Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
156.070,
205.520,
605.115,
314.470, 20 U.S.C. 33,
34 C.F.R.
300.320,
300.321,
300.324,
42
C.F.R. 440.110
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 for the provision of
Medicaid services to Kentucky's indigent citizenry. This administrative
regulation establishes the provisions relating to school-based health services
(SBHS) for which payment shall be made by the Medicaid Program on behalf of
Medicaid recipients who are eligible for school-based health services under 20
U.S.C. Chapter 33.
Section 1.
Definitions.
(1) "Advanced practice
registered nurse" is defined by
KRS
314.011(7).
(2) "ARC" means an admissions and release
committee which meets the:
(a) ARC
requirements established in
707 KAR
1:320; and
(b) IEP team requirements established in
34
C.F.R. 300.321.
(3) "Assistive technology device" means an
item, piece of equipment, or product system that is:
(a) Used to increase, maintain, or improve
the functional capabilities of a child with a disability; and
(b) Medically necessary to implement the
health services in the child's individualized education program.
(4) "Board Certified Assistant
Behavior Analyst" or "BCABA" means an individual who:
(a) Has met all of the BCABA requirements
established by the Behavior Analyst Certification Board®, Inc.;
and
(b) Is currently recognized by
the Behavior Analyst Certification Board®, Inc. as a BCABA.
(5) "Board Certified Behavior
Analyst" or "BCBA" means an individual who:
(a) Has met all of the BCABA requirements
established by the Behavior Analyst Certification Board®, Inc.;
and
(b) Is currently recognized by
the Behavior Analyst Certification Board, Inc. as a BCBA.
(6) "Certified psychologist" means an
individual who holds the title of certified psychologist pursuant to
KRS
319.056.
(7) "Certified psychologist with autonomous
functioning" means an individual who holds the title of certified psychologist
with autonomous functioning pursuant to
KRS
319.056.
(8) "Certified social worker" means an
individual with a certified social worker license pursuant to
KRS
335.080.
(9) "Department of Education" means the
Commonwealth of Kentucky, Department of Education.
(10) "Federal financial participation" is
defined in
42 C.F.R.
400.203.
(11) "IEP team" is defined by
34
C.F.R. 300.321.
(12) "Incidental interpreter services" means
the interpreter services that are necessary to allow the child to benefit from
other covered school-based health services.
(13) "Individualized Education Program" or
"IEP" is defined by
34 C.F.R.
300.320.
(14) "Licensed clinical social worker" means
an individual possessing a current licensed clinical social worker license
pursuant to
KRS
335.100.
(15) "Licensed practical nurse" is defined by
KRS
314.011(9).
(16) "Licensed professional clinical
counselor" is defined by
KRS
335.500(3).
(17) "Licensed professional counselor
associate" is defined by
KRS
335.500(4).
(18) "Licensed psychological associate" means
an individual holding the title of licensed psychological associate pursuant to
KRS
319.064.
(19) "Licensed psychological practitioner"
means an individual who meets the licensed psychological practitioner
requirements established in
KRS
319.053.
(20) "Licensed psychologist" means a
psychologist who holds a licensed psychologist license pursuant to
KRS
319.010(6).
(21) "Licensed social worker" means an
individual possessing a current licensed social worker license pursuant to
KRS
335.090.
(22) "Occupational therapist" is defined by
KRS
319A.010(3).
(23) "Occupational therapy assistant" is
defined by
KRS
319A.010(4).
(24) "Physical therapist" is defined by
KRS
327.010(2).
(25) "Physical therapist assistant" means an
individual:
(a) With a current credential from
the Kentucky Board of Physical Therapy; and
(b) Working under the supervision of a
physical therapist.
(26)
"Psychologist" is defined by
KRS
319.010(9).
(27) "Recipient" is defined by
KRS
205.8451(9).
(28) "Registered nurse" is defined by
KRS
314.011(5).
(29) "Respiratory care practitioner" is
defined by
KRS
314A.010(3).
(30) "SBHS" or "School-based health services"
means medically-necessary health services:
(a)
Provided for in
907
KAR 11:034; and
(b) Specified in an individualized education
program for a child determined to be eligible under the provisions of the
Individuals with Disabilities Education Act, 20 U.S.C. Chapter 33, and 707 KAR
Chapter 1.
(31) "SBHS
recipient" means a recipient who:
(a) Is
under the age of twenty-one (21) years; and
(b) Receives school-based health
services.
(32) "Special
transportation" means a special arrangement, special equipment, or a special
vehicle:
(a) Which is appropriate for the
child's disability; and
(b) The
need for which is described in the child's individualized education
plan.
