Section 6. Covered
Services.
(2) An ABI waiver provider shall provide the
following services to a participant:
(a) Case
management services in accordance with Section 4 of this administrative
regulation;
(b) Behavioral
services, which shall:
1. Be a systematic
application of techniques and methods to influence or change a behavior in a
desired way;
2. Include a
functional analysis of the participant's behavior including:
a. An evaluation of the impact of an ABI on:
(i) Cognition; and
(ii) Behavior;
b. An analysis of potential communicative
intent of the behavior;
c. The
history of reinforcement for the behavior;
d. Critical variables that precede the
behavior;
e. Effects of different
situations on the behavior; and
f.
A hypothesis regarding the:
(i) Motivation
behind the behavior;
(ii) Purpose
of the behavior; and
(iii) Factors
that maintain the behavior;
3. Include the development of a behavioral
support plan, which shall:
a. Be developed by
the behavioral specialist;
b. Not
be implemented by the behavior specialist who wrote the plan;
c. Be revised as necessary;
d. Define the techniques and procedures
used;
e. Include the hierarchy of
behavior interventions ranging from the least to the most
restrictive;
f. Reflect the use of
positive approaches; and
g.
Prohibit the use of:
(i) Prone or supine
restraint;
(ii) Corporal
punishment;
(iii)
Seclusion;
(iv) Verbal abuse;
and
(v) Any procedure which denies
private communication, requisite sleep, shelter, bedding, food, drink, or use
of a bathroom facility;
4. Include the provision of training to other
ABI providers concerning implementation of the behavioral intervention
plan;
5. Include the monitoring of
a participant's progress, which shall be accomplished through:
a. The analysis of data concerning the
behavior's:
(i) Frequency;
(ii) Intensity; and
(iii) Duration; and
b. Reports involved in implementing the
behavioral service plan;
6. Be provided by a behavior specialist who
shall:
a. Be:
(i) A psychologist;
(ii) A psychologist with autonomous
functioning;
(iii) A licensed
psychological associate;
(iv) A
psychiatrist;
(v) A licensed
clinical social worker;
(vi) A
clinical nurse specialist with a master's degree in psychiatric nursing or
rehabilitation nursing;
(vii) An
advanced practice registered nurse;
(viii) A board certified behavior analyst;
or
(ix) A licensed professional
clinical counselor; and
b. Have at least one (1) year of behavior
specialist experience or provide documentation of completed coursework
regarding learning and behavior principles and techniques; and
7. Be documented by a detailed
staff note in the MWMA which shall include:
a.
The date of the service;
b. The
beginning and ending time;
c. The
signature and title of the behavioral specialist; and
d. A summary of data analysis and progress of
the individual related to the approved person-centered service plan;
(c) Community living
supports, which shall:
1. Be provided in
accordance with the participant's person-centered service plan, including:
a. A nonmedical service;
b. Supervision; or
c. Socialization;
2. Include assistance, prompting, observing,
or training in activities of daily living;
3. Include activities of daily living which
shall include:
a. Bathing;
b. Eating;
c. Dressing;
d. Personal hygiene;
e. Shopping; and
f. Money management;
4. Include prompting, observing, and
monitoring of medications and nonmedical care not requiring a nurse or
physician intervention;
5. Include
socialization, relationship building, and participation in community activities
according to the approved person-centered service plan which are therapeutic
and not diversional in nature;
6.
