RELATES TO:
KRS
13B.050,
13B.125,
17.500,
209.030,
214.181,
214.625,
216B.020(2),
222.003,
222.005,
222.231,
222.271,
222.441,
222.462,
222.990,
309.080,
309.0831,
309.130,
311.571,
311.840(3),
314.011,
319.050,
319.056,
319.064,
335.080,
335.100,
335.300,
335.500,
422.317,
439.3401,
620.030,
42 C.F.R. Part 2, 45 C.F.R. Parts 160, 164,
42
U.S.C. 1320d-2-1320
d-8,
42
U.S.C. 290ee-3
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
222.231(2) requires the
cabinet to promulgate administrative regulations to establish requirements and
standards for treatment programs, including licensing fees, application,
procedures for renewal and revocation, procedures for program evaluation, and
minimum operating, training, and maintenance of patient records standards. This
administrative regulation establishes licensing procedures, fees,
responsibilities of the governing authority, quality assurance and utilization
review, policies and procedures, staff qualifications and training, client
rights, client records, assessment, treatment planning, and adverse action
procedures for outpatient and residential alcohol and other drug treatment
entities.
Section 1. Definitions.
(1) "Agency" is defined by
KRS
222.005(2).
(2) "Adverse action" means action taken by
the cabinet to deny, suspend, or revoke an alcohol and other drug treatment
entity's license to operate.
(3)
"Alcohol and other drug treatment entity" or "AODE" means a nonhospital-based
agency owned by an individual or entity that provides one (1) or more of the
following services or operates one (1) or more of the following programs:
(a) Outpatient treatment services;
(b) Intensive outpatient services;
(c) Partial hospitalization;
(d) Withdrawal management services, including
medication-assisted treatment;
(e)
A non-physician owned facility that employs or has an affiliation with a
physician or advanced practice registered nurse who provides office-based
opiate treatment services to fifty (50) percent or more of the facility's
patients;
(f) A narcotic treatment
program (NTP) utilizing methadone, buprenorphine, or other FDA approved drug
formulations;
(g) A residential
treatment program;
(h) A family
residential program;
(i) A
residential transitional living program; or
(j) An adolescent residential
program.
(4) "Cabinet" is
defined by
KRS
222.005(4).
(5) "Case management" means a collaborative
process of assessment, planning, facilitation, care coordination, evaluation,
and advocacy for options and services to meet a client's and his or her
family's needs through communication and available resources to promote
quality, cost-effective outcomes.
(6) "Co-occurring disorder" means concurrent
substance use disorder and mental health disorder and shall not carry
implication as to:
(a) Which disorder is
primary and which secondary;
(b)
Which disorder occurred first; or
(c) Whether one disorder caused the
other.
(7) "Outpatient
service" means an organized nonresidential service in which addiction and
mental health treatment personnel provide professionally directed evaluation
and treatment for substance-related, addictive, and mental disorders.
(8) "Residential" means a setting that
provides twenty-four (24) hour structure and support in which addiction and
mental health treatment personnel provide organized and intensive individual
and group therapeutic activities to strengthen a client's recovery
skills.
(9) "Significant financial
interest" means lawful ownership of an AODE, whether by share, contribution, or
otherwise in an amount equal to or greater than twenty-five (25) percent of
total ownership of the AODE.
Section
2. Licensure Application and Fees.
(1) Unless exempt in accordance with
subsection (2) of this section, any person, organization, corporation,
community mental health center, or driving under the influence program planning
to operate an outpatient or residential AODE shall submit the following to the
cabinet:
(a) A completed Application for
License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity
(AODE) and any required documentation;
(b) A licensure fee of $500; and
(c) A fee of eighty (80) dollars per
outpatient AODE extension site that is:
1.
Separate from the outpatient parent facility; and
2. Not located in a school or other
community-based setting that is not operated by the outpatient AODE.
(2) The following
settings shall be exempt from licensure as an AODE:
(a) A program or activity of a voluntary
self-help organization or community group exempt in accordance with
KRS 222.003(1) or
(2);
(b) A licensed chemical dependency treatment
service exempt in accordance with
KRS
222.231(1);
(c) A department, agency, or institution of
the federal government exempt in accordance with
KRS
222.231(1);
(d) A federally certified rural health clinic
or a federally qualified health center that provides services to patients with
behavioral health or psychiatric conditions, including substance use
disorder;
(e) The private office or
clinic of a practitioner in accordance with
KRS
216B.020(2);
(f) A licensed psychiatric residential
treatment facility that provides outpatient behavioral health services to
individuals who are age twenty-one (21) or younger and have been diagnosed with
substance use disorder; or
(g) A
residential crisis stabilization unit licensed in accordance with
902
KAR 20:440.
