Kentucky adult day health care program license: certificate of need, 902 KAR 20:066 and waiver rules

Who needs this license

KRS 216B.0441(2) is blunt: “No person, association, corporation, or other organization shall operate or maintain an adult day health care program without first obtaining a license.”⁠¹ Neither the statute nor the rule sets a minimum number of clients. The Chapter 216B definition of “health services” covers clinically related services provided to two or more persons.⁠¹⁵ Services the statute expressly allows include medical therapeutic services and physical and speech therapy.⁠¹

You may be confusing this license with a neighboring one:

• Residential care. If clients sleep over, you need a different license. Look at the assisted living community and family care home guides.
• Care in clients’ homes. Services delivered in clients’ homes are not adult day health care. They fall under Kentucky’s separate home health agency and personal services agency rules, which this guide does not cover.
• Social-only day programs. A program with no health component, such as companionship, meals and activities with no medication supervision or nursing, is not described in KRS 216B.0441. The Legislative Research Commission now marks the older social-model rule, 910 KAR 1:160 (Adult Day and Alzheimer’s Respite Program), “INACTIVE: This document is no longer current,” and its text is no longer posted.⁠¹⁶ The sources checked do not say whether a private-pay social-only day program needs any state approval, so put that question to the OIG Division of Health Care before you open one.

Step one is the certificate of need

Under KRS 216B.061(1), no person may “establish a health facility” or “make a substantial change in a health service” without first obtaining a certificate of need.⁠⁴ KRS 216B.020(3) exempted a list of outpatient categories of care from CON and licensure on July 14, 2018. KRS 216B.020(4)(b)3. names adult day health care as a category those exemptions “shall not apply to.”⁠³ In practice, every new program files a CON application with the Division of Certificate of Need. Its monthly newsletter lists applicants seeking to “Establish an adult day health care program.”⁠⁷

Formal or nonsubstantive review. Kentucky has two CON tracks:

• Formal review decides an application within 90 days, measured against the review criteria in KRS 216B.040 and 900 KAR 6:070.⁠⁵
• Nonsubstantive review applies to services that have no component in the State Health Plan, among other cases.⁠⁵ An application on this track is presumed needed and presumed consistent with the State Health Plan. The OIG must approve it unless someone requests a hearing, and a decision is due within 35 days of the date nonsubstantive status is granted.⁠⁵

The March 2026 newsletter listed two adult day health care applications under “Non-Sub Review Proposals Scheduled for Decision April 23, 2026.” Those were Owensboro (Daviess County), with a stated project cost of $285,500, and Franklin (Simpson County), at $168,000. Affected persons had until March 29, 2026 to request a hearing.⁠⁷ The same newsletter recorded new applications for Glasgow ($72,000) and Leitchfield ($175,000).⁠⁷

The State Health Plan in force is the “2025 Update to the State Health Plan,” January 2026, incorporated by 900 KAR 5:020 effective January 22, 2026.⁠⁸ The plan text itself was not available to check. The Division’s page says nonsubstantive applications “do not have review criteria in the State Health Plan,” and the March 2026 newsletter lists adult day health care applications on the nonsubstantive track, which indicates the plan has no adult day health care component.⁠¹⁴⁠⁷ If the plan did contain one, nonsubstantive applications for the same service would be reviewed against each other instead of on their own.⁠⁵ Ask the Division of Certificate of Need to confirm the track before you file.

Hearings. Once nonsubstantive status is granted, any affected person has 10 days to request a hearing. They can argue that the application does not qualify for that track or should not be approved.⁠⁵ A health facility in your health service area that provides similar services, such as an existing adult day program, counts as an affected person. If you are disapproved, you may ask for reconsideration under KRS 216B.090.⁠⁵

CON application fees (900 KAR 6:020, as published on October 12, 2026):⁠⁶

The fee must be paid with the application, and the application is not complete until it is paid. The fee is refunded only if you withdraw within five working days of the Cabinet receiving the application.⁠⁶ CON forms are posted on the Division’s page, and the Division can be reached at (502) 564-9592.⁠⁷⁠¹⁴

A CON is issued for a specific location.⁠⁴ Altering a location or geographic area designated on a CON or license, or making a substantial change in a health service, is itself a CON-triggering action.⁠⁴

Deciding whether you will provide nursing

Under 902 KAR 20:066, nursing services are an add-on authority that must appear on the license itself.⁠² Nursing services means delivering medication or treatment by a registered nurse, or by a licensed practical nurse supervised by an RN.⁠² If you check nursing on your initial application, the license will “reflect the authority to provide nursing services.” An already-licensed program adds nursing by filing a revised application. The OIG may survey before issuing an amended license.⁠²

