RELATES TO: KRS Chapter 45A, 194A.060(2), 205.201, 205.203,
205.455(4), 205.465, 209A.030, 310.005, 310.021, 310.031,
29 U.S.C.
794, 42 U.S.C. 3018, 3025, 3027, 3030a to
3030g-22
NECESSITY, FUNCTION, AND CONFORMITY:
42
U.S.C. 3030e authorizes grants to states
under state plans, approved under
42
U.S.C. 3027, to establish and operate a
nutrition program for older persons.
KRS
194A.050(1) authorizes the
Cabinet for Health and Family Services to promulgate administrative regulations
as necessary to implement programs mandated by federal law, or to qualify for
receipt of federal funds.
KRS
205.204(1) and (2)
designates the cabinet as the state agency to administer the Older Americans
Act,
42 U.S.C.
3001 to
3058ff, in
Kentucky and authorizes the cabinet to promulgate administrative regulations
necessary to comply with any requirement imposed or required by federal law.
This administrative regulation establishes the standards of operation for the
nutrition program for older persons.
Section
1. Definitions.
(1) "Area
Agencies on Aging and Independent Living" or "AAAIL" means an entity designated
by the state to administer, at the local level, the programs funded by the
department.
(2) "Area plan" means
the plan that:
(a) Is submitted by a district
for the approval of the department; and
(b) Releases funds under contract for the
delivery of services within the planning and service area.
(3) "Central kitchen" means an institutional
kitchen that is equipped and used for preparing food to be sent to meal sites
for service.
(4) "Certified
nutritionist" is defined by
KRS
310.005 and
KRS
310.031.
(5) "Community" means a county designated as
urban or rural in accordance with the most current percentage of population
listing from the U.S. Census Bureau.
(6) "Congregate meal" means a meal provided
to a qualified individual in a congregate or group setting.
(7) "Congregate nutrition services" means the
provision of meals and related nutrition services in a group setting to older
individuals that include:
(a) Nutrition
education;
(b) Nutrition
assessment;
(c) Nutrition
counseling;
(d) Nutrition
screening;
(e) Malnutrition
screening;
(f) Opportunities for
social engagement at senior centers or on field trips; and
(g) Volunteer roles that contribute to
overall health and well-being.
(8) "Congregate setting" means a senior
center or a restaurant.
(9) "Cycle
menu" means a menu planned for at least five (5) weeks and repeated with
modification for seasonal menu items.
(10) "Department" means the Department for
Aging and Independent Living.
(11)
"Dietary reference intakes" means the nutritional requirementsestablished by
the Food and Nutrition Board of the Institute of Medicine of the National
Academies;
(12) "District" is
defined by KRS
205.455(4).
(13) "District nutrition program" means the
program approved by the department and administered in each of the fifteen (15)
planning and service areas in Kentucky by the districts or other contract
agencies.
(14) "Home delivered
meal" means a meal provided to a qualified individual in his or her place of
residence.
(15) "Home delivered
nutrition services" means the provision of meals and related nutrition services
to older individuals who are homebound, such as:
(a) Nutrition screening;
(b) Malnutrition screening;
(c) Nutrition education;
(d) Nutrition assessment; and
(e) Nutrition counseling.
(16) "Licensed dietitian" is
defined by KRS
310.005(11).
(17) "Meal" means a portion of food that:
(a) Provides the equivalent of one-third
(1/3) of the dietary reference intakes;
(b) Meets the requirements of the Dietary
Guidelines for Americans; and
(c)
Is served with optional condiments to complete the meal as approved by the
licensed dietitian or certified nutritionist.
(18) "Modified atmosphere packaging" means
the method of extending the shelf life of fresh food products where the
atmospheric air inside a package is replaced with a protective gas mix that
helps ensure the product stays fresh for as long as possible.
(19) "Modified Meal" means a meal that has an
altered texture such as pureed, chopped, or thickened liquids to accommodate
the needs of an individual with difficulty in chewing or swallowing.
(20) "Nontraditional meal" means a meal
approved by the department that is cold, frozen, dried, canned, or modified
atmosphere packaging.
(21)
"Nutrition counseling" means individualized guidance:
(a) To an individual who is at nutritional
risk because of the individual's health or nutritional history, dietary intake,
chronic illness, or medications use, or to caregivers; and
(b) Provided one-on-one by a licensed
dietitian to address options and methods for improving the individual's
nutrition status.
