Home health (HH) services are recognized in Kentucky Medicaid as Provider Type (34). To enroll and bill Kentucky Medicaid, a home health service provider must be:
Covered Services
HH services are available to Medicaid beneficiaries of all ages and are intended to be short-term in duration. HH services are physician-prescribed and must follow a written plan of care. HH services can include intermittent skilled nursing services; physical, speech, and occupational therapies; non-routine medical supplies required for an episode of care; medical social services; and home health aide services. HH provider qualifications, services, and limitations are defined in
907 KAR 1:030. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. 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.
Recertification
Requests for recertifications may be submitted for review up to five business days before the service plan start date. If a request for re-certification is not submitted before the expiration of the current certification period, the re-certification shall begin on the date that a completed packet is received by the QIO. The physician shall sign, date and recertify the plan of care no less frequently than every two months, with a maximum of 60 days per certification period.
Reimbursement
HH services are reimbursed per the HH Fee Schedule and
907 KAR 1:031.
2022 Home Health Fee Schedule:
PDF -
Excel
2021 Home Health Fee Schedule
Find Current Fee and Rate Schedules
Duplication of Service
Kentucky Medicaid will not reimburse a service provided to a beneficiary by more than one provider of any program in which the service is covered during the same period.
Prior Authorization
Carewise Health manages prior authorizations for Kentucky Medicaid fee-for-service beneficiaries. Each MCO manages prior authorization for its beneficiaries.
All services and/or supplies must be prior authorized to ensure the service or modification of the service is medically necessary and adequate for the needs of the beneficiary. Healthcare Common Procedure Coding System (HCPCS) codes are required on prior authorization requests and claims submitted for payment for revenue codes 270 non-routine medical supplies and 279 nutritional supplements.
Claims Submission
Kentucky Medicaid currently contracts with
Gainwell Technologies to process the Kentucky Medicaid FFS claims. Each MCO processes its claims.
Find FFS Provider Billing Instructions
Coding
Kentucky Medicaid uses the National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify incidental or mutually exclusive codes. Kentucky Medicaid also uses Current Procedural Terminology (CPT) and HCPCS codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. Kentucky Medicaid requires the use of the UB-04 billing forms. Providers must bill Kentucky Medicaid using the 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 within 12 months of the date of service or six months from the Medicare pay date whichever is longer, or within 12 months of the last Kentucky Medicaid denial. Please refer to the MCO if appealing an MCO claim.
Regulations
907 KAR - Cabinet For Health and Family Services DMS Title Page
907 KAR 1:030 - Home health agency services
907 KAR 1:031 - Payment for home health services
907 KAR 3:130 - Medical necessity and clinically appropriate determination basis
Provider Resources
Search for Provider Letters
Search for MAP Forms
Home Health Manual
Durable Medical Equipment
PT 34 - HH Services Provider Summary
If you can't find the information you need or have additional questions, please direct your inquiries to:
FFS Billing Questions -
Gainwell Technologies - (800) 807-1232
Provider Questions - (855) 824-5615
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance -
Gainwell Technologies - (800) 205-4696
FFS Pharmacy Information -
DMS Pharmacy Policy Branch
Rate Setting Branch - DMS Division of Fiscal Management
Report Fraud and Abuse - (800) 372-2970
MCO Contacts
Anthem - (800) 205-5870
Aetna Better Health of KY - (855) 300-5528
Humana - (855) 852-7005
Passport Health Plan by Molina- (800) 578-0775
United Healthcare Community Plan - (866) 633-4449
WellCare of Kentucky - (877) 389-9457