MedicaidAdministrativeMedium impact
KMAP BULLETIN: HCBS PCS in Congregate Settings Exempt from EVV Requirement
Kansas Medicaid (KanCare)·KS · Occupational Therapy, Physical Therapy, Geriatrics·Specialty Services
Effective date
Dec 3, 2023
We identified it
Jun 21, 2026
Summary
Kansas Medicaid HCBS Personal Care Services provided in congregate settings (assisted living, residential health care facilities) are now exempt from Electronic Visit Verification requirements. Billing codes S5125 UA and S5125 U9 are affected with specific implementation dates.
Action Required
Immediately: Billing team must update system to exempt S5125 UA (HCBS/FE) and S5125 U9 (HCBS/PD through March 31, 2024) from EVV requirements when services are provided in congregate settings. By April 1, 2024: Switch all HCBS/PD congregate setting claims from S5125 U9 to S5125 UA. Verify reimbursement rate of $4.55 per unit is configured correctly. Check KMAP website regularly for rate updates.