CABINET FOR HEALTH AND
FAMILY SERVICES
Department for Medicaid
Services
Division of Community
Alternatives
(Amendment)
907 KAR 1:160. Home and community
based waiver services version 1.
RELATES TO: KRS 205.520(3), 205.5605,
205.5606, 205.5607, 205.635, 42 C.F.R. 440.180
STATUTORY AUTHORITY: KRS 194A.030(2),
194A.050(1), 205.520(3), 205.5606, 42 C.F.R. 440.180, 42 U.S.C. 1396a, 1396b,
1396d, 1396n
NECESSITY, FUNCTION, AND CONFORMITY: The
Cabinet for Health and Family Services, Department for Medicaid Services has
responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes
the cabinet to comply with any requirement that may be imposed, or opportunity
presented, by federal law to qualify for federal Medicaid funds[the
provision of medical assistance to Kentucky's indigent citizenry. KRS
205.5606(1) requires the cabinet to promulgate administrative regulations to establish
a consumer-directed services program to provide an option for the home and
community based services waiver]. This administrative regulation
establishes the provisions for home and community based waiver services version
1, including participant-[a consumer]directed services[option]
pursuant to KRS 205.5606.
Section 1. Definitions. (1) "1915(c)
home and community based services waiver program" means a Kentucky
Medicaid program established pursuant to and in accordance with 42 U.S.C.
1396n(c).
(2) "Abuse" regarding:
(a) An adult is defined by KRS
209.020(8); or
(b) A child means abuse pursuant to
KRS Chapter 600 or 620.
(3) "ADHC"
means adult day health care.
(4)[(2)]
"ADHC center" means an adult day health care center licensed in accordance
with 902 KAR 20:066.
(5)[(3)] "ADHC
services" means health-related services provided on a regularly-scheduled
basis that ensure optimal functioning of a participant[an HCB recipient] who does not require twenty-four (24) hour care in an
institutional setting.
(6)[(4)] "Advanced
practice registered nurse[practitioner]" or "APRN[ARNP]"
means a person who acts within his or her scope of practice and is licensed in
accordance with KRS 314.042.
(7)[(5)] "Assessment
team" means a team that[which]:
(a) Conducts assessment or
reassessment services; and
(b) Consists of:
1. Two (2) registered nurses;
or
2. One (1) registered nurse and one
(1) of the following:
a. A certified social worker;
b. A certified psychologist with
autonomous functioning;
c. A licensed psychological practitioner;
d. A licensed marriage and family
therapist;[or]
e. A licensed professional clinical
counselor; or
f. A licensed clinical social worker.
(8)[(6)] "Blended
services" means a nonduplicative combination of HCB waiver services
identified in Section 5 of this administrative regulation and PDS[CDO
services] identified in Section 6 of this administrative regulation
provided pursuant to a recipient's approved plan of care.
(9)[(7)] "Budget
allowance" is defined by KRS 205.5605(1).
(10)[(8)] "Certified
psychologist
with autonomous functioning" or "licensed psychological
practitioner" means a person licensed pursuant to KRS Chapter 319.
(11) "Certified social worker"
means an individual who meets the requirements established in KRS 335.080.
(12) "Chemical restraint"
means a drug or medication:
(a) Used to
restrict an individual’s:
1. Behavior; or
2. Freedom of
movement; and
(b)1. That is
not a standard treatment for the individual’s condition; or
2. Dosage that
is not an appropriate dosage for the individual’s condition.
(13)[(9)] "Communicable
disease" means a disease that is transmitted:
(a) Through direct contact with an
infected individual;
(b) Indirectly through an organism that carries disease-causing microorganisms from one (1)
host to another or a bacteriophage, a plasmid, or another agent that transfers
genetic material from one (1) location to another; or
(c) Indirectly by a
bacteriophage, a plasmid, or another agent that transfers genetic material from
one (1) location to another.
(14)[(10) "Consumer"
is defined by KRS 205.5605(2).
(11) "Consumer-directed
option" or "CDO" means an option established by KRS 205.5606
within the home- and community-based services waiver that allows recipients to:
(a) Assist with the design
of their programs;
(b) Choose their providers
of services; and
(c) Direct the delivery of
services to meet their needs.
(12)] "Covered
services and supports" is defined by KRS 205.5605(3).
(15)[(13)] "DCBS"
means the Department for Community Based Services.
(16)[(14)] "Department"
means the Department for Medicaid Services or its designee.
(17)[(15)] "Electronic
signature" is defined by KRS 369.102(8).
(18) "Exploitation"
regarding:
(a) An adult is defined by
KRS 209.020(9); or
(b) A child means
exploitation pursuant to KRS Chapter 600 or 620.
(19)[(16) "HCB
recipient" means an individual who:
(a) Is a recipient as
defined by KRS 205.8451(9);
(b) Meets the NF level of
care criteria established in 907 KAR 1:022; and
(c) Meets the eligibility
criteria for HCB waiver services established in Section 4 of this
administrative regulation.
(17)] "Home and
community based waiver services" or "HCB waiver services" means
home and community based waiver services:
(a) For individuals
who meet the requirements of Section 4 of this administrative regulation;
and
(b) Covered by the
department pursuant to this administrative regulation.
(20)[(18)] "Home
and community support services" means nonresidential and nonmedical home
and community based services and supports that:
(a) Meet the participant’s[consumer's]
needs; and
(b) Constitute a
cost-effective use of funds.
(21)[(19)] "Home
health agency" means an agency that is:
(a) Licensed in accordance
with 902 KAR 20:081; and
(b) Medicare and Medicaid
certified.
(22) "Illicit drug" means:
(a) A drug,
prescription or not prescription, used illegally or in excess of therapeutic levels;
or
(b) A prohibited
drug.
(23) "Licensed clinical social
worker" means an individual who meets the requirements established in KRS
335.100.
(24)[(20)] "Licensed
marriage and family therapist" or "LMFT" is defined by KRS
335.300(2).
(25)[(21)] "Licensed
practical nurse" or "LPN" means a person who:
(a) Meets the definition
established by[in] KRS 314.011(9); and
(b) Works under the
supervision of a registered nurse.
(26)[(22)] "Licensed
professional clinical counselor" or "LPCC" is defined by KRS
335.500(3)
(27) "Neglect"
regarding:
(a) An adult is defined by
KRS 209.020(16); or
(b) A child means neglect
pursuant to KRS Chapter 600 or 620.
(28)[(23)] "NF"
means nursing facility.
(29)[(24)] "NF
level of care" means a high intensity or low intensity patient status determination
made by the department in accordance with 907 KAR 1:022.
(30)[(25)] "Normal baby sitting" means
general care provided to a child that[which] includes custody,
control, and supervision.
(31)[(26)] "Occupational therapist" is
defined by KRS 319A.010(3).
(32)[(27)] "Occupational therapy
assistant" is defined by KRS 319A.010(4).
(33) "Participant" means a
recipient who meets the:
(a) NF level of care
criteria established in 907 KAR 1:022; and
(b) Eligibility criteria for
HCB waiver services established in Section 4 of this administrative regulation.
