Kansas - Adult Companion Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

In Kansas, Adult Companion Services are primarily delivered under the state's Home and Community-Based Services (HCBS) waivers, such as the Frail Elderly (FE) waiver, where they are often billed as Senior Companion Services. These services provide non-medical supervision, socialization, and assistance with daily living tasks to help adults remain safely in their homes and communities, strictly excluding hands-on nursing care or medication administration.

The single biggest structural barrier to entry for this service in Kansas is the dual requirement of obtaining a Home Health Agency license (specifically for Non-Medical Supportive Care Services) from the Kansas Department of Health and Environment (KDHE) prior to Medicaid enrollment, followed by mandatory credentialing and contracting with the three KanCare Managed Care Organizations (MCOs). Because Kansas operates under a fully managed care model, KMAP enrollment alone does not guarantee the ability to bill; MCOs may restrict network access based on regional network adequacy, acting as a closed-network gatekeeper.

1. Service Definition and Scope

Kansas defines companion care as non-medical care, supervision, and socialization provided to an eligible waiver recipient. The service is designed to reduce social isolation and assist with activities that do not require a licensed medical professional.

Providers must operate within the strict boundaries of non-medical care. Any hands-on nursing, wound care, or medication administration requires a different level of licensure and cannot be billed under companion service codes.

• Service Code: S5135 (Senior Companion Services) is the primary code used under the HCBS-FE waiver.
• Target Population: Adults 65 years of age and older on the HCBS Frail Elderly waiver, or eligible adults on the Physical Disability (PD) or Traumatic Brain Injury (TBI) waivers.
• Included Activities: Gentle prompting for medication reminders, light household help, socialization, and assistance getting to community appointments.
• Excluded Activities: Hands-on nursing care, medication administration, and medical treatments.
• Setting Requirements: Services must be delivered in the participant's home or community settings that fully comply with the KDADS HCBS Settings Final Rule.

2. Regulatory and Oversight Agencies

Oversight of companion services in Kansas is divided among three primary state entities and three managed care organizations. Licensure is handled by the health department, waiver policy by the aging and disability department, and payment by the Medicaid agency and its contracted MCOs.

Providers must maintain compliance with the regulations of all these bodies simultaneously to remain in good standing.

• Licensing Authority: Kansas Department of Health and Environment (KDHE) (https://www.kdhe.ks.gov)
• Waiver Operator: Kansas Department for Aging and Disability Services (KDADS) (https://www.kdads.ks.gov)
• Medicaid Enrollment: Kansas Medical Assistance Program (KMAP) (https://www.kmap-state-ks.us)
• Managed Care Oversight: KanCare (https://www.kancare.ks.gov)
• MCO 1: Aetna Better Health of Kansas (https://www.aetnabetterhealth.com/kansas)
• MCO 2: Sunflower Health Plan (https://www.sunflowerhealthplan.com)
• MCO 3: UnitedHealthcare Community Plan of Kansas (https://www.uhccommunityplan.com/ks)

3. Gatekeeping Prerequisites: Who Can Even Apply

Kansas does not require a Certificate of Need (CON) for non-medical home care agencies. However, there are strict structural preconditions that block an applicant from billing Medicaid if not met in the correct sequence.

The most significant gatekeeping mechanisms are the mandatory state licensure prior to Medicaid enrollment and the MCO contracting phase, which is subject to network need.

• Licensure Prerequisite: Applicants must obtain a Home Health Agency license (Non-Medical Supportive Care Services category) from KDHE before KMAP will accept a Medicaid enrollment application.
• MCO Network Adequacy: KanCare MCOs utilize closed networks based on regional adequacy; even with KMAP enrollment, MCOs can deny contracting if they determine they have enough companion providers in a specific county.
• CDDO Affiliation (IDD Waiver Only): If attempting to serve the Intellectual/Developmental Disability waiver, providers must secure an affiliation agreement with the local Community Developmental Disability Organization (CDDO) before state approval.
• Business Registration: The operating entity must be registered and in good standing with the Kansas Secretary of State.
• Tax Clearance: Applicants must obtain and submit a State of Kansas tax clearance certificate during the affiliation and licensure processes.

