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. Definitions.
(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) "Abuse" is defined by
KRS
209.020(8).
(3) "Adult day health care center" means an
adult day health care center licensed in accordance with
902 KAR 20:066.
(4) "Adult foster care home" means a home:
(a) Not owned or leased by an SCL
provider;
(b) In which a
participant:
1. Is at least eighteen (18)
years of age; and
2. Receives SCL
services and resides in the family occupied (leased or owned) home;
and
(c) In which the
family:
1. Includes the participant in the
family's household routines;
2.
Provides training and supervision; and
3. Ensures that the participant's needs are
met in accordance with the participant's person-centered service
plan.
(5)
"Advance directive" is defined by
KRS
311.621(2).
(6) "Aversive technique" means:
(a) Withholding:
1. Food or hydration as a means to control or
impose calm;
2. Access to a legal
advocate or ombudsman;
3. Access to
toilet, bath, or shower;
4. Access
to personal belongings; or
5.
Access to natural supports;
(b) Depriving medical attention or prescribed
medication; or
(c) Depriving
sleep.
(7) "Behavior
intervention committee" or "BIC" means a group of individuals:
(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) "Case manager" means an individual who:
(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) "Case
manager supervisor" means an individual who:
(a) Provides professional oversight of case
managers;
(b)
1. Has a bachelor's or higher degree in a
human service field from an accredited college or university;
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. Is a registered nurse;
(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)
"Certified nutritionist" is defined by
KRS
310.005(12).
(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) "Chemical restraint" means a drug or
medication:
(a) Used to restrict an
individual's:
1. Behavior; or
2. Freedom of movement; and
(b)
1. That is not a standard treatment for the
individual's condition; or
2.
Dosage that is not an appropriate dosage for the individual's
condition.
(16)
"Community access specialist" means an individual who:
(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) Has:
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. At
least one (1) year of experience in the field of intellectual or developmental
disabilities; and
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)
"Community guide" means an individual who:
(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) Has:
1.
A bachelor's degree in a human services field from an accredited college or
university;
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) "Controlled substance" is
defined by KRS
218A.010(6).
(19) "Covered services and supports" is
defined by KRS
205.5605(3).
(20) "DBHDID" means the Department for
Behavioral Health, Developmental and Intellectual Disabilities.
(21) "DCBS" means the Department for
Community Based Services.
(22)
"Department" means the Department for Medicaid Services or its
designee.
(23) "Developmental
disability" means a disability that:
(a) Is
manifested prior to the age of twenty-two (22);
(b) Constitutes a substantial disability to
the affected individual; and
(c) Is
attributable either to an intellectual disability or a condition related to an
intellectual disability that:
1. Results in an
impairment of general intellectual functioning and adaptive behavior similar to
that of a person with an intellectual disability; and
2. Is a direct result of, or is influenced
by, the person's cognitive deficits.
(24) "Direct support professional" means an
individual who:
(a) Provides services to a
participant in accordance with Section 4 of this administrative
regulation;
(b) Has direct contact
with a participant when providing services to the participant;
(c) Is at least:
1. Eighteen (18) years old and has a high
school diploma or GED; or
2.
Twenty-one (21) years old;
(d) Meets the personnel and training
requirements established in Section 3 of this administrative
regulation;
(e) Has the ability to:
1. Communicate effectively with a participant
and the participant's family;
2.
Read, understand, and implement written and oral instructions;
3. Perform required documentation;
and
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) "Direct support professional
supervisor" means an individual who:
(a)
Provides oversight of direct support professionals in the provision of services
to participants;
(b) Is at least:
1. Eighteen (18) years old and has a high
school diploma or GED; or
2.
Twenty-one (21) years old;
(c) Meets the personnel and training
requirements established in Sections 3 and 10 of this administrative
regulation;
(d) Has the ability to:
1. Communicate effectively with a participant
and the participant's family;
2.
Read, understand, and implement written and oral instructions;
3. Perform required documentation;
and
4. Participate as a member of
the participant's person-centered team if requested by the
participant;
(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) "Drug paraphernalia" is defined by
KRS
218A.500(1).
(27) "Early and periodic screening,
diagnostic, and treatment services" is defined by
42 U.S.C.
1396d(r).
(28) "Electronic signature" is defined by
KRS
369.102(8).
(29) "Employee" means an individual who is
employed by an SCL provider.
(30)
"Executive director" means an individual who shall:
(a) Lead the design, development, and
implementation of strategic plans for an SCL provider;
(b) Maintain responsibility for the
day-to-day operation of the SCL provider organization;
(c)
1. Have
a bachelor's or higher degree from an accredited institution; or
2. Be a registered nurse;
(d) Have at least two (2) years
of:
1. Experience in the field of intellectual
or developmental disabilities; and
2. Administrative experience:
a. In an organization that served individuals
with an intellectual or developmental disability; and
b. That includes experience in the execution
of the overall administration of an agency including:
(i) Development, implementation, and
maintenance of the agency's budget;
(ii) Development, review, implementation, and
revisions as needed of the organization's policies and procedures;
and
(iii) Supervision of employees
including conducting performance evaluations;
(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) "Exploitation" is defined by
KRS
209.020(9).
(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) "Family home provider" means a home:
(a) Not owned or leased by an SCL
provider;
(b) In which a
participant receives SCL services and resides in the family occupied (leased or
owned) home; and
(c) In which the
family:
1. Includes the participant in the
family's household routines;
2.
