MedicaidDocumentationMedium impact
Sepsis Criteria for Hospitals 6.12.23
Kentucky Medicaid·KY · Critical Care, Emergency Medicine, Infectious Disease·Provider Letter
Effective date
Jun 13, 2023
We identified it
Jun 20, 2026
Summary
Kentucky Medicaid now requires hospitals to use Sepsis-3 criteria (instead of SIRS criteria) for sepsis diagnosis and utilization management. This affects how sepsis cases are documented and potentially how they are coded and reimbursed.
Action Required
Immediately: Hospital utilization management teams must update sepsis case review processes to use Sepsis-3 criteria instead of SIRS criteria. Clinical documentation specialists should ensure providers are documenting sepsis using current Sepsis-3 standards for proper coding and reimbursement.