Nursing comes with physical-plant and order requirements:⁠²

• Nursing services must be ordered in writing by the participant’s physician, or by another licensed professional acting within scope.
• Telephone orders go to an RN or LPN and are immediately reduced to writing. A telephone order must be countersigned within 30 days.
• Everything except oral medications must be given in a treatment room of at least 120 square feet. The room needs a hand-washing sink, a work counter, storage for clean and sterile supplies, and furnishings suited to nursing care.
• You also need a workroom or closet with a hand-washing sink, a waste receptacle and a soiled-linen receptacle.
• You must have arrangements for getting prescribed drugs from a pharmacy that holds a Kentucky Board of Pharmacy permit.

The decision matters for funding too. The Medicaid HCB waiver defines its adult day health care service around skilled nursing by an RN or LPN, and requires “the presence of an RN or LPN” during posted hours (see the Medicaid section below).⁠¹⁰ A program that plans to bill Medicaid will in practice need nursing authority on its license.

The building

Beyond the nursing rooms, 902 KAR 20:066 states its space rules as outcomes, not square-footage formulas:⁠²

• There must be “adequate space in the facility to provide for patient needs and comfort.”
• A participant who becomes ill needs space to rest in comfort and privacy.
• Open windows and doors must be screened. The building must be free of insects and rodents, and grounds must be clear of refuse and dense undergrowth.
• Sharps go into puncture-resistant containers and are incinerated or rendered nonhazardous. Blood and blood products are incinerated, autoclaved, or poured down a drain connected to a sanitary sewer. You need written waste-handling policies.
• The kitchen, or any caterer you contract with, must comply with KRS 219.011 to 219.081 and the food service rule 902 KAR 45:005.

The rule contains no per-participant square footage and no capacity cap. The OIG charges for reviewing construction or renovation plans for health facilities at $0.10 per square foot, $200 minimum, filed on Form OIG PR-1.⁠⁹ The licensing rule asks the OIG to review plans and specifications “if appropriate” and does not say when that applies to an adult day health care program, so ask the Division of Health Care whether your building needs plan review before you sign a lease.⁠⁹

Administrator, staff and screening

Administrator. Every program needs an administrator who runs the facility and delegates responsibility when absent.⁠² The administrator must meet one of two tests:⁠²

• At least two years of college, or equivalent training, with at least two years of clinical experience, a degree, or a license in a health-related profession; or
• A Kentucky nursing home administrator license under KRS 216A.080.

The administrator must attend educational programs suited to the position. They must also designate the person primarily responsible for dietary and activity services.⁠²

Staffing levels. The rule sets no numeric ratio. The program must “employ or have access to a sufficient number of qualified personnel” to deliver required services and meet participants’ needs.⁠² Physical or speech therapy requires a written physician order and must be provided by, or supervised by, a licensed physical therapist or speech-language pathologist. Occupational therapy must be provided by, or supervised by, a licensed occupational therapist.⁠²

Personnel rules in 902 KAR 20:066:⁠²

• Written job descriptions for each category of staff, reviewed every year.
• Employee files with training and experience, proof of required licensure, health records and performance evaluations.
• A tuberculosis test before or within the first week of employment, and every year after that.
• Orientation for new staff and a planned in-service training program.
• Current CPR certification from the American Heart Association or the American Red Cross for every employee with direct patient care duties.
• Supervision of assistants and volunteers.

Background checks. The Kentucky National Background Check Program (906 KAR 1:190) lists adult day health care programs among its employers. For private employers it applies when they participate voluntarily.⁠¹² Participating employers pay a fee of up to $30 to the Cabinet, plus State Police and FBI fingerprint charges. They may hire an applicant provisionally for up to 60 days after fingerprinting, with on-site supervision.⁠¹²

Ownership screening. The OIG returns a license application and fee if an individual with a significant financial interest (ownership of 25% or more) had such an interest in a Kentucky-licensed facility that had its license or certificate denied, suspended, revoked or voluntarily relinquished in the prior seven years, as the result of an investigation or adverse action that placed patients at risk of death or serious harm. It also returns an application that misrepresents or gives false information.⁠⁹

Services and written policies the OIG will look for

The program must provide all of the following:⁠²

• Health monitoring, including supervision of self-administered medications.
• First aid, plus arrangements for emergency medical care and transport.
• Self-care training aimed at independent living.
• Personal care: bathing, shaving, nail care, mouth care and hair care.
• A balanced activity program for all ages served, planned with participants.
• A daily rest period.
• At least one hot meal, providing no less than one-third of the daily nutritional requirement. Food must be cut, chopped or ground to individual needs, and adaptive eating devices supplied where required.