4. Licensure and Certification Requirements

To provide companion services, agencies must be licensed by KDHE. Because companion care is non-medical, providers apply for a Home Health Agency license but specifically operate under the Non-Medical Supportive Care Services tier.

This license encompasses chore, companionship, and assistance with Activities of Daily Living (ADLs). An initial license is typically granted for a six-month probationary period before full licensure is awarded.

• Application Form: KDHE State Licensure Form for Home Health Agencies.
• License Category: Non-Medical Supportive Care Services (or Skilled Services if the agency also intends to provide nursing).
• Required Documents: Submission of a comprehensive business plan, organizational chart, and a full policies and procedures manual.
• Financial Solvency: A financial statement projecting the first month's operating income and expenses, with a balance sheet showing at least one month's operating expenses in cash or owner's equity.
• Administrator Qualifications: The agency must designate an administrator with documented experience in health or human services administration.
• Renewal Cycle: Licenses must be renewed annually through the KDHE portal.

5. Medicaid Provider Enrollment

Once licensed by KDHE, providers must enroll in the Kansas Medical Assistance Program (KMAP). Enrollment in KMAP is a mandatory prerequisite for contracting with the KanCare MCOs.

Kansas utilizes a multi-layered enrollment system. Providers must complete the KMAP Provider Enrollment Wizard and then separately submit MCO Contracting Request Forms to each of the three KanCare health plans.

• System: KMAP Provider Enrollment Wizard (https://portal.kmap-state-ks.us/ProviderEnrollment/EnrollmentCreate).
• Provider Type: Enroll as an HCBS Provider (Type 08) with the specific specialty codes for the target waivers (e.g., Frail Elderly).
• Application Fee: The federal Medicaid application fee applies to institutional providers and agencies unless a waiver or proof of prior payment to Medicare/another state is provided.
• Location Rules: Separate KMAP applications and distinct Provider Identification Numbers are required for each physical service location; you cannot enroll multiple locations on one application.
• MCO Contracting: After KMAP approval, providers must independently contact Aetna, Sunflower, and UnitedHealthcare to request network inclusion.
• Revalidation: Providers must revalidate their KMAP enrollment at least every 3 to 5 years per federal regulations.

6. Staffing, Training and Background Checks

Direct care workers providing companion services must meet baseline qualifications established by KDADS and KDHE. Agencies are responsible for verifying and documenting these qualifications before a worker provides any billable service.

Background checks are strictly enforced, and any history of abuse, neglect, or exploitation permanently disqualifies an individual from providing HCBS services in Kansas.

• Age Requirement: Direct care workers must be at least 18 years of age.
• Background Checks: Mandatory Kansas Bureau of Investigation (KBI) criminal record check and clearance through the Kansas Adult and Child Abuse Registries.
• Initial Training: Staff must complete training on the HCBS Settings Final Rule, participant rights, and recognizing/reporting abuse, neglect, and exploitation (ANE).
• First Aid/CPR: All direct care staff must hold and maintain current CPR and First Aid certifications.
• Competency Verification: The agency must document that the worker has the ability to communicate effectively and follow the participant's individualized plan of care.

7. Documentation, Policies and Records

Kansas requires HCBS providers to maintain rigorous documentation to justify Medicaid billing. All services must tie directly back to the KDADS-approved plan of care.

During KDHE surveys or MCO audits, missing service logs or incomplete personnel files are the most common sources of recoupment and citations.

• Care Plan Alignment: Services must be delivered strictly according to the frequency, duration, and scope outlined in the participant's KDADS plan of care.
• Service Logs: Documentation for every visit must include the date, exact start and stop times, specific activities performed, and the signatures of both the worker and the participant.
• Personnel Files: Must contain KBI background check results, CPR/First Aid certificates, initial training logs, and annual performance evaluations.
• Incident Reporting: Agencies must have written policies for reporting adverse incidents (e.g., falls, suspected abuse) to KDADS and the respective KanCare MCO within 24 hours.
• Record Retention: All clinical and financial records must be retained for a minimum of 5 years after the date of service, or longer if stipulated by specific MCO contracts.

