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Cabinet for Health and Family Services
Office of Inspector General
Division of Health Care
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Long Term Care Provider Newsletter
August 2023
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Assisted Living Communities (ALCs)
Changes Coming Soon!
When SB 11 was enacted in 2022, it introduced a new approach to elder care in Kentucky. SB 11 changes the way that assisted living communities are regulated and it expands the services ALCs can provide. Through those changes, SB 11 seeks to create a more integrated continuum of care that will promote allowing seniors to age in place with access to the services they need and will result in less disruption to their lives.
In order to fully implement SB 11, the cabinet worked with the provider community to promulgate 902 KAR 20:480, the new assisted living communities (ALCs) regulation, which outlines the new licensure levels and requirements for ALCs. This article provides an introduction to the different licensure levels, some of the new changes, and provides links to websites with more detailed information.
The new regulation replaces the current structure for certified social model ALCs with a new framework. Instead of becoming certified by the Department for Aging and Independent Living, ALCs will be required to seek licensure from the Office of Inspector General. An ALC may continue as a social model (licensed as an ALC), or choose to add basic health and health-related services (licensed as an ALC-BH), or also provide services in a secure dementia care unit (licensed as an ALC-DC). SB 11 also merged elder model personal care homes that meet the physical plant requirements of KRS 194A.703 with ALCs into a broader ALC licensure category.
A social model ALC may elect to continue to operate as a social model in which case it will continue to offer its current level of services and will be prohibited from providing health services. An ALC-BH will be able to offer services beyond what a social model ALC can offer, including nursing services, PT, OT, speech pathology services, dietician services, or social worker services. It may also provide medication management, hands-on assistance with transfers and mobility, treatments and therapies, and assistance with eating, and other services.
An ALC-DC will provide those same basic health services in addition to person-centered care of residents with dementia, to include assistance with ADLs, providing access to social activities, individualized activity plans, and for newly built dementia units, access to secured outdoor space.
An ALC that elects to offer basic health and health-related services or that wants to also add a new secured dementia will be able to expand the services it offers only after it has made any changes to its facility, operations, and staffing that are necessary to comply with the requirements of 902 KAR 20:480; all applicable fire, safety, and building code requirements; and all applicable statutes.
Through the three-tiered licensure structure, the provider has the ability to choose the type of services it will provide and the consumer will have more clarity regarding the services offered and any limitations to those services. If it is important to a prospective resident to be able to age in place at the ALC, the resident can choose a facility that offers more health services in the event those additional services will be needed as the resident ages. An ALC is prohibited by statute from representing that it provides any service other than a service it is licensed to provide.
All ALCs, regardless of licensure level, will be required to complete a standardized functional needs assessment for each resident upon move-in and at least every 12 months thereafter, and sooner if there is a change in the resident’s condition. This form should be used by the facilities to gather enough information to ensure that prospective residents meet the eligibility criteria for an ALC and do not need a higher level of care such as what is provided in a skilled nursing facility. The eligibility criteria for ALCs are set out in KRS 194A.711.
As is already currently allowed, social model ALCs will continue to be able to provide assistance with self-administration of medication, but in a significant change for current ALCs, ALCs-BH and ALCs-DC will be able to directly administer medications to residents if the ALC meets the necessary licensure and staffing requirements.
Not only will a nurse working in an ALC-BH or ALC-DC be able to directly administer medications, but pursuant to new statutes and the new ALC regulation, a nurse may also delegate the administration of certain types of medication to unlicensed staff if the unlicensed staff has the appropriate credentials and training. More detailed information can be found through the links at the bottom of this article, but in summary, an unlicensed staff person will be able to administer oral or topical medication if he or she has a certified medication aide I (CMA I) credential or Kentucky medication aide (KMA) credential. If the unlicensed staff person has a certified medication aide II (CMA II) credential, he or she could administer preloaded insulin injections. The CMA credentials will be available from any training program approved by the Kentucky Board of Nursing (KBN) pursuant to a new KBN regulation that will soon become effective. These changes should help address some of the problems created by the nursing shortage while also helping to keep residents safe from medication errors.
