Current through Register Vol. 50, No. 6, December 1, 2023
RELATES TO:
KRS
205.510,
205.520,
205.622,
205.8451,
309.080,
309.0831,
309.130,
311.840,
314.011,
319.010,
319.050,
319.053,
319C.010,
335.080,
335.100,
335.300,
335.500,
369.101 - 369.120,
42 C.F.R.
400.203,
405.2401(b),
405.2412-405.2417,
405.2450,
405.2452,
405.2468,
431.17,
438.2,
440.20,
491.1 -
491.11,
45 C.F.R. Part 164,
20 U.S.C.
1400,
21 U.S.C. 823,
29 U.S.C.
701,
42 U.S.C. 1395x(aa) and
(hh)
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
Family Services, Department for Medicaid Services has responsibility to
administer the Medicaid program.
KRS
205.520(3) authorizes the
cabinet, by administrative regulation, to comply with any requirement that may
be imposed or opportunity presented by federal law to qualify for federal
Medicaid funds. This administrative regulation establishes the Medicaid program
coverage provisions and requirements relating to rural health clinic
services.
Section 1. Definitions.
(1) "Adult peer support specialist" means an
individual who meets the requirements for an adult peer support specialist
established in
908 KAR 2:220.
(2) "Advanced practice registered nurse" is
defined by KRS
314.011(7).
(3) "Approved behavioral health practitioner"
means an independently licensed practitioner who is:
(a) A physician;
(b) A psychiatrist;
(c) An advanced practice registered
nurse;
(d) A physician
assistant;
(e) A licensed
psychologist;
(f) A licensed
psychological practitioner;
(g) A
certified psychologist with autonomous functioning;
(h) A licensed clinical social
worker;
(i) A licensed professional
clinical counselor;
(j) A licensed
marriage and family therapist;
(k)
A licensed professional art therapist;
(l) A licensed clinical alcohol and drug
counselor; or
(m) A licensed
behavior analyst.
(4)
"Approved behavioral health practitioner under supervision" means an individual
under billing supervision of an approved behavioral health practitioner who is:
(a)
1. A
licensed psychological associate working under the supervision of a
board-approved licensed psychologist;
2. A certified psychologist working under the
supervision of a board-approved licensed psychologist;
3. A marriage and family therapy
associate;
4. A certified social
worker;
5. A licensed professional
counselor associate;
6. A licensed
professional art therapist associate;
7. A licensed clinical alcohol and drug
counselor associate;
8. A certified
alcohol and drug counselor;
9. A
behavioral health associate, as permissible pursuant to 907 KAR Chapter 15;
or
10. A licensed assistant
behavior analyst; and
(b)
Employed by or under contract with the same billing provider as the billing
supervisor.
(5) "ASAM
Criteria" means the most recent edition of "The ASAM Criteria, Treatment
Criteria for Addictive, Substance-Related, and Co-occurring Conditions"
published by the American Society of Addiction Medicine.
(6) "Certified alcohol and drug counselor" is
defined by KRS
309.080(4).
(7) "Certified social worker" means an
individual who meets the requirements established in
KRS
335.080.
(8) "Community support associate" means a
paraprofessional whomeets the community support associate requirements
established in
908 KAR 2:250.
(9) "Co-occurring disorder" means a mental
health and substance use disorder.
(10) "Department" means the Department for
Medicaid Services or its designee.
(11) "Enrollee" means a recipient who is
enrolled with a managed care organization.
(12) "Family peer support specialist" means
an individual who meets the requirements for a Kentucky family peer support
specialist established in
908 KAR 2:230.
(13) "Federal financial participation" is
defined by 42 C.F.R.
400.203.
(14) "Homebound recipient" is defined by
42 C.F.R.
440.20(b)(4)(iv).
(15) "In-person" means a healthcare encounter
occurring:
(a) Via direct consultation and
interaction between the individual and healthcare provider;
(b) At the same location; and
(c) Not via telehealth.
(16) "Intermittent nursing care" is defined
by 42 C.F.R.
405.2401(b).
(17) "Licensed assistant behavior analyst" is
defined by KRS
319C.010(7).
(18) "Licensed behavior analyst" is defined
by KRS
319C.010(6).
(19) "Licensed clinical alcohol and drug
counselor" is defined by
KRS
309.080(7).
(20) "Licensed clinical alcohol and drug
counselor associate" is defined by
KRS
309.080(9).
(21) "Licensed clinical social worker" means
an individual who meets the licensed clinical social worker requirements
established in KRS
335.100.
(22) "Licensed marriage and family therapist"
is defined by KRS
335.300(2).
(23) "Licensed professional art therapist" is
defined by KRS
309.130(2).
(24) "Licensed professional art therapist
associate" is defined by
KRS
309.130(3).
(25) "Licensed professional clinical
counselor" is defined by
KRS
335.500(3).
(26) "Licensed professional counselor
associate" is defined by
KRS
335.500(4).
(27) "Licensed psychological associate"
means:
(a) An individual who:
1. Currently possesses a licensed
psychological associate license in accordance with
KRS
319.010(6); and
2. Meets the licensed psychological associate
requirements established in 201 KAR Chapter 26; or
(b) A certified
psychologist.
(28)
"Licensed psychological practitioner" means:
(a) An individual who meets the requirements
established in KRS
319.053; or
(b) A certified psychologist with autonomous
functioning.
(29)
"Licensed psychologist" means an individual who:
(a) Currently possesses a licensed
psychologist license in accordance with
KRS
319.010(6); and
(b) Meets the licensed psychologist
requirements established in 201 KAR Chapter 26.
(30) "Managed care organization" means an
entity for which the Department for Medicaid Services has contracted to serve
as a managed care organization as defined by
42 C.F.R.
438.2.
(31) "Marriage and family therapy associate"
is defined by KRS
335.300(3).
(32) "Medically necessary" means that a
covered benefit or service is necessary in accordance with
907 KAR 3:130.
(33) "Medication assisted treatment" means
the treatment of a substance use disorder with approved medications in
combination with counseling, behavior therapies, and other supports.
(34) "Other ambulatory services" is defined
by 42 C.F.R.
440.20(c).
(35) "Part-time nursing care" is defined by
42 C.F.R.
405.2401(b).
(36) "Physician" is defined by
KRS
205.510(12).
(37) "Physician assistant" is defined by
KRS
311.840(3) and
42 C.F.R.
405.2401(b).
(38) "Recipient" is defined by
KRS
205.8451(9).
(39) "Registered alcohol and drug peer
support specialist" is defined by
KRS
309.080(12).