Provides training and supervision; and
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)
Illness or hospitalization of the individual that is expected to last sixty
(60) days or less;
(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) "Group home"
means a residential setting:
(b) That is managed by a provider who meets
the SCL provider requirements established in Section 3 of this administrative
regulation; and
(c) In which no
more than eight (8) participants reside.
(38) "Guardian" is defined by
KRS
387.010(3) for a minor and
by KRS
387.812(3) for an
adult.
(39) "Homicidal ideation"
means thoughts about homicide that may range from vague ideas to detailed or
fully formulated plans without taking action.
(40) "Human rights committee" means a group
of individuals:
(a) Comprised of
representatives from home and community based waiver provider agencies in the
community where a participant resides; and
(b) Who meet:
1. To ensure that the rights of participants
are respected and protected through due process; and
2. In accordance with the human rights
committee requirements established in Section 7 of this administrative
regulation.
(41) "Human services field" means:
(a) Psychology;
(b) Behavioral analysis;
(c) Counseling;
(d) Rehabilitation counseling;
(e) Public health;
(f) Special education;
(g) Sociology;
(h) Gerontology;
(i) Recreational therapy;
(j) Education;
(k) Occupational therapy;
(l) Physical therapy;
(m) Speech-language pathology;
(n) Social work; or
(o) Family studies.
(42) "ICF-IID" means an intermediate care
facility for individuals with intellectual disabilities.
(43) "Illicit substance" means:
(a) A drug, prescription or not prescription,
used illegally or in excess of therapeutic levels;
(b) A prohibited drug; or
(c) A prohibited substance.
(44) "Immediate family member" is
defined by KRS
205.8451(3).
(45) "Impact service" means a service
designed to decrease the amount of paid supports a participant requires as the
participant becomes:
(a) More independent;
and
(b) Less reliant on an
employee.
(46)
"Individual family service plan" or "IFSP" is defined by
KRS
200.654(9).
(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) "Integrated setting"
means a setting that:
(a) Enables a
participant to interact with nondisabled persons to the fullest extent
possible;
(b) Includes access to
community activities and opportunities at times, frequencies, and with persons
of a participant's choosing; and
(c) Affords a participant choice in the
participant's daily life activities.
(49) "Intellectual disability" or "ID" means:
(a) A demonstration:
1. Of significantly sub-average intellectual
functioning and an intelligence quotient (IQ) of seventy (70) plus or minus
five (5); and
2. Of concurrent
deficits or impairments in present adaptive functioning in at least two (2) of
the following areas:
a.
Communication;
b.
Self-care;
c. Home
living;
d. Social or interpersonal
skills;
e. Use of community
resources;
f.
Self-direction;
g. Functional
academic skills;
h. Work;
i. Leisure; or
j. Health and safety; and
(b) An intellectual
disability that had an onset before eighteen (18) years of age.
(50) "Legally responsible
individual" means an individual who has a duty under state law to care for
another person and includes:
(a) A parent
(biological, adoptive, or foster) who provides care to the parent's minor
child;
(b) A guardian who provides
care to the guardian's minor child; or
(c) A spouse of a participant.
(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) "Licensed dietitian" is defined by
KRS
310.005(11).
(54) "Licensed marriage and family therapist"
or "LMFT" is defined by
KRS
335.300(2).
(55) "Licensed medical professional" means
(a) A physician;
(b) An advanced practice registered
nurse;
(c) A physician
assistant;
(d) A registered
nurse;
(e) A licensed practical
nurse; or
(f) A
pharmacist.
(56)
"Licensed practical nurse" is defined by
KRS
314.011(9).
(57) ''Licensed professional clinical
counselor" or "LPCC" is defined by
KRS
335.500(3).
(58) "Licensed psychological associate" means
an individual who:
(a) Currently possesses a
licensed psychological associate license in accordance with
KRS
319.010(6); and
(b) Meets the licensed psychological
associate requirements established in 201 KAR Chapter 26.
(59) "Licensed psychological practitioner"
means an individual who meets the requirements established in
KRS
319.053.
(60) "Licensed psychologist" means an
individual who:
(a) Currently possesses a
licensed psychologist license in accordance with
KRS
319.010(6); and
(b) Meets the licensed psychologist
requirements established in 201 KAR Chapter 26.
(61) "Life history" means an account of the
series of events making up a participant's life including:
(a) Developmental and historical information
regarding family of origin, childhood experiences, and life events to
present;
(b) History of supports
received across the life span; and
(c) Life style practices that may lead to
greater insight regarding a participant's current preferences, behavioral
patterns, wants, and needs.
(62) "Medical order for scope of treatment"
is defined by KRS
311.621(12).
(63) "Medically necessary" or "medical
necessity" means that a covered benefit is determined to be needed in
accordance with
907 KAR 3:130.
(65) "National Core Indicators" means:
(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) Standard measures:
1. Used across states to assess the outcomes
of services provided to individuals and families; and
2. That address key areas of concern
including employment, rights, service planning, community inclusion, choice,
and health and safety.
(66) "Natural supports" means assistance,
relationships, or interactions that:
(a) Allow
a participant to be in the community;
(b) Include working in a job of the
participant's choice in ways similar to people without disabilities;
and
(c) Are based on ordinary
social relationships at work and in the community.
(67) "Neglect" is defined by
KRS
209.020(16).
(68) "Occupational therapist" is defined by
KRS
319A.010(3).
(69) "Occupational therapy assistant" is
defined by KRS
319A.010(4).
