Section
4. Covered Services.
(2) The following services shall be covered
under this administrative regulation in accordance with the following
requirements:
(a) A screening, crisis
intervention, or intensive outpatient program service provided by:
1. A licensed psychologist;
2. A licensed psychological
practitioner;
3. A certified
psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A licensed
clinical alcohol and drug counselor in accordance with Section 12 of this
administrative regulation; or
14. A
behavioral health practitioner under supervision, except for a licensed
assistant behavior analyst;
(b) An assessment provided by:
1. A licensed psychologist;
2. A licensed psychological
practitioner;
3. A certified
psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed behavior
analyst;
12. A licensed
psychological associate working under the supervision of a board-approved
licensed psychologist;
13. A
certified psychologist working under the supervision of a board-approved
licensed psychologist;
14. A
licensed clinical alcohol and drug counselor in accordance with Section 12 of
this administrative regulation; or
15. A behavioral health practitioner under
supervision;
(c)
Psychological testing provided by:
1. A
licensed psychologist;
2. A
licensed psychological practitioner;
3. A certified psychologist with autonomous
functioning;
4. A licensed
psychological associate working under the supervision of a board-approved
licensed psychologist; or
5. A
certified psychologist working under the supervision of a board-approved
licensed psychologist;
(d) Day treatment or mobile crisis services
provided by:
1. A licensed
psychologist;
2. A licensed
psychological practitioner;
3. A
certified psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A licensed
clinical alcohol and drug counselor in accordance with Section 12 of this
administrative regulation;
14. A
behavioral health practitioner under supervision, except for a licensed
assistant behavior analyst; or
15.
a. A peer support specialist working under
the supervision of an approved behavioral health services provider;
or
b. A registered alcohol and drug
peer support specialist working under the supervision of an approved behavioral
health services provider;
(e) Peer support provided by a:
1. Peer support specialist working under the
supervision of an approved behavioral health services provider; or
2. Registered alcohol and drug peer support
specialist working under the supervision of an approved behavioral health
services provider;
(f)
Individual outpatient therapy, group outpatient therapy, or collateral
outpatient therapy provided by:
1. A licensed
psychologist;
2. A licensed
psychological practitioner;
3. A
certified psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed behavior
analyst;
12. A licensed
psychological associate working under the supervision of a board-approved
licensed psychologist;
13. A
certified psychologist working under the supervision of a board-approved
licensed psychologist;
14. A
licensed clinical alcohol and drug counselor in accordance with Section 12 of
this administrative regulation; or
15. A behavioral health practitioner under
supervision;
(g) Family
outpatient therapy provided by:
1. A licensed
psychologist;
2. A licensed
psychological practitioner;
3. A
certified psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A licensed
clinical alcohol and drug counselor in accordance with Section 12 of this
administrative regulation; or
14. A
behavioral health practitioner under supervision, except for a licensed
assistant behavior analyst;
(h) Service planning provided by:
1. A licensed psychologist;
2. A licensed psychological
practitioner;
3. A certified
psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed behavior
analyst;
12. A licensed
psychological associate working under the supervision of a board-approved
licensed psychologist;
13. A
certified psychologist working under the supervision of a board-approved
licensed psychologist; or
14. A
behavioral health practitioner under supervision except for:
a. A certified alcohol and drug counselor;
or
b. A licensed clinical alcohol
and drug counselor associate in accordance with Section 12 of this
administrative regulation;
(i) A screening, brief intervention, and
referral to treatment for a substance use disorder or SBIRT provided by:
1. A licensed psychologist;
2. A licensed psychological
practitioner;
3. A certified
psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A licensed
clinical alcohol and drug counselor in accordance with Section 12 of this
administrative regulation; or
14. A
behavioral health practitioner under supervision, except for a licensed
assistant behavior analyst;
(j) Assertive community treatment provided
by:
1. A licensed psychologist;
2. A licensed psychological
practitioner;
3. A certified
psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A behavioral
health practitioner under supervision except for a:
a. Licensed assistant behavior
analyst;
b. Certified alcohol and
drug counselor; or
c. Licensed
clinical alcohol and drug counselor associate in accordance with Section 12 of
this administrative regulation;
14. A peer support specialist working under
the supervision of an approved behavioral health services provider except for
a:
a. Licensed clinical alcohol and drug
counselor in accordance with Section 12 of this administrative
regulation;
b. Licensed clinical
alcohol and drug counselor associate in accordance with Section 12 of this
administrative regulation; or
c.
