907 KAR 12:010. New Supports for community living waiver service and coverage policies.

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 service and coverage policies for the Supports for Community Living (SCL) waiver program. The SCL waiver program is federally authorized via a 1915(c) home and community based waiver that enables individuals with an intellectual or developmental disability to reside and receive services in a community setting rather than in an intermediate care facility for individuals with intellectual disabilities, including a participant directed services option pursuant to KRS 205.5606.

Section 1.

(1)

"1915(c) home and community based waiver program" means a Kentucky Medicaid program established pursuant to, and in accordance with, 42 U.S.C. 1396n(c).

(2)

(3)

"Adult day health care center" means an adult day health care center licensed in accordance with 902 KAR 20:066.

(4)

(a)

(b)

1.

2.

(c)

1.

2.

3.

Ensures that the participant's needs are met in accordance with the participant's person-centered service plan.

(5)

(6)

(a)

1.

2.

3.

4.

5.

(b)

(c)

(7)

(a)

Established to evaluate the technical adequacy of a proposed behavioral intervention for a participant; and

(b)

That meets in accordance with the BIC policies established in Section 8 of this administrative regulation.

(8)

"Board" means three (3) meals a day or other full nutritional regimen of a caregiver for the purpose of providing shared living services.

(9)

(a)

Meets the requirements for a case manager established in Section 6 of this administrative regulation; and

(b)

Meets all personnel and training requirements established in Section 3 of this administrative regulation.

(10)

(a)

(b)

1.

2.

Has a bachelor's degree in any other field from an accredited college or university with at least one (1) year of experience in the field of intellectual disability; or

3.

(c)

Has at least two (2) years of experience of case management responsibility in an organization that serves individuals with intellectual or developmental disabilities;

(d)

Completes a case management supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities; and

(e)

Meets all personnel and training requirements established in Section 3 of this administrative regulation.

(11)

(12)

"Certified psychologist" means an individual who is recognized as a certified psychologist in accordance with 201 KAR Chapter 26.

(13)

"Certified psychologist with autonomous functioning" means a person licensed pursuant to KRS 319.056.

(14)

"Certified school psychologist" means an individual certified by the Kentucky Education Professional Standards Board under 16 KAR 2:090.

(15)

(a)

1.

2.

(b)

1.

2.

(16)

(a)

Provides support and training that enables a participant to develop a network of natural supports to achieve a clearly defined and valued social role within the participant's community;

(b)

1.

Previously qualified or been credentialed by the department to provide community access services prior to the effective date of this administrative regulation; or

2.

a.

b.

Completed a department approved training program within one (1) year of application while providing community access services under the direct supervision of a community access specialist; and

(c)

Meets the personnel and training requirements established in Section 3 or 10 of this administrative regulation.

(17)

(a)

Has been selected by a participant to provide training, technical assistance, and support including individual budget development and implementation in aspects of participant direction; and

(b)

1.

2.

A bachelor's degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or

3.

Experience in the field of intellectual or developmental disabilities that will substitute for the educational requirements stated in subparagraph 1. or 2. of this paragraph on a year-for-year basis;

(c)

Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation;

(d)

Completes a community guide training curriculum approved by DBHDID within six (6) months of being employed by the first participant supported; and

(e)

Provides services to a participant in accordance with Section 4 or 10 of this administrative regulation.

(18)

(19)

(20)

(21)

(22)

(23)

(a)

(b)

(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.

(24)

(a)

(b)

(c)

1.

2.

(d)

Meets the personnel and training requirements established in Section 3 of this administrative regulation;

(e)

1.

2.

3.

4.

Participate as a member of the participant's person-centered team if requested by the participant; and

(f)

Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan.

(25)

(a)

(b)

1.

2.

(c)

Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation;

(d)

1.

2.

3.

4.

(e)

Has at least two (2) years of experience in providing direct support to persons with a developmental disability;

(f)

Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan; and

(g)

Completes a supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities.

(26)

(27)

(28)

(29)

(30)

(a)

(b)

(c)

1.

2.

(d)

1.

2.

a.

b.

(i)

(ii)

Development, review, implementation, and revisions as needed of the organization's policies and procedures; and

(iii)

(e)

Meet all personnel and training requirements specified in Section 3 of this administrative regulation; and

(f)

If providing professional oversight or supervision of employees, meet the supervisory qualifications specified for each service.

(31)

(32)

"Extended family member" means a relative of an individual by blood or marriage beyond the individuals included in the definition of immediate family member.

(33)

(a)

(b)

In which a participant receives SCL services and resides in the family occupied (leased or owned) home; and

(c)

1.

2.

3.

Ensures that the participant's needs are met in accordance with the participant's person-centered service plan.

(34)

"Financial management agency" means an agency contracted by the department that manages individual participant-directed service plans.

(35)

"Functional assessment" means an assessment performed using evidenced based tools, direct observation, and empirical measurement to obtain and identify functional relations between behavioral and environmental factors.

(36)

"Good cause" means a circumstance beyond the control of an individual that affects the individual's ability to access funding or services, which includes:

(a)

(b)

Required paperwork and documentation for processing in accordance with Section 2 of this administrative regulation has not been completed but is expected to be completed in two (2) weeks or less; or

(c)

The individual or his or her guardian 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.

(37)

(a)

(b)

That is managed by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and

(c)

(38)

(39)

"Homicidal ideation" means thoughts about homicide that may range from vague ideas to detailed or fully formulated plans without taking action.

(40)

(a)

Comprised of representatives from home and community based waiver provider agencies in the community where a participant resides; and

(b)

1.

2.

In accordance with the human rights committee requirements established in Section 7 of this administrative regulation.

(41)

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

(k)

(l)

(m)

(n)

(o)

(42)

(43)

(a)

(b)

(c)

(44)

(45)

"Impact service" means a service designed to decrease the amount of paid supports a participant requires as the participant becomes:

(a)

(b)

(46)

(47)

"Integrated employment site" means the location of an activity or job that provides regular interaction with people without disabilities, excluding service providers, to the same extent that a worker without disabilities in a comparable position interacts with others.

(48)

(a)

(b)

Includes access to community activities and opportunities at times, frequencies, and with persons of a participant's choosing; and

(c)

(49)

(a)

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.

b.

c.

d.

e.

f.

g.

h.

i.

j.

(b)

(50)

"Legally responsible individual" means an individual who has a duty under state law to care for another person and includes:

(a)

(b)

(c)

(51)

"Level of care determination" means a determination by the department that an individual meets patient status criteria for an intermediate care facility for individuals with intellectual disabilities as established in 907 KAR 1:022.

(52)

"Licensed clinical social worker" means an individual who meets the licensed clinical social worker requirements established in KRS 335.100.

(53)

(54)

(55)

(a)

(b)

(c)

(d)

(e)

(f)

(56)

(57)

(58)

(a)

Currently possesses a licensed psychological associate license in accordance with KRS 319.010(6); and

(b)

(59)

"Licensed psychological practitioner" means an individual who meets the requirements established in KRS 319.053.

(60)

(a)

(b)

(61)

(a)

Developmental and historical information regarding family of origin, childhood experiences, and life events to present;

(b)

(c)

Life style practices that may lead to greater insight regarding a participant's current preferences, behavioral patterns, wants, and needs.

(62)

(63)

"Medically necessary" or "medical necessity" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

(64)

"MWMA" means the Kentucky Medicaid Waiver Management Application internet portal located at http://chfs.ky.gov/dms/mwma.htm.

(65)

(a)

A collaboration between the National Association of State Directors of Developmental Disability Services and the Human Services Research Institute;

(b)

An effort by public developmental disabilities agencies to measure and track their own performance; and

(c)

1.

2.

That address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety.

(66)

(a)

(b)

Include working in a job of the participant's choice in ways similar to people without disabilities; and

(c)

(67)

(68)

(69)

(70)

(a)

(b)

To provide individualized services to eligible individuals with disabilities with a substantial impediment to employment in order for the individual to gain and maintain employment.

(71)

(a)

Meets patient status criteria for an intermediate care facility for individuals with intellectual disabilities as established in 907 KAR 1:022;

(b)

(c)

(72)

"Participant-directed service" 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)

(b)

(c)

(73)

(a)

Assists a participant and the participant's person-centered team in implementing and monitoring the effectiveness of the participant's person-centered service plan;

(b)

(c)

Is responsible for training a participant, family, guardian, natural and unpaid supports, and other members of the person-centered team when barriers challenge the success of the participant in achieving his or her goals;

(d)

1.

2.

a.

b.

(e)

Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

(f)

Performs documentation necessary to facilitate compliance with the documentation requirements established in Section 4(12)(d) of this administrative regulation.

(74)

"Person-Centered Employment Plan" means a document that identifies the unique preferences, strengths, and needs of a participant in relation to the participant's work.

(75)

"Person-centered service plan" means a written individualized plan of services for a participant that meets the requirements established in Section 5 of this administrative regulation.

(76)

"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)

1.

2.

3.

(77)

"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 orthopedically prescribed devices or other devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a person for the purpose of:

1.

2.

3.

(78)

(79)

(a)

(b)

(80)

(a)

Provides evidence-based individualized interventions that assist a participant with acquisition or maintenance of skills for community living and behavioral intervention for the reduction of maladaptive behaviors;

(b)

Has a master's degree in a behavioral science and one (1) year of experience in behavioral programming;

(c)

Has at least one (1) year of direct service experience with individuals with intellectual or developmental disabilities; and

(d)

Meets all personnel and training requirements established in Section 3 of this administrative regulation.

(81)

"Prohibited drug" means a drug or substance that is illegal under KRS Chapter 218A or other statutes or administrative regulations of the Commonwealth of Kentucky.

(82)

(83)

(84)

(85)

(86)

(a)

(b)

(c)

(87)

"Room" means the aggregate expense of housing costs for the purpose of providing shared living, including:

(a)

(b)

(c)

(d)

(e)

(88)

(a)

Has at least one (1) year of experience working with persons with an intellectual or developmental disability;

(b)

Meets all personnel and training requirements established in Section 3 of this administrative regulation; and

(c)

1.

2.

3.

(89)

"SCL provider" means an entity that meets the criteria established in Section 3 of this administrative regulation.

(90)

(a)

(b)

(91)

"Serious medication error" means a medication error that requires or has the potential to require a medical intervention or treatment.

(92)

(a)

(b)

Provides supervision and necessary personal assistance services as specified in the participant's person-centered service plan;

(c)

1.

2.

(d)

Meets all personnel and training requirements established in Section 10 of this administrative regulation;

(e)

1.

2.

3.

Perform documentation necessary to facilitate compliance with the documentation requirements established in Section 4(20)(j) of this administrative regulation;

(f)

Has been determined by the participant's person-centered team, prior to being alone with the participant, to meet the following qualifications:

1.

Demonstrate competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan; and

2.

Have the ability to participate as a member of the participant's person-centered team if requested by the participant; and

(g)

1.

2.

3.

4.

(93)

(94)

(a)

That is owned or leased by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and

(b)

(95)

(96)

(a)

(b)

(c)

(97)

"Suicidal ideation" means thoughts about suicide that may range from being fleeting in nature to detailed planning.

