Krista Quarles, Kara Daniel; Stephanie Brammer-Barnes

This administrative regulation establishes the minimum licensure requirements for the operation of and services provided by nursing facilities.

This administrative regulation is necessary to comply with KRS 216B.042, which requires the cabinet to promulgate administrative regulations necessary for the proper administration of the licensure function, including licensure standards and procedures to ensure safe, adequate, and efficient health facilities and health services.

This administrative regulation conforms to the content of KRS 216B.042 by establishing the minimum licensure requirements for the operation of and services provided by nursing facilities.

This administrative regulation assists in the effective administration of the statutes by establishing the minimum licensure requirements for the operation of and services provided by nursing facilities.

This amendment requires unlicensed staff who administer medications to nursing facility residents under the delegation of a nurse to be a certified medication aide I or Kentucky medication aide, or be a certified medication aide II.

This amendment in necessary to align with the 2023 passage of SB 110, which amended KRS 194A.705(2)(c) to require all long-term care facilities that provide basic health and health-related services or dementia care services to ensure that unlicensed staff who administer oral or topical medications, or preloaded injectable insulin to residents under the delegation of a nurse to have successfully completed a medication aide training and skills competency evaluation program approved by the Kentucky Board of Nursing (KBN).

This amendment conforms to the content of KRS 194A.705(2)(c) because the statute applies to all long-term care facilities, including nursing facilities.

This amendment assists in the effective administration of KRS 194A.705(2)(c) because the statute applies to all long-term care facilities, including nursing facilities.

This amendment affects the 290 licensed nursing facilities in Kentucky.

Nursing facilities must ensure that unlicensed staff who administer oral or topical medications to residents under the delegation of a nurse be a certified medication aide I or Kentucky medication aide, or be a certified medication aide II to administer preloaded injectable insulin to residents.

No additional costs will be incurred to comply with this amendment.

Most licensed nursing facilities use certified medication aides to administer medications under the delegation of a nurse. In addition, it is important to stress that the use of properly trained and competent medication aides leads to fewer errors with drug use and medication administration, thereby enhancing liability protections for the facility and helping ensure fewer negative outcomes for residents.

There are no additional costs to the Office of Inspector General for implementation of this amendment.

There are no additional costs to the Office of Inspector General for implementation of this amendment on a continuing basis.

The source of funding used for the implementation and enforcement of the licensure function is from federal funds and state matching funds of general and agency appropriations.

No increase in fees or funding is necessary to implement this amendment.

This amendment does not establish or increase any fees.

Tiering is not applicable as compliance with this administrative regulation applies equally to all individuals or entities regulated by it.

This administrative regulation impacts the Cabinet for Health and Family Services, Office of Inspector General, and licensed nursing facilities.

KRS 194A.705(2)(c) and 216B.042.

This amendment will not generate additional revenue for state or local government.

This amendment will not generate additional revenue for state or local government during subsequent years.

This amendment imposes no additional costs on the administrative body.

This amendment imposes no additional costs on the administrative body during subsequent years.

See response above.

This administrative regulation is anticipated to have minimal fiscal impact to the cabinet.

This administrative regulation will not generate cost savings for regulated entities during the first year.

This administrative regulation will not generate cost savings for regulated entities during subsequent years.

This administrative regulation imposes no additional costs on regulated entities.

This administrative regulation imposes no additional costs on regulated entities during subsequent years.

"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. [KRS 13A.010(13)] This amendment is not expected to have a major economic impact on the regulated entities.

42 C.F.R. 483.1-483.95

KRS 216B.042

42 C.F.R. 483.1-483.95 establishes the Federal requirements for participation in Medicare and Medicaid to ensure the health and safety of individuals to whom services are furnished in nursing facilities.

The existing language of this regulation requires Kentucky-licensed nursing facilities to comply with the consolidated Medicare and Medicaid requirements for participation for long-term care facilities (42 C.F.R. 483.1-483.95); requires compliance with the abuse registry checks required by KRS 216.532 and KRS 209.032; requires compliance with the criminal background checks required by KRS 216.785 – 216.793; requires compliance with the tuberculosis (TB) testing requirements established by 902 KAR 20:200 and 902 KAR 20:205; requires facilities to ensure that residents rights are protected in accordance with KRS 216.515 – 216.520; requires facilities to conspicuously display posters required by KRS 216.525; requires facilities to provide information required by KRS 216.535(3); requires compliance with the requirements for access to the facility pursuant to KRS 216.540(2) – (5); requires compliance with the posting requirements of KRS 216.543; requires compliance with the statement required by KRS 215.545(2); requires compliance with the requirements for public inspection of the information and documents identified in KRS 216.547(1); requires compliance with the licensing procedures and fee schedule established by 902 KAR 20:008; and requires compliance with the reporting requirements of KRS 209.030(2) – (4). In accordance with KRS 194A.705(2)(c) and 201 KAR 20:700, this amendment requires nursing facilities to ensure that any unlicensed staff who administer oral or topical medications to residents under the delegation of a nurse be a certified medication aide I or Kentucky medication aide, or be a certified medication aide II to administer preloaded injectable insulin to residents.

The additional requirements for nursing facilities are established in state law as identified above.