How to start a hospice in Kentucky

Kentucky requires a Hospice license (freestanding hospice, or hospice operated by a hospital, long-term care facility, home health agency, HMO or other licensed facility) from Kentucky Cabinet for Health and Family Services, Office of Inspector General to operate a hospice.

License required

Yes

License

Hospice license (freestanding hospice, or hospice operated by a hospital, long-term care facility, home health agency, HMO or other licensed facility)

Issuing agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

902 KAR 20:140 (Operation and services; hospice); KRS 216B.042, 216B.155-216B.170; 900 KAR 5:020 (State Health Plan for CON)

1. Determine Certificate of Need requirements with the OIG Division of Certificate of Need (CON decisions must be consistent with the State Health Plan, 900 KAR 5:020)
2. Apply for hospice licensure under 902 KAR 20:140
3. Establish permanent administrative offices and record storage, and written policies
4. Staff the required medical director, administrator and RN patient-care coordinator

Staffing

• Medical director: licensed physician available at least on a consultative basis
• Administrator: prior hospice administrator in a state-approved program, or a bachelor's degree in health care, human services or administration, or equivalent health care administrative experience
• Patient-care coordinator: registered nurse knowledgeable in home-based skilled nursing for the terminally ill
• Interdisciplinary team; services available 24/7 on call

Program

Kentucky Medicaid (Department for Medicaid Services)

Enrollment portal

Kentucky Medicaid Partner Portal Application (MPPA)

Fiscal agent

Gainwell Technologies (fiscal agent for KY Medicaid claim processing, KYHealth-Net)

Application fee

Kentucky's MAP-811 checklist tells providers subject to the fee to attach a check payable to the Kentucky State Treasurer; DMS's provider-type summaries say which types owe it. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Kentucky Medicaid enrollment guide →

CON program

Yes

Program

Certificate of Need

Agency

Kentucky Cabinet for Health and Family Services, Office of Inspector General

Services covered

• hospitals
• ambulatory surgical centers
• home health agencies
• hospice (including residential hospice by a non-hospice entity)
• nursing facilities, personal care homes, ICF and ICF/IID
• chemical dependency treatment programs
• psychiatric residential treatment facilities (Level I and II)
• PET, MRI, megavoltage radiation and cardiac catheterization
• open heart surgery and organ transplant programs
• special care neonatal beds
• prescribed pediatric extended care facilities
• ground ambulance providers (unless exempt)
• nonsubstantive review: adult day health, private duty nursing agencies, PACE, hospital-owned off-campus freestanding EDs, industrial ambulance, certain acute bed transfers

Kentucky certificate of need details →

State minimum wage

$7.25 an hour

Effective

2009-07-24

Scheduled increases

No scheduled change found in the official sources reviewed.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

54 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

23 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

1,264,449 (as of Jun 1, 2026)