Kentucky - Home Health Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Kentucky Provider Type 34 Home Health Agency (HHA) services operate under 907 KAR 1:030 and require dual approval from the Cabinet for Health and Family Services (CHFS) Office of Inspector General (OIG) and the Department for Medicaid Services (DMS). The service delivers intermittent skilled nursing, home health aide services, and therapies to Medicaid enrollees under a physician-ordered plan of care.

Applicants must secure a Certificate of Need (CON) from the CHFS OIG Division of Certificate of Need before applying for a state license under 902 KAR 20:081. Following licensure, agencies must obtain Medicare certification, as Kentucky Medicaid sequences PT 34 enrollment strictly behind Medicare approval and blocks applications with effective dates preceding the Medicare effective date.

1. Service Definition and Scope

Home Health Agency services in Kentucky are defined under 907 KAR 1:030 as intermittent skilled nursing, home health aide services, and therapies provided to Medicaid enrollees.

Services must be delivered under a physician's plan of care and cannot duplicate other Medicaid services provided during the same time period.

• Provider Type: PT 34 Home Health Agency.
• Regulatory Definition: 907 KAR 1:030 Section 1(5) defines an HHA as a Medicare and Medicaid-certified agency licensed under 902 KAR 20:081.
• Core Services: Intermittent skilled nursing, physical therapy, speech-language pathology, and home health aide services.
• Duplication Rule: 907 KAR 1:030 Section 5 prohibits billing HHA services concurrently with standalone therapy for the same time period.
• Electronic Signatures: Permitted under KRS 369.101 to 369.120 provided the agency implements a written security policy.

2. Regulatory and Oversight Agencies

The Cabinet for Health and Family Services (CHFS) divides oversight between the Office of Inspector General (OIG) for licensure and the Department for Medicaid Services (DMS) for enrollment.

Managed Care Organizations (MCOs) handle credentialing and authorization for enrolled members once the DMS enrollment is complete.

• Licensing Agency: CHFS Office of Inspector General (OIG) (https://chfs.ky.gov/agencies/os/oig).
• CON Authority: CHFS OIG Division of Certificate of Need (https://chfs.ky.gov/agencies/os/oig/dcn/Pages/cn.aspx).
• Medicaid Authority: Department for Medicaid Services (DMS) (https://chfs.ky.gov/agencies/dms).
• Enrollment Portal: KY MPPA (Kentucky Medicaid Partner Portal Application) (https://medicaidsystems.ky.gov/Partnerportal/home.aspx).

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky strictly gates Home Health Agency licensure and enrollment through a Certificate of Need and Medicare certification.

An agency cannot simply apply for a license; it must first prove need, and it cannot enroll in Medicaid until Medicare approves it.

• Certificate of Need (CON): Required prior to licensure application, administered by CHFS OIG Division of Certificate of Need.
• Medicare Certification: 907 KAR 1:030 Section 1(5) requires PT 34 agencies to be Medicare-certified.
• Medicare Sequencing: KY MPPA hard-stops PT 34 applications if the requested Medicaid effective date precedes the Medicare effective date.
• NPI Registration: Organizational Type 2 NPI must be active in NPPES with a matching primary taxonomy.
• IRS Verification: Pre-printed IRS FEIN verification letter is required; Form W-9 is explicitly rejected.

4. Licensure and Certification Requirements

Licensure is governed by 902 KAR 20:081, which establishes minimum standards for operation and services.

Agencies must submit Form OIG004117 and pass an initial survey to receive a provisional license.

• Licensure Regulation: 902 KAR 20:081 establishes minimum standards for operation and services.
• Application Form: Home Health License Application (OIG004117).
• Required Documentation: Organizational structure, medical personnel list, and administrative/operational policies.
• Coordination Agreement: Required agreement to coordinate health care services within the agency's service area.
• Dementia Training: Compliance with dementia-specific training requirements for home health aides under KRS 216.9375(11)(a).

5. Medicaid Provider Enrollment

Enrollment is processed electronically through KY MPPA under 907 KAR 1:671 and 907 KAR 1:672.

Paper applications are not accepted per KRS 205.532, and the process can take up to 90 days.