Accompany and assist a participant while utilizing transportation
services;
7. Include documentation
in a detailed staff note in the MWMA which shall include the:
a. Progress toward goals and objectives
identified in the approved person-centered service plan;
b. Date of the service;
c. Beginning and ending time; and
d. Signature and title of the individual
providing the service;
8. Not be provided to a participant who
receives community residential services; and
9. Be provided by a:
a. Home health agency licensed and operating
in accordance with
902 KAR 20:081;
b. Community mental health center licensed
and operating in accordance with
902 KAR 20:091;
c. Community habilitation program certified
at least annually by the department; or
d. Supervised residential care setting
certified at least annually by the department;
(d) Supervised residential care level I,
which:
1. Shall be provided by:
a. A community mental health center licensed
and operating in accordance with
902 KAR 20:091 and certified at
least annually by the department; or
b. An approved waiver provider certified at
least annually by the department;
2. Shall not be provided to a participant
unless the participant has been authorized to receive residential care by the
department's residential review committee which shall:
a. Consider applications for residential care
in the order in which the applications are received;
b. Base residential care decisions on the
following factors:
(i) Whether the applicant
resides with a caregiver or not;
(ii) Whether the applicant resides with a
caregiver but demonstrates maladaptive behavior which places the applicant at
significant risk of injury or jeopardy if the caregiver is unable to
effectively manage the applicant's behavior or the risk it poses, resulting in
the need for removal from the home to a more structured setting; or
(iii) Whether the applicant demonstrates
behavior which may result in potential legal problems if not
ameliorated;
c. Be
comprised of three (3) Cabinet for Health and Family Services employees:
(i) With professional or personal experience
with brain injury or other cognitive disabilities; and
(ii) Two (2) of whom shall not be supervised
by the manager of the acquired brain injury branch; and
d. Only consider applications for a monthly
committee meeting which were received no later than the close of business the
day before the committee convenes;
3. Shall not have more than three (3)
participants simultaneously in a home rented or owned by the ABI
provider;
4. Shall provide
twenty-four (24) hours of supervision daily unless the provider implements,
pursuant to subparagraph 5. of this paragraph, an individualized plan allowing
for up to five (5) unsupervised hours per day;
5. May include the provision of up to five
(5) unsupervised hours per day per participant if the provider develops an
individualized plan for the participant to promote increased independence which
shall:
a. Contain provisions necessary to
ensure the participant's health, safety, and welfare;
b. Be approved by the participant's treatment
team, with the approval documented by the provider; and
c. Contain periodic reviews and updates based
on changes, if any, in the participant's status;
6. Shall include assistance and training with
daily living skills including:
a.
Ambulating;
b. Dressing;
c. Grooming;
d. Eating;
e. Toileting;
f. Bathing;
g. Meal planning;
h. Grocery shopping;
i. Meal preparation;
j. Laundry;
k. Budgeting and financial matters;
l. Home care and cleaning;
m. Leisure skill instruction; or
n. Self-medication instruction;
7. Shall include social skills
training including the reduction or elimination of maladaptive behaviors in
accordance with the individual's person-centered service plan;
8. Shall include provision or arrangement of
transportation to services, activities, or medical appointments as
needed;
9. Shall include
accompanying or assisting a participant while the participant utilizes
transportation services as specified in the participant's person-centered
service plan;
10. Shall include
participation in medical appointments or follow-up care as directed by the
medical staff;
11. Shall be
documented by a detailed staff note in the MWMA which shall document:
a. Progress toward goals and objectives
identified in the approved person-centered service plan;
b. The date of the service;
c. The beginning and ending time of the
service; and
d. The signature and
title of the individual providing the service;
12. Shall not include the cost of room and
board;
13. Shall be provided to a
participant who:
a. Does not reside with a
caregiver;
b. Is residing with a
caregiver but demonstrates maladaptive behavior that places him or her at
significant risk of injury or jeopardy if the caregiver is unable to
effectively manage the behavior or the risk it presents, resulting in the need
for removal from the home to a more structured setting; or
c. Demonstrates behavior that may result in
potential legal problems if not ameliorated;
14. May utilize a modular home only if the:
a. Wheels are removed;
b. Home is anchored to a permanent
foundation; and
c. Windows are of
adequate size for an adult to use as an exit in an emergency;
15. Shall not utilize a motor
home;
16. Shall provide a sleeping
room which ensures that a participant:
a. Does
not share a room with an individual of the opposite gender who is not the
participant's spouse;
b. Does not
share a room with an individual who presents a potential threat; and
c. Has a separate bed equipped with
substantial springs, a clean and comfortable mattress, and clean bed linens as
required for the participant's health and comfort; and
17. Shall provide service and training to
obtain the outcomes for the participant as identified in the approved
person-centered service plan;
(e) Supervised residential care level II,
which shall:
1. Meet the requirements
established in paragraph (d) of this subsection except for the requirements
established in paragraph (d)4 and 5;
2. Provide twelve (12) to eighteen (18) hours
of daily supervision, the amount of which shall:
a. Be based on the participant's
needs;
b. Be approved by the
participant's treatment team; and
c. Be documented in the participant's
person-centered service plan which shall also contain periodic reviews and
updates based on changes, if any, in the participant's status; and
3. Include provision of
twenty-four (24) hour on-call support;
(f) Supervised residential care level III,
which shall:
1. Meet the requirements
established in paragraph (d) of this subsection except for the requirements
established in paragraph (d)4 and 5;
2. Be provided in a single family home,
duplex, or apartment building to a participant who lives alone or with an
unrelated roommate;
3. Not be
provided to more than two (2) participants simultaneously in one (1) apartment
or home;
4. Not be provided in more
than two (2) apartments in one (1) building;
5. If provided in an apartment building, have
staff:
a. Available twenty-four (24) hours per
day and seven (7) days per week; and
b. Who do not reside in a dwelling occupied
by a participant; and
6.
