Kentucky - I/DD Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Kentucky funds intellectual and developmental disability services primarily through the Supports for Community Living (SCL) and Michelle P. Waiver (MPW) programs, which are overseen by the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID). These 1915(c) waivers provide a continuum of care ranging from supported employment and day training to 24-hour residential services for individuals with I/DD.

Before an agency can submit a Medicaid enrollment application to the Department for Medicaid Services (DMS), it must first pass DBHDID's multi-step provider certification process, which requires submitting a Letter of Intent, completing mandatory New Provider Orientation, and passing an On-Site Pre-Service Readiness Review. Only after DBHDID issues a formal certification letter can the provider access the Medicaid Partner Portal Application (MPPA) to obtain a Medicaid ID.

1. Service Definition and Scope

Kentucky's I/DD waiver array encompasses services designed to allow individuals to live in the community rather than in intermediate care facilities (ICF/IID). The SCL waiver focuses on individuals requiring intensive, often 24/7 support, while the MPW provides alternative community services for those who do not require residential habilitation.

Providers can be certified for specific services within these waivers, meaning an agency must explicitly define its scope during the DBHDID certification process.

• Supports for Community Living (SCL): Provides residential, day training, and supported employment services.
• Michelle P. Waiver (MPW): Provides personal assistance, respite, and day training without a residential component.
• Residential Support Services: Includes staffed residences and family home providers (adult foster care) under SCL.
• Day Training: Facility-based or community-based services focusing on daily living and socialization skills.
• Supported Employment: Assistance with obtaining and maintaining competitive employment in the community.

2. Regulatory and Oversight Agencies

The Cabinet for Health and Family Services (CHFS) is the umbrella agency for all Medicaid and human services in Kentucky. Within CHFS, distinct departments handle the programmatic, financial, and facility-licensing aspects of I/DD services.

DBHDID acts as the operating agency for the waivers, while DMS retains ultimate authority over Medicaid funding and provider enrollment.

• Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID): Operates the waivers and certifies providers (https://chfs.ky.gov/agencies/dbhdid).
• Department for Medicaid Services (DMS): Manages Medicaid enrollment, billing, and overall waiver authority (https://chfs.ky.gov/agencies/dms).
• Office of Inspector General (OIG): Licenses specific facility types, such as Adult Day Health or residential facilities, if applicable to the service model (https://chfs.ky.gov/agencies/os/oig).
• Gainwell Technologies: Acts as the fiscal agent for Kentucky Medicaid fee-for-service claims processing (https://kymmis.com).

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky does not require a Certificate of Need (CON) for standard HCBS waiver agencies, but it strictly gates Medicaid enrollment behind DBHDID programmatic certification. An applicant cannot simply apply to Medicaid; they must first be invited to apply for certification by DBHDID.

The state periodically updates its orientation schedules, and applicants must wait for an open New Provider Orientation slot before their Letter of Intent is actionable.

• Letter of Intent (LOI): Must be submitted to DBHDID to initiate the certification process before any application is accepted.
• New Provider Orientation: Mandatory training that agency directors must attend before receiving the full certification packet.
• DBHDID Pre-Service Readiness Review: An on-site inspection by DBHDID to verify operational readiness, safety, and policy compliance before certification is granted.
• OIG Licensure Prerequisite: If providing facility-based day training or specific residential models, the physical location must secure OIG licensure before DBHDID will finalize certification.

4. Licensure and Certification Requirements

Under 907 KAR 7:005, all 1915(c) waiver providers must be certified by the appropriate operating agency (DBHDID) before enrolling in Medicaid. The certification process evaluates the agency's administrative capacity, financial stability, and alignment with the waiver's fidelity models.

Providers must submit a comprehensive certification packet that includes detailed policies, procedures, and proof of required insurance.

• Certification Packet: A comprehensive submission to DBHDID detailing agency structure, service models, and staff qualifications.
• Policies and Procedures: Must align with 907 KAR 12:010 (SCL) or 907 KAR 1:835 (MPW) requirements, including participant rights and incident management.
• Financial Solvency: Applicants must demonstrate sufficient operating capital to sustain services prior to initial Medicaid reimbursement.
• Commercial Liability Insurance: Proof of adequate general and professional liability coverage is required in the certification packet.

5. Medicaid Provider Enrollment

Once DBHDID issues the official certification letter, the agency must enroll as a Kentucky Medicaid provider through the Medicaid Partner Portal Application (MPPA). Enrollment requires paying the federal application fee and undergoing standard screening.

Providers must also register for the Medicaid Waiver Management Application (MWMA), which is the mandatory system for managing waiver participant care and incident reporting.