In addition to the changes discussed above, the new laws also introduced many other significant changes for ALCs regarding: how controlled substances are to be handled; minimal staffing requirements; regular on-site inspections by OIG; residents’ rights and grievances; residents’ records; required facility policies and procedures; dietary services; and emergency planning, just to name a few. For more detailed information please review the relevant statutes and regulations in their entirety as well as the cabinet’s training slides and FAQs at the links below:
In the coming weeks, ALCs will receive direct communication from the cabinet with more information about the timeline for transition and any next steps they need to take. The new ALC regulation, 902 KAR 20:480, became effective on July 25th; however, it requires significant changes for both the providers and the cabinet, so new OIG licenses for ALCs will not be issued until the responsibilities for ALC oversight are fully transitioned to OIG from the Department for Aging and Independent Living, which is expected to take several months. Additionally, it is important to note that a currently certified ALC must retain its social model status until it has hired a sufficient number of personnel who can appropriately provide the additional services required and can meet all other statutory and regulatory requirements to operate as an ALC-BH or ALC-DC, including any applicable building code requirements.
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The Inspector General and Deputy Inspector General were able to visit a CMP grant in action. Promoting Health Across the Lifespan Among Kentucky Certified Nursing Facility Residents Through Bingocize®, an Evidence-based Health Promotion Program CMP project (2021-04-KY-0614) at Sayre Christian Village. It was wonderful for them to see the residents actively engaging in the program. The smiles on their faces were priceless.
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COMING SOON - Free MDS Training!
Minimum Data Set training, hosted annually by the Kentucky Office of Inspector General and presented by Myers and Stauffer LC, will be available as six (6) webinars on TRAIN in early October. Each webinar in this "Back to the Basics" series will cover a different Chapter of the RAI Manual.
The Kentucky Board of Nursing has approved contact hours for Kentucky RNs and LPNs upon completion, assessment, and evaluation of each individual session. Kentucky LTC Administrators will also receive contact hours. (Please note that you must have an individual TRAIN account in order to receive credit.)
Please contact Darlene Cox with any questions by email or at 502-564-5805.
Stay tuned for more details!
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POST-EVENT MATERIALS AVAILABLE
The SNF MDS 3.0 RAI v1.18.11 Guidance Training Program
A Post-Event Q&A document from the SNF MDS 3.0 RAI v1.18.11 Guidance Training Program is now available.
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NOW AVAILABLE: Final MDS 3.0 RAI User’s Manual version 1.18.11
This version of the MDS 3.0 RAI Manual contains substantial revisions related to the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act), which requires that standardized assessment items be collected across post-acute care (PAC) settings. Standardized data will enable cross-setting data collection, outcome comparison, exchangeability of data, and comparison of quality within and across PAC settings. Additionally, the language of the manual has been updated throughout to be gender neutral. Guidance and examples in numerous chapters and appendices have been revised for clarification and to reflect current regulations and best practices. Due to the scope of the revisions, CMS will not issue Replacement Pages for v1.18.11; those wishing to continue using a physical copy of the manual are encouraged to print the new version.
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New Minimum Data Set (MDS) 3.0 Frequency Report Website
Effective August 21, 2023, MDS 3.0 Frequency data will be available from a new location on the data.cms.gov website (https://data.cms.gov/quality-of-care/minimum-data-set-frequency). This new website replaces the previous MDS 3.0 Frequency Report webpage which was decommissioned on August 1, 2023.
Users will find very similar information on this new website to that which was provided on the historical MDS 3.0 Frequency Report webpage, including an overview of the data that are accessible from the website, explanatory text that identifies the methodology for calculation of those data, and the item response frequency data. Enhanced functionality on the new website allows users to view the Frequency data online, including filtering functionality of the data to meet the user’s needs. This new website also allows users to download and save theFrequency data in Comma Separated Value (CSV) or CSV for Excel files by calendar quarter. The downloadable files contain MDS 3.0 Frequency data for all states and the Nation by the calendar quarter report period. Downloadable CSV files will be available for all calendar quarters beginning with Calendar Year (CY) 2020 (Q1, 2020) through Q2, 2023. As each new calendar quarter begins, data for the prior calendar quarter will be made available on the website. For example, Q3, 2023 data will be available for download approximately mid-late October, 2023.
