CABINET FOR HEALTH AND FAMILY SERVICES
Department for Public Health
Division of Maternal and Child Health
††††† STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 200.660
††††† NECESSITY, FUNCTION, AND CONFORMITY: KRS 200.660 requires the Cabinet for Health and Family Services to administer all funds appropriated to implement provisions of KRS 200.650 to 200.676, to enter into contracts with service providers, and to promulgate administrative regulations. This administrative regulation establishes the provisions of covered services under First Steps, Kentucky's Early Intervention Program.
††††† Section 1. Covered Services. (1) Services shall be covered if the services are included and authorized through parent signature on the Individualized Family Service Plan (IFSP) developed by an IFSP team which shall include, at a minimum, the family and two (2):
††††† (a) Professionals as identified in 902 KAR 30:150, Section 2(1);
††††† (b) Paraprofessionals as identified in 902 KAR 30:150, Section 2(2); or
††††† (c) Service positions as identified in 902 KAR 30:150, Section 2(3).
††††† (2) Services covered shall include:
††††† (a) Service coordination as provided in accordance with 902 KAR 30:110, Section 3, and this paragraph:
††††† 1. A child shall have only one (1) designated service coordinator at a given time;
Service coordination shall be provided by qualified professionals in accordance
with 902 KAR 30:150, Section 2(3)(b)[
Service coordination shall be provided under the limitations of 902 KAR 30:200,
(2)(a) and 2(3)(b)];
††††† (b) Initial evaluation as provided in accordance with 902 KAR 30:120 and this paragraph. Initial evaluation shall be:
††††† 1. Considered the first level of a two (2) tier system of evaluation; and
††††† 2. Provided by qualified professionals in accordance with 902 KAR 30:150, Section 2(3)(c) and (d);
††††† (c) Intensive team evaluation as provided in accordance with 902 KAR 30:120, Section 1(4) and (5)(b), and this paragraph. Intensive team evaluation shall be:
††††† 1. Considered the second level of a two (2) tier system of evaluation; and
Provided by qualified professionals in accordance with 902 KAR 30:150,
30:120, Section 2(9)];
††††† (d) Assessment of the child as provided in accordance with 902 KAR 30:130, Section 1, and 902 KAR 30:200, Section 3(1);
††††† (e) Early intervention.
Early intervention shall be provided in accordance with 34 C.F.R. 303.13(a) through[
††††† 2. Except as provided in subparagraph 3. of this paragraph, early intervention, which is face-to-face intervention with the child and caregivers within the context of the environment, shall include four (4) types of service:
††††† a. Individual home or community service which shall include intervention provided by a First Steps qualified professional to an eligible child at the child's home or other natural setting in which children under three (3) years of age are typically found (including non-First Steps provider day care centers or family day care homes) under the limitations of 902 KAR 30:200, Section 3(2);
††††† b. Individual office or center-based service which shall include intervention provided by First Steps qualified professionals to an eligible child at the professional's office or center site under the limitations of 902 KAR 30:200, Section 3(2);
††††† c. Group intervention which shall include the provision of early intervention services by First Steps qualified personnel in a group, with two (2) or more eligible children, at an early intervention professional's site, office, center, or other community-based setting where children under three (3) years of age are typically found.
††††† (i) The group may also include children without disabilities as long as a three (3) to one (1) ratio of children to staff is maintained.
††††† (ii) Group intervention shall be provided under the limitations of 902 KAR 30:200, Section 3(2)(b); or
††††† d. Co-treatment which shall occur if more than one (1) provider is present and providing early intervention services at the same time. Each providerís service log shall document:
††††† (i) Why this approach is being used;
††††† (ii) The outcomes and activities;
††††† (iii) Who is performing the activities; and
††††† (iv) That the service providers involved are providing or learning about the early intervention at the same time.
††††† 3. If early intervention services are provided by a psychologist, counselor, marriage and family therapist, or social worker, the child shall not be required to attend the intervention. The reason the childís presence is clinically contraindicated shall be documented in the service note.
