# 907 KAR 12:010: 907 KAR 12:010. New Supports for community living waiver service and coverage policies > Kentucky · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_KY_KAR_T907_C012_R010 ## Section - **Citation:** 907 KAR 12:010 - **Heading:** 907 KAR 12:010. New Supports for community living waiver service and coverage policies - **Jurisdiction:** Kentucky - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Kentucky Administrative Regulations / Title 907 (Cabinet for Health and Family Services - Department for Medicaid Services) / Chapter 012 / 907 KAR 12:010 ## Text Section 1. Definitions. (1) "1915(c) home and community based waiver program" means a Kentucky Medicaid program established pursuant to, and in accordance with, 42 U.S.C. 1396n(c). (2) "Abuse" is defined by KRS 209.020(8). (3) "Adult day health care center" means an adult day health care center licensed in accordance with 902 KAR 20:066. (4) "Adult foster care home" means a home: (a) Not owned or leased by an SCL provider; (b) In which a participant: 1. Is at least eighteen (18) years of age; and 2. Receives SCL services and resides in the family occupied (leased or owned) home; and (c) In which the family: 1. Includes the participant in the family's household routines; 2. Provides training and supervision; and 3. Ensures that the participant's needs are met in accordance with the participant's person-centered service plan. (5) "Advance directive" is defined by KRS 311.621(2). (6) "Aversive technique" means: (a) Withholding: 1. Food or hydration as a means to control or impose calm; 2. Access to a legal advocate or ombudsman; 3. Access to toilet, bath, or shower; 4. Access to personal belongings; or 5. Access to natural supports; (b) Depriving medical attention or prescribed medication; or (c) Depriving sleep. (7) "Behavior intervention committee" or "BIC" means a group of individuals: (a) Established to evaluate the technical adequacy of a proposed behavioral intervention for a participant; and (b) That meets in accordance with the BIC policies established in Section 8 of this administrative regulation. (8) "Board" means three (3) meals a day or other full nutritional regimen of a caregiver for the purpose of providing shared living services. (9) "Case manager" means an individual who: (a) Meets the requirements for a case manager established in Section 6 of this administrative regulation; and (b) Meets all personnel and training requirements established in Section 3 of this administrative regulation "Board" means three (3) meals a day or other full nutritional regimen of a caregiver for the purpose of providing shared living services. (9) "Case manager" means an individual who: (a) Meets the requirements for a case manager established in Section 6 of this administrative regulation; and (b) Meets all personnel and training requirements established in Section 3 of this administrative regulation. (10) "Case manager supervisor" means an individual who: (a) Provides professional oversight of case managers; (b)  1. Has a bachelor's or higher degree in a human service field from an accredited college or university; 2. Has a bachelor's degree in any other field from an accredited college or university with at least one (1) year of experience in the field of intellectual disability; or 3. Is a registered nurse; (c) Has at least two (2) years of experience of case management responsibility in an organization that serves individuals with intellectual or developmental disabilities; (d) Completes a case management supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities; and (e) Meets all personnel and training requirements established in Section 3 of this administrative regulation. (11) "Certified nutritionist" is defined by KRS 310.005(12). (12) "Certified psychologist" means an individual who is recognized as a certified psychologist in accordance with 201 KAR Chapter 26. (13) "Certified psychologist with autonomous functioning" means a person licensed pursuant to KRS 319.056. (14) "Certified school psychologist" means an individual certified by the Kentucky Education Professional Standards Board under 16 KAR 2:090. (15) "Chemical restraint" means a drug or medication: (a) Used to restrict an individual's: 1. Behavior; or 2. Freedom of movement; and (b)  1. That is not a standard treatment for the individual's condition; or 2. Dosage that is not an appropriate dosage for the individual's condition logist" means an individual certified by the Kentucky Education Professional Standards Board under 16 KAR 2:090. (15) "Chemical restraint" means a drug or medication: (a) Used to restrict an individual's: 1. Behavior; or 2. Freedom of movement; and (b)  1. That is not a standard treatment for the individual's condition; or 2. Dosage that is not an appropriate dosage for the individual's condition. (16) "Community access specialist" means an individual who: (a) Provides support and training that enables a participant to develop a network of natural supports to achieve a clearly defined and valued social role within the participant's community; (b) Has: 1. Previously qualified or been credentialed by the department to provide community access services prior to the effective date of this administrative regulation; or 2.  a. At least one (1) year of experience in the field of intellectual or developmental disabilities; and b. Completed a department approved training program within one (1) year of application while providing community access services under the direct supervision of a community access specialist; and (c) Meets the personnel and training requirements established in Section 3 or 10 of this administrative regulation. (17) "Community guide" means an individual who: (a) Has been selected by a participant to provide training, technical assistance, and support including individual budget development and implementation in aspects of participant direction; and (b) Has: 1. A bachelor's degree in a human services field from an accredited college or university; 2. A bachelor's degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or 3. Experience in the field of intellectual or developmental disabilities that will substitute for the educational requirements stated in subparagraph 1. or 2 services field from an accredited college or university; 2. A bachelor's degree in any other field from an accredited college or university plus at least one (1) year of experience in the field of intellectual or developmental disability; or 3. Experience in the field of intellectual or developmental disabilities that will substitute for the educational requirements stated in subparagraph 1. or 2. of this paragraph on a year-for-year basis; (c) Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation; (d) Completes a community guide training curriculum approved by DBHDID within six (6) months of being employed by the first participant supported; and (e) Provides services to a participant in accordance with Section 4 or 10 of this administrative regulation. (18) "Controlled substance" is defined by KRS 218A.010(6). (19) "Covered services and supports" is defined by KRS 205.5605(3). (20) "DBHDID" means the Department for Behavioral Health, Developmental and Intellectual Disabilities. (21) "DCBS" means the Department for Community Based Services. (22) "Department" means the Department for Medicaid Services or its designee. (23) "Developmental disability" means a disability that: (a) Is manifested prior to the age of twenty-two (22); (b) Constitutes a substantial disability to the affected individual; and (c) Is attributable either to an intellectual disability or a condition related to an intellectual disability that: 1. Results in an impairment of general intellectual functioning and adaptive behavior similar to that of a person with an intellectual disability; and 2. Is a direct result of, or is influenced by, the person's cognitive deficits. (24) "Direct support professional" means an individual who: (a) Provides services to a participant in accordance with Section 4 of this administrative regulation; (b) Has direct contact with a participant when providing services to the participant; (c) Is at least: 1 hat of a person with an intellectual disability; and 2. Is a direct result of, or is influenced by, the person's cognitive deficits. (24) "Direct support professional" means an individual who: (a) Provides services to a participant in accordance with Section 4 of this administrative regulation; (b) Has direct contact with a participant when providing services to the participant; (c) Is at least: 1. Eighteen (18) years old and has a high school diploma or GED; or 2. Twenty-one (21) years old; (d) Meets the personnel and training requirements established in Section 3 of this administrative regulation; (e) Has the ability to: 1. Communicate effectively with a participant and the participant's family; 2. Read, understand, and implement written and oral instructions; 3. Perform required documentation; and 4. Participate as a member of the participant's person-centered team if requested by the participant; and (f) Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan. (25) "Direct support professional supervisor" means an individual who: (a) Provides oversight of direct support professionals in the provision of services to participants; (b) Is at least: 1. Eighteen (18) years old and has a high school diploma or GED; or 2. Twenty-one (21) years old; (c) Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation; (d) Has the ability to: 1. Communicate effectively with a participant and the participant's family; 2. Read, understand, and implement written and oral instructions; 3. Perform required documentation; and 4 old and has a high school diploma or GED; or 2. Twenty-one (21) years old; (c) Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation; (d) Has the ability to: 1. Communicate effectively with a participant and the participant's family; 2. Read, understand, and implement written and oral instructions; 3. Perform required documentation; and 4. Participate as a member of the participant's person-centered team if requested by the participant; (e) Has at least two (2) years of experience in providing direct support to persons with a developmental disability; (f) Demonstrates competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan; and (g) Completes a supervisory training curriculum approved by DBHDID within six (6) months of beginning supervisory responsibilities. (26) "Drug paraphernalia" is defined by KRS 218A.500(1). (27) "Early and periodic screening, diagnostic, and treatment services" is defined by 42 U.S.C. 1396d(r). (28) "Electronic signature" is defined by KRS 369.102(8). (29) "Employee" means an individual who is employed by an SCL provider. (30) "Executive director" means an individual who shall: (a) Lead the design, development, and implementation of strategic plans for an SCL provider; (b) Maintain responsibility for the day-to-day operation of the SCL provider organization; (c)  1. Have a bachelor's or higher degree from an accredited institution; or 2. Be a registered nurse; (d) Have at least two (2) years of: 1. Experience in the field of intellectual or developmental disabilities; and 2. Administrative experience: a. In an organization that served individuals with an intellectual or developmental disability; and b o-day operation of the SCL provider organization; (c)  1. Have a bachelor's or higher degree from an accredited institution; or 2. Be a registered nurse; (d) Have at least two (2) years of: 1. Experience in the field of intellectual or developmental disabilities; and 2. Administrative experience: a. In an organization that served individuals with an intellectual or developmental disability; and b. That includes experience in the execution of the overall administration of an agency including: (i) Development, implementation, and maintenance of the agency's budget; (ii) Development, review, implementation, and revisions as needed of the organization's policies and procedures; and (iii) Supervision of employees including conducting performance evaluations; (e) Meet all personnel and training requirements specified in Section 3 of this administrative regulation; and (f) If providing professional oversight or supervision of employees, meet the supervisory qualifications specified for each service. (31) "Exploitation" is defined by KRS 209.020(9). (32) "Extended family member" means a relative of an individual by blood or marriage beyond the individuals included in the definition of immediate family member. (33) "Family home provider" means a home: (a) Not owned or leased by an SCL provider; (b) In which a participant receives SCL services and resides in the family occupied (leased or owned) home; and (c) In which the family: 1. Includes the participant in the family's household routines; 2. Provides training and supervision; and 3. Ensures that the participant's needs are met in accordance with the participant's person-centered service plan. (34) "Financial management agency" means an agency contracted by the department that manages individual participant-directed service plans. (35) "Functional assessment" means an assessment performed using evidenced based tools, direct observation, and empirical measurement to obtain and identify functional relations between behavioral and environmental factors ipant's person-centered service plan. (34) "Financial management agency" means an agency contracted by the department that manages individual participant-directed service plans. (35) "Functional assessment" means an assessment performed using evidenced based tools, direct observation, and empirical measurement to obtain and identify functional relations between behavioral and environmental factors. (36) "Good cause" means a circumstance beyond the control of an individual that affects the individual's ability to access funding or services, which includes: (a) Illness or hospitalization of the individual that is expected to last sixty (60) days or less; (b) Required paperwork and documentation for processing in accordance with Section 2 of this administrative regulation has not been completed but is expected to be completed in two (2) weeks or less; or (c) The individual or his or her guardian has made diligent contact with a potential provider to secure placement or access services but has not been accepted within the sixty (60) day time period. (37) "Group home" means a residential setting: (a) That is licensed in accordance with 902 KAR 20:078; (b) That is managed by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and (c) In which no more than eight (8) participants reside. (38) "Guardian" is defined by KRS 387.010(3) for a minor and by KRS 387.812(3) for an adult. (39) "Homicidal ideation" means thoughts about homicide that may