922 KAR 1:360. Private child care placement, levels of care, and payment.

 

      RELATES TO: KRS Chapter 13B, 199.011, 199.640-199.680, 199.801, 600.020(23), 605.090(1)(b), (d), 610.110, 2008 Acts ch. 127 Part 1, H.10(3), 42 U.S.C. 672

      STATUTORY AUTHORITY: KRS 194A.050(1), 199.641(4), 605.090(1)(d), 605.150(1)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to operate programs and fulfill the responsibilities vested in the cabinet. KRS 199.641(4) requires the cabinet to establish the rate setting methodology and the rate of payment for nonprofit child-caring facilities, consistent with the level and quality of service provided. KRS 605.090(1)(d) authorizes the cabinet to place a child committed to the Department of Juvenile Justice, or the cabinet, in a child-caring facility operated by a local governmental unit or private organization willing to receive the child, upon such conditions as the cabinet may prescribe. KRS 605.150(1) authorizes the cabinet to promulgate administrative regulations to implement the provisions of KRS Chapter 605. This administrative regulation establishes: (a) five (5) levels of care based upon the needs of a child for whom the cabinet has legal responsibility; (b) a payment rate for each level; (c) gatekeeper responsibilities; (d) provider requirements; (e) procedures for classification at the appropriate level of care; and (f) procedures for determination of components of the model program cost analysis.

 

      Section 1. Definitions. (1) "Cabinet" is defined by KRS 199.011(2).

      (2) "Child-caring facility" or "facility" is defined by KRS 199.641(1)(b).

      (3) "Department" means the Department for Community Based Services or the department’s agent.

      (4) "District placement coordinator" means an individual whose responsibilities are described in KRS 199.801.

      (5) "Emergency shelter" is defined by KRS 600.020(23).

      (6) "Gatekeeper" means the department or agent responsible for:

      (a) Making a clinical determination of the level of care necessary to meet a child's treatment and service needs; and

      (b) Other administrative duties in the areas of:

      1. Assessment;

      2. Placement;

      3. Performance measurement; and

      4. Consultation regarding children and their needs.

      (7) "Index factor" means a specific number derived from time-study data, used to determine payment for each level of care.

      (8) "Initial level of care" means a level of care:

      (a) Assigned by the gatekeeper to a child at the point of entry into the level of care system; and

      (b) That is time-limited and effective for the first six (6) months of a child’s placement.

      (9) "Level of care" means one (1) of five (5) standards representing the treatment and service needs of a child placed by the cabinet in out-of-home care.

      (10) "Level of care packet" means an assessment conducted by designated cabinet staff, and a collection of forms required for submission to the gatekeeper for the purpose of determining the appropriate level of care, which includes the following:

      (a) DPP-886, Private Child Care Client Inter-agency Referral Form;

      (b) DPP-886A, Application for Referral and Needs Assessment; and

      (c) If a child has an IQ of seventy (70) or above:

      1. Child Behavior Checklist For Ages 1 1/2-5 (Achenbach); or

      2. Child Behavior Checklist For Ages 6-18; (Achenbach)

      (11) "Model program cost analysis" is defined by KRS 199.641(1)(d).

      (12) "Reassigned level of care" means a level of care that is:

      (a) Determined by the gatekeeper after a child’s level of care expires; and

      (b) Authorized for a specific period of time.

      (13) "Time study" is defined by KRS 199.641(1)(e).

      (14) "Utilization review" means a gatekeeper's examination, during a child’s placement in a child-caring facility or child-placing agency, of the child's case record and existing documentation for the purpose of:

      (a) Identifying the child's current level of functioning; and

      (b) Assigning the appropriate level of care.

 

      Section 2. Referral Process for Level of Care System Placement. (1) A level of care packet shall be completed by a cabinet staff person and submitted to the gatekeeper for a child at least forty-eight (48) months of age at the time that:

      (a) The child enters the level of care system;

      (b) A child currently placed in a child-caring facility or a child-placing agency reaches forty-eight (48) months of age; or

      (c) A child’s level of care expires and assignment of a new level is necessary.

      (2)(a) Upon assignment of an initial level of care by the gatekeeper, a cabinet staff person shall submit a copy of the completed level of care packet, including level assignment, to the district placement coordinator.

