TECHNICAL AMENDMENT

November 4, 2014

 

††††† 907 KAR 12:010. New supports for community living waiver service and coverage policies.

 

††††† RELATES TO: KRS 205.520, 205.5605, 205.5606, 205.5607, 42 C.F.R. 441 Subpart G, 42 U.S.C. 1396a, b, d, n

††††† STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.5606(1), 205.6317

††††† 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 to qualify for federal Medicaid funds. 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 service and coverage policies for a new version of the Supports for Community Living (SCL) waiver program and applies to SCL waiver services covered pursuant to this administrative regulation rather than SCL waiver services covered pursuant to 907 KAR 1:145. The SCL waiver program is federally authorized via a 1915(c) home and community based waiver which enables individuals with an intellectual or developmental disability to reside and receive services in a community setting rather than in an intermediate care facility for individuals with an intellectual or developmental disability, including a consumer directed option pursuant to KRS 205.5606.

 

††††† Section 1. Definitions. (1) "1915(c) home and community based waiver program" means a Kentucky Medicaid program established pursuant to, and in accordance with, 42 U.S.C. 1396n(c).

††††† (2) "Abuse" is defined by KRS 209.020(8).

††††† (3) "Adult day health care center" means an adult day health care center licensed in accordance with 902 KAR 20:066.

††††† (4) "Adult foster care home" means a home:

††††† (a) Not owned or leased by an SCL provider;

††††† (b) In which a participant:

††††† 1. Is at least eighteen (18) years of age; and

††††† 2. Receives SCL services and resides in the family occupied (leased or owned) home; and

††††† (c) In which the family:

††††† 1. Includes the participant in the familyís household routines;

††††† 2. Provides training and supervision; and

††††† 3. Ensures that the participantís needs are met in accordance with the:

††††† a. Participantís plan of care; and

††††† b. Supports for Community Living Policy Manual.

††††† (5) "Behavior intervention committee" or "BIC" means a group of individuals:

††††† (a) Established to evaluate the technical adequacy of a proposed behavioral intervention for a participant; and

††††† (b) Which meets in accordance with the BIC policies established in the Supports for Community Living Manual.

††††† (6) "Board" means three (3) meals a day or other full nutritional regimen of a caregiver for the purpose of providing shared living services.

††††† (7) "Case manager" means an individual who:

††††† (a) Works closely with a participant to ensure that the:

††††† 1. Participantís person centered plan of care focuses on the participantís ongoing expectations and satisfaction with the participantís life; and

††††† 2. Participant maintains the freedom of choice of providers in a conflict free climate;

††††† (b)1. Has a bachelorís or higher degree in a human service field from an accredited college or university;

††††† 2. Has a bachelorís degree in any other field from an accredited college or university with at least one (1) year of experience in the field of intellectual disability; or

††††† 3. Is a registered nurse who has at least one (1) year of experience as a professional nurse in the field of intellectual disability;

††††† (c) Shall be supervised by a case management supervisor; and

††††† (d) Meets all personnel and training requirements established in Section 3 of this administrative regulation.

††††† (8) "Case manager supervisor" means an individual who:

††††† (a) Provides professional oversight of case managers;

††††† (b)1. Has a bachelorís or higher degree in a human service field from an accredited college or university;

††††† 2. Has a bachelorís degree in any other field from an accredited college or university with at least one (1) year of experience in the field of intellectual disability; or

††††† 3. Is a registered nurse;

††††† (c) Has at least two (2) years of experience of case management responsibility in an organization which serves individuals with intellectual or developmental disabilities;

††††† (d) Completes a case management supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities;

††††† (e) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (f) Participates in six (6) hours per year of professional development or continuing education in the areas of person centered processes, supervision, and mentoring of employees.

††††† (9) "Certified nutritionist" is defined by KRS 310.005(12).

††††† (10) "Certified psychologist with autonomous functioning" means a person licensed pursuant to KRS 319.056.

††††† (11) "Certified school psychologist" means an individual certified by the Kentucky Education Professional Standards Board under 16 KAR 2:090.

††††† (12) "Chemical restraint" means the use of over-the-counter or prescription medication to control a participant or participantís behavior:

††††† (a) For the convenience of staff; or

††††† (b) As a punishment.

††††† (13) "Community access specialist" means an individual who:

††††† (a) Provides support and training to a participant that empowers the participant to:

††††† 1. Participate in meaningful routines or events;

††††† 2. Hold a membership in a club, group, association, church, business, or organization in the community; and

††††† 3. Build a natural support system;

††††† (b) Has:

††††† 1. A bachelorís degree in a human services field from an accredited college or university;

††††† 2. A bachelorís degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or

††††† 3. Relevant experience or credentialing that will substitute for the educational requirements stated in subparagraph 1. or 2. of this paragraph on a year-for-year basis; and

††††† (c) Meets the personnel and training requirements established in Section 3 of this administrative regulation.

††††† (14) "Community guide" means an individual who:

††††† (a) Has been selected by a participant to provide training, technical assistance, and support including individual budget development and implementation in aspects of participant direction; and

††††† (b) Has:

††††† 1. A bachelorís degree in a human services field from an accredited college or university;

††††† 2. A bachelorís degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or

††††† 3. Relevant experience or credentialing that will substitute for the educational requirements stated in subparagraph 1. or 2. of this paragraph on a year-for-year basis;

††††† (c) Meets the personnel and training requirements established in Section 3 of this administrative regulation;

††††† (d) Completes a community guide training curriculum approved by DBHDID within six (6) months of being employed by the first participant supported; and

††††† (e) Provides services to a participant in accordance with Section 4 of this administrative regulation.

††††† (15) "Conflict free" means a scenario in which an agency, including any subsidiary, partnership, not-for-profit, or other business entity under control of the agency, providing case management to an individual does not also provide another waiver service to the individual.

††††† (16) "Controlled substance" is defined by KRS 218A.010(6).

††††† (17) "Covered services and supports" is defined by KRS 205.5605(3).

††††† (18) "DBHDID" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

††††† (19) "DCBS" means the Department for Community Based Services.

††††† (20) "Department" means the Department for Medicaid Services or its designee.

††††† (21) "Developmental disability" means a disability that:

††††† (a) Is manifested prior to the age of twenty-two (22);

††††† (b) Constitutes a substantial disability to the affected individual; and

††††† (c) Is attributable either to an intellectual disability or a condition related to an intellectual disability that:

††††† 1. Results in an impairment of general intellectual functioning and adaptive behavior similar to that of a person with an intellectual disability; and

††††† 2. Is a direct result of, or is influenced by, the personís cognitive deficits.

††††† (22) "Direct support professional" means an individual who:

††††† (a) Provides services to a participant in accordance with Section 4 of this administrative regulation;

††††† (b) Has direct contact with a participant when providing services to the participant;

††††† (c) Is at least:

††††† 1. Eighteen (18) years old and has a high school diploma or GED; or

††††† 2. Twenty-one (21) years old;

††††† (d) Meets the personnel and training requirements established in Section 3 of this administrative regulation;

††††† (e) Has the ability to:

††††† 1. Communicate effectively with a participant and the participantís family;

††††† 2. Read, understand, and implement written and oral instructions;

††††† 3. Perform required documentation; and

††††† 4. Participate as a member of the participantís person centered team if requested by the participant; and

††††† (f) Demonstrates competence and knowledge on topics required to safely support the participant as described in the participantís person centered plan of care.

††††† (23) "Direct support professional supervisor" means an individual who:

††††† (a) Provides oversight of direct support professionals in the provision of services to participants;

††††† (b) Is at least:

††††† 1. Eighteen (18) years old and has a high school diploma or GED; or

††††† 2. Twenty-one (21) years old;

††††† (c) Meets the personnel and training requirements established in Section 3 of this administrative regulation;

††††† (d) Has the ability to:

††††† 1. Communicate effectively with a participant and the participantís family;

††††† 2. Read, understand, and implement written and oral instructions;

††††† 3. Perform required documentation; and

††††† 4. Participate as a member of the participantís person centered team if requested by the participant;

††††† (e) Has at least two (2) years of experience in providing direct support to persons with a developmental disability;

††††† (f) Demonstrates competence and knowledge on topics required to safely support the participant as described in the participantís person centered plan of care; and

††††† (g) Completes a supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities.

††††† (24) "Drug paraphernalia" is defined by KRS 218A.500(1).

††††† (25) "Early and periodic screening, diagnostic, and treatment services" is defined by 42 U.S.C. 1396d(r).

††††† (26) "Electronic signature" is defined by KRS 369.102(8).

††††† (27) "Employee" means an individual who is employed by an SCL provider.

††††† (28) "Executive director" means an individual who shall:

††††† (a) Design, develop, and implement strategic plans for an SCL provider;

††††† (b) Maintain responsibility for the day-to-day operation of the SCL provider organization;

††††† (c)1. Have a bachelorís or higher degree from an accredited institution; or

††††† 2. Be a registered nurse;

††††† (d) Have at least two (2) years of administrative responsibility:

††††† 1. In an organization which served individuals with an intellectual or developmental disability; and

††††† 2. That includes experience in the execution of the overall administration of an agency including:

††††† a. Development, implementation, and accountability of the agencyís budget;

††††† b. Development, review, and implementation of the agencyís policies and procedures; and

††††† c. Supervision of employees including conducting performance evaluations;

††††† (e) Meet all personnel and training requirements specified in Section 3 of this administrative regulation; and

††††† (f) If providing professional oversight or supervision of employees, meet the supervisory qualifications specified for each service.

††††† (29) "Exploitation" is defined by KRS 209.020(9).

††††† (30) "Extended family member" means a relative of an individual by blood or marriage beyond the individuals included in the definition of immediate family member.

††††† (31) "Family home provider" means a home:

††††† (a) Not owned or leased by an SCL provider;

††††† (b) In which a participant receives SCL services and resides in the family occupied (leased or owned) home; and

††††† (c) In which the family:

††††† 1. Includes the participant in the familyís household routines;

††††† 2. Provides training and supervision; and

††††† 3. Ensures that the participantís needs are met in accordance with the:

††††† a. Participantís plan of care; and

††††† b. Supports for Community Living Policy Manual.

††††† (32) "Financial management agency" means an agency contracted by the department that manages individual participant-directed service budgets.

††††† (33) "Functional Assessment" means an assessment performed using evidenced based tools, direct observation, and empirical measurement to obtain and identify functional relations between behavioral and environmental factors.

††††† (34) "Good cause" means a circumstance beyond the control of an individual that affects the individual's ability to access funding or services, which includes:

††††† (a) Illness or hospitalization of the individual which is expected to last sixty (60) days or less;

††††† (b) Required paperwork and documentation for processing in accordance with Section 2 of this administrative regulation has not been completed but is expected to be completed in two (2) weeks or less; or

††††† (c) The individual or his or her guardian 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.

††††† (35) "Group home" means a residential setting:

††††† (a) That is licensed in accordance with 902 KAR 20:078;

††††† (b) That is managed by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and

††††† (c) In which no more than eight (8) participants reside.

††††† (36) "Guardian" is defined by KRS 387.010(3) for a minor and in KRS 387.812(3) for an adult.

††††† (37) "Homicidal ideation" means thoughts about homicide which may range from vague ideas to detailed or fully formulated plans without taking action.

††††† (38) "Human rights committee" means a group of individuals:

††††† (a) Comprised of representatives from home and community based waiver provider agencies in the community where a participant resides; and

††††† (b) Who meet:

††††† 1. To ensure that the rights of participants are respected and protected through due process; and

††††† 2. In accordance with the Human Rights Committee requirements established in the Supports for Community Living Policy Manual.

††††† (39) "Human services field" means psychology, behavioral analysis, counseling, rehabilitation counseling, public health, special education, sociology, gerontology, recreational therapy, education, occupational therapy, physical therapy, speech therapy, social work, or family studies.

††††† (40) "ICF- IID" means an intermediate care facility for an individual with an intellectual disability.

††††† (41) "Illicit substance" means:

††††† (a) A drug, prescription or not prescription, used illegally or in excess of therapeutic levels;

††††† (b) A prohibited drug; or

††††† (c) A prohibited substance.

††††† (42) "Immediate family member" is defined by KRS 205.8451(3).

††††† (43) "Impact service" means a service designed to decrease the amount of paid supports a participant requires as the participant becomes:

††††† (a) More independent; and

††††† (b) Less reliant on an employee.

††††† (44) "Individual family service plan" or "IFSP" is defined by KRS 200.654(9).

††††† (45) "Integrated employment site" means the location of an activity or job that provides regular interaction with people without disabilities, excluding service providers, to the same extent that a worker without disabilities in a comparable position interacts with others.

††††† (46) "Integrated setting" means a setting that:

††††† (a) Enables a participant to interact with nondisabled persons to the fullest extent possible;

††††† (b) Includes access to community activities and opportunities at times, frequencies, and with persons of a participantís choosing; and

††††† (c) Affords a participant choice in the participantís daily life activities.

††††† (47) "Intellectual disability" or "ID" means:

††††† (a) A demonstration:

††††† 1. Of significantly sub-average intellectual functioning and an intelligence quotient (IQ) of approximately seventy (70) or below; and

††††† 2. Of concurrent deficits or impairments in present adaptive functioning in at least two (2) of the following areas:

††††† a. Communication;

††††† b. Self-care;

††††† c. Home living;

††††† d. Social or interpersonal skills;

††††† e. Use of community resources;

††††† f. Self-direction;

††††† g. Functional academic skills;

††††† h. Work;

††††† i. Leisure; or

††††† j. Health and safety; and

††††† (b) An intellectual disability that had an onset before eighteen (18) years of age.

††††† (48) "Legally responsible individual" means an individual who has a duty under state law to care for another person and includes:

††††† (a) A Parent (biological, adoptive, or foster) of a minor child who provides care to the child;

††††† (b) The guardian of a minor child who provides care to the child; or

††††† (c) A spouse of a participant.

††††† (49) "Level of care determination" means a determination by the department that an individual meets patient status criteria for an intermediate care facility for an individual with an intellectual disability as established in 907 KAR 1:022.

††††† (50) "Licensed clinical social worker" means an individual who is currently licensed in accordance with KRS 335.100.

††††† (51) "Licensed dietitian" is defined by KRS 310.005(11).

††††† (52) "Licensed marriage and family therapist" or "LMFT" is defined by KRS 335.300(2).

††††† (53) ĎĎLicensed professional clinical counselor" or "LPCC" is defined by KRS 335.500(3).

††††† (54) "Licensed psychological associate" means an individual who is currently licensed in accordance with KRS 319.064.

††††† (55) "Licensed psychological practitioner" means an individual who is currently licensed in accordance with KRS 319.053.

††††† (56) "Licensed psychologist" means an individual who is currently licensed in accordance with KRS 319.050.

††††† (57) "Life history" means an account of the series of events making up a participantís life including:

††††† (a) Developmental and historical information regarding family of origin, childhood experiences, and life events to present;

††††† (b) History of supports received across the life span; and

††††† (c) Life style practices which may lead to greater insight regarding a participantís current preferences, behavioral patterns, wants, and needs.

††††† (58) "Medically necessary" or "medical necessity" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

††††† (59) "National Core Indicators" means:

††††† (a) A collaboration between the National Association of State Directors of Developmental Disability Services and the Human Services Research Institute;

††††† (b) An effort by public developmental disabilities agencies to measure and track their own performance; and

††††† (c) Standard measures:

††††† 1. Used across states to assess the outcomes of services provided to individuals and families; and

††††† 2. Which address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.

††††† (60) "Natural supports" means assistance, relationships, or interactions that:

††††† (a) Allow a participant to be in the community;

††††† (b) Include working in a job of the participantís choice in ways similar to people without disabilities; and

††††† (c) Are based on ordinary social relationships at work and in the community.

††††† (61) "Neglect" is defined by KRS 209.020(16).

††††† (62) "Occupational therapist" is defined by KRS 319A.010(3).

††††† (63) "Occupational therapy assistant" is defined by KRS 319A.010(4).

††††† (64) "Office of Vocational Rehabilitation" means the agency mandated:

††††† (a) By the Rehabilitation Act of 1973, as amended; and

††††† (b) To provide individualized services to eligible individuals with disabilities with a substantial impediment to employment in order for the individual to gain and maintain employment.

††††† (65) "Participant" means a Medicaid recipient who:

††††† (a) Meets patient status criteria for an intermediate care facility for an individual with an intellectual or developmental disability as established in 907 KAR 1:022;

††††† (b) Is authorized by the department to receive SCL waiver services; and

††††† (c) Utilizes SCL waiver services and supports in accordance with a person centered plan of care.

