Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:160 - Home and community based waiver services version 1

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520(3),
				205.5605,
				205.5606,
				205.5607,
				205.635,
				42 C.F.R.
				440.180
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 to comply with any requirement that may be imposed, or opportunity
				presented, by federal law to qualify for federal Medicaid funds. This
				administrative regulation establishes the provisions for home and community
				based waiver services version 1, including participant-directed services
				pursuant to KRS
				205.5606.
Section
			 1. Definitions.
(1) "1915(c)
			 home and community based services waiver program" means a Kentucky Medicaid
			 program established pursuant to and in accordance with
			 42 U.S.C.
			 1396n(c).
(2) "Abuse" regarding:
(a) An adult is defined by
			 KRS
			 209.020(8); or
(b) A child means abuse pursuant to KRS
			 Chapter 600 or 620.
(3)
			 "ADHC" means adult day health care.
(4) "ADHC center" means an adult day health
			 care center licensed in accordance with
			 902 KAR 20:066.
(5) "ADHC services" means health-related
			 services provided on a regularly-scheduled basis that ensure optimal
			 functioning of a participant who:
(a) Does not
			 require twenty-four (24) hour care in an institutional setting; and
(b) May need twenty-four (24) hour respite
			 services when experiencing a short-term crisis due to the temporary or
			 permanent loss of the primary caregiver.
(6) "Advanced practice registered nurse" or
			 "APRN" is defined by KRS
			 314.011(7).
(7) "Assessment team" means a team that:
(a) Conducts assessment or reassessment
			 services; and
(b) Consists of:
1. Two (2) registered nurses; or
2. One (1) registered nurse and one (1) of
			 the following:
a. A certified social
			 worker;
b. A certified psychologist
			 with autonomous functioning;
c. A
			 licensed psychological practitioner;
d. A licensed marriage and family
			 therapist;
e. A licensed
			 professional clinical counselor;
f.
			 A licensed social worker; or
g. A
			 licensed clinical social worker.
(8) "Blended services" means a
			 non-duplicative combination of HCB waiver services identified in Section 5 of
			 this administrative regulation and PDS identified in Section 6 of this
			 administrative regulation provided pursuant to a recipient's approved plan of
			 care.
(9) "Budget allowance" is
			 defined by KRS
			 205.5605(1).
(10) "Certified psychologist with autonomous
			 functioning" or "licensed psychological practitioner" means a person licensed
			 pursuant to KRS Chapter 319.
(11)
			 "Certified social worker" means an individual who meets the requirements
			 established in KRS
			 335.080.
(12) "Chemical restraint" means a drug or
			 medication:
(a) Used to restrict an
			 individual's:
1. Behavior; or
2. Freedom of movement; and
(b)
1. That is not a standard treatment for the
			 individual's condition; or
2.
			 Dosage that is not an appropriate dosage for the individual's
			 condition.
(13) "Communicable disease" means a disease
			 that is transmitted:
(a) Through direct
			 contact with an infected individual;
(b) Indirectly through an organism that
			 carries disease-causing microorganisms from one (1) host to another or a
			 bacteriophage, a plasmid, or another agent that transfers genetic material from
			 one (1) location to another; or
(c)
			 Indirectly by a bacteriophage, a plasmid, or another agent that transfers
			 genetic material from one (1) location to another.
(14) "Covered services and supports" is
			 defined by KRS
			 205.5605(3).
(15) "DCBS" means the Department for
			 Community Based Services.
(16)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(17) "Electronic
			 signature" is defined by
			 KRS
			 369.102(8).
(18) "Exploitation" regarding:
(a) An adult is defined by
			 KRS
			 209.020(9); or
(b) A child means exploitation pursuant to
			 KRS Chapter 600 or 620.
(19) "Home and community based waiver
			 services" or "HCB waiver services" means home and community based waiver
			 services:
(a) For individuals who meet the
			 requirements of Section 4 of this administrative regulation; and
(b) Covered by the department pursuant to
			 this administrative regulation.
(20) "Home and community support services"
			 means nonresidential and nonmedical home and community based services and
			 supports that:
(a) Meet the participant's
			 needs; and
(b) Constitute a
			 cost-effective use of funds.