      (b) The district placement coordinator shall forward the level of care packet to potential child-caring facilities or child-placing agencies.

      (3) If a child-caring facility or child-placing agency accepts a child for out-of-home placement and the cabinet approves the placement, a cabinet staff person shall:

      (a) Complete the DPP-114, Level of Care Schedule, with the level of care payment rate:

      1. As assigned by the gatekeeper within the previous six (6) months; or

      2. In the event of an emergency placement, within two (2) business days of the placement; and

      (b) Arrange transportation for the child to the placement.

 

      Section 3. Gatekeeper Responsibilities. The gatekeeper shall:

      (1) Evaluate a child forty-eight (48) months of age or older:

      (a) Who is referred by the department or currently placed in a child-caring facility or child-placing agency; and

      (b) For an initial or reassigned level of care;

      (2) Within three (3) working days of receipt of the level of care packet:

      (a) Determine the appropriate level of care according to a needs assessment consistent with one (1) of the five (5) levels of care; and

      (b) Return the completed DPP-886, Private Child Care Client Inter-agency Referral Form, to the department;

      (3) Reassess a child utilization review:

      (a) Six (6) months from the initial placement or reassignment and placement in a child-caring facility and child-placing agency; and

      (b)1. Every three (3) months thereafter if the child is in a private child care residential placement; or

      2. Every six (6) months thereafter if the child is in a foster care placement or therapeutic foster care;

      (4) Reassign a child’s level of care after the previous level has expired;

      (5) Monitor each child-caring facility and child-placing agency; and

      (6) Maintain a confidential information system for each child served that shall include:

      (a) Placement history;

      (b) Level of care assignments;

      (c) Length of treatment; and

      (d) Discharge outcomes.

 

      Section 4. Levels of Care. A level of care shall be assigned in accordance with the following standards:

      (1) A Level I child requires a routine home environment that:

      (a) Provides maintenance;

      (b) Provides guidance;

      (c) Provides supervision to meet the needs of the child; and

      (d) Ensures the emotional and physical well-being of the child.

      (2) A Level II child:

      (a) May engage in nonviolent antisocial acts, but be capable of meaningful interpersonal relationships; and

      (b) Requires supervision in a structured supportive setting with:

      1. Counseling available from professional or paraprofessional staff;

      2. Educational support; and

      3. Services designed to improve development of normalized social skills.

      (3) A Level III child:

      (a) May engage in an occasional violent act;

      (b) May have superficial or fragile interpersonal relationships;

      (c) Requires supervision in a structured, supportive environment where the level of supervision and support may vary from low to moderate, proportional to the child’s ability to handle reduced structure;

      (d) May occasionally require intense levels of intervention to maintain the least restrictive environment; and

      (e) Requires a program flexible enough to allow:

      1. Extended trials of independence when the child is capable;

      2. A period of corrective and protective structure during relapse; and

      3. Counseling available from professional or paraprofessional staff.

      (4) A Level IV child:

      (a) Has behavioral and physical, mental, or social needs that may present a moderate risk of causing harm to himself or others;

      (b) Requires a structured supportive setting with:

      1. Therapeutic counseling available by professional staff; and

      2. A physical, environmental, and treatment program designed to improve social, emotional, and educational adaptive behavior.

      (5) A Level V child:

      (a) Has a severe impairment, disability, or need;

      (b) Is consistently unable or unwilling to cooperate in his own care;

      (c) Presents a severe risk of causing harm to himself or others; and

      (d) Requires Level IV services and a:

      1. Highly structured program with twenty-four (24) hour supervision; or

      2. Specialized setting that provides safe and effective care for a severe, chronic medical condition, behavioral disorder, or emotional disturbance.

 

      Section 5. Payment Methodology and Rates. (1) Payment Methodology.

      (a) The cabinet shall base a per diem rate for the care of a child placed by the cabinet in a private child-caring facility, upon the model program cost analysis defined at KRS 199.641(1)(d).

      (b) Each private, nonprofit child caring facility shall report to the cabinet annually, on Form DPP-888, Cost Report and Time Study and Instructions.

      (2) The cabinet shall establish an index factor for payment on behalf of a child for whom a level of care has been determined.