(34)[(28)] "Patient liability" means
the financial amount an individual is required to contribute toward cost of
care in order to maintain Medicaid eligibility.
(35) "PDS" means
participant-directed services.
(36) "Physical restraint"
means any manual method or physical or mechanical device, material,
or equipment that:
(a) Immobilizes
or reduces the ability of a person to move his or her arms, legs, body, or head
freely; and
(b) Does not
including orthopedically prescribed devices or other devices, surgical
dressings or bandages, protective helmets, or other methods that involve the
physical holding of a person for the purpose of:
1. Conducting
routine physical examinations or tests;
2. Protecting
the person from falling out of bed; or
3. Permitting
the person to participate in activities without the risk of physical harm.
(37)[(29)] "Physical
therapist" is defined by KRS 327.010(2).
(38)[(30)] "Physical
therapist assistant" means a skilled health care worker who:
(a) Is certified by the Kentucky Board of
Physical Therapy; and
(b) Performs physical therapy and related duties as assigned by the supervising physical
therapist.
(39)[(31)] "Physician assistant" or "PA" is
defined by KRS 311.840(3).
(40)[(32)] "Plan of care" or "POC" means a written
individualized comprehensive plan that:
(a) Encompasses all HCB
waiver services; and
(b) Is developed by a
participant[an HCB recipient] or a participant’s[an HCB
recipient's] legal representative, case manager, or other individual
designated by the participant[HCB recipient].
(41)[(33)] "Plan of treatment" means a care plan developed
and used by an ADHC center based on the recipient's individualized ADHC service
needs, goals, interventions and outcomes.
(42) "Prohibited drug" means
a drug or substance that is illegal under KRS Chapter 218A or statutes or
administrative regulations of the Commonwealth of Kentucky.
(43)[(34)] "Registered nurse" or "RN" means a person
who:
(a) Meets the definition
established by[in] KRS 314.011(5); and
(b) Has one (1) year or more
experience as a professional nurse.
(44)[(35)] "Representative" is defined by KRS 205.5605(6).
(45)[(36)] "Sex crime" is defined by KRS 17.165(1).
(46)[(37) "Social worker" means a person with a bachelor's
degree in social work, sociology, or a related field.
(38)] "Speech-language pathologist" is defined by KRS
334A.020(3).
(47)[(39)] "Support broker" means an individual chosen by a participant[consumer]
from an agency designated by the department to:
(a) Provide training,
technical assistance, and support to a participant[consumer]; and
(b) Assist a participant[consumer]
in any other aspects of PDS [CDO].
(48)[(40)] "Support spending plan" means a plan for a participant[consumer]
that identifies the:
(a) PDS[CDO
services] requested;
(b) Employee name;
(c) Hourly wage;
(d) Hours per month;
(e) Monthly pay;
(f) Taxes; and
(g) Budget allowance.
(49)[(41)] "Violent crime" is defined by KRS 17.165(3).
(50) "Violent
offender" is defined by KRS 17.165(2).
Section 2. Provider
Participation. (1) In order to provide HCB waiver services version 1, excluding
participant-[consumer] directed [option] services, an
HCB waiver[a] provider shall be a home health agency or ADHC center
that provides services:
(a) Directly; or
(b) Indirectly through a
subcontractor.
(2) An out-of-state provider
shall comply with the requirements of this administrative regulation.
(3) An HCB waiver[A]
provider[shall]:
(a) Shall comply with the
following administrative regulations and program requirements:
1. 902 KAR 20:081[,
Operations and services; home health agencies];
2. 907 KAR 1:671[,
Conditions of Medicaid provider participation; withholding overpayments,
administrative appeal process, and sanctions];
3. 907 KAR 1:672[,
Provider enrollment, disclosure, and documentation for Medicaid participation];
4. 907 KAR 1:673[, Claims
processing];
5. The Department for
Medicaid Services Home and Community Based Waiver Services Manual; and
6. The Department for
Medicaid Services Adult Day Health Care Services Manual;
(b) Shall not enroll a
participant[an HCB recipient] for whom the provider cannot provide
HCB waiver services;
(c) Shall be permitted to accept or not accept a participant[an
HCB recipient];
(d) Shall implement a procedure to ensure that the following
is reported:
1. Abuse, neglect, or exploitation of a
participant[an HCB recipient] in accordance with KRS Chapters 209 or
620;
2. A slip or fall;
3. A transportation incident;
4. Improper administration of
medication;
5. A medical complication; or
6. An incident caused by the
recipient, including:
a. Verbal or physical abuse
of staff or other recipients;
b. Destruction or damage of
property; or
c. Recipient self-abuse;
(e) Shall ensure a copy of each
incident reported in accordance with paragraph (d) of this subsection is
maintained in a central file subject to review by the department;
(f) Shall implement a process for communicating the incident,
the outcome, and the prevention plan to:
1. A participant[an HCB recipient],
family member, or [his] responsible party; and
2. The attending physician, PA, or APRN[ARNP];
(g) Shall maintain documentation of any communication
provided in accordance with paragraph (f) of this subsection. The documentation
shall be:
1. Recorded in the participant’s[HCB
recipient’s] case record; and
2. Signed and dated by the staff member
making the entry;
(h) Shall implement a procedure that ensures the reporting of a
recipient or any interested party's complaint against the provider or its personnel
to the provider agency or facility;
(i) Shall ensure that
a copy of each complaint reported is maintained in a central file subject to
review by the department;
(j) Shall implement a
process for communicating a complaint, the resulting outcome, and related prevention
plan to:
1. The participant[HCB
recipient], family member, or the participant’s[HCB recipient’s] responsible party; and
2. The attending physician,
PA, or APRN[ARNP] if appropriate;
(k) Shall maintain
documentation of any communication provided in accordance with paragraph (j) of
this subsection. The documentation shall be:
1. Recorded in the participant’s[HCB
recipient’s] case record; and
2. Signed and dated by the
staff member making the entry;
(l) Shall inform a
recipient or any interested party in writing of the provider's:
1. Hours of operation; and
2. Policies and procedures;
(m) Shall not permit a
staff member who has contracted a communicable disease to provide a service to a participant[an HCB recipient]
until the condition is determined to no longer be contagious;[and]
(n) Shall ensure that
a staff member who provides direct services:
1. Demonstrates the ability
to:
a. Read;
b. Write;
c. Understand and carry out
instructions;
d. Keep simple records; and
e. Interact with a participant[an HCB recipient] when providing an HCB waiver service;
2. Is trained by an HCB
waiver provider; and
3. Is supervised by an RN at
least every other month;
(o) Shall ensure that each staff
person:
1. Prior to independently providing a
direct service, is trained regarding:
a. Abuse, neglect, fraud, and
exploitation;
b. The reporting of abuse, neglect,
fraud, and exploitation;
c. Person-centered planning
principles;
d. Documentation requirements; and
e. HCB services definitions and
requirements;
2. Receives
cardio pulmonary resuscitation certification and first aid certification provided
by a nationally accredited entity within six (6) months of employment;
3. Maintains current CPR
certification and first aid certification for the duration of the staff
person’s employment;
4.a. Completes a
tuberculosis (TB) risk assessment performed by a licensed medical professional
within the past twelve (12) months and annually thereafter; and
