910 KAR 1:180. Homecare program for the elderly.

 

      RELATES TO: KRS 13B.010-13B.170, 194A.700(1), (7), 205.010(6), 205.201, 205.203, 205.455-465, 209.030(2) (3), 42 U.S.C. Chapter 35

      STATUTORY AUTHORITY: KRS 194A.050(1), 205.204(2)

      NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. Chapter 35 authorizes grants to states to provide assistance in the development of new or improved programs for older persons. KRS 194A.050(1) authorizes the secretary to promulgate administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds. KRS 205.204 designates the cabinet as the state agency to administer 42 U.S.C. Chapter 35 in Kentucky and promulgate administrative regulations for this purpose. This administrative regulation sets forth the standards of operation for a homecare program for elderly persons in Kentucky.

 

      Section 1. Definitions. (1) "Activities of daily living" is defined by KRS 194A.700(1).

      (2) "Area plan" means the plan submitted by a district for the approval of the division which releases funds under contract for the delivery of services within the planning and service area.

      (3) "Assessment" means the collection and evaluation of information about a person's situation and functioning.

      (4) "Case management" means a process, coordinated by a case manager, for linking a client to appropriate, comprehensive, and timely homecare services as identified in a "DAS-891, Plan of Care" by:

      (a) Planning;

      (b) Referring;

      (c) Monitoring; and

      (d) Advocating.

      (5) "Case manager" means an individual who meets the requirements of Section 5(1) and (2) of this administrative regulation.

      (6) "District" is defined by KRS 205.455(4).

      (7) "Formal support system" means paid services provided to an individual from any funding source.

      (8) "Homecare services" means services that:

      (a) Are:

      1. Provided to an eligible individual who is functionally impaired as defined by KRS 205.455(7); and

      2. Directed to the individual specified in subparagraph 1 of this paragraph toward:

      a. Prevention of unnecessary institutionalization; and

      b. Maintenance in the least restrictive environment, excluding residential facilities; and

      (b) Include:

      1. Chore services as defined by KRS 205.455(1);

      2. Core services as defined by KRS 205.455(2);

      3. Escort services as defined by KRS 205.455(5);

      4. Home-delivered meals as defined by KRS 205.455(8);

      5. Home-health aide services as defined by KRS 205.455(9);

      6. Homemaker services as defined by KRS 205.455(10);

      7. Home repair services as defined by KRS 205.455(11);

      8. Personal care services as established in subsection 11 of this section;

      9. Respite services as defined by KRS 205.455(12);

      (9) "Informal support system" means any care provided to an individual which is not provided as part of a public or private formal service program;

      (10) "Instrumental activities of daily living" as defined by KRS 194A.700(7).

      (11) "Personal care services" means assistance with activities of daily living.

      (12) "Reassessment" means reevaluation of the situation and functioning of a client.

 

      Section 2. Service Provider Responsibilities. A service provider contracting with a district to provide homecare services supported in whole or in part from funds received from the cabinet shall:

      (1) Assure the provision of homecare services throughout the geographic area covered under its plan or proposal;

      (2) Review the provision of homecare services to assure safety and consistency;

      (3) Treat the client in a respectful and dignified manner and involve the client and caregiver in the delivery of homecare services;

      (4) Permit staff of the cabinet and the district to monitor and evaluate homecare services provided;

      (5) Assure that each paid or voluntary staff member meets qualification and training standards established for each specific service by the Division of Aging Services;

      (6) Maintain a written job description for each paid staff and volunteer position involved in direct service delivery;

      (7) Develop and maintain written personnel policies and a wage scale for each job classification; and

      (8) Designate a supervisor to assure that staff providing homecare services are provided supervision.

 

      Section 3. Homecare Plan. For program approval, a district shall submit to the cabinet a proposal within its area plan to include at least the following:

      (1) An assurance of access for the Division of Aging Services to records of the district pertaining to its contract for delivery of homecare services; and

      (2) A plan for the delivery of homecare services in the area to be served by the district containing:

      (a) Identification of services currently provided in the district; and

      (b) The following assurances:

      1. A justification of a decision not to fund a homecare service, including an assurance of adequate availability from another funding source;

      2. A policy and procedure for assuring a client's:

      a. Eligibility in accordance with Section 5(4) of this administrative regulation; and

      b. Implementation of case management;

      3. A policy and procedure for a client's referral for service to other appropriate programs and services as specified in paragraph (a) of this subsection;

      4. A policy and procedure for

       volunteer programs to be utilized;

      5. Identification of a service provider for each specific service;

      6. A policy and procedure for the periodic monitoring of a client for the appropriateness of homecare services and to assure safety and consistency;

      7. A number of proposed clients for homecare services to be provided directly or by contract;

      8. A unit cost per service to be used as a basis for determining an applicable percentage for the fee schedule as established in Section 8(2) of this administrative regulation.

