Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 45A, 200.460, 313.035
NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.030(5) authorizes
the Office for Children with Special Health Care Needs to promulgate
administrative regulations to implement and administer its responsibilities
under KRS 200.460 to 200.490. This administrative regulation establishes
requirements relating to the Office for Children with Special Health Care Needs
medical staff.
Section 1. Definitions.
(1) "Advanced practice registered nurse" is
defined by KRS 314.011(7).
(2)
"Dentist" is defined by KRS 313.010(10).
(3) "MAC" means the Medical Advisory
Committee, which is an internal OCSHCN committee that consists of thirteen (13)
members and advises OCSHCN on issues pertaining to medical staff qualification,
credentialing, quality, and other related issues.
(4) "OCSHCN" means Office for Children with
Special Health Care Needs.
(5)
"Physician" is defined by KRS 311.550(12).
(6) "Physician assistant" is defined by KRS 311.840(3).
(7) "Psychologist" is
defined by KRS 319.010(9).
Section
2. Qualifications for Acceptance to OCSHCN Active Medical Staff.
(1) In order to be eligible for acceptance to
the OCSHCN active medical staff, an individual shall be:
(a) Licensed to practice in Kentucky as a:
1. Physician;
2. Dentist;
3. Advanced practice registered
nurse;
4. Physician assistant;
or
5. Psychologist; and
(b) Able to document:
1. Background, experience, training, and
competence;
2. Adherence to the
ethics of the individual's profession;
3. Professionalism; and
4. Interpersonal skills.
(2) A physician or dentist shall
be:
(a)
1.
Eligible for membership in the national medical or dental society; or
2. Enrolled as a member of the national
medical or dental society; and
(b) Enrolled as a participating provider in
the Kentucky Medicaid program, in accordance with 907 KAR 1:672.
(3) For specific medical
specialties, for which there is a generally recognized certification by a board
giving examinations in the field, the individual shall be:
(a) Eligible to sit for the examination of
the board; or
(b) Board
certified.
(4) For
initial appointment to the medical staff in a dental specialty area, the
individual shall be licensed in the specialty area, in accordance with KRS 313.035 and 201 KAR 8:532.
Section
3. Categories of Medical Staff. The medical staff shall consist of
the following categories:
(1) Temporary active
status, pursuant to Section 6 of this administrative regulation;
(2) Active status, pursuant to Sections 2, 4,
and 5 of this administrative regulation; and
(3) Contracted status, pursuant to Section 7
of this administrative regulation.
Section 4. Initial Application Process for
Active Medical Staff.
(1) An individual
seeking initial appointment to the medical staff shall submit to OCSHCN a
completed application packet containing:
(a) A
completed and signed:
1.
a. OCSHCN-60a, Application for Active Medical
or Dental Staff, if the individual is a dentist or physician;
b. OCSHCN-60b, Application for Active Medical
APRN Staff, if the individual is an advanced practice registered
nurse;
c. OCSHCN-60c, Application
for Active Psychology Staff, if the individual is a psychologist; or
d. OCSHCN-60d, Application for Active Medical
Physician Assistant Staff, if the individual is a physician
assistant;
2.
OCSHCN-60e, Authorization, Attestation, and Release; and
3. OCSHCN-60f, Anti-Harassment and
Discrimination Acknowledgment;
4.
Two (2) OCSHCN- 60g, Peer Reference Letter Medical or Dental;
(b) A copy of the individual's
current Council for Affordable Quality Healthcare (CAQH) application;
(c) A current curriculum vitae;
(d) A copy of the individual's malpractice
insurance endorsement; and
(e) The
applicable information required by subsections (2) through (5) of this
section.
(2) If the
individual is a dentist or physician, the following attachments shall be
included:
(a) A copy of the individual's
license to practice, issued by the Kentucky:
1. Board of Dentistry; or
2. Board of Medical Licensure; and
(b) If applicable, a copy of the
individual's current Form DEA-223, Controlled Substance Registration
Certificate issued by the United States Department of Justice, Drug Enforcement
Administration.
(3) If
the individual is an advanced practice registered nurse, the following
attachments shall be included:
(a) A copy of a
signed Collaborative Practice Agreement between the physician and the
individual, as submitted to the Kentucky Board of Nursing; and
(b) A copy of the individual's current
credentialing from the:
1. American Nurses
Credentialing Center (ANCC); or
2.
American Academy of Nurse Practitioners (AANP).
(4) If the individual is a psychologist, the
application packet shall include a copy of the individual's license to
practice, issued by the Kentucky Board of Examiners of Psychology.