(3) An outpatient or residential AODE program
shall not admit clients until the program has obtained a license from the
cabinet to operate the specific modality or modalities of treatment referenced
on its application.
(4) An entity
shall be subject to penalties in accordance with
KRS
222.990(2) if the program
operates a private facility without obtaining licensure as required by
KRS
222.231(1).
(5) Once licensed, an outpatient or
residential AODE shall submit a completed Application for License to Operate a
Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE) accompanied by
the same licensure fee identified in subjection (1)(b) and (c) of this section
to the cabinet annually for license renewal.
(6) Extension site locations shall not be
allowed for the following levels of care:
(a)
A residential AODE program that operates in accordance with this administrative
regulation and
908
KAR 1:372;
(b) A non-physician owned facility that
provides office-based opiate treatment services in accordance with this
administrative regulation and
908
KAR 1:374, Section 6; or
(c) An NTP that operates in accordance with
this administrative regulation and
908
KAR 1:374, Section 7.
Section 3. Licenses and Authority to Enter
Upon Premises.
(1) A license shall be
conspicuously posted in a public area of the outpatient or residential AODE at
all times.
(2) If more than one (1)
AODE operates at the same location, each AODE shall maintain a separate
organizational identity by:
(a) Conspicuously
posting a sign in a public area showing the name of the AODE;
(b) Using a separate logo or letterhead on
written materials;
(c) Maintaining
client records in a separate and secure cabinet; and
(d) Providing treatment services separate
from another AODE located at the same location.
(3) A survey visit or complaint investigation
by cabinet staff shall be unannounced.
(4) An outpatient or residential AODE shall
be subject to an annual survey visit.
(5) Nothing in this administrative regulation
shall prevent the cabinet from:
(a) Conducting
an investigation related to a complaint; or
(b) Making an on-site survey of an AODE more
often if the cabinet deems necessary.
(6) For an outpatient AODE program operating
an NTP, unannounced monitoring visits may occur in conjunction with the Center
for Substance Abuse Treatment (CSAT) and the Drug Enforcement Administration
(DEA).
(7)
(a) A representative of the cabinet shall
have access to the AODE during business hours.
(b) An applicant for licensure or a current
licensee shall not deny access to a representative of the cabinet, after proper
identification, to make an inspection for determining compliance with the
licensure requirements under:
(c)
1.
Denial of access, including any effort to delay, interfere with, or obstruct an
effort by a representative of the cabinet to enter the AODE, or deny access to
records relevant to the inspection shall result in disciplinary action,
including denial, revocation, modification, or suspension of the AODE's
license.
2. Denial, revocation,
modification, or suspension of an AODE's license shall be subject to appeal in
accordance with
KRS
222.231(6).
(d) An inspection of an AODE shall
be conducted as follows:
1. The inspection
shall be made at any time during the licensee's hours of operation;
2. The inspection shall be limited to ensure
compliance with the standards set forth in 908 KAR
1:370,
908
KAR 1:372 or
908
KAR 1:374, and KRS Chapter 222; and
3. The inspection, if based on a complaint or
a follow-up visit, shall not be limited in scope to the basis of the complaint
or the implementation of a plan of correction.
Section 4. Change of Status.
(1) Name change.
(a) An outpatient or residential AODE shall:
1. Notify the cabinet in writing within ten
(10) calendar days of the effective date of a change in the facility's name;
and
2. Submit a processing fee of
twenty-five (25) dollars.
(b) The cabinet shall issue a new license for
the remainder of the licensure period unless the AODE is under investigation
that may result in a negative licensure action in accordance with Section 20 of
this administrative regulation.
(2) Change of location. An AODE shall not
change the location where a program is operated, including a change in an
outpatient extension site's location, until an Application for Licensure to
Operate an Alcohol or Drug Treatment (AODE) accompanied by a processing fee of
eighty (80) dollars is filed with the cabinet.
(3) Change of ownership.
(a) The new owner of an AODE shall submit to
the cabinet an Application for License to Operate a Nonhospital-based Alcohol
and Other Drug Treatment Entity (AODE) accompanied by a fee of $500 within ten
(10) calendar days of the effective date of the ownership change.
(b) A change of ownership shall be deemed to
occur if more than twenty-five (25) percent of an existing AODE or capital
stock or voting rights of a corporation is purchased, leased, or otherwise
acquired by one (1) person from another.