(22)
"Nutrition screening" means the identification of those at risk of poor
nutrition in accordance with Section 9 of this administrative
regulation.
(23) "Nutrition service
provider" means an entity that is awarded a contract under the area plan to
provide nutrition services covered under this administrative
regulation.
(24) "Nutrition
Services Incentive Program" or "NSIP" means federally provided incentives to
encourage and reward effective performance by states in the efficient delivery
of nutrition meals to older individuals.
(25) "OAA" means the Older Americans Act of
1965, as amended, with the relevant portions of the federal law for purposes of
this program codified as
42 U.S.C.
3030a to
3030g-22.
(26) "Rural" means a community with less than
50,000 population living in a rural area as designated by the most current
listing from the U.S. Census Bureau.
(27) "Standardized recipe" means a written
formula for producing food items of a consistent quality and quantity that
specifies the yield and portion size adjusted for the requirements of the
nutrition program for older persons.
(28) "State nutrition program for older
persons" means the nutrition program administered by the department, consisting
of:
(a) Meals;
(b) Nutrition screening and education;
and
(c) Nutrition assessment and
counseling.
(29) "Target
group" means:
(a) Low-income individuals,
including low-income minority older individuals;
(b) Older individuals with limited English
proficiency;
(c) Older individuals
residing in rural areas; or
(d)
Older individuals at risk for institutional placement.
(30) "Traditional meal" means a ready to eat
hot meal.
(31) "Urban" means a
community with 50,000 or more population living in an urbanized area as
designated by the most current listing from the U.S. Census Bureau.
Section 2. Eligibility.
(1) Except as provided in subsection (2) of
this section, an individual shall be eligible for congregate meals and
congregate nutrition services if the individual:
(a) Is aged sixty (60) or older;
(b) Is the spouse of an individual aged sixty
(60) or older; or
(c) Has a
disability and resides at home with the eligible older individual.
(2) The AAAIL may, in accordance
with 42 U.S.C.
3030g-21(2)(H),
(I), provide a congregate meal to:
(a) A volunteer providing services during
meal hours; or
(b) An individual
under age sixty (60) who:
1. Has a disability;
and
2. Resides in a housing
facility primarily occupied by older individuals at which congregate nutrition
services are provided.
(3) An individual shall be eligible for
home-delivered meals and home-delivered nutrition services if the individual:
(a)
1. Is a
person aged sixty (60) or over, or the spouse of a person aged sixty (60) or
over;
2. Is unable to attend a
congregate site because of illness or an incapacitating disability;
and
3. Does not have a person in
the home able to prepare a nutritious meal on a regular basis; or
(b)
1. Is under age sixty (60);
2. Has a disability; and
3. Resides with a homebound individual aged
sixty (60) or over.
(4) Eligibility for the Homecare Program
home-delivered meals shall be in accordance with
910 KAR
1:180.
Section 3. District Nutrition Funding. The
district nutrition program may include meals or nutrition services from the
following funding sources:
(1) Congregate or
home delivered meals funded by the OAA;
(2) Home delivered meals as specified in
910 KAR
1:180 funded by the State Homecare Program;
(3) A congregate meal as specified in
910 KAR 1:160 funded by the State
Adult Day and Alzheimer's Respite Program;
(4) NSIP funding for expansion of meals
served in the state; or
(5) Other
funds designated in the AAAIL's approved area plan, such as United Way or other
local funding.
Section
4. Congregate Nutrition Services.
(1)
(a)
Congregate meals shall be provided by a nutrition service provider who, five
(5) or more days per week, in each rural or urban community within the
nutrition service provider's service and planning area, provides at least one
(1) hot or nontraditional meal per day and any additional meals which the
nutrition service provider may elect to provide in a congregate
setting.
(b) A waiver may be
approved by the department for a rural area to serve less frequently if the
budget does not sustain five (5) days per week, pursuant to
42
U.S.C.
3030e.
(2) The requirements established in this
subsection shall apply to the transportation of meals to a congregate site.
(a)
1. Bulk
foods shall be transported in a stainless steel pan or aluminum disposable pan
in an insulated container.
2. Use
of plastic shall be restricted to cold foods only.