b.(i) If a TB
risk assessment resulted in a TB skin test being performed, have a negative
result within the past twelve (12) months as documented on test results received
by the provider within thirty (30) days of the date of hire; and
(ii) If it is
determined that signs or symptoms of active disease are present, in order for
the person to be allowed to work, he or she shall be administered follow-up testing
by his or her physician with the testing indicating the person does not have
active TB disease; and
5. Prior to the
beginning of employment, has successfully passed a drug test with no indication
of prohibited or illicit drug use;
(p) Prior to hiring an individual:
1. Shall obtain:
a. The result of a criminal record
check from the Kentucky Administrative Office of
the Courts and equivalent out-of-state agency if the individual resided or
worked outside of Kentucky during the twelve (12) months prior to employment;
b. The results
of a Nurse Aide Abuse Registry check as described in 906 KAR 1:100 and an
equivalent out-of-state agency if the individual resided or worked outside of
Kentucky during the twelve (12) months prior to employment;
c. The results
of a Caregiver Misconduct Registry check as described in 922 KAR 5:120 and
equivalent out-of-state agency if the individual resided or worked outside of
Kentucky during the twelve (12) months prior to employment; and
d. Within thirty
(30) days of the date of hire, the results of a Central Registry check as
described in 922 KAR 1:470 and an equivalent out-of-state agency if the
individual resided or worked outside of Kentucky during the twelve (12) months
prior to employment; or
2. May use Kentucky’s
national background check program established by 906 KAR 1:190 to satisfy the
background check requirements of subparagraph 1 of this paragraph; and
(q) Shall not
allow a staff person to provide HCB waiver services if the individual:
1. Has a prior
conviction of or pled guilty to a:
a. Sex crime; or
b. Violent crime;
2. Is a violent
offender;
3. Has a prior
felony conviction;
4. Has a drug
related conviction, felony plea bargain, or amended plea bargain conviction
within the past five (5) years;
5. Has a
positive drug test for an illicit or a prohibited drug;
6. Has a
conviction of abuse, neglect, or exploitation;
7. Has a Cabinet
for Health and Family Services finding of:
a. Child abuse
or neglect pursuant to the Central Registry as described in 922 KAR 1:470; or
b. Adult abuse,
neglect, or exploitation pursuant to the Caregiver Misconduct
Registry as described in
922 KAR 5:120;
8. Is listed on
the Nurse Aide Abuse Registry pursuant to 906 KAR 1:100;
9. Within the
twelve (12) months prior to employment, is listed on or has a finding indicated
on another state’s equivalent of the:
a. Nurse Aide
Abuse Registry as described in 906 KAR 1:100 if the other state has an
equivalent;
b. Caregiver
Misconduct Registry as described in 922 KAR 5:120 if the other state has an
equivalent; or
c. Central
Registry as described in 922 KAR 1:470 if the other state has an equivalent; or
10. Has been convicted of Medicaid or
Medicare fraud.
Section 3. Maintenance of
Records. (1) An HCB waiver provider shall maintain:
(a) A clinical record for
each participant[HCB recipient]. The clinical record shall contain
the following:
1. Pertinent medical,
nursing, and social history;
2. A comprehensive assessment
entered on form MAP-351, Medicaid Waiver Assessment and signed by the:
a. Assessment team; and
b. Department;
3. A completed MAP 109,
Plan of Care/Prior Authorization for Waiver Services;
4. A copy of the MAP-350, Long Term Care
Facilities and Home and Community Based Program Certification Form signed by the
recipient or recipient's[his] legal representative at the time of
application or reapplication and each recertification thereafter;
5. The name of the case
manager;
6. Documentation of all level
of care determinations;
7. All documentation related
to prior authorizations, including requests, approvals, and denials;
8. Documentation of each contact
with, or on behalf of, a
participant[an
HCB recipient];
9. Documentation that the participant[HCB
recipient] receiving ADHC services was provided a copy of the ADHC center’s
posted hours of operation;[and]
10. Documentation that the participant[recipient]
or legal representative was informed of the procedure for reporting complaints;
and
11.
Documentation of each service provided that shall include:
a. The date the service was
provided;
b. The duration of the
service;
c. The arrival and departure
time of the provider, excluding travel time, if the service was provided at the
participant’s[HCB recipient’s] home;
d. Itemization of each personal
care or homemaking service delivered;
e. The participant’s[HCB
recipient’s] arrival and departure time, excluding travel time, if the
service was provided at the ADHC center;
f. Progress notes,
which shall include
documentation of changes, responses, and treatments utilized to evaluate
the participant’s[HCB recipient’s] needs; and
g. The name, title, and
signature of the service provider; and
(b) Fiscal reports, service
records, and incident reports regarding services provided. These reports shall
be retained:
1. At least six (6) years
from the date that a covered service is provided; or
2. For a minor, three
(3) years after the recipient reaches the age of majority under state law, whichever
is longest.
(2) Upon request, an HCB waiver
provider shall make information regarding service and financial records available
to the:
(a) Department;
(b) Cabinet for Health and
Family Services, Office of Inspector General or its designee;
(c) Department for Health and
Human Services or its designee;
(d) General Accounting Office
or its designee;
(e) Office of the Auditor of
Public Accounts or its designee; or
(f) Office of the Attorney
General or its designee.
Section 4. Participant[HCB
Recipient] Eligibility Determinations and Redeterminations. (1) An HCB
waiver service shall be provided to a Medicaid eligible participant[HCB
recipient] who:
(a) Is determined by the
department to meet NF level of care requirements; and
(b) Would, without waiver
services, be admitted by a physician's order to an NF.
(2) The department shall
perform an NF level of care determination for each participant[HCB
recipient] at least once every twelve (12) months or more often if necessary.
(3) An HCB waiver service
shall not be provided to an individual who:
(a) Does not require a
service other than:
1. A minor home adaptation;
2. Case management; or
3. A minor home adaptation
and case management;
(b) Is an inpatient of:
1. A hospital;
2. An NF; or
3. An intermediate care
facility for individuals with an intellectual disability[an individual
with mental retardation or a developmental disability];
(c) Is a resident of a licensed
personal care home; or
(d) Is receiving services
from another 1915(c)[Medicaid] home and community based services
waiver program.
(4) An HCB waiver provider
shall:
(a) Inform a participant[an HCB recipient] or the participant’s[his] legal representative
of the choice to receive:
1. HCB waiver services; or
2. Institutional services;
and
(b) Require a participant[an HCB recipient]
to sign a MAP-350, Long Term Care Facilities
and Home and Community Based Program Certification Form at the time of application or reapplication and at each
recertification to document that the individual was informed of the choice to receive
HCB waiver or institutional services.
(5) An eligible participant[HCB
recipient] or the participant’s[recipient's] legal representative
shall select a participating HCB waiver provider from which the participant[recipient]
wishes to receive HCB waiver services.
