906 KAR | Title 906 KAR — Cabinet for Health and Family Services

Chapter 1 Office of Inspector General

906 KAR 1:040 Blood establishment inspection {#sec-906-kar-1-040 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:040}

Section 1. Definitions. "Blood establishment" is defined in KRS 214.450(2).

Section 2. Annual Inspection. The Office of Inspector General shall conduct an annual inspection of all blood establishments to determine their compliance with KRS 214.450 to 214.464 and 214.468.

Section 3. Fees for Inspections. For inspections conducted by the Office of Inspector General to determine compliance with KRS 214.450 to 214.464 and 214.468, blood establishments shall pay an annual inspection fee in the amount of $100.

Section 4. Payment of Fees. The annual inspection fee shall be due and payable on January 1, 1997, and on January 1 of each succeeding year thereafter. A check for the amount of the fee shall be made payable to the Kentucky State Treasurer and sent to the Division of Licensing and Regulation, Office of Inspector General, Cabinet for Health Services, 275 East Main Street, Frankfort, Kentucky 40621.

Section 5. Enforcement Notification. If the Office of Inspector General (OIG) ascertains that a blood establishment is not meeting the requirements of this administrative regulation, the OIG shall inform the Office of the Attorney General of a potential violation of KRS 214.452 to 214.464.

History

RELATES TO: KRS 216B.010-216B.055, 333.120, 21 C.F.R. Chapter 1, Part 601
STATUTORY AUTHORITY: KRS 214.020, 214.450-214.464, 214.468, 214.990(7), EO 96-862
NECESSITY, FUNCTION, AND CONFORMITY: KRS 214.452 mandates that the Cabinet for Health Services promulgate administrative regulations to establish fees for the cost of regular inspections of all blood establishments to determine their compliance with KRS 214.450 to 214.464 and 214.468. KRS 214.452(1) requires blood establishments to be licensed by the United States Food and Drug Administration. Federal regulation 21 CFR Chapter 1, Part 601, does not require Kentucky to conduct the federal inspection required for licensure. This administrative regulation does not conflict with those federal requirements because its purpose is to establish fees for the cost of inspections necessary to determine compliance with KRS 214.450 to 214.464 and 214.468. Executive Order 96-862, effective July 2, 1996, reorganizes the Cabinet for Human Resources and places the Office of Inspector General and its Programs under the Cabinet for Health Services.
History: 15 Ky.R. 767; eff. 11-4-1988; 23 Ky.R. 2320; eff. 12-18-1996; Crt eff. 4-30-2019; Crt eff. 4-21-2026.

906 KAR 1:100 Nurse aide abuse registry, home health aide abuse registry, and hearing procedures {#sec-906-kar-1-100 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:100}

Section 1. Definitions.

(1) "Abuse" means the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish and includes physical abuse, verbal abuse, sexual abuse, and mental abuse.

(2) "Abuse registry" means a computerized listing of nurse aides certified under 907 KAR 1:450 and home health aides who have had a final order issued by the Secretary of the Cabinet for Health and Family Services substantiating resident or patient neglect, abuse, or misappropriation of a resident's or patient's property, or who have failed to request or perfect an appeal following a preliminary determination of resident or patient neglect, abuse, or misappropriation of a resident's or patient's property.

(3) "Cabinet" means the Cabinet for Health and Family Services.

(4) "Certified" means a nurse aide has satisfactorily completed all course work and clinical skills training and passed all examinations required for certification under 907 KAR 1:450.

(5) "Home health agency" is defined by KRS 216. 935.

(6) "Home health aide" is defined by KRS 216.935.

(7) "Misappropriation of a resident's or patient's property" means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use, of a resident's or patient's belongings or money without the resident's or patient's consent.

(8) "Neglect" means failure to provide goods or services that are necessary to avoid physical harm, mental anguish, or mental illness, but does not include a failure caused by factors beyond the control of the individual.

(9) "Nurse aide" is defined by KRS 216.935.

(10) "Nursing facility" means a facility that is licensed under 902 KAR 20:300 or 902 KAR 20:026.

(11) "Secretary" means the Secretary of the Cabinet for Health and Family Services.

(12) "Willful" means the voluntary, conscious decision to do the act which the law forbids, but does not require specific intent to cause harm, pain, or mental anguish.

Section 2. Abuse Registry and Preliminary Determination.

(1) The cabinet shall establish and maintain accountability of an abuse registry that includes the listing of nurse aides and home health aides who have had a final order issued by the secretary of the cabinet substantiating resident or patient abuse, neglect, or misappropriation of a resident's or patient's property, or who have failed to appeal following a preliminary finding of resident or patient neglect, abuse, or misappropriation of a resident's or patient's property. The registry shall include the information specified in Section 4 of this administrative regulation.

(2) If the cabinet makes a preliminary determination that a nurse aide working in a nursing facility or a home health aide employed by a home health agency has committed neglect or abuse or has misappropriated a resident's or patient's property, the cabinet shall notify in writing by certified mail within ten (10) working days of the completion of the cabinet's investigation:

(a) If a nurse aide, the nurse aide and the current administrator of the facility in which the nurse aide was employed when the incident occurred;

(b) If a home health aide, the home health aide and the home health agency that employed the home health aide.

(3) The notice to the nurse aide or home health aide shall include:

(a) The preliminary determination establishing the nature of the allegation, the date and time of occurrence, and a summary of the evidence that led the cabinet to conclude the allegation is valid;

(b) An opportunity to make a written response that shall be maintained with the abuse registry along with the cabinet's findings;

(d) A statement that the preliminary determination of neglect, abuse, or misappropriation of a resident's or patient's property shall be reported on the abuse registry within ten (10) working days of the date the finding becomes final; and

(e) A statement that the preliminary determination shall become final when:

The secretary issues the final order after an administrative hearing;
The nurse aide or home health aide fails to file a written request for hearing with the secretary on or before thirty (30) days after the notice was mailed; or
Fails to appeal.

Section 3. Administrative Hearing.

(1) A nurse aide or home health aide who has received a preliminary determination of neglect, abuse, or misappropriation of a resident's or patient's property may appeal the finding and request an administrative hearing.

(2) The appeal and request for administrative hearing shall be made in writing and filed with the secretary within thirty (30) calendar days of the date the notice of preliminary finding is mailed to the nurse aide or home health aide. If a request for hearing is not filed or if the appeal is not timely filed, the preliminary determination shall become final, and the individual's name shall be placed on the abuse registry within ten (10) working days of the expiration of the appeal time.

(3) Upon receipt of a request for hearing, the cabinet shall appoint a hearing officer to preside over the matter appealed. The hearing officer shall:

(a) Notify the appellant of the scheduled hearing and the right to have counsel present in accordance with KRS Chapter 13B;

(b) Conduct the administrative hearing in accordance with KRS Chapter 13B;

(c) Issue proposed findings of fact, conclusions of law, and a recommended decision within sixty (60) days after the last day of testimony or the adjournment of the hearing, whichever occurs first; and

(d) Include a finding that the preliminary determination is substantiated or not substantiated based on the law and evidence of record.

(4) A party who disagrees with the hearing officer's proposed findings of fact, conclusions of law, and recommended decision may tender written exceptions that shall:

(a) Be filed with the secretary within fifteen (15) days from the date the proposed findings of fact, conclusions of law, and recommended decision was mailed;

(b) Specify all facts and conclusions of law that are in dispute; and

(5) The secretary shall issue the final decision of the cabinet within fifteen (15) calendar days of receipt of exceptions if exceptions are filed or within fifteen (15) calendar days of the date exceptions were due if exceptions are not filed.

(6) A party who has exhausted administrative remedies may appeal the final order to the circuit court by filing a petition for review within thirty (30) calendar days after the final order of the agency is mailed or delivered by personal service.

Section 4. Reporting Requirements and Abuse Registry Content.

(1) If the nurse aide or home health aide fails to appeal a preliminary determination, or if a final order is issued substantiating neglect, abuse, or misappropriation of a resident's or patient's property, the cabinet shall place the individual's name and adverse findings on the abuse registry within ten (10) working days of the last date to appeal or issuance of the final order and shall include:

(a) A summary statement, if any, by the individual disputing the findings, which shall be disclosed in response to inquiries made to the registry;

(b) Documentation of the investigation, including a summary of evidence that led to the finding of neglect, abuse, or misappropriation of a resident's or patient's property; and

(2) If the nurse aide or home health aide fails to appeal, or if the final order substantiates neglect, abuse, or misappropriation of a resident's or patient's property, the cabinet shall report the findings in writing within ten (10) working days of the final date to appeal or issuance of the final order to:

(a) The individual against whom the decision has been made;

(b)

The home health agency that employed the home health aide on the date the incident occurred; or
The administrator of the nursing facility in which the incident occurred; and

(c) If known, the administrator of the nursing facility or home health agency currently employing the nurse aide or home health aide.

(3) If the cabinet's preliminary determination of neglect, abuse, or misappropriation of a resident's or patient's property is not substantiated in the hearing process, the cabinet shall:

(a) Not place the individual's name on the registry; and

(b) Send notification to the individual that the preliminary finding is not substantiated.

Section 5. Review of Prior Findings.

(1) A nurse aide or home health aide whose name was added to the abuse registry after January 1, 1995 may petition the cabinet to review the finding of nurse aide or home health aide neglect after the passage of one (1) year from the date that the nurse aide's or home health aide's name was placed on the abuse registry.

(2) The nurse aide or home health aide petitioning the cabinet to have his name removed from the abuse registry shall submit a written request for review of the finding to the cabinet.

(3) The cabinet secretary shall make the determination to remove the name from the abuse registry if the nurse aide or home health aide proves:

(a) The employment and personal history of the nurse aide or home health aide does not reflect a pattern of abusive behavior, neglect or misappropriation of property; and

(b) The neglect involved in the finding which resulted in the name of the nurse aide or home health aide being added to the abuse registry was a singular occurrence.

(4) If the cabinet does not remove the nurse aide's or home health aide's name from the abuse registry upon consideration of the grounds stated in the petition for review, the nurse aide or home health aide may request a hearing within thirty (30) days of notification of the cabinet's decision. The hearing shall be conducted pursuant to KRS Chapter 13B and shall follow the hearing procedure established in Section 3 of this administrative regulation.

History

RELATES TO: KRS 13B.005-13B.070, 194A.030(1)(c), 216.532, 216.935, 216.937, 314.025, 42 C.F.R. 488.301
STATUTORY AUTHORITY: KRS 13B.170, 216.936, 216.939, 42 C.F.R. 483.75, 483.150-.158, 488.335, 42 U.S.C. 1395I-3(g)(1)(d), 1396r(g)(1)(d)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.936 requires the Cabinet for Health and Family Services to establish an abuse registry to include findings of resident and patient abuse, neglect, and misappropriation of a resident's or patient's property by a nurse aide or home health aide. KRS 216.939 requires the cabinet to promulgate administrative regulations that establish the abuse registry and appeals process. 42 C.F.R. 483.156(a) requires the Cabinet for Health and Family Services, as part of its agreement with the Centers for Medicare and Medicaid Services, to establish and maintain a nurse aide registry. This administrative regulation establishes the procedures for placing a nurse aide or home health aide on the abuse registry and an administrative appeals process to provide due process to an aide against whom a charge is brought.
History: 906 KAR 001:100. 18 Ky.R. 2083; 2581; eff. 3-7-1992; 22 Ky.R. 2174; eff. 7-5-1996; 30 Ky.R. 1106; 1519; eff. 1-5-2004; 32 Ky.R. 2380; 33 Ky.R. 418; eff. 9-1-2006; Crt eff. 1-11-2019; Crt eff. 12-1-2025.

906 KAR 1:110 Critical access hospital services {#sec-906-kar-1-110 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:110}

Section 1. Definitions.

(1) "Cabinet" is defined by KRS 216B.015(6).

(2) "Licensee" means the entity that has been issued and holds a valid critical access hospital license from the cabinet.

Section 2. Requirements for Critical Access Status.

(1) An applicant for initial licensure of a critical access hospital shall provide documentation to the cabinet verifying that the hospital:

(a) Complies with the requirements of KRS 216.380 and this administrative regulation ; and

(b) Qualifies for state designation under 42 U.S.C. 1395i-4(c)(2).

(2) In accordance with 42 U.S.C. 1395i-4(c)(2)(B), a critical access hospital that was certified by the secretary of the cabinet as a necessary provider of services prior to January 1, 2006, may be relicensed as a critical access hospital if the requirements of this administrative regulation are met.

(3)

(a) If an application for initial licensure of a critical access hospital is denied by the cabinet, the applicant shall be entitled to an administrative hearing pursuant to KRS 216B.040(1)(c) and (2)(b), and KRS 216B.105.

(b) Licensure hearings shall follow the procedures established by 900 KAR 6:040.

Section 3. Administration and Operation.

(1) The licensee shall be legally responsible for the operation of the critical access hospital and for compliance with federal, state, and local laws and administrative regulations pertaining to the operation of the critical access hospital.

(2) A critical access hospital shall be under the medical direction of a physician licensed to practice medicine or osteopathy in Kentucky.

(3) The licensee shall:

(a) Establish written policies and lines of authority; and

(b) Designate an administrator as the person principally responsible for the daily operation of the critical access hospital.

(4) The licensee shall develop patient care policies with the advice of a group of healthcare professionals identified by the licensee.

(a) Pursuant to 42 C.F.R. 485.635(a)(2), the advisory group shall include:

At least one (1) Kentucky-licensed doctor of medicine or doctor of osteopathic medicine; and
One (1) or more physician assistants, advanced registered nurse practitioners, or clinical nurse specialists.