(b)
1. Hot
items shall be transported in a bulk container separated from cold
products.
2. A container shall be
preheated or prechilled before being loaded.
(3) The order of service shall be as
established in this subsection.
(a) Congregate
meals shall be served after packaging the home delivered meals.
(b) Nutritional site personnel shall check
and record temperatures of congregate meals daily.
(c) Milk or other cold food items shall not
be preset on a table prior to meal service.
(d) A table shall not be preset with eating
or drinking utensils more than four (4) hours prior to meal service unless each
item is individually wrapped.
(e) A
preset table shall not be used for activities prior to meal service.
(f) After all participants have been served,
volunteers or other staff may be served.
(4) If more meals were prepared than arrived
guests at meal time, after guests have been served, left over full meals may be
packaged for frozen meals to be used for emergency or weekend meals.
(5) Food items left over after packaging for
emergency or weekend meals shall be:
(a)
Offered as seconds to a participant, if requested by the participant and after
all have been served;
(b) Donated
to a local facility, such as a food bank or homeless shelter if overproduced;
or
(c) Discarded.
(6)
(a) Only complete meals shall be claimed for
payment.
(b) Omission of required
meal components shall cause that meal to be incomplete and ineligible for
payment and for USDA reimbursement.
(c) Refusal by a participant of specific meal
components shall not render that meal incomplete.
(7)
(a) A
participant shall be allowed to carry out left over foods.
(b) Center staff shall assure that a
participant is advised concerning the risks involved if foods are held at
unsafe temperatures.
(c) Staff or
volunteers shall not devote time or supplies to the task of packaging
individual menu items as carry-outs for participants or staff.
(8) A participant shall have an
opportunity to complete a satisfaction survey to evaluate meals and service at
least annually.
(9)
(a) An ongoing participant nutrition
education program shall be implemented by the nutrition service provider or
AAAIL and include at a minimum one (1) session per month at each nutrition
site.
(b) The education program
shall include a variety of teaching methods on the following topics:
1. Nutrition and its relevance to health
promotion and disease prevention;
2. Consumer approaches to food safety and
food purchasing;
3. Food fads and
diets;
4. Physical activity;
and
5. Activities to modify
behavior and improve health literacy, including providing information and
optimal nutrients.
(c)
An annual nutrition education plan shall be developed by the AAAIL and the
nutrition service providers.
(d)
The plan shall include a minimum of one (1) session each month at each
nutrition site.
(e) The plan shall
include a variety of topics using a wide range of teaching
techniques.
(f) The plan shall
include how educational materials shall be provided to home delivered meals
clients at least monthly.
(g) The
plan and educational materials shall be provided in the participants preferred
language.
(h) The DAIL Senior
Health and Wellness Newsletter may be utilized to meet the nutrition education
requirements monthly.
Section 5. Home Delivered Nutrition Services.
(1) Home delivered meals shall be provided by
a nutrition service provider who, five (5) or more days a week, in each rural
or urban community within the nutrition service provider's service and planning
area, provides at least one (1) home delivered hot or nontraditional meal per
day and any additional meals which the nutrition service provider may elect to
provide.
(2)
(a) Except as provided in paragraph (b) of
this subsection, a meal shall be delivered only to an eligible person in the
eligible person's home. The delivery driver shall leave the meal only if:
1. The delivery driver sees or hears the
participant;
2. The delivery driver
takes the meal to the door of a participant; or
3. The participant acknowledges the delivery
through electronic means such as a video doorbell, or intercom.
(b) A meal may be left with a
designee of the older person if the designee has been informed of the
requirements of the nutrition program and provides to the AAAIL assurance they
have the ability to comply with the following requirements:
1. Store cold foods in a manner that
maintains cold food at or below forty-one (41) degrees Fahrenheit;
and
2. Store hot foods in a manner
that maintains the temperature above 135 degrees Fahrenheit; or
3. Store hot foods below forty-one (41)
degrees Fahrenheit.
(c)
For a traditional meal, an AAAIL shall train and monitor delivery staff to
ensure that the meal participant or designee acknowledges delivery of the
meal.
