What types of policy changes does Kentucky Medicaid issue?

Kentucky Medicaid regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Kentucky Medicaid update its policies?

Kentucky Medicaid typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Kentucky Medicaid policy changes are tracked here?

This page currently tracks 44 documented Kentucky Medicaid policy changes. New items are added as they are identified.

What should I do when Kentucky Medicaid changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Kentucky Medicaid Policy Changes & Prior Auth Updates

We track 44 documented policy changes from Kentucky Medicaid across KY. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Kentucky Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Kentucky Medicaid updates automatically.

Medium impact
Revised Processing for State-Directed Payments
Kentucky Medicaid·Effective Jul 1, 2026
Kentucky Medicaid is changing how hospitals receive State Directed Payments (SDP) starting July 1, 2026. Instead of receiving a single payment through the Kentucky Hospital Association, hospitals will receive separate payments directly from each of the five Managed Care Organizations (MCOs).
Medium impact
Update on Coverage of Psychoeducation Services (H2027)
Kentucky Medicaid·Effective Jul 15, 2026
Kentucky Medicaid will no longer reimburse standalone psychoeducation services (H2027) effective July 15, 2026. Psychoeducation can still be provided as part of other behavioral health services like IOP and PHP, but cannot be billed separately.
Medium impact
PDS Transition to Waiver Operating Agency
Kentucky Medicaid·Effective Jan 1, 2027
Kentucky is transitioning oversight of Participant Directed Services (PDS) for 1915(c) waiver programs from the Department for Aging and Independent Living to individual waiver operating agencies. This is a phased transition completing by January 1, 2027, affecting contact information and administrative processes for waiver-related billing.
High impact
Documentation Submission Clarification for Non-Institutional Hospice Providers
Kentucky Medicaid·Effective Jun 1, 2026
Kentucky Medicaid is enforcing strict submission deadlines for hospice documentation, requiring election and discharge forms within 3 business days. Starting June 1, 2026, late submissions will not be processed at all.
High impact
Coverage of Psychoeducation Services (H2027)
Kentucky Medicaid·Effective Apr 10, 2026
Kentucky Medicaid has eliminated coverage for psychoeducation services (H2027) effective April 10, 2026. This service is no longer reimbursable in either individual or group settings, and all Managed Care Organizations will deny claims for this code.
High impact
Kentucky Medicaid Section 1115 Serious Mental Illness (SMI) Implementation
Kentucky Medicaid·Effective Jan 15, 2026
Kentucky Medicaid will begin covering short-term psychiatric hospital stays (up to 60 days) for beneficiaries ages 21-64 in Institutes for Mental Disease starting January 15, 2026. All new fee-for-service psychiatric admissions will require prior authorization with medical necessity review and continued stay reviews.
High impact
Electronic Visit Verification Claims Compliance Deadline
Kentucky Medicaid·Effective Jan 1, 2026
Starting January 1, 2026, Kentucky Medicaid will deny all claims for Home and Community Based Services waiver services that don't have corresponding visits documented in Electronic Visit Verification (EVV) systems. Providers must ensure all EVV visits are properly entered in Therap or integrated third-party systems to avoid automatic claim denials.
High impact
Changes to EPSDT Therapy Billing Codes
Kentucky Medicaid·Effective Jan 1, 2026
Kentucky Medicaid is requiring EPSDT therapy providers to transition from billing S-codes (S9128, S9131, S9129) to appropriate 9-series CPT codes with specific modifiers (GN, GO, GP) starting January 1, 2026. The flat reimbursement rate of $85.05 per therapy type remains unchanged.
High impact
Behavioral Health Prior Authorization
Kentucky Medicaid·Effective Jun 25, 2025
Kentucky Medicaid is rescinding their March 2025 letter that would have resumed prior authorization for behavioral health services on May 1, 2025. Instead, House Bill 695 requires reinstatement of all behavioral health prior authorization requirements that were in place on January 1, 2020, effective June 25, 2025.
High impact
KLOCS Backdating and Correcting LOC Guidance
Kentucky Medicaid·Effective Jun 20, 2025
Kentucky Medicaid updated guidance for backdating and correcting Level of Care (LOC) dates in the KLOCS system, replacing April 2021 guidance. Facilities must complete LOC prior to admission and discharge/transfer members timely, or face delayed reimbursement and potential corrective action.
High impact
EVV HHCS Compliance Deadline
Kentucky Medicaid·Effective Jan 1, 2025
Kentucky Medicaid requires Electronic Visit Verification (EVV) for home health, private duty nursing, and Model II waiver services starting January 1, 2024. Effective January 1, 2025, any home health care services claims without corresponding EVV documentation will be automatically denied.
High impact
Anthem Transition Written Notice
Kentucky Medicaid·Effective Jan 1, 2025
Anthem is terminating as a Medicaid MCO in Kentucky effective January 1, 2025. All Anthem Medicaid members will be automatically reassigned to either Humana or United Healthcare MCOs, but existing Anthem prior authorizations will be honored by the new MCOs.
High impact
Psychoeducation Policy Update H2027 H0038
Kentucky Medicaid·Effective Jan 1, 2025
Kentucky Medicaid has updated policies for Psychoeducation (H2027) and Peer Support Services (H0038) effective January 1, 2025. The changes include reduced reimbursement rates for H2027 across all provider types, new annual unit limits (500 units for H2027, 800 units for H0038), and clarified billing restrictions including which providers can deliver services and when bundling applies.
High impact
Oral Surgeons Billing Change
Kentucky Medicaid·Effective Jan 1, 2025