• System: KY MPPA accessed via KYID (formerly KOG).
• Provider Category: Must select Entity or Group correctly at initiation, as it locks upon advancing.
• Application Fee: $750 for institutional providers in 2026 (proof of payment to Medicare satisfies this).
• Outstanding Debt: DMS will automatically return an application if the provider has an unsettled account receivable.
• Revalidation: Required at intervals not to exceed five years.

6. Staffing, Training and Background Checks

Staffing standards are defined in 902 KAR 20:081 and 907 KAR 1:030.

Agencies must maintain qualified nursing and therapy staff with current credentials and health clearances.

• Nursing Staff: Licensed Practical Nurses (LPNs) must be licensed under KRS 314.051.
• Home Health Aides: Defined and regulated under KRS 216.935(3).
• CPR Certification: Direct care staff must have documented, current CPR certification.
• Tuberculosis Testing: Documentation of employee TB tests is required.
• Dementia Training: Home health aides must complete dementia-specific training per KRS 216.9375.

7. Documentation, Policies and Records

Agencies must maintain comprehensive operational and clinical records.

Electronic signatures are permitted if specific security policies are in place.

• Electronic Signatures: Must comply with KRS 369.101 to 369.120.
• Security Policy: Providers using electronic signatures must develop and implement a written security policy.
• Ownership Disclosures: Required at initial application and annually thereafter in KY MPPA.
• Malpractice Coverage: Declaration page showing current effective dates must be uploaded during enrollment.
• Address Matching: Practice addresses must match exactly across NPPES, CAQH, and the KY MPPA application.

8. Billing, Rates and Claims

Claims processing is handled through KYMMIS and KY Health Net, separate from the KY MPPA enrollment system.

Providers must bill the appropriate MCO for managed care enrollees.

• Claims System: KYMMIS and KY Health Net process claims and remittance advice.
• Third Party Liability: Providers must comply with KRS 205.622 regarding third-party payers.
• MCO Billing: Claims for managed care members are billed directly to the contracted MCO (e.g., Aetna Better Health of Kentucky, Passport by Molina).
• Financial Risk: Services delivered before the official DMS effective date are at the provider's own financial risk.
• EFT Updates: Adding an EFT account requires a bank letter or voided check submitted via a maintenance application.

9. Approval Sequence and Timeline

The approval process is strictly sequential, beginning with the CON and ending with MCO credentialing.

DMS enrollment takes up to 60-90 days, and MCO credentialing cannot begin until the Medicaid ID is active.

• Step 1: Obtain Certificate of Need from CHFS OIG.
• Step 2: Apply for provisional Home Health licensure (Form OIG004117).
• Step 3: Obtain Medicare certification (required for PT 34).
• Step 4: Submit KY MPPA enrollment (takes 60 to 90 days per KRS 205.532 and 907 KAR 1:672).
• Step 5: Request network participation and credentialing with Kentucky MCOs.

10. Common Denials and Survey Findings

Enrollment applications are frequently returned to the provider (RTP) for documentation mismatches or sequencing errors.

Licensure surveys focus on personnel files and policy adherence.

• Medicare Date Error: KY MPPA hard-stops PT 34 applications if the requested effective date precedes the Medicare effective date.
• Invalid FEIN Proof: Submitting a Form W-9 instead of an IRS pre-printed letter causes automatic rejection.
• Address Mismatches: Discrepancies between NPPES, CAQH, and KY MPPA trigger returns.
• Unsettled Debt: DMS halts applications if the entity owes an outstanding debt to the department.
• Invalid ID: Submitting a Social Security card marked not valid for employment results in rejection.

11. Key Contacts and Resources

Providers utilize specific portals and contact centers for enrollment and licensure inquiries.

The KY MPPA Contact Center is the primary support line for Medicaid enrollment issues.

• KY MPPA Contact Center: (877) 838-5085 (Ext 1 for technical, Ext 2 for policy).
• CHFS OIG Division of Certificate of Need: https://chfs.ky.gov/agencies/os/oig/dcn/Pages/cn.aspx
• KY MPPA Portal: https://medicaidsystems.ky.gov/Partnerportal/home.aspx
• Aetna Better Health of Kentucky: https://www.aetnabetterhealth.com/kentucky/providers.html
• Passport by Molina Healthcare: https://www.molinahealthcare.com/providers/ky/passport/home.aspx

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