Hospice services are Kentucky Medicaid Provider Type (44). To bill Kentucky Medicaid, hospice providers must be:
- Licensed in the state in which they operate. In Kentucky, hospice providers must contact the
Office of Inspector General Division of Health Care to obtain licensing.
- Enrolled as an active Medicaid provider and, if applicable, with the managed care organization (MCO) of any beneficiary it serves.
Covered Services
Hospice services are available to individuals who have a terminal diagnosis with a life expectancy of six months or less as certified by a physician. Hospice services provide the care the individual needs to live as fully and comfortably as possible. Hospice also supports the individual's family as they adjust to the individual's illness and death. Hospice services are provided at home, in a nursing facility, or in an intermediate care facility for individuals with intellectual disabilities.
Hospice providers must meet the coverage provisions and requirements of
907 KAR 1:330. Services must be performed within the scope of practice for any provider. Listing of services in an administrative regulation is not a guarantee of payment. Providers must follow all relevant Kentucky Medicaid regulations and the requirements of any MCO in which they participate. All services must be medically necessary.
Eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based
KYHealth-Net System.
To receive hospice services, individuals must complete the
MAP-374 - Election of Medicaid Hospice Benefit Form. Individuals receive treatment for conditions related to their terminal illness by their hospice provider. Individuals younger than 21 are eligible to receive curative treatment for their terminal illness concurrently with hospice services. If an individual is eligible for both Medicare and Medicaid, known as dual eligibility, the hospice benefit must be elected and revoked simultaneously under both programs.
Benefits
Hospice benefits consist of two 90-day periods. An additional 60 days of hospice benefits are covered until revocation or termination for other reasons such as ineligibility or death. Recertification is required for each 60-day extension benefit period.
- Send non-institutional MAP-374, MAP-375, MAP-376, MAP-378 and MAP-403 forms to DMS via
email.
- Mail or fax the MAP-377, MAP-383, MAP-384 and MAP-397 to:
Carewise Health
9200 Shelbyville Road Suite 800
Louisville, KY 40222
Fax: (800) 292-2392, option 9
Reimbursement
Hospice services are reimbursed per 907 KAR 1:340.
Hospice Rates
2023-2024
Hospice - County:
PDF -
Excel
Hospice - Facility:
PDF -
Excel
Hospice:
PDF -
Excel
2022-2023
Hospice - County
Hospice - Facility
Hospice
2021-2022
Hospice - County
Hospice - Facility
Hospice
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered during the same period.
Prior Authorization
Some Hospice services may require prior authorization. Carewise Health manages prior authorizations for Kentucky Medicaid fee-for-service (FFS) beneficiaries. Each MCO manages prior authorization for its beneficiaries.
Claims Submission
Kentucky Medicaid currently contracts with
Gainwell Technologies to process FFS claims. Each MCO processes its own claims.
Coding: Kentucky Medicaid uses the National Correct Coding Initiative edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of CMS 1500 billing forms. Providers must bill Kentucky Medicaid using the correct CPT codes.
Claim Appeals: Appeal requests made on denied FFS claims must be submitted to
Gainwell Technologies. The request must include the reason for the request along with a hard copy claim. Please refer to the MCO if appealing an MCO claim.
Timely Filing: Claims must be received the longer of either 12 months from the date of service or six months from the Medicare pay date or within 12 months of the last Kentucky Medicaid denial.
Regulations and Statutes
907 KAR - Cabinet for Health and Family Services - DMS Title Page
907 KAR 1:330 - Hospice services
907 KAR 1:340 - Reimbursement for hospice services
907 KAR 3:130 - Medical necessity and clinically appropriate determination basis
KRS Chapter 216B.195 - Residential hospice facilities - automated pharmacy system
Provider Resources
MAP Forms
MAP-374 - Election of Medicaid Hospice Benefit Form
MAP-375 - Revocation of Medicaid Hospice Benefits
MAP-376 - Change of Hospice Providers
MAP-377 - Physician certification for Medicaid hospice benefit recertification
MAP-378 - Termination of Medicaid Hospice Benefits
MAP-379 - Representation Statement for Election of Hospice Benefits
MAP-383 - Other Hospital Statement Form
MAP-384 - Hospice Non-Related Drug Form
MAP-397 - Other Services Statement Form
MAP-403 - Hospice Patient Status Change
Find MAP Forms
Level of Care Information
Kentucky Level of Care System (KLOCS)
KLOCS NF, Hospice and ICF User Guide
Helpful Links
PT 44 - Hospice Provider Summary
Find Provider Letters
If you can't find the information you need or have additional questions, please direct your inquiries to:
MCO Contacts