Kentucky Medicaid is ending the ability for oral surgeons to bill D-codes on CMS1500 forms effective December 31, 2024. Starting January 1, 2025, all oral surgeons must use ADA claim forms for D-code billing to standardize dental billing processes.
High impact
1915(c) HCBS Waiver Rate Increase Guidance
Kentucky Medicaid·Effective Jan 1, 2025
Kentucky Medicaid is implementing rate increases for multiple 1915(c) HCBS waiver services effective January 1, 2025, requiring providers to update person-centered service plans and use corrected billing codes. Key changes include unit conversions from hourly to 15-minute billing, service code updates, and higher reimbursement rates for participant-directed services.
High impact
Provider Letter - MPW Assessments Follow Up
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is reminding Community Mental Health Centers about Michelle P. Waiver assessment requirements, emphasizing that only qualified assessment teams can complete MAP-351 forms and strict timelines must be met. Non-compliance puts providers at risk for recoupment of payments.
High impact
Provider Letter - Behavioral Health Service Facility Location
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid now requires all residential and inpatient behavioral health facilities to include specific service facility location information on all claims. This includes the program name, address, and NPI in CMS 1500 Box 32 and corresponding fields in KY HealthNet FFS claims.
High impact
Fee for Service Utilization Management and Prior Authorization
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is implementing a new online Utilization Management Provider Portal (Essette) in Fall 2023 to replace paper, phone, and fax prior authorization processes. Providers must attend mandatory training and will submit all prior authorization requests through the new web-based system.
Medium impact
40-Hour Limit for Legally Responsible Individual Participant Directed Services Employees
Kentucky Medicaid·Effective May 31, 2026
Kentucky Medicaid has established a 40-hour per week limit for Legally Responsible Individuals (parents, guardians, spouses) providing paid services under the 1915(c) Home and Community Based Services waiver Participant Directed Services program. Case managers must modify service plans by May 31, 2026 to comply with this limit.
Medium impact
KY-Moms MATR Guidance
Kentucky Medicaid·Effective Jan 7, 2026
Kentucky Medicaid clarified billing requirements for KY-Moms MATR services for pregnant and postpartum women with substance use disorders. The guidance specifies required modifiers (UD for case management, HM for prevention), supervision requirements for non-licensed staff, and billing limitations based on client type and service maximums.
Medium impact
Concurrent Billing Codes for Applied Behavioral Analysis
Kentucky Medicaid·Effective Dec 2, 2025
Kentucky Medicaid now allows concurrent billing of CPT codes 97153 and 97155 for Applied Behavioral Analysis (ABA) services when a qualified health professional is directing a technician who is implementing a modified treatment protocol with the patient present. This change enables providers to bill both codes simultaneously under specific circumstances.
Medium impact
Discharging Patients to Medicaid-Certified Nursing Facilities
Kentucky Medicaid·Effective Sep 16, 2025
Kentucky Medicaid clarifies that hospital discharges to nursing facilities must complete PASRR screening and level of care determination BEFORE admission, not within 3 days after. Hospitals must provide compliant History & Physical documentation to expedite the process.
Medium impact
Behavioral Health Providers American Society for Addiction Medicine (ASAM) Fourth Edition
Kentucky Medicaid·Effective Jun 25, 2025
Kentucky Medicaid is transitioning from ASAM Criteria 3rd Edition to 4th Edition for substance use disorder (SUD) adult services effective June 25, 2025. This affects placement standards and treatment criteria for behavioral health providers treating adults with addiction and co-occurring conditions.
Medium impact
Behavioral Health Prior Authorization Resumption
Kentucky Medicaid·Effective May 1, 2025
Kentucky Medicaid will resume prior authorization requirements for specific behavioral health services starting May 1, 2025. Services like inpatient psychiatric stays over 3 days, intensive outpatient programs beyond 30 days, and several other behavioral health services will require PA, with MCOs required to develop consistent notification protocols.
Medium impact
Netsmart to Therap EVV Transition for 1915(c) HCBS Waivers Complete)
Kentucky Medicaid·Effective Apr 1, 2025
Kentucky has completed the transition from Netsmart to Therap for electronic visit verification (EVV) systems for 1915(c) Home and Community Based Services Waiver providers. Providers must download their Netsmart data before April 1, 2025, when read-only access ends permanently.
Medium impact
1915(c) HCBS Waiver Respite Guidance
Kentucky Medicaid·Effective Jan 1, 2025
Kentucky's 1915(c) Home and Community Based Services waivers changed respite billing from cost-based to unit-based effective January 1, 2025. Michelle P. Waiver respite is now billed at $5.92 per 15-minute unit with a 1,312 unit annual limit, while HCB waiver respite has a 42 unit daily limit and 1,000 unit annual limit.
Medium impact
Early Elective Deliveries (EED) Prior to 39 weeks Gestation
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has updated its policy on Early Elective Deliveries (EED) prior to 39 weeks gestation, likely introducing new prior authorization requirements or coverage restrictions for elective deliveries before 39 weeks. This policy change affects obstetric billing and delivery-related procedures.
Medium impact
CMHC Provider Letter #A-107 - Professional Equivalents
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has updated professional equivalent requirements for Community Mental Health Centers (CMHC) providers. This policy clarifies which professional credentials and qualifications are acceptable for billing mental health services under Kentucky Medicaid.
Medium impact
Provider Letter regarding 2nd Notice of PAD Reimbursement change