(70) "Office of Vocational Rehabilitation"
means the agency mandated:
(a) By the
Rehabilitation Act of 1973, as amended; and
(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)
"Participant" means a Medicaid recipient who:
(a) Meets patient status criteria for an
intermediate care facility for individuals with intellectual disabilities as
established in
907 KAR 1:022;
(b) Is authorized by the department to
receive SCL waiver services; and
(c) Utilizes SCL waiver services and supports
in accordance with a person-centered service plan.
(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) Assists with the design of the
program;
(b) Chooses the providers
of services; and
(c) Directs the
delivery of services to meet his or her needs.
(73) "Person-centered coach" means a person
who:
(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) Models person-centered
thinking;
(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) Has:
1.
A high school diploma or GED; and
2.
a. Two
(2) years of experience in the field of intellectual or developmental
disabilities; or
b. Completed
twelve (12) hours of college coursework in a human services field;
(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) Include providers who
receive payment for services who shall:
1. Be
active contributing members of the person-centered team meetings;
2. Base their input upon evidence-based
information; and
3. Not request
reimbursement for person-centered team meetings.
(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. Conducting routine physical
examinations or tests;
2.
Protecting the person from falling out of bed; or
3. Permitting the person to participate in
activities without the risk of physical harm.
(78) "Physical therapist" is defined by
KRS
327.010(2).
(79) "Physical therapist assistant" means a
skilled health care worker who:
(a) Is
certified by the Kentucky Board of Physical Therapy; and
(b) Performs physical therapy and related
duties as assigned by the supervising physical therapist.
(80) "Positive behavior support specialist"
means an individual who;
(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) "Registered agent" means an individual
meeting the requirements of
KRS
14A.4-010(1)(b).
(83) "Registered nurse" is defined by
KRS
314.011(5).
(84) "Registered office" means an office
meeting the requirements of
KRS
14A.4-010(1)(a).
(85) "Representative" is defined by
KRS
205.5605(6).
(86) "Rights restriction" means any
intervention that restricts a participant's:
(a) Movement;
(b) Access to other individuals, locations,
or activities; or
(c)
Rights.
(87) "Room" means
the aggregate expense of housing costs for the purpose of providing shared
living, including:
(a) Rent, lease, or
mortgage payments;
(b) Real estate
taxes;
(c) Insurance;
(d) Maintenance; and
(e) Utilities.
(88) "SCL intellectual disability
professional" or "SCL IDP" means an individual who:
(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. Is a doctor of medicine or
osteopathy;
2. Is a registered
nurse; or
3. Holds at least a
bachelor's degree from an accredited institution in a human services
field.
(89)
"SCL provider" means an entity that meets the criteria established in Section 3
of this administrative regulation.
(90) "Seclusion" means the involuntary
confinement of a participant alone in:
(a) A
room; or
(b) An area from which the
participant is physically prevented from leaving.
(91) "Serious medication error" means a
medication error that requires or has the potential to require a medical
intervention or treatment.
(92)
"Shared living caregiver" means an unrelated individual who:
(a) Resides with a participant in the
participant's home;
(b) Provides
supervision and necessary personal assistance services as specified in the
participant's person-centered service plan;
(c)
1. Is
at least eighteen (18) years of age and has a high school diploma or GED;
or
2. Is at least twenty-one (21)
years old;
(d) Meets all
personnel and training requirements established in Section 10 of this
administrative regulation;
(e) Has
the ability to:
1. Communicate effectively
with a participant and the participant's family;
2. Read, understand, and implement written
and verbal instructions; and
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) Does
not have any of the following relationships to the participant:
1. Immediate family member;
2. Extended family member;
3. Guardian; or
4. Legally responsible individual.
(93) "Speech-language
pathologist" is defined by
KRS
334A.020(3).
(94) "Staffed residence" means a residential
setting:
(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) In which no more than three (3)
participants reside.
(95)
"State plan" is defined by 42 C.F.R.
430.10.
(96) "Subcontractor" means an entity or an
individual:
(a) Who is a currently
credentialed professional or other service provider;
(b) Who has signed an agreement with a
certified SCL agency to provide SCL services and supports; and
(c) To whom the employee requirements in this
administrative regulation apply.
(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) "Supported employment specialist" means
an individual who:
(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) Is administered by a trained professional
in the human services field as approved by the department.
Section 4. Covered Services.
(1)
(a) An
SCL waiver service shall:
1. Be prior
authorized by the department; and
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) SCL covered services shall include:
(a) Case management;
(b) Community access services;
(c) Community guide services;
(d) Community transition services;
(e) Consultative clinical and therapeutic
services;
(f) Day
training;
(g) Environmental
accessibility adaptation services;
(h) Goods and services;
(i) Natural supports training;
(j) Person-centered coaching;
(k) Personal assistance services;
(l) Positive behavior supports;
(m) Residential support services, which may
include:
1. Level I residential
supports;
2. Technology assisted
residential services; or
3. Level
II residential supports;
(n) Respite;
(o) Shared living;
(p) Specialized medical equipment and
supplies;
(q) Supported
employment;
(r) Transportation
services; or
(s) Vehicle
adaptation.
(3) Case
management requirements shall be as established in Section 6 of this
administrative regulation.
(4) A
community access service:
(a) Shall be
provided by a community access specialist;
(b) Shall be designed to support a
participant to participate in meaningful routines, events, and activities
through various community organizations;
(c) Shall be designed to empower a
participant in developing natural supports;
(d) May be participant directed;
(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. Connecting
with others;
2. Independent
functioning;
3. Self
advocacy;
4.
