205.217 Long-term care case management demonstration.

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205.217 Long-term care case management demonstration. (1) As used in this section, unless the context requires otherwise: (a) &quot;Case manager&quot; means an employee of the area development district or an agency under contract with the area development district who shall assist any <br>functionally impaired person in identifying and accessing the long-term-care <br>services most appropriate to the individual's social and medical needs. (b) &quot;Functionally impaired person&quot; means any person who is unable to perform without assistance any of the activities of daily living including, but not <br>limited to dressing, bathing, toileting, transferring, or feeding, or any of the <br>instrumental activities of daily living including but not limited to meal <br>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 <br>coordinate all services provided or funded by the cabinet with respect to long-term <br>care, conducted in at least three (3) area development districts. This demonstration <br>program shall serve as the focal point for the provision of all services provided to <br>functionally impaired persons to assure that services are consistent with the <br>following goals: <br>(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 <br>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 <br>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 <br>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; <br>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 <br>are utilized. (3) The following programs and services shall be included in the Long-Term Care Case Management Demonstration Program: <br>(a) Hospital-based long-term-care services including dual-licensed beds, swing beds and physical rehabilitation services, skilled-nursing facility services, <br>intermediate-care-facility services, nursing-facility services, home-health <br>services, and home- and community-based waiver services funded by the <br>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 <br>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 <br>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 <br>persons using or applying for the services set forth in subsection (3) of this section, <br>and that the services are consistent with the goals set forth in subsection (2) of this <br>section. All persons applying for these services shall be assigned a case manager. <br>The duties of the case manager shall include preparation of a general plan of care, <br>based on the person's need for services, arranging placements or other needed <br>services or equipment, coordination and management of the applicant through the <br>eligibility process for these services, and reviewing each case on a periodic basis to <br>assure the plan of care is being followed. Case management shall not include the <br>determination of eligibility for Medicaid covered services, long-term-care facility <br>preadmission reviews, level-of-care determinations for purposes of Medicaid <br>reimbursement, or peer review activities. The general plan of care shall not replace <br>a daily care plan prescribed by a physician for treatment of a person in a hospital or <br>long-term-care facility or receiving home-health services. The general plan of care <br>shall identify the categories of services or type of placement required and the <br>providers of the services. Case managers shall serve as advocates for applicants for <br>the services set forth in subsection (3) of this section, and shall interact with the <br>existing administrative structure within the Cabinet for Health and Family Services <br>to meet the goals stated in subsection (2) of this section. Patients discharged from a <br>hospital to a long-term-care facility shall receive case management services in the <br>hospital on a timely basis or immediately after admission to a long-term-care <br>facility. The goal of each case plan shall be the provision of services in the least <br>restrictive setting designed to best meet the individual needs of the functionally <br>impaired person. When persons are determined to need services to maintain <br>independent living, but do not meet the financial or eligibility criteria for services, <br>case managers shall attempt to ensure that services are provided from community <br>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 <br>potentially in need of long-term-care services without regard to the person's income, <br>in order to assist functionally impaired persons in accessing available services. In <br>administering the Long-Term Care Demonstration Program, the cabinet shall <br>provide services to meet the needs of the minority elderly as identified by the <br>cabinet pursuant to KRS 205.201. The cabinet may charge a fee for providing <br>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 <br>ch. 426, sec. 190, effective July 15, 1998. -- Amended 1992 Ky. Acts ch. 246, sec. 4, <br>effective July 14, 1992. -- Created 1990 Ky. Acts ch. 482, sec. 28, effective July 13, <br>1990.