Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:090 - Acquired brain injury waiver services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.5605,
				205.5606,
				205.5607,
				205.8451,
				205.8477,
				42 C.F.R.
				441.300-
				310,
				42 C.F.R.
				455.100-
				106,
				42 U.S.C.
				1396a, b, d, n
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. KRS
				205.5606(1) requires the
				cabinet to promulgate administrative regulations to establish a
				participant-directed services program to provide an option for the home and
				community-based services waivers. This administrative regulation establishes
				the coverage provisions relating to home- and community-based waiver services
				provided to an individual with an acquired brain injury as an alternative to
				nursing facility services and including a participant-directed services program
				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) "ABI" means an acquired brain
			 injury.
(3) "ABI provider" means an
			 entity that meets the criteria established in Section 2 of this administrative
			 regulation.
(4) "Acquired Brain
			 Injury Branch" or "ABIB" means the Acquired Brain Injury Branch of the
			 Department for Medicaid Services, Division of Community Alternatives.
(5) "Acquired brain injury waiver service" or
			 "ABI waiver service" means a home and community based waiver service provided
			 to a Medicaid eligible individual who has acquired a brain injury.
(6) "Advanced practice registered nurse" is
			 defined by KRS
			 314.l011(7).
(7) "Assessment" or "reassessment" means a
			 comprehensive evaluation of abilities, needs, and services that:
(a) Serves as the basis for a level of care
			 determination;
(b) Is completed on
			 a MAP 351, Medicaid Waiver Assessment that is uploaded into the MWMA;
			 and
(c) Occurs at least once every
			 twelve (12) months thereafter.
(8) "Behavior intervention committee" or
			 "BIC" means a group of individuals established to evaluate the technical
			 adequacy of a proposed behavior intervention for an ABI recipient.
(9) "Blended services" means a nonduplicative
			 combination of ABI waiver services identified in Section 4 of this
			 administrative regulation and participant directed services identified in
			 Section 10 of this administrative regulation provided pursuant to a recipient's
			 approved person-centered service plan.
(10) "Board certified behavior analyst" means
			 an independent practitioner who is certified by the Behavior Analyst
			 Certification Board, Inc.
(11)
			 "Budget allowance" is defined by
			 KRS
			 205.5605(1).
(12) "Case manager" means an individual who
			 manages the overall development and monitoring of a recipient's person-centered
			 service plan.
(13) "Covered
			 services and supports" is defined by
			 KRS
			 205.5605(3).
(14) "Crisis prevention and response plan"
			 means a plan developed by the person centered team to identify any potential
			 risk to a recipient and to detail a strategy to minimize the risk.
(15) "DCBS" means the Department for
			 Community Based Services.
(16)
			 "Department" means the Department for Medicaid Services or its
			 designee.
(17) "Good cause" means a
			 circumstance beyond the control of an individual that affects the individual's
			 ability to access funding or services, including:
(a) Illness or hospitalization of the
			 individual which is expected to last sixty (60) days or less;
(b) Death or incapacitation of the primary
			 caregiver;
(c) Required paperwork
			 and documentation for processing in accordance with Section 3 of this
			 administrative regulation that has not been completed but is expected to be
			 completed in two (2) weeks or less; or
(d) The individual or his or her legal
			 representative has made diligent contact with a potential provider to secure
			 placement or access services but has not been accepted within the sixty (60)
			 day time period.
(18)
			 "Human rights committee" or "HRC" means a group of individuals established to
			 protect the rights and welfare of an ABI recipient.
(19) "Level of care certification" means
			 verification, by the department, of ABI program eligibility for:
(a) An individual; and
(b) A specific period of time.
(20) "Licensed marriage and family
			 therapist" or "LMFT" is defined by
			 KRS
			 335.300(2).
(21) "Licensed medical professional" means:
(a) A physician;
(b) An advanced practice registered
			 nurse;
(c) A physician
			 assistant;
(d) A registered
			 nurse;
(e) A licensed practical
			 nurse; or
(f) A
			 pharmacist.
(22)
			 "Licensed professional clinical counselor" is defined by
			 KRS
			 335.500(3).
(23) "Medically necessary" or "medical
			 necessity" means that a covered benefit is determined to be needed in
			 accordance with
			 907 KAR 3:130.
(24) "MWMA" means the Kentucky Medicaid
			 Waiver Management Application internet portal located at
http://chfs.ky.gov/dms/mwma.htm
.
(25) "Occupational therapist" is defined by
			 KRS
			 319A.010(3).
(26) "Occupational therapy assistant" is
			 defined by KRS
			 319A.010(4).
(27) "Participant directed services" or "PDS"
			 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 their needs.
(28) "Patient liability" means the financial
			 amount, determined by the department, that an individual is required to
			 contribute towards cost of care in order to maintain Medicaid
			 eligibility.
(29) "Person-centered
			 service plan" means a written individualized plan of services for a participant
			 that meets the requirements established in Section 4 of this administrative
			 regulation.
(30) "Person centered
			 team" means a participant, the participant's guardian or representative, and
			 other individuals who are natural or paid supports and who:
(a) Recognize that evidenced based decisions
			 are determined within the basic frame-work of what is important for the
			 participant and within the context of what is important to the participant
			 based on informed choice;
(b) Work
			 together to identify what roles they will assume to assist the participant in
			 becoming as independent as possible in meeting the participant's needs;
			 and
(c) Include providers who
			 receive payment for services who shall:
1. Be
			 active contributing members of the person centered team meetings;
2. Base their input upon evidence-based
			 information; and
3. Not request
			 reimbursement for person-centered team meetings.
(31) "Personal services agency" is
			 defined by KRS
			 216.710(8).
(32) "Psychologist" is defined by
			 KRS
			 319.010(9).
(33) "Psychologist with autonomous
			 functioning" means an individual who is licensed in accordance with
			 KRS
			 319.056.
(34) "Qualified mental health professional"
			 is defined by KRS
			 202A.011(12).
(35) "Representative" is defined by
			 KRS
			 205.5605(6).
(36) "Speech-language pathologist" is defined
			 by KRS
			 334A.020(3).
(37) "Support broker" means an individual
			 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.
(38) "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.
(39) "Transition plan" means a plan that is
			 developed by the person centered team to aid an ABI recipient in exiting from
			 the ABI program into the community.