Socialization;
5. Community
participation;
6. Personal
responsibility;
7. Financial
responsibility; and
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. Less reliance on formal supports;
and
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) Shall
not duplicate residential support or day training services, or authorized
therapies;
(k) Shall be provided to
a participant with a:
1. One (1) to one (1)
staff to participant ratio; or
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) Shall occur
in an integrated community setting;
(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) Shall be documented in the MWMA by:
1. A note documenting each contact, which
shall include:
a. A full description of each
service rendered;
b. Evidence of
training or service to support outcomes designated in the participant's
person-centered service plan;
c.
The date of the service;
d. The
location of the service;
e. The
beginning and ending times of the service;
f. The signature and title of the individual
providing the service; and
g. The
date the entry was made in the record; and
2. A monthly summary note, which shall
include:
a. The month and year for the time
period the note covers;
b. An
analysis of progress toward the participant's outcome or outcomes;
c. Identification of barriers to achievement
of outcomes;
d. Projected plan to
achieve the next step in achievement of outcomes;
e. The signature and title of the community
access specialist completing the note; and
f. The date the note was written;
and
(o) Shall
not exceed 160 fifteen (15) minute units per week alone or in combination with
community access group services.
(5)
(a) A
community guide service shall:
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. Be designed to empower a participant to
define and direct the participant's services;
3. Only be for a participant who chooses
participant-directed supports for some or all of the participant's support
services;
4. Include:
a. Direct assistance to a participant in
meeting his or her participant-directed responsibilities;
b. Information and assistance that helps the
participant in:
(i) Problem solving;
(ii) Decision making;
(iii) Developing supportive community
relationships; and
(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. Be documented in the MWMA by:
a. A note documenting each contact, which
shall include:
(i) A full description of each
service rendered;
(ii) The date of
the service;
(iii) The location of
the service;
(iv) The beginning and
ending times of the service;
(v)
The signature and title of the community guide providing the service;
and
(vi) The date the entry was
made in the record; and
b. A completed monthly summary note, which
shall include:
(i) The month and year for the
time period the note covers;
(ii)
An analysis of the efficacy of the service provided including recommendations
and identification of additional support needs;
(iii) The signature and title of the
community guide completing the note; and
(iv) The date the note was written;
and
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) If needed, directed assistance provided
by a community guide:
1. Shall be based on the
needs of the participant; and
2.
May include assistance with:
a. Recruiting,
hiring, training, managing, evaluating, and changing employees;
b. Scheduling and outlining the duties of
employees;
c. Developing and
managing the individual budget;
d.
Understanding provider qualifications; or
e. Recordkeeping and other program
requirements.
(d) A community guide service shall not
duplicate a case management service.
(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) Community transition services:
(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) May include:
1. A security deposit that is required to
obtain a lease on an apartment or home;
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. A
necessary home accessibility adaptation; or
6. An activity to assess a need and arrange
for and procure needed resources;
(d) Shall be furnished only:
1. To the extent that the service is
reasonable and necessary;
2. As
clearly identified in the participant's person-centered service plan;
and
3. If the service cannot be
obtained from other sources;
(e) Shall not include:
1. Monthly rental or mortgage
expense;
2. Food;
3. Regular utility charges;
4. Items that are intended for purely
diversional or recreational purposes; or
5. Furnishings for living arrangements that
are owned or leased by an SCL provider;
(f) Shall be coordinated and documented in
the MWMA by the participant's case manager by:
1. Description or itemized line item of
purchase and cost;
2. A receipt for
a procurement including date of purchase;
3. The signature and title of the case
manager; and
4. The date the entry
was made in the record; and
(g) Shall not exceed $2,000 per approved
transition.
(7) A
consultative clinical and therapeutic service shall:
(a) Be provided by a person who:
1. Meets the personnel and training
requirements established in Section 3 of this administrative regulation;
and
2. Is a:
a. Certified nutritionist;
b. Licensed dietitian;
c. Licensed marriage and family
therapist;
d. Licensed professional
clinical counselor;
e. Licensed
psychological associate;
f.
Licensed psychologist;
g. Licensed
psychological practitioner;
h.
Licensed clinical social worker; or
i. Positive behavior support
specialist;
(b)
Include:
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. Providing treatment that:
a. Is consistent with assessment results and
diagnosis;
b. Is evidence based or
current best practice; and
c.
Encompasses psychological treatment or counseling as indicated by the condition
of the participant;
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. Monitoring:
a. Of the fidelity of data reporting and
participant's person-centered service plan implementation;
b. Of the effectiveness of the participant's
person-centered service plan;
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. That shall be conducted:
(i) In the settings where the participant's
person-centered service plan is implemented;
(ii) Through discussions and observations of
people implementing the participant's person-centered service plan;
and
(iii) Through reporting data;
7. A
functional assessment, which shall:
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) Licensed psychologist;
(ii) Certified psychologist with autonomous
functioning; or
(iii) Positive
behavior support specialist;
b. Include:
(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. Identify specific skills to be taught or
reinforced that shall:
(i) Achieve the same
function as the behavior of concern;
(ii) Allow the participant to cope more
effectively with circumstances; and
(iii) Be documented when they occur;
8.
Documentation in the MWMA of each contact, which shall include:
a. A full description of each service
rendered;
b. An analysis of the
efficacy of the service provided including any recommendation or identification
of additional support needs if needed;
c. The date of the service;
d. The location of the service;
e. The beginning and end times of the
service;
f. The signature and title
of the professional providing the service;
g. The date the entry was made in the record;
and
(c) Not
exceed 160 fifteen (15) minute units per one (1) year authorized
person-centered service plan period.