(b) The patient care policies shall include:

A description of services that the critical access hospital furnishes, including services provided through a contractual agreement;
A written program narrative describing in detail the:

a. Services offered;

b. Methods and protocols for service delivery;

c. Qualifications of personnel involved in the delivery of services; and

d. Outcomes expected to be attained through the delivery of specified services;

Guidelines for the medical management of health problems, including:

a. Criteria for determining if a case requires medical consultation;

b. Patient referral procedures; and

c. Maintenance of health records;

Procedures for the proper storage, handling, and administration of drugs and biologicals;
Procedures establishing annual review and evaluation of services provided;
Procedures that assure compliance with KRS 216B.165 ; and
A surgical smoke safety and control policy that shall be available to staff if the hospital offers any surgical procedure that is likely to produce surgical smoke.

(5) A critical access hospital shall establish written policies regarding patient rights and responsibilities to assure that each patient is:

(a) Informed of:

Patient rights;
Rules and regulations governing patient conduct and responsibilities; and
The procedure for handling a patient grievance;

(b) Informed of services available and related charges, including charges not covered by Medicare, Medicaid, or other third-party payor;

Medical condition, unless medically contraindicated as documented in the patient's medical record;
Right to participate in planning his or her medical treatment; and
Right to refuse to participate in experimental research;

(d) Assisted in understanding his or her patient rights;

(e) Provided confidential treatment of his or her records in accordance with subsection (9) of this section;

(f) Treated with consideration, respect, and recognition of the patient's dignity and individuality, including privacy in treatment and care of personal health needs; and

(g) Informed of the procedure for filing a grievance or a recommendation to change a policy or service. The policy shall establish a time frame within which critical access hospital personnel shall determine what corrective action to take.

(6) Personnel.

(a) Staffing shall be maintained in accordance with KRS 216.380(9).

(b) A physician shall:

Be responsible for all medical aspects of the critical access hospital;
Provide direct medical services in accordance with KRS Chapter 311;
Be present to provide medical direction, supervision, and consultation to staff at least once in every two (2) week period, unless no patient has been treated since the last visit;
Participate with other medical personnel in developing, executing, and periodically reviewing written policies and services;
Review and sign patient records during the site visit; and
Provide medical orders and medical care services to patients in accordance with the critical access hospital's protocols.

(7) The critical access hospital shall have transfer and linkage contracts in accordance with KRS 216.380(11) and (12).

(8) Medical records.

(a) A critical access hospital shall maintain a complete, comprehensive, accurate, and legible medical record for each patient. The record shall include the following information:

The names of the patient's immediate family members;
Medical and social history, including information obtainable from other providers;
Description of each medical visit or contact, including:

a. Condition or reason necessitating visit or contact;

b. Assessment;

c. Diagnosis;

d. Services provided;

e. Medications and treatments prescribed; and

f. Disposition made;

Reports of laboratory, x-ray, and other test findings; and
Documentation of referrals, including:

a. Reason for the referral;

b. To whom patient was referred; and

c. Information obtained from the referral source.

(b) Confidentiality of individual patient records shall be maintained in accordance with subsection (9)(b) of this section.

Establish systematic procedures to assist with continuity of care if a patient transfers to another licensed level of care; and
Upon proper release, transfer medical records or an abstract upon request.

(d) Retention of records. Medical records shall be retained for at least:

Six (6) years from the date of discharge; or
If the patient is a minor, three (3) years after the patient reaches the age of majority under state law, whichever is the longest.

(9)

(a) Ownership.

Medical records shall be the property of the critical access hospital.
The original medical record shall not be removed from the critical access hospital except by court order or subpoena.
Copies of a medical record or portions of the record may be used and disclosed. Use and disclosure shall be as established by paragraph (b) of this subsection.

(b) Confidentiality and Security: Use and Disclosure.

The critical access hospital shall maintain the confidentiality and security of medical records in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164, as amended, including the security requirements mandated by subparts A and C of 45 C.F.R. Part 164, or as provided by applicable federal or state law.
The critical access hospital may use and disclose medical records. Use and disclosure shall be as established or required by HIPAA, 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164, or as established in this administrative regulation.
A critical access hospital may establish higher levels of confidentiality and security than required by HIPAA, 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164.

(10) Utilization review and medical audit. In order to determine the appropriateness of services delivered, there shall be a written plan for utilization review that specifies the frequency of reviews and composition of the body conducting the review.

(11) Quality assessment and performance improvement program.

(a) Pursuant to KRS 216.380(10), a critical access hospital shall have a program to ensure continuous and effective mechanisms for:

Review and evaluation of patient care; and
Corrective action.

(b) The quality assessment and performance improvement program shall:

Be approved by the licensee;
Establish responsibility for the monitoring and evaluation of services;
Delineate the scope of care;
Identify specific aspects of care to be provided;
Establish and document clinical criteria used to monitor care and services;
Systematically evaluate the standard of care to identify problems and recommend corrective action or alternatives to improve the standard of care;
Establish criteria to assess the effectiveness of corrective action taken to improve care; and
Require documentation of improvements in the standard of care subsequent to corrective action taken.

(12) Contract[ services. The critical access hospital shall assure that a service provided under contract is properly licensed or certified in accordance with applicable local, state, and federal regulations and statutes.

Section 4. Provision of Services.

(1) A critical access hospital shall provide services in accordance with KRS 216.380(5).

(2) Laboratory services.

(a) A critical access hospital shall provide basic laboratory services essential to the immediate diagnosis and treatment of each patient.

(b) If the critical access hospital provides laboratory services directly, the hospital shall comply with 902 KAR 20:016, Section 4(4).

(c) If the critical access hospital contracts for laboratory services, the laboratory shall be licensed pursuant to KRS 333.030.

(d) The following services shall be provided:

Chemical examination of urine, including ketone measurement, by stick or tablet method, or both;
Microscopic examination of urine sediment;
Hemoglobin or hematocrit;
Blood glucose;
Examination of stool specimens for occult blood;
Pregnancy tests; and
Primary culturing for transmittal to a hospital laboratory or licensed laboratory.

(3) Emergency services.

(a) A critical access hospital shall:

Provide medical emergency procedures as a first response to common life-threatening injuries and acute illness;
Have available drugs and biologicals commonly used in life-saving procedures, such as analgesics, local anesthetics, antibiotics, anticonvulsants, antidotes and emetics, serums and toxoids; and
Provide examination services in accordance with 902 KAR 20:012.

(b) There shall be a physician, nurse practitioner, or physician assistant with training or experience in emergency care:

On-call and immediately available by telephone or radio contact; and
Available on site within thirty (30) minutes on a twenty-four (24) hour per-day basis.

(c) A registered nurse shall be on duty at the hospital to provide immediate emergency care on a twenty-four (24) hour per day basis.

(4) Pharmacy services.

(a) In accordance with KRS 216.380(5)(b), a critical access hospital shall provide basic pharmacy services essential to the treatment of the patient.

(b) If the critical access hospital provides pharmacy services directly, the hospital shall comply with 902 KAR 20:016, Section 4(5).

(c) If the critical access hospital contracts for pharmacy services, the pharmacy shall have a permit to operate in accordance with KRS 315.035.

(5) Radiology services.

(a) In accordance with KRS 216.380(5)(b), a critical access hospital shall provide basic radiology services essential to the immediate diagnosis and treatment of the patient.

(b) If the critical access hospital provides radiology services directly, the hospital shall comply with 902 KAR 20:016, Section 4(6).

(c) If the critical access hospital contracts for radiology services, the radiology facility shall be currently licensed or registered pursuant to KRS 211.842 to 211.852.

(6) Dietary services. Pursuant to KRS 216.380(5)(b), the critical access hospital shall provide dietary services directly or by contract in accordance with 902 KAR 20:016, Section 4(3) to each patient who is admitted to the hospital and remains for more than twelve (12) hours.

(7) Psychiatric units. A critical access hospital that provides inpatient psychiatric services in a distinct part unit in accordance with KRS 216.380(7)(a) shall comply with 902 KAR 20:180.

(8) Rehabilitation units. A critical access hospital that provides inpatient rehabilitation services in a distinct part unit in accordance with KRS 216.380(7)(b) shall comply with the requirements of 902 KAR 20:240.

(9) Surgical services.

(a) If a critical access hospital provides surgical services, the hospital shall comply with 42 C.F.R. 485.639.

(b)

In accordance with KRS 216B.153, a critical access hospital that utilizes an energy-generating device shall make use of a smoke evacuation system:

a. That effectively captures and neutralizes surgical smoke at the site of origin and before the smoke can make ocular contact or contact with the respiratory tract of the occupants of the room; and

b. During any surgical procedure that is likely to produce surgical smoke.

The cabinet shall impose fines in accordance with KRS 216B.990(8) for each violation of noncompliance with KRS 216B.153 only if the violation has not been remedied after the hospital has had an opportunity to correct the violation through the filing of a plan of correction in accordance with 902 KAR 20:008, Section 2(13).

Section 5. Physical and Sanitary Environment. A critical access hospital shall maintain the condition of the physical plant and hospital's overall environment in accordance with 902 KAR 20:016, Section 3(10).

Section 6. Facility Requirements. A critical access hospital shall comply with the applicable structural specifications and physical plant requirements established by 902 KAR 20:009 for services offered.

History

RELATES TO: KRS 205.639(3), 211.842-211.852, 216.378, 216.379, 216.380, 216B.015(6), 216B.040(1)(c), (2)(b), 216B.105, 216B.153, 216B.165, 216B.990, Chapter 311, 315.035, 333.030, 42 C.F.R. 485.601-42 C.F.R. 485.647, 45 C.F.R. Part 160, Part 164, 42 U.S.C. 1320d-2—1320d-8, 42 U.S.C. 1395i-4(c)(2)
STATUTORY AUTHORITY: KRS 216.380(14), 216B.042(1)(a), (c)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.380(14) requires the Cabinet for Health and Family Services to promulgate administrative regulations necessary to implement a program for the licensure of critical access hospitals. KRS 216B.042(1)(a) and (c) require the cabinet to promulgate administrative regulations necessary for the proper administration of the licensure function and to establish licensure standards and procedures to ensure safe, adequate, and efficient health facilities and health services. This administrative regulation establishes quality of care and licensure standards for critical access hospitals.
History: 18 Ky.R. 3562; 19 Ky.R. 424; eff. 8-28-1992; 25 Ky.R. 2979; 26 Ky.R. 398; eff. 8-16-1999; 27 Ky.R. 1624; 2173; eff. 2-1-2001; 32 Ky.R. 2380; 33 Ky.R. 418; eff. 7-24-2006; Crt eff. 1-11-2019; 48 Ky.R. 2302, 3010; eff. 8-25-2022.

906 KAR 1:120 Informal dispute resolution {#sec-906-kar-1-120 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:120}

Section 1. Definitions.

(1) "CMS" means the Centers for Medicare and Medicaid Services.

(2) "Deficiency" means a failure to meet either a state licensure requirement or a federal requirement for participation in the Medicare or Medicaid Program.

(3) "Enforcement action" means a remedy applied to effect prompt compliance by a provider with program requirements.

(4) "IDR" means informal dispute resolution.

(5) "IDR coordinator" means a CMS-certified surveyor employed by the Office of Inspector General, Division of Long-term Care, designated by the Director of the Division of Long-term Care to serve as the IDR coordinator.

(6) "Immediate jeopardy" is defined in 42 C.F.R. 488.301.

(7) "Inspector general" means the inspector general or his designee.

(8) "Plan of correction" means a description of actions by a provider to correct a deficiency.

(9) "Provider" means a "long-term care facility" as defined in KRS 216.510.

(10) "Scope and severity assessment" means the letter designation assigned to a federal deficiency to represent the level of:

(a) Actual or potential impact to resident outcome; and

(b) Number of residents affected.

(11) "Statement of deficiencies" means the written notification to the provider describing how the provider fails to meet regulatory requirements.

(12) "Substandard quality of care" is defined in 42 C.F.R. 488.301.

Section 2. Request for Informal Dispute Resolution.

(1) A provider shall have one (1) opportunity to informally dispute a cited deficiency or scope and severity assessment that constitutes substandard quality of care or immediate jeopardy.

(2) The provider requesting an informal dispute resolution shall select one (1) of the following appropriate formats:

(a) A desk review which shall be available for a cited deficiency;

(b) A telephone conference review which shall be available for a cited deficiency; or

A cited deficiency with a scope and severity assessment of G, H, I, J, K, or L;
A cited deficiency with a scope and severity assessment that constitutes a substandard quality of care;
A cited deficiency that results in an enforcement action by the Cabinet for Health Services;
A federal deficiency cited at the condition level; or
A disputed deficiency cited in conjunction with a deficiency qualifying for a panel review.

(3) A provider may request IDR upon receipt of the statement of deficiencies.

(4) A request shall be in writing and shall:

(a) Specify the deficiency in dispute;

(b) Explain and provide a detailed basis for the dispute; and

(5) Unless the provider requests a five (5) calendar day extension pursuant to paragraph (c) of this subsection, documentation in support of the provider's position shall be attached to the request.

(a) A provider requesting a panel review IDR shall submit five (5) copies of the required documentation and shall:

Highlight or otherwise mark specific information pertinent to the disputed deficiency; and
Annotate with the specific state licensure deficiency or federal deficiency in dispute.

(b) A provider requesting a desk or telephone conference review shall submit two (2) copies of the required documentation and shall:

Highlight or otherwise mark specific information pertinent to the disputed deficiency; and
Annotate with the specific state licensure deficiency or federal deficiency in dispute.

(c) A provider may request an additional five (5) calendar days to provide documentation in support of their position by attaching a statement requesting the five (5) calendar day extension to the request for IDR.

(d) Documentation not submitted at the time of the request for IDR, or within a requested five (5) calendar day extension, shall not be reviewed.

(6) The request and attachments shall be delivered, on or before the mandated return date for the plan of correction, to the IDR coordinator at the Office of Inspector General, Division of Long-term Care, CHR Building, 275 East Main Street, 5E-A, Frankfort, Kentucky 40621.