(40) "Registered behavior technician" means
an individual who meets the following requirements by the Behavior Analyst
Certification Board:
(a) Be at least eighteen
(18) years of age;
(b) Have a high
school diploma or its equivalent; and
(c) Within six (6) months of hire for a new
employee or within six (6) months of January 1, 2023 for an existing employee:
1. Complete a training program that is:
a. Approved by the Behavior Analyst
Certification Board;
b. Based on
the current edition of the RBT Task List endorsed by the Behavior Analyst
Certification Board; and
c.
Conducted by Behavior Analyst Certification Board
certificants;
2. Pass the
Registered Behavior Technician Competency Assessment administered by a Behavior
Analyst Certification Board certificant; and
3. Pass the Registered Behavior Technician
exam provided by an assistant assessor supervised by a Behavior Analyst
Certification Board certificant.
(41) "Rural health clinic" or "RHC" is
defined by 42 C.F.R.
405.2401(b).
(42) "State plan" is defined by
42 C.F.R.
400.203.
(43) "Visiting nurse services" is defined by
42 C.F.R.
405.2401(b).
(44) "Withdrawal management" means a set of
interventions aimed at managing acute intoxication and withdrawal based on the
severity of the illness and co-occurring conditions identified through a
comprehensive biopsychosocial assessment with linkage to addiction management
services, and incorporated into a recipient's care as needed throughout the
appropriate levels of care.
(45)
"Youth peer support specialist" means an individual who meets the requirements
established for a Kentucky youth peer support specialist established in
908 KAR
2:240.
Section 2. Covered Services Other Than
Behavioral Health Services. The department shall cover the following medically
necessary rural health clinic services provided by a RHC that has been
certified in accordance with 42 C.F.R. 491.1 through
491.11:
(1) Services pursuant to
42 U.S.C.
1395x(aa);
(2) Services provided by a physician if the
physician:
(a) Complies with the physician
responsibility requirements established by
42 C.F.R.
491.8(b); and
(b)
1.
Performs the services in a RHC; or
2. Is compensated under an agreement with a
RHC for providing services provided to a Medicaid eligible RHC patient in a
location other than the RHC;
(3) Services provided by a physician
assistant or advanced practice registered nurse who is employed by or receives
compensation from the RHC if the services:
(a)
Are provided by a member of the RHC's staff who complies with the
responsibility requirements established by
42 C.F.R.
491.8(c);
(b) Are provided under the medical
supervision of a physician, except for services provided by an APRN as these
services shall not be required to be provided under the medical supervision of
a physician;
(c) Are provided in
accordance with a medical order for the care and treatment of a patient as
prepared by a physician or an advanced practice registered nurse;
(d) Are within the provider's
legally-authorized scope of practice; and
(e) Would be covered if provided by a
physician;
(4) Services
or supplies provided as incidental to services provided by a physician,
physician assistant, or advanced practice registered nurse if the service or
supply meets the criteria established in
42 C.F.R.
405.2413 or
42 C.F.R. 405.2415;
(5) Part-time or intermittent visiting nurse
care and related supplies, except for drugs or biologicals, if:
(a) The RHC is located in an area where a
determination has been made that there is a shortage of home health agencies
pursuant to 42 C.F.R.
405.2417;
(b) The services are provided by a registered
nurse or licensed practical nurse who is employed by or compensated for the
services by the RHC; and
(c) The
services are provided to a homebound recipient under a written plan of
treatment that is:
1. Established and reviewed
at least every sixty (60) days by a supervising physician of the RHC;
or
2. Established by a physician,
physician assistant, or advanced practice registered nurse and reviewed and
approved at least every sixty (60) days by a supervising physician of the RHC;
or
(6) Other
ambulatory services as established in the state plan.
Section 3. Behavioral Health Services.
(1) Except as established in the requirements
stated for a given service, the services covered may be provided for:
(a) A mental health disorder;
(b) A substance use disorder; or
(c) Co-occurring mental health and substance
use disorders.
(2) The
department shall cover, and a rural health clinic may provide, the following
services:
(a) Behavioral health services
provided by a licensed psychologist, licensed clinical social worker, or
advanced practice registered nurse within the provider's legally authorized
scope of service; or
(b) Services
or supplies incidental to a licensed psychologist's or licensed clinical social
worker's behavioral health services if the service or supply meets the criteria
established in 42 C.F.R.
405.2452.
(3) In addition to the services referenced in
subsection (2) of this section, the following behavioral health services
provided by a rural health clinic shall be covered under this administrative
regulation in accordance with the corresponding following requirements:,
(a) A screening shall:
1. Determine the likelihood that an
individual has a mental health disorder, a substance use disorder, or
co-occurring disorders;
2. Not
establish the presence or specific type of disorder;
3. Establish the need for an in-depth
assessment:
4. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision;
(b) An assessment shall:
1. Include gathering information and engaging
in a process with the individual that enables the provider to:
a. Establish the presence or absence of a
mental health disorder, substance use disorder, or co-occurring
disorders;
b. Determine the
individual's readiness for change;
c. Identify the individual's strengths or
problem areas that could affect the treatment and recovery processes;
and
d. Engage the individual in
developing an appropriate treatment relationship;
2. Establish or rule out the existence of a
clinical disorder or service need;
3. Include working with the individual to
develop a treatment and service plan;
4. Not include a psychological or psychiatric
evaluation or assessment;
5. If
being made for the treatment of a substance use disorder, utilize a
multidimensional assessment that complies with the most current edition of the
ASAM Criteria to determine the most appropriate level of care; and
6. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision;
(c) Psychological testing shall:
1. Include a psychodiagnostic assessment of
personality, psychopathology, emotionality, or intellectual
disabilities;
2. Include an
interpretation and a written report of testing results;
3. Be provided by a licensed:
a. Psychologist;
b. Psychological practitioner; or
c. Psychological associate working under the
supervision of a licensed psychologist; and
4. Be in-person or via telehealth as
appropriate pursuant to
907 KAR
3:170;
(d) Crisis intervention:
1. Shall be a therapeutic intervention for
the purpose of immediately reducing or eliminating the risk of physical or
emotional harm to:
a. The recipient;
or
b. Another individual;
2. Shall consist of clinical
intervention and support services necessary to provide integrated crisis
response, crisis stabilization interventions, or crisis prevention activities
for an individual with a behavioral health disorder;
3. Shall be provided:
a. On-site at a rural health
clinic;
b. As an immediate relief
to the presenting problem or threat; and
c. In a one-on-one encounter between the
provider and the recipient, which shall be delivered either in-person or via
telehealth if appropriate pursuant to
907 KAR
3:170;
4. May include:
a. Verbal de-escalation, risk assessment, or
cognitive therapy; or
b. Further
service planning including:
(i) Lethal means
reduction for suicide; or
(ii)
Substance use disorder or relapse prevention;
5. Shall be followed by a referral to
non-crisis services if applicable; and
6. Shall be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision;
(e)
1. Service planning shall:
a. Be provided in-person or via telehealth as
appropriate pursuant to the most current version of The ASAM Criteria and
907 KAR 3:170;
b. Involve assisting a recipient in creating
an individualized plan for services needed for maximum reduction of an
intellectual disability and to restore the individual to his or her best
possible functional level;
c.