(8) Day training:
(a) Shall be provided by a direct support
professional;
(b) Shall include:
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. Are person-centered and designed to
support employment related goals;
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. Include:
(i) Skill development to communicate
effectively with supervisors, co-workers, and customers;
(ii) Generally accepted community workplace
conduct and dress;
(iii) Workplace
problem solving skills and strategies;
(iv) General workplace safety;
(v) The ability to follow
directions;
(vi) The ability to
attend tasks; or
(vii) Mobility
training;
3.
Supported retirement activities including:
a.
Altering schedules to allow for more rest time throughout the day; or
b. Support to participate in hobbies, clubs,
or other activities in the participant's community; or
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) Shall, if provided in an adult day health
care center, only be available for a participant who:
1. Is at least twenty-one (21) years of age;
and
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) Shall include environments
that:
1. Are not diversional in nature;
and
2. Occur in a variety of
settings in the community and shall not be limited to fixed-site
facilities;
(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)
Shall include documentation in the MWMA that shall be:
1. A note for each contact, which shall
include:
a. A full description of each service
rendered;
b. The date of the
service;
c. The location of the
service;
d. The beginning and
ending times of the service;
e. The
signature and title of the individual providing the service; and
f. The date the entry was made in the record;
and
2. A completed
monthly summary note, which shall include:
a.
The month and year for the time period the note covers;
b. An analysis of the efficacy of the service
provided including recommendations and identification of additional support
needs;
c. The signature and title
of the individual completing the note; and
d. The date the note was written;
and
(i) Shall
be limited to:
1. Five (5) days per week
excluding weekends; and
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) An environmental accessibility adaptation
service:
1. Shall be:
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. A physical adaptation to a
participant's or family's home, which shall be necessary to:
(i) Ensure the health, welfare, and safety of
the participant; or
(ii) Enable the
participant to function with greater independence in the home and without which
the participant would require institutionalization;
2. May include the following if
necessary for the welfare of a participant:
a. Installation of a ramp or
grab-bar;
b. Widening of a
doorway;
c. Modification of a
bathroom facility; or
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. Shall not include:
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. An adaptation to a
provider-owned residence;
4. Shall be provided:
a. In accordance with applicable state and
local building codes; and
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. Shall be
coordinated and documented in the MWMA by a case manager by:
a. A description of each adaptation
purchased;
b. A receipt for every
adaptation made, which shall include the:
(i)
Date of purchase;
(ii) Description
of the item;
(iii) Quantity and per
unit price; and
(iv) Total amount
of the purchase;
c. The
signature and title of the case manager; and
d. The date the entry was made in the
record.
(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) Goods and services shall:
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. Not be a good
or service available to a recipient outside of the department's SCL waiver
program;
4. Meet the following
requirements:
a. The good or service shall
decrease the need for other Medicaid services;
b. The good or service shall promote
participant inclusion in the community;
c. The good or service shall increase a
participant's safety in the home environment; and
d. The participant shall not have the funds
to purchase the good or service;
5. If participant directed and purchased from
a participant-directed budget, be prior authorized;
6. Not include experimental or prohibited
treatments;
7. Be clearly linked to
a participant need that has been documented in the participant's
person-centered service plan;
8. Be
coordinated and documented in the MWMA by a case manager by:
a. Description or itemized line item of
purchase and cost;
b. Receipts for
procurements that include the date of purchase;
c. The signature and title of the case
manager; and
d. The date the entry
was made in the record; and
9. Not exceed $1,800 per one (1) year
authorized person-centered service plan period.
(b) A purchase of a good or service shall not
circumvent other restrictions on SCL waiver services:
1. Established in this administrative
regulation; and
2. Including the
prohibition against claiming for the costs of room and board.
(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) A case manager
shall submit reimbursement documentation to the financial management
agency.
(e) Equipment purchased as
a good shall become the property of the participant.
(11)
(a)
Natural supports training shall:
1. Be
provided by a qualified entity as identified in the person-centered service
plan;
2. Be participant directed
and include:
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.
Instruction on current best practices;
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. Not duplicate or occur simultaneously with
any education or training provided through:
a.
State plan physical therapy services;
b. State plan occupational therapy
services;
c. State plan
speech-language pathology services;
d. Consultative clinical and therapeutic
services; or
e. Positive behavior
support services;
6. Be
provided in:
a. A participant's own home or a
participant's family's home; or
b.
Community setting specific to community-based natural supports training goals
specified in the participant's person-centered service plan;
7. Not include:
a. Services reimbursable by any other
support;
b. Training paid
caregivers;
c. Costs of travel,
meals, or overnight lodging to attend a training event or conference;
or
d. Services not related to the
needs of the participant; and
8. Be coordinated and documented in the MWMA
by a case manager by:
a. The specific training
provided;
b. The date and the
beginning and ending time when the service was provided;
c. The service location;
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. Verification of
registration and certificate of attendance at any formal training;
and
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) A case manager shall submit reimbursement
documentation to the financial management agency.
(12)
(a)
Person-centered coaching shall:
1. Be provided
by a person-centered coach who shall:
a.
Operate independently of a residential or day training provider;
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. Include:
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. Not duplicate
case management or any other service;
5. Not supplant an educational service
available under the Individuals with Disabilities Education Act (20 U.S.C.
101 et seq.); and
6. Be limited to 1,320 fifteen (15) minute
units per year.
(b)
Person-centered coaching shall be outcome-based with a plan for the gradual
withdrawal of the services.
