Adult Day Health Care (ADHC) Services - PT (43)

​​​​​​​​​​​​​​Adult day health care (ADHC) is Kentucky Medicaid provider type 43.  To enroll and bill Kentucky Medicaid, ADHC service providers must be:

Covered Services

ADHC services are provided on-site at a center where individuals receive skilled nursing care, routine personal care and health care, meals, and are part of daily activities.

An ADHC service provider must meet the coverage provisions and requirements of 
907 KAR 7:010. Services must be performed in 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 state Medicaid regulations. 

Verify Eligibility

Verify eligibility by calling the automated voice response system at (800) 807-1301 or by using the web-based KYHealth-Net System.  


ADHC services are reimbursed per 907 KAR 7:015. Current reimbursement rates for the HCB waiver are available on the DMS Fee and Rate Schedule webpage​.

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 service is covered during the same period.

Service Authorization 

Case managers approve most 1915(c) HCBS services. Carewise Health reviews requests for high-cost or high-skill services as part of the Kentucky Medicaid Utilization Management (UM) Program​. If you have questions about service authorization, please contact the UM Call Center at (800) 292-2392. 

Claims Submission

Kentucky Medicaid currently contracts with Gainwell Technologies to process Medicaid fee-for-service claims. 

Find FFS Provider Billing Instructions

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 Current 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 fee-for-service claims must be submitted to Gainwell Technologies and include the reason for the request along with a hard-copy 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 from the last Kentucky Medicaid denial.


907 K​​AR - Cabinet for Health and Family Services DMS Title Page
907 KAR 7:005 - Certified waiver provider requirements 
907 KAR 7:010 - HCB Waiver
907 KAR 7:015 - Reimbursement for HCB waiver services  
907 KAR 1:022​ - Nursing facility level of care 

​Provider Resources

MAP Forms
MAP-10: Ph​ysician's Recommendation 
MAP-115: Application Intake - Participant Authorization
MAP-116: Service Plan - Participant Authorization
MAP-351: Medicaid Waiver Assessment
MAP-531: Conflict Free Case Management Exemption
​Search for all MAP forms ​

Helpful Links
HCB Waiver Provider Information
Home Delivered Meals Provider Information 
ADHC Provider Summary
Medicaid Waiver Management Application (MWMA) Information
Incident Reporting: Instructional Guide and FAQ
Service Authorization Crosswalks, Training, and Resources​​

If you can't find the information you need or have additional questions, please direct your inquiries to:

Billing Questions - Gainwell Technologies - (800) 807-1232
1915(c) HCBS Waiver Policy Questions - (844) 784-5614
Service Authorization - (800) 292-2392
Provider Enrollment or Revalidation - (877) 838-5085
KyHealth-Net assistance - Gainwell Technologies - (800) 205-4696
MWMA Technical Support - (844) 784-5614, option 1
OIG Questions - (502) 564-7963
Report Fraud and Abuse - (800) 372-2970

For more specific inquiries, see the 1915(c) HCBS waiver contacts listing.   

Contact Information