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907 KAR 7:015. Reimbursement for home and community based waiver services version 2

KentuckyregulationCabinet for Health and Family Services, Department for Medicaid Services· effective 2025-07-30

What this rule requires your agency to do

  • 1Three (3) quotes from a prospective provider shall be required for an environmental or minor home adaptation, or for goods and services.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 2Except as established in Sections 3, 4, or 5, the department shall reimburse for an HCB waiver service or item at the lesser of the billed charges or the fixed upper payment limit for each unit.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 3Reimbursement for a service provided as a PDS shall not exceed the department's allowed reimbursement for the same service as established in the Section 2(1) rate table.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 4Participants receiving services through the PDS option shall have three (3) months from the date of level of care recertification to comply with the reimbursement limit.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 5A local health department shall each year complete and submit a Home Health and Home and Community Based Cost Report to the department at fiscal year's end.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 6Reimbursement for an ADHC service shall be made directly to an ADHC center, only for services provided on site during posted hours of operation, and shall be limited to 200 units per calendar week per participant; payments for services not during posted hours shall be recouped.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 7Documentation justifying the need for an environmental/minor home adaptation or goods and services shall be uploaded into the MWMA.(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)
  • 8The level and reimbursement rate for any ADHC service provided to a participant shall be determined by an assessment using the Kentucky Home Assessment Tool (K-HAT).(907 KAR 7:015. Reimbursement for home and community based waiver services version 2)

Applies to: personal care

Establishes Medicaid reimbursement rates, units, and payment limits for Kentucky's home and community based (HCB) waiver version 2 services, including attendant care, respite, adult day health care, and participant-directed services.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.