(6) The department may
exclude from the HCB waiver program an individual for whom the aggregate cost
of HCB waiver services would reasonably be expected to exceed the cost of NF
services.
(7) An HCB waiver provider
shall use a MAP-24, Memorandum to notify the local DCBS office and the
department of a
participant’s[an
HCB recipient’s]:
(a) Termination from the HCB
waiver program; or
(b)1. Admission to an NF for
less than sixty (60) consecutive days; and
2. Return to the HCB waiver
program from an NF within sixty (60) consecutive days.
Section 5. Covered Services.
(1) An HCB waiver service shall:
(a) Be prior authorized by
the department to ensure that the service or modification of the service already
meets the needs of the participant[HCB recipient];
(b) Be provided pursuant to a
plan of care or, for a PDS[CDO service], pursuant to a plan of
care and support spending plan;
(c) Except for a PDS[CDO
service], not be provided by a member of the participant’s[HCB
recipient’s] family. A PDS[CDO service] may be provided by a participant’s[an HCB recipient’s] family member; and
(d) Be accessed within sixty
(60) days of the date of prior authorization.
(2) To request prior
authorization, a provider shall submit a completed MAP 10, MAP 109, Plan of
Care/Prior Authorization for Waiver Services, and MAP 351, Medicaid
Waiver Assessment to the department.
(3) Covered HCB services
shall include:
(a) A comprehensive
assessment, which shall:
1. Identify a participant’s[an HCB recipient’s ]
needs and the services that the participant[HCB
recipient] or the participant’s[recipient's] family cannot
manage or arrange for on the participant’s[recipient's] behalf;
2. Evaluate a participant’s[an HCB recipient’s] physical health, mental health, social supports, and environment;
3. Be requested by an
individual seeking HCB waiver services or the individual's family, legal
representative, physician, physician assistant, or APRN[ARNP];
4. Be conducted by an
assessment team within seven (7) calendar days of receipt of the request for
assessment; and
5. Include at least one (1)
face-to-face home visit by a member of the assessment team with the participant[HCB
recipient] and, if appropriate, the participant’s[recipient's]
family;
(b) A reassessment service,
which shall:
1. Determine the continuing
need for HCB waiver services and, if appropriate, PDS[CDO services];
2. Be performed at least every
twelve (12) months;
3. Be conducted using the
same procedures used in an assessment service;
4. Not be retroactive; and
5. Be initiated by an HCB
waiver provider or support broker who shall:
a. Notify the department no
more than three (3) weeks prior to the expiration of the current level of care
certification to ensure that certification is consecutive; and
b. Not be reimbursed for a
service provided during a period that a participant[an HCB recipient] is not covered by a valid level of care certification;
(c) A case management service,
which shall:
1. Consist of coordinating
the delivery of direct and indirect services to a participant[an HCB recipient];
2. Be provided by a case
manager who shall:
a. Be an RN, LPN, certified
social worker, certified psychologist with autonomous functioning, licensed
psychological practitioner, LMFT, licensed clinical social worker, or an
LPCC;
b. Arrange for a service but
not provide a service directly;
c. Contact the participant[HCB
recipient] monthly by telephone or through a face-to-face visit at the participant’s[HCB
recipient’s] residence or in the ADHC center, with a minimum of one (1)
face-to-face visit between the case manager and the participant[recipient]
every other month; and
d. Assure that service
delivery is in accordance with a participant’s[an HCB recipient’s] plan of care;
3. Not include a group
conference; and
4. Include development of a
plan of care that shall:
a. Be completed on the MAP
109, Plan of Care/Prior Authorization for Waiver Services;
b. Reflect the needs of the participant[HCB
recipient];
c. List goals, interventions,
and outcomes;
d. Specify services needed;
e. Determine the amount,
frequency, and duration of services;
f. Provide for reassessment
at least every twelve (12) months;
g. Be developed and signed by
the assessment team, case manager, and participant[HCB recipient]
or participant’s[his] family; and
h. Be submitted to the
department no later than thirty (30) calendar days after receiving the
department's verbal approval of NF level of care;
(d) A homemaker service,
which shall consist of general household activities and shall be provided:
1. By staff pursuant to
Section 2(3)(m) and (n) of this administrative regulation; and
2. To a participant[an HCB recipient]:
a. Who is functionally unable,
but would normally perform age-appropriate homemaker tasks; and
b. If the caregiver regularly
responsible for homemaker activities is temporarily absent or functionally
unable to manage the homemaking activities;
(e) A personal care service,
which shall consist of age-appropriate medically-oriented services and be provided:
1. By staff pursuant to
Section 2(3)(m) and (n) of this administrative regulation; and
2. To a participant[an HCB recipient]:
a. Who does not need highly
skilled or technical care;
b. For whom services are
essential to the participant’s[recipient's] health and welfare
and not for the participant’s[recipient's] family; and
c. Who needs assistance with
age-appropriate activities of daily living;
(f) An attendant care service,
which shall consist of hands-on care that is:
1. Provided by staff pursuant
to Section 2(3)(m) and (n) of this administrative regulation to a participant[an HCB recipient] who:
a. Is medically stable but
functionally dependent and requires care or supervision twenty-four (24) hours
per day; and
b. Has a family member or
other primary caretaker who is employed and not able to provide care during
working hours;
2. Not of a general
housekeeping nature; and
3. Not provided to a participant[an HCB recipient] who is receiving any of the following HCB waiver services:
a. Personal care;
b. Homemaker; or
c. ADHC;
(g) A respite care service,
which shall be short term care based on the absence or need for relief of the
primary caretaker and be:
1. Provided by staff pursuant
to Section 2(3)(m) and (n) of this administrative regulation who provide services
at a level that appropriately and safely meets the medical needs of the participant[HCB
recipient] in the following settings:
a. A participant’s[an HCB recipient’s] place of residence; or
b. An ADHC center during
posted hours of operation;
2. Provided to a participant[an HCB recipient]
who has care needs beyond normal baby sitting;
3. Used no less than every
six (6) months; and
4. Provided in accordance
with 902 KAR 20:066;
(h) A minor home adaptation
service, which shall be a physical adaptation to a home that is
necessary to ensure the health, welfare, and safety of a participant,[an HCB recipient] and which shall:
1. Meet all applicable safety
and local building codes;
2. Relate strictly to the participant’s[HCB
recipient’s] disability and needs;
3. Exclude an adaptation or
improvement to a home that has no direct medical or remedial benefit to the participant[HCB
recipient]; and
4. Be submitted on form
MAP-95 Request for Equipment Form for prior authorization; or
(i) An ADHC service,
which shall:
1. Except for a participant[an HCB recipient] approved for an ADHC service prior to May 1, 2003, be
provided to a participant[an HCB recipient] who is at least twenty-one (21) years of age;
2. Include the following
basic services and necessities provided to participants[Medicaid
waiver recipients] during the posted hours of operation:
a. Skilled nursing services
provided by an RN or LPN, including ostomy care, urinary catheter care,
decubitus care, tube feeding, venipuncture, insulin injections, tracheotomy
care, or medical monitoring;
b. Meal service corresponding
with hours of operation with a minimum of one (1) meal per day and therapeutic
diets as required;
c. Snacks;
d. The presence of[Supervision
by] an RN or LPN;
e. Age and diagnosis
appropriate daily activities; and
f. Routine services that meet
the daily personal and health care needs of a participant[an HCB recipient], including:
(i) Monitoring of vital signs;
(ii) Assistance with
activities of daily living; and
(iii) Monitoring and
supervision of self-administered medications, therapeutic programs, and
incidental supplies and equipment needed for use by a participant[an HCB recipient];
3. Include developing,
implementing, and maintaining nursing policies for nursing or medical
procedures performed in the ADHC center;
4. Include ancillary services
in accordance with 907 KAR 1:023, if ordered by a physician, PA, or APRN[ARNP]
in a
participant’s[an
HCB recipient’s] ADHC plan of treatment.