(98)

"Supported Employment Long-Term Support Plan" means a document that identifies the amount and kind of support necessary for a participant to maintain employment and achieve individualized employment goals.

(99)

(a)

Provides ongoing support services to eligible participants in supported employment jobs in accordance with Section 4 or 10 of this administrative regulation;

(b)

1.

Has previously qualified or been credentialed by the department to provide supported employment services prior to the effective date of this administrative regulation; or

2.

a.

Has at least one (1) year of experience in the field of intellectual or developmental disabilities; and

b.

Has completed a department required training program within one (1) year of application while providing supported employment services under the direct supervision of a supported employment specialist; and

(c)

Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation.

(100)

"Supports for Community Living" or "SCL" means home and community-based waiver services for an individual with an intellectual or developmental disability.

(101)

"Supports Intensity Scale" or "SIS" means an assessment tool developed by the American Association on Intellectual and Developmental Disabilities that:

(a)

Measures practical support requirements of individuals with intellectual or developmental disabilities in daily living, medical, and behavioral areas; and

(b)

Section 2.

(1)

(a)

1.

2.

(b)

Shall receive notification of potential SCL funding in accordance with Section 12 of this administrative regulation;

(c)

(d)

(e)

1.

A completed MAP – 350 Long Term Care Facilities and Home and Community Based Program Certification Form;

2.

3.

4.

(2)

(a)

1.

A participant shall be administered a Supports Intensity Scale assessment by the department at least once every twenty-four (24) months from the level of care end date;

2.

3.

An ICF-IID level of care determination shall be performed by the department at least once every twelve (12) months.

(b)

1.

2.

(3)

(a)

(b)

(c)

(4)

(a)

(b)

1.

An applicant fails to access an SCL waiver service within sixty (60) days of receiving notice of potential funding without receiving an extension based on demonstration of good cause; or

2.

a.

Fails to access any services outlined in the participant's service plan for a period greater than sixty (60) consecutive days without receiving an extension based on demonstration of good cause;

b.

c.

(5)

(a)

1.

The SCL provider to simultaneously notify electronically or in writing the participant or participant's guardian, the participant's case manager, the department, and DBHDID at least thirty (30) days prior to the effective date of the termination; and

2.

a.

Provide the participant or participant's guardian with the name, address, and telephone number of each current SCL provider in Kentucky;

b.

Provide assistance to the participant or participant's guardian in making contact with another SCL provider;

c.

d.

e.

f.

g.

(b)

1.

2.

3.

4.

The participant's right to appeal the intended action through the provider's appeal or grievance process.

(6)

(a)

DBHDID shall initiate an intent to discontinue a participant's participation in the SCL waiver program if the participant or participant's guardian submits a written notice of intent to discontinue services to:

1.

2.

(b)

An action to terminate waiver participation shall not be initiated until thirty (30) calendar days from the date of the notice referenced in paragraph (a) of this subsection.

(c)

A participant or guardian may reconsider and revoke the notice referenced in paragraph (a) of this subsection in writing during the thirty (30) calendar day period.

Section 3.

(1)

(a)

(b)

(c)

(d)

(e)

(f)

The Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-2, and 45 C.F.R. Parts 160, 162, and 164;

(g)

(h)

(2)

In order to provide an SCL waiver service in accordance with Section 4 of this administrative regulation, an SCL provider shall:

(a)

(b)

(c)

In accordance with KRS 273.182, maintain a registered agent and a registered office in Kentucky with the Office of the Secretary of State and file appropriate statement of change documentation with the filing fee with the Office of Secretary of State if the registered office or agent changes;

(d)

Be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020;

(e)

(f)

Maintain policy that complies with this administrative regulation concerning the operation of the SCL provider and the health, safety, and welfare of all people supported or served by the SCL provider;

(g)

Maintain an executive director who shall have the authority and responsibility for the management of the affairs of the SCL provider in accordance with written policy and procedures that comply with this administrative regulation; and

(h)

(3)

(a)

Shall ensure that SCL waiver services shall not be provided to a participant by a staff person of the SCL provider who is a guardian, legally responsible individual, or immediate family member of the participant unless allowed for a participant-directed service in accordance with Section 4 of this administrative regulation;

(b)

(c)

Shall have and follow written criteria that comply with this administrative regulation for determining the eligibility of a participant for admission to services;

(d)

1.

2.

(e)

1.

2.

3.

Any memorandum of understanding between a participant's case management agency and the participant's service providers;

4.

Information regarding participants' satisfaction with services and the utilization of that information;

5.

a.

Includes updated findings and corrective actions as a result of department and case management quality assurance monitoring; and

b.

(i)

(ii)

(iii)

(iv)

6.

Evidence of continuous improvement of utilizing best practice standards toward meeting the critical strategic areas identified in the annual report released by the Kentucky National Core Indicators available at the Kentucky National Core Indicators Web site of http://www.nationalcoreindicators.org/states/KY/; and

7.

a.

b.

(f)

(g)

1.

Separate accounting shall be maintained for each participant or for the participant's interest in a common trust or special account;

2.

Account balance and records of transactions shall be provided to the participant or the participant's guardian on a quarterly basis; and

3.

The participant or the participant's guardian shall be notified if a balance is accrued that may affect Medicaid eligibility;

(h)

1.

2.

3.

4.

Support team meetings that help ensure and promote the participant's right to choice, inclusion, employment, growth, and privacy;

5.

Foster a restraint-free environment where the use of physical restraints, seclusion, chemical restraints, or aversive techniques shall be prohibited; and

6.

a.

b.

c.

d.

(i)

Shall have written policy and procedures for communication and interaction with a participant, family, or participant's guardian, which shall include:

1.

2.

3.

4.

Visitation with the participant at a reasonable time, without prior notice, and with due regard for the participant's right of privacy;

5.

Involvement in decision making regarding the selection and direction of the person-centered service provided; and

6.

Consideration of the cultural, educational, language, and socioeconomic characteristics of the participant and family being supported;

(j)

1.

2.

Making available a description of the rights and means by which the rights can be exercised and supported including the right to:

a.

b.

c.

d.

e.

f.

g.

h.

i.

Voice grievances and complaints regarding services and supports that are furnished without fear of retaliation, discrimination, coercion, or reprisal;

j.

k.

l.

Be informed of and participate in preparing the person-centered service plan and any changes in the person-centered service plan;

m.

(i)

(ii)

n.

o.

p.

Be informed of the name, business, telephone number, and business address of the person supervising the services and how to contact the person;

q.

r.

Be fully informed of any cost sharing liability and the consequences if any cost sharing is not paid;

s.

t.

u.

Be free from and educated on mental, verbal, sexual, and physical abuse, neglect, exploitation, isolation, and corporal or unusual punishment, including interference with daily functions of living; and

v.

3.

4.

Ensuring access to participation in the local human rights committee in accordance with the human rights committee requirements established in Section 7 of this administrative regulation; and

5.

a.

b.

In accordance with the behavior intervention committee requirements established in Section 8 of this administrative regulation;

(k)

Shall maintain fiscal records, service records, investigations, medication error logs, and incident reports for a minimum of six (6) years from the date that:

1.

2.

The participant turns twenty-one (21) years of age, if the participant is under the age of twenty-one (21);

(l)

1.

a.

b.

c.

d.

e.

f.

g.

h.

i.

2.

a.

b.

(m)

(n)

1.

2.

3.

4.

5.

a.

b.

c.

d.

(i)

Be administered by trained personnel using the department approved protocol at least annually and updated as needed; and

(ii)

e.

f.

The goals and objectives identified by the participant and the participant's person-centered team that facilitates achievement of the participant's chosen outcomes as identified in the participant's person-centered service plan;

g.

h.

i.

The participant's medication record, including a copy of the signed or authorized current prescription or medical orders and the medication administration record if medication is administered at the service site;

j.

k.

Legally adequate consent, updated annually, and a copy of which is located at each service site for the provision of services or other treatment requiring emergency attention;

l.

m.

n.

o.

p.

The MAP-350, Long Term Care Facilities and Home and Community Based Program Certification Form updated annually in the MWMA;

q.

r.

s.

t.

6.

a.

b.

Allows the participant or guardian to determine when to share the information in accordance with law; and

7.

(o)

1.

2.

Has a valid Social Security number or valid work permit if not a citizen of the United States of America; and

3.

If responsible for driving a participant during a service delivery, has a valid driver's license with proof of current mandatory liability insurance for the vehicle used to transport the participant;

(p)

1.

Completes a tuberculosis (TB) risk assessment performed by a licensed medical professional and, if indicated, a TB skin test with a negative result within the past twelve (12) months as documented on test results received by the provider within thirty (30) days of the date of hire or date the individual began serving as a volunteer; or

2.

a.

Shall be assessed annually by a licensed medical professional for signs or symptoms of active disease; and

b.

If it is determined that signs or symptoms of active disease are present, in order for the person to be allowed to work or volunteer, is administered follow-up testing by his or her physician with the testing indicating the person does not have active TB disease;

(q)

1.

Of an annual TB risk assessment or negative TB test for each employee who performs direct support or a supervisory function; or

2.

Annually for each employee with a positive TB test that ensures no active disease symptoms are present;

(r)

Shall provide a written job description for each staff person that describes the required qualifications, duties, and responsibilities for the person's job;

(s)

1.

2.

3.

4.

5.

(t)

1.

a.

b.

2.

For a volunteer recruited and placed by an agency or provider who has the potential to interact with a participant;

(u)

Shall ensure that a volunteer placed by an agency or provider does not have unsupervised interaction with a participant;

(v)

1.

a.

The results of a criminal record check from the Kentucky Administrative Office of the Courts and equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism;

b.

The results of a nurse aide abuse registry check as described in 906 KAR 1:100 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism;

c.

The results of a caregiver misconduct registry check as described in 922 KAR 5:120 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; and

d.

Within thirty (30) days of the date of hire or initial date of volunteerism, the results of a central registry check as described in 922 KAR 1:470 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; or

2.

May use Kentucky's national background check program established by 906 KAR 1:190 to satisfy the background check requirements of subparagraph 1 of this paragraph;

(w)

Shall for each potential employee obtain negative results of drug testing for illicit or prohibited drugs;

(x)

1.

Randomly select and perform criminal history background checks, nurse aide abuse registry checks, central registry checks, and caregiver misconduct registry checks of at least twenty-five (25) percent of employees; and

2.

(y)

Shall not use an employee or volunteer to provide 1915(c) home and community based waiver services if the employee or volunteer:

1.

2.

3.

Has a drug related conviction, felony plea bargain, or amended plea bargain conviction within the past five (5) years;

4.

5.

6.

a.

b.

7.

(z)

Shall not permit an employee to transport a participant if the employee has a driving under the influence conviction, amended plea bargain, or diversion during the past year;

(aa)

(bb)

Shall establish written guidelines that address and ensure the health, safety, and welfare of a participant, which shall include:

1.

a.

b.

c.

d.

2.