If you transport participants, you must make provision for wheelchair users and provide an escort when needed.⁠²

The licensee must have written, enforced policies on each of these:⁠²

• The services provided.
• First aid and emergency medical arrangements.
• Emergency transport.
• Admission, needs evaluation and discharge.
• Reporting abuse, neglect or exploitation under KRS Chapters 209 and 620.
• Keeping every participant protected and accounted for.
• Infection control consistent with CDC guidelines, covering blood and body-fluid precautions, airborne infections and work restrictions for sick staff.
• Medication storage. Medications must be labeled, kept locked and refrigerated where needed. Controlled substances need a double lock “(e.g., a locked box in a locked cabinet)” and a running record.

If you will serve children, you also need a written policy that each child is free from abuse and neglect and has age-appropriate activities. Children must be kept “segregated from adult patients except for meals and special events.”⁠²

Records. Each participant must be evaluated on admission and have a care plan.⁠² You must keep:⁠²

• An individual record for each participant, with history and physical, allergies and next of kin.
• Signed progress notes.
• Medication sheets.
• Incident reports.
• A permanent, chronological patient registry book.

Records are kept for at least five years. For a minor, keep them until three years after the patient reaches the age of majority, if that is longer.⁠²

Licensing, in order

1. Get the certificate of need

   File the CON application and fee with the Division of Certificate of Need. Watch the monthly newsletter for your public notice, the 10-day hearing window and the decision date.⁠⁵⁠⁶⁠⁷

2. Apply to the OIG Division of Health Care

   902 KAR 20:066 names Form OIG 144 (February 2001). The general licensing rule, 902 KAR 20:008, now incorporates Form OIG 001, “Application for License to Operate a Health Facility or Health Service” (July 2018). Neither rule says which of the two the OIG accepts for an adult day health care license, and the Division of Health Care page checked does not post forms, so ask the Division which form to file. Mark nursing services on the form if you will provide them.⁠²⁠⁹⁠¹³

3. Pay the licensure fee

   The fee is $170 for day health care (as published on October 12, 2026).⁠⁹

4. Completeness review

   The OIG reviews your ownership, personnel, operating and administrative policies, the services you will offer and, if appropriate, construction plans.⁠⁹

5. Provisional license

   If the application is complete and no deficiencies are found, the OIG issues a provisional license. You then start serving participants. If you have not started within 10 business days, you must tell the Cabinet why and when you will start. Once you do start, you must notify the Cabinet within 3 business days.⁠⁹

6. Unannounced inspection

   The OIG conducts an unannounced on-site inspection within three months of the provisional license’s effective date.⁠⁹ Cited violations require a signed plan of correction within 10 days of the notice.⁠⁹

7. Regular license

   The provisional license ends when the OIG approves or denies the license. An approved license is backdated to the provisional issuance date. If the license is denied, you must stop providing services immediately.⁠⁹

Post the license in a public area of the facility.⁠⁹

Renewal, changes and enforcement

A license expires one year from its effective date. It is renewed by validation letter when you submit a completed application, pay the fee, have no pending adverse action and have answered the Cabinet’s utilization surveys.⁠⁹ Renewing late costs a penalty of 20% of the renewal fee or $25, whichever is greater.⁠⁹ Under 902 KAR 20:008 you must also report these changes:⁠⁹

• Change of ownership: within 30 calendar days. Acquiring more than 25% of the program, or of the equity or voting rights of the licensee, counts as a change.
• Name or administrator change: within 10 calendar days.
• Change of location: within 10 calendar days, if no CON review is required.

Inspections may be unannounced and cover the whole rule, even when they follow up on a complaint. Denying or delaying an inspector’s access can lead to denial, suspension or revocation of the license.⁠⁹ The Cabinet may deny, revoke, suspend or modify the license for noncompliance.⁠¹

How Kentucky programs get paid by Medicaid

Medicaid pays licensed adult day health care centers through the Home and Community Based (HCB) waiver. To bill, a center must be licensed under 902 KAR 20:066 and certified for Medicaid participation by the Department for Medicaid Services.⁠¹⁰⁠¹¹ Waiver participants receiving this service must be at least 21.⁠¹⁰

Waiver rules go further than the licensing rule. During posted hours the center must provide:⁠¹⁰

• Skilled nursing by an RN or LPN, such as catheter, ostomy, wound or tube-feeding care, insulin injections or medical monitoring.
• The presence of an RN or LPN.
• At least one meal a day, plus snacks.
• Vital-sign monitoring and help with activities of daily living.
• Specialized respite care.

