Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 12 - Supports for Community Living Waiver › Section 907 KAR 12:020 - Reimbursement for New Supports for Community Living Waiver Services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 C.F.R.
				441, Subpart G, 447.272,
				42 U.S.C.
				1396a, b, d, n
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, is required 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 reimbursement
				policies for SCL waiver services provided to individuals pursuant to the new
				Supports for Community Living (SCL) waiver program established by
				907 KAR 12:010.
Section 1. Definitions.
(1) "DBHDID" means the Department for
			 Behavioral Health, Developmental and Intellectual Disabilities.
(2) "Department" means the Department for
			 Medicaid Services or its designee.
(3) "Developmental disability" means a
			 disability that:
(a) Is manifested prior to
			 the age of twenty-two (22);
(b)
			 Constitutes a substantial disability to the affected individual; and
(c) Is attributable either to an intellectual
			 disability or a condition related to an intellectual disability that:
1. Results in an impairment of general
			 intellectual functioning and adaptive behavior similar to that of a person with
			 an intellectual disability; and
2.
			 Is a direct result of, or is influenced by, the person's cognitive
			 deficits.
(4)
			 "Exceptional support" means a service:
(a)
			 Requested by a participant and the participant's team; and
(b) That due to an extraordinary circumstance
			 related to a participant's physical health, psychiatric issue, or behavioral
			 health issue is necessary to:
1. Be provided
			 in excess of the upper payment limit for the service for a specified amount of
			 time; and
2. Meet the assessed
			 needs of the participant.
(5) "Immediate family member" is defined by
			 KRS
			 205.8451(3).
(6) "Intellectual disability" or "ID" means:
(a) A demonstration:
1. Of significantly sub-average intellectual
			 functioning and an intelligence quotient (IQ) of seventy (70) plus or minus
			 five (5); and
2. Of concurrent
			 deficits or impairments in present adaptive functioning in at least two (2) of
			 the following areas:
a.
			 Communication;
b.
			 Self-care;
c. Home
			 living;
d. Social or interpersonal
			 skills;
e. Use of community
			 resources;
f.
			 Self-direction;
g. Functional
			 academic skills;
h. Work;
i. Leisure; or
j. Health and safety; and
(b) An intellectual
			 disability that had an onset before eighteen (18) years of age.
(7) "Legally responsible
			 individual" means an individual who has a duty under state law to care for
			 another person and includes:
(a) A parent
			 (biological, adoptive, or foster) who provides care to the parent's minor
			 child;
(b) A guardian who provides
			 care to the guardian's minor child; or
(c) A spouse of a participant.
(8) "Participant" means a Medicaid
			 recipient who:
(a) Meets patient status
			 criteria for an intermediate care facility for individuals with intellectual
			 disabilities as established in
			 907 KAR 1:022;
(b) Is authorized by the department to
			 receive SCL waiver services; and
(c) Utilizes SCL waiver services and supports
			 in accordance with a person-centered service plan.
(9) "Participant-directed service" means an
			 option established by
			 KRS
			 205.5606 within the 1915(c) home and
			 community based service waiver programs that allows recipients 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.
(10) "State plan" is defined by
			 42 C.F.R.
			 430.10.
(11) "Supports for community living services"
			 or "SCL services" means community-based waiver services for a participant who
			 has an intellectual or developmental disability.