Section
2. Provider Requirements.
(1) A
school district that requests to participate as a school-based health care
provider shall not be qualified to provide school-based health services:
(a) Until it has enrolled as a Medicaid
provider pursuant to
907
KAR 1:672;
(b) Until it has been certified by the
Department of Education to provide school-based health services; and
(c) Unless it is currently compliant with the
Medicaid provider participation requirements established in
907
KAR 1:671.
(2) The Department of Education shall grant
certification to a district that agrees to:
(a) Provide services as:
1. Required by 20 U.S.C. Chapter 33;
and
2. Specified in an approved
individualized education program developed by an ARC that includes a
multidisciplinary team of professionals acting within their scope of
practice;
(b) Comply with
the service provision requirements mandated by 20 U.S.C. Chapter 33 and in
accordance with
707 KAR
1:320;
(c)
Employ or contract with health care professionals who meet the qualifications
specified in Section 4 of this administrative regulation;
(d) Provide the Department of Education with
a proposed quality assurance outline;
(e) Maintain and submit to the Department of
Education all required records and reports to ensure compliance with 20 U.S.C.
Chapter 33; and
(f) Provide the
Department of Education with a list of school-based health services that the
school district provides. This list shall contain the following information for
employees and contractors providing the services:
1. Name; and
2. Credentials.
(3) The Department for Medicaid
Services shall grant Medicaid enrollment to a provider who:
(a) Meets the criteria established in
subsections (1) and (2) of this section;
(b) Works within his or her scope of practice
as established in Kentucky law; and
(c) Is recommended by the Department of
Education for certification and enrollment in the Kentucky Medicaid Program as
a provider of school-based health services.
(4) A Medicaid school-based health services
provider shall:
(a) Submit to an annual review
by the Department of Education to ensure compliance with the standards for
continued participation as a Medicaid provider;
(b) Have an on-site survey completed by the
Department of Education as necessary to determine compliance with the Medicaid
Program;
(c) Take action as
specified by the Department of Education to correct a deficiency if found to be
in noncompliance with the provision of services outlined in
707 KAR
1:320 or this administrative regulation;
(d) Agree to implement a quality assurance
program approved by the Department of Education for the provision of
Medicaid-covered services within one (1) year from the date the Department of
Education recommends enrollment to the Medicaid Program;
(e) Maintain a current list of school-based
health services that the school district provides. The list shall contain the
information listed in subsection (2)(f) of this section for an employee or
contractor providing the services;
(f) Maintain records on each SBHS recipient
who receives services reimbursed by Medicaid. The records shall:
1. Identify the child, services performed,
and quantity or units of service;
2. Be signed and dated by the professional
who provided or supervised the service;
3. Be legible with statements written in an
objective manner;
4. Indicate
progress being made, any change in treatment, and response to the treatment;
and
5. Be retained for a minimum of
five (5) years plus any additional time required by law; and
(g) Comply with
907
KAR 1:671 and
907
KAR 1:672.
Section 3. Covered Services.
(1) A school-based health service that is
included in an IEP authorized by an IEP team or ARC and provided in accordance
with this administrative regulation shall:
(a)
Be considered medically necessary; and
(b) Not be subject to additional Medicaid
prior-authorization requirements.
(2) The following services shall be covered
if provided to address a medical or mental disability and to assist an
individual in benefiting from special education programming which is included,
authorized, and provided in accordance with the individualized education
program:
(a) Nursing;
(b) Audiology;
(c) Speech and language;
(d) Occupational therapy;
(e) Physical therapy;
(f) Behavioral health services;
(g) Incidental interpreter services provided
in conjunction with another covered service;
(h) Orientation and mobility services;
(i) Respiratory therapy;
(j) Assistive technology devices and
appropriate related evaluations if the devices purchased by the Medicaid
Program become the property of the SBHS recipient; and
(k) Special transportation with the following
limitations:
1. A special transportation
service shall be limited to transporting an SBHS recipient to receive a
Medicaid-covered service at:
a. A site other
than the school building in which the child is enrolled for general education
purposes;
b. The child's home if
the child is a home-bound student and receives general education services at
home; or
c. The school building
where the child receives the Medicaid-covered service. Special transportation
to the school building from the child's home or other site and return special
transportation from the school building to the child's home or other site shall
be covered for the day the Medicaid-covered service is provided at the school
building;
2. A special
transportation service shall be provided using a type of vehicle which:
a. Meets the specifications established by
KRS
156.153,
702 KAR
5:060, and
702
KAR 5:130; and
b. Is appropriate for the child's disability
as determined by the ARC in accordance with
702 KAR
5:100; and
3. A special transportation service provided
by a member of an SBHS recipient's household to the SBHS recipient shall not be
covered unless the SBHS recipient's household member is an employee of the
school district.