Involve restoring a recipient's functional level to the recipient's best
possible functional level; and
d.
Be performed using a person-centered planning process;
2. A service plan:
a. Shall be directed and signed by the
recipient;
b. Shall include
practitioners of the recipient's choosing; and
c. May include:
(i) A mental health advance directive being
filed with a local hospital;
(ii) A
crisis plan; or
(iii) A relapse
prevention strategy or plan;
(f) Individual outpatient therapy shall:
1. Be provided to promote the:
a. Health and wellbeing of the individual;
and
b. Restoration of a recipient
to the recipient's best possible functional level from a substance use disorder
or a co-occurring disorder;
2. Consist of:
a. An in-person or via telehealth as
appropriate pursuant to
907 KAR 3:170, one-on-one
encounter between the provider and recipient; and
b. A behavioral health therapeutic
intervention provided in accordance with the recipient's identified treatment
plan;
3. Be aimed at:
a. Reducing adverse symptoms;
b. Reducing or eliminating the presenting
problem of the recipient; and
c.
Improving functionality;
4. Not exceed three (3) hours per day;
and
5. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(g)
1. Family outpatient therapy shall consist of
an in-person, or via telehealth as appropriate pursuant to
907 KAR 3:170, behavioral health
therapeutic intervention provided:
a. Through
scheduled therapeutic visits between the therapist and the recipient and at
least one (1) member of the recipient's family; and
b. To address issues interfering with the
relational functioning of the family and to improve interpersonal relationships
within the recipient's home environment.
2. A family outpatient therapy session shall
be billed as one (1) service regardless of the number of individuals, including
multiple members from one (1) family, who participate in the session.
3. Family outpatient therapy shall:
a. Be provided to promote the:
(i) Health and wellbeing of the individual;
or
(ii) Restoration of a recipient
to their best possible functional level from a substance use disorder or
co-occurring disorders; and
b. Not exceed three (3) hours per day alone
or in combination with any other outpatient therapy per recipient unless
additional time is medically necessary.
4. Family outpatient therapy shall be
provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision;
(h)
1.
Group outpatient therapy shall:
a. Be a
behavioral health therapeutic intervention provided in accordance with a
recipient's identified plan of care;
b. Be provided to promote the:
(i) Health and wellbeing of the individual;
and
(ii) Restoration of a recipient
to their best possible functional level from a substance use disorder or
co-occurring disorder;
c.
Consist of an in-person, or via telehealth as appropriate pursuant to
907 KAR 3:170, behavioral health
therapeutic intervention provided in accordance with the recipient's identified
treatment plan;
d. Be provided to a
recipient in a group setting:
(i) Of
nonrelated individuals; and
(ii)
Not to exceed twelve (12) individuals in size;
e. Focus on the psychological needs of the
recipients as evidenced in each recipient's plan of care;
f. Center on goals including building and
maintaining healthy relationships, personal goals setting, and the exercise of
personal judgment;
g. Not include
physical exercise, a recreational activity, an educational activity, or a
social activity; and
h. Not exceed
three (3) hours per day alone or in combination with any other outpatient
therapy per recipient unless additional time is medically
necessary.
2. A family
outpatient therapy group shall have a:
a.
Deliberate focus; and
b. Defined
course of treatment.
3.
The subject of a group receiving group outpatient therapy shall be related to
each recipient participating in the group.
4. The provider shall keep individual notes
regarding each recipient within the group and within each recipient's health
record.
5. Family outpatient
therapy shall be provided by:
a. An approved
behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision;
(i)
1.
Collateral outpatient therapy shall:
a.
Consist of an in-person or appropriate telehealth, provided pursuant to
907 KAR 3:170, behavioral health
consultation:
(i) With a parent or caregiver
of a recipient, household member of a recipient, legal representative of a
recipient, school personnel, treating professional, or other person with
custodial control or supervision of the recipient; and
(ii) That is provided in accordance with the
recipient's treatment plan;
b. Not be reimbursable if the therapy is for
a recipient who is at least twenty-one (21) years of age; and
c. Not exceed three (3) hours per day alone
or in combination with any other outpatient therapy per recipient unless
additional time is medically necessary.
2. Written consent by a parent or custodial
guardian to discuss a recipient's treatment with any person other than a parent
or legal guardian shall be signed and filed in the recipient's health
record.
3. Collateral outpatient
therapy shall be provided by:
a. An approved
behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision;
(j)
1.
Screening, brief intervention, and referral to treatment for a substance use
disorder shall:
a. Be an evidence-based early
intervention approach for an individual with non-dependent substance use to
provide an effective strategy for intervention prior to the need for more
extensive or specialized treatment;
b. Consist of:
(i) Using a standardized screening tool to
assess an individual for risky substance use behavior;
(ii) Engaging a recipient who demonstrates
risky substance use behavior in a short conversation and providing feedback and
advice; and
(iii) Referring a
recipient to additional substance use disorder or co-occurring disorder
services if the recipient is determined to need additional services to address
substance use if the recipient is determined to need other additional
services;
c. Be provided
in-person or via telehealth as appropriate according to
907 KAR 3:170;
d. Be provided by:
(i) An approved behavioral health
practitioner; or
(ii) An approved
behavioral health practitioner under supervision.
2. A screening and brief
intervention that does not meet criteria for referral to treatment may be
subject to coverage by the department.
(k)
1. Day
treatment shall be a nonresidential, intensive treatment program designed for a
child under the age of twenty-one (21) years who has:
a. An emotional disability, neurobiological
disorder, or substance use disorder; and
b. A high risk of out-of-home placement due
to a behavioral health issue.
