907 KAR 3:090. Acquired brain injury
waiver services.
RELATES TO: KRS 205.5605, 205.5606,
205.5607, 205.8451, 205.8477, 42 C.F.R. 441.300 - 310, 42 C.F.R. 455.100 - 106,
42 U.S.C. 1396a, b, d, n
STATUTORY AUTHORITY: KRS 194A.010(1),
194A.030(2), 194A.050(1), 205.520(3)
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, by administrative regulation, to comply with any requirement that
may be imposed, or opportunity presented, by federal law for 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 waivers. This administrative regulation establishes
the coverage provisions relating to home- and community-based waiver services
provided to an individual with an acquired brain injury as an alternative to
nursing facility services and including a consumer-directed services program
pursuant to KRS 205.5606.
Section 1. Definitions. (1)
"ABI" means an acquired brain injury.
(2) "ABI provider" means an entity
that meets the criteria established in Section 2 of this administrative
regulation.
(3) "ABI recipient" means an
individual who meets the criteria established in Section 3 of this
administrative regulation.
(4) "Acquired Brain Injury
Branch" or "ABIB" means the Acquired Brain Injury Branch of the
Department for Medicaid Services, Division of Community Alternatives.
(5) "Acquired brain injury waiver
service" or "ABI waiver service" means a home and community
based waiver service provided to a Medicaid eligible individual who has acquired
a brain injury.
(6) "Advanced practice registered
nurse" is defined by KRS 314.l011(7).
(7) "Assessment" or
"reassessment" means a comprehensive evaluation of abilities, needs,
and services that is:
(a) Completed on a MAP-351;
(b) Submitted to the department:
1. For a level of care determination; and
2. No less than every twelve (12) months
thereafter.
(8) "Behavior intervention
committee" or "BIC" means a group of individuals established to
evaluate the technical adequacy of a proposed behavior intervention for an ABI
recipient.
(9) "Blended services" means a
nonduplicative combination of ABI waiver services identified in Section 4 of
this administrative regulation and CDO services identified in Section 8 of this
administrative regulation provided pursuant to a recipient's approved plan of
care.
(10) "Board certified behavior
analyst" means an independent practitioner who is certified by the
Behavior Analyst Certification Board, Inc.
(11) "Budget allowance" is
defined by KRS 205.5605(1).
(12) "Case manager" means an
individual who manages the overall development and monitoring of a recipient’s
plan of care.
(13) "Consumer" is defined by
KRS 205.5605(2).
(14) "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.
(15) "Covered services and supports" is defined by
KRS 205.5605(3).
(16) "Crisis
prevention and response plan" means a plan developed by an
interdisciplinary team to identify any potential risk to a recipient and to
detail a strategy to minimize the risk.
(17) "DCBS" means the
Department for Community Based Services.
(18) "Department" means the
Department for Medicaid Services or its designee.
(19) "Good
cause" means a circumstance beyond the control of an individual that
affects the individual's ability to access funding or services, including:
(a) Illness or hospitalization of the
individual which is expected to last sixty (60) days or less;
(b) Death or incapacitation of the
primary caregiver;
(c) Required paperwork and documentation
for processing in accordance with Section 3 of this administrative regulation
that has not been completed but is expected to be completed in two (2) weeks or
less; or
(d) The individual or his or her legal
representative has made diligent contact with a potential provider to secure
placement or access services but has not been accepted within the sixty (60)
day time period.
(20) "Human rights committee"
or "HRC" means a group of individuals established to protect the
rights and welfare of an ABI recipient.
(21) "Interdisciplinary team"
means a group of individuals that assist in the development and implementation
of an ABI recipient’s plan of care consisting of:
(a) The ABI recipient and legal
representative if appointed;
(b) A chosen ABI service provider;
(c) A case manager; and
(d) Others as designated by the ABI
recipient.
(22) "Level of care
certification" means verification, by the department, of ABI program
eligibility for:
(a) An individual; and
(b) A specific period of time.
(23) "Licensed marriage and family
therapist" or "LMFT" is defined by KRS 335.300(2).
(24) "Licensed professional clinical
counselor" is defined by KRS 335.500(3).
(25) "Medically necessary" or
"medical necessity" means that a covered benefit is determined to be
needed in accordance with 907 KAR 3:130.
(26) "Occupational therapist"
is defined by KRS 319A.010(3).
(27) "Occupational therapy
assistant" is defined by KRS 319A.010(4).
(28) "Patient liability" means
the financial amount, determined by the department, that an individual is
required to contribute towards cost of care in order to maintain Medicaid
eligibility.
(29) "Personal services agency"
is defined by KRS 216.710(8).
(30) "Psychologist" is defined
by KRS 319.010(9).
(31) "Psychologist with autonomous
functioning" means an individual who is licensed in accordance with KRS
319.056.
(32) "Qualified mental health
professional" is defined by KRS 202A.011(12).
(33) "Representative" is
defined by KRS 205.5605(6).
(34) "Speech-language
pathologist" is defined by KRS 334A.020(3).
(35) "Support broker" means an
individual designated by the department to:
(a) Provide training, technical
assistance, and support to a consumer; and
(b) Assist a consumer in any other
aspects of CDO.
(36) "Support spending plan"
means a plan for a consumer that identifies the:
(a) CDO services requested;
(b) Employee name;
(c) Hourly wage;
(d) Hours per month;
(e) Monthly
pay;
(f) Taxes; and
(g) Budget allowance.
(37) "Transition plan" means a
plan that is developed by an interdisciplinary team to aid an ABI recipient in
exiting from the ABI program into the community.
Section 2. Non-CDO Provider
Participation. (1) In order to provide an ABI waiver service in accordance with
Section 4 of this administrative regulation, excluding a consumer-directed
option service, an ABI provider shall:
(a) Be enrolled as a Medicaid provider in
accordance with 907 KAR 1:671;
(b) Be certified by the department prior
to the initiation of the service;
(c) Be recertified at least annually by
the department;
(d) Have an office within the
Commonwealth of Kentucky; and
(e) Complete and submit a MAP-4100a to
the department.
(2) An ABI provider shall comply with:
(a) 907 KAR 1:672;
(b) 907 KAR 1:673; and
(c) 902 KAR 20:078.
(3) An ABI provider shall have a
governing body that shall be:
(a) A legally-constituted entity within
the Commonwealth of Kentucky; and
(b) Responsible for the overall operation
of the organization including establishing policy that complies with this
administrative regulation concerning the operation of the agency and the
health, safety and welfare of an ABI recipient served by the agency.
(4) An ABI provider shall:
(a) Unless participating in the CDO
program, ensure that an ABI waiver service is not provided to an ABI recipient
by a staff member of the ABI provider who has one (1) of the following blood
relationships to the ABI recipient:
1. Child;
2. Parent;
3. Sibling; or
4. Spouse;
(b) Not enroll an ABI recipient for whom
the ABI provider cannot meet the service needs; and
(c) Have and follow written criteria that
complies with this administrative regulation for determining the eligibility of
an individual for admission to services.
(5) An ABI provider shall comply with the
requirements of the Health Insurance Portability and Accountability Act (HIPAA)
of 1996, 42 U.S.C. 1320d to 1320d-8.
(6) An ABI provider shall meet the
following requirements if responsible for the management of an ABI recipient's
funds:
(a) Separate accounting shall be
maintained for each ABI recipient or for his or her interest in a common trust
or special account;
(b) Account balance and records of
transactions shall be provided to the ABI recipient or legal representative on
a quarterly basis; and
(c) The ABI recipient or legal
representative shall be notified when a large balance is accrued that may
affect Medicaid eligibility.
(7) An ABI provider shall have a written
statement of its mission and values.
(8) An ABI provider shall have written
policy and procedures for communication and interaction with a family and legal
representative of an ABI recipient which shall:
(a) Require a timely response to an
inquiry;
(b) Require the opportunity for
interaction with direct care staff;
(c) Require prompt notification of any
unusual incident;
(d) Permit visitation with the ABI
recipient at a reasonable time and with due regard for the ABI recipient's
right of privacy;
(e) Require involvement of the legal
representative in decision-making regarding the selection and direction of the
service provided; and
(f) Consider the cultural, educational,
language and socioeconomic characteristics of the ABI recipient.
(9) An ABI provider shall ensure the
rights of an ABI recipient by:
(a) Making available a description of the
rights and the means by which the rights may be exercised, including:
1. The right to time, space, and
opportunity for personal privacy;
2. The right to retain and use personal
possessions; and
3. For a supervised residential care,
personal care, companion or respite provider, the right to communicate, associate
and meet privately with a person of the ABI recipient’s choice, including:
a. The right to send and receive unopened
mail; and
b. The right to private, accessible use
of the telephone;
(b) Maintaining a grievance and appeals
system;
(c) Complying with the Americans with
Disabilities Act (28 C.F.R. Part 35); and
(d) Prohibiting the use of:
1. Prone or supine restraint;
2. Corporal punishment;
3. Seclusion;
4. Verbal abuse; or
5. Any procedure which denies private communication,
requisite sleep, shelter, bedding, food, drink, or use of a bathroom facility.
(10) An ABI provider shall maintain
fiscal and service records and incident reports for a minimum of six (6) years
from the date that a covered service is provided and all the records and
reports shall be made available to the:
(a) Department;
(b) ABI recipient’s selected case
manager;
(c) Cabinet for Health and Family
Services, Office of Inspector General or its designee;
(d) General Accounting Office or its designee;
(e) Office of the Auditor of Public
Accounts or its designee;
(f) Office of the Attorney General or its
designee; or
(g) Centers for Medicare and Medicaid
Services.
