An Official Website of the Commonwealth of Kentucky
Cabinet for Health and Family Services
In this section Department for Behavioral Health, Developmental and Intellectual Disabilities In this section Department for Behavioral Health, Developmental and Intellectual Disabilities
SCL Application
Applications are to be submitted in the Medicaid Waiver Management Application.
Medicaid Waiver Management Application
Level of Care (LOC) Determination Forms to Upload in MWMA
Supports Intensity Scale-Adult Version™: Annual Review Protocol - If the SIS was not done within the last few months and will not be done during the LOC year
SCL Level of Care Form
Prior Authorization of Person Centered Service Plan (PSCP) Forms to Upload in MWMA
MAP-116 - Service Plan Participant Authorization
POC Sign-in Sheet
Additional Forms and Tips To Use When Applicable
Emergency SCL Request Form (can be used only if already on the SCL waiting list)
LOC and Plan Paperwork Tips
MAP-531 - Freedom of Choice and Case Management Conflict Exemption
Supports Intensity Scale-Adult Version™: Annual Review Protocol Training for Case Management
All Medicaid (MAP) forms will continue to be found on the Department for Medicaid Services (DMS) SCL Web page under Forms in the right-hand column.