2. Day treatment services shall:
a. Consist of an organized, behavioral health
program of treatment and rehabilitative services (substance use disorder,
mental health disorder, or co-occurring disorders);
b. Have unified policies and procedures that:
(i) Address the program philosophy, admission
and discharge criteria, admission and discharge process, staff training, and
integrated case planning; and
(ii)
Have been approved by the recipient's local education authority and the day
treatment provider;
c.
Include:
(i) Individual outpatient therapy,
family outpatient therapy, or group outpatient therapy;
(ii) Behavior management and social skill
training;
(iii) Independent living
skills that correlate to the age and development stage of the recipient;
or
(iv) Services designed to
explore and link with community resources before discharge and to assist the
recipient and family with transition to community services after discharge;
and
d. Be provided:
(i) In collaboration with the education
services of the local education authority including those provided through
20 U.S.C.
1400 et seq. (Individuals with Disabilities
Education Act) or 29 U.S.C.
701 et seq. (Section 504 of the
Rehabilitation Act);
(ii) On school
days and during scheduled breaks;
(iii) In coordination with the recipient's
individualized education program if the recipient has an individualized
education program;
(iv) Under the
supervision of a licensed or certified behavioral health practitioner or a
behavioral health practitioner working under billing supervision; and
(v) With a linkage agreement with the local
education authority that specifies the responsibilities of the local education
authority and the day treatment provider.
3. To provide day treatment services, a RHC
shall have:
a. The capacity to employ staff
authorized to provide day treatment services in accordance with subparagraph 2.
of this paragraph and to coordinate the provision of services among team
members;
b. The capacity to provide
the full range of services as stated in subparagraphs 1 and 2 of this
paragraph;
c. Demonstrated
experience in serving individuals with behavioral health disorders, mental
health disorders, and co-occurring disorders;
d. The administrative capacity to ensure
quality of services;
e. A financial
management system that provides documentation of services and costs;
f. The capacity to document and maintain
individual case records; and
g.
Knowledge of substance use disorders.
4. Day treatment shall not include a
therapeutic clinical service that is included in a child's individualized
education program.
(l)
1. Comprehensive community support services
shall:
a. Be activities necessary to allow an
individual to live with maximum independence in community-integrated
housing;
b. Be intended to ensure
successful community living through the utilization of skills training, cueing,
or supervision as identified in the recipient's treatment plan;
c. Include:
(i) Reminding a recipient to take medications
and monitoring symptoms and side effects of medications; or
(ii) Teaching parenting skills, teaching
community resource access and utilization, teaching emotional regulation
skills, teaching crisis coping skills, teaching how to shop, teaching about
transportation, teaching financial management, or developing and enhancing
interpersonal skills; and
d. Meet the requirements for comprehensive
community support services established in
908 KAR
2:250.
2. To provide comprehensive community support
services, a RHC shall have:
a. The capacity to
employ staff authorized to provide comprehensive community support services in
accordance with subsection (3)(l) of this section and to coordinate the
provision of services among team members;
b. The capacity to provide the full range of
comprehensive community support services as stated in subparagraph 1 of this
paragraph;
c. Demonstrated
experience in serving individuals with behavioral health disorders;
d. The administrative capacity to ensure
quality of services;
e. A financial
management system that provides documentation of services and costs;
and
f. The capacity to document and
maintain individual case records.
3. Comprehensive community support services
shall be provided by:
a. An approved
behavioral health practitioner, except for a licensed clinical alcohol and drug
counselor; or
b. An approved
behavioral health practitioner under supervision, except for a:
(i) Certified alcohol and drug counselor;
or
(ii) Licensed clinical alcohol
and drug counselor associate.
4. Support services for comprehensive
community support services conducted by a rural health clinic by an individual
working under the supervision of an approved behavioral health practitioner
shall be provided by a:
a. Community support
associate; or
b. Registered
behavioral technician under the supervision of a licensed behavioral
analyst.
(m)
1. Intensive outpatient program services
shall:
a. Be an alternative to or transition
from inpatient hospitalization or partial hospitalization for a mental health
disorder, substance use disorder, or co-occurring disorders;
b. Offer a multi-modal, multi-disciplinary
structured outpatient treatment program that is significantly more intensive
than individual outpatient therapy, group outpatient therapy, or family
outpatient therapy;
c. If provided
for a substance use disorder, meet the service criteria, including the
components for support systems, staffing, and therapies outlined in the most
current version of the ASAM Criteria for intensive outpatient level of care
services;
d. Be provided at least
three (3) hours per day at least three (3) days per week;
e. Be provided at least six (6) hours per
week for adolescents; and
f.
Include:
(i) Individual outpatient therapy,
group outpatient therapy, or family outpatient therapy unless
contraindicated;
(ii) Crisis
intervention; or
(iii)
Psycho-education related to identified goals in the recipient's treatment
plan.
2. During
psycho-education, the recipient or family member shall be:
a. Provided with knowledge regarding the
recipient's diagnosis, the causes of the condition, and the reasons why a
particular treatment might be effective for reducing symptoms; and
b. Taught how to cope with the recipient's
diagnosis or condition in a successful manner.
3. An intensive outpatient program treatment
plan shall:
a. Be individualized;
and
b. Focus on stabilization and
transition to a lesser level of care.
4. To provide intensive outpatient program
services, a RHC shall have:
a. Access to a
board-certified or board-eligible psychiatrist for consultation;
b. Access to a psychiatrist, other physician,
physician's assistant, or advanced practiced registered nurse for medication
prescribing and monitoring;
c.
Adequate staffing to ensure a minimum recipient-to-staff ratio of ten (10) to
one (1);
d. The capacity to provide
services utilizing a recognized intervention protocol based on nationally
accepted treatment principles;
e.
The capacity to employ staff authorized to provide intensive outpatient program
services in accordance with subparagraph 4. of this paragraph and to coordinate
the provision of services among team members;
f. The capacity to provide the full range of
intensive outpatient program services as stated in this paragraph;
g. Demonstrated experience in serving
individuals with behavioral health disorders;
h. The administrative capacity to ensure
quality of services;
i. A financial
management system that provides documentation of services and costs;
and
j. The capacity to document and
maintain individual case records.
5. Intensive outpatient program services
shall be provided by:
a. An approved
behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision.
(n)
1.
Therapeutic rehabilitation program services shall:
a. Occur at the provider's site or in the
community;
b. Be provided to an
adult with a severe and persistent mental illness or to a child (under the age
of twenty-one (21) years) who has a serious emotional disability;
c. Be designed to maximize the reduction of
an intellectual disability and the restoration of the individual's functional
level to the individual's best possible functional level; and
d. Not be a residential program.