(c) A
person-centered coach shall not be considered as part of a staffing ratio,
plan, or pattern.
(d) Documentation
of a person-centered coaching service shall be entered in the MWMA and shall
include:
1. A note documenting each contact,
which shall include:
a. A full description of
each service rendered;
b. The date
of the service;
c. The location of
the service;
d. The beginning and
ending time of the service;
e. The
signature and title of the person-centered coach providing the service;
and
f. The date the entry was made
in the record; and
2. A
completed monthly summary note, which shall include:
a. The month and year for the time period the
note covers;
b. A summary of the
service provided including recommendations and identification of additional
support needs if any exist;
c. The
signature and title of the individual completing the note;
d. The date the note was written;
and
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) Personal assistance services:
(a) Shall be provided by a direct support
professional;
(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) Shall include:
1. Hands-on assistance (performing a task for
a participant);
2. Reminding,
observing, guiding, or training a participant in activities of daily
living;
3. Reminding, observing,
guiding, or training a participant in instrumental activities of daily
living;
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) Shall not be available to a participant:
1. Receiving paid residential supports;
or
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) Shall be documented in the MWMA by:
1. A note for each contact, which shall
include:
a. A full description of each service
rendered;
b. Evidence of training
or service to support outcomes designated in the participant's person-centered
service plan as appropriate;
c. The
date of the service;
d. The
location of the service;
e. The
beginning and ending time of the service;
f. The signature and title of the direct
support professional providing the service; and
g. The date the entry was made in the record;
and
2. A detailed monthly
summary note, which shall include:
a. The
month and year for the time period the note covers;
b. Evidence of progress toward the
participant's outcome or outcomes;
c. Identification of barriers to achievement
of outcome or outcomes;
d.
Projected plan to achieve the next step in achievement of outcome or
outcomes;
e. The signature and
title of the direct support professional completing the note; and
f. The date the note was written.
(14)
(a) Positive behavior supports shall include:
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 positive behavior support
plan, which shall:
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. Be
developed with the participant and participant's person-centered
team;
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. Include specific criteria for
re-evaluation when the data does not demonstrate progress;
j. Clarify in measurable terms the frequency,
intensity, and duration of the target behaviors:
(i) That will signify that a reduction in
services is in order; and
(ii) When
services are at an end;
k. Be revised whenever necessary and
submitted for review to the local behavior intervention committee along with:
(i) The participant's person-centered service
plan;
(ii) The participant's
functional assessment;
(iii) The
participant's life history;
(iv)
The participant's medical assessment; and
(v) Any other appropriate
assessment;
l. Be
submitted to the local human rights committee if rights restrictions are
recommended; and
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) Positive behavior
supports shall be provided by a positive behavior support specialist.
(c) Behavioral health treatment and positive
behavioral supports shall be utilized in a collaborative manner.
(d) One (1) unit of positive behavior
supports shall equal one (1) plan.
(e) Positive behavior supports shall be
billed in accordance with
907 KAR
12:020.
(15)
(a)
Residential support services shall:
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. Ensure that the participant has:
a. Privacy in the sleeping or living unit in
a residential setting;
b. An option
for a private unit in a residential setting;
c. A unit with lockable entrance doors and
with only the individual and appropriate staff having keys to those
doors;
d. A choice of roommates or
housemates;
e. The freedom to
furnish or decorate the participant's sleeping or living units within the lease
or other agreement;
f. Visitors of
the participant's choosing at any time and access to a private area for
visitors; and
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) Bedrooms
shall be accessible to the appropriate persons.
(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) The following shall be documented in the
participant's person-centered service plan:
1.
Identification of a specific and individualized assessed need;
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. A clear description of
the condition that is directly proportionate to the specific assessed
need;
5. Regular collection and
review of data to measure the ongoing effectiveness of the
modification;
6. Established time
limits for periodic reviews to determine if the modification is still necessary
or can be terminated;
7. The
informed consent of the participant; and
8. An assurance that interventions and
supports will cause no harm to the participant.
(g) Residential support services shall:
1. Include:
a. Level I residential supports;
b. Technology assisted residential supports;
or
c. Level II residential
supports; and
2. Be
documented in the MWMA by a:
a. Daily note,
which shall include:
(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) The date of the service;
(iii) The location of the service;
(iv) The signature and title of the
individual providing the service; and
(v) The date the entry was made in the
record; and
b. Detailed
monthly summary note, which shall include:
(i)
The month and year for the time period covered by the note;
(ii) An analysis of progress toward a
participant's outcome or outcomes;
(iii) A projected plan to achieve the next
step in achievement of an outcome or outcomes;
(iv) Information regarding events that
occurred that had an impact on the participant's life;
(v) The signature and title of the direct
support professional writing the note; and
(vi) The date the note was
written;.
(16)
(a)
Level I residential supports shall:
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. Be for a participant who requires a
twenty-four (24) hour a day, intense level of support;
3. Include no more than five (5) unsupervised
hours per day per participant:
a. To promote
increased independence; and
b. That
shall be based on the:
(i) Needs of the
participant as determined by the participant's person-centered team;
and
(ii) Participant's
person-centered service plan;
4. Include:
a. Adaptive skill development;
b. Assistance with activities of daily living
including bathing, dressing, toileting, transferring, or maintaining
continence;
c. Community
inclusion;
d. Adult education
supports;
e. Social and leisure
development;
f. Protective
oversight or supervision;
g.