(7) A request for IDR shall not delay an enforcement action.

Section 3. Review Process.

(1) The IDR coordinator shall receive and review each request for an IDR, and:

(a) Conduct a desk review, if requested by the provider;

(b) Schedule a telephone conference review, if appropriate and requested by the provider; or

(2) If a desk review is conducted the IDR coordinator shall:

(a) Review documentation submitted by the provider; and

(b) Make a recommendation to the inspector general to:

Uphold the cited deficiency;
Modify the cited deficiency by deleting a finding;
Modify the cited deficiency by lowering the scope and severity determination;
Modify the cited deficiency by changing the tag number; or
Delete the cited deficiency.

(3) If a telephone conference review is conducted, the IDR coordinator shall:

(a) Review documentation submitted by the provider;

(b) Conduct a telephone conference call with the provider to:

Receive verbal comments relating to the disputed deficiency; and
Seek answers to questions relating to the disputed deficiency; and

Uphold the cited deficiency;
Modify the cited deficiency by deleting a finding;
Modify the cited deficiency by lowering the scope and severity determination;
Modify the cited deficiency by changing the tag number; or
Delete the cited deficiency.

(4) If a panel review is conducted:

(a) The panel shall consist of:

The IDR coordinator serving as a nonvoting panel moderator;
Two (2) CMS certified surveyors who:

a. Are employed by the Office of Inspector General; and

b. Were not responsible for citing the deficiency in dispute; and

A person currently engaged in the provision of long-term care services who has no affiliation with the provider disputing a deficiency.

(b) The members of the panel shall review documentation submitted by the provider prior to the panel review meeting;

(c) Unless the provider requests and the IDR coordinator agree to an expanded time period, the panel review meeting shall not exceed one (1) hour. The decision to expand the time period for the IDR shall be based on the number and complexity of the deficiencies to be disputed;

(d) The provider may present additional oral information relating to the disputed deficiency;

(e) A member of the survey team responsible for citing the disputed deficiency may respond to the information presented by the provider;

(f) A panel member may ask questions of either the provider or the survey team member;

(g) A person presenting information to the panel or answering questions of the panel may refer to relevant reference materials

(h) The provider may present an oral summary of its response to a disputed deficiency;

(i) After the panel review meeting has concluded, the panel shall review all of the information presented relating to the disputed deficiency;

(j) The voting members of the panel shall make a recommendation to the inspector general to:

Uphold the cited deficiency;
Modify the cited deficiency by deleting the finding;
Modify the cited deficiency by lowering the scope and severity assessment;
Modify the cited deficiency by changing the tag number; or
Delete the cited deficiency.

(5) The inspector general shall make the final determination to:

(a) Uphold the cited deficiency;

(b) Modify the cited deficiency by deleting the finding;

(d) Modify the cited deficiency by changing the tag number; or

(e) Delete the cited deficiency.

(6) A determination and the reasons supporting the determination made by the inspector general as a result of the desk review, telephone conference, or panel review IDR shall be mailed to the provider within thirty-five (35) working days of receipt of a request for IDR.

(7) If the Inspector General makes a determination that is different from the recommendation of the IDR coordinator or the IDR panel:

(a) The notification required by subsection (6) of this section shall also include the specific reasons for the difference; and

(b) The provider shall be given an opportunity for an in-person meeting with the Inspector General to present documentation originally submitted to the IDR Coordinator or the IDR panel and seek a reconsideration of the determination. The meeting shall be conducted to allow sufficient time to ensure that a reconsidered determination can be mailed to the provider within thirty-five (35) working days of the receipt of the request for IDR.

(8) If a cited deficiency was modified as a result of the informal dispute resolution process the provider may request the Office of Inspector General, Division of Long-term Care to provide:

(a) A copy of the statement of deficiencies indicating each modification by:

Striking through deleted language; and
Underlining new language; or

(b) A new statement of deficiencies containing the modified deficiency. If a new statement of deficiencies is issued the provider will be required to complete a new plan of correction.

(9) If a cited deficiency was deleted the provider may request the Office of Inspector General, Division of Long-term Care to provide:

(a) A copy of the statement of deficiencies indicating each deletion; or

(b) A new statement of deficiencies absent the deleted deficiency. If the new statement of deficiencies contains other cited deficiencies that were not deleted the provider shall be required to complete a new plan of correction.

History

RELATES TO: 42 C.F.R. 488.301, 488.331
STATUTORY AUTHORITY: KRS 194A.050(1), 42 C.F.R. 488.331
NECESSITY, FUNCTION, AND CONFORMITY: 42 C.F.R. 488.331 requires the cabinet to establish an informal dispute resolution process to be used by a provider to informally dispute a finding of deficiency at a nursing facility or skilled nursing facility. This administrative regulation establishes the informal dispute resolution process and expands the process to all long-term care facilities.
History: 906 KAR 001:120. 24 Ky.R. 1196; 1687; eff. 2-17-1998; 28 Ky.R. 2101; 2351; eff. 4-30-2002; 30 Ky.R. 723; 1309; 1768; eff. 1-23-2004; Crt eff. 1-11-2019; Crt eff. 11-24-2025.

906 KAR 1:140 Validation and complaint investigation procedures for deemed hospitals {#sec-906-kar-1-140 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:140}

Section 1. Definitions.

(1) "CMS" means the Centers for Medicare and Medicaid Services.

(2) "Deemed hospital" means a hospital that is deemed to be in compliance with licensure requirements pursuant to the provisions of KRS 216B.185.

(3) "Inspecting agency" means the Cabinet for Health Services, Office of the Inspector General.

(4) "State licensure standard" means an individual requirement contained within the operations and services regulation of a deemed hospital.

Section 2. Licensure Validation Inspection.

(1) On an annual basis the inspecting agency shall select a minimum of five (5) percent and no more than ten (10) percent of the total number of deemed hospitals and conduct an on-site inspection to validate that state licensure standards are met.

(2) A deemed hospital that has received a CMS certification validation survey in the previous twelve (12) months shall not be selected for a licensure validation inspection.

(3) A deemed hospital that is selected to receive a licensure validation inspection shall be notified of the inspection at least seven (7) days before the scheduled inspection date.

(4) The inspecting agency shall conduct validation surveys in accordance with the provisions contained in Section 4 of this administrative regulation.

Section 3. Complaint Investigation Inspection.

(1) If the inspecting agency receives a complaint or becomes aware from another state agency or through the media that a deemed hospital may not be in compliance with a state licensure standard, the inspecting agency shall conduct an investigation of the alleged noncompliance.

(2) Complaint investigations shall be unannounced and conducted in accordance with the procedures in Section 4 of this administrative regulation.

Section 4. Procedures for Conducting Validation and Complaint Investigations of Deemed Hospitals.

(1) If the inspecting agency determines, as a result of an on-site licensure validation or compliant investigation inspection, that a hospital is not in compliance with a state licensure standard:

(a) At the conclusion of the of the on-site inspection, the survey staff of the inspecting agency shall conduct an exit conference to discuss preliminary findings with the hospital administrator or designee;

(b) The inspecting agency shall inform the hospital in writing of the violation of the state licensure standard within ten (10) days of the inspection; and

(c) The hospital shall submit to the inspecting agency, within ten (10) days of receipt of the written notice, a written plan for the correction of the violation;

The plan shall specify:

a. The date by which the violation shall be corrected;

b. The specific measures utilized to correct the violation; and

c. The specific measures that will be utilized to ensure the violation will not reoccur.

Following a review of the plan, the inspecting agency shall notify the hospital in writing of the acceptability of the plan.
If a portion or all of the plan is unacceptable:

a. The inspecting agency shall specify the reasons for the unacceptability; and

b. The hospital shall modify or amend the plan and resubmit it to the inspecting agency within ten (10) days.

Upon receipt of an acceptable plan of correction, the inspecting agency may conduct a follow-up on-site inspection to ensure that the violation has been corrected.

(2) The hospital shall lose its status as a deemed hospital if, as a result of the on-site licensure validation or complaint investigation inspection, the inspecting agency determines that a hospital has:

(a) A single violation of a state licensure standard of sufficient severity that the violation poses a substantial risk to patient care or patient safety; or

(b) A substantial number of violations of state licensure standards.

(3) The hospital shall regain its deemed status when the inspecting agency determines that the violation or violations have been corrected.

History

RELATES TO: KRS 216.2925, 216.530, 216B.010, 216B.015, 216B.040, 216B.042, 216B.045-216B.055, 216B.075, 216B.105-216B.131, 216B.990
STATUTORY AUTHORITY: KRS 216B.185
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.185 requires that the cabinet promulgate the necessary administrative regulations to implement the licensing validation process for hospitals deemed in compliance with licensure requirements. This administrative regulation implements the licensing validation process and establishes a procedure for investigating complaints at deemed hospitals.
History: 906 KAR 001:140. 29 Ky.R. 3002; 30 Ky.R. 870; eff. 10-15-2003; Crt eff. 1-11-2019; Crt eff. 11-24-2025.

906 KAR 1:160 Monitoring system for products containing ephedrine, pseudoephedrine, or phenylpropanolamine {#sec-906-kar-1-160 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:160}

Section 1. Definitions.

(1) "Attempted purchase" means information regarding a transaction is entered into the KEMPT system by a dispenser of a precursor to methamphetamine and the sale is not completed because the system recommends that the transaction be denied pursuant to KRS 218A.1446(5) or (6).

(2) "Cabinet" is defined by KRS 218A.010(3).

(3) "Dispenser of a precursor to methamphetamine" means a registered pharmacist, pharmacy intern, or pharmacy technician who lawfully sells a nonprescription compound, mixture, or preparation containing a detectable quantity of ephedrine, pseudoephedrine, phenylpropanolamine, their salts or optical isomers, or salts of optical isomers.

(4) "Kentucky Electronic Methamphetamine Precursor Tracking" or "KEMPT" means the electronic recordkeeping mechanism used by the Office of Drug Control Policy to monitor the sale of a nonprescription compound, mixture, or preparation containing any detectable quantity of ephedrine, pseudoephedrine, or phenylpropanolamine, their salts or optical isomers, or salts of optical isomers.

(5) "Law enforcement officer" means a:

(a) Drug enforcement agent designated by the Cabinet for Health and Family Services pursuant to KRS 218A.240(2);

(b) Kentucky peace officer certified pursuant to KRS 15.380 as a:

Kentucky State Police officer;
City, county, or urban-county police officer;
Deputy sheriff; or
State or public university safety and security officer;

(d) Federal peace officer.

(6) "ODCP" means the Office of Drug Control Policy within the Kentucky Justice and Public Safety Cabinet.

(7) "Precursor to methamphetamine" means a nonprescription compound, mixture, or preparation containing any detectable quantity of ephedrine, pseudoephedrine, or phenylpropanolamine, their salts or optical isomers, or salts of optical isomers.

(8) "Purchaser" means an individual age eighteen (18) or older who purchases, or attempts to purchase, a nonprescription compound, mixture, or preparation containing any detectable quantity of ephedrine, pseudoephedrine, or phenylpropanolamine, their salts or optical isomers, or salts of optical isomers.

Section 2. Electronic Reporting.

(1) The following information shall be entered in the KEMPT system upon the purchase, or attempted purchase, of a precursor to methamphetamine:

(a) Date of transaction pursuant to KRS 218A.1446(2)(b), which is entered manually or recorded automatically by KEMPT;

(b) Identifying information regarding the purchaser pursuant to KRS 218A.1446(2)(b) and a government-issued photo identification number; and

(2) The ODCP shall be solely responsible for the security of the transaction information required by subsection (1) of this section after a dispenser of a precursor to methamphetamine transmits the information.

(3) The ODCP shall provide a toll-free telephone number:

(a) For technical support available to a dispenser of a precursor to methamphetamine twenty-four (24) hours per day, seven (7) days per week; and

(b) For customer service available to a purchaser who has an inquiry regarding a transaction, Monday through Friday, 8 a.m. to 4:30 p.m., except for state recognized holidays.

(4) A pharmacy may use a hardcopy signature logbook consisting of each purchaser's signature and transaction number to meet the requirement for obtaining electronic signatures.

Section 3. Extension for Reporting Information and Exemption from Electronic Reporting.

(1) If a dispenser of a precursor to methamphetamine experiences mechanical or electronic failure, the ODCP shall grant an extension for reporting the information required by Section 2(1) of this administrative regulation.

(2) To request an extension for reporting information required by Section 2(1) of this administrative regulation, a dispenser of a precursor to methamphetamine shall submit a request to the ODCP that:

(a) States the reason for the request;

(b) Identifies the period of time for which the extension is necessary, not to exceed seventy-two (72) hours; and

Within twenty-four (24) hours of discovery of the circumstances resulting in the need for an extension request; or
On the day following a holiday or weekend if the discovery occurs on a day that ODCP offices are closed.

(3) If a transaction occurs during the time period in which a request described in subsection (2) of this section is pending, a dispenser of a precursor to methamphetamine shall:

(a) Maintain a written log or electronic recordkeeping mechanism approved pursuant to KRS 218A.1446(2)(b) of the information required by Section 2(1) of this administrative regulation; and

(b) Enter the information in the KEMPT system within seventy-two (72) hours of the system becoming operational.

(4) The ODCP shall acknowledge receipt of a request described in subsection (2) of this section within:

(a) Twenty-four (24) hours of receipt; or

(b) On the day following a holiday or weekend if ODCP offices are closed.

Section 4. Request for KEMPT Reports.

(1) The ODCP shall provide a KEMPT report:

(a) To a law enforcement officer whose duty is to enforce the laws of this state, another state, or of the United States relating to drugs;

(b) To a pharmacy;

(d) Pursuant to a court order issued by a criminal court.

(2) The ODCP shall not provide a KEMPT report to a person or entity that is not authorized in accordance with subsection (1) of this section to receive the report.