††††† (66) "Participant directed service" means an option to receive a service which is based on the principles of self-determination and person centered thinking.

††††† (67) "Person centered coach" means a person who:

††††† (a) Assists a participant and the participantís person centered team in implementing and monitoring the effectiveness of the participantís person centered plan of care;

††††† (b) Models person centered thinking;

††††† (c) Is responsible for training a participant, family, guardian, natural and unpaid supports, and other members of the person centered team when barriers challenge the success of the participant in achieving his or her goals;

††††† (d) Has:

††††† 1. A high school diploma or GED; and

††††† 2.a. Two (2) years of experience in the field of intellectual or developmental disabilities; or

††††† b. Completed twelve (12) hours of college coursework in a human services field;

††††† (e) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (f) Performs required documentation.

††††† (68) "Person centered employment plan" means a document that identifies the unique preferences, strengths, and needs of a participant in relation to the participantís work.

††††† (69) "Person centered plan of care" or "POC" means:

††††† (a) The eight (8) page form incorporated by reference titled "Person Centered Plan of Care"; and

††††† (b) A written individualized plan that is developed:

††††† 1. By:

††††† a. An SCL participant or an SCL participantís guardian;

††††† b. The case manager; and

††††† c. Any other person designated by the SCL participant if the SCL participant designates any other person; and

††††† 2. Using a process that:

††††† a. Allows the participant, or the participantís guardian, to direct the planning and allocation of resources to meet the participantís life goals;

††††† b. Achieves understanding of how the participant:

††††† (i) Learns;

††††† (ii) Makes decisions; and

††††† (iii) Chooses to live and work in the community;

††††† c. Discovers the participantís likes and dislikes; and

††††† d. Empowers the participant or the participantís guardian to create a life plan and corresponding plan of care for the participant that:

††††† (i) Is based on the participantís preferences, ideas, and needs;

††††† (ii) Encourages and supports the participantís long term satisfaction;

††††† (iii) Is supported by a short-term plan that is based on reasonable costs, given the participantís support needs;

††††† (iv) Includes participant input;

††††† (v) Includes a range of supports, including funded, community, and natural supports;

††††† (vi) Includes information necessary to support a participant during times of crisis, to include crisis prevention strategies, crisis intervention strategies, and positive behavioral supports, if deemed necessary by the participant and the participantís support team; and

††††† (vii) Assists the participant in making informed choices by facilitating knowledge of and access to services and supports.

††††† (70) "Person centered team" means a participantís guardian or representative and other individuals who are natural or paid supports and who:

††††† (a) Recognize that evidenced based decisions are determined within the basic framework of what is important for the participant and within the context of what is important to the participant based on informed choice;

††††† (b) Work together to identify what roles they will assume to assist the participant in becoming as independent as possible in meeting the participantís needs; and

††††† (c) Include providers who receive payment for services who shall:

††††† 1. Be active contributing members of the person centered team meetings;

††††† 2. Base their input upon evidence-based information; and

††††† 3. Not request reimbursement for person centered team meetings.

††††† (71) "Physical therapist" is defined by KRS 327.010(2).

††††† (72) "Physical therapist assistant" means a skilled health care worker who:

††††† (a) Is certified by the Kentucky Board of Physical Therapy; and

††††† (b) Performs physical therapy and related duties as assigned by the supervising physical therapist.

††††† (73) "Positive behavior support specialist" means an individual who;

††††† (a) Provides evidence-based individualized interventions that assist a participant with acquisition or maintenance of skills for community living and behavioral intervention for the reduction of maladaptive behaviors;

††††† (b) Has a masterís degree in a behavioral science and one (1) year of experience in behavioral programming;

††††† (c) Has at least one (1) year of direct service experience with individuals with intellectual or developmental disabilities;

††††† (d) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (e) Participates in at least six (6) hours per year of professional development or continuing education in the areas of psychology, behavioral supports, applied behavioral science, or school psychology.

††††† (74) "Prohibited drugs" means all drugs and substances which are illegal under KRS Chapter 218A or other statutes or administrative regulations of the Commonwealth of Kentucky.

††††† (75) "Registered agent" means an individual meeting the requirements of KRS 14A.4-010(1)(b).

††††† (76) "Registered nurse" is defined by KRS 314.011(5).

††††† (77) "Registered office" means an office meeting the requirements of KRS 14A.4-010(1)(a).

††††† (78) "Representative" is defined in KRS 205.5605(6).

††††† (79) "Room" means the aggregate expense of housing costs for the purpose of providing shared living, including:

††††† (a) Rent, lease, or mortgage payments;

††††† (b) Real estate taxes;

††††† (c) Insurance;

††††† (d) Maintenance; and

††††† (e) Utilities.

††††† (80) "SCL intellectual disability professional" or "SCL IDP" means an individual who:

††††† (a) Has at least one (1) year of experience working with persons with intellectual or developmental disabilities;

††††† (b) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (c)1. Is a doctor of medicine or osteopathy;

††††† 2. Is a registered nurse; or

††††† 3. Holds at least a bachelorís degree from an accredited institution in a human services field.

††††† (81) "SCL provider" means an entity that meets the criteria established in Section 3 of this administrative regulation.

††††† (82) "Serious medication error" means a medication error that requires or has the potential to require a medical intervention or treatment.

††††† (83) "Shared living caregiver" means an unrelated individual who:

††††† (a) Resides with a participant in the participantís home;

††††† (b) Provides supervision and necessary personal assistance services as specified in the participantís person centered plan of care;

††††† (c)1. Is at least eighteen (18) years of age and has a high school diploma or GED; or

††††† 2. Is at least twenty-one (21) years old;

††††† (d) Meets all personnel and training requirements established in Section 3 of this administrative regulation;

††††† (e) Has the ability to:

††††† 1. Communicate effectively with a participant and the participantís family;

††††† 2. Read, understand and implement written and verbal instructions; and

††††† 3. Perform required documentation;

††††† (f) Has been determined by the participantís person centered team, prior to being alone with the participant, to meet the following qualifications:

††††† 1. Demonstrate competence and knowledge on topics required to safely support the participant as described in the participantís person centered plan of care; and

††††† 2. Have the ability to participate as a member of the participantís person centered team if requested by the participant; and

††††† (g) Does not have any of the following relationships to the participant:

††††† 1. Immediate family member;

††††† 2. Extended family member;

††††† 3. Guardian; or

††††† 4. Legally responsible individual.

††††† (84) "Speech-language pathologist" is defined by KRS 334A.020(3).

††††† (85) "Staffed residence" means a residential setting:

††††† (a) That is owned or leased by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and

††††† (b) In which no more than three (3) participants reside.

††††† (86) "Subcontractor" means an entity or an individual:

††††† (a) Who is a currently credentialed professional or other service provider;

††††† (b) Who has signed an agreement with a certified SCL agency to provide SCL services and supports; and

††††† (c) To whom the employee requirements in this administrative regulation apply.

††††† (87) "Suicidal ideation" means thoughts about suicide which may range from being fleeting in nature to detailed planning.

††††† (88) "Supported Employment Long-Term Support Plan" means a document that identifies the amount and kind of support necessary for a participant to maintain employment and achieve individualized employment goals.

††††† (89) "Supported employment specialist" means an individual who:

††††† (a) Provides ongoing support services to eligible participants in supported employment jobs in accordance with Section 4 of this administrative regulation;

††††† (b)1. Has at least a bachelorís degree from an accredited college or university and one (1) year of experience in the field of developmental disabilities; or

††††† 2. Has relevant experience or credentialing that substitutes for the educational requirement stated in subparagraph 1. of this paragraph on a year-for-year basis;

††††† (c) Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (d) Completes the Kentucky Supported Employment Training Project curriculum from the Human Development Institute at the University of Kentucky within six (6) months of the date the specialist begins providing SCL supported employment services.

††††† (90) "Supports for Community Living" or "SCL" means home and community-based waiver services for an individual with an intellectual or developmental disability.

††††† (91) "Supports Intensity Scale" or "SIS" means an assessment tool developed by the American Association on Intellectual and Developmental Disabilities (AAIDD) that:

††††† (a) Measures practical support requirements of individuals with intellectual or developmental disabilities in daily living, medical, and behavioral areas; and

††††† (b) Is administered by a trained professional in the human services field as approved by the department.

 

††††† Section 2. SCL Participant Eligibility, Enrollment and Termination. (1) To be eligible to receive a service in the SCL program, an individual shall:

††††† (a) Receive notification of potential SCL funding in accordance with Section 7 of this administrative regulation;

††††† (b) Meet ICF-IID patient status requirements established in 907 KAR 1:022;

††††† (c) Meet Medicaid eligibility requirements established in 907 KAR 1:605;

††††† (d) Upon receiving notification of potential SCL funding, submit an application packet to the department which is included in the Supports for Community Living Policy Manual and which shall contain:

††††† 1. A completed Long Term Care Facilities and Home and Community Based Program Certification Form, MAP-350;

††††† 2. The results of a physical examination that was conducted within the last twelve (12) months;

††††† 3. A life history which is less than one (1) year old; and

††††† 4. A MAP-24C documenting a participantís status change.

††††† (2)(a) To maintain eligibility as a participant:

††††† 1. A participant shall be administered a Supports Intensity Scale assessment by the department at least once every twenty-four (24) months;

††††† 2. A participant shall maintain Medicaid eligibility requirements established in 907 KAR 1:605; and

††††† 3. An ICF-IID level of care determination shall be performed by the department at least once every twelve (12) months.

††††† (b) The department shall:

††††† 1. Obtain the rights to use a Supports Intensity Scale; and

††††† 2. Use it in accordance with the terms and conditions required by the copyright associated with it.

††††† (3) An SCL waiver service shall not be provided to an individual who is:

††††† (a) Receiving a service in another 1915(c) home and community based waiver program;

††††† (b) Receiving a duplicative service provided through another funding source; or

††††† (c) An inpatient of an ICF-IID or other facility.

††††† (4) Involuntary termination and loss of an SCL waiver program placement shall be:

††††† (a) In accordance with 907 KAR 1:563; and

††††† (b) Initiated if:

††††† 1. An applicant fails to access an SCL waiver service within sixty (60) days of receiving notice of potential funding without receiving an extension based on demonstration of good cause; or

††††† 2. A participant:

††††† a. Fails to access any services outlined in the participantís POC for a period greater than sixty (60) consecutive days without receiving and extension based on demonstration of good cause;

††††† b. Moves to a residence outside of the Commonwealth of Kentucky;

††††† c. Does not meet ICF-IID patient status criteria in accordance with 907 KAR 1:022.

††††† (5)(a) An involuntary termination of a service to a participant by an SCL provider shall require:

††††† 1. The SCL provider to:

††††† a. Simultaneously notify in writing the participant or participantís guardian, the participantís case manager, the department, and DBHDID at least thirty (30) days prior to the effective date of the termination;

††††† b. Submit a MAP-24C to the department and DBHDID at the time of termination; and

††††† 2. The participantís case manager, in conjunction with the SCL provider, to:

††††† a. Provide the participant or participantís guardian with the name, address, and telephone number of each current SCL provider in Kentucky;

††††† b. Provide assistance to the participant or participantís guardian in making contact with another SCL provider;

††††† c. Arrange transportation for a requested visit to an SCL provider site;

††††† d. Provide a copy of pertinent information to the participant or participantís guardian;

††††† e. Ensure the health, safety, and welfare of the participant until an appropriate placement is secured;

††††† f. Continue to provide supports until alternative services or another placement is secured; and

††††† g. Provide assistance to ensure a safe and effective service transition.

††††† (b) The notice referenced in paragraph (a)1.a. of this subsection shall include:

††††† 1. A statement of the intended action;

††††† 2. The basis for the intended action;

††††† 3. The authority by which the intended action is taken; and

††††† 4. The participantís right to appeal the intended action through the providerís appeal or grievance process.

††††† (6)(a) DBHDID shall initiate an intent to discontinue a participantís participation in the SCL waiver program if the participant or participantís guardian submits a written notice of intent to discontinue services to:

††††† 1. The SCL provider; and

††††† 2. DBHDID.

††††† (b) An action to terminate waiver participation shall not be initiated until thirty (30) calendar days from the date of the notice referenced in paragraph (a) of this subsection.

††††† (c) A participant or guardian may reconsider and revoke the notice referenced in paragraph (a) of this subsection in writing during the thirty (30) calendar day period.

 

††††† Section 3. Provider Participation. (1) An SCL provider shall comply with:

††††† (a) 907 KAR 1:671;

††††† (b) 907 KAR 1:672;

††††† (c) 907 KAR 1:673;

††††† (d) 902 KAR 20:078;

††††† (e) The Supports for Community Living Policy Manual;

††††† (f) The Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-2, and 45 C.F.R. Parts 160, 162, and 164; and

††††† (g) 42 U.S.C. 1320d to 1320d-8.

††††† (2) In order to provide an SCL waiver service in accordance with Section 4 of this administrative regulation, an SCL provider shall:

††††† (a) Be certified by the department prior to the initiation of a service;

††††† (b) Be recertified at least biennially by the department;

††††† (c) In accordance with KRS 273.182, maintain a registered agent and a registered office in Kentucky with the Office of the Secretary of State and file appropriate statement of change documentation with the filing fee with the Office of Secretary of State if the registered office or agent changes;

††††† (d) Be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020;

††††† (e) Abide by the laws which govern the chosen business or tax structure of the SCL provider;

††††† (f) Maintain policy that complies with this administrative regulation concerning the operation of the SCL provider and the health, safety, and welfare of all people supported or served by the SCL provider;

††††† (g) Maintain an executive director who shall have the authority and responsibility for the management of the affairs of the SCL provider in accordance with written policy and procedures that comply with this administrative regulation; and

††††† (h) Participate in the National Core Indicatorsí surveys and all department survey initiatives.

††††† (3) An SCL provider shall:

††††† (a) Ensure that SCL waiver services shall not be provided to a participant by a staff person of the SCL provider who is a guardian, legally responsible individual, or immediate family member of the participant unless allowed for a participant directed service in accordance with Section 4 of this administrative regulation;

††††† (b) Not enroll a participant whose needs the SCL provider is unable to meet;

††††† (c) Have and follow written criteria that comply with this administrative regulation for determining the eligibility of a participant for admission to services;

††††† (d)[(e)] Document:

††††† 1. A denial for a service; and

††††† 2. The reason for the denial;

††††† (e)[(f)] Maintain documentation of its operations including:

††††† 1. A written description of available SCL waiver services;

††††† 2. A current table of organization;

††††† 3. A memorandum of understanding with all providers with whom the SCL provider shares person centered plans of care;

††††† 4. Information regarding participantsí satisfaction with services and the utilization of that information;

††††† 5. A quality improvement plan that includes updated findings and corrective actions as a result of department and case management quality assurance monitoring;

††††† 6. Evidence of continuous improvement of utilizing best practice standards toward meeting SCL program goals and the critical strategic areas identified in the annual report released by the Kentucky National Core Indicators available at the Kentucky National Core Indicators Web site of http://www.nationalcoreindicators.org/states/KY/;

††††† 7. A written plan of how the SCL provider shall participate in the:

††††† a. Human Rights Committee in the area in which the SCL provider is located; and

††††† b. Behavior Intervention Committee in the area in which the SCL provider is located;

††††† (f)[(g)] Maintain accurate fiscal information including documentation of revenues and expenses;

††††† (g)[(h)] Maintain a written policy that room and board charges shall be determined as the lesser of:

††††† 1. Seventy (70) percent of the federal benefits rate as determined by the United States Social Security Administration; or

††††† 2. An amortized amount determined by the SCL provider based on the participants being served by the SCL provider sharing the following on an equal basis:

††††† a. Lease, mortgage payment, or market rent;

††††† b. Utilities and basic television services;

††††† c. The costs of food and household goods based upon the number of people, including participants and staff, in the home during waking hours; and

††††† d. The costs of residential telephone services on the basis of the SCL provider paying fifty (50) percent of the costs (excluding long distance telephone costs) and the participants sharing the burden of the remaining costs;

††††† (h)[(i)] Meet the following requirements if responsible for the management of a participantís funds:

††††† 1. Separate accounting shall be maintained for each participant or for the participantís interest in a common trust or special account;

††††† 2. Account balance and records of transactions shall be provided to the participant or the participantís guardian on a quarterly basis; and