††††† 4. Disciplines providing early intervention shall be qualified professionals in accordance with 902 KAR 30:150, Section 2(1), or qualified paraprofessionals in accordance with 902 KAR 30:150, Section 2(2), and shall include the following:
††††† a. An audiologist;
††††† b. A marriage and family therapist;
††††† c. A developmental interventionist;
††††† d. A nurse;
††††† e. A dietician;
††††† f. An occupational therapist;
††††† g. An occupational therapy assistant;
††††† h. An orientation and mobility specialist;
††††† i. A physical therapist;
††††† j. A physical therapistís assistant;
††††† k. A licensed psychologist, a certified psychologist with autonomous functioning, a licensed psychological practitioner, certified psychologist, or licensed psychological associate;
††††† l. A speech-language pathologist;
††††† m. A licensed social worker;
††††† n. A licensed professional clinical counselor (LPCC);
††††† o. A teacher of the visually impaired;
††††† p. A teacher of the deaf and hard of hearing;
††††† q. A physician;
††††† r. An optometrist;
††††† s. An ophthalmologist; or
††††† t. A sign language and cued language specialist;
††††† (f) Collateral service as provided in accordance with 902 KAR 30:200, Section 3(4);
††††† (g) Assistive technology in accordance with 902 KAR 30:001, Section 1(3), and 30:130, Section 4;
††††† (h) Respite which shall be a service provided to the family of an eligible child for the purpose of providing relief from the care of the child in order to strengthen the family's ability to attend to the child's developmental needs under the limitations of 902 KAR 30:200, Section 3(3);
††††† (i) Transportation and related cost which shall be the costs of travel that are necessary to enable an eligible child to receive early intervention services; and
††††† (j) Language access services for all families consistent with the provisions of the Individuals with Disabilities Education Improvement Act (IDEA), 34 C.F.R. 303.421(c), that, at a minimum, assists the family in understanding the purpose of First Steps and the family's procedural safeguards during referral, eligibility determination activities, and IFSP meetings.
STEPHANIE MAYFIELD GIBSON, MD, FCAP, Commissioner
AUDREY HAYNES, Secretary
††††† APPROVED BY AGENCY: May 7, 2014
††††† FILED WITH LRC: May 9, 2014 at 2.p.m.
††††† PUBLIC HEARING AND PUBLIC COMMENT PERIOD: A public hearing on this administrative regulation shall, if requested, be held on June 23, 2014, at 9:00 a.m. in the Auditorium, Health Services Building, First Floor, 275 East Main Street, Frankfort, Kentucky. Individuals interested in attending this hearing shall notify this agency in writing by June 16, 2014, five (5) workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is receive by that date, the hearing may be canceled. The hearing is open to the public. Any person who attends will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to attend the public hearing, you may submit written comments regarding this proposed administrative regulation. You may submit written comments on the proposed administrative regulation until June 30, 2014. Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to:
††††† CONTACT PERSON: Tricia Orme, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40621, phone 502-564-7905, fax 502-564-7573, email firstname.lastname@example.org
REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT
Contact Person: Paula Goff
††††† (1) Provide a brief summary of 902 KAR 30:160:
††††† (a) What this administrative regulation does: This regulation describes the services that are provided and paid in the Kentucky Early Intervention system.
††††† (b) The necessity of this administrative regulation: This regulation is necessary to eliminate confusion in the types of services provided and paid by the Kentucky Early Intervention System. The Kentucky Early Intervention System uses multiple funding streams to support the provision of services.
††††† (c) How this administrative regulation conforms to the content of the authorizing statute: KRS 200.652 (5) requires the coordination of payment for early intervention services from federal, state, local and private insurance coverage, and the use of sliding fee scales.
††††† (d) How this administrative regulation currently assists in the effective administration of the statutes: The regulation is needed to provide guidance and clarity for the implementation of the early intervention system in compliance with federal statute and regulation.