(3) Documentation
for the provision of a non-traditional meal shall show:
(a) The participant has expressed a
preference for the non-traditional meal or lives off an established
route;
(b) Proper storage and
heating facilities are available in the home;
(c) The participant is able to prepare and
consume the meal alone or with available assistance; and
(d) Cost is no more than a traditional
meal.
(4)
(a) A provider of home delivered meals shall
use methods of delivery that shall be delivered in a sanitary manner to prevent
outside contamination and hold food at appropriate temperatures as specified in
paragraph (b) of this subsection.
(b) Meals shall be delivered in accordance
with the requirements established in this paragraph.
1. Delivery routes shall be established by
the nutrition service provider to minimize nutrient loss and to facilitate
temperature retention.
2. Meals
shall be delivered within four (4) hours from the end of preparation to the
final destination.
3. Hot food
shall be maintained at or above 135 degrees Fahrenheit.
4. Cold food shall be maintained at or below
forty-one (41) degrees Fahrenheit, and ice may be used if the food containers
are constructed to prevent water seepage into the food.
5.
a.
Nutrition site personnel shall check and record temperatures of meals at least
weekly toward the end of each meal delivery route.
b. If the temperatures are not consistent
with the requirements of subparagraphs 3. and 4. of this paragraph, the
nutrition site personnel shall check and record the meal temperatures daily
until the temperatures are consistent with those requirements.
6. Neutral temperature foods shall
be packaged and delivered in a way as to prevent outside
contamination.
7.
a. Frozen meals shall be maintained in a
frozen state during delivery.
b. If
the meal has thawed to the extent that ice crystals are not contained in the
meal or the temperature is above forty (40) degrees Fahrenheit, the meal shall
not be refrozen for later use. The meal shall be either:
(i) Heated and consumed immediately;
or
(ii) Discarded.
(5) A participant shall have an opportunity
to:
(a) Complete a satisfaction survey
developed by the nutrition service provider to evaluate meals and services at
least annually; and
(b) Provide
ongoing comments for preparation of menus.
(6)
(a) An
ongoing participant nutrition education program shall be implemented by the
nutrition service provider and shall include a minimum of one (1) session each
month for the home delivered meal participant.
(b) The program shall include nutrition
training as specified in Section 4(9)(b) of this administrative
regulation.
(7) A
nutrition service provider shall have a contingency plan in place to replace a
meal if the meal:
(a) Does not register the
correct temperature on delivery; or
(b) Is not delivered.
Section 6. Emergency Meals.
(1) Provisions shall be made for furnishing
emergency meals during inclement weather conditions, power failure, or any
disaster that may cause isolation or create a special need.
(2) An emergency meal shall:
(a) Be shelf stable, frozen, freeze-dried,
dehydrated, modified atmosphere packaging, or a combination of these types of
meals;
(b) Meet the nutritional
requirements of this program;
(c)
Follow a menu that has been:
1. Approved by a
certified nutritionist or licensed dietitian;
2. Planned for a minimum of three (3) days;
and
3. Delivered, reported, and
billed in the same month; and
(d) Use frozen meals only if the:
1. Participant is able to store, prepare, and
consume the meal alone or with available assistance; and
2. Delivery system is arranged so that
storage time after delivery is minimal.
(3) Water shall be provided, if necessary, to
prepare a meal.
(4) The menu plan
shall include some foods which require no cooking prior to
consumption.
(5) One (1) dish meals
may be used if the nutritional requirements of the Dietary Guidelines of
Americans are met.
(6)
(a) Foods may be taken to the nutrition
site.
(b) A participant may assist
with packaging foods for distribution if the participant is a volunteer at the
nutrition site.
(7) An
emergency meal package shall be distributed to the eligible homebound client
receiving home delivered meals.
(8)
Emergency meals may be used for a congregate participant if the center is
closed.
Section 7.
Nutrition Services Incentive Program (NSIP).
(1) Additional funding received from the NSIP
for the nutrition program shall be used exclusively to purchase food and shall
not be used to pay for another nutrition-related service or for state or agency
administrative costs.
(2) The
department shall disburse NSIP monies to AAAILs based upon the AAAIL's
proportion of the total number of eligible meals served in the state.