range from vague ideas to detailed or fully formulated plans without taking action. (40) "Human rights committee" means a group of individuals: (a) Comprised of representatives from home and community based waiver provider agencies in the community where a participant resides; and (b) Who meet: 1. To ensure that the rights of participants are respected and protected through due process; and 2. In accordance with the human rights committee requirements established in Section 7 of this administrative regulation means a group of individuals: (a) Comprised of representatives from home and community based waiver provider agencies in the community where a participant resides; and (b) Who meet: 1. To ensure that the rights of participants are respected and protected through due process; and 2. In accordance with the human rights committee requirements established in Section 7 of this administrative regulation. (41) "Human services field" means: (a) Psychology; (b) Behavioral analysis; (c) Counseling; (d) Rehabilitation counseling; (e) Public health; (f) Special education; (g) Sociology; (h) Gerontology; (i) Recreational therapy; (j) Education; (k) Occupational therapy; (l) Physical therapy; (m) Speech-language pathology; (n) Social work; or (o) Family studies. (42) "ICF-IID" means an intermediate care facility for individuals with intellectual disabilities. (43) "Illicit substance" means: (a) A drug, prescription or not prescription, used illegally or in excess of therapeutic levels; (b) A prohibited drug; or (c) A prohibited substance. (44) "Immediate family member" is defined by KRS 205.8451(3). (45) "Impact service" means a service designed to decrease the amount of paid supports a participant requires as the participant becomes: (a) More independent; and (b) Less reliant on an employee. (46) "Individual family service plan" or "IFSP" is defined by KRS 200.654(9). (47) "Integrated employment site" means the location of an activity or job that provides regular interaction with people without disabilities, excluding service providers, to the same extent that a worker without disabilities in a comparable position interacts with others. (48) "Integrated setting" means a setting that: (a) Enables a participant to interact with nondisabled persons to the fullest extent possible; (b) Includes access to community activities and opportunities at times, frequencies, and with persons of a participant's choosing; and (c) Affords a participant choice in the participant's daily life activities n a comparable position interacts with others. (48) "Integrated setting" means a setting that: (a) Enables a participant to interact with nondisabled persons to the fullest extent possible; (b) Includes access to community activities and opportunities at times, frequencies, and with persons of a participant's choosing; and (c) Affords a participant choice in the participant's daily life activities. (49) "Intellectual disability" or "ID" means: (a) A demonstration: 1. Of significantly sub-average intellectual functioning and an intelligence quotient (IQ) of seventy (70) plus or minus five (5); and 2. Of concurrent deficits or impairments in present adaptive functioning in at least two (2) of the following areas: a. Communication; b. Self-care; c. Home living; d. Social or interpersonal skills; e. Use of community resources; f. Self-direction; g. Functional academic skills; h. Work; i. Leisure; or j. Health and safety; and (b) An intellectual disability that had an onset before eighteen (18) years of age. (50) "Legally responsible individual" means an individual who has a duty under state law to care for another person and includes: (a) A parent (biological, adoptive, or foster) who provides care to the parent's minor child; (b) A guardian who provides care to the guardian's minor child; or (c) A spouse of a participant. (51) "Level of care determination" means a determination by the department that an individual meets patient status criteria for an intermediate care facility for individuals with intellectual disabilities as established in 907 KAR 1:022. (52) "Licensed clinical social worker" means an individual who meets the licensed clinical social worker requirements established in KRS 335.100. (53) "Licensed dietitian" is defined by KRS 310.005(11). (54) "Licensed marriage and family therapist" or "LMFT" is defined by KRS 335.300(2) or an intermediate care facility for individuals with intellectual disabilities as established in 907 KAR 1:022. (52) "Licensed clinical social worker" means an individual who meets the licensed clinical social worker requirements established in KRS 335.100. (53) "Licensed dietitian" is defined by KRS 310.005(11). (54) "Licensed marriage and family therapist" or "LMFT" is defined by KRS 335.300(2). (55) "Licensed medical professional" means (a) A physician; (b) An advanced practice registered nurse; (c) A physician assistant; (d) A registered nurse; (e) A licensed practical nurse; or (f) A pharmacist. (56) "Licensed practical nurse" is defined by KRS 314.011(9). (57) ''Licensed professional clinical counselor" or "LPCC" is defined by KRS 335.500(3). (58) "Licensed psychological associate" means an individual who: (a) Currently possesses a licensed psychological associate license in accordance with KRS 319.010(6); and (b) Meets the licensed psychological associate requirements established in 201 KAR Chapter 26. (59) "Licensed psychological practitioner" means an individual who meets the requirements established in KRS 319.053. (60) "Licensed psychologist" means an individual who: (a) Currently possesses a licensed psychologist license in accordance with KRS 319.010(6); and (b) Meets the licensed psychologist requirements established in 201 KAR Chapter 26. (61) "Life history" means an account of the series of events making up a participant's life including: (a) Developmental and historical information regarding family of origin, childhood experiences, and life events to present; (b) History of supports received across the life span; and (c) Life style practices that may lead to greater insight regarding a participant's current preferences, behavioral patterns, wants, and needs. (62) "Medical order for scope of treatment" is defined by KRS 311.621(12). (63) "Medically necessary" or "medical necessity" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130 upports received across the life span; and (c) Life style practices that may lead to greater insight regarding a participant's current preferences, behavioral patterns, wants, and needs. (62) "Medical order for scope of treatment" is defined by KRS 311.621(12). (63) "Medically necessary" or "medical necessity" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130. (64) "MWMA" means the Kentucky Medicaid Waiver Management Application internet portal located at http://chfs.ky.gov/dms/mwma.htm. (65) "National Core Indicators" means: (a) A collaboration between the National Association of State Directors of Developmental Disability Services and the Human Services Research Institute; (b) An effort by public developmental disabilities agencies to measure and track their own performance; and (c) Standard measures: 1. Used across states to assess the outcomes of services provided to individuals and families; and 2. That address key areas of concern including employment, rights, service planning, community inclusion, choice, and health and safety. (66) "Natural supports" means assistance, relationships, or interactions that: (a) Allow a participant to be in the community; (b) Include working in a job of the participant's choice in ways similar to people without disabilities; and (c) Are based on ordinary social relationships at work and in the community. (67) "Neglect" is defined by KRS 209.020(16). (68) "Occupational therapist" is defined by KRS 319A.010(3). (69) "Occupational therapy assistant" is defined by KRS 319A.010(4). (70) "Office of Vocational Rehabilitation" means the agency mandated: (a) By the Rehabilitation Act of 1973, as amended; and (b) To provide individualized services to eligible individuals with disabilities with a substantial impediment to employment in order for the individual to gain and maintain employment d by KRS 319A.010(3). (69) "Occupational therapy assistant" is defined by KRS 319A.010(4). (70) "Office of Vocational Rehabilitation" means the agency mandated: (a) By the Rehabilitation Act of 1973, as amended; and (b) To provide individualized services to eligible individuals with disabilities with a substantial impediment to employment in order for the individual to gain and maintain employment. (71) "Participant" means a Medicaid recipient who: (a) Meets patient status criteria for an intermediate care facility for individuals with intellectual disabilities as established in 907 KAR 1:022; (b) Is authorized by the department to receive SCL waiver services; and (c) Utilizes SCL waiver services and supports in accordance with a person-centered service plan. (72) "Participant-directed service" or "PDS" means an option established by KRS 205.5606 within the 1915(c) home and community based service waiver programs that allows recipients to receive non-medical services in which the individual: (a) Assists with the design of the program; (b) Chooses the providers of services; and (c) Directs the delivery of services to meet his or her needs. (73) "Person-centered coach" means a person who: (a) Assists a participant and the participant's person-centered team in implementing and monitoring the effectiveness of the participant's person-centered service plan; (b) Models person-centered thinking; (c) Is responsible for training a participant, family, guardian, natural and unpaid supports, and other members of the person-centered team when barriers challenge the success of the participant in achieving his or her goals; (d) Has: 1. A high school diploma or GED; and 2.  a. Two (2) years of experience in the field of intellectual or developmental disabilities; or b s person-centered thinking; (c) Is responsible for training a participant, family, guardian, natural and unpaid supports, and other members of the person-centered team when barriers challenge the success of the participant in achieving his or her goals; (d) Has: 1. A high school diploma or GED; and 2.  a. Two (2) years of experience in the field of intellectual or developmental disabilities; or b. Completed twelve (12) hours of college coursework in a human services field; (e) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and (f) Performs documentation necessary to facilitate compliance with the documentation requirements established in Section 4(12)(d) of this administrative regulation. (74) "Person-Centered Employment Plan" means a document that identifies the unique preferences, strengths, and needs of a participant in relation to the participant's work. (75) "Person-centered service plan" means a written individualized plan of services for a participant that meets the requirements established in Section 5 of this administrative regulation. (76) "Person-centered team" means a participant, the participant's guardian or representative, and other individuals who are natural or paid supports and who: (a) Recognize that evidenced based decisions are determined within the basic framework of what is important for the participant and within the context of what is important to the participant based on informed choice; (b) Work together to identify what roles they will assume to assist the participant in becoming as independent as possible in meeting the participant's needs; and (c) Include providers who receive payment for services who shall: 1. Be active contributing members of the person-centered team meetings; 2. Base their input upon evidence-based information; and 3. Not request reimbursement for person-centered team meetings identify what roles they will assume to assist the participant in becoming as independent as possible in meeting the participant's needs; and (c) Include providers who receive payment for services who shall: 1. Be active contributing members of the person-centered team meetings; 2. Base their input upon evidence-based information; and 3. Not request reimbursement for person-centered team meetings. (77) "Physical restraint" means any manual method or physical or mechanical device, material, or equipment that: (a) Immobilizes or reduces the ability of a person to move his or her arms, legs, body, or head freely; and (b) Does not include orthopedically prescribed devices or other devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a person for the purpose of: 1. Conducting routine physical examinations or tests; 2. Protecting the person from falling out of bed; or 3. Permitting the person to participate in activities without the risk of physical harm. (78) "Physical therapist" is defined by KRS 327.010(2). (79) "Physical therapist assistant" means a skilled health care worker who: (a) Is certified by the Kentucky Board of Physical Therapy; and (b) Performs physical therapy and related duties as assigned by the supervising physical therapist. (80) "Positive behavior support specialist" means an individual who; (a) Provides evidence-based individualized interventions that assist a participant with acquisition or maintenance of skills for community living and behavioral intervention for the reduction of maladaptive behaviors; (b) Has a master's degree in a behavioral science and one (1) year of experience in behavioral programming; (c) Has at least one (1) year of direct service experience with individuals with intellectual or developmental disabilities; and (d) Meets all personnel and training requirements established in Section 3 of this administrative regulation tervention for the reduction of maladaptive behaviors; (b) Has a master's degree in a behavioral science and one (1) year of experience in behavioral programming; (c) Has at least one (1) year of direct service experience with individuals with intellectual or developmental disabilities; and (d) Meets all personnel and training requirements established in Section 3 of this administrative regulation. (81) "Prohibited drug" means a drug or substance that is illegal under KRS Chapter 218A or other statutes or administrative regulations of the Commonwealth of Kentucky. (82) "Registered agent" means an individual meeting the requirements of KRS 14A.4-010(1)(b). (83) "Registered nurse" is defined by KRS 314.011(5). (84) "Registered office" means an office meeting the requirements of KRS 14A.4-010(1)(a). (85) "Representative" is defined by KRS 205.5605(6). (86) "Rights restriction" means any intervention that restricts a participant's: (a) Movement; (b) Access to other individuals, locations, or activities; or (c) Rights. (87) "Room" means the aggregate expense of housing costs for the purpose of providing