Kentucky Medicaid·Identified Jun 20, 2026
This is a second notice regarding changes to PAD (Peripheral Arterial Disease) reimbursement rates in Kentucky Medicaid. The policy indicates upcoming changes to how PAD-related services will be reimbursed, though specific details would need to be reviewed in the full document.
Medium impact
Notification of KY Medicaid Partner Portal Application (KYMPPA) Update
Kentucky Medicaid·Identified Jun 20, 2026
This policy change notification references a Kentucky Medicaid Partner Portal Application (KYMPPA) update, but the actual policy content is not accessible from the provided URL. Without the full policy text, the specific changes and requirements cannot be determined.
Medium impact
Provider Letter - 1915(c) Waiver PDS Budgets
Kentucky Medicaid·Identified Jun 20, 2026
This policy update addresses 1915(c) Waiver PDS (Personal Development Services) budgets for Kentucky Medicaid providers. However, the policy content appears to be incomplete or corrupted, showing only page markers without actual policy details.
Medium impact
Provider Letter: ABI Renewal Update and Therapy Information
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is moving Occupational Therapy and Speech Therapy from ABI waiver coverage to Medicaid state plan coverage. Participants can receive up to 20 visits each of OT, ST, and PT before prior authorization is required, with prior auths now required every 90 days instead of the previous waiver schedule.
Medium impact
Provider Letter: Reimbursement Fee schedule change (PL A-4)
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has updated reimbursement fee schedules for dental services (CDT codes), which will affect billing rates for dental procedures. This appears to be a state-specific Medicaid reimbursement change that dental practices need to update in their billing systems.
Medium impact
Wrap Supplemental Payment Attachment
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky DMS updated guidance for FQHC, RHC, and CCBHC providers on tracking and researching missing WRAP (supplemental) payments through the KYHealthNet system. The policy provides detailed procedures for reconciling supplemental payments between 30-45 days after MCO payment, including specific contact information for each MCO and required data elements for inquiries.
Medium impact
Oral Pathology
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has updated their fee schedule to make oral pathology codes payable for adults, allowing dental oral surgeons to bill these codes. Providers should resubmit previously denied claims for oral pathology services to managed care organizations.
Medium impact
MSRP vs Invoice Billing
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has clarified reimbursement rates for medical supplies, equipment, and appliances (MSEA). Standard items are reimbursed at manufacturer suggested retail price (MSRP) minus 18%, while customized items or items without MSRP are reimbursed at invoice cost plus 20%.
Medium impact
Appendix K Supplemental Rate
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is continuing the 50% supplemental rate increase for certain Home and Community Based Services waiver programs, but only for providers who already have attestation forms on file as of May 1, 2024. Providers must continue passing 85% of the increase to direct service professionals and cannot selectively bill the add-on rate.
Low impact
Addendum to Memorandum dated June 23, 2017, re Early Elective Deliveries EED) Prior to 39 Weeks Gestation
Kentucky Medicaid·Identified Jun 20, 2026
This appears to be an addendum to a 2017 policy regarding Early Elective Deliveries (EED) prior to 39 weeks gestation, but the actual policy content is not provided in the document sections shown.
Low impact
Provider Letter - Orthodontic Services
Kentucky Medicaid·Identified Jun 20, 2026
This policy appears to be about orthodontic services based on the title, but the actual policy content is not provided in the source material - only metadata and a URL reference to a Kentucky Medicaid provider letter from 2019.
Low impact
Tier II Behavioral Health Service Organizations Provider Letter #A-10 - Non-Emergent Medical Transportation (NEMT)
Kentucky Medicaid·Identified Jun 20, 2026
This policy update covers Non-Emergent Medical Transportation (NEMT) services for Tier II Behavioral Health Service Organizations in Kentucky's Medicaid program. The policy appears to establish or update coverage guidelines for transportation services to behavioral health appointments for Medicaid beneficiaries.
Low impact
No Show Dashboard
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid has launched a new No-Show Dashboard in the KYMMIS provider system that allows providers to search and analyze patient no-shows by provider type and reason. This is an informational announcement about a new reporting tool available under DMS Reports in the KYHealthNet application.
Low impact
DME Name Change Corrected Letter
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is changing the official name of Durable Medical Equipment (DME) providers to Medical Supplies, Equipment, and Appliances (MSEA) providers. This is a terminology change that will appear in regulations, state plan amendments, and fee schedules.
Low impact
DME Name Change
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky Medicaid is changing the name of Durable Medical Equipment (DME) providers to Medical Supplies, Equipment, and Appliances (MSEA) providers. This is a required name change per CMS that will appear on regulations, state plan amendments, and fee schedules.
Low impact
Provider Guidance on iRISE Regulations Governing IPS Supported Employment
Kentucky Medicaid·Identified Jun 20, 2026
Kentucky clarifies documentation requirements for 1915(i) RISE Initiative supported employment services, specifying that IPS providers should use 'career profile' instead of 'Person-Centered Employment Plan (PCEP)' and 'OVR Extended Services Plans OVR 6 and 7' instead of 'long-term employment support plan (LTSEP)' for required documentation.