††††† 3. The participant or the participantís guardian shall be notified if a balance is accrued that may affect Medicaid eligibility;

††††† (i)[(j)] Have a written statement of its mission and values which shall:

††††† 1. Support participant empowerment and informed decision-making;

††††† 2. Support and assist participants to form and remain connected to natural support networks;

††††† 3. Promote participant dignity and self-worth;

††††† 4. Support team meetings which help ensure and promote the participantís right to choice, inclusion, employment, growth, and privacy;

††††† 5. Foster a restraint-free environment where the use of mechanical restraints, seclusion, manual restraints including any manner of prone or supine restraint, or chemical restraints shall be prohibited; and

††††† 6. Support the SCL program goal that all participants:

††††† a. Receive person centered waiver services;

††††† b. Are safe, healthy, and respected in the participantís community;

††††† c. Live in the community with effective, individualized assistance, and

††††† d. Enjoy living and working in the participantís community;

††††† (j)[(k)] Have written policy and procedures for communication and interaction with a participant, family, or participantís guardian which shall include:

††††† 1. A timely response to an inquiry;

††††† 2. The opportunity for interaction by direct support professionals;

††††† 3. Prompt notification of any unusual occurrence;

††††† 4. Visitation with the participant at a reasonable time, without prior notice, and with due regard for the participantís right of privacy;

††††† 5. Involvement in decision making regarding the selection and direction of the person-centered service provided; and

††††† 6. Consideration of the cultural, educational, language, and socioeconomic characteristics of the participant and family being supported;

††††† (k)[(l)] Ensure the rights of a participant by:

††††† 1. Providing conflict free services and supports that are person centered;

††††† 2. Making available a description of the rights and means by which the rights can be exercised and supported including the right to:

††††† a. Live and work in an integrated setting;

††††† b. Time, space, and opportunity for personal privacy;

††††† c. Communicate, associate, and meet privately with the person of choice;

††††† d. Send and receive unopened mail;

††††† e. Retain and use personal possessions including clothing and personal articles; and

††††† f. Private, accessible use of a telephone;

††††† 3. Having a grievance and appeals system that includes an external mechanism for review of complaints; and

††††† 4. Ensuring access to participation in an area human rights committee in accordance with the human rights committee policies established in the Supports for Community Living Policy Manual;

††††† (l)[(m)] Maintain fiscal records, service records, investigations, medication error logs, and incident reports for a minimum of six (6) years from the date that:

††††† 1. A covered service is provided; or

††††† 2. The participant turns twenty-one (21) years of age, if the participant is under the age of twenty-one (21);

††††† (m)[(n)] Make available all records, internal investigations, and incident reports:

††††† 1. To the:

††††† a. Department;

††††† b. DBHDID;

††††† c. 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;

††††† g. DCBS; or

††††† h. Centers for Medicare and Medicaid Services; or

††††† 2. Pertaining to a participant to:

††††† a. The participant, the participantís guardian, or the participantís case manager upon request; or

††††† b. Protection and Advocacy upon written request;

††††† (n)[(o)] Cooperate with monitoring visits from monitoring agents;

††††† (o)[(p)] Maintain a record for each participant served that shall:

††††† 1. Be recorded in a readable print format in ink or typed print;

††††† 2. Be free from correction fluid or correction tape;

††††† 3. Have a strike through each error that is initialed and dated;

††††† 4. Contain no blank lines in between each entry;

††††† 5. Document late entries;

††††† 6. Contain all information necessary to support person centered practices;

††††† 7. Be cumulative;

††††† 8. Be readily available;

††††† 9. Contain documentation which meets the requirements of Section 4 of this administrative regulation;

††††† 10. Contain the following:

††††† a. The participant summary sheet;

††††† b. The participantís name, Social Security number, and Medicaid identification number;

††††† c. The Supports Intensity Scale Assessment Form;

††††† d. The results of a health risk screening performed using a Health Risk Screening Tool which shall:

††††† (i) Be administered by trained personnel at least annually and updated as needed;

††††† (ii) Assist in determining a participantís areas of vulnerability for a potential health risk; and

††††† (iii) Be provided in accordance with the health risk screening tool requirements established in the Supports for Community Living Policy Manual;

††††† e. The current person centered plan of care;

††††† f. The goals and objectives identified by the participant and the participantís person centered team which facilitates achievement of the participantís chosen outcomes as identified in the participantís POC;

††††† g. A list containing emergency contact telephone numbers;

††††† h. The participantís history of allergies with appropriate allergy alerts;

††††† i. The participantís medication record, including a copy of the signed or authorized current prescription or medical orders and the medication administration record (MAR) if medication is administered at the service site;

††††† j. A recognizable photograph of the participant;

††††† k. Legally adequate consent, updated annually, and a copy of which is located at each service site for the provision of services or other treatment requiring emergency attention;

††††† l. The participantís individual educational plan or individual family service plan, if applicable;

††††† m. The participantís life history updated at least annually;

††††† n. The results of an annual physical exam;

††††† o. The results of an annual dental exam;

††††† p. The Long Term Care Facilities and Home and Community Based Program Certification Form, MAP-350 updated annually;

††††† q. A psychological evaluation;

††††† r. A current level of care certification;

††††† s. The prior authorization notifications; and

††††† t. Incident reports, if any exist;

††††† 11. Be maintained by the provider in a manner that:

††††† a. Ensures the confidentiality of the participantís record and other personal information; and

††††† b. Allows the participant or guardian to determine when to share the information in accordance with law;

††††† 12. Be safe from loss, destruction, or use by an unauthorized person ensured by the provider; and

††††† 13. Have a corresponding legend which the provider shall make readily accessible;

††††† (p)[(q)] Ensure that an employee or volunteer:

††††† 1. Behaves in a legal and ethical manner in providing a service;

††††† 2. Has a valid Social Security number or valid work permit if not a citizen of the United States of America; and

††††† 3. If responsible for driving a participant during a service delivery, has a valid driverís license with proof of current mandatory liability insurance for the vehicle used to transport the participant;

††††† (q)[(r)] Ensure that an employee or volunteer:

††††† 1. Completes 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 within thirty (30) days of the date of hire or date the individual began serving as a volunteer; or

††††† 2. Who tests positive for TB or has a history of positive TB skin tests:

††††† a. Shall be assessed annually by a licensed medical professional for signs or symptoms of active disease; and

††††† b. If it is determined that signs or symptoms of active disease are present, in order for the person to be allowed to work or volunteer, he or she shall be administered follow-up testing by his or her physician with the testing indicating the person does not have active TB disease;

††††† (r)[(s)] Maintain documentation:

††††† 1. Of an annual TB risk assessment or negative TB test for each employee who performs direct support or a supervisory function; or

††††† 2. Annually for each employee with a positive TB test that ensures no active disease symptoms are present;

††††† (s)[(t)] Provide a written job description for each staff person that describes the required qualifications, duties, and responsibilities for the personís job;

††††† (t)[(u)] Maintain an employee record for each employee that includes:

††††† 1. The employeeís experience;

††††† 2. The employeeís training;

††††† 3. Documented competency of the employee;

††††† 4. Evidence of the employeeís current licensure or registration if required by law; and

††††† 5. An annual evaluation of the employeeís performance;

††††† (u)[(v)] Require a background check:

††††† 1. And drug testing for each employee who is paid with funds administered by the department and who:

††††† a. Provides support to a participant who utilizes SCL services; or

††††† b. Manages funds or services on behalf of a participant who utilizes SCL services; or

††††† 2. For a volunteer recruited and placed by an agency or provider who has the potential to interact with a participant;

††††† (v)[(w)] Ensure that a volunteer placed by an agency or provider does not have unsupervised interaction with a participant;

††††† (w)[(x)] For a potential employee or volunteer obtain:

††††† 1. 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 or volunteerism;

††††† 2. The results of a nurse aide abuse registry check as described in 906 KAR 1:100 or an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the year prior to employment or volunteerism; and

††††† 3. Within thirty (30) days of the date of hire or initial date of volunteerism, the results of a central registry check as described in 922 KAR 1:470 or an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the year prior to employment or volunteerism;

††††† (x)[(y)] For each potential employee obtain negative results of drug testing for illicit or prohibited drugs;

††††† (y)[(z)] On an annual basis:

††††† 1. Randomly select and perform criminal history background checks, nurse aide abuse registry checks, and central registry checks of at least twenty-five (25) percent of employees; and

††††† 2. Conduct drug testing of at least five (5) percent of employees;

††††† (z)[(aa)] Not employ, subcontract with, or place an individual as a volunteer who:

††††† 1. Has a prior conviction of an offense delineated in KRS 17.165(1) through (3);

††††† 2. Has a prior felony conviction, plea bargain, amended plea bargain, or diversion program that has not been completed;

††††† 3. Has a drug related conviction within the past five (5) years;

††††† 4. Has a positive drug test for prohibited drugs;

††††† 5. Has a conviction of abuse, neglect, or exploitation;

††††† 6. Has a Cabinet for Health and Family Services finding of child abuse or neglect pursuant to the central registry; or

††††† 7. Is listed on the nurse aide abuse registry;

††††† (aa)[(bb)] Not permit an employee to transport a participant if the individual has a driving under the influence conviction, amended plea bargain, or diversion during the past year;

††††† (bb)[(cc)] Maintain adequate staffing and supervision to implement services being billed;

††††† (cc)[(dd)] Establish written guidelines that address and ensure the health, safety, and welfare of a participant, which shall include:

††††† 1. A basic infection control plan that includes:

††††† a. Universal precautions;

††††† b. Hand washing;

††††† c. Proper disposal of biohazards and sharp instruments; and

††††† d. Management of common illness likely to be emergent in the particular service setting;

††††† 2. Effective cleaning and maintenance procedures sufficient to maintain a sanitary and comfortable environment that prevents the development and transmission of infection;

††††† 3. Ensuring that each site operated by the provider is equipped with:

††††† a. An operational smoke detector placed in all bedrooms and other strategic locations; and

††††† b. At least two (2) correctly charged fire extinguishers placed in strategic locations, at least one (1) of which shall be capable of extinguishing a grease fire and have a rating of 1A10BC;

††††† 4. Ensuring the availability of an ample supply of hot and cold running water with the water temperature complying with the safety limits established in the participantís POC;

††††† 5. Establishing written procedures concerning the presence of deadly weapons as defined in KRS 500.080 which shall ensure:

††††† a. Safe storage and use; and

††††† b. That firearms and ammunition are permitted:

††††† (i) Only in nonprovider owned or leased residences; and

††††† (ii) Only if stored separately and under double lock;

††††† 6. Establishing written procedures concerning the safe storage of common household items;

††††† 7. Ensuring that the nutritional needs of a participant 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;

††††† 8. Ensuring that an adequate and nutritious food supply is maintained as needed by the participant;

††††† 9. Ensuring that:

††††† a. Every case manager and any employee who will be administering medication, unless the employee is a currently licensed or registered nurse, has:

††††† (i) Specific training provided by a registered nurse per a DBHDID medication administration approved curriculum; and

††††† (ii) Documented competency on medication administration, medication cause and effect, and proper administration and storage of medication; and

††††† b. An individual administering medication documents all medication administered, including self-administered and over-the-counter drugs, on a medication administration record, with the date, time, and initials of the person who administered the medication and ensure that the medication shall:

††††† (i) Be kept in a locked container;

††††† (ii) If a controlled substance, be kept under double lock with a documented medication count performed every shift;

††††† (iii) Be carried in a proper container labeled with medication and dosage pursuant to KRS 315.010(8) and 217.182(6);

††††† (iv) Accompany and be administered to a participant at a program site other than the participantís residence if necessary; and

††††† (v) Be documented on a medication administration record and properly disposed of, if discontinued; and

††††† 10. Adhering to policies and procedures for ongoing monitoring of medication administration;

††††† (dd)[(ee)] Establish and follow written guidelines for handling an emergency or a disaster which shall:

††††† 1. Be readily accessible on site;

††††† 2. Include instruction for notification procedures and the use of alarm and signal systems to alert a participant according to the participantís disability;

††††† 3. Include documentation of training of staff and participants on emergency disaster drills;

††††† 4. Include an evacuation drill to be conducted in three (3) minutes or less, documented at least quarterly and, for a participant who receives residential support services, is scheduled to include a time when the participant is asleep; and

††††† 5. Mandate that the result of an evacuation drill be evaluated and if not successfully completed within three (3) minutes shall modify staffing support as necessary and repeat the evacuation drill within seven (7) days;

††††† (ee)[(ff)] Provide orientation for each new employee which shall include the mission, goals, organization, and practices, policies, and procedures of the agency;

††††† (ff)[(gg)]1. Annually provide or arrange for the provision of at least six (6) hours of professional development or continuing education units of competency-based training to each employee to teach and enhance skills related to the performance of duties, except for a case management supervisor or positive behavior support specialist;

††††† 2. Annually provide or arrange for the provision of at least six (6) hours of professional development or continuing education units in the area of person centered processes, supervision, or mentoring to each employee who is a case management supervisor; or

††††† 3. Annually provide or arrange for the provision of at least six (6) hours of professional development or continuing education units in the area of psychology, behavioral supports, applied behavioral science, or school psychology to each employee who is a positive behavior support specialist;

††††† (gg)[(hh)] Require documentation of all face-to-face training which shall include:

††††† 1. The type of training provided:

††††† 2. The name and title of the trainer;

††††† 3. The training objectives;

††††† 4. The length of the training;

††††† 5. The date of completion;

††††† 6. The signature of the trainee verifying completion; and

††††† 7. Verification of competency of the trainee as demonstrated by post-training assessments, competency checklists, or post-training observations and evaluations;

††††† (hh)[(ii)] Require documentation of Web-based training which shall include:

††††† 1. Transcripts verifying successful completion of training objectives with scores of eighty-five (85) percent or higher; and

††††† 2. Competency checklist listing date of completion, signature of evaluator, and signature of trainee for all Phase I or Phase II Kentucky College of Direct Support modules within the timeframe specified;

††††† (ii)[(jj)] Ensure that each case manager or employee prior to independent functioning successfully completes training which shall include:

††††† 1. First aid, which shall be provided by a certified trainer with a nationally-accredited organization to include the American Red Cross and the American Heart Association and evidenced by official documentation of completion from the nationally-accredited organization;

††††† 2. Cardiopulmonary resuscitation which shall be provided by a certified trainer with a nationally-accredited organization to include the American Red Cross and the American Heart Association and evidenced by official documentation of completion from the nationally-accredited organization;

††††† 3. Department of Behavioral Health, Developmental and Intellectual Disabilitiesí Crisis Prevention and Intervention Training;

††††† 4. Successful completion of all Kentucky College of Direct Support Phase I training modules;

††††† 5. Individualized instruction about the person centered POC of the participant to whom the trainee provides supports; and

††††† 6. Verification of trainee competency as demonstrated by pre- and post-training assessments, competency checklists, and post-training observations or evaluations;

††††† (jj)[(kk)] Ensure that all case managers or employees, unless the case manager or employee is a licensed professional providing a service governed by the licensure of the individualís profession, complete the Kentucky College of Direct Support Phase II training modules, no later than six (6) months from the date of employment or when the individual began providing services;

††††† (kk)[(ll)] Ensure that each case manager complete DBHDID approved case management training after three (3) months but within nine (9) months from the date of hire;

††††† (ll)[(mm)] Ensure that each case manager employed prior to the effective date of this administrative regulation completes the DBHDID case management training within one (1) year of this administrative regulationís effective date; and

††††† (mm)[(nn)] Ensure that each adult family member residing in a level II residential adult foster care home or family home provider who may be left alone with the participant will receive training regarding the individualized needs of the participant.

††††† (4) DBHDID shall:

††††† (a) Obtain the rights to use:

††††† 1. The Health Risk Screening Tool required to be used by an SCL waiver provider pursuant to this administrative regulation; or

††††† 2. The Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation; and

††††† (b) Facilitate access to the:

††††† 1. Health Risk Screening Tool required to be used by an SCL waiver provider pursuant to this administrative regulation; or

††††† 2. Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation.

††††† (5) An SCL provider, employee, or volunteer shall:

††††† (a) Not manufacture, distribute, dispense, be under the influence of, purchase, possess, use, or attempt to purchase or obtain, sell, or transfer any of the following in the workplace or while performing work duties:

††††† 1. An alcoholic beverage;

††††† 2. A controlled substance except an SCL provider, employee, or volunteer may use or possess a medically necessary and legally prescribed controlled substance;

††††† 3. An illicit drug;

††††† 4. A prohibited drug or prohibited substance;

††††† 5. Drug paraphernalia; or

††††† 6. A substance that resembles a controlled substance, if there is evidence that the individual intended to pass off the item as a controlled substance; and

††††† (b) Not possess a prescription drug for the purpose of selling or distributing it.