(11) An ABI provider shall cooperate with
monitoring visits from monitoring agents.
(12) An ABI provider shall maintain a
record for each ABI recipient served that shall:
(a) Be recorded in permanent ink;
(b) Be free from correction fluid;
(c) Have a strike through each error
which is initialed and dated; and
(d) Contain no blank lines between each
entry.
(13) A record of each ABI recipient who
is served shall:
(a) Be cumulative;
(b) Be readily available;
(c) Contain a legend that identifies any
symbol or abbreviation used in making a record entry; and
(d) Contain the following specific
information:
1. The ABI recipient's name and Medical
Assistance Identification Number (MAID);
2. An assessment summary relevant to the
service area;
3. The MAP-109;
4. The crisis prevention and response
plan that shall include:
a. A list containing emergency contact
telephone numbers; and
b. The ABI recipient’s history of any
allergies with appropriate allergy alerts for severe allergies;
5. The transition plan that shall
include:
a. Skills to be obtained from the ABI
waiver program;
b. A listing of the on-going formal and
informal community services available to be accessed; and
c. A listing of additional resources
needed;
6. The training objective for any service
which provides skills training to the ABI recipient;
7. The ABI recipient's medication record,
including a copy of the prescription or the signed physician’s order and the medication
log if medication is administered at the service site;
8. Legally-adequate consent for the
provision of services or other treatment including a consent for emergency
attention which shall be located at each service site;
9. The Long Term Care Facilities and Home
and Community Based Program Certification form, MAP-350, updated at recertification;
and
10. Current level of care certification;
(e) Be maintained by the provider in a
manner to ensure the confidentiality of the ABI recipient's record and other
personal information and to allow the ABI recipient or legal representative to
determine when to share the information as provided by law;
(f) Be secured against loss, destruction
or use by an unauthorized person ensured by the provider; and
(g) Be available to the ABI recipient or
legal guardian according to the provider's written policy and procedures which
shall address the availability of the record.
(14) An ABI provider shall:
(a)1. Ensure that each new staff person
or volunteer performing direct care or a supervisory function has had a tuberculosis
(TB) risk assessment performed by a licensed medical professional and, if
indicated, a TB skin test with a negative result within the past twelve (12)
months as documented on test results received by the provider;
2. Maintain, for existing staff,
documentation of each staff person’s or, if a volunteer performs direct care or
a supervisory function, the volunteer’s annual TB risk assessment or negative
tuberculosis test required by subparagraph 1 of this paragraph;
3. Ensure that an employee or volunteer
who tests positive for TB or has a history of a positive TB skin test shall be
assessed annually by a licensed medical professional for signs or symptoms of
active disease;
4. Before allowing a staff person or
volunteer determined to have signs or symptoms of active disease to work,
ensure that follow-up testing is administered by a physician with the test
results indicating the person does not have active TB disease; and
5. Maintain annual documentation for an
employee or volunteer with a positive TB test to ensure no active disease
symptoms are present;
(b)1. For each potential employee or
volunteer expected to perform direct care or a supervisory function, obtain
prior to the date of hire or date of service as a volunteer, the results of:
a. A criminal record check from the
Administrative Office of the Courts or equivalent out-of-state agency if the
individual resided, worked, or volunteered outside Kentucky during the year
prior to employment or volunteer service; and
b. A nurse aide abuse registry check as
described in 906 KAR 1:100;
2. Obtain, within thirty (30) days of the
date of hire or date of service as a volunteer, the results of a central
registry check as described in 922 KAR 1:470; and
3. Annually, for twenty-five (25) percent
of employees randomly selected, obtain the results of a criminal record check
from the Kentucky Administrative Office of the Courts or equivalent
out-of-state agency if the individual resided or worked outside of Kentucky during
the year prior to employment; and
(c) Not employ or permit an individual to
serve as a volunteer performing direct care or a supervisory function if the individual
has a prior conviction of an offense delineated in KRS 17.165(1) through (3) or
prior felony conviction;
(d) Not permit an employee or volunteer
to transport an ABI recipient if the employee or volunteer:
1. Does not possess a valid operator's
license issued pursuant to KRS 186.410; or
2. Has a conviction of Driving Under the
Influence (DUI) during the past year;
(e) Not employ or permit an individual to
serve as a volunteer performing direct care or a supervisory function if the individual
has a conviction of trafficking, manufacturing, or possession of an illegal
drug during the past five (5) years;
(f) Not employ or permit an individual to
serve as a volunteer performing direct care or a supervisory function if the individual
has a conviction of abuse, neglect or exploitation;
(g) Not employ or permit an individual to
serve as a volunteer performing direct care or a supervisory function if the individual
has a Cabinet for Health and Family Services finding of child abuse or neglect
pursuant to the central registry;
(h) Not employ or permit an individual to
serve as a volunteer performing direct care or a supervisory function if the individual
is listed on the nurse aide abuse registry;
(i) Evaluate and document the performance
of each employee upon completion of the agency’s designated probationary period
and at a minimum of annually thereafter; and
(j) Conduct and document periodic and
regularly-scheduled supervisory visits of all professional and paraprofessional
direct-service staff at the service site in order to ensure that high quality,
appropriate services are provided to the ABI recipient.
(15) An ABI provider shall:
(a) Have an executive director who:
1. Is qualified with a bachelor’s degree
from an accredited institution in administration or a human services field; and
2. Has a minimum of one (1) year of
administrative responsibility in an organization which served an individual
with a disability; and
(b) Have adequate direct-contact staff
who:
1. Is eighteen (18) years of age or
older;
2. Has a high school diploma or GED; and
3.a. Has a minimum of two (2) years
experience in providing a service to an individual with a disability; or
b. Has successfully completed a
formalized training program such as nursing facility nurse aide training.
(16) An ABI provider shall establish
written guidelines that address the health, safety and welfare of an ABI
recipient, which shall include:
(a) Ensuring the health, safety and
welfare of the ABI recipient;
(b) Maintenance of sanitary conditions;
(c) Ensuring each site operated by the
provider is equipped with:
1. Operational smoke detectors placed in
strategic locations; and
2. A minimum of two (2) correctly-charged
fire extinguishers placed in strategic locations, one (1) of which shall be capable
of extinguishing a grease fire and have a rating of 1A10BC;
(d) For a supervised residential care or
adult day training provider, ensuring the availability of an ample supply of
hot and cold running water with the water temperature at a tap used by the ABI
recipient not exceeding 120 degrees Fahrenheit;
(e) Ensuring that the nutritional needs
of the ABI recipient are met in accordance with the current recommended dietary
allowance of the Food and Nutrition Board of the National Research Council or
as specified by a physician;
(f) Ensuring that staff who supervise
medication administration:
1. Unless the employee is a licensed or
registered nurse, have specific training provided by a licensed medical
professional (a nurse, pharmacist, or medical doctor) and documented competency
on cause and effect and proper administration and storage of medication; and
2. Document all medication administered,
including self-administered, over-the-counter drugs, on a medication log, with
the date, time, and initials of the person who administered the medication and
ensure that the medication shall:
a. Be kept in a locked container;
b. If a controlled substance, be kept
under double lock;
c. Be carried in a proper container labeled
with medication, dosage, time of administration, and the recipient’s name if
administered to the ABI recipient or self-administered at a program site other
than his or her residence; and
d. Be documented on a medication
administration form and properly disposed of if discontinued; and
(g) Establish policies and procedures for
on-going monitoring of medication administration as approved by the department.
(17) An ABI provider shall establish and
follow written guidelines for handling an emergency or a disaster which shall:
(a) Be readily accessible on site;
(b) Include an evacuation drill:
1. To be conducted and documented at
least quarterly; and
2. For a residential setting, scheduled
to include a time overnight when an ABI recipient is typically asleep;
(c) Mandate that:
1. The result of an evacuation drill be
evaluated and modified as needed; and
2. Results of the prior year’s evacuation
drill be maintained on site.
(18) An ABI provider shall:
(a) Provide orientation for each new
employee which shall include the mission, goals, organization and policy of the
agency;
(b) Require documentation of all training
which shall include:
1. The type of training provided;
2. The name and title of the trainer;
3. The length of the training;
4. The date of completion; and
5. The signature of the trainee verifying
completion;
(c) Ensure that each employee complete
ABI training consistent with the curriculum that has been approved by the
department prior to working independently with an ABI recipient which shall
include:
1. Required orientation in brain injury;
2. Identifying and reporting abuse,
neglect and exploitation;
3. Unless the employee is a licensed or
registered nurse, first aid, which shall be provided by an individual certified
as a trainer by the American Red Cross or other nationally-accredited
organization; and
4. Coronary pulmonary resuscitation which
shall be provided by an individual certified as a trainer by the American Red
Cross or other nationally-accredited organization;
(d) Ensure that each employee completes
at least six (6) hours of continuing education in brain injury annually;
(e) Not be required to receive the
training specified in paragraph (c)1 of this subsection if the provider is a
professional who has, within the prior five (5) years, 2,000 hours of
experience in serving a person with a primary diagnosis of a brain injury
including:
1. An occupational therapist or
occupational therapy assistant providing occupational therapy;
2. A psychologist or psychologist with
autonomous functioning providing psychological services;
3. A speech-language pathologist
providing speech therapy; or
4. A board certified behavior analyst;
and
(f) Ensure that prior to the date of
service as a volunteer, an individual receives training which shall include:
1. Required orientation in brain injury
as specified in paragraph (c)1, 2, 3, and 4 of this subsection;
2. Orientation to the agency;
3. A confidentiality statement; and
4. Individualized instruction on the
needs of the ABI recipient to whom the volunteer will provide services.
