Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 7 - Certified Provider Requirements › Section 907 KAR 7:010 - Home and community based waiver services version 2

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 provisions and requirements
				for home and community based waiver services version 2.
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) "Area agency on aging and independent
			 living" means:
(a) An area agency on living as
			 defined by 42 U.S.C.
			 3002(6); and
(b) A local agency designated by the
			 Department for Aging and Independent Living to administer funds received under
			 Title III for a given planning and service area.
(8) "Assessment" means an evaluation
			 completed using the Kentucky Home Assessment Tool (K-HAT).
(9) "Blended services" means a
			 non-duplicative combination of HCB waiver services that are not
			 participant-directed services as well as participant-directed
			 services.
(10) "Center for
			 independent living" is defined by
			 42 U.S.C.
			 796a(1).
(11) "Certified nutritionist" is defined by
			 KRS
			 310.005(12).
(12) "Certified social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.080.
(13) "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.
(14) "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.
(15) "DAIL" means the Department for Aging
			 and Independent Living.
(16) "DCBS"
			 means the Department for Community Based Services.
(17) "Department" means the Department for
			 Medicaid Services or its designee.
(18) "Electronic signature" is defined by
			 KRS
			 369.102(8).
(19) "Experimental goods or services" means
			 goods or services that are serving the ends of or used as a means of
			 experimentation.
(20)
			 "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.
(21) "Home and community based waiver
			 services" or "HCB waiver services" means home and community based waiver
			 services:
(a) Covered by the department
			 pursuant to this administrative regulation; and
(b) For individuals who meet the requirements
			 of Section 4 of this administrative regulation.
(22) "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.
(23) "Home delivered meal provider" means a
			 food service establishment as defined by
			 KRS
			 217.015(21).
(24) "Home health agency" means an agency
			 that is:
(a) Licensed in accordance with
			 902 KAR 20:081; and
(b) Medicare and Medicaid
			 certified.
(25) "Illicit
			 drug" means:
(a) A drug, prescription or not
			 prescription, used illegally or in excess of therapeutic levels; or
(b) A prohibited drug.
(26) "Immediate family member" is defined by
			 KRS
			 205.8451(3).
(27) "Informed choice" means a choice among
			 options based on accurate and thorough knowledge and understanding to the
			 participant regarding:
(a) The services and
			 supports to be received; and
(b)
			 From whom services and supports will be received.
(28) "Legally responsible individual" means
			 an individual who:
(a) Has a duty under state
			 law to care for another person; and
(b)
1. Is a
			 parent (biological, adoptive, or foster) of a minor child and provides care to
			 the child;
2. Is the guardian of a
			 minor child and provides care to the child; or
3. Is a spouse of a participant.
(29) "Licensed clinical
			 social worker" means an individual who meets the requirements established by
			 KRS
			 335.100.
(30) "Licensed dietitian" is defined by
			 KRS
			 310.005(11).
(31) "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.
(32)
			 "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.
(33)
			 "Licensed social worker" means an individual who meets the requirements
			 established by KRS
			 335.090.
(34) "MWMA" means the Kentucky Medicaid
			 Waiver Management Application internet portal located at
http://chfs.ky.gov/dms/mwma.htm
.
(35) "Natural supports" means a non-paid
			 person, persons, primary caregiver, or community resource who can provide or
			 has historically provided assistance to the participant or due to the familial
			 relationship would be expected to provide assistance.
(36) "Neglect" regarding:
(a) An adult is defined by
			 KRS
			 209.020(016); or
(b) A child means neglect pursuant to KRS
			 Chapter 600 or 620.
(37)
			 "NF" means nursing facility.
(38)
			 "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.
(39) "Normal baby-sitting" means general care
			 provided to a child that includes custody, control, and supervision.
(40) "Normal care sitting" means general
			 care:
(a) Provided to an adult who is at least
			 eighteen (18) years of age; and
(b)
			 That includes custody, control, and supervision.
(41) "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.
(42) "Participant corrective
			 action plan" means a written plan that is developed by the case manager or
			 service advisor in conjunction with the participant or representative to
			 identify, eliminate, and prevent future violations from occurring by:
(a) Providing the participant or
			 representative with the specific administrative regulation that has been
			 violated;
(b) Identifying factual
			 information regarding the violation; and
(c) Reaching an agreement between the case
			 manager and the participant or representative to the resolution and being in
			 compliance within the timeframe established in the participant corrective
			 action plan being issued.
(43) "PDS" means participant-directed
			 services.
(44) "Person-centered
			 service plan" means a written individualized plan of services for a participant
			 that meets the requirements established in Section 7 of this administrative
			 regulation.
(45) "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 framework 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 and 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.
(46) "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.
(47)
			 "Physician assistant" or "PA" is defined by
			 KRS
			 311.840(3).
(48) "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.
(49) "Prohibited drug" means a drug or
			 substance that is illegal under KRS Chapter 218A.
(50) "Public health department" means an
			 agency recognized by the Department for Public Health pursuant to 902 KAR
			 Chapter 8.
(51) "Recipient" is
			 defined by KRS
			 205.8451(9).
(52) "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.
(53)
			 "Representative" is defined by
			 KRS
			 205.5605(6).
(54) "Service advisor" is defined by
			 KRS
			 205.5605(7).
(55) "Sex crime" is defined by
			 KRS
			 17.165(1).
(56) "Violent crime" is defined by
			 KRS
			 17.165(3).
(57) "Violent offender" is defined by
			 KRS
			 17.165(2).