 

††††† Section 4. Covered Services. (1)(a) An SCL waiver service shall:

††††† 1. Be prior authorized by the department; and

††††† 2. Be provided to a participant pursuant to the participantís person centered POC by an individual who meets the requirements established in Section 3 of this administrative regulation.

††††† (b) Any combination of day training, community access, personal assistance, or supported employment shall not exceed sixteen (16) hours per day.

††††† (2) SCL covered services shall include:

††††† (a) Case management;

††††† (b) Community access services;

††††† (c) Community guide services;

††††† (d) Community transition services;

††††† (e) Consultative clinical and therapeutic services;

††††† (f) Day training;

††††† (g) Environmental accessibility adaptation services;

††††† (h) Goods and services;

††††† (i) Natural supports training;

††††† (j) Occupational therapy;

††††† (k) Person centered coaching;

††††† (l) Personal assistance services;

††††† (m) Physical therapy;

††††† (n) Positive behavior supports;

††††† (o) Residential support services;

††††† (p) Respite;

††††† (q) Shared living;

††††† (r) Specialized medical equipment and supplies;

††††† (s) Speech therapy;

††††† (t) Supported employment;

††††† (u) Transportation services; or

††††† (v) Vehicle adaptation services.

††††† (3) Case management shall:

††††† (a) Not include any other SCL waiver service;

††††† (b) Be provided by a case manager who:

††††† 1. Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† 2. Shall not provide any other SCL waiver service to the participant receiving case management from the case manager;

††††† (c) Be conflict free unless the department grants an exemption to the conflict free requirement in accordance with subsection (4)(b) of this section;

††††† (d) Include initiation, coordination, implementation, and monitoring of the assessment, reassessment, evaluation, intake, and eligibility process;

††††† (e) Include assisting a participant in the identification, coordination, and arrangement of the person centered team and person centered team meetings;

††††† (f) Include facilitating person centered team meetings that assist a participant to develop, update, and monitor the POC which shall:

††††† 1. Reflect the principles and tools of self-determination to assist a participant in creating supports and services:

††††† a. Designed to meet the needs of the participant; and

††††† b. That promote choice, community experiences, employment, and personal satisfaction;

††††† 2. Be developed and prior authorized within thirty (30) days of the initiation of a service;

††††† 3. Include the objectives and interventions, goals, and outcomes that meet the participantís identified needs from all assessments and person centered team members;

††††† 4. Include documented participation in the development of the POC by the participant, participantís guardian, family members, other providers, or other people the participant has identified as important in the participantís life and as members of the person centered team; and

††††† 5. Include information about:

††††† a. What is important to the participant;

††††† b. What the person centered plan will help the participant accomplish;

††††† c. What people like and admire about the participant;

††††† d. The characteristics of people providing support that are important to and for the participant;

††††† e. What people need to know or do to help the participant stay healthy and safe;

††††† f. Instructions for those who support the participant;

††††† g. The barriers that block the participantís progress towards the participantís goals;

††††† h. What action steps are needed to ensure that a participantís goals are reached;

††††† i. Who is responsible for each action; and

††††† j. When the action is anticipated to be completed;

††††† (g) Include assisting a participant to gain access to and maintain employment, membership in community clubs, groups, activities and opportunities at the times, frequencies, and with the people the participant chooses;

††††† (h) Include coordination and monitoring of all waiver and non-waiver services which shall include:

††††† 1. Monthly face-to-face contacts with the participant to determine if the participantís needs are being met which shall include:

††††† a. Contact at a location where the participant is engaged in services; and

††††† b. Utilization of a DBHDID-approved monitoring tool to:

††††† (i) Identify that person centered practices are demonstrated by the service provider;

††††† (ii) Ensure that the participantís health, safety, and welfare is not at risk;

††††† (iii) Gather data regarding the participantís satisfaction with the services for use in guiding the person centered planning process; and

††††† (iv) Generate monthly summary notes;

††††† 2. Responsibility to initiate a person centered team meeting and receive prior authorization within fourteen (14) days of a contact visit if the results of a monthly contact visit indicate that different or additional services or other changes in the participantís POC are required to meet the participantís needs;

††††† 3. Assistance with participant directed services which shall include:

††††† a. Assisting the participant in identifying, if necessary, a community guide and a representative who shall work with the participant on the development of a POC, budget, and emergency back-up plan;

††††† b. Assisting the participant in recruiting and managing employees;

††††† c. Assigning modules within the Kentucky College of Direct Supports for training purposes and assisting the participant, the community guide, or the representative in monitoring the completion of training within timeframes specified in Section 5 of this administrative regulation; and

††††† d. Monitoring the provision of services and submission of required documentation to the financial management agency; and

††††† 4. Authority to require immediate remediation of identified deficiencies that impact the health, safety, and welfare of a participant;

††††† (i) Include assisting a participant in planning resource use and assuring protection of resources to include:

††††† 1. Clearly outlining the participantís insurance options and availability; and

††††† 2. Exploring the potential availability of other resources and social service programs for which the participant may qualify;

††††† (j) Include ensuring that notification with the MAP-24C occurs to the local DCBS office, the department, and DBHDID if a participant is:

††††† 1. Terminated from the SCL waiver program;

††††† 2. Admitted to an ICF-IID;

††††† 3. Admitted to a hospital;

††††† 4. Admitted to a skilled nursing facility;

††††† 5. Transferred to another Medicaid 1915(c) home and community based waiver program; or

††††† 6. Relocated to a different address;

††††† (k) Include monitoring to ensure that services continue if a participant has been terminated from any service until an alternate provider, if needed, has been chosen by the participant and services have been approved;

††††† (l) Include providing a participant and the participantís team members twenty-four (24) hour telephone access to a case management staff person;

††††† (m) Include documentation of services by:

††††† 1. A monthly DBHDID approved person centered monitoring tool; and

††††† 2. A detailed monthly summary note which shall include:

††††† a. The month and year for the time period the note covers;

††††† b. An analysis of progress toward the participantís outcome or outcomes;

††††† c. Identification of barriers to achievement of outcomes;

††††† d. A projected plan to achieve the next step in achievement of outcomes;

††††† e. The signature and title of the case manager completing the note; and

††††† f. The date the note was generated;

††††† (n) Include person centered team meetings which shall not constitute the required monthly face-to-face visit with a participant;

††††† (o) Include the case manager being responsible for providing information about participant directed services:

††††† 1. At the time the initial POC is developed; and

††††† 2. At least annually thereafter and upon inquiry from the participant or participantís guardian; and

††††† (p) Include the case manager supervisor performing supervision duties:

††††† 1. As outlined in the Supports for Community Living Policy Manual; and

††††† 2. In accordance with a DBHDID approved case manager supervisor training.

††††† (4)(a) If a case management service is approved to be provided despite not being conflict free, the case management provider shall document and demonstrate that the participant:

††††† 1. Receives the same level of advocacy; and

††††† 2. Exercises free choice of providers and services.

††††† (b) An exemption to the conflict free requirement shall be granted if:

††††† 1. A participant requests the exemption; and

††††† 2. The participantís case manager provides documentation to DBHDID, in accordance with the Supports for Community Living Policy Manual, that:

††††† a. Provides evidence that there is a lack of a qualified case manager within thirty (30) miles of the participantís residence; or

††††† b. There is a relationship between the participant and the participantís case manager.

††††† (c) A request to receive a case management service that is not conflict free shall accompany each prior authorization request for the case management service.

††††† (d) One (1) unit of a case management service shall equal one (1) month.

††††† (e) A provider shall bill for a case management service in accordance with 907 KAR 12:020.

††††† (5) A community access service:

††††† (a) Shall be provided by a community access specialist;

††††† (b) Shall be designed to support a participant to participate in meaningful routines, events, and activities through various community organizations;

††††† (c) Shall be designed to empower a participant in developing natural supports;

††††† (d) May be participant directed;

††††† (e) If participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 5 of this administrative regulation;

††††† (f) Shall stress training that empowers a participant in acquiring, practicing, utilizing, and improving skills related to:

††††† 1. Connecting with others;

††††† 2. Independent functioning;

††††† 3. Self advocacy;

††††† 4. Socialization;

††††† 5. Community participation;

††††† 6. Personal responsibility;

††††† 7. Financial responsibility; and

††††† 8. Other skills related to optimal well-being as defined in the participantís POC;

††††† (g) Shall be designed to result in an increased ability to develop natural supports and access community resources including educational, recreational, religious, civic, or volunteer opportunities with an outcome of:

††††† 1. Less reliance on formal supports; and

††††† 2. Greater reliance on natural or unpaid supports as established in the participantís POC;

††††† (h) Shall have an emphasis on the development of personal social networks, membership opportunities, friendships, and relationships for the participant as established in the participantís POC;

††††† (i) Shall be provided outside the participantís home or residential setting and occur during the day, in the evening, or on weekends;

††††† (j) Shall not duplicate residential, day training services, or authorized therapies;

††††† (k) Shall be provided to a participant with a:

††††† 1. One (1) to one (1) staff to participant ratio; or

††††† 2. Ratio of one (1) staff to no more than two (2) participants according to the participantís POC, if the participant invites a friend;

††††† (l) Shall occur in an integrated community setting;

††††† (m) Shall be an impact service and the participantís POC shall define steps to decrease the provision of the service as the participant becomes more independent in accessing and becoming part of the community;

††††† (n) Shall be documented by:

††††† 1. A note documenting each contact which shall include:

††††† a. A full description of each service rendered;

††††† b. Evidence of training or service to support outcomes designated in the participantís POC;

††††† c. The date of the service;

††††† d. The location of the service;

††††† e. The beginning and ending times of the service;

††††† f. The signature and title of the individual providing the service; and

††††† g. The date the entry was made in the record; and

††††† 2. A monthly summary note which shall include:

††††† a. The month and year for the time period the note covers;

††††† b. An analysis of progress toward the participantís outcome or outcomes;

††††† c. Identification of barriers to achievement of outcomes;

††††† d. Projected plan to achieve the next step in achievement of outcomes;

††††† e. The signature and title of the community access specialist completing the note; and

††††† f. The date the note was written; and

††††† (o) Shall not exceed 160 fifteen (15) minute units per week alone or in combination with community access group services.

††††† (6)(a) A community guide service shall:

††††† 1. Be provided by a community guide who meets the personnel and training requirements established in Sections 3 and 5 of this administrative regulation;

††††† 2. Be designed to empower a participant to define and direct the participantís services;

††††† 3. Only be for a participant who chooses participant directed supports for some or all of the participantís support services;

††††† 4. Include:

††††† a. Direct assistance to a participant in meeting his or her participant directed responsibilities;

††††† b. Information and assistance that helps the participant in:

††††† (i) Problem solving;

††††† (ii) Decision making;

††††† (iii) Developing supportive community relationships; and

††††† (iv) Accessing resources that promotes implementation of the participantís POC; and

††††† c. Information to ensure that the participant understands the responsibilities involved with directing the participantís services;

††††† 5. Be documented by:

††††† a. A note documenting each contact which shall include:

††††† (i) A full description of each service rendered;

††††† (ii) The date of the service;

††††† (iii) The location of the service;

††††† (iv) The beginning and ending times of the service;

††††† (v) The signature and title of the individual providing the service; and

††††† (vi) The date the entry was made in the record; and

††††† b. A completed monthly summary note which shall include:

††††† (i) The month and year for the time period the note covers;

††††† (ii) An analysis of the efficacy of the service provided including recommendations and identification of additional support needs;

††††† (iii) The signature and title of the community guide completing the note; and

††††† (iv) The date the note was written; and

††††† 6. Be limited to 576 fifteen (15) minute units per year.

††††† (b)1. A participant and the participantís person centered team shall determine the community guide services to be received.

††††† 2. The community guide services to be received by a participant shall be specified in the participantís POC.

††††† (c) If needed, directed assistance provided by a community guide:

††††† 1. Shall be based on the needs of the participant; and

††††† 2. May include assistance with:

††††† a. Recruiting, hiring, training, managing, evaluating, and changing employees;

††††† b. Scheduling and outlining the duties of employees;

††††† c. Developing and managing the individual budget;

††††† d. Understanding provider qualifications; or

††††† e. Recordkeeping and other program requirements.

††††† (d) A community guide service shall not duplicate a case management service.

††††† (e) A community guide providing community guide services to a participant shall not provide other direct waiver services to any participant.

††††† (f) A community guide shall not be employed by an agency that provides other direct waiver services to the participant receiving community guide services from the community guide.

††††† (7) Community transition services:

††††† (a) Shall be nonrecurring set-up expenses for a participant who is transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence where the participant is directly responsible for his or her own living expenses;

††††† (b) Shall be expenses that are necessary to enable a participant to establish a basic household that do not constitute room and board;

††††† (c) May include:

††††† 1. A security deposit that is required to obtain a lease on an apartment or home;

††††† 2. An essential household furnishings or moving expense required to occupy and use a community domicile, including furniture, window coverings, food preparation items, or bed or bath linens;

††††† 3. A one (1) time set-up fee or deposit for utility or service access, including telephone, electricity, heating, or water;

††††† 4. A service necessary for the participantís health and safety including pest eradication or one (1) time cleaning prior to occupancy;

††††† 5. A necessary home accessibility adaptation; or

††††† 6. An activity to assess a need and arrange for and procure needed resources;

††††† (d) Shall be:

††††† 1. Furnished only:

††††† a. To the extent that the service is reasonable and necessary;

††††† b. As clearly identified in the participantís POC; and

††††† c. If the service cannot be obtained from other sources;

††††† (e) Shall not include:

††††† 1. Monthly rental or mortgage expense;

††††† 2. Food;

††††† 3. Regular utility charges;

††††† 4. Household appliances or items that are intended for purely diversional or recreational purposes; or

††††† 5. Furnishings for living arrangements that are owned or leased by an SCL provider;

††††† (f) Shall be coordinated and documented by the participantís case manager by:

††††† 1. Description or itemized line item of purchase and cost;

††††† 2. A receipt for a procurement including date of purchase;

††††† 3. The signature and title of the case manager; and

††††† 4. The date the entry was made in the record; and

††††† (g) Shall not exceed $2,000 per qualified transition.

††††† (8) A consultative clinical and therapeutic service shall:

††††† (a) Be provided by a person who meets the personnel and training requirements established in Section 3 of this administrative reg; and

††††† (b) Is a:

††††† 1. Certified nutritionist;

††††† 2. Licensed dietitian;

††††† 3. Licensed marriage and family therapist;

††††† 4. Licensed professional clinical counselor;

††††† 5. Licensed psychological associate;

††††† 6. Licensed psychologist;

††††† 7. Licensed psychological practitioner;

††††† 8. Licensed clinical social worker; or

††††† 9. Positive behavior support specialist;

††††† (c) Include:

††††† 1. Professional consultation, evaluation, and assessment of the participant, the environment and the system of support and written summary of findings and recommendations for the participant and the participantís person-centered team;

††††† 2. Providing treatment that:

††††† a. Is consistent with assessment results and diagnosis;

††††† b. Is evidence based or current best practice; and

††††† c. Encompasses psychological treatment or counseling as indicated by the condition of the participant;

††††† 3. Coordinating program wide support, as needed, that addresses the assessed needs, conditions, or symptoms affecting a participantís ability to fully participate in the participantís community;

††††† 4. Participating in developing and revising, as needed, home treatment or support plans as components of a participantís POC;

††††† 5. Providing training and technical assistance to carry out recommendations and plans which shall occur within the settings in which the recommendations, home treatment, or support plans are to be carried out;

††††† 6. Monitoring:

††††† a. Of the fidelity of data reporting and participantís POC implementation;

††††† b. Of the effectiveness of the participantís POC;

††††† c. Of the impact of the participantís POC on the participant, the participantís environment and system of supports; and

††††† d. Which shall be conducted:

††††† (i) In the settings where the participantís POC is implemented;

††††† (ii) Through discussions and observations of people implementing the participantís POC; and

††††† (iii) Through reporting data;

††††† 7. A functional assessment which shall:

††††† a. Be conducted by a person who meets the personnel and training requirements established in Section 3 of this administrative regulation and is a:

††††† (i) Licensed psychologist;

††††† (ii) Certified psychologist with autonomous functioning; or

††††† (iii) Positive behavior support specialist; and

††††† b. Include all functional assessment components specified in the Supports for Community Living Policy Manual; and

††††† 8. Documentation of a service by a note documenting each contact which shall include:

††††† a. A full description of each service rendered;

††††† b. An analysis of the efficacy of the service provided including any recommendation or identification of additional support needs if needed;

††††† c. The date of the service;

††††† d. The location of the service;

††††† e. The beginning and end times of the service;

††††† f. The signature and title of the professional providing the service;

††††† g. The date the entry was made in the record; and

††††† (d) Not exceed 160 fifteen (15) minute units per year.

