​​​​Supports for Community (SCL) is Kentucky Medicaid provider type 33. To bill Kentucky Medicaid, an SCL waiver provider must be:  

• Certified and meet the provider participation requirements in 907 KAR 12:010.
  
• Enrolled as a Kentucky Medicaid provider. 
  

Covered Services

The SCL and MPW waivers provide services traditional Medicaid does not cover to adults and children with intellectual or developmental disabilities. Services include behavior supports, personal assistance/community living supports, and residential support services (SCL only). SCL and MPW services help individuals live in the community as independently as possible. 

An SCL service provider must meet the coverage provisions and requirements in 907 KAR 12:010  and 907 KAR 12:020. An MPW service provider must meet the coverage provisions and requirements in 907 KAR 1:835. Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations. All services must be medically necessary. 

Verify Eligibility

Verify eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System. 

Reimbursement

SCL waiver services are reimbursed per 907 KAR 12:020. MPW waiver services are reimbursed per 907 KAR 1:835. 

Service Authorization

Case managers approve most 1915(c) HCBS services. Kentucky Medicaid reviews requests for high-cost or high-skill services. If you have questions, please email the 1915(c) Waiver Help Desk or call (844) 784-5614.

Claims Submission

Kentucky Medicaid currently contracts with Gainwell Technologies to process Medicaid fee-for-service claims.

Coding: Kentucky Medicaid utilizes the National Correct Coding Initiative edits and the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Current Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.

Claim Appeals: Appeal requests made on denied fee-for-service claims must be submitted to DXC and include the reason for the request along with a hard-copy claim.

Timely Filing: Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months from the last Kentucky Medicaid denial.

Provider Contact Information

If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions - Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization - (844) 784-5614
Provider Enrollment or Revalidation - (877) 838-5085
KYHealth-Net assistance - Gainwell Technologies - (800) 205-4696