Ancillary services shall:
a. Consist of evaluations or
reevaluations for the purpose of developing a plan, which shall be
carried out by the participant[HCB recipient] or ADHC center
staff;
b. Be reasonable and
necessary for the participant’s[HCB recipient’s] condition;
c. Be rehabilitative in
nature;
d. Include physical therapy
provided by a physical therapist or physical therapist[therapy]
assistant, occupational therapy provided by an occupational therapist or
occupational therapy[therapist] assistant, or speech therapy
provided by a speech-language pathologist; and
e. Comply with the physical,
occupational, and speech therapy requirements established in Technical Criteria
for Reviewing Ancillary Services for Adults;
4. Include respite care
services pursuant to paragraph (g) of this subsection;
5. Be provided to a participant[an HCB recipient] by the health team in an ADHC center, which may include:
a. A physician;
b. A physician assistant;
c. An APRN[ARNP];
d. An RN;
e. An LPN;
f. An activities director;
g. A physical therapist;
h. A physical therapist
assistant;
i. An occupational therapist;
j. An occupational therapy
assistant;
k. A speech pathologist;
l. A certified social
worker;
m. A licensed clinical
social worker;
n. A nutritionist;
o.[n.] A health
aide;
p.[o.] An LPCC;
q.[p.] An LMFT;
r.[q.] A
certified psychologist with autonomous functioning; or
s.[r.] A
licensed psychological practitioner; and
7. Be provided pursuant to a
plan of treatment. The plan of treatment shall:
a.[(i)] Be
developed and signed by each member of the plan of treatment team, which
shall include the participant[recipient] or a legal
representative of the participant[recipient];
b.[(ii)] Include
pertinent diagnoses, mental status, services required, frequency of visits to
the ADHC center, prognosis, rehabilitation potential, functional limitation,
activities permitted, nutritional requirements, medication, treatment, safety
measures to protect against injury, instructions for timely discharge, and
other pertinent information; and
c.[(iii)] Be
developed annually from information on the MAP 351, Medicaid Waiver
Assessment and revised as needed.
(4) Modification of an
ancillary therapy service or an ADHC unit of service shall require prior
authorization as established in this subsection.[follows:]
(a) Prior authorization shall:
1. Be requested by an RN or
designated ADHC center staff; and
2. Require submission of a
revised MAP 109, Plan of Care/Prior Authorization for Waiver Services
and an order signed by a physician, physician assistant, or APRN.[ARNP;]
(b) An RN or designated ADHC
center staff shall forward a copy of the documents required in paragraph (a) of
this subsection to the HCB case manager or the participant’s[consumer's]
support broker for inclusion in the participant’s[HCB recipient’s]
case records within ten (10) working days of the prior authorization request.[;
and]
(c) Upon approval or denial
of a prior authorization request, the department shall provide written
notification to the HCB agency, the ADHC center, and the participant[HCB
recipient].
(d) The case manager or
support broker shall:
1. Inform the ADHC center
of approval or denial; and
2. Document the approval
or denial in the case record.
(5)(a) An ADHC center shall maintain a
sign in and out log documenting the provision of services to participants.
(b) Documentation shall include:
1. The date the service was provided;
2. The duration of the service;
3. The arrival and departure time of
the participant;
4. A description of the service
provided; and
5. The title and signature of the
staff who provided the service.
Section 6. Participant-[Consumer]
Directed Services[Option]. (1) Covered services and supports provided to a
participant[an HCB recipient] participating in PDS[CDO]
shall include:
(a) A home and community support service, which shall:
1. Be available only under the participant-[consumer]
directed services [option];
2. Be provided in the participant’s[consumer's]
home or in the community;
3. Be based upon therapeutic goals and
not divisional in nature; and
4. Not be provided to a participant[an
individual] if the same or similar service is being provided to the participant[individual]
via non-PDS[CDO] HCB waiver services; or
(b) Goods and services, which shall:
1. Be individualized;
2. Meet identified needs required by the participant’s[individual's]
plan of care that[which] are necessary to ensure the health,
welfare and safety of the participant[individual];
3. Be items or minor adaptations[in
the] that are utilized to reduce the need for personal care or to enhance
independence within the home or community of the participant[recipient];
4. Not include experimental goods or services;
and
5. Not include chemical or physical restraints.
(2) To be covered, a PDS[CDO
service] shall be specified in the plan of care.
(3) Reimbursement for a PDS[CDO
service] shall not exceed the department’s allowed reimbursement for the
same or similar service provided in a non-PDS[CDO] HCB setting.
(4) A participant[consumer],
including a married participant[consumer], shall choose providers
and a participant’s[consumer's] choice shall be reflected or documented
in the plan of care.
(5)(a) A participant[consumer]
may designate a representative to act on the participant’s[consumer's] behalf.
(b) A PDS[The CDO]
representative shall:
1.[(a)] Be twenty-one (21)
years of age or older;
2.[(b)] Not be monetarily
compensated for acting as the PDS [CDO] representative or
providing a PDS[CDO service];[and]
3.[(c)] Be appointed by the
participant[consumer] on a MAP 2000, Initiation/Termination of
Participant-Directed Services;
4. Comply with the requirements for background
and related checks established in Section 2(3)(p) of this administrative
regulation; and
5. Not be a PDS representative if
found in violation of any of the provisions established in subsection (11)(i) of
this section[form].
(6) A participant[consumer]
may voluntarily terminate PDS[CDO services] by completing a MAP 2000,
Initiation/Termination of Participant-Directed Services and submitting it
to the support broker.
(7) The department shall immediately
terminate a participant[consumer] from PDS[CDO services] if:
(a) Imminent danger to the participant’s[consumer's]
health, safety, or welfare exists;
(b) The participant[consumer]
fails to pay patient liability;
(c) The participant’s[consumer's] plan of care indicates he or she
requires more hours of service than the program can provide, which may
jeopardize the participant’s[consumer's] safety and welfare due to being
left alone without a caregiver present; or
(d) The participant[consumer],
caregiver, family, or guardian threaten or intimidate a support broker
or other PDS[CDO] staff.
(8) The department may terminate a participant[consumer]
from PDS[CDO
services] if it determines that the participant’s
PDS[consumer's CDO]
provider has not adhered to the plan of care.