2. A recipient in a therapeutic
rehabilitation program shall establish the recipient's own rehabilitation goals
within the person-centered service plan.
3. A therapeutic rehabilitation program
shall:
a. Be delivered using a variety of
psychiatric rehabilitation techniques;
b. Focus on:
(i) Improving daily living skills;
(ii) Self-monitoring of symptoms and side
effects;
(iii) Emotional regulation
skills;
(iv) Crisis coping skill;
and
(v) Interpersonal
skills;
c. Be delivered
individually or in a group; and
d.
Include:
(i) An individualized plan of care
identifying measurable goals and objectives including discharge and relapse
prevention planning;
(ii)
Coordination of services the individual receives; and
(iii) Referral to other necessary service
supports as needed.
4. To provide therapeutic rehabilitation
program services, a RHC shall:
a. Have the
capacity to employ staff authorized to provide therapeutic rehabilitation
program services in accordance with paragraph (n) of this subsection and to
coordinate the provision of services among team members;
b. Have the capacity to provide the full
range of therapeutic rehabilitation program services as stated in this
paragraph;
c. Have demonstrated
experience in serving individuals with mental health disorders;
d. Have the administrative capacity to ensure
quality of services;
e. Have a
financial management system that provides documentation of services and costs;
and
f. Have the capacity to
document and maintain individual case records.
5. Program staffing for a therapeutic
rehabilitation program shall include:
a.
Licensed clinical supervision, consultation, and support to direct care staff;
and
b. Direct care staff to provide
scheduled therapeutic activities, training, and support.
6. Therapeutic rehabilitation services shall
be provided by:
a. An approved behavioral
health practitioner, except for a licensed clinical alcohol and drug counselor;
or
b. An approved behavioral health
practitioner under supervision, except for a:
(i) Certified alcohol and drug counselor;
or
(ii) Licensed clinical alcohol
and drug counselor associate.
7. If not provided by an allowed practitioner
pursuant to clause 6. of this subparagraph, support services for therapeutic
rehabilitation services shall be conducted by a provider:
a. Working under the supervision of an
approved behavioral health practitioner; and
b. Who is:
(i) An adult peer support
specialist;
(ii) A family peer
support specialist; or
(iii) A
youth peer support specialist.
(o)
1. Peer
support services shall:
a. Be emotional
support that is provided by:
(i) An individual
who has been trained and certified in accordance with
908 KAR 2:220 and who is
experiencing or has experienced a substance use disorder to a recipient by
sharing a similar substance use disorder in order to bring about a desired
social or personal change;
(ii) A
parent or other family member, who has been trained and certified in accordance
with 908 KAR 2:230, of a child having
or who has had a substance use disorder to a parent or family member of a child
sharing a similar substance use disorder in order to bring about a desired
social or personal change;
(iii) An
individual who has been trained and certified in accordance with
908 KAR 2:240 and identified as
experiencing a substance use disorder; or
(iv) A registered alcohol and drug peer
support specialist who has been trained and certified in accordance with
KRS
309.0831 and is a self-identified consumer of
substance use disorder services who provides emotional support to others with
substance use disorder to achieve a desired social or personal
change;
b. Be an
evidence-based practice;
c. Be
structured and scheduled non-clinical therapeutic activities with an individual
recipient or a group of recipients;
d. Promote socialization, recovery,
self-advocacy, preservation, and enhancement of community living skills for the
recipient;
e. Except for the
engagement into substance use disorder treatment through an emergency
department bridge clinic, be coordinated within the context of a comprehensive,
individualized plan of care developed through a person-centered planning
process;
f. Be identified in each
recipient's plan of care; and
g. Be
designed to contribute directly to the recipient's individualized goals as
established in the recipient's plan of care.
2. To provide peer support services, a
chemical dependency treatment center shall:
a.
Have demonstrated:
(i) The capacity to provide
peer support services for the behavioral health population being served
including the age range of the population being served; and
(ii) Experience in serving individuals with
behavioral health disorders;
b. Employ peer support specialists who are
qualified to provide peer support services in accordance with
908 KAR 2:220,
908 KAR 2:230,
908 KAR 2:240, or
KRS
309.0831;
c. Use an approved behavioral health
practitioner to supervise peer support specialists;
d. Have the capacity to coordinate the
provision of services among team members;
e. Have the capacity to provide ongoing
continuing education and technical assistance to peer support
specialists;
f. Require individuals
providing peer support services to recipients to provide no more than thirty
(30) hours per week of direct recipient contact; and
g. Require peer support services provided to
recipients in a group setting to not exceed eight (8) individuals within any
group at one (1) time.
(p)
1.
Partial hospitalization services shall be:
a.
Short-term with an average of four (4) to six (6) weeks,
b. Less than twenty-four (24) hours each
day;
c. An intensive treatment
program for an individual who is experiencing significant impairment to daily
functioning; and
d. Provided
in-person or via telehealth as appropriate pursuant to the most recent version
of The ASAM Criteria and
907 KAR
3:170.
2. Partial hospitalization may be provided to
an adult or a minor.
3. Admission
criteria for partial hospitalization shall be based on an inability of
community-based therapies or intensive outpatient services to adequately treat
the recipient.
4. A partial
hospitalization program shall meet the service criteria, including the
components for support systems, staffing, and therapies outlined in the most
current version of The ASAM Criteria for partial hospitalization level of care
services.
5. A partial
hospitalization program shall consist of:
a.
Individual outpatient therapy;
b.
Group outpatient therapy;
c. Family
outpatient therapy;
d. Medication
management;
e. Psychoeducation;
or
f. Peer support
services.
6. The
department shall not reimburse for educational, vocational, or job training
services provided as part of partial hospitalization.
7.
a. A
rural health clinic's partial hospitalization program shall have an agreement
with the local educational authority to come into the program to provide all
educational components and instruction that are not Medicaid billable or
reimbursable.
b. Services in a
Medicaid eligible child's individualized education program shall be coverable
under Medicaid.
8.
Partial hospitalization shall be:
a. Provided
for at least four (4) hours per day; and
b. Focused on one (1) primary presenting
problem.
9. A partial
hospitalization program operated by a rural health clinic shall:
a. Include the following personnel for the
purpose of providing medical care:
(i) An
advanced practice registered nurse, a physician assistant, or a physician
available on site; and
(ii) A
board-certified or board-eligible psychiatrist available for consultation;
and
b. Have the capacity
to:
(i) Provide services utilizing a
recognized intervention protocol based on nationally accepted treatment
principles;
(ii) Employ required
practitioners and coordinate service provision among rendering practitioners;
and
(iii) Provide the full range of
services included in the scope of partial hospitalization established in this
paragraph.
