910 KAR | Title 910 KAR — Cabinet for Health and Family Services - Office of Aging Services

Chapter 1 Aging Services

910 KAR 1:090 Personal care attendant program and assistance services {#sec-910-kar-1-090 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:090}

Section 1. Definitions.

(1) "Administrative support personnel" means staff designated within a contract agency who offer technical assistance to, and monitor the activities of, the qualified agency.

(2) "Approved plan" means an agreement between the department and a contract agency to administer the personal care attendant program.

(3) "Assessment" means the collection and evaluation of information:

(a) About a person's situation and functioning;

(b) To determine the applicant's or participant's service level; and

(4) "Attendant" means a person who provides personal care assistance services.

(5) "Contract agency" means the agency with which the cabinet has contracted to administer the personal care attendant program.

(6) "Department" means the Department for Aging and Independent Living or its designee.

(7) "Evaluation team" is defined by KRS 205.900(2).

(8) "Evaluation team's findings and recommendations" means the official response of the evaluation team signed by all three (3) team members.

(9) "Immediate family member" is defined by KRS 205.8451(3).

(10) "Income eligibility standard" means a formula to determine an applicant's income eligibility for the personal care attendant program pursuant to KRS 205.910(1).

(11) "Natural supports" means a non-paid person or persons or community resource, that can provide, or has historically provided, assistance to the participant or due to the familial relationship, and would be expected to provide assistance.

(12) "Participant" means a person accepted into the personal care attendant program and who has met the eligibility requirements of a severely physically disabled adult.

(13) "PCAP" means personal care attendant program.

(14) "Personal care assistance services" is defined by KRS 205.900(3).

(15) "Prescreening" means a process that assesses whether or not an applicant appears to meet the basic requirements for eligibility.

(16) "Qualified agency or organization" is defined by KRS 205.900(4).

(17) "Reassessment" means reevaluation of the situation and functioning of a client.

(18) "Service area" means those counties listed in an approved plan of the qualified agency or organization.

(19) "Severely physically disabled adult" is defined by KRS 205.900(6).

(20) "Subsidy" means a financial reimbursement paid by the cabinet to an adult who qualifies to receive personal care assistance services in accordance with KRS 205.905(1).

(21) "Work agreement" means an agreement of time and tasks developed by the participant as the employer for the attendant as the employee.

Section 2. Eligibility.

(1) To be eligible for participation in the personal care attendant program, an applicant shall:

(a) Be a severely physically disabled adult who:

Meets the qualifications required by KRS 205.905(1); and
Has the ability to be responsible for performing the functions required by KRS 205.905(2) to receive a subsidy;

(b) Agree to obtain an initial assessment for eligibility and a reasessment at least biennially by an evaluation team in accordance with KRS 205.905(2)(b)1 and 2;

(d) Work with a program coordinator in establishing a work agreement between the participant and attendant;

(e) Be responsible for attendant payroll reports and computing required employer tax statements;

(f) Have an immediate family member or natural supports to meet the individual's needs if a paid attendant is not available; and

(g) Not be receiving the same services obtainable from any federal, state, or combination of federal and state funded programs. If the individual's needs cannot be met with the funding received from any of those programs, the individual may be eligible to receive personal care attendant program services above and beyond what the other programs provide.

(2) An applicant shall be accepted for service if:

(a) The evaluation team determines that the applicant is eligible to participate in the program in accordance with this section;

(b) The department agrees that the determination is in accordance with this section; and

(3) An applicant shall be income eligible if they are eligible for:

(a) Supplemental Security Income; or

(b) Medicaid.

(4) If an applicant's gross annual income is less than 200 percent of the official poverty income guidelines published annually in the Federal Register by the United States Department of Health and Human Services, the applicant shall be income eligible.

(5) If an applicant is not eligible pursuant to subsections (3) or (4) of this section, the income eligibility standard shall be determined by a program coordinator using the PCAP-05 Income Eligibility form as follows:

(a) The program coordinator shall determine the adjusted gross income by deducting:

The cost of unreimbursed extraordinary medical expenses, and impairment-related expenses as recorded on the PCAP-05;
An amount adjusted for family size based on 200 percent of the official poverty guidelines published annually in the Federal Register by the United States Department of Health and Human Services; and
Dependent care expenses.

(b) If the adjusted gross income is less than 200 percent of the annual federal poverty guidelines, the applicant shall be income eligible.

(c) If the adjusted gross income is more than 200 percent of the annual federal poverty guidelines, the following shall be used to determine the applicant's contribution to cost of care:

From the adjusted gross income subtract a current annual standard deduction for one (1) as determined by the Internal Revenue Service;
Divide the remaining income by two (2) to allow for the unique economic and social needs of the severely disabled adult;
Divide the final income by fifty-two (52) weeks; and
Calculate the estimated cost of personal care services by multiplying the estimated number of hours of personal care assistance services per week times the cost per hour of service.

(d)

If the resulting monetary amount in paragraph (c)3. of this subsection is less than the estimated cost of services calculated in paragraph (c)4. of this subsection, the qualified agency shall provide the full subsidy.
If the resulting monetary amount in paragraph (c)3. of this subsection is more than the estimated cost of services calculated in paragraph (c)4. of this subsection, the participant shall pay the difference between the cost of services and the qualified agency's maximum hourly rate.

(6) The income eligibility criteria established in subsections (3) through (5) of this section shall be applied to a current participant at the time of the participant's next reassessment.

Section 3. Application and Evaluation.

(1) A referral to the personal care attendant program may be made by:

(a) The applicant;

(b) Family, with applicant knowledge;

(d) Agency, with applicant knowledge.

(2) If an opening for services is available, a program coordinator shall:

(a) Visit and assist an applicant in the completion of a PCAP-01 Application for Services; and

(b) Complete and have all evaluation team members sign a PCAP-04 Evaluation Team Findings and Recommendations.

(3) A qualified agency shall:

(a) Report an evaluation team's findings and recommendations to the contract agency for final review of the applicant or participant; and

(b) Notify the applicant or participant if the evaluation team's findings and recommendations are accepted by the contract agency.

(4) A contract agency shall:

(a) Review the evaluation team's findings and recommendations and notify the qualified agency in writing of the final determination within ten (10) business days of receipt of the recommendations; and

(b) Notify the applicant or participant in writing within twenty (20) business days of receipt of the evaluation team's findings and recommendations in accordance with KRS 205.905(3):

Whether the evaluation team's findings and recommendations are accepted or not accepted; and
The reasons for the contract agency's decision.

Section 4. Waiting List.

(1) If the personal care attendant program is at capacity, an eligible applicant shall be placed on a waiting list entered into the state data system and, as a vacancy occurs, be accepted for services in priority order based on the following categories:

(a) Emergency situation because of an imminent danger to self or at risk of institutionalization;

(b) Urgent situation because there are no community supports; or

(2) Every effort shall be used to provide referrals to other services if personal care assistance services are not available.

Section 5. Relocation.

(1) If an eligible participant receiving personal care assistance services relocates to another service area to complete a training or educational course, the participant shall remain a client of the service area of origin, if the:

(a) Participant considers the personal care attendant program service area of origin to be his or her place of residence; and

(b) Participant's purpose for relocation is to complete a course of education or training to increase employment skills.

(2) The receiving service area shall provide courtesy monitoring to coordinate the aspects of program requirements.

(3) The service area of origin shall retain responsibility for:

(a) Payment of a subsidy, if the participant meets eligibility for the duration of the educational or training course; and

(b) Monthly programmatic and financial reports.

(4) The receiving service area shall forward a copy of reports to the service area of origin by the fifth of the following month.

(5) If a participant moves from one service area of origin to another for any reason other than relocation for a training or educational course, the participant's program funding shall be transferred to the receiving service area.

(6) If a participant's personal care assistance services terminate, the program funding shall return to the service area of origin.

Section 6. Suspension of Services.

(1) Suspension of services shall occur for the following reasons:

(a) Condition improved – on reassessment a participant is determined to need less than fourteen (14) hours of care per week;

(b) Condition worsened - on reassessment a participant is determined to need more hours of care than the program can provide and to be in danger if left alone due to lack of other caregivers;

(d) Participant does not submit required employer taxes to the qualified agency;

(e) Participant moves from Kentucky;

(f) Participant fails to hire an attendant;

(g) Participant dies;

(h) Participant chooses to:

Give up personal care assistance services; and
Be admitted to a long-term care facility; or

(i) Participant requests suspension of services.

(2) Services may be suspended if there is:

(a) A non-return of an overpayment of services; or

(b) An intentional deception to obtain services.

(3) Suspension of services shall occur if there are any substantiated deceptive practices of paying for services that are:

(a) Not actually provided; or

(b) Duplicative services obtained through another program or agency at the same time.

Section 7. Participant Responsibilities. A participant shall:

(1) Meet the eligibility requirements to receive a subsidy established in Section 2(1) of this administrative regulation;

(2) Select an attendant for personal care assistance services including screening and interviewing the attendant for employment;

(3) Instruct the attendant on specific personal care assistance services;

(4) Evaluate the attendant's personal care assistance services;

(5) Discuss and come to a written agreement with each attendant about:

(a) Services that shall be provided; and

(b) The terms of employment, including:

Time;
Hours;
Duties; and
Responsibilities;

(6) Keep records and report to the qualified agency attendant hours worked for payment to the attendant;

(7) Be responsible for all requirements of being an employer, including:

(a) Employee payroll;

(b) Withholdings;

(d) Taxes appropriate to being an employer; and

(e) Issuing the employee a W-2 as required by the Internal Revenue Service;

(8) Negotiate for room and board for an attendant as established in Section 9(4)(a) of this administrative regulation; and

(9) Coordinate with a program coordinator the aspects of program requirements.

Section 8. Attendant Responsibilities.

(1) An attendant shall:

(a) Enter into and comply with the written agreement for terms of work required by Section 7(5) of this administrative regulation;

(b) Perform personal care assistance services and other tasks that may include:

Turning;
Repositioning;
Transferring;
Assistance with oxygen;
Hygiene;
Grooming;
Washing hair;
Skin care;
Shopping;
Transportation;
Chores;
Light correspondence;
Equipment cleaning; and
Emergency procedures, if necessary;

(d) Report to work as scheduled;

(e) Maintain the privacy and confidentiality of the participant;

(f) If unable to report for work as scheduled, notify the participant at least six (6) hours in advance unless an emergency arises;

(g) Maintain a list of emergency numbers;

(h) Participate in attendant training provided by the participant related to his or her specific care needs and, if applicable, training related to dementia care, established by 910 KAR 4:010;

(i) Keep a daily record of hours worked and services rendered;

(j) Submit to the participant documents and material necessary to comply with the formal payment process;

(k) Meet with the participant and program coordinator for monitoring and coordinating the aspects of the program;

(l) Disclose misdemeanor or felony convictions to the applicant or participant through a law enforcement agency;

(m) Authorize a qualified agency to obtain a criminal background check from the Kentucky National Background Check Program as defined in 906 KAR 1:190; and

(n) Notify the program coordinator of conditions that seriously threaten the health,safety, or welfare of the participant or attendant.

(2) An individual shall not be hired as an attendant if the individual:

(a) Has not submitted to the background checks established in subsection (1)(m) of this section;

(b) Has pled guilty or been convicted of committing:

A felony crime related to theft or drugs; or
A misdemeanor or felony crime related to sexual or violent offenses, including assault; or

Section 9. Attendant Payment.

(1) The amount of attendant payment shall be in compliance with paragraphs (a) through (d) of this subsection.

(a) The maximum hourly subsidized rate for direct personal care assistance services shall not exceed eleven (11) dollars per hour.

(b) If the hourly subsidized rate established in paragraph (a) of this subsection is insufficient to obtain direct personal care assistance services in a specific Kentucky service area, a provider may request a higher rate by mailing a written request and justification of the need for a higher rate to the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621.

(d) Maximum hours for direct personal care assistance services per week shall be forty (40).

(2) In an extreme situation that results in a temporary increased need for services, such as the illness of the participant, or illness or death of a caregiver, a temporary waiver of maximum hours and the resulting cost may be granted by the contract agency.

(3) A special night rate may be negotiated:

(a) If a participant does not:

Require an attendant during the day; or
Need direct personal care assistance services from this attendant; or

(b) To provide for caregiver respite service.

(4)

(a) It shall be the responsibility of the participant who is in need of a live-in attendant to directly negotiate, if necessary, with a potential attendant on room and board for personal care assistance services.

(b) A live-in attendant shall not be excluded from employment as a part-time attendant.

(c) Maximum payment under this arrangement shall be for forty (40) hours of personal care assistance services per week, and overtime shall not be provided or paid.

Section 10. Program Coordinator Qualifications and Responsibilities.

(1) A program coordinator shall meet at least one (1) of the following minimum qualifying requirements:

(a) A bachelor's degree with two (2) years' experience working in the disability community; or

(b) Completion of fifty-four (54) semester hours of college with four (4) years working in the disability community.

(2) The department may waive the education requirements required by subsection (1) of this section based on consideration of work experience involving:

(a) Interviewing to select an employment candidate;

(b) More than five (5) years of experience working with the disability community;

The review of assessment criteria;
Monitoring program compliance;
Training program participants, employees, and staff regarding program requirements; or

(d) Determination of eligibility for human services programs.

(3) If employed, a program coordinator shall complete the following hours of training:

(a) Within thirty (30) working days of hire:

Complete a minimum of sixteen (16) hours of orientation program training; and
Shadow an experienced program coordinator for one (1) to two (2) days;

(b) Within the first six (6) months of employment, complete a minimum of fourteen (14) hours of initial program coordination training; and

(4) A program coordinator shall:

(a) Collaborate with the evaluation team to determine if an applicant is eligible to participate in the personal care attendant program in accordance with Section 2 of this administrative regulation;

(b) Complete the application process required by Section 3(2)(a) of this administrative regulation;

(c) Maintain a waiting list of eligible applicants who are unable to be funded for program participation until an opening occurs; and

(d) Perform the assessments required in Section 12(2) of this administrative regulation.

(5) A program coordinator or program coordinator's designee shall:

(a) Identify severely physically disabled adults who may be eligible for participation in the personal care attendant program;

(b) Prescreen an applicant for eligibility to participate in the personal care attendant program;

(d) Assist in or arrange for the training of the attendant, if necessary;

(e) Review with the participant the results of an assessment or reassessment signed by an evaluation team;

(f) Assist the participant in completing and updating a PCAP-06 Plan of Care;

(g) Assist the participant in developing a work agreement between the participant and attendant;

(h) Obtain a PCAP-02 Authorization for Release of Confidential Information from the participant;

(i) Monitor the program with each participant on a quarterly basis, including:

A face-to-face visit with the participant during at least two (2) of the quarters; and
Making verbal contact with the participant in the quarters that a face-to-face visit is not made;

(j) Assist the participant in finding a back-up attendant for:

An emergency; or
The regular attendant's time off;

(k) Assist in the recruitment and referral of an attendant, if requested;

(l) Submit monthly activity reports to a qualified agency as established in Section 15(2) of this administrative regulation by the fifth (5th) of the following month; and

(m) Assure that the participant:

Enters into agreement to pay employee taxes with a PCAP-03 Employer Tax Agreement; and
Receives training in recordkeeping and tax responsibilities related to services.

Section 11. Qualified Agency Responsibilities. A qualified agency shall:

(1) Employ or contract with an evaluation team pursuant to KRS 205.905(2);

(2) Provide monthly programmatic and financial reports on an attendant per participant to the contract agency by the fifth of the following month;

(3) Develop a procedure for:

(a) Payment of a subsidy; and

(b) Establishment of appropriate fiscal control within the qualified agency;

(4) Employ or contract for the services of a program coordinator;

(5) Supervise the training requirements for a program coordinator as established in Section 10(3) of this administrative regulation;

(6) Obtain a criminal background check from the Kentucky National Background Check Program as defined in 906 KAR 1:190 on a potential attendant;

(7) Report the evaluation team's findings and recommendations to a contract agency as established in Section 3(3) of this administrative regulation;

(8) Maintain participant records as required by Section 15(1) of this administrative regulation; and

(9) Provide accessibility to services through proper evaluation of applicants who are deaf or hard-of-hearing by utilizing an interpreter service in accordance with KRS 12.290.

Section 12. Evaluation Team Members and Responsibilities.

(1) An evaluation team:

(a) Shall consist of a program coordinator; and

(b) May consist of:

An occupational or physical therapist;
A registered nurse;
A director or executive director of the qualified agency;
A fiscal officer of the qualified agency;
A mental health provider;
An in-home services coordinator; or
Another entity involved in the participant's care.

(2) The program coordinator of the evaluation team shall complete:

(a) An applicant's initial assessment to establish eligibility pursuant to KRS 205.905(2)(b)1; and

(b) A participant's reassessment, at least biennially for continuing services pursuant to KRS 205.905(2)(b)2.

Section 13. Contract Agency Responsibilities. The contract agency shall:

(1) Have a process in place to conduct prescreening of referrals to ensure they meet the program and financial requirements;

(2) Implement a personal care attendant program according to an approved plan;

(3) Assume fiscal accountability for state funds designated for the program;

(4) Provide necessary administrative support personnel within a contract agency office;

(5) Provide an appeals procedure and hearing process in compliance with:

(a) KRS Chapter 13B; and

(b) KRS 205.915;

(6) Monitor management practices, including program evaluation, to assure effective and efficient program operation and compliance with cabinet financial audit requirements;

(7) Provide, in conjunction with a qualified agency, a procedure for attendant payment;

(8) Review the evaluation team's findings and recommendations and notify a participant and qualified agency as established in Section 3(4) of this administrative regulation;

(9) Submit monthly program reports along with the submission of financial invoices to the department as established in Section 15(3) of this administrative regulation; and

(10) Maintain files and records for cabinet audit, including participant records and statistical reports in accordance with 725 KAR 1:061.

Section 14. Department Responsibilities. The department shall:

(1) Provide a format for the approved plan for the personal care attendant program;

(2) Review proposed plans submitted by a contract agency to administer the personal care attendant program;

(3) Inform the contract agency in writing of the action taken regarding the proposed plan for administration of the personal care attendant program that shall include one (1) of the following outcomes:

(a) Approve the plan as submitted;

(b) Require the contract agency to revise the plan; or

(4) Monitor the contract agency at least annually;

(5) Develop and revise program and fiscal requirements;

(6) Allocate available funding;

(7) Advocate for program expansion; and

(8) Provide technical assistance.

Section 15. Reporting and Recording.

(1) An individual record for each participant shall be maintained by the qualified agency and shall include:

(a) The forms incorporated by reference in Section 17 of this administrative regulation;

(b) A chronological record of contacts with:

The participant;
The family;
The physician; and
Others involved in care with quarterly monitoring reports; and

(2) A program coordinator shall:

(a) Submit completed reports for monthly activities to a qualified agency by a designated date in the contract; and

(b) Forward a copy to the contract agency.

Section 16. Appeals. An applicant or participant may request an informal dispute resolution or an appeal.

(1) A recipient may request an informal dispute resolution.

(2) A dispute resolution shall be limited to:

(a) The denial, reduction, or termination of a:

Personal care attendant program plan; or
Personal care attendant program plan amendment;

(b) The reduction of personal care attendant program funding as requested in the plan; or

(c) The reduction or termination of personal care attendant program grant program funding, unless due to state budget cuts.

(3) A request for an informal dispute resolution shall:

(a) Be submitted to the department's PCAP program coordinator within thirty (30) days following the notification by the personal care attendant program grant program coordinator of a decision in subsection (2) of this section; and

(b) Contain the:

Name, address, and telephone number of the recipient;
Decision being disputed;
Justification for the dispute;
Documentation supporting the dispute; and
Signature of person requesting the dispute resolution.

(4) The dispute resolution shall be heard by:

(a) Three (3) members of the council, one (1) of whom shall be the chairman or the chairman's designee;

(b) One (1) member of the review team; and

(5) The recipient shall be provided an opportunity to appear before the dispute resolution team to present facts or concerns about the denial, reduction, or termination of the grant.

(6) The dispute resolution team shall inform a recipient, in writing, of the decision resulting from the dispute resolution within ten (10) business days of the review.

(7) A recipient dissatisfied with the result of the dispute resolution may request an appeal. An appeal shall be made:

(a) In accordance with:

KRS Chapter 13B; and
KRS 205.915; and

(b) Within thirty (30) days of any decision by the:

Cabinet;
Contract agency; or
Qualified agency; and

(c) By submitting a written request for appeal to the Office of Ombudsman and Administrative Review, Quality Advancement Branch, 275 E. Main St, 2 E-O, Frankfort, KY 40621.

Section 17. Incorporation by Reference.

(1) The following forms are incorporated by reference:

(a) "PCAP-01 Application for Services", edition 4/2018;

(b) "PCAP-02 Authorization for Release of Confidential Information", edition 4/2018;

(d) "PCAP-04 Evaluation Team Findings and Recommendations", edition 4/2018;

(e) "PCAP-05 Income Eligibility", edition 4/2018; and

(f) "PCAP-06 Plan of Care", edition 4/2018.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. This material may also be viewed on the department's Web site at https://chfs.ky.gov/agencies/dail/Pages/default.aspx.

History

RELATES TO: KRS 12.290, Chapter 13B, 171.530, 205.455(4), 205.8451(3), 205.900 - 205.925
STATUTORY AUTHORITY: KRS 194A.050(1), 205.910, 205.920
NECESSITY, FUNCTION, AND CONFORMITY: KRS 205.910 requires the Cabinet for Health and Family Services to establish by administrative regulation, an eligibility standard for personal care assistance services that takes into consideration the unique economic and social needs of severely physically disabled adults. KRS 205.920 authorizes the cabinet to promulgate administrative regulations to implement provisions concerning personal care assistance services. This administrative regulation establishes the personal care attendant program.
History: 12 Ky.R. 386; eff. 10-8-1985; 18 Ky.R. 2051; 2574; 2828; eff. 3-7-1992; 19 Ky.R. 2143; 2450; eff. 4-21-1993; Recodified from 905 KAR 8:090, 10-30-1998; Recodified from 923 KAR 1:090, 7-8-1999; 34 Ky.R. 1578; 2128; eff. 3-19-2008; 45 Ky.R. 187, 657; eff. 9-19-2018; 49 Ky.R. 451, 1276; eff. 1-12-2023.

910 KAR 1:140 Appeal procedures {#sec-910-kar-1-140 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:140}

Section 1. Definitions.

(1) "Area Agency on Aging and Independent Living" or "AAAIL" means an area agency on aging as defined by 42 U.S.C. 3002(6).

(2) "Area plan" means a plan submitted by an AAAIL to the department that releases funds under contract for the delivery of service within a planning and service area.

(3) "Assistant secretary" means the Assistant Secretary for Administration on Community Living as defined by 42 U.S.C. 3002(7).

(4) "Cabinet" is defined by KRS 194A.005(1).

(5) "Department" means the Department for Aging and Independent Living.

(6) "Department contracting agency" means an agency contracting directly with the department to administer department programs and services not affiliated with 42 U.S.C. 3021-3030s-2, Title III of the Older Americans Act.

(7) "District" is defined by KRS 205.455(4).

(8) "Local administrative review" means the process for consultation and review of a protest or complaint as defined in subsection (10) of this section.

(9) "Planning and service area" or "PSA" means the multicounty geographical entity in which a given AAAIL is responsible for the delivery of aging services.

(10) "Protest" or "complaint" means a written objection by:

(a) An applicant or provider to a proposed award or award of contract denied by an AAAIL;

(b) A provider to an AAAIL's decision to terminate or not renew its contract to provide services;

(d) A client of a provider or AAAIL in receipt of or non-receipt of services; or

(e) A client in receipt of or non-receipt of services administered directly by the department.

(11) "Provider" means a person or entity that is awarded a contract from an AAAIL to provide services under an approved area plan.

(12) "Receipt of notice" means the date notice is received.

(13) "RFP file" means those documents that are maintained regarding a particular procurement including:

(a) Request for proposal;

(b) Newspaper advertisement;

(d) Correspondence pertaining to the RFP;

(e) Review by the AAAIL;

(f) Rating or scoring and selection documents;

(g) Notice of award; and

(h) Contract.

(14) "Secretary" is defined by KRS 194A.005(2).

Section 2. Local Administrative and State Hearing Procedures for AAAIL Contractor Selection.

(1)

(a) An AAAIL shall send written notice to an applicant or provider for contractor selection by registered or certified mail within seven (7) calendar days of the AAAIL's decision which:

Denies the applicant or provider its request to a proposed award or award of contract; or
Terminates or does not renew the provider's contract to provide a service.

(b) The notice shall specify:

The reason for the adverse action;
That the provider or applicant may file with the AAAIL a written protest or complaint within ten (10) calendar days from receipt of notice; and
That failure to file the protest or complaint within the ten (10) calendar days shall constitute a waiver of opportunity for a state administrative hearing.

(2)

(a) An AAAIL shall develop and submit written local administrative review procedures for contractor selection to the department for approval.

(b) The procedures shall provide that:

The district shall not proceed further with the solicitation, award, or termination during the pendency of a local administrative review for contractor selection, except under a contingency plan approved by the department;
A request for a state administrative hearing shall not be accepted until all administrative remedies have been exhausted at the local level;
The applicant or provider shall have an opportunity to review pertinent evidence upon which the adverse action was based including competing proposals and scoring sheets;
A request for reconsideration of an award shall state in writing why the protest is filed and the factual circumstances and issues to be considered during the review;
A local administrative review for the applicant or provider shall include the following:

a. An opportunity for the applicant or provider to appear in person before an individual or a group of three (3) persons who can render an impartial decision;

b. An opportunity to present witnesses and documentary evidence;

c. An opportunity to be represented by counsel;

d. An opportunity to cross-examine witnesses; and

e. A written impartial decision describing:

(i) The reasons for the decision;

(ii) The evidence on which the decision is based; and

(iii) A statement explaining the right to request a state administrative hearing if the protest or complaint is not resolved at the local administrative review;

An AAAIL shall:

a. Complete a local administrative review for the applicant or provider no later than twenty (20) calendar days after receipt of the applicant's or provider's written protest or complaint; and

b. Within seven (7) calendar days of receipt of the protest or complaint, send a written notice to the applicant or provider by certified mail return receipt requested that specifies:

(i) The date, time, and place for the review; and

(ii) A statement that failure to attend the review shall constitute a waiver of opportunity for a state administrative hearing;

If the protest or complaint is not resolved and all administrative remedies have been exhausted, the AAAIL shall send a written response by certified mail return receipt requested to the applicant or provider within seven (7) calendar days of finalizing the local administrative review that includes:

a. The AAAIL's findings and determinations on the issues raised in the protest or complaint; and

b. A statement of the right to request a state administrative hearing with the cabinet; and

An AAAIL shall, within ten (10) calendar days of finalizing the review, forward a complete copy of the local administrative review and RFP file relating to a particular procurement to the department.

(3) An applicant or provider may request a state administrative hearing in writing to the department on one (1) or more of the following grounds:

(a) The award does not comply with the applicable request for proposal;

(b) The local administrative review does not comply with the approved procedures of the AAAIL; or

(c) Denial by the AAAIL in whole or in a substantial part of an application to provide services or the AAAIL decision to terminate or not renew the contract to provide services is:

Arbitrary or capricious;
An abuse of discretion;
Biased;
The result of a conflict of interest;
Not based upon substantial evidence; or
Not in compliance with the terms of the contract.

(4) The written request for a state administrative hearing by an applicant or provider shall:

(a) Set forth the grounds and their alleged factual basis;

(b) Be mailed to the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621;

(c) Be postmarked not later than thirty (30) calendar days from receipt of the AAAIL's local administrative review findings and determinations; and

(d) Be copied and mailed to the AAAIL that provided the local administrative review.

(5) Failure of the applicant or provider to comply with procedures provided in subsection (4) of this section shall constitute a forfeiture of the opportunity for a state administrative hearing, and the request shall be returned to the applicant or provider with a written explanation.

(6) The department may waive its timeliness requirements provided in subsection (4)(c) of this section and shall notify the parties of the reason for the waiver upon:

(a) Receipt of a written request from a party to waive the timeliness requirements and a determination that good cause or exigent circumstances exist; or

(b) Determination that a waiver is in the best interest of the department.

(7) The department may expedite scheduling and notify the parties in writing of the reason upon determination that:

(a) A reduction in the time frame is in the best interest of the department; or

(b) The rights of the parties at the state administrative hearing are not prejudiced by the reduction.

(8)

(a) Upon receipt of the applicant's or provider's request for a state administrative hearing, the department shall determine whether the matter is subject to review on the grounds specified in subsection (3) of this section.

(b) If the matter is not specific to subsection (3) of this section, the department shall inform the applicant or provider in writing by certified mail return receipt requested, with a copy to the AAAIL, within ten (10) calendar days of receipt of the request.

(c) If the matter is specific to subsection (3) of this section, the department shall submit the applicant's or provider's request to the cabinet's Administrative Hearings Branch within three (3) calendar days of its decision.

(9) The procedures for a state administrative hearing shall be in accordance with KRS Chapter 13B.

(10) The final decision of the secretary shall be based on the record of the hearing and may direct that appropriate action be taken including:

(a) Affirming the action of the AAAIL;

(b) Directing that the award be made to the next most advantageous proposal, taking into consideration price and the evaluation factors set forth in the RFP;

(d) Reversing the decision and awarding the contract to the appellant.

(11) The department may approve a contingency plan for delivery of services while the AAAIL takes action to conform to the decision.

(12) If the applicant or provider, AAAIL, department, and other interested parties negotiate a written agreement that resolves the issue which led to the request for a hearing, the department may terminate a formal hearing.

(13) Pursuant to KRS 13B.140(1), an applicant or provider may appeal a final decision to the circuit court within thirty (30) days after the final order of the secretary is mailed or delivered by personal service to the applicant or provider.

Section 3. Hearing Procedures for an AAAIL.

(1) The department shall provide an opportunity for a state administrative hearing to an AAAIL if the department proposes the following adverse actions:

(a) Disapproves the AAAIL's area plan or plan amendment as specified in 45 C.F.R. 1321.35(a)(2), except as set forth in 45 C.F.R. 74, App A;

(b) Withdraws the AAAIL's designation as provided in 45 C.F.R. 1321.35(a) or initiates an action outlined in 42 U.S.C. 3025(b)(5)(C)(i);

(d) Denies or reduces the AAAIL's payment pursuant to 42 U.S.C. 3026(f)(2)(B).

(2)

(a) The department shall send a written notice to the AAAIL by registered or certified mail within seven (7) calendar days of determination of the adverse action.

(b) The notice shall specify:

The reasons for the adverse action;
A statement of the right to request a state administrative hearing with the cabinet within ten (10) calendar days from receipt of notice; and
That failure to file the request within the ten (10) calendar days constitutes a waiver of opportunity for a state administrative hearing.

(3) An AAAIL's written request for a state administrative hearing shall:

(a) Specify the reasons for disputing the department action; and

(b) Be mailed to the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621.

(4)

(a) Upon receipt of the AAAIL's written request, the department shall determine if the AAAIL's request is subject to review according to the adverse actions outlined in subsection (1) of this section.