Provide less than twelve (12) hours of supervision or support in the home based
on an individualized plan developed by the provider to promote increased
independence which shall:
a. Contain
provisions necessary to ensure the participant's health, safety, and
welfare;
b. Be approved by the
participant's treatment team, with the approval documented by the provider;
and
c. Contain periodic reviews and
updates based on changes, if any, in the participant's status;
(g) Counseling
services, which:
1. Shall be designed to help
a participant resolve personal issues or interpersonal problems resulting from
the participant's ABI;
2. Shall
assist a family member in implementing a participant's approved person-centered
service plan;
3. In a severe case,
shall be provided as an adjunct to behavioral programming;
4. Shall include substance use or chemical
dependency treatment, if needed;
5.
Shall include building and maintaining healthy relationships;
6. Shall develop social skills or the skills
to cope with and adjust to the brain injury;
7. Shall increase knowledge and awareness of
the effects of an ABI;
8. May
include group counseling if the service is:
a.
Provided to a maximum of twelve (12) participants; and
b. Included in the participant's approved
person-centered service plan for:
(i)
Substance use or chemical dependency treatment;
(ii) Building and maintaining healthy
relationships;
(iii) Developing
social skills;
(iv) Developing
skills to cope with and adjust to a brain injury, including the use of
cognitive remediation strategies consisting of the development of compensatory
memory and problem solving strategies, and the management of impulsivity;
and
(v) Increasing knowledge and
awareness of the effects of the acquired brain injury upon the participant's
functioning and social interactions;
9. Shall be provided by:
a. A psychiatrist;
b. A psychologist;
c. A psychologist with autonomous
functioning;
d. A licensed
psychological associate;
e. A
licensed clinical social worker;
f.
A clinical nurse specialist with a master's degree in psychiatric
nursing;
g. An advanced practice
registered nurse;
h. A certified
alcohol and drug counselor;
i. A
licensed marriage and family therapist;
j. A licensed professional clinical
counselor;
k. A licensed clinical
alcohol and drug counselor associate effective and contingent upon approval by
the Centers for Medicare and Medicaid Services; or
l. A licensed clinical alcohol and drug
counselor effective and contingent upon approval by the Centers for Medicare
and Medicaid Services; and
10. Shall be documented by a detailed staff
note in the MWMA which shall include:
a.
Progress toward the goals and objectives established in the person-centered
service plan;
b. The date of the
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(h) Family training, which shall:
1. Provide training and counseling services
for the families of individuals served in the ABI long term care waiver.
Training to family or other responsible persons shall include:
a. Interpretation or explanation of medical
examinations and procedures;
b.
Treatment regimens;
c. Use of
equipment specified in the person-centered service plan; or
d. Advising how to assist the
participant;
2. Include
updates as needed to safely maintain the participant at home;
3. Include specified goals in the
participant's person-centered service plan;
4. Be training provided to family that may
include a person who:
a. Lives with, or
provides care to, a participant; and
b. Is a:
(i)
Parent;
(ii) Spouse;
(iii) Child;
(iv) Relative;
(v) Foster family; or
(vi) In-law;
5. Not include an individual who is employed
to care for the participant;
6. Be
provided by an approved ABI waiver provider that is certified at least annually
and which may include:
a. An occupational
therapist;
b. A certified
occupational therapy assistant;
c.
A licensed practical nurse;
d. A
physical therapist;
e. A physical
therapist assistant;
f. A
registered nurse;
g. A
speech-language pathologist;
h. A
psychiatrist;
i. A
psychologist;
j. A psychologist
with autonomous functioning;
k. A
licensed psychological associate;
l. A clinical nurse specialist with a
master's degree in:
(i) Psychiatric nursing;
or
(ii) Rehabilitative
nursing;
m. An advanced
practice registered nurse;
n. A
certified alcohol and drug counselor;
o. A licensed professional clinical
counselor;
p. A board certified
behavior analyst;
q. A licensed
clinical social worker;
r. A
licensed marriage and family therapist;
s. A licensed clinical alcohol and drug
counselor associate effective and contingent upon approval by the Centers for
Medicare and Medicaid Services; or
t. A licensed clinical alcohol and drug
counselor effective and contingent upon approval by the Centers for Medicare
and Medicaid Services; and
7. Be documented by a detailed staff note in
the MWMA which shall include:
a. Progress
toward the goals and objectives established in the person-centered service
plan;
b. The date of the
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(i) Nursing supports, which shall
include:
1.