(19) An ABI provider shall provide
information to a case manager necessary for completion of a Mayo-Portland
Adaptability Inventory-4 for each ABI recipient served by the provider.
(20) A case management
provider shall:
(a) Establish a human rights committee which shall:
1. Include an:
a. Individual with a brain injury or a
family member of an individual with a brain injury;
b. Individual not affiliated with the ABI
provider; and
c. Individual who has knowledge and
experience in human rights issues;
2. Review and approve each plan of care
with human rights restrictions at a minimum of every six (6) months;
3. Review and approve, in conjunction
with the ABI recipient’s team, behavior intervention plans that contain human
rights restrictions; and
4. Review the use of a psychotropic
medication by an ABI recipient without an Axis I diagnosis; and
(b) Establish a behavior intervention
committee which shall:
1. Include one (1) individual who has
expertise in behavior intervention and is not the behavior specialist who wrote
the behavior intervention plan;
2. Be separate from the human rights
committee; and
3. Review and approve, prior to
implementation and at a minimum of every six (6) months in conjunction with the
ABI recipient's team, an intervention plan that includes highly restrictive
procedures or contain human rights restrictions; and
(c) Complete and submit a Mayo-Portland Adaptability Inventory-4 to the department
for each ABI recipient:
1. Within thirty (30) days of
the recipient's admission into the ABI program;
2. Annually thereafter; and
3. Upon discharge from the
ABI waiver program.
Section 3. ABI Recipient Eligibility,
Enrollment and Termination. (1) To be eligible to receive a service in the ABI
program:
(a) An individual shall:
1. Be at least eighteen (18) years of
age;
2. Have acquired a brain injury of the
following nature, to the central nervous system:
a. An injury from physical trauma;
b. Damage from anoxia or from a hypoxic
episode; or
c. Damage from an allergic condition,
toxic substance, or another acute medical incident; and
3. Apply to be placed on the ABI waiting
list in accordance with Section 7 of this administrative regulation;
(b) A case manager or support broker, on
behalf of an applicant, shall submit a certification packet to the department
containing the following:
1. A copy of the allocation letter;
2. A Medicaid Waiver Assessment, MAP-351;
3. A statement for the need for ABI
waiver services which shall be signed and dated by a physician on a MAP-10,
Waiver Services – Physician’s Recommendation;
4. A Long Term Care Facilities and Home
and Community Based Program Certification form, MAP-350;
5. A MAP-109; and
6. The MAP 24C, Admittance, Discharge or
Transfer of an Individual in the ABI/SCL Program;
(c) An individual shall receive
notification of potential funding allocated for ABI services for the individual;
(d) An individual shall meet the patient
status criteria for nursing facility services established in 907 KAR 1:022
including nursing facility services for a brain injury;
(e) An individual shall meet the
following conditions:
1. Have a primary diagnosis that
indicates an ABI with structural, nondegenerative brain injury;
2. Be medically stable;
3. Meet Medicaid eligibility requirements
established in 907 KAR 20:010;
4. Exhibit cognitive, behavioral, motor
or sensory damage with an indication for rehabilitation and retraining
potential; and
5. Have a rating of at least four (4) on
the Family Guide to the Rancho Levels of Cognitive Functioning; and
(f) An individual shall receive
notification of approval from the department.
(2) An individual shall not remain in the
ABI waiver program for an indefinite period of time.
(3) The basis of an eligibility
determination for participation in the ABI waiver program shall be:
(a) The presenting problem;
(b) The plan of care goal;
(c) The expected benefit of the
admission;
(d) The expected outcome;
(e) The service required; and
(f) The cost effectiveness of service
delivery as an alternative to nursing facility and nursing facility brain
injury services.
(4) An ABI waiver service shall not be
furnished to an individual if the individual is:
(a) An inpatient of a hospital, nursing
facility or an intermediate care facility for individuals with mental
retardation or a developmental disability; or
(b) Receiving a service in another home
and community based waiver program.
(5) The department shall make:
(a) An initial evaluation to determine if
an individual meets the nursing facility patient status criteria established in
907 KAR 1:022; and
(b) A determination of whether to admit
an individual into the ABI waiver program.
(6) To maintain eligibility as an ABI
recipient:
(a) An individual shall maintain Medicaid
eligibility requirements established in 907 KAR 20:010; and
(b) A reevaluation shall be conducted at
least once every twelve (12) months to determine if the individual continues to
meet the patient status criteria for nursing facility services established in
907 KAR 1:022.
(7) An ABI case management provider shall
notify the local DCBS office, ABIB, and the department via a MAP 24C, Admittance,
Discharge or Transfer of an Individual in the ABI/SCL Program, if the ABI
recipient is:
(a) Admitted to the ABI waiver program;
(b) Discharged from the ABI waiver
program;
(c) Temporarily discharged from the ABI
waiver program;
(d) Readmitted from a temporary
discharge;
(e) Admitted to a nursing facility;
(f) Changing the primary provider; or
(g) Changing the case management agency.
(8) The department may exclude an
individual from receiving ABI waiver services if the projected cost of ABI
waiver services for the individual is reasonably expected to exceed the cost of
nursing facility services for the individual.
(9) Involuntary termination and loss of
an ABI waiver program placement shall be in accordance with 907 KAR 1:563 and
shall be initiated if:
(a) An individual fails to initiate an
ABI waiver service within sixty (60) days of notification of potential funding
without good cause shown. The individual or legal representative shall have the
burden of providing documentation of good cause, including:
1. A statement signed by the recipient or
legal representative;
2. Copies of letters to providers; and
3. Copies of letters from providers;
(b) An ABI recipient or legal
representative fails to access the required service as outlined in the plan of
care for a period greater than sixty (60) consecutive days without good cause
shown.
1. The recipient or legal representative
shall have the burden of providing documentation of good cause including:
a. A statement signed by the recipient or
legal representative;
b. Copies of letters to providers; and
c. Copies of letters from providers; and
2. Upon receipt of documentation of good
cause, the department shall grant one (1) extension in writing which shall be:
a. Sixty (60) days for an individual who
does not reside in a facility; and
b. For an individual who resides in a
facility, the length of the transition plan and contingent upon continued
active participation in the transition plan;
(c) An ABI recipient changes residence
outside the Commonwealth of Kentucky;
(d) An ABI recipient does not meet the
patient status criteria for nursing facility services established in 907 KAR
1:022;
(e) An ABI recipient is no longer able to
be safely served in the community;
(f) The ABI recipient has reached maximum
rehabilitation potential; or
(g) The ABI recipient is no longer
actively participating in services within the approved plan of care as
determined by the interdisciplinary team.
(10) Involuntary termination of a service
to an ABI recipient by an ABI provider shall require:
(a) Simultaneous notice to the
department, the ABI recipient or legal representative and the case manager at
least thirty (30) days prior to the effective date of the action, which shall
include:
1. A statement of the intended action;
2. The basis for the intended action;
3. The authority by which the action is
taken; and
4. The ABI recipient’s right to appeal
the intended action through the provider’s appeal or grievance process; and
(b) The case manager in conjunction with
the provider to:
1. Provide the ABI recipient with the
name, address and telephone number of each current ABI provider in the state;
2. Provide assistance to the ABI
recipient in making contact with another ABI provider;
3. Arrange transportation for a requested
visit to an ABI provider site;
4. Provide a copy of pertinent
information to the ABI recipient or legal representative;
5. Ensure the health, safety and welfare
of the ABI recipient until an appropriate placement is secured;
6. Continue to provide supports until
alternative services or another placement is secured; and
7. Provide assistance to ensure a safe
and effective service transition.
(11) Voluntary termination and loss of an
ABI waiver program placement shall be initiated if an ABI recipient or legal
representative submits a written notice of intent to discontinue services to
the service provider and to the department.
(a) An action to terminate services shall
not be initiated until thirty (30) calendar days from the date of the notice;
and
(b) The ABI recipient or legal
representative may reconsider and revoke the notice in writing during the
thirty (30) calendar day period.
Section 4. Covered Services. (1) An ABI
waiver service shall:
(a) Be prior-authorized by the
department; and
(b) Be provided pursuant to the plan of
care.