(b) If the matter is not applicable to subsection (1) of this section, the department shall inform the AAAIL in writing within ten (10) calendar days of receipt of the request.

(c) If the matter is specific to subsection (1) of this section, the department shall submit the AAAIL's request to the cabinet's administrative hearings branch within three (3) calendar days of its decision.

(5) The procedures for a state administrative hearing shall be in accordance with KRS Chapter 13B.

(6) Final decision shall be rendered by the secretary.

(7) An AAAIL may appeal a final decision to the circuit court within thirty (30) days after the final order of the cabinet is mailed or delivered by personal service to the AAAIL pursuant to KRS 13B.140(1).

(8) If the applicant or provider, AAAIL, department, and other interested parties negotiate a written agreement that resolves the issue which led to the request for a hearing, the department may terminate a formal hearing.

(9) After due process is provided, an AAAIL may bring an appeal to the Assistant Secretary of the Administration for Community Living pursuant to 42 U.S.C. 3025(b)(5)(C)(iii).

Section 4. Hearing Procedures for a Department Contracting Agency. An opportunity for a state administrative hearing for a department contracting agency shall be in accordance with KRS Chapter 13B.

Section 5. Hearing Procedures for a Provider's Client or Applicant Services.

(1) A provider shall:

(a) Have written procedures for filing a grievance approved by the AAAIL for a provider's client or applicant; and

(b) Ensure the client or applicant is notified of the provider's policies.

(2) A client or applicant for services may request an administrative review with the AAAIL to resolve the complaint.

(3) The AAAIL shall:

(a) Conduct and complete a local administrative review with the client or applicant no later than twenty (20) calendar days after receipt of the client's or applicant's written protest or complaint; and

(b) Notify the client or applicant within three (3) calendar days of receipt of the client's or applicant's protest or complaint that specifies:

The date, time, and place for a local administrative review; and
Failure to participate in the review shall constitute a waiver of opportunity for a state administrative hearing.

(4) Within three (3) calendar days of its findings and determinations of the written protest or complaint, the AAAIL shall:

(a) Submit a copy of the results of the local grievance to the DAIL; and

(b) Send a written response of the review to the client:

By certified mail return receipt requested;
Specifying its findings and determinations of the issues raised in the protest or complaint; and
With a statement of the right to a CHFS administrative hearing if the protest or complaint is not resolved.

(5) A written request for a state administrative hearing shall:

(a) Set forth the grounds for the protest or complaint;

(b) Be mailed to the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621; and

(c) Be postmarked no later than thirty (30) calendar days from receipt of the local administrative review findings and determinations.

(6) Upon receipt of the client's or applicant's request for a state administrative hearing, the department shall submit the client's or applicant's request to the cabinet's administrative hearings branch within three (3) calendar days.

(7) The procedures for a state administrative hearing shall be in accordance with KRS Chapter 13B.

(8) Final decision shall be rendered by the secretary.

(9) If the applicant or provider, AAAIL, department, and other interested parties negotiate a written agreement that resolves the issue which led to the request for a hearing, the department may terminate a formal hearing.

(10) A client or applicant may appeal a final decision to the circuit court within thirty (30) days after the final order of the cabinet is mailed or delivered by personal service to the client pursuant to KRS 13B.140(1).

Section 6. Hearing Procedures for a Department Contracting Agency's Applicant or Client.

(1) A department contracting agency shall:

(a) Have written grievance procedures for a client or applicant; and

(b) Ensure the client or applicant is notified of the contracting agency's grievance policies.

(2) A contracting agency's client or applicant for services may request a state administrative hearing with the cabinet if the protest or complaint is not resolved at the contracting agency's level.

(3) The department contracting agency shall:

(a) Submit a copy of the results of the administrative review with the client or applicant to the department; and

(b) Send a written response of the review to the client:

By certified mail return receipt requested;
Specifying its findings and determinations of the issues raised in the protest or complaint; and
With a statement of the right to a state administrative hearing if the protest or complaint is not resolved.

(4) A department contracting agency's client or applicant shall be subject to the hearing procedures outlined in Section 5(7) through (10) of this administrative regulation.

(5) If the applicant or provider, AAAIL, department, and other interested parties negotiate a written agreement that resolves the issue which led to the request for a hearing, the department may terminate a formal hearing.

(6) A contracting agency's client or applicant may appeal a final decision to the circuit court within thirty (30) days after the final order of the cabinet is mailed or delivered by personal service to the client pursuant to KRS 13B.140(1).

History

RELATES TO: KRS Chapter 13B, 205.201, 205.204, 205.460-205.465, 42 U.S.C. 3021-3030s-2, 45 C.F.R. 74 App A, 1321.35
STATUTORY AUTHORITY: KRS 13B.170, 194A.050(1), 42 U.S.C. 3025(b)(5)(C)(i), 3026(f)(2)(B), 42 U.S.C. 3027(a)(5)
NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. 3027(a)(5) requires that the department afford an opportunity for a hearing upon request to providers and applicants who provide services under 42 U.S.C. 3021-3030s-2, Title III of the Older Americans Act of 1965, as amended in 2006 (Public Law 109-365). KRS 13B.170 authorizes the cabinet to promulgate administrative regulations necessary to carry out the provisions of KRS Chapter 13B. This administrative regulation establishes the department's appeals procedures.
History: 17 Ky.R. 854; Am. 1515; eff. 12-7-1990; Recodified from 905 KAR 8:140, 10-30-1998; Recodified from 923 KAR 1:140, 7-8-1999; 41 Ky.R. 2138; 2568; eff. 6-17-2015; Cert Eff. 11-17-2021.

910 KAR 1:170 Older Americans Act supportive services for the elderly {#sec-910-kar-1-170 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:170}

Section 1. Definitions.

(1) "Access" means information and referral services, outreach service and transportation service.

(2) "Agency" means the area agency on aging, an entity designated by the state to administer, at the local level, the programs funded by the Older Americans Act of 1965, as amended.

(3) "Assessment" means the collection and evaluation of information about a person's situation and functioning to determine the applicant or recipient service level and development of a plan of care utilizing a holistic, person centered approach by a case manager.

(4) "Assisted transportation" means a one-way trip to accompany an eligible person who requires assistance for safety or protection to or from his or her physician, dentist, or other necessary service.

(5) "Case management" means a process, coordinated by a case manager, for linking a client to appropriate, comprehensive, and timely home or community based services as identified in the plan of care by:

(a) Planning;

(b) Referring;

(d) Advocating; and

(e) Following the timeline of the assessment agency to obtain:

Service level; and
Development of the plan of care.

(6) "Case management supervisor" means an individual meeting the requirements of Section 5(1) and (2) of this administrative regulation and who has four (4) years or more experience as a case manager.

(7) "Case manager" means the individual employee, meeting the requirements of Section 5 of this administrative regulation, and who is responsible for case management including:

(a) Coordinating services and supports from all agencies involved in providing services required by the plan of care;

(b) Completing the initial assessment, plan of care, and annual reassessment;

(d) Ensuring that services are delivered as required.

(8) "Community" means a county designated as either urban or rural in accordance with the most current percentage of population listing from the U.S. Census Bureau.

(9) "District" is defined by KRS 205.455(4).

(10) "Educational or experiential equivalent" means:

(a) Two (2) semesters totaling at least twenty-four (24) hours of course work; and

(b) At least 400 documented hours of experience assisting aging or disabled individuals through:

Practicum placement;
Clinicals; or
Volunteerism.

(11) "Home modification" means the provision of minor home adaptations, additions, or modifications to enable the elderly to live independently or safely or to facilitate mobility, including emergency summons systems.

(12) "Information and assistance" means a service for individuals that provides current information about services available within the community.

(13) "In-home services" means the performance of heavy housecleaning, yard tasks, and other activities needed to assist a functionally impaired elderly person remain in his or her own home.

(14) "Legal assistance" means:

(a) Legal advice and representation by an attorney; or

(b) Counseling or other appropriate assistance by a paralegal or law student under the supervision of an attorney.

(15) "Multipurpose senior center" is defined by 42 U.S.C. 3002(36).

(16) "Natural supports" means a non-paid person or community resource who can provide, or has historically provided, assistance to the consumer or, due to the familial relationship, would be expected to provide assistance when capable.

(17) "OAA" means the Older Americans Act of 1965, 42 U.S.C. 3001 et seq., as amended.

(18) "Outreach" means interventions with individuals initiated by an agency or organization for the purpose of identifying potential clients or their caregivers and encouraging their use of existing services and benefits.

(19) "Planning and service area" is defined by 42 U.S.C.3002(43).

(20) "Rural" means a community with less than 50,000 population as designated by the most current listing from the U.S. Census Bureau.

(21) "Satellite senior center" means a facility that is used to provide services specified in Section 10(3) of this administrative regulation if a multipurpose senior center is not available to provide the services.

(22) "Senior center services" means the provision of activities that foster the health or social well-being of individuals through social interaction and leisure.

(23) "Service level" means the minimum contact required through face-to-face visits and telephone calls by the case manager or social service assistant.

(24) "Social service assistant" means an individual who:

(a) Has at least a high school diploma or equivalent;

(b) Works directly under the direction of the case management supervisor;

(d) Helps determine what type of assistance a client needs;

(e) Assists the client in getting services to carry out the plan of care;

(f) Coordinates services provided to the client;

(g) Assists a client in applying for other services or benefits for which he may qualify; and

(h) Monitors a client to ensure services are provided appropriately.

(25) "Supportive service provider" means an entity that provides supportive services funded by the OAA under an approved area plan.

(26) "Telephone reassurance" means providing a wellness check by phone with the agreement of the individual.

(27) "Transportation" means transporting an individual from one (1) location to another.

(28) "Unit of service" means one (1):

(a) Hour of direct contact with or on behalf of the participant;

(b) Contact for the information and referral service;

(d) Contact for the outreach service;

(e) One-way trip for the transportation service; and

(f) Contact for senior center service.

(29) "Urban" means a community with 50,000 or more population as designated by the most current listing from the U.S. Census Bureau.

Section 2. Eligibility.

(1) Participants receiving supportive services funded by the OAA shall be sixty (60) years of age or older.

(2) Agencies shall utilize the DAIL-GA-01 Priority Screening Tool for prioritizing applicants to ensure services are targeted to those in greatest need.

(3) Means tests shall not be allowed to determine eligibility.

Section 3. Service Provider Responsibilities.

(1) A supportive service provider contracting with a district to provide supportive services supported in whole or in part from funds received from the cabinet shall:

(a) Provide services in accordance with the approved agency area plan which shall ensure the provision of supportive services throughout the geographic area covered under its plan, and shall not supplant the natural supports;

(b) Review the provision of supportive services to assure safety and consistency;

(c) Treat the client in a respectful and dignified manner and involve the client and caregiver in the delivery of services;

(d) Authorize staff of the cabinet and the district to monitor and evaluate services provided;

(e) Assure that each paid or voluntary staff member meets qualification and training standards established for each specific service by the department;

(f) Maintain a written job description for each paid staff and volunteer position involved in direct service delivery;

(g) Develop and maintain written personnel policies and a wage scale for each job classification;

(h) Designate a supervisor to assure that staff providing in-home services are provided supervision;

(i) Monitor, evaluate, and conduct satisfaction surveys; and

(j) Maintain a record for each client including:

Participant name;
Address;
Phone number;
Emergency contact information;
Request for services;
Verification of eligibility;
Services provided; and
Monitoring of services provided.

(2) Staff of the provider agency shall not:

(a) Accept personal gratuities from participants or vendors;

(b) Be involved in any client financial transaction without prior approval from the contracting agency; or

The individual or company is the provider of last resort;
A written justification is provided; and
The request is approved by DAIL.

(3) A procedure shall be utilized annually for the evaluation of unmet need, the results to be made available to the agency.

(4) The legal assistance provider shall:

(a) Specify how it intends to target services for the needs of low-income minority individuals;

(b) Attempt to provide services to the population of low-income minority individuals in at least the same proportion as the population bears to the older population as a whole;

(c) Provide individual legal casework, legal referral, and legal education to the elderly and training for attorneys in areas of law relevant to the elderly;

(d) Contact institutionalized elderly and inform and educate these individuals about the legal assistance services available;

(e) Specify how it intends to coordinate its efforts with the efforts of the Long-term Care Ombudsman Office;

(f) Meet at least annually with the local ombudsman program;

(g) Submit a written quarterly activities report to the agency, documenting the legal activities and services provided to participants; and

(h) Not divulge information protected by the attorney-client privilege.

Section 4. Support Services. Services funded by the OAA and administered by the area agencies on aging and independent living shall be provided as established in this section.

(1) Except for senior center and access services, the case manager and the individual shall determine the service needs of the individual.

(2) Information and assistance services shall:

(a) Provide information in response to an inquiry regarding opportunities and services available;

(b) Assist in accessing opportunities and services;

(d) Utilize current records of appropriate community resources, including local procedures for assessing participant needs and for making referrals to appropriate agencies.

(3) Legal assistance services shall:

(a) Be available for institutionalized older persons and other elderly persons otherwise entitled to legal assistance;

(b) Not be denied because of a person's failure to disclose information about income or resources; and

(c) Assure providers maintain records to include individual client services and group activities, covering topics, presenters, locations, and numbers of participants.

(4) Outreach services shall:

(a) Locate or reestablish contact initiated by providers, to identify participants in need of services;

(b) Provide information;

(d) Be provided in the total geographic area served by the agency, in accordance with a plan to identify the elderly and caregivers in the area, with priority given to a rural, low income minority, limited English speaking, or disabled individual; and

(e) Be provided by a worker with current knowledge of services available to the elderly, caregivers, and individuals with disabilities in accordance with an established procedure for worker assistance to the participant in accessing appropriate services, including follow-up to assure needs have been met.

(5) Senior center services shall provide activities which foster the health or social well-being of an individual through social interaction and the use of leisure time.

(6) OAA Title IIIB allocation shall be provided:

(a) By staff who are knowledgeable and skilled in the services provided, including a volunteer under the supervision of the center director; and

(b) With consideration for the physical and mental conditions and activity preferences of a participant.

(7) Telephone reassurance services shall:

(a) Provide regular telephone contact to or from isolated individuals;

(b) Be provided by a staff who is knowledgeable and skilled in the services provided, including a volunteer under the supervision of the center director;

(d) Maintain a log of calls documenting:

Date of the contact;
Length of the call;
Summary of the contact;
Demographics of the participant;
Determination of safety and well-being; and
Determination of special assistance needed;

(e) Establish a procedure to be implemented in the event of a non-answered call; and

(f) Include the participant's preference regarding frequency of calls.

(8) Transportation services shall:

(a) Be provided by a trained individual;

(b) Carry older persons to or from community resources to access or receive needed services;

(d) Use vehicles safe and accessible to older persons and properly insured to protect the participants in accordance with state laws.

(9) Assisted transportation services shall be provided:

(a) In accordance with subsection (8) of this section; and

(b) To a person who requires accompaniment for reasons of safety or protection to or from his or her physician, dentist, or other necessary services as determined by the case manager.

(10) In-home services shall be provided:

(a) By trained staff;

(b) As determined by the case manager; and

(c) By an individual licensed, insured, and experienced in the appropriate trade to complete home modifications or repairs.

Section 5. Case Manager Requirements.

(1) A case manager shall:

(a)

Possess a bachelor's degree in a health or human services field from an accredited college or university:

a. With one (1) year experience in health or human services; or

b. The educational or experiential equivalent in the field of aging or physical disabilities;

Be a currently licensed RN as defined in KRS 314.011(5) who has at least two (2) years of experience as a professional nurse in the field of aging or physical disabilities; or
Be a currently licensed LPN as defined in KRS 314.011(9) who:

a. Has at least three (3) years of experience in the field of aging or physical disabilities; and

b. Is supervised by an RN who consults and collaborates on changes to the plan of care;

(b) Be a department certified case manager beginning July 1, 2015; and

(2) A master's degree from an accredited college or university may be substituted for the required experience.

(3) Each client shall be assigned a:

(a) Case manager; or

(b) Social service assistant.

(4) A client shall be assessed initially and reassessed at least annually thereafter by a case manager that possesses a bachelor's degree, a master's degree, or is a licensed registered nurse (RN).

(5) After each assessment or reassessment, the case manager shall determine eligibility and service level based on the DAIL-HC-01, Scoring Service Level of each assessed individual.

(6) If the client is ineligible, the case shall be closed and the reason documented in the case record with notification mailed to the client or caregiver.

(7) The case manager shall:

(a) Be responsible for coordinating, arranging, and documenting those services provided by:

Any funding source; or
A volunteer;

(b) Make a reasonable effort to secure and utilize informal supports for each client;

(d) Monitor each client by conducting a home visit according to the assessed service level and coordinate a telephone contact between home visits. Clients shall be contacted at a minimum as follows:

Level 1, a home visit shall be conducted every other month;
Level 2, a home visit shall be conducted every four (4) months; or
Level 3, a home visit shall be conducted every six (6) months; and

(e) Document in the case record each contact made with a client, as specified in paragraph (d) of this subsection.

(8) A district shall employ a case manager to assess the eligibility and needs for each client.

(9) A client assessed at a Level 1 or a Level 2 shall be assigned a case manager.

(10) A client assessed at a Level 3 shall have a case manager or a social service assistant assigned to assist with meeting the client's needs.

(11) A client shall receive in-home services in accordance with an individualized plan of care developed through participant directed planning which shall:

(a) Relate to an assessed problem;

(b) Identify goals to be achieved;

(d) Identify a source of service;

(e) Include a plan for reassessment; and

(f) Be signed by the client or client's representative and case manager with a copy provided to the client.

(12) Case management services shall not be provided to an individual on a waiting list.

Section 6. Multipurpose Senior Center Selection.

(1) An area agency on aging and independent living (AAAIL) shall designate a multipurpose senior center within each urban community of the AAAIL's planning and service area.

(2) If only rural communities are within an AAAIL's planning and service area, the AAAIL shall designate at least one (1) multipurpose senior center in the AAAIL's planning and service area.

(3) Selection of a multipurpose senior center location shall be based on:

(a) Demographic information concerning the population of older persons in its service area; and

(b) The advice of public and voluntary agencies serving the elderly.

(4) The AAAIL shall specify designation of a multipurpose senior center within its area plan.

(5) The following factors shall be given consideration in choosing a site for the multipurpose senior center:

(a) Demographic information and projections;

(b) Accessibility to the maximum number of people with particular attention to:

Low-income older individuals, including low-income minority older individuals;
Older individuals with limited English proficiency;
Older individuals residing in rural areas; and
The number of older individuals at-risk for institutional placement;

(d) Convenience to public or private transportation or a location within walking distance for participants;

(e) The absence of structural barriers or difficult terrain; and

(f) The safety and security of participants and staff.

Section 7. Multipurpose Senior Center Specifications.

(1) A multipurpose senior center shall:

(a) Provide barrier-free access and movement within the facility pursuant to 45 C.F.R. 85.42 and 85.43;

(b) Be clearly identified with a sign;

For the security of facility equipment, furniture, and files; and
To offer activities at other sites in its service area; and

(d) Be free of physical hazards in accordance with the DAIL-MSC-01 Multipurpose Senior Center Site Approval Checklist.

(2) The facility shall be properly maintained and repaired to meet the safety and security of staff and participants.

(3) An existing multipurpose senior center that does not meet the requirements of subsections (1) and (2) of this section shall comply with a corrective action plan administered by the department.

(4) The multipurpose senior center shall have thirty (30) days from receipt of the corrective action plan to comply.

(5) The department may withhold funding if the multipurpose senior center does not comply with the corrective action plan.

Section 8. Multipurpose Senior Center Requirements.

(1) Each multipurpose senior center shall have a full time director and paid or volunteer staff to administer the center.

(2) At least one (1) staff person or the director shall be present at the site during hours of operation.

(3) At a minimum, a multipurpose senior center shall be open six (6) hours per day and five (5) days per week.

(4) A multipurpose senior center shall provide the following services:

(a) Nutrition services in accordance with 910 KAR 1:190; and

(b) Support Services including:

Transportation;
Outreach;
Information and assistance; and
Other services identified in the planning and service regions area plan.

(5) A multipurpose senior center shall:

(a) Comply with the confidentiality and disclosure of a client as follows:

Adhere to the confidentiality and disclosure of client information pursuant to KRS 194A.060 and 5 U.S.C. 552, the Federal Freedom of Information Act;
Not disclose client information without the informed consent of the person or legal representative, unless the disclosure is required by a court order or for program monitoring authorized by federal, state, or local monitoring agencies; and
Not reveal client information that is protected by attorney-client privilege; and

(b) Refer reports of abuse, neglect, or exploitation to the Department for Community Based Services.

Section 9. Satellite Senior Center Selection.

(1) The AAAIL shall designate a satellite senior center within the planning and service area of each rural community if:

(a) A multipurpose senior center is not already located in the county; or

(b) Additional satellite senior centers are needed to provide aging programs to seniors of that area.

(2) The AAAIL shall specify designation of a satellite senior center within its area plan.

(3) A satellite senior center shall meet the multipurpose senior center selection requirements of Section 6(2) of this administrative regulation.

Section 10. Satellite Senior Center Requirements.

(1) Each satellite senior center shall have a director who is responsible for the administration of the site.

(2) At least one (1) staff person or the director shall be present at the site during hours of operation.

(3) At a minimum, a satellite senior center shall be open for eight (8) nonconsecutive hours per week.

(4) An AAAIL shall organize and advertise activities, services, and schedules of operation in advance.

(5) A satellite senior center shall:

(a) Unless already established in a multipurpose senior center in the same community, provide access services which shall include:

Transportation;
Outreach; and
Information and referral; and

(b) Adhere to the confidentiality requirements of Section 8(5) of this administrative regulation.

(6) A satellite senior center may provide nutrition services in accordance with 910 KAR 1:190.

Section 11. Approval of a Multipurpose and Satellite Senior Center.

(1) Supportive or nutrition services shall be funded at a multipurpose and satellite senior center if the center has been approved by the department.

(2) A multipurpose and satellite senior center shall not become operational until an on-site visit by the department has been completed and approval given by the department.

(3) Prior to approval of a multipurpose and satellite senior center, it shall be inspected by the following:

(a) The local health department for compliance with applicable health codes depending on the types of services provided at the site;

(b) The local fire department for compliance with fire and building safety codes; and

DAIL-MSC-01 Multipurpose Senior Center Checklist; or
DAIL-SSC-02 Satellite Senior Center Checklist.

Section 12. Altering Multipurpose or Satellite Senior Center.

(1) Prior approval shall be obtained from the department by an AAAIL which intends to:

(a) Close or open a new multipurpose or satellite senior center;

(b) Change the location of the multipurpose or satellite senior center;

(d) Reduce the level or number of services.

(2) Justification for the change shall include:

(a) The proposed effective date;

(b) The need or reason;

(d) Whether this change is temporary or permanent;

(e) A cost benefit analysis;

(f) For a change made to an existing multipurpose or satellite senior center, whether this facility was altered, renovated, or constructed with Older Americans Act funds and the date work was completed;

(g) Whether the AAAIL advisory council recommended this change;

(h) What provisions are proposed to continue services to the participants; and

(i) For a proposed multipurpose or satellite senior center, costs involved in meeting local fire, health, safety, and sanitation regulations.

(3) A request to open a new multipurpose or satellite senior center shall include copies of completed local health department inspections and a completed:

(a) DAIL-MSC-01 Multipurpose Senior Center Checklist; or

(b) DAIL-SSC-02 Satellite Senior Center Checklist.

(4) If meal preparation at a new multipurpose or satellite senior center is proposed, the multipurpose or satellite senior center shall notify the:

(a) Department;

(b) Local fire department; and

(5) The department shall review the information submitted and determine if an on-site visit is necessary for approval.

(6) In case of altered multipurpose or satellite senior center operations due to damages caused by fire, flood, storm, high winds, tornados, or other safety issues, the department shall be notified within one (1) business day that emergency alterations are necessary by:

(a) Telephone;

(b) Email; or

(7) Prior approval shall be obtained from the department on a conditional basis for emergency circumstances with final approval pending:

(a) Written documentation of the proposed change;

(b) Local fire, health, and safety inspections; and

(8) The AAAIL shall specify alterations of a multipurpose and satellite senior center within its area plan for department approval.

Section 13. Training and Education. An AAAIL shall implement the following training and education programs for multipurpose and satellite senior center providers of service:

(1) An annual program assessment to identify training needs and develop correlating plans;

(2) An identification and review of resources available to meet training needs;

(3) The development of a comprehensive education and training plan;

(4) A search for additional resources to implement the plan;

(5) The coordination of education programs with private, public, governmental, and educational organizations and institutions; and

(6) A plan to implement staff development initiatives.

Section 14. Monitoring. An AAAIL shall:

(1) Monitor and assess services to determine compliance with contract requirements and an approved area plan; and

(2) Submit written evaluation of its findings to DAIL annually.

Section 15. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "DAIL-GA-01, Priority Screening Tool", November 2014;

(b) "DAIL-MSC-01, Multipurpose Senior Center Checklist", August 2014;

(d) "DAIL-HC-01, Scoring Service Level", December 2023.

History

RELATES TO: KRS 194A.060, 205.201, 205.203, 205.455-205.460, 314.011, 5 U.S.C. 552, 42 U.S.C. 3001 et seq., 45 C.F.R. 85.42-85.43
STATUTORY AUTHORITY: KRS 194A.050, 205.204(2)
NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. 3001 et seq., the Older Americans Act of 1965, as amended, authorizes grants to states to provide assistance in the development of new or improved programs for older persons. KRS 194A.050 requires the secretary for the Cabinet for Health and Family Services to promulgate administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds. KRS 205.204 designates the Cabinet for Health and Family Services as the state agency to administer the Older Americans Act in Kentucky. This administrative regulation establishes the standards of operation for the Supportive Services Program in Kentucky.
History: 18 Ky.R. 1745; Am. 2275; eff. 1-10-92; Recodified from 905 KAR 8:170, 10-30-98; Recodified from 923 KAR 1:170, 7-8-1999; TAm eff. 6-14-2013; 41 Ky.R. 2143; 2573; 42 Ky.R. 332; eff. 7-15-2015; 50 Ky.R. 1584, 2055; eff. 7-2-2024.

910 KAR 1:180 Homecare program for the elderly {#sec-910-kar-1-180 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:180}

Section 1. Definitions.

(1) "Activities of daily living" is defined by KRS 194A.700(1).

(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) "Assessment" means the collection and evaluation of information about a person's situation and functioning to determine the applicant's or recipient's service level and development of a plan of care utilizing a holistic, person-[]centered approach by a qualified case manager.

(4) "Case management" means a process, coordinated by a case manager, for linking a client to appropriate, comprehensive, and timely home or community based services as identified in the plan of care by:

(a) Planning;

(b) Referring;

(d) Advocating; and

(e) Following the timeline of the assessment agency to obtain:

Service level; and
Development of the plan of care.

(5) "Case management supervisor" means an individual:

(a) Meeting the requirements of Section 5(1)(a) of this administrative regulation; and

(b) Who has four (4) years or more experience as a case manager.

(6) "Case manager" means the individual employee responsible for:

(a) Coordinating services and supports from all agencies involved in providing services required by the plan of care;

(b) Completing the initial assessment, plan of care, and annual reassessment;

(d) Ensuring services are delivered as required.

(7) "Case record" means the collection of information, documents, demographics, and required information maintained in the Aging Services tracking data system.

(8) "Department" means the Department for Aging and Independent Living.

(9) "District" is defined by KRS 205.455(4).

(10) "Extraordinary out-of-pocket expenses" means medical expenses not covered by insurance including:

(a) Copays;

(b) Deductibles;

(d) Premiums for medical insurance; or

(e) Other medical, dental, or vision cost incurred as a result of medically necessary treatments or procedures.

(11) "Homecare services" means services that:

(a) Are:

Provided to an eligible individual who is a "functionally impaired elderly person" as defined by KRS 205.455(7); and
Directed to the individual established in subparagraph 1 of this paragraph toward:

a. Prevention of unnecessary institutionalization; and

b. Maintenance in the least restrictive environment, excluding residential facilities; and

(b) Include:

"Chore services" as defined by KRS 205.455(1);
"Core services" as defined by KRS 205.455(2);
"Escort services" as defined by KRS 205.455(5);
"Home-delivered meals" as defined by KRS 205.455(8);
"Home-health aide services" as defined by KRS 205.455(9);
"Homemaker services" as defined by KRS 205.455(10);
"Home repair services" as defined by KRS 205.455(11);
"Personal care services" as defined by subsection (16) of this section; and
"Respite services" as defined by KRS 205.455(12).

(12) "Informal supports" means any care provided to an individual that is not provided as part of a public or private formal service program.

(13) "Instrumental activities of daily living" is defined by KRS 194A.700(7).

(14) "Natural Supports" means a non-paid person or community resource who can provide, or has historically provided, assistance to the consumer or, due to the familial relationship, would be expected to provide assistance if capable.

(15) "Personal care services" means assistance with activities of daily living.

(16) "Person-centered planning" means a process:

(a) For selecting and organizing the services and supports that an older adult or person with a disability might need to live in the community and is directed by the person who receives the support; and

(b) That is directed by the person who receives the support.

(17) "Reassessment" means reevaluation of the situation and functioning of a client.

(18) "Service level" means the minimum contact required through face-to-face visits and telephone calls by the case manager or social service assistant.

(19) "Social service assistant" means an individual who:

(a) Has at least a high school diploma or equivalent;

(b) Works under the direction of the case manager supervisor;

(d) Helps determine what type of assistance their clients need;

(e) Assists the client in getting services to carry out the plan of care;

(f) Coordinates services provided to the client;

(g) Assists clients in applying for other services or benefits for which they may qualify; and

(h) Monitors clients to ensure services are provided appropriately.

Section 2. Service Provider Responsibilities. A service provider contracting with a district to provide homecare services supported in whole or in part from funds received from the cabinet shall:

(1) Assure the provision of homecare services throughout the geographic area covered under its plan or proposal;

(2) Review the provision of homecare services to assure safety and consistency;

(3) Treat the client in a respectful and dignified manner and involve the client and caregiver in the delivery of homecare services;

(4) Allow staff of the cabinet and the district to monitor and evaluate homecare services provided;

(5) Assure that each paid or voluntary staff member meets qualification and training standards established for each specific service by the department;

(6) Maintain a written job description for each paid staff and volunteer position involved in direct service delivery;

(7) Develop and maintain written personnel policies and a wage scale for each job classification; and

(8) Designate a supervisor to assure that staff providing homecare services are provided supervision.

