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2026 Recommendations

—

by

Patti

Overall Quality Improvement

Kentucky has a regulation requiring state providers to utilize areas identified in the National Core Indicators annual report; however, the regulation is not specific about how to use them.

 Recommendation

  1. The Kentucky Division of Development and Intellectual Disabilities (DDID) with assistance from the Human Development Institute (HDI) will provide technical assistance to providers for appropriate utilization of National Core Indicator (NCI) data in the development and implementation of quality improvement plans. DDID and HDI will inform providers that technical assistance is available when recommendations are shared. HDI will track the number of technical assistance requests.

Employment Recommendations:

Kentucky is an Employment First state which means that “competitive integrated employment shall be considered the first and primary option for persons with disabilities of working age who desire to become employed.” The NCI data consistently shows a gap between the number of people who say they want to work and the number of people who have employment in their service plan. People who have a job overwhelming report liking their job (90%) and 19% report that they would like to work more hours. The Committee recommendations about employment reflect the need to make sure people receive quality information about employment options and that their service plans accurately reflect their goals.

Recommendations for providers:

  1. Case managers ensure understandable and meaningful conversations about the participant’s desire for community integrated employment, documenting the details of that conversation in the annual Individual Narrative in MWMA.
  2. Case Managers document discussions regarding community involvement and employment in monthly summary notes.*
  3. Case Managers ensure that a plan to provide employment services is included in the person-centered service plan for anyone who has expressed a desire to work in alignment with Kentucky Employment First policy as codified in Senate Bill 104, now KRS 151B.211-214.
  4. Ensure providers are following best practices including discovery, job development, acquisition and long-term support. This includes knowing both the job seeker and the business community in order to find opportunities for employment

*See 907 KAR 12:010

Recommendations for community partners:

  1. DDID to ensure Quality Administrators (QA) monitor case management agency compliance with Kentucky Employment First policy and provide technical assistance as needed.
  2. DDID to ensure case management provider recertification includes review of documentation of discussions, aspirations, and person-centered service plans.
  3. DDID, HDI, and other relevant partners will encourage dissemination of resources on the possibilities of employment for people with disabilities, including how to access help to find and keep a good job, the overall benefits to employment for people, and more at the Kentucky Supported Employment Training and Orientation to Employment.

    Resources:

    NCI survey questions used to track progress:

    • Do you do any type of job training?
    • Person has a paid individual job in a community-based setting. (e.g., competitive employment).
    • Is community employment a goal in this person’s service plan (also known as an Individual Service Plan, or ISP)?
    • Do you have a paid job in the community?
      • If No, ask: Do you want a paid job in the community?
    • If  person has a  job, ask: Thinking about the amount of hours you work each week, would you like to work more hours?- Kentucky specific question
    • If not working, ask: You said that you do not have a job, has your Case Manager or service provider talked with you about finding a job? (For example, has your Case Manager talked to you about what you might want to do, observe at different businesses, how to apply for a job, going to job fairs, getting information about VR, etc.) – Kentucky specific question

    Health & Wellness Recommendations:

    While Kentucky ranks higher than the national average in health indicators related to access to medical and dental exams, Kentucky also ranks higher in indicators related to poorer health outcomes, including tobacco use and obesity.

    Recommendations for providers:

    1. Providers include activities for health and wellness in their quality improvement plan.
    2. Providers utilize the Merge resources to strengthen mental health support.
    3. Providers in Eastern Kentucky access and utilize the Rooted & Rising projects to enhance mental health services..
    4. Providers determine and implement activities aimed at increasing the percentage of people who report their overall health as “good” or better.
    5. Providers determine and implement activities aimed at increasing the percentage of people who report they can do healthy things (exercising, sports, gardening, eating healthy food, etc.).
    6. Providers determine and implement activities to increase the number of people who follow the physical activity guidelines as recommended by the Office of Disease Prevention and Health Promotion and the National Institutes of Health.

    Recommendations for community partners:

    1. DDID to ensure Quality Administrators (QAs) discuss quality improvement plans for inclusion of health and wellness activities.
    2. DDID and partners seek opportunities to collaborate on mental health initiatives aimed at increasing quality mental health services and resources.

    Resources:

    NCI survey questions used to track progress:

    Relationships and Community Inclusion Recommendations:

    While Kentucky has made significant improvement in the number of individuals who report not being lonely and also having friends who are not staff or family members, Kentucky lags far behind the nation in the percentage of SCL recipients reporting that they can see their friends in person when they want (30% vs. 68% nationally), other ways of communicating with friends (49% vs 79% nationally), see/communicate with family they don’t live with (57% to 84% nationally) and a way to get to places outside the home for fun (58% to 82% nationally). As a state, we have a tremendous need for improvement in these areas.

