The Community Health for Improved Lives and Development (CHILD) waiver is Kentucky Medicaid provider type 49. To bill Kentucky Medicaid, CHILD providers must:- Meet the certified waiver provider qualifications as defined in the approved waiver application.
- Be enrolled as a Kentucky Medicaid provider.
Covered Services
The CHILD waiver offers services not otherwise available through the Medicaid state plan to support qualifying children or youth in the community as they work toward their unique goals. All services will be provided by certified, Medicaid-enrolled traditional agency providers. Services include:
- Case Management
- Clinical Therapeutic Services
- Community Living Supports
- Environmental and Minor Home Modifications
- Respite
- Supervised Residential Care
A CHILD waiver provider must meet the coverage provisions and requirements of the approved waiver application. Listing of services is not a guarantee of payment. Providers must follow all relevant state Medicaid regulations.
Eligibility
Verify participant eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System.
Reimbursement
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered, during the same time.
Service Authorization
Case managers approve most 1915(c) HCBS services. DMS reviews requests for Clinical Therapeutic Services and Environmental and Minor Home Modifications. If you have questions about service authorization, call the 1915(c) Waiver Help Desk at (844) 784-5614.
Claims Submission
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Coding
Kentucky Medicaid requires providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal requests for denied FFS claims must be submitted to Gainwell Technologies. The request must include the Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please review the Kentucky Medicaid Contacts List to find additional support from Kentucky Medicaid. For more specific waiver inquiries, view the 1915(c) waiver Who to Call listing.