(2) The following services shall be
provided to an ABI recipient by an ABI waiver provider:
(a) Case management services, which
shall:
1. Include initiation, coordination,
implementation, and monitoring of the assessment or reassessment, evaluation,
intake, and eligibility process;
2. Assist an ABI recipient in the
identification, coordination, and facilitation of the interdisciplinary team
and interdisciplinary team meetings;
3. Assist an ABI recipient and the
interdisciplinary team to develop an individualized plan of care and update it
as necessary based on changes in the recipient's medical condition and
supports;
4. Include monitoring of the delivery of
services and the effectiveness of the plan of care, which shall:
a. Be initially developed with the ABI
recipient and legal representative if appointed prior to the level of care
determination;
b. Be updated within the first thirty
(30) days of service and as changes or recertification occurs; and
c. Include the MAP-109 being sent to the
department or its designee prior to the implementation of the effective date
the change occurs with the ABI recipient;
5. Include a transition plan that shall
be developed within the first thirty (30) days of service, updated as changes
or recertification occurs, updated thirty (30) days prior to discharge, and shall
include:
a. The skills or service obtained from
the ABI waiver program upon transition into the community; and
b. A listing of the community supports
available upon the transition;
6. Assist an ABI recipient in obtaining a
needed service outside those available by the ABI waiver;
7. Be provided by a case manager who:
a.(i) Is a registered nurse;
(ii) Is a licensed practical nurse;
(iii) Is an individual who has a
bachelor’s or master’s degree in a human services field who meets all
applicable requirements of his or her particular field including a degree in
psychology, sociology, social work, rehabilitation counseling, or occupational
therapy;
(iv) Is an independent case manager; or
(v) Is employed by a free-standing case
management agency;
b. Has completed case management training
that is consistent with the curriculum that has been approved by the department
prior to providing case management services;
c. Shall provide an ABI recipient and
legal representative with a listing of each available ABI provider in the
service area;
d. Shall maintain documentation signed by
an ABI recipient or legal representative of informed choice of an ABI provider
and of any change to the selection of an ABI provider and the reason for the
change;
e. Shall provide a distribution of the
crisis prevention and response plan, transition plan, plan of care, and other
documents within the first thirty (30) days of the service to the chosen ABI service
provider and as information is updated;
f. Shall provide twenty-four (24) hour
telephone access to an ABI recipient and chosen ABI provider;
g. Shall work in conjunction with an ABI
provider selected by an ABI recipient to develop a crisis prevention and
response plan which shall be:
(i) Individual-specific; and
(ii) Updated as a change occurs and at
each recertification;
h. Shall assist an ABI
recipient in planning resource use and assuring protection of resources;
i.(i) Shall conduct two (2) face-to-face
meetings with an ABI recipient within a calendar month occurring at a covered
service site no more than fourteen (14) days apart, with one (1) visit
quarterly at the ABI recipient’s residence; and
(ii) For an ABI recipient receiving
supervised residential care, shall conduct at least one (1) of the two (2) monthly
visits at the ABI recipient’s supervised residential care provider site;
j. Shall ensure twenty-four (24) hour
availability of services; and
k. Shall ensure that the ABI
recipient’s health, welfare, and safety needs are met; and
8. Be documented by a detailed staff note
which shall include:
a. The ABI recipient’s health, safety and
welfare;
b. Progress toward outcomes identified in
the approved plan of care;
c. The date of the service;
d. Beginning and ending time;
e. The signature and title of the
individual providing the service; and
f. A quarterly summary which shall
include:
(i) Documentation of monthly contact with
each chosen ABI provider; and
(ii) Evidence of monitoring of the
delivery of services approved in the recipient’s plan of care and of the
effectiveness of the plan of care;
(b) Behavior programming services which
shall:
1. Be the systematic application of
techniques and methods to influence or change a behavior in a desired way;
2. Include a functional analysis of the
ABI recipient's behavior which shall include:
a. An evaluation of the impact of an ABI
on cognition and behavior;
b. An analysis of potential communicative
intent of the behavior;
c. The history of reinforcement for the
behavior;
d. Critical variables that precede the
behavior;
e. Effects of different situations on the
behavior; and
f. A hypothesis regarding the motivation,
purpose and factors which maintain the behavior;
3. Include the development of a
behavioral support plan which shall:
a. Be developed by the behavioral
specialist;
b. Not be implemented by the behavior
specialist who wrote the plan;
c. Be revised as necessary;
d. Define the techniques and procedures
used;
e. Include the hierarchy of behavior
interventions ranging from the least to the most restrictive;
f. Reflect the use of positive
approaches; and
g. Prohibit the use of prone or supine
restraint, corporal punishment, seclusion, verbal abuse, and any procedure
which denies private communication, requisite sleep, shelter, bedding, food,
drink, or use of a bathroom facility;
4. Include the provision of training to
other ABI providers concerning implementation of the behavioral intervention
plan;
5. Include the monitoring of an ABI
recipient's progress which shall be accomplished through:
a. The analysis of data concerning the
frequency, intensity, and duration of a behavior;
b. Reports involved in implementing the
behavioral service plan; and
c. A monthly summary which assesses the
participant’s status related to the plan of care;
6. Be provided by a behavior specialist
who shall:
a.(i) Be a psychologist;
(ii) Be a psychologist with autonomous
functioning;
(iii) Be a licensed psychological
associate;
(iv) Be a psychiatrist;
(v) Be a licensed clinical social worker;
(vi) Be a clinical nurse specialist with
a master’s degree in psychiatric nursing or rehabilitation nursing;
(vii) Be an advanced practice registered
nurse (APRN);
(viii) Be a board certified behavior
analyst; or
(ix) Be a licensed professional clinical
counselor; and
b. Have at least one (1) year of behavior
specialist experience or provide documentation of completed coursework
regarding learning and behavior principles and techniques; and
7. Be documented by a detailed staff note
which shall include:
a. The date of the service;
b. The beginning and ending time; and
c. The signature and title of the
behavioral specialist;
(c) Companion services which shall:
1. Include a nonmedical service,
supervision or socialization as indicated in the recipient's plan of care;
2. Include assisting with but not
performing meal preparation, laundry and shopping;
3. Include light housekeeping tasks which
are incidental to the care and supervision of an ABI waiver service recipient;
4. Include services provided according to
the approved plan of care which are therapeutic and not diversional in nature;
5. Include accompanying and assisting an
ABI recipient while utilizing transportation services;
6. Include documentation by a detailed
staff note which shall include:
a. Progress toward goal and objectives
identified in the approved plan of care;
b. The date of the service;
c. Beginning and ending time; and
d. The signature and title of the
individual providing the service;
7. Not be provided to an ABI recipient
who receives supervised residential care; and
8. Be provided by:
a. A home health agency licensed and
operating in accordance with 902 KAR 20:081;
b. A community mental health center
licensed and operating in accordance with 902 KAR 20:091 and certified at least
annually by the department;
c. A community habilitation program
certified by the department; or
d. A supervised residential care
provider;
(d) Supervised residential care level I
services, which:
1. Shall be provided by:
a. A community mental health center
licensed and operating in accordance with 902 KAR 20:091 and certified at least
annually by the department; or
b. An ABI provider;
2. Shall not be provided to an ABI
recipient unless the recipient has been authorized to receive residential care
by the department’s residential review committee which shall:
a. Consider applications for residential
care in the order in which the applications are received;
b. Base residential care decisions on the
following factors:
(i) Whether the applicant resides with a
caregiver or not;
(ii) Whether the applicant resides with a
caregiver but demonstrates maladaptive behavior which places the applicant at
significant risk of injury or jeopardy if the caregiver is unable to
effectively manage the applicant’s behavior or the risk it poses, resulting in
the need for removal from the home to a more structured setting; or
(iii) Whether the applicant demonstrates
behavior which may result in potential legal problems if not ameliorated;
c. Be comprised of three (3) Cabinet for
Health and Family Services employees:
(i) With professional or personal
experience with brain injury or other cognitive disabilities; and
(ii) None of whom shall be supervised by
the manager of the acquired brain injury branch; and
d. Only consider applications at a
monthly committee meeting if the applications were received at least three (3)
business days before the committee convenes;
3. Shall not have more than three (3) ABI
recipients simultaneously in a residence rented or owned by the ABI provider;
4. Shall provide twenty-four (24) hours
of supervision daily unless the provider implements, pursuant to subparagraph 5
of this paragraph, an individualized plan allowing for up to five (5) unsupervised
hours per day;
5. May include the provision of up to
five (5) unsupervised hours per day per recipient if the provider develops an
individualized plan for the recipient to promote increased independence. The
plan shall:
a. Contain provisions necessary to ensure
the recipient’s health, safety, and welfare;
b. Be approved by the recipient’s
treatment team, with the approval documented by the provider; and
c. Contain periodic reviews and updates
based on changes, if any, in the recipient’s status;
6. Shall include assistance and training
with daily living skills including:
a. Ambulating;
b. Dressing;
c. Grooming;
d. Eating;
e. Toileting;
f. Bathing;
g. Meal planning;
h. Grocery shopping;
i. Meal preparation;
j. Laundry;
k. Budgeting and financial matters;
l. Home care and cleaning;
m. Leisure skill instruction; or
n. Self-medication instruction;
7. Shall include social skills training
including the reduction or elimination of maladaptive behaviors in accordance
with the individual’s plan of care;
8. Shall include provision or arrangement
of transportation to services, activities, or medical appointments as needed;
9. Shall include accompanying or
assisting an ABI recipient while the recipient utilizes transportation services
as specified in the recipient’s plan of care;
10. Shall include participation in
medical appointments or follow-up care as directed by the medical staff;
11. Shall be documented by a detailed
staff note which shall document:
a. Progress toward goals and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time of the
service; and
d. The signature and title of the
individual providing the service;
12. Shall not include the cost of room
and board;
13. Shall be provided to an ABI recipient
who:
a. Does not reside with a caregiver;
b. Is residing with a caregiver but
demonstrates maladaptive behavior that places him or her at significant risk of
injury or jeopardy if the caregiver is unable to effectively manage the
