BEHAVIORAL HEALTH SERVICES PROVIDER IN KENTUCKY

SUPPORTING MENTAL HEALTH, EMOTIONAL WELLNESS, AND RECOVERY THROUGH COMMUNITY-BASED CARE

Behavioral Health Services in Kentucky are designed to support individuals with mental health disorders, substance use disorders (SUD), and co-occurring conditions. These services help Medicaid members achieve stability, recovery, and community integration through person-centered, evidence-based interventions. Behavioral health services are covered under Kentucky’s State Plan Medicaid and may also be integrated into some Home and Community-Based Services (HCBS) waiver programs.

1. GOVERNING AGENCIES

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

Role: Administers Medicaid coverage, provider enrollment, and reimbursement for behavioral health services

Agency: Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID)

Role: Licenses behavioral health providers and oversees service delivery standards and quality

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Ensures federal compliance for behavioral health services under the State Plan and waiver programs

Agency: Managed Care Organizations (MCOs)

Role: Authorize behavioral health treatment plans, credential providers, and manage billing, utilization reviews, and care coordination

2. SERVICE OVERVIEW

Behavioral Health Services help individuals manage emotional, psychological, and substance use challenges that interfere with daily life and functioning.

Covered services may include:

• Diagnostic assessments and treatment planning

• Individual, group, and family therapy

• Crisis intervention and stabilization

• Substance use disorder (SUD) treatment and peer support

• Case management and community support

• Medication evaluation and management (by a psychiatrist or APRN)

• Targeted interventions for children, adults, and special populations (e.g., trauma survivors, justice-involved individuals)

Services must be medically necessary and documented in the participant’s Individualized Treatment Plan (ITP) or Person-Centered Service Plan (PCSP).

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register business with the Kentucky Secretary of State

• Obtain IRS EIN and Type 2 NPI

• Obtain licensure or certification from DBHDID as a Behavioral Health Services Organization (BHSO)

• Enroll through the Medicaid Partner Portal Application (MPPA)

• Maintain liability and malpractice insurance

• Employ licensed clinicians and qualified behavioral health professionals

• Develop a Behavioral Health Services Policy & Procedure Manual

• Implement HIPAA-compliant documentation, intake, billing, and quality systems

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: DBHDID Licensure

• Apply for certification as a BHSO through DBHDID

• Submit clinical staffing model, service descriptions, and compliance documentation

• Complete inspections and site readiness reviews (if applicable)

Step 2: Medicaid Enrollment via MPPA

• Apply as a Behavioral Health Provider or Mental Health/SUD Clinic

• Complete MCO credentialing for network participation

Step 3: Program Implementation

• Begin providing services per participant’s treatment plan

• Submit claims using approved CPT or HCPCS codes through MCOs or fee-for-service billing

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Kentucky business license

• IRS EIN and NPI confirmation

• BHSO license or certification

• Behavioral Health Services Policy & Procedure Manual, including:

  • Intake assessments and treatment planning templates

  • Progress notes and session documentation

  • ITP/PCSP development and review forms

  • Crisis and suicide prevention protocols

  • Participant rights and grievance policies

  • HIPAA and 42 CFR Part 2 compliance procedures

  • Staff credentialing, supervision, and licensure verification

  • Billing templates and audit documentation systems

6. STAFFING REQUIREMENTS

Role: Licensed Behavioral Health Professional (e.g., LCSW, LPCC, LMFT, Licensed Psychologist)

Requirements: Licensed in Kentucky; responsible for clinical treatment and therapy

Role: Behavioral Health Associate (e.g., case managers, peer support specialists)

Requirements: Certified or supervised; background checks and orientation required

Role (optional): Psychiatrist / Psychiatric APRN

Requirements: Licensed prescriber; medication management, diagnosis, and treatment planning

All staff must complete:

• HIPAA and 42 CFR Part 2 training

• Crisis prevention and de-escalation techniques

• Trauma-informed care and cultural competency training

• Annual continuing education as required by license or role

7. MEDICAID PROGRAMS & HCBS WAIVERS

Behavioral Health Services are available under:

• State Plan Medicaid (Traditional Fee-for-Service and MCO plans)

• Supports for Community Living (SCL) Waiver (select behavioral supports)

• Michelle P. Waiver (MPW) (behavioral interventions for individuals with ID/DD)

• Acquired Brain Injury (ABI & ABI-LTC) Waivers (neurobehavioral supports)

Service delivery settings include:

• Outpatient clinics

• Participant’s home

• Community settings (e.g., schools, employment sites)

• Telehealth platforms (as approved by Medicaid)

8. TIMELINE TO LAUNCH

Phase: Licensure and Staff Onboarding

Timeline: 2–3 months

Phase: Medicaid Enrollment and MCO Credentialing

Timeline: 60–90 days

Phase: Documentation System and Quality Compliance Setup

Timeline: 30–45 days

Phase: Program Launch and Referral Network Development

Timeline: Ongoing

9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)

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

Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID)

Website: https://dbhdid.ky.gov

Medicaid Partner Portal Application (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 BEHAVIORAL HEALTH PROVIDER

WCG supports outpatient clinics, nonprofits, and mental health professionals in launching Medicaid-compliant Behavioral Health Services across Kentucky.

Scope of Work:

• DBHDID certification assistance and site readiness checklists

• MPPA Medicaid enrollment and MCO credentialing

• Behavioral Health Services Policy & Procedure Manual

• Intake, assessment, and ITP documentation templates

• Staff credentialing logs and compliance tracking

• HIPAA and 42 CFR Part 2 templates and billing systems

• Referral network building with schools, courts, waiver teams, and PCPs

Continue To Our Client Portal To Get Started

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