(3) The AAAIL shall:
(a) Expend NSIP monies within the fiscal year
funds are allocated by the department;
(b) Use the NSIP funds to expand the total
number of meals provided in the state;
(c) Not use the NSIP funds to reduce funds
from any other grant or contract which the provider may be given;
(d) Maintain records to show the amount of
cash received and how it was expended;
(e) Only use the NSIP funds to purchase:
1. Foods approved by the United States
Department of Health and Human Services or other foods produced in the United
States of America; or
2. Meals if
the cost of the meal is quoted as a unit of service cost which includes both
food and labor. Ready to serve meals may be purchased on a unit of service cost
basis if each meal contains food equivalent in value to the current rate of
reimbursement; and
(f)
Serve meals through a nutrition service provider under the jurisdiction,
control, management, and audit authority of the department and AAAIL and to
eligible individuals as described in Section 2 of this administrative
regulation.
(4)
Financial records kept by the nutrition service provider shall show:
(a) Meals provided are bid without regard to
NSIP reimbursement;
(b) NSIP funds
are used as a revenue source for expansion of meals served in the
state;
(c) The unit of service cost
of a meal is not reduced in anticipation of future NSIP reimbursement but is
stated as a true cost in both bidding and reporting procedures; and
(d) Monthly financial reports reflect NSIP
expenditures.
(5) NSIP
funding shall not be used for the following situations:
(a) Meals served to individuals, guests, or
staff less than sixty (60) years of age;
(b) Meals served to a person who is paying a
set fee for the meal;
(c) Meals
that are served to consumers that meet income eligibility criteria under other
programs;
(d) Meals used as a
non-federal match for other federal program funding;
(e) Alcoholic beverages and vitamin
supplements;
(f) Sponsored meals if
a set fee or charge is involved; or
(g) Meals served to individuals in nursing
homes, adult day care, or assisted living facilities if the meal is a part of
the per diem.
Section
8. Nutrition Program Costs.
(1)
Ready-to-serve meal costs shall include the following:
(a) The cost of raw food, including food
purchased with NSIP cash resources;
(b) The costs of serving supplies,
disposables, cleaning materials, and noncapital items used in the preparation
of food;
(c) The costs of labor for
food preparation, cooking, portioning of foods, and delivery of food to the
site of service. Labor costs shall include:
1.
Fringe benefits;
2. Wages for
persons who prepare and maintain the sanitary condition of the kitchen and
storage areas; and
3. Wages paid
for time spent in food and supplies inventorying, storing and receiving, and in
direct supervision of employees;
(d) Equipment costs for capital items such as
a:
1. Range;
2. Dishwasher;
3. Truck or van;
4. Steam table; or
5. Freezer;
(e) The costs of space, related utility
costs, equipment operation, maintenance and repair costs; and
(f) The nonlabor costs of transporting food,
food storage, insurance, and general liability.
(2) Food service and delivery costs shall
include:
(a) The total labor costs for serving
foods and for home delivery of meals to a participant;
(b) Mileage and maintenance of vehicle costs
for home delivery of meals;
(c)
Costs incurred for nutrition education and nutrition outreach services;
and
(d) Project management costs,
including personnel, equipment, and supply costs.
(3)
(a) A
food service contract bid shall be structured in accordance with Kentucky's
Procurement Code, KRS Chapter 45A.
(b) Meals shall:
1. Be bid without regard to funding source;
and
2. Contain both a meal
preparation cost and a delivery cost.
Section 9. Responsibilities of
AAAIL.
(1) An AAAIL shall have written
policies and procedures to carry out the AAAIL's responsibilities as
established in this subsection. The AAAIL shall:
(a) Solicit the expertise of a dietitian or
other individual with equivalent education and training in nutrition science or
an individual with comparable expertise in the planning of nutritional services
pursuant to
42
U.S.C.
3030g-21(1);
(b) Pursuant to
42
U.S.C.
3030g-21(2)(K),
encourage individuals who distribute nutrition services to provide homebound
older individuals with medical information approved by health care
professionals, such as informational brochures on how to get vaccines in the
individual's community for:
1.