Each participant needs a plan of treatment signed by the team, including the participant, and updated each year. The center must keep a sign-in and sign-out log showing each participant’s arrival and departure times and the staff who provided services. Changing a participant’s units requires prior authorization.⁠¹⁰

Medicaid pays the lower of your usual and customary charge or the base rate. It pays only for services delivered on site during posted hours, and only up to 200 units per participant per calendar week.⁠¹¹ The Level I or Level II rate depends on the participant’s assessment using the Kentucky Home Assessment Tool.⁠¹¹ The rate table in 907 KAR 7:015 lists the HCB waiver only. Other Kentucky waivers or managed care plans may pay adult day health care differently, so ask the Department for Medicaid Services before you assume a payer mix.

Recent changes to watch

• KRS 216B.061, the core CON statute, was amended by 2026 Ky. Acts ch. 105, effective July 15, 2026.⁠⁴ The statute text posted by the General Assembly still lists “establish a health facility” and “make a substantial change in a health service” as actions needing a CON, and does not identify what the 2026 act altered, so confirm the current rule with the Division of Certificate of Need.
• CON rules 900 KAR 6:075 and the State Health Plan regulation, 900 KAR 5:020, were both amended effective January 22, 2026. The new State Health Plan edition is the 2025 Update, dated January 2026.⁠⁵⁠⁸
• KRS 216B.020 was amended twice in 2025, effective June 27, 2025. Adult day health care is still on its list of services not exempted from CON.⁠³
• HCB waiver rates in 907 KAR 7:015 were amended effective July 30, 2025, with base rates dated January 1, 2025.⁠¹¹
• 902 KAR 20:066 was recertified on February 17, 2026 with no change to the 2001 text, so it still refers to the February 2001 Form OIG 144.⁠²

For other care licenses in the state, see the Kentucky state page.

Sources

1. 1
   Kentucky General Assembly, KRS 216B.0441: Cabinet to license and regulate adult day care health programs Checked 12 Oct 2026 · Back to text ↑
2. 2
   Kentucky Legislative Research Commission, 902 KAR 20:066: Operation and services; adult day health care programs Checked 12 Oct 2026 · Back to text ↑
3. 3
   Kentucky General Assembly, KRS 216B.020: Certificate of need exemptions and categories of care not exempted Checked 12 Oct 2026 · Back to text ↑
4. 4
   Kentucky General Assembly, KRS 216B.061: Actions requiring certificates of need Checked 12 Oct 2026 · Back to text ↑
5. 5
   Kentucky Legislative Research Commission, 900 KAR 6:075: Certificate of need nonsubstantive review Checked 12 Oct 2026 · Back to text ↑
6. 6
   Kentucky Legislative Research Commission, 900 KAR 6:020: Certificate of need application fee schedule Checked 12 Oct 2026 · Back to text ↑
7. 7
   Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need, Certificate of Need Newsletter, March 2026 Checked 12 Oct 2026 · Back to text ↑
8. 8
   Kentucky Legislative Research Commission, 900 KAR 5:020: State Health Plan for facilities and services Checked 12 Oct 2026 · Back to text ↑
9. 9
   Kentucky Legislative Research Commission, 902 KAR 20:008: License procedures and fee schedule Checked 12 Oct 2026 · Back to text ↑
10. 10
    Kentucky Legislative Research Commission, 907 KAR 7:010: Home and community based waiver services version 2 Checked 12 Oct 2026 · Back to text ↑
11. 11
    Kentucky Legislative Research Commission, 907 KAR 7:015: Reimbursement for home and community based waiver services version 2 Checked 12 Oct 2026 · Back to text ↑
12. 12
    Kentucky Legislative Research Commission, 906 KAR 1:190: Kentucky National Background Check Program (NBCP) Checked 12 Oct 2026 · Back to text ↑
13. 13
    Cabinet for Health and Family Services, Office of Inspector General, Division of Health Care Checked 12 Oct 2026 · Back to text ↑
14. 14
    Cabinet for Health and Family Services, Office of Inspector General, Division of Certificate of Need, Certificate of Need Checked 12 Oct 2026 · Back to text ↑
15. 15
    Kentucky General Assembly, KRS 216B.015: Definitions for chapter Checked 12 Oct 2026 · Back to text ↑
16. 16
    Kentucky Legislative Research Commission, 910 KAR 1:160: Program and certification requirements for the Adult Day and Alzheimer's Respite Program (inactive) Checked 12 Oct 2026 · Back to text ↑

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