behavior or the risk it presents, resulting in the need for removal from the
home to a more structured setting; or
c. Demonstrates behavior that may result
in potential legal problems if not ameliorated;
14. May utilize a modular home only if
the:
a. Wheels are removed;
b. Home is anchored to a permanent
foundation; and
c. Windows are of adequate size for an
adult to use as an exit in an emergency;
15. Shall not utilize a motor home;
16. Shall provide a sleeping room which
ensures that an ABI recipient:
a. Does not share a room with an
individual of the opposite gender who is not the ABI recipient's spouse;
b. Does not share a room with an
individual who presents a potential threat; and
c. Has a separate bed equipped with
substantial springs, a clean and comfortable mattress, and clean bed linens as
required for the ABI recipient's health and comfort; and
17. Shall provide service and training to
obtain the outcomes for the ABI recipient as identified in the approved plan of
care;
(e) Supervised residential care level II
services, which:
1. Shall be provided by:
a. A community mental health center
licensed and operating in accordance with 902 KAR 20:091 and certified at least
annually by the department; or
b. An ABI provider;
2. Shall not be provided to an ABI
recipient unless the recipient has been authorized to receive residential care
by the department’s residential review committee which shall:
a. Consider applications for residential
care in the order in which the applications are received;
b. Base residential care decisions on the
following factors:
(i) Whether the applicant resides with a
caregiver or not;
(ii) Whether the applicant resides with a
caregiver but demonstrates maladaptive behavior which places the applicant at
significant risk of injury or jeopardy if the caregiver is unable to
effectively manage the applicant’s behavior or the risk it poses, resulting in
the need for removal from the home to a more structured setting; or
(iii) Whether the applicant demonstrates
behavior which may result in potential legal problems if not ameliorated;
c. Be comprised of three (3) Cabinet for
Health and Family Services employees:
(i) With professional or personal
experience with brain injury or other cognitive disabilities; and
(ii) None of whom shall be supervised by
the manager of the acquired brain injury branch; and
d. Only consider applications at a
monthly committee meeting if the applications were received at least three (3)
business days before the committee convenes;
3. Shall not have more than three (3) ABI
recipients simultaneously in a residence rented or owned by the ABI provider;
4. Shall provide twelve (12) to eighteen
(18) hours of daily supervision, the amount of which shall:
a. Be based on the recipient’s needs;
b. Be approved by the recipient’s treatment
team; and
c. Be documented in the recipient’s plan
of care which shall also contain periodic reviews and updates based on changes,
if any, in the recipient’s status;
5. Shall include assistance and training
with daily living skills including:
a. Ambulating;
b. Dressing;
c. Grooming;
d. Eating;
e. Toileting;
f. Bathing;
g. Meal planning;
h. Grocery shopping;
i. Meal preparation;
j. Laundry;
k. Budgeting and financial matters;
l. Home care and cleaning;
m. Leisure skill instruction; or
n. Self-medication instruction;
6. Shall include social skills training
including the reduction or elimination of maladaptive behaviors in accordance
with the individual’s plan of care;
7. Shall include provision or arrangement
of transportation to services, activities, or medical appointments as needed;
8. Shall include accompanying or
assisting an ABI recipient while the recipient utilizes transportation services
as specified in the recipient’s plan of care;
9. Shall include participation in medical
appointments or follow-up care as directed by the medical staff;
10. Shall include provision of
twenty-four (24) hour on-call support;
11. Shall be documented by a detailed
staff note which shall document:
a. Progress toward goals and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time of the
service; and
d. The signature and title of the
individual providing the service;
12. Shall not include the cost of room
and board;
13. Shall be provided to an ABI recipient
who:
a. Does not reside with a caregiver;
b. Is residing with a caregiver but
demonstrates maladaptive behavior that places him or her at significant risk of
injury or jeopardy if the caregiver is unable to effectively manage the behavior
or the risk it presents, resulting in the need for removal from the home to a
more structured setting; or
c. Demonstrates behavior that may result
in potential legal problems if not ameliorated;
14. May utilize a modular home only if
the:
a. Wheels are removed;
b. Home is anchored to a permanent
foundation; and
c. Windows are of adequate size for an
adult to use as an exit in an emergency;
15. Shall not utilize a motor home;
16. Shall provide a sleeping room which
ensures that an ABI recipient:
a. Does not share a room with an
individual of the opposite gender who is not the ABI recipient's spouse;
b. Does not share a room with an
individual who presents a potential threat; and
c. Has a separate bed equipped with
substantial springs, a clean and comfortable mattress, and clean bed linens as
required for the ABI recipient's health and comfort; and
17. Shall provide service and training to
obtain the outcomes for the ABI recipient as identified in the approved plan of
care;
(f) Supervised residential care level III
services, which:
1. Shall be provided by:
a. A community mental health center
licensed and operating in accordance with 902 KAR 20:091 and certified at least
annually by the department; or
b. An ABI provider;
2. Shall not be provided to an ABI
recipient unless the recipient has been authorized to receive residential care
by the department’s residential review committee which shall:
a. Consider applications for residential
care in the order in which the applications are received;
b. Base residential care decisions on the
following factors:
(i) Whether the applicant resides with a
caregiver or not;
(ii) Whether the applicant resides with a
caregiver but demonstrates maladaptive behavior which places the applicant at
significant risk of injury or jeopardy if the caregiver is unable to
effectively manage the applicant’s behavior or the risk it poses, resulting in
the need for removal from the home to a more structured setting; or
(iii) Whether the applicant demonstrates
behavior which may result in potential legal problems if not ameliorated;
c. Be comprised of three (3) Cabinet for
Health and Family Services employees:
(i) With professional or personal
experience with brain injury or other cognitive disabilities; and
(ii) None of whom shall be supervised by
the manager of the acquired brain injury branch; and
d. Only consider applications at a
monthly committee meeting if the applications were received at least three (3)
business days before the committee convenes;
3. Shall be provided in a single family
home, duplex or apartment building to an ABI recipient who lives alone or with
an unrelated roommate;
4. Shall not be provided to more than two
(2) ABI recipients simultaneously in one (1) apartment or home;
5. Shall not be provided in more than two
(2) apartments in one (1) building;
6. Shall, if provided in an apartment
building, have staff:
a. Available twenty-four (24) hours per
day and seven (7) days per week; and
b. Who do not reside in a dwelling
occupied by an ABI recipient;
7. Shall provide less than twelve (12)
hours of supervision or support in the residence based on an individualized
plan developed by the provider to promote increased independence which shall:
a. Contain provisions necessary to ensure
the recipient’s health, safety, and welfare;
b. Be approved by the recipient’s
treatment team, with the approval documented by the provider; and
c. Contain periodic reviews and updates
based on changes, if any, in the recipient’s status;
8. Shall include assistance and training
with daily living skills including:
a. Ambulating;
b. Dressing;
c. Grooming;
d. Eating;
e. Toileting;
f. Bathing;
g. Meal planning;
h. Grocery shopping;
i. Meal preparation;
j. Laundry;
k. Budgeting and financial matters;
l. Home care and cleaning;
m. Leisure skill instruction; or
n. Self-medication instruction;
9. Shall include social skills training
including the reduction or elimination of maladaptive behaviors in accordance
with the individual’s plan of care;
10. Shall include provision or
arrangement of transportation to services, activities, or medical appointments
as needed;
11. Shall include accompanying or
assisting an ABI recipient while the recipient utilizes transportation services
as specified in the recipient’s plan of care;
12. Shall include participation in
medical appointments or follow-up care as directed by the medical staff;
13. Shall be documented by a detailed
staff note which shall document:
a. Progress toward goals and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time of the
service;
d. The signature and title of the
individual providing the service; and
e. Evidence of at least one (1) daily
face-to-face contact with the ABI recipient;
14. Shall not include the cost of room
and board;
15. Shall be provided to an ABI recipient
who:
a. Does not reside with a caregiver;
b. Is residing with a caregiver but
demonstrates maladaptive behavior that places him or her at significant risk of
injury or jeopardy if the caregiver is unable to effectively manage the
behavior or the risk it presents, resulting in the need for removal from the
home to a more structured setting; or
c. Demonstrates behavior that may result
in potential legal problems if not ameliorated;
16. May utilize a modular home only if
the:
a. Wheels are removed;
b. Home is anchored to a permanent
foundation; and
c. Windows are of adequate size for an
adult to use as an exit in an emergency;
17. Shall not utilize a motor home;
18. Shall provide a sleeping room which
ensures that an ABI recipient:
a. Does not share a room with an
individual of the opposite gender who is not the ABI recipient's spouse;
b. Does not share a room with an
individual who presents a potential threat; and
c. Has a separate bed equipped with
substantial springs, a clean and comfortable mattress, and clean bed linens as
required for the ABI recipient's health and comfort; and
19. Shall provide service and training to
obtain the outcomes for the ABI recipient as identified in the approved plan of
care;
(g) Counseling services which:
1. Shall be designed to help an ABI
waiver service recipient resolve personal issues or interpersonal problems
resulting from his or her ABI;
2. Shall assist a family member in
implementing an ABI waiver service recipient’s approved plan of care;
3. In a severe case, shall be provided as
an adjunct to behavioral programming;
4. Shall include substance abuse or
chemical dependency treatment, if needed;
5. Shall include building and maintaining
healthy relationships;
6. Shall develop social skills or the
skills to cope with and adjust to the brain injury;
7. Shall increase knowledge and awareness
of the effects of an ABI;
8. May include a group therapy service if
the service is:
a. Provided to a minimum of two (2) and a
maximum of eight (8) ABI recipients; and
b. Included in the recipient’s approved
plan of care for:
(i) Substance abuse or chemical
dependency treatment, if needed;
(ii) Building and maintaining healthy
relationships;
(iii) Developing social skills;
(iv) Developing skills to cope with and
adjust to a brain injury, including the use of cognitive remediation strategies
consisting of the development of compensatory memory and problem solving
strategies, and the management of impulsivity; and
(v) Increasing knowledge and awareness of
the effects of the acquired brain injury upon the ABI recipient’s functioning
and social interactions;
9. Shall be provided by:
a. A psychiatrist;
b. A psychologist;
c. A psychologist with autonomous
functioning;
d. A licensed psychological associate;
