Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS Chapters 202A, 202B, 645
NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective
July 9, 2004, created the Cabinet for Health and Family Services and placed the
Department for Behavioral Health, Developmental and Intellectual Disabilities
within the cabinet. This administrative regulation sets forth the cabinet's
services and procedures for: providing crisis stabilization units; transporting
and holding individuals; using restraints; providing privacy to individuals who
are held for evaluation; identifying rights for individuals held to communicate
by phone; and planning and coordinating the required services.
Section 1. Definitions.
(1) "Community behavioral health,
developmental and intellectual disabilities center" or "center" means a
facility licensed by the cabinet pursuant to KRS Chapter 216B that provides
inpatient, outpatient, psychosocial rehabilitation, emergency, consultation,
and education services to persons needing behavioral health, developmental and
intellectual disabilities, and substance abuse services as provided within
KRS
210.410 and
908 KAR
2:010.
(2)
"Evaluation" means a mental health evaluation performed by a qualified mental
health professional, as defined in
KRS
202A.011 and
600.020,
conducted to determine if an individual meets the criteria for involuntary
hospitalization as defined in
KRS
202A.026 or
645.090.
(3) "Facility" means any hospital or
psychiatric facility as defined in
KRS
202A.011 or a mental health facility as
defined in
KRS
645.020 used for the purpose of conducting an
evaluation pursuant to KRS Chapters 202A or 202B or 645.120.
(4) "Hold", "held" or "holding" means the
detainment of an individual by a peace officer or a provider of transportation
services authorized by the peace officer.
(5) "Individual" means a person who is being
held and evaluated under KRS Chapters 202A, 202B or 645.
(6) "Peace officer" means a law enforcement
officer as defined in
KRS
446.010(24).
(7) "Providers of transportation services" or
"providers" means peace officers and ambulance services designated by the
cabinet, service providers, or agencies on contract with the cabinet. The
providers of emergency or nonemergency transportation services include those
service providers or agencies that are approved by the Department for Medicaid
Services or the centers.
Section
2. Crisis Stabilization Unit.
(1)
Centers may establish crisis stabilization units for the purpose of reducing
hospitalization in the treatment of mental illness. Services shall include:
(a) Evaluations;
(b) Crisis intervention and emergency mental
health services; and
(c) Referral
for follow-up care.
(2)
Crisis stabilization units shall be operated as twenty-four (24) hour per day,
seven (7) days per week facilities.
(3) Crisis stabilization units may admit
individuals who voluntarily seek mental health services or who are in need of
evaluation pursuant to KRS Chapters 202A or 202B or 645.120.
Section 3. Transportation.
(1) A peace officer shall:
(a) Transport an individual pursuant to KRS
Chapter 202A or 645.120 for evaluation; and
(b) Hold the individual until the evaluation
is completed, unless the facility agrees to hold the individual.
(2) Following the evaluation, the
provider shall transport the individual to:
(a) A hospital if the evaluation criteria are
met and so ordered by the court; or
(b) The location of the individual's choice
in either the individual's home county or county where the holding originated,
if the evaluation criteria are not met.
(3) The provider shall not use sirens or
emergency lights of any kind except in a bona fide emergency.
(4) The peace officer who has taken the
individual into custody under
KRS
202A.041 shall:
(a) Document the behavior of the individual
by describing:
1. How the situation was
brought to the attention of the peace officer; and
2. The behavior of the individual that was
considered a danger to self or others; and
(b) Provide this documentation to the
qualified mental health professional evaluating the individual.
(5) Reimbursement of
transportation costs may be negotiated by the center in accordance with the
center's contract with the cabinet.
(6) Reimbursement for the individual
transported to a facility shall be paid by the center if:
(a) The individual is transported pursuant to
KRS
202A.028,
202A.041,
202A.051,
or
645.120;
and
(b) A center or a designated
subcontractor of the center conducts the evaluation.
(7) Transportation provided to the individual
upon discharge from the hospital to their home county shall be:
(a) Reimbursed by the center, if a provider
is the most appropriate means of transportation; or
(b) The responsibility of the hospital, if
the hospital determines that an alternate form of transportation is more
appropriate.