Certified alcohol and drug counselor; or
15. A community support associate;
(k) Comprehensive community
support services provided by:
1. A licensed
psychologist;
2. A licensed
psychological practitioner;
3. A
certified psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed behavior
analyst;
12. A licensed
psychological associate working under the supervision of a board-approved
licensed psychologist;
13. A
certified psychologist working under the supervision of a board-approved
licensed psychologist;
14. A
behavioral health practitioner under supervision except for a:
a. Licensed clinical alcohol and drug
counselor associate in accordance with Section 12 of this administrative
regulation; or
b. Certified alcohol
and drug counselor; or
15. A community support associate;
(l) Therapeutic rehabilitation
program services provided by:
1. A licensed
psychologist;
2. A licensed
psychological practitioner;
3. A
certified psychologist with autonomous functioning;
4. A licensed clinical social
worker;
5. A licensed professional
clinical counselor;
6. A licensed
professional art therapist;
7. A
licensed marriage and family therapist;
8. A physician;
9. A psychiatrist;
10. An advanced practice registered
nurse;
11. A licensed psychological
associate working under the supervision of a board-approved licensed
psychologist;
12. A certified
psychologist working under the supervision of a board-approved licensed
psychologist;
13. A behavioral
health practitioner under supervision except for a:
a. Licensed assistant behavior
analyst;
b. Licensed clinical
alcohol and drug counselor associate in accordance with Section 12 of this
administrative regulation; or
c.
Certified alcohol and drug counselor; or
14. A peer support specialist working under
the supervision of an approved behavioral health services provider except for
a:
a. Licensed clinical alcohol and drug
counselor in accordance with Section 12 of this administrative
regulation;
b. Licensed clinical
alcohol and drug counselor associate in accordance with Section 12 of this
administrative regulation; or
c.
Certified alcohol and drug counselor; or
(m) Partial hospitalization provided by:
1. A licensed psychologist;
2. A licensed professional clinical
counselor;
3. A licensed clinical
social worker;
4. A licensed
marriage and family therapist;
5. A
physician;
6. A
psychiatrist;
7. An advanced
practice registered nurse;
8. A
licensed psychological practitioner;
9. A certified psychologist with autonomous
functioning;
10. A licensed
clinical alcohol and drug counselor in accordance with Section 12 of this
administrative regulation;
11. A
licensed psychological associate working under the supervision of a
board-approved licensed psychologist;
12. A certified psychologist working under
the supervision of a board-approved licensed psychologist; or
13. A behavioral health practitioner under
supervision, except for a licensed assistant behavioral analyst.
(3)
(a) A screening shall:
1. Determine the likelihood that an
individual has a mental health disorder, substance use disorder, or
co-occurring disorders;
2. Not
establish the presence or specific type of disorder; and
3. Establish the need for an in-depth
assessment.
(b) An
assessment shall:
1. Include gathering
information and engaging in a process with the individual that enables the
practitioner 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 may affect the treatment and recovery processes;
and
d. Engage the individual in the
development of 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 plan of care; and
4. Not
include psychological or psychiatric evaluations or assessments.
(c) Psychological testing shall:
1. Include:
a. A psychodiagnostic assessment of
personality, psychopathology, emotionality, or intellectual disabilities;
and
b. Interpretation and a written
report of testing results; and
2. Be performed by an individual who has met
the requirements of KRS Chapter 319 related to the necessary credentials to
perform psychological testing.
(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 individuals;
3. Shall be
provided:
a. On-site at the psychiatric
hospital;
b. As an immediate relief
to the presenting problem or threat; and
c. In a face-to-face, one-on-one encounter
between the provider and the recipient;
4. Shall be followed by a referral to
non-crisis services if applicable; and
5. May include:
a. Further service prevention planning that
includes:
(i) Lethal means reduction for
suicide risk; or
(ii) Substance use
disorder relapse prevention; or
b. Verbal de-escalation, risk assessment, or
cognitive therapy.
