Adult Day Health Services (ADHS) in Kentucky provide structured, facility-based programs that offer health monitoring, social interaction, and assistance with daily activities to adults with disabilities, chronic health conditions, or age-related needs. These services are designed to prevent institutionalization and provide caregiver relief while enhancing participant well-being. ADHS is reimbursable under select Kentucky Medicaid Home and Community-Based Services (HCBS) waivers.

1. GOVERNING AGENCIES

Agency: Kentucky Cabinet for Health and Family Services (CHFS) — Department for Medicaid Services (DMS)
Role: Administers Medicaid reimbursement and enrollment for Adult Day Health providers

Agency: Kentucky Department for Aging and Independent Living (DAIL)
Role: Establishes licensing and operational standards for adult day health programs

Agency: Centers for Medicare & Medicaid Services (CMS)
Role: Ensures federal compliance with Medicaid community-based service requirements

Agency: Managed Care Organizations (MCOs) under Kentucky Medicaid
Role: Authorize ADHS in participant care plans, credential providers, and process claims

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2. SERVICE OVERVIEW

Adult Day Health Services provide participants with daytime supervision, socialization, and health-related support in a licensed facility.

Authorized services may include:

Assistance with Activities of Daily Living (ADLs): toileting, grooming, mobility, eating

• Medication administration and health monitoring by a licensed nurse
• Therapeutic activities (music, exercise, memory support)
• Social, recreational, and educational programs
• Nutritionally balanced meals and snacks
• Transportation to and from the center (if approved)
• Care coordination with family caregivers and medical teams
• Behavioral and emotional support
• Fall prevention and safety monitoring

Services are outlined in each participant’s Person-Centered Service Plan (PCSP) and tailored to their functional and medical needs.

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3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register your business with the Kentucky Secretary of State
• Obtain IRS EIN and Type 2 NPI
• Enroll with Kentucky Medicaid through the Medicaid Partner Portal Application (MPPA)
• Obtain Adult Day Health Center certification or licensure from DAIL
• Pass site inspections for safety, staffing, and ADA compliance
• Maintain general liability, facility, and workers’ compensation insurance
• Hire qualified staff, including RNs or LPNs for health services
• Develop an Adult Day Health Services Policy & Procedure Manual
• Implement HIPAA-compliant documentation systems and emergency protocols

4. KENTUCKY PROVIDER ENROLLMENT PROCESS

Step 1: Licensure & Facility Setup

• Apply for Adult Day Health Center licensure or certification with DAIL
• Pass inspections for fire safety, health, and sanitation

Step 2: Medicaid Enrollment

• Apply as an ADHS provider via MPPA
• Complete MCO credentialing and network contracting

Step 3: Documentation Submission

• Submit policies, staffing plans, insurance, licenses, and inspection reports

Step 4: Service Authorization & Program Launch

• Coordinate with case managers to align ADHS with participant PCSPs
• Obtain MCO authorization and begin services
• Submit claims using approved HCPCS codes

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5. REQUIRED DOCUMENTATION

• Kentucky Articles of Incorporation or business license
• IRS EIN and NPI confirmation
• DAIL license/certification for Adult Day Health Center
• Facility safety inspection reports and zoning compliance
• General liability and workers’ compensation insurance

Adult Day Health Services Policy & Procedure Manual, including:

• Participant intake forms and health assessments
• ADL assistance and medication administration logs
• Staff training and supervision records
• Daily attendance logs and activity schedules
• Emergency response and evacuation plans
• Participant rights and grievance procedures
• HIPAA compliance policies and audit documentation templates

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6. STAFFING REQUIREMENTS

Role: Direct Support Staff / Program Aide
Requirements: Experience in elder or disability services, CPR/First Aid certified, background check

Role: Registered Nurse (RN) or Licensed Practical Nurse (LPN)
Requirements: Licensed in Kentucky, responsible for medication administration and health monitoring

Role (optional): Activity Coordinator, Social Worker, or Transportation Staff
Requirements: Relevant certifications or training preferred, must complete orientation and annual continuing education

All staff must complete:

• HCBS participant rights and HIPAA training
• Emergency drills and infection control procedures
• Abuse and neglect prevention training
• Continuing education as required by DAIL and waiver-specific rules

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7. MEDICAID PROGRAMS & HCBS WAIVERS

Adult Day Health Services are available under:

• Home and Community Based (HCB) Waiver
• Acquired Brain Injury (ABI and ABI-LTC) Waivers
• Model II Waiver (MIIW)
• Supports for Community Living (SCL) Waiver (day services category)

Service delivery must occur in:

• A licensed adult day health center
• A non-residential setting approved by DAIL and meeting federal HCBS settings criteria

8. TIMELINE TO LAUNCH

Phase: Facility Licensing and Safety Certification
Timeline: 2–3 months

Phase: Medicaid Enrollment and MCO Credentialing
Timeline: 2–3 months

Phase: Staff Hiring and Program Readiness
Timeline: 1–2 months

Phase: Participant Enrollment and Service Launch
Timeline: 30–60 days

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9. CONTACT INFORMATION

Kentucky Department for Medicaid Services (DMS)
Website: https://chfs.ky.gov/agencies/dms

Kentucky Department for Aging and Independent Living (DAIL)
Website: https://chfs.ky.gov/agencies/dail

Medicaid Provider Enrollment (MPPA): https://mppa.ky.gov

Kentucky Cabinet for Health and Family Services (CHFS)
Website: https://chfs.ky.gov

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10. SCOPE OF WORK

• Facility planning, licensing preparation, and fire inspection guidance
• MPPA enrollment and MCO credentialing assistance
• Policy & Procedure Manual for adult day services
• Staffing model design and training protocols
• Participant intake packets, attendance logs, and billing templates
• Emergency and incident response systems
• Branding, website, and outreach materials for hospital, family, and case manager referrals