(q)
1.
Withdrawal management services provided by a rural health clinic shall:
a. Be provided in-person or via telehealth as
consistent with
907 KAR 3:170 for recipients with
a substance use disorder or co-occurring disorder and incorporated into a
recipient's care along the continuum of care as needed;
b. Meet service criteria in accordance with
the most current version of the ASAM Criteria for withdrawal management levels
in an outpatient setting; and
c. If
provided in an outpatient setting, comply with
908 KAR 1:374, Section
2.
2. A recipient who is
receiving withdrawal management services shall meet the most current edition of
diagnostic criteria for substance withdrawal management as established by the
most recent version of the Diagnostic and Statistical Manual of Mental
Disorders.
3. Withdrawal management
services in an outpatient setting shall be provided by:
a. A physician;
b. A psychiatrist;
c. A physician assistant;
d. An advanced practice registered nurse;
or
e. An approved behavioral health
practitioner or behavioral health practitioner under supervision with oversight
by a physician, advanced practice registered nurse, or physician
assistant.
(r)
1. Medication assisted treatment services
shall be provided by an authorized prescribing provider who:
a. Is:
(i)
A physician;
(ii) An advanced
practice registered nurse;
(iii) A
physician assistant; or
(iv) A
psychiatrist;
b. Meets
standards established pursuant to
201 KAR 9:270 or
201 KAR 20:065;
c. Maintains a current waiver under
21 U.S.C.
823(g)(2) to prescribe
buprenorphine products including any waiving or expansion of buprenorphine
prescribing authority by the federal government; and
d. Has experience and knowledge in addiction
medicine.
2. Medication
assisted treatment supporting behavioral health services shall Be co-located
within the same practicing site as the practitioner who maintains a current
waiver, as necessary, under 21 U.S.C.
823(g)(2) to prescribe
buprenorphine products or via telehealth as appropriate pursuant to
907 KAR 3:170; or
3. A medication assisted treatment program
shall:
a. Assess the need for treatment
including:
(i) A full patient history to
determine the severity of the patient's substance use disorder; and
(ii) Identifying and addressing any
underlying or co-occurring diseases or conditions, as necessary;
b. Educate the patient about how
the medication works, including:
(i) The
associated risks and benefits; and
(ii) Overdose prevention;
c. Evaluate the need for medically
managed withdrawal from substances;
d. Refer patients for higher levels of care
if necessary; and
e. Obtain
informed consent prior to integrating pharmacologic or nonpharmacologic
therapies.
(s)
1. Applied behavior analysis services shall
produce socially significant improvement in human behavior via the:
a. Design, implementation, and evaluation of
environmental modifications;
b. Use
of behavioral stimuli and consequences; or
c. Use of direct observation, measurement,
and functional analysis of the relationship between environment and
behavior.
2. Applied
behavior analysis shall be based on scientific research and the direct
observation and measurement of behavior and environment, which utilize
contextual factors, establishing operations, antecedent stimuli, positive
reinforcement, and other consequences to assist recipients in:
a. Developing new behaviors;
b. Increasing or decreasing existing
behaviors; and
c. Eliciting
behaviors under specific environmental conditions.
3. Applied behavior analysis services may
include principles, methods, and procedures of the experimental analysis of
behavior and applied behavior analysis, including applications of those
principles, methods, and procedures to:
a.
Design, implement, evaluate, and modify treatment programs to change the
behavior of individuals;
b. Design,
implement, evaluate, and modify treatment programs to change the behavior of
individuals that interact with a recipient;
c. Design, implement, evaluate, and modify
treatment programs to change the behavior of a group or groups that interact
with a recipient; or
d. Consult
with individuals and organizations.
4.
a.
Applied behavior analysis services shall be provided by:
(i) A licensed behavior analyst;
(ii) A licensed assistant behavior
analyst;
(iii) An approved
behavioral health practitioner with documented training in applied behavior
analysis; or
(iv) An approved
behavioral health practitioner under supervision with documented training in
applied behavior analysis.
b. A registered behavior technician under the
supervision of an appropriate practitioner pursuant to clause a. of this
subparagraph may provide support services, which shall be performed as
established in this paragraph.
(4)
(a)
Laboratory services shall be reimbursable in accordance with
907 KAR 1:028 if provided by a
RHC if:
1. The RHC has the appropriate
Clinical Laboratory Improvement Amendments (CLIA) certificate to perform
laboratory testing pursuant to
907 KAR 1:028; and
2. The services are prescribed by a
physician, advanced practice registered nurse, or physician assistant who is
employed by or has a contractual relationship with the RHC.
(b) Laboratory services may be
administered, as appropriate, by:
1. An
approved behavioral health practitioner; or
2. An approved behavioral health practitioner
under supervision.
(5)
(a) The
requirements established in
908 KAR 1:370 shall apply to any
provider of a service to a recipient for a substance use disorder or
co-occurring mental health and substance use disorders.
(b) The withdrawal management requirements
established in
908 KAR 1:370 shall apply to a
provider of a withdrawal management service.
(6) The extent and type of assessment
performed shall depend upon the problem of the individual seeking or being
referred for services.
(7) A
diagnosis or clinical impression shall be made using terminology established in
the most current edition of the American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders.
(8)
(a)
Direct consultation between a provider or practitioner and a recipient shall be
required for each service, except for a collateral service for a child under
the age of twenty-one (21) years if the collateral service is in the child's
plan of care.
(b) A service that
does not meet the requirement in paragraph (a) of this subsection shall not be
covered.
(9) A billable
unit of service shall be actual time spent delivering a service in an
encounter.
(10) A service shall be:
(a) Stated in the recipient's treatment
plan;
(b) Provided in accordance
with the recipient's treatment plan;
(c) Provided on a regularly scheduled basis,
except for a screening or assessment; and
(d) Made available on a nonscheduled basis if
necessary during a crisis or time of increased stress for the
recipient.