• Medicaid Partner Portal Application (MPPA): The online portal used for submitting the Medicaid enrollment application (https://mppa.ky.gov).
• DBHDID Certification Letter: Must be uploaded into MPPA as proof of eligibility to enroll as a waiver provider.
• Application Fee: Payment of the CMS-mandated provider enrollment fee (or proof of hardship waiver/prior payment) is required.
• Medicaid Waiver Management Application (MWMA): Mandatory system access required for all HCBS waiver providers to manage plans of care (https://www.chfs.ky.gov/agencies/dms/dca/Pages/mwma.aspx).

6. Staffing, Training and Background Checks

Kentucky requires rigorous background screening and training for all Direct Support Professionals (DSPs). Training compliance is tracked centrally through the DBHDID Training Records Information System (TRIS).

Agencies must ensure staff complete required modules, such as those offered through the College of Direct Support, before providing unsupervised care.

• Background Checks: Mandatory state police background checks and registry checks (abuse/neglect) prior to employment.
• DBHDID-TRIS: The web-based Training Records Information System where all DSP training hours and certifications must be logged (https://chfs.ky.gov/agencies/dbhdid/Pages/tris.aspx).
• First Aid and CPR: All direct care staff must maintain current, in-person CPR and First Aid certification.
• College of Direct Support (CDS): Online curriculum often utilized to meet DBHDID's foundational training requirements for DSPs.

7. Documentation, Policies and Records

Pursuant to 907 KAR 1:160, waiver providers must maintain detailed clinical and financial records for every participant. The state mandates specific forms for assessments and care planning.

Incident reporting is highly regulated and must be entered directly into the MWMA system within strict timeframes.

• MAP-109 Form: The Plan of Care/Prior Authorization for Waiver Services that must be completed and maintained in the participant's file.
• MAP-350 Form: The Long Term Care Facilities and Home and Community Based Program Certification Form signed by the participant.
• Record Retention: Clinical and fiscal records must be retained for at least six (6) years from the date of service.
• Incident Reporting: Critical incidents must be reported via MWMA, often within 8 to 24 hours depending on severity.

8. Billing, Rates and Claims

I/DD waiver services are billed to Kentucky Medicaid's fiscal agent, Gainwell Technologies, using standard HIPAA-compliant claim formats. Rates are established by DMS and published in the waiver fee schedules.

Certain services, particularly personal care and in-home respite, are subject to Electronic Visit Verification (EVV) mandates.

• Gainwell Technologies: The MMIS contractor processing fee-for-service waiver claims.
• Electronic Visit Verification (EVV): Required for applicable in-home services to capture time, location, and service delivery data.
• DMS Fee Schedule: Published by Medicaid, dictating the exact reimbursement rates for SCL and MPW procedure codes.
• Prior Authorization: Claims will deny if the service is not explicitly authorized on the participant's approved MAP-109 in MWMA.

9. Approval Sequence and Timeline

Becoming an I/DD waiver provider in Kentucky is a lengthy process, typically taking 6 to 9 months from the initial Letter of Intent to receiving a Medicaid ID.

Delays often occur during the DBHDID policy review phase or while waiting for an available On-Site Pre-Service Readiness Review.

• Step 1: Submit Letter of Intent to DBHDID.
• Step 2: Attend DBHDID New Provider Orientation.
• Step 3: Submit full Certification Packet to DBHDID (reviewed within 30-60 days).
• Step 4: Pass DBHDID On-Site Pre-Service Readiness Review.
• Step 5: Receive DBHDID Certification Letter.
• Step 6: Submit MPPA Medicaid Enrollment Application (processed within 30-45 days).

10. Common Denials and Survey Findings

DBHDID frequently denies certification packets that contain generic policies not tailored to Kentucky's specific waiver regulations (907 KAR 12:010 or 907 KAR 1:835).

During post-enrollment surveys, the Office of Inspector General (OIG) or DBHDID commonly cite providers for failing to maintain accurate training records in TRIS.

• Generic Policies: Denials for submitting boilerplate manuals that do not reference Kentucky KAR citations or MWMA processes.
• TRIS Deficiencies: Citations for failing to upload DSP training sign-in sheets to the DBHDID-TRIS system.
• Background Check Gaps: Findings related to staff providing care before background checks are fully cleared.
• Care Plan Deviations: Billing for services that do not match the frequency or duration specified in the MAP-109.

11. Key Contacts and Resources

Prospective providers must utilize the official CHFS portals and department websites to access current manuals, fee schedules, and training schedules.

Technical assistance is available through DBHDID for certification questions and through Gainwell for billing issues.

• DBHDID Provider Information: https://chfs.ky.gov/agencies/dbhdid
• Medicaid Partner Portal Application (MPPA): https://mppa.ky.gov
• Medicaid Waiver Management Application (MWMA): https://www.chfs.ky.gov/agencies/dms/dca/Pages/mwma.aspx
• DBHDID-TRIS System: https://chfs.ky.gov/agencies/dbhdid/Pages/tris.aspx
• Kentucky Medicaid Provider Directory/Gainwell: https://kymmis.com

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