(9) Except as provided in subsection (7)
of this section to a participant’s[consumer's] termination from PDS[CDO
services], the support broker shall:
(a) Notify the assessment or reassessment
service provider of potential termination;
(b) Assist the participant[consumer]
in developing a resolution and prevention plan;
(c) Allow at least thirty (30) but no
more than ninety (90) days for the participant[consumer] to
resolve the issue, develop and implement a prevention plan, or designate
a PDS[CDO] representative;
(d) Complete[,] and submit to the
department[,] a MAP 2000, Initiation/Termination of
Participant-Directed Services terminating the participant[consumer]
from PDS[CDO
services] if the participant[consumer] fails to meet
the requirements in paragraph (c) of this subsection; and
(e) Assist the participant[consumer]
in transitioning back to traditional HCB waiver services.
(10) Upon an involuntary termination of PDS[CDO services],
the department shall:
(a) Notify a participant[consumer]
in writing of its decision to terminate the participant’s PDS[consumer’s
CDO] participation; and
(b) Except if a participant[in
a case where a consumer] failed to pay patient liability, inform the participant[consumer]
of the right to appeal the department’s decision in accordance with Section 9[8]
of this administrative regulation.
(11) A PDS[CDO] provider
shall:
(a) Be selected by the participant[consumer];
(b) Submit a completed Kentucky Participant-[Consumer]
Directed Services[Option] Employee Provider Contract to the
support broker;
(c) Be eighteen (18) years of age or
older;
(d) Be a citizen of the United States
with a valid Social Security number or possess a valid work permit if not a
U.S. citizen;
(e) Be able to communicate effectively
with the participant[consumer], participant[consumer] representative, or family;
(f) Be able to understand and carry out instructions;
(g) Be able to keep records as required
by the participant[consumer];
(h) Submit to the[a criminal]
background and related checks established in Section 2(3)(p) of this
administrative regulation[check];
(i) Not be a PDS provider if the
individual:
1. Has a prior
conviction of or pled guilty to a:
a. Sex crime; or
b. Violent
crime;
2. Is a violent
offender;
3. Has a prior
felony conviction;
4. Has a drug
related conviction, felony plea bargain, or amended plea bargain conviction
within the past five (5) years;
5. Has a
conviction of abuse, neglect, or exploitation;
6. Has a Cabinet
for Health and Family Services finding of:
a. Child abuse
or neglect pursuant to the Central Registry as described in 922 KAR 1:470; or
b. Adult abuse,
neglect, or exploitation pursuant to the Caregiver Misconduct
Registry as described in
922 KAR 5:120;
7.
Is listed on the Nurse Aide Abuse Registry pursuant to 906 KAR 1:100;
8. Within twelve
(12) months prior to employment, is listed on or has a finding indicated on another
state’s equivalent of the:
a. Nurse Aide
Abuse Registry as described in 906 KAR 1:100 if the other state has an
equivalent;
b. Caregiver
Misconduct Registry as described in 922 KAR 5:120 if the other state has an
equivalent; or
c. Central
Registry as described in 922 KAR 1:470 if the other state has an equivalent; or
9. Has been convicted of Medicaid or
Medicare fraud[Submit to a check of the nurse aide abuse registry
maintained in accordance with 906 KAR 1:100, and not be found on the registry];
(j) Prior to the beginning of
employment,[Not have pled guilty or been convicted of committing a sex
crime or violent crime as defined in KRS 17.165(1) through (3);
(k)] complete training on the reporting
of abuse, neglect, or exploitation in accordance with KRS 209.030 or
620.030 and on the needs of the participant[consumer];
(k) Comply with the TB risk assessment
and test requirements established in Section 2(3)(o)4 of this administrative
regulation;
(l)1. Obtain first aid certification
within six (6) months of providing PDS services; and
2. Maintain first aid certification
for the duration of being a PDS provider; and
(m)1. Except as established in
subparagraph 2 of this paragraph:
a. Obtain cardiopulmonary
resuscitation (CPR) certification by a nationally accredited entity within six
(6) months of employment; and
b. Maintain CPR certification for the
duration of being a PDS provider; or
2. If the participant to whom a PDS
provider provides services has a signed Do Not Resuscitate order, not be
required to meet the requirements established in subparagraph 1 of this
paragraph;
(n)[(l)] Be approved by the
department;
(o)[(m)] Maintain and
submit timesheets documenting hours worked; and
(p)[(n)] Be a friend,
spouse, parent, family member, other relative, employee of a provider agency,
or other person hired by the participant[consumer].
(12) A PDS provider[parent,
parents combined or a spouse] shall not provide more than forty (40) hours
of PDS[services] in a calendar week (Sunday through Saturday)[regardless
of the number of children who receive waiver services].
(13)(a) The department shall establish a
budget for a participant[consumer] based on the individual’s
historical costs minus five (5) percent to cover costs associated with
administering the participant-[consumer] directed services[option].
If no historical cost exists for the participant[consumer], the participant’s[consumer's]
budget shall equal the average per capita, per service historical costs of HCB
recipients minus five (5) percent.
(b) Cost of services authorized by the
department for the participant’s[individual’s] prior year plan of
care but not utilized may be added to the budget if necessary to meet the participant’s[individual’s]
needs.
(c) The department shall adjust a participant’s[consumer's]
budget based on the participant’s[consumer's] needs and in accordance with
paragraphs (d) and (e) of this subsection.
(d) A participant’s[consumer's] budget shall not be adjusted to
a level higher than established in paragraph (a) of this subsection unless:
1. The participant’s[consumer's] support broker requests an
adjustment to a level higher than established in paragraph (a) of this subsection;
and
2. The department approves the
adjustment.
(e) The department shall consider the
following factors in determining whether to allow for a budget adjustment:
1. If the proposed services are necessary
to prevent imminent institutionalization;
2. The cost effectiveness of the proposed
services;
3. Protection of the participant’s[consumer's]
health, safety and welfare; and
4. If a significant change has occurred
in the participant’s[recipient's]:
a. Physical condition resulting in
additional loss of function or limitations to activities of daily living and
instrumental activities of daily living;
b. Natural support system; or
c. Environmental living arrangement
resulting in the participant’s[recipient's] relocation.
(f) A participant’s[consumer's] budget shall not exceed the average
per capital cost of services provided to individuals in an[a] NF.
(14) Unless approved by the department
pursuant to subsection (13)(b) through (e) of this section, if a PDS[CDO
service] is expanded to a point in which expansion necessitates a budget
allowance increase, the entire service shall only be covered via a traditional
(non-PDS[CDO]) waiver service provider.
(15) A support broker shall:
(a) Provide any needed assistance to a participant[consumer]
with any aspect of PDS[CDO] or blended services;
(b) Be available to a participant[consumer]
twenty-four (24) hours per day, seven (7) days per week;
(c) Comply with all applicable federal
and state laws and requirements;
(d) Continually monitor a participant’s[consumer's]
health, safety, and welfare; and
(e) Complete or revise a plan of care
using the person-centered planning principles established in Person Centered
Planning: Guiding Principles.