(8) No
payment shall be made by the center if reimbursement of these costs is
otherwise available from:
(a) Private
insurance;
(b) Other source of
payment;
(c) Medicare; or
(d) The Department for Medicaid
Services.
(9) The
authority of the cabinet to negotiate rates of reimbursement and enter into
contracts with providers may be delegated to the center.
Section 4. Use of Restraints.
(1) A peace officer, ambulance provider,
physician or facility may use restraints only if the individual exhibits or is
threatening to exhibit assaultive or self-injurious behavior.
(2) Restraints may be applied through
physical contact or devices used by peace officers, ambulance providers, or
facilities in a manner consistent with the practice of each profession.
Restraint may also be applied through the appropriate use of medications
ordered by a licensed physician and administered by a qualified health care
professional.
(3) The peace
officers, ambulance providers, physician or facility shall document in writing
the use of any restraint. The documentation shall include:
(a) The reason for using the
restraint;
(b) Type of restraint
used;
(c) When the restraint was
initiated; and
(d) Length of time
the restraint was used, or if medication was used, name of medications, dosage
and effect on individual.
(4) Documentation concerning the use of
restraint shall be given to:
(a) The qualified
mental health professional who performs the evaluation; and
(b) The facility, crisis stabilization unit,
or intermediate care facility where the individual is being held or
treated.
Section
5. Privacy.
(1) A provider or
facility shall not disclose the psychiatric condition or other personal
information regarding the individual except to:
(a) Persons acting under the provisions of
KRS Chapters 202A, 202B and 645;
(b) The individual;
(c) The individual's legal
guardian;
(d) The individual's
parent(s) or person exercising custodial control or supervision of the
individual, if a minor; or
(e) Any
person given legal authority to receive that information on the individual's
behalf.
(2) Facilities
shall maintain the individual's privacy during the holding period.
(3) The qualified mental health professional
shall evaluate the individual in an examining room or clinician's
office.
(4) The individual or the
other persons identified in subsection (1) of this section may receive copies
of all documents generated during the transportation and holding as provided in
KRS
61.878 and
61.884.
(5) The qualified mental health professional
who performed the evaluation or other facility staff shall inform the
individual of the availability of the documents and the opportunity to review
the individual's medical record.
Section 6. Communication.
(1) At the time of holding, the provider
shall inform the individual that reasonable access to telephone communication
shall be offered at the facility.
(2) The facility shall:
(a) Inform the individual of the availability
of phone calls;
(b) Provide
telephone communications to the individual at the earliest opportunity
available;
(c) Assist the
individual in completing phone calls to persons of their choice; and
(d) Pay for no more than two (2) completed
long distance phone calls, if the individual has insufficient funds.
Section 7. Community
Behavioral Health, Developmental and Intellectual Disabilities Centers
Responsibilities.
(1) Under the authority of
KRS 210.040(7) and
(8), the cabinet may delegate to the
community behavioral health, developmental and intellectual disabilities
centers the responsibility to plan, prepare written protocols, and coordinate
services as provided within KRS Chapters 202A and 202B and 645.120.
(2) The center shall:
(a) Designate facilities for the purpose of
conducting evaluations by qualified mental health professionals;
(b) Notify providers of transportation
services, district judges and the cabinet of the identity and location of the
facilities that are designated for the purpose of evaluating
individuals;
(c) Make qualified
mental health professionals available twenty-four (24) hours per day, seven (7)
days per week at designated facilities to perform evaluations;
(d) Conduct evaluation requested by
facilities within three (3) hours of the time of the request unless extensions
of time are negotiated between the facility and the centers; and
(e) Assist the facility in referring the
individual to a hospital for treatment if the evaluation criteria are met and
the individual has not been admitted to the hospital where the evaluation is
conducted.
STATUTORY AUTHORITY:
KRS
194A.050,
202A.008,
202A.028(3),
(4),
202A.041(1),
202A.051(6),
202A.101(3),
202A.241,
645.120,
EO 2004-726