Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:835 - Michelle P. waiver services and reimbursement

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 coverage and reimbursement provisions
				for Michelle P. waiver services.
Section
			 1. Definitions.
(1) "1915(c) home
			 and community based waiver services program" means a Kentucky Medicaid program
			 established pursuant to and in accordance with
			 42 U.S.C.
			 1396n(c).
(2) "ADHC" means adult day health
			 care.
(3) "ADHC center" means an
			 adult day health care center licensed in accordance with
			 902 KAR 20:066.
(4) "ADHC services" means health-related
			 services provided on a regularly-scheduled basis that ensure optimal
			 functioning of a participant who does not require twenty-four (24) hour care in
			 an institutional setting.
(5)
			 "Advanced practice registered nurse" or "APRN" means a person who acts within
			 his or her scope of practice and is licensed in accordance with
			 KRS
			 314.042.
(6) "Assessment team" means a team which:
(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 social worker;
b. A certified psychologist with autonomous
			 functioning;
c. A licensed
			 psychological practitioner;
d. A
			 licensed marriage and family therapist; or
e. A licensed professional clinical
			 counselor.
(7) "Behavior support specialist" means an
			 individual who has:
(a) A master's degree from
			 an accredited institution with formal graduate course work in a behavioral
			 science; and
(b) At least one (1)
			 year of experience in behavioral programming.
(8) "Blended services" means a nonduplicative
			 combination of Michelle P. waiver services identified in Section 6 of this
			 administrative regulation and participant-directed services identified in
			 Section 7 of this administrative regulation provided pursuant to a
			 participant's approved person-centered service plan.
(9) "Budget allowance" is defined by
			 KRS
			 205.5605(1).
(10) "Certified psychologist" means an
			 individual who is a certified psychologist in accordance with
			 KRS
			 319.056.
(11) "Covered services and supports" is
			 defined by KRS
			 205.5605(3).
(12) "DCBS" means the Department for
			 Community Based Services.
(13)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(14) "Developmental
			 disability" means a severe, chronic disability that:
(a) Is attributable to:
1. Cerebral palsy or epilepsy; or
2. Any other condition, excluding mental
			 illness, closely related to an intellectual disability resulting in impairment
			 of general intellectual functioning or adaptive behavior similar to that of an
			 individual with an intellectual disability and which requires treatment or
			 services similar to those required by persons with an intellectual
			 disability;
(b) Is
			 manifested prior to the individual's 22nd birthday;
(c) Is likely to continue indefinitely;
			 and
(d) Results in substantial
			 functional limitations in three (3) or more of the following areas of major
			 life activity:
1. Self-care;
2. Understanding and use of
			 language;
3. Learning;
4. Mobility;
5. Self-direction; or
6. Capacity for independent living.
(15) "Direct care staff"
			 means an individual hired by a Michelle P. waiver provider to provide services
			 to the participant and who:
(a)
1.
a. Is
			 eighteen (18) years of age or older; and
b. Has a high school diploma or GED;
			 or
2.
a. Is twenty-one (21) years of age or older;
			 and
b. Is able to communicate with
			 a participant in a manner that the participant or participant's legal
			 representative or family member can understand;
(b) Has a valid Social Security number or
			 valid work permit if not a U.S. citizen;
(c) Can understand and carry out simple
			 instructions;
(d) Has the ability
			 to keep simple records; and
(e) Is
			 managed by the provider's supervisory staff.
(16) "Electronic signature" is defined by
			 KRS
			 369.102(8).
(17) "Federal financial participation" is
			 defined in 42 C.F.R.
			 400.203.
(18) "Home health agency" means an agency
			 that is:
(a) Licensed in accordance with
			 902 KAR 20:081; and
(b) Medicare and Medicaid
			 certified.
(19) "ICF-IID"
			 means an intermediate care facility for individuals with an intellectual
			 disability.
(20) "Intellectual
			 disability" means an individual has:
(a)
			 Significantly sub-average intellectual functioning;
(b) An intelligence quotient of seventy (70)
			 or below;
(c) Concurrent deficits
			 or impairments in present adaptive functioning in at least two (2) of the
			 following areas:
1. Communication;
2. Self-care;
3. Home living;
4. Social or interpersonal skills;
5. Use of community resources;
6. Self-direction;
7. Functional academic skills;
8. Work;
9. Leisure; or
10. Health and safety; and
(d) Had an onset prior to eighteen
			 (18) years of age.