      (a) The factor shall be determined as follows:

      1. Based on the amount of treatment provided at each level of care; and

      2. By determining the median of:

      a. Number of daily treatment hours, derived from time study data, provided to children served by private, nonprofit child-caring facilities; and

      b. Level of care of children served by private, nonprofit child-caring facilities that contract with the cabinet;

      (b)1. For children whose level is determined, the median level of care shall be represented by an index factor of one. (1)

      2. For children whose level is not determined, the median level of care shall be represented by an index factor that is proportionate to the amount of treatment provided to the children in the median level pursuant to subparagraph 1 of this paragraph.

      (3) A statewide median cost, including board, care, and treatment components, for each level of care shall be calculated by using a utilization factor of ninety (90) percent for residential treatment and seventy-five (75) percent for a group home.

      (4) The payment rate for each level of care shall be calculated by multiplying the median cost by the index factor specific to that level of care. The rate for each level of care shall be adjusted by the Consumer Price Index during each intervening period between the fiscal year used for the cost analysis and calculation of the rate.

      (5) Statewide median cost shall be calculated:

      (a) Using a utilization factor of eighty (80) percent:

      1. For an emergency shelter with a treatment license:

      a. Board;

      b. Care; and

      c. Treatment components; or

      2. For an emergency shelter without a treatment license:

      a. Board; and

      b. Care components; and

      (b) Adjusting for each level of care by the Consumer Price Index during each intervening period between the fiscal year used for the cost analysis and calculation of the rate.

      (6)(a) To the extent funds are available, an incentive payment for a private child-caring facility that participates in a per diem rate contract with the cabinet shall be determined by evaluating the performance of the child-caring facility, in accordance with KRS 199.641(2)(a). Measurable performance outcomes shall include:

      1. Child safety while in the care of a private child-caring facility or child-placing agency;

      2. Child safety after reunification with the child’s family;

      3. Adequate educational support;

      4. Reduced time spent in out-of-home care without an increase in the rate of out-of-home care reentry;

      5. Increased placement stability during the service period;

      6. Increased achievement of permanency goals; and

      7. Increased stability in permanency placement following planned discharge.

      (b) The cabinet’s contract with a private child-caring facility shall specify the:

      1. Indicators used to measure the performance outcomes described in paragraph (a) of this subsection of this section; and

      2. Target percentages used as performance goals.

      (c) Each child in the custody of the cabinet who is placed in a private child-caring facility during the contract period shall be included in the percentage of children for whom the cabinet expects achievement of an outcome.

      (d) At the time the contract period expires, each private child-caring facility shall be ranked based on the percentage of children for whom the facility achieved an outcome. To the extent funds are available, a payment incentive shall be distributed to a private child-caring facility that performed in the top one-third (1/3) of the facilities.

      (e) The amount of a payment incentive shall be determined according to the funding appropriated for this purpose in the biennial budget.

      (7) In addition to services provided on a per diem rate, the cabinet shall solicit proposals from private child-caring facilities or child-placing agencies to provide alternative services to children and their families. To the extent funds are available, the alternative services:

      (a) Shall be geared toward improved performance outcomes; and

      (b) May include case management responsibilities shared between the cabinet and the child-caring facility or child-placing agency.

      (8) Payment to child-caring facilities or child-placing agencies that provide alternative services according to subsection (7) of this section shall be based upon expectations agreed upon between the cabinet and the child-caring facility or child-placing agency such as:

      (a) Reduced length of stay in out-of-home placement;

      (b) Increased safety from child abuse or neglect;

      (c) Increased number of children moving into and remaining in permanent placement;

      (d) Increased number of children and their families cared for in close proximity to their home communities;

      (e) Increased number of children reunified with their families;

      (f) Increased accountability for success in after care; or

      (g) Decreased reentry into state custody.

 

      Section 6. Residential Care. (1) A child-caring facility in the levels of care reimbursement plan shall be licensed under 922 KAR 1:305 and shall meet the standards for child-caring facilities established in 922 KAR 1:300.

      (2) The facility shall comply with 922 KAR 1:390, Section 4, Residential Treatment Program, if providing treatment oriented services.

      (3) The daily rate for residential care to a child-caring facility shall be:

      (a) Level I - fifty-one (51) dollars and nineteen (19) cents;

      (b) Level II - sixty-one (61) dollars and fifty-two (52) cents;

      (c) Level III - $109.71;

      (d) Level IV- $151.03; and

      (e) Level V - $210.64.