Effective cleaning and maintenance procedures sufficient to maintain a sanitary and comfortable environment that prevents the development and transmission of infection;

3.

a.

b.

At least two (2) correctly charged fire extinguishers placed in strategic locations, at least one (1) of which shall be capable of extinguishing a grease fire and have a rating of 1A10BC;

4.

Ensuring the availability of an ample supply of hot and cold running water with the water temperature complying with the safety limits established in the participant's person-centered service plan;

5.

Establishing written procedures concerning the presence of deadly weapons as defined in KRS 500.080, which shall ensure:

a.

b.

(i)

(ii)

6.

7.

Ensuring that the nutritional needs of a participant are met in accordance with the current recommended dietary allowance of the Food and Nutrition Board of the National Research Council or as specified by a physician;

8.

9.

Ensuring a smoke-free environment for any participant who chooses a smoke-free environment including settings in which the participant is expected to spend any amount of time, including home, a day training site, a meeting site, or any other location;

10.

a.

Every case manager and any employee who will be administering medication, unless the employee is a currently licensed or registered nurse, has:

(i)

Specific training provided by a registered nurse per a DBHDID medication administration approved curriculum; and

(ii)

Documented competency on medication administration, medication cause and effect, and proper administration and storage of medication; and

b.

An individual administering medication documents all medication administered, including self-administered and over-the-counter drugs, on a medication administration record, with the date, time, and initials of the person who administered the medication and ensuring that the medication shall:

(i)

(ii)

If a controlled substance, be kept under double lock with a documented medication count performed every shift;

(iii)

Be carried in a proper container labeled with medication and dosage pursuant to KRS 315.010(8) and 217.182(6);

(iv)

Accompany and be administered to a participant at a program site other than the participant's residence if necessary; and

(v)

11.

(cc)

1.

2.

Include instruction for notification procedures and the use of alarm and signal systems to alert a participant according to the participant's disability;

3.

Include documentation of training and competency of staff and training of participants on emergency disaster drills;

4.

Include an evacuation drill to be conducted in three (3) minutes or less, documented at least quarterly and, for a participant who receives residential support services, is scheduled to include a time when the participant is asleep; and

5.

Mandate that the result of an evacuation drill be evaluated and if not successfully completed within three (3) minutes shall modify staffing support as necessary and repeat the evacuation drill within seven (7) days;

(dd)

Shall provide orientation for each new employee, which shall include the mission, goals, organization, and practices, policies, and procedures of the agency;

(ee)

1.

2.

3.

4.

5.

6.

7.

Verification of competency of the trainee as demonstrated by post-training assessments, competency checklists, or post-training observations and evaluations;

(ff)

1.

Transcripts verifying successful completion of training objectives with scores of eighty-five (85) percent or higher; and

2.

Competency checklist listing date of completion, signature of evaluator, and signature of trainee for all Phase I or Phase II Kentucky College of Direct Support modules within the timeframe specified;

(gg)

Shall ensure that each case manager or employee prior to independent functioning and no later than six (6) months from the date of employment successfully completes training that shall include:

1.

2.

a.

Department of Behavioral Health, Developmental and Intellectual Disabilities' crisis prevention and intervention training; or

b.

(i)

(ii)

(iii)

(iv)

3.

4.

Individualized instruction about the person-centered service plan of the participant to whom the trainee provides supports; and

5.

Verification of trainee competency as demonstrated by pre- and post-training assessments, competency checklists, and post-training observations or evaluations;

(hh)

Shall ensure that all case managers or employees, unless the case manager or employee is a licensed professional providing a service governed by the licensure of the individual's profession, complete the Kentucky College of Direct Support Phase II training modules, no later than six (6) months from the date of employment or when the individual began providing services;

(ii)

Shall ensure that each case manager complete DBHDID approved case management training after three (3) months but within nine (9) months from the date of hire; and

(jj)

Shall ensure that each adult family member residing in a level II residential adult foster care home or family home provider who may be left alone with the participant will receive training regarding the individualized needs of the participant.

(4)

(a)

Obtain the rights to use the Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation; and

(b)

1.

A screening tool to assess health risk required to be used by an SCL waiver provider of residential services pursuant to this administrative regulation; or

2.

Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation.

(5)

(a)

Not manufacture, distribute, dispense, be under the influence of, purchase, possess, use, or attempt to purchase or obtain, sell, or transfer any of the following in the workplace or while performing work duties:

1.

2.

A controlled substance except an SCL provider, employee, or volunteer may use or possess a medically necessary and legally prescribed controlled substance;

3.

4.

5.

6.

A substance that resembles a controlled substance, if there is evidence that the individual intended to pass off the item as a controlled substance; and

(b)

Section 4.

(1)

(a)

1.

2.

Be provided to a participant pursuant to the participant's person-centered service plan by an individual who meets the requirements established in Section 3 of this administrative regulation.

(b)

Any combination of day training, community access, personal assistance, or any hours of paid community employment or on-site supported employment service shall not exceed sixteen (16) hours per day.

(2)

(a)

(b)

(c)

(d)

(e)

(f)

(g)

(h)

(i)

(j)

(k)

(l)

(m)

1.

2.

3.

(n)

(o)

(p)

(q)

(r)

(s)

(3)

(4)

(a)

(b)

Shall be designed to support a participant to participate in meaningful routines, events, and activities through various community organizations;

(c)

(d)

(e)

If participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation;

(f)

Shall stress training that empowers a participant in acquiring, practicing, utilizing, and improving skills related to:

1.

2.

3.

4.

5.

6.

7.

8.

Other skills related to optimal well-being as defined in the participant's person-centered service plan;

(g)

Shall be designed to result in an increased ability to develop natural supports and access community resources including educational, recreational, religious, civic, or volunteer opportunities with an outcome of:

1.

2.

Greater reliance on natural or unpaid supports as established in the participant's person-centered service plan;

(h)

Shall have an emphasis on the development of personal social networks, membership opportunities, friendships, and relationships for the participant as established in the participant's person-centered service plan;

(i)

Shall be provided outside the participant's home or residential setting and occur during the day, in the evening, or on weekends;

(j)

(k)

1.

2.

Ratio of one (1) staff to no more than two (2) participants according to the participant's person-centered service plan, if the participant invites a friend;

(l)

(m)

Shall be an impact service and the participant's person-centered service plan shall define steps to decrease the provision of the service as the participant becomes more independent in accessing and becoming part of the community;

(n)

1.

a.

b.

Evidence of training or service to support outcomes designated in the participant's person-centered service plan;

c.

d.

e.

f.

g.

2.

a.

b.

c.

d.

e.

f.

(o)

Shall not exceed 160 fifteen (15) minute units per week alone or in combination with community access group services.

(5)

(a)

1.

Be provided by a community guide who meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation;

2.

3.

Only be for a participant who chooses participant-directed supports for some or all of the participant's support services;

4.

a.

b.

(i)

(ii)

(iii)

(iv)

Accessing resources that promote implementation of the participant's person-centered service plan; and

c.

Information to ensure that the participant understands the responsibilities involved with directing the participant's services;

5.

a.

(i)

(ii)

(iii)

(iv)

(v)

(vi)

b.

(i)

(ii)

An analysis of the efficacy of the service provided including recommendations and identification of additional support needs;

(iii)

(iv)

6.

Be limited to 576 fifteen (15) minute units per one (1) year authorized person-centered service plan period.

(b)

1.

A participant and the participant's person-centered team shall determine the community guide services to be received.

2.

The community guide services to be received by a participant shall be specified in the participant's person-centered service plan.

(c)

1.

2.

a.

b.

c.

d.

e.

(d)

(e)

A community guide providing community guide services to a participant shall not provide other direct waiver services to any participant.

(f)

A community guide shall not be employed by an agency that provides other direct waiver services to the participant.

(6)

(a)

Shall be nonrecurring set-up expenses for a participant who is transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence where the participant is directly responsible for his or her own living expenses;

(b)

Shall be expenses that are necessary to enable a participant to establish a basic household that do not constitute room and board;

(c)

1.

2.

Essential household furnishings or moving expense required to occupy and use a community domicile, including furniture, window coverings, food preparation items, or bed or bath linens;

3.

A one (1) time set-up fee or deposit for utility or service access, including telephone, electricity, heating, or water;

4.

A service necessary for the participant's health and safety including pest eradication or one (1) time cleaning prior to occupancy;

5.

6.

(d)

1.

2.

3.

(e)

1.

2.

3.

4.

5.

(f)

1.

2.

3.

4.

(g)

(7)

(a)

1.

Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

2.

a.

b.

c.

d.

e.

f.

g.

h.

i.

(b)

1.

Professional consultation, evaluation, and assessment of the participant, the environment and the system of support, and written summary of findings and recommendations for the participant and the participant's person-centered team;

2.

a.

b.

c.

3.

Coordinating program wide support, as needed, that addresses the assessed needs, conditions, or symptoms affecting a participant's ability to fully participate in the participant's community;

4.

Participating in developing and revising, as needed, home treatment or support plans as components of a participant's person-centered service plan;

5.

Providing training and technical assistance to carry out recommendations and plans that shall occur within the settings in which the recommendations, home treatment, or support plans are to be carried out;

6.

a.

b.

c.

Of the impact of the participant's person-centered service plan on the participant, and the participant's environment and system of supports; and

d.

(i)

(ii)

Through discussions and observations of people implementing the participant's person-centered service plan; and

(iii)

7.

a.

Be conducted by a person who meets the personnel and training requirements established in Section 3 of this administrative regulation and is a:

(i)

(ii)

(iii)

b.

(i)

A description of the behavior patterns identified through the functional assessment and the goals of intervention; and

(ii)

Modifications to the social or physical environment that may prevent the behavior or increase the likelihood of alternative adaptive behaviors; and

c.

(i)

(ii)

(iii)

8.

a.

b.

An analysis of the efficacy of the service provided including any recommendation or identification of additional support needs if needed;

c.

d.

e.

f.

g.

(c)

Not exceed 160 fifteen (15) minute units per one (1) year authorized person-centered service plan period.

(8)

(a)

(b)

1.

Providing regularly scheduled activities in a non-residential setting that are designed to foster the acquisition of skills, build positive social behavior and interpersonal competence, and foster greater independence and personal choice;

2.

Career planning or pre-vocational activities to develop experiential learning opportunities and career options consistent with the participant's skills and interests that:

a.

b.

Provide active training designed to prepare a participant to transition from school to adult responsibilities, community integration, and work;

c.

Enable each individual to attain the highest level of work in the most integrated setting with the job matched to the participant's interests, strengths, priorities, abilities, and capabilities; and

d.

(i)

(ii)

(iii)

(iv)

(v)

(vi)

(vii)

3.

a.

b.

4.

Training and supports designed to maintain skills and functioning and to prevent or slow regression, rather than acquiring new skills or improving existing skills;

(c)

Shall include required informational sessions sponsored by the provider at least annually for the participant regarding community involvement or employment services and arrangement of opportunities for the participant to explore community integration, supported employment, and other employment opportunities in the community;

(d)

1.

2.