Section 3. Homecare Plan. For program approval, a district shall submit to the cabinet a proposal within its area plan to include at least:

(1) An assurance of access for the department to records of the district pertaining to its contract for delivery of homecare services; and

(2) A plan for the delivery of homecare services in the area to be served by the district containing:

(a) Identification of services currently provided in the district; and

(b) The following assurances:

A justification of a decision not to fund a homecare service, including an assurance of adequate availability from another funding source;
A policy and procedure for assuring a client's:

a. Eligibility in accordance with Section 4 of this administrative regulation; and

b. Implementation of case management;

A policy and procedure for a client's referral for service to other appropriate programs and services as established in paragraph (a) of this subsection;
A policy and procedure for volunteer programs to be utilized;
Identification of a service provider for each specific service;
A policy and procedure for the periodic monitoring of a client for the appropriateness of homecare services and to assure safety and consistency by:

a. In home visits; and

b. Review of records on site and electronically;

A number of proposed clients for homecare services to be provided directly or by contract;
A unit cost per service to be used as a basis for determining an applicable percentage for the fee schedule as established in Section 9(2) of this administrative regulation;
A policy and procedure for the acceptance of a voluntary contribution and assurance the contribution shall be used to maintain or increase the level of service;
A policy and procedure for the reporting of abuse, neglect, and exploitation consistent with KRS 209.030(2) and (3);
A policy and procedure for the manner in which delivery of homecare services shall be provided to an eligible individual;
A policy and procedure for monitoring a subcontract for delivery of direct homecare services;
A policy and procedure assuring that assessments and client information, as established in Section 5(4) of this administrative regulation, shall include the following information submitted electronically to the department in the formats prescribed by the Aging Services Tracking System:

a. Demographic information, including family income;

b. Physical health;

c. Activities of daily living and instrumental activities of daily living;

d. Physical environment;

e. Mental and emotional status;

f. Assistive devices, sensory impairment, and communication abilities;

g. Formal and informal resources; and

h. Summary and judgment;

A policy and procedure assuring that training shall be provided or requested for issues found during sub-provider monitoring;
A policy and procedure for placing clients on hold including:

a. Reasons the individual is a client;

b. How contact will be made while client is on hold;

c. Any exceptions to the hold policy; and

d. Length of time a client may be on hold; and

A policy and procedure for termination or reduction of services.

Section 4. Eligibility.

(1) A prospective client for homecare services shall:

(a) Verify that the prospective client is a person sixty (60) years of age or older;

(b) Not be eligible for the same or similar services through Medicaid unless the individual is:

Considered inappropriate for person directed services due to:

a. An inability to manage the individual's own services; and

b. A lack of availability of a person to act as the individual's representative; or

Unable to access the Home and Community Based Waiver through a traditional provider; and

Be functionally impaired in the performance of:

a. Two (2) activities of daily living;

b. Three (3) instrumental activities of daily living; or

c. A combination of one (1) activity of daily living and two (2) instrumental activities of daily living;

Have a stable medical condition requiring skilled health services; or
Be:

a. Currently residing in:

(i) A skilled nursing facility;

(ii) An intermediate care facility; or

(iii) A personal care facility; and

b. Able to be maintained at home if appropriate living arrangements and support systems are established.

(2) Eligibility shall be determined by a case manager who shall be qualified in accordance with Section 5(2) of this administrative regulation.

(3) If a client meets eligibility requirements of subsection (1) of this section for homecare services, the client or caregiver shall be informed that the client shall be eligible for services.

(4) The case manager shall determine a prospective client's eligibility for:

(a)

In-home services; or
Respite for the unpaid primary caregiver; and

(b) Service level of case management as determined on the DAIL-HC-01, Scoring Service Level.

(5)

(a) The homecare program shall not supplant or replace services provided by the client's natural support system.

(b) Except as established in paragraph (c) of this subsection, if needs are being met by the natural support system, the client shall be deemed ineligible.

(6) An applicant who is eligible for services and for whom funding is not available shall be placed on a waiting list for services.

Section 5. Case Management Requirements.

(1) A district shall employ a case manager to assess the eligibility and needs for each client and provide case management.

(2) A case manager shall:

(a) Meet one (1) of the following qualifications:

Possess a minimum of a bachelor's degree in at least one (1) of the following:

a. Social work;

b. Gerontology;

c. Psychology;

d. Sociology; or

e. A field related to geriatrics;

Possess a bachelor's degree in nursing with a current Kentucky nursing license;
Possess:

a. A bachelor's degree in a field not related to geriatrics with two (2) years of experience working with the elderly; or

b. A master's degree in a human services field, which shall substitute for the required experience;

Possess an associate's degree in a health or family services field and two (2) years of experience working with the elderly, which shall substitute for a bachelor's degree;
Be a Kentucky-registered nurse with a current Kentucky license and two (2) years of experience working with the elderly; or
Be a licensed practical nurse with a current Kentucky license and three (3) years of experience working with the elderly. and

(b) Be supervised by a case management supervisor.

(3) Each client shall be assigned a case manager.

(4) The case manager shall assess the eligibility and needs of individuals:

(a) Initially; and

(b) At least annually thereafter.

(c) If the client is ineligible, the case manager shall close the case, document the reason in the case record, provide a list of potential resources, and notify the client or caregiver by mail.

(5) Case management services shall not be provided to individuals on a waiting list for homecare.

(6) The case manager shall:

(a) Be responsible for coordinating, arranging, and documenting those services provided by:

Any funding source;
A volunteer; or
Formal or informal supports;

(b)

Make a reasonable effort to secure and utilize informal supports for each client; and
Document the reasonable effort in the client's case record;

(c) Monitor each client by conducting a home visit according to the assessed service level and through a telephone contact between home visits. Clients shall be contacted at a minimum as follows:

Level 1, a home visit shall be conducted every other month;
Level 2, a home visit shall be conducted every four (4) months; and
Level 3, a home visit shall be conducted every six (6) months;

(d) Document in the case record each contact made with a client, as established in paragraph (c) of this subsection, or on behalf of the client.

(e) Practice cultural humility with awareness and respect for diversity and inclusion; and

(f) Provide a copy of the Rights and Responsibilities form to the client, in his or her preferred language; and

Explain the rights and responsibilities to the client; and
Document receipt of form in the client record.

(7) A social service assistant may be assigned to Level 3 clients to assist with meeting the assessed needs.

Section 6. Service Planning.

(1) The client shall participate in the assessment and development of a person-centered plan of care with the case manager, natural supports, and other formal or informal service providers as available.

(2) Upon the receipt of a referral the case manager shall:

(a) Contact the client or client's representative and schedule the initial assessment;

(b) Perform the assessment through:

Interviews with the client, existing care givers, and natural supports;
Direct observation of the client's abilities and deficits; and
Discovery of the client's cultural preferences, practices, and beliefs;

(d) Document all activities and determinations in the case record;

(e) Meet with the person-centered planning team and identify:

The assessed needs of the client;
The services that will address the identified needs; and
Goals that support the client's needs and preferences; and

(f) Compose the plan of care.

(3) The plan of care shall:

(a) Relate to an assessed problem;

(b) Identify a goal to be achieved;

(d) Identify a source of service;

(e) Include a plan for reassessment; and

(f) Be signed by the client or client's representative and case manager, with a copy provided to the client.

(4) The client shall be reassessed at least annually, and more frequently if there is a documented change in status that indicates a need for adjustment to the service level or plan of care.

Section 7. Quality Service. If a client is determined eligible for homecare services, the case manager shall:

(1) Read, or have read and explained to the client, the purpose of the DAIL-HC- 02, Quality Service Agreement;

(2) Document the client's acknowledgement of receipt in the case record;

(3) Maintain the original document in the client's case record;

(4) Provide a copy of the completed agreement to the client. The copy shall contain the name, address, and telephone number of:

(a) The current case manager;

(b) A designated representative of the district; and

(5) Inform the client of his or her right to file a complaint regarding services and provide assistance as requested;

(6) Ensure that a copy of a DAIL – HC- 03, Report of Complaint or Concern containing written complaints and detailed reports of telephoned or verbal complaints, concerns or homecare service suggestions is maintained in the client's case record and documented in a centralized log;

(7) Keep the identity of a complainant confidential; and

(8) Document investigation and efforts at resolution or service improvement that shall be available for monitoring by the district and department staff.

Section 8. Appeals. A client may request an informal dispute resolution or an appeal.

(1) An informal dispute resolution shall be limited to the denial, reduction, or termination of services.

(2) An informal dispute resolution shall not be accepted if services are unavailable due to:

(a) The program not having funding to provide the services; or

(b) The individual [does ]not meeting the eligibility requirements pursuant to Section 4 of this administrative regulation.

(3) A request for an informal dispute resolution shall:

(a) Be submitted to the department's homecare program coordinator within thirty (30) days following the notification of an adverse decision; and

(b) Contain the:

Name, address, and telephone number of the client;
Decision being disputed;
Justification for the dispute;
Documentation supporting the dispute; and
Signature of person requesting the dispute resolution.

(4) The dispute resolution shall be heard by three (3) employees of the departments Division of Quality Living. One (1) of whom shall be the division director or the division director's designee.

(5) The complainant shall be provided an opportunity to appear before the dispute resolution team to present facts or concerns about the denial, reduction, or termination of services.

(6) The dispute resolution team shall inform the complainant, in writing, of the decision resulting from the dispute resolution within ten (10) business days of the review.

(7) A complainant may request an appeal for an administrative hearing conducted in accordance with KRS Chapter 13B:

(a) Within thirty (30) calendar days of the notice regarding the results of the dispute resolution;

(b) Within thirty (30) calendar days of the notice regarding the adverse action by the cabinet; or

(c) By submitting a written request for appeal to the Office of the Ombudsman and Administrative Review, Quality Advancement Branch, 275 E. Main St, 2 E-O, Frankfort, Kentucky 40621.

Section 9. Fees and Contributions.

(1) The case manager shall be responsible for determining fee paying status, using the criteria established in this subsection.

(a) A fee shall not be assessed for the provision of assessment, case management services, or home-delivered meals.

(b) The case manager shall:

Consider extraordinary out-of-pocket expenses to determine a client's ability to pay; and
Document in a case record a waiver or reduction of fee due to the extraordinary out-of-pocket expenses.

(c) A fee shall not be assessed to an eligible individual who meets the definition of "needy aged" as defined by KRS 205.010(6).

(d)

SSI income or a food stamp allotment shall not be deemed available to other family members.
The applicant receiving SSI benefits or a food stamp allotment shall be considered a family of one (1) for the purpose of fee determination.

(2) An eligible person shall be charged a fee determined by the cost of the service unit multiplied by the applicable percentage rate based upon income and size of family using 130 percent the official poverty income guidelines published annually in the Federal Register by the United States Department of Health and Human Services. Service unit cost shall be determined by the state agency or contracting entity in accordance with its contract. The copayment amount shall be based on the household's percentage of poverty, as follows:

(3)

(a) A contribution from an individual or family with a zero percent copay shall be encouraged.

(b) Suggested contribution or donation rates may be established, without pressure shall not be placed upon the client to donate or contribute.

(c) Homecare services shall not be withheld from an otherwise eligible individual based upon the individual's failure to voluntarily contribute to support services.

(4) The district shall review and approve or deny, based on the contracted agency's district policies, the procedure implemented by a service provider for the collecting, accounting, spending, and auditing of fees and donations.

Section 10. Allocation Formula. The homecare program funding formula shall consist of a $40,000 base for each district, with the remaining amount of funds distributed in proportion to the district's elderly (sixty (60) plus) population in the state.

Section 11. Termination or Reduction of Homecare Services.

(1)

(a) A case manager or client may terminate or reduce homecare services.

(b) Homecare services shall be terminated if:

The program can no longer safely meet the client's needs;
The client does not pay the copay for services as established in Section 9(2) of this administrative regulation;
The client refuses to follow the plan of care; or

a. The client or family member has exhibited abusive, intimidating, or threatening behavior; and

b. The client or representative is unable or unwilling to comply with the corrective action plan.

(2) Homecare services may be reduced if:

(a) The client's condition or support system improves;

(b) Program funding has been reduced; or

(3) If homecare services are terminated or reduced, the case manager shall:

(a) Inform the client of the right to file a complaint;

(b) Notify the client or caregiver of the action taken; and

(4) If homecare services are terminated or reduced due to reasons unrelated to the client's needs or condition, the designated district representative in conjunction with the case manager shall determine reduction or termination on a case-by-case basis based on the requirements established in this administrative regulation.

Section 12. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "DAIL-HC 01, Scoring Service Level", 4/2014;

(b) "DAIL –HC- 02, Quality Service Agreement", 4/2014;

(d) "Rights and Responsibilities", 1/2023.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8:00 a.m. to 4:30 p.m. This material may also be viewed on the department's Web site at https://chfs.ky.gov/agencies/dail/Pages/default.aspx.

History

RELATES TO: KRS 13B.010-13B.170, 194A.700(1), (7), 205.010(6), 205.201, 205.203, 205.455-465, 209.030(2), (3), 42 U.S.C. Chapter 35
STATUTORY AUTHORITY: KRS 194A.050(1), 205.204(2)
NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. Chapter 35 authorizes grants to states to provide assistance in the development of new or improved programs for older persons. KRS 194A.050(1) authorizes the secretary to promulgate administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds. KRS 205.204 designates the cabinet as the state agency to administer 42 U.S.C. Chapter 35 in Kentucky and promulgate administrative regulations for this purpose. This administrative regulation establishes the standards of operation for a homecare program for elderly persons in Kentucky.
History: 18 Ky.R. 1748; Am. 2278; eff. 1-10-1992; Am. 23 Ky.R. 4000; 24 Ky.R. 110; eff. 6-18-1997; Recodified from 905 KAR 8:180, 10-30-1998; Recodified from 923 KAR 1:180, 7-8-1999; 32 Ky.R. 420; 686; eff. 10-19-2005; 41 Ky.R. 200; 527; eff. 10-15-2014; 49 Ky.R. 1841, 2309; eff. 6-21-2023.

910 KAR 1:190 Nutrition program for older persons {#sec-910-kar-1-190 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:190}

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;

(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;

(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

(29) "Target group" means:

(a) Low-income individuals, including low-income minority older individuals;

(b) Older individuals with limited English proficiency;

(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

(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:

Has a disability; and
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)

Is a person aged sixty (60) or over, or the spouse of a person aged sixty (60) or over;
Is unable to attend a congregate site because of illness or an incapacitating disability; and
Does not have a person in the home able to prepare a nutritious meal on a regular basis; or

(b)

Is under age sixty (60);
Has a disability; and
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)

Bulk foods shall be transported in a stainless steel pan or aluminum disposable pan in an insulated container.
Use of plastic shall be restricted to cold foods only.

(b)

Hot items shall be transported in a bulk container separated from cold products.
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.

(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

(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.

(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:

Nutrition and its relevance to health promotion and disease prevention;
Consumer approaches to food safety and food purchasing;
Food fads and diets;
Physical activity; and
Activities to modify behavior and improve health literacy, including providing information and optimal nutrients.

(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:

The delivery driver sees or hears the participant;
The delivery driver takes the meal to the door of a participant; or
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:

Store cold foods in a manner that maintains cold food at or below forty-one (41) degrees Fahrenheit; and
Store hot foods in a manner that maintains the temperature above 135 degrees Fahrenheit; or
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;

(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.

Delivery routes shall be established by the nutrition service provider to minimize nutrient loss and to facilitate temperature retention.
Meals shall be delivered within four (4) hours from the end of preparation to the final destination.
Hot food shall be maintained at or above 135 degrees Fahrenheit.
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.

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.

Neutral temperature foods shall be packaged and delivered in a way as to prevent outside contamination.

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;

Approved by a certified nutritionist or licensed dietitian;
Planned for a minimum of three (3) days; and
Delivered, reported, and billed in the same month; and

(d) Use frozen meals only if the:

Participant is able to store, prepare, and consume the meal alone or with available assistance; and
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;

(d) Maintain records to show the amount of cash received and how it was expended;

(e) Only use the NSIP funds to purchase:

Foods approved by the United States Department of Health and Human Services or other foods produced in the United States of America; or
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;

(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:

Fringe benefits;
Wages for persons who prepare and maintain the sanitary condition of the kitchen and storage areas; and
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:

Range;
Dishwasher;
Truck or van;
Steam table; or
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;

(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:

Be bid without regard to funding source; and
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:

Influenza;
Pneumonia; and
Shingles;

(d) Assure that a nutrition service provider provides:

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;
Meals to reach the maximum number of eligible older individuals consistent with the requirement established in 42 U.S.C. 3025(a)(2)(E);
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.

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;
An emergency plan for back up food preparation sites, nutrition sites, and meal delivery; and
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:

A completed DAIL-NP-17.96 Kitchen Checklist; and

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

(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

(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:

Demographic information and projections;
Accessibility to the maximum number of people who are socially or economically deprived;
Proximity to other services and facilities;
Convenience to public or private transportation or location within comfortable walking distance for participants;
Clear of structural barriers or difficult terrain; and
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;

(d) Adopt procedures for fire safety, including:

Fire drills;
Inspection;
Maintenance of fire extinguishers; and
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.

At least one (1) hot meal in accordance with Section 4 of this administrative regulation;
Outreach services that may be funded by Title III-B or Title III-C;
Information and referral; and
Nutrition education.

(d) An optional service may be home-delivered meals.

(e) A congregate meal shall be:

Prepared on site;
Catered; or
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;

(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:

Facility specifications;
Food preparation; and
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:

May be solicited if the method of solicitation is noncoercive; and
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.

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
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:

(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;

(d) Provided to each participating older individual and shall include a meal plan to provide:

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);
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
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:

Meals are provided through an approved national distribution center, and
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)

Posted in a conspicuous location, including at each congregate meal site and each preparation site; or
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.

The handling and preparation of food shall be conducted in safe and hygienic conditions pursuant to 902 KAR 45:005 State food service code.
Hot foods shall be produced within eight (8) hours preceding service unless otherwise directed in the recipe.
Protein foods shall be cooked completely once the cooking cycle has begun.
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.
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.

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.
Cold foods shall not exceed forty-one (41) degrees Fahrenheit during transportation and service.
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.

Food temperatures for both hot and cold items shall be checked and recorded daily at the kitchen and at the site of service.
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 – https://chfs.ky.gov/agencies/dail/Documents/DAIL-NP-17.96 KitchenChecklist.pdf; and

(b) Dietary Guidelines for Americans – www.dietaryguidelines.gov.

History

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
STATUTORY AUTHORITY: KRS 194A.050(1), 205.204(1), (2), 42 U.S.C. 3030e
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.
History: 18 Ky.R. 1752; 2281; eff. 1-10-1992; Recodified from 905 KAR 8:190, 10-30-1998; Recodified from 923 KAR 1:190, 7-8-1999; Recodified from 908 KAR 2:190, 6-19-2009; 37 Ky.R. 1866; 2185; 4-1-2011; 39 Ky.R. 164; 490; eff. 9-19-2012; 40 Ky.R. 895; 1296; eff. 1-3-2014; 48 Ky.R. 1956, 2490; eff. 6-2-2022.

910 KAR 1:200 Senior Community Service Employment Program {#sec-910-kar-1-200 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:200}

Section 1. Definitions.

(1) "Area plan" means a plan, submitted by a district for approval of the department, which releases funds under contract for the delivery of SCSEP services within a planning and service area.

(2) "At risk for homelessness" means an individual who:

(a) Is likely to become homeless; and

(b) Lacks the resources and support networks needed to obtain housing.

(3) "Authorized position" means an enrollment opportunity during a program year based on an average national unit cost pursuant to 20 C.F.R. 641.140.

(4) "Co-enrollment" means enrollment for an individual who meets the qualifications for SCSEP participation and is also enrolled as a participant in WIA or another employment and training program, as provided in the participant's Individual Employment Plan.

(5) "Community service" means a service provided by the SCSEP participant within a community to gain work experience and job skills, including:

(a) Social, health, welfare, and educational services including literacy and tutoring;

(b) Legal and other counseling services and assistance including tax counseling and assistance and financial counseling;

(d) Recreational;

(e) Conservation, maintenance, or restoration of natural resources;

(f) Community betterment or beautification;

(g) Antipollution and environmental quality efforts;

(h) Weatherization activities;

(i) Economic development; or

(j) Other services essential and necessary to the community as determined by the Secretary of Health and Human Services.

(6) "Community service assignment" means part-time, temporary employment paid with grant funds for a project at a host agency through which an eligible individual is engaged in community service and receives work experience and job skills that can lead to unsubsidized employment.

(7) "Department" means the Department for Aging and Independent Living.

(8) "Disability" means a mental or physical impairment, or a combination of mental and physical impairments, that result in substantial functional limitations in one (1) or more of the following areas of major life activity:

(a) Self-care;

(b) Receptive and expressive language;

(d) Mobility;

(e) Self-direction;

(f) Capacity for independent living;

(g) Economic self-sufficiency;

(h) Cognitive functioning; or

(i) Emotional adjustment.

(9) "District" is defined by KRS 205.455(4).

(10) "Frail" means an individual fifty-five (55) years of age or older who is functionally impaired because the individual:

(a) Is unable to perform at least two (2) activities of daily living without verbal reminding, physical cueing, or supervision; or

(b) Requires supervision due to a cognitive or other mental impairment and behaves in a manner that poses a health or safety hazard to the individual or another individual pursuant to 42 U.S.C. 2002(22).

(11) "Greatest economic need" means the need resulting from an income level at or below the poverty guidelines established by the Department of Health and Human Services and approved by the Office of Management and Budget pursuant to 42 U.S.C. 3002(23).

(12) "Greatest social need" means the need caused by non-economic factors pursuant to 42 U.S.C. 3002(24), including:

(a) Physical and mental disabilities;

(b) Language barriers; and

Restricts the ability of an individual to perform normal daily tasks; or
Threatens the capacity of the individual to live independently.

(13) "Homeless" means an individual, pursuant to 42 U.S.C. 11302(a), who:

(a) Lacks a fixed regular nighttime residence; and

(b) Has a primary nighttime residence that is:

A supervised publicly or privately operated shelter designed to provide temporary living accommodations including:

a. A welfare hotel;

b. A congregate shelter; or

c. Transitional housing for the mentally ill;

An institution that provides a temporary residence for individuals intended to be institutionalized; or
A public or private place not designed for or ordinarily used as regular sleeping accommodations for human beings.

(14) "Host agency" means a public agency or private, nonprofit organization, other than a political party, exempt from taxation under the provision of Section 501(c)(3) of the Internal Revenue Code of 1986, 26 U.S.C. 501(c)(3), which provides a training worksite and supervision for one (1) or more participants.

(15) "Individual employment plan" or "IEP" means a participant's plan based on:

(a) An assessment of the participant conducted by the sub-recipient; or

(b) A recent assessment or plan of the participant developed by another employment and training program and a related service strategy.

(16) "Job ready" means an individual does not require further education or training to perform work that is available in the individual's labor market.

(17) "Limited English proficiency" means an individual who does not speak English as a primary language and has a limited ability to read, speak, write, or understand English.

(18) "Low income" means an income that during the preceding six (6) months on an annualized basis or the actual income during the preceding twelve (12) months, whichever is more beneficial to the applicant, is not more than 125 percent more than the poverty levels established and periodically updated by the United States Department of Health and Human Services.

(19) "OAA" means the Older Americans Act, 42 U.S.C. 3001 to 3058ee, as amended.

(20) "One-Stop center" means the One-Stop center system in a WIA local area through which One-Stop partners provide core services and access to other programs and services carried out by the One-Stop partners.

(21) "One-Stop delivery system" means a system through which:

(a) Employment and training programs, services, and activities are available through a network of One-Stop partners;

(b) Information about and access to core services is available regardless of where the individual initially entered the workforce investment system;

(d) Access to other activities and programs carried out by other One-Stop partners is available.

(22) "Participant" means an individual who is:

(a) Determined to be eligible for the SCSEP program;

(b) Given a community service assignment; and

(23) "Program year" means the one (1) year period beginning on July 1 and ending on June 30.

(24) "Project" means an undertaking by a sub-recipient in accordance with a contract agreement between the department and sub-recipient that provides service to a community and training and employment opportunities to an eligible individual.

(25) "SCSEP" means the Senior Community Service Employment Program authorized under Title V of the OAA, 42 U.S.C. 3056n, and administered by the Department of Labor that serves unemployed low income persons who:

(a) Are fifty-five (55) years of age and older;

(b) Have poor employment prospects; and

(c) Need training in part-time community service assignments, skills, and experience to facilitate transition to unsubsidized employment.

(26) "Sub-recipient" means the legal entity to which a sub-award of financial SCSEP assistance is made by the department and who is accountable to the department for the use of the funds provided.

(27) "Sub-recipient agreement" means an agreement between the department and sub-recipient that provides for transfer of SCSEP funds to the sub-recipient for the purpose of carrying out the activities authorized in the agreement.

(28) "Supportive services" means services and incidentals, specified in Section 7 of this administrative regulation, that are necessary to enable an individual to participate in activities authorized under the SCSEP.

(29) "Unemployment" means an individual who is without a job, is available to work and wants to work, or has occasional employment that does not result in a constant source of income.

(30) "Workforce Investment Act" or "WIA" means the Workforce Investment Act of 1998, 29 U.S.C. 2801 to 2901, as amended.

Section 2. Eligibility Criteria. To participate in SCSEP, an applicant shall be:

(1) At least fifty-five (55) years old;

(2) Unemployed;

(3) An individual or a member of a family with an income that is not more than 125 percent of the federal poverty guidelines, updated annually in the Federal Register by the United States Department of Health and Human Services under authority of 42 U.S.C. 9902(2); and

(4) A resident of Kentucky.

Section 3. Application.

(1) A participant shall not be considered a federal employee solely as a result of the participant's participation in the SCSEP.

(2) To apply for SCSEP, an applicant shall submit official records to a sub-recipient that substantiate:

(a) The applicant's state of residence, such as:

Driver's license;
State, federal, or tribal ID card;
Social Security statement;
Rental agreement; or
Voter registration card;

(b) The applicant's date of birth, such as:

Birth certificate;
Driver's license;
Government identification card; or
Social Security award letter;

Lease; or
Signed attestation:

a. From a third party who has knowledge of the number of individuals residing in the applicant's household; and

b. That reflects the living situation at the time of the application;

(d) If applicable, that the applicant has a disability and shall be considered a family-of-one, with documentation such as:

Social Security Disability Insurance (SSDI) or other Social Security Administration records; and
Records indicating disability, such as the following:

a. Medical records;

b. Disability records;

c. Veteran's medical record;

d. Vocational rehabilitation letter; or

e. Worker's compensation record; and

(e)

The applicant's employment including official documents and business records that establish includable income, military discharge papers, or other military identification; and
Attestation that other includable income does not exist.

(3) An individual selected for participation in the SCSEP shall participate in the following activities:

(a) Initial orientation;

(b) Initial assessment;

(d) Development of initial and updated IEP.

Section 4. Eligibility Determination.

(1) A sub-recipient shall determine an applicant's initial eligibility through the application process established in Section 3 of this administrative regulation and annually thereafter.

(2) The sub-recipient shall:

(a) Calculate:

The includable income received by the applicant during the twelve (12) month period ending on the date the applicant applied; and
The annualized income for the six (6) month period ending on the date the applicant applied; and

(b) Compute the applicant's income eligibility using the method identified in paragraph (a) of this subsection that is more favorable to the applicant.

(3) The following benefit payments shall be included in SCSEP income eligibility determinations:

(a) Earnings;

(b) Seventy-five (75) percent of benefits received under Title II of the Social Security Act, 42 U.S.C. 402;

(d) Pension or retirement income;

(e) Interest income;

(f) Dividends;

(g) Rents, royalties, estates, and trusts;

(h) Educational assistance;

(i) Alimony; and

(j) Other inclusions as authorized by the Department of Labor, pursuant to 20 C.F.R. 641.507 and 641.510.

(4) The following benefit payments shall be excluded from SCSEP income eligibility determinations:

(a) Unemployment compensation received under Title XVI of the Social Security Act, 42 U.S.C. 3021;

(b) A payment made to or on behalf of veterans or former members of the Armed Forces administered under the Secretary of Veterans Affairs;

(d) Social Security Income or Social Security Disability Income; and

(e) Other exclusions allowed by the Department of Labor, pursuant to 20 C.F.R. 641.507 and 641.510.

(5) Priority for SCSEP shall be given to an individual who has one (1) or more of the following characteristics:

(a) Is age sixty-five (65) years of age or older;

(b) Has a disability;

(d) Resides in a rural area;

(e) Has low employment prospects;

(f) Has failed to find employment after using services provided through the One-Stop delivery system;

(g) Is homeless or at risk for homelessness; or

(h) Is:

A veteran as defined by the Jobs for Veterans Act, 38 U.S.C 4215(a);
The spouse of a veteran who died of a service-connected disability;
The spouse of a member of the Armed Forces on active duty who has been listed for a total of more than ninety (90) days as missing in action, captured in the line of duty by hostile force, or forcibly detained by a foreign government or power;
The spouse of a veteran who has a total disability resulting from a service connected disability; or
The spouse of a veteran who died while a disability so evaluated was in existence.

(6) A sub-recipient shall apply priorities in the following order:

(a) A veteran or veteran's spouse who:

Qualifies as a covered person under the Job for Veterans Act, 38 U.S.C. 4215(a); and
Possesses at least one (1) of the priority characteristics specified in subsection (5)(a) through (g) of this section;

(b) A veteran or veteran's spouse who:

Qualifies as a covered person under the Job for Veterans Act, 38 U.S.C. 4215(a); and
Does not possess any of the priority characteristics specified in subsection (5)(a) through (g) of this section; and

Is not a veteran or veteran's spouse;
Does not qualify as a covered person under the Jobs for Veterans Act, 38 U.S.C. 4215(a); and
Possesses at least one (1) of the priority characteristics specified in subsection (5)(a) through (g) of this section.

Section 5. Enrollment Process.

(1) If an individual is selected for participation in the SCSEP program, the sub-recipient shall:

(a) Provide orientation to the SCSEP, including:

Information of project goals and objectives;
Community service assignments;
Training opportunities;
Available supportive services;
The availability of a free physical examination;
Participant rights and responsibilities;
Permitted and prohibited political activities pursuant to the Hatch Act, 5 U.S.C. 7323; and
A written copy and verbal review of its policies for terminating a participant as specified in Section 10(4) of this administrative regulation;

(b) Assess a participant's work history, including:

Skills and interests;
Physical capabilities;
Talents;
Aptitudes;
Needs for supportive services;
Occupational preferences;
Training needs;
Potential for performing community service assignments; and
Potential for transition to unsubsidized employment;

(c)

Perform an initial assessment upon program entry, unless an assessment has already been performed under Title I of WIA, 29 U.S.C. 2881 to 2901; and
Perform assessments at least twice annually, including the initial assessment;

(d) Use the information gathered during an initial assessment to develop an IEP that includes an employment goal for the participant, except that an assessment and IEP developed under Title I of WIA shall satisfy the requirement for SCSEP assessment and IEP in accordance with 42 U.S.C. 641.230;

(e) Update an IEP to reflect information gathered during subsequent assessments;

(f) Place a participant in a community service assignment in the community in which the participant resides or a nearby community;

(g) Provide or arrange for training identified in a participant's IEP consistent with the SCSEP's goal of unsubsidized employment;

(h) Assist a participant with supportive services identified in the participant's IEP;

(i) Provide services for a participant or refer the participant to services through the One-Stop delivery system established under WIA;

(j) Provide counseling to the participant on progress in meeting the goals and objectives identified in the participant's IEP and in meeting the participant's supportive service needs;

(k) Provide a participant with wages and benefits for time spent in the community service assignment, orientation, and training;

(l) Monitor to ensure a participant's safe and healthy working conditions at the participant's community services employment worksite; and

(m) Assist the participant in obtaining unsubsidized employment, including providing or arranging for employment counseling in support of the participant's IEP.

