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Cabinet for Health and Family Services

Cabinet for Health and Family Services

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Kentucky Cabinet for Health and Family Services
Go to home - Kentucky Cabinet for Health and Family Services Kentucky Cabinet for Health and Family Services
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In this section Department for Behavioral Health, Developmental and Intellectual Disabilities

  • Division of Developmental and Intellectual Disabilities
  • Division of Program Integrity
  • Clinical Services Branch
  • Community Supports Branch
  • Crisis Prevention and Response System
  • Division of Developmental and Intellectual Disabilities
  • Division of Program Integrity
  • House Bill 144 Commission
  • Human Rights and Behavior Intervention Committees
  • Kentucky Overdose Response Effort (KORE)
  • Preadmission Screening and Resident Review (PASRR)
  • SCL and MPW Regulations
  • SCL Case Management Forms
  • SCL Certification Process Forms
  • SCL Supported Employment Forms
  • Supports for Community Living Waiver Branch
  • Supports for Community Living Waiver Branch
  • Home
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  • Department for Behavioral Health, Developmental and Intellectual Disabilities
  • SCL Case Management Forms

SCL Case Management Forms

Main Content

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

Life Story

  • 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.

Relative Content

Related Links

  • SCL Brochure
  • SCL Forms
  • SCL Program Philosophy
  • SCL Regulations
  • SCL Services​
  • SCL Tr​aining
  • Medicaid Services Division of Long Term Services & Supports
  • Michelle P. Waiver
  • New Provider Information

Additional Information

Contact Information

286

Related Agencies

  • Department for Behavioral Health, Developmental and Intellectual Disabilities
  • Department for Community Based Services

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