(21)
			 "Intellectual disability professional" means an individual who:
(a) Has at least one (1) year of experience
			 working with individuals with an intellectual or developmental
			 disability;
(b) Meets the personnel
			 and training requirements established in Section 2 of this administrative
			 regulation; and
(c)
1. Is a doctor of medicine or
			 osteopathy;
2. Is a registered
			 nurse; or
3. Holds a bachelor's
			 degree from an accredited institution in a human services field.
(22) "Level of care
			 determination" means a determination that an individual meets the Michelle P.
			 waiver service level of care criteria established in Section 5 of this
			 administrative regulation.
(23)
			 "Licensed clinical social worker" means an individual who meets the licensed
			 clinical social worker 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
			 of 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 psychological associate" means
			 an individual who meets the requirements established in
			 KRS
			 319.064.
(28) "Licensed psychological practitioner"
			 means an individual who:
(a) Meets the
			 requirements established in
			 KRS
			 319.053; or
(b) Is a certified psychologist with
			 autonomous functioning.
(29) "Licensed psychologist" means an
			 individual who:
(a) Currently possesses a
			 licensed psychologist license in accordance with
			 KRS
			 319.010(6); and
(b) Meets the licensed psychologist
			 requirements established in 201 KAR Chapter 26.
(30) "MWMA" means the Kentucky Medicaid
			 Waiver Management Application internet portal located at
http://chfs.ky.gov/dms/mwma.htm
.
(31) "Normal babysitting" means general care
			 provided to a child which 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 an individual who:
(a) Is a recipient as defined by
			 KRS
			 205.8451(9);
(b) Meets the Michelle P. waiver service
			 level of care criteria established in Section 5 of this administrative
			 regulation; and
(c) Meets the
			 eligibility criteria for Michelle P. waiver services established in Section 4
			 of this administrative regulation.
(35) "Participant-directed services" or "PDS"
			 means an option established by
			 KRS
			 205.5606 within the 1915(c) home and
			 community based waiver services programs that allows participants to receive
			 non-medical services in which the individual:
(a) Assists with the design of the
			 program;
(b) Chooses the providers
			 of services; and
(c) Directs the
			 delivery of services to meet his or her needs.
(36) "Patient liability" means the financial
			 amount an individual is required to contribute toward cost of care in order to
			 maintain Medicaid eligibility.
(37)
			 "Person-centered service plan" means a written individualized plan of services
			 for a participant that meets the requirements established in Section 8 of this
			 administrative regulation.
(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 treatment" means a care plan
			 used by an ADHC center.
(42)
			 "Psychologist with autonomous functioning" means an individual who is licensed
			 in accordance with KRS 319.056.
(43) "Qualified professional in the area of
			 intellectual disabilities" is defined by
			 KRS
			 202B.010(12).
(44) "Registered nurse" or "RN" means a
			 person who:
(a) Meets the definition
			 established in KRS
			 314.011(5); and
(b) Has at least one (1) year of experience
			 as a licensed practical nurse or a registered nurse.
(45) "Representative" is defined by
			 KRS
			 205.5605(6).
(46) "Sex crime" is defined by
			 KRS
			 17.165(1).
(47) "Social worker" means a person with a
			 bachelor's degree in social work, sociology, or a related field.
(48) "Speech-language pathologist" is defined
			 by KRS
			 334A.020(3).
(49) "State plan" is defined by
			 42 C.F.R.
			 400.203.
(50) "Supervisory staff" means an individual
			 employed by the Michelle P. waiver provider who shall manage direct care staff
			 and who:
(a)
1.
a. Is
			 eighteen (18) years of age or older; and
b. Has a high school diploma or GED;
			 or
2. Is twenty-one (21)
			 years of age or older;
(b) Has a minimum of one (1) year experience
			 in providing services to individuals with an intellectual or developmental
			 disability;
(c) Is able to
			 adequately communicate with the participants, staff, and family
			 members;
(d) Has a valid Social
			 Security number or valid work permit if not a U.S. citizen; and
(e) Has the ability to perform required
			 record keeping.
(51)
			 "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 the participant; and
(b) Assist the participant in any other
			 aspects of PDS.
(52)
			 "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;
(g) Budget allowance; and
(h) Twelve (12) month budget.
(53) "Violent crime" is defined by
			 KRS
			 17.165(3).