8. Billing, Rates and Claims

In Kansas, Medicaid claims for companion services are submitted directly to the participant's KanCare MCO, not to KMAP (except for a very small fee-for-service population).

Rates are established by the state, and MCOs are required to honor the state's fee-for-service rate floor for in-network providers.

• Billing Codes: S5135 (Senior Companion Services) is standard, often requiring specific modifiers (like UD) to denote the waiver program.
• Reimbursement Floor: KanCare MCOs must pay at least 100 percent of the current KMAP fee-for-service Medicaid rate to all contracted, in-network providers.
• Out-of-Network Rate: If a provider does not contract with an MCO but is authorized to provide a service, they are considered out-of-network and receive 90 percent of the fee-for-service rate.
• Claims Submission: Claims are submitted via MCO-specific clearinghouses or portals (such as Availity).
• EVV Requirement: Electronic Visit Verification (EVV) is federally mandated and required in Kansas for all in-home personal care and companion services to validate service delivery.

9. Approval Sequence and Timeline

Becoming a fully billable companion care provider in Kansas is a sequential process that cannot be rushed. Agencies should plan for a 6 to 9-month timeline from initial business formation to billing the first claim.

Because each step depends on the approval of the previous one, delays in KDHE licensure will directly delay KMAP enrollment and MCO contracting.

• Step 1: Submit Letter of Intent and initial Home Health Agency (Non-Medical) licensure application to KDHE (takes 2-3 months for review and initial survey).
• Step 2: Receive initial 6-month probationary license from KDHE.
• Step 3: Submit KMAP enrollment application via the Provider Enrollment Wizard using the KDHE license (takes 30-60 days for KMAP approval).
• Step 4: Submit credentialing applications and negotiate contracts with Aetna, Sunflower, and UnitedHealthcare (takes 90-120 days).
• Step 5: Complete state-mandated EVV system onboarding and training.
• Step 6: Begin accepting KanCare participant referrals and billing for services.

10. Common Denials and Survey Findings

Providers frequently face application rejections or survey citations due to a misunderstanding of Kansas's multi-layered regulatory environment.

Failing to treat KMAP enrollment and MCO credentialing as two distinct, mandatory processes is the most common administrative failure for new agencies.

• Single Application Error: Attempting to enroll multiple physical office locations under a single KMAP application, resulting in immediate rejection.
• MCO Ignorance: Assuming KMAP approval automatically grants the ability to bill KanCare MCOs without completing separate MCO credentialing.
• Background Check Gaps: KDHE surveyors frequently cite agencies for allowing staff to provide care before KBI and registry background checks are fully returned and filed.
• EVV Non-Compliance: Failure to consistently use the EVV system for clocking in and out, leading to MCO claim denials.
• Care Plan Deviations: Billing for hours that exceed the participant's authorized plan of care, resulting in immediate recoupment of funds.

11. Key Contacts and Resources

Navigating the Kansas HCBS system requires interacting with multiple state portals and managed care websites. Providers should bookmark these essential resources.

For specific questions regarding waiver policies, KDADS is the primary authority, while KDHE handles all questions related to the physical agency license.

• KDHE Facilities & Licensing: Oversees Home Health Agency licensure (https://www.kdhe.ks.gov/2173/Skilled-Services)
• KDADS HCBS Programs: Manages waiver policies and Final Rule compliance (https://www.kdads.ks.gov/services-programs/long-term-services-supports/home-and-community-based-services-hcbs-programs)
• KMAP Provider Portal: For Medicaid enrollment and revalidation (https://portal.kmap-state-ks.us/ProviderEnrollment/EnrollmentCreate)
• KanCare: Managed care oversight and general MCO information (https://www.kancare.ks.gov)
• Aetna Better Health of Kansas: MCO contracting (https://www.aetnabetterhealth.com/kansas)
• Sunflower Health Plan: MCO contracting (https://www.sunflowerhealthplan.com)
• UnitedHealthcare Community Plan of Kansas: MCO contracting (https://www.uhccommunityplan.com/ks)

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