Department for Community Based Services

Standards of Practice Online Manual

12.18.4 Specialized Medically Complex Home

Cabinet for Health and Family Services

Department for Community Based Services
Division of Protection and Permanency
Standards of Practice Online Manual
Chapter 12-Resource Family Recruitment, Certification and Reimbursement
12.18.4 Specialized Medically Complex Home

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Legal Authority/Introduction



Foster/adoptive homes approved as specialized medically complex provide care for children designated by cabinet staff that meet specialized medical complex criteria and require a higher level of medical care or oversight. Children with medical complexity may also have behavioral or emotional needs related to their medical condition.  Specialized medically complex homes may be degreed or non-degreed.


The R&C Worker:

  1. Follows the procedures outlined in SOP 12.18 Specialized Foster Care Services and SOP 12.18.3 Medically Complex Home, as well as, the procedures listed below;
  2. Determines whether the applicant foster or adoptive home parent applying  for approval as a degreed specialized medically complex home is a health professional who is actively licensed in Kentucky as a:
    1. Physician;
    2. Physicians Assistant;
    3. Advance Registered Nurse Practitioner; or
    4. Registered nurse under the supervision of a Physician
  3. Determines if the applicant is applying for approval as a specialized medically complex home;
  4. Determines whether the applicant home has the aptitude and desire to provide specialized medically complex foster care services;
  5. Documents that the medically complex foster or adoptive home parent has completed the following tasks:
    1. Twelve (12) hours of ongoing Cabinet-sponsored training or training approved in advance by the Cabinet, in the following topic areas specific to providing care to children with medical complexity of:
      1. Growth and development;
      2. An overview of procedures and techniques which may be utilized to provide care;
      3. Observation and assessment;
      4. Management of diet and environment;
      5. Documentation of provided care;
      6. Parenting skills;
      7. Permanency planning; and
    2. Certification in infant, child and adult Cardiopulmonary resuscitation (CPR) and first aid;
  6. The SRA or designee may approve the specialized medically complex rate if the applicant:
    1. Is a primary caretaker who is not employed outside the home, unless it is determined that the child’s needs will continue to be met, as approved by the Director of Protection and Permanency;
    2. Completes all requirements for an specialized medically complex  foster or adoptive home;
    3. Receives individual documented training from a health professional, medically complex foster/adoptive parent or licensed practical nurse in how to care for specific specialized medically complex child who is placed in the foster or adoptive home;
    4. Cooperates with the Cabinet in carrying out the child’s health plan.
  7. If approved, documentation is completed in TWIST by the addition of a new Foster or adoptive Recommendation.

Practice Guidance

  • The determining factor in figuring the per diem reimbursement for each Specialized Medically Complex child is the level of extra professional care required by that child daily and the level of licensure of the Specialized Medically Complex parent.
  • Consultation regarding these decisions may be obtained from the Medical Support Section.




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