(2) A sub-recipient shall not enroll a job-ready individual as a SCSEP participant but shall refer the individual to an employment provider such as a One-Stop Center for job placement assistance under WIA or another employment program.

Section 6. Participant Training.

(1) In addition to the training provided in a community service assignment, a sub-recipient may arrange skill training for a participant, if the training:

(a) Is consistent with the participant's IEP;

(b) Makes the most effective use of the participant's skills and talents; and

(2) If training is provided, training shall be:

(a) Before or during a community service agreement;

(b) In the form of:

Lectures;
Seminars;
Classroom instruction;
Individual instruction; or
On-the-job experiences; or

(3) A sub-recipient shall pay, if necessary in accordance with a participant's IEP, for:

(a) Participant training including the payment of costs of:

Instructors;
Classroom rental;
Training supplies;
Materials;
Equipment; and
Tuition; or

(b) Costs associated with supportive services as specified in Section 7 of this administrative regulation.

Section 7. Supportive Services.

(1) A sub-recipient shall, if necessary in accordance with the participant's IEP, provide directly or arrange for supportive services identified on a participant's IEP to enable the participant to successfully participate in the SCSEP project, such as:

(a) Costs of transportation;

(b) Health and medical services;

(d) Incidentals for work or training, such as:

Shoes;
Badges;
Uniforms;
Eyeglasses;
Tools;
Dependent care;
Housing, including temporary shelter; or
Other needs-related payments for job readiness.

(2) A sub-recipient shall contact a placed participant throughout the first twelve (12) months following placement to determine if the participant has the necessary supportive services to remain employed and to provide or arrange to provide the services if needed.

Section 8. Wages and Benefits.

(1)

(a) Pursuant to 20 C.F.R. 641.565(a), a sub-recipient shall pay a participant's wages for time spent in:

Orientation;
Training; and
Community service assignments.

(b) The highest applicable required wage shall be either the:

Minimum wage applicable under the Fair Labor Standards Act of 1938, 29 U.S.C. 206; or
Prevailing rate of pay for persons employed in similar public occupations by the same employer.

(2) A SCSEP participant shall be paid the highest applicable required wage while receiving WIA intensive services.

(3) A sub-recipient shall:

(a) Make adjustments to minimum wage rates payable to a participant as required by the Fair Labor Standards Act, 29 U.S.C. 206;

(b) Ensure that a participant receives Worker's Compensation pursuant to KRS Chapter 342;

A physical examination is a benefit and not an eligibility criterion; and
A participant may choose not to accept the physical examination;

(d)

Document a participant's refusal, if applicable, of an annual physical examination through a signed statement by the participant and within at least sixty (60) workdays of commencement of the community service assignment;
Each year thereafter, offer the physical examination and document the offer and a participant's refusal, if applicable;

(e) Provide compensation for scheduled work hours during which a host agency's business is closed for a federal holiday, that shall either be paid or in the form of rescheduled work time; and

(f) Provide sick leave that is not part of an accumulated sick leave program that shall either be paid or in the form of rescheduled work time.

(4) A sub-recipient shall not:

(a) Carry over allowable benefits from one (1) program year to the next;

(b) Provide payment or otherwise compensate a participant for unused benefits such as sick leave or a holiday; and

To provide contributions to a retirement system or plan;
To pay the cost of pension benefits for a program participant;
For annual leave;
For accumulated sick leave; or
For a bonus.

Section 9. Durational Limits.

(1)

(a) Except as established in subsection (3) of this section, an eligible individual shall not participate in the SCSEP for more than forty-eight (48) months in the aggregate.

(b) Consecutive participation shall not be required, from the later of July 1, 2007, or the date of the individual's enrollment in the program.

(2) A sub-recipient shall:

(a) Inform a participant, upon enrollment in the SCSEP, of the time limit specified in subsection (1) of this section and possible extension in subsection (3) of this section;

(b) Provide for a system to transition a participant to unsubsidized employment or other assistance before the maximum enrollment duration has expired;

(d) Ensure that a project does not exceed the overall average participation cap for all participants as described in subsection (4) of this section.

(3) The department may request from the Department of Labor increased periods of participation beyond forty-eight (48) months for a participant who:

(a) Has not obtained the participant's IEP goal; and

(b)

Has a severe disability; or
Is frail.

(4)

(a) Except as provided in paragraph (b) of this subsection, a sub-recipient shall manage its SCSEP project so that it does not exceed an average participation cap for all participants of twenty-seven (27) months in the aggregate.

(b) The department may request an extended average participation period of up to thirty-six (36) months (in the aggregate) for a particular project area in a given program year, if the Department of Labor determines that circumstances exist to justify an extension due to the following:

High rates of unemployment or poverty or participation in the program of block grants to States for temporary assistance for needy families under part A of Title IV of the Social Security Act, 42 U.S.C. 601, in the areas served by a sub-recipient, relative to other areas of the state involved or of the nation;
Significant downturns in the economy of an area served by the sub-recipient or in the national economy;
Significant numbers or proportions of participants with one (1) or more barriers to employment, including "most-in-need" individuals described in 20 C.F.R. 641.710(a)(6), serviced by a sub-recipient relative to the numbers or proportions for sub-recipients serving other areas of the state or nation;
Changes in federal, state, or local minimum wage requirements; or
Limited economies of scale for the provision of community service employment and other authorized activities in the areas served by the sub-recipient.

(5) An authorized break in participation from the program shall:

(a) Be considered a formal leave of absence for the following reasons:

Personal circumstances; or
If a suitable community service assignment is not available;

(b) Be formally entered by the sub-recipient in the SCSEP Performance and Results Quarterly Performance Reporting (SPARQ) system; and

(c) Not count toward the individual time limit specified in subsection (1) of this section or the average participation cap specified in subsection (4) of this section.

(6) A host agency shall notify the sub-recipient of a participant's absence or break in participation without pay for up to:

(a) Two (2) weeks approved by the host agency supervisor; or

(b) Sixty (60) calendar days with approval of the host agency supervisor and sub-recipient staff.

(7) A participant shall be granted a leave of absence with approval from the department for up to ninety (90) calendar days in extenuating circumstances such as:

(a) Illness;

(b) Family care; or

(8) Except for an extenuating circumstance specified in subsection (7) of this section, the participant shall request a leave of absence or approved break in participation from the host agency supervisor at least five (5) working days prior to the proposed absence or break.

(9) A sub-recipient may request a waiver to the state SCSEP coordinator ninety (90) days prior to a participant reaching the forty-eight (48) month durational limit, if the participant meets the requirements of subsection (3) of this section.

Section 10. Termination.

(1) A sub-recipient shall give a participant written notice explaining the reason for termination and grievance procedures and may terminate the participant thirty (30) days after it has provided the written notice for the following reasons:

(a) If the sub-recipient determines that a participant was incorrectly declared eligible as a result of false information knowingly given by the individual;

(b) If, during eligibility verification, the sub-recipient finds a participant is no longer eligible for enrollment;

(c) If the sub-recipient determines that it incorrectly determined a participant to be eligible for the program through no fault of the participant;

(d) For failure to comply with the requirements of this administrative regulation or for cause, such as:

An act or threat of violence;
Inappropriate, disrespectful, demeaning, or abusive behavior such as:

a. Loud, abusive, profane, foul, obscene, vulgar, crude, insulting, or threatening language;

b. Inappropriate jokes or gestures, discriminatory slurs, or sexual comments;

Theft or being a party to theft;
Dissemination of confidential information obtained during the course of the participant's community service assignment;
Illegal use, possession, or sale of prescription medication, alcohol, or drugs; or
Intoxication during work hours; or

(e) Refusal to accept a reasonable number, in accordance with 20 C.F.R 641.580(e), of job offers or referrals to unsubsidized employment consistent with the IEP and if there are no extenuating circumstances that would hinder the participant from moving to unsubsidized employment.

(2) If a sub-recipient makes an unfavorable determination of enrollment eligibility, the sub-recipient shall refer the individual to other potential sources of assistance, such as the One-Stop delivery system.

(3) If a sub-recipient terminates a participant, the sub-recipient shall refer the participant to other potential sources of assistance, such as the One-Stop delivery system.

(4) A sup-recipient shall provide a participant, upon enrollment, with a written copy and verbal review of its policies for terminating a participant as specified in subsection (1) of this section.

(5)

(a) A participant shall not be terminated from the SCSEP solely on the basis of age.

(b) A sub-recipient shall not impose an upper age limit for participation in the SCSEP.

Section 11. Sub-recipient Responsibilities. A sub-recipient shall:

(1) Provide SCSEP services throughout the geographic area under its area plan or proposal;

(2) Adhere to provisions set forth in the OAA and federal regulations promulgated under the Act, 20 C.F.R. Part 641;

(3) Implement and carry out the SCEP in accordance with the provisions of a sub-recipient agreement;

(4) Pursuant to 42 U.S.C. 3056(a)(4)(c), enroll and serve eligible individuals, with the focus on:

(a) Individuals with the greatest economic need;

(b) Minority individuals;

(d) Individuals with the greatest social need;

(5) Recruit and determine the eligibility of SCSEP participants;

(6) Recruit and select host agencies;

(7) Ensure that a host agency shall not reduce the number of employment opportunities or vacancies that would be available to an individual not participating in the program;

(8) Provide supervision for SCSEP participants;

(9) Assist a participant with supportive services identified on the participant's IEP;

(10) Provide participant wages and benefits;

(11) Coordinate with the local Workforce Investment Board initiatives and programs including co-enrollment of SCEP participants;

(12) Monitor for a participant's safe and healthy working conditions;

(13) Permit staff of the department and the district to monitor and evaluate provided SCSEP services;

(14) Monitor that each paid or volunteer staff member meets the qualification and training requirements of SCSEP;

(15) Develop a policy and procedure for a referral for service to other programs and services in accordance with a participant's IEP;

(16) Work with a participant to ensure the participant is:

(a) Receiving SCSEP services; and

(b) Taking actions designed to help achieve the participant's goals;

(17) Contact private and public employers directly or through the One-Stop delivery system to develop or identify unsubsidized employment opportunities;

(18) Encourage host agencies to assist a participant in the participant's transition to unsubsidized employment, including unsubsidized employment in the host agency;

(19) Adhere to other sub-recipient requirements set forth in this administrative regulation; and

(20) Submit required SCSEP data monthly to the Department of Labor, pursuant to 20 C.F.R. 641.700.

Section 12. Department Responsibilities. The department shall:

(1) Develop and implement the state SCSEP plan with the assistance of sub-recipients and national SCSEP providers;

(2) Have an equitable distribution of authorized positions in the aggregate;

(3) Adhere to provisions set forth in the Older Americans Act and federal regulations promulgated under the Act, 20 C.F.R. Part 641;

(4) Pursuant to 42 U.S.C. 3056(a)(4)(c), enroll and serve eligible individuals, with the focus on:

(a) Individuals with the greatest economic need;

(b) Minority individuals;

(d) Individuals with the greatest social need;

(5) Provide a sub-recipient with:

(a) Technical assistance related to SCSEP;

(b) SCSEP information required to accomplish the sub-recipient's agreement responsibilities; and

(6) Monitor the performance of the sub-recipient for compliance with the terms, conditions, and performance criteria included within the sub-recipient agreement;

(7) Submit required SCSEP data quarterly to the Department of Labor, pursuant to 20 C.F.R. 641.700;

(8) Review performance measures on a quarterly basis and relay that information to each sub-recipient;

(9)

(a) Allocate SCSEP funds to a sub-recipient; and

(b) Monitor the sub-recipient:

For use of the allocated funds; and
To ensure the nonfederal share of the total SCSEP costs shall be used for in-kind services at a fair market value to services and facilities contributed; and

(10) Adhere to performance measures and indicators as determined by the U.S. Department of Labor annually, pursuant to 20 C.F.R. 641.700.

Section 13. Grievance Procedures.

(1)

(a) A participant receiving services from a contract agency of the sub-recipient may request a local resolution with the contract agency. The request shall be made within thirty (30) calendar days of receipt of denial for eligibility or termination of services.

(b) If the participant is dissatisfied with the results of the local resolution with the contract agency, the participant may request a local resolution with the sub-recipient. The request shall be made within thirty (30) calendar days of receipt of the results of the local resolution.

(c) If the participant is dissatisfied with the results of the local resolution with the sub-recipient, the participant may request a state administrative hearing.

The hearing shall be in accordance with KRS Chapter 13B.
The participant shall submit a written request to the department within thirty (30) days after receipt of the results of the local resolution.

(2)

(a) A participant receiving services from a sub-recipient may have a local resolution with the sub-recipient. The local resolution shall be made within thirty (30) calendar days of receipt of denial for eligibility or termination of services.

(b) If the participant is dissatisfied with the results of the local resolution with the sub-recipient, the participant may request a state administrative hearing.

The hearing shall be in accordance with KRS Chapter 13B.
The participant shall submit a written request to the department within thirty (30) days after receipt of the results of the local resolution.

History

RELATES TO: KRS 205.201, 205.455, Chapter 342, 20 C.F.R. Part 641, 5 U.S.C. 7323, 29 U.S.C. 206, 2801, 2881, 2901, 38 U.S.C. 4215(a)(1), 42 U.S.C. 401, 402, 641.230. 2002(22), 3021, 3056n, 11302(a)
STATUTORY AUTHORITY: KRS 194A.050(1), 205.204(1), (2), 42 U.S.C. 3001
NECESSITY, FUNCTION, AND CONFORMITY: The Older Americans Act of 1965, as amended, authorizes grants to states to provide assistance in the development of new or improved programs for older persons. KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 205.204(1) and (2) authorize the cabinet secretary to administer the Older Americans Act in Kentucky and authorize the cabinet to promulgate administrative regulations to comply with any requirement imposed or required by federal law. This administrative regulation sets forth the standards of operation for the senior community service employment program in Kentucky.
History: 18 Ky.R. 1758; 2286; eff. 1-10-1992; Recodified from 905 KAR 8:200, 10-30-1998; Recodified from 923 KAR 1:200, 7-8-1999; 37 Ky.R. 1875; 2193; eff. 4-1-2011; Crt eff. 8-10-2018; Crt to Am filing deadline 10-23-2026.

910 KAR 1:210 Kentucky Long-term Care Ombudsman Program {#sec-910-kar-1-210 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:210}

Section 1. Definitions.

(1) "Access" means the right to enter a long-term care facility, meet with the residents, and review the records of a resident including the name and contact information of the resident representative.

(2) "Active" means program staff and volunteers actively participating in the program by performing program activities or cases at least quarterly.

(3) "Administrator" means any person charged with the general administration or supervision of a long-term care facility without regard to whether the person has an ownership interest in the facility or to whether the person's functions and duties are shared with one (1) or more other persons.

(4) "Advisory council member" means a non-certified volunteer who serves on the ombudsman advisory council to advise and support the program.

(5) "Case" means each inquiry brought to, or initiated by, the ombudsman on behalf of a resident or group of residents involving one (1) or more complaints and includes an ombudsman investigation or strategy to resolve and follow-up.

(6) "Certification" means the official notification by the Kentucky long-term care ombudsman that local long-term care ombudsman individual staff are qualified and acceptable to function in that capacity.

(7) "Complaint" means an allegation filed by residents or on behalf of residents relating to the health, safety, welfare, and rights of a resident.

(8) "Complaint resolution" means either corrective action taken in regard to an allegation or a determination as to the validity of the allegation.

(9) "DAIL" means the Department for Aging and Independent Living.

(10) "Designation" means formal notification by the Kentucky long-term care ombudsman that a district program meets requirements and shall be considered a subdivision of the state office.

(11) "Designee" means an individual who is chosen to act on behalf of the KLTCO and who meets the same qualifications as the KLTCO pursuant to Section 8 of this administrative regulation.

(12) "District ombudsman" means that individual certified by the Kentucky long-term care ombudsman to implement the ombudsman provisions of the approved contract agency plan.

(13) "Educational or experiential equivalent" means:

(a) Two (2) semesters totaling at least twenty-four (24) hours of course work; and

(b) At least 400 documented hours of experience assisting aging or disabled individuals through:

Practicum placement;
Clinicals; or
Volunteerism.

(14) "Evaluation" means periodic analysis and review conducted by the Kentucky long-term care ombudsman of district, regional, and state ombudsman programs, including quality assurance and outcome measures pertaining to individual and programmatic performance.

(15) "Friendly visitor" means a trained non-certified volunteer who visits residents in long-term care facilities to assist the district long-term care ombudsman program.

(16) "Investigation" means the formal response by a long-term care ombudsman to complaints of issues involving the health, safety, welfare, and rights of a resident.

(17) "Kentucky long-term care ombudsman" or "KLTCO" means the individual charged with the administration of the Kentucky Long-term Care Ombudsman Program under the provisions of the Older Americans Act of 1965, as amended.

(18) "Long-term care facility" is defined by KRS 216.510(1).

(19) "Monitoring" means periodic review measuring ombudsman program's adherence to approved plans, including analysis of non-client specific data relating to program performance.

(20) "Office" means the designated state long-term care ombudsman.

(21) "Referral" means the appropriate channeling of information to affect a desired outcome.

(22) "Regional long-term care ombudsman" means ombudsmen who operate directly from the Kentucky Long-term Care Ombudsman Program and whose responsibilities include coordination of a multi-area development district area.

(23) "Resident representative" is defined by 45 C.F.R. 1324.1.

(24) "Volunteer ombudsman" means a certified unpaid individual serving within a district program to assist a district ombudsman.

Section 2. Responsibilities of Kentucky Long-term Care Ombudsman.

(1) The Kentucky Long-term Care Ombudsman Program shall be administered by a full time ombudsman operated by DAIL or through a contracted entity.

(2) The Kentucky long-term care ombudsman shall be responsible for the:

(a) Design, implementation, and management of a statewide uniform system for receiving, investigating, resolving, and reporting complaints on behalf of residents in long-term care facilities and provide ongoing support to assist in the resolution of those complaints;

(b) Investigation of complaints made by or on behalf of residents in long-term care facilities from areas of the state temporarily without local ombudsman programs if a local backup ombudsman is not available;

Receipt, investigation, verification, and resolution of complaints;
Protecting confidentiality of records and identity of complainants;
Establishing the right of public access to information regarding conditions in long-term care facilities; and
Securing ombudsman access to long-term care facilities, residents, and residents' personal and medical records;

(d) Development and management of a system for the operation of a statewide network of district programs, including:

Designation of district programs through:

a. Reviewing applications for designation of district ombudsman contained in their plans for operating either directly or under subcontract;

b. Providing written confirmation of the designation; and

c. Administration of certification and training requirements;

Development of district program operating procedures and reporting requirements; and
Establishment of a communications link between the Kentucky long-term care ombudsman and district programs;

(e) Establishment and maintenance of program official files and adoption of procedures to protect the confidentiality of those files;

(f) Provision of information and education concerning:

Program activities;
The long-term care system; and
The rights and concerns of residents and potential residents of long-term care facilities;

(g) Provision of assistance to citizen organizations, consumer groups, and other interested community organizations to enhance the rights of residents in long-term care facilities;

(h) Promotion of the development of citizen organizations at the state and local level to participate in the program;

(i) Use of publicity and outreach efforts directed at long-term care residents and families, network staff, and the general public about the availability of the program to receive and investigate complaints;

(j) Review of complaint, case, and issue data submitted by the district programs and analysis for trends, patterns, and issue identification;

(k) Annual National Ombudsman Reporting System (NORS) report to the Administration on Community Living;

(l) Assistance to the district ombudsman to establish, develop, and coordinate ombudsman activities;

(m) Development of agreements and working relationships with relevant agencies to encourage their cooperation and assistance with the program at the state and local levels;

(n) Development of agreements and working relationships with legal services programs, particularly those funded by the Older Americans Act of 1965, as amended;

(o) Development of agreements and working relationships with the licensure and certification agencies;

(p) Development and provision of training on an ongoing basis for regional and district ombudsman program staff and volunteers;

(q) Identification and development of additional funding and staffing resources for the long-term care ombudsman program;

(r) Support and promotion of the formation of resident councils in long-term care facilities;

(s) Development and provision of testimony and comment on proposed legislation, administrative regulations, policies, and rule changes affecting the long-term care residents;

(t) Conduction of other activities related to the protection and dignity of residents of long-term care facilities;

(u) Performance of other activities required by the Administration on Community Living;

(v) Policy that shall require the district ombudsman program to perform the functions and responsibilities of the ombudsman pursuant to 45 C.F.R. 1324.13 and adhere to the requirements of section 712 of the Older Americans Act of 1965, as amended;

(w) Policy and procedure clarifying the local ombudsman shall have access to the agency's programmatic fiscal information; and

(x) Policy and procedure for the receipt and review of grievances received regarding the determination or action of the ombudsman and representatives.

Section 3. Responsibilities of the Regional Long-term Care Ombudsman. The regional long-term care ombudsman shall be staff of, and report directly to, the Kentucky long-term care ombudsman and shall have the following responsibilities:

(1) Receive, investigate, and resolve complaints;

(2) Provide technical assistance and coordination of district programs;

(3) Assist in training of volunteers and local program personnel;

(4) Provide information to public agencies regarding problems of long-term care residents;

(5) Abide by established policies and procedures related to reporting and confidentiality; and

(6) Perform other job duties as required by the Kentucky long-term care ombudsman.

Section 4. Designation of District Programs.

(1) The Kentucky long-term care ombudsman shall designate district entities throughout the state to operate the long-term care ombudsman program.

(2) The district ombudsman program entity shall submit a plan that shall serve as the application for designation of a district ombudsman. The application shall include:

(a) Definition of program in terms of the following personnel:

Program supervisor;
Ombudsman advisory council;
District ombudsman;
Friendly visitors; and
Volunteer ombudsman;

(b) Agency to conduct the program;

(d) Maintenance of a complaint documentation system;

(e) Ability to monitor the development and implementation of laws, policies, and regulations that apply to residential long-term care;

(f) Ability to recruit and provide standardized training for volunteers;

(g) Ability to respond in a timely fashion to requests from the Kentucky Long-term Care Ombudsman Program for statistical data and other information;

(h) Ability to receive training and continuing education from the Kentucky Long-term Care Ombudsman Program;

(i) Ability to assure confidentiality of files;

(j) Ability to inform and educate residents, sponsors, organizations, the long-term care industry, and the general public relative to issues affecting the long-term care system, the ombudsman program, and resident rights and concerns;

(k) Provision that an individual involved in the appointment of a subdivision of the office and that an officer, employee, or other representative of the office is not subject to a conflict of interest;

(l) Provision that representatives of the Kentucky Long-term Care Ombudsman Program shall not be liable under state law for the good faith performance of official duties; and

(m) Provision of an annual written statement that the district ombudsman program and contracted entity shall ensure there is not a conflict of interest for the following:

Staff;
Volunteers;
Governing board members;
Advisory board members; or
Other parties representing or providing oversight to the long-term care ombudsman program.

(3) Designated ombudsmen shall be representatives of the Kentucky Long-term Care Ombudsman Program and shall be accorded rights and privileges of that office.

(4) The district ombudsman agency shall coordinate with the Kentucky long-term care ombudsman prior to hiring a district ombudsman to confirm eligibility through verification of:

(a) Qualifications as defined in section 8 of this administrative regulation; and

(b) Free of any conflict of interest .

Section 5. Responsibilities of the District Ombudsman. The district ombudsman shall:

(1) Provide services as follows:

(a) There shall be a staff person, qualified by training and experience, responsible for administering each service and supervising assigned staff and volunteers;

(b) There shall be designated staff who are trained and skilled in assessing and dealing with the needs of older adults and in the delivery of each service;

(d) New staff shall receive an orientation and shall be trained and certified prior to assuming responsibilities;

(e) Staff shall attend required training and provide in-service training for staff and volunteers of local programs;

(f) Staff and volunteers shall not accept personal gifts or money from participants or vendors; and

(g) Staff and volunteers shall not pay bills or cash checks for clients or participants;

(2) Assure services are accessible to older persons by telephone, correspondence, or person-to-person contact;

(3) Represent residents residing in long-term care facilities within the assigned geographical areas;

(4) Assure residents' rights are upheld and promote quality care in long-term care facilities;

(5) Investigate and work to resolve complaints on behalf of long-term care residents;

(6) Promote community involvement in the program by:

(a) Publicizing the existence and function of the local and state programs;

(b) Advising the public about the availability of current state, local, and federal inspection reports, statements of deficiency, and plans for correction for individual long-term care facilities in the service area;

(d) Assisting in the development of resident or family and friends councils;

(e) Sponsoring community education and training programs for long-term care facilities, human service workers, families, and the general public about long-term care and residents' rights issues; and

(f) Promoting citizen involvement in order to ensure regular visitations, especially for those residents without available family or friends;

(7) Implement accurate recordkeeping procedures to assure that:

(a) An accurate record shall be maintained on each participant that documents:

Participant identification data;
Requests for assistance;
Eligibility for services provided;
Follow-up; and
Closure;

(b) Reports for the Kentucky long-term care ombudsman are prepared and submitted in a format and time frame as directed;

(d) Nonclient-specific statistical and financial data is submitted as required; and

(8) Ensure staff and volunteers remain active.

Section 6. Responsibilities of the Volunteer Ombudsman. The volunteer ombudsman shall:

(1) Complete required training, including training and certification requirements for those involved in complaint investigation;

(2) Provide regular visitation of residents in long-term care facilities;

(3) Adhere to guidelines provided by the Kentucky long-term care ombudsman and district ombudsmen; and

(4) Complete required paperwork.

Section 7. Ombudsman Advisory Council.

(1) The designated district ombudsman program shall have an advisory council whose functions are to:

(a) Review and advise programs on policies and procedures;

(b) Provide ongoing support and leadership; and

(2) The advisory council shall be comprised as follows:

(a) Members shall be persons with a strong interest in improving the quality of life for the long-term care residents and for protecting their rights;

(b) Group size and composition shall be individualized to the needs of the local program but shall not be less than seven (7); and

(3) Advisory council members shall not:

(a) Be responsible for certifying or licensing long-term care facilities;

(b) Be a provider of long-term care services or part of an association of providers;

(c) Have any interest or association that may impair the ability of the ombudsman to objectively and independently investigate and resolve complaints;

(d) Gain economically or receive any compensation from a long-term care facility or association;

(e) Be on the Vulnerable Adult Maltreatment Registry or the Kentucky Nurse Aide registry; or

(f) Have been found guilty of the following:

A violent crime as defined by KRS 439.3401;
Abuse, neglect, or exploitation of another person, including assault;
Felony theft offense; or
Felony drug offense.

Section 8. Qualifications, Certification, and Training of Long-Term Care Ombudsmen.

(1) The Kentucky long-term care ombudsman, regional long-term care ombudsman, and district long-term care ombudsman shall:

(a) Possess a minimum of a bachelor's degree in a health or human services profession from an accredited college or university with:

One (1) year experience in health or human services; or
The educational or experiential equivalent in the field of aging or physical disabilities; or

(b) Be a certified regional or district ombudsman.

(2) The Kentucky long-term care ombudsman shall meet the qualifications of subsection (1)(a) or (b) of this section and have expertise in:

(a) Long-term services and supports or other direct services for older persons or individuals with disabilities;

(b) Consumer-oriented public policy advocacy;

(d) Negotiation and problem solving skills.

(3) The Kentucky long-term care ombudsman, a district, regional, or volunteer ombudsman, advisory council member, and a friendly visitor shall have a completed background check conducted prior to hire using the following:

(a) The Vulnerable Adult Maltreatment Registry;

(b) The Kentucky Nurse Aide registry; and

(c) A criminal record check utilizing the Kentucky Administrative Office of the Courts or the Kentucky Justice and Public Safety Cabinet and not have been found guilty of the following:

A violent crime as defined by KRS 439.3401;
Abuse, neglect, or exploitation of another person, including assault;
Felony theft offense; or
Felony drug offense.

(4) Program sponsors, sub-contract agency directors, and directors of other sponsoring agencies shall receive basic training whenever possible.

(5) The long-term care ombudsman, program staff, and volunteers shall receive a minimum of thirty-six (36) hours of training in order to be eligible for certification as a long-term care ombudsman, including at least the following areas:

(a) Governing statutes and regulations, the Older Americans Act, Ombudsman program federal rule at 45 C.F.R. 1324;

(b) Ombudsman program organization and structure;

(d) Duties of designated representative of the office;

(e) Individual and organizational conflicts of interest;

(f) Introduction to common health issues individuals may experience using long-Term services and supports;

(g) Resident living experience in a long-term care situation;

(h) Residents' rights;

(i) The long-term care setting and levels of care;

(j) Myths and stereotypes about older adults and persons with disabilities;

(k) Assessment, care planning, and person-centered care;

(l) Transfer and discharge requirements and challenges;

(m) Licensing survey and certification process;

(n) Resident and family councils;

(o) Confidentiality;

(p) Access to residents, facilities, and records;

(q) Disclosure of resident information and ombudsman program records;

(r) Resident decision-making;

(s) Guardianship and third-party decision makers;

(t) Complaint investigation;

(u) Problem solving including verification and resolution;

(v) Abuse, neglect, exploitation, and the role of the ombudsman program;

(w) Program policies and procedures;

(x) Resources and agencies;

(y) Documentation; and

(z) Communication.

(6) District ombudsmen shall attend training meetings as established by the Kentucky long-term care ombudsman.

(7) All certified long-term care ombudsmen shall be:

(a) Certified within thirty (30) days of hire or prior to providing services;

(b) Re-certified every four (4) years prior to the expiration of the current certification; and

(8) Certification shall be awarded after submitting certification documentation of:

(a) Verification of completion of minimum training requirements; and

(b) A score of at least eighty (80) percent on the certification examination.

(9) A maximum of twenty percent (20%) of the certification training may involve independent study, while a minimum of ten (10) hours shall be spent in the field.

(10) Long-term care ombudsman program volunteers who are not certified ombudsmen shall:

(a) Receive a minimum of two (2) hours initial training from the district ombudsman; and

(b) Complete a minimum of four (4) hours of continuing education annually based on the volunteer's start date.

Section 9. Confidentiality. Investigatory files, complaints, responses to complaints, and other information related to complaints or investigations maintained by the ombudsman program shall be considered confidential information in accordance with the Older Americans Act of 1965, 42 U.S.C. 3027(a)(12)(C). Confidentiality shall be maintained using the criteria established in this section.

(1) Persons who gain access to a resident's records shall not discuss or disclose information in the records or disclose a resident's identity outside of the program.

(2) The Kentucky long-term care ombudsman shall release information only with:

(a) A resident or resident representative who communicates informed consent orally, visually, or through the use of auxiliary aids and services and such consent is documented. The disclosure of identifying information of any complainant shall not be disclosed without informed consent orally, visually, or through the use of auxiliary aids and services and such consent is documented; or

(b) A court order to disclose.

(3) Information shall be secured as follows:

(a) Complaint files shall be contained in a locked file cabinet;

(b) Computerized systems shall have secured access codes; and

(4) The confidentiality and disclosure criteria shall not preclude the ombudsman's use of otherwise confidential information in the files for preparation and disclosure of statistical, case study, and other data if the ombudsman does not disclose the identity of persons otherwise protected in this section.