††††† (9) Day training:

††††† (a) Shall be provided by a direct support professional;

††††† (b) Shall include:

††††† 1. Providing regularly scheduled activities in a non-residential setting that are designed to foster the acquisition of skills, build positive social behavior and interpersonal competence, foster greater independence and personal choice; and

††††† 2. Career planning or pre-vocational activities to develop experiential learning opportunities and career options consistent with the participantís skills and interests that:

††††† a. Are person centered and designed to support employment related goals;

††††† b. Provide active training designed to prepare a participant to transition from school to adult responsibilities, community integration, and work;

††††† c. Enable each individual to attain the highest level of work in the most integrated setting with the job matched to the participantís interests, strengths, priorities, abilities, and capabilities; and

††††† d. Include:

††††† (i) Skill development to communicate effectively with supervisors, co-workers, and customers;

††††† (ii) Generally accepted community workplace conduct and dress;

††††† (iii) Workplace problem solving skills and strategies;

††††† (iv) General workplace safety;

††††† (v) The ability to follow directions;

††††† (vi) The ability to attend tasks; or

††††† (vii) Mobility training;

††††† 3. Supported retirement activities including:

††††† a. Altering schedules to allow for more rest time throughout the day; or

††††† b. Support to participate in hobbies, clubs, or other senior-related activities in the participantís community; or

††††† 4. Training and supports designed to maintain skills and functioning and to prevent or slow regression, rather than acquiring new skills or improving existing skills;

††††† (c) Shall include required informational sessions sponsored by the provider at least annually for the participant regarding community involvement or employment services and arrangement of opportunities for the participant to explore community integration, supported employment, and other employment opportunities in the community;

††††† (d) Shall, if provided in an adult day health care center, only be available for a participant who:

††††† 1. Is at least twenty-one (21) years of age; and

††††† 2. Requires skilled nursing services or nursing supervision in a licensed adult day health care center as outlined in the participantís POC;

††††† (e) Shall include environments that:

††††† 1. Are not diversional in nature;

††††† 2. Occur in a variety of settings in the community and shall not be limited to fixed-site facilities; and

††††† 3. Coordinate with any needed therapies in the participantís POC;

††††† (f) May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 5 of this administrative regulation;

††††† (g) Shall not be reimbursable if vocational in nature and for the primary purpose of producing goods or performing services;

††††† (h) Shall include documentation that shall be:

††††† 1. A note for each contact which shall include:

††††† a. A full description of each service rendered;

††††† b. The date of the service;

††††† c. The location of the service;

††††† d. The beginning and ending times of the service;

††††† e. The signature and title of the individual providing the service; and

††††† f. The date the entry was made in the record; and

††††† 2. A completed monthly summary note which shall include:

††††† a. The month and year for the time period the note covers;

††††† b. An analysis of the efficacy of the service provided including recommendations and identification of additional support needs;

††††† c. The signature and title of the individual completing the note; and

††††† d. The date the note was written; and

††††† (i) Shall be limited to:

††††† 1. Five (5) days per week excluding weekends; and

††††† 2. 160 fifteen (15) minute units per week for day training alone or in combination with any hours of paid community employment or on-site supported employment service.

††††† (10)(a) An environmental accessibility adaptation service:

††††† 1. Shall be:

††††† a. Designed to enable participants to interact more independently with their environment thereby enhancing their quality of life and reducing their dependence on physical support from others; and

††††† b. A physical adaptation to a participantís or familyís home which shall be necessary to:

††††† (i) Ensure the health, welfare, and safety of the participant; or

††††† (ii) Enable the participant to function with greater independence in the home and without which the participant would require institutionalization;

††††† 2. May include the following if necessary for the welfare of a participant:

††††† a. Installation of a ramp or grab-bar;

††††† b. Widening of a doorway;

††††† c. Modification of a bathroom facility; or

††††† d. Installation of a specialized electric and plumbing system which shall be necessary to accommodate the medical equipment or supplies necessary for the welfare of the participant;

††††† 3. Shall not include:

††††† a. An adaptation or improvement to a home which is not of direct medical or remedial benefit to a participant;

††††† b. An adaptation that adds to the total square footage of a home except if necessary to complete an adaptation; and

††††† c. An adaptation to a provider-owned residence;

††††† 4. Shall be provided:

††††† a. In accordance with applicable state and local building codes; and

††††† b. By a vendor who shall be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020;

††††† 5. Shall be coordinated and documented by a case manager by:

††††† a. A description of each adaptation purchased;

††††† b. A receipts for every adaptation made which shall include the:

††††† (i) Date of purchase;

††††† (ii) Description of the item;

††††† (iii) Quantity and per unit price; and

††††† (iv) Total amount of the purchase;

††††† c. The signature and title of the case manager; and

††††† d. The date the entry was made in the record; and

††††† 6. Shall be limited to $8,000 per lifetime.

††††† (b) An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a vendor or provider of an environmental accessibility service for the participant.

††††† (c) A home accessibility modification shall not be furnished to a participant who receives residential habilitation services except if the services are furnished in the participantís own home.

††††† (d) A request shall be documented in a participantís POC and include cost of adaptations.

††††† (11)(a) Goods and services shall:

††††† 1. Be services, equipment, or supplies that are individualized to a participant who chooses to use participant direct services;

††††† 2. Be utilized to reduce the need for personal care or to enhance independence within a participantís home or community;

††††† 3. Not be a good or service available to a recipient outside of the departmentís SCL waiver program;

††††† 4. Meet the following requirements:

††††† a. The good or service shall decrease the need for other Medicaid services;

††††† b. The good or service shall promote participant inclusion in the community;

††††† c. The good or service shall increase a participantís safety in the home environment; and

††††† d. The participant shall not have the funds to purchase the good or service;

††††† 5. If participant directed and purchased from a participant directed budget, be prior authorized;

††††† 6. Not include experimental or prohibited treatments;

††††† 7. Be clearly linked to a participant need that has been documented in the participantís POC;

††††† 8. Be coordinated and documented by a case manager by:

††††† a. Description or itemized line item of purchase and cost;

††††† b. Receipts for procurements which include the date of purchase;

††††† c. The signature and title of the case manager; and

††††† d. The date the entry was made in the record; and

††††† 9. Not exceed $1,800 per one (1) year authorized POC period.

††††† (b) A purchase of a good or service shall not circumvent other restrictions on SCL waiver services:

††††† 1. Established in this administrative regulation; and

††††† 2. Including the prohibition against claiming for the costs of room and board.

††††† (c) An immediate family member, guardian, or legally responsible individual of a participant shall not be a provider of participant directed goods and services to the participant.

††††† (d)[(e)] A case manager shall submit reimbursement documentation to the financial management agency.

††††† (e)[(f)] Equipment purchased as a good shall become the property of the participant.

††††† (12)(a) Natural supports training shall:

††††† 1. [Shall] Be provided by a qualified entity as identified in the POC;

††††† 2. Be participant directed and include:

††††† a. Training and education to individuals who provide unpaid support, training, companionship, or supervision to participants;

††††† b. Instruction about treatment regimens and other services specified in the participantís POC;

††††† c. Instruction on current best practices;

††††† d. The costs of registration and training fees associated with formal instruction in areas relevant to the participantís needs identified in the participantís POC; or

††††† e. Training provided by a member of the participantís community regarding specific interests of the participant and how the natural support network shall support the participantís inclusion in activities and events surrounding the area of interest;

††††† 3. Be individualized, direct training of families and natural support networks for acquisition or enhancement of their ability to support the participant;

††††† 4. Relate to needs identified in a participantís person centered POC and be tied to a specific goal in the POC;

††††† 5. Not duplicate or occur simultaneously with any education or training provided through:

††††† a. Physical therapy services;

††††† b. Occupational therapy services;

††††† c. Speech and language therapy services;

††††† d. Consultative clinical and therapeutic services; or

††††† e. Positive behavior support services;

††††† 6. Be provided in:

††††† a. A participantís own home or a participantís familyís home; or

††††† b. Community setting specific to community-based natural supports training goals specified in the participantís POC;

††††† 7. Not include:

††††† a. Services reimbursable by any other support;

††††† b. Training paid caregivers;

††††† c. Costs of travel, meals, or overnight lodging to attend a training event or conference; or

††††† d. Services not related to the needs of the participant;

††††† 8. Be coordinated and documented by a case manager by:

††††† a. The specific training provided;

††††† b. The date and the beginning and ending time when the service was provided;

††††† c. The service location;

††††† d. The receipts or verification of service provision, including first and last name and title (if applicable) of the person providing the service and the signature of the person providing the service;

††††† e. Verification of registration and certificate of attendance at any formal training; and

††††† f. The progress made in moving the participant towards independence as reflected in goals and the participantís POC; and

††††† 9. Not exceed $1,000 per one (1) year authorized POC period.

††††† (b) An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a participant directed provider of natural supports training services for the participant.

††††† (c) For purposes of natural supports training, an individual shall be defined as any person, family member, neighbor, friend, companion, or coworker who provides uncompensated care, training, guidance, companionship, or support to the participant who utilizes natural supports training.

††††† (d) A case manager shall submit reimbursement documentation to the financial management agency.

††††† (13) Occupational therapy shall:

††††† (a) Be provided by:

††††† 1. A person who:

††††† a. Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† b.[2.] Is either an:

††††† (i)[a.] Occupational therapist; or

††††† (ii)[b.] Occupational therapy assistant; and

††††† 2. Order of a physician;

††††† (b) Be evaluation and therapeutic services that are not available to a participant outside of a 1915(c) home and community based waiver program;

††††† (c) Include:

††††† 1. Evaluation of a participant and the participantís environment;

††††† 2. Therapeutic activities to improve functional performance;

††††† 3. Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; and

††††† 4. Participant and family education;

††††† (d) Facilitate maximum independence by establishing life skills with an emphasis on safety and environmental adaptation to improve quality of life and increase meaning and purpose in daily living and community integration;

††††† (e) Promote fine motor skills, coordination, sensory integration, and facilitate the use of adaptive equipment or other assistive technology;

††††† (f) Include, as needed, coordination of program wide support addressing assessed needs, conditions, or symptoms affecting a participantís ability to fully participate in the participantís community;

††††† (g) Include the development of a home treatment or support plan with training and technical assistance provided on-site to improve the ability of paid and unpaid caregivers to carry out therapeutic interventions;

††††† (h) Be delivered in a participantís home or in the community as described in the participantís POC;

††††† (i) Include monitoring:

††††† 1. Of the fidelity of data reporting and participantís POC implementation;

††††† 2. Of the effectiveness of the participantís POC;

††††† 3. Of the impact of the participantís POC on the participant, the participantís environment, and system of supports; and

††††† 4. Which shall be conducted:

††††† a. In the settings where the participantís POC is implemented;

††††† b. Through discussions and observations of people implementing the participantís POC; and

††††† c. Through reporting data;

††††† (j) Be documented by a note documenting each contact which shall include:

††††† 1. A full description of each service rendered;

††††† 2. Evidence of progress toward the participantís outcome or outcomes;

††††† 3. Identification of barriers to achievement of outcomes;

††††† 4. The projected plan to achieve the next step in achievement of outcomes;

††††† 5. The date of the service;

††††† 6. The location of the service;

††††† 7. The beginning and ending time of the service;

††††† 8. The signature and title of the person providing the service;

††††† 9. The date the entry was made in the record; and

††††† 10. The signature and title of the occupational therapist supervising the occupational therapy assistant and date of the documentation review, if applicable;

††††† (k) Not be available to a participant under the age of twenty-one (21);

††††† (l) Not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 101 et seq.); and

††††† (m) Be limited to fifty-two (52) fifteen (15) minute units per month.

††††† (14)(a) Person centered coaching shall:

††††† 1. Be provided by a person centered coach who shall:

††††† a. Operate independently of a residential or day training provider;

††††† b. Work under the direction of a positive behavior support specialist or other licensed professional in the settings where the POC is implemented; and

††††† c. Meet the personnel and training requirements specified in Section 3 of this administrative regulation;

††††† 2. Be an individualized service to be utilized when a barrier challenges the success of a participant in achieving the participantís goals;

††††† 3. Include:

††††† a. The provision of training developed in conjunction with certified or licensed professionals from the participantís person centered team, to the participant, family, guardian, natural and paid supports on implementation of all or designated components of the participantís POC;

††††† b. Monitoring the effectiveness of person centered planning as demonstrated by the support systemís implementation of the POC or designated components across the array of service settings and reporting of required and pertinent data; and

††††† c. Data collection which shall be utilized by the participantís person centered team to modify the environment or POC as needed;

††††† 4. Not duplicate case management or any other service;

††††† 5. Not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 101 et seq.); and

††††† 6. Be limited to 1,320 fifteen (15) minute units per year.

††††† (b) An individualized service shall be outcome-based with a plan for the gradual withdrawal of the services.

††††† (c) A person centered coach shall not be considered as part of a staffing ratio, plan, or pattern.

††††† (d) Documentation of a person centered coaching service shall include:

††††† 1. A note documenting each contact which shall include:

††††† a. A full description of each service rendered;

††††† b. The date of the service;

††††† c. The location of the service;

††††† d. The beginning and ending time of the service;

††††† e. The signature and title of the individual providing the service;

††††† f. The date the entry was made in the record; and

††††† 2. A completed monthly summary note which shall include:

††††† a. The month and year for the time period the note covers;

††††† b. A summary of the service provided including recommendations and identification of additional support needs if any exist;

††††† c. The signature and title of the individual completing the note;

††††† d. The date the note was written; and

††††† e. The signature, title, and date of review of documentation by the positive behavior specialist or other licensed professional directing the work of the person centered coach.

††††† (15) Personal assistance services:

††††† (a) Shall be provided by a direct support professional;

††††† (b) Shall enable a participant to accomplish tasks that the participant normally would do for himself or herself if the participant did not have a disability;

††††† (c) Shall be available only to a participant who lives in the participantís own residence or in the participantís family residence;

††††† (d) May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 5 of this administrative regulation;

††††† (e) Shall include:

††††† 1. Hands-on assistance (performing a task for a participant);

††††† 2. Reminding, observing, guiding, or training a participant in activities of daily living;

††††† 3. Reminding, observing, guiding, or training a participant in independent activities of daily living;

††††† 4. Assisting a participant in managing the participantís medical care including making medical appointments and accompanying the participant to medical appointments; or

††††† 5. Transportation, which is not otherwise available under the Medicaid Program, to access community services, activities, and appointments;

††††† (f) Shall take place in a participantís home or in the community as appropriate to the participantís need;

††††† (g) Shall not be available to a participant:

††††† 1. Receiving paid residential supports; or

††††† 2. Under the age of twenty-one (21) if medically necessary personal assistance is available as an early and periodic screening, diagnostic, and treatment service;

††††† (h) Shall not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.); and

††††† (i) Shall be documented by:

††††† 1. A note for each contact which shall include:

††††† a. A full description of each service rendered;

††††† b. Evidence of training or service to support outcomes designated in the participantís POC as appropriate;

††††† c. The date of the service;

††††† d. The location of the service;

††††† e. The beginning and ending time of the service;

††††† f. The signature and title of the direct support professional providing the service; and

††††† g. The date the entry was made in the record; and

††††† 2. A detailed monthly summary note which shall include:

††††† a. The month and year for the time period the note covers;

††††† b. Evidence of progress toward the participantís outcome or outcomes;

††††† c. Identification of barriers to achievement of outcome or outcomes;

††††† d. Projected plan to achieve the next step in achievement of outcome or outcomes;

††††† e. The signature and title of the direct support professional completing the note;

††††† f. The date the note was written; and

††††† g. The signature, title, and date the documentation was reviewed by the direct support professional supervisor supervising the direct support professional.