(3) A KEMPT report provided to a pharmacy shall not identify the dispenser of a precursor to methamphetamine or the dispensing pharmacy.

Section 5. Denial of Transactions and Overrides.

(1) If an individual attempts to purchase a precursor to methamphetamine in violation of the thirty (30) day or one (1) year restrictions established by KRS 218A.1446(5), or the age restriction established by KRS 218A.1446(6), the KEMPT system shall:

(a) Notify the pharmacy at the time of sale; and

(b) Recommend that the pharmacy deny the transaction.

(2) The KEMPT system shall provide an override feature for use by a dispenser of a precursor of methamphetamine to allow completion of the sale.

Section 6. Compliance Date. All pharmacies that dispense precursors to methamphetamine shall:

(1) Comply with the electronic reporting requirements of Section 2 of this administration regulation within (30) days of the date that a pharmacy has access to KEMPT; or

(2) Submit a request to ODCP for an extension if the pharmacy is not able to comply with the electronic reporting requirements on the date the pharmacy has access to KEMPT.

History

RELATES TO: KRS 15.380, 218A.1446, 218A.240
STATUTORY AUTHORITY: KRS 218A.1446, 218A.250
NECESSITY, FUNCTION, AND CONFORMITY: KRS 218A.1446 authorizes the Cabinet for Health and Family Services and the Office of Drug Control Policy to establish an electronic recordkeeping mechanism for monitoring the sale of any nonprescription compound, mixture, or preparation containing any detectable quantity of ephedrine, pseudoephedrine, or phenylpropanolamine, their salts or optical isomers, or salts of optical isomers. KRS 218A.250 authorizes the cabinet to promulgate administrative regulations to carry out the provisions of KRS Chapter 218A. This administrative regulation establishes the Kentucky Electronic Methamphetamine Precursor Tracking (KEMPT) system.
History: 906 KAR 001:160. 34 Ky.R. 687; 1509; 1753; eff. 2-1-2008; 35 Ky.R. 1322; eff. 2-6-09; 39 Ky.R. 335; 771; eff. 10-17-2012; Crt eff. 1-11-2019; Crt eff. 11-24-2025.

906 KAR 1:170 Administrative subpoenas {#sec-906-kar-1-170 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:170}

Section 1. Definitions.

(1) "Documents" means information in any form or format that is relevant to a review, audit, or investigation conducted by the Office of Inspector General and may include:

(a) Medical records;

(b) Written documents;

(d) Photographs;

(e) Audio and video recordings;

(f) Employment or wage data;

(g) Pension payment or insurance payment data;

(h) Account information from financial institutions; or

(i) Applications or other documents that establish eligibility for public assistance programs.

(2) "Justified by the circumstances" means that:

(a) Information requested by the Inspector General or Inspector General's designee is relevant to a review, audit, or investigation conducted by the Office of Inspector General; and

(b) The Inspector General or Inspector General's designee has reasonable grounds to believe that the requested information exists.

Section 2. Administrative Subpoenas.

(1) If justified by the circumstances, the Inspector General or Inspector General's designee may issue a subpoena in accordance with KRS 205.170 to require the production of documents at a specified time and place.

(2) If information requested by the Inspector General or Inspector General's designee is encrypted, the respondent shall:

(a) Provide the information in a readable format; and

(b) Provide proof acceptable to the Inspector General or Inspector General's designee that the requested information has been translated to a readable format without error or omission.

(3) A person served with a subpoena in accordance with subsection (1) of this section shall not intentionally destroy, alter, or falsify documents requested by the Inspector General or Inspector General's designee.

Section 3. Noncompliance.

(1) If a person fails without good cause to produce requested documents in accordance with Section 2(1) of this administrative regulation, the Inspector General or Inspector General's designee may apply to the circuit court of the county in which compliance is sought for an appropriate order to compel compliance with the provisions of the subpoena.

(2) If a person served with a subpoena issued pursuant to Section 2(1) of this administrative regulation believes that the subpoena seeks to compel the production of documents that are protected, privileged, or not properly the subject of an administrative subpoena, the individual may, prior to the date designated for the production of the documents, apply to the circuit court of the county in which compliance is sought for an appropriate protective order limiting the scope of the subpoena or quashing it entirely.

History

RELATES TO: KRS 194A.025, 194A.030, 205.8453
STATUTORY AUTHORITY: KRS 194A.050(1), 205.170(1)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) directs the Secretary of the Cabinet for Health and Family Services to promulgate, administer, and enforce administrative regulations relating to the operation of programs within the cabinet. KRS 194A.030(1) provides that the Office of the Inspector General shall be responsible for the conduct of audits and investigations for detecting the perpetration of fraud or abuse of any program by any client, or by any vendor of services with whom the cabinet has contracted, and the conduct of special investigations requested by the secretary, commissioners, or office heads of the cabinet into matters related to the cabinet or its programs. KRS 205.8453(4) allows the Cabinet for Health and Family Services to institute necessary or useful measures in controlling fraud and abuse. KRS 205.170(1) allows the Secretary of the Cabinet for Health and Family Services or the Secretary's authorized representative to issue subpoenas to compel the attendance of witnesses and production of books, papers, correspondence, memoranda and other records considered necessary and relevant as evidence in connection with the administration of the cabinet. This administrative regulation provides for the delegation of the Secretary's subpoena power to the Inspector General and prescribes the conditions of that delegation of power. The Inspector General may issue subpoenas to compel the production of documents, records, or other physical evidence relevant to reviews, audits, or investigations conducted by the Office of Inspector General.
History: 906 KAR 001:170. 35 Ky.R. 1115; eff. 1-5-2009; Crt eff. 1-11-2019; Crt eff. 11-24-2025.

906 KAR 1:180 Operation and services; personal services agencies {#sec-906-kar-1-180 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:180}

Section 1. Definitions.

(1) "Adverse action" means action taken by the cabinet's Office of Inspector General (OIG) to deny or revoke the certification of a personal services agency.

(2) "Cabinet" is defined by KRS 216.710(1).

(3) "Certification" means that a person, business entity, corporation, or association, either for-profit or not-for-profit, has been issued a certificate by the Office of Inspector General to operate a personal services agency.

(4) "Client" is defined by KRS 216.710(2).

(5) "Designated representative" is defined by KRS 216.710(5).

(6) "Direct-care staff member" is defined by KRS 216.710(6).

(7) "Direct service" is defined by KRS 216.710(7).

(8) "Employee" means an individual who is:

(a) Directly employed by a personal services agency;

(b) An agent of a personal services agency;

(c) An independent contractor who has a contractual arrangement with a personal services agency to provide personal services; or

(d) Referred by another person or other agency that has an ownership or financial interest that is realized from the delivery of personal services rendered by the individual for whom the referral is made.

(9) "Facilitate the self-administration of medication" means the client or the client's guardian, healthcare surrogate as defined by KRS 311.621(16), or attorney-in-fact as appointed by a durable power of attorney authorizing the attorney-in-fact to make health care decisions for the client, has executed a written consent designating the persons or entities authorized to prepare or direct the client's medications and authorizing the personal services agency to facilitate the self-administration of medication in accordance with Section 7(1)(b) of this administrative regulation.

(10) "Parent personal services agency" is defined by KRS 216.710(11).

(11) "Personal services" is defined by KRS 216.710(9).

(12) "Personal services agency" is defined by KRS 216.710(10).

(13) "Provisional certification" means that the Office of Inspector General (OIG) has issued a ninety (90) day preliminary certificate to operate a personal services agency to a person, business entity, corporation, or association, either for-profit or not-for-profit, which:

(a) Has three (3) or fewer employees when the initial application is filed; and

(b) Indicated on the application that it intends to hire additional employees within ninety (90) calendar days of the date of the application.

(14) "Significant financial interest" means lawful, direct or indirect ownership of a personal services agency or health care facility licensed pursuant to KRS Chapter 216B in an amount equal to or greater than twenty-five (25) percent total ownership of the personal services agency or health care facility.

Section 2. Certification of Personal Services Agencies.

(1) To operate a personal services agency, a person or entity shall obtain certification from the Office of Inspector General.

(2) If an out-of-state personal services agency operates a branch office in Kentucky, the out-of-state agency shall be required to obtain separate certificates for each of its branch offices in Kentucky.

(3) A branch office of a parent personal services agency shall be owned and controlled by the parent personal services agency.

(4) A "health facility" or a "health service" as defined by KRS 216B.015 or a health-care practitioner licensed, certified, or regulated by local, state, or federal statutes or administrative regulations shall not be required to obtain certification to provide personal services pursuant to KRS 216.710(9)(b)9.

Section 3. Initial Application, Provisional Certification, and Approval.

(1) A person, entity, corporation, or association shall not provide personal services prior to obtaining certification.

(2) An applicant for initial certification, including provisional certification, shall submit to the OIG:

(a) An initial application fee of $500 made payable to the Kentucky State Treasurer;

(b) A completed Application for Certification to Operate a Personal Services Agency, OIG – 1180; and

(3) Approval of initial certification shall be contingent on:

(a) Submission of the initial application fee of $500;

(b) The applicant's demonstration of compliance with the requirements of this administrative regulation and KRS 216.712, as documented on the Application for Certification to Operate a Personal Services Agency, OIG - 1180; and

(4)

(a) Approval of provisional certification shall be contingent on:

Submission of the initial application fee of $500;
The applicant's demonstration of compliance with the requirements of this administrative regulation and KRS 216.712, as documented on the Application for Certification to Operate a Personal Services Agency, OIG - 1180; and
Submission of the documentation required by Section 3.A, if applicable, and Section 6 of the application.

(b) A personal services agency operating under provisional certification shall, no later than fourteen (14) calendar days prior to expiration of the provisional certificate, submit employee information required by Section 6, paragraph 2 of the Application for Certification to Operate a Personal Services Agency, OIG - 1180 for each employee hired by the agency after submission of the application for initial certification.

(c) If a personal services agency operates under provisional certification prior to approval of initial certification, the initial certification period shall expire one (1) year from the date of the provisional certificate.

Section 4. Annual Recertification.

(1) At least sixty (60) calendar days prior to expiration of certification, the personal services agency shall submit to the OIG:

(a) An annual recertification fee of $350 made payable to the Kentucky State Treasurer;

(b) A completed Application for Certification to Operate a Personal Services Agency, OIG – 1180; and

(2) Approval of recertification shall be contingent on:

(a) Submission of the annual recertification fee of $350;

(b) The applicant's demonstration of continued compliance with the requirements of this administrative regulation and KRS 216.712, as documented on the Application for Certification to Operate a Personal Services Agency, OIG - 1180; and

Section 5. Change of Status.

(1) Within thirty (30) calendar days after a change in an ownership interest of more than twenty-five (25) percent of a personal services agency, the following shall be submitted to the OIG:

(a) An Application for Certification to Operate a Personal Services Agency, OIG - 1180;

(b) Documentation required by Section 3.A, if applicable, and Section 6 of the application;

(d) A bill of sale or comparable document that includes:

The name and signature of the new owner or corporation;
The name and signature of the buyer and the seller; and
The effective date of the transaction.

(2) Following a change of ownership reported in accordance with subsection (1) of this section, certification shall be effective for a period of one (1) year from the date the change of ownership is approved by the OIG.

(3) A personal services agency shall notify the OIG in writing within thirty (30) calendar days after the effective date of:

(a) A change of name;

(b) A change in the location of the parent personal services agency or a branch office;

(d) The closing of the parent personal services agency or an existing branch office within the state.

Section 6. Staff Requirements.

(1)

(a) A personal services agency shall employ an individual to act as the personal services agency's manager.

(b) The manager shall be responsible for the organization and daily operation of the personal services agency.

(c) The manager shall designate in writing one (1) or more individuals to act on behalf of the manager, or to perform any or all of the manager's responsibilities during the time in which the manager is unavailable to perform daily managerial duties for at least three (3) consecutive business days.

(2) Prior to acting as a personal services agency's manager, or prior to providing direct services to a client, an applicant for employment in a personal services agency shall submit to, and have completed a:

(a) Criminal record check conducted by the Justice and Public Safety Cabinet, Administrative Office of the Courts, or a company that conducts a search of criminal record information maintained by the Justice and Public Safety Cabinet or Administrative Office of the Courts;

(b) Check of the nurse aide and home health aide abuse registry established by 906 KAR 1:100;

(d) Substance abuse test; and

(e)

A tuberculosis (TB) risk assessment performed and reported by a physician, advanced practice registered nurse, physician assistant, or registered nurse.
If the TB risk assessment indicates that the applicant for employment is at increased risk for developing tuberculosis infection, or for progressing to active TB disease if infected, the individual shall submit to the following for purposes of employment:

a. Follow-up tuberculin skin test (TST); or

b. Blood assay for M. tuberculosis (BAMT).

An individual who has a positive TST result or a positive BAMT result:

a. Shall have a medical evaluation for possible active TB and receive a chest x-ray; and

b. Shall not provide direct services to a client until evidence is provided to the personal services agency documenting that the individual is free of active TB as verified through a health professional's statement, signed by a physician, advanced practice registered nurse, physician assistant, or registered nurse.

(3) A personal services agency may, at its discretion, request that its manager or an employee who provides direct services to a client submit to any of the following background checks after the date of initial hire:

(b) Check of the nurse aide and home health aide abuse registry;

(d) Substance abuse test.

