205.217 Long-term care case management demonstration. - Kentucky Statutes

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205.217 Long-term care case management demonstration. (1) As used in this section, unless the context requires otherwise: (a) "Case manager" means an employee of the area development district or an agency under contract with the area development district who shall assist any
functionally impaired person in identifying and accessing the long-term-care
services most appropriate to the individual's social and medical needs. (b) "Functionally impaired person" means any person who is unable to perform without assistance any of the activities of daily living including, but not
limited to dressing, bathing, toileting, transferring, or feeding, or any of the
instrumental activities of daily living including but not limited to meal
preparation, laundry, housecleaning, budgeting, and shopping. (2) There shall be established within the Cabinet for Health and Family Services a Long-Term Care Case Management Demonstration Program to consolidate and
coordinate all services provided or funded by the cabinet with respect to long-term
care, conducted in at least three (3) area development districts. This demonstration
program shall serve as the focal point for the provision of all services provided to
functionally impaired persons to assure that services are consistent with the
following goals:
(a) That functionally impaired persons be allowed to live independently at home or with others as long as the citizen desires without requiring inappropriate or
premature institutionalization; (b) That services provided or funded by the cabinet promote independent living by functionally impaired persons and prevent or minimize illness or social
isolation; (c) That institutional services be used only as a last resort when in-home or community-based support services are not available or are not adequate to
meet the needs of functionally impaired persons; (d) That a single entry point for all services for functionally impaired persons be available to all persons in need of information about or access to the services;
and (e) That the use of informal providers of care, such as friends and relatives of functionally impaired persons, be used as long as possible before paid services
are utilized. (3) The following programs and services shall be included in the Long-Term Care Case Management Demonstration Program:
(a) Hospital-based long-term-care services including dual-licensed beds, swing beds and physical rehabilitation services, skilled-nursing facility services,
intermediate-care-facility services, nursing-facility services, home-health
services, and home- and community-based waiver services funded by the
Kentucky Medical Assistance Program; (b) In-home and community-based services for elderly persons funded under the Older Americans Act (42 U.S.C. secs. 3001 et seq.) and Title XX of the Social
Security Act (42 U.S.C. secs. 1397-1397f); (c) Services provided under the home care program pursuant to KRS 205.460; and (d) Personal-care-home services or domiciliary care funded by supplemental payments to persons receiving supplemental security income benefits pursuant
to KRS 205.245. (4) The Long-Term Care Case Management Demonstration Program shall employ a system of case management to assure that appropriate services are provided to all
persons using or applying for the services set forth in subsection (3) of this section,
and that the services are consistent with the goals set forth in subsection (2) of this
section. All persons applying for these services shall be assigned a case manager.
The duties of the case manager shall include preparation of a general plan of care,
based on the person's need for services, arranging placements or other needed
services or equipment, coordination and management of the applicant through the
eligibility process for these services, and reviewing each case on a periodic basis to
assure the plan of care is being followed. Case management shall not include the
determination of eligibility for Medicaid covered services, long-term-care facility
preadmission reviews, level-of-care determinations for purposes of Medicaid
reimbursement, or peer review activities. The general plan of care shall not replace
a daily care plan prescribed by a physician for treatment of a person in a hospital or
long-term-care facility or receiving home-health services. The general plan of care
shall identify the categories of services or type of placement required and the
providers of the services. Case managers shall serve as advocates for applicants for
the services set forth in subsection (3) of this section, and shall interact with the
existing administrative structure within the Cabinet for Health and Family Services
to meet the goals stated in subsection (2) of this section. Patients discharged from a
hospital to a long-term-care facility shall receive case management services in the
hospital on a timely basis or immediately after admission to a long-term-care
facility. The goal of each case plan shall be the provision of services in the least
restrictive setting designed to best meet the individual needs of the functionally
impaired person. When persons are determined to need services to maintain
independent living, but do not meet the financial or eligibility criteria for services,
case managers shall attempt to ensure that services are provided from community
resources, family member, or volunteers. (5) The cabinet, through the Long-Term Care Demonstration Program, shall provide access to information, counseling, and screening as appropriate, for persons
potentially in need of long-term-care services without regard to the person's income,
in order to assist functionally impaired persons in accessing available services. In
administering the Long-Term Care Demonstration Program, the cabinet shall
provide services to meet the needs of the minority elderly as identified by the
cabinet pursuant to KRS 205.201. The cabinet may charge a fee for providing
information, counseling, and screening services based on the client's ability to pay. (6) The secretary for health and family services may promulgate administrative regulations necessary to implement the Long-Term Care Demonstration Program. Effective: June 20, 2005 History: Amended 2005 Ky. Acts ch. 99, sec. 223, effective June 20, 2005. -- Amended 2000 Ky. Acts ch. 6, sec. 23, effective July 14, 2000. -- Amended 1998 Ky. Acts
ch. 426, sec. 190, effective July 15, 1998. -- Amended 1992 Ky. Acts ch. 246, sec. 4,
effective July 14, 1992. -- Created 1990 Ky. Acts ch. 482, sec. 28, effective July 13,
1990.