††††† (16) Physical therapy shall:

††††† (a) Include evaluation or therapeutic services that are not available to a participant outside of a 1915(c) home and community based waiver program;

††††† (b) Address physical therapy needs that result from a participantís developmental disability;

††††† (c) Facilitate a participantís independent functioning or prevent progressive disabilities;

††††† (d) Include:

††††† 1. Evaluation;

††††† 2. Therapeutic procedures;

††††† 3. Therapeutic exercises to increase range of motion and flexibility;

††††† 4. Participant or family education;

††††† 5. Assessment of a participantís environment;

††††† 6. If needed, development of a home treatment or support plan with training and technical assistance provided on-site to improve the ability of paid and unpaid caregivers to carry out therapeutic interventions;

††††† 7. As needed, coordination of program wide support addressing assessed needs, conditions, or symptoms affecting a participantís ability to fully participate in the community;

††††† 8. Monitoring:

††††† a. Of the fidelity of data reporting and participantís POC implementation;

††††† b. Of the effectiveness of the participantís POC;

††††† c. Of the impact of the participantís POC on the participant, the participantís environment, and system of supports; and

††††† d. Which shall be conducted:

††††† (i) In the settings where the participantís POC is implemented;

††††† (ii) Through discussions and observations of people implementing the participantís POC; and

††††† (iii) Through reporting data;

††††† (e) Be provided by:

††††† 1. A person who:

††††† a. Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† b.[2.] Is either:

††††† (i)[a.] A physical therapist; or

††††† (ii)[b.] A physical therapist assistant; and

††††† 2. An order of a physician;

††††† (f) Be delivered in a participantís home or in the participantís community as described in the participantís POC;

††††† (g) Not be available to a participant under the age of twenty-one (21) years;

††††† (h) Not supplant educational services available under the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.);

††††† (i) Be documented by a note documenting each contact which shall include:

††††† 1. A full description of each service rendered;

††††† 2. Evidence of progress toward the participantís outcome or outcomes;

††††† 3. Identification of barriers to achievement of outcomes;

††††† 4. The projected plan to achieve the next step in achievement of outcomes;

††††† 5. The date of the service;

††††† 6. The location of the service;

††††† 7. The beginning and ending time of the service;

††††† 8. The signature and title of the person providing the service;

††††† 9. The date the entry was made in the record; and

††††† 10. The signature and title of the physical therapist supervising the physical therapist assistant and date of the documentation review if applicable; and

††††† (j) Be limited to fifty-two (52) fifteen (15) minute units per month.

††††† (17)(a) Positive behavior supports shall include:

††††† 1. The utilization of evidenced based and best practices in behavioral techniques, interventions, and methods to assist a participant with significant, intensive challenges which interfere with activities of daily living, social interaction, or work;

††††† 2. Evidenced based or best practices regarding treatment of a behavioral health condition which shall be the primary support services if supplemental behavioral interventions are needed; and

††††† 3. A positive behavior support plan which shall:

††††† a. Be clearly based upon the information, data collected, and recommendations from the functional assessment;

††††† b. Meet the primary purpose of having the participant acquire or maintain skills for community living while behavioral interventions are delivered for the reduction of significant challenges which interfere with activities of daily living, social interaction, or work;

††††† c. Be developed with the participant and participantís person centered team;

††††† d. Be related to goals of interventions, such as greater participation in activities, enhanced coping or social skills;

††††† e. Include all the positive behavior support components specified in the Supports for Community Living Policy Manual;

††††† f. Be revised whenever necessary; and

††††† g. Be implemented across service settings by the various people, both paid and natural supports, assisting a participant to reach the participantís goals and dreams.

††††† (b) Positive behavior supports shall be provided by a positive behavior support specialist.

††††† (c) Behavioral health treatment and positive behavioral supports shall be utilized in a collaborative manner.

††††† (d) One (1) unit of positive behavior supports shall equal one (1) plan.

††††† (e) Positive behavior supports shall be billed in accordance with 907 KAR 12:020.

††††† (18) Residential support services shall:

††††† (a) Be authorized for a participant based upon information from the participantís Supports Intensity Scale assessment, Health Risk Screening Tool assessment, and approved person centered POC;

††††† (b) Include:

††††† 1. Level I residential supports;

††††† 2. Technology assisted residential supports; or

††††† 3. Level II residential supports; and

††††† (c) Be documented by a:

††††† 1. Daily note which shall include:

††††† a. Information about how a participant spent the day including any effort toward meeting any outcome identified in the participantís POC;

††††† b. The date of the service;

††††† c. The location of the service;

††††† d. The signature and title of the individual providing the service; and

††††† e. The date the entry was made in the record; and

††††† 2. Detailed monthly summary note which shall include:

††††† a. The month and year for the time period covered by the note;

††††† b. An analysis of progress toward a participantís outcome or outcomes;

††††† c. A projected plan to achieve the next step in achievement of an outcome or outcomes;

††††† d. Information regarding events that occurred that had an impact on the participantís life;

††††† e. The signature and title of the individual writing the note;

††††† f. The date the note was written; and

††††† g. The signature, title, and date of documentation review by the direct support professional supervisor providing supervision to the direct support professional.

††††† (19)(a) Level I residential supports shall:

††††† 1. Be furnished in a provider-owned or leased residence which complies with the Americans with Disabilities Act based upon the needs of each participant receiving a support in the residence;

††††† 2. Be for a participant who requires a twenty-four (24) hour a day, intense level of support;

††††† 3. Include no more than five (5) unsupervised hours per day per participant:

††††† a. To promote increased independence; and

††††† b. Which shall be based on the:

††††† (i) Needs of the participant as determined by the participantís person centered team; and

††††† (ii) Participantís POC;

††††† 4. Include:

††††† a. Adaptive skill development;

††††† b. Assistance with activities of daily living including bathing, dressing, toileting, transferring, or maintaining continence;

††††† c. Community inclusion;

††††† d. Adult education supports;

††††† e. Social and leisure development;

††††† f. Protective oversight or supervision;

††††† g. Transportation;

††††† h. Personal assistance; and

††††† i. The provision of medical or health care services that are integral to meeting the participantís daily needs; and

††††† 5. Be outlined in a participantís POC.

††††† (b) Level I residential supports shall be provided by a:

††††† 1. Staffed residence which:

††††† a. Has been certified:

††††† (i) By the department to be an SCL waiver provider; and

††††† (ii) By DBHDID to provide level I residential supports; and

††††† b. Shall have no more than three (3) participants receiving publicly-funded supports in a home leased or owned by the provider; or

††††† 2. Group home which:

††††† a. Has been certified:

††††† (i) By the department to be an SCL waiver provider; and

††††† (ii) By DBHDID to provide level I residential supports; and

††††† b. Shall have no more than eight (8) participants in the group home.

††††† (c)1. For a participant approved for unsupervised time, a safety plan shall be included in the participantís POC based upon the participantís assessed needs.

††††† 2. A participantís case manager and other person centered team members shall ensure that a participant is able to implement a safety plan.

††††† 3. A participantís case manager shall provide ongoing monitoring of the safety plan, procedures, or assistive devices required by a participant to ensure relevance, the participantís ability to implement the safety plan, and the functionality of the devices if required.

††††† (d) If a participant experiences a change in support needs or status, the participantís person centered team shall meet to make the necessary adjustments in the:

††††† 1. Participantís POC; and

††††† 2. Residential services to meet the participantís needs.

††††† (e) A level I residential support provider shall employ staff who shall be a:

††††† 1. Direct support professional; or

††††† 2. Direct support professional supervisor if providing supervision.

††††† (20)(a) Technology assisted residential services shall:

††††† 1. Be furnished in a participantís residence:

††††† a. Which complies with the Americans with Disabilities Act based upon the needs of each participant receiving a support in the residence; and

††††† b. To three (3) or fewer participants who reside in the residence with twenty-four (24) hour staff support;

††††† 2. Be for a participant who:

††††† a. Requires up to twenty-four (24) hours a day of support; and

††††† b. Is able to increase his or her level of independence with a reduced need for onsite staff;

††††† 3. Include, to the extent required for a participant:

††††† a. Protective oversight or supervision;

††††† b. Transportation;

††††† c. Personal assistance; or

††††† d. The provision of medical or health care services that are integral to meeting the participantís daily needs;

††††† 4. Increase a participantís independence without undue risk to the participantís health or safety;

††††† 5. Be a real-time monitoring system with a two (2) way method of communication linking a participant to a centralized monitoring station; and

††††† 6. Be allowed to include:

††††† a. An electronic sensor;

††††† b. A speaker or microphone;

††††† c. A video camera which shall not be located in a bedroom or a bathroom;

††††† d. A smoke detector; or

††††† e. A personal emergency response system.

††††† (b)1. A device listed in paragraph (a)6. of this subsection shall link a participantís residence to remote staff employed to provide electronic support.

††††† 2. A technology assisted residential service provider shall have a plan established to ensure that staff is available twenty-four (24) hours a day, seven (7) days a week for a participant or participants receiving services from the provider.

††††† (c) Technology shall be used by the technology assisted residential service provider to assist a participant in residing in the most integrated setting appropriate to the participantís needs.

††††† (d) The level and types of technology assisted residential services provided to a participant shall be:

††††† 1. Determined by a participantís person centered team; and

††††† 2. Outlined in a participantís POC.

††††† (e) A participantís person centered team shall give careful consideration to the participantís medical, behavioral, and psychiatric condition in determining the level and types of technology assisted residential services needed for a participant.

††††† (f) The use of technology to reduce a participantís need for residential staff support in a residence may be utilized if there is an individualized person centered POC which has been developed to promote a participantís increased independence:

††††† 1. Based on the participantís needs as indicated in the scores and results of the Supports Intensity Scale assessment and Health Risk Screening Tool assessment; and

††††† 2. As recommended by the participantís person centered team.

††††† (g)1. If a participant experiences a change in support need or status, the technology assisted residential service provider shall:

††††† a. Immediately adjust the participantís supervision to meet any acute need of the participant; and

††††† b. Reassess the appropriateness of technology assisted residential services and make any adjustment, if needed, to meet any chronic support need of the participant.

††††† 2. Any adjustment shall be made in collaboration with the participantís case manager and person centered team if the adjustment is to be implemented for a period longer than what was determined by the participantís person centered team when developing the participantís POC.

††††† (h) A technology assisted residential service provider shall:

††††† 1. Be responsible for arranging or providing a participantís transportation between the participantís residence and any other service site or community location;

††††† 2. Employ staff who:

††††† a. Shall be a:

††††† (i) Direct support professional; or

††††† (ii) Direct support professional supervisor if providing supervision; and

††††† b. Demonstrate:

††††† (i) Proficiency in the individualís ability to operate all monitoring devices utilized in technology assisted residential services; and

††††† (ii) The ability to respond appropriately to the needs of participants in a timely manner; and

††††† 3. Have daily contact with the participant.

††††† (21)(a) Level II residential supports shall:

††††† 1. Be for a participant who requires up to a twenty-four (24)-hour level of support;

††††† 2. Be a support tailored to a participant to assist the participant with acquiring, retaining, or improving skills related to living in a community;

††††† 3. Be designed and implemented to assist a participant to reside in the most integrated setting appropriate to the participantís needs;

††††† 4. Provide support for a participant up to twenty-four (24) hours a day; and

††††† 5. Be furnished in:

††††† a. An adult foster care home;

††††† b. A family home provider; or

††††† c. A participantís own home.

††††† (b) Level II residential supports shall be provided by:

††††† 1. An adult foster care provider which:

††††† a. Has been certified:

††††† (i) By the department to be an SCL waiver provider; and

††††† (ii) By DBHDID to provide level II residential supports; and

††††† b. Shall have no more than three (3) participants who are:

††††† (i) Aged eighteen (18) years or older; and

††††† (ii) Receiving publicly-funded supports and living in the home; or

††††† 2. A family home provider which:

††††† a. Has been certified:

††††† (i) By the department to be an SCL waiver provider; and

††††† (ii) By DBHDID to provide level II residential supports; and

††††† b. Shall have no more than three (3) participants receiving publicly-funded supports living in the home.

††††† (c) A level II residential support provider shall employ staff who shall be a:

††††† 1. Direct support professional; or

††††† 2. Direct support professional supervisor if providing supervision.

††††† (d) If a participant experiences a change in support need or status, the level II residential services provider shall adjust services provided to the participant to meet the participantís altered need or status.

††††† (22) Respite:

††††† (a) Shall:

††††† 1. Be provided to a participant who:

††††† a. Does not receive residential services;

††††† b. Resides in the participantís own home or family's home; and

††††† c. Is unable to independently administer self-care;

††††† 2. Be provided:

††††† a. In a variety of settings;

††††† b. By a direct support professional; and

††††† c. On a short-term basis due to the absence or need for relief of an individual providing care to a participant;

††††† 3. Documented by a contact note which shall include:

††††† a. The date of the service;

††††† b. The beginning and ending time of the service;

††††† c. A full description of each service rendered;

††††† d. The signature and title of the individual providing the service; and

††††† e. The date the entry was made in the record; and

††††† 4. Not exceed 830 hours per calendar year; and

††††† (b) May be participant directed and if participant directed, may be provided by an immediate family member or guardian of the participant in accordance with Section 5 of this administrative regulation.

††††† (23)(a) Shared living shall be a participant directed service designed to:

††††† 1. Be an alternative to residential support services; and

††††† 2. Be provided by a shared living caregiver who provides some of the participantís supports in exchange for the caregiverís share of room and board expenses.

††††† (b) A payment for the portion of the costs of rent or food attributable to an unrelated personal caregiver shall be routed through the financial management agency specifically for reimbursing the participant.

††††† (c) If two (2) participants choose to live together in a home, the two (2) may share a caregiver.

††††† (d) Depending upon the need of a participant, a caregiver may provide:

††††† 1. Assistance with the acquisition, retention, or improvement in skills related to activities of daily living; or

††††† 2. Supervision required for safety or the social and adaptive skills necessary to enable the participant to reside safely and comfortably in the participantís own home.

††††† (e) Shared living services shall:

††††† 1. Address a participantís needs identified in the participantís person centered planning process;

††††† 2. Be outlined in the participantís POC;

††††† 3. Be specified in a contractual agreement between the participant and the caregiver; and

††††† 4. Complement other services the participant receives and enhance increased independence for the participant.

††††† (f) A participantís person centered team shall decide and ensure that the individual who will serve as the participantís caregiver has the experience, skills, training, and knowledge appropriate to the participant and the type of support needed.

††††† (g) A participantís caregiver shall meet direct support professional qualifications in accordance with Section 1(24) of this administrative regulation.

††††† (h) Room and board expenses for an unrelated caregiver living with a participant shall be:

††††† 1. Reflected in the participantís person centered POC; and

††††† 2. Specified in the contractual agreement between the participant and the caregiver.

††††† (i) A payment shall not be made if a participant lives in the caregiverís home or in a residence that is owned or leased by an SCL provider.

††††† (j) Documentation shall:

††††† 1. Be maintained by a participantís case manager; and

††††† 2. Include:

††††† a. A dated monthly summary note that is written by the case manager and details how services were provided according to the contractual agreement and the participantís person centered POC;

††††† b. A monthly receipt for the caregiverís room and board expenses that were reimbursed to the participant;

††††† c. The signature and title of the case manager writing the note;

††††† d. The date the note was written;

††††† e. A signed and dated statement from the participant or the participantís guardian indicating that the participant is satisfied with the services provided by the caregiver; and

††††† f. The signature, title and date of documentation review by the case manager supervisor who is supervising the case manager.

††††† (k) Shared living shall not exceed $600 per month.