(5) If the individual is a physician
assistant, the following attachments shall be included:
(a) A copy of the individual's license to
practice, issued by the Kentucky Board of Medical Licensure;
(b) A copy of the initial and any applicable
Supplemental Application for Physician to Supervise Physician Assistant, as
submitted to the Kentucky Board of Medical Licensure; and
(c) A copy of the National Commission on
Certification of Physician Assistants (NCCPA) certification.
Section 5. Procedures
for Application Review and Appointment.
(1)
Within seven (7) working days of receipt of the application pursuant to Section
4 of this administrative regulation, designated OCSHCN staff shall request
that:
(a) Individuals listed as references
complete the OCSHCN 60g, Peer Reference Letter Medical or Dental; and
(b) An individual submit missing information
or other required documents necessary to an evaluation of the individual's
qualifications.
(2) If
the documentation requested pursuant to subsection (1) of this section is not
received by OCSHCN within forty-five (45) working days from the date of the
request, designated OCSHCN staff shall notify the individual in writing that:
(a) The individual shall be responsible for
following up to obtain missing information and ensuring receipt by OCSHCN
within twenty (20) working days of written notice;
(b) Failure to submit the missing information
within twenty (20) working days of written notice under paragraph (a) of this
subsection shall result in the application being placed in closed status
without further review;
(c)
Reapplication for staff appointment shall not be considered for a period of six
(6) months from the date of the notice that the application has been closed
pursuant to paragraph (b) of this subsection; and
(d) Reapplication for staff appointment shall
be processed as an initial application.
(3) Upon receipt of documentation requested
pursuant to subsection (1) of this section, designated OCSHCN staff shall make
the application and other documentation available to the MAC chair, who shall
present the application at the next meeting of the MAC.
(4) The MAC shall:
(a) Ensure that all necessary documents and
investigations have been validated with objectivity, fairness, and
impartiality, and that recommendations are soundly based and compatible with
the objectives of OCSHCN;
(b)
Determine if the individual meets all necessary qualifications for the category
of staff membership and clinical privileges requested;
(c) If the MAC determines that the individual
meets all necessary qualifications for the category of staff membership and
clinical privileges requested, recommend to designated OCSHCN staff:
1. Appointment to the appropriate staff
category; and
2. Granting of
privileges according to the specialty to which the individual shall be
assigned; and
(d) If the
MAC determines that the individual does not meet all necessary qualifications
for the category of staff membership and clinical privileges requested:
1. Defer consideration of the application, if
clarifying information is needed; or
2. Reject the application.
(5) Upon the MAC
approving the individual, designated OCSHCN staff shall add the individual
approved in accordance with this section to OCSHCN's active medical staff for a
period of three (3) years.
(6) An
individual aggrieved by an adverse decision pursuant to subsection (4)(d) of
this section may request to address the MAC to seek reconsideration pursuant to
Section 12 of this administrative regulation.
Section 6. Temporary Active Medical Staff.
(1) The executive director or designee may
make a temporary active medical staff appointment if necessary to provide
clinical coverage. This type of staff appointment shall be:
(a) Emergency in nature;
(b) Made based on information currently
available that may reasonably be obtained as to the competence and ethical
standing of the individual; and
(c)
Reviewed by the MAC within six (6) months following the appointment.
(2) A temporary active medical
staff appointment shall last no longer than six (6) months, at which time the
appointment shall be eligible for conversion to the active medical staff
pursuant to the processes established in Sections 4 and 5 of this
administrative regulation.
(3) Each
appointee to the temporary active medical staff shall have an assigned member
of the active medical staff review performance during clinic and make
recommendations to the MAC as necessary regarding conversion to the active
medical staff.
(4) An appointee to
temporary active medical staff status shall be compensated in accordance with
Section 10 of this administrative regulation.
Section 7. Contracted Staff.
(1) In accordance with KRS Chapter 45A,
OCSHCN may contract with medical or dental specialists to provide services to
children outside of OCSHCN offices and clinics.
(2) OCSHCN-enrolled children may be referred
to contracted staff by a member of the active OCSHCN medical staff or the
OCSHCN medical director.
Section
8. Annual Review and Reappointment Process.
(1) OCSHCN shall, on an annual basis, verify
for each member of the active medical staff:
(a) Current state license; and
(b) Current malpractice insurance.
(2) Each member of the active
medical staff shall undergo a re-credentialing process every three (3) years.
Required documents to be submitted to OCSHCN shall include:
(a) OCSHCN-60i, Renewal Application for
Active Medical or Dental Staff; and
(b) All documents requested by OCSHCN-60i,
Renewal Application for Active Medical or Dental Staff.
(3) The reappointment evaluation shall
include:
(a) Review of required forms and
documents;
(b) Timely completion
and preparation of medical and other required patient records;
(c) Satisfactory evidence of compliance with
ethics;
(d) Compliance with OCSHCN
procedures;
(e) General cooperation
and ability to work with others;
(f) Results of quality assurance audits, if
conducted; and
(g) Reports of
disciplinary action requested, or proceedings initiated against a provider at
any institution.