Transportation;
h. Personal
assistance; and
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) Level I
residential supports shall be provided by a:
1. Staffed residence that:
a. Has been certified:
(i) By the department to be an SCL waiver
provider; and
(ii) By DBHDID to
provide level I residential supports; and
b. Shall have no more than three (3)
participants receiving publicly-funded supports in a home leased or owned by
the provider; or
2. Group
home that:
a. Has been certified:
(i) By the department to be an SCL waiver
provider; and
(ii) By DBHDID to
provide level I residential supports; and
b. Shall have no more than eight (8)
participants in the group home.
(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. Participant's person-centered service
plan; and
2. Residential services
to meet the participant's needs.
(e) A level I residential support provider
shall employ staff who shall be a:
1. Direct
support professional; or
2. Direct
support professional supervisor if providing supervision.
(17)
(a) Technology assisted residential services
shall:
1. Be furnished in a participant's
residence:
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. Be for a participant who:
a. Requires up to twenty-four (24) hours a
day of support; and
b. Is able to
increase his or her level of independence with a reduced need for onsite
staff;
3. Include, to the
extent required for a participant:
a.
Protective oversight or supervision;
b. Transportation;
c. Personal assistance; or
d. The provision of medical or health care
services that are integral to meeting the participant's daily needs;
4. Increase a participant's
independence without undue risk to the participant's health or
safety;
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. Be allowed to include:
a. An electronic sensor;
b. A speaker or microphone;
c. A video camera, which shall not be located
in a bedroom or a bathroom;
d. A
smoke detector; or
e. A personal
emergency response system.
(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) The level and types of
technology assisted residential services provided to a participant shall be:
1. Determined by a participant's
person-centered team; and
2.
Outlined in a participant's person-centered service plan.
(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. As recommended by the participant's
person-centered team.
(g)
1. If a participant experiences a change in
support need or status, the technology assisted residential service provider
shall:
a. Immediately adjust the
participant's supervision to meet any acute need of the participant;
and
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) A technology assisted residential service
provider shall:
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. Employ staff who:
a. Shall be a:
(i) Direct support professional; or
(ii) Direct support professional supervisor
if providing supervision; and
b. Demonstrate:
(i) Proficiency in the individual's ability
to operate all monitoring devices utilized in technology assisted residential
services; and
(ii) The ability to
respond appropriately to the needs of participants in a timely manner; and
3. Have daily
contact with the participant.
(18)
(a)
Level II residential supports shall:
1. Be for
a participant who requires up to a twenty-four (24)-hour level of
support;
2. Be a support tailored
to a participant to:
a. Assist the participant
with acquiring, retaining, or improving skills related to living in a
community; and
b. Promote increased
independence;
3. Be
designed and implemented to assist a participant to reside in the most
integrated setting appropriate to the participant's needs;
4. Provide support for a participant up to
twenty-four (24) hours a day;
5. Be
furnished in:
a. An adult foster care
home;
b. A family home provider;
or
c. A participant's own
home;
6. Be based on the:
a. Needs of the participant as determined by
the participant's person-centered team; and
b. Participant's person-centered service
plan; and
7. Include:
a. Adaptive skill development;
b. Assistance with activities of daily living
including bathing, dressing, toileting, transferring, or maintaining
continence;
c. Community
inclusion;
d. Adult education
supports;
e. Social and leisure
development;
f. Protective
oversight or supervision;
g.
Transportation;
h. Personal
assistance; and
i. The provision of
medical or health care services that are integral to meeting the participant's
daily needs.
(b) Level II residential supports shall be
provided by:
1. An adult foster care provider
that:
a. Has been certified:
(i) By the department to be an SCL waiver
provider; and
(ii) By DBHDID to
provide level II residential supports; and
b. Shall have no more than three (3)
participants who are:
(i) Aged eighteen (18)
years or older; and
(ii) Receiving
publicly-funded supports and living in the home; or
2. A family
home provider that:
a. Has been certified:
(i) By the department to be an SCL waiver
provider; and
(ii) By DBHDID to
provide level II residential supports; and
b. Shall have no more than three (3)
participants receiving publicly-funded supports living in the home.
(c) A level II
residential support provider shall employ staff who shall be a:
1. Direct support professional; or
2. Direct support professional supervisor if
providing supervision.
(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) For a participant
approved for unsupervised time, a safety plan shall:
1. Be included in the participant's
person-centered service plan based upon the participant's assessed needs;
and
2. Ensure that:
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)
Relevance;
(ii) The participant's
ability to implement the safety plan; and
(iii) The functionality of the devices if
required.
(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.
Participant's person-centered service plan; and
2. Residential services to meet the
participant's needs.
(19) Respite:
(a) Shall:
1. Be provided to a participant who:
a. Does not receive residential
services;
b. Resides in the
participant's own home or family's home; and
c. Is unable to independently administer
self-care;
2. Be
provided:
a. In a variety of
settings;
b. By a direct support
professional; and
c. On a
short-term basis due to the absence or need for relief of a non-paid primary
caregiver;
3. Be
documented in the MWMA by a contact note, which shall include:
a. The date of the service;
b. The beginning and ending time of the
service;
c. A full description of
each service rendered;
d. The
signature and title of the individual providing the service; and
e. The date the entry was made in the record;
and
4. Not exceed 830
hours per each one (1) year authorized person-centered service plan period;
and
(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)
Shared living shall be a participant-directed service designed to:
1. Be an alternative to residential support
services; and
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) If two (2)
participants choose to live together in a home, the two (2) may share a
caregiver.