Influenza;
2. Pneumonia;
and
3. Shingles;
(c) Provide implementation and
management of the state nutrition program for older persons;
(d) Assure that a nutrition service provider
provides:
1. At least one (1) meal per day in
a congregate nutrition site or provide home delivered meals based upon a
determination of a participant's needs;
2. Meals to reach the maximum number of
eligible older individuals consistent with the requirement established in
42 U.S.C.
3025(a)(2)(E);
3. Nutrition screening, malnutrition
screening, counseling and nutrition education services to address a
participant's assessed needs and ensure that nutrition funds are used to
provide these services.
a. Nutrition screening
and malnutrition screening shall be provided for all participants of the
nutrition program for older persons as outlined in the state data system at
least annually.
b. The results of
this screening shall be reported to the department.
c. A participant who receives a nutrition
score of six (6) or higher shall have documentation of further action based on
a referral to a:
(i) Dietitian for nutrition
counseling; or
(ii) Participant's
physician;
d. A
participant who receives a malnutrition score of two (2) or higher shall have
documentation of further action based on a referral to a:
(i) Dietitian for nutrition counseling;
or
(ii) Participant's
physician;
e. A
participant shall receive follow up regarding their nutrition and malnutrition
screening score within three (3) months of the assessment date to address the
needs and concerns.
4.
Nutrition services to keep older persons healthy, reduce the older adult's risk
of chronic disease and disability, and help the older adult to manage chronic
diseases and conditions;
5. An
emergency plan for back up food preparation sites, nutrition sites, and meal
delivery; and
6. A plan for
furnishing emergency meals during an emergency, such as:
a. Inclement weather conditions;
b. Power failure;
c. A disaster that may cause isolation;
or
d. A medical emergency;
and
(e) Use
meal contributions to increase the number of meals served and facilitate access
to these meals.
(2) If
the AAAIL is the provider of meals and services, the AAAIL shall comply with
all responsibilities of the nutrition service provider as specified in Section
12 of this administrative regulation.
Section 10. Nutrition Site Operation.
(1)
(a)
Congregate meal services shall be funded at a site if the site has been
approved by the department, in accordance with this section.
(b) The services shall not become operational
until the department grants written approval through review of:
1. A completed DAIL-NP-17.96 Kitchen
Checklist; and
2.
a. Pictures documenting compliance with the
checklist; or
b. An on-site visit
by the department.
(2) Prior to approval of any site, it shall
be inspected by the following:
(a) A local
health department for compliance with applicable health codes;
(b) A local fire department for compliance
with fire and building safety codes; and
(c) The department for compliance with
42
U.S.C.
3027(a)(8).
(3) A site shall:
(a) Be located as near as possible to the
target group of individuals;
(b)
Comply with the confidentiality and disclosure requirements of
KRS
194A.060(2); and
(c) Be clearly identified to the public with
a sign.
(4)
(a) Selection of a site to offer congregate
meal services shall be based on information on older people in its service area
and on the advice of public and voluntary agencies serving the
elderly.
(b) The following factors
shall be given consideration in choosing a site:
1. Demographic information and
projections;
2. Accessibility to
the maximum number of people who are socially or economically
deprived;
3. Proximity to other
services and facilities;
4.
Convenience to public or private transportation or location within comfortable
walking distance for participants;
5. Clear of structural barriers or difficult
terrain; and
6. The safety and
security of participants and staff.
(5) A site shall:
(a) Take necessary actions to create for
handicapped older people barrier-free access and movement within the facility
in conformance with the requirements of
29 U.S.C.
794, Section
504
of the Rehabilitation Act of 1973;
(b) Make arrangements for security of site
equipment, furniture, and files;
(c) Have signs visible for exits, entrances,
and other areas of importance;
(d)
Adopt procedures for fire safety, including:
1. Fire drills;
2. Inspection;
3. Maintenance of fire extinguishers;
and
4. Training by fire department
personnel; and
(e)
Maintain and repair the site.
(6) A site that does not meet the
requirements of subsection (5) of this section shall comply with a corrective
action plan administered by the department.
(7)
(a) A
site shall have an individual, either volunteer or paid staff, who shall be
responsible for the administration of the site.
(b) At least one (1) staff person or trained
volunteer shall be present at the site during hours of operation.
(c) A site shall have available the following
minimum services:
1. At least one (1) hot meal
in accordance with Section 4 of this administrative regulation;
2. Outreach services that may be funded by
Title III-B or Title III-C;
3.
Information and referral; and
4.
Nutrition education.
(d)
An optional service may be home-delivered meals.
(e) A congregate meal shall be:
1. Prepared on site;
2. Catered; or
3. Prepared in a central kitchen.
Section 11.