a. A physician order to monitor medical
conditions; or
b. A physician order
for training and oversight of medical procedures;
2. The monitoring of specific medical
conditions;
3. Services that shall
be provided by:
a. A registered nurse who
meets the definition established in
KRS
314.011(5); or
b. A licensed practical nurse as defined by
KRS
314.011(9) who works under
the supervision of a registered nurse; and
4. Documentation by a detailed staff note in
the MWMA which shall include:
a. Progress
toward the goals and objectives established in the person-centered service
plan;
b. The date of the
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(j) Occupational therapy, which
shall be:
1. A physician-ordered evaluation
of a participant's level of functioning by applying diagnostic and prognostic
tests;
2. Physician-ordered
services in a specified amount and duration to guide a participant in the use
of therapeutic, creative, and self-care activities to assist the participant in
obtaining the highest possible level of functioning;
3. Provided by an occupational therapist or
an occupational therapy assistant if supervised by an occupational therapist in
accordance with
201 KAR 28:130; and
4. Documented by a detailed staff note in the
MWMA which shall include:
a. Progress toward
goals and objectives identified in the approved person-centered service
plan;
b. The date of the
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(k) A physical therapy service,
which shall be:
1. A physician-ordered
evaluation of a participant by applying muscle, joint, and functional ability
tests;
2. Physician-ordered
treatment in a specified amount and duration to assist a participant in
obtaining the highest possible level of functioning;
3. Training of another ABI provider to
improve the level of functioning of the participant in that provider's service
setting;
4. Provided by a physical
therapist or a physical therapist assistant supervised by a physical therapist
in accordance with
201 KAR 22:001 and
201 KAR 22:020; and
5. Documented by a detailed staff note in the
MWMA, which shall include:
a. Progress made
toward outcomes identified in the person-centered service plan;
b. The date of the service;
c. The beginning and ending time of the
service; and
d. The signature and
title of the individual providing the service;
(l) A respite service, which shall:
1. Be provided only to a participant unable
to administer self-care;
2. Be
provided by a:
a. Nursing facility;
b. Community mental health center;
c. Home health agency;
d. Supervised residential care
provider;
e. Adult day training
provider; or
f. Adult day health
care provider;
3. Be
provided on a short-term basis due to the absence or need for relief of a
non-paid primary caregiver;
4. Be
limited to 5,760 fifteen (15) minute units per one (1) year authorized
person-centered service plan period unless an individual's non-paid primary
caregiver is unable to provide care due to a:
a. Death in the family;
b. Serious illness; or
c. Hospitalization;
5. Not be provided to a participant who
receives supervised residential care;
6. Not include the cost of room and board if
provided in a nursing facility; and
7. Be documented by a detailed staff note in
the MWMA, which shall include:
a. Progress
toward goals and objectives identified in the approved person-centered service
plan;
b. The date of the
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(m) Speech-language pathology
services, which shall be:
1. A
physician-ordered evaluation of a participant with a speech, hearing, or
language disorder;
2. A
physician-ordered habilitative service in a specified amount and duration to
assist a participant with a speech and language disability in obtaining the
highest possible level of functioning;
3. Provided by a speech-language pathologist;
and
4. Documented by a detailed
staff note in the MWMA, which shall include:
a. Progress toward goals and objectives
identified in the approved person-centered service plan;
b. The date of the service;
c. The beginning and ending time;
and
d. The signature and title of
the individual providing the service;
(n) Adult day training services, which shall:
1. Be provided by:
a. An adult day training center that is
certified at least annually by the department;
b. An outpatient rehabilitation facility that
is licensed and operating in accordance with
902 KAR 20:190; or
c. A community mental health center licensed
and operating in accordance with
902 KAR 20:091;
2. Focus on enabling the
participant to attain or maintain the participant's maximum functional level
and reintegrate the participant into the community;