shared living, including: (a) Rent, lease, or mortgage payments; (b) Real estate taxes; (c) Insurance; (d) Maintenance; and (e) Utilities. (88) "SCL intellectual disability professional" or "SCL IDP" means an individual who: (a) Has at least one (1) year of experience working with persons with an intellectual or developmental disability; (b) Meets all personnel and training requirements established in Section 3 of this administrative regulation; and (c)  1. Is a doctor of medicine or osteopathy; 2. Is a registered nurse; or 3. Holds at least a bachelor's degree from an accredited institution in a human services field. (89) "SCL provider" means an entity that meets the criteria established in Section 3 of this administrative regulation. (90) "Seclusion" means the involuntary confinement of a participant alone in: (a) A room; or (b) An area from which the participant is physically prevented from leaving tered nurse; or 3. Holds at least a bachelor's degree from an accredited institution in a human services field. (89) "SCL provider" means an entity that meets the criteria established in Section 3 of this administrative regulation. (90) "Seclusion" means the involuntary confinement of a participant alone in: (a) A room; or (b) An area from which the participant is physically prevented from leaving. (91) "Serious medication error" means a medication error that requires or has the potential to require a medical intervention or treatment. (92) "Shared living caregiver" means an unrelated individual who: (a) Resides with a participant in the participant's home; (b) Provides supervision and necessary personal assistance services as specified in the participant's person-centered service plan; (c)  1. Is at least eighteen (18) years of age and has a high school diploma or GED; or 2. Is at least twenty-one (21) years old; (d) Meets all personnel and training requirements established in Section 10 of this administrative regulation; (e) Has the ability to: 1. Communicate effectively with a participant and the participant's family; 2. Read, understand, and implement written and verbal instructions; and 3. Perform documentation necessary to facilitate compliance with the documentation requirements established in Section 4(20)(j) of this administrative regulation; (f) Has been determined by the participant's person-centered team, prior to being alone with the participant, to meet the following qualifications: 1. Demonstrate competence and knowledge on topics required to safely support the participant as described in the participant's person-centered service plan; and 2. Have the ability to participate as a member of the participant's person-centered team if requested by the participant; and (g) Does not have any of the following relationships to the participant: 1. Immediate family member; 2. Extended family member; 3. Guardian; or 4. Legally responsible individual fely support the participant as described in the participant's person-centered service plan; and 2. Have the ability to participate as a member of the participant's person-centered team if requested by the participant; and (g) Does not have any of the following relationships to the participant: 1. Immediate family member; 2. Extended family member; 3. Guardian; or 4. Legally responsible individual. (93) "Speech-language pathologist" is defined by KRS 334A.020(3). (94) "Staffed residence" means a residential setting: (a) That is owned or leased by a provider who meets the SCL provider requirements established in Section 3 of this administrative regulation; and (b) In which no more than three (3) participants reside. (95) "State plan" is defined by 42 C.F.R. 430.10. (96) "Subcontractor" means an entity or an individual: (a) Who is a currently credentialed professional or other service provider; (b) Who has signed an agreement with a certified SCL agency to provide SCL services and supports; and (c) To whom the employee requirements in this administrative regulation apply. (97) "Suicidal ideation" means thoughts about suicide that may range from being fleeting in nature to detailed planning. (98) "Supported Employment Long-Term Support Plan" means a document that identifies the amount and kind of support necessary for a participant to maintain employment and achieve individualized employment goals. (99) "Supported employment specialist" means an individual who: (a) Provides ongoing support services to eligible participants in supported employment jobs in accordance with Section 4 or 10 of this administrative regulation; (b)  1. Has previously qualified or been credentialed by the department to provide supported employment services prior to the effective date of this administrative regulation; or 2.  a. Has at least one (1) year of experience in the field of intellectual or developmental disabilities; and b cipants in supported employment jobs in accordance with Section 4 or 10 of this administrative regulation; (b)  1. Has previously qualified or been credentialed by the department to provide supported employment services prior to the effective date of this administrative regulation; or 2.  a. Has at least one (1) year of experience in the field of intellectual or developmental disabilities; and b. Has completed a department required training program within one (1) year of application while providing supported employment services under the direct supervision of a supported employment specialist; and (c) Meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation. (100) "Supports for Community Living" or "SCL" means home and community-based waiver services for an individual with an intellectual or developmental disability. (101) "Supports Intensity Scale" or "SIS" means an assessment tool developed by the American Association on Intellectual and Developmental Disabilities that: (a) Measures practical support requirements of individuals with intellectual or developmental disabilities in daily living, medical, and behavioral areas; and (b) Is administered by a trained professional in the human services field as approved by the department. Section 2. SCL Participant Eligibility, Enrollment, and Termination. (1) To be eligible to receive a service in the SCL program, an individual: (a) Or individual's representative shall: 1. Apply for 1915(c) home and community based waiver services via the MWMA; and 2 , and behavioral areas; and (b) Is administered by a trained professional in the human services field as approved by the department. Section 2. SCL Participant Eligibility, Enrollment, and Termination. (1) To be eligible to receive a service in the SCL program, an individual: (a) Or individual's representative shall: 1. Apply for 1915(c) home and community based waiver services via the MWMA; and 2. Complete and upload into the MWMA a MAP - 115 Application Intake - Participant Authorization; (b) Shall receive notification of potential SCL funding in accordance with Section 12 of this administrative regulation; (c) Shall meet ICF-IID patient status requirements established in 907 KAR 1:022; (d) Shall meet Medicaid eligibility requirements established in 907 KAR 20:010; and (e) Upon receiving notification of potential SCL funding, shall upload the following into the MWMA: 1. A completed MAP – 350 Long Term Care Facilities and Home and Community Based Program Certification Form; 2. The results of a physical examination that was conducted within the last twelve (12) months; 3. A life history that has been completed within the past twelve (12) months; and 4. Documentation of a participant's status change. (2)  (a) To maintain eligibility as a participant: 1. A participant shall be administered a Supports Intensity Scale assessment by the department at least once every twenty-four (24) months from the level of care end date; 2. A participant shall maintain Medicaid eligibility requirements established in 907 KAR 20:010; and 3. An ICF-IID level of care determination shall be performed by the department at least once every twelve (12) months. (b) The department shall: 1. Obtain the rights to use a Supports Intensity Scale; and 2. Use it in accordance with the terms and conditions required by the copyright associated with it participant shall maintain Medicaid eligibility requirements established in 907 KAR 20:010; and 3. An ICF-IID level of care determination shall be performed by the department at least once every twelve (12) months. (b) The department shall: 1. Obtain the rights to use a Supports Intensity Scale; and 2. Use it in accordance with the terms and conditions required by the copyright associated with it. (3) An SCL waiver service shall not be provided to an individual who is: (a) Receiving a service in another 1915(c) home and community based waiver program; (b) Receiving a duplicative service provided through another funding source; or (c) An inpatient of an ICF-IID or other facility. (4) Involuntary termination and loss of an SCL waiver program placement shall be: (a) In accordance with 907 KAR 1:563; and (b) Initiated if: 1. An applicant fails to access an SCL waiver service within sixty (60) days of receiving notice of potential funding without receiving an extension based on demonstration of good cause; or 2. A participant: a. Fails to access any services outlined in the participant's service plan for a period greater than sixty (60) consecutive days without receiving an extension based on demonstration of good cause; b. Moves to a residence outside of the Commonwealth of Kentucky; or c. Does not meet ICF-IID patient status criteria in accordance with 907 KAR 1:022. (5)  (a) An involuntary termination of a service to a participant by an SCL provider shall require: 1. The SCL provider to simultaneously notify electronically or in writing the participant or participant's guardian, the participant's case manager, the department, and DBHDID at least thirty (30) days prior to the effective date of the termination; and 2. The participant's case manager, in conjunction with the SCL provider, to: a. Provide the participant or participant's guardian with the name, address, and telephone number of each current SCL provider in Kentucky; b g the participant or participant's guardian, the participant's case manager, the department, and DBHDID at least thirty (30) days prior to the effective date of the termination; and 2. The participant's case manager, in conjunction with the SCL provider, to: a. Provide the participant or participant's guardian with the name, address, and telephone number of each current SCL provider in Kentucky; b. Provide assistance to the participant or participant's guardian in making contact with another SCL provider; c. Arrange and provide transportation for a requested visit to an SCL provider site; d. Provide a copy of pertinent information to the participant or participant's guardian; e. Ensure the health, safety, and welfare of the participant until an appropriate placement is secured; f. Continue to provide supports until alternative services or another placement is secured; and g. Provide assistance to ensure a safe and effective service transition. (b) The notice referenced in paragraph (a)1. of this subsection shall include: 1. A statement of the intended action; 2. The basis for the intended action; 3. The authority by which the intended action is taken; and 4. The participant's right to appeal the intended action through the provider's appeal or grievance process. (6)  (a) DBHDID shall initiate an intent to discontinue a participant's participation in the SCL waiver program if the participant or participant's guardian submits a written notice of intent to discontinue services to: 1. The SCL provider; and 2. DBHDID. (b) An action to terminate waiver participation shall not be initiated until thirty (30) calendar days from the date of the notice referenced in paragraph (a) of this subsection. (c) A participant or guardian may reconsider and revoke the notice referenced in paragraph (a) of this subsection in writing during the thirty (30) calendar day period. Section 3. Non-PDS Provider Participation Requirements ) An action to terminate waiver participation shall not be initiated until thirty (30) calendar days from the date of the notice referenced in paragraph (a) of this subsection. (c) A participant or guardian may reconsider and revoke the notice referenced in paragraph (a) of this subsection in writing during the thirty (30) calendar day period. Section 3. Non-PDS Provider Participation Requirements. (1) An SCL provider shall comply with: (a) 907 KAR 1:671; (b) 907 KAR 1:672; (c) 907 KAR 1:673; (d) 902 KAR 20:078; (e) 907 KAR 7:005; (f) The Health Insurance Portability and Accountability Act, 42 U.S.C. 1320d-2, and 45 C.F.R. Parts 160, 162, and 164; (g) 42 U.S.C. 1320d to 1320d-8; and (h) Local laws and ordinances governing smoke-free environments. (2) In order to provide an SCL waiver service in accordance with Section 4 of this administrative regulation, an SCL provider shall: (a) Be certified by the department prior to the initiation of a service; (b) Be recertified at least biennially by the department; (c) In accordance with KRS 273.182, maintain a registered agent and a registered office in Kentucky with the Office of the Secretary of State and file appropriate statement of change documentation with the filing fee with the Office of Secretary of State if the registered office or agent changes; (d) Be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020; (e) Abide by the laws that govern the chosen business or tax structure of the SCL provider; (f) Maintain policy that complies with this administrative regulation concerning the operation of the SCL provider and the health, safety, and welfare of all people supported or served by the SCL provider; (g) Maintain an executive director who shall have the authority and responsibility for the management of the affairs of the SCL provider in accordance with written policy and procedures that comply with this administrative regulation; and (h) Participate in the National Core Indicators' su f the SCL provider and the health, safety, and welfare of all people supported or served by the SCL provider; (g) Maintain an executive director who shall have the authority and responsibility for the management of the affairs of the SCL provider in accordance with written policy and procedures that comply with this administrative regulation; and (h) Participate in the National Core Indicators' surveys and all department survey initiatives. (3) An SCL provider: (a) Shall ensure that SCL waiver services shall not be provided to a participant by a staff person of the SCL provider who is a guardian, legally responsible individual, or immediate family member of the participant unless allowed for a participant-directed service in accordance with Section 4 of this administrative regulation; (b) Shall