Section 10. Rights of Access.

(1) Kentucky, regional, volunteer, and district ombudsmen shall have unrestricted access to long-term care facilities:

(a) Without prior notice;

(b) To meet with one (1) or more residents; and

(2) Ombudsmen shall have access to the:

(a) Residents' dining area;

(b) Residents' living area;

(d) Lounges; and

(e) Areas open to the general public.

(3) Certified representatives of the Kentucky Long-term Care Ombudsman Program shall have access to a resident's medical and social records with permission of the resident or his legal guardian, except as provided for under KRS 209.030(7).

(4) Access shall not include the right to examine the financial records of the facility without the consent of the administrator.

(5) If the ombudsman is denied entry to a long-term care facility, or denied upon a request for copies of all licensing and certification records maintained by the state with respect to long-term care facilities, the ombudsman shall inform the administrator or operator of the statutory authority for access. If access is still denied, the ombudsman shall inform the:

(a) Kentucky long-term care ombudsman;

(b) Office of Inspector General, Division of Health Care; and

(6)

(a) Willful interference, as governed by KRS 216.541(3), with representatives of the Kentucky Long-term Care Ombudsman Program in the performance of official duties shall be unlawful and result in a fine of $100 to $500 for each violation.

(b) Each day the violation continues shall constitute a separate offense.

Section 11. Referrals.

(1) Representatives of the long-term care ombudsman program shall be exempt from making reports of abuse, neglect, or exploitation to the Department for Community Based Services, Division of Protection and Permanency, and, if appropriate, the Office of Inspector General, Division of Health Care, for investigation without appropriate consent or court order pursuant to 45 C.F.R. Part 1324.

(2) The ombudsman shall seek consent of the resident:

(a) To work to resolve complaints and make referrals to agencies; or

(b) When the ombudsman personally witnesses abuse, gross neglect, or exploitation of the resident.

(3) Communication of consent to reveal the identity of the resident or complainant may be made in writing, orally, or visually.

(4) When the resident is unable to communicate consent and has no resident representative, the ombudsman shall:

(a) Take steps to investigate complaints that adversely affect the health, safety, welfare, or rights of the resident; and

(b) Refer the matter and disclose identifying information of the resident to the management of the facility in which the resident resides or the appropriate agencies in the following circumstances:

The ombudsman personally witnesses suspected abuse, gross neglect, or exploitation of a resident and has no evidence indicating that the resident would not wish a referral to be made; and
The ombudsman has reasonable cause to believe that disclosure would be in the best interest of the resident.

(5) If the resident is unable to communicate consent and has a resident representative, the ombudsman shall contact the resident representative for consent.

(6) If there is reasonable cause to believe the resident representative through their action, inaction, or decision making may adversely affect the health, safety, welfare, or rights of the resident, the ombudsman shall:

(a) Seek permission of the KLTCO or designee during an investigation if a resident is unable to give consent and the resident representative is not acting in the best interest of the resident; and

(b) Make a referral to the appropriate agencies upon approval of the KLTCO or designee.

(7) Referrals under this section shall not affect the continuing duty, full freedom, and independence of the ombudsman to:

(a) Ensure the continued adequacy and responsiveness of complaint investigation and resolution, monitoring, and data collection systems consistent with the Older Americans Act of 1965, as amended;

(b) Maintain an independent capacity to investigate and resolve complaints as governed by Section 13 of this administrative regulation;

(c) Receive and process, on a regular basis, information related to the number, type, and source of complaints, facilities involved, and the manner of complaint resolution; and

(d) Maintain by specific agreement the power, ability, and right to monitor the agency's complaint processing performance and take action necessary to correct and improve deficiencies.

(8) District ombudsmen shall address concerns regarding the investigation or resolution of complaints to the Kentucky long-term care ombudsman or designee.

(9) District ombudsmen shall make referrals to county attorneys, legal aid agencies, and legal assistance offices.

(10) District ombudsman shall report to the Kentucky long-term care ombudsman a referral to the Office of the Attorney General or any federal agency.

Section 12. Receiving Reports.

(1) The Kentucky long-term care ombudsman, regional ombudsmen, district ombudsmen, and persons identified and approved by these ombudsmen shall have the authority to provide intake of a complaint.

(2) The person receiving a report shall obtain as much information as possible, making a reasonable effort to obtain the:

(a) Name and location of the long-term care facility involved;

(b) Name and location of the resident;

(d) Nature of the complaint as specifically as possible;

(e) Name and location of the alleged perpetrator; and

(f) Identity of the reporting source, though reports may be made anonymously.

(3) The person receiving the report may contact other agencies or individuals to secure additional information relevant to the investigation.

Section 13. Complaint Investigation.

(1) A long-term care facility resident shall have the right to:

(a) Voice grievances and recommend changes in policies and services to facility staff and outside representatives of the resident's choice, free from restraint, interference, coercion, discrimination, or reprisal;

(b) Associate and communicate privately with persons of the resident's choice; and

(c) Private meetings with the appropriate long-term care facility inspectors from the Cabinet for Health and Family Services.

(2) A long-term care ombudsman shall investigate and resolve complaintsmade by or on behalf of an individual who is a resident of a long-term care facility relating to action that may adversely affect the health, safety, welfare, or rights of the resident.

(3) District and volunteer ombudsmen shall not investigate complaints unless certified by the Kentucky Long-term Care Ombudsman Program.

(4) The Kentucky and regional ombudsmen shall inform the district ombudsmen of on-site investigations conducted in their districts.

(5) The investigation shall be conducted according to the criteria established in this subsection.

(a) Investigation shall include contact with the resident, staff of the long-term care facility, and collateral contacts.

(b) A representative of the program shall, upon entering the facility, promptly notify the administrator or his designated representative of his presence.

(c) A representative of the program shall not enter the living area of a resident without identifying himself to the resident.

(6) The investigating ombudsman, with permission of the resident or resident representative, shall take steps to investigate a complaint and attempt to resolve the complaint to the resident's satisfaction. Resolution may include:

(a) Collaborating or negotiating at the nursing home administrative level to change particular nursing home behavior, pattern, or practice affecting the resident;

(b) Consulting with a resident, relative, or nursing home staff member to resolve a problem;

(d) Proposing regulatory or statutory changes or additions;

(e) Communicating with community groups and professional organizations; and

(f) Encouraging the utilization of legal services assistance.

(7) Documentation shall be completed on complaint investigations and incorporated into the ombudsman data system as follows:

(a) The documentation entered into the data system shall be entered by the 15th of the month for all cases completed the prior month; and

(b) Documentation of the investigation shall include the:

Identity of the resident on whom the report is made;
Date the face-to-face visit with the resident was completed;
Identity of the long-term care facility;
Complaint;
Identity of persons interviewed and records or documents reviewed during the course of the investigation;
Factual information used to support findings and conclusions; and
Actions taken and services provided.

(8) Resolution shall include documented follow-up and ongoing monitoring of the situation for a reasonable period of time, depending on the complexity of the situation, through contact with the complainant or resident or, if appropriate, for the purpose of determining that the causes giving rise to the complaint have not been repeated and have not recurred.

(9)

(a) In accordance with KRS 216.541(2) and (3), retaliation and reprisals by a long-term care facility or other entity against an employee or resident for having filed a complaint or having provided information to the Kentucky Long-term Care Ombudsman Program shall be unlawful and shall result in a fine of $100 to $500 for each violation.

(b) Each day a violation continues shall constitute a separate offense.

Section 14. Reporting Requirements. The Kentucky Long-Term Care Ombudsman Program shall maintain a statewide uniform reporting system to collect and analyze information on complaints and conditions in long-term care facilities for the purpose of identifying and resolving significant problems.

(1) The contracted agency providing the district long-term care program shall submit quarterly reports to the Kentucky long-term care ombudsman according to the contractual agreement.

(2) The district ombudsman shall submit an annual report to the Kentucky long-term care ombudsman no later than determined in the contractual agreement for inclusion in the annual state ombudsman report.

Section 15. Monitoring and Evaluation.

(1) District long-term care ombudsman programs shall be monitored annually by the contract agency or the Kentucky long-term care ombudsman according to contract or, if services are provided directly by the Kentucky long-term care ombudsman, by the DAIL.

(2) Formal evaluations of the district ombudsman program shall be conducted at regular intervals, at least annually, by the Kentucky long-term care ombudsman.

(3) The results of the evaluation, omitting client identifying information, shall be made available to the district long-term care ombudsman contracting agency to be used to plan and implement program changes to meet participant needs.

(4) The Kentucky long-term care ombudsman and district long-term care ombudsman contracting agency shall permit staff of the Cabinet for Health and Family Services, persons acting for the Cabinet for Health and Family Services, or staff designated by appropriate federal agencies to:

(a) Monitor and evaluate programs and activities initiated under the Older Americans Act of 1965, as amended, and other programs for which the department has administrative responsibility; and

(b) Interview clients by persons and agencies listed in this subsection, except if confidentiality requirements are applicable.

History

RELATES TO: KRS 205.201, 209.030(5), (7), 216.510(1), 216.535, 216.540-216.543, 439.3401, 42 U.S.C. 3001 et seq. 35, 3027(a)(12)(C), 45 C.F.R. 1324 Subpart A
STATUTORY AUTHORITY: KRS 194A.050, 205.204
NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. 3001 et seq. 35, the Older Americans Act of 1965, as amended, requires states to establish and operate, either directly or by contract, a long-term care ombudsman program to protect the rights of older individuals. KRS 194A.050 requires the secretary for the Cabinet for Health and Family Services to promulgate administrative regulations necessary to implement programs mandated by federal law. KRS 205.204 designates the Cabinet for Health and Family Services as the state agency to administer the Older Americans Act of 1965, as amended, in Kentucky. This administrative regulation establishes a statewide long-term care ombudsman program.
History: 18 Ky.R. 2077; Am. 2577; eff. 3-7-1992; Recodified from 905 KAR 8:210, 10-30-1998; Recodified from 923 KAR 1:210, 7-8-1999; 41 Ky.R. 2150; 2578; eff. 6-17-2015; 43 Ky.R. 136, 421, 550; eff. 10-19-2016; 43 Ky.R. 2070; eff. 7-17-2017; 51 Ky.R. 1004; eff. 2-13-2025.

910 KAR 1:220 General administration, programs for older individuals and persons with disabilities {#sec-910-kar-1-220 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:220}

Section 1. Definitions.

(1) "Administration on Community Living" or "ACL" means the federal agency housed within the Office of the Secretary of Health and Human Services which is responsible for the administration of grant awards to state units on aging under Title III of the Older Americans Act.

(2) "Area Agency on Aging and Independent Living" or "AAAIL" means an area agency on aging as defined by 42 U.S.C. 3002(6).

(3) "Area plan" means a plan submitted by an AAAIL to the department that releases funds under contract for the delivery of service within a planning and service area.

(4) "Corrective action" means the written statement of non-compliance issued to a provider for failure to comply with contractual obligations, federal or state regulations, or department policy.

(5) "Corrective action plan" means the written response of the provider to eliminate the non-compliance issues addressed in the written corrective action statement and prevent future non-compliance from occurring.

(6) "Department" or "DAIL" means the Department for Aging and Independent Living.

(7) "Fidelity bond" means a bond indemnifying the recipient against losses resulting from the fraud or lack of integrity, honesty, or fidelity of one (1) or more employees, officers, or other person holding positions of trust.

(8) "Greatest economic need" is defined by 42 U.S.C. 3002(23).

(9) "Greatest social need" is defined by 42 U.S.C. 3002(24).

(10) "In-kind resources" means the value of property or services which benefit a grant-supported project or program and which are contributed by nonfederal third parties without charge to the grantee.

(11) "Planning and service area" or "PSA" means that multicounty geographical entity in which a given AAAIL is responsible for the planning of aging services.

(12) "Program income" means the gross income earned by a provider agency from activities of which part or all of the cost is either borne as a direct cost counted towards meeting a cost sharing or matching requirement of department contracted funds.

(13) "Provider agency" means an entity that provides for the performance of services or performs a specific service under contract.

(14) "Service provider" means the agency under contract with DAIL or a provider agency to provide direct services.

(15) "State plan" means the formal application of the office for federal Title III funds under the Older Americans Act and provides a basis for the expenditures of these funds.

(16) "Target group" means older individuals:

(a) Who are low-income, including low-income minority;

(b) With limited English proficiency;

(d) At risk for institutional placement.

Section 2. Responsibilities of the DAIL. The DAIL shall:

(1) Develop the state plan on aging and disability;

(2) Consider the views of older persons and the general public in developing and administering the state plan by:

(a) Receiving public and consumer participation in identifying service needs and establishing funding priorities prior to the submission of the state plan for approval;

(b) Responding to requests of the Institute for Aging for information and submit for its review and comment on proposed plans, budgets, programs, policies, and general initiatives;

(d) Reviewing and considering comments received regarding program plans, budgets, policies, and general initiatives and making changes if feasible and in the best interests of those individuals for whom the programs are designed;

(3) Coordinate statewide planning and development of activities and provide technical assistance to provider agencies to ensure effective coordination of programs;

(4) Establish and enforce appropriate procedures for data collection from contract agencies to permit the state to compile and transmit statewide data in a form the commissioner directs on an annual basis;

(5) Conduct, within budget limitations, activities to implement training and education programs which include the following:

(a) Conducting annual assessments to identify training needs and develop correlating plans;

(b) Identifying and reviewing resources available to meet training needs;

(d) Seeking additional resources to implement the plan;

(e) Effecting interagency coordination for the provision of specialized training;

(f) Facilitating and assisting the efforts of higher education in statewide forums of a gerontological or disability orientation;

(g) Coordinating education programs with private, public, governmental, and educational organizations and institutions;

(h) Providing and coordinating training opportunities for personnel of agencies and programs utilizing department funding;

(i) Providing training to provider agencies on self-evaluation and monitoring; and

(j) Providing training as part of the state training plan including ongoing technical assistance and annual program evaluation;

(6) Participate in appointments to boards and commissions as required by the cabinet;

(7) Review, monitor, evaluate, and comment on federal, state, and local area plans which affect or may affect older individuals and those with disabilities;

(8) Recommend changes in these plans which the department deems appropriate including:

(a) Budgets;

(b) Regulations;

(d) Laws;

(e) Levies;

(f) Hearings;

(g) Policies; and

(h) Actions;

(9) Monitor the performance of programs and activities for quality and effectiveness and to determine compliance with contract requirements, approved area plans, and applicable federal and state statutory and regulatory requirements;

(10) Have an adequate number of qualified staff to carry out the functions prescribed in 45 C.F.R. 1321.9 of the Older Americans Act and other program regulations for which the department has administrative responsibility;

(11) Give preference to individuals aged sixty (60) or older, subject to the requirements of merit employment systems of state and local governments;

(12) Assure that the provider agency allots an adequate proportion of its funding for the provision of direct services to eligible participants;

(13) Develop and make known to the provider agency procedures for and conditions under which funding may be suspended;

(14) Comply with the provisions of the Older Americans Act of 1965, as amended;

(15) Designate PSAs in accordance with 42 U.S.C. 3025(a)(1)(E);

(16) Designate the AAAIL in each PSA;

(17) Develop and use a federally approved intrastate funding formula for Older Americans Act of 1965 funding;

(18) Provide area-specific information in a statewide summary of the local needs assessment conducted in each PSA;

(19) Conduct joint meetings with the provider agencies to:

(a) Coordinate statewide planning and development of activities; and

(b) Provide technical assistance to each provider agency to ensure effective procedures for coordination of programs within the PSA;

(20) Notify the contract agencies in writing in advance of the date the joint meeting shall take place;

(21) Solicit input from the contract agency as to the topics to address and discuss at the joint meeting; and

(22) Issue a waiver of program requirements:

(a) In compliance with 42 U.S.C. 3030c-3; or

(b) To develop pilot projects as allowed for state funded programs.

Section 3. Distribution of State and Federal Funding for Aging and Disability Programs. Directly or through contract with a provider agency, funding allocations shall be distributed according to program requirements.

(1) The department shall distribute available state and federal funds to the provider agency according to a funding formula determined by the department.

(2) Older Americans Act funding shall be allocated based on the funding formula developed by the department and approved by the ACL.

(3) Funding allocated from funds authorized under the following categories shall be for the purpose of assisting the department to develop or enhance comprehensive and coordinated community-based services throughout the state:

(a) State administration;

(b) Provider agency administration;

(d) Personal Care Assistant Program;

(e) Traumatic Brain Injury Trust Fund;

(f) Hart Supported Living Program;

(g) Kentucky Family Caregiver Program;

(h) Brain Injury Behavioral Program;

(i) Senior Community Employment Program;

(j) State long-term care ombudsman, Title III-B and Title VII;

(k) Supportive services, Title III-B;

(l) Congregate meals services, Title III C 1;

(m) Home-delivered meals services, Title III C 2;

(n) Evidence based health promotion services, Title III-D; and

(o) Elder abuse services, if funds are available, Title VII.

(4) Except for the State Long-Term Care Ombudsman and state administration, the department shall award the available Older Americans Act funds according to the federally approved intrastate funding formula:

(a) Determined by the department after consultation with the AAAILs in the state and publication of the formula by the department for review and comment by older persons and the general public; and

(b) Which shall reflect the proportion among the PSA of persons age sixty (60) and over in greatest economic or social need with particular attention to low income minority individuals.

(5) The department shall follow the procedures for and conditions under which funding may be temporarily suspended or terminated according to Section 10 of this administrative regulation.

Section 4. Designation and Withdrawal of Designation of an AAAIL.

(1) Each PSA shall have designated by DAIL a public or private nonprofit agency or organization as the AAAIL in accordance with 42 U.S.C. 3025(c).

(2) The department shall withdraw the AAAIL designation if, after reasonable notice and opportunity for a hearing, the department finds that:

(a) The AAAIL does not meet the requirements set out in subsection (1) of this section or Section 5 of this administrative regulation;

(b) The plan or plan amendment is not approved;

(c) There is substantial failure in the provision or administration of an approved area plan to comply with provisions of the area plan requirements under the Older Americans Act; or

(d) There is a request by the AAAIL.

(3) The department shall initiate the designation withdrawal process of the AAAIL and shall:

(a) Notify the AAAIL of its intent to withdraw designation, citing non-compliance issues and outlining steps to be taken to appeal the intent to withdraw designation in accordance with 910 KAR 1:140; and

(b) Assist in the facilitation of the hearing as set forth in 910 KAR 1:140 if the AAAIL requests a state hearing.

(4) Following the appeal process, the cabinet shall notify the AAAIL in writing of the hearing.

(5) If the department withdraws the AAAIL's designation, it shall:

(a) Notify the administrator of the ACL and the cabinet secretary in writing of its action;

(b) Provide a plan for the continuity of planning and services in the affected PSA; and

(6) To ensure continuity of planning and services in a PSA, the DAIL may, for a period of up to 180 days after its final decision to withdraw designation of a AAAIL:

(a) Perform the responsibilities of the AAAIL; or

(b) Assign the responsibilities of the AAAIL to another provider agency in the PSA.

(7) If necessary, the administrator of the ACL may extend for a period of up to an additional 180 days the limit in subsection (6) of this section if the state agency:

(a) Requests an extension; and

(b) Demonstrates to the administrator of the ACL a need for the extension.

Section 5. Responsibilities of the AAAIL. The AAAIL shall be designated by the department in each PSA and shall:

(1) Establish an advisory council as follows:

(a) The area advisory council shall carry out functions which further the AAAIL's mission of developing and coordinating community-based systems of services for older persons in the PSA. The council shall advise the AAAIL relative to:

Developing, reviewing, and commenting on the area plan prior to submitting to the department for approval;
Conducting public hearings;
Representing the interest of older persons; and
Reviewing and commenting on community policies, programs, and actions which affect older persons with the intent of assuring maximum coordination and responsiveness to older persons.

(b) The advisory council shall be made up of:

More than fifty (50) percent older persons, including minority individuals who are participants or who are eligible to participate in programs under the Older Americans Act;
Representatives of older persons;
Representatives of health care provider organizations, including providers of veterans' health care if providers of veterans' health care are located in the geographical area served within the PSA;
Representatives of supportive services provider organizations;
Persons with leadership experience in the private and voluntary sectors;
Local elected officials; and
The general public;

(2) Include individuals and representatives of community organizations who shall help to enhance the leadership role of the AAAIL in developing community-based systems of services;

(3) Serve as the public advocate for the development for enhancement of comprehensive and coordinated community-based systems of services in each community throughout the PSA;

(4) Monitor, evaluate, and provide comment on policies, programs, hearings, levies, and community actions which affect older persons and persons with disabilities;

(5) Solicit comments from the public on the needs of older persons, and persons with disabilities having procedures for receiving community and consumer participation in the planning and service delivery process in conformance with 45 C.F.R. 1321.57(c) and 1321.61(b);

(6) Represent the interests of older persons and persons with disabilities to local-level and executive branch officials and public and private agencies or organizations;

(7) Consult with and support the Commonwealth's long-term care ombudsman program;

(8) Undertake ongoing activities designed to facilitate the coordination of area plans and activities with other public and private organizations;

(9) Promote new or expanded benefits and opportunities for older persons and persons with disabilities;

(10) Undertake a leadership role in assisting communities throughout the PSA to target resources from appropriate sources to:

(a) Meet the needs of the target group; and

(b) Recommend the location of services and specialization in the types of services most needed by the above-referenced group;

(11) Prohibit means testing for services funded through Older Americans Act funds;

(12) Prepare and develop for a PSA an area plan as determined by the department and in accordance with 42 U.S.C. 3026:

(a) By the annually established deadline;

(b) Which shall include:

A mission and vision statement;
Planning and service area geographics;
A profile of regional demographics;
Funding sources for the AAAIL;
Services offered within the PSA;
Partnerships and associations;
A capacity assessment;
A capacity building plan;
Public hearings;
Service usage;
Participants of aging programs feedback and satisfaction;
Coordination and collaborations;
Outreach and expansion;
Community opportunities;
Intake and referral;
Financial management and fund development;
AAAIL advisory council membership;
AAAIL administrative staffing plan;
AAAIL direct staffing plan;
A provider agency staffing plan;
Long Term Care Ombudsman advisory council membership;
A provider site list;
Performance plans;
Waivers and special program approvals;
Provider approvals;
Assurances;
A financial plan and outputs; and
Other information requested in advance by the department; and

(13) Provide area-specific information of the local needs assessment conducted in the PSA;

(14) Specify in writing to the department how the AAAIL intends to satisfy the needs of the target group served through the contract in proportion to the population served;

(15) Within budget limitations, implement education and training programs that respond to the needs of older individuals, the disabled, service providers, and other groups which include:

(a) Conducting annual assessments to identify training needs and develop correlating plans;

(b) Identifying, reviewing, and pursuing resources available to meet training needs;

(d) Coordinating interagency collaboration for the provision of specialized training;

(e) Facilitating and assisting the efforts of higher education in statewide forums related to the aging and disabled populations;

(f) Conducting and coordinating education and training related to the aging and disabled population and programs for area advisory councils and the general community;

(g) Specifying the training requirements of the service providers; and

(h) Planning and implementing staff development initiatives; and

(16) Conduct periodic evaluations of, and public hearings on, activities carried out in the PSA.

Section 6. Public Hearings.

(1) The department shall, if appropriate, utilize public hearings as one (1) method of obtaining both proactive and reactive community and consumer participation in prioritizing and evaluating activities and projects carried out under the state plan.

(2) If public hearings are utilized, the department shall:

(a) Schedule a minimum of one (1) public hearing annually for the purpose of evaluating activities and projects carried out in the state plan;

(b) Specify the inclusion of an evaluation of the state plan's effectiveness in reaching the target population;

(c) If appropriate, schedule public hearings for the purpose of receiving community and consumer participation in the development and implementation of service activities;

(d) Require of the AAAIL a timely conducted public hearing prior to the consideration of a request of the department for a waiver from a service provision responsibility required in the area plan; and

(e) Schedule, advertise, and conduct public hearings it deems appropriate in a manner designed to encourage, enhance, and facilitate community and consumer participation.

(3) The department shall consider the views of older persons and the general public in developing and administering the state plan and shall:

(a) Utilize methods which include public hearings in receiving public and consumer participation in identifying service needs and establishing funding priorities prior to the submission of the state plan for federal approval;

(b) Advertise the date, time, location, and purpose of each public hearing with the local media in the PSA in and for which the hearing is being held;

(d) Require AAAILs to develop procedures for receiving community and consumer participation in the planning and service delivery process in conformance with 45 C.F.R. 1321.57(c) and 1321.61(b); and

(e) Review and consider comments received regarding program plans, budgets, policies, and general initiatives and make changes if feasible and in the best interests of those individuals for whom the programs are designed.

Section 7. Responsibilities of a Provider Agency.

(1) A provider agency shall:

(a) Adhere to the contractual agreement, state and federal regulations, and department policy;

(b) Provide for each employee providing services funded through the department a comprehensive training course that shall be:

Monitored by the provider agency through record review; and
Reviewed or monitored by the DAIL through records maintained by the provider agency; and

(c) Verify participant or applicant eligibility for DAIL funded programs only once even though the participant may receive multiple services through state or federal funding sources.

(2) Participant records shall include the following information:

(a) The participant's age or birth date if age is an eligibility requirement;

(b) Documentation of the method used to verify the reported age;

(d) Other eligibility determinants; and

(e) Verification of other eligibility determinants.

(3) The provider agency shall conduct monitoring and evaluation of services and shall:

(a) Permit staff of the Cabinet for Health and Family Services, persons acting for the cabinet, and staff designated by appropriate federal agencies to monitor and evaluate programs and activities performed and administered by the provider agency and subcontractors for which the department has administrative responsibility;

(b) Respond to monitoring reports including submission of a corrective action plan;

(c) Be responsible for fiscal or program exceptions established by evaluation, monitoring, or audit and promptly settle monitoring, fiscal, and program audit exceptions by:

Making direct payment;
Accepting reduction of future reimbursement; or
Other methods approved by the Cabinet for Health and Family Services;

(d) Furnish appropriate technical assistance to, and conduct an annual evaluation of, the effectiveness of program outcomes;

(e) Assess services to determine compliance with contractual agreement and with applicable federal and state requirements;

(f) Submit written corrective action or recommendations regarding on-site monitoring visits and reports to the service providers as applicable;

(g) Require the service provider to have provision for the interview of clients by persons and agencies listed in paragraph (a) of this subsection and the provider agency, except if confidentiality requirements are applicable; and

(h) Review subcontractors' forms and procedures and forward a copy of the information to the DAIL prior to the implementation of the contract for final approval, if applicable.

(4) Each provider agency shall have a policy for denial, suspension, or reduction of services to eligible persons, which shall:

(a) Be maintained on file at the provider agency and be accessible for monitoring purposes;

(b) Specify, at a minimum, that if services for a client or participant are denied, suspended, or reduced, one (1) of the following situations shall be present and documented:

Funds are no longer available or are reduced;
The service level is no longer needed;
Prioritization and needs determination indicate that the client no longer meets the criteria established for receiving services;
The client refuses to follow the service plan or plan of care; or
The client or family member has exhibited abusive, intimidating, or threatening behavior and the client or representative is unable or unwilling to comply with a corrective action plan; and

(c) Include notification to a client of the right to request an appeal based on the denial, suspension, or reduction of services to an eligible person as listed in paragraph (b)2. through 5. of this subsection in accordance with 910 KAR 1:140.

(5) A provider agency shall adhere to the procurement requirements as follows:

(a) Promote open and free competition among qualified competitors;

(b) Not restrict or eliminate competition by placing unreasonable or unnecessary requirements on potential bidders;

A method for resolving protests, disputes, and claims;
A written code or standards of conduct;
A review process to avoid unnecessary purchases or duplicative items;
Affirmative action standards that encourage contracting with minority-owned small businesses;
A method for procurement; and
Evaluation and selection criteria; and

(d) Formally advertise programs and services.

(6) If the provider agency chooses to utilize noncompetitive negotiations, it shall:

(a) Clearly document and maintain on file that:

Only one (1) responsible provider is available, capable, and qualified to provide the service; and
By using noncompetitive negotiations, open and free competition shall not be restricted;

(b) Maintain records sufficient to detail the significant history of the procurement; and

(7) A provider agency shall comply with the program reporting requirements of the contractual agreement or the following as applicable:

(a) A quarterly program performance report shall be submitted to the department fifteen (15) calendar days after each quarter;

(b) An annual program performance report shall be submitted to the department for the federal fiscal year October 1 - September 30;

(d) A monthly meal count report for Title III and Homecare shall be submitted to the department by the contractual deadline; and

(e) Title V reporting and entering into the statewide data system shall be in accordance with 910 KAR 1:200.

(8) The provider agency conducting assessments shall complete an assessment within seven (7) calendar days of referral unless:

(a) Funding is not available to provide a service; and

(b) The individual is placed on the waiting list.

(9) The provider agency shall assure that a written uniform system is in place for maintenance of waiting lists and shall follow these guidelines:

(a) Each waiting list for services shall be reported to the department as part of the quarterly program performance report;

(b) The waiting list shall be updated monthly and a new DAIL-GA-01 Priority Screening Tool completed if there is a change in needs;

(d) An applicant shall be advised of the procedures and method of facilitating the waiting list and provided with the written procedures upon request;

(e) An applicant who is determined to be potentially eligible based on screening information gathered by the designated agency staff may be placed on a waiting list; and

(f) Once funding is available for a service, the individual on the waiting list with the highest priority screening score on the DAIL-GA-01 Priority Screening Tool shall be assessed within seven (7) calendar days.

(10) Each provider agency may use its own definition of equipment as long as it includes tangible personal property having a useful life of at least one (1) year and a unit cost of $500 or more.

(a) Equipment records shall be current and shall contain at least the following information:

Description of the item;
Serial number;
Source of funds used to purchase the item;
Percentage per source and program of the cost;
Acquisition cost and date;
Unit cost;
Location, use, and condition of the equipment;
Information on the disposition of the item; and
The replacement schedule of the equipment being replaced, if applicable.

(b) There shall be a system to prevent loss, damage, or theft.

(d) Purchase of equipment with a unit cost of $500 or more shall require prior approval from the DAIL.

(e) Replaced equipment may be:

Traded in; or
Sold and the proceeds applied to the acquisition cost.

(f) Equipment with a unit cost of $1,000 or more shall be disposed of, not replaced, and the granting agency may require transfer of the equipment and title to an eligible party.

(g) Equipment may be sold if approved by the granting agency.

(h) If equipment is sold, the federal share of the proceeds may be applied to the program as program income but if the federal share is not applied to the program as program income, the federal share, less selling expenses, shall be returned to the federal government or an eligible nonfederal party named by the DAIL.

(i) The provider agency shall agree to the transfer of equipment and supplies with a value of less than $1,000 to a new provider if:

A new provider is selected:

a. As a result of competition; or

b. Due to a contract being terminated; and

The transfer is made within thirty (30) days from the date of receipt of notice from the department made by:

a. Certified mail; or

b. Return receipt requested.

(j) Equipment and supplies shall be transferred to the DAIL if no new provider has been secured.