(11) The
following services or activities shall not be covered under this administrative
regulation:
(a) A behavioral health service
provided to:
1. A resident of:
a. A nursing facility; or
b. An intermediate care facility for
individuals with an intellectual disability;
2. An inmate of a federal, local, or state:
a. Jail;
b. Detention center; or
c. Prison; or
3. An individual with an intellectual
disability without documentation of an additional psychiatric
diagnosis;
(b)
Psychiatric or psychological testing for another agency, including a court or
school, that does not result in the individual receiving psychiatric
intervention or behavioral health therapy from the independent
provider;
(c) A consultation or
educational service provided to a recipient or to others;
(d) Collateral outpatient therapy for an
individual aged twenty-one (21) years or older;
(e) A telephone call, an email, a text
message, or other electronic contact that does not meet the requirements stated
in the definition for telehealth established pursuant to
KRS
205.510(16) and implemented
pursuant to
907 KAR 3:170;
(f) Travel time;
(g) A field trip;
(h) A recreational activity;
(i) A social activity; or
(j) A physical exercise activity
group.
(12) A third party
contract shall not be covered under this administrative
regulation.
Section 4.
Provision of Services. A RHC shall comply with the service provision
requirements established by 42 C.F.R. 491.9.
Section 5. Immunizations. A RHC shall
provide, upon request from a recipient, the following covered immunizations:
(1) Diphtheria and tetanus toxoids and
pertussis vaccine (DPT);
(2)
Measles, mumps, and rubella virus vaccine live (MMR);
(3) Poliovirus vaccine, live, oral (any
type(s)) (OPV);
(4) Hemophilus B
conjugate vaccine (HBCV):
(5)
Hepatitis A;
(6) Meningococcal
vaccines;
(7) Meningococcal ACWY
vaccine (MenACWY); or
(8) Any other
vaccine that is recommended by the Advisory Committee on Immunization Practice
(ACIP) vaccines.
Section
6. Medical Necessity Requirement. To be covered pursuant to this
administrative regulation, a service shall be:
(1) Medically necessary for the recipient;
and
(2) Provided to a
recipient.
Section 7.
Noncovered Services.
(1) The following
services shall not be covered as rural health clinic services:
(a) Services provided in a hospital as
defined by 42 U.S.C.
1395x(e);
(b) Institutional services;
(c) Housekeeping, babysitting, or other
similar homemaker services; and
(d)
Services that are not provided in accordance with restrictions imposed by law
or administrative regulation.
(2) A third party contract shall not be
covered under this administrative regulation.
Section 8. No Duplication of Service.
(1) The department shall not reimburse for a
service provided to a recipient by more than one (1) provider of any program in
which the service is covered during the same time period.
(2) For example, if a recipient is receiving
a service from an independent behavioral health service provider, the
department shall not reimburse for the same service provided to the same
recipient during the same time period by a rural health
clinic.
Section 9.
Protection, Security, and Records Maintenance Requirements for All Services.
(1)
(a) A
provider shall maintain a current health record for each recipient.
(b)
1. A
health record shall document each service provided to the recipient including
the date of service and signature of the individual who provided the
service.
2. The individual who
provided the service shall date and sign the health record within seventy-two
(72) hours of the date that the individual provided the service.
(2)
(a) Except as established in paragraph (b) of
this subsection, a provider shall maintain a health record regarding a
recipient for at least five (5) years from the date of the service or until any
audit dispute or issue is resolved beyond five (5) years.
(b) If the secretary of the United States
Department of Health and Human Services requires a longer document retention
period than the period referenced in paragraph (a) of this subsection, pursuant
to 42 C.F.R.
431.17, the period established by the
secretary shall be the required period.
(3)
(a) A
provider shall comply with 45 C.F.R. Part 164.
(b) All information contained in a health
record shall:
1. Be treated as
confidential;
2. Not be disclosed
to an unauthorized individual; and
3. If requested, be disclosed to an
authorized representative of:
a. The
department; or
b. Federal
government.
(c)
1. Upon request, a provider shall provide to
an authorized representative of the department or federal government
information requested to substantiate:
a.
Staff notes detailing a service that was rendered;
b. The professional who rendered a service;
and
c. The type of service rendered
and any other requested information necessary to determine, on an individual
basis, if the service is reimbursable by the department.
2. Failure to provide information established
in subparagraph 1. of this paragraph shall result in denial of payment for any
service associated with the requested
information.
Section 10. Documentation and Records
Maintenance Requirements for Behavioral Health Services.
(1) The requirements in this section shall
apply to health records associated with behavioral health services.
(2) A health record shall:
(a) Include:
1. An identification and intake record
including:
a. Name;
b. Social Security number;
c. Date of intake;
d. Home (legal) address;
e. Health insurance or Medicaid
information;
f. Referral source and
address of referral source;
g.
Primary care physician and address;
h. The reason the individual is seeking help
including the presenting problem and diagnosis;
i. Any physical health diagnosis, if a
physical health diagnosis exists for the individual, and information regarding:
(i) Where the individual is receiving
treatment for the physical health diagnosis; and
(ii) The physical health provider;
and
j. The name of the
informant and any other information deemed necessary by the independent
provider to comply with the requirements of:
(i) This administrative regulation;
(ii) The provider's licensure
board;
(iii) State law;
or
(iv) Federal law;
2. Documentation of the:
a. Screening;
b. Assessment;
c. Disposition; and
d. Six (6) month review of a recipient's
treatment plan each time a six (6) month review occurs;
3. A complete history including mental status
and previous treatment;
4. An
identification sheet;
5. A consent
for treatment sheet that is accurately signed and dated; and
6. The individual's stated purpose for
seeking services; and
(b)
Be:
1. Maintained in an organized central
file;
2. Provided to the Cabinet
for Health and Family Services upon request;
3. Made available for inspection and copying
by Cabinet for Health and Family Services' personnel;
4. Readily accessible; and
5. Adequate for the purpose of establishing
the current treatment modality and progress of the
recipient.
(3)
Documentation of a screening shall include:
(a) Information relative to the individual's
stated request for services; and
(b) Other stated personal or health concerns
if other concerns are stated.
(4)
(a) A
provider's notes regarding a recipient shall:
1. Be made within seventy-two (72) hours of
the reconciliation of the record of each service visit; and
2. Describe the:
a. Recipient's symptoms or behavior, reaction
to treatment, and attitude;
b.
Therapist's intervention;
c.
Changes in the treatment plan if changes are made; and
d. Need for continued treatment if continued
treatment is needed.
(b)
1. Any
edit to notes shall:
a. Clearly display the
changes; and
b. Be initialed and
dated.
2. Notes shall not
be erased or illegibly marked out.
(c)
1.
Notes recorded by a practitioner working under supervision shall be co-signed
and dated by the supervising professional providing the service.
2. If services are provided by a practitioner
working under supervision, there shall be a monthly supervisory note recorded
by the supervising professional reflecting consultations with the practitioner
working under supervision concerning the:
a.