not enroll a participant whose needs the SCL provider is unable to meet; (c) Shall have and follow written criteria that comply with this administrative regulation for determining the eligibility of a participant for admission to services; (d) Shall document: 1. A denial for a service; and 2. The reason for the denial; (e) Shall maintain documentation of its operations including: 1. A written description of available SCL waiver services; 2. A current table of organization; 3. Any memorandum of understanding between a participant's case management agency and the participant's service providers; 4. Information regarding participants' satisfaction with services and the utilization of that information; 5. A quality improvement plan that: a. Includes updated findings and corrective actions as a result of department and case management quality assurance monitoring; and b 3. Any memorandum of understanding between a participant's case management agency and the participant's service providers; 4. Information regarding participants' satisfaction with services and the utilization of that information; 5. A quality improvement plan that: a. Includes updated findings and corrective actions as a result of department and case management quality assurance monitoring; and b. Addresses how the provider shall accomplish the following goals: (i) Ensure that the participant receives person-centered SCL waiver services; (ii) Enable the participant to be safe, healthy, and respected in the participant's community; (iii) Enable the participant to live in the community with effective, individualized assistance; and (iv) Enable the participant to enjoy living and working in the participant's community; 6. Evidence of continuous improvement of utilizing best practice standards toward meeting the critical strategic areas identified in the annual report released by the Kentucky National Core Indicators available at the Kentucky National Core Indicators Web site of http://www.nationalcoreindicators.org/states/KY/; and 7. A written plan of how the SCL provider shall participate in the: a. Human rights committee in the area in which the SCL provider is located; and b. Behavior intervention committee in the area in which the SCL provider is located; (f) Shall maintain accurate fiscal information including documentation of revenues and expenses; (g) Shall meet the following requirements if responsible for the management of a participant's funds: 1. Separate accounting shall be maintained for each participant or for the participant's interest in a common trust or special account; 2. Account balance and records of transactions shall be provided to the participant or the participant's guardian on a quarterly basis; and 3 venues and expenses; (g) Shall meet the following requirements if responsible for the management of a participant's funds: 1. Separate accounting shall be maintained for each participant or for the participant's interest in a common trust or special account; 2. Account balance and records of transactions shall be provided to the participant or the participant's guardian on a quarterly basis; and 3. The participant or the participant's guardian shall be notified if a balance is accrued that may affect Medicaid eligibility; (h) Shall have a written statement of its mission and values, which shall: 1. Support participant empowerment and informed decision-making; 2. Support and assist participants to form and remain connected to natural support networks; 3. Promote participant dignity and self-worth; 4. Support team meetings that help ensure and promote the participant's right to choice, inclusion, employment, growth, and privacy; 5. Foster a restraint-free environment where the use of physical restraints, seclusion, chemical restraints, or aversive techniques shall be prohibited; and 6. Support the SCL program goal that all participants: a. Receive person-centered waiver services; b. Are safe, healthy, and respected in the participant's community; c. Live in the community with effective, individualized assistance, and d. Enjoy living and working in the participant's community; (i) Shall have written policy and procedures for communication and interaction with a participant, family, or participant's guardian, which shall include: 1. A timely response to an inquiry; 2. The opportunity for interaction by direct support professionals; 3. Prompt notification of any unusual occurrence; 4. Visitation with the participant at a reasonable time, without prior notice, and with due regard for the participant's right of privacy; 5. Involvement in decision making regarding the selection and direction of the person-centered service provided; and 6 response to an inquiry; 2. The opportunity for interaction by direct support professionals; 3. Prompt notification of any unusual occurrence; 4. Visitation with the participant at a reasonable time, without prior notice, and with due regard for the participant's right of privacy; 5. Involvement in decision making regarding the selection and direction of the person-centered service provided; and 6. Consideration of the cultural, educational, language, and socioeconomic characteristics of the participant and family being supported; (j) Shall ensure the rights of a participant by: 1. Providing conflict free services and supports that are person-centered; 2. Making available a description of the rights and means by which the rights can be exercised and supported including the right to: a. Live and work in an integrated setting; b. Time, space, and opportunity for personal privacy; c. Communicate, associate, and meet privately with the person of choice; d. Send and receive unopened mail; e. Retain and use personal possessions including clothing and personal articles; f. Private, accessible use of a telephone or cell phone; g. Access accurate and easy-to-read information; h. Be treated with dignity and respect and to maintain one's dignity and individuality; i. Voice grievances and complaints regarding services and supports that are furnished without fear of retaliation, discrimination, coercion, or reprisal; j. Choose among service providers; k. Accept or refuse services; l. Be informed of and participate in preparing the person-centered service plan and any changes in the person-centered service plan; m. Be advised in advance of the: (i) Provider or providers who will furnish services; and (ii) Frequency and duration of services; n. Confidential treatment of all information, including information in the participant's records; o. Receive services in accordance with the current person-centered service plan; p ng the person-centered service plan and any changes in the person-centered service plan; m. Be advised in advance of the: (i) Provider or providers who will furnish services; and (ii) Frequency and duration of services; n. Confidential treatment of all information, including information in the participant's records; o. Receive services in accordance with the current person-centered service plan; p. Be informed of the name, business, telephone number, and business address of the person supervising the services and how to contact the person; q. Have the participant's property and residence treated with respect; r. Be fully informed of any cost sharing liability and the consequences if any cost sharing is not paid; s. Review the participant's records upon request; t. Receive adequate and appropriate services without discrimination; u. Be free from and educated on mental, verbal, sexual, and physical abuse, neglect, exploitation, isolation, and corporal or unusual punishment, including interference with daily functions of living; and v. Be free from mechanical, chemical, or physical restraints; 3. Having a grievance and appeals system that includes an external mechanism for review of complaints; 4. Ensuring access to participation in the local human rights committee in accordance with the human rights committee requirements established in Section 7 of this administrative regulation; and 5. Ensuring access to participation in the local behavior intervention committee: a. Established as a subset of the local human rights committee; and b. In accordance with the behavior intervention committee requirements established in Section 8 of this administrative regulation; (k) Shall maintain fiscal records, service records, investigations, medication error logs, and incident reports for a minimum of six (6) years from the date that: 1. A covered service is provided; or 2 a. Established as a subset of the local human rights committee; and b. In accordance with the behavior intervention committee requirements established in Section 8 of this administrative regulation; (k) Shall maintain fiscal records, service records, investigations, medication error logs, and incident reports for a minimum of six (6) years from the date that: 1. A covered service is provided; or 2. The participant turns twenty-one (21) years of age, if the participant is under the age of twenty-one (21); (l) Shall make available all records, internal investigations, and incident reports: 1. To the: a. Department; b. DBHDID; c. Office of Inspector General or its designee; d. General Accounting Office or its designee; e. Office of the Auditor of Public Accounts or its designee; f. Office of the Attorney General or its designee; g. DCBS; h. Centers for Medicare and Medicaid Services; or i. The Department of Aging and Independent Living; or 2. Pertaining to a participant to: a. The participant, the participant's guardian, or the participant's case manager upon request; or b. Protection and Advocacy upon written request; (m) Shall cooperate with monitoring visits from monitoring agents; (n) Shall maintain a record in the MWMA for each participant served that shall: 1. Contain all information necessary to support person-centered practices; 2. Be cumulative; 3. Be readily available; 4. Contain documentation that meets the requirements of Section 4 of this administrative regulation; 5. Contain the following: a. The participant summary sheet; b. The participant's name, Social Security number, and Medicaid identification number; c. The Supports Intensity Scale Assessment profile; d. The results of a department approved screening tool to assess health risk, which shall: (i) Be administered by trained personnel using the department approved protocol at least annually and updated as needed; and (ii) Assist in determining a participant's areas of vulnerability for a potential health risk; e and Medicaid identification number; c. The Supports Intensity Scale Assessment profile; d. The results of a department approved screening tool to assess health risk, which shall: (i) Be administered by trained personnel using the department approved protocol at least annually and updated as needed; and (ii) Assist in determining a participant's areas of vulnerability for a potential health risk; e. The current person-centered service plan; f. The goals and objectives identified by the participant and the participant's person-centered team that facilitates achievement of the participant's chosen outcomes as identified in the participant's person-centered service plan; g. A list containing emergency contact telephone numbers; h. The participant's history of allergies with appropriate allergy alerts; i. The participant's medication record, including a copy of the signed or authorized current prescription or medical orders and the medication administration record if medication is administered at the service site; j. A recognizable photograph of the participant; k. Legally adequate consent, updated annually, and a copy of which is located at each service site for the provision of services or other treatment requiring emergency attention; l. The participant's individual educational plan or individual family service plan, if applicable; m. The participant's life history updated at least annually; n. The results of an annual physical exam; o. The results of an annual dental exam; p. The MAP-350, Long Term Care Facilities and Home and Community Based Program Certification Form updated annually in the MWMA; q. A psychological evaluation; r. A current level of care certification; s. The prior authorization notifications; and t. Incident reports, if any exist; 6. Be maintained by the provider in a manner that: a. Ensures the confidentiality of the participant's record and other personal information; and b. Allows the participant or guardian to determine when to share the information in accordance with law; and 7 ological evaluation; r. A current level of care certification; s. The prior authorization notifications; and t. Incident reports, if any exist; 6. Be maintained by the provider in a manner that: a. Ensures the confidentiality of the participant's record and other personal information; and b. Allows the participant or guardian to determine when to share the information in accordance with law; and 7. Be safe from loss, destruction, or use by an unauthorized person ensured by the provider; (o) Shall ensure that an employee or volunteer: 1. Behaves in a legal and ethical manner in providing a service; 2. Has a valid Social Security number or valid work permit if not a citizen of the United States of America; and 3. If responsible for driving a participant during a service delivery, has a valid driver's license with proof of current mandatory liability insurance for the vehicle used to transport the participant; (p) Shall ensure that an employee or volunteer: 1. Completes a tuberculosis (TB) risk assessment performed by a licensed medical professional and, if indicated, a TB skin test with a negative result within the past twelve (12) months as documented on test results received by the provider within thirty (30) days of the date of hire or date the individual began serving as a volunteer; or 2. Who tests positive for TB or has a history of positive TB skin tests: a. Shall be assessed annually by a licensed medical professional for signs or symptoms of active disease; and b. If it is determined that signs or symptoms of active disease are present, in order for the person to be allowed to work or volunteer, is administered follow-up testing by his or her physician with the testing indicating the person does not have active TB disease; (q) Shall maintain documentation: 1. Of an annual TB risk assessment or negative TB test for each employee who performs direct support or a supervisory function; or 2 or symptoms of active disease are present, in order for the person to be allowed to work or volunteer, is administered follow-up testing by his or her physician with the testing indicating the person does not have active TB disease; (q) Shall maintain documentation: 1. Of an annual TB risk assessment or negative TB test for each employee who performs direct support or a supervisory function; or 