Kitchen Approval.
(1) A new kitchen preparing
a congregate meal or home delivered meal shall not become operational until
inspected by the following:
(a) A local health
department for compliance with applicable health codes;
(b) A local fire department for compliance
with fire and building safety codes;
(c) An AAAIL inspector for compliance with
DAIL-NP-17.96, Kitchen Checklist; and
(d) The department utilizing the
DAIL-NP-17.96, Kitchen Checklist, submitted in accordance with Section
10(1)(b)1. and 2. of this administrative regulation, for compliance with:
1. Facility specifications;
2. Food preparation; and
3. Clean up.
(2) The department shall notify the AAAIL of
kitchen operation approval within ten (10) days of the initial on-site
visit.
Section 12.
Responsibilities of Nutrition Service Providers.
(1) The nutrition service provider
contracting to provide meals and services shall have written policies and
procedures to carry out the responsibilities of the service provider as
established in this subsection. The nutrition service provider shall:
(a) Provide the AAAIL using the state data
system with statistical and other information necessary for state reporting
requirements established in
KRS
205.465 and federal reporting requirements
established in
42 U.S.C.
3018;
(b) Provide a recipient with an opportunity
to voluntarily contribute to the cost of the service. Pursuant to
42 U.S.C.
3030c-2(b), voluntary
contributions:
1. May be solicited if the
method of solicitation is noncoercive; and
2. Shall be encouraged for an individual
whose self-declared income is at or above 185 percent of the federal poverty
level, at contribution levels based on the actual cost of the
service;
(c) Assure that
an older person shall not be denied service because the older person does not
or cannot contribute to the cost of the service;
(d) Protect the privacy of each older person
with respect to contributions;
(e)
Report to appropriate officials, such as Department for Community Based
Services, EMS, local law enforcement, for follow-up, conditions or
circumstances which place the older person or his or her household in imminent
danger;
(f) Make arrangements for
services to older persons in weather-related or declared emergencies;
(g) Assist a participant with access to
benefits under other programs;
(h)
Employ staff to ensure that the service staff is based on the number of program
participants and the type of services provided;
(i) Have a site director, on a paid or
volunteer basis, responsible for activities at the site.
1. Congregate and home delivered meals funds
shall pay up to a maximum of five (5) hours, per day, of a paid site director's
time; and
2. Other funding sources
may be used to pay for additional hours;
(j) Permit staff of the AAAIL, the cabinet,
and federal representatives to monitor and inspect the operation of the site;
and
(k) Attend meetings and
training sessions as requested by the AAAIL and the department.
(2) The service provider
contracting to provide meals only shall:
(a)
Provide the AAAIL using the state data system with statistical and other
information necessary for state reporting requirements established in
KRS
205.465 and federal reporting requirements
established in
42 U.S.C.
3018; and
(b) Abide by the requirements of subsection
(1)(i) through (k) of this section.
Section 13. Meal Planning.
(1) Nutrient dense meals shall be planned
using preparation and delivery methods that preserve the nutritional value of
foods. The use of saturated fats, salt, and sugar shall be restricted to
maintain good health, in accordance with the dietary reference intakes and the
Dietary Guidelines for Americans.
(2) Menus shall be:
(a) Planned through a formal procedure for
soliciting participant comments established in each district;
(b) Planned a minimum of one (1) month in
advance or, if a cycle menu is planned, used at least for five (5)
weeks;
(c) In compliance with the
Dietary Guidelines for Americans;
(d) Provided to each participating older
individual and shall include a meal plan to provide:
1. A minimum of thirty-three and one-third
(33 1/3) percent of the allowances established in the dietary reference
intakes, if the individual is provided one (1) meal per day, pursuant to
42
U.S.C.
3030g-21(2)(A)(ii)(I);
2. A minimum of sixty-six and two-third (66
2/3) percent of the allowances established in the dietary reference intakes, if
the individual is provided two (2) meals per day, pursuant to
42
U.S.C. 3030g-21(2)(A)
(ii)(II); or
3. 100 percent of the allowances established
in the dietary reference intakes, if the individual is provided three (3) meals
per day, pursuant to
42
U.S.C.