Requires skilled nursing services or nursing supervision in a licensed adult day health care center as outlined in the participant's person-centered service plan;

(e)

1.

2.

(f)

May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation;

(g)

Shall not be reimbursable if vocational in nature and for the primary purpose of producing goods or performing services;

(h)

1.

a.

b.

c.

d.

e.

f.

2.

a.

b.

An analysis of the efficacy of the service provided including recommendations and identification of additional support needs;

c.

d.

(i)

1.

2.

160 fifteen (15) minute units per week for day training alone or in combination with any hours of paid community employment or on-site supported employment service.

(9)

(a)

1.

a.

Designed to enable participants to interact more independently with their environment thereby enhancing their quality of life and reducing their dependence on physical support from others; and

b.

(i)

(ii)

Enable the participant to function with greater independence in the home and without which the participant would require institutionalization;

2.

a.

b.

c.

d.

Installation of a specialized electric and plumbing system, which shall be necessary to accommodate the medical equipment or supplies necessary for the welfare of the participant;

3.

a.

An adaptation or improvement to a home that is not of direct medical or remedial benefit to a participant;

b.

An adaptation that adds to the total square footage of a home except if necessary to complete an adaptation; and

c.

4.

a.

b.

By a vendor who shall be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020; and

5.

a.

b.

(i)

(ii)

(iii)

(iv)

c.

d.

(b)

An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a vendor or provider of an environmental accessibility adaptation service for the participant.

(c)

A home accessibility modification shall not be furnished to a participant who receives residential habilitation services except if the services are furnished in the participant's own home.

(d)

A request shall be documented in a participant's person-centered service plan and include cost of adaptations.

(10)

(a)

1.

Be services, equipment, or supplies that are individualized to a participant who chooses to use participant-directed services;

2.

Be utilized to reduce the need for personal care or to enhance independence within a participant's home or community;

3.

4.

a.

b.

c.

d.

5.

6.

7.

Be clearly linked to a participant need that has been documented in the participant's person-centered service plan;

8.

a.

b.

c.

d.

9.

(b)

1.

2.

(c)

An immediate family member, guardian, or legally responsible individual of a participant shall not be a provider of participant-directed goods and services to the participant.

(d)

(e)

(11)

(a)

1.

2.

a.

Training and education to individuals who provide unpaid support, training, companionship, or supervision to participants;

b.

Instruction about treatment regimens and other services specified in the participant's person-centered service plan;

c.

d.

The costs of registration and training fees associated with formal instruction in areas relevant to the participant's needs identified in the participant's person-centered service plan; or

e.

Training provided by a member of the participant's community regarding specific interests of the participant and how the natural support network shall support the participant's inclusion in activities and events surrounding the area of interest;

3.

Be individualized, direct training of families and natural support networks for acquisition or enhancement of their ability to support the participant;

4.

Relate to needs identified in a participant's person-centered service plan and be tied to a specific goal in the person-centered service plan;

5.

a.

b.

c.

d.

e.

6.

a.

b.

Community setting specific to community-based natural supports training goals specified in the participant's person-centered service plan;

7.

a.

b.

c.

d.

8.

a.

b.

c.

d.

The receipts or verification of service provision, including first and last name and title (if applicable) of the person providing the service and the signature of the person providing the service;

e.

f.

The progress made in moving the participant towards independence as reflected in goals and the participant's person-centered service plan.

(b)

An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a participant-directed provider of natural supports training services for the participant.

(c)

For purposes of natural supports training, an individual shall be defined as any person, family member, neighbor, friend, companion, or coworker who provides uncompensated care, training, guidance, companionship, or support to the participant who utilizes natural supports training.

(d)

(12)

(a)

1.

a.

b.

Work under the direction of a positive behavior support specialist or other licensed professional in the settings where the person-centered service plan is implemented; and

c.

Meet the personnel and training requirements specified in Section 3 of this administrative regulation;

2.

Be an individualized service to be utilized when a barrier challenges the success of a participant in achieving the participant's goals;

3.

a.

The provision of training developed in conjunction with certified or licensed professionals from the participant's person-centered team, to the participant, family, guardian, natural and paid supports on implementation of all or designated components of the participant's person-centered service plan;

b.

Monitoring the effectiveness of person-centered planning as demonstrated by the support system's implementation of the person-centered service plan or designated components across the array of service settings and reporting of required and pertinent data; and

c.

Data collection that shall be utilized by the participant's person-centered team to modify the environment or person-centered service plan as needed;

4.

5.

Not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 101 et seq.); and

6.

(b)

Person-centered coaching shall be outcome-based with a plan for the gradual withdrawal of the services.

(c)

(d)

1.

a.

b.

c.

d.

e.

f.

2.

a.

b.

A summary of the service provided including recommendations and identification of additional support needs if any exist;

c.

d.

e.

The signature, title, and date of review of documentation by the positive behavior specialist or other licensed professional directing the work of the person-centered coach.

(13)

(a)

(b)

Shall enable a participant to accomplish tasks that the participant normally would do for himself or herself if the participant did not have a disability;

(c)

Shall be available only to a participant who lives in the participant's own residence or in the participant's family residence;

(d)

May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation;

(e)

1.

2.

3.

4.

Assisting a participant in managing the participant's medical care including making medical appointments and accompanying the participant to medical appointments; or

5.

Transportation, which is not otherwise available under the Medicaid Program, to access community services, activities, and appointments;

(f)

Shall take place in a participant's home or in the community as appropriate to the participant's need;

(g)

1.

2.

Under the age of twenty-one (21) if medically necessary personal assistance is available as an early and periodic screening, diagnostic, and treatment service;

(h)

Shall not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.); and

(i)

1.

a.

b.

Evidence of training or service to support outcomes designated in the participant's person-centered service plan as appropriate;

c.

d.

e.

f.

g.

2.

a.

b.

c.

d.

e.

f.

(14)

(a)

1.

The utilization of evidenced based and best practices in behavioral techniques, interventions, and methods to assist a participant with significant, intensive challenges that interfere with activities of daily living, social interaction, or work;

2.

Evidenced based or best practices regarding treatment of a behavioral health condition that shall be the primary support services if supplemental behavioral interventions are needed; and

3.

a.

Be clearly based upon the information, data collected, and recommendations from the functional assessment;

b.

Meet the primary purpose of having the participant acquire or maintain skills for community living while behavioral interventions are delivered for the reduction of significant challenges that interfere with activities of daily living, social interaction, or work;

c.

d.

Be related to goals of interventions, such as greater participation in activities, or enhanced coping or social skills;

e.

Identify strategies for managing consequences to maximize reinforcement of adaptive or positive behavior and minimize that for target behavior;

f.

Delineate goals of intervention and specific replacement behavior or skills that are incorporated into the participant's total service plan;

g.

If necessary to ensure safety and rapid de-escalation of a targeted behavior, outline the de-escalation techniques and scaled response with criteria for use and documentation requirements;

h.

Include specific criteria for how data including rate, frequency, duration, and intensity shall be recorded;

i.

j.

(i)

(ii)

k.

Be revised whenever necessary and submitted for review to the local behavior intervention committee along with:

(i)

(ii)

(iii)

(iv)

(v)

l.

m.

Be implemented across service settings by the various people, both paid and natural supports, assisting a participant to reach the participant's goals and dreams.

(b)

(c)

Behavioral health treatment and positive behavioral supports shall be utilized in a collaborative manner.

(d)

(e)

(15)

(a)

1.

Be authorized for a participant based upon information from the participant's Supports Intensity Scale assessment, a screening tool that assesses health risk, and an approved person-centered service plan; and

2.

a.

b.

c.

A unit with lockable entrance doors and with only the individual and appropriate staff having keys to those doors;

d.

e.

The freedom to furnish or decorate the participant's sleeping or living units within the lease or other agreement;

f.

g.

Physical accessibility defined as being easy to approach, enter, operate, or participate in a safe manner and with dignity by a person with or without a disability.

(b)

To be considered physically accessible, a setting shall meet the Americans with Disabilities Act, 42 U.S.C. Chapter 126, standards of accessibility for all participants served in the setting.

(c)

All communal areas shall be accessible to all participants as well as having a means to enter the building, such as a key or security code.

(d)

(e)

Any modification of the additional residential conditions, except for the setting being physically accessible requirement, shall be supported by a specific assessed need and justified in the person-centered service plan.

(f)

1.

2.

Documentation of any positive intervention or support used prior to any modifications to the person-centered service plan;

3.

Documentation of any less intrusive method of meeting the participant's needs that has been tried but did not work;

4.

5.

6.

Established time limits for periodic reviews to determine if the modification is still necessary or can be terminated;

7.

8.

(g)

1.

a.

b.

c.

2.

a.

(i)

Information about how a participant spent the day including any effort toward meeting any outcome identified in the participant's person-centered service plan;

(ii)

(iii)

(iv)

(v)

b.

(i)

(ii)

(iii)

(iv)

(v)

(vi)

(16)

(a)

1.

Be furnished in a provider-owned or leased residence that complies with the Americans with Disabilities Act based upon the needs of each participant receiving a support in the residence;

2.

3.

a.

b.

(i)

(ii)

4.

a.

b.

Assistance with activities of daily living including bathing, dressing, toileting, transferring, or maintaining continence;

c.

d.

e.

f.

g.

h.

i.

The provision of medical or health care services that are integral to meeting the participant's daily needs; and

5.

Be outlined in a participant's person-centered service plan with an accurate reflection of the responsibilities of the residential provider.

(b)

1.

a.

(i)

(ii)

b.

Shall have no more than three (3) participants receiving publicly-funded supports in a home leased or owned by the provider; or

2.

a.

(i)

(ii)

b.

(c)

1.

For a participant approved for unsupervised time, a safety plan shall be included in the participant's person-centered service plan based upon the participant's assessed needs.

2.

A participant's case manager and other person-centered team members shall ensure that a participant is able to implement a safety plan.

3.

A participant's case manager shall provide ongoing monitoring of the safety plan, procedures, or assistive devices required by a participant to ensure relevance, the participant's ability to implement the safety plan, and the functionality of the devices if required.

(d)

If a participant experiences a change in support needs or status, the participant's person-centered team shall meet to make the necessary adjustments in the:

1.

2.

(e)

1.

2.

(17)

(a)

1.

a.

That complies with the Americans with Disabilities Act based upon the needs of each participant receiving a support in the residence; and

b.

To three (3) or fewer participants who, through the use of technology assisted residential services, reduce the amount of in-home staff support;

2.

a.

b.

3.

a.

b.

c.

d.

The provision of medical or health care services that are integral to meeting the participant's daily needs;

4.

5.

Be a real-time monitoring system with a two (2) way method of communication linking a participant to a centralized monitoring station; and

6.

a.

b.

c.

d.

e.

(b)

1.

A device listed in paragraph (a)6. of this subsection shall link a participant's residence to remote staff employed to provide electronic support.

2.

A technology assisted residential service provider shall have a plan established to ensure that staff is available twenty-four (24) hours a day, seven (7) days a week for a participant or participants receiving services from the provider.