2. Annually for each employee with a positive TB test that ensures no active disease symptoms are present; (r) Shall provide a written job description for each staff person that describes the required qualifications, duties, and responsibilities for the person's job; (s) Shall maintain an employee record for each employee that includes: 1. The employee's experience; 2. The employee's training; 3. Documented competency of the employee; 4. Evidence of the employee's current licensure or registration if required by law; and 5. An annual evaluation of the employee's performance; (t) Shall require a background check: 1. And drug testing for each employee who is paid with funds administered by the department and who: a. Provides support to a participant who utilizes SCL services; or b. Manages funds or services on behalf of a participant who utilizes SCL services; or 2. For a volunteer recruited and placed by an agency or provider who has the potential to interact with a participant; (u) Shall ensure that a volunteer placed by an agency or provider does not have unsupervised interaction with a participant; (v)  1. Shall for a potential employee or volunteer obtain: a. The results of a criminal record check from the Kentucky Administrative Office of the Courts and equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; b by an agency or provider does not have unsupervised interaction with a participant; (v)  1. Shall for a potential employee or volunteer obtain: a. The results of a criminal record check from the Kentucky Administrative Office of the Courts and equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; b. The results of a nurse aide abuse registry check as described in 906 KAR 1:100 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; c. The results of a caregiver misconduct registry check as described in 922 KAR 5:120 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; and d. Within thirty (30) days of the date of hire or initial date of volunteerism, the results of a central registry check as described in 922 KAR 1:470 and an equivalent out-of-state agency if the individual resided or worked outside of Kentucky during the twelve (12) months prior to employment or volunteerism; or 2. May use Kentucky's national background check program established by 906 KAR 1:190 to satisfy the background check requirements of subparagraph 1 of this paragraph; (w) Shall for each potential employee obtain negative results of drug testing for illicit or prohibited drugs; (x) Shall on an annual basis: 1. Randomly select and perform criminal history background checks, nurse aide abuse registry checks, central registry checks, and caregiver misconduct registry checks of at least twenty-five (25) percent of employees; and 2. Conduct drug testing of at least five (5) percent of employees; (y) Shall not use an employee or volunteer to provide 1915(c) home and community based waiver services if the employee or volunteer: 1. Has a prior conviction of an offense delineated in KRS 17.165(1) through (3); 2 tral registry checks, and caregiver misconduct registry checks of at least twenty-five (25) percent of employees; and 2. Conduct drug testing of at least five (5) percent of employees; (y) Shall not use an employee or volunteer to provide 1915(c) home and community based waiver services if the employee or volunteer: 1. Has a prior conviction of an offense delineated in KRS 17.165(1) through (3); 2. Has a prior felony conviction or diversion program that has not been completed; 3. Has a drug related conviction, felony plea bargain, or amended plea bargain conviction within the past five (5) years; 4. Has a positive drug test for prohibited drugs; 5. Has a conviction of abuse, neglect, or exploitation; 6. Has a Cabinet for Health and Family Services finding of: a. Child abuse or neglect pursuant to the central registry; or b. Adult abuse, neglect, or exploitation pursuant to the Caregiver Misconduct Registry; or 7. Is listed on the nurse aide abuse registry; (z) Shall not permit an employee to transport a participant if the employee has a driving under the influence conviction, amended plea bargain, or diversion during the past year; (aa) Shall maintain adequate staffing and supervision to implement services being billed; (bb) Shall establish written guidelines that address and ensure the health, safety, and welfare of a participant, which shall include: 1. A basic infection control plan that includes: a. Universal precautions; b. Hand washing; c. Proper disposal of biohazards and sharp instruments; and d. Management of common illness likely to be emergent in the particular service setting; 2. Effective cleaning and maintenance procedures sufficient to maintain a sanitary and comfortable environment that prevents the development and transmission of infection; 3. Ensuring that each site operated by the provider is equipped with: a. An operational smoke detector placed in all bedrooms and other strategic locations; and b illness likely to be emergent in the particular service setting; 2. Effective cleaning and maintenance procedures sufficient to maintain a sanitary and comfortable environment that prevents the development and transmission of infection; 3. Ensuring that each site operated by the provider is equipped with: a. An operational smoke detector placed in all bedrooms and other strategic locations; and b. At least two (2) correctly charged fire extinguishers placed in strategic locations, at least one (1) of which shall be capable of extinguishing a grease fire and have a rating of 1A10BC; 4. Ensuring the availability of an ample supply of hot and cold running water with the water temperature complying with the safety limits established in the participant's person-centered service plan; 5. Establishing written procedures concerning the presence of deadly weapons as defined in KRS 500.080, which shall ensure: a. Safe storage and use; and b. That firearms and ammunition are permitted: (i) Only in nonprovider owned or leased residences; and (ii) Only if stored separately and under double lock; 6. Establishing written procedures concerning the safe storage of common household items; 7. Ensuring that the nutritional needs of a participant are met in accordance with the current recommended dietary allowance of the Food and Nutrition Board of the National Research Council or as specified by a physician; 8. Ensuring that an adequate and nutritious food supply is maintained as needed by the participant; 9. Ensuring a smoke-free environment for any participant who chooses a smoke-free environment including settings in which the participant is expected to spend any amount of time, including home, a day training site, a meeting site, or any other location; 10. Ensuring that: a pecified by a physician; 8. Ensuring that an adequate and nutritious food supply is maintained as needed by the participant; 9. Ensuring a smoke-free environment for any participant who chooses a smoke-free environment including settings in which the participant is expected to spend any amount of time, including home, a day training site, a meeting site, or any other location; 10. Ensuring that: a. Every case manager and any employee who will be administering medication, unless the employee is a currently licensed or registered nurse, has: (i) Specific training provided by a registered nurse per a DBHDID medication administration approved curriculum; and (ii) Documented competency on medication administration, medication cause and effect, and proper administration and storage of medication; and b. An individual administering medication documents all medication administered, including self-administered and over-the-counter drugs, on a medication administration record, with the date, time, and initials of the person who administered the medication and ensuring that the medication shall: (i) Be kept in a locked container; (ii) If a controlled substance, be kept under double lock with a documented medication count performed every shift; (iii) Be carried in a proper container labeled with medication and dosage pursuant to KRS 315.010(8) and 217.182(6); (iv) Accompany and be administered to a participant at a program site other than the participant's residence if necessary; and (v) Be documented on a medication administration record and properly disposed of, if discontinued; and 11. Adhering to policies and procedures for ongoing monitoring of medication administration; (cc) Shall establish and follow written guidelines for handling an emergency or a disaster, which shall: 1. Be readily accessible on site; 2. Include instruction for notification procedures and the use of alarm and signal systems to alert a participant according to the participant's disability; 3 nued; and 11. Adhering to policies and procedures for ongoing monitoring of medication administration; (cc) Shall establish and follow written guidelines for handling an emergency or a disaster, which shall: 1. Be readily accessible on site; 2. Include instruction for notification procedures and the use of alarm and signal systems to alert a participant according to the participant's disability; 3. Include documentation of training and competency of staff and training of participants on emergency disaster drills; 4. Include an evacuation drill to be conducted in three (3) minutes or less, documented at least quarterly and, for a participant who receives residential support services, is scheduled to include a time when the participant is asleep; and 5. Mandate that the result of an evacuation drill be evaluated and if not successfully completed within three (3) minutes shall modify staffing support as necessary and repeat the evacuation drill within seven (7) days; (dd) Shall provide orientation for each new employee, which shall include the mission, goals, organization, and practices, policies, and procedures of the agency; (ee) Shall require documentation of all face-to-face training, which shall include: 1. The type of training provided: 2. The name and title of the trainer; 3. The training objectives; 4. The length of the training; 5. The date of completion; 6. The signature of the trainee verifying completion; and 7. Verification of competency of the trainee as demonstrated by post-training assessments, competency checklists, or post-training observations and evaluations; (ff) Shall require documentation of Web-based training, which shall include: 1. Transcripts verifying successful completion of training objectives with scores of eighty-five (85) percent or higher; and 2 e trainee verifying completion; and 7. Verification of competency of the trainee as demonstrated by post-training assessments, competency checklists, or post-training observations and evaluations; (ff) Shall require documentation of Web-based training, which shall include: 1. Transcripts verifying successful completion of training objectives with scores of eighty-five (85) percent or higher; and 2. Competency checklist listing date of completion, signature of evaluator, and signature of trainee for all Phase I or Phase II Kentucky College of Direct Support modules within the timeframe specified; (gg) Shall ensure that each case manager or employee prior to independent functioning and no later than six (6) months from the date of employment successfully completes training that shall include: 1. First aid and cardiopulmonary resuscitation certification by a nationally-accredited entity; 2.  a. Department of Behavioral Health, Developmental and Intellectual Disabilities' crisis prevention and intervention training; or b. Crisis prevention and intervention training that: (i) Is competency based; (ii) Is nationally accredited; (iii) Excludes restraints; and (iv) Is approved by the Department for Behavioral Health, Developmental and Intellectual Disabilities; 3. Successful completion of all Kentucky College of Direct Support Phase I training modules; 4. Individualized instruction about the person-centered service plan of the participant to whom the trainee provides supports; and 5 cy based; (ii) Is nationally accredited; (iii) Excludes restraints; and (iv) Is approved by the Department for Behavioral Health, Developmental and Intellectual Disabilities; 3. Successful completion of all Kentucky College of Direct Support Phase I training modules; 4. Individualized instruction about the person-centered service plan of the participant to whom the trainee provides supports; and 5. Verification of trainee competency as demonstrated by pre- and post-training assessments, competency checklists, and post-training observations or evaluations; (hh) Shall ensure that all case managers or employees, unless the case manager or employee is a licensed professional providing a service governed by the licensure of the individual's profession, complete the Kentucky College of Direct Support Phase II training modules, no later than six (6) months from the date of employment or when the individual began providing services; (ii) Shall ensure that each case manager complete DBHDID approved case management training after three (3) months but within nine (9) months from the date of hire; and (jj) Shall ensure that each adult family member residing in a level II residential adult foster care home or family home provider who may be left alone with the participant will receive training regarding the individualized needs of the participant. (4) DBHDID shall: (a) Obtain the rights to use the Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation; and (b) Facilitate access to: 1. A screening tool to assess health risk required to be used by an SCL waiver provider of residential services pursuant to this administrative regulation; or 2. Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation an SCL waiver provider pursuant to this administrative regulation; and (b) Facilitate access to: 1. A screening tool to assess health risk required to be used by an SCL waiver provider of residential services pursuant to this administrative regulation; or 2. Kentucky College of Direct Support training modules required to be used by an SCL waiver provider pursuant to this administrative regulation. (5) An SCL provider, employee, or volunteer shall: (a) Not manufacture, distribute, dispense, be under the influence of, purchase, possess, use, or attempt to purchase or obtain, sell, or transfer any of the following in the workplace or while performing work duties: 1. An alcoholic beverage; 2. A controlled substance except an SCL provider, employee, or volunteer may use or possess a medically necessary and legally prescribed controlled substance; 3. An illicit drug; 4. A prohibited drug or prohibited substance; 5. Drug paraphernalia; or 6. A substance that resembles a controlled substance, if there is evidence that the individual intended to pass off the item as a controlled substance; and (b) Not possess a prescription drug for the purpose of selling or distributing it. Section 4. Covered Services. (1)  (a) An SCL waiver service shall: 1. Be prior authorized by the department; and 2. Be provided to a participant pursuant to the participant's person-centered service plan by an individual who meets the requirements established in Section 3 of this administrative regulation. (b) Any combination of day training, community access, personal assistance, or any hours of paid community employment or on-site supported employment service shall not exceed sixteen (16) hours per day and 2. Be provided to a participant pursuant to the participant's person-centered service plan by an individual who meets the requirements established in Section 3 of this administrative regulation. (b) Any combination of day training, community access, personal assistance, or any hours of paid community employment or on-site supported employment service shall not exceed sixteen (16) hours per day. (2) SCL covered services shall include: (a) Case management; (b) Community access services; (c) Community guide services; (d) Community transition services; (e) Consultative clinical and therapeutic services; (f) Day training; (g) Environmental accessibility adaptation services; (h) Goods and services; (i) Natural supports training; (j) Person-centered coaching; (k) Personal assistance services; (l) Positive behavior supports; (m) Residential support services, which may include: 1. Level I residential supports; 2. Technology assisted residential services; or 3. Level II residential supports; (n) Respite; (o) Shared living; (p) Specialized medical equipment and supplies; (q) Supported employment; (r) Transportation services; or (s) Vehicle adaptation. (3) Case management requirements shall be as established in Section 6 of this administrative regulation. (4) A community access service: (a) Shall be provided by a community access specialist; (b) Shall be designed to support a participant to participate in meaningful routines, events, and activities through various community organizations; (c) Shall be designed to empower a participant in developing natural supports; (d) May be participant directed; (e) If participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation; (f) Shall stress training that empowers a participant in acquiring, practicing, utilizing, and improving skills related to: 1. Connecting with others; 2. Independent functioning; 3. Self advocacy; 4. Socialization; 5 irected, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation; (f) Shall stress training that empowers a participant in acquiring, practicing, utilizing, and improving skills related to: 1. Connecting with others; 2. Independent functioning; 3. Self advocacy; 4. Socialization; 5. Community participation; 6. Personal responsibility; 7. Financial responsibility; and 8. Other skills related to optimal well-being as defined in the participant's person-centered service plan; (g) Shall be designed to result in an increased ability to develop natural supports and access community resources including educational, recreational, religious, civic, or volunteer opportunities with an outcome of: 1. Less reliance on formal supports; and 2. Greater reliance on natural or unpaid supports as established in the participant's person-centered service plan; (h) Shall have an emphasis on the development of personal social networks, membership opportunities, friendships, and relationships for the participant as established in the participant's person-centered service plan; (i) Shall be provided outside the participant's home or residential setting and occur during the day, in the evening, or on weekends; (j) Shall not duplicate residential support or day training services, or authorized therapies; (k) Shall be provided to a participant with a: 1. One (1) to one (1) staff to participant ratio; or 2. Ratio of one (1) staff to no more than two (2) participants according to the participant's person-centered service plan, if the participant invites a friend; (l) Shall occur in an integrated community setting; (m) Shall be an impact service and the participant's person-centered service plan shall define steps to decrease the provision of the service as the participant becomes more independent in accessing and becoming part of the community; (n) Shall be documented in the MWMA by: 1 nt's person-centered service plan, if the participant invites a friend; (l) Shall occur in an integrated community setting; (m) Shall be an impact service and the participant's person-centered service plan shall define steps to decrease the provision of the service as the participant becomes more independent in accessing and becoming part of the community; (n) Shall be documented in the MWMA by: 1. A note documenting each contact, which shall include: a. A full description of each service rendered; b. Evidence of training or service to support outcomes designated in the participant's person-centered service plan; c. The date of the service; d. The location of the service; e. The beginning and ending times of the service; f. The signature and title of the individual providing the service; and g. The date the entry was made in the record; and 2. A monthly summary note, which shall include: a. The month and year for the time period the note covers; b. An analysis of progress toward the participant's outcome or outcomes; c. Identification of barriers to achievement of outcomes; d. Projected plan to achieve the next step in achievement of outcomes; e. The signature and title of the community access specialist completing the note; and f. The date the note was written; and (o) Shall not exceed 160 fifteen (15) minute units per week alone or in combination with community access group services. (5)  (a) A community guide service shall: 1. Be provided by a community guide who meets the personnel and training requirements established in Sections 3 and 10 of this administrative regulation; 2. Be designed to empower a participant to define and direct the participant's services; 3. Only be for a participant who chooses participant-directed supports for some or all of the participant's support services; 4. Include: a. Direct assistance to a participant in meeting his or her participant-directed responsibilities; b ents established in Sections 3 and 10 of this administrative regulation; 2. Be designed to empower a participant to define and direct the participant's services; 3. Only be for a participant who chooses participant-directed supports for some or all of the participant's support services; 4. Include: a. Direct assistance to a participant in meeting his or her participant-directed responsibilities; b. Information and assistance that helps the participant in: (i) Problem solving; (ii) Decision making; (iii) Developing supportive community relationships; and (iv) Accessing resources that promote implementation of the participant's person-centered service plan; and c. Information to ensure that the participant understands the responsibilities involved with directing the participant's services; 5. Be documented in the MWMA by: a. A note documenting each contact, which shall include: (i) A full description of each service rendered; (ii) The date of the service; (iii) The location of the service; (iv) The beginning and ending times of the service; (v) The signature and title of the community guide providing the service; and (vi) The date the entry was made in the record; and b. A completed monthly summary note, which shall include: (i) The month and year for the time period the note covers; (ii) An analysis of the efficacy of the service provided including recommendations and identification of additional support needs; (iii) The signature and title of the community guide completing the note; and (iv) The date the note was written; and 6. Be limited to 576 fifteen (15) minute units per one (1) year authorized person-centered service plan period. (b)  1. A participant and the participant's person-centered team shall determine the community guide services to be received. 2. The community guide services to be received by a participant shall be specified in the participant's person-centered service plan. (c) If needed, directed assistance provided by a community guide: 1 units per one (1) year authorized person-centered service plan period. (b)  1. A participant and the participant's person-centered team shall determine the community guide services to be received. 2. The community guide services to be received by a participant shall be specified in the participant's person-centered service plan. (c) If needed, directed assistance provided by a community guide: 1. Shall be based on the needs of the participant; and 2. May include assistance with: a. Recruiting, hiring, training, managing, evaluating, and changing employees; b. Scheduling and outlining the duties of employees; c. Developing and managing the individual budget; d. Understanding provider qualifications; or e. Recordkeeping and other program requirements. (d) A community guide service shall not duplicate a case management service. (e) A community guide providing community guide services to a participant shall not provide other direct waiver services to any participant. (f) A community guide shall not be employed by an agency that provides other direct waiver services to the participant. (6) Community transition services: (a) Shall be nonrecurring set-up expenses for a participant who is transitioning from an institutional or other provider-operated living arrangement to a living arrangement in a private residence where the participant is directly responsible for his or her own living expenses; (b) Shall be expenses that are necessary to enable a participant to establish a basic household that do not constitute room and board; (c) May include: 1. A security deposit that is required to obtain a lease on an apartment or home; 2. Essential household furnishings or moving expense required to occupy and use a community domicile, including furniture, window coverings, food preparation items, or bed or bath linens; 3. A one (1) time set-up fee or deposit for utility or service access, including telephone, electricity, heating, or water; 4 ude: 1. A security deposit that is required to obtain a lease on an apartment or home; 2. Essential household furnishings or moving expense required to occupy and use a community domicile, including furniture, window coverings, food preparation items, or bed or bath linens; 3. A one (1) time set-up fee or deposit for utility or service access, including telephone, electricity, heating, or water; 4. A service necessary for the participant's health and safety including pest eradication or one (1) time cleaning prior to occupancy; 5. A necessary home accessibility adaptation; or 6. An activity to assess a need and arrange for and procure needed resources; (d) Shall be furnished only: 1. To the extent that the service is reasonable and necessary; 2. As clearly identified in the participant's person-centered service plan; and 3. If the service cannot be obtained from other sources; (e) Shall not include: 1. Monthly rental or mortgage expense; 2. Food; 3. Regular utility charges; 4. Items that are intended for purely diversional or recreational purposes; or 5. Furnishings for living arrangements that are owned or leased by an SCL provider; (f) Shall be coordinated and documented in the MWMA by the participant's case manager by: 1. Description or itemized line item of purchase and cost; 2. A receipt for a procurement including date of purchase; 3. The signature and title of the case manager; and 4. The date the entry was made in the record; and (g) Shall not exceed $2,000 per approved transition. (7) A consultative clinical and therapeutic service shall: (a) Be provided by a person who: 1. Meets the personnel and training requirements established in Section 3 of this administrative regulation; and 2. Is a: a. Certified nutritionist; b. Licensed dietitian; c. Licensed marriage and family therapist; d. Licensed professional clinical counselor; e. Licensed psychological associate; f. Licensed psychologist; g. Licensed psychological practitioner; h. Licensed clinical social worker; or i Meets the personnel and training requirements established in Section 3 of this administrative regulation; and 2. Is a: a. Certified nutritionist; b. Licensed dietitian; c. Licensed marriage and family therapist; d. Licensed professional clinical counselor; e. Licensed psychological associate; f. Licensed psychologist; g. Licensed psychological practitioner; h. Licensed clinical social worker; or i. Positive behavior support specialist; (b) Include: 1. Professional consultation, evaluation, and assessment of the participant, the environment and the system of support, and written summary of findings and recommendations for the participant and the participant's person-centered team; 2. Providing treatment that: a. Is consistent with assessment results and diagnosis; b. Is evidence based or current best practice; and c. Encompasses psychological treatment or counseling as indicated by the condition of the participant; 3. Coordinating program wide support, as needed, that addresses the assessed needs, conditions, or symptoms affecting a participant's ability to fully participate in the participant's community; 4. Participating in developing and revising, as needed, home treatment or support plans as components of a participant's person-centered service plan; 5. Providing training and technical assistance to carry out recommendations and plans that shall occur within the settings in which the recommendations, home treatment, or support plans are to be carried out; 6. Monitoring: a. Of the fidelity of data reporting and participant's person-centered service plan implementation; b. Of the effectiveness of the participant's person-centered service plan; c. Of the impact of the participant's person-centered service plan on the participant, and the participant's environment and system of supports; and d ns, home treatment, or support plans are to be carried out; 6. Monitoring: a. Of the fidelity of data reporting and participant's person-centered service plan implementation; b. Of the effectiveness of the participant's person-centered service plan; c. Of the impact of the participant's person-centered service plan on the participant, and the participant's environment and system of supports; and d. That shall be conducted: (i) In the settings where the participant's person-centered service plan is implemented; (ii) Through discussions and observations of people implementing the participant's person-centered service plan; and (iii) Through reporting data; 7. A functional assessment, which shall: a. Be conducted by a person who meets the personnel and