(21) "Home health agency" means an agency
			 that is:
(a) Licensed in accordance with
			 902 KAR 20:081; and
(b) Medicare and Medicaid
			 certified.
(22) "Illicit
			 drug" means:
(a) A drug, prescription or not
			 prescription, used illegally or in excess of therapeutic levels; or
(b) A prohibited drug.
(23) "Licensed clinical social worker" means
			 an individual who meets the requirements established in
			 KRS
			 335.100.
(24) "Licensed marriage and family therapist"
			 or "LMFT" is defined by
			 KRS
			 335.300(2).
(25) "Licensed practical nurse" or "LPN"
			 means a person who:
(a) Meets the definition
			 established by KRS
			 314.011(9); and
(b) Works under the supervision of a
			 registered nurse.
(26)
			 "Licensed professional clinical counselor" or "LPCC" is defined by
			 KRS
			 335.500(3).
(27) "Licensed social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.090.
(28) "Neglect" regarding:
(a) An adult is defined by
			 KRS
			 209.020(16); or
(b) A child means neglect pursuant to KRS
			 Chapter 600 or 620.
(29)
			 "NF" means nursing facility.
(30)
			 "NF level of care" means a high intensity or low intensity patient status
			 determination made by the department in accordance with
			 907 KAR 1:022.
(31) "Normal baby-sitting" means general care
			 provided to a child that includes custody, control, and supervision.
(32) "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(33) "Occupational therapy assistant" is
			 defined by KRS
			 319A.010(4).
(34) "Participant" means a recipient who
			 meets the:
(a) NF level of care criteria
			 established in
			 907 KAR 1:022; and
(b) Eligibility criteria for HCB waiver
			 services established in Section 4 of this administrative regulation.
(35) "Patient liability" means the
			 financial amount an individual is required to contribute toward cost of care in
			 order to maintain Medicaid eligibility.
(36) "PDS" means participant-directed
			 services.
(37) "Physical restraint"
			 means any manual method or physical or mechanical device, material, or
			 equipment that:
(a) Immobilizes or reduces the
			 ability of a person to move his or her arms, legs, body, or head freely;
			 and
(b) Does not include:
1. Orthopedically prescribed devices or other
			 devices, surgical dressings or bandages, or protective helmets; or
2. Other methods that involve the physical
			 holding of a person for the purpose of:
a.
			 Conducting routine physical examinations or tests;
b. Protecting the person from falling out of
			 bed; or
c. Permitting the person to
			 participate in activities without the risk of physical harm.
(38)
			 "Physical therapist" is defined by
			 KRS
			 327.010(2).
(39) "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.
(40) "Physician assistant" or "PA" is defined
			 by KRS
			 311.840(3).
(41) "Plan of care" or "POC" means a written
			 individualized comprehensive plan that:
(a)
			 Encompasses all HCB waiver services; and
(b) Is developed by a participant or a
			 participant's legal representative, case manager, or other individual
			 designated by the participant.
(42) "Plan of treatment" means a care plan
			 developed and used by an ADHC center based on the participant's individualized
			 ADHC service needs, goals, interventions, and outcomes.
(43) "Prohibited drug" means a drug or
			 substance that is illegal under KRS Chapter 218A.
(44) "Registered nurse" or "RN" means a
			 person who:
(a) Meets the definition
			 established by KRS
			 314.011(5); and
(b) Has one (1) year or more experience as a
			 professional nurse.
(45)
			 "Representative" is defined by
			 KRS
			 205.5605(6).
(46) "Sex crime" is defined by
			 KRS
			 17.165(1).
(47) "Speech-language pathologist" is defined
			 by KRS
			 334A.020(3).
(48) "Support broker" means an individual
			 chosen by a participant from an agency designated by the department to:
(a) Provide training, technical assistance,
			 and support to a participant; and
(b) Assist a participant in any other aspects
			 of PDS.
(49) "Support
			 spending plan" means a plan for a participant that identifies the:
(a) PDS requested;
(b) Employee name;
(c) Hourly wage;
(d) Hours per month;
(e) Monthly pay;
(f) Taxes; and
(g) Budget allowance.
(50) "Violent crime" is defined by
			 KRS
			 17.165(3).
(51) "Violent offender" is defined by
			 KRS
			 17.165(2).