The CSV files contain the following data elements:
- Geographical Location – this column identifies the State or National location for which the MDS 3.0 Frequency data are reported.
- Report Date – this column identifies the Calendar Quarter and Year for which the MDS 3.0 Frequency data are reported (e.g., Q1, 2022).
- MDS Item Question/Description – this column identifies the item ID and section description as displayed on the MDS assessment instrument, followed by the item specific description for which the data are reported. Example: A0800: Identification Information – Gender.
- MDS Item Response – this column contains item responses that correspond to the assessment item. Each response for an item is listed on a separate row so that counts and percentages are displayed for each response by geographic location.
- Percent – this column contains the percent of responses for each item, geographical location, and reporting quarter.
- Total Residents – this column identifies the number of times each response was answered for an item grouped at a state and national level for the reporting quarter.
With this migration to the new webpage, active MDS items for which the frequency counts are calculated for the report periods above are included in the CSV files and retired items have been removed. As new items are added to the MDS assessment instrument, they will be included in the downloadable files if the item/response value are appropriate for the MDS 3.0 Frequency calculations.
If you have any questions regarding this information, please contact the QIES/iQIES Service Center by phone at (800) 339-9313 or send an email.
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UPDATED: Optional State Assessment (OSA) Item Set and OSA Manual
The Optional State Assessment (OSA) Item Set and OSA Manual have been updated, and the updated versions are now available in the Downloads section on the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI) Manual page. Some items, listed below, have been corrected, and a number of other items have had small changes to their formatting. Screenshots in the manual have been updated, where needed, to reflect these changes.
The OSA is not a Federally required assessment; rather, it may be required in some States for payment purposes. Each State determines whether the OSA is required and if so, when the assessment must be completed. For questions regarding completion of the OSA, please contact your State Survey Agency.
The following corrections were made:
A0700 The word <patient> was changed to <recipient>.
C0300A Erroneous numbering (1–4) was changed to the correct numbering (0–3).
C0500 The wording of the instruction was changed from <Enter Code> to <Enter Score>.
O0100 The label above subitem Z was corrected from <Other> to <None of the above>.
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CMP Grant Opportunities Available
CMP Reinvestment Fund*
OIG seeks innovative projects that support, protect, and benefit certified nursing facility residents. These initiatives must be outside the scope of normal facility operations and cannot be used to fund goods or services that the applicant already offers or is required to provide by state or federal law or regulation.
- There is no minimum or maximum amount that can be applied for
- There is currently no application deadline and applications can be submitted at any time.
COVID-19 Emergency CMP Grants
The COVID-19 Emergency CMP Grants are temporary programs in place during the federal Public Health Emergency. Kentucky will continue to accept applications until CMS closes the programs. CNFs can apply for all three programs for up to a total of $9,000 for the purchase of:
- Communication devices and accessories to allow residents to communicate remotely
- In-person visitation aids such as tents/outdoor shelters, outdoor furniture, clear dividers, and more
- Portable fans and/or room air cleaners with HEPA filters (H-13, -14
*OIG review of new CMP applications currently on hold.
CMS has initiated a comprehensive review of the Civil Monetary Penalty Reinvestment Program. During this review, the approval of applications for CMP reinvestment funds may be delayed as they work to ensure the integrity of distributions, in keeping with the goal of improving nursing home resident quality of life and achieving care innovations. Following this review, CMS will issue updated formal guidance outlining any new processes or program parameters. OIG will communicate any changes to the program or application process and restart the review of new applications at that time.
Please note: While the CMS review is ongoing, CMS will continue to approve applications for the COVID-19 Emergency CMP Grants. Therefore, interested parties may continue to submit applications for COVID-19 Emergency CMP grants to OIG for consideration.