      9. A policy and procedure

       for the acceptance of a voluntary contribution and assurance the contribution shall be used to maintain or increase the level of service;

      10. A policy and procedure for the reporting of abuse, neglect, and exploitation consistent with KRS 209.030(2) and (3);

      11. A policy and procedure for

       the manner in which delivery of homecare services shall be provided to an eligible individual;

      12. A policy and procedure for monitoring a subcontract for delivery of direct homecare services; and

      13. A policy and procedure assuring

       that an assessment, as specified in Section 5(4) of this administrative regulation, shall include the following information submitted electronically to the division in the formats prescribed by the Aging Services Tracking System:

      a. Demographic information, including family income;

      b. Physical health;

      c. Activities of daily living and instrumental activities of daily living;

      d. Physical environment;

      e. Mental and emotional status;

      (f) Assistive devices, sensory impairment, and communication abilities;

      (g) Formal and informal resources; and

      (h) Summary and judgement.

 

      Section 4. Eligibility. (1) A prospective client for homecare services shall:

      (a) Demonstrate that the prospective client is a person sixty (60) years of age or older; and

      (b) Meet one (1) of the following criteria:

      1. Be functionally impaired in the performance of:

      a. Two (2) activities of daily living;

      b. Three (3) instrumental activities of daily living; or

      c. A combination of one (1) activity of daily living and two (2) instrumental activities of daily living;

      (c) Have a stable medical condition requiring skilled health services along with services related to activities of daily living requiring an institutional level of care; or

      (d) Be:

      1. Currently residing in a:

      a. Skilled nursing facility;

      b. An intermediate care facility; or

      c. A personal care facility; and

      2. Able to be maintained at home if appropriate living arrangements and support systems are established.

      (2) Eligibility shall be determined by a case manager:

      (a) Qualified in accordance with Section 5(1) and (2) of this administrative regulation; and

      (b) In accordance with Section 5(4) of this administrative regulation.

      (3) If a client meets eligibility requirements of subsection (1) of this section for homecare services, the client or caregiver shall be informed that the client shall be eligible for services as long as he or she meets eligibility requirements.

      (4) The case manager shall determine a prospective client's eligibility for:

      (a) The following services in accordance with 910 KAR 1:160:

      1. Adult day services;

      2. Adult day health services; or

      3. Alzheimer's respite care services; or

      (b) In-home services.

      (5)(a) The homecare program shall not supplant or replace services provided by the client's informal support system.

      (b) If needs are being met by the informal support system, the client shall be deemed ineligible.

      (c) An applicant who needs respite services shall not be deemed ineligible as a result of this subsection.

 

      Section 5. Case Management. (1) A case manager shall meet one (1) of the following qualifications:

      (a) A minimum of a bachelor's degree in one (1) of the following, no experience required:

      1. Social work;

      2. Gerontology;

      3. Psychology;

      4. Sociology, or

      5. A field relevant to geriatrics;

      (b) A minimum of a bachelor's degree in nursing with a current Kentucky nursing license, no experience required;

      (c) A bachelor's degree in a field not relevant to geriatrics or listed in Section 1(4)(a) of this administrative regulation with two (2) years experience in working with the elderly;

      (d) A Kentucky registered nurse with a current Kentucky license and two (2) years experience in working with the elderly; or

      (e) A Licensed practical nurse with a current Kentucky license and three (3) years experience in working with the elderly.

      (2)(a) In addition to meeting the requirements of subsection (1) of this section, case management training shall be required as follows:

      1. Fourteen (14) hours of initial training within six (6) months of hire; and

      2. Sixteen (16) hours of in-service training annually.

      (b) Volunteer experience working with the elderly shall be counted on an hour-for-hour basis.

      (3) Each client shall be assigned a case manager.

      (4)(a) A client shall be assessed initially and reassessed at least every six (6) months thereafter by a case manager.

      (b) After each assessment or reassessment, the case manager shall complete the DAS-888, Homecare Certification of Eligibility.

      (c) If the client is ineligible, the case shall be closed with the reason documented in the case record and notification shall be mailed to the client or caregiver.

      (5) The case manager shall:

      (a) Be responsible for coordinating, arranging, and documenting those services provided by:

      1. Any funding source; or

      2. Volunteer;

      (b)1. Make a reasonable effort to secure and utilize informal supports for each client; and

      2. Document the reasonable effort in the client's case record; and

      (c) Monitor each client monthly including one (1):

      1. Home visit with face-to-face contact at least every other month; or

      2. Phone contact during any month a home visit does not occur; and

      (d) Document in the case record each contact made with a client, as specified in paragraph (c) of this subsection, or on behalf of the client.

      (7)(a) A district shall assure

       a minimum of one (1) full-time equivalent case manager for each 100 clients.

      (b) If the case manager also provides assessment services, the case manager's caseload shall not exceed seventy-five (75) clients.

      (c) Time used to provide agency administration or supervision of other staff shall not be counted toward meeting the full-time equivalency requirement.

      (d) Two (2) adult day care, adult day health care or Alzheimer's respite care clients may be counted as one (1) for the purpose of determining compliance with paragraphs (a) and (b) of this subsection.