3. Not exceed a staffing ratio of five (5)
participants per one (1) staff person;
4. Include the following services:
a. Social skills training related to
problematic behaviors identified in the participant's person-centered service
plan;
b. Sensory or motor
development;
c. Reduction or
elimination of a maladaptive behavior;
d. Prevocational; or
e. Teaching concepts and skills to promote
independence including:
(i) Following
instructions;
(ii) Attendance and
punctuality;
(iii) Task
completion;
(iv) Budgeting and
money management;
(v) Problem
solving; or
(vi) Safety;
5. Be provided in a
nonresidential setting;
6. Be
developed in accordance with a participant's overall approved person-centered
service plan;
7. Reflect the
recommendations of a participant's person-centered team;
8. Be appropriate:
a. Given a participant's:
(i) Age;
(ii) Level of cognitive and behavioral
function; and
(iii)
Interest;
b. Given a
participant's ability prior to and after the participant's injury;
and
c. According to the approved
person-centered service plan and be therapeutic in nature and not
diversional;
9. Be
coordinated with the occupational, speech, or other rehabilitation therapy
included in a participant's person-centered service plan;
10. Provide a participant with an organized
framework within which to function in the participant's daily
activities;
11. Entail frequent
assessments of a participant's progress and be appropriately revised as
necessary; and
12. Be documented by
a detailed staff note in the MWMA, which shall include:
a. Progress toward goals and objectives
identified in the approved person-centered service plan;
b. The date of the service;
c. The beginning and ending time;
and
d. The signature and title of
the individual providing the service;
(o) Adult day health care services, which
shall:
1. Be provided by an adult day health
care center that is licensed and operating in accordance with
902 KAR 20:066; and
2. Include the following basic services and
necessities provided to a participant during the posted hours of operation:
a. Skilled nursing services provided by a
registered nurse or licensed practical nurse, including:
(i) Ostomy care;
(ii) Urinary catheter care;
(iii) Decubitus care;
(iv) Tube feeding;
(v) Venipuncture;
(vi) Insulin injections;
(vii) Tracheotomy care; or
(viii) Medical monitoring;
b. Meal service corresponding with
hours of operation with a minimum of one (1) meal per day and therapeutic diets
as required;
c. Snacks;
d. Supervision by a registered
nurse;
e. Daily activities that are
appropriate, given a participant's:
(i)
Age;
(ii) Level of cognitive and
behavioral function; and
(iii)
Interest; and
f. Routine
services that meet the daily personal and health care needs of a participant,
including:
(i) Monitoring of vital
signs;
(ii) Assistance with
activities of daily living; and
(iii) Monitoring and supervision of
self-administered medications, therapeutic programs, and incidental supplies
and equipment needed for use by a participant;
3. Include developing, implementing, and
maintaining nursing policies for nursing or medical procedures performed in the
adult day health care center;
4.
Focus on enabling the participant to attain or maintain the participant's
maximum functional level and reintegrate a participant into the community by
providing the following training:
a. Social
skills training related to problematic behaviors identified in the
participant's person-centered service plan;
b. Sensory or motor development;
c. Reduction or elimination of a maladaptive
behavior per the participant's person-centered service plan;
d. Prevocational services; or
e. Teaching concepts and skills to promote
independence including:
(i) Following
instructions;
(ii) Attendance and
punctuality;
(iii) Task
completion;
(iv) Budgeting and
money management;
(v) Problem
solving; or
(vi) Safety;
5. Be provided in a
nonresidential setting;
6. Be
developed in accordance with a participant's overall approved person-centered
service plan, therapeutic in nature, and not diversional;
7. Reflect the recommendations of a
participant's person-centered team;
8. Include ancillary services in accordance
with 907 KAR 1:023 if ordered by a
physician, physician assistant, or advanced practice registered nurse in a
participant's adult day health care plan of treatment. Ancillary services
shall:
a. Consist of evaluations or
reevaluations for the purpose of developing a plan that shall be carried out by
the participant or adult day health care center staff;
b. Be reasonable and necessary for the
participant's condition;
c. Be
rehabilitative in nature;
d.