(c)

Technology shall be used by the technology assisted residential service provider to assist a participant in residing in the most integrated setting appropriate to the participant's needs.

(d)

1.

2.

(e)

A participant's person-centered team shall give careful consideration to the participant's medical, behavioral, and psychiatric condition in determining the level and types of technology assisted residential services needed for a participant.

(f)

The use of technology to reduce a participant's need for residential staff support in a residence may be utilized if there is an individualized person-centered service plan that has been developed to promote a participant's increased independence:

1.

Based on the participant's needs as indicated in the scores and results of the Supports Intensity Scale assessment and a screening tool that assesses health risk; and

2.

(g)

1.

If a participant experiences a change in support need or status, the technology assisted residential service provider shall:

a.

b.

Reassess the appropriateness of technology assisted residential services and make any adjustment, if needed, to meet any chronic support need of the participant.

2.

Any adjustment shall be made in collaboration with the participant's case manager and person-centered team if the adjustment is to be implemented for a period longer than what was determined by the participant's person-centered team when developing the participant's person-centered service plan.

(h)

1.

Be responsible for arranging or providing a participant's transportation between the participant's residence and any other service site or community location;

2.

a.

(i)

(ii)

b.

(i)

Proficiency in the individual's ability to operate all monitoring devices utilized in technology assisted residential services; and

(ii)

3.

(18)

(a)

1.

2.

a.

Assist the participant with acquiring, retaining, or improving skills related to living in a community; and

b.

3.

Be designed and implemented to assist a participant to reside in the most integrated setting appropriate to the participant's needs;

4.

5.

a.

b.

c.

6.

a.

b.

7.

a.

b.

Assistance with activities of daily living including bathing, dressing, toileting, transferring, or maintaining continence;

c.

d.

e.

f.

g.

h.

i.

The provision of medical or health care services that are integral to meeting the participant's daily needs.

(b)

1.

a.

(i)

(ii)

b.

(i)

(ii)

2.

a.

(i)

(ii)

b.

Shall have no more than three (3) participants receiving publicly-funded supports living in the home.

(c)

1.

2.

(d)

If a participant experiences a change in support need or status, the level II residential services provider shall adjust services provided to the participant to meet the participant's altered need or status.

(e)

1.

Be included in the participant's person-centered service plan based upon the participant's assessed needs; and

2.

a.

The participant's case manager and other person centered service plan team members ensure that the participant is able to implement the safety plan; and

b.

The participant's case manager provides ongoing monitoring of the safety plan, procedures, or assistive devices required by the participant to ensure:

(i)

(ii)

(iii)

(f)

If a participant experiences a change in support needs or status, the participant's person-centered team shall meet to make the necessary adjustments in the:

1.

2.

(19)

(a)

1.

a.

b.

c.

2.

a.

b.

c.

3.

a.

b.

c.

d.

e.

4.

(b)

May be participant directed and if participant directed, may be provided by an immediate family member or guardian of the participant in accordance with Section 10 of this administrative regulation.

(20)

(a)

1.

2.

Be provided by a shared living caregiver who provides some of the participant's supports in exchange for the caregiver's share of room and board expenses.

(b)

A payment for the portion of the costs of rent or food attributable to an unrelated personal caregiver shall be routed through the financial management agency specifically for reimbursing the participant.

(c)

(d)

1.

Assistance with the acquisition, retention, or improvement in skills related to activities of daily living; or

2.

Supervision required for safety or the social and adaptive skills necessary to enable the participant to reside safely and comfortably in the participant's own home.

(e)

1.

2.

3.

4.

Complement other services the participant receives and enhance increased independence for the participant.

(f)

A participant's person-centered team shall decide and ensure that the individual who will serve as the participant's caregiver has the experience, skills, training, and knowledge appropriate to the participant and the type of support needed.

(g)

A participant's caregiver shall meet the participant-directed services provider requirements established in Section 10 of this administrative regulation.

(h)

1.

2.

(i)

A payment shall not be made if a participant lives in the caregiver's home or in a residence that is owned or leased by an SCL provider.

(j)

1.

2.

a.

A dated monthly summary note that is written by the case manager and details how services were provided according to the contractual agreement and the participant's person-centered service plan;

b.

A monthly receipt for the caregiver's room and board expenses that were reimbursed to the participant;

c.

d.

e.

A signed and dated statement from the participant or the participant's guardian indicating that the participant is satisfied with the services provided by the caregiver; and

f.

The signature, title and date of documentation review by the case manager supervisor who is supervising the case manager.

(k)

(21)

(a)

1.

Include a device, control, or appliance specified in a participant's person-centered service plan that shall:

a.

b.

2.

Include assessment or training needed to assist a participant with mobility, seating, bathing, transferring, security, or other skills including operating a wheelchair, a lock, a door opener, or a side lyre;

3.

Include a computer necessary for operating communication devices, a scanning communicator, a speech amplifier, a control switch, an electronic control unit, a wheelchair, a lock, a door opener, or a side lyre;

4.

5.

Include partial nutrition supplements, special clothing, an enuresis protective chuck, or another authorized supply that is specified in the participant's person-centered service plan;

6.

7.

8.

Be recommended by a person whose signature shall verify the type of specialized equipment or supply that is necessary to meet the participant's need; and who:

a.

Meets the personnel and training requirements established in Section 3 of this administrative regulation; and is:

(i)

(ii)

(iii)

b.

Is a certified or licensed practitioner whose scope of practice includes the evaluation and recommendation of specialized equipment or supplies;

9.

Not include equipment, a supply, an orthotic, prosthetic, service, or item covered under the department's:

a.

b.

c.

10.

a.

b.

c.

d.

e.

The signature, title, and date of the documentation review by the case manager supervisor providing supervision to the case manager.

(b)

Equipment purchased pursuant to this subsection for a participant shall become the property of the participant.

(22)

(a)

Supported employment shall be funded by the Rehabilitation Act of 1973 (29 U.S.C. Chapter 16) or Individuals with Disabilities Education Act (IDEA) (20 U.S.C. 1401 et seq.) for a participant if funding is available under either act for the participant.

(b)

If the funding referenced in paragraph (a) of this subsection is not available for a participant, SCL waiver funding may be accessed for the participant for all defined supported employment services if there has been no change in the impact of the participant's disability on the participant's employment.

(c)

1.

Be services that enable a participant to engage in paid work that occurs in an integrated community setting with competitive wages and benefits commensurate to the job responsibilities;

2.

Be covered for a participant if no change in the impact of a participant's disability on the participant's employment has occurred and:

a.

A Supported Employment Long-Term Support Plan has been completed, incorporated into the participant's person-centered service plan, and uploaded into the MWMA; or

b.

There is documentation of the payment of the supported employment individual outcome placement fee indicating closure of the case by the Office of Vocational Rehabilitation;

3.

4.

a.

b.

(i)

Meets the personnel and training requirements established in Section 3 of this administrative regulation; and

(ii)

Works for an SCL certified provider that is a vendor of supported employment services for the Office of Vocational Rehabilitation;

5.

Be delivered on a one (1) to one (1) basis with a participant or indirectly on behalf of a participant;

6.

7.

Be coordinated with other applicable 1915(c) home and community based waiver services, if applicable, in support of the participant's employment outcome.

(d)

Supported employment services delivered on a one-to-one basis and the hours spent by a participant performing paid employment and day training shall not exceed:

1.

2.

(e)

1.

2.

(f)

1.

a.

Be a respectful way to get to know a participant who is seeking a job and break past conceived notions about what a participant can or cannot do; and

b.

(i)

(ii)

(iii)

(iv)

(v)

(vi)

(vii)

2.

The Person-Centered Employment Plan shall be completed by the employment specialist, entered into the MWMA, and updated as needed.

3.

4.

Prior to receiving employment services and job development, a participant and the participant's person-centered team shall review the content of the Person-Centered Employment Plan and ensure that the plan:

a.

b.

c.

5.

a.

Person-centered job selection shall conclude with a meeting at which parties supporting the participant provide:

(i)

Suggestions of places in the participant's area where the participant might be able to perform the job tasks identified in the Person-Centered Employment Plan in return for at least minimum wage; and

(ii)

b.

Information gathered at the job planning meeting shall be documented in the participant's individual plan for employment.

6.

a.

(i)

Be conducted to determine the skills that the participant will need to successfully contribute in a specific workplace;

(ii)

Include deciding how to talk about the impact of the participant's disability in relation to the contributions that the participant can offer the employer;

(iii)

Include facilitating the development of natural supports based on ordinary social relationships at work; and

(iv)

Include matching job tasks that need to be completed for potential employers with the interests, skills, and abilities established in the participant's Person-Centered Employment Plan beginning with the leads provided during the job planning meeting.

b.

A participant and the participant's employment specialist may access up to ninety (90) units of job development services.

7.

a.

b.

Stabilization services shall include becoming as independent as is possible in the workplace through assistance from natural supports.

c.

The expectation shall be for systemic fading of the supported employment specialist to begin as soon as possible without jeopardizing the job and continuing until the participant receives only monitoring, career planning, and crisis assistance.

d.

A participant and the participant's supported employment specialist may access up to 800 units of job acquisition and stabilization services.

8.

Prior to initiating long-term support and follow-up services, the participant and the participant's person-centered team shall review the supported employment long-term support plan and ensure that the:

a.

Participant is functioning well in the job in terms of general satisfaction, number of hours worked, and performance of job duties;

b.

Participant is comfortable in interacting with coworkers and supervisors, and performs job duties through the use of natural supports; and

c.

Long-term support plan has been completed and integrated into the participant's person-centered service plan.

9.

a.

Long-term support and follow-up shall be provided to help a participant maintain the job and experience continued success after the:

(i)

(ii)

b.

The supported employment specialist shall continue to be available for the participant if and when needed for support or assistance with any job change or job advancement.

c.

(i)

The participant and the participant's supported employment specialist may access twenty-four (24) units of supported employment each month.

(ii)

Any increase in supported employment units shall be justified in the long-term employment support plan and approved by the participant and the participant's person-centered team.

10.

A person-centered employment plan activity note, notes regarding a participant's job development activity, notes regarding a participant's job acquisition or stabilization activity, and notes regarding a participant's long-term employment support activity shall:

a.

Be completed, and uploaded into the MWMA, by a participant's supported employment specialist to document each contact with the participant or action provided on behalf of the participant; and

b.

(i)

(ii)

(iii)

(iv)

(v)

(vi)

(vii)

(viii)

(23)

(a)

1.

Enable a participant who chooses to use participant-directed services to gain access to integrated waiver and other community services, activities, resources, and organizations typically utilized by the general population;

2.

a.

Otherwise and customarily available through natural supports including family, friends, neighbors, or community agencies; or

b.

3.

4.

Be clearly described in a participant's person-centered service plan, which shall include information regarding the unavailability of other transportation services or resources;

5.

Be reimbursable based upon the assessed needs of a participant as specified in the participant's person-centered service plan;

6.

a.

Is at least eighteen (18) years of age and legally licensed to operate the transporting vehicle to which the individual is assigned or owns;

b.