(4) A personal services agency shall not employ or retain an individual to serve as a manager or provide direct services to a client if the individual:

(a) Has been convicted of a crime defined by KRS 216.710(3) as verified through a criminal record check conducted pursuant to subsection (2)(a) or (3)(a) of this section;

(b) Appears on the nurse aide and home health aide abuse registry as verified through a check of the registry conducted pursuant to subsection (2)(b) or (3)(b) of this section;

(c) Appears on the caregiver misconduct registry as verified through a check of the registry conducted pursuant to subsection (2)(c) or (3)(c) of this section;

(d) Tests positive for the presence of an illegal drug as verified through a substance abuse test conducted pursuant to subsection (2)(d) or subsection (3)(d) of this section; or

(e) Fails to provide upon initial employment pursuant to subsection (2)(e) or annually pursuant to subsection (5) of this section:

A copy of the results of a health professional's statement documenting that the individual is free of active tuberculosis;
Documentation of a negative TST; or
Documentation of a negative BAMT.

(5)

(a) A personal services agency shall require its manager and each employee who provides direct services to a client to submit annually to a tuberculosis risk assessment performed and reported by a physician, advanced practice registered nurse, physician assistant, or registered nurse.

(b) If a determination is made from the annual tuberculosis risk assessment that the employee is at increased risk for developing tuberculosis infection, or for progressing to active TB disease if infected, the employee shall submit to a follow-up TST or BAMT.

(c) An employee who has a positive TST result or a newly positive BAMT shall have a medical evaluation for possible active TB and receive a chest x-ray.

(d) If the annual tuberculosis screening reveals that the employee is recently infected, the employee shall not provide direct services to a client until evidence is provided documenting that the employee is free of active tuberculosis as verified through a health professional's statement signed by a physician, advanced practice registered nurse, physician's assistant, or a registered nurse.

(6) A personal services agency shall maintain documentation of the following in employee records:

(a) The results of each criminal record check conducted pursuant to subsection (2)(a) and (3)(a) of this section;

(b) The results of each check of the nurse aide and home health aide abuse registry conducted pursuant to subsection (2)(b) and (3)(b) of this section;

(c) The results of each check of the caregiver misconduct registry conducted pursuant to subsection (2)(c) and (3)(c) of this section;

(d) The results of the substance abuse test conducted pursuant to subsection (2)(d) and (3)(d) of this section; and

(e) Documentation from a health professional that the employee is free of active TB and, if applicable, documentation of a follow-up TST or BAMT, chest x-ray, or medical evaluation.

(7) A personal services agency shall:

(a) Maintain employee records for a period of at least five (5) years; and

(b) Ensure that the records of current employees are:

Maintained on the premises of the agency; or
Accessible via a central computer file.

(8) A personal services agency or agency employee shall not be, or shall not apply to be a client's:

(a) Guardian;

(b) Power of attorney;

(d) Limited conservator;

(e) Limited guardian;

(f) Standby guardian; or

(g) Testamentary guardian.

Section 7. Staff training and Competency.

(1) Prior to providing direct services to a client, each employee shall receive training from the personal services agency regarding the following:

(a) Procedures for reporting abuse, neglect, or exploitation of an adult pursuant to KRS 209.030(2) and (3), or child abuse or neglect pursuant to KRS 620.030(1);

(b) Procedures for facilitating the self-administration of medications if personal services agency staff facilitate the self-administration of medication, in accordance with the following requirements:

A client's medication shall:

a. Be prepared or directed in accordance with KRS 216.710(9)(a)2 by:

(i) The client's designated representative; or

(ii) A licensed health-care professional who is not an owner, manager, or employee of the personal services agency;

b. Except for ointments, be preset in a medication organizer or be a single dose unit; and

c. Include the client's name on the medication organizer or container in which the single dose unit is stored;

A personal services agency direct care staff person may:

a. Remind a client when to take medications and observe to ensure that the client takes the medication as directed;

b. Hand the client's medication to the client. If the client is unable to open the medication, the staff person may open the unit dose or medication organizer, remove the medication from a medication organizer, and close the medication organizer for the client;

c. Assist a client in consuming oral medication, including tablets, capsules, or liquid medication, by:

(i) Placing the dose in a container and placing the container to the mouth of the client;

(ii) Placing the medication in the client's hand or mouth; or

(iii) Following the written instructions of the client's designated representative or licensed health care professional for how to enable the client to take his or her medication; or

(iv) Steady or guide a client's hand while applying ointments; and

Facilitating the self-administration of medication shall not include:

a. Instilling eye, ear, or nasal drops;

b. Mixing, compounding, converting, or calculating medication doses;

c. The preparation of syringes for injection or the administration of medications by any injectable route;

d. Administration of medications through intermittent positive pressure breathing machines or a nebulizer;

e. Administration of medications by way of a tube inserted in a cavity of the body;

f. Administration of parenteral preparations;

g. Administration of irrigations or debriding agents used in the treatment of a skin condition; or

h. Administration of rectal, urethral, or vaginal preparations; and

(2)

(a)

In addition to the training required by subsection (1) of this section and within ninety (90) days from the most recent effective date of this administrative regulation, a direct-care staff member who provides services to a client that exhibits symptoms of Alzheimer's disease or other dementia shall complete at least six (6) hours of initial training and three (3) hours of annual training in dementia care pursuant to the requirements established by KRS 216.713(3).
In accordance with KRS 216.713(2), a direct-care staff member shall successfully complete the initial training in dementia care prior to providing services to a client that exhibits symptoms of Alzheimer's disease or other dementia.
Pursuant to KRS 216.713(6), a direct-care staff member who has a lapse of twenty-four (24) months or more providing care to a client that exhibits symptoms of Alzheimer's disease or other dementia shall complete the six (6) hours of initial training within sixty (60) days of resuming the delivery of care to a client that exhibits symptoms of Alzheimer's disease or other dementia.

(b) A personal services agency shall:

Obtain cabinet approval of the agency's dementia care training curriculum in accordance with the process established by 910 KAR 4:010;
Provide a certificate of completion pursuant to KRS 216.713(4) to each direct-care staff member who successfully completes the initial and annual dementia care training; and
Maintain documentation of successful completion of dementia care training for each direct-care staff member in accordance with KRS 216.713(5).

(c)

The cabinet shall impose fines in accordance with KRS 216.713(9) and (10).
All fines collected by the cabinet shall be deposited in the Kentucky personal services agency fund pursuant to KRS 216.716(1)(c).

(3)

(a) A personal services agency shall evaluate the competency of each employee who will provide direct services to a client.

(b) The agency's evaluation to determine competency shall pertain to each personal services task the agency chooses to have the employee perform.

(4)

(a) An employee's evaluation and a determination by the personal services agency that the employee is competent to perform a personal services task shall occur before the employee performs the task for a client without direct agency supervision.

(b) The content of the employee's training and evaluation shall:

Be documented and maintained in the employee's record, which shall be retained for a period of at least five (5) years; and
Include the date and the signature of the:

a. Person who conducted the training and evaluation; and

b. Employee who received the training and evaluation.

Section 8. Service Agreement.

(1) Each personal services agency shall provide a written service agreement to the client or the client's designated representative that includes the following:

(a) The charge for each service provided by the personal services agency;

(b) The personal services agency's policy for notifying the client or client's designated representative of any change in the charge for services. Notice of an increase in the charge for services shall be given to a participating client or client's designated representative at least thirty (30) calendar days in advance of the effective date of the increase;

(d) The procedure for contacting the personal services agency's manager or the manager's designee;

(e) The procedure and telephone number to call for the purpose of filing a grievance with the personal services agency as described in Section 10 of this administrative regulation;

(f) An explanation of whether the personal services agency:

Directly employs the individual who will be providing personal services to the client;
Provides bonded protection for the client; and
Pays workers compensation or other benefits for the individual who will be providing personal services to the client;

(g) Name of the personal services agency's owner, including anyone with a significant financial interest in the agency;

(h) The procedure for changing or terminating a client's service plan; and

(i) A statement of client rights, which shall include the following:

The client has the right to have the client's property treated with respect;
The client has the right to request a change in his or her service plan, including the temporary suspension, permanent termination, temporary addition, or permanent addition of a service;
The client has the right to file a grievance as described in Section 10 of this administrative regulation regarding services, employee conduct, or the lack of respect for property and not be subject to discrimination or reprisal for filing the grievance; and
The client has the right to be free from verbal, physical, and psychological abuse, and to be treated with dignity.

(2) A personal services agency shall report to the cabinet an incident of suspected:

(a) Abuse, neglect, or exploitation of an adult pursuant to KRS 209.030(2) and (3); or

(b) Child abuse or neglect pursuant to KRS 620.030(1).

Section 9. Service Plan.

(1) A personal services agency's manager or the manager's designee shall prepare a service plan. The initial service plan shall:

(a) Be in writing, dated, and signed by the:

Individual who prepared it; and
Client or client's designated representative;

(b) List the types and schedule of services to be provided to the client; and

(2) If a client or the client's designated representative requests a change in the type of service, duration of the service, or an increase or decrease in the number of visits, the personal services agency manager or manager's designee shall document on the client's service plan the:

(a) Requested change;

(b) Name of the person who requested the change; and

(3) A personal services agency shall provide a copy of the service plan to the client within ten (10) calendar days of the date that the agency begins providing initial services.

Section 10. Client Grievances.

(1) A personal services agency shall investigate a grievance made by a client or the client's designated representative alleging:

(a) An issue with a service that is furnished;

(b) Failure to furnish a service listed in the service plan;

(d) Inappropriate conduct of an employee while the individual is providing services to the client; or

(e) A violation of the client's rights.

(2)

(a) A personal services agency shall:

Document how the agency investigated each grievance; and
Maintain on file for a period of at least five (5) years a written record documenting the outcome of the agency's investigation, including any action taken by the agency.

(b) Upon completing an investigation of a grievance, the personal services agency shall document that it notified the individual who reported the grievance of the outcome of the investigation and any action the agency plans to take as a result.

Section 11. Complaint Investigations.

(1) The OIG shall investigate a:

(a) Report of any business that provides personal services without receiving certification;

(b) Report of any business that markets its services as a personal services agency without receiving certification;

(c) Complaint against a certified personal services agency in which the agency is alleged to be in noncompliance with the requirements of this administrative regulation, KRS 216.712, or 216.713;

(d) Complaint against a certified personal services agency in which an agency employee is alleged to have abused or neglected a client, or misappropriated a client's property; or

(e) Complaint against a certified personal services agency in which an agency employee is alleged to have provided services to a client that exceed the scope of personal services.

(2)

(a) A certified personal services agency or a business that is the subject of a complaint investigation shall not deny access to a representative of the OIG, after proper identification, to make an inspection for determining compliance with the requirements of this administrative regulation, KRS 216.712, or 216.713.

(b) Denial of access, including any effort to delay, interfere with, or obstruct an effort by a representative of the OIG to enter the agency or deny access to records related to an inspection or investigation shall result in revocation of a personal services agency's certification.

Section 12. Request for Additional Information and Plans of Correction.

(1)

(a) The OIG shall notify an applicant or certified personal services agency in writing after:

Receipt of an incomplete or illegible application for initial certification or recertification;
Receipt of an application for initial certification or recertification in which additional information is needed by the OIG to verify that the applicant or personal services agency is in compliance with the requirements of this administrative regulation, KRS 216.712, and in the case of recertification, KRS 216.713; or
Completion of a complaint investigation pursuant to Section 11 of this administrative regulation.

(b) The OIG's written notification specified in paragraph (a) of this subsection shall request that the applicant or certified personal services agency submit the following within ten (10) calendar days of the date of the notice:

Additional information needed by the OIG to deem an initial or recertification application as complete or legible;
Additional information needed by the OIG to make a determination of compliance with the requirements of this administrative regulation, KRS 216.712, and in the case of recertification, KRS 216.713; or
A written plan of correction if the OIG has found upon completion of a complaint investigation that the certified personal services agency is in violation of this administrative regulation, KRS 216.712, or 216.713. A plan of correction shall:

a. Be signed by the personal services agency's owner or manager;

b. Specify the date by which the agency intends to have corrected the violation;

c. Identify the specific measures the agency intends to use to correct the violation; and

d. Identify the specific measures the agency plans to use to ensure the violation will not recur.

(c) The OIG shall review additional information or a written plan of correction submitted pursuant to paragraph (b) of this subsection and notify the applicant or certified personal services agency in writing of the decision to:

Approve or not approve an application;
Accept or not accept a plan of correction;
Deny or revoke certification for a violation of this administrative regulation or KRS 216.712; or
Impose a fine in accordance with Section 7(2)(c) of this administrative regulation.

(d) If the OIG determines that a plan of correction is not acceptable and makes a written request for an amended plan of correction, the certified personal services agency shall submit the amended plan of correction within ten (10) calendar days of the date of the OIG's written request. The OIG shall review an amended plan of correction and notify the personal services agency in writing of the decision to:

Accept the amended plan of correction;
Deny or revoke certification for a violation of this administrative regulation or KRS 216.712;
Require the agency to submit an acceptable plan of correction; or
Impose a fine in accordance with Section 7(2)(c) of this administrative regulation.

(e) Except for a violation for which a fine is imposed pursuant to Section 7(2)(c) of this administrative regulation, a certified personal services agency that fails to submit an acceptable plan of correction or acceptable amended plan of correction shall have its certification revoked.

(2) The OIG may impose fines in accordance with KRS 216.714(1) or (2).

Section 13. Denial, Revocation, and Fines.

(1) Initial certification shall be denied if an applicant:

(a) Has a significant financial interest in the entity applying for certification and held a significant financial interest in a personal services agency or health facility licensed pursuant to KRS Chapter 216B in which the agency's certification or facility's licensure was revoked during the three (3) years immediately preceding the filing of the application;

(b) Knowingly misrepresents or submits false information on the application; or

(c) Submits an application which fails to validate the entity's compliance with the requirements of this administrative regulation and KRS 216.712.

