• services of a respiratory therapist, registered or certified by the National Board of Respiratory Care

You may be  eligible for Model Waiver II Services if:

• An individual shall be considered ventilator (or respiration stimulating mechanism) dependent if the individual requires mechanical support for 12 or more hours per day as defined by 907 KAR 1:022 Section 7(2)(a).
• You meet the income and resource limitations required by the program.

• A physician request that a Home Health Agency conduct an assessment of the person's condition to determine appropriateness of Model Wavier II services.
• The home health agency provider telephones the QIO to provide information necessary to perform the level of care determination as defined by Section 7 of 907 KAR 1:022.
• 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 Model Waiver II provider completes the comphrensive assessment process by:
  • Developing an individual plan of care
  • Advise the patient(caregiver) go to the local local Department for Community Based Services (DCBS) Office to apply for Medicaid
  • Advise the patient(caregiver) about freedom of choice
  • Submit MAP 109 -Requesting specific services
  • Reevaluation for Model Waiver II services is required every 60 days.
• Level of care determination is required every six months.