Kentucky - Skilled Respite Service — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

Kentucky funds Specialized Respite Care through its 1915(c) Home and Community Based Services (HCBS) waivers, requiring providers to hold an active Home Health Agency (HHA) or Private Duty Nursing (PDN) license from the Cabinet for Health and Family Services (CHFS) Office of Inspector General (OIG). Because Kentucky does not issue a standalone license for skilled respite, agencies must first navigate the state's Certificate of Need (CON) process to establish a home health agency before applying to deliver this waiver service.

Once licensed, providers enroll through the Kentucky Medicaid Partner Portal under 907 KAR 7:005 as a Certified Waiver Provider. Approval requires demonstrating compliance with nursing delegation protocols, maintaining RN or LPN staffing capable of managing complex medical needs like tube feedings or tracheotomy care, and securing contracts with Kentucky's Medicaid Managed Care Organizations (MCOs).

1. Service Definition and Scope

In Kentucky, skilled respite is officially termed "Specialized Respite Care" under the state's 1915(c) HCBS waiver programs. It provides short-term relief to primary caregivers of participants whose medical conditions require skilled nursing interventions that exceed the scope of standard personal care or basic respite.

This service is strictly limited to tasks that require a licensed nurse and cannot be delegated to unlicensed direct support professionals.

• Service Name: Specialized Respite Care.
• Target Population: Medicaid waiver participants requiring skilled nursing tasks.
• Covered Interventions: Ostomy care, urinary catheter care, decubitus care, tube feeding, venipuncture, insulin injections, tracheotomy care, and medical monitoring.
• Delivery Setting: The participant's home or an approved Adult Day Health Care (ADHC) center.
• Excluded Activities: Standard personal care tasks that do not require a licensed nurse.

2. Regulatory and Oversight Agencies

Oversight is divided between the licensing body and the Medicaid authority within the Cabinet for Health and Family Services (CHFS).

The Office of Inspector General handles facility licensure and surveys, while the Department for Medicaid Services manages waiver rules and provider enrollment.

• Licensing Authority: CHFS Office of Inspector General (OIG) (https://chfs.ky.gov/agencies/os/oig).
• Medicaid Authority: Department for Medicaid Services (DMS), Division of Long-Term Services and Supports (https://chfs.ky.gov/agencies/dms/dca/Pages/HCBSWaiver.aspx).
• Enrollment Portal: Kentucky Medicaid Partner Portal (https://medicaidsystems.ky.gov).
• Certificate of Need: CHFS Office of Health Data and Analytics (https://chfs.ky.gov/agencies/ohda).

3. Gatekeeping Prerequisites: Who Can Even Apply

Kentucky does not allow open enrollment for new home health agencies, which are the primary vehicle for delivering specialized respite. Applicants must clear strict market-entry barriers before OIG will accept a licensure application.

Providers cannot simply apply to be a "respite agency"; they must meet the structural requirements of a fully licensed nursing agency first.

• Certificate of Need (CON): Required for all new Home Health Agencies in Kentucky; applicants must prove geographic need before applying for licensure.
• Licensure Prerequisite: Must hold an active Home Health Agency or Private Duty Nursing Agency license to bill for skilled nursing respite tasks.
• MCO Contracting: Required to serve the majority of Medicaid participants; providers must secure network agreements with MCOs.
• Waiver Certification: Must be approved as a Certified Waiver Provider under 907 KAR 7:005.

4. Licensure and Certification Requirements

Providers must comply with 907 KAR 7:005 for waiver certification and the respective OIG regulations for their facility type.

The licensure process involves submitting detailed operational policies and passing an initial on-site survey.

• HHA Licensure: Governed by 902 KAR 20:081 for Home Health Agencies.
• Waiver Certification: Governed by 907 KAR 7:005 for 1915(c) HCBS providers.
• Application Submission: Submitted to the OIG Division of Health Care.
• Survey Readiness: Must pass an initial on-site OIG survey demonstrating clinical policy compliance.

5. Medicaid Provider Enrollment

Enrollment is processed through the Kentucky Medicaid Partner Portal. Providers must meet the participation requirements of 907 KAR 1:671 and 1:672.