††††† (24)(a) Specialized medical equipment and supplies shall:

††††† 1. Include a device, control, or appliance specified in a participantís POC which shall:

††††† a. Be necessary to ensure the health, welfare, and safety of the participant; or

††††† b. Enable the participant to function with greater independence in the home;

††††† 2. Include assessment or training needed to assist a participant with mobility, seating, bathing, transferring, security, or other skills including operating a wheelchair, a lock, a door opener, or a side lyre;

††††† 3. Include a computer necessary for operating communication devices, a scanning communicator, a speech amplifier, a control switch, an electronic control unit, a wheelchair, a lock, a door opener, or a side lyre;

††††† 4. Include customizing a device to meet a participantís needs;

††††† 5. Include partial nutrition supplements, special clothing, an enuresis protective chuck, or another authorized supply that is specified in the participantís POC;

††††† 6. Include an ancillary supply necessary for the proper functioning of an approved device;

††††† 7. Be identified in a participantís POC;

††††† 8. Be recommended by a person whose signature shall verify the type of specialized equipment or supply that is necessary to meet the participantís need; and who

††††† a. Meets the personnel and training requirements established in Section 3 of this administrative regulation and is a:

††††† (i) An occupational therapist;

††††† (ii) A physical therapist;

††††† (iii) A speech therapist; or

††††† b. Is a certified or licensed practitioner whose scope of practice includes the evaluation and recommendation of specialized equipment or supplies;

††††† 9. Not include equipment, a supply, an orthotic, prosthetic, service, or item covered under the departmentís:

††††† a. Durable medical equipment program pursuant to 907 KAR 1:479;

††††† b. Hearing services program pursuant to 907 KAR 1:038 or 907 KAR 1:039; or

††††† c. EPSDT program pursuant to 907 KAR 11:034 or 907 KAR 11:035; and

††††† 10. Be coordinated and documented by a case manager by:

††††† a. A description or itemized line item of purchase and cost;

††††† b. Receipts for procurements which include the date of purchase;

††††† c. The signature and title of the case manager;

††††† d. The date the entry was made in the record; and

††††† e. The signature, title, and date of the documentation review by the case manager supervisor providing supervision to the case manager.

††††† (b) Equipment purchased pursuant to this subsection for a participant shall become the property of the participant.

††††† (25) Speech therapy shall:

††††† (a) Be provided by:

††††† 1. A speech language pathologist who meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† 2. An order of a physician;

††††† (b) Include:

††††† 1. Evaluation or therapeutic services that are not available to a participant outside of a 1915(c) home and community based waiver program;

††††† 2. Speech and language therapy evaluation;

††††† 3. Individual treatment of voice;

††††† 4. Communication;

††††† 5. Auditory processing;

††††† 6. Therapeutic services for the use of a speech-device including:

††††† a. Programming and modification; or

††††† b. Participant and family education;

††††† 7. Development of a home treatment or support plan with training and technical assistance provided on site to improve the ability of paid and unpaid caregivers to carry out therapeutic interventions;

††††† 8. As needed, coordination of program-wide support addressing assessed needs, conditions, or symptoms affecting a participantís ability to fully participate in the participantís community;

††††† 9. Monitoring:

††††† a. Of the fidelity of data reporting and participantís POC implementation;

††††† b. Of the effectiveness of the participantís POC;

††††† c. Of the impact of the participantís POC on the participant, the participantís environment and system of supports; and

††††† d. Which shall be conducted:

††††† (i) In the settings where the participantís POC is implemented;

††††† (ii) Through discussions and observations of people implementing the participantís POC; and

††††† (iii) Through reporting data;

††††† (c) Preserve abilities for independent function in communication, motor and swallowing functions, facilitate use of assistive technology, and prevent regression;

††††† (d) Be delivered in a participantís home or in the participantís community as described in the participantís POC;

††††† (e) Not be available to a participant under the age of twenty-one (21) years;

††††† (f) Not supplant educational services available under the IDEA (20 U.S.C. 1401 et seq.); and

††††† (g) Be documented by a note documenting each contact which shall include:

††††† 1. A full description of each service rendered;

††††† 2. Evidence of progress toward the participantís outcome or outcomes;

††††† 3. Identification of barriers to achievement of outcomes;

††††† 4. The projected plan to achieve the next step in achievement of outcomes;

††††† 5. The date of the service;

††††† 6. The location of the service;

††††† 7. The beginning and ending time of the service;

††††† 8. The signature and title of the speech language pathologist providing the service; and

††††† 9. The date the entry was made in the record; and

††††† (h) Be limited to fifty-two (52) fifteen (15) minute units per month.

††††† (26)(a) Supported employment shall be funded by the Rehabilitation Act of 1973 (29 U.S.C. Chapter 16) or Individuals with Disabilities Education Act (IDEA) (20 U.S.C. 1401 et seq.) for a participant if funding is available under either act for the participant.

††††† (b) If the funding referenced in paragraph (a) of this subsection is not available for a participant, SCL waiver funding may be accessed for the participant for all defined supported employment services if there has been no change in the impact of the participantís disability on the participantís employment.

††††† (c) Supported employment shall:

††††† 1. Be covered for a participant if no change in the impact of a participantís disability on the participantís employment has occurred and:

††††† a. A Supported Employment Long-Term Support Plan has been completed and incorporated into the participantís person centered POC; or

††††† b. There is documentation of the payment of the supported employment individual outcome placement fee indicating closure of the case by the Office of Vocational Rehabilitation;

††††† 2. Be participant directed, if a participant chooses this option;

††††† 3. Be provided:

††††† a. In a variety of settings;

††††† b. By a supported employment specialist who:

††††† (i) Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

††††† (ii) Works for an SCL certified provider that is a vendor of supported employment services for the Office of Vocational Rehabilitation; and

††††† c. In accordance with the supported employment policies stated in the current Supports for Community Living Policy Manual;

††††† 4. Be delivered on a one (1) to one (1) basis with a participant or indirectly on behalf of a participant;

††††† 5. Exclude work performed directly for the supported employment provider or other service provider; and

††††† 6. Be coordinated with other applicable 1915(c) home and community based waiver services, if applicable, in support of the participantís employment outcome.

††††† (d) Supported employment services delivered on a one-to-one basis and the hours spent by a participant performing paid employment and adult day training shall not exceed:

††††† 1. Forty (40) hours per week; or

††††† 2. 160 units per week.

††††† (e) A supported employment service shall be provided and documented as required by this paragraph.

††††† 1. A Person Centered Employment Plan shall be completed by a participantís supported employment specialist and updated as needed as required in the Supports for Community Living Policy Manual.

††††† 2. A Supported Employment Long-Term Support Plan shall be completed by a participantís supported employment specialist and updated as needed as required in the Supports for Community Living Policy Manual.

††††† 3. A Person Centered Employment Plan Activity Note, notes regarding a participantís job development activity, notes regarding a participantís job acquisition or stabilization activity, and notes regarding a participantís long-term employment support activity shall:

††††† a. Be completed by a participantís supported employment specialist to document each contact with the participant or action provided on behalf of the participant; and

††††† b. Contain:

††††† (i) The date of the service;

††††† (ii) The beginning time of the service;

††††† (iii) The ending time of the service;

††††† (iv) A description of the activity that was conducted;

††††† (v) The justification of the activity;

††††† (vi) The results of the activity;

††††† (vii) The anticipated content of the next activity; and

††††† (viii) The signature of the supported employment specialist who provided the service.

††††† (27)(a) A transportation service shall:

††††† 1. Enable a participant who chooses to use participant directed services to gain access to integrated waiver and other community services, activities, resources, and organizations typically utilized by the general population; and

††††† 2. Only be provided when transportation is not:

††††† a. Otherwise and customarily available through natural supports including family, friends, neighbors, or community agencies; or

††††† b. Included as an element of another SCL waiver service;

††††† 3. Include nonemergency travel;

††††† 4. Be clearly described in a participantís POC which shall include information regarding the unavailability of other transportation services or resources;

††††† 5. Be reimbursable based upon the assessed needs of a participant as specified in the participantís POC;

††††† 6. Be provided by a driver who:

††††† a. Is at least eighteen (18) years of age and legally licensed to operate the transporting vehicle to which the individual is assigned or owns;

††††† b. Has proof of current liability insurance for the vehicle in which the participant will be transported; and

††††† c. Is an individual or other public transit resource including a local cab or bus service; and

††††† 7. Not:

††††† a. Include transporting a participant to school (through the twelfth grade);

††††† b. Be available to a participant who:

††††† (i) Receives transportation as an element of another covered service;

††††† (ii) Is receiving a residential service via the SCL waiver program;

††††† (iii) Has access to transportation under the Individuals with Disabilities Education Act; or

††††† (iv) Customarily receives transportation from a relative.

††††† (b) A participant shall not contract with an individual to provide transportation if the individual has a driving under the influence conviction within the past twelve (12) months.

††††† (c) A transportation service may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 5 of this administrative regulation.

††††† (d) A case manager shall:

††††† 1. Coordinate transportation services; and

††††† 2. Ensure that the following documentation is completed and submitted to the financial management agency for direct payment to the approved vendor:

††††† a. The specific type and purpose of transportation provided;

††††† b. The date and the beginning and ending time when the service was provided;

††††† c. The location of origin of the transportation service, destination of the transportation service, and the mileage incurred from point to point;

††††† d. Verification of service delivery, including the first and last name and title (if applicable) of the individual providing the service; and

††††† e. A receipt from the driver if a bus, taxicab, or similar type of transportation service in which the participant directly purchases the service is utilized.

††††† (28)(a) A vehicle adaptation shall:

††††† 1. Be a device, control, or service that enables a participant to:

††††† a. Increase the participantís independence and physical safety; and

††††† b. Interact more independently with the participantís environment and reduce the participantís dependence on physical support from others;

††††† 2. Be made to a participantís or a participantís familyís privately owned vehicle;

††††† 3. Include:

††††† a. A hydraulic lift;

††††† b. A ramp;

††††† c. A special seat; or

††††† d. An interior modification to allow for access into and out of the vehicle as well as safety while the vehicle is moving;

††††† 4. Be limited to $6,000 per five (5) years per participant;

††††† 5. Be prior authorized by the department in order to be reimbursable by the department; and

††††† 6. Be coordinated and documented by a case manager by:

††††† a. Documenting an estimate from a vendor determined to be qualified to complete vehicle modifications by the Office of Vocational Rehabilitation;

††††† b. Documentation from the Office of Vocational Rehabilitation that the participant is not qualified to receive a vehicle modification from the Office of Vocational Rehabilitation;

††††† c. A description or itemized line item of purchase and cost;

††††† d. A receipt for procurements which shall include the date of purchase;

††††† e. Verification by the case manager that the work is complete, adequate, and satisfactory within ten (10) business days of completion before payment is requested and issued;

††††† f. The signature and title of the case manager; and

††††† g. The date the entry was made in the record.

††††† (b) The departmentís SCL program shall be the payer of last resort for a vehicle adaptation.

††††† (c) The need for a vehicle adaptation shall:

††††† 1. Be documented in a participantís person centered POC; and

††††† 2. Include an assessment from an occupational therapist or physical therapist specializing in vehicle modifications that result in specific recommendations for the type of modification to meet the needs of the participant.

††††† (d) The department shall not reimburse for the repair or replacement costs of a vehicle adaptation of a vehicle owned by an SCL provider.

††††† (e) A vehicle adaptation vendor shall be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020.

††††† (f) An immediate family member, guardian, or legally responsible individual of the participant shall not be eligible to be a vendor or provider of a vehicle adaptation service for the participant.

††††† (g) A case manager shall submit reimbursement documentation to the financial management agency.

 

††††† Section 5. Participant Directed Services (PDS). (1)(a) The following services may be participant directed and shall be provided in accordance with the specifications and requirements established in Section 4 of this administrative regulation, the Supports for Community Living Policy Manual, and the training requirements specified in paragraph (b) of this subsection:

††††† 1. Community access services;

††††† 2. Community guide services;

††††† 3. Day training;

††††† 4. Personal assistance services;

††††† 5. Respite;

††††† 6. Shared living; or

††††† 7. Supported employment.

††††† (b) An individual who provides a participant directed service shall complete the following training requirements in the timeframe established by paragraph (c) of this subsection:

††††† 1. First aid and cardiopulmonary resuscitation certification by the American Red Cross or the American Heart Association;

††††† 2. If administering or monitoring the administration of a medication, an approved DBHDID medication administration curriculum;

††††† 3. Individualized instruction regarding the participant receiving a support;

††††† 4. The following areas of the Kentucky College of Direct Support modules:

††††† a. Maltreatment of vulnerable adults and children;

††††† b. Individual rights and choices;

††††† c. Safety at home and in the community;

††††† d. Supporting healthy lives; and

††††† e. Person centered planning; and

††††† 5. Other training if required by the participant.

††††† (c) The training required by paragraph (b) of this subsection shall be completed:

††††† 1. Within six (6) months of the date of hire for a new provider of a participant-directed service; or

††††† 2. Within one (1) year of the effective date of this administrative regulation for an employee providing a participant-directed service on the effective date of this administrative regulation.

††††† (2) An individual providing a participant directed service to more than three (3) participants in the same household or different households shall complete all provider training requirements as specified in Section 3 of this administrative regulation.

††††† (3)(a) The following services may be participant directed and shall be provided in accordance with the specifications and requirements established in the Supports for Community Living Manual and in Section 4 of this administrative regulation:

††††† 1. Environmental accessibility adaptation services;

††††† 2. Goods and services;

††††† 3. Natural supports training;

††††† 4. Transportation services; or

††††† 5.[2.] Vehicle adaptation services.

††††† (b) A participant directed service shall not be available to a participant who resides in a living arrangement, regardless of funding source, that is furnished to four (4) or more individuals who are unrelated to the proprietor.

††††† (4) An immediate family member or guardian of a participant may provide a support to a participant directed service if:

††††† (a) Allowed to do so pursuant to Section 4 of this administrative regulation;

††††† (b) The family member or guardian has the unique abilities necessary to meet the needs of the participant;

††††† (c) The service is not something normally provided by the family member or guardian to the participant;

††††† (d) Delivery of the service by the family member or guardian is cost effective;

††††† (e) The use of the family member or guardian is age and developmentally appropriate;

††††† (f) The use of the family member or guardian enables the participant to:

††††† 1. Learn and adapt to different people; and

††††† 2. Form new relationships;

††††† (g) The participant learns skills to increase independence;

††††† (h) Having the family member or guardian provide the service:

††††† 1. Truly reflects the participantís wishes and desires;

††††† 2. Increases the participantís quality of life in measurable ways;

††††† 3. Increases the participantís level of independence;

††††† 4. Increases the participantís choices; and

††††† 5. Increases the participantís access to the amount of service hours for needed support; and

††††† (i)1. There is no qualified provider within thirty (30) miles from the participantís residence; or

††††† 2. There is no qualified provider who can furnish the service at the necessary times and places.

††††† (5) A legally responsible individual may provide a service to a participant if:

††††† (a) Allowed to do so pursuant to Section 4 of this administrative regulation;

††††† (b) The legally responsible individual meets the requirements established for a family member or guardian in subsection (4) of this section;

††††† (c) The service exceeds the range of activities that a legally responsible individual would ordinarily provide in a household on behalf of a person:

††††† 1. Without a disability; and

††††† 2. Of the same age; and

††††† (d) The service is necessary to:

††††† 1. Assure the health and welfare of the participant; and

††††† 2. Avoid institutionalization.

††††† (6) An individual serving as a representative for a participant shall not be eligible to provide a waiver service to the participant.

††††† (7) A participant directed reimbursement service shall be provided by a financial management agency with whom the department contracts that shall:

††††† (a) Only pay for service identified and prior authorized in a participantís POC;

††††† (b) Ensure compliance with all Internal Revenue Service regulations, United States Department of Labor regulations, and Kentucky Department of Workersí Claims administrative regulations regarding workersí compensation;

††††† (c) Process employer-related payroll and deposit and withhold necessary mandatory employer withholdings;

††††† (d) Receive, disburse, and track public funds based on a participantís approved POC;

††††† (e) Provide:

††††† 1. A participant and the participantís case manager with payroll reports semi-monthly;

††††† 2. Additional payroll information to a participantís case manager on a per request basis; and

††††† 3. Reports to DBHDID.

††††† (8)(a) A participant may voluntarily disenroll from a participant directed service at any time.

††††† (b) If a participant elects to disenroll from a participant directed service, the participantís case manager shall assist the participant and the participantís guardian to locate a traditional waiver service provider of the participantís choice to provide the service.

††††† (c) 1. Except as provided in subparagraph 2 of this paragraph, a participant directed service shall not be terminated until a traditional service provider is ready to provide the service.

††††† 2. If a participant does not wish to continue receiving the service, the service shall be terminated.

††††† (9)(a) If case management monitoring reveals that a participantís health, safety, or welfare is being jeopardized, the participantís case manager shall:

††††† 1. Develop a corrective action plan in conjunction with the participant, the participantís guardian, and any other person centered team member; and

††††† 2. Monitor the progress of the corrective action plan and resulting outcomes to resolve the health, safety, or welfare issue.

††††† (b) If the health, safety, or welfare issue referenced in paragraph (a) of this subsection is not resolved, the participantís case manager, in conjunction with the participantís person centered team members, shall assist the participant to locate a traditional waiver service provider of the participantís choice to provide the service.