Case; and
b. Supervising
professional's evaluation of the services being provided to the
recipient.
(5) Immediately following a screening of a
recipient, the provider shall perform a disposition related to:
(a) An appropriate diagnosis;
(b) A referral for further consultation and
disposition, if applicable; and
(c)
1. Termination of services and referral to an
outside source for further services; or
2. Termination of services without a referral
to further services.
(6)
(a) A
recipient's treatment plan shall be reviewed at least once every six (6)
months.
(b) Any change to a
recipient's treatment plan shall be documented, signed, and dated by the
rendering provider.
(7)
(a) Notes regarding services to a recipient
shall:
1. Be organized in chronological
order;
2. Be dated;
3. Be titled to indicate the service
rendered;
4. State a starting and
ending time for the service; and
5.
Be recorded and signed by the rendering provider and include the professional
title (for example, licensed clinical social worker) of the provider.
(b) Initials, typed signatures, or
stamped signatures shall not be accepted.
(c) Telephone contacts, family collateral
contacts not covered under this administrative regulation, or other
nonreimbursable contacts shall:
1. Be recorded
in the notes; and
2. Not be
reimbursable.
(8)
(a) A
termination summary shall:
1. Be required,
upon termination of services, for each recipient who received at least three
(3) service visits; and
2. Contain
a summary of the significant findings and events during the course of treatment
including the:
a. Final assessment regarding
the progress of the individual toward reaching goals and objectives established
in the individual's treatment plan;
b. Final diagnosis of clinical impression;
and
c. Individual's condition upon
termination and disposition.
(b) A health record relating to an individual
who terminated from receiving services shall be fully completed within ten (10)
days following termination.
(9) If an individual's case is reopened
within ninety (90) days of terminating services for the same or related issue,
a reference to the prior case history with a note regarding the interval period
shall be acceptable.
(10) If a
recipient is transferred or referred to a health care facility or other
provider for care or treatment, the transferring provider shall, if the
recipient gives the provider written consent to do so, forward a copy or
summary of the recipient's health record to the health care facility or other
provider who is receiving the recipient.
(11)
(a) If
a provider's Medicaid program participation status changes as a result of
voluntarily terminating from the Medicaid program, involuntarily terminating
from the Medicaid program, a licensure suspension, or death of the provider,
the health records of the provider shall:
1.
Remain the property of the provider; and
2. Comply with the retention requirements
established in Section 9(2) of this administrative regulation.
(b) A provider shall have a
written plan addressing how to maintain health records in the event of the
provider's death.
Section
11. Medicaid Program Participation Requirements.
(1)
(a) A
participating RHC shall be currently:
1.
Enrolled in the Kentucky Medicaid program in accordance with
907 KAR 1:672; and
2. Except as established in paragraph (b) of
this subsection, participating in the Kentucky Medicaid program in accordance
with 907 KAR
1:671.
(b) In accordance with
907 KAR 17:015, Section 3(3), a
provider of a service to an enrollee shall not be required to be currently
participating in the fee-for-service Medicaid program.
(2)
(a) To
be initially enrolled with the department, a RHC shall:
1. Enroll in accordance with
907 KAR 1:672; and
2. Submit proof of its certification by the
United States Department of Health and Human Services, Health Resources and
Services Administration as a RHC.
(b) To remain enrolled and participating in
the Kentucky Medicaid program, a RHC shall:
1.
Comply with the enrollment requirements established in
907 KAR 1:672;
2. Comply with the participation requirements
established in
907 KAR 1:671; and
3. Annually submit proof of its certification
by the United States Department of Health and Human Services, Health Resources
and Services Administration as a RHC to the department.
(3) A RHC that has been terminated
from federal participation shall be terminated from Kentucky Medicaid program
participation.
(4) A participating
RHC and its staff shall comply with all applicable federal laws and
regulations, state laws and administrative regulations, and local laws and
regulations regarding the administration and operation of a RHC.
(5)
(a) If
a RHC receives any duplicate payment or overpayment from the department,
regardless of reason, the provider shall return the payment to the
department.
(b) Failure to return a
payment to the department in accordance with paragraph (a) of this subsection
may be:
1. Interpreted to be fraud or abuse;
and
2. Prosecuted in accordance
with applicable federal or state law.
Section 12. Third Party Liability. A provider
shall comply with KRS 205.622.
Section 13. Use of Electronic Signatures.
(1) The creation, transmission, storage, and
other use of electronic signatures and documents shall comply with the
requirements established in
KRS
369.101 through
369.120.
(2) A provider that chooses to use electronic
signatures shall:
(a) Develop and implement a
written security policy that shall:
1. Be
adhered to by each of the provider's employees, officers, agents, or
contractors;
2. Identify each
electronic signature for which an individual has access; and
3. Ensure that each electronic signature is
created, transmitted, and stored in a secure fashion;
(b) Develop a consent form that shall:
1. Be completed and executed by each
individual using an electronic signature;
2. Attest to the signature's authenticity;
and
3. Include a statement
indicating that the individual has been notified of his or her responsibility
in allowing the use of the electronic signature; and
(c) Provide the department, immediately upon
request, with:
1. A copy of the provider's
electronic signature policy;
2. The
signed consent form; and
3. The
original filed signature.
Section 14. Auditing Authority. The
department shall have the authority to audit any claim, medical record, or
documentation associated with any claim or medical record.
Section 15. Federal Approval and Federal
Financial Participation. The department's coverage of services pursuant to this
administrative regulation shall be contingent upon:
(1) Receipt of federal financial
participation for the coverage; and
(2) Centers for Medicare and Medicaid
Services' approval for the coverage.
Section 16. Appeals.
(1) An appeal of an adverse action by the
department regarding a service and a recipient who is not enrolled with a
managed care organization shall be in accordance with
907 KAR 1:563.
(2) An appeal of an adverse action by a
managed care organization regarding a service and an enrollee shall be in
accordance with
907 KAR
17:010.
8 Ky.R. 257; eff.
11-5-1981; 1187; eff. 6-2-1982; Recodified from 904 KAR 1:082, 5-2-1986; 15
Ky.R. 1329; eff. 12-13-1988; 34 Ky.R. 1831; 2116; eff. 4-4-2008; 39 Ky.R. 1977;
2510; 2736; eff. 7-7-2014; Crt eff. 12-6-2019; TAm eff. 3-20-2020;
48
Ky.R. 3092; 49 Ky.R. 838, 2113; eff.
6/21/2023.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3)