(16)(a) For a PDS[CDO] participant,
a support broker may conduct an assessment or reassessment; and
(b) A PDS[CDO] assessment
or reassessment performed by a support broker shall comply with the assessment
or reassessment provisions established in Section 5(3) of this administrative
regulation.
Section 7. Use of Electronic Signatures. (1)
The creation, transmission, storage, and other use of electronic signatures and
documents shall comply with the requirements established in KRS 369.101 to
369.120.
(2) A home health provider that chooses
to use electronic signatures shall:
(a) Develop and implement a written security
policy that shall:
1. Be adhered to by each of the
provider's employees, officers, agents, and contractors;
2. Identify each electronic signature for
which an individual has access; and
3. Ensure that each electronic signature
is created, transmitted, and stored in a secure fashion;
(b) Develop a consent form that shall:
1. Be completed and executed by each
individual using an electronic signature;
2. Attest to the signature's
authenticity; and
3. Include a statement indicating that
the individual has been notified of his or her responsibility in
allowing the use of the electronic signature; and
(c) Provide the department,
immediately upon request, with:
1. A copy of the provider's electronic
signature policy;
2. The signed consent form; and
3. The original filed signature[immediately
upon request].
Section 8. Applicability
and Transition to HCB Waiver Version 2. (1) The provisions
and requirements established in this administrative regulation shall:
(a)
Apply to HCB waiver services provided to an HCB waiver service recipient until
the recipient transitions to the HCB waiver version 2; and
(b) Not apply to
individuals receiving HCB waiver services version 2 pursuant to 907 KAR 7:010.
(2)
An HCB waiver recipient receiving services pursuant to this administrative
regulation shall transition to receiving services pursuant to 907 KAR 7:010
upon the recipient’s next level-of-care determination provided that the
determination confirms that the individual is still eligible for HCB waiver
services.
(3)
The provisions and requirements established in this administrative regulation
shall become null and void at the time that every eligible HCB waiver recipient
served in accordance with this administrative regulation has transitioned to the
HCB waiver services Version 2 program pursuant to 907 KAR 7:010.
Section 9. Appeal
Rights. An
appeal of a department determination regarding NF level of care or services to a
participant[an HCB recipient or a consumer] shall be in accordance
with 907 KAR 1:563.
Section 10.[9.]
Incorporation by Reference. (1) The following material is incorporated by reference:
(a) "Department for
Medicaid Services Adult Day Health Care Services Manual", May 2005[edition];
(b) "Department for Medicaid
Services Home and Community Based Waiver Services Manual", September 2006[edition];
(c) "Person Centered Planning:
Guiding Principles", March 2005 [edition];
(d) "Technical Criteria for
Reviewing Ancillary Services for Adults", November 2003[edition];
(e) "MAP-24, [The Commonwealth of
Kentucky, Cabinet for Health and Family Services, Department for Community
Based Services] Memorandum", August 2008[February 2001 edition];
(f) "MAP-95 Request for Equipment
Form" June 2007[edition];
(g) "MAP 109, Plan of Care/Prior Authorization
for Waiver Services", July 2008[March 2007 edition];
(h) "MAP-350, Long Term Care
Facilities and Home and Community Based Program Certification Form", July
2008[January 2000 edition];
(i) "MAP-351,[The Department for
Medicaid Services,] Medicaid Waiver Assessment", July 2015;[March
2007 edition:]
(j) "MAP 2000,
Initiation/Termination of Participant-[Consumer] Directed Services[Option
(CDO)]", June 2015[2007, edition];
(k) "MAP-10, Waiver Services Physician’s
Recommendation", August 2014[March 2007 edition]; and
(l) Kentucky Participant-[Consumer]
Directed Services[Option] Employee Provider Contract, June
2015[March 2008].
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Department for
Medicaid Services, 275 East Main Street, Frankfort, Kentucky, 40621, Monday
through Friday, 8 a.m. to 4:30 p.m.907 KAR 1:160
LISA LEE, Commissioner
AUDREY TAYSE HAYNES, Secretary
APPROVED BY AGENCY: October 13, 2015
FILED WITH LRC: October 14, 2015 at 1 p.m.
PUBLIC HEARING AND PUBLIC COMMENT PERIOD:
A public hearing on this administrative regulation shall, if requested, be held
on November 23, 2015, at 9:00 a.m. in Suite B of the Health Services
Auditorium, Health Services Building, First Floor, 275 East Main Street,
Frankfort, Kentucky 40621. Individuals interested in attending this hearing
shall notify this agency in writing November 16, 2015, five (5) workdays prior
to the hearing, of their intent to attend. If no notification of intent to
attend the hearing is received by that date, the hearing may be canceled. The
hearing is open to the public. Any person who attends will be given an
opportunity to comment on the proposed administrative regulation. A transcript
of the public hearing will not be made unless a written request for a
transcript is made. If you do not wish to attend the public hearing, you may
submit written comments on the proposed administrative regulation. You may
submit written comments regarding this proposed administrative regulation until
November 30, 2015. Send written notification of intent to attend the public
hearing or written comments on the proposed administrative regulation to:
CONTACT PERSON: Tricia Orme, tricia.orme@ky.gov, Office of Legal Services, 275 East Main
Street 5 W-B, Frankfort, Kentucky, 40601, phone (502) 564-7905, fax (502)
564-7573.
REGULATORY IMPACT
ANALYSIS And Tiering Statement
Contact Person: Stuart Owen
(1) Provide a brief summary of:
(a) What this administrative regulation
does: This administrative regulation establishes the Medicaid program coverage
provisions and requirements regarding home and community based (HCB) waiver
services. This program enables individuals who have nursing facility level of
care needs to be able to reside in and receive services in a community setting
(including their own residence) rather than have to be admitted to a nursing
facility.
(b) The necessity of this administrative
regulation: This administrative regulation is necessary to establish the
Medicaid program coverage provisions and requirements regarding
(c) How this administrative regulation
conforms to the content of the authorizing statutes: This administrative
regulation conforms to the content of the authorizing statutes by helping
enable individuals who have nursing facility level of care needs to reside in
and receive services in a community setting rather than in a nursing facility.
(d) How this administrative regulation
currently assists or will assist in the effective administration of the
statutes: This administrative regulation will assist in the effective
administration of the authorizing statutes by helping enable individuals who
have nursing facility level of care needs to reside in and receive services in
a community setting rather than in a nursing facility.
(2) If this is an amendment to an
existing administrative regulation, provide a brief summary of:
(a) How the amendment will change this
existing administrative regulation: The amendments including establishing that
the provisions in this administrative regulation apply to individuals receiving
services under the current version of this waiver program until they transition
to a new version – Version 2. The Department for Medicaid Services (DMS) is
concurrently promulgating administrative regulations (907 KAR 7:010 and 907 KAR
7:015) which establish provisions and requirements associated with Version 2 of
this waiver program. Individuals currently receiving HCB waiver services will
continue to receive services pursuant to this administrative regulation until
their next "recertification." The recertification is an annual
process whereby individuals are re-assessed to verify that they continue to
meet the criteria to qualify for HCB waiver services. At the time individuals
are recertified (provided they continue to meet the criteria) they will
transition to Version 2 of this program. Until then they will receive services
pursuant to this administrative regulation (Version 1 of the program.) After
all individuals have transitioned to Version 2, DMS intends to repeal this
administrative regulation. Additional amendments include safeguards to protect
program participants such as prohibiting HCB provider staff (as well as
individuals who provide participant directed services) from providing services
if they’ve pled guilty to or been convicted of a sex crime or violent crime or
have a felony conviction; requiring providers to perform background checks such
as a criminal records check of the Kentucky Administrative Office of the
Courts, a Nurse Aid Abuse Registry check, a Caregiver Misconduct Registry
check, a Central Registry check (or allowing the checks established in the
Office of Inspector General’s Kentucky Applicant Registry and Employment
Screening (KARES) Program satisfy the aforementioned checks); requiring
providers to have staff complete training in abuse, neglect, fraud, and
exploitation; requiring provider staff to obtain cardiopulmonary resuscitation
(CPR) certification and first aid certification; requiring provider staff to
have been assessed for tuberculosis (TB) risk and prohibited from providing
care if signs of TB are present; prohibiting providers from hiring individuals
who have not successfully passed a drug test; requiring individuals chosen by
participants to represent them (representatives) or to provide
participant-directed services to them to meet background and related check
requirements; requiring individuals who provide participant-directed services
to obtain CPR and first aid certification; and other safeguards. Other
amendments include defining terms for clarity; replacing the term "consumer-directed
option" or "CDO" with "participant-directed services"
or "PDS"; and language or formatting revisions to comply with KRS
Chapter 13A standards.
(b) The necessity of the amendment to
this administrative regulation: The amendment is necessary to enable DMS to
transition individuals who receive HCB waiver services over the course of a
year from this version of the program to Version 2. Additional amendments are
necessary to protect the health, safety, and welfare of individuals receiving
services via this program.
(c) How the amendment conforms to the
content of the authorizing statutes: The amendment conforms to the content of
the authorizing statutes by enabling DMS to transition individuals from the
current version of this program to a new version over the course of a year and
by enhancing health, safety, and welfare safeguards for individuals who receive
services via this program.
(d) How the amendment will assist in the
effective administration of the statutes: The amendment will assist in the
effective administration of the authorizing statutes by enabling DMS to
transition individuals from the current version of this program to a new version
over the course of a year and by enhancing health, safety, and welfare safeguards
for individuals who receive services via this program.
(3) List the type and number of
individuals, businesses, organizations, or state and local government affected
by this administrative regulation: There are currently sixty-three (63)
providers (home health departments and adult day health care centers) enrolled
as HCB waiver program providers. Over 9,500 individuals are currently receiving
services through the program.
(4) Provide an analysis of how the
entities identified in question (3) will be impacted by either the
implementation of this administrative regulation, if new, or by the change, if
it is an amendment, including:
(a) List the actions that each of the
regulated entities identified in question (3) will have to take to comply with
this administrative regulation or amendment: No action is required by
providers. No action is required.
(b) In complying with this administrative
regulation or amendment, how much will it cost each of the entities identified
in question (3): No cost is imposed.
(c) As a result of compliance, what
benefits will accrue to the entities identified in question (3): This
administrative regulation continues the program as is temporarily; thus, there
is no change in benefits.
(5) Provide an estimate of how much it
will cost to implement this administrative regulation:
(a) Initially: The Department for
Medicaid Services (DMS) anticipates that the amendment will be budget neutral
initially.
(b) On a continuing basis: DMS
anticipates that the amendment will be budget neutral on a continuing basis.
(6) What is the
source of the funding to be used for the implementation and enforcement of this
administrative regulation: The sources of revenue to be used for implementation
and enforcement of this administrative regulation are federal funds authorized
under the Social Security Act, Title XIX and matching funds of general fund
appropriations.
(7) Provide an assessment of whether an
increase in fees or funding will be necessary to implement this administrative
regulation, if new, or by the change if it is an amendment. Neither an increase
in fees nor funding is necessary to implement the amendment.
(8) State whether or not this
administrative regulation establishes any fees or directly or indirectly
increases any fees: The amendment neither establishes nor increases any fees.
(9) Tiering: Is tiering applied? Tiering
was not appropriate in this administrative regulation because the
administrative regulation applies equally to all those individuals or entities
regulated by it.
FEDERAL MANDATE ANALYSIS
COMPARISON
1. Federal statute or regulation
constituting the federal mandate. 42 U.S.C. 1396a(a)(19), and 42 C.F.R. 447.26.
2. State compliance standards. KRS
205.520(3) states, "Further, it is the policy of the Commonwealth to take
advantage of all federal funds that may be available for medical assistance. To
qualify for federal funds the secretary for health and family services may by
regulation comply with any requirement that may be imposed or opportunity that
may be presented by federal law. Nothing in KRS 205.510 to 205.630 is intended
to limit the secretary's power in this respect."
3. Minimum or uniform standards contained
in the federal mandate. 42 U.S.C. 1396a(a)(19) requires Medicaid programs to
provide care and services consistent with the best interests of Medicaid
recipients.
4. Will this administrative regulation
impose stricter requirements, or additional or different responsibilities or requirements,
than those required by the federal mandate? The amendment does not impose
stricter, additional or different requirements than those required by the
federal mandate.
5. Justification for the imposition of
the stricter standard, or additional or different responsibilities or
requirements. Stricter requirements are not imposed.
FISCAL NOTE ON STATE OR
LOCAL GOVERNMENT
1. What units, parts or divisions of
state or local government (including cities, counties, fire departments, or
school districts) will be impacted by this administrative regulation? This
amendment will affect the Department for Medicaid Services.
2. Identify each state or federal statute
or federal regulation that requires or authorizes the action taken by the
administrative regulation. KRS 194A.030(2), 194A.050(1), 205.520(3).
3. Estimate the effect of this
administrative regulation on the expenditures and revenues of a state or local
government agency (including cities, counties, fire departments, or school
districts) for the first full year the administrative regulation is to be in
effect.
(a) How much revenue will this
administrative regulation generate for the state or local government (including
cities, counties, fire departments, or school districts) for the first year? This
amendment will not generate any additional revenue for state or local governments
during the first year of implementation.
(b) How much revenue will this
administrative regulation generate for the state or local government (including
cities, counties, fire departments, or school districts) for subsequent years?
This amendment will not generate any additional revenue for state or local
governments during subsequent years of implementation.
(c) How much will it cost to administer
this program for the first year? The Department for Medicaid Services (DMS)
anticipates that the amendment will be budget neutral for the first year.
(d) How much will it cost to administer
this program for subsequent years? DMS anticipates that the amendment will be
budget neutral for subsequent years.
Note: If specific dollar estimates cannot
be determined, provide a brief narrative to explain the fiscal impact of the
administrative regulation.
Revenues (+/-):
Expenditures (+/-):
Other Explanation: No additional
expenditures are necessary to implement this amendment.