(2) Certification shall be revoked if a personal services agency:

(a) Fails to apply for annual recertification pursuant to Section 4(1) of this administrative regulation;

(b) Knowingly misrepresents or submits false information on the application at the time of annual recertification;

(c) Submits an application for annual recertification which fails to validate the agency's compliance with the requirements of this administrative regulation and KRS 216.712;

(d) Fails to comply with the background check and employment requirements of Section 6(2), (4), and (5) of this administrative regulation;

(e) Knowingly retains an employee who is:

Found by the cabinet to have abused or misappropriated a client's property; or
Convicted of, or pleads guilty, to a crime as defined by KRS 216.710(3);

(f) Fails to submit an acceptable plan of correction or acceptable amended plan of correction pursuant to Section 12(1)(b)3 or (d) of this administrative regulation;

(g) Interferes with a cabinet representative's ability to perform an official duty; or

(h) Provides services that are beyond the scope of personal services as defined by KRS 216.710(9).

(3) Written notice of adverse action or notice of a decision to impose a fine pursuant to Section 7(2)(c) of this administrative regulation shall be provided at least thirty (30) calendar days prior to the:

(a) Effective date of the denial, revocation; or

(b) Date by which the amount of the fine shall be paid in full.

(4) The notice shall:

(a) Explain the reason for the:

Denial or revocation of certification; or
Decision to impose a fine;

(b) Unless a fine is imposed pursuant to Section 7(2)(c) of this administrative regulation, specify that the personal services agency shall cease operation prior to the effective date of the adverse action;

Effective date of the adverse action; or
Date by which the amount of the fine shall be paid in full;

(d) Specify that denial, revocation, or fine shall be stayed if an appeal is requested; and

(e) Require the agency to:

Surrender the certificate of operation to OIG when the denial or revocation becomes effective; or
Pay any fine in full if an appeal is not requested.

Section 14. Closure of a Personal Services Agency. If a personal services agency closes voluntarily or as the result of adverse action, the agency shall relinquish to the OIG its certificate to operate as a personal services agency immediately after the effective date of the closure.

Section 15. Appeals.

(1) A personal services agency that submits a written request for appeal within thirty (30) calendar days of the date the agency receives a notice of adverse action or notice of a decision to impose a fine shall be afforded a hearing in accordance with KRS Chapter 13B.

(2) If a hearing officer's final order does not uphold revocation of certification, the personal services agency may resume providing personal services.

Section 16. Incorporation by Reference.

(1) "OIG - 1180, Application for Certification to Operate a Personal Services Agency", edition September 2021 , is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Office of Inspector General, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. This material may also be viewed on the Office of Inspector General's Web site at: https://chfs.ky.gov/agencies/os/oig/dhc/Pages/ltcapplications.aspx

History

RELATES TO: KRS Chapter 13B, 209.030(2), (3), 209.032, 216.710-216.716, 216B.015, 311.621(16), 620.030(1)
STATUTORY AUTHORITY: KRS 216.712(4), 216.713(11)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.712(4) requires the Secretary of the Cabinet for Health and Family Services to promulgate administrative regulations to implement KRS 216.712 through 216.716, which require that personal service agencies be certified by the Cabinet for Health and Family Services. KRS 216.713(11) requires the cabinet to promulgate administrative regulations to implement, monitor, and enforce compliance with the dementia-specific training requirements for direct-care staff members. This administrative regulation establishes standards for the certification of personal services agencies.
History: 906 KAR 001:180. 36 Ky.R. 1403; 2103-M; 2197; eff. 6-4-2010; TAm eff. 3-11-2011; Crt eff. 1-11-2019; 48 Ky.R 1403, 2232; eff. 2-10-2022; Crt eff. 11-24-2025.

906 KAR 1:190 Kentucky National Background Check Program (NBCP) {#sec-906-kar-1-190 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:190}

Section 1. Definitions.

(1) "Applicant" means an individual who:

(a) Applies for employment with an employer identified in subsection (6) of this section; or

(b) Is subject to background screening by a professional licensing board that enrolls contingent upon approval by the Federal Bureau of Investigation and Department of Kentucky State Police in the Kentucky NBCP.

(2) "Cabinet" means the Cabinet for Health and Family Services.

(3) "Criminal background check" means a state and national fingerprint-supported criminal history background check performed by the Department of Kentucky State Police (KSP) and the Federal Bureau of Investigation (FBI) and includes a comparison of the applicant's fingerprints with any fingerprints that may be on file with KSP or the FBI.

(4) "Disqualifying offense" means:

(a) A conviction of, or a plea of guilty, an Alford plea, or a plea of nolo contendere to:

A misdemeanor offense related to:

a. Abuse, neglect, or exploitation of an adult as defined by KRS 209.020(4);

b. Abuse, neglect, or exploitation of a child;

c. A sexual offense;

d. Assault occurring less than seven (7) years from the date of the criminal background check;

e. Stalking occurring less than seven (7) years from the date of the criminal background check;

f. Theft occurring less than seven (7) years from the date of the criminal background check, excluding KRS 514.040;

g. Fraud occurring less than seven (7) years from the date of the criminal background check;

h. Unlawfully possessing or trafficking in a legend drug or controlled substance occurring less than seven (7) years from the date of the criminal background check;

i. KRS 525.130, Cruelty to animals in the second degree – Exemptions – Offense involving equines;

j. KRS 525.135, Torture of dog or cat; or

k. Any other misdemeanor offense relating to abuse, neglect, or exploitation that is not listed in this subsection and occurred less than seven (7) years from the date of the criminal background check;

A criminal offense against a victim who is a minor, as defined in KRS 17.500(3);
A felony offense involving a child victim;
A felony offense under:

a. KRS Chapter 209, protection of adults;

b. KRS 217.182, Sale, distribution, administration, prescription, or possession of legend drugs – Penalty;

c. KRS Chapter 218A, controlled substances;

d. KRS 506.120, Engaging in organized crime;

e. KRS Chapter 434, offenses against property by fraud;

f. KRS Chapter 507, criminal homicide;

g. KRS Chapter 507A, fetal homicide;

h. KRS Chapter 508, assault and related offenses;

i. KRS Chapter 509, kidnapping and related offenses;

j. KRS Chapter 510, sexual offenses;

k. KRS Chapter 511, burglary and related offenses;

l. KRS Chapter 512, criminal damage to property;

m. KRS Chapter 513, arson and related offenses;

n. KRS Chapter 514, theft and related offenses, excluding KRS 514.040;

o. KRS Chapter 515, robbery;

p. KRS Chapter 516, forgery and related offenses;

q. KRS Chapter 517, business and commercial frauds;

r. KRS Chapter 520, escape and other offenses related to custody;

s. KRS Chapter 525, riot, disorderly conduct, and related offenses;

t. KRS Chapter 527, offenses relating to firearms and weapons;

u. KRS Chapter 529, prostitution offenses;

v. KRS Chapter 530, family offenses, excluding KRS 530.050;

w. KRS Chapter 531, pornography; or

x. Any other felony offense relating to abuse, neglect, exploitation, drugs, theft, or fraud not listed in this subsection;

An offense under a criminal statute of the United States or of another state similar to an offense specified in this paragraph; or
A crime described in 42 U.S.C. 1320a-7;

(b) A pending charge or an outstanding warrant for a criminal offense related to:

A sex crime as defined by KRS 17.500(8);
KRS Chapter 209, protection of adults;
KRS 218A.1412, Trafficking in controlled substance in first degree - Penalties;
KRS Chapter 507, Criminal homicide;
KRS Chapter 508, Assault and related offenses;
KRS Chapter 509, Kidnapping and related offenses;
KRS Chapter 510, Sexual offenses;
KRS Chapter 513, Arson and related offenses;
KRS Chapter 515, Robbery;
KRS Chapter 516, Forgery and related offenses; or
KRS Chapter 531, Pornography;

(c) An out-of-state or federal charge that is pending or any outstanding warrant from another state or jurisdiction that is similar to an offense specified in subsection (b) of this section;

(d) A substantiated finding of neglect, abuse, or misappropriation of property by a state or federal agency pursuant to an investigation conducted in accordance with 42 U.S.C. 1395i-3 or 1396r;

(e) Registration as a sex offender under federal law or under the law of any state; or

(f) Being listed on a registry as defined in subsection (10) of this section.

(5) "Employee" means an individual who:

(a)

Is hired directly or through contract by an employer defined in subsection (6) of this section, and has duties that involve or may involve one-on-one contact with a patient, resident, or client; or
Unless excluded pursuant to Section 2(3)(c) through (e) of this administrative regulation, is a volunteer who has duties that are equivalent to the duties of an employee providing direct services and the duties involve, or may involve, one-on-one contact with a patient, resident, or client; and

(b) Has access to the personal belongings or funds of a patient, resident, or client.

(6) "Employer" means:

(a) A long-term care facility as defined in KRS 216.510;

(b) A nursing pool as defined in subsection (9) of this section providing staff to a long-term care facility or provider;

(d) An assisted living-community as defined in KRS 194A.700(5);

(e) A home health agency as defined in KRS 216.935;

(f) A provider of hospice care as defined in 42 U.S.C. 1395x(dd)(1) and licensed pursuant to KRS Chapter 216B;

(g) A personal services agency as defined in KRS 216.710(10);

(h) A long-term care hospital as defined in 42 U.S.C. 1395ww(d)(1)(B)(iv);

(i) A provider of home and community-based services authorized under KRS Chapter 205;

(j) A staffing agency with a contracted relationship to provide one (1) or more employers as listed in this subsection with staff whose duties are equivalent to duties performed by an employee pursuant to subsection (5) of this section; or

(k) Any other provider licensed by the cabinet for which a state and national background check is required as a condition of employment.

(7) "KARES system" means the cabinet's secure, web-based application used to facilitate abuse registry and fingerprint-supported state and national criminal background checks for authorized users of the system.

(8) "Kentucky National Background Check Program" or "NBCP" means a background screening program administered by the Cabinet for Health and Family Services, Office of Inspector General to facilitate registry and fingerprint-supported state and national criminal history background checks conducted by the Department of Kentucky State Police and the Federal Bureau of Investigation for the following:

(a) Prospective employees of any employer identified in subsection (6)(a) through (j) of this section that participates voluntarily in the Kentucky National Background Check Program;

(b) Any other individuals required by state law or administrative regulation to submit to a state and national background check as a condition of:

Employment; or
Licensure, certification, or registration by a professional licensing board that enrolls contingent upon approval by the Federal Bureau of Investigation and Department of Kentucky State Police in the Kentucky NBCP; and

(9) "Nursing pool" means a person, firm, corporation, partnership, or association engaged for hire in the business of providing or procuring temporary employment in or with a long-term care facility or provider for medical personnel, including nurses, nursing assistants, nursing aides, and orderlies.

(10) "Registry" means the:

(a) Nurse aide abuse registry maintained pursuant to 906 KAR 1:100 and 42 C.F.R. 483.156;

(b) Child abuse and neglect registry maintained pursuant to 922 KAR 1:470 and required by 42 U.S.C. 671(a)(20);

(c) List of Excluded Individuals and Entities maintained by the United States Department of Health and Human Services, Office of Inspector General pursuant to 42 U.S.C. 1320a-7;

(d) Caregiver misconduct registry required by KRS 209.032; and

(e) Any available abuse registry, including the abuse and neglect registries of another state if an applicant resided or worked in that state.

(11) "State" is defined by KRS 446.010(40).

(12) "Violent offender" is defined by KRS 439.3401(1).

Section 2. Applicability and Exceptions.

(1) This administrative regulation shall establish requirements for registry and criminal background checks of prospective employees seeking employment with a:

(a) State-owned or operated health facility licensed pursuant to KRS Chapter 216B; or

(b) Private long-term care employer that participates voluntarily in Kentucky's NBCP.

(2) This administrative regulation shall not apply to current employees of any employer that participates voluntarily in the Kentucky National Background Check program.

(3) A prospective employee shall not include:

(a) An individual who independently contracts with a KARES-participating employer to provide utility, construction, communications, or other services if the contracted services are not directly related to the provision of services to a resident, patient, or client of the employer;

(b) A physician, surgeon, dentist, psychologist, psychiatrist, podiatrist, audiologist, ophthalmologist, optometrist, dietician, therapist, phlebotomist, or any health care practitioner who is licensed to practice in Kentucky and is under contract with a participating employer in which a background check is required as a condition of professional licensure;

(c) A member of a community-based or faith-based organization that provides volunteer services that do not involve unsupervised interaction with a patient or resident;

(d) A student participating in an internship program; or

(e) A family member or friend visiting a patient or resident.

Section 3. Continuous Assessment.

(1) To ensure that the information remains current in the KARES system, the cabinet shall collaborate with the Department of Kentucky State Police (KSP) to implement a mechanism for continuous assessment in which KSP:

(a) Retains the fingerprints of an individual screened under the Kentucky NBCP:

For a minimum period of five (5) years from the date of fingerprint submission; and
On a five (5) year renewal basis thereafter; and

(b) Facilitates the retention of the fingerprints by the FBI upon approval to participate in the FBI's Next Generation Identification (NGI) rap back service.

(2) Upon implementation of the process for continuous assessment, the Department of Kentucky State Police may provide notification to the cabinet of triggering events for each applicant after initial processing of the applicant's criminal background check, subject to any applicable administrative regulations of the Department of Kentucky State Police and the FBI.

Section 4. Enrolling in the Kentucky NBCP. To enroll in the Kentucky NBCP, an employer or a participating professional licensing board shall:

(1) Log on to the KARES portal; and

(2) Confirm acceptance of the terms and conditions for using the KARES system.

Section 5. Registry and Criminal Background Checks: Procedures and Payment.

(1) To initiate the process for obtaining a background check on a prospective employee or licensee, the employer or participating professional licensing board shall:

(a) Request that the applicant provide a copy of his or her driver's license or other government-issued photo identification and verify that the photograph clearly matches the applicant;

(b) Request that the applicant sign the OIG 1:190-1, Disclosures to be Provided to and Signed by Applicant for Employment or Licensure;

(d) Log on to the KARES portal, which shall be a secure web-based system maintained by the cabinet, and enter the applicant's demographic information for a check of:

Each registry as defined by Section 1(10) of this administrative regulation; and
Available databases maintained separately by the Kentucky Board of Medical Licensure, Kentucky Board of Nursing, Kentucky Board of Physical Therapy, and any other available professional licensing board with oversight of health care professionals, including behavioral health professionals, to validate the applicant's professional licensure status, if applicable.