††††† (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:
††††† (a) How the amendment will change the existing administrative regulation: The changes in this regulation correct the citations to the other early intervention regulations being amended.
††††† (b) The necessity of the amendment to this administrative regulation: This amendment is necessary to provide the correction citation to the other referenced regulations.
††††† (c) How the amendment conforms to the content of the authorizing statute: KRS 200.652(3) and (5) require the state to implement a statewide, comprehensive, interagency system of early intervention and to facilitate payment from multiple funding streams.
††††† (d) How the amendment will assist in the effective administration of the statute: These amendments will help to assure compliance with federal statute and regulation.
††††† (3) List the type and number of individuals, businesses, organizations, or state and local governments affected by the administrative regulation: Approximately 1,500 early intervention providers will be affected by these regulations. No state or local governments are affected by the administrative regulation.
††††† (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:
††††† (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment: Regulated entities will continue to provide early intervention services as they currently practice.
††††† (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3): There are no additional costs to entities to comply with the amended regulations.
††††† (c) As a result of the compliance, what benefits will accrue to the entities identified in question (3): Early intervention providers will be eligible for payment of covered services and participation in First Steps.
††††† (5) Provide an estimate of how much it will cost to implement this regulation:
††††† (a) Initially: There are no costs to implement the amendment to this regulation.
††††† (b) On a continuing basis: There are no costs to implement the amendment to this regulation.
††††† (6) What is the source of the funding that will be used for the implementation and enforcement of the administrative regulation? Federal Part C funds, state general funds, and Medicaid funds are used to support the early intervention system.
††††† (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new or by the change if it is an amendment: No increase in fees or funding is necessary to implement this amended administrative regulation.
††††† (8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees: No, this administrative regulation does not directly or indirectly increase any fees.
††††† (9) TIERING: Is tiering applied? Tiering is not applied because First Steps regulations apply consistently across all children and families participating in the First Steps program as well as all providers participating in the First Steps program.
FISCAL NOTE ON STATE OR LOCAL GOVERNMENT
††††† 1. What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation?
††††† This administrative regulation impacts the fifteen (15) local Point of Entry, approx. 1,500 direct service providers as well as the state administrative office that governs the First Steps program.
††††† 2. Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation. 20 U.S.C. 1435, 34 C.F.R. Part 303, KRS 194A.050, KRS 200.650-676
††††† 3. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.
††††† (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? There will be no revenue generated by this administrative regulation for the first year.
††††† (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? There will be no revenue generated by this administrative regulation during subsequent years.
††††† (c) How much will it cost to administer this program for the first year? There will be no new expenditures to implement this administrative regulation for the first year.
††††† (d) How much will it cost to administer this program for subsequent years? There will be no expenditures to implement this administrative regulation during subsequent years.
††††† Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.
††††† Revenues (+/-):
††††† Expenditures (+/-):
††††† Other Explanation: There is no fiscal impact on local or state government for this administrative regulation.
FEDERAL MANDATE ANALYSIS COMPARISION
††††† 1. Federal statute or regulation constituting the federal mandate. 34 C.F.R. 303.340 through 303.346 outlines the content if the Individual Family Service Plan (IFSP), including the content of the IFSP and responsibility and accountability. This amendment ensures full compliance with the provisions under that part.
††††† 2. State compliance standards KRS 200.664 charges the Cabinet for Health and Family Services, Department for Public Health to develop an Individual Family Service Plan the conforms to the federal requirements for the IFSP.
††††† 3. Minimum or uniform standards contained in the federal mandate. By revising this administrative regulation Kentucky is in full compliance with federal statutes and regulations.
††††† 4. Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate? This amendment does not impose stricter than federal requirements.
††††† 5. Justification for the imposition of stricter standard, or additional or different responsibilities or requirement. This amendment does not impose stricter than federal requirements.