Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:022 - Nursing facility services and intermediate care facility for individuals with an intellectual disability

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				42 C.F.R.
				431.153,
				431.154,
				447.280,
				482.58,
				42 U.S.C.
				1395tt,
				1396l,
				1396r
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. This administrative regulation establishes the provisions
				relating to nursing facility services and services at an intermediate care
				facility for individuals with an intellectual disability for which payment
				shall be made by the Medicaid Program on behalf of both the categorically needy
				and medically needy recipients.
Section
			 1. Definitions.
(1) "Department"
			 means the Department for Medicaid Services or its designee.
(2) "Department approved system" means a
			 technology system in which:
(a) Providers
			 electronically submit and track level of care (LOC) requests through a
			 self-service portal;
(b) The system
			 triggers LOC tasks as reminders to providers and allows them to submit
			 reassessments electronically; and
(c) Information is exchanged electronically
			 with Kentucky's:
1. Medicaid Enterprise
			 Management Solution (MEMS); and
2.
			 Integrated eligibility and enrollment system.
(3) "High-intensity nursing care services"
			 means care provided:
(a) To a
			 Medicaid-eligible individual who meets high-intensity nursing care patient
			 status criteria in accordance with Section 4 of this administrative regulation;
			 and
(b) By a nursing facility or a
			 nursing facility with Medicaid waiver participating in the Medicaid Program
			 with care provided in beds also participating in the Medicare
			 Program.
(4)
			 "High-intensity rehabilitation services" means therapy services that:
(a) Are expected to improve an individual's
			 condition while the individual possesses reasonable potential for improvement
			 in functional capability; and
(b)
			 Do not include restorative and maintenance nursing procedures, including
			 routine range of motion exercises and application of splints or braces by
			 nurses and staff.
(5)
			 "Intermediate care facility for individuals with an intellectual disability" or
			 "ICF-IID" means a licensed intermediate care facility for individuals with an
			 intellectual disability certified by the Department for Medicaid Services as
			 meeting all standards for an intermediate care facility for individuals with an
			 intellectual disability.
(6)
			 "Intermediate care facility for individuals with an intellectual disability
			 services" or "ICF-IID services" means care provided:
(a) To a Medicaid-eligible individual who
			 meets ICF-IID patient status criteria in accordance with Section 4 of this
			 administrative regulation; and
(b)
			 By an ICF-IID participating in the Medicaid Program.
(7) "Intermittent high-intensity nursing care
			 services" means services for an individual who requires high-intensity nursing
			 care services at regular or irregular intervals, but not on a twenty-four (24)
			 hour-per-day basis and not less than three (3) calendar days per
			 week.
(8) "Low-intensity nursing
			 care services" means care provided:
(a) To a
			 Medicaid-eligible individual who meets low-intensity nursing care patient
			 status criteria in accordance with Section 4 of this administrative regulation;
			 and
(b) By a nursing facility or a
			 nursing facility with Medicaid waiver participating in the Medicaid
			 program.
(9) "Medical
			 condition" means a state of health relative to a clinical diagnosis made by a
			 licensed physician, physician assistant, advanced practice registered nurse, or
			 a qualified behavioral health professional.
(10) "Nursing facility" or "NF" means:
(a) A facility:
1. To which the Cabinet for Health and Family
			 Services, Office of Inspector General has granted an NF license;
2. For which the Cabinet for Health and
			 Family Services, Office of Inspector General has recommended to the department
			 certification as a Medicaid provider; and
3. To which the department has granted
			 certification for Medicaid participation; or
(b) A hospital swing bed that provides
			 services in accordance with
			 42 U.S.C.
			 1395tt and
			 1396l,
			 if the swing bed is certified to the department as meeting requirements for the
			 provision of swing bed services in accordance with
			 42 U.S.C.
			 1396r(b), (c), (d),
			 42 C.F.R.
			 447.280 and
			 482.58.
(11) "Nursing facility with Medicaid waiver"
			 or "NF-W" means a facility:
(a) To which the
			 Cabinet for Health and Family Services, Office of Inspector General has granted
			 an NF license;
(b) For which the
			 Cabinet for Health and Family Services, Office of Inspector General has
			 recommended to the department certification as a Medicaid provider;
(c) To which the department has granted a
			 waiver of the nurse staffing requirement; and
(d) To which the department has granted
			 certification for Medicaid participation.
(12) "Patient status" means an individual's
			 level of care in accordance with Section 4 of this administrative regulation
			 for treatment in an institutional setting.
(13) "Personal care" means services to help
			 an individual achieve and maintain good personal hygiene, which may include
			 assistance with bathing, shaving, cleaning and trimming of fingernails and
			 toenails, cleaning of the mouth and teeth, washing, and grooming and cutting of
			 hair.
(14) "Stable medical
			 condition" means a medical condition that is capable of being maintained in
			 accordance with a planned treatment regimen requiring a minimum amount of
			 medical supervision without significant change or fluctuation in a patient's
			 condition or treatment regimen.