907 KAR 3:090. Acquired brain injury waiver services

Link to law: http://www.lrc.ky.gov/kar/907/003/090.htm
Published: 2015

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      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.)