training requirements established in Section 3 of this administrative regulation and is a: (i) Licensed psychologist; (ii) Certified psychologist with autonomous functioning; or (iii) Positive behavior support specialist; b. Include: (i) A description of the behavior patterns identified through the functional assessment and the goals of intervention; and (ii) Modifications to the social or physical environment that may prevent the behavior or increase the likelihood of alternative adaptive behaviors; and c. Identify specific skills to be taught or reinforced that shall: (i) Achieve the same function as the behavior of concern; (ii) Allow the participant to cope more effectively with circumstances; and (iii) Be documented when they occur; 8. Documentation in the MWMA of each contact, which shall include: a. A full description of each service rendered; b. An analysis of the efficacy of the service provided including any recommendation or identification of additional support needs if needed; c. The date of the service; d. The location of the service; e. The beginning and end times of the service; f. The signature and title of the professional providing the service; g ch contact, which shall include: a. A full description of each service rendered; b. An analysis of the efficacy of the service provided including any recommendation or identification of additional support needs if needed; c. The date of the service; d. The location of the service; e. The beginning and end times of the service; f. The signature and title of the professional providing the service; g. The date the entry was made in the record; and (c) Not exceed 160 fifteen (15) minute units per one (1) year authorized person-centered service plan period. (8) Day training: (a) Shall be provided by a direct support professional; (b) Shall include: 1. Providing regularly scheduled activities in a non-residential setting that are designed to foster the acquisition of skills, build positive social behavior and interpersonal competence, and foster greater independence and personal choice; 2. Career planning or pre-vocational activities to develop experiential learning opportunities and career options consistent with the participant's skills and interests that: a. Are person-centered and designed to support employment related goals; b. Provide active training designed to prepare a participant to transition from school to adult responsibilities, community integration, and work; c. Enable each individual to attain the highest level of work in the most integrated setting with the job matched to the participant's interests, strengths, priorities, abilities, and capabilities; and d. Include: (i) Skill development to communicate effectively with supervisors, co-workers, and customers; (ii) Generally accepted community workplace conduct and dress; (iii) Workplace problem solving skills and strategies; (iv) General workplace safety; (v) The ability to follow directions; (vi) The ability to attend tasks; or (vii) Mobility training; 3. Supported retirement activities including: a. Altering schedules to allow for more rest time throughout the day; or b rs, co-workers, and customers; (ii) Generally accepted community workplace conduct and dress; (iii) Workplace problem solving skills and strategies; (iv) General workplace safety; (v) The ability to follow directions; (vi) The ability to attend tasks; or (vii) Mobility training; 3. Supported retirement activities including: a. Altering schedules to allow for more rest time throughout the day; or b. Support to participate in hobbies, clubs, or other activities in the participant's community; or 4. Training and supports designed to maintain skills and functioning and to prevent or slow regression, rather than acquiring new skills or improving existing skills; (c) Shall include required informational sessions sponsored by the provider at least annually for the participant regarding community involvement or employment services and arrangement of opportunities for the participant to explore community integration, supported employment, and other employment opportunities in the community; (d) Shall, if provided in an adult day health care center, only be available for a participant who: 1. Is at least twenty-one (21) years of age; and 2. Requires skilled nursing services or nursing supervision in a licensed adult day health care center as outlined in the participant's person-centered service plan; (e) Shall include environments that: 1. Are not diversional in nature; and 2. Occur in a variety of settings in the community and shall not be limited to fixed-site facilities; (f) May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation; (g) Shall not be reimbursable if vocational in nature and for the primary purpose of producing goods or performing services; (h) Shall include documentation in the MWMA that shall be: 1. A note for each contact, which shall include: a. A full description of each service rendered; b. The date of the service; c idual of the participant in accordance with Section 10 of this administrative regulation; (g) Shall not be reimbursable if vocational in nature and for the primary purpose of producing goods or performing services; (h) Shall include documentation in the MWMA that shall be: 1. A note for each contact, which shall include: a. A full description of each service rendered; b. The date of the service; c. The location of the service; d. The beginning and ending times of the service; e. The signature and title of the individual providing the service; and f. The date the entry was made in the record; and 2. A completed monthly summary note, which shall include: a. The month and year for the time period the note covers; b. An analysis of the efficacy of the service provided including recommendations and identification of additional support needs; c. The signature and title of the individual completing the note; and d. The date the note was written; and (i) Shall be limited to: 1. Five (5) days per week excluding weekends; and 2. 160 fifteen (15) minute units per week for day training alone or in combination with any hours of paid community employment or on-site supported employment service. (9)  (a) An environmental accessibility adaptation service: 1. Shall be: a. Designed to enable participants to interact more independently with their environment thereby enhancing their quality of life and reducing their dependence on physical support from others; and b. A physical adaptation to a participant's or family's home, which shall be necessary to: (i) Ensure the health, welfare, and safety of the participant; or (ii) Enable the participant to function with greater independence in the home and without which the participant would require institutionalization; 2. May include the following if necessary for the welfare of a participant: a. Installation of a ramp or grab-bar; b. Widening of a doorway; c. Modification of a bathroom facility; or d (i) Ensure the health, welfare, and safety of the participant; or (ii) Enable the participant to function with greater independence in the home and without which the participant would require institutionalization; 2. May include the following if necessary for the welfare of a participant: a. Installation of a ramp or grab-bar; b. Widening of a doorway; c. Modification of a bathroom facility; or d. Installation of a specialized electric and plumbing system, which shall be necessary to accommodate the medical equipment or supplies necessary for the welfare of the participant; 3. Shall not include: a. An adaptation or improvement to a home that is not of direct medical or remedial benefit to a participant; b. An adaptation that adds to the total square footage of a home except if necessary to complete an adaptation; and c. An adaptation to a provider-owned residence; 4. Shall be provided: a. In accordance with applicable state and local building codes; and b. By a vendor who shall be in good standing with the Office of the Secretary of State of the Commonwealth of Kentucky pursuant to 30 KAR 1:010 and 30 KAR 1:020; and 5. Shall be coordinated and documented in the MWMA by a case manager by: a. A description of each adaptation purchased; b. A receipt for every adaptation made, which shall include the: (i) Date of purchase; (ii) Description of the item; (iii) Quantity and per unit price; and (iv) Total amount of the purchase; c. The signature and title of the case manager; and d. The date the entry was made in the record. (b) An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a vendor or provider of an environmental accessibility adaptation service for the participant. (c) A home accessibility modification shall not be furnished to a participant who receives residential habilitation services except if the services are furnished in the participant's own home immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a vendor or provider of an environmental accessibility adaptation service for the participant. (c) A home accessibility modification shall not be furnished to a participant who receives residential habilitation services except if the services are furnished in the participant's own home. (d) A request shall be documented in a participant's person-centered service plan and include cost of adaptations. (10)  (a) Goods and services shall: 1. Be services, equipment, or supplies that are individualized to a participant who chooses to use participant-directed services; 2. Be utilized to reduce the need for personal care or to enhance independence within a participant's home or community; 3. Not be a good or service available to a recipient outside of the department's SCL waiver program; 4. Meet the following requirements: a. The good or service shall decrease the need for other Medicaid services; b. The good or service shall promote participant inclusion in the community; c. The good or service shall increase a participant's safety in the home environment; and d. The participant shall not have the funds to purchase the good or service; 5. If participant directed and purchased from a participant-directed budget, be prior authorized; 6. Not include experimental or prohibited treatments; 7. Be clearly linked to a participant need that has been documented in the participant's person-centered service plan; 8. Be coordinated and documented in the MWMA by a case manager by: a. Description or itemized line item of purchase and cost; b. Receipts for procurements that include the date of purchase; c. The signature and title of the case manager; and d. The date the entry was made in the record; and 9. Not exceed $1,800 per one (1) year authorized person-centered service plan period. (b) A purchase of a good or service shall not circumvent other restrictions on SCL waiver services: 1 on or itemized line item of purchase and cost; b. Receipts for procurements that include the date of purchase; c. The signature and title of the case manager; and d. The date the entry was made in the record; and 9. Not exceed $1,800 per one (1) year authorized person-centered service plan period. (b) A purchase of a good or service shall not circumvent other restrictions on SCL waiver services: 1. Established in this administrative regulation; and 2. Including the prohibition against claiming for the costs of room and board. (c) An immediate family member, guardian, or legally responsible individual of a participant shall not be a provider of participant-directed goods and services to the participant. (d) A case manager shall submit reimbursement documentation to the financial management agency. (e) Equipment purchased as a good shall become the property of the participant. (11)  (a) Natural supports training shall: 1. Be provided by a qualified entity as identified in the person-centered service plan; 2. Be participant directed and include: a. Training and education to individuals who provide unpaid support, training, companionship, or supervision to participants; b. Instruction about treatment regimens and other services specified in the participant's person-centered service plan; c. Instruction on current best practices; d. The costs of registration and training fees associated with formal instruction in areas relevant to the participant's needs identified in the participant's person-centered service plan; or e. Training provided by a member of the participant's community regarding specific interests of the participant and how the natural support network shall support the participant's inclusion in activities and events surrounding the area of interest; 3. Be individualized, direct training of families and natural support networks for acquisition or enhancement of their ability to support the participant; 4 aining provided by a member of the participant's community regarding specific interests of the participant and how the natural support network shall support the participant's inclusion in activities and events surrounding the area of interest; 3. Be individualized, direct training of families and natural support networks for acquisition or enhancement of their ability to support the participant; 4. Relate to needs identified in a participant's person-centered service plan and be tied to a specific goal in the person-centered service plan; 5. Not duplicate or occur simultaneously with any education or training provided through: a. State plan physical therapy services; b. State plan occupational therapy services; c. State plan speech-language pathology services; d. Consultative clinical and therapeutic services; or e. Positive behavior support services; 6. Be provided in: a. A participant's own home or a participant's family's home; or b. Community setting specific to community-based natural supports training goals specified in the participant's person-centered service plan; 7. Not include: a. Services reimbursable by any other support; b. Training paid caregivers; c. Costs of travel, meals, or overnight lodging to attend a training event or conference; or d. Services not related to the needs of the participant; and 8. Be coordinated and documented in the MWMA by a case manager by: a. The specific training provided; b. The date and the beginning and ending time when the service was provided; c. The service location; d. The receipts or verification of service provision, including first and last name and title (if applicable) of the person providing the service and the signature of the person providing the service; e. Verification of registration and certificate of attendance at any formal training; and f. The progress made in moving the participant towards independence as reflected in goals and the participant's person-centered service plan of service provision, including first and last name and title (if applicable) of the person providing the service and the signature of the person providing