 

      Section 7. Emergency Shelter Care. (1) An emergency shelter child-caring facility shall meet the requirements of 922 KAR 1:380. The rate for emergency shelter care shall be:

      (a) $115.31 per day for a child-caring facility with a treatment license; or

      (b) $101.41 per day for a child-caring facility without a treatment license.

      (2) If a child’s treatment placement is disrupted and the child enters an emergency shelter child-caring facility with a treatment license, the emergency shelter child-caring facility shall:

      (a) Receive a rate consistent with the child's assigned level of care for residential care during the previous placement, pending results of the next-scheduled utilization review; or

      (b) If the child is Level II or lower, receive a rate not less than the rate for emergency shelter care in accordance with subsection (1) of this section per day; and

      (c) Adhere to the child’s individual treatment plan.

      (3)(a) If the department determines that a child without an assigned level of care shall remain in an emergency shelter child-caring facility longer than thirty (30) days, the department shall make a referral to the gatekeeper, by the 20th day of placement, for assignment to an appropriate level of care.

      (b) If a child remains in an emergency shelter longer than thirty (30) days, the emergency shelter child-caring facility with a treatment license shall:

      1. Receive the residential rate consistent with the assigned level of care for each day the child is in the facility beyond the 30th day;

      2. If the child is Level II or lower, receive a rate not less than the rate for emergency shelter care in accordance with subsection (1) of this section per day; and

      3. Adhere to the child’s individual treatment plan.

 

      Section 8. Foster Care and Therapeutic Foster Care for a Child-Placing Agency. (1) The basic daily rate for foster care shall be forty-three (43) dollars.

      (2) The daily rates for therapeutic foster care shall be as follows:

      (a) Levels I and II, if the child is stepped down from Level III or higher - seventy-three (73) dollars.

      (b) Level III - seventy nine (79) dollars and seventy-eight (78) cents.

      (c) Level IV - ninety-seven (97) dollars and eleven (11) cents.

      (d) Level V - $134.26.

 

      Section 9. Pregnant and Parenting Teen Programs. A child-caring facility with a pregnant and parenting teen program shall receive:

      (1) A rate consistent with the assigned level of care for the adolescent parent; and

      (2) Inclusive of child care cost, forty-three (43) dollars per day, for the committed child of an adolescent parent who is committed to the cabinet.

 

      Section 10. Provider Requirements. (1) A child-caring facility or child-placing agency shall:

      (a) Inform the department of the levels of care the facility or agency has the ability to serve;

      (b) Demonstrate its ability to provide services, either directly or by contract, appropriate to the assigned level for each child, including:

      1. Room, board, and other activity contributing to housing, food, clothing, school supplies, or personal incidentals;

      2. Clinical services including:

      a. The evaluation and treatment of an emotional disorder, mental illness, or substance abuse problem; and

      b. Identification and alleviation of related disability or distress, experienced by a child who follows a specific individual treatment plan targeted to identify a problem; and

      3. Support services that:

      a. Identify necessary resources and coordinate services provided by a range of agencies or professionals;

      b. Allow a child to cope with the disability or distress;

      c. Provide access to improving the educational or vocational status of the child; and

      d. Provide essential elements of daily living;

      (c) Submit the following reports to the gatekeeper in time for the reports to be received by the gatekeeper within thirty (30) days prior to the utilization review due date:

      1. For a child who has an IQ above seventy (70), a behavior inventory appropriate to the child’s developmental level consisting of completed forms:

      a. Child Behavior Checklist for Ages one and one-half (1 1/2) - five (5) (Achenbach); or

      b. Child Behavior Checklist for Ages six (6) - eighteen (18) (Achenbach), every six (6) months; and

      2. For a child who has an IQ below seventy (70), a behavioral inventory appropriate to the child’s development level consisting of a completed Reiss Scales for Children's Dual Diagnosis (Mental Retardation and Psychopathology) by the first utilization review due date and every twelve (12) months thereafter; and

      3. To the gatekeeper and designated cabinet staff, a copy of the following completed forms:

      a. On a quarterly basis, for a private child care residential placement, CRP-001, Children’s Review Program Residential Application for Level of Care Payment; or

      b. On a semiannual basis for a foster care placement, CRP-003, Children’s Review Program Foster Care Application for Level of Care Payment;

      (d) Provide outcomes data and information as requested by the gatekeeper; and

      (e) Obtain accreditation within two (2) years of initial licensure or within two (2) years of acquiring an agreement with the cabinet, whichever is later, from a nationally-recognized accreditation organization, such as:

      1. The Council on Accreditation; or

      2. The Joint Commission on Accreditation for Healthcare Organizations.

      (2) Emergency shelters without a treatment license shall be exempt from the accreditation requirements specified in subsection (1)(e) of this section.