      (8) A client shall receive homecare services in accordance with an individualized "Plan of Care" developed cooperatively with the client's case manager. The plan shall:

      (a) Relate to an assessed problem;

      (b) Identify a goal to be achieved;

      (c) Identify a scope, duration and unit of service required;

      (d) Identify a source of service;

      (e) Include a plan for reassessment; and

      (f) Be signed by the client or client's representative and case manager, with a copy provided to the client.

 

      Section 6. Quality Service. If a client is determined eligible for homecare services, the case manager shall:

      (1) Read, or have read and explained to the client the purpose of the "DAS-889, Quality Service Agreement";

      (2) Provide a copy of the completed agreement to the client which shall contain the name, address, and telephone number of:

      (a) The current case manager;

      (b) A designated representative of the district; and

      (c) A representative of the Division of Aging Services;

      (3) Ensure that a copy of a "DAS-890, Report of Complaint or Concern" containing written complaints and detailed reports of telephoned or verbal complaints, concerns or homecare service suggestions is maintained in the client's permanent file and documented in a centralized log; and

      (4) Document investigation and efforts at resolution or service improvement that shall be available for monitoring by the district and Division of Aging Services staff.

 

      Section 7. Request for a Hearing. A client may request a hearing:

      (1) As provided by KRS 13B.010-170; and

      (2) Within thirty (30) days of any decision by the:

      (a) Cabinet;

      (b) District; or

      (c) Service provider.

 

      Section 8. Fees and Contributions. (1) A case manager shall be responsible for determining fee paying status, using the following criteria:

      (a) A fee shall not be assessed for the provision of assessment, case management services, or home-delivered meals.

      (b) The case manager shall:

      1. Consider extraordinary out-of-pocket expenses to determine a client's ability to pay; and

      2. Document in a case record a waiver or reduction of fee due to the extraordinary out-of-pocket expenses.

      (c) A fee shall not be assessed to an eligible individual who meets the definition of "needy aged" as governed by KRS 205.010(6).

      (d)1. SSI income or a food stamp allotment shall not be deemed available to other family members.

      2. The applicant receiving SSI benefits or a food stamp allotment shall be considered a family of one (1) for the purpose of fee determination.

      (2) An eligible person shall be charged a fee determined by the cost of the service unit multiplied by the applicable percentage rate based upon income and size of family using 130 percent the official poverty income guidelines published annually in the Federal Register by the United States Department of Health and Human Services. Service unit cost shall be determined by the state agency or contracting entity in accordance with its contract. The copayment amount shall be based on the household's percentage of poverty, as follows:

Percentage of Poverty

1 Person

2 Person

3 Person or More

0-129%

0%

0%

0%

130%-149%

20%

0%

0%

150%-169%

40%

20%

0%

170%-189%

60%

40%

20%

190%-209%

80%

60%

40%

210%-229%

100%

80%

60%

230%-249%

100%

100%

80%

250% and above

100%

100%

100%

      (3)(a) A contribution from an individual, family, or other entity shall be encouraged.

      (b) Suggested contribution or donation rates may be established; however, pressure shall not be placed upon the client to donate or contribute.

      (c) Homecare services shall not be withheld from an otherwise eligible individual based upon the individual's failure to voluntarily contribute to support services.

      (4) The district shall review and approve the procedure implemented by a service provider for the collecting, accounting, spending, and auditing of fees and donations.

 

      Section 9. Allocation Formula. The homecare program funding formula shall consist of a $20,000 base for each district, with the remaining amount of funds distributed in proportion to the district's elderly (sixty (60) plus) population in the state.

 

      Section 10. Termination or Reduction of Homecare Services. (1)(a) A case manager or client shall decide to terminate homecare services.

      (b) Homecare services may be reduced or terminated if:

      1. The client's condition or support system improves; or

      2. A determination is made that the "DAS-891, Plan of Care" cannot be followed.

      (2) If homecare services are terminated or reduced, the case manager shall:

      (a) Inform the client of the right to file a complaint;

      (b) Notify the client or caregiver of the action taken; and

      (c) Assist the client and family in making referrals to another agency if applicable.

      (3) If homecare services are terminated or reduced due to reasons unrelated to the client's needs or condition, the designated district representative, in conjunction with the case manager, shall determine reduction or termination on a case-by-case basis.

 

      Section 11. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "DAS-888, Homecare Certification of Eligibility, 8/05";

      (b) "DAS-889, Quality Service Agreement, 8/05";

      (c) "DAS-890, Report of Complaint or Concern, 8/05"; and

      (d) "DAS-891, Plan of Care, 8/05".

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (18 Ky.R. 1748; Am. 2278; eff. 1-10-92; Am. 23 Ky.R. 4000; 24 Ky.R. 110; eff. 6-18-97; Recodified from 905 KAR 8:180, 10-30-98; Recodified from 923 KAR 1:180, 7-8-99; 32 Ky.R. 420; 686; eff. 10-19-05.)