(4) At
each regularly scheduled meeting, the MAC shall complete a review of the active
medical staff that are due for a three (3) year re-credentialing appraisal. The
review shall include:
(a) OCSHCN-60i, Renewal
Application for Active Medical or Dental Staff; and
(b) Any other information pertinent to
continuation on the medical staff.
(5) After the review, the MAC shall make a
determination to re-credential or not re-credential based on the information
requested in this section.
Section
9. Duties and Responsibilities of Medical Staff.
(1) Each member of the medical staff shall
assume the same responsibility for care and treatment of the staff member's
assigned patients as in private practice.
(2) A resident physician or dentist in
training may assist in the care of patients, if a member of the active medical
staff:
(a) Remains entirely responsible for
the care of each patient;
(b)
Examines and, if indicated, recommends treatment for each new patient under the
staff member's care;
(c) Remains
present in the surgical suite at all operations and other procedures in which
general anesthesia is used;
(d)
Directs the examination of all patients assigned to the active staff member for
discharge from the hospital and designates follow-up care; and
(e) Maintains oversight of the resident
physician or dentist.
(3) Active medical staff members assigned to
OCSHCN clinics shall be present to conduct an assigned clinic. If an active
medical staff member cannot be present to conduct an assigned clinic, the staff
member shall:
(a) Make arrangements with
another member of the OCSHCN medical staff to serve in the staff member's
place, if the staff member advises the assigned OCSHCN staff of this change;
or
(b) Request that assigned OCSHCN
staff reschedule the clinic, if the request is timely enough to allow OCSHCN
staff to notify patients of the rescheduling.
(4) For a clinic with more than one (1)
provider representing different specialties, if an active medical staff member
cannot be present to conduct an assigned clinic, the staff member shall:
(a) Make arrangements with another member of
the OCSHCN medical staff to serve in the staff member's place, if the staff
member advises the assigned OCSHCN staff of this change; or
(b) Make arrangements with the other active
medical staff members assigned to the clinic to reschedule the entire clinic,
if the request is timely enough to allow OCSHCN staff to notify patients of the
rescheduling.
(5) If an
active medical staff member who has responsibility for a clinic fails to attend
two (2) clinics during a twelve (12) month period and does not comply with
subsection (3) or (4) of this section, the active medical staff member shall
be:
(a) Removed from the active medical staff;
and
(b) Advised in writing of:
1. The removal; and
2. Right to be heard by the MAC pursuant to
Section 12 of this administrative regulation.
(6) Medical staff members participating in
OCSHCN onsite clinics shall document a summary of each patient visit.
Documentation shall be completed:
(a) On the
day of the visit; or
(b) Within
seventy-two (72) hours of the visit if it cannot be finished on the day of the
visit.
(7) Medical staff
members participating in OCSHCN onsite clinics shall:
(a) Not remove patient medical records from
OCSHCN premises; and
(b)
Authenticate their medical record entries regarding diagnosis, findings, and
recommendations for treatment, by:
1.
Signature; or
2.
Initials.
(8)
If a medical staff member elects to initial the medical record pursuant to
subsection (7) of this section, OCSHCN shall maintain a legend for purpose of
identity, which shall include the typed or printed name of the medical staff
member, followed by hand signed initials.
(9) A medical staff member may see OCSHCN
patients in the staff member's private office, as deemed necessary by the
medical staff member. Office visit records shall be:
(a) Completed; and
(b) Forwarded to the assigned OCSHCN office
within three (3) working days of the visit.
(10) To the extent possible, total care for
the child shall be considered while the specific condition for which treatment
is sought is being cared for. Coexistent diseases, disabilities, or anomalies
shall be investigated and treated if:
(a) The
referring physician or dentist, if any, approves and consents; and
(b) The services fall within the categories
eligible for treatment by OCSHCN in accordance with 911 KAR 1:010.
(11) A program of total care for
the child shall be developed by a team approach. There shall be discussion of
all phases of the problem of each child by all medical personnel concerned with
the child's care, including therapists and other professional personnel. Team
care shall be provided within the context of a multidisciplinary
clinic.
(12) Contracted staff shall
be available for consultation and treatment if indicated. Arrangements for
contracts shall be made through the assigned OCSHCN office on an individual
basis.
Section 10.
Compensation.
(1) A member of the medical
staff shall be compensated for services provided during OCSHCN clinics in
accordance with a contract agreed to pursuant to the provisions of KRS Chapter
45A.
(2) If OCSHCN staff refer
patients to a member of the active medical staff for services outside of an
OCSHCN clinic, information needed to bill the appropriate insurance carrier
shall be included.
