Licensure Information & Forms

Medicare Forms

Medicare Provider-Supplier Enrollment

Centers for Medicare and Medicaid Services Forms List

Medicare Learning Network Guided Pathways to Medicare Resources
MLN Guided Pathways to Medicare Resources Intermediate Curriculum for Health Care Professionals and Suppliers (Part B) has been removed and re-posted as a comprehensive resource guide for the MLN Medicare Billing Certificate Programs. To access the Billing Certificate Programs and the resource documents, visit the MLN Learning Management and Product Ordering System (LM/POS). Login, click on “Training Catalog”, search for “Billing Certificate”, see Medicare Billing Certificate Programs “Part A” or “Part B” for Providers.

Medicaid Enrollment Forms

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HCBS Provider Enrollment Information

Kansas Medical Assistance Program (KMAP)

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License Renewal and Change Forms

State Licensure Renewal

The submission of the annual Licensure Renewal and license fees associated with the renewal is done on the Facility Home Page within an online Kansas Tracking of Adult Care Homes (KOTA) Web Application. An electronic notice is sent to the Administrator prior to the renewal due date. Access the KOTA web app.

For any questions regarding this application, please contact KDADS SCCC Licensing at KDADS.ACHSLicensure@ks.gov.

Change Forms

The submission of the below changes are done on the Facility Home Page within a On-Line Kansas Tracking of Adult Care Homes (KOTA) Web Application. Access the KOTA web app.

For any questions regarding this application, please contact KDADS SCCC Licensing at KDADS.ACHSLicensure@ks.gov.

KOTA Access Questions

KDADS Applications Help Desk
Monday - Friday: 7 am - 5 pm CST
Phone: 785-296-4987 - Option 1
E-mail: KDADS.HELPDESK@ks.gov