(3) A covered school-based health service:
(a) Shall not be limited by site of
service;
(b) Shall be provided in:
1. A group of no more than six (6);
or
2. In a one-on-one situation;
and
(c) May include:
1. An assessment or evaluation if the
assessment or evaluation is stated in the SBHS recipient's IEP, except as
allowed in subsection (4) of this section; or
2. A treatment component if the treatment
component is stated in the SBHS recipient's IEP.
(4) An assessment or evaluation conducted
prior to the establishment of an individualized education program shall be
covered if the individualized education program is subsequently developed and
implemented as a result of the assessment or evaluation.
Section 4. Staffing Requirements.
School-based health services shall be reimbursable if provided by a
professional acting within his or her scope of practice as defined by state law
and as provided in this section.
(1) A
nursing service shall be provided by:
(a) An
advanced practice registered nurse;
(b) A registered nurse;
(c) A licensed practical nurse; or
(d) A health aide if:
1. The aide is under the supervision of a
specific registered nurse or advanced practice registered nurse;
2. The supervising registered nurse or
advanced practice registered nurse has trained the aide for the specific SBHS
nursing service for the specific recipient; and
3. The supervising registered nurse or
advanced practice registered nurse has verified in writing that the aide has
appropriate training and skills to perform the specific service in a safe,
effective manner.
(2) Audiology services shall be provided by
an audiologist with a current license from the Kentucky Board of
Speech-Language Pathology and Audiology.
(3) Speech and language services shall be
provided by a speech-language pathologist who has a current certificate of
clinical competence issued by the American Speech and Hearing
Association.
(4) Occupational
therapy services shall be provided by:
(a) An
occupational therapist:
(b) An
occupational therapy assistant; or
(c) An unlicensed occupational therapy aide
who:
1. Provides supportive services to
occupational therapists and occupational therapy assistants; and
2. Is under the direct supervision of an
occupational therapist.
(5) Physical therapy services shall be
provided by:
(a) A physical
therapist;
(b) A physical therapist
assistant;
(c) An individual with a
temporary permit to perform physical therapy in Kentucky pursuant to
KRS
327.010(5);
(d) A student of physical therapy under the
supervision of a physical therapist; or
(e) Physical therapy supportive personnel
under the direct on-site supervision of a:
1.
Physical therapist; or
2. Physical
therapist assistant in accordance with the provisions of
201
KAR 22:053.
(6) A behavioral health service shall be
provided by:
(a) A licensed
psychologist;
(b) A licensed
psychological practitioner;
(c) A
certified psychologist with autonomous functioning;
(d) A certified psychologist;
(e) A licensed psychological
associate;
(f) A licensed clinical
social worker;
(g) A licensed
social worker;
(h) A certified
social worker;
(i) An advanced
practice registered nurse who has a specialty area in accordance with the
American Nurses' Association's Scope and Standards of Psychiatric-Mental Health
Nursing Practice in accordance with
201
KAR 20:057;
(j) A licensed professional clinical
counselor;
(k) A licensed
professional counselor associate;
(l) A board certified behavior analyst;
or
(m) A board certified assistant
behavior analyst.
(7) An
incidental interpreter service shall be provided by an interpreter licensed by
the Kentucky Board of Interpreters for the Deaf and Hard of Hearing pursuant to
KRS
309.312 or
309.314.
(8) Orientation and mobility services shall
be provided by an orientation and mobility specialist certified by the:
(a) Academy for Certification of Vision
Rehabilitation and Education Professionals (ACVREP); or
(b) National Blindness Professional
Certification Board (NBPCB).
(9) Respiratory therapy services shall be
provided by a respiratory care practitioner.
Section 5. Reimbursement.
(1) Reimbursement for SBHS shall be provided
in accordance with the school-based health service reimbursement provisions
established in
907
KAR 11:035.
(2) A school-based health services provider
shall certify the expenditure of state or local funds for school-based health
services in accordance with
702 KAR
3:285.
Section 6. Individualized Education Program.
An IEP shall:
(1) Be developed, reviewed, and
revised in accordance with:
(a)
707 KAR
1:320; and
(b)
34 C.F.R.
300.324; and
(2) Not be considered authorized unless it
has been approved by an IEP team.
Section 7. Federal financial participation. A
policy established in this administrative regulation shall be null and void if
the Centers for Medicare and Medicaid Services:
(1) Denies federal financial participation
for the policy; or
(2) Disapproves
the policy.
STATUTORY AUTHORITY:
KRS
194A.030(2),
194A.050(1),
205.520(3),
205.560