(e) Mobile crisis services shall:
1. Be available twenty-four (24) hours per
day, seven (7) days per week, every day of the year;
2. Ensure access to a board-certified or
board-eligible psychiatrist twenty-four (24) hours per day, seven (7) days per
week, every day of the year;
3. Be
provided for a duration of less than twenty-four (24) hours;
4. Not be an overnight service;
5. Be a multi-disciplinary team-based
intervention in a home or community setting that ensures access to mental
health and substance use disorder services and supports to:
a. Reduce symptoms or harm; or
b. Safely transition an individual in an
acute crisis to the appropriate least restrictive level of care;
6. Involve all services and
supports necessary to provide:
a. Integrated
crisis prevention;
b. Assessment
and disposition;
c.
Intervention;
d. Continuity of care
recommendations; and
e. Follow-up
services; and
7. Be
provided face-to-face.
(f)
1. Day
treatment shall be a non-residential, intensive treatment program for an
individual under the age of twenty-one (21) years who has:
a. A mental health disorder, substance use
disorder, or co-occurring mental health and substance use disorders;
and
b. A high risk of out-of-home
placement due to a behavioral health issue.
2. Day treatment shall:
a. Consist of an organized, behavioral health
program of treatment and rehabilitative services;
b. Include:
(i) Individual outpatient therapy, family
outpatient therapy, or group outpatient therapy;
(ii) Behavior management and social skills
training;
(iii) Independent living
skills that correlate to the age and developmental 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
c. 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 on non-instructional weekdays during the school year including
scheduled school breaks;
(iii) In
coordination with the recipient's individualized educational plan or Section
504 plan if the recipient has an individualized educational plan or Section 504
plan;
(iv) Under the supervision of
a licensed or certified approved behavioral health services provider or a
behavioral health practitioner working under clinical 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 psychiatric hospital shall have:
a. The capacity to employ staff authorized to
provide day treatment services in accordance with this section and to
coordinate the provision of services among team members; and
b. Knowledge of substance use
disorders.
4. Day
treatment shall not include a therapeutic clinical service that is included in
a child's individualized education plan.
(g)
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 mental health disorder, substance use
disorder, or co-occurring mental health and substance use disorders to a
recipient by sharing a similar mental health disorder, substance use disorder,
or co-occurring mental health and substance use disorders in order to bring
about a desired social or personal change;
(ii) A parent who has been trained and
certified in accordance with
908 KAR 2:230 of a child having
or who has had a mental health disorder, substance use disorder, or
co-occurring mental health and substance use disorders to a parent or family
member of a child sharing a similar mental health disorder, substance use
disorder, or co-occurring mental health and substance use disorders in order to
bring about a desired social or personal change;
(iii) A family member who has been trained
and certified in accordance with
908 KAR 2:230 of a child having
or who has had a mental health disorder, substance use disorder, or
co-occurring mental health and substance use disorders to a parent or family
member of a child sharing a similar mental health disorder, substance use
disorder, or co-occurring mental health and substance use disorders in order to
bring about a desired social or personal change; or
(iv) A registered alcohol and drug peer
support specialist 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;
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. 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 specified in the recipient's plan of
care.
2. To provide peer
support services, a psychiatric hospital 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:
(i) Peer support specialists who are
qualified to provide peer support services in accordance with
908 KAR 2:220,
908 KAR 2:230, or
908 KAR 2:240; or
(ii) Registered alcohol and drug peer support
specialists;
c. Use an
approved behavioral health services provider to supervise:
(i) Peer support specialists; or
(ii) Registered alcohol and drug peer support
specialists;
d. Have the
capacity to coordinate the provision of services among team members;
and
e. Have the capacity to provide
on-going continuing education and technical assistance to:
(i) Peer support specialists; or
(ii) Registered alcohol and drug peer support
specialists.
(h)
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. Be provided
at least three (3) hours per day at least three (3) days per week;
and
d. Include:
(i) Individual outpatient therapy, group
outpatient therapy, or family outpatient therapy unless
contraindicated;
(ii) Crisis
intervention; or
(iii)
Psycho-education.
2. During psycho-education the recipient or
recipient's 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 services 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 psychiatric hospital shall
have:
a. Access to a board-certified or
board-eligible psychiatrist for consultation;
b. Access to a psychiatrist, physician, or
advanced practice registered nurse for medication prescribing and
monitoring;
c. Adequate staffing to
ensure a minimum recipient-to-staff ratio of ten (10) recipients to one (1)
staff person;
d. The capacity to
provide services utilizing a recognized intervention protocol based on
nationally accepted treatment principles; and
e. The capacity to employ staff authorized to
provide intensive outpatient program services in accordance with this section
and to coordinate the provision of services among team members.