(c) An individual, shareholder, or legal
entity shall not acquire a significant financial interest in an AODE if that
individual, shareholder, or legal entity previously held a significant
financial interest in a licensed facility that had its license or certificate
to operate denied, suspended, revoked, or voluntarily relinquished as the
result of an investigation or adverse action that placed patients, residents,
or clients at risk of death or serious harm within the preceding seven (7)
years.
(4) Voluntary
closure. If an outpatient or residential AODE voluntarily ceases to operate,
the AODE shall notify the cabinet in writing within ten (10) calendar days of
closure.
Section 5.
Violations.
(1) The cabinet shall notify an
outpatient or residential AODE in writing of a regulatory violation identified
during an inspection.
(2) The
outpatient or residential AODE shall submit to the cabinet, within ten (10)
calendar days of the notice, a written plan for the correction of the
regulatory violation.
(3) The plan
of correction shall be signed by the AODE's administrator, the licensee, or a
person designated by the licensee and shall specify:
(a) The date by which the violation shall be
corrected;
(b) The specific
measures utilized to correct the violation; and
(c) The specific measures utilized to ensure
the violation will not recur.
(4) The cabinet shall review the plan of
correction and notify the AODE in writing of the decision to:
(a) Accept the plan;
(b) Not accept the plan; or
(c) Deny, suspend, or revoke the license for
a substantial regulatory violation in accordance with
KRS
222.231(6).
(5) The notice specified in
subsection (4)(b) of this section shall:
(a)
State the specific reasons the plan is unacceptable; and
(b) Require an amended plan of correction
within ten (10) calendar days of receipt of the notice by the AODE.
(6) The cabinet shall review the
amended plan of correction and notify the AODE in writing of the decision to:
(a) Accept the plan;
(b) Deny, suspend, or revoke the license for
a substantial regulatory violation in accordance with
KRS
222.231(6); or
(c) Require the AODE to submit an acceptable
plan of correction.
(7)
An AODE that fails to submit an acceptable amended plan of correction may be
notified that the license will be denied, suspended, or revoked in accordance
with
KRS
222.231(6).
Section 6. Governing Authority.
(1) An outpatient or residential AODE shall
have a governing authority that shall be legally responsible for the
management, operation, and financial viability of the AODE.
(2) The governing authority shall:
(a) Establish the AODE's mission and
purpose;
(b) Ensure that the AODE
is operating in accordance with its mission and in the case of a non-profit,
the purpose for which it was granted tax-exemption;
(c) Appoint an administrator who shall:
1. Be principally responsible for the
day-to-day operation of the AODE; and
2. Ensure that information is provided in
response to a request by the cabinet for data collected in accordance with
KRS
222.462(2)(b);
(d) Establish a client fee
schedule;
(e) Ensure that the
client fee schedule is posted in a public area of the outpatient or residential
AODE;
(f) Maintain financial
records regarding the assessment and payment of client fees;
(g) Oversee the implementation of policies
and procedures, and ensure that they are available to all personnel and
maintained electronically or in hard copy at the AODE's administrative office;
and
(h) Ensure that an AODE's
policies and procedures are reviewed every two (2) years and revised as
needed.
Section
7. Quality Assurance and Utilization Review.
(1) An outpatient or residential AODE shall
have a quality assurance and utilization review program designed to:
(a) Enhance treatment and care through the
ongoing objective assessment of services provided, including the correction of
identified problems; and
(b)
Provide an effective mechanism for review and evaluation of the service needs
of clients.
(2) An
outpatient or residential AODE shall have a utilization review team that shall:
(a) Be made up of a representative sample of
the AODE's clinical staff responsible for providing services;
(b) Assess the appropriateness and clinical
necessity of client admissions;
(c)
Evaluate the need for continuing services immediately upon a change in a
client's service needs or a change in the client's condition to ensure that
proper arrangements have been made for:
1.
Discharge;
2. Transfer;
or
3. Referral to another service
provider, if appropriate; and
(d) Submit a written record of findings
related to inappropriate patterns of service accompanied by recommended action
for correcting a problem to the administrator or other individual with overall
responsibility for the program's treatment
services.
Section
8. Co-occurring Services.
(1) An
outpatient or residential AODE shall:
(a)
Screen for co-occurring disorders; and
(b) Treat or refer a client in need of
co-occurring services.
(2) An outpatient or residential AODE that
provides substance use disorder treatment to clients diagnosed with a
co-occurring disorder shall have clearly written policies and procedures that:
(a) Govern the integrated treatment of
substance use and mental health treatment, which shall include screening,
assessment, diagnosis, and service provision;
(b) Allow for the use of psychiatric
medication when indicated;