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Revised Processing for State-Directed Payments

Update on Coverage of Psychoeducation Services (H2027)

PDS Transition to Waiver Operating Agency

Documentation Submission Clarification for Non-Institutional Hospice Providers

Coverage of Psychoeducation Services (H2027)

Kentucky Medicaid Section 1115 Serious Mental Illness (SMI) Implementation

Electronic Visit Verification Claims Compliance Deadline

Changes to EPSDT Therapy Billing Codes

Behavioral Health Prior Authorization

KLOCS Backdating and Correcting LOC Guidance

EVV HHCS Compliance Deadline

Anthem Transition Written Notice

Psychoeducation Policy Update H2027 H0038

Oral Surgeons Billing Change

1915(c) HCBS Waiver Rate Increase Guidance

Provider Letter - MPW Assessments Follow Up

Provider Letter - Behavioral Health Service Facility Location

Fee for Service Utilization Management and Prior Authorization

40-Hour Limit for Legally Responsible Individual Participant Directed Services Employees

KY-Moms MATR Guidance

Concurrent Billing Codes for Applied Behavioral Analysis

Discharging Patients to Medicaid-Certified Nursing Facilities

Behavioral Health Providers American Society for Addiction Medicine (ASAM) Fourth Edition

Behavioral Health Prior Authorization Resumption

Netsmart to Therap EVV Transition for 1915(c) HCBS Waivers Complete)

1915(c) HCBS Waiver Respite Guidance

Early Elective Deliveries (EED) Prior to 39 weeks Gestation

CMHC Provider Letter #A-107 - Professional Equivalents

Provider Letter regarding 2nd Notice of PAD Reimbursement change

Notification of KY Medicaid Partner Portal Application (KYMPPA) Update

Provider Letter - 1915(c) Waiver PDS Budgets

Provider Letter: ABI Renewal Update and Therapy Information

Provider Letter: Reimbursement Fee schedule change (PL A-4)

Wrap Supplemental Payment Attachment

Oral Pathology

MSRP vs Invoice Billing

Appendix K Supplemental Rate

Addendum to Memorandum dated June 23, 2017, re Early Elective Deliveries EED) Prior to 39 Weeks Gestation

Provider Letter - Orthodontic Services

Tier II Behavioral Health Service Organizations Provider Letter #A-10 - Non-Emergent Medical Transportation (NEMT)

No Show Dashboard

DME Name Change Corrected Letter

DME Name Change

Provider Guidance on iRISE Regulations Governing IPS Supported Employment