Has proof of current liability insurance for the vehicle in which the participant will be transported; and

c.

7.

a.

b.

(i)

(ii)

(iii)

(iv)

(b)

A participant shall not contract with an individual to provide transportation if the individual has a driving under the influence conviction within the past twelve (12) months.

(c)

A transportation service may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation.

(d)

1.

2.

Ensure that the following documentation is completed and submitted to the financial management agency for direct payment to the approved vendor:

a.

b.

c.

The location of origin of the transportation service, destination of the transportation service, and the mileage incurred from point to point;

d.

Verification of service delivery, including the first and last name and title (if applicable) of the individual providing the service; and

e.

A receipt from the driver if a bus, taxicab, or similar type of transportation service in which the participant directly purchases the service is utilized.

(24)

(a)

1.

a.

b.

Interact more independently with the participant's environment and reduce the participant's dependence on physical support from others;

2.

3.

a.

b.

c.

d.

An interior modification to allow for access into and out of the vehicle as well as safety while the vehicle is moving;

4.

5.

6.

a.

Documenting an estimate from a vendor determined to be qualified to complete vehicle modifications by the Office of Vocational Rehabilitation;

b.

Documentation from the Office of Vocational Rehabilitation that the participant is not qualified to receive a vehicle modification from the Office of Vocational Rehabilitation;

c.

d.

e.

Verification by the case manager that the work is complete, adequate, and satisfactory within ten (10) business days of completion before payment is requested and issued;

f.

g.

(b)

(c)

1.

2.

Include an assessment from an occupational therapist or physical therapist specializing in vehicle modifications that result in specific recommendations for the type of modification to meet the needs of the participant.

(d)

The department shall not reimburse for the repair or replacement costs of a vehicle adaptation of a vehicle owned by an SCL provider.

(e)

A vehicle adaptation vendor shall be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020.

(f)

An immediate family member, guardian, or legally responsible individual of the participant shall not be eligible to be a vendor or provider of a vehicle adaptation service for the participant.

(g)

Section 5.

(1)

(a)

(b)

1.

2.

3.

4.

Any other individual chosen by the participant if the participant chooses any other individual to participate in developing the person-centered service plan;

(c)

1.

Provides the necessary information and support to empower the participant, the participant's guardian, or participant's representative to direct the planning process in a way that empowers the participant to have the freedom and support to control the participant's schedules and activities without coercion or restraint;

2.

3.

4.

a.

b.

In a way that is accessible to an individual with a disability or who has limited English proficiency;

5.

Offers an informed choice defined as a choice from options based on accurate and thorough knowledge and understanding to the participant regarding the services and supports to be received and from whom;

6.

Includes a method for the participant to request updates to the person-centered service plan as needed;

7.

a.

b.

c.

8.

9.

a.

(i)

(ii)

(iii)

(iv)

b.

(i)

(ii)

(iii)

c.

d.

(i)

(ii)

(iii)

e.

Includes a range of supports including funded, community, and natural supports that shall assist the participant in achieving identified goals;

f.

(i)

(ii)

g.

Assists the participant in making informed choices by facilitating knowledge of and access to services and supports;

h.

i.

j.

Is understandable to the participant and to the individuals who are important in supporting the participant;

k.

l.

Is finalized and agreed to with the informed consent of the participant or participant's representative in writing with signatures by each individual who will be involved in implementing the person-centered service plan;

m.

Shall be distributed to the individual and other people involved in implementing the person-centered service plan;

n.

o.

(d)

1.

Have access to make private phone calls, texts, or emails at the participant's preference or convenience; and

2.

a.

b.

c.

d.

(i)

(ii)

(iii)

(2)

If a participant's person-centered service plan includes ADHC services, the ADHC services plan of treatment shall be addressed in the person-centered service plan.

(3)

(a)

1.

2.

(b)

A participant or participant's authorized representative shall complete and upload into the MWMA a MAP - 116 Service Plan - Participant Authorization prior to or at the time the person-centered service plan is uploaded into the MWMA.

Section 6.

(1)

(a)

Have a bachelor's degree from an accredited institution in a human services field and be supervised by:

1.

2.

A registered nurse who has at least two (2) years of experience working with individuals with an intellectual or a development disability;

3.

An individual with a bachelor's degree in a human services field who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability;

4.

A licensed clinical social worker who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability;

5.

A licensed marriage and family therapist who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability;

6.

A licensed professional clinical counselor who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability;

7.

A certified psychologist or licensed psychological associate who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability; or

8.

A licensed psychological practitioner or certified psychologist with autonomous functioning who has at least two (2) years of experience working with individuals with an intellectual or a developmental disability;

(b)

(c)

(d)

(e)

(f)

(g)

(2)

(a)

(b)

(c)

1.

Be competent in the participant's language either through personal knowledge of the language or through interpretation; and

2.

Demonstrate a heightened awareness of the unique way in which the participant interacts with the world around the participant;

(d)

1.

a.

b.

c.

2.

All individuals involved in implementing the participant's person-centered service plan are informed of changes in the scope of work related to the person-centered service plan as applicable;

(e)

1.

2.

Coordinate services through team meetings with representatives of all agencies involved in implementing a participant's person-centered service plan;

(f)

1.

Include the participant's participation or representative's participation in the case management process; and

2.

(g)

1.

A participant's interactions and communications with other agencies involved in implementing the participant's person-centered service plan; and

2.

(h)

Advocate for a participant with service providers to ensure that services are delivered as established in the participant's person-centered service plan;

(i)

Assess the quality of services, safety of services, and cost effectiveness of services being provided to a participant in order to ensure that implementation of the participant's person-centered service plan is successful and done so in a way that is efficient regarding the participant's financial assets and benefits;

(j)

Document services provided to a participant by entering into the MWMA a monthly contact note, which shall include:

1.

2.

3.

4.

5.

6.

(k)

1.

2.

3.

4.

5.

6.

(l)

Provide information about participant-directed services to the participant or the participant's guardian:

1.

2.

3.

(m)

(3)

(a)

Case management for any individual who begins receiving SCL services after the effective date of this administrative regulation shall be conflict free except as allowed in paragraph (b) of this subsection.

(b)

1.

Conflict free case management shall be a scenario in which a provider including any subsidiary, partnership, not-for-profit, or for-profit business entity that has a business interest in the provider who renders case management to a participant shall not also provide another 1915(c) home and community based waiver service to that same participant unless the provider is the only willing and qualified SCL provider within thirty (30) miles of the participant's residence.

2.

a.

b.

The participant's case manager provides documentation of evidence to DBHDID, that there is a lack of a qualified case manager within thirty (30) miles of the participant's residence;

c.

The participant or participant's representative and case manager signs a completed MAP - 531 Conflict-Free Case Management Exemption; and

d.

The participant, participant's representative, or case manager uploads the completed MAP - 531 Conflict-Free Case Management Exemption into the MWMA.

3.

If a case management service is approved to be provided despite not being conflict free, the case management provider shall document conflict of interest protections, separate case management and service provision functions within the provider entity, and demonstrate that the participant is provided with a clear and accessible alternative dispute resolution process.

4.

An exemption to the conflict free case management requirement shall be requested upon reassessment or at least annually.

(c)

A participant who receives SCL services prior to the effective date of this administrative regulation shall transition to conflict free case management when the participant's next level of care determination occurs.

(d)

During the transition to conflict free case management, any case manager providing case management to a participant shall educate the participant and members of the participant's person-centered team of the conflict free case management requirement in order to prepare the participant to decide, if necessary, to change the participant's:

1.

2.

(4)

(a)

Initiation, coordination, implementation, and monitoring of the assessment, reassessment, evaluation, intake, and eligibility process;

(b)

Assisting a participant in the identification, coordination, and arrangement of the person centered team and person centered team meetings;

(c)

Facilitating person-centered team meetings that assist a participant to develop, update, and monitor the person-centered service plan, which shall be distributed or made available to all members of the person-centered team within five (5) business days of development;

(d)

Assisting a participant to gain access to and maintain employment, membership in community clubs and groups, activities, and opportunities at the times, frequencies, and with the people the participant chooses;

(e)

Coordinating and monitoring all 1915(c) home and community based waiver services and non-waiver services including having monthly face-to-face contacts with the participant to determine if the participant's needs are being met.

1.

2.

a.

b.

Gather data regarding the participant's satisfaction with the services for use in guiding the person centered planning process;

c.

(i)

(ii)

(iii)

d.

3.

a.

Initiating person-centered team meetings and receiving prior authorization within fourteen (14) days of a contact visit if the results of a monthly contact visit indicate that different or additional services or other changes in the participant's person-centered service plan are required to meet the participant's needs;

b.

(i)

Assisting the participant in identifying, if necessary, a community guide and a representative who shall work with the participant on the development of a person-centered service plan, budget, and emergency back-up plan;

(ii)

(iii)

Assigning modules within the Kentucky College of Direct Supports for training purposes and assisting the participant, the community guide, or the representative in monitoring the completion of training within timeframes specified in Section 10 of this administrative regulation;

c.

Monitoring the provision of services and submission of required documentation to the financial management agency; and

d.

(f)

1.

2.

Exploring the potential availability of other resources and social service programs for which the participant may qualify;

(g)

Monitoring to ensure that services continue if a participant has been terminated from any service until an alternate provider, if needed, has been chosen by the participant and services have been approved;

(h)

Providing a participant and the participant's team members twenty-four (24) hour telephone access to a case management staff person;

(i)

Documentation, uploaded into the MWMA, of services by a detailed monthly summary note, which shall include:

1.

2.

3.

4.

5.

6.

(j)

Person-centered team meetings, which shall not constitute the required monthly face-to-face visit with a participant; and

(k)

Supervision duties performed by the case manager supervisor who provides supervision in accordance with a DBHDID approved case manager supervisor training.

(5)

(a)

(b)

(6)

(a)

(b)

Section 7.

(1)

A human rights committee shall meet on a routine, scheduled basis, no less than quarterly to ensure that the rights of participants utilizing SCL services are respected and protected through due process.

(2)

(a)

(b)

At least one (1) member from the community at large with experience in human rights issues or in the field of intellectual or developmental disabilities;

(c)

(d)

(e)

1.

2.

(3)

(a)

(b)

Provide the necessary documentation to the local human rights committee for review and approval prior to implementation of any rights restrictions or positive behavior support plans involving rights restrictions.

(4)

A human rights committee meeting shall have a quorum of at least three (3) members, including at least one (1) self-advocate and one (1) community at large member.

(5)

(a)

(b)

1.

2.

(6)

(a)

(b)

(c)

Function in accordance with the Health Insurance Portability and Accountability Act codified as 45 C.F.R. Parts 160, 162, and 164.

(7)

(a)

1.

2.

3.

Paired with learning or training components to assist the participant in eventual reduction or elimination of the restriction;

4.

5.

Reviewed by the human rights committee at least once annually if the restriction remains in place for at least twelve (12) months.

(b)

In an emergency where there is imminent danger or potential harm to a participant or other individuals, the participant's SCL service provider in consultation with the case manager and participant's guardian, as appropriate, may limit or restrict the participant's rights for a maximum of one (1) week.