Section 8. Record Check.

(1) An applicant for employment or a volunteer with direct client contact shall authorize the provider agency to conduct a records check through the following:

(a) A criminal record check through the Kentucky Justice Cabinet, Administrative Office of the Courts, or a national criminal record check;

(b) The Central Registry;

(d) The Nurse Aid Abuse Registry.

(2) An applicant or volunteer with a criminal record may be employed only with the approval of the executive director of the provider agency if the individual has not been found guilty of the following:

(a) A violent crime as defined by KRS 439.3401;

(b) Abuse, neglect, or exploitation of another person, including assault;

(d) Felony drug offense.

Section 9. Corrective Action.

(1) The department shall issue corrective action if a provider agency is not fulfilling its contract or is non-compliant with program requirements. Upon identification of the deficiency, the department shall:

(a) Notify the provider agency of the requirement to submit a written corrective action plan within the time frame specified by the department;

(b) Review for approval or revision the corrective action plan submitted by the provider agency which shall include:

How the deficiency will be corrected;
Steps to ensure the deficiency will not reoccur; and
The timeline for full compliance;

(d) Notify other licensing or regulatory agencies if the deficiency exists within their jurisdiction.

(2) A provider agency shall submit documentation to confirm the deficiency was resolved.

(3) If the provider agency continues to be in noncompliance, the department staff shall:

(a) Notify the provider agency of the continuing problem or deficiency;

(b) Advise the commissioner of the DAIL of the problem and make a recommendation for action; and

Section 10. Suspension of Funding or Termination of Contract.

(1) The department may temporarily suspend operations or terminate the contract award in whole or in part if the provider agency or service provider fails to adhere to the following:

(a) Contract award stipulations;

(b) Federal and state laws and regulations;

(d) A department approved corrective action plan; or

(e) Performance goals and deliverables.

(2) To suspend operations or terminate a contract, the department shall, thirty (30) days prior to the effective date:

(a) Notify the provider agency in writing of the action being taken;

(b) Provide the provider agency with the reason for the action;

(d) Inform of the effective date of the suspension; and

(e) Inform the provider agency of the right to appeal the decision.

(3) The department shall grant to a provider agency whose funding has been suspended in whole or in part or whose contract has been terminated as a result, an opportunity for a hearing in accordance with the provision set forth in 910 KAR 1:140.

(4) The department may:

(a) Temporarily withhold cash payments pending an approved corrective action plan by the provider agency or pending a decision by the department to terminate the contract;

(b) Disallow both the use of funds and any applicable matching funds for all or part of the cost not in compliance;

(d) Withhold future awards; or

(e) Exercise any other remedies that may be legally available.

(5) The department may impose additional requirements for provider agencies for the following:

(a) History of poor performance;

(b) Financial instability;

(d) Not conforming to the terms and conditions of previous contract awards.

(6) Costs to a provider agency resulting from obligations incurred during the suspension or after termination of a contract award shall not be allowable unless the department:

(a) Expressly authorizes them in the notice of suspension or termination of contract award; or

(b) Subsequently determines the expenses:

Are necessary and not reasonably avoidable;
Result from obligations which were properly incurred by the provider agency before the effective date of the suspension or termination;
Are not in anticipation of the suspension or termination and in the case of a termination are non-cancellable; and
Would be allowable if the award were not suspended or expired normally at the end of the funding period in which the termination takes effect.

(7) In suspending operations or terminating a contract, the department shall:

(a) Determine the amount of unearned state and federal funds the provider agency has on hand and interest earned, if any;

(b) Request a return of funds for all unearned or unallowable funds received by the provider agency from the department; and

(8) Upon suspension or termination, the provider agency shall be required to submit all financial, programmatic, and other reports pursuant to the terms and conditions of the contract.

(9) If the suspension of operations continues for three (3) consecutive months in a budget year:

(a) Funding of operations shall be terminated;

(b) Monetary assistance from the department shall cease in whole or in part under a contract at a time prior to the date of completion; and

(10) The department may, at its discretion, reinstate the suspended operations if it determines that the provider agency has come into compliance with the contract, federal and state regulations, and department policies.

(11) The department shall reimburse the provider agency according to the terms and conditions of the contract for allowable program activities and cost upon reinstatement of operations.

(12) Operations may resume:

(a) Immediately upon notification; or

(b) Within the time period as designated by the department.

(13) Costs accrued for program operations while a program is suspended shall not be reimbursed.

(14) The obligational authority unearned at suspension shall become available for earning by the project at the previously established matching ratio.

(15) Termination of operational obligation or authority shall result in:

(a) Withdrawal of AAAIL designation that shall comply with subsection (13) of this section; or

(b) Withdrawal of a contract for services.

(16) The department shall withdraw the AAAIL designation or contract if, after reasonable notice and opportunity for a hearing, the department finds that:

(a) The AAAIL or provider agency does not meet the requirements set out in Section 5 or Section 7 of this administrative regulation;

(b) The plan or plan amendment is not approved;

(c) There is substantial failure in the provision or administration of an approved area plan to comply with provisions of the area plan requirements under the Older Americans Act; or

(d) There is a request by the provider agency.

(17) If the department withdraws the AAAILs designation or contract, it shall:

(a) Notify the administrator of the ACL and the CHFS secretary in writing of its action;

(b) Provide a plan for the continuity of planning and services in the affected PSA; and

(18) To ensure continuity of planning and services in a PSA, the DAIL may, for a period of up to 180 days after its final decision to withdraw designation of an AAAIL or contract with a provider agency:

(a) Perform the responsibilities of the AAAIL or provider agency; or

(b) Assign the responsibilities of the AAAIL or provider to another agency in the PSA.

(19) If necessary, the administrator of the ACL may extend an additional 180 days if the state agency:

(a) Requests an extension; and

(b) Demonstrates to the administrator of the ACL a need for the extension.

Section 11. Incorporation by Reference.

(1) The "DAIL-GA-01 Priority Screening Tool", November 2014, is incorporated by reference.

History

RELATES TO: KRS 205.201, 205.203, 205.455-465.31, 205.900(3), 211.470-211.478, 45 C.F.R. 92.25(g)(2), (3), Part 74, Subpart B, 213, 1321, 5 U.S.C. 552, 7501 et seq., 42 U.S.C. 3001 et seq.
STATUTORY AUTHORITY: KRS 194A.050, 205.204(2)
NECESSITY, FUNCTION, AND CONFORMITY: 42 U.S.C. 3001 et seq., the Older Americans Act of 1965, as amended, authorizes grants to states to provide assistance in the development of new or improved programs for older persons. KRS 194A.050 requires the secretary for the Cabinet for Health and Family Services to promulgate administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds. KRS 205.204 designates the Cabinet for Health and Family Services as the state agency to administer the Older Americans Act in Kentucky. This administrative regulation establishes the policies and procedures governing the general administration of the aging and disabilities programs and Older Americans Act in Kentucky.
History: 18 Ky.R. 1763; Am. 2291; eff. 1-10-1992; Recodified from 905 KAR 8:220, 10-30-1998; Recodified from 923 KAR 1:220, 7-8-1999; TAm eff. 6-14-2013; 41 Ky.R. 2157; 2583; eff. 6-17-2015; Cert. eff. 4-11-2022.

910 KAR 1:260 Kentucky Family Caregiver Program {#sec-910-kar-1-260 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:260}

Section 1. Definitions.

(1) "District" is defined by KRS 205.455(4).

(2) "Federal poverty level" means the degree to which a household's gross income matches the official poverty income guidelines published annually in the Federal Register by the U.S. Department of Health and Human Services.

(3) "Formal support system" means a service obtainable through public or private service programs.

(4) "Grandchild" means a grandparent's grandchild:

(a) Through blood, marriage, or adoption; and

(b) Who is no more than eighteen (18) years of age.

(5) "Grant" means a payment to a grandparent for services specified in Sections 6(3)(a) or 7 of this administrative regulation and based on:

(a) Need; and

(b) Actual cost.

(6) "Household" means an individual or group of individuals who are living together in a principal residence as one (1) economic unit.

(7) "Household income" means all annual gross earned and unearned income received by a household, including a:

(a) Lump sum payment; or

(b) State or federal benefit assistance payment.

(8) "Informal support system" means any care provided to an individual which is not provided as part of a public or private formal service program.

(9) "Local resolution" means a phone conversation or meeting between a grandparent and district to resolve the grandparent's dispute against denial of eligibility.

(10) "National Family Caregiver Support Program" means the program established by 42 U.S.C. 3030s-1.

(11) "Primary caregiver" means a grandparent providing full time care for that person's grandchild.

(12) "Respite services" is defined by KRS 205.455(12).

(13) "Supplemental services" means the services that a grandparent may receive in accordance with Section 7 of this administrative regulation through application and grant or voucher process.

(14) "Support services" means the services that a grandparent may receive in accordance with Section 6 of this administrative regulation through application and grant or voucher process.

(15) "Voucher" means a payment made directly to a vendor for the services specified in Sections 6(3)(a) or 7 of this administrative regulation.

Section 2. Eligibility.

(1) To be eligible for the Kentucky Family Caregiver Program, a grandparent shall:

(a) Be a Kentucky resident;

(b) Be the primary caregiver for a grandchild;

(c) Reside with the grandchild who shall not be residing in the same household with the grandchild's parent, but may reside in a house owned by the grandchild's parent;

(d) Not receive a monthly payment for Kinship Care in accordance with 922 KAR 1:130; and

(e) Not have household income that exceeds 150 percent of the federal poverty level.

(2) A grandparent who has adopted a grandchild shall be eligible for the Kentucky Family Caregiver Program:

(a) If the grandparent is not eligible for other state or federal adoption subsidies; and

(b) For a period not to exceed one (1) calendar year from final order of adoption.

(3) To apply or reapply for the Kentucky Family Caregiver Program, a grandparent shall complete, sign, and submit a DAIL-KFC-1 Application for Kentucky Family Caregiver Services:

(a) To a local district of residence; and

(b) For each voucher or grant requested.

(4) An applicant shall receive a written notice of eligibility or non-eligibility from a district within thirty (30) days of meeting the requirements of subsections (1) and (3) of this section.

(5) A payment from the Kentucky Family Caregiver Program may affect the eligibility income requirements for receipt of a federal or state benefit assistance payment.

(6) If a child receives assistance from the Kentucky Children's Health Insurance Program or the Department for Medicaid Services, the child shall not be eligible to receive the medical services specified in Section 7(1)(e) of this administrative regulation.

(7) National Family Caregiver Support Program participation shall not exclude participation in the Kentucky Family Caregiver Program.

Section 3. District Responsibilities.

(1) A district shall review the DAIL-KFC-1 Application for Kentucky Family Caregiver Services to determine completeness of the following information:

(a) Demographics;

(b) Establishment of eligibility relationship between grandparent and grandchild;

A federal tax form;
A W-2;
A pay stub; or
Other documentation of monthly gross income;

(d) Living arrangements of household;

(e) Residency;

(f) Need per grandchild; and

(g) Formal or informal support systems.

(2) A district shall consider applications on a priority basis, with applicants that did not receive services through the program in the past fiscal year, receiving a higher priority.

(3) A district shall:

(a) Develop a policy and procedure for:

Grandparent outreach of the Kentucky Family Caregiver Program;
Assurance of a grandparent's eligibility in accordance with Section 2(1) and (2) of this administrative regulation;
Informing a grandparent of the grandparent's rights and responsibilities; and
Client confidentiality and referrals;

(b) Develop a process for use of assistance, including a grant or voucher;

Billing a participating vendor for provided services;
Monitoring and evaluation of the program; and
The review of invoices and receipts for approved items and expenditures;

(d) Notify the cabinet in writing if the process specified in paragraph (c) of this subsection changes;

(e) Make payment for the services specified in Sections 6(3)(a) and 7 of this administrative regulation through a voucher or grant;

(f) Document and maintain a case file for a grandparent that:

Is kept in a locked cabinet;
Has all documentation regarding the grandparent secured to the file; and
Includes at a minimum:

a. The DAIL-KFC-1 Application for Kentucky Family Caregiver Services;

b. Consent and release of information;

c. Verification of eligibility;

d. Verification that the grandparent was informed of the grandparent's rights and responsibilities;

e. Documentation showing services provided;

f. Documentation of referrals and other resources given to the grandparent;

g. Progress notes or case notes, if applicable;

h. Correspondence, if applicable;

i. Documentation of grievance, local resolution, or hearing, if applicable;

j. Documentation of service termination, if applicable; and

k. Assignment of a case number;

(g) Provide the department with documentation of services provided and the number of grandparents served through the Kentucky Family Caregiver Program in that district;

(h) Verify with a local department for community based services office:

That a grandchild or grandparent is not receiving a monthly payment specified in Section 2(1)(e) of this administrative regulation;
Any type of state or federal benefit assistance payment a grandparent or grandchild is receiving; and
Medical services a grandchild receives through the Kentucky Children's Health Insurance Program or the Department for Medicaid Services;

(i) Provide for appeal procedures in accordance with Section 10 of this administrative regulation;

(j) Provide referral and assistance to access other community services needed by the grandparent or grandchild; and

(k) Maintain a current fiscal year waiting list for prioritizing a grandparent in the following year if the grandparent:

Applied for the current fiscal year;
Was not served in the current fiscal year; and
Reapplies for the program the following fiscal year.

Section 4. Department Responsibilities. The department shall:

(1) Be the state-wide administrator for the Kentucky Family Caregiver Program;

(2) Monitor a district at a minimum annually for assurance of compliance with the program requirements of this administrative regulation;

(3) Allocate available funding; and

(4) Provide technical and programmatic assistance, if needed.

Section 5. Kentucky Family Caregiver Payment.

(1) To the extent funds are available, the maximum total of assistance per grandchild, including a grant or voucher, shall be up to $500 per grandchild in any one (1) fiscal year

(2) Funds shall be allocated based on priority order as specified in Section 3(2) of this administrative regulation.

(3) A grant or voucher shall not be given for services that occur before a district's establishment of a grandparent's eligibility.

(4) Prior approval with a district for counseling and supplemental services shall be required before actual purchase.

(5) If the Kentucky Family Caregiver Program funding is at capacity, an eligible applicant shall be placed on a waiting list and as funding becomes available be accepted for services in priority order as specified in Section 3(2) of this administrative regulation.

Section 6. Support Services. Support services shall include:

(1) Information about available services;

(2) Assistance in gaining access to services; and

(3) Assistance to the grandparent in decision-making and problem-solving relating to a care giving role including:

(a) Individual counseling;

(b) Organization of a support group; and

Section 7. Supplemental Services.

(1) Supplemental services specific to the grandchild shall include:

(a) Child clothing and personal care needs;

(b) Respite services provided by a caregiver or agency approved by the district, for the grandparent;

(d) Required legal services which shall:

Be related to the grandchild's safety and stability; and
Not include representation against any criminal charges;

(e) Medical and dental services, except for copays and premiums; and

(f) Furniture to be used by the grandchild including a:

Bed; or
Dresser.

(2) Supplemental Services shall not include:

(a) Utilities;

(b) Appliances for household use, unless approved by the department;

(d) Technology unless prescribed for communication due to a disability; or

(e) Computers unless written documentation is provided by the school requiring a home computer and then one (1) per household is allowed.

Section 8. Grandparent Responsibilities. A grandparent shall:

(1) Provide a district with the information required to determine eligibility as specified in Section 2 of this administrative regulation;

(2) Comply with a district's application process as established in Section 2(3) of this administrative regulation;

(3) Comply with the district's policies for expenditures of assistance, including:

(a) A grant or voucher; or

(b) Submittal of a receipt for cost reimbursement, if applicable.

(4) Comply with the appeal procedures established in Section 10 of this administrative regulation if making an appeal; and

(5) Notify the district immediately of a change in status that is in noncompliance with the eligibility requirements specified in Section 2 of this administrative regulation.

Section 9. Fraud. A grandparent's fraudulent use of a voucher or grant may result in prosecution pursuant to KRS Chapter 514.

Section 10. Appeal Procedure.

(1) A grandparent wishing to appeal denied eligibility for services shall first have a local resolution with the district of residence.

(2) If the grandparent is dissatisfied with the results of the local resolution, the grandparent may request a state administrative hearing in accordance with KRS Chapter 13B.

Section 11. Incorporation by Reference.

(1) "DAIL-KFC-1 Application for Kentucky Family Caregiver Services", edition 8/2012, is incorporated by reference.

History

RELATES TO: KRS Chapter 13B, Chapter 514, 199.011(4), 205.455(4), 42 U.S.C. 601, 651, 1381, 3030s, 3030s-1
STATUTORY AUTHORITY: KRS 194A.050(1), 205.201(1)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 205.201(1) requires the cabinet to promote and aid in the establishment of local programs to the aging. KRS 194A.050(1) requires the secretary to promulgate all administrative regulations authorized by applicable state laws necessary to operate programs and fulfill the responsibilities vested in the cabinet. This administrative regulation establishes the Kentucky Family Caregiver Program.
History: 33 Ky.R. 1027; 1332; eff. 12-1-2006; 34 Ky.R. 884; 1492; eff. 12-17-2007; 36 Ky.R. 1997; 2201; eff. 6-4-2010; 39 Ky.R. 875; 1169; eff. 12-11-2012; Crt eff. 8-10-2018; Crt eff. 5-19-2025.

910 KAR 1:270 Hart-Supported Living grant program {#sec-910-kar-1-270 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:270}

Section 1. Definitions.

(1) "Adaptive and therapeutic equipment" means an item recommended by a physician, physician assistant, advanced practice registered nurse, or licensed therapist that is necessary for the recipient's independent functioning and communication.

(2) "Applicant" means a person who may be eligible for a Hart-Supported Living grant and submits a completed DAIL-HSL-01 Application to the regional Hart-Supported Living grant program coordinator by the deadline established by Section 3 of this administrative regulation.

(3) "Application" means a DAIL-HSL-01 Application that is completed and submitted in accordance with Section 3 of this administrative regulation to the regional Hart-Supported Living grant program coordinator.

(4) "Budget narrative" means a justification and explanation of the amount requested in each budget category.

(5) "Council" means the Hart- Supported Living Council that oversees the Hart-Supported Living grant program as described by KRS 210.775 and 210.780.

(6) "Department" or "DAIL" means the Department for Aging and Independent Living.

(7) "Designated Representative" means an uncompensated individual:

(a) Designated by the consumer to assist in managing the consumer's Hart Supported Living plan and needed services; and

(b) Chosen by the recipient, family, or legal guardian.

(8) "Duplicative service" means a support or service received through the Hart-Supported Living grant program which an individual is eligible to receive from another agency or program and is offered or available at the same time.

(9) "Eligibility" means meeting the financial eligibility criteria established in:

(a) Section 2 of this administrative regulation; and

(b) KRS 210.790.

(10) "Extraordinary out of pocket expenses" means medical expenses of the recipient or applicant not covered by insurance including:

(a) Co-pays;

(b) Deductibles;

(d) Premiums for medical insurance;

(e) Other medical, dental, or vision cost incurred as a result of medically necessary treatments or procedures; or

(f) Other services or supports related to the person's disability.

(11) "Family" means the recipient's parent, stepparent, adoptive parent, foster parent, grandparent, siblings, spouse, or legal guardian.

(12) "Family responsibility" means:

(a) Activities or provisions that a family or legal guardian performs naturally until the recipient reaches eighteen (18) years of age including:

Educational activities;
Housing;
Food;
Clothing;
Child care; and
Medical care; and

(b) Personal care activities or provisions that a family performs naturally until the recipient reaches twelve (12) years of age.

(13) "Federal poverty guidelines" means the poverty guidelines updated annually in the Federal Register by the U.S. Department of Health and Human Services under the authority of 42 U.S.C. 9902(2).

(14) "Hart-Supported Living grant" means an award of funds for a fiscal year to a recipient and is defined by KRS 210.770(5) and (6).

(15) "Hart-Supported Living grant program" or "HSL" is defined by KRS 210.770(5) and (6).

(16) "Hart-Supported Living plan" means the DAIL-HSL-02 Plan document developed with the recipient to account for the services to be provided and the costs as outlined in DAIL-HSL-01 and DAIL-HSL-04.

(17) "Hart-Supported Living plan amendment" means the DAIL-HSL-03 Plan Amendment document that is a written request for any change in the currently approved Hart-supported living plan in the same fiscal year.

(18) "Hart-Supported Living services" means services that are:

(a) Provided to a person with a disability; and

(b) Directed to the recipient toward integrated community living and include:

Homemaker services:

a. As authorized by KRS 210.770(8)(b); and

b. That include:

(i) Cooking;

(ii) Cleaning;

(iii) Shopping;

(iv) Laundry; or

(v) Housekeeping;

Personal care services:

a. As authorized by KRS 205.900(3); or

b. For recipients twelve (12) years of age or older, as authorized by KRS 210.770(8)(c);

In-home training and home management assistance:

a. As authorized by KRS 210.770(8)(d); and

b. That include services to individuals over the age of twelve (12) to assist with one-on-one instruction in the home, including:

(i) Property maintenance;

(ii) Financial planning;

(iii) Housekeeping such as laundering, meal preparation, vacuuming, storing purchased items, washing dishes, and changing bed linens; and

(iv) Shopping;

Start-up grants:

a. As authorized by KRS 210.770(8)(e);

b. That include a grant for one (1) time expenses if the expenses support the recipient's independent living and are for:

(i) A security deposit, not to exceed one (1) month's rent;

(ii) Utility deposits, submitted with documentation and shall not include past due amounts owed by consumer; or

(iii) Purchases of furniture, and appliances up to $2,500;and

c. Limited to one (1) start up grant per lifetime, per applicant;

Transportation:

a. As authorized by KRS 210.770(8)(f); and

b. That includes mileage reimbursement if it:

(i) Is for a person or provider who transports the recipient to work, community activities, medical appointments, or other destinations in the community as specified in the recipients Hart Supported Living plan;

(ii) Does not exceed the state reimbursement rate for individual provider and as specified in DAIL-HSL-01 or DAIL-HSL-04; and

(iii) Does not exceed the vendor specified budget amount in DAIL-HSL-02;

Home modifications that:

a. Are authorized by KRS 210.770(8)(g);

b. Include:

(i) An architectural change;

(ii) A ramp;

(iii) A widening of doors; or

(iv) Other adaptation if it is requested for the recipient's primary residence to directly accommodate the recipient's disability; and

c. Do not exceed the $45,000 per recipient lifetime limit;

Adaptive and therapeutic equipment:

a. As authorized by KRS 210.770(8)(h); and

b. That includes an item which promotes the recipient's independent functioning and is recommended by a:

(i) Physician;

(ii) Physician assistant;

(iii) Advanced practice registered nurse; or

(iv) Licensed therapist;

Individualized life planning authorized by KRS 210.770(8)(i); and
Respite care.

a. Skilled or unskilled service provided to a recipient on a short-term basis if there is an absence or need for relief of a recipient's caregiver; and

b. As defined in DAIL-HSL-02 Plan.

(19) "Operating agency" means the department or its designee that administers Hart-Supported Living.

(20) "Person with a disability" is defined by KRS 210.770(2).

(21) "Primary residence" means a dwelling where the recipient permanently resides and is owned or leased by the recipient or recipient's family as documented on the deed or lease agreement.

(22) "Recipient" means a person who has applied, been approved for a Hart-Supported Living grant, and signed a DAIL-HSL-02 Plan.

(23) "Recoupment" means a return of funds for any payment that was made in an incorrect amount including overpayments and underpayments under statutory, contractual, administrative, or other legally applicable requirements.

(24) "Regional Hart-Supported Living grant program coordinator" means a person or entity designated by the DAIL who is responsible for fiscal and programmatic oversight of Hart-Supported Living grants and plans.

(25) "Request for informal dispute resolution" means the process to be followed if a recipient disagrees with a decision made by the department, review team, or council.

(26) "Review team" means a team designated by the department to perform the functions established in Section 5 of this administrative regulation.

Section 2. Eligibility.

(1) []An applicant who is eligible for services through Medicaid or a Medicaid Waiver shall not be eligible for on-going services through a Hart-Supported Living grant unless the applicant is:

(a) Considered inappropriate for participant directed services due to:

An inability to manage his or her own services; and
A lack of availability of a person to act as his or her representative; or

(b) Unable to access the Medicaid program though a traditional provider.

(2) Medicaid eligible individuals requesting services that are not available or exceed program limits through Medicaid may apply for a Hart-Supported Living grant for those services not covered through Medicaid.

(3) Applicants shall submit a copy of the following for each member of the applicant's household:

(a) The most recent year's income tax returns disclosing the adjusted gross income;

(b) The past three (3) months' pay stubs; or

(4) An individual receiving Social Security Insurance shall be considered a household of one (1).

(5) Applicants with an annual household adjusted gross income at or below 300 percent of the federal poverty guidelines shall be considered an eligible applicant.

(6) Applicants with a household adjusted gross income above 300 percent of the federal poverty guidelines shall not be considered an eligible applicant unless the deduction of allowable extraordinary out of pocket expenses adjusts the household income to 300 percent of the federal poverty guidelines or lower.

Section 3. Applicant Responsibilities.

(1) To be considered for a Hart-Supported Living grant, the applicant shall submit a completed DAIL-HSL-01 or DAIL-HSL-04 Application to the regional Hart-Supported Living grant program coordinator where the applicant resides on or before the annual deadline of:

(a) February 1 for all on-going recipients submitting a DAIL-HSL-04 Request For Renewal; or

(b) April 1 for new applications or on-going recipients requesting a new item or service submitting a DAIL-HSL-01 Application.

(2) The DAIL-HSL-01 or DAIL-HSL-04 Application shall be submitted:

(a) With all sections and attachments completed; and

(b) Via:

The U.S. postal service postmarked by annual deadline;
Hand delivered to the HSL staff;
Electronically through email or Web site submission; or
By facsimile to program staff.

(3) An applicant shall disclose any relationship with:

(a) The regional Hart Supported-Living coordinator;

(b) A council member; or

(4) A Hart-Supported Living grant program application shall not be used or approved to pay for the following:

(a) Rent or mortgage payments;

(b) Payment of a recipient's or employee's insurance premium regardless of insurance type or medical bills;

(d) Modifications costing over $2,500 to rental property;

(e) Modifications of rental property without written permission from the property owner;

(f) A home improvement not related to a person's disability, including roofing, foundation, and regular home maintenance;

(g) Rental of a vehicle;

(h) Purchase of a vehicle;

(i) Supports or services for individuals in accordance with KRS 210.770(6)(a)-(e);

(j) Equipment or service that is duplicative or obtainable from another program or funding source for which the applicant qualifies;

(k) Tuition and associated costs to any educational institution;

(l) Transportation, costs, or fees for a program or activity in which the majority of participants are persons with a disability;

(m) Furniture not related to a start-up grant;

(n) Household items;

(o) Utility bills including:

Mobile phones;
Land line phones;
Internet access;
Cable;
Satellite dish;
Gas;
Electric;
Water;
Sewer; or
Other home related costs that may be considered utility and ongoing;

(p) Vacations;

(q) Camps that are segregated;

(r) Payment of medical treatments including:

Medical costs;
Prescriptions;
Vitamins and supplements;
Nutritional supplements; or
Medical supplies;

(s) Groceries, meals, or dining out;

(t) Fees and expenses for anyone other than the recipient and one (1) attendant; or

(u) Studies or research projects.

(5) Community activity fees shall:

(a) Be limited to pay for the recipient and one (1) attendant to accompany the recipient to an activity that promotes participation in the community with members of the general citizenry;

(b) Not be provided for activities that are a family responsibility; and

(6) Community activity fees, membership fees, and services funded through a Hart-Supported Living grant shall be provided and purchased in Kentucky unless they are not available in Kentucky.

Section 4. Application Evaluation and Funding Criteria.

(1) The review team shall recommend funding for a Hart-Supported Living grant based on the DAIL-HSL-01 Application which shall:

(a) Be received or postmarked on or before the due date;

(b) Be filled out in its entirety;

(d) Clearly identify and justify the cost for requested services;

(e) Clearly identify how the services will be provided;

(f) Clearly identify who will provide the services;

(g) Include a budget sheet and budget narrative for the funding requested for each service and provider;

(h) Identify personal resources that will be utilized to provide identified services; and

(i) Adhere to the core principles and definitions of the Hart-Supported Living grant program in accordance with KRS 210.770(5) and (6) and 210.795.

(2) Funding for the application shall be dependent upon:

(a) Meeting the eligibility criteria established in Section 2 of this administrative regulation;

(b) Completeness;

(d) Evaluation by the review team; and

(e) Availability of funding.

(3) Once the allocation of funds have been obligated to applications based on the review criteria, other applications shall not be approved for funding unless additional funding becomes available.

Section 5. Review Teams.

(1) A review team shall:

(a) Evaluate applications in accordance with the criteria in Section 4 of this administrative regulation;

(b) Make recommendations for applications to be funded in accordance with subsection (2) of this section;

(d) Not authorize a plan amendment to increase the grant award; and

(e) Reallocate grant awards that are underspent to fund individuals in the following priority order:

Applicants approved through the informal dispute or appeals process for the current fiscal year or, if no funding is available, these individuals shall be the first funded in the next fiscal year; and
Applicants in the current fiscal year based on priority order according to paragraphs (a) through (d) of this subsection and subsection (2)(a) and (b) of this section that funding was not available prior to the reallocation of grant awards.

(2) Funding recommendations shall be made in the following order:

(a) Current recipients requesting the same amount or less for on-going supports;

(b) Current recipients requesting additional funding in order to ensure the continuation of their current plan. Additional funding may be granted for the following:

An increase in the pay rate of a provider, agency, or vendor for services currently in the plan;
An increase in employer taxes for services currently in the plan;
An increase in worker's compensation rates; or
Payment to a provider to compute required employer taxes and withholdings;

(c) Applicants denied funding from the previous fiscal year and approved for funding by the informal dispute resolution or administrative hearing process as outlined in Section 14 of this administrative regulation; and

(d) New applicants and current recipients requesting additions to their plans.

(3) Multiple review teams may be established based upon the number of applications received annually and shall be designated by the department and made up of a minimum of three (3) individuals consisting of:

(a) One (1) employee of the department;

(b) One (1) council member; and

(4) If needed and available, technical assistance may be provided for educational purposes to the review team by a subject matter expert.

Section 6. Recipient Responsibilities.

(1) A recipient of a Hart-Supported Living grant shall:

(a) Meet the eligibility requirements established in Section 2 of this administrative regulation;

(b) Participate in the development of a DAIL-HSL-02 Plan with the regional Hart-Supported Living grant program coordinator;

(d) Negotiate the grant funded services to be provided by:

A service providing agency; or
An individual who provides services, as an employee or independent contractor; and

(e) Be responsible for the recoupment of funds when used for any purpose other than the approved plan or approved amended plan.

(2) A recipient of a Hart-Supported Living grant who is an employer shall:

(a) Be responsible for the computation, payment, and reporting of employee payroll, withholdings, workers' compensation, unemployment, and taxes;

(b) Establish terms of employment for an employee to:

Include time, duties, and responsibilities;
Be in the form of a signed agreement; and
Retain a copy of the valid driver's license and car insurance for any employee providing transportation.