(i) Individual
outpatient therapy shall:
1. Be provided to
promote the:
a. Health and well-being of the
recipient; and
b. Recipient's
recovery from a substance use disorder, mental health disorder, or co-occurring
mental health and substance use disorders;
2. Consist of:
a. A face-to-face, one-on-one encounter
between the provider and recipient; and
b. A behavioral health therapeutic
intervention provided in accordance with the recipient's identified plan of
care;
3. Be aimed at:
a. Reducing adverse symptoms;
b. Reducing or eliminating the presenting
problem of the recipient; and
c.
Improving functioning; and
4. Not exceed three (3) hours per day unless
additional time is medically necessary.
(j)
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
well-being of the recipient; and
(ii) Recipient's recovery from a substance
use disorder, mental health disorder, or co-occurring mental health and
substance use disorders;
c. Consist of a face-to-face behavioral
health therapeutic intervention provided in accordance with the recipient's
identified plan of care;
d. Be
provided to a recipient in a group setting:
(i) Of nonrelated individuals except for
multi-family group therapy; and
(ii) Not to exceed twelve (12)
individuals;
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 per recipient unless additional time is medically necessary.
2. The group shall have a:
a. Deliberate focus; and
b. Defined course of treatment.
3. The subject of group outpatient
therapy shall relate 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.
(k)
1. Family outpatient therapy shall consist of
a face-to-face 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
well-being of the recipient; or
(ii) Recipient's recovery from a substance
use disorder, mental health disorder, or co-occurring mental health and
substance use disorders; and
b. Not exceed three (3) hours per day per
individual unless additional time is medically necessary.
(l)
1. Collateral outpatient therapy shall:
a. Consist of a face-to-face behavioral
health consultation:
(i) With a parent or
caregiver of a recipient, household member of a recipient, recipient's
representative, school staff person, treating professional, or other person
with custodial control or supervision of the recipient; and
(ii) That is provided in accordance with the
recipient's plan of care; and
b. Not be reimbursable if the therapy is for
a recipient who is at least twenty-one (21) years of age.
2. Consent 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.
(m)
1.
Service planning shall:
a. Involve assisting a
recipient in creating an individualized plan for services needed for maximum
reduction of the effects of a mental health disorder;
b. Involve restoring a recipient's functional
level to the recipient's best possible functional level; and
c. Be performed using a person-centered
planning process.
2. A
service plan:
a. Shall be directed by the:
(i) Recipient; or
(ii) Recipient's representative if the
recipient is under the age of eighteen (18) years or is unable to provide
direction;
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.
(n) Screening, brief intervention, and
referral to treatment for a substance use disorder shall:
1. Be an evidence-based early intervention
approach for an individual with non-dependent substance use in order to provide
an effective strategy for intervention prior to the need for more extensive or
specialized treatment; and
2.
Consist of:
a. Using a standardized screening
tool to assess an individual for risky substance use behavior;
b. Engaging a recipient who demonstrates
risky substance use behavior in a short conversation and providing feedback and
advice to the recipient; and
c.
Referring a recipient to additional mental health disorder, substance use
disorder, or co-occurring disorders services if the recipient is determined to
need additional services to address the recipient's substance use.
(o)
1. Assertive community treatment shall:
a. Be an evidence-based psychiatric
rehabilitation practice which provides a comprehensive approach to service
delivery for individuals with a severe mental illness; and
b. Include:
(i) Assessment;
(ii) Treatment planning;
(iii) Case management;
(iv) Psychiatric services;
(v) Medication prescribing and
monitoring;
(vi) Individual
outpatient therapy;
(vii) Group
outpatient therapy;
(viii) Mobile
crisis services;
(ix) Mental health
consultation;
(x) Family support
and basic living skills; or
(xi)
Peer support.
2.
a. Mental
health consultation shall involve brief, collateral interactions with other
treating professionals who may have information for the purpose of treatment
planning and service delivery.
b.
Family support shall involve the assertive community treatment team's working
with the recipient's natural support systems to improve family relations in
order to:
(i) Reduce conflict; and
(ii) Increase the recipient's autonomy and
independent functioning.
c. Basic living skills shall be
rehabilitative services focused on teaching activities of daily living
necessary to maintain independent functioning and community living.