(c)

If a participant is under the care of a psychologist, counselor, psychiatrist, or behavior support specialist, a restriction plan:

1.

Shall be developed with the input of the psychologist, counselor, psychiatrist, or behavior support specialist; and

2.

(d)

A proposed continuation of a restriction shall be immediately reviewed and approved by three (3) members of the local human rights committee while alternative strategies are being developed.

(e)

If it is decided that a rights restriction needs to be continued and addressed in the participant's person-centered service plan, the restriction shall be submitted to the local:

1.

2.

Section 8.

(1)

(a)

(b)

At least one (1) member from the community at large with experience in human rights issues or in the field of intellectual or developmental disabilities;

(c)

(d)

1.

2.

3.

4.

(2)

(a)

A behavior intervention committee shall meet at least quarterly to review, approve, and as necessary, make written technical recommendations for each new or revised positive behavior support plan as submitted.

(b)

A behavior intervention committee meeting shall have a quorum of at least three (3) members including at least one (1):

1.

2.

a.

b.

(3)

(a)

Positive behavior supports are clinically sound and based on person-centered values considering what is important for the participant;

(b)

Assessments and interventions utilize evidenced based and best practices for treatment of a behavioral health condition as the primary support services when supplemental behavioral interventions are needed;

(c)

The use of both behavioral health treatment and positive behavioral supports shall be utilized in a collaborative manner; and

(d)

1.

2.

(4)

(a)

(b)

1.

2.

(5)

(a)

(b)

(c)

Function in accordance with the Health Insurance Portability and Accountability Act codified as 45 C.F.R. Parts 160, 162, and 164.

Section 9.

(1)

(a)

1.

2.

(b)

The participant's freedom of choice as defined by the experience of independence, individual initiative, or autonomy in making life choices in all matters (small as well as large);

(c)

That the participant or participant's representative chooses services, providers, and service settings including non-disability specific settings if so desired;

(d)

That the participant is provided with a choice of where to live with as much independence as possible and in the most community-integrated environment; and

(e)

1.

2.

(2)

(3)

(a)

(b)

(c)

Section 10.

(1)

(a)

1.

The services listed in subparagraph 2. of this paragraph may be participant directed and shall be provided in accordance with the:

a.

Specifications and requirements established in Section 4 of this administrative regulation except for the monthly summary note requirements established in Section 4 of this administrative regulation; and

b.

2.

a.

b.

c.

d.

e.

f.

g.

(b)

1.

Background and related requirements established in Section 3(3)(p), (q), (r), (v), (w), (x), (y), and (z) of this administrative regulation; and

2.

a.

b.

If providing supported employment services, the Kentucky Supported Employment Training Project curriculum from the Human Development Institute at the University of Kentucky within eight (8) months of the date of employment as an employment specialist;

c.

d.

(i)

(ii)

(iii)

(iv)

(v)

e.

(c)

The training required by paragraph (b) of this subsection shall be completed within six (6) months of the date of hire for a new provider of a participant-directed service.

(2)

An individual providing a participant-directed service to more than three (3) participants in the same household or different households shall complete all provider training requirements as specified in Section 3 of this administrative regulation.

(3)

(a)

The following services may be participant directed and shall be provided in accordance with the specifications and requirements established in Section 4 of this administrative regulation and this section:

1.

2.

3.

4.

5.

(b)

A participant-directed service shall not be available to a participant who resides in a living arrangement, regardless of funding source, that is furnished to four (4) or more individuals who are unrelated to the proprietor.

(4)

An immediate family member or guardian of a participant may provide a support to a participant-directed service if:

(a)

(b)

The family member or guardian has the unique abilities necessary to meet the needs of the participant;

(c)

(d)

(e)

(f)

1.

2.

(g)

(h)

1.

2.

3.

4.

5.

(i)

1.

2.

(j)

1.

Completes a MAP - 532 PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as Paid Service Provider; and

2.

Uploads the completed MAP - 532 PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as Paid Service Provider into the MWMA.

(5)

(a)

(b)

The legally responsible individual meets the requirements established for a family member or guardian in subsection (4) of this section;

(c)

The service exceeds the range of activities that a legally responsible individual would ordinarily provide in a household on behalf of a person:

1.

2.

(d)

1.

2.

(e)

1.

Completes a MAP - 532 PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as Paid Service Provider; and

2.

Uploads the completed MAP - 532 PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as Paid Service Provider into the MWMA.

(6)

An individual serving as a representative for a participant shall not be eligible to provide a 1915(c) home and community based waiver service to the participant.

(7)

A participant-directed reimbursement service shall be provided by a financial management agency with whom the department contracts that shall:

(a)

Only pay for a service identified and prior authorized in a participant's person-centered service plan;

(b)

Ensure compliance with all Internal Revenue Service regulations, United States Department of Labor regulations, and Kentucky Department of Workers' Claims administrative regulations regarding workers' compensation;

(c)

(d)

Receive, disburse, and track public funds based on a participant's approved person-centered service plan; and

(e)

1.

2.

(8)

(a)

(b)

If a participant elects to disenroll from a participant-directed service, the participant's case manager shall assist the participant and the participant's guardian to locate a traditional 1915(c) home and community based waiver service provider of the participant's choice to provide the service.

(c)

1.

Except as provided in subparagraph 2 of this paragraph, a participant-directed service shall not be terminated until a traditional service provider is ready to provide the service.

2.

(9)

(a)

A participant's case manager shall develop a corrective action plan in conjunction with the participant, the participant's guardian, and any other person-centered team member if:

1.

2.

The participant, a family member of the participant, an employee of the participant, the participant's guardian, or a legal representative of the participant threatens, intimidates, or consistently refuses services from an SCL provider;

3.

4.

The participant, a family member of the participant, an employee of the participant, the participant's guardian, or a legal representative of the participant interferes with or denies the provision of case management.

(b)

The participant's case manager shall monitor the progress of the corrective action plan and resulting outcomes to resolve the issue described in paragraph (a) of this subsection that necessitated a corrective action plan.

(c)

If the issue referenced in paragraph (a) of this subsection is not resolved, the participant's case manager, in conjunction with the participant's person-centered team members, shall assist the participant to locate a traditional 1915(c) home and community based waiver service provider of the participant's choice to provide the service.

(d)

A participant-directed service shall not be terminated until a traditional service provider is ready to provide the service.

(10)

(a)

(b)

1.

A full description of each service provided to support an outcome or outcomes in the participant's person-centered service plan;

2.

3.

4.

5.

6.

(c)

Section 11.

(1)

(a)

(b)

(2)

An incident shall be any occurrence that impacts the health, safety, welfare, or lifestyle choice of a participant and includes:

(a)

(b)

(c)

(3)

(a)

(b)

1.

2.

3.

4.

5.

6.

(4)

(a)

1.

Individual who discovered or witnessed the incident shall document the details of the incident and report it to designated agency staff for entry into the MWMA; and

2.

(b)

If an assessment of an incident indicates that the potential for abuse, neglect, or exploitation exists:

1.

The individual who discovered or witnessed the incident shall immediately act to ensure the health, safety, or welfare of the at-risk participant;

2.

3.

The critical incident procedures established in subsection (5) of this section shall be followed; and

4.

The SCL provider shall report the incident to the participant's case manager and participant's guardian, if the participant has a guardian, within twenty-four (24) hours of discovery of the incident.

(5)

(a)

If a critical incident occurs, the individual who witnessed the critical incident or discovered the critical incident shall Immediately act to ensure the health, safety, and welfare of the at-risk participant.

(b)

1.

Requires reporting of abuse, neglect, or exploitation, the critical incident shall be immediately reported via the MWMA; or

2.

Does not require reporting of abuse, neglect, or exploitation, the critical incident shall be reported via the MWMA by a designated agency staff person within eight (8) hours of discovery.

(c)

1.

Conduct an immediate investigation and involve the participant's case manager in the investigation; and

2.

a.

Identifying information of the participant involved in the critical incident and the person reporting the critical incident;

b.

c.

(i)

Diagnostic impressions and medical diagnoses based on the current version of American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders TM ;

(ii)

(iii)

(iv)

(6)

(a)

Following a death of a participant receiving services from an SCL provider, the SCL provider shall enter mortality data documentation into the MWMA within fourteen (14) days of the death.

(b)

1.

2.

3.

The participant's medication administration records from all service sites for the past three (3) months along with a copy of each prescription, if applicable;

4.

Progress notes regarding the participant from all service elements for the past thirty (30) days, including case management notes;

5.

6.

7.

8.

9.

A full life history of the participant including any update from the last version of the life history;

10.

Names and contact information for all staff members who provided direct care to the participant during the last thirty (30) days of the participant's life;

11.

12.

13.

a.

The participant's advance directive, medical order for scope of treatment, living will, or health care directive if applicable;

b.

Any functional assessment of behavior or positive behavior support plan regarding the participant that has been in place over any part of the past twelve (12) months; and

c.

The cardiopulmonary resuscitation and first aid card for any SCL provider's staff member who was present at the time of the incident that resulted in the participant's death;

14.

A record of all medical appointments or emergency room visits by the participant within the past twelve (12) months; and

15.

A record of any crisis training for any staff member present at the time of the incident that resulted in the participant's death.

(7)

An SCL provider shall document all medication error details on a medication error log retained on file at the SCL provider site.

Section 12.

(1)

(a)

1.

2.

(b)

The following information shall be included in the information entered by the individual into the MWMA:

1.

A signature from a physician or an SCL developmental disability professional verifying diagnostic impressions and medical diagnoses;

2.

A current and valid intellectual or development disability diagnosis, including supporting documentation to validate the diagnosis and age of onset; and

3.

(c)

1.

A psychological or psycho-educational report of the assessment results of at least an individual test of intelligence resulting in an intelligence quotient (IQ) score; and

2.

The results of an assessment of adaptive behavior abilities that has been signed by the licensed psychologist, licensed psychological associate, certified psychologist with autonomous functioning, or certified school psychologist who prepared the report.

(d)

1.

Have been conducted before the age of eighteen (18) years for a diagnosis of intellectual disability or before the age of twenty-two (22) years for a diagnosis of a developmental disability; or

2.

If a record of an IQ score prior to the age of eighteen (18) years for an applicant with an intellectual disability or prior to the age of twenty-two (22) years for an applicant with a developmental disability cannot be obtained, the following shall qualify as supporting documentation to validate a diagnosis and age of onset:

a.

Individual education program documentation that contains an IQ score and a report or description of adaptive behavior skills;

b.

The results of a psychological assessment submitted during the course of guardianship proceedings; or

c.

(i)

Include evidence of onset prior to the age of eighteen (18) years for an intellectual disability or the age of twenty-two (22) years for a developmental disability obtained through a comprehensive developmental history; and

(ii)

Provide documentation ruling out factors or conditions that may contribute to diminished cognitive and adaptive functioning, including severe mental illness, chronic substance abuse, or medical conditions.