(2) If an applicant is cleared for hire after a check of the registries and databases identified in subsection (1)(d) of this section, the participating entity shall submit payment via credit or debit card for the criminal background check.

(3)

(a) A participating entity enrolled in the Kentucky NBCP shall pay a non-refundable fee not to exceed thirty (30) dollars to cover the cabinet's administrative cost for facilitating a criminal background check in addition to any fees charged by the Department of Kentucky State Police and the FBI for the actual cost of processing a fingerprint-supported state and national criminal background check and for providing continuous assessment services as described in Section 3(2) of this administrative regulation.

(b) If an applicant's continuous assessment period identified under Section 3 of this administrative regulation has not expired, a fee of twenty (20) dollars shall be charged to view the applicant's current fitness determination and process a new application, in which case a new fingerprint check is not needed.

(4)

(a) Upon submission of payment pursuant to subsection (3) of this section, the employer or other participating entity shall print a copy of the Live Scan Fingerprinting Form from the KARES portal and provide the form to the applicant.

(b) The applicant shall:

Have thirty (30) calendar days from the date of payment pursuant to subsection (2) of this section to submit his or her fingerprints at an authorized collection site; and
Present the Live Scan Fingerprinting Form and driver's license or other government-issued photo identification to the designated agent at an authorized collection site prior to fingerprint submission.

(5) Upon completion of a criminal background check, the cabinet:

(a) Shall provide notice to the employer that the applicant is:

Eligible for hire; or
Not eligible for hire if the applicant is found by the cabinet to have a disqualifying offense as identified in Section 1(4) of this administrative regulation;

(b) May release any record of state criminal history found in the files of the Kentucky centralized criminal history record information system to the employer or entity listed on the OIG 1:190-2, Waiver Agreement and Statement incorporated by reference in Section 15 of this administrative regulation; and

(c) Shall, upon receipt of a written request from an applicant, send a copy if any of a KSP or FBI criminal history report to the applicant by certified mail, restricted delivery service. The applicant shall show proof of identity and sign to receive his or her criminal history report from the local post office.

(6) An employer shall not be obligated to employ or offer employment to an individual who has been found by the cabinet to be eligible for hire pursuant to subsection (5)(a) of this section.

Section 6. Provisional Employment.

(1) If an applicant is not found on a registry and the individual's license has been validated, if applicable, an employer may hire the applicant for a period of provisional employment pending completion of the criminal background check.

(2) The period of provisional employment shall:

(a) Not commence prior to the date the applicant submitted his or her fingerprints; and

(b) Not exceed sixty (60) calendar days from the date of fingerprint collection.

(3) During the period of provisional employment, the individual shall not have supervisory or disciplinary power or routine contact with patients, residents, or clients without supervision on-site and immediately available to the individual.

Section 7. Individuals Ineligible to be Hired. An employer participating in the KARES program or a state-owned or operated health facility shall not employ, contract with, or permit to work as an employee any applicant that submits to a background check if one (1) or more of the following are met:

(1) The applicant refuses to provide photo identification or complete the Disclosures Form or Waiver Agreement and Statement Form required by Section 5(1) (b) and (c) of this administrative regulation;

(2) The applicant is found on a registry as defined by Section 1(10) of this administrative regulation;

(3) The applicant's professional license is not in good standing, if applicable;

(4) The applicant fails to submit his or her fingerprints at an authorized collection site within thirty (30) calendar days of payment submitted pursuant to Section 5(3) of this administrative regulation; or

(5) Upon completion of the initial criminal background check for an applicant, or subsequent to the initial fingerprint check on a current employee, the employer, cabinet agency, or state-owned or operated health facility receives notice from the cabinet that the applicant is not eligible for hire based on a cabinet determination that the individual has been found to have a disqualifying offense.

Section 8. Notice of a Disqualifying Offense and Appeals.

(1) The cabinet shall notify each applicant or current employee determined to have a disqualifying offense.

(2) In addition to the cabinet's notification required by subsection (1) of this section, an employer that receives notice from the cabinet that an individual has been determined to have a disqualifying offense shall notify the individual of the cabinet's determination within three (3) business days of receipt of the notice.

(3) An applicant or current employee who receives notice of a disqualifying offense may:

(a) Challenge the accuracy of the cabinet's determination regarding a disqualifying offense by submitting a written request for informal review, including any information the applicant wishes to be considered, to the Office of Inspector General, Cabinet for Health and Family Services, 275 East Main Street, 5E-A, Frankfort, Kentucky 40621, within ten (10) calendar days of the date of notice of the disqualifying offense; or

(b) Request a rehabilitation review pursuant to Section 10(2) of this administrative regulation.

(4) Upon completion of an informal review if requested pursuant to subsection (3)(a) of this section, the Office of Inspector General shall within ten (10) calendar days of receipt of the request provide written notice to the applicant or employee of the cabinet's decision to uphold or rescind the notice of the disqualifying offense.

(5) An applicant or current employee may appeal the results of an informal review or a rehabilitation review conducted in accordance with Section 10 of this administrative regulation by submitting a written request for an administrative hearing within thirty (30) calendar days from the date of notice of the decision from an informal review or rehabilitation review.

(6)

(a) A written request for an administrative hearing shall be mailed to the Office of Ombudsman, Cabinet for Health and Family Services, 275 East Main Street, 1E-B, Frankfort, Kentucky 40621.

(b) The administrative hearing shall be held no later than forty-five (45) calendar days from the date that the request is received by the Office of Ombudsman unless the applicant or employee agrees to a later date.

(c) The issues considered at the hearing shall be limited to the issues directly raised and considered during the informal review or rehabilitation review.

(d) The administrative hearing shall be conducted pursuant to KRS 13B.080.

(e) The hearing officer shall issue a recommended order pursuant to KRS 13B.110.

(f) The secretary or designee shall issue a final order pursuant to KRS 13B.120.

(7) If an applicant or current employee wishes to challenge the accuracy of a criminal background check, the cabinet shall refer the individual to the appropriate state or federal law enforcement agency.

(8) If an applicant or current employee challenges the finding that he or she is the true subject of the results from a registry check, the cabinet shall refer the individual to the agency responsible for maintaining the registry.

Section 9. Termination of an Employee Upon Receipt of Notice of a Disqualifying Offense.

(1) If a provisional employee or current employee has not requested an informal review or a rehabilitation review pursuant to Section 8(3) of this administrative regulation, the employer shall:

(a) Terminate the employee no later than fifteen (15) calendar days after receipt of notice of the disqualifying offense; and

(b) Use the KARES system to provide electronic notification to the cabinet affirming the employee's dismissal within three (3) business days of termination.

(2)

(a) If a provisional employee or current employee requests an informal review or a rehabilitation review pursuant to Section 8(3) of this administrative regulation, the employer:

May retain the employee pending resolution of the employee's informal review or rehabilitation review; and
Shall ensure that the employee is:

a. Subject to direct, on-site supervision; or

b. Reassigned to duties that do not involve one-on-one contact with a resident, patient, or client of the employer.

(b) An employer shall terminate the employee if the:

Informal review upholds the cabinet's determination of a disqualifying offense or the rehabilitation review committee does not grant a waiver; and
The employee does not request an administrative hearing in accordance with Section 8(5) of this administrative regulation, in which case the employer shall terminate the employee no later than the thirty-first calendar day following written notice of the results of the informal review or rehabilitation review.

(c) If an employee requests an administrative hearing to appeal the decision from an informal review or rehabilitation review, the employer:

May retain the employee pending resolution of the appeal if the employee:

a. Remains subject to direct, on-site supervision; or

b. Is reassigned to duties that do not involve one-on-one contact with a resident, patient, or client; and

Shall terminate the employee as soon as practicable upon issuance of a final order if the employee does not prevail.

(d) Using the KARES system, the employer shall provide electronic notification to the cabinet affirming the individual's dismissal within three (3) business days of termination.

Section 10. Rehabilitation Review.

(1)

(a) An applicant or employee found to have a disqualifying offense upon completion of the criminal background check shall be eligible for consideration of rehabilitation under an independent review process.

(b) Consideration of a disqualifying offense under the rehabilitation review process described in this section shall not apply to:

A disqualifying felony offense that occurred less than seven (7) years prior to the date of the criminal background check;
Any disqualifying felony or misdemeanor offense related to abuse, neglect, or exploitation of an adult defined by KRS 209.020(4) or child, or a sexual offense;
Registration as a sex offender under federal law or under the law of any state;
Any person who is a violent offender as defined by Section 1(12) of this administrative regulation; or
A pending charge or an outstanding warrant for a criminal offense described in Section 1(4)(b) of this administrative regulation.

(2)

(a) An applicant or employee may submit a written request for a rehabilitation review to the cabinet no later than fourteen (14) calendar days from the date of the notice of the cabinet's determination issued pursuant to Section 8(1) of this administrative regulation regarding a determination of a disqualifying offense.

(b) If an applicant or employee requests a rehabilitation review, the employee may be retained on staff and shall be subject to termination in accordance with Section 9(2) of this administrative regulation.

(3) The request for a rehabilitation review shall include the following information:

(a) A written explanation of each disqualifying offense, including:

A description of the events related to the disqualifying offense;
The number of years since the occurrence of the disqualifying offense;
The age of the offender at the time of the disqualifying offense; and
Any other circumstances surrounding the offense;

(b) Official documentation showing that all fines, including court-imposed fines or restitution, have been paid or documentation showing adherence to a payment schedule, if applicable;

(d) Employment and character references, including any other evidence demonstrating the ability of the individual to perform the employment responsibilities and duties competently.

(4) A rehabilitation review shall be conducted by a committee of three (3) employees of the cabinet, none of whom:

(a) Is an employee of the Office of Inspector General; or

(b) Was responsible for determining that the individual has a disqualifying offense.

(5) The committee shall consider the information required under subsection (3) of this section, and shall also consider mitigating circumstances including:

(a) The amount of time that has elapsed since the disqualifying offense;

(b) The lack of a relationship between the disqualifying offense and the position for which the individual has applied; and

(6) No later than thirty (30) calendar days from receipt of the written request for the rehabilitation review, the Office of Inspector General shall send the committee's determination on the rehabilitation waiver to the applicant.

(7) The decision of the committee shall be subject to appeal in accordance with Section 8(5) and (6) of this administrative regulation.

(8) An employer shall not be obligated to employ or offer employment to an individual who is granted a waiver pursuant to this section.

Section 11. Pardons and Expungement. An applicant who has received a pardon for a disqualifying offense or has had the record expunged may be employed.

Section 12. Status of Employment. An employer participating in KARES shall maintain the employment status of each employee who has submitted to a fingerprint-supported criminal background check by reporting the status using the KARES web-based system.

Section 13. Kentucky National Background Check Fund.

(1)

(a) The cabinet shall establish a trust and agency fund called the Kentucky National Background Check fund to be administered by the Finance and Administration Cabinet.

(b) The fund shall be funded with moneys collected under Section 5(3) of this administrative regulation.

(2) Moneys in the fund shall be used solely to operate the Kentucky National Background Check program.

Section 14. Termination of Participation. The cabinet shall terminate a voluntarily participating employer's participation in the Kentucky NBCP for a period of no less than ninety (90) days if there has been substantial failure by the employer to comply with the provisions of this administrative regulation.

Section 15. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) OIG 1:190-1, "Disclosures to be Provided to and Signed by Applicant for Employment or Licensure", September 2016;

(b) OIG 1:190-2, "Waiver Agreement and Statement", September 2016; and

History

RELATES TO: KRS Chapter 13B, 209.020, Chapter 216B, 42 U.S.C. 1320a-7I, 34 U.S.C. 40102, 40104
STATUTORY AUTHORITY: KRS 194A.050(1), 42 U.S.C. 1320a-7I
NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to operate programs and fulfill the responsibilities vested in the cabinet, qualify for the receipt of federal funds, and cooperate with other state and federal agencies for the proper administration of the cabinet and its programs. 42 U.S.C. 1320a-7I directs the secretary of the United States Department of Health and Human Services to establish a program to identify efficient, effective, and economical procedures for long-term care facilities or providers to conduct background checks on prospective direct patient access employees on a nationwide basis. The Cabinet for Health and Family Services, Office of Inspector General, is charged with responsibility to oversee and coordinate Kentucky's fingerprint-supported NBCP initiative. This administrative regulation establishes procedures for the implementation of Kentucky's NBCP as a voluntary program. The conditions set forth in this administrative regulation for voluntary KARES system participants are in addition to the name-based, state only background check requirements of KRS 216.533, 216.712(2), 216.787, and 216.789.
History: 40 Ky.R. 203; 873; 1085; eff. 12-10-2013; 43 Ky.R. 806, 1427, 1574; eff. 3-31-2017; 45 Ky.R. 181; eff. 11-27-2018; 50 Ky.R. 970; eff. 2-16-2024.

906 KAR 1:200 Use of Civil Money Penalty Funds Collected from Certified Long-term Care Facilities {#sec-906-kar-1-200 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:200}

Section 1. Definitions.

(1) "Cabinet" means the Cabinet for Health and Family Services.

(2) "CMP" means civil money penalties imposed by CMS on certified long-term care facilities (serving Medicare and Medicaid beneficiaries) that do not comply with applicable federal health and safety laws and regulations.

(3) "CMS" means the Centers for Medicare and Medicaid Services.

(4) "Funding" means a grant from collected CMP funds distributed by the cabinet upon approval by CMS.