 

      Section 11. Utilization Review and Authorization of Payment. (1) The child-caring facility or child-placing agency shall submit to the gatekeeper the reports specified in Section 10(1)(c) of this administrative regulation for the utilization review in time for the reports to be received by the gatekeeper within thirty (30) days prior to the utilization review due date.

      (2) If the child-caring facility or child-placing agency fails to submit the reports as specified in Section 10(1)(c) of this administrative regulation in time for the reports to be received by the gatekeeper within thirty (30) days prior to the utilization review due date, the cabinet shall:

      (a) Suspend payments until the necessary information has been submitted to the gatekeeper;

      (b) If a child’s level is reduced after untimely reports are received by the gatekeeper, make an adjustment for overpayment retroactive to the first utilization review due date that was missed; or

      (c) If a child’s level is increased as a result of delinquent reports, apply a higher rate beginning the day after the untimely reports are received by the gatekeeper.

      (3) If the child-caring facility makes timely submission of the reports, and if the:

      (a) Level of care remains unchanged, payments shall continue unchanged;

      (b) Level of care is reduced, and the:

      1. Child remains in the same placement, the lower level of care shall be effective on the 31st day following the utilization review due date; or

      2. Child is placed in another child-caring facility or child-placing agency after the utilization review due date, the rate for the lower level shall be effective on the day the child is placed; or

      (c) Level of care is increased, the rate for the higher level of care shall be effective the day after the utilization review due date.

      (4) If a child-caring facility, child-placing agency, or the department determines it to be in the best interest of a child to be transitioned from a residential program to another program and the required reports specified in Section 10(1)(c) of this administrative regulation have been submitted on time, and if:

      (a) The program is not therapeutic foster care, the rate for the level resulting from the utilization review shall remain in effect until the next scheduled utilization review; or

      (b) The new program is therapeutic foster care, the residential rate for the level resulting from the utilization review shall remain in effect for thirty (30) days after the change in placement. On the 31st day the therapeutic foster care rate for the assigned level shall apply.

      (5) If the child-caring facility, child-placing agency, or cabinet staff disagrees with the level of care assigned by the gatekeeper, the child-caring facility, child-placing agency, or cabinet staff may request a redetermination as specified in Section 12 of this administrative regulation.

 

      Section 12. Redetermination. (1) If the child-caring facility, child-placing agency, or cabinet staff disagrees with the level of care assigned by the gatekeeper, the child-caring facility, child-placing agency, or cabinet staff may request a redetermination of the assigned level by providing to the gatekeeper:

      (a) New information which supports the request for a new level; and

      (b) Completion of the "request for redetermination" section of one (1) of the following forms:

      1. DPP-886, Private Child Care Client Inter-agency Referral Form for an initial or reassigned level;

      2. CRP-002, Children’s Review Program Private Child Care Notice of Level of Care Payment Authorization form for a utilization review;

      3. CRP-005, Children’s Review Program DCBS Foster Care Utilization Review Notice of Level Assignment form for a utilization review; or

      4. CRP-006, Children’s Review Program Private Child Care Notice of Level of Care Payment Authorization Reassignment, form for a reassignment.

      (2) If the request for a redetermination is received by the gatekeeper within thirty (30) days after the most recent utilization review or admission, and if the gatekeeper assigns a higher level with a CRP-004, Children's Review Program Notice of Level of Care Redetermination, the increased payment shall be retroactive to the most recent of the following:

      (a) The date of the most recent utilization review due date; or

      (b) The date of admission.

      (3) If the request for redetermination is received by the gatekeeper more than thirty (30) days after the most recent utilization review or admission, and if a:

      (a) Higher level is assigned by the gatekeeper with a CRP-004, the increased payment shall be effective the day after the request is received by the gatekeeper; or

      (b) Lower level is assigned by the gatekeeper with a CRP-004, the lower payment shall be effective thirty (30) days after the request is received by the gatekeeper.