(d) Depending upon the
need of a participant, a caregiver may provide:
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) Shared living services shall:
1. Address a participant's needs identified
in the participant's person-centered planning process;
2. Be outlined in the participant's
person-centered service plan;
3. Be
specified in a contractual agreement between the participant and the caregiver;
and
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) Room and board expenses for an unrelated
caregiver living with a participant shall be:
1. Reflected in the participant's
person-centered service plan; and
2. Specified in the contractual agreement
between the participant and the caregiver.
(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)
Documentation shall:
1. Be maintained by a
participant's case manager in the MWMA; and
2. Include:
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. The signature and
title of the case manager writing the note;
d. The date the note was written;
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)
Shared living shall be based on a prior authorized amount not to exceed $600
per month.
(21)
(a) Specialized medical equipment and
supplies shall:
1. Include a device, control,
or appliance specified in a participant's person-centered service plan that
shall:
a. Be necessary to ensure the health,
welfare, and safety of the participant; or
b. Enable the participant to function with
greater independence in the home;
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. Include customizing a device to meet a
participant's needs;
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.
Include an ancillary supply necessary for the proper functioning of an approved
device;
7. Be identified in a
participant's person-centered service plan;
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) An
occupational therapist;
(ii) A
physical therapist; or
(iii) A
speech-language pathologist; or
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:
10. Be coordinated
and documented in the MWMA by a case manager by:
a. A description or itemized line item of
purchase and cost;
b. Receipts for
procurements that include the date of purchase;
c. The signature and title of the case
manager;
d. The date the entry was
made in the record; and
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) Supported employment shall:
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. Be
participant directed, if a participant chooses this option;
4. Be provided:
a. In a variety of settings; and
b. By a supported employment specialist who:
(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. Exclude work performed directly for the
supported employment provider or other service provider; and
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. Forty (40) hours per week; or
2. 160 units per week.
(e) A supported employment service shall:
1. Be provided and documented as required by
this subsection; and
2. Include the
components established in this subsection.
(f)
1.
Supported employment shall include person-centered job selection discovery that
shall:
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. Include developing a Person Centered
Employment Plan based upon the participant's:
(i) Life experiences;
(ii) Interests;
(iii) Talents;
(iv) Contributions;
(v) Impact of disability;
(vi) Vulnerabilities; and
(vii) Support needs.
2. The Person-Centered Employment
Plan shall be completed by the employment specialist, entered into the MWMA,
and updated as needed.
3. A
participant may access up to 120 units of person-centered job selection
funding.
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. Represents
an accurate description of the participant's interests, goals, and
objectives;
b. Is based upon the
development of a career rather than short-term employment; and
c. Is incorporated into the participant's
person-centered service plan.
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) Contacts, if available, for the places
referenced in subclause (i) of this clause.
b. Information gathered at the job planning
meeting shall be documented in the participant's individual plan for
employment.
6.
a. Job development and analysis shall:
(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. Job acquisition with support shall be the
actual acceptance of a position by the participant.
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) Participant is fully
integrated into the workplace; and
(ii) Supported employment specialist is no
longer needed on a regular basis.
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.
Contain:
(i) The date of the
service;
(ii) The beginning time of
the service;
(iii) The ending time
of the service;
(iv) A description
of the activity that was conducted;
(v) The justification of the
activity;
(vi) The results of the
activity;
(vii) The anticipated
content of the next activity; and
(viii) The signature of the supported
employment specialist who provided the service.
(23)
(a) A transportation service shall:
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. Only
be provided when transportation is not:
a.
Otherwise and customarily available through natural supports including family,
friends, neighbors, or community agencies; or
b. Included as an element of another SCL
waiver service;
3.
Include nonemergency travel;
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. Be provided by a driver who:
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. Is an
individual or other public transit resource including a local cab or bus
service; and
7. Not:
a. Include transporting a participant to
school (through the twelfth grade);
b. Be available to a participant who:
(i) Receives transportation as an element of
another covered service;
(ii) Is
receiving a residential service via the SCL waiver program;
(iii) Has access to transportation under the
Individuals with Disabilities Education Act; or
(iv) Customarily receives transportation from
a relative.
(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) A case manager
shall:
1. Coordinate transportation services;
and
2. Ensure that the following
documentation is completed and submitted to the financial management agency for
direct payment to the approved vendor:
a. The
specific type and purpose of transportation provided;
b. The date and the beginning and ending time
when the service was provided;
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) A
vehicle adaptation shall:
1. Be a device,
control, or service that enables a participant to:
a. Increase the participant's independence
and physical safety; and
b.
Interact more independently with the participant's environment and reduce the
participant's dependence on physical support from others;
2. Be made to a participant's or a
participant's family's privately owned vehicle;
3. Include:
a. A hydraulic lift;
b. A ramp;
c. A special seat; or
d. An interior modification to allow for
access into and out of the vehicle as well as safety while the vehicle is
moving;
4. Be limited to
$6,000 per five (5) years per participant;
5. Be prior authorized by the department in
order to be reimbursable by the department; and
6. Be coordinated and documented in the MWMA
by a case manager by:
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. A description or itemized line item of
purchase and cost;
d. A receipt for
procurements that shall include the date of purchase;
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. The signature and title of the case
manager; and
g. The date the entry
was made in the record.
(b) The department's SCL program shall be the
payer of last resort for a vehicle adaptation.
(c) The need for a vehicle adaptation shall:
1. Be documented in a participant's
person-centered service plan; and
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) A case manager
shall submit reimbursement documentation to the financial management
agency.