††††† (c) A participant directed service shall not be terminated until a traditional service provider is ready to provide the service.

††††† (10) Documentation of a participant directed service shall include:

††††† (a) A timesheet; and

††††† (b) A note documenting each contact which shall include:

††††† 1. A full description of each service provided to support an outcome or outcomes in the participantís POC;

††††† 2. The date of the service;

††††† 3. The location of the service;

††††† 4. The beginning and ending time of the service;

††††† 5. The signature and title of the person providing the service; and

††††† 6. The date the entry was made in the record; and

††††† (c) Any applicable form for each service in accordance with Section 4 of this administrative regulation.

 

††††† Section 6. Incident Reporting Process. (1) The following shall be the two (2) classes of incidents:

††††† (a) An incident; or

††††† (b) A critical incident.

††††† (2) An incident shall be any occurrence that impacts the health, safety, welfare, or lifestyle choice of a participant and includes:

††††† (a) A minor injury;

††††† (b) A medication error without a serious outcome; or

††††† (c) A behavior or situation which is not a critical incident.

††††† (3) A critical incident shall be an alleged, suspected, or actual occurrence of an incident that:

††††† (a) Can reasonably be expected to result in harm to a participant; and

††††† (b) Shall include:

††††† 1. Abuse, neglect, or exploitation;

††††† 2. A serious medication error;

††††† 3. Death;

††††† 4. A homicidal or suicidal ideation;

††††† 5. A missing person; or

††††† 6. Other action or event that the provider determines may result in harm to the participant.

††††† (4)(a) An incident shall:

††††† 1. Be documented on an Incident Report form; and

††††† 2. Be immediately assessed for potential abuse, neglect, or exploitation.

††††† (b) If an assessment of an incident indicates the potential for abuse, neglect, or exploitation exists:

††††† 1. The individual who discovered or witnessed the incident shall immediately act to ensure the health, safety, or welfare of the at-risk participant;

††††† 2. The incident shall immediately be considered a critical incident;

††††† 3. The critical incident procedures established in subsection (5) of this section shall be followed;

††††† 4. The SCL provider shall report the incident to the participantís case manager and participantís guardian within twenty-four (24) hours of discovery of the incident;

††††† 5. The witness of the incident or the discovering agencyís employee or volunteer shall record details of the incident on an Incident Report form;

††††† 6. A completed Incident Report form shall be retained on file by the SCL provider; and

††††† 7. A copy of the completed Incident Report form shall be provided to the case management agency providing case management to the participant.

††††† (5)(a) If a critical incident occurs, the individual who witnessed the critical incident or discovered the critical incident shall:

††††† 1. Immediately act to ensure the health, safety, and welfare of the at-risk participant;

††††† 2. Immediately report the critical incident to:

††††† a. The Department for Community Based Services, Adult Protective Services Branch or Child Protective Services Branch, as applicable:

††††† b. The participantís case manager;

††††† c. The participantís guardian; and

††††† d. DBHDID, via fax, if abuse, neglect, or exploitation is suspected; and

††††† 3. Document the incident on a Critical Incident Report form.

††††† (b) If the critical incident is not one which requires reporting of abuse, neglect, or exploitation, the critical incident shall be reported within eight (8) hours of discovery to:

††††† 1. The participantís case manager;

††††† 2. The participantís guardian; and

††††† 3. To BHDID by fax, unless it occurs after 4:30 p.m. Eastern Standard Time or on a weekend, in which case notification shall be sent to DBHDID on the following business day.

††††† (c) The witness of the critical incident or the discovering agencyís employee or volunteer shall record details of the critical incident on a Critical Incident Report form.

††††† (d) The SCL provider shall:

††††† 1. Conduct an immediate investigation and involve the participantís case manager in the investigation; and

††††† 2. Prepare a report of the investigation which shall include:

††††† a. Identifying information of the participant involved in the critical incident and the person reporting the critical incident;

††††† b. Details of the critical incident; and

††††† c. Relevant participant information including:

††††† (i) Axis I diagnosis or diagnoses;

††††† (ii) Axis II diagnosis or diagnoses;

††††† (iii) Axis III diagnosis or diagnoses;

††††† (iv) A listing of recent medical concerns;

††††† (v) An analysis of causal factors; and

††††† (vi) Recommendations for preventing future occurrences.

††††† (e) The SCL provider shall:

††††† 1. Maintain the documentation of the critical incident required in this subsection at the SCL providerís site; and

††††† 2. Provide a copy of the documentation to the case management agency of the participantís case manager.

††††† (6) An SCL provider shall submit, by fax, mortality data documentation following a death of a participant receiving services from the SCL provider to DBHDID within fourteen (14) days and include:

††††† (a) The participantís plan of care at the time of death;

††††† (b) Any current assessment forms regarding the participant;

††††† (c) The participantís medication administration records from all service sites for the past three (3) months along with a copy of each prescription;

††††† (d) Progress notes regarding the participant from all service elements for the past thirty (30) days;

††††† (e) The results of the participantís most recent physical exam;

††††† (f) All incident reports, if any exists, regarding the participant for the past six (6) months;

††††† (g) Any medication error report, if any exists, related to the participant for the past six (6) months;

††††† (h) The most recent psychological evaluation of the participant;

††††† (i) A full life history of the participant including any update from the last version of the life history;

††††† (j) Names and contact information for all staff members who provided direct care to the participant during the last thirty (30) days of the participantís life;

††††† (k) Emergency medical services notes regarding the participant if available;

††††† (l) The police report if available;

††††† (m) A copy of:

††††† 1. The participantís advance directive, living will, or health care directive if applicable;

††††† 2. Any functional assessment of behavior or positive behavior support plan regarding the participant that has been in place over any part of the past twelve (12) months; and

††††† 3. The cardiopulmonary resuscitation and first aid card for any SCL providerís staff member who was present at the time of the incident which resulted in the participantís death;

††††† (n) A record of all medical appointments or emergency room visits by the participant within the past twelve (12) months; and

††††† (o) A record of any crisis training for any staff member present at the time of the incident which resulted in the participantís death.

††††† (7)(a) An SCL provider shall report a medication error to DBHDID by the fifteenth of the month following the error by completing the Medication Error Report Form.

††††† (b) An SCL provider shall document all medication error details on a medication error log retained on file at the SCL provider site.

 

††††† Section 7. SCL Waiting List. (1)(a) In order to be placed on the SCL waiting list, an individual shall submit to DBHDID a completed MAP-620, Application for I/DD Services, which shall include:

††††† 1. A signature from a physician or an SCL developmental disability professional indicating medical necessity;

††††† 2. A current and valid intellectual or development disability diagnosis, including supporting documentation to validate the diagnosis and age of onset; and

††††† 3. Completion of the Axis I, II, and III diagnoses list.

††††† (b) Supporting documentation to validate a diagnosis and age of onset shall include:

††††† 1. A psychological or psycho-educational report of the assessment results of at least an individual test of intelligence resulting in an intelligence quotient (IQ) score; and

††††† 2. The results of an assessment of adaptive behavior abilities which has been signed by the licensed psychologist, licensed psychological associate, certified psychologist with autonomous functioning, or certified school psychologist who prepared the report.

††††† (c) The IQ test referenced in paragraph (b)1. of this subsection shall:

††††† 1. Have been conducted before the age of eighteen (18) years for a diagnosis of intellectual disability or before the age of twenty-two (22) years for a diagnosis of a developmental disability; or

††††† 2. If a record of an IQ score prior to the age of eighteen (18) years for an applicant with an intellectual disability or prior to the age of twenty-two (22) years for an applicant with a developmental disability cannot be obtained, the following shall qualify as supporting documentation to validate a diagnosis and age of onset:

††††† a. Individual education program documentation which contains an IQ score and a report or description of adaptive behavior skills;

††††† b. The results of a psychological assessment submitted during the course of guardianship proceedings; or

††††† c. The results of a current psychological assessment which shall:

††††† (i) Include evidence of onset prior to the age of eighteen (18) years for an intellectual disability or the age of twenty-two (22) years for a developmental disability obtained through a comprehensive developmental history; and

††††† (ii) Provide documentation ruling out factors or conditions which may contribute to diminished cognitive and adaptive functioning, including severe mental illness, chronic substance abuse, or medical conditions.

††††† (2) DBHDID shall validate a MAP-620 application information.

††††† (3) An individualís order of placement on the SCL waiting list shall be determined by the chronological date of receipt of a completed MAP-620 and by category of need of the individual as established in paragraphs (a) through (c) of this subsection.

††††† (a) An individualís category of need shall be the emergency category if an immediate service is needed as determined by any of the following if all other service options have been explored and exhausted:

††††† 1. Abuse, neglect, or exploitation of the individual as substantiated by DCBS;

††††† 2. The death of the individual's primary caregiver and lack of a alternative primary caregiver;

††††† 3. The lack of appropriate placement for the individual due to:

††††† a. Loss of housing;

††††† b. Loss of funding; or

††††† c. Imminent discharge from a temporary placement;

††††† 4. Jeopardy to the health and safety of the individual due to the primary caregiverís physical or mental health status; or

††††† 5. Imminent or current institutionalization.

††††† (b) An individualís category of need shall be the urgent category if an SCL service is needed within one (1) year; and

††††† 1. There is a threatened loss of the individual's existing funding source for supports within the year due to the individualís age or eligibility;

††††† 2. The individual is residing in a temporary or inappropriate placement but the individualís health and safety is assured;

††††† 3. The individualís primary caregiver has a diminished capacity due to physical or mental status and no alternative primary caregiver exists; or

††††† 4. The individual exhibits an intermittent behavior or action that requires hospitalization or police intervention.

††††† (c) An individualís category of need shall be classified as future planning if an SCL service is needed in more than one (1) year; and

††††† 1. The individual is currently receiving a service through another funding source that meets the individualís needs;

††††† 2. The individual is not currently receiving a service and does not currently need the service; or

††††† 3. The individual is in the custody of DCBS.

††††† (4) A written notification of original placement on the SCL waiting list and any change due to a reconsideration shall be mailed to an individual or the individualís guardian and case management provider if identified.

††††† (5) In determining chronological status, the original date of receipt of a MAP-620 shall be maintained and shall not change if an individual is moved from one (1) category of need to another.

††††† (6) If multiple applications are received on the same arrival date, a lottery shall be held to determine placement on the SCL waiting list within each category of need.

††††† (7) Maintenance of the SCL waiting list shall occur as established in this subsection.

††††† (a) The department shall, at a minimum, annually update the waiting list information about an individual during the birth month of that individual.

††††† (b) The individual or individualís guardian and case management provider, if identified, shall be contacted in writing to verify the accuracy of the information on the SCL waiting list and the individualís or individualís guardianís continued desire to pursue placement in the SCL program.

††††† (c) If a discrepancy in diagnostic information is noted at the time of the annual update, the department may request a current diagnosis of intellectual or developmental disability signed by a physician or SCL IDP, including documentation supporting the diagnosis.

††††† (d) The information referenced in paragraph (c) of this subsection shall be received by the department within thirty (30) days from the date of the written request in order to be considered timely.

††††† (8) A reassignment of an individualís category of need shall be completed based on updated information and the validation process.

††††† (9) An individual or individualís guardian may submit a written request for consideration of movement from one (1) category of need to another if there is a change in status of the individual.

††††† (10)(a) The criteria for removal from the SCL waiting list shall be:

††††† 1. After a documented attempt, the department is unable to locate the individual or the individualís guardian;

††††† 2. The individual is deceased;

††††† 3. A review of documentation reveals that the individual does not have an intellectual or a developmental disability diagnosis;

††††† 4. A notification of potential SCL funding is made and the individual or the individualís guardian declines the potential funding and does not request to be maintained on the SCL waiting list; or

††††† 5. Notification of potential SCL funding is made and the individual or the individualís guardian does not complete the enrollment process with DBHDID nor notify DBHDID of the need for an extension within sixty (60) days of the potential funding notice date.

††††† (b)1. A notification of need for an extension for good cause shall consist of a statement signed by the individual or the individualís guardian explaining the reason for the delay in accessing services, steps being taken to access services, and expected date to begin utilizing services.

††††† 2. Upon receipt of documentation, the department shall grant, in writing, one (1) sixty (60) day extension.

††††† (11) If a notification of potential SCL funding is made and an individual or the individualís guardian declines the potential funding but requests to be maintained on the SCL waiting list:

††††† (a) The individual shall be placed in the appropriate category on the SCL waiting list; and

††††† (b) The chronological date shall remain the same.

††††† (12) If an individual is removed from the SCL waiting list, DBHDID shall mail written notification to the:

††††† (a) Individual or the individualís guardian; and

††††† (b) Individualís case management provider.

††††† (13) The removal of an individual from the SCL waiting list shall not prevent the submission of a new application at a later date.

††††† (14) An individual shall be allocated potential funding based upon:

††††† (a) Category of need;

††††† (b) Chronological date of placement on the SCL waiting list; and

††††† (c) Region of origin in accordance with KRS 205.6317(3) and (4).

††††† (15) To be allocated potential funding, an individual residing in an institution shall meet the following criteria in addition to the criteria established in this section.

††††† (a) The individualís treatment professionals shall determine that an SCL placement is appropriate for the individual; and

††††† (b) The SCL placement is not opposed by the individual or the individualís guardian.

 

††††† Section 8. Use of Electronic Signatures. (1) The creation, transmission, storage, or other use of electronic signatures and documents shall comply with:

††††† (a) The requirements established in KRS 369.101 to 369.120; and

††††† (b) All applicable state and federal statutes and regulations.

††††† (2) An SCL service provider choosing to utilize electronic signatures shall:

††††† (a) Develop and implement a written security policy which shall:

††††† 1. Be adhered to by all of the providerís employees, officers, agents, or contractors;

††††† 2. Stipulate which individuals have access to each electronic signature and password authorization; and

††††† 3. Ensure that an 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 utilizing an electronic signature;

††††† 2. Attest to the signatureís 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) Produce to the department a copy of the agencyís electronic signature policy, the signed consent form, and the original filed signature immediately upon request.

††††† (3) A participant or participantís guardian may choose to use an electronic signature and, if choosing to use an electronic signature, shall execute a consent form which shall:

††††† (a)[1.] Be completed and executed by each individual utilizing an electronic signature;

††††† (b)[2.] Attest to the signatureís authenticity; and

††††† (c)[3.] Include a statement indicating that the individual has been notified of his or her responsibility in allowing the use of the electronic signature.

 

††††† Section 9. Employee Policies and Requirements Apply to Subcontractors. Any policy or requirement established in this administrative regulation regarding an employee shall apply to a subcontractor.

 

††††† Section 10. Appeal Rights. (1) An appeal of a department decision regarding a Medicaid beneficiary 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.

††††† (4) The department shall not grant an appeal regarding a category of need determination made pursuant to Section 7 of this administrative regulation.

 

††††† Section 11. Transition from 907 KAR 1:145. (1) There shall be a one (1) year transition period, based on each recipientís birth month, to enable an individual who is receiving SCL services in accordance with 907 KAR 1:145 on the effective date of this administrative regulation to transition to receiving services in accordance with this administrative regulation.

††††† (2) During the one (1) year transition period, in the month of an SCL waiver recipientís birthday, an SCL waiver recipient who remains approved to receive SCL waiver services shall transition to receiving services in accordance with this administrative regulation rather than in accordance with 907 KAR 1:145.

††††† (3) Funding for the SCL waiver program shall be associated with and generated through SCL waiver program participants rather than SCL waiver service providers.

 

††††† Section 12. Incorporation by Reference. (1) The following material is incorporated by reference:

††††† (a) The "Supports for Community Living Policy Manual", December 2012 edition;

††††† (b) The "Person Centered Plan of Care", November 2012 edition;

††††† (c) The "Supported Employment Long-Term Support Plan", December 2011 edition;

††††† (d) The "Critical Incident Report", November 2012 edition;

††††† (e) The "Incident Report", November 2012 edition;

††††† (f) The "Person Centered Employment Plan", March 2012 edition;

††††† (g) The "Person Centered Employment Plan Activity Note", July 2012 edition; and

††††† (h) The "Medication Error Report Form", August 2012 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. or online at the departmentís Web site at http://www.chfs.ky.gov/dms/incorporated.htm. (39 Ky.R. 690; 1239; 1431; eff. 2-1-2013; TAm eff. 9-10-2014; TAm eff. 11-4-2014.)