ADULT DAY HEALTH SERVICES PROVIDER IN KENTUCKY

Fatumata Kaba
Jul 25
4 min read

PROMOTING COMMUNITY ENGAGEMENT, HEALTH MONITORING, AND DAILY SUPPORT FOR ADULTS IN A STRUCTURED SETTING

Adult Day Health Services (ADHS) in Kentucky provide structured, facility-based programs that offer health monitoring, social interaction, and assistance with daily activities to adults with disabilities, chronic health conditions, or age-related needs. These services are designed to prevent institutionalization and provide caregiver relief while enhancing participant well-being. ADHS is reimbursable under select Kentucky Medicaid Home and Community-Based Services (HCBS) waivers.

1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)

Role: Administers Medicaid reimbursement and enrollment for Adult Day Health providers

Agency: Kentucky Department for Aging and Independent Living (DAIL)

Role: Establishes licensing and operational standards for adult day health programs

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures federal compliance with Medicaid community-based service requirements

Agency: Managed Care Organizations (MCOs) under Kentucky Medicaid

Role: Authorize ADHS in participant care plans, credential providers, and process claims

2. SERVICE OVERVIEW

Adult Day Health Services provide participants with daytime supervision, socialization, and health-related support in a licensed facility.

Authorized services may include:

Assistance with Activities of Daily Living (ADLs): toileting, grooming, mobility, eating
Medication administration and health monitoring by a licensed nurse
Therapeutic activities (music, exercise, memory support)
Social, recreational, and educational programs
Nutritionally balanced meals and snacks
Transportation to and from the center (if approved)
Care coordination with family caregivers and medical teams
Behavioral and emotional support
Fall prevention and safety monitoring

Services are outlined in each participant’s Person-Centered Service Plan (PCSP) and tailored to their functional and medical needs.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register your business with the Kentucky Secretary of State
Obtain IRS EIN and Type 2 NPI
Enroll with Kentucky Medicaid through the Medicaid Partner Portal Application (MPPA)
Obtain Adult Day Health Center certification or licensure from DAIL
Pass site inspections for safety, staffing, and ADA compliance
Maintain general liability, facility, and workers’ compensation insurance
Hire qualified staff, including RNs or LPNs for health services
Develop an Adult Day Health Services Policy & Procedure Manual
Implement HIPAA-compliant documentation systems and emergency protocols

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: Licensure & Facility Setup

Apply for Adult Day Health Center licensure or certification with DAIL
Pass inspections for fire safety, health, and sanitation

Step 2: Medicaid Enrollment

Apply as an ADHS provider via MPPA
Complete MCO credentialing and network contracting

Step 3: Documentation Submission

Submit policies, staffing plans, insurance, licenses, and inspection reports

Step 4: Service Authorization & Program Launch

Coordinate with case managers to align ADHS with participant PCSPs
Obtain MCO authorization and begin services
Submit claims using approved HCPCS codes

5. REQUIRED DOCUMENTATION

Kentucky Articles of Incorporation or business license
IRS EIN and NPI confirmation
DAIL license/certification for Adult Day Health Center
Facility safety inspection reports and zoning compliance
General liability and workers’ compensation insurance
Adult Day Health Services Policy & Procedure Manual, including:
- Participant intake forms and health assessments
- ADL assistance and medication administration logs
- Staff training and supervision records
- Daily attendance logs and activity schedules
- Emergency response and evacuation plans
- Participant rights and grievance procedures
- HIPAA compliance policies and audit documentation templates

6. STAFFING REQUIREMENTS

Role: Direct Support Staff / Program Aide

Requirements: Experience in elder or disability services; CPR/First Aid certified; background check

Role: Registered Nurse (RN) or Licensed Practical Nurse (LPN)

Requirements: Licensed in Kentucky; responsible for medication administration and health monitoring

Role (optional): Activity Coordinator, Social Worker, or Transportation Staff

Requirements: Relevant certifications or training preferred; must complete orientation and annual continuing education

All staff must complete:

HCBS participant rights and HIPAA training
Emergency drills and infection control procedures
Abuse and neglect prevention training
Continuing education as required by DAIL and waiver-specific rules

7. MEDICAID PROGRAMS & HCBS WAIVERS

Adult Day Health Services are available under:

Home and Community-Based (HCB) Waiver
Acquired Brain Injury (ABI and ABI-LTC) Waivers
Model II Waiver (MIIW)
Supports for Community Living (SCL) Waiver (day services category)

Service delivery must occur in:

A licensed adult day health center
A non-residential setting approved by DAIL and meeting federal HCBS settings criteria

8. TIMELINE TO LAUNCH

Phase: Facility Licensing and Safety Certification

Timeline: 2–3 months

Phase: Medicaid Enrollment and MCO Credentialing

Timeline: 2–3 months

Phase: Staff Hiring and Program Readiness

Timeline: 1–2 months

Phase: Participant Enrollment and Service Launch

Timeline: 30–60 days

9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)

Website: https://chfs.ky.gov/agencies/dms

Kentucky Department for Aging and Independent Living (DAIL)

Website: https://chfs.ky.gov/agencies/dail

Medicaid Provider Enrollment (MPPA): https://mppa.ky.gov

Kentucky Cabinet for Health and Family Services (CHFS)

Website: https://chfs.ky.gov

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — KENTUCKY ADULT DAY HEALTH PROVIDER

WCG supports adult day programs, home health agencies, and community-based nonprofits in launching Medicaid-compliant Adult Day Health Services across Kentucky.

Scope of Work:

Facility planning, licensing preparation, and fire inspection guidance
MPPA enrollment and MCO credentialing assistance
Policy & Procedure Manual for Adult Day Services
Staffing model design and training protocols
Participant intake packets, attendance logs, and billing templates
Emergency and incident response systems
Branding, website, and outreach materials for hospital, family, and case manager referrals