    For Providers:

    1. Providers increase involvement in community groups by ensuring that individuals receiving waiver services get information and support to explore existing organizations (e.g., volunteer opportunities, faith communities), other groups and clubs that relate to their interests, registering to vote, as well as information about transportation options.
    2. Providers ensure practices align with the Medicaid Home and Community Based Services Settings Rule.

    Recommendations for community partners:

    1. DDID will provide information to the DBHDID Lived Experience and Community Engagement workgroup related to NCI outcomes for relationships and community inclusion. DDID to then disseminate information from that workgroup to providers, community partners, and ensure case managers distribute it to family members and waiver recipients.

    Resources:

    NCI survey questions used to track progress:

    • What activities does the person typically do at least once a week? Where possible, please include the name of the place where this person does each activity.
      • Does things in the community with paid support
      • Volunteers
    • Do you have friends you like to talk to or do things with?
    • How many times did you go out to a religious service or spiritual practice in the past month? (Examples: church, synagogue, study, or other place of worship)
    • Are you a part of any groups, organizations, or communities? This can be done in-person or virtually.
    • Do you have a way to get places you want to go outside of the home for fun?
    • Can you meet up with your friends in-person when you want to?
    • Can you see and/or talk to family who do not live with you when you want to?

    Psychotropic Medication Use Recommendations:

    Kentucky’s use of medication for mood, anxiety, or psychotic disorders continues to be significantly above the NCI national average (62% vs 46% nationally).

    Recommendations for providers:

    1. Residential and Case Management providers follow the Health Risk Screening Tool (HRST) protocol to ensure medication information is kept up to date in HRST.
    2. Residential providers access, utilize, and discuss the following reports from HRST with their QA during monitoring:
      • Clinical Reviews with outstanding Disagreements
      • Scoring alerts
      • Meds and Diagnoses with no end date
      • Health care level (HCL) change over time (last 3 months)
        • Persons with no health care level.
    3. Case management providers access, utilize, and discuss the Change Over Time report from HRST with their QA during monitoring.
    4. Providers ensure the purpose of medication is explained to each person and all staff administering that medication.
    5. Providers ensure medication review is done during each annual physical.
    6. Providers ensure each prescribing physician is provided a listing of all medications for each person.

    Recommendations for community partners:

    1. DDID to ensure Quality Administrators (QA) review and discuss the HRST reports during their monitoring.

    Resources:

    • Kentucky HRST Protocol:
      • The HRST shall be updated by the residential provider within 10 business days of any significant change in a person’s health, functional or behavioral status including but not limited to:
        • Medication or Diagnosis change
        •  Hospitalization
        • Emergency room/critical care visit
        • Significant behavioral change
        • Communication by person of changes to how they feel
        • Applicable changes to any of the 22 rating items
        • The residential provider shall upload each completed HRST into MWMA within 7 business days of its completion and notify the Case Manager.

    NCI survey questions used to track progress:

    • Does this person currently take medications to treat mood disorders, anxiety, and/or psychotic disorders?
    • If yes, how many medications to treat mood disorders, anxiety, and/or psychotic disorders does this person take?
    • Does this person currently take medications for behavioral challenges?
    • If yes, how many medications to treat behavioral challenges does this person take?
    • If you take medication, do you know what it’s for/why you take it? – Kentucky specific question

    Rights and Respect Recommendations:

    While Kentucky has made an improvement in the percentage of individuals who report that others always let them know before they enter the individual’s bedroom and Kentucky is actually above the national average in the percentage of individuals who can lock their bedroom door (76% vs 60% nationally), Kentucky lags significantly behind the nation in the number of individuals who report having a key to their own home or who can stay at home if others go somewhere else.

    Recommendations For Providers:

    1. Residential providers will include federal settings rule compliance in their quality improvement plans.
    2. Case management providers ensure that the federal settings rule is being adhered to.

    Recommendations For Community Partners:

    1.  DDID to work with providers, Waiver recipients, and family members to improve these important life indicators:
      • Increase the percentage of people who have access to their home (key, code for a keypad lock, app to unlock door, etc.).
      • Increase the percentage of people who are able to stay at home when others in their home go out.
      • Decrease the number of people who have others enter their homes without permission.
      • Increase the number of people who participate in or have access to self-advocacy events and activities.
      • Increase the number of people who vote in local, state, and/or national elections, in part by providing information and access to early voting and absentee voting options.

    Resources:

    NCI survey questions used to track progress:

    • Does this person have a key to the home?
    • Can this person stay at home if others go somewhere (if not living alone)?
    • Do people let the person know before entering your home?
    • Has this person participated in a self-advocacy event?
    • Do you know about any self-advocacy groups in your area? – Kentucky specific question
    • Has this person ever voted in a local, state, and/or national election?