e. A licensed clinical social worker;
f. A clinical nurse specialist with a
master’s degree in psychiatric nursing;
g. An advanced practice registered nurse
(APRN); or
h. A certified alcohol and drug
counselor;
i. A licensed marriage and family
therapist; or
j. A licensed professional clinical
counselor; and
10. Shall be documented by a detailed
staff note which shall include:
a. Progress toward the goals and objectives
established in the plan of care;
b. The date of the service;
c. The beginning and ending time; and
d. The signature and title of the
individual providing the service;
(h) Occupational therapy which shall be:
1. A physician-ordered evaluation of an
ABI recipient’s level of functioning by applying diagnostic and prognostic
tests;
2. Physician-ordered services in a
specified amount and duration to guide an ABI recipient in the use of
therapeutic, creative, and self-care activities to assist the ABI recipient in
obtaining the highest possible level of functioning;
3. Exclusive of maintenance or the
prevention of regression;
4. Provided by an occupational therapist
or an occupational therapy assistant if supervised by an occupation therapist
in accordance with 201 KAR 28:130; and
5. Documented by a detailed staff note
which shall include:
a. Progress toward goal and objectives
identified in the approved plan of care;
b. The date of the service;
c. Beginning and ending time; and
d. The signature and title of the
individual providing the service;
(i) Personal care services which shall:
1. Include the retraining of an ABI
waiver service recipient in the performance of an activity of daily living by
using repetitive, consistent and ongoing instruction and guidance;
2. Be provided by:
a. An adult day health care center
licensed and operating in accordance with 902 KAR 20:066;
b. A home health agency licensed and
operating in accordance with 902 KAR 20:081;
c. A personal services agency; or
d. Another ABI provider;
3. Include the following activities of
daily living:
a. Eating, bathing, dressing or personal
hygiene;
b. Meal preparation; and
c. Housekeeping chores including
bed-making, dusting and vacuuming;
4. Be documented by a detailed staff note
which shall include:
a. Progress toward goal and objectives
identified in the approved plan of care;
b. The date of the service;
c. Beginning and ending time; and
d. The signature and title of the
individual providing the service; and
5. Not be provided to an ABI
recipient who receives supervised residential care
(j) A respite service which shall:
1. Be provided only to an ABI recipient
unable to administer self-care;
2. Be provided by a:
a. Nursing facility;
b. Community mental health center;
c. Home health agency;
d. Supervised residential care provider;
or
e. Community habilitation program;
3. Be provided on a short-term basis due
to absence or need for relief of an individual providing care to an ABI
recipient;
4. Be limited to 336 hours in a twelve
(12) month period unless an individual's normal caregiver is unable to provide
care due to a:
a. Death in the family;
b. Serious illness; or
c. Hospitalization;
5. Not be provided to an ABI
recipient who receives supervised residential care;
6. Not include the cost of room and board
if provided in a nursing facility; and
7. Be documented by a detailed staff note
which shall include:
a. Progress toward goals and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time; and
d. The signature and title of the
individual providing the service;
(k) Speech, hearing and language services
which shall be:
1. A physician-ordered evaluation of an
ABI recipient with a speech, hearing or language disorder;
2. A physician-ordered habilitative
service in a specified amount and duration to assist an ABI recipient with a
speech and language disability in obtaining the highest possible level of
functioning;
3. Exclusive of maintenance or the prevention
of regression;
4. Provided by a speech language
pathologist; and
5. Documented by a detailed staff note
which shall include:
a. Progress toward goals and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time; and
d. The signature and title of the
individual providing the service;
(l) Adult day training services which
shall:
1. Be provided by:
a. An adult day health care center which
is certified by the department and licensed and operating in accordance with
902 KAR 20:066;
b. An outpatient rehabilitation facility
which is certified by the department and licensed and operating in accordance
with 902 KAR 20:190;
c. A community mental health center
licensed and operating in accordance with 902 KAR 20:091;
d. A community habilitation program;
e. A sheltered employment program; or
f. A therapeutic rehabilitation program;
2. Rehabilitate, retrain and reintegrate
an individual into the community;
3. Not exceed a staffing ratio of five
(5) ABI recipients per one (1) staff person, unless an ABI recipient requires
individualized special service;
4. Include the following services:
a. Social skills training related to
problematic behaviors identified in the recipient's plan of care;
b. Sensory or motor development;
c. Reduction or elimination of a
maladaptive behavior;
d. Prevocational; or
e. Teaching concepts and skills to
promote independence including:
(i) Following instructions;
(ii) Attendance and punctuality;
(iii) Task completion;
(iv) Budgeting and money management;
(v) Problem solving; or
(vi) Safety;
5. Be provided in a nonresidential
setting;
6. Be developed in accordance with an ABI
waiver service recipient’s overall approved plan of care;
7. Reflect the recommendations of an ABI
waiver service recipient’s interdisciplinary team;
8. Be appropriate:
a. Given an ABI waiver service
recipient’s age, level of cognitive and behavioral function and interest;
b. Given an ABI waiver service
recipient’s ability prior to and since his or her injury; and
c. According to the approved plan of care
and be therapeutic in nature and not diversional;
9. Be coordinated with occupational,
speech, or other rehabilitation therapy included in an ABI waiver service
recipient’s plan of care;
10. Provide an ABI waiver service
recipient with an organized framework within which to function in his or her
daily activities;
11. Entail frequent assessments of an ABI
waiver service recipient’s progress and be appropriately revised as necessary;
and
12. Be documented by a detailed staff
note which shall include:
a. Progress toward goal and objectives
identified in the approved plan of care;
b. The date of the service;
c. The beginning and ending time;
d. The signature and title of the individual
providing the service; and
e. A monthly summary that assesses the
participant’s status related to the approved plan of care;
(m) Supported employment services which
shall be:
1. Intensive, ongoing services for an ABI
recipient to maintain paid employment in an environment in which an individual
without a disability is employed;
2. Provided by a:
a. Supported employment provider;
b. Sheltered employment provider; or
c. Structured day program provider;
3. Provided one-on-one;
4. Unavailable under a program funded by
either the Rehabilitation Act of 1973 (29 U.S.C. Chapter 16) or Pub.L. 99-457
(34 C.F.R. Parts 300 to 399), proof of which shall be documented in the ABI
recipient's file;
5. Limited to forty (40) hours per week
alone or in combination with structured day services;
6. An activity needed to sustain paid
work by an ABI recipient receiving waiver services including supervision and
training;
7. Exclusive of work performed directly
for the supported employment provider; and
8. Documented by a time and attendance
record which shall include:
a. Progress towards the goals and
objectives identified in the plan of care;
b. The date of service;
c. The beginning and ending time; and
d. The signature and title of the
individual providing the service;
(n) Specialized medical equipment and
supplies which shall:
1. Include durable and nondurable medical
equipment, devices, controls, appliances or ancillary supplies;
2. Enable an ABI recipient to increase
his or her ability to perform daily living activities or to perceive, control
or communicate with the environment;
3. Be ordered by a physician and
submitted on a Request for Equipment form, MAP-95, and include three (3)
estimates for vision and hearing;
4. Include equipment necessary to the
proper functioning of specialized items;
5. Not be available through the
department’s durable medical equipment, vision or hearing programs;
6. Not be necessary for life support;
7. Meet applicable standards of
manufacture, design and installation; and
8. Exclude those items which are not of
direct medical or remedial benefit to an ABI recipient;
(o) Environmental modifications which
shall:
1. Be provided in accordance with
applicable state and local building codes;
2. Be provided to an ABI recipient if:
a. Ordered by a physician;
b. Prior-authorized by the department;
c. Submitted on a Request for Equipment
form, MAP-95, by a case manager or support broker;
d. Specified in an ABI recipient’s
approved plan of care;
e. Necessary to enable an ABI recipient
to function with greater independence within his or her home; and
f. Without the modification, the ABI
recipient would require institutionalization;
3. Not include a vehicle modification;
4. Be limited to no more than $2,000 for
an ABI recipient in a twelve (12) month period; and
5. If entailing:
a. Electrical work, be provided by a
licensed electrician; or
b. Plumbing work, be provided by a
licensed plumber;
(p) An assessment which shall:
1. Be a comprehensive assessment which
shall identify:
a. An ABI waiver recipient’s needs; and
b. Services that an ABI
recipient’s family cannot manage or arrange for the recipient;
2. Evaluate an ABI waiver recipient’s
physical health, mental health, social supports, and environment;
3. Be requested by:
a. An individual requesting ABI
waiver services;
b. A family member of the individual
requesting ABI services; or
c. A legal representative of the
individual requesting ABI services;
4. Be conducted:
a. By an ABI case manager or support
broker; and
b. Within seven (7) calendar days of
receipt of the request for an assessment;
5. Include at least one (1) face-to-face
contact in the ABI waiver recipient’s home between the assessor, the ABI waiver
recipient, and, if appropriate, the recipient’s family;
6. Not be reimbursable if the individual
no longer meets ABI program eligibility requirements; or
(q) A reassessment, which shall:
1. Be performed at least once every
twelve (12) months;
2. Be conducted:
a. Using the same procedures as for an assessment;
and
b. By an ABI case manager or support
broker;
3. Be timely conducted to enable the
results to be submitted to the department within three (3) weeks prior to the
expiration of the current level of care certification to ensure that certification
is consecutive;
4. Not be reimbursable if the individual
no longer meets ABI program eligibility requirements; and
5. Not be retroactive.
Section 5. Exclusions of the Acquired
Brain Injury Waiver Program. A condition included in the following list shall
not be considered an acquired brain injury requiring specialized
rehabilitation:
(1) A stroke treatable in a nursing
facility providing routine rehabilitation services;
(2) A spinal cord injury for which there
is no known or obvious injury to the intracranial central nervous system;
(3) Progressive dementia or another
condition related to mental impairment that is of a chronic degenerative
nature, including senile dementia, organic brain disorder, Alzheimer’s Disease,
alcoholism or another addiction;
(4) A depression or a psychiatric
disorder in which there is no known or obvious central nervous system damage;
(5) A birth defect;
(6) Mental retardation without an
etiology to an acquired brain injury;
(7) A condition which causes an
individual to pose a level of danger or an aggression which is unable to be
managed and treated in a community; or
(8) Determination that the recipient has
met his or her maximum rehabilitation potential.
