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 a requirement that may be
imposed or opportunity presented by federal law to qualify for federal Medicaid
funds. This administrative regulation establishes the definitions for 907 KAR
Chapter 15.
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" or "APRN" 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; or
9. 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)
"Behavioral health multi-specialty group" means a group of more than one (1)
individually licensed behavioral health practitioners of varying practitioner
types who form a business entity to:
(a)
Render behavioral health services; and
(b) Bill the Medicaid Program for services
rendered to Medicaid recipients.
(7) "Behavioral health provider group" means
a group of more than one (1) individually licensed behavioral health
practitioners of the same practitioner type who form a business entity to:
(a) Render behavioral health services;
and
(b) Bill the Medicaid Program
for services rendered to Medicaid recipients.
(8) "Behavioral health services organization"
means an entity that is licensed as a behavioral health services organization
pursuant to:
(a)
902
KAR 20:430 for a behavioral health services
organization tier I (BHSO I);
(9) "Billing provider" means the individual,
group of individual providers, or organization that:
(a) Is authorized to bill the department or a
managed care organization for a service; and
(b) Is eligible to be reimbursed by the
department or a managed care organization for a service.
(10) "Billing supervisor" means an individual
who is:
(a)
1. A physician;
2. A psychiatrist;
3. An advanced practice registered
nurse;
4. A physician
assistant;
5. A licensed clinical
alcohol and drug counselor;
6. A
licensed psychologist;
7. A
licensed clinical social worker;
8.
A licensed professional clinical counselor;
9. A licensed psychological
practitioner;
10. A certified
psychologist with autonomous functioning;
11. A licensed marriage and family
therapist;
12. A licensed
professional art therapist; or
13.
A licensed behavior analyst; and
(b) Employed by or under contract with the
same billing provider as the behavioral health practitioner under supervision
who renders services under the supervision of the billing supervisor.
(11) "Certified alcohol and drug
counselor" is defined by
KRS
309.080(2).
(12) "Certified psychologist" means an
individual who is a certified psychologist pursuant to
KRS
319.056.
(13) "Certified psychologist with autonomous
functioning" means an individual who is a certified psychologist with
autonomous functioning pursuant to
KRS
319.056.
(14) "Certified social worker" means an
individual who meets the requirements established in
KRS
335.080.
(15) "Chemical dependency treatment center"
means an entity that is licensed as a chemical dependency treatment center
pursuant to
902
KAR 20:160.
(16) "Community support associate" means a
paraprofessional who meets the application, training, and supervision
requirements of
908
KAR 2:250.
(17) "Co-occurring disorder" means a mental
health and substance use disorder.
(18) "Department" means the Department for
Medicaid Services or its designee.
(19) "Electronic signature" is defined by
KRS
369.102(8).
(20) "Enrollee" means a recipient who is
enrolled with a managed care organization.
(21) "Face-to-face" means occurring in
person.
(22) "Family peer support
specialist" means an individual who meets the requirements for a Kentucky
family peer support specialist established in
908 KAR
2:230.
(23) "Federal financial participation" is
defined by
42 C.F.R.
400.203.
(24) "Healthcare common procedure coding
system" or "HCPCS" means a collection of codes acknowledged by the Centers for
Medicare and Medicaid Services (CMS) that represents procedures or
items.
(25) "Kentucky-specific
Medicare Physician Fee Schedule" means the list or process by which current
reimbursement rates for physician services are established or published by the
department.
(26) "Level I
psychiatric residential treatment facility" means an entity that is licensed as
a Level I psychiatric residential treatment facility pursuant to
902
KAR 20:320.
(27) "Level II psychiatric residential
treatment facility" means an entity that is licensed as a Level II psychiatric
residential treatment facility pursuant to
902
KAR 20:320.
(28) "Licensed assistant behavior analyst" is
defined by
KRS
319C.010(7).
(29) "Licensed behavior analyst" is defined
by
KRS
319C.010(6).
(30) "Licensed clinical alcohol and drug
counselor" is defined by
KRS
309.080(4).
(31) "Licensed clinical alcohol and drug
counselor associate" is defined by
KRS
309.080(5).
(32) "Licensed clinical social worker" means
an individual who meets the licensed clinical social worker requirements
established in
KRS
335.100.
(33) "Licensed marriage and family therapist"
is defined by
KRS
335.300(2).
(34) "Licensed professional art therapist" is
defined by
KRS
309.130(2).
(35) "Licensed professional art therapist
associate" is defined by
KRS
309.130(3).
(36) "Licensed professional clinical
counselor" is defined by
KRS
335.500(3).
(37) "Licensed professional counselor
associate" is defined by
KRS
335.500(4).
(38) "Licensed psychological associate" means
an individual who meets the requirements established in
KRS
319.064.
(39) "Licensed psychological practitioner"
means an individual who meets the requirements established in
KRS
319.053.
(40) "Licensed psychologist" means an
individual who currently possesses a licensed psychologist license in
accordance with
KRS
319.010(6).
(41) "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.
(42) "Marriage and family therapy associate"
is defined by
KRS
335.300(3).
(43) "Medicaid-covered service" means a
service covered by the department as established in Title 907 of the Kentucky
Administrative Regulations.
(44)
"Medically necessary" or "medical necessity" means that a covered benefit is
determined to be needed in accordance with
907
KAR 3:130.
(45) "Medication assisted treatment" means
the treatment of a substance use disorder with approved medications in
combination with counseling, behavioral therapies, and other
supports.
(46) "Physician" is
defined by
KRS
205.510(11).
(47) "Physician assistant" is defined by
KRS
311.840(3).
(48) "Practitioner working under supervision"
means:
(a) An approved behavioral health
practitioner under supervision;
(b)
A registered behavior technician;
(c) A community support associate;
or
(d) A peer support
specialist.
(49)
"Provider" is defined by
KRS
205.8451(7).
(50) "Provider abuse" is defined by
KRS
205.8451(8).
(51) "Psychiatric hospital" means an entity
licensed as a psychiatric hospital pursuant to
902 KAR
20:180.
(52) "Recipient" is defined by
KRS
205.8451(9).
(53) "Recipient abuse" is defined by
KRS
205.8451(10).
(54) "Recipient's representative" means:
(a) For a recipient who is authorized by
Kentucky law to provide written consent, an individual acting on behalf of, and
with written consent from, the recipient; or
(b) A legal guardian.
(55) "Registered alcohol and drug peer
support specialist" is defined by
KRS
309.080(8).
(56) "Registered behavior technician" means
an individual who meets the following requirements provided 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 the effective date of this administrative
regulation 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 or by an assistant assessor overseen by a Behavior Analyst
Certification Board certificant; and
3. Pass the Registered Behavior Technician
exam provided by the Behavior Analyst Certification Board.
(57) "Registered nurse" is defined
by
KRS
314.011(5).
(58) "Residential crisis stabilization unit"
means an entity that is licensed as a residential crisis stabilization unit
pursuant to
902
KAR 20:440.
(59) "Section 504 plan" means a plan
developed:
(a) Under the auspices of Section
504 of the Rehabilitation Act of 1973, as amended,
29 U.S.C.
794 (Section 504); and
(b) To ensure that a child who has a
disability identified under the law and is attending an elementary or secondary
educational institution receives accommodations to ensure the child's academic
success and access to the learning environment.
(60) "Telehealth" is defined by
KRS
205.510(15).
(61) "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.
(62)
"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.