Kentucky Administrative Regulations › Title 911 - CABINET FOR HEALTH AND FAMILY SERVICES - OFFICE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS › Chapter 1 - Children with Special Health Care Needs Services › Section 911 KAR 1:010 - Application to clinical programs

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				200.460,
				200.470,
				200.654(13),
				Chapters 311, 319, 334A,
				42
				U.S.C. 9902(2),
				42 C.F.R.
				435.603
NECESSITY, FUNCTION, AND CONFORMITY:
				KRS
				194A.030(5) authorizes the
				Office for Children with Special Health Care Needs to promulgate administrative
				regulations to implement and administer its responsibilities. This
				administrative regulation establishes application forms used for clinical
				programs, procedures for application and reapplication, eligibility criteria,
				assignment of pay category, and processes used to determine initial and
				continuing eligibility for services, as well as a process for reconsideration
				of an adverse decision.
Section 1.
			 Definitions.
(1) "Affordable Care Act" is
			 defined by
			 42
			 U.S.C. 9902(2).
(2) "Applicant" means a person in need of
			 services offered by the Office for Children with Special Health Care Needs
			 clinical program.
(3) "Clinical
			 program" means an established clinical service by which OCSHCN delivers care to
			 treat conditions listed on the OCSHCN-10g, Medical Eligibility List for
			 Clinical and Case Management Services, through a provider:
(a) Contracted in accordance with
			 911 KAR 1:060;
			 or
(b) Employed by OCSHCN as an
			 audiologist.
(4)
			 "Eligibility Committee" means an OCSHCN committee that is charged with:
(a) Clarifying financial eligibility
			 questions that arise during:
1. The
			 application review process; and
2.
			 Ongoing eligibility reviews;
(b) Evaluating appeal requests for
			 reconsideration pursuant to Section 13 of this administrative
			 regulation;
(c) Clarifying medical
			 eligibility questions that arise during the application review process;
			 and
(d) Determining if a diagnosis
			 qualifies for inclusion in the clinical program.
(5) "Income" means money received from:
(a) Statutory benefits (for example, Social
			 Security, Veterans Administration pension, black lung benefits, or railroad
			 retirement benefits);
(b) Military
			 housing;
(c) Clerical
			 housing;
(d) Farm or business
			 operations;
(e) Pensions;
(f) Wages for labor or services;
(g) Royalties;
(h) Alimony, maintenance, or child
			 support;
(i) Miscellaneous income
			 as defined by the Internal Revenue Service at
www.irs.gov/form1099misc
.;
(j) Retirement Survivors Disability
			 Insurance;
(k) Disability
			 benefits;
(l) Unemployment
			 benefits;
(m) Supplemental Security
			 Income;
(n) Workers'
			 compensation;
(o) Annuities;
			 or
(p) Interest and
			 dividends.
(6) "OCSHCN"
			 means Office for Children with Special Health Care Needs.
(7) "Responsible adult" means a person who
			 is:
(a) Responsible for making decisions about
			 an OCSHCN clinical program applicant or recipient of services; or
(b) Required to provide financial support for
			 an OCSHCN clinical program applicant or recipient of services.