Section 2. Funding Opportunities. Collected CMP funds may be used to support activities that benefit Kentucky's residents of certified long-term care facilities, including:

(1) Assistance to support and protect residents of a certified long-term care facility that closes (voluntarily or involuntarily) or is decertified, and may include offsetting the costs of relocating residents to a home and community-based setting or another facility;

(2) Projects that support resident and family councils;

(3) Consumer involvement activities which assure quality care in long-term care facilities; or

(4) Facility improvement initiatives approved by CMS, which may include:

(a) Joint training of facility staff and the cabinet's long-term care facility surveyors;

(b) Technical assistance for facilities implementing quality assurance programs; or

Section 3. Prohibited Uses of CMP Funds. CMP funds shall not be approved:

(1) For a project in which a conflict of interest exists or the appearance of a conflict of interest exists;

(2) If the applicant is currently paid by a federal or state source to perform the same function as the proposed CMP project or use;

(3) For capital improvements to a long-term care facility, or to build a long-term care facility;

(4) To pay for services or supplies that are the responsibility of the long-term care facility, including laundry, linen, food, heat, or staffing costs;

(5) To pay the salaries of temporary managers who are actively managing a long-term care facility; or

(6) To recruit or provide Long-Term Care Ombudsman certification training for staff or volunteers, or investigate and work to resolve complaints.

Section 4. Applicants.

(1) An entity that applies for and receives funding shall be qualified and capable of carrying out the intended project or use described in the State Request for Approval of Use of Civil Money Penalty Funds for Certified Nursing Homes.

(2) Entities that may qualify for funding include:

(a) Consumer advocacy organizations;

(b) Resident or family councils;

(d) State Long-term Care Ombudsman programs;

(e) Quality improvement organizations;

(f) Private contractors;

(g) Academic or research institutions;

(h) Certified long-term care facilities;

(i) State, local, or tribal governments; or

(j) Profit or not-for-profit organizations.

Section 5. Application Process. To apply for funding, an applicant shall:

(1) Download a copy of the application titled State Request for Approval of Use of Civil Money Penalty Funds for Certified Nursing Homes from the cabinet's Web site at https://chfs.ky.gov/agencies/os/oig/dhc/Pages/cmp-funds.aspx; and

(2) Complete and email the application to the cabinet at the following Web address: CMPAPPLICATION_OIG@KY.GOV.

Section 6. Review of Applications.

(1) Upon receipt of an application, the cabinet shall review the application and determine if the application meets the criteria for use of collected CMP funds pursuant to:

(a) Sections 2 through 4 of this administrative regulation; and

(b) The application's instructions.

(2) Upon review of the application based on the criteria for use of collected CMP funds in 42 C.F.R. 488.433, the Office of Inspector General shall forward the application to CMS, including an initial determination on the ability of the project to improve resident outcomes and advance the care and services provided in certified long-term care facilities.

Section 7. Reporting. If an application is approved by CMS, the organization or entity from which the application originated shall:

(1) Submit a quarterly report on the status of the project to the CMS regional office and the cabinet;

(2) Submit a follow-up report within five (5) calendar days of conclusion of the funded project to the CMS regional office and the cabinet; and

(3) Submit a final report monitoring the success of the project within six (6) months of conclusion of the funded project to the CMS regional office and the cabinet.

Section 8. Denials. An application that is denied shall:

(1) Be accompanied by an explanation; and

(2) Not be subject to an appeal.

Section 9. Incorporation by Reference.

(1) The Centers for Medicare and Medicaid Services, Region IV Atlanta, "State Request for Approval of Use of Civil Money Penalty Funds for Certified Nursing Homes", May 2013, is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

RELATES TO: KRS 194A.050(1), 42 C.F.R. 488.433
STATUTORY AUTHORITY: KRS 194A.050(1), 42 U.S.C. 1395i-3(h)(2)(B)(ii)(IV)(ff), 42 U.S.C. 1396r(h)(3)(C)(ii)(IV)(ff)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the Secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to operate programs and fulfill the responsibilities vested in the cabinet, qualify for the receipt of federal funds, and cooperate with other state and federal agencies for the proper administration of the cabinet and its programs. 42 U.S.C. 1395i-3(h)(2)(B)(ii)(IV)(ff) and 42 U.S.C. 1396r(h)(3)(C)(ii)(IV)(ff) pertain to the collection and use of civil money penalties (CMP) imposed by the Centers for Medicare and Medicaid Services (CMS) on certified long-term care facilities (serving Medicare and Medicaid beneficiaries) that do not comply with applicable federal health and safety laws and regulations. Except for temporary use in the case of sudden nursing facility relocations, natural disasters, or similar emergencies, states are required to obtain prior approval from CMS for any new project, new grantee, or new use of federally imposed CMP funds. Upon approval by CMS, states may direct collected CMP funds to a variety of organizations if the funds are used in accordance with 42 U.S.C. 1395i-3(h)(2)(B)(ii)(IV)(ff) and 42 U.S.C. 1396r(h)(3)(C)(ii)(IV)(ff). This administrative regulation establishes a competitive grant program to provide funding to organizations which offer programs or services approved by CMS for the use of CMP funds, thereby establishing the CMP Fund Grant Program.
History: 40 Ky.R. 209; 548; eff. 9-18-2013; 44 Ky.R. 2454; 45 Ky.R. 42; eff. 7-18-2018; Crt eff. 5-19-2025.

906 KAR 1:210 Health care services agencies {#sec-906-kar-1-210 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:210}

Section 1. Definitions.

(1) "Assisted-living community" is defined by KRS 216.718(1).

(2) "Cabinet" is defined by KRS 216.718(2).

(3) "Controlling person" is defined by KRS 216.718(3).

(4) "Direct care service" is defined by KRS 216.718(4).

(5) "Permanent direct care staff" is defined by KRS 216.718(8).

(6) "Health care services agency" is defined by KRS 216.718(5).

(7) "Hospital" is defined by KRS 216.718(6).

(8) "Long-term care facilities" is defined by KRS 216.718(7).

(9) "Temporary direct care staff" is defined by KRS 216.718(9).

Section 2. Registration.

(1) A health care services agency that refers temporary direct care staff to assisted-living communities, long-term care facilities, or hospitals in Kentucky shall register with the cabinet as required by KRS 216.720(1).

(2) In accordance with KRS 216.725, the requirements of this administrative regulation shall not apply to the placement of permanent direct care staff.

Section 3. Application and Fees.

(1) An applicant for initial registration or annual renewal as a health care services agency shall submit to the Office of Inspector General:

(a) A completed Application for Registration to Operate a Health Care Services Agency; and

(b) In accordance with KRS 216.720(2)(f), an accompanying fee in the amount of $3,000, made payable to the Kentucky State Treasurer.

(2) As a condition of annual renewal, the application required by subsection (1) of this section shall be submitted to the cabinet at least sixty (60) days prior to the date of expiration of the agency's registration.

(3) In accordance with KRS 216.720(1), each separate location of a health care services agency shall register and obtain a separate registration.

(4)

(a) Name change. A health care services agency shall:

Notify the Office of Inspector General in writing within ten (10) calendar days of the effective date of a change in the agency's name; and
Submit a processing fee of twenty-five (25) dollars.

(b) Change of location. A health care services agency shall not change the location where a facility is operated until an Application for Registration to Operate a Health Care Services Agency accompanied by a fee of $100 is filed with the Office of Inspector General.

In accordance with KRS 216.720(4), if a controlling person changes, the health care services agency is sold, or the management is transferred, the agency shall submit to the Office of Inspector General a completed Application for Registration to Operate a Health Care Services Agency accompanied by a fee of $3,000 no later than thirty (30) calendar days from the effective date of the change.
A change of ownership shall be deemed to occur if more than twenty-five (25) percent of an existing health care services agency or capital stock or voting rights of the corporation is purchased, leased, or otherwise acquired by one (1) person from another.

Section 4. Scope of Operations.

(1) A health care services agency shall meet all of the minimum requirements as established in KRS 216.722(1)(a) through (f) relating to documentation, health and qualifications of personnel, professional and general liability insurance, an employee dishonesty bond, worker's compensation, and record retention.

(2) A health care services agency shall demonstrate compliance with:

(a) KRS 216.724;

(b) KRS 216.789; and

Section 5. Quarterly Reports.

(1) In accordance with KRS 216.728, a health care services agency shall submit quarterly reports to the cabinet on the Quarterly Report form that includes the following information:

(a) The name, professional licensure or certification, and assigned location for each temporary direct care staff;

(b) The length of time the temporary direct care staff person has been assigned to the assisted-living community, long-term care facility, or hospital and the total hours worked; and

Copies of all invoices submitted to the long-term care facility or hospital; and
Proof of payment by the long-term care facility or hospital.

(2) The quarterly reports shall be submitted to the cabinet for the preceding calendar quarter by February 1, May 1, August 1, and November 1 of each year.

Section 6. Complaints. In accordance with KRS 216.726, a complaint relating to a health care services agency or temporary direct care staff may be made in accordance with the instructions provided in the complaint information document available for download from the Office of Inspector General's Web site: https://chfs.ky.gov/agencies/os/oig/dhc/Pages/default.aspx.

Section 7. Denial, Expiration, Revocation, and Fines.

(1) The cabinet shall deny an Application for Registration to Operate a Health Care Services Agency if:

(a) The applicant or existing agency knowingly misrepresents or submits false information on the application;

(b) The applicant or existing agency fails to provide the information and fee required by Section 3(1) of this administrative regulation;

(d) A controlling person in the entity applying for registration was a controlling person in a previously registered health care services agency that had its registration revoked for noncompliance during the five (5) year period immediately preceding the filing of the application.

(2)

(a) In accordance with KRS 216.720(4), a health care services agency's registration shall expire one (1) year from the date of issuance.

(b) If the health care services agency fails to renew its registration pursuant to Section 3(2) of this administrative regulation:

Its registration shall be cancelled effective one (1) day after the expiration date;
The Office of Inspector General shall document the agency's registration as inactive; and
The agency shall not continue to refer staff to an assisted-living community, long-term care facility, or hospital in Kentucky until its registration is renewed.

(3) Failure to comply with Section 4(1) of this administrative regulation shall result in the penalties as established in KRS 216.722(2).

(4) The cabinet shall revoke registration:

(a) In accordance with KRS 216.722(3); or

(b) If the cabinet determines that there has been substantial failure by the health care services agency to comply with the provisions of this administrative regulation or KRS 216.718 – 216.728.

Section 8. Notice of Adverse Action.

(1) Except for a violation of KRS 216.722(3), OIG shall provide written notice of adverse action at least thirty (30) calendar days prior to the effective date of the denial or revocation.

(2) The cabinet shall immediately notify a health care services agency that its registration will be revoked in fifteen (15) days if the cabinet determines an agency has knowingly engaged in the conduct described in KRS 216.722(3).

(3) A notice of adverse action issued in accordance with subsection (1) or (2) of this section shall:

(a) Explain the reason for the denial or revocation, and monetary penalty if applicable;

(b) Advise the health care services agency of the right to request an appeal prior to the effective date of the denial or revocation, and monetary penalty if applicable; and

Section 9. Closure of a Health Care Services Agency. If a health care services agency closes voluntarily or as the result of denial or revocation of the registration, the agency shall relinquish to the cabinet its registration to operate as a health care services agency immediately after the effective date of the closure.

Section 10. Appeals. A health care services agency that submits a written request for appeal within thirty (30) calendar days of the date the agency receives a notice of adverse action, including revocation pursuant to KRS 216.722(3), shall be afforded a hearing in accordance with KRS Chapter 13B.

Section 11. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) Form OIG 1:210, "Application for Registration to Operate a Health Care Services Agency", May 2023 edition; and

(b) Form OIG 1:210-A, "Quarterly Report", May 2023 edition.

History

RELATES TO: KRS 216.718 – 216.728, 216.785 – 216.793
STATUTORY AUTHORITY: KRS 216.720(2), 216.728(2)
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.720(2) requires the cabinet to promulgate administrative regulations in accordance with KRS Chapter 13A to establish the application process for registration of health care services agencies. KRS 216.728(2) requires the cabinet to promulgate administrative regulations in accordance with KRS Chapter 13A to establish requirements for health care services agencies to submit quarterly reports. This administrative regulation establishes requirements for health care services agency registration and quarterly reporting.
History: 49 Ky.R. 703, 1434; eff. 1-12-2023; 49 Ky.R. 2385; 50 Ky.R. 594; eff. 9-27-2023.

Title 906 KAR — Cabinet for Health and Family Services

Chapter 1 Office of Inspector General

906 KAR 1:040 Blood establishment inspection {#sec-906-kar-1-040 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:040}

906 KAR 1:100 Nurse aide abuse registry, home health aide abuse registry, and hearing procedures {#sec-906-kar-1-100 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:100}

906 KAR 1:110 Critical access hospital services {#sec-906-kar-1-110 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:110}

906 KAR 1:120 Informal dispute resolution {#sec-906-kar-1-120 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:120}

906 KAR 1:140 Validation and complaint investigation procedures for deemed hospitals {#sec-906-kar-1-140 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:140}

906 KAR 1:160 Monitoring system for products containing ephedrine, pseudoephedrine, or phenylpropanolamine {#sec-906-kar-1-160 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:160}

906 KAR 1:170 Administrative subpoenas {#sec-906-kar-1-170 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:170}

906 KAR 1:180 Operation and services; personal services agencies {#sec-906-kar-1-180 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:180}

906 KAR 1:190 Kentucky National Background Check Program (NBCP) {#sec-906-kar-1-190 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:190}

906 KAR 1:200 Use of Civil Money Penalty Funds Collected from Certified Long-term Care Facilities {#sec-906-kar-1-200 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:200}

906 KAR 1:210 Health care services agencies {#sec-906-kar-1-210 omnilex-key=us-ky-regs-official--title-906--906 KAR 1:210}

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