Section 6. Incident Reporting Process.
(1) An incident shall be documented on an Incident Report form.
(2) There shall be three (3) classes of
incidents as follows:
(a) A Class I incident which
shall:
1. Be minor in nature and not
create a serious consequence;
2. Not require an
investigation by the provider agency;
3. Be reported to the case
manager or support broker within twenty-four (24) hours;
4. Be reported to the
guardian as directed by the guardian; and
5. Be retained on file at the
provider and case management or support brokerage agency;
(b) A Class II incident which
shall:
1.a. Be serious in nature; or
b. Include a medication
error;
2. Require an investigation
which shall be initiated by the provider agency within twenty-four (24) hours
of discovery and shall involve the case manager or support broker; and
3. Be reported to the
following by the provider agency:
a. The case manager or
support broker within twenty-four (24) hours of discovery;
b. The guardian within
twenty-four (24) hours of discovery; and
c. BISB within twenty-four
(24) hours of discovery followed by a complete written report of the incident
investigation and follow-up within ten (10) calendar days of discovery; and
(c) A Class III incident
which shall:
1.a. Be grave in nature;
b. Involve suspected abuse,
neglect or exploitation;
c. Involve a medication error
which requires a medical intervention or hospitalization;
d. Be an admission to an
acute or psychiatric hospital;
e. Involve the use of a
chemical or physical restraint; or
f. Be a death;
2. Be Immediately investigated
by the provider agency, and the investigation shall involve the case manager or
support broker; and
3. Be reported by the
provider agency to:
a. The case manager or
support broker within eight (8) hours of discovery;
b. DCBS, immediately upon
discovery, if involving suspected abuse, neglect, or exploitation in accordance
with KRS Chapter 209;
c. The guardian within eight
(8) hours of discovery; and
d. BISB, within
eight (8) hours of discovery, followed by a complete written report of the
incident investigation and follow-up within seven (7) calendar days of
discovery. If an incident occurs after 5 p.m. EST on a weekday or occurs
on a weekend or holiday, notification to BISB shall occur on the following
business day.
(3) The following documentation with a
complete written report shall be submitted for a death:
(a) The plan of care in effect at the
time of death;
(b) The list of prescribed medications,
including PRN medications, in effect at the time of death;
(c) The crisis plan in effect at the time
of death;
(d) Medication administration review
(MAR) forms for the current and previous month;
(e) Staff notes from the current and
previous month including details of physician and emergency room visits;
(f) Any additional information requested
by the department;
(g) A coroner's report; and
(h) If performed, an autopsy report.
Section 7. ABI Waiting List. (1) An
individual of age eighteen (18) years or older applying for an ABI
waiver service shall be placed on a statewide waiting list which shall be
maintained by the department.
(2) In order to be placed on the ABI
waiting list, an individual shall submit to the department a completed MAP-26,
Program Application Kentucky Medicaid Program Acquired Brain Injury (ABI)
Waiver Services Program, and a completed MAP-10, Waiver Services – Physician’s
Recommendation.
(3) The order of placement on the ABI
waiting list shall be determined by chronological date of receipt of the
completed MAP-10, Waiver Services – Physician’s Recommendation, and by category
of need.
(4) The ABI waiting list categories of
need shall be emergency or nonemergency.
(5) To be placed in the emergency
category of need, an individual shall be determined by the emergency review
committee to meet the emergency category criteria established in subsection (8)
of this section.
(6) The emergency review committee shall:
(a) Be comprised of three (3) individuals
from the department:
1. Who shall each have professional or
personal experience with brain injury or cognitive disabilities; and
2. None of whom shall be supervised by
the branch manager of the department’s acquired brain injury branch;
(b) Meet during the fourth (4th) week of
each month to review and consider applications for the acquired brain injury
waiver program to determine if applicants meet the emergency category of need
criteria established in subsection (8) of this subsection.
(7) A completed MAP-26, Program
Application Kentucky Medicaid Program Acquired Brain Injury (ABI) Waiver
Services Program, and a completed MAP-10, Waiver Services – Physician’s Recommendation
for an ABI waiting list applicant shall be submitted to the department no later
than three (3) business days prior to the fourth (4th) week of each month in
order to be considered by the emergency review committee during that month’s
emergency review committee meeting.
(8) An applicant shall meet the emergency
category of need criteria if the applicant is currently demonstrating behavior
related to his or her acquired brain injury:
(a) That places the individual,
caregiver, or others at risk of significant harm; or
(b) Which has resulted in the applicant
being arrested.
(9) An applicant who does not meet the
emergency category of need criteria established in subsection (8) of this
subsection shall be considered to be in the nonemergency category of need.
(10) In determining chronological status
of an applicant, the original date of receipt of the MAP-26, Program
Application Kentucky Medicaid Program Acquired Brain Injury (ABI) Waiver Services
Program, and the MAP-10, Waiver Services – Physician’s Recommendation, shall be
maintained and not change if an individual is moved from one (1) category of
need to another.
(11) A written statement by a physician
or other qualified mental health professional shall be required to support the
validation of risk of significant harm to a recipient or caregiver.
(12) Written documentation by law
enforcement or court personnel shall be required to support the validation of a
history of arrest.
(13) If multiple applications are
received on the same date, a lottery shall be held to determine placement on
the waiting list within each category of need.
(14) A written notification of placement
on the waiting list shall be mailed to the individual or his or her legal
representative and case management provider if identified.
(15) Maintenance of the ABI waiting list
shall occur as follows:
(a) The department shall, at a minimum,
annually update the waiting list during the birth month of an individual;
(b) If an individual is removed from the
ABI waiting list, written notification shall be mailed by the department to the
individual and his or her legal representative and also the ABI case manager;
and
(c) The requested data shall be received
by the department within thirty (30) days from the date on the written notice
required by subsection (14) of this section.
(16) Reassignment of an applicant’s
category of need shall be completed based on the updated information and
validation process.
(17) An individual or legal representative
may submit a request for consideration of movement from one category of need to
another at any time that an individual’s status changes.
(18) An individual shall be removed from
the ABI waiting list if:
(a) After a documented attempt, the
department is unable to locate the individual or his or her legal
representative;
(b) The individual is deceased;
(c) The individual or individual’s legal
representative refuses the offer of ABI placement for services and does not
request to be maintained on the waiting list; or
(d) An ABI placement for services offer
is refused by the individual or legal representative and he or she does not,
without good cause, complete the Acquired Brain Injury Waiver Services Program
Application form, MAP-26, within sixty (60) days of the placement allocation
date.
1. The individual or individual’s legal
representative shall have the burden of providing documentation of good cause
including:
a. A signed statement by the individual
or the legal representative;
b. Copies of letters to providers; and
c. Copies of letters from providers.
2. Upon receipt of documentation of good
cause, the department shall grant one (1) sixty (60) day extension in writing.
(19) If an individual is removed from the
ABI waiting list, written notification shall be mailed by the department to the
individual or individual’s legal representative and the ABI case manager.
(20) The removal of an individual from
the ABI waiting list shall not prevent the submittal of a new application at a
later date.
(21) Potential funding allocated for
services for an individual shall be based upon:
(a) The individual’s category of need;
and
(b) The individual’s chronological date
of placement on the waiting list.
Section 8. Consumer Directed Option. (1)
Covered services and supports provided to an ABI recipient participating in CDO
shall include:
(a) Home and community support services;
(b) Community day support services;
(c) Goods or services; or
(d) Financial management.
(2) A home and community support service shall:
(a) Be available only under the consumer
directed option;
(b) Be provided in the consumer’s home or
in the community;
(c) Be based upon therapeutic goals;
(d) Not be diversional in nature;
(e) Not be provided to an individual if
the same or similar service is being provided to the individual via non-CDO ABI
services; and
(f)1. Be respite for the primary
caregiver; or
2. Be supports and assistance related to
chosen outcomes to facilitate independence and promote integration into the
community for an individual residing in his or her own home or the home of a
family member and may include:
a. Routine household tasks and
maintenance;
b. Activities of daily living;
c. Personal hygiene;
d. Shopping;
e. Money management;
f. Medication management;
g. Socialization;
h. Relationship building;
i. Meal planning;
j. Meal preparation;
k. Grocery shopping; or
l. Participation in community activities.