      (4) If the child-caring facility, child-placing agency, or cabinet staff does not agree with the redetermination as provided by the CRP-004, an appeal may be requested in accordance with Section 14 or 15 of this administrative regulation.

 

      Section 13. Reassignment. (1) If the level of care expires and the child is moved to a different placement, a reassigned level of care shall be obtained by the:

      (a) Department completing a level of care packet for a level assignment; or

      (b) New child-caring facility or child-placing agency submitting the following within thirty (30) days of the placement:

      1. A cover letter requesting a reassignment;

      2. An assessment of the child;

      3. Documentation to support the level of care assignment, such as the level of care packet or discharge summary; and

      4. If the child has an IQ of seventy (70) or above:

      a. Child Behavior Checklist For Ages one and one-half (1 1/2) - five (5) (Achenbach); or

      b. Child Behavior Checklist for Ages six (6) - eighteen (18).

      (2) The reassigned level of care rate shall be effective on the date of admission to the new placement.

      (3) If the child-caring facility or child-placing agency disagrees with the level of care assigned by the gatekeeper, the child-caring facility or child-placing agency may request a redetermination as specified in Section 12 of this administrative regulation.

 

      Section 14. Informal Dispute Resolution. (1) A contract agent dissatisfied by a decision of the cabinet or a gatekeeper may seek informal resolution by filing a request with the secretary of the cabinet, or designee, within ten (10) days following notice of the decision.

      (2) Upon receipt of a request for informal resolution, the cabinet shall:

      (a) Review the request; and

      (b) Render a written decision on the issue raised.

      (3) If the dispute relates to a decrease or denial of payment, the contract agent may request an administrative hearing in accordance with Section 15 of this administrative regulation.

 

      Section 15. Administrative Hearing Process. A child-caring facility or child-placing agency may request an administrative hearing in accordance with 922 KAR 1:320.

 

      Section 16. Incorporation by Reference. (1) The following material is incorporated by reference:

      (a) "Child Behavior Checklist for Ages 1 1/2 - 5 (Achenbach)", edition 7/00;

      (b) "Child Behavior Checklist for Ages 6-18 (Achenbach)", edition 6/01;

      (c) "CRP-001, Children’s Review Program Residential Application for Level of Care Payment", edition 11/04;

      (d) "CRP-002, Children’s Review Program Private Child Care Notice of Level of Care Payment Authorization", edition 11/04;

      (e) "CRP-003, Children’s Review Program Foster Care Application for Level of Care Payment", edition 7/07;

      (f) "CRP-004, Children’s Review Program Notice of Level of Care Redetermination", edition 11/04;

      (g) "CRP-005, Children’s Review Program DCBS Foster Care Utilization Review Notice of Level Assignment", edition 11/04;

      (h) "CRP-006, Children’s Review Program Private Child Care Notice of Level of Care Payment Authorization Reassignment", edition 7/07;

      (i) "DPP-114, Level of Care Schedule", edition 6/08;

      (j) "DPP-886, Private Child Care Client Inter-agency Referral Form", edition 10/04;

      (k) "DPP-886A, Application for Referral and Needs Assessment", edition 07/07;

      (l) "DPP-888, Kentucky Cabinet for Health and Family Services Annual Audited Cost Report and Time Study and Instructions for Completing the Cost Report Time Study Codes and Definitions, and Instructions for the Time Study, for Child-Caring and Child-Placing Programs and Facilities", edition 10/04; and

      (m) "Reiss Scales for Children’s Dual Diagnosis (Mental Retardation and Psychopathology)", edition 1990.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Community Based Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (23 Ky.R. 1484; Am. 1952; eff. 10-16-96; 24 Ky.R. 2477; 25 Ky.R. 105; eff. 6-11-98; Recodified from 905 KAR 1:360, 10-30-98; 27 Ky.R. 1359; 1817; eff. 1-15-2001; 28 Ky.R. 2469; 29 Ky.R. 471; 725; eff. 8-21-02; 31 Ky.R. 882; 1309; eff. 2-22-05; 34 Ky.R. 481; 1067; 1500; eff. 12-17-2007; 35 Ky.R. 446; 845; eff. 10-15-2008.)