the service; e. Verification of registration and certificate of attendance at any formal training; and f. The progress made in moving the participant towards independence as reflected in goals and the participant's person-centered service plan. (b) An immediate family member, guardian, or legally responsible individual of a participant shall not be eligible to be a participant-directed provider of natural supports training services for the participant. (c) For purposes of natural supports training, an individual shall be defined as any person, family member, neighbor, friend, companion, or coworker who provides uncompensated care, training, guidance, companionship, or support to the participant who utilizes natural supports training. (d) A case manager shall submit reimbursement documentation to the financial management agency. (12)  (a) Person-centered coaching shall: 1. Be provided by a person-centered coach who shall: a. Operate independently of a residential or day training provider; b. Work under the direction of a positive behavior support specialist or other licensed professional in the settings where the person-centered service plan is implemented; and c. Meet the personnel and training requirements specified in Section 3 of this administrative regulation; 2. Be an individualized service to be utilized when a barrier challenges the success of a participant in achieving the participant's goals; 3. Include: a. The provision of training developed in conjunction with certified or licensed professionals from the participant's person-centered team, to the participant, family, guardian, natural and paid supports on implementation of all or designated components of the participant's person-centered service plan; b ier challenges the success of a participant in achieving the participant's goals; 3. Include: a. The provision of training developed in conjunction with certified or licensed professionals from the participant's person-centered team, to the participant, family, guardian, natural and paid supports on implementation of all or designated components of the participant's person-centered service plan; b. Monitoring the effectiveness of person-centered planning as demonstrated by the support system's implementation of the person-centered service plan or designated components across the array of service settings and reporting of required and pertinent data; and c. Data collection that shall be utilized by the participant's person-centered team to modify the environment or person-centered service plan as needed; 4. Not duplicate case management or any other service; 5. Not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 101 et seq.); and 6. Be limited to 1,320 fifteen (15) minute units per year. (b) Person-centered coaching shall be outcome-based with a plan for the gradual withdrawal of the services. (c) A person-centered coach shall not be considered as part of a staffing ratio, plan, or pattern. (d) Documentation of a person-centered coaching service shall be entered in the MWMA and shall include: 1. A note documenting each contact, which shall include: a. A full description of each service rendered; b. The date of the service; c. The location of the service; d. The beginning and ending time of the service; e. The signature and title of the person-centered coach providing the service; and f. The date the entry was made in the record; and 2. A completed monthly summary note, which shall include: a. The month and year for the time period the note covers; b. A summary of the service provided including recommendations and identification of additional support needs if any exist; c. The signature and title of the individual completing the note; d centered coach providing the service; and f. The date the entry was made in the record; and 2. A completed monthly summary note, which shall include: a. The month and year for the time period the note covers; b. A summary of the service provided including recommendations and identification of additional support needs if any exist; c. The signature and title of the individual completing the note; d. The date the note was written; and e. The signature, title, and date of review of documentation by the positive behavior specialist or other licensed professional directing the work of the person-centered coach. (13) Personal assistance services: (a) Shall be provided by a direct support professional; (b) Shall enable a participant to accomplish tasks that the participant normally would do for himself or herself if the participant did not have a disability; (c) Shall be available only to a participant who lives in the participant's own residence or in the participant's family residence; (d) May be participant directed and if participant directed, may be provided by an immediate family member, guardian, or legally responsible individual of the participant in accordance with Section 10 of this administrative regulation; (e) Shall include: 1. Hands-on assistance (performing a task for a participant); 2. Reminding, observing, guiding, or training a participant in activities of daily living; 3. Reminding, observing, guiding, or training a participant in instrumental activities of daily living; 4. Assisting a participant in managing the participant's medical care including making medical appointments and accompanying the participant to medical appointments; or 5. Transportation, which is not otherwise available under the Medicaid Program, to access community services, activities, and appointments; (f) Shall take place in a participant's home or in the community as appropriate to the participant's need; (g) Shall not be available to a participant: 1. Receiving paid residential supports; or 2 ts and accompanying the participant to medical appointments; or 5. Transportation, which is not otherwise available under the Medicaid Program, to access community services, activities, and appointments; (f) Shall take place in a participant's home or in the community as appropriate to the participant's need; (g) Shall not be available to a participant: 1. Receiving paid residential supports; or 2. Under the age of twenty-one (21) if medically necessary personal assistance is available as an early and periodic screening, diagnostic, and treatment service; (h) Shall not supplant an educational service available under the Individuals with Disabilities Education Act (20 U.S.C. 1401 et seq.); and (i) Shall be documented in the MWMA by: 1. A note for each contact, which shall include: a. A full description of each service rendered; b. Evidence of training or service to support outcomes designated in the participant's person-centered service plan as appropriate; c. The date of the service; d. The location of the service; e. The beginning and ending time of the service; f. The signature and title of the direct support professional providing the service; and g. The date the entry was made in the record; and 2. A detailed monthly summary note, which shall include: a. The month and year for the time period the note covers; b. Evidence of progress toward the participant's outcome or outcomes; c. Identification of barriers to achievement of outcome or outcomes; d. Projected plan to achieve the next step in achievement of outcome or outcomes; e. The signature and title of the direct support professional completing the note; and f. The date the note was written. (14)  (a) Positive behavior supports shall include: 1. The utilization of evidenced based and best practices in behavioral techniques, interventions, and methods to assist a participant with significant, intensive challenges that interfere with activities of daily living, social interaction, or work; 2 e of the direct support professional completing the note; and f. The date the note was written. (14)  (a) Positive behavior supports shall include: 1. The utilization of evidenced based and best practices in behavioral techniques, interventions, and methods to assist a participant with significant, intensive challenges that interfere with activities of daily living, social interaction, or work; 2. Evidenced based or best practices regarding treatment of a behavioral health condition that shall be the primary support services if supplemental behavioral interventions are needed; and 3. A positive behavior support plan, which shall: a. Be clearly based upon the information, data collected, and recommendations from the functional assessment; b. Meet the primary purpose of having the participant acquire or maintain skills for community living while behavioral interventions are delivered for the reduction of significant challenges that interfere with activities of daily living, social interaction, or work; c. Be developed with the participant and participant's person-centered team; d. Be related to goals of interventions, such as greater participation in activities, or enhanced coping or social skills; e. Identify strategies for managing consequences to maximize reinforcement of adaptive or positive behavior and minimize that for target behavior; f. Delineate goals of intervention and specific replacement behavior or skills that are incorporated into the participant's total service plan; g. If necessary to ensure safety and rapid de-escalation of a targeted behavior, outline the de-escalation techniques and scaled response with criteria for use and documentation requirements; h. Include specific criteria for how data including rate, frequency, duration, and intensity shall be recorded; i. Include specific criteria for re-evaluation when the data does not demonstrate progress; j n; g. If necessary to ensure safety and rapid de-escalation of a targeted behavior, outline the de-escalation techniques and scaled response with criteria for use and documentation requirements; h. Include specific criteria for how data including rate, frequency, duration, and intensity shall be recorded; i. Include specific criteria for re-evaluation when the data does not demonstrate progress; j. Clarify in measurable terms the frequency, intensity, and duration of the target behaviors: (i) That will signify that a reduction in services is in order; and (ii) When services are at an end; k. Be revised whenever necessary and submitted for review to the local behavior intervention committee along with: (i) The participant's person-centered service plan; (ii) The participant's functional assessment; (iii) The participant's life history; (iv) The participant's medical assessment; and (v) Any other appropriate assessment; l. Be submitted to the local human rights committee if rights restrictions are recommended; and m. Be implemented across service settings by the various people, both paid and natural supports, assisting a participant to reach the participant's goals and dreams. (b) Positive behavior supports shall be provided by a positive behavior support specialist. (c) Behavioral health treatment and positive behavioral supports shall be utilized in a collaborative manner. (d) One (1) unit of positive behavior supports shall equal one (1) plan. (e) Positive behavior supports shall be billed in accordance with 907 KAR 12:020. (15)  (a) Residential support services shall: 1. Be authorized for a participant based upon information from the participant's Supports Intensity Scale assessment, a screening tool that assesses health risk, and an approved person-centered service plan; and 2. Ensure that the participant has: a. Privacy in the sleeping or living unit in a residential setting; b. An option for a private unit in a residential setting; c support services shall: 1. Be authorized for a participant based upon information from the participant's Supports Intensity Scale assessment, a screening tool that assesses health risk, and an approved person-centered service plan; and 2. Ensure that the participant has: a. Privacy in the sleeping or living unit in a residential setting; b. An option for a private unit in a residential setting; c. A unit with lockable entrance doors and with only the individual and appropriate staff having keys to those doors; d. A choice of roommates or housemates; e. The freedom to furnish or decorate the participant's sleeping or living units within the lease or other agreement; f. Visitors of the participant's choosing at any time and access to a private area for visitors; and g. Physical accessibility defined as being easy to approach, enter, operate, or participate in a safe manner and with dignity by a person with or without a disability. (b) To be considered physically accessible, a setting shall meet the Americans with Disabilities Act, 42 U.S.C. Chapter 126, standards of accessibility for all participants served in the setting. (c) All communal areas shall be accessible to all participants as well as having a means to enter the building, such as a key or security code. (d) Bedrooms shall be accessible to the appropriate persons. (e) Any modification of the additional residential conditions, except for the setting being physically accessible requirement, shall be supported by a specific assessed need and justified in the person-centered service plan. (f) The following shall be documented in the participant's person-centered service plan: 1. Identification of a specific and individualized assessed need; 2. Documentation of any positive intervention or support used prior to any modifications to the person-centered service plan; 3. Documentation of any less intrusive method of meeting the participant's needs that has been tried but did not work; 4 f) The following shall be documented in the participant's person-centered service plan: 1. Identification of a specific and individualized assessed need; 2. Documentation of any positive intervention or support used prior to any modifications to the person-centered service plan; 3. Documentation of any less intrusive method of meeting the participant's needs that has been tried but did not work; 4. A clear description of the condition that is directly proportionate to the specific assessed need; 5. Regular collection and review of data to measure the ongoing effectiveness of the modification; 6. Established time limits for periodic reviews to determine if the modification is still necessary or can be termina [Text truncated at 120,000 characters. The full text is on the page linked above.] ## Nearby sections - [907 KAR 12:010 907 KAR 12:010. New Supports for community living waiver service and coverage policies](https://www.frixlaw.com/law-library/statutes/STATE_KY_KAR_T907_C012_R010.md) - [907 KAR 12:020 907 KAR 12:020. Reimbursement for New Supports for Community Living Waiver Services](https://www.frixlaw.com/law-library/statutes/STATE_KY_KAR_T907_C012_R020.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_KY_KAR_T907_C012_R010. Check the current official text before relying on it. Not legal advice.