(2)

DBHDID shall review an individual's application information to determine if the information is complete and valid.

(3)

(a)

1.

The chronological date of receipt of complete application information regarding the individual being entered into the MWMA; and

2.

(b)

An individual's category of need shall be the emergency category if an immediate service is needed as determined by any of the following if all other service options have been explored and exhausted:

1.

2.

3.

a.

b.

c.

4.

Jeopardy to the health and safety of the individual due to the primary caregiver's physical or mental health status; or

5.

(c)

An individual's category of need shall be the urgent category if an SCL service is needed within one (1) year; and

1.

There is a threatened loss of the individual's existing funding source for supports within the year due to the individual's age or eligibility;

2.

The individual is residing in a temporary or inappropriate placement but the individual's health and safety is assured;

3.

The individual's primary caregiver has a diminished capacity due to physical or mental status and no alternative primary caregiver exists; or

4.

The individual exhibits an intermittent behavior or action that requires hospitalization or police intervention.

(d)

An individual's category of need shall be classified as future planning if an SCL service is needed in more than one (1) year; and

1.

The individual is currently receiving a service through another funding source that meets the individual's needs;

2.

3.

(4)

A written notification of original placement on the SCL waiting list and any change due to a reconsideration shall be mailed to an individual or the individual's guardian and case management provider if identified.

(5)

In determining chronological status, the original date of an individual's complete application information being entered into the MWMA shall:

(a)

(b)

(6)

(a)

The department shall, at a minimum, annually update the waiting list information about an individual during the birth month of that individual.

(b)

The individual or individual's guardian and case management provider, if identified, shall be contacted in writing to verify the accuracy of the information on the SCL waiting list and the individual's or individual's guardian's continued desire to pursue placement in the SCL program.

(c)

If a discrepancy in diagnostic information is noted at the time of the annual update, the department may request a current diagnosis of intellectual or developmental disability signed by a physician or SCL IDP, including documentation supporting the diagnosis.

(d)

The information referenced in paragraph (c) of this subsection shall be received by the department within thirty (30) days from the date of the written request in order to be considered timely.

(7)

A reassignment of an individual's category of need shall be completed based on updated information and the validation process.

(8)

An individual or individual's guardian may submit a written request for consideration of movement from one (1) category of need to another if there is a change in status of the individual.

(9)

(a)

1.

After a documented attempt, the department is unable to locate the individual or the individual's guardian;

2.

3.

A review of documentation reveals that the individual does not have an intellectual or a developmental disability diagnosis;

4.

a.

b.

5.

Notification of potential SCL funding is made and the individual or the individual's guardian does not complete the enrollment process with DBHDID nor notify DBHDID of the need for an extension within sixty (60) days of the potential funding notice date.

(b)

1.

A notification of need for an extension for good cause shall consist of a statement signed by the individual or the individual's guardian explaining the reason for the delay in accessing services, steps being taken to access services, and expected date to begin utilizing services.

2.

Upon receipt of documentation, the department shall grant, in writing, one (1) sixty (60) day extension.

(10)

If a notification of potential SCL funding is made and an individual or the individual's guardian declines the potential funding but requests to be maintained on the SCL waiting list, the:

(a)

(b)

(11)

If an individual is removed from the SCL waiting list, DBHDID shall mail written notification to the:

(a)

(b)

(12)

The removal of an individual from the SCL waiting list shall not prevent the submission of a new application at a later date.

(13)

(a)

(b)

(c)

(14)

To be allocated potential funding, an individual residing in an institution shall meet the following criteria in addition to the criteria established in this section:

(a)

The individual's treatment professionals shall determine that an SCL placement is appropriate for the individual; and

(b)

Section 13.

Use of Electronic Signatures. The creation, transmission, storage, or other use of electronic signatures and documents shall comply with:

(1)

(2)

Section 14.

Employee Policies and Requirements Apply to Subcontractors. Any policy or requirement established in this administrative regulation regarding an employee shall apply to a subcontractor.

Section 15.

(1)

An appeal of a department decision regarding a Medicaid beneficiary based upon an application of this administrative regulation shall be in accordance with 907 KAR 1:563.

(2)

An appeal of a department decision regarding Medicaid eligibility of an individual based upon an application of this administrative regulation shall be in accordance with 907 KAR 1:560.

(3)

An appeal of a department decision regarding a provider based upon an application of this administrative regulation shall be in accordance with 907 KAR 1:671.

(4)

The department shall not grant an appeal regarding a category of need determination made pursuant to Section 12 of this administrative regulation.

Section 16.

Participant Rather than Provider Driven. Funding for the SCL waiver program shall be associated with and generated through SCL waiver program participants rather than SCL waiver service providers.

Section 17.

Federal Approval and Federal Financial Participation. The department's coverage of services pursuant to this administrative regulation shall be contingent upon:

(1)

(2)

Section 18.

(1)

(a)

(b)

(c)

"MAP - 350 Long Term Care Facilities and Home and Community Based Program Certification Form", June 2015;

(d)

(e)

(f)

(g)

"MAP - 532 PDS Request Form for Immediate Family Member, Guardian, or Legally Responsible Individual as Paid Service Provider", December 2013.

(2)

(a)

At the Department for Medicaid Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.; or

(b)

HISTORY: (39 Ky.R. 690; 1239; 1431; eff. 2-1-2013; TAm eff. 9-10-2014; TAm eff. 11-4-2014; 42 Ky.R. 1031, 1871, 2759; eff. 6-3-2016; TAm eff. 5-3-2017; Cert. eff. 5-9-2023.)

907 KAR 12:010. New Supports for community living waiver service and coverage policies.

RELATES TO:

STATUTORY AUTHORITY:

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 service and coverage policies for the Supports for Community Living (SCL) waiver program. The SCL waiver program is federally authorized via a 1915(c) home and community based waiver that enables individuals with an intellectual or developmental disability to reside and receive services in a community setting rather than in an intermediate care facility for individuals with intellectual disabilities, including a participant directed services option pursuant to KRS 205.5606.

Section 1.

(1)

"1915(c) home and community based waiver program" means a Kentucky Medicaid program established pursuant to, and in accordance with, 42 U.S.C. 1396n(c).

(2)

(3)

"Adult day health care center" means an adult day health care center licensed in accordance with 902 KAR 20:066.

(4)

(a)

(b)

1.

2.

(c)

1.

2.

3.

Ensures that the participant's needs are met in accordance with the participant's person-centered service plan.

(5)

(6)

(a)

1.

2.

3.

4.

5.

(b)

(c)

(7)

(a)

Established to evaluate the technical adequacy of a proposed behavioral intervention for a participant; and

(b)

That meets in accordance with the BIC policies established in Section 8 of this administrative regulation.

(8)

"Board" means three (3) meals a day or other full nutritional regimen of a caregiver for the purpose of providing shared living services.

(9)

(a)

Meets the requirements for a case manager established in Section 6 of this administrative regulation; and

(b)

Meets all personnel and training requirements established in Section 3 of this administrative regulation.

(10)

(a)

(b)

1.

2.

Has a bachelor's degree in any other field from an accredited college or university with at least one (1) year of experience in the field of intellectual disability; or

3.

(c)

Has at least two (2) years of experience of case management responsibility in an organization that serves individuals with intellectual or developmental disabilities;

(d)

Completes a case management supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities; and

(e)

Meets all personnel and training requirements established in Section 3 of this administrative regulation.

(11)

(12)

"Certified psychologist" means an individual who is recognized as a certified psychologist in accordance with 201 KAR Chapter 26.

(13)

"Certified psychologist with autonomous functioning" means a person licensed pursuant to KRS 319.056.

(14)

"Certified school psychologist" means an individual certified by the Kentucky Education Professional Standards Board under 16 KAR 2:090.

(15)

(a)

1.

2.

(b)

1.

2.

(16)

(a)

Provides support and training that enables a participant to develop a network of natural supports to achieve a clearly defined and valued social role within the participant's community;

(b)

1.

Previously qualified or been credentialed by the department to provide community access services prior to the effective date of this administrative regulation; or

2.

a.

b.

Completed a department approved training program within one (1) year of application while providing community access services under the direct supervision of a community access specialist; and

(c)

Meets the personnel and training requirements established in Section 3 or 10 of this administrative regulation.

(17)

(a)

Has been selected by a participant to provide training, technical assistance, and support including individual budget development and implementation in aspects of participant direction; and

(b)

1.

2.

A bachelor's degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or

3.

Experience in the field of intellectual or developmental disabilities that will substitute for the educational requirements stated in subparagraph 1. or 2. of this paragraph on a year-for-year basis;

(c)

Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation;

(d)

Completes a community guide training curriculum approved by DBHDID within six (6) months of being employed by the first participant supported; and

(e)

Provides services to a participant in accordance with Section 4 or 10 of this administrative regulation.

(18)

(19)

(20)

(21)

(22)

(23)

(a)

(b)

(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.

(24)

(a)

(b)

(c)

1.

2.

(d)

Meets the personnel and training requirements established in Section 3 of this administrative regulation;

(e)

1.

2.

3.

4.

Participate as a member of the participant's person-centered team if requested by the participant; and

(f)

Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan.

(25)

(a)

(b)

1.

2.

(c)

Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation;

(d)

1.

2.

3.

4.

(e)

Has at least two (2) years of experience in providing direct support to persons with a developmental disability;

(f)

Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan; and

(g)

Completes a supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities.

(26)

(27)

(28)

(29)

(30)

(a)

(b)

(c)

1.

2.

(d)

1.

2.

a.

b.

(i)

(ii)

Development, review, implementation, and revisions as needed of the organization's policies and procedures; and

(iii)

(e)

Meet all personnel and training requirements specified in Section 3 of this administrative regulation; and

(f)

If providing professional oversight or supervision of employees, meet the supervisory qualifications specified for each service.

(31)

(32)

"Extended family member" means a relative of an individual by blood or marriage beyond the individuals included in the definition of immediate family member.

(33)

(a)

(b)

In which a participant receives SCL services and resides in the family occupied (leased or owned) home; and

(c)

1.

2.

3.

Ensures that the participant's needs are met in accordance with the participant's person-centered service plan.

(34)

"Financial management agency" means an agency contracted by the department that manages individual participant-directed service plans.

(35)

"Functional assessment" means an assessment performed using evidenced based tools, direct observation, and empirical measurement to obtain and identify functional relations between behavioral and environmental factors.

(36)

"Good cause" means a circumstance beyond the control of an individual that affects the individual's ability to access funding or services, which includes:

(a)

(b)

Required paperwork and documentation for processing in accordance with Section 2 of this administrative regulation has not been completed but is expected to be completed in two (2) weeks or less; or

(c)

The individual or his or her guardian 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.

(37)

(a)

(b)

That is managed by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and

(c)

(38)

(39)

"Homicidal ideation" means thoughts about homicide that may range from vague ideas to detailed or fully formulated plans without taking action.

(40)

(a)

Comprised of representatives from home and community based waiver provider agencies in the community where a participant resides; and

(b)

1.

2.

In accordance with the human rights committee requirements established in Section 7 of this administrative regulation.