Proof of licensure or certification and insurance;
Services to be provided and compensation; and
A signed agreement.

(3) A recipient shall not sell or donate equipment or another item purchased with Hart-Supported Living grant funds without the written consent of the council.

(4) A recipient of a Hart-Supported Living grant shall comply with standards as set forth in KRS 210.795.

(5) A recipient shall immediately notify the regional Hart-Supported Living coordinator upon the receipt of additional supports or services.

(6) A recipient shall submit:

(a) Documentation with a request for payment that shows a support or service approved on a DAIL-HSL-02 Plan has been provided; and

(b) A timesheet that shall be signed and dated by an employee and employer.

(7) A recipient of grant funds shall submit an application to request an increase of services or funding by April 1 to be considered with all applicants for a Hart-Supported Living grant for the fiscal year beginning July 1.

(8) Recipients of grant funding shall:

(a) Receive priority for funding of existing services listed on the individuals Hart-Supported Living plan, if the application is complete and submitted in compliance with Section 3 of this administrative regulation; and

(b) Not receive priority funding for:

New services;
Expanded services; or
Requesting additional funding for existing services.

Section 7. Recipient's Employee Responsibilities.

(1) An employee shall:

(a) Be selected by the recipient;

(b) Be eighteen (18) years of age or older;

(c) Enter into and comply with the written agreement for terms of work required by the recipient's DAIL-HSL-02 Plan or DAIL-HSL-03 Plan Amendment;

(d) Be a citizen of the United States with a valid Social Security number or possess a valid work permit if not a U.S. citizen;

(e) Be able to communicate effectively with the recipient, recipient's representative, or family;

(f) Be able to understand and carry out instructions;

(g) Keep records as required by the recipient;

(h) Report to work as scheduled;

(i) Maintain the privacy and confidentiality of the recipient;

(j) Complete training on the reporting of abuse, neglect, or exploitation in accordance with KRS 209.030 and on the needs of the recipient;

(k) Maintain and submit timesheets documenting hours worked and services provided;

(l) Provide proof of the following background checks, completed no more than sixty (60) days prior to hire and submitted prior to the first day of employment:

A criminal background check from the Administrative Office of the Courts or Justice and Public Safety Cabinet that shows the employee has not plead guilty to or been convicted of:

a. Committing a sex crime or violent crime as defined in KRS 17.165(1)-(3); and

b. A felony offense related to theft, abuse of a person, or drugs;

A check of the nurse aid abuse registry maintained in accordance with 906 KAR 1:100 that shows the employee was not found on the registry;
A check of the central registry maintained in accordance with 922 KAR 1:470 that shows the employee was not found on the registry; and
A check of the Adult Protective Services Vulnerable Adult Maltreatment Registry maintained in accordance with 922 KAR 5:120 that shows the employee was not found on the registry;

(m) Notify the regional Hart Supported-Living coordinator of conditions which seriously threaten the health or safety of the recipient or employee; and

(n) Provide employer with proof of valid driver's license and insurance if providing transportation.

(2) An individual shall not be hired as an employee if the individual:

(a) Has not submitted proof of the background checks specified in subsection (1)(l)1.-4. of this section;

(b) Is on the Central Registry, Nurse Aid Abuse Registry, or Adult Protective Services Vulnerable Adult Maltreatment Registry;

(c) Has pled guilty to or been convicted of committing a crime as specified in subsection (1)(l)1.a.or b. of this section; or

(d) Is not able to understand or carry out a recipient's instructions or services as listed on the DAIL-HSL-02 Plan or DAIL-HSL-03 Plan Amendment.

(3) An employee shall not work more than forty (40) hours in a calendar week (Sunday through Saturday).

Section 8. Operating Agency Responsibilities. The operating agency for Hart-Supported Living grant program funds shall:

(1) Implement the Hart-Supported Living grant program in accordance with KRS 210.770, 210.790, and 210.795;

(2) Assume fiscal accountability for the state funds designated for the program;

(3) Provide necessary personnel within the operating agency office that shall:

(a) Meet qualifications for the position held that include at a minimum:

A bachelor's degree in human services or a related field;
One (1) year of experience working in a social service field; and
Documentation of completion of six (6) hours of annual training related to the position or population;

(b) Not have a conflict of interest; and

(4) Establish a cost center and record staff costs for administering the Hart-Supported Living grant Program;

(5) Maintain files and records for cabinet audit, including participant records, and statistical reports in accordance with 725 KAR 1:061;

(6) Issue payment of recoupment to DAIL if:

(a) The department's documentation is not sufficient to determine that HSL funds were used according to this administrative regulation; or

(b) The recipient used his or her plan inappropriately; and

(7) Not request the recouped funds back from the recipient unless:

(a) The department demonstrates by compelling evidence that the recipient used his or her plan inappropriately; and

(b) The department provides written approval to recoup the funds from the recipient.

Section 9. Council Responsibilities.

(1) A council member shall:

(a) Adhere to the:

Cabinet's confidentiality of records and reports requirements in accordance with KRS 194A.060; and
Confidentiality requirements for an applicant's or recipient's health information pursuant to 45 C.F.R. 164.502 - 164.514;

(b) Disclose any relationship with any person receiving a Hart-Supported Living grant, including themselves; and

(2) If a council member fails to act in accordance with this section, the chair or any council member may:

(a) Call for a vote of the council to recommend the dismissal of the council member; and

(b) Upon a majority vote for dismissal, recommend to the governor that the member be dismissed.

(3) A council member shall not:

(a) Influence, discuss, deliberate, or vote on a decision if the member has a conflict of interest that is:

Personal;
Professional; or
Financial;

(b) Be physically present in a meeting or portion of a meeting during which the subject matter of the conflict of interest is discussed or voted on; or

(c) Assist another individual, regardless of where the person resides, to complete an application for Hart-Supported Living grant funds or services except as provided in subsection (4) of this section.

(4) A council member may assist in the completion of an application for himself, if eligible, or an eligible family member.

(5) A council member shall assist in the review of applications in accordance with Section 5 of this administrative regulation.

Section 10. Department Responsibilities. The Department shall:

(1) In cooperation with the council, establish deadlines, budgets, and priorities for Hart-Supported Living grant program funds;

(2) Maintain aggregate financial and programmatic data;

(3) Provide staff support, technical assistance, and training for the Hart-Supported Living grant Program; and

(4) Provide monitoring of the Hart-Supported Living grant Program.

Section 11. Regional Hart-Supported Living Grant Program Coordinator Responsibilities. The regional Hart-Supported Living grant program coordinator shall:

(1) Disseminate applications for the Hart-Supported Living grant program;

(2) Provide assistance in the completion of the DAIL-HSL-01 Application upon request by an eligible applicant or individual on the applicant's behalf;

(3) Receive the DAIL-HSL-01 Application, document the date received, and send notice of receipt of application to the applicant;

(4) Prescreen applications to determine completeness, compliance with the instructions, and conformity with KRS 210.770(5) and (6);

(5) Maintain a database by fiscal year of applicants and recipients that shall include the individual's:

(a) Name;

(b) Address;

(d) Birth date;

(e) County of residence;

(f) Services or supports requested;

(g) Cost of each service or support;

(h) Contact person phone number; and

(i) Amount of allocated funding;

(6) Notify all applicants of the status of their applications:

(a) By June 15 for the fiscal year beginning July 1; or

(b) Within fifteen (15) days of the state budget allocation being received;

(7) Within thirty (30) days of the recommendation for funding of an applicant, conduct a face-to-face visit to finalize the Hart-Supported Living grant program plan and budget;

(8) Conduct a home visit to verify the need for home modifications;

(9) Educate a recipient on the recipient's responsibilities as outlined in Section 6 of this administrative regulation;

(10) Approve payments for funded Hart-Supported Living plans by:

(a) Receiving bills or other documentation that a service has been provided;

(b) Verifying the service as a part of the established plan; and

(11) Arrange for the billing and payment directly to a vendor for one (1) time expenditures or to an agency as requested by a grant recipient;

(12) Ensure compliance with this administrative regulation and the successful implementation of the Hart-Supported Living plans through monitoring which shall include:

(a) Conducting a home visit or site visit at the location where the services are received;

(b) Visiting the home when home modifications are requested and completed;

Within six (6) months of completion of the service for one (1) time services received by a recipient; and
Within the first three (3) months of the initiation of the Hart-Supported Living plan and for services received by a recipient; and

(d) Maintaining monitoring reports as a permanent part of the recipient's record;

(13) Attend trainings and meetings as required by the council;

(14) Submit database information as outlined in this section to the department; and

(15) Disclose any relationship with an applicant or recipient of a Hart-Supported Living grant including:

(a) Family member;

(b) Friend;

(d) Co-worker family member; or

(e) Co-worker friend.

Section 12. Reduction of a Hart-Supported Living Grant.

(1) The regional Hart-Supported Living grant program coordinator shall recommend a reduction in Hart-Supported Living grant funding by the amount that duplicates a support or service on the Hart-Supported Living plan to the Hart-Supported Living council.

(2) The Hart-Supported Living grant shall be reduced if:

(a) The support does not comply with the principles and definition of the Hart-Supported Living grant program in KRS 210.770 through 210.795;

(b) The recipient no longer needs a support or service in whole or in part; or

Section 13. Termination of a Hart-Supported Living Plan.

(1) The regional Hart-Supported Living grant program coordinator shall recommend to the council that a recipient's grant be terminated if the recipient:

(a) Does not use the funds in accordance with the principles and definition of Hart-Supported Living found in KRS 210.770, 210.795, and this administrative regulation;

(b) Does not comply with employer responsibilities, if applicable;

(d) Requests termination of the Hart-Supported Living grant;

(e) Does not utilize funds in accordance with the approved DAIL-HSL-02 Plan;

(f) Does not notify the Hart-Supported Living grant program coordinator upon receipt of additional supports or services as required in Section 6(5) of this administrative regulation; or

(g) Passes away.

(2) The regional Hart-Supported Living grant program coordinator shall recommend termination of the program if a council member or program staff is threatened, harassed, or intimidated by a recipient's:

(a) Caregiver;

(b) Family member;

(d) Designated representative.

(3) A termination shall be appealable in accordance with Section 14 of this administrative regulation.

Section 14. Request for Informal Dispute Resolution or Administrative Hearing.

(1) A recipient may request an informal dispute resolution.

(2) A dispute resolution shall be limited to:

(a) The denial, reduction, or termination of a:

Hart-Supported Living plan; or
Hart-Supported Living plan amendment;

(b) The reduction of Hart-Supported Living grant program funding as requested in the plan; or

(3) A request for an informal dispute resolution shall:

(a) Be submitted to the department's HSL program coordinator within thirty (30) days following the notification by the Hart-Supported Living grant program coordinator of a decision in subsection (2) of this section; and

(b) Contain the following information:

Name, address, and telephone number of the recipient;
Decision being disputed;
Justification for the dispute;
Documentation supporting the dispute; and
Signature of person requesting the dispute resolution.

(4) The dispute resolution shall be heard by:

(a) Three (3) members of the council, one (1) of whom shall be the chairman or the chairman's designee;

(b) One (1) member of a review team; and

(5) The recipient shall be provided an opportunity to appear before the dispute resolution team to present facts or concerns about the denial, reduction, or termination of the grant.

(6) The dispute resolution team shall inform a recipient, in writing, of the decision resulting from the dispute resolution within ten (10) business days of the review.

(7) A recipient dissatisfied with the result of the dispute resolution may appeal to the Division of Administrative Hearings of the Office of Communications and Administrative Review.

(8) The appeal shall be submitted:

(a) Within fifteen (15) business days from the date on the letter providing the decision of the dispute resolution team;

(b) In writing; and

(9) The department shall request the Division of Administrative Hearings of the Office of Communications and Administrative Review to conduct a hearing pursuant to KRS Chapter 13B.

Section 15. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "DAIL-HSL-01 Application", January 2024;

(b) "DAIL-HSL-02 Plan", January 2024;

(d) "DAIL-HSL-04 Request for Renewal", January 2024.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Aging and Independent Living, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. through 4:30 p.m., or at https://www.chfs.ky.gov/agencies/dail/Pages/hslp.aspx.

History

RELATES TO: KRS 17.165, 194A.060, 205.900(3), 209.030, 210.770-210.795, 42 U.S.C. 9902(2), 45 C.F.R. 164.502-164.514, 164.530
STATUTORY AUTHORITY: KRS 210.780(3), 210.795(3)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.780(3) authorizes the Hart-Supported Living Council to recommend necessary administrative regulations to carry out the purposes of KRS 210.770 to 210.795. KRS 210.795(3) requires the cabinet in concert with the Hart-Supported Living Council to promulgate administrative regulations to establish the methods of awarding Hart-Supported Living grants, monitoring the quality of service delivery, and providing for administrative appeals of decisions. This administrative regulation establishes the Hart-Supported Living grant program application and award procedures, the standards to monitor the quality of service delivery, and the appellate procedure.
History: 24 Ky.R. 2043; Am. 2729; 25 Ky.R. 346; eff. 8-17-1998; 33 Ky.R. 1737; 2324; eff. 3-9-2007; Recodified from 908 KAR 2:190; eff. 6-19-2009; 42 Ky.R. 161; 763; eff. 9-16-2015; TAm eff. 3-17-2020; 50 Ky.R. 1978; 51 Ky.R. 63, 281; eff. 8-28-2024.

Chapter 3 Brain Injury

910 KAR 3:020 Behavioral services for individuals with brain injuries {#sec-910-kar-3-020 omnilex-key=us-ky-regs-official--title-910--910 KAR 3:020}

Section 1. Definitions.

(1) "Behavioral services" means:

(a) Services that effectively manage severe behavioral issues which occur as the result of a brain injury; and

(b) Rehabilitative services for the brain injury.

(2) "Behavioral specialist" means a professional who has the skills and qualifications, as specified in Section 5(3)(b) of this administrative regulation, to:

(a) Manage severe behavioral issues which occur as the result of a brain injury; and

(b) Provide rehabilitative services for the brain injury.

(3) "Brain injury" is defined by KRS 211.470(3).

(4) "Case manager" means a professional described in Section 5(3) of this administrative regulation who manages the overall development and monitoring of a recipient's plan of care.

(5) "Crisis intervention" means a short-term intensive service of a least restrictive nature to aid an individual to regain a sense of control over an immediate situation.

(6) "Crisis stabilization unit" means a unit operated to provide short-term intensive treatment.

(7) "Department" means the Department for Aging and Independent Living.

(8) "Discharge plan" means a plan that is developed to aid a recipient in exiting from one (1) provider to another or into the community.

(9) "Emergency" means a situation in which an applicant is living in conditions that present a substantial risk of death or eminent and serious physical harm to the applicant or others.

(10) "Provider" means an individual, business agency, or facility providing brain injury services.

(11) "Recipient" means an applicant approved for services.

(12) "Residential" means a placement that assists an applicant or recipient who is unable to be managed or treated through crisis stabilization in the community.

(13) "Review team" means a team composed of three (3) program cabinet staff with professional or personal experience with brain injury or other cognitive disabilities who reviews and approves or denies an application for services.

(14) "Targeted case management" means a set of activities which assist an applicant or recipient in accessing needed medical, social, education, and other supportive services.

(15) "Transitional services" means transitioning a recipient from one (1) setting to another such as for receipt of:

(a) Crisis intervention services;

(b) Residential services;

(d) In-home environment services.

(16) "Wrap around" means a service or item, specified in Section 5(7)(b) of this administrative regulation, that enhances a recipient's ability to live in the community.

Section 2. Eligibility.

(1) An applicant for services shall be eligible to receive a benefit under this program if:

(a) The applicant has a diagnosed brain injury;

(b) The applicant is a legal resident of Kentucky;

(d) The applicant meets the requirements for crisis intervention or residential services in accordance with subsections (2) and (3) of this section.

(2) An applicant for crisis intervention services shall:

(a) Meet the requirements of subsection (1) of this subsection and be non-Medicaid eligible; or

(b) Be Medicaid eligible receiving services under one (1) of the Medicaid ABI Waivers and in an emergency status.

(3) An applicant for residential services shall:

(a) Meet the requirements of subsection (1) of this subsection;

(b) Be non-Medicaid eligible;

(d) Be in an emergency status.

(4) An applicant or applicant's guardian or legal representative shall:

(a) Document that the applicant has no other funding source for services contained in this administrative regulation; and

(b) Provide the department with medical documentation of the applicant's brain injury including a completed DAIL-BI-020, Physician's Recommendation form signed by the applicant's physician confirming diagnosis of brain injury.

(5) The following conditions shall not be included to receive services under this administrative regulation:

(a) Strokes treatable in nursing facilities providing routine rehabilitation services;

(b) Spinal cord injuries in which there are no known or obvious injuries to the intracranial central nervous system;

(d) Depression and psychiatric disorders; and

(e) Mental retardation or birth defect related disorders.

Section 3. Application Process.

(1) A referral for services may be made by, or on behalf of, an eligible person by contacting the department by:

(a) Telephone; or

(b) In writing such as by:

Facsimile;
Email; or
U.S. mail.

(2) Upon an applicant's request for services, the department shall provide the applicant with an application packet containing the following forms:

(a) DAIL-BI-010, Application for Behavioral Services; and

(b) DAIL-BI-020, Physician's Recommendation.

(3) The applicant or applicant's guardian or legal representative shall provide the department with:

(a) The completed forms specified in subsection (2) of this section;

(b) Documentation specified in Section 2(4)(a) of this administrative regulation; and

(c) Other medical documentation for processing the request for services as specified in Section 2(4)(b) of this administrative regulation.

(4) The department shall:

(a) Submit the completed forms and documentation to the review team who shall determine the applicant's eligibility for services; and

(b) Notify the applicant in writing of approval or denial for services.

(5) An applicant who wishes to appeal the denial of services may make a request in accordance with Section 10 of this administrative regulation.

Section 4. Review Team.

(1) At least two (2) members of the review team shall not be supervised by the department's Long Term Care Branch.

(2) A review team shall:

(a) Assess the applicant's eligibility for services;

(b) Identify the applicant's need for crisis intervention or residential services;

(d) Determine that this program is the payor of last resort; and

(e) Meet monthly at a minimum, or more often as needed for an emergency.

(3) The review team may approve the following behavioral services for a recipient:

(a) Crisis intervention services that shall:

Include:

a. Training and consultation;

b. Wrap around services;

c. Targeted case management;

d. Crisis stabilization unit; or

e. Environmental modification; and

Be approved for no more than three (3) months, unless an exception to this timeframe is approved by the department based on individualized stabilization as documented by a provider's service plan, progress notes, or additional supporting documentation; or

(b) Residential services that shall include:

Wrap around services;
Targeted case management, if applicable; or
Transitional services in which a recipient:

a. Returns to the recipient's previous setting, upon stabilization; and

b. May be provided additional wrap around services to assist with transitioning back to the previous setting, if funding is available.

(4)

(a) Except for an emergency as specified in Section 8(10) of this administrative regulation, an application shall be considered in the order in which it is received by the department.

(b) To be considered at the monthly review team meeting, an application shall be received by the department no later than three (3) business days prior to the review team meeting.

(5) The review team may make a recommendation to the applicant and the department about other available resources or means to meet the applicant's needs for services and supports.

(6) A final determination from the review team shall be submitted to the department in writing not to exceed three (3) business days from the date of determination and shall contain:

(a) An approval or denial for services; and

(b) An explanation of the review team's decision and recommendations for other resources to meet the applicant's needs, if services were denied.

(7) If an applicant is determined ineligible for services, the applicant may submit to the department additional medical records or medical documentation to support the diagnosis of the injury.

(8) The department shall submit, at the next review team meeting, the additional medical information for reconsideration of the eligibility determination.

Section 5. Covered Services.

(1) Covered services shall be prior-authorized by the review team and provided in accordance with a plan of care.

(2) A crisis stabilization unit setting shall include the following crisis intervention services:

(a) Reestablishing problem-solving abilities;

(b) Staff as specified in subsection (5)(b) of this section;

(d) Assessing functioning and coping skills; and

(e) Providing stabilization, wrap around, and transitional services.

(3) Targeted case management shall include the following:

(a) Ensuring twenty-four (24) hour availability of services;

(b)

Assessment;
Advocacy;
Reassessment and follow-up;
Establishment and maintenance of a recipient's record; and
Crisis assistance planning;

(d)

Initiation;
Coordination and implementation of services;
Monitoring of the delivery of services and the effectiveness of a plan of care; and
Monitoring a recipient's eligibility;

(e) Assistance with development of an individualized plan of care and updates as necessary based on changes in the recipient's medical condition, transition, and supports;

(f) A plan for transitional services which shall be developed within seven (7) calendar days of receiving services and updated as changes occur; and

(g) A case manager who has one (1) or more year's experience working in the brain injury field and is one (1) of the following:

A registered nurse;
A licensed practical nurse; or
An individual who has a bachelor's or master's degree in a human services field who meets all applicable requirements of his or her particular field including a degree in:

a. Psychology;

b. Sociology;

c. Social work; or

d. Rehabilitation counseling.

(4) Training and consultation services:

(a) Shall include:

Training that includes:

a. Resolving personal issues or interpersonal problems resulting from the recipient's brain injury;

b. Substance abuse or chemical dependency treatment;

c. Building and maintaining healthy relationships;

d. Social skills or the skills to cope with and adjust to the brain injury;

e. Knowledge and awareness of the effect of a brain injury;

f. Interpretation or explanation of medical examinations and procedures;

g. Treatment regimens;

h. Use of equipment; and

i. How to assist the recipient; and

Counseling and consultation services to:

a. Professionals;

b. Families; or

c. Providers working with individuals with a brain injury; and

(b) Shall be provided by a behavioral specialist who:

a. A psychologist;

b. A psychologist with autonomous functioning;

c. A licensed psychological associate;

d. A psychiatrist;

e. A licensed social worker;

f. A clinical nurse specialist with a master's degree in psychiatric nursing or rehabilitation nursing;

g. An advanced registered nurse practitioner (ARNP);

h. A board certified behavior analyst;

i. A certified alcohol and drug counselor;

j. A licensed marriage and family therapist; or

k. A licensed professional clinical counselor; and

Has at least one (1) year of behavior specialist experience.

(5) Residential services shall:

(a) Include such services as:

Physical therapy;
Occupational therapy;
Speech therapy;
Cognitive and behavioral therapy; or
Neuropsychological consultation and medical management; and

(b) Be provided by a licensed facility or certified Medicaid provider who shall:

Have access to a:

a. Neuropsychologist;

b. Nurse and physician for medical management; and

c. Direct care staff member who shall:

(i) Be twenty-one (21) years of age or older;

(ii) Have a high school diploma or GED;

(iii) Have a valid driver's license;

(iv) Have a minimum of one (1) year of experience in providing a service to an individual with a disability; and

(v) Complete a brain injury training program approved by the department prior to service provision that includes the mission, goals, organization, and policy of the facility or provider; documentation of all training including the type of training provided, name and title of the trainer, length of the training, date of completion, and signature of the trainee verifying completion; and six (6) hours annually of continuing education in brain injury;

Prior to an employee's date of hire, obtain results of:

a. A criminal record check from the Administrative Office of the Courts or the equivalent out-of-state agency, if the individual resided or worked outside Kentucky during the year prior to employment;

b. A nurse aide abuse registry check as described in 906 KAR 1:100; and

c. Within thirty (30) days of the date of hire, a central registry check as described in 922 KAR 1:470;

Annually, for twenty-five (25) percent of employees randomly selected, obtain:

a. The results of a criminal record check from the Kentucky Administrative Office of the Courts; or

b. The equivalent out-of-state agency, if the individual resided or worked outside of Kentucky during the year;

Evaluate and document the performance of each employee upon completion of the agency's designated probationary period, and at a minimum, annually thereafter;
Conduct and document periodic and regularly scheduled supervisory visits of all professional and paraprofessional direct service staff at the service site in order to ensure that high quality services are provided to the recipient;
Not permit an employee to transport a recipient, if the employee has a conviction of driving under the influence (DUI) during the past year; and
Not employ an individual to perform direct care or a supervisory function, if the individual:

a. Has a prior conviction of an offense delineated in KRS 17.165(1) through (3) or prior felony conviction;

b. Has a conviction of abuse or sale of illegal drugs during the past five (5) years;

c. Has a conviction of abuse, neglect, or exploitation;

d. Has a Cabinet for Health and Family Services finding of child abuse or neglect pursuant to the central registry; or

e. Is listed on the nurse aide abuse registry.

(6) The individuals providing case management services, behavior specialist services, and residential services shall document a monthly detailed staff note which shall:

(a) Include:

Date of the service;
The beginning and ending time;
The signature, date of signature, and title of the individual providing the service;
Information regarding the recipient's health, safety, and welfare;
Services provided and progress toward outcomes identified in the approved plan of care; and
Daily notes; and

(b) Be provided to the department with a report on the recipient's progress:

By the tenth of each month following admission; and
By the tenth of the month following the month of discharge.

(7) Wrap around services shall:

(a) Be facilitated by targeted case management; and

(b) Include:

A service such as:

a. Personal care;

b. Companion care;

c. Transportation; or

d. Environmental modification; or

Durable medical equipment.

(8) The following services shall not be covered:

(a) Institutionalization;

(b) Hospitalization; and

Section 6. Provider Participation. A participating provider shall:

(1) Have a contractual agreement with the Commonwealth of Kentucky;

(2) Have policy and procedures including prohibition of physical and chemical resources reviewed and approved by the department;

(3) Be responsible for incident reporting requirements established in Section 7 of this administrative regulation;

(4) Be responsible for the involuntary termination requirements of Section 9(4) of this administrative regulation; and

(5) Submit an invoice for payment to the department due by the 15th of the month following the month of service.

Section 7. Incident Reporting Process.

(1) An incident report:

(a) Shall be documented on a DAIL-BI-030, Incident Report; and

(b) Shall be submitted by the provider to the individuals or departments indicated and by the timeframes specified in subsection (2) of this section.

(2) There shall be three (3) classes of incidents as follows:

(a) A Class I incident which shall:

Be minor in nature and not create a serious consequence;
Not require an investigation by the provider;
Be reported to a case manager within twenty-four (24) hours;
Be reported to the recipient's guardian or legal representative as directed by the guardian or legal representative; and
Be retained on file at the provider and case management agency;

(b) A Class II incident which shall:

a. Be serious in nature;

b. Include a medication error; or

c. Involve the use of a physical or chemical restraint;

Require an investigation which shall be initiated by the provider within four (4) hours of discovery and shall involve the case manager;
Require a complete written report of the incident investigation submitted to the department within forty eight (48) hours of discovery; and
Be reported within four (4) hours of discovery to:

a. The recipient's guardian or legal representative; and

b. The department:

(i) Via email, facsimile transmission, or the department's business phone if the incident occurs Monday through Friday by 1:30 p.m.; or

(ii) Via email, or cellular number provided by the department if the incident occurs Monday through Friday after 1:30 p.m. or on a holiday or weekend; and

a. Be grave in nature;

b. Involve suspected abuse, neglect, or exploitation;

c. Involve a medication error which requires a medical intervention; or

d. Be a death;

Be immediately investigated by the provider, and the investigation shall involve the case manager;
Require a complete written report of the incident investigation submitted to the department within forty eight (48) hours of discovery; and
Be reported to the:

a. Department for Community Based Services, immediately upon discovery, if involving suspected abuse, neglect, or exploitation in accordance with KRS Chapter 209;

b. Recipient's guardian or legal representative within four (4) hours of discovery; and

c. Department within four (4) hours of discovery:

(i) Via email, facsimile transmission, or the department's business phone if the incident occurs Monday through Friday by 1:30 p.m.; or

(ii) Via email, or cellular number provided by the department if the incident occurs Monday through Friday after 1:30 p.m. or on a holiday or weekend.

(3) In addition to the report specified in subsection (2)(c)3 of this section, the following documentation that was in existence at the time of a death shall be submitted to the department:

(a) A current plan of care;

(b) A current list of prescribed medications including PRN medications;

(d) The provider's medication administration review for the current and previous month;

(e) Staff notes from the current and previous month including details of physician and emergency room visits;

(f) Documentation of Class I or II incidents;

(g) A coroner's report; and

(h) If performed, an autopsy report.

Section 8. Waiting List for Residential Services. The department shall establish and maintain a waiting list for residential services. The waiting list shall be implemented as follows:

(1) In order to be placed on the waiting list, the individual shall submit to the department the documentation specified in Sections 2(4) and 3(2) of this administrative regulation.

(2) The order of placement on the waiting list shall be determined chronologically by date of receipt of the completed application packet specified in Section 3(2) of this administrative regulation.

(3) In determining chronological status, the original date of receipt of the completed application packet shall:

(a) Be Maintained; and

(b) Not be changed.

(4) A written notification of the date and placement on the waiting list shall be mailed to the applicant or the applicant's guardian or legal representative.

(5) Maintenance of the waiting list shall occur as follows:

(a) The department shall update the waiting list monthly; and

(b) If an individual is removed from the waiting list, written notification shall be mailed by the department to the individual or the individual's guardian or legal representative.

(6) An individual shall be removed from the waiting list if:

(a) The department is unable to locate the individual or the individual's guardian or legal representative;

(b) The individual is deceased; or

(7) The removal of an individual from the waiting list shall not prevent the submittal of a new application at a later date.

(8) Available funding shall be allocated to an individual having emergency status prior to allocating funding to individuals having nonemergency status.

Section 9. Termination of Services.

(1) A recipient may have services terminated if:

(a) The recipient no longer actively participates in the services within a plan of care;

(b) Services can no longer be safely provided to the recipient; or

(2) If a recipient has services terminated, the provider shall implement a discharge plan in accordance with the requirements of subsection (4) of this section.

(3) Voluntary termination and loss of behavioral services shall be initiated if a recipient or the recipient's guardian or legal representative submits a written notice of intent to discontinue services to the provider and to the department.

(4) Involuntary termination of a recipient by a provider shall require:

(a) Simultaneous notice to the department, the recipient, the recipient's guardian or legal representative, and the case manager at least sixty (60) days prior to the effective date of the action, which shall include:

A statement of the intended action;
The basis for the intended action;
The authority by which the action is taken; and
The recipient's right to appeal the intended action through the provider's appeal or grievance process;

(b) The targeted case manager in conjunction with the recipient and provider to:

Provide assistance to ensure a safe and effective service transition; and
Ensure the health, safety, and welfare of the recipient until an appropriate placement is secured; and

Section 10. Appeal Procedures for Denial of a Request for Services.

(1) An applicant who wishes to appeal a denial of services shall notify the department in writing, within thirty (30) days of receipt of notification of the denial.

(2) The department shall:

(a) Acknowledge receipt of a written appeal, in writing, within five (5) working days after receipt of the appeal;

(b) Direct the appeal request to the Division of Administrative Hearings Branch, Office of Communications Review to conduct a hearing pursuant to KRS Chapter 13B; and

(c)

Render a final decision in accordance with KRS 13B.120 by the Secretary of the Cabinet for Health and Family Services; and
The final order shall make clear reference to the availability of judicial review pursuant to KRS 13B.140 and 13B.150.