Include:
(i) Physical therapy provided by a
physical therapist or physical therapist assistant;
(ii) Occupational therapy provided by an
occupational therapist or occupational therapy assistant; or
(iii) Speech-language pathology services
provided by a speech-language pathologist; and
e. Comply with the physical, occupational,
and speech-language pathology service requirements established in
907 KAR 1:030, Section
3;
9. Be provided to a
participant by the health team in an adult day health care center, which may
include:
a. A physician;
b. A physician assistant;
c. An advanced practice registered
nurse;
d. A registered
nurse;
e. A licensed practical
nurse;
f. An activities
director;
g. A physical
therapist;
h. A physical therapist
assistant;
i. An occupational
therapist;
j. An occupational
therapy assistant;
k. A
speech-language pathologist;
l. A
social worker;
m. A
nutritionist;
n. A health
aide;
o. An LPCC;
p. A licensed marriage and family
therapist;
q. A certified
psychologist with autonomous functioning; or
r. A licensed psychological
associate;
10. Be
provided pursuant to a plan of treatment and developed annually in accordance
with 902 KAR 20:066 and from
information in the MAP 351, Medicaid Waiver Assessment and revised as needed;
and
11. Be documented by a detailed
staff note in the MWMA, which shall include:
a. Progress toward goals and objectives
identified in the approved person-centered service plan;
b. The date of the service;
c. The beginning and ending time;
d. The signature and title of the individual
providing the service; and
e. A
monthly summary that assesses the participant's status related to the approved
person-centered service plan;
(p) Supported employment, which shall be:
1. Intensive, ongoing services for a
participant to maintain paid employment in an environment in which an
individual without a disability is employed;
2. Provided by a:
a. Supported employment provider;
b. Sheltered employment provider;
or
c. Structured day program
provider;
3. Provided
one-on-one;
4. Unavailable under a
program funded by either the Rehabilitation Act of 1973 (29 U. S. C. Chapter
16) or Pub.L.
99-457 (34 C.F. R. Parts 300 to 399), proof of
which shall be documented in the participant's file;
5. Limited to forty (40) hours per week alone
or in combination with adult day training or adult day health
services;
6. An activity needed to
sustain paid work by a participant receiving waiver services, including:
a. Supervision; and
b. Training;
7. Exclusive of work performed directly for
the supported employment provider; and
8. Documented by a time and attendance
record, which shall include:
a. Progress
toward the goals and objectives identified in the person-centered service
plan;
b. The date of
service;
c. The beginning and
ending time; and
d. The signature
and title of the individual providing the service;
(q) Specialized medical equipment
and supplies, which shall:
1. Include durable
and nondurable medical equipment, devices, controls, appliances, or ancillary
supplies;
2. Enable a participant
to increase his or her ability to perform daily living activities or to
perceive, control, or communicate with the environment;
3. Be ordered by a physician, documented in a
participant's person-centered service plan, entered into the MWMA by the
participant's case manager or support broker, and include three (3) estimates
if the equipment is needed for vision or hearing;
4. Include equipment necessary for the proper
functioning of specialized items;
5. Not be available through the department's
durable medical equipment, vision, or hearing programs;
6. Not be necessary for life
support;
7. Meet applicable
standards of manufacture, design, and installation; and
8. Exclude those items which are not of
direct medical or remedial benefit to a participant;
(r) Environmental and minor home adaptations,
which shall:
1. Be provided in accordance with
applicable state and local building codes;
2. Be provided to a participant if:
a. Ordered by a physician;
b. Prior-authorized by the ABIB;
c. Specified in the participant's approved
person-centered service plan and entered into the MWMA, by the participant's
case manager or support broker;
d.
Necessary to enable the participant to function with greater independence
within the participant's home; and
e. Without the modification, the participant
requires institutionalization;
3. Not include a vehicle
modification;
4. Be limited to no
more than $2,000 for a participant in a twelve (12) month period; and
5. If entailing:
a. Electrical work, be provided by a licensed
electrician; or
b. Plumbing work,
be provided by a licensed plumber;
(s) Assessment services, which shall:
1. Be a comprehensive assessment that shall
identify a participant's needs and the services that the participant's family
cannot manage or arrange for the participant;
2. Evaluate a participant's physical health,
mental health, social supports, and environment;
3. Be requested by an individual requesting
ABI services or a family or legal representative of the individual;
4. Be conducted by an ABI case manager or
support broker;
5. Be conducted
within seven (7) calendar days of receipt of the request for
assessment;
6. Include at least one
(1) face-to-face contact with the participant and, if appropriate, the
participant's family by the assessor in the participant's home; and
7. Not be reimbursable if the individual does
not receive a level of care certification; or
(t) Reassessment services, which shall:
1. Be performed at least every twelve (12)
months;
2. Be conducted using the
same procedures as for an assessment service;
3. Be conducted by an ABI case manager or
support broker and submitted to the department no more than three (3) weeks
prior to the expiration of the current level of care certification to ensure
that certification is consecutive;
4. Not be reimbursable if conducted during a
period that the participant is not covered by a valid level of care
certification; and
5. Not be
retroactive.