3030g-21(2)(A)(ii)(III);
(e) Altered to meet participant
dietary needs such as low sugar, low salt, low fat, or low
cholesterol;
(f) Certified by a
Kentucky licensed dietitian or Kentucky certified nutritionist as meeting the
nutritional requirements, unless:
1. Meals are
provided through an approved national distribution center, and
2. Approved by the DAIL dietitian.
(g) Adhered to without
substitution, unless a substitution is approved by the licensed dietitian or
certified nutritionist. If a substitution is approved, the nutrition service
provider shall provide a copy of the revised menu to the AAAIL; and
(h)
1.
Posted in a conspicuous location, including at each congregate meal site and
each preparation site; or
2.
Provided in advance to each participant receiving home delivered
meals.
(3)
Special menus which allow for modified meals, religious, ethnic, cultural, or
regional dietary practices may be provided if foods and preparations are
available.
(4)
(a) Additional foods, such as fresh produce,
baked items, or donated canned items, may be added to the meal to provide
personal satisfaction and additional nutrition but shall not be considered part
of the reimbursable program meal.
(b) Home-canned foods shall not be
used.
(5)
(a) If a potluck meal is served at a
particular site, a congregate meal shall not be served at that site for that
particular mealtime.
(b) Home
delivered meals shall be provided on the same basis as if the potluck meal had
not been scheduled.
Section 14. Food Procurement.
(1) Foods purchased for use in the nutrition
program shall be obtained from sources which conform to the nutritional
requirements of
902 KAR
45:005.
(2)
(a)
Term contracts may be used for repetitively purchased items.
(b) Fixed quantity contracting shall be used
if definite items and quantities can be determined for future delivery
dates.
Section
15. Food Preparation.
(1)
(a) Standardized recipes shall be used in
food preparation and yield shall be indicated.
(b) Recipes shall specify the yield and
portion size adjusted for the requirements of the nutrition program for older
persons.
(2) The
standards established in this section shall apply for quality control.
(a) Food production standards.
1. The handling and preparation of food shall
be conducted in safe and hygienic conditions pursuant to
902 KAR 45:005
State food service code.
2. Hot
foods shall be produced within eight (8) hours preceding service unless
otherwise directed in the recipe.
3. Protein foods shall be cooked completely
once the cooking cycle has begun.
4. Foods to be served cold and neutral
temperature foods may be prepared earlier than the preceding eight (8) hours if
so directed in the recipe.
5. Solid
and semisolid cooked foods stored under refrigeration shall be placed in
containers that are no more than four (4) inches in depth.
(b) The holding time for hot foods shall not
exceed four (4) hours after preparation.
(c) Temperature standards.
1. Hot foods shall be packed at temperatures
of at least 160 degrees Fahrenheit, and the internal temperature of hot foods
to be transported shall be at least 135 degrees Fahrenheit during
transportation and service.
2. Cold
foods shall not exceed forty-one (41) degrees Fahrenheit during transportation
and service.
3. Thermometers used
to check food temperatures shall be:
a. Of
metal stem-type construction;
b.
Numerically scaled;
c. Accurate to
plus or minus three (3) degrees Fahrenheit; and
d. Checked periodically to ensure that each
thermometer is registering accurately.
4. Food temperatures for both hot and cold
items shall be checked and recorded daily at the kitchen and at the site of
service.
5. Infrared thermometers
may be used for lettuce-based salads, sandwich garnishes, and during the home
delivery route to check weekly temperatures of hot and frozen meals.
(3)
(a) Food preparation facilities shall be in
compliance with state and local fire, health, sanitation, and safety
administrative regulations which apply to food service operations.
(b) A food preparation and service kitchen
shall be inspected periodically by state and local health officials and the
department dietitian.
(4) Standards for food handling and personal
hygiene shall be in accordance with the food service requirements of the
Kentucky Food Code governed by
902 KAR
45:005.
Section 16. Incorporation by Reference.
(1) The following material is incorporated by
reference:
(a) "DAIL-NP-17.96 Kitchen
Checklist", edition 5/12; and
(b)
"Dietary Guidelines for Americans 2020-2025",, U.S. Department of Agriculture,
and U.S. Department of Health and Human Services.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Cabinet for Health and
Family Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday
through Friday, 8 a.m. to 4:30 p.m. and may be accessed online at the following
Web sites:
(a) Kitchen checklist -;
and