After state enrollment, providers must credential with individual MCOs to receive authorizations and payments.

• System: Kentucky Medicaid Partner Portal (https://medicaidsystems.ky.gov).
• Provider Type: Enrolled as a Certified Waiver Provider or Home Health Agency.
• Application Fee: Required federal Medicaid application fee applies unless waived by Medicare enrollment.
• MCO Assignment: Anthem is exiting Jan 1, 2025; providers must contract with remaining MCOs like Aetna Better Health.

6. Staffing, Training and Background Checks

Specialized respite must be delivered by licensed nursing personnel. Unlicensed direct support professionals cannot perform these duties.

All staff must clear state and national background checks before having direct contact with participants.

• Staff Qualifications: Must be a Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensed in Kentucky.
• Background Checks: Required via the Kentucky National Background Check Program (906 KAR 1:190).
• Out-of-State Checks: Required if the employee lived outside Kentucky in the 12 months prior to employment.
• Abuse Registry: Must clear the Kentucky Child Abuse and Neglect (CAN) registry and adult abuse registries.

7. Documentation, Policies and Records

907 KAR 7:005 mandates strict documentation for specialized respite to prevent fraud and ensure continuity of care.

Clinical notes must justify the need for a licensed nurse rather than a standard caregiver.

• Service Log: Must maintain a sign-in and out log documenting arrival and departure times.
• Clinical Notes: Must include a full description of the skilled service provided.
• Nursing Policies: Must maintain written policies for all medical procedures performed.
• Record Retention: Records must be kept for a minimum of five years or until audit resolution.

8. Billing, Rates and Claims

Reimbursement is handled through the Medicaid Management Information System (MMIS) or the respective MCO's clearinghouse.

Services must be prior-authorized and cannot duplicate other nursing services.

• Billing System: KY MMIS or MCO portals for managed care claims.
• Prior Authorization: Required from the participant's waiver case manager or MCO before delivering services.
• Unit Measurement: Typically billed in 15-minute increments as defined by the specific waiver fee schedule.
• Duplication of Service: Cannot be billed concurrently with private duty nursing or standard personal care.

9. Approval Sequence and Timeline

The pathway to becoming a specialized respite provider is lengthy due to the CON requirement.

Providers should expect a multi-stage process spanning over a year from initial planning to first claim.

• Step 1: Obtain Certificate of Need approval (can take 6-12 months).
• Step 2: Submit HHA or PDN licensure application to OIG.
• Step 3: Pass initial OIG licensure survey (3-6 months post-application).
• Step 4: Submit Medicaid enrollment via Partner Portal (30-90 days).
• Step 5: Complete MCO credentialing and contracting (90-120 days).

10. Common Denials and Survey Findings

OIG and DMS frequently cite providers for documentation lapses and unapproved staff performing skilled tasks.

Failing to maintain continuous compliance with 907 KAR 7:005 can result in immediate suspension of waiver certification.

• CON Denial: Application rejected for failing to prove geographic need for a new home health agency.
• Documentation Deficiencies: Missing arrival/departure times or vague descriptions of skilled tasks on service logs.
• Background Check Lapses: Allowing staff to provide care before the background check clears.
• Scope of Practice Violations: Unlicensed staff performing tasks restricted to RNs or LPNs.

11. Key Contacts and Resources

These official portals and agency pages are required for navigating the Kentucky HCBS and licensure landscape.

Providers should monitor DMS bulletins for updates to waiver regulations and MCO contracting changes.

• Kentucky Medicaid Partner Portal: https://medicaidsystems.ky.gov
• CHFS Division of Long-Term Services and Supports: https://chfs.ky.gov/agencies/dms/dca/Pages/HCBSWaiver.aspx
• CHFS Provider Enrollment Information: https://www.chfs.ky.gov/agencies/dms/dpi/pe/Pages/apply.aspx
• Aetna Better Health of Kentucky (MCO): https://www.aetnabetterhealth.com/kentucky/providers/join-our-network/

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