3. To provide assertive community
treatment services, a psychiatric hospital shall:
a. Employ at least one (1) team of
multidisciplinary professionals:
(i) Led by an
approved behavioral health services provider except for a licensed clinical
alcohol and drug counselor in accordance with Section 12 of this administrative
regulation, a licensed clinical alcohol and drug counselor associate in
accordance with Section 12 of this administrative regulation, or a certified
alcohol and drug counselor; and
(ii) Comprised of at least four (4) full-time
equivalents including a psychiatrist, a nurse, a case manager, a peer support
specialist, a registered alcohol and drug peer support specialist, or an
approved behavioral health services provider except for a licensed clinical
alcohol and drug counselor in accordance with Section 12 of this administrative
regulation, a licensed clinical alcohol and drug counselor associate in
accordance with Section 12 of this administrative regulation, or a certified
alcohol and drug counselor;
b. Have adequate staffing to ensure that no
team's caseload size exceeds ten (10) participants per team member (for
example, if the team includes five (5) individuals, the caseload for the team
shall not exceed fifty (50) recipients);
c. Have the capacity to:
(i) Employ staff authorized to provide
assertive community treatment services in accordance with this
paragraph;
(ii) Coordinate the
provision of services among team members;
(iii) Provide the full range of assertive
community treatment services as stated in this paragraph; and
(iv) Document and maintain individual health
records; and
d.
Demonstrate experience in serving individuals with persistent and severe mental
illness who have difficulty living independently in the community.
(p)
1. Comprehensive community support services
shall:
a. Be activities necessary to allow an
individual to live with maximum independence in the community;
b. Be intended to ensure successful community
living through the utilization of skills training as identified in the
recipient's plan of care; and
c.
Consist of using a variety of psychiatric rehabilitation techniques to:
(i) Improve daily living skills;
(ii) Improve self-monitoring of symptoms and
side effects;
(iii) Improve
emotional regulation skills;
(iv)
Improve crisis coping skills; and
(v) Develop and enhance interpersonal
skills.
2. To
provide comprehensive community support services, a psychiatric hospital shall:
a. Have the capacity to employ staff
authorized pursuant to
908 KAR 2:250 to provide
comprehensive community support services in accordance with subsection (2)(k)
of this section and to coordinate the provision of services among team members;
and
b. Meet the requirements for
comprehensive community support services established in
908 KAR 2:250.
(q)
1. Therapeutic rehabilitation program
services shall be:
a. A rehabilitative service
for an:
(i) Adult with a severe mental
illness; or
(ii) Individual under
the age of twenty-one (21) years who has a severe emotional disability;
and
b. Designed to
maximize the reduction of the effects of a mental health disorder and the
restoration of the individual's functional level to the individual's best
possible functional level.
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 skills;
and
(v) Interpersonal skills;
and
c. Be delivered
individually or in a group.
(r)
1.
Partial hospitalization shall be a short-term (average of four (4) to six (6)
weeks), less than twenty-four (24)-hour, intensive treatment program for an
individual who is experiencing significant impairment to daily functioning due
to a substance use disorder, a mental health disorder, or co-occurring mental
health and substance use disorders.
2. Partial hospitalization may be provided to
an adult or a child.
3. Admission
criteria for partial hospitalization shall be based on an inability to
adequately treat the recipient through community-based therapies or intensive
outpatient services.
4. A partial
hospitalization program shall consist of individual outpatient therapy, group
outpatient therapy, family outpatient therapy, or medication
management.
5.
a. The department shall not reimburse for
educational, vocational, or job training services provided as part of partial
hospitalization.
b. An outpatient
hospital'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 which are not Medicaid billable or
reimbursable.
c. The department
shall not reimburse for services identified in a Medicaid-eligible child's
individualized education program.
6. Partial hospitalization shall typically
be:
a. Provided for at least four (4) hours
per day; and
b. Focused on one (1)
primary presenting problem (i.e. substance use, sexual reactivity, or another
problem).
7. An
outpatient hospital's partial hospitalization program shall:
a. Include the following personnel for the
purpose of providing medical care if necessary:
(i) An advanced practice registered
nurse;
(ii) A physician assistant
or physician available on site; and
(iii) 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
subsection.
(4) The extent and type of a screening shall
depend upon the nature of the problem of the individual seeking or being
referred for services.
(5) 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 DisordersTM.
(6) The department shall not reimburse for a
service billed by or on behalf of an entity or individual who is not a billing
provider.