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Division of Health Care Contact Information
Central Office
Belinda Beard, Director
Marissia Izlar, Assistant Director
Andrea Willhite, Assistant Director
275 E. Main St., 5E-A Frankfort, KY 40621
Phone: 502-564-7963
Fax: 502-564-6546
Western Enforcement Branch
Terri Gipson, Regional Program Manager
901 B South Main Street, Hopkinsville, KY 42240
Phone: 270-889-6052
Fax: 270-889-6089
Northern Enforcement Branch
Patricia Hinson, Regional Program Manager
L & N Building 10-W, 908 W. Broadway, Louisville, KY 40203
Phone: 502-595-4958
Fax: 502-595-4540
Southern Enforcement Branch
Tammy Ricks, Regional Program Manager
116 Commerce Ave., London, KY 40744
Phone: 606-330-2030
Fax: 606-330-2054
Eastern Enforcement Branch
Will Hendrickson, Human Services Program Branch Manager
455 Park Place, Suite 120A, Lexington, KY 40511
Phone: 859-246-2301
Fax: 859-246-2307
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Kentucky's Top 10 Citations
for Nursing Homes
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Informal Appeal of Survey Findings
Interested in Serving on an IDR Panel?
Kentucky requires one member of the IDR panel to be "a person currently engaged in the provision of Long Term Care services who has no affiliation with the provider disputing a deficiency." Typically, a Long Term Care Administrator is on each IDR panel. There is no payment or travel reimbursement for an Administrator serving on a panel. Administrators will be rotated. If a Long Term Care Administrator is interested in serving on a panel, a confidentiality statement must be signed prior to the participation in the first IDR panel.
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Jennifer Smith, RN
RAI/Oasis/IDR-IIDR Coordinator
Office of Inspector General
Division of Health Care
275 E. Main St., 5E-A
Frankfort, KY 40621
Fax: (502) 564-6546
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MDS/RAI CONTACT INFORMATION
For questions regarding MDS Assessment, Coding, Transmission or
Please do not send any identifiable patient information through e-mail. This includes patient names, SSNs, dates of birth, or any other data items considered identifiers or Protected Health Information (PHI) under HIPAA. Please redact any PHI prior to sending.
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All certified nursing facilities must sign up for ePOC. Please be diligent about keeping your account and password up to date. All correspondence is handled in the ePOC system, including the plan of correction. Furthermore, if there is a change in administrator, it is incumbent upon the facility to update the system.
If your facility is not yet signed up, see the Account Setup instructions.
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Have you notified your residents?
Click the link below to download and/or print the contact list for various agencies.
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Which Branch is Serving You?
To provide the highest level of service, the Division of Health Care operates through four regional offices. Knowing the appropriate Branch to contact with questions and concerns will ensure you receive maximum service in minimum time. Review links below for detailed information.
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CMS Survey and Certification memoranda, guidance, clarifications and instructions to State Survey Agencies and CMS Regional Offices.
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Transfer/Discharge Hearing Appeals
Please submit your requests for transfer/discharge hearing appeals to Secretary Eric C. Friedlander, Cabinet for Health and Family Services, by emailing:
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LTC Facility Self-Reported
Incidents & Complaints
New email addresses have been established for communications regarding LTC Facility Self-Reported Incidents and for use by residents and the general public to report possible violations of regulatory requirements. Click Here for the email addresses and additional contact information.
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Quality, Safety & Education Portal
CMS's QSEP provides the full curriculum of surveyor training and guidance on health care facility regulations. All training is available on-demand on a top-notch self-service portal. 24/7 access means you have the freedom to learn what you want, where you want, when you want.
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Employment Opportunities
To search and apply for positions within the Office of Inspector General, please visit the Kentucky Personnel Cabinet's web page by clicking below.
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DHC Leadership Team:
Inspector General
Deputy Inspector General
Director
Assistant Director
Assistant Director
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Want to Sign Up for This Newsletter?
If you have received a copy of this newsletter from a friend or co-worker, you can click here and enter your information to join our mailing list, or contact MelissaD.Richard@ky.gov.
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Commonwealth of Kentucky | Office of Inspector General | 275 East Main St., Frankfort, KY 40621 |
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The Office of Inspector General is the regulatory and licensing agency for all health care, day care and long-term care facilities and child adoption/child-placing agencies in the commonwealth.
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