Section
11. Corrective Action.
(1) The
following parties may request corrective action be directed toward a member of
the medical staff:
(a) Any member of the
medical staff;
(b) The chair of the
MAC;
(c) OCSHCN staff; or
(d) A member of the family of an
OCSHCN-enrolled child.
(2) The basis for a request for corrective
action shall include activities or professional conduct that are considered to
be:
(a) Contrary to the standards or aims of
the medical staff; or
(b)
Disruptive to OCSHCN operations, programs, or clinics.
(3) A request for corrective action shall be:
(a) In writing;
(b) Addressed to the executive director;
and
(c) Supported by references to
the specific activities or conduct that constitutes grounds for the
request.
(4) Within ten
(10) working days of receipt of a request for corrective action, the executive
director or designee shall:
(a) Initiate an
investigation of the facts and circumstances surrounding the grounds for the
requested corrective action;
(b)
Interview the member of the medical staff against whom the corrective action is
requested;
(c) Document the
interview in writing; and
(d)
Submit a report and recommendation to the MAC for consideration.
(5) Within ninety (90) working
days following the receipt of the recommendation by the executive director, the
MAC shall make recommendations on the request.
(6) In accordance with subsection (5) of this
section, the MAC may:
(a) Reject the request
for corrective action;
(b) Issue a
warning, letter of admonition, or letter of reprimand;
(c) Impose terms of probation or a suspension
from the medical staff; or
(d)
Recommend that the affected member's medical staff membership be suspended or
revoked.
(7) The
executive director shall have the authority to summarily suspend or dismiss a
member of the medical staff if action is needed immediately in the interest of
patient care. Grounds for summary suspension or dismissal from the medical
staff shall include:
(a) Action by the
governing Board of Medical Licensure, Board of Dentistry, Board of Nursing, or
Board of Examiners of Psychology, in which a member's license is revoked or
suspended;
(b) Loss of hospital
privileges; or
(c) Behavior that
creates a risk of harm to children or OCSHCN staff.
Section 12. Request for
Reconsideration.
(1) A provider may request to
appear before the MAC to advocate for reconsideration if the provider:
(a) Was denied appointment to the medical
staff pursuant to Section 5 of this administrative regulation;
(b) Was removed from the active medical staff
pursuant to Section 9(5) of this administrative regulation; or
(c) Has been the subject of corrective action
pursuant to Section 11 of this administrative regulation.
(2) A provider who is aggrieved pursuant to
subsection (1) of this section shall complete form OCSHCN-60k, Request for
Reconsideration by Medical Advisory Committee, to include:
(a) Name of provider;
(b) Specialty;
(c) Address;
(d) Telephone;
(e) E-mail address, if available;
(f) Justification for
reconsideration;
(g) Supporting
documentation, if available, including:
1.
Verification of training or work history; and
2. Provider statements or recommendations;
and
(h) Dated signature
of the provider.
(3) The
MAC shall review the completed form and supporting documentation.
(4) The MAC may request additional pertinent
information, as needed, within five (5) working days of the review
date.
(5) The provider shall return
the information requested pursuant to subsection (4) of this section within ten
(10) working days.
(6) The MAC
shall communicate to the provider:
(a) The
date to appear before the MAC; and
(b) Within five (5) working days of the
receipt of all information requested.
(7) Following the provider's appearance at
the MAC, the MAC shall communicate within five (5) working days to the
provider:
(a) The decision made; and
(b) A brief explanation.
Section 13. Incorporation by
Reference.
(1) The following material is
incorporated by reference:
(a) OCSHCN-60a,
"Application for Active Medical or Dental Staff," 06/2022;
(b) OCSHCN-60b, "Application for Active
Medical APRN Staff," 06/2022;
(c)
OCSHCN-60c, "Application for Active Psychology Staff," 06/2022;
(d) OCSHCN-60d, "Application for Active
Medical Physician Assistant Staff," 06/2022;
(e) OCSHCN-60e, "Authorization, Attestation,
and Release," 01/2019;
(f)
OCSHCN-60f, "Anti-Harassment and Discrimination Acknowledgment,"
01/2019;
(g) OCSHCN-60g, "Peer
Reference Letter Medical or Dental," 06/2022;
(h) OCSHCN-60i, "Renewal Application for
Active Medical or Dental Staff," 06/2022; and
(i) OCSHCN-60k, "Request for Reconsideration
by Medical Advisory Committee," 06/2022.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Office for Children
with Special Health Care Needs, 310 Whittington Parkway, Suite 200, Louisville,
Kentucky 40222, Monday through Friday, 8 a.m. to 4:30 p.m. or online at the
agency's Web site at
https://chfs.ky.gov/agencies/ccshcn/Pages/Incorporated.aspx.
STATUTORY AUTHORITY: KRS 194A.030(5)