Section 11. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "DAIL-BI-010, Application for Behavioral Services", edition 3/09;

(b) "DAIL-BI-020, Physician's Recommendation", edition 3/09;

(d) "DAIL-BI-040, Plan of Care", edition 3/09.

History

RELATES TO: KRS Chapter 13B, Chapter 45A, 189A.010(1)(a)- (d), 211.470(3)
STATUTORY AUTHORITY: KRS 189A.050(3)(d)2, 194A.050(1)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 189A.050(3)(d)2 requires the cabinet to promulgate an administrative regulation to provide direct services to individuals with brain injuries including long-term supportive services and training and consultation to professionals working with individuals with brain injuries. KRS 194A.050(1) requires the Secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary under applicable state laws to protect, develop, and maintain the health, personal dignity, integrity, and sufficiency of the individual citizens of the commonwealth. This administrative regulation establishes procedures for the provision of behavioral services to individuals with brain injuries.
History: 35 Ky.R. 1988; 2120; 2298; eff. 5-1-2009; TAm eff. 5-14-2009; Crt eff. 8-10-2018; Cert eff. 10-8-2024.

910 KAR 3:030 Traumatic brain injury trust fund operations program {#sec-910-kar-3-030 omnilex-key=us-ky-regs-official--title-910--910 KAR 3:030}

Section 1. Definitions.

(1) "Applicant" means a person:

(a) Who applies for the program, including a legally responsible individual on behalf of an applicant;

(b) Who participates in the development of, and agrees to, a service plan for the use of the program; and

(2) "Benefit" means financial assistance provided to a recipient to cover the cost of services approved by the service plan review committee.

(3) "Benefit management program" or "program" means the entity recommended by the board that provides case management services and facilitates distribution of trust fund monies.

(4) "Board" is defined by KRS 211.470(1).

(5) "Cabinet" is defined by KRS 211.470(2).

(6) "Case management" means a process, coordinated by a case manager, for linking a recipient to appropriate, comprehensive, and timely home or community based services as identified in the service plan by:

(a) Planning;

(b) Referring;

(d) Advocating.

(7) "Case manager" means the individual employee responsible for:

(a) Coordinating services and supports from all agencies involved in providing services required by the service plan;

(b) Ensuring all service providers have a working knowledge of the service plan; and

(8) "Companion services" means nonmedical supervision and socialization services for the purpose of:

(a) Preventing the need for institutionalization; and

(b) Assisting a recipient in maintaining community placement based upon an approved service plan.

(9) "Conflict free" means a scenario in which an agency, including any subsidiary, partnership, not-for-profit, or other business entity under the control of the agency, is providing case management to an individual without providing any other waiver service.

(10) "Department" means the Department for Aging and Independent Living (DAIL).

(11) "Educational or experiential equivalent" means:

(a) Two (2) semesters totaling at least twenty-four (24) hours of course work; and

(b) At least 400 documented hours of experience assisting brain injured or other disabled individuals through:

Practicum placement;
Clinicals; or
Volunteerism.

(12) "Environmental modification" means a physical adaptation to a recipient's home:

(a) For the purpose of helping a recipient function with greater independence in the recipient's own home; or

(b) Which is necessary to accommodate medical equipment and supplies required for the recipient's welfare.

(13) "Fund" or "trust fund" is defined by KRS 211.470(4).

(14) "Good cause" means a circumstance beyond the control of a recipient that affects the recipient's ability to access an approved benefit, including:

(a) Illness or hospitalization of the individual that is expected to last thirty (30) days;

(b) Death or incapacitation of the primary caregiver; or

(15) "Immediate family" is defined by KRS 205.8451(3).

(16) "Integrated environment" means other individuals in a nonresidential setting integrated with those individuals who have a brain injury and in which both are being served to improve community living skills.

(17) "KYTBI data system" means the internet based data system used to monitor, track, and maintain recipient information, annual and lifetime allocations, and case work performed on behalf of a recipient.

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

(a) A biological, adoptive, or foster parent of a minor child who provides care to the child;

(b) The legal guardian who is responsible for the care of the recipient; or

(19) "Medical records" means records signed by a physician documenting an applicant's or recipient's traumatic brain injury including:

(a) Hospital records; or

(b) Diagnostic imaging reports as related to KRS 211.470(3).

(20) "Natural supports" means a non-paid person, or community resource who can provide, or has historically provided assistance to the consumer or, due to the familial relationship, would be expected to provide assistance when capable.

(21) "Noncrisis behavior programming" means an individually-designated nonemergency service plan intended to increase a recipient's adaptive social behavior that is provided by a behavioral therapist or clinical psychologist.

(22) "Occupational therapist" is defined by KRS 319A.010(3).

(23) "Occupational therapy" means the therapeutic use of self-care, work, and leisure activities to enhance independent functioning or skill development.

(24) "Personal care assistance services" is defined by KRS 205.900(3).

(25) "Physical therapist" is defined by KRS 327.010(2).

(26) "Physical therapy" is defined by KRS 327.010(1).

(27) "Prevocational service" means a service designed to develop a prerequisite skill necessary to prepare a recipient for paid or unpaid employment provided beyond other external program resources and provided by an occupational therapist or rehabilitation counselor.

(28) "Psychological and mental health services" means services provided by a mental health professional licensed by the state which are:

(a) Designed to help a recipient to resolve personal issues or interpersonal problems resulting from a traumatic brain injury; or

(b) Provided to a recipient's direct caregiver to preserve the stability of a recipient's community living situation, as part of an approved service plan.

(29) "Recipient" means an eligible applicant who receives a benefit as defined by Section 1(2) of this administrative regulation.

(30) "Respite care" means a skilled or unskilled service provided to a recipient on a short-term basis if there is an absence or need for relief of a recipient's caregiver.

(31) "Service plan" means a document that itemizes the goals, services, equipment, or items which are subject to review by the service plan review committee.

(32) "Service plan review committee" or "SPRC" means a committee composed of persons with traumatic brain injuries or their legally responsible individual and professionals in the field of brain injury as outlined in Section 4(5)(b).

(33) "Specialized medical equipment and supplies" means items which are of direct medical or therapeutic benefit to a recipient and assist the recipient to maintain community placement.

(34) "Speech-language pathologist" is defined by KRS 334A.020(3).

(35) "Speech and language therapy" means an intervention designed to maximize a recipient's language, pragmatic, articulation, swallowing, and cognitive skills.

(36) "Structured day program services" means a service:

(a) Provided by a certified or licensed entity; and

(b) Performed in a nonresidential setting which is designed to develop and improve a recipient's skills through activities and skill trainings in areas of:

Personal well being;
Social and community living; and
Independent living management.

(37) "Supported employment services" means supervision and training of a recipient in a work site at which persons without disabilities are employed and for a recipient who:

(a) Is unlikely to obtain competitive employment at or above minimum wage; or

(b) Needs ongoing support to perform competitive employment.

(38) "Traumatic brain injury" is defined in KRS 211.470(3).

(39) "Wrap-around service" means a service, equipment, or item, not excluded by KRS 211.474(2)(e), which will enhance a recipient's ability to live in the community, consistent with the recipient's overall service plan.

Section 2. Board Operating Procedures.

(1)

(a) A board member shall adhere to the bylaws of the board and the confidentiality requirements as specified in KRS 211.474(3).

(b) If a member fails to act in accordance with the bylaws, the chair of the board shall recommend to the governor the dismissal of that member.

(2) A board member shall not:

(a) Influence, discuss, deliberate, or vote on a decision if the member has a conflict of interest that is:

Personal;
Professional; or
Financial; or

(b) Directly assist another individual, regardless of where the person resides, to apply for benefits from the fund, except a board member:

May refer another individual but not directly assist another individual to apply for benefits from the fund; and
Shall not refer himself or an eligible family member or receive benefits from the fund at the same time as being a member of the board.

(3) The board shall review a quarterly report of the program's activities in accordance with Section 4(8) of this administrative regulation.

(4) The board shall direct the department to:

(a) Issue a request for proposal for the benefit management program in accordance with KRS 45A.080; or

(b) Operate the program within the department.

Section 3. Department Duties.

(1) The department may issue a request for proposal:

(a) If directed by the board; and

(b) In accordance with KRS 45A.080.

(2) The department may rescind all or part of an awarded benefit if the recipient does not utilize all or part of the benefit within a twelve (12) month plan period.

Section 4. Duties of the Program. The program shall:

(1) Maintain a toll free telephone number for the purpose of enabling individuals with a traumatic brain injury to apply for benefits from the fund;

(2) Engage in public information activities for the purpose of informing individuals with a traumatic brain injury about the availability of case management services and benefits from the fund and other sources;

(3) Review an applicant's documentation of the applicant's diagnosed brain injury and Kentucky residency to determine eligibility as specified in Section 5 of this administrative regulation;

(4) Assign a case manager within two (2) business days of the determination;

(5) Establish a SPRC:

(a) For the purpose of reviewing proposed service plans for approval or denial;

(b) Which shall:

Include a minimum of one (1) person with a traumatic brain injury or the legally responsible individual of a person with a traumatic brain injury;
Include a minimum of one (1) professional with expertise in the field of traumatic brain injury; and
Not have two (2) individuals from the same agency or family serve consecutive terms; and

(c) In which a member shall be limited to serve twelve (12) consecutive months but may be reappointed to the SPRC twelve (12) months after the date of the expiration of the member's most recent term of service on the committee;

(6) Accept a request for benefits from the fund;

(7) Distribute benefits to a recipient based upon an approved service plan;

(8) Submit a list of approved or denied service plans in a quarterly report to the department;

(9) Provide conflict free case management services:

(a) To applicants and recipients statewide, including the provision of assistance in accessing a needed support or service, regardless of funding source; and

(b) By a case manager who:

Possesses a bachelor's degree in a health or human services profession from an accredited college or university with:

a. One (1) year experience in health or human services; or

b. The educational or experiential equivalent in the field of brain injury or physical disabilities;

Is a currently licensed RN as defined by KRS 314.011(5) who has at least two (2) years of experience as a professional nurse in the field of brain injury or physical disabilities;
Is a currently licensed LPN as defined by KRS 314.011(9) who has:

a. At least three (3) years of experience in the field of brain injury or physical disabilities; and

b. An RN to consult and collaborate with regarding changes to the service plan; or

Has a master's degree from an accredited college or university;

(10) Be certified by the DAIL beginning July 1, 2015; and

(11) Be supervised by a case management supervisor who shall have four (4) years or more experience as a case manager.

Section 5. Eligibility.

(1) An applicant shall be eligible for a benefit from the fund:

(a) In accordance with:

KRS 211.470(3); and
KRS 211.472(2)(a) and (c); and

(b) If the applicant is a legal resident of Kentucky.

(2) A resident of an institution or hospital shall not be eligible for benefits from the fund:

(a) Unless the resident is anticipated to be within two (2) weeks of discharge and the benefits facilitate a discharge to the community; and

(b) If funding is available.

(3) An applicant shall provide medical records of the applicant's traumatic brain injury to the program.

(4) An applicant shall document that the applicant has no other public or private payor source, other than the trust fund, which covers the type of service the applicant is requesting.

Section 6. Procedures for Obtaining a Benefit from the Fund.

(1)

(a) A benefit for assistance from the fund shall be directly related to an applicant's brain injury or care of the applicant.

(b) A referral for benefits may be made by, or on behalf of, an eligible person by contacting the program in the following manner:

Telephone;
In person;
In writing;
Facsimile;
Email; or
Online.

(2) Upon receipt of referral, the program shall notify the applicant or referral source of the documentation needed to determine eligibility as specified in Section 5 of this administrative regulation.

Section 7. Benefits Available from the Fund.

(1) An applicant may apply for one (1) or more benefits from the fund as follows:

(a) Noncrisis behavior programming;

(b) Case management;

Dressing;
Oral hygiene;
Hair care;
Grooming;
Bathing;
Housekeeping;
Laundry;
Meal preparation;
Shopping; or
Twenty-four (24) hour supervision of a recipient;

(d) Companion services;

(e) Environmental modification to the recipient's residence if:

a. The recipient is listed on the deed or recorded land contract and a copy is provided to the case manager;

b. The recipient is a minor residing in a home owned by his parent; or

c. The recipient is an adult residing in a home owned by his legal guardian and provides:

(i) Written documentation, by the owner, approving the modification;

(ii) A copy of the legal documents verifying parental status or guardianship;

(iii) A copy of the deed documenting the owner who has provided the written approval for modification; and

(iv) Written documentation that the dwelling is safe and free of structural defect;

d. A letter from the landlord, if under a lease agreement, approving an environmental modification; or

The recipient or owner provides:

a. At least two (2) estimates of cost and scope of modification; or at least one (1) estimate of cost and scope of modification approved by the Department branch manager;

b. A copy of the chosen contractor's license and liability insurance policy or a signed release of liability that no contractor is available within thirty (30) miles of the recipient's residence; and

c. Documentation from a health care professional that the requested modification is necessary;

(f) Occupational therapy provided by an occupational therapist;

(g) Physical therapy provided by a physical therapist;

(h) Prevocational service, which shall include at least the following:

Assisting a recipient to understand the meaning, value, and demands of work;
Assisting a recipient to learn or reestablish skills, attitudes, and behaviors necessary for employment; or
Assisting the individual to improve functional capacities;

(i) Psychological and mental health services, which may include the following:

Training to improve interpersonal skills;
Social skills;
Problem-solving skills;
Training to remediate a cognitive problem resulting from the traumatic brain injury;
Treatment for a substance abuse problem related to the traumatic brain injury;
Psychological assessment; and
Neuropsychological evaluation;

(j) Respite care in:

The recipient's own home;
Another personal residence; or
Another setting, if approved by the program;

(k) Specialized medical equipment and supplies with written documentation of need from a:

Physician;
Licensed health care provider; or
Licensed therapist;

(l) Speech and language therapy provided by a speech-language pathologist which may include the following:

Articulation therapy;
The design of and instruction in the use of augmentative communication strategies or devices;
Cognitive retraining strategies; or
Swallowing therapy;

(m) Structured day program services, which shall include at least the following:

Direct supervision of the recipient;
Specific training to allow a recipient to improve functioning and to reintegrate into the community;
Social skills training;
Sensory skill development;
Motor skill development;
Teaching of concepts and skills necessary for the increased independence of the recipient; and
Other services to increase:

a. Adaptive behavioral responses; and

b. Community reintegration;

(n) Supported employment services; or

(o) Wrap-around services, which may include the following:

Assistance in transporting a recipient, such as to and from:

a. A medical appointment;

b. A therapy appointment;

c. A counseling appointment; or

d. Other destinations in the community as specified in the recipient's service plan;

Dental services by a licensed professional;
Vision services by an optometrist, ophthalmologist, or optician;
Hearing services by a licensed audiologist;
Modification to the recipient's vehicle for accessibility if the:

a. Recipient, or legally responsible individual is listed on the vehicle title and a copy is provided to the case manager; or

b. Owner provides written documentation:

(i) Approving the vehicle modification;

(ii) That the vehicle is for the use of the recipient;

(iii) That the vehicle is safe and mechanically sound; and

(iv) That the vehicle is insured.

(2) Program funds shall not be expended to pay for:

(a) Attorney fees or other legal fees;

(b) Court costs or fines assessed as a result of a conviction for a criminal offense;

(d) Other court ordered monetary judgments;

(e) Insurance premiums, copays, or deductibles;

(f) The purchase or leasing of vehicles;

(g) The purchase or renting of homes;

(h) Home owner association fees;

(i) Vacations;

(j) Recreational activities;

(k) Food, including groceries or eating out;

(l) Utilities;

(m) Immediate family;

(n) Natural supports; or

(o) modifications to rental properties over $2,500.

Section 8. Case Management Services.

(1) Following the program's determination of eligibility, the assigned case manager shall contact a recipient no later than three (3) business days and complete the following responsibilities:

(a) Conduct an independent assessment;

(b) Identify the recipient's needs for service and supports;

(d) Assist the applicant in obtaining needed services and supports regardless of funding source;

(e) Determine that the fund is the payor of last resort;

(f) Coordinate, arrange, and document identified service needs of the recipient;

(g) Develop an individualized service plan that shall:

Relate to assessed needs;
Identify a source of service utilized in this administrative regulation; and
Be signed by the recipient or recipient's representative and case manager, with a copy provided to the recipient;

(h) Assist in the identification of local resources for individuals with traumatic brain injury;

(i) Document all virtual and in person face-to-face contacts with the recipient in the KYTBI data system including time in and out, if applicable;

(j) Maintain caseload as assigned:

Upon available funding, at a minimum one (1):

a. In person face-to-face contact at least every six (6) months;

b. In person face-to-face at place of residence at least annually; and

c. Phone contact, or virtual face-to-face during any month an in person face-to-face contact does not occur; and

Document in the KYTBI data system each contact made with the recipient including the face-to-face visit's time in and out and mileage, if applicable; and

(k) Complete a proposed service plan which shall specify:

The name, address, and telephone number of the applicant;
The TBI Trust Fund identification number;
A clinical summary of the recipient's traumatic brain injury;
An explanation of needed services and supports;
The requested benefit from the fund;
Documentation of the recipient's lack of a payor source for the requested service including:

a. An explanation of circumstances leading to the need to request funding; and

b. Attempts to find other funding such as:

(i) An agency denial or documentation of a noncovered service by insurance or other entity;

(ii) Department for Medicaid Services denial; or

(iii) Denial from other community programs;

The signature of the applicant, or the applicant's legal representative, indicating agreement with the terms of the service plan; and
The mechanism for distribution of benefits from the fund.

(2) The case manager shall submit the proposed service plan in the KYTBI data system upon completion of all supporting documents.

(3) The program designee shall verify completion of the service plan and place the case on the SPRC list in chronological order of receipt.

Section 9. Service Plan Review Committee (SPRC) Duties.

(1) The SPRC shall:

(a) Verify the trust fund is payor of last resort of the submitted service plan specified in Section 8(1)(h) of this administrative regulation, based upon supplemental documents outlined in Section 5(3) and (4) of this administrative regulation and is not a duplication of services;

(b) Verify eligibility of an applicant or recipient's service plan in accordance with Section 5 of this administrative regulation;

(d) Review the service plan to determine if the benefit requested from the fund meets the requirements of KRS 211.474(2)(d);

(e) Approve or deny an applicant or recipient's service plan;

(f) Approve reimbursement for the delivery of services according to a recipient's approved service plan; and

(g) Notify the program of an approved or denied service plan.

(2) The SPRC may:

(a) Approve the proposed service plan, for a period not to exceed twelve (12) months;

(b) Amend the proposed service plan; or

(c) Deny the proposed service plan and may provide recommendations to the applicant and the applicant's assigned case manager about other available resources or means to meet the applicant's need for services and supports.

(3) If the applicant disagrees with the decision made by the SPRC, the applicant may appeal the decision in accordance with Section 15 of this administrative regulation.

(4) The SPRC shall not approve the distribution of a benefit to a recipient in excess of $15,000 within any twelve (12) month period and $60,000 per lifetime pursuant to KRS 211.474(2)(c).

(5) The SPRC shall not approve the distribution of benefits to an applicant:

(a) Who does not meet the eligibility requirements established in Section 5 of this administrative regulation;

(b) If the requested benefits are intended for a purpose other than the direct health, safety, and welfare of the applicant;

(c) If the applicant fails to demonstrate a good faith effort that no other payor source is available to obtain the requested benefit;

(d) If other resources are available to the applicant to substantially meet a reasonable need for which the benefit is requested, including trusts, settlements, or restitution; or

(e) If the benefit requested is for the purpose of reimbursing the recipient for expenses incurred prior to approval of a service plan by the SPRC.

(6) A service plan shall be signed by the director of the program or the director's designee, and the applicant or the applicant's legally responsible individual.

Section 10. Approved Service Plan.

(1) A recipient shall receive notification of an approved benefit based upon the following types of services:

(a) Individual;

(b) Purchased goods; or

(2) A recipient with an approved service plan may change a service provider within an approved service category if there is no increased cost of the service.

(3) A recipient may make a permitted change by informing the case manager by:

(a) Telephone;

(b) Email;

(d) In writing.

(4) The case manager may approve a service provider change in a service plan made without review by the SPRC.

(5) Involuntary termination and loss of approved benefits may be initiated if an individual fails to access the approved benefits as outlined in the service plan within ninety(90) calendar days of notification of approval of the service plan without good cause shown.

(a) The recipient or his designee shall have the burden of providing documentation of good cause as to the reason services cannot be accessed within ninety (90) calendar days, including:

A statement signed by the recipient or legal representative;
A copy of letters to providers;
A copy of letters from providers; and
A copy of documentation from physicians or other health care professionals.

(b) Upon receipt of documentation of good cause, the program shall grant one (1) sixty (60) day extension in writing.

Section 11. Service Provider Requirements.

(1) A service provider may be:

(a) An employee of the recipient who shall provide:

A completed I-9 and a copy of two (2) documents from the list of approved documents;
A completed W-9;
A signed service agreement;
A criminal background check as required by law;
Verification of abuse, neglect, and fraud training; and
Completed timesheets submitted bi-weekly by noon on Monday or the following work day if Monday is a state recognized holiday;

(b) A licensed or certified agency that shall provide a:

Copy of the agency's license or certification;
Signed service agreement; and
Completed W-9; or

A copy of the business license;
A copy of the liability insurance;
A completed W-9;
A signed service agreement;
Pictures before work begins; and
Pictures of the completed work.

(2) Upon notification of an approved service plan, the service provider shall:

(a) Accept the reimbursement approved in Section 9(1)(f) of this administrative regulation as payment in full;

(b) Not require additional payment from a recipient;

(d) Not attempt to recoup from the SPRC beyond an approved reimbursement without prior written agreement by the recipient or legal representative.

(3) A request for payment submitted after forty-five (45) days of the date of service delivery shall not be:

(a) Reimbursed by the Benefit Management Program; or

(b) Billed to the board or recipient.

Section 12. Procedures for Distribution of Benefits from the Fund.

(1) The program shall distribute the fund to a service provider, contractor, or retailer for services rendered.

(2) The payment terms shall be specified in the service agreement.

(3) The service provider or recipient shall provide to the program documentation of the delivery of a service or benefit to a recipient according to the terms of the service agreement.

(4) A service shall be reimbursed or paid if it is delivered in accordance with a recipient's approved service agreement.

(5) An expenditure not included in an approved service agreement shall not be paid by the provider, board, or cabinet.

(6) The cost of providing case management services to an applicant or recipient shall be exempt from the benefit limits established in Section 9(4) of this administrative regulation.

Section 13. Procedures for Placement on a Waiting List.

(1) The program may establish a waiting list for benefits from the fund if it determines that no further funding is available.

(2) The waiting list shall be implemented as follows:

(a) An applicant or recipient shall be placed on the waiting list upon receipt, completion, and verification of a service plan by a program designee.

(b) The order of placement on the waiting list shall be determined chronologically by date and time of verification.

(3) The applicant shall be removed from the waiting list if:

(a) The applicant secures requested benefit through another resource;

(b) The applicant refuses a benefit in an approved service plan, unless the individual has made a permitted change in accordance with Section 10(2) through (4) of this administrative regulation; or

(4) The removal from the waiting list shall not prevent the submission of a new application at a later date for the applicant.

(5) If the applicant is removed from the waiting list, the program shall notify the applicant, or his legal representative, in writing within ten (10) business days from the removal.

Section 14. Discharge Criteria.

(1) A recipient shall be discharged from the Brain Injury Trust Fund Program if:

(a) The recipient reaches the maximum $60,000 lifetime benefit, except if the board waives the expenditure in accordance with KRS 211.474(2)(c);

(b) The recipient is noncompliant with program requirements;

(d) The recipient, caregiver, family, or guardian threatens or intimidates a case manager or other program staff;

(e) Services accessed are referred and provided by another agency for continued service, if applicable;

(f) There is a substantiation of fraud related to the program involving:

The recipient; or
Both the recipient and the service provider;

(g) The recipient is no longer eligible pursuant to KRS 211.470(3)(a) through (f); or

(h) The recipient is deceased.

(2) A recipient may be discharged from the Brain Injury Trust Fund Program if:

(a) A service plan is completed for an approved timeframe and no other service is needed;

(b) A requested service plan is denied;

(d) No case management services have been provided within a six (6) month period.

(3) Recipients may reapply to the program without submittal of medical records except in accordance with subsection (1)(a) of this section.

(4) All discharges shall be appealable in accordance with Section 15, except in accordance with subsection (1)(a) or (f) of this section.

Section 15. Procedures for Appealing the Denial of an Application for Benefits from the Fund.

(1) If an applicant is determined to be ineligible for benefits from the fund because medical records do not provide documentation of a traumatic brain injury, the applicant may submit:

(a) Medical documentation to support the diagnosis of the injury; or

(b) Additional medical opinions about the disability.

(2)

(a) The program shall notify the applicant in writing if the SPRC does not approve a requested benefit.

(b) Notification shall be made within five (5) business days of the committee's decision.

(3) The program or the board shall not be liable for the cost of:

(a) A medical opinion obtained by an applicant; or

(b) An appeal.

(4) An applicant who wishes to appeal the denial of eligibility or benefits shall notify the program, in writing, within thirty (30) days of notification of the denial.

(5) Upon receipt of a written appeal, the program shall encumber funds if applicable and available in the amount requested until final resolution of the appeal.

(6) The program shall acknowledge receipt of a written appeal to the applicant, in writing, within three (3) business days of receipt.

(7) The program shall provide an opportunity for an informal dispute resolution for an applicant or his representative:

(a) To appear before the program director or designee and the benefits management program administrator to present facts or concerns about the denial; and

(b) Within ten (10) business days of receipt of written appeal.

(8) The program shall inform an applicant, in writing, of the decision resulting from the informal dispute resolution within ten (10) business days of the review.

(9) An applicant dissatisfied with the result of the informal dispute resolution may request an administrative hearing:

(a) Within thirty (30) calendar days of the decision; and

(b) By submitting a written request for appeal to the Office of the Ombudsman and Administrative Review, Quality Advancement Branch, 275 E. Main St, 2 E-O Frankfort, Kentucky 40621;

History

RELATES TO: KRS 13B, 42.320(2)(d), 45A.075, 45A.080, 189A.050(3)(d)1, 205.900(3), 211.470-211.478, 314.011
STATUTORY AUTHORITY: KRS 211.474(1), EO 2009-541
NECESSITY, FUNCTION, AND CONFORMITY: EO 2009-541 transferred the functions and funds of KRS 189A.050(3)(d)1 to the Department for Aging and Independent Living. KRS 211.474(1) requires the Traumatic Brain Injury Trust Fund Board of Directors to promulgate administrative regulations necessary to carry out the provisions of KRS 211.470 through 211.478. This administrative regulation establishes the Traumatic Brain Injury Trust Fund Operations Program.
History: 27 Ky.R. 2017; Am. 2829; eff. 4-9-2001; 29 Ky.R. 1145; 1659; eff. 12-18-2002; 2779; 30 Ky.R. 47; eff. 7-16-2003; 31 Ky.R. 1450; 1675; eff. 4-22-2005; Recodified from 908 KAR 4:030; eff. 6-19-2009; 36 Ky.R. 1535; 2068-M; eff. 4-2-2010; 41 Ky.R. 1455; 1994; eff. 4-3-2015; 49 Ky.R. 2401; eff. 9-27-2023.

Chapter 4 Office of Dementia Services

910 KAR 4:010 Alzheimer's and dementia services curriculum review and approval {#sec-910-kar-4-010 omnilex-key=us-ky-regs-official--title-910--910 KAR 4:010}

Section 1. Definitions.

(1) "Department" means the Department for Aging and Independent Living or "DAIL".

(2) "Provider agency" means a home health agency, personal services agency, or assisted-living community that employs, directly or by contract, aides or other non-licensed personnel whose work involves extensive contact with individuals who exhibit symptoms of Alzheimer's disease or other dementias.

Section 2. Curriculum Approval. Curriculum approval shall be granted when it meets the requirements of 216.713(1)-(3).

Section 3. Submission of Curriculum.

(1) All provider agencies shall submit to the department the agency's proposed training curriculum:

(a) Upon development of the curriculum and prior to implementation of the training;

(b) By notification of the standardized curriculum being utilized and verifying the curriculum is being utilized in its entirety without alterations; or

(c) If the training was in place prior to July 15, 2021, the provider agency may continue to use the curriculum until the curriculum is either:

Officially approved by the department for permanent use; or
Determined not to meet the criteria for approval by the department.

(2) Unaltered, standardized curricula used by provider agencies, may be utilized prior to official approval by the department if submitted pursuant to paragraph (b) or (c) of subsection (1) of this section.

(3) The provider agency may submit curriculum for review by:

(a) Mail to the Department for Aging and Independent Living, Office of Dementia Services, 275 E Main St. 3 E-E, Frankfort, Kentucky 40621;

(b) Hand delivered to the department; or

History

RELATES TO: KRS 216.710-216.716, 216.935-216.939, Pub.L. 116-131
STATUTORY AUTHORITY: 194A.050(1), 216.713
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.713 requires the Cabinet for Health and Family Services to establish the submission and approval process for training curriculum utilized by agencies that provide services to individuals who exhibit symptoms of Alzheimer's disease or other dementias. This administrative regulation establishes the process for submitting curricula for cabinet approval that will meet the minimum training requirements for direct-care staff serving individuals exhibiting symptoms of Alzheimer's or other dementias.
History: 48 Ky.R. 1442, 2237; eff. 2-10-2022.

Title 910 KAR — Cabinet for Health and Family Services - Office of Aging Services

Chapter 1 Aging Services

910 KAR 1:090 Personal care attendant program and assistance services {#sec-910-kar-1-090 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:090}

910 KAR 1:140 Appeal procedures {#sec-910-kar-1-140 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:140}

910 KAR 1:170 Older Americans Act supportive services for the elderly {#sec-910-kar-1-170 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:170}

910 KAR 1:180 Homecare program for the elderly {#sec-910-kar-1-180 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:180}

910 KAR 1:190 Nutrition program for older persons {#sec-910-kar-1-190 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:190}

910 KAR 1:200 Senior Community Service Employment Program {#sec-910-kar-1-200 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:200}

910 KAR 1:210 Kentucky Long-term Care Ombudsman Program {#sec-910-kar-1-210 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:210}

910 KAR 1:220 General administration, programs for older individuals and persons with disabilities {#sec-910-kar-1-220 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:220}

910 KAR 1:260 Kentucky Family Caregiver Program {#sec-910-kar-1-260 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:260}

910 KAR 1:270 Hart-Supported Living grant program {#sec-910-kar-1-270 omnilex-key=us-ky-regs-official--title-910--910 KAR 1:270}

Chapter 3 Brain Injury

910 KAR 3:020 Behavioral services for individuals with brain injuries {#sec-910-kar-3-020 omnilex-key=us-ky-regs-official--title-910--910 KAR 3:020}

910 KAR 3:030 Traumatic brain injury trust fund operations program {#sec-910-kar-3-030 omnilex-key=us-ky-regs-official--title-910--910 KAR 3:030}

Chapter 4 Office of Dementia Services

910 KAR 4:010 Alzheimer's and dementia services curriculum review and approval {#sec-910-kar-4-010 omnilex-key=us-ky-regs-official--title-910--910 KAR 4:010}

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