(3) A community day support service
shall:
(a) Be available only under the
consumer-directed option;
(b) Be provided in a community setting;
(c) Be based upon therapeutic goals;
(d) Not be diversional in nature;
(e) Be tailored to the consumer’s
specific personal outcomes related to the acquisition, improvement, and
retention of skills and abilities to prepare and support the consumer for:
1. Work;
2. Community activities;
3. Socialization;
4. Leisure; or
5. Retirement activities; and
(f) Not be provided to an individual if
the same or similar service is being provided to the individual via non-CDO ABI
services.
(4) Goods or services shall:
(a) Be individualized;
(b) Be utilized to:
1. Reduce the need for personal care; or
2. Enhance independence within the
consumer’s home or community;
(c) Not include experimental goods or
services; and
(d) Not include chemical or physical
restraints.
(5) To be covered, a CDO service shall be
specified in a consumer’s plan of care.
(6) Reimbursement for a CDO service shall
not exceed the department’s allowed reimbursement for the same or a similar service
provided in a non-CDO ABI setting.
(7) A consumer, including a married
consumer, shall choose providers and the choice of CDO provider shall be documented
in his or her plan of care.
(8) A consumer may designate a
representative to act on the consumer's behalf. The CDO representative shall:
(a) Be twenty-one (21) years of age or
older;
(b) Not be monetarily compensated for
acting as the CDO representative or providing a CDO service; and
(c) Be appointed by the consumer on a
MAP-2000 form.
(9) A consumer may voluntarily terminate
CDO services by completing a MAP-2000 and submitting it to the support broker.
(10) The department shall immediately
terminate a consumer from CDO services if:
(a) Imminent danger to the consumer’s
health, safety, or welfare exists;
(b) The recipient’s plan of care
indicates he or she requires more hours of service than the program can
provide, thus jeopardizing the recipient’s safety or welfare due to being left
alone without a caregiver present; or
(c) The recipient, caregiver, family
member, or guardian threatens or intimidates a support broker or other CDO
staff.
(11) The department may terminate a
consumer from CDO services if it determines that the consumer’s CDO provider
has not adhered to the plan of care.
(12) Prior to a consumer’s termination
from CDO services, the support broker shall:
(a) Notify the assessment or reassessment
service provider of potential termination;
(b) Assist the consumer in developing a
resolution and prevention plan;
(c) Allow at least thirty (30), but no
more than ninety (90), days for the consumer to resolve the issue, develop and
implement a prevention plan, or designate a CDO representative;
(d) Complete and submit to the department
a MAP-2000 form terminating the consumer from CDO services if the consumer
fails to meet the requirements in paragraph (c) of this subsection; and
(e) Assist the consumer in transitioning
back to traditional ABI services.
(13) Upon an involuntary termination of
CDO services, the department shall:
(a) Notify a consumer in writing of its
decision to terminate the consumer’s CDO participation; and
(b) Inform the consumer of the right to
appeal the department’s decision in accordance with Section 10 of this
administrative regulation.
(14) A CDO provider:
(a) Shall be selected by the consumer;
(b) Shall submit a completed Kentucky
Consumer Directed Option Employee Provider Contract to the support broker;
(c) Shall be eighteen (18) years of age
or older;
(d) Shall 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) Shall be able to communicate
effectively with the consumer, consumer representative, or family;
(f) Shall be able to understand and carry
out instructions;
(g) Shall be able to keep records as
required by the consumer;
(h) Shall submit to a criminal background
check conducted by the Administrative Office of the Courts if the individual is
a Kentucky resident or equivalent out-of-state agency if the individual resided
or worked outside Kentucky during the year prior to selection as a provider of
CDO services;
(i) Shall submit to a check of the
central registry maintained in accordance with 922 KAR 1:470 and not be found
on the registry:
1. A consumer may employ a provider prior
to a central registry check result being obtained for up to thirty (30) days;
and
2. If a consumer does not obtain a
central registry check result within thirty (30) days of employing a provider,
the consumer shall cease employment of the provider until a favorable result is
obtained;
(j) Shall 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;
(k) Shall not have pled guilty or been
convicted of committing a sex crime or violent crime as defined in KRS 17.165
(1) through (3);
(l) Shall 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 consumer;
(m) Shall be approved by the department;
(n) Shall maintain and submit timesheets
documenting hours worked; and
(o) Shall be a friend, spouse, parent,
family member, other relative, employee of a provider agency, or other person
hired by the consumer.
(15) A parent, parents combined, or a
spouse shall not provide more than forty (40) hours of services in a calendar
week (Sunday through Saturday) regardless of the number of family members who
receive waiver services.
(16)(a) The department shall establish a
budget for a consumer based on the individual’s historical costs minus five (5)
percent to cover costs associated with administering the consumer directed
option. If no historical cost exists for the consumer, the consumer's budget
shall equal the average per capita historical costs of ABI recipients minus
five (5) percent.
(b) Cost of services authorized by the
department for the individual's prior year plan of care but not utilized may be
added to the budget if necessary to meet the individual's needs.
(c) The department may adjust a
consumer's budget based on the consumer's needs and in accordance with
paragraphs (d) and (e) of this subsection.
(d) A consumer's budget shall not be
adjusted to a level higher than established in paragraph (a) of this subsection
unless:
1. The 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 consumer's health,
safety, and welfare; and
4. If a significant change has occurred
in the 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 recipient’s relocation.
(f) A consumer’s budget shall not exceed
the average per capita cost of services provided to individuals with a brain
injury in a nursing facility.
(17) Unless approved by the department
pursuant to subsection (16)(b) through (e) of this section, if a 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-CDO)
waiver service provider.
(18) A support broker shall:
(a) Provide needed assistance to a
consumer with any aspect of CDO or blended services;
(b) Be available to a consumer by phone
or in person:
1. Twenty-four (24) hours per day, seven
(7) days per week; and
2. To assist the consumer in obtaining
community resources as needed;
(c) Comply with applicable federal and
state laws and requirements;
(d) Continually monitor a consumer's
health, safety, and welfare; and
(e) Complete or revise a plan of care
using the Person Centered Planning: Guiding Principles.
(19) For a CDO participant, a support
broker may conduct an assessment or reassessment.
(20) Financial management shall:
(a) Include managing, directing, or
dispersing a consumer’s funds identified in the consumer’s approved CDO budget;
(b) Include payroll processing associated
with the individual hired by a consumer or the consumer’s representative;
(c) Include:
1. Withholding local, state, and federal
taxes; and
2. Making payments to appropriate tax
authorities on behalf of a consumer;
(d) Be performed by an entity that:
1. Is enrolled as a Medicaid provider in
accordance with 907 KAR 1:672;
2. Is currently compliant with 907 KAR
1:671;
3. Has at least two (2) years of
experience working with individuals with an acquired brain injury; and
(e) Include preparation of fiscal
accounting and expenditure reports for:
1. A consumer or consumer’s
representative; and
2. The department.
Section 9. Electronic Signature Usage.
(1) The
creation, transmission, storage, or other use of electronic signatures and documents
shall comply with the requirements established in KRS 369.101 to 369.120.
(2) An ABI provider which
chooses to use electronic signatures shall:
(a) Develop and implement a
written security policy which 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
which 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.
Section 10. Appeal Rights. (1) An appeal
of a department decision regarding a recipient or applicant based upon an
application of this administrative regulation shall be in accordance with 907
KAR 1:563.
(2) An appeal of a department decision
regarding Medicaid eligibility of an individual based upon an application of
this administrative regulation shall be in accordance with 907 KAR 1:560.
(3) An appeal of a department decision
regarding a provider based upon an application of this administrative
regulation shall be in accordance with 907 KAR 1:671.
Section 11. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) "MAP-109, Prior Authorization
for Waiver Services", July 2008 edition;
(b) "MAP 24C, Admittance, Discharge
or Transfer of an Individual in the ABI/SCL Program", August 2010 edition;
(c) "MAP-26, Program Application
Kentucky Medicaid Program Acquired Brain Injury (ABI) Waiver Services Program”,
July 2008 edition;
(d) "MAP-95, Request for Equipment
Form", May 2010 edition;
(e) "MAP-10, Waiver Services –
Physician’s Recommendation", August 2010 edition;
(f) "Incident Report", July
2008 edition;
(g) "MAP-2000,
Initiation/Termination of Consumer Directed Option (CDO)", July 2008
edition;
(h) "MAP-350, Long Term Care Facilities and Home and Community Based Program
Certification Form", July 2008 edition;
(i) "Family
Guide to the Rancho Levels of Cognitive Functioning", August 2006 edition;
(j) "MAP-351,
Medicaid Waiver Assessment", July 2008 edition;
(k)
"Mayo-Portland Adaptability Inventory-4", March 2003 edition;
(l) "Person
Centered Planning: Guiding Principles", March 2005 edition;
(m)
"MAP-4100a", September 2010 edition; and
(n) “Kentucky
Consumer Directed Option Employee Provider Contract”, May 4, 2007 edition.
(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. (25 Ky.R. 2993; Am. 26 Ky.R. 400; eff. 8-16-99;
28 Ky.R. 1244; 1878; eff. 2-7-2002; 30 Ky.R. 1970; 2042; eff. 3-18-04; 31 Ky.R.
471; 720; eff. 11-5-04; 34 Ky.R. 460; 1050;1480; eff. 1-4-2008; 37 Ky.R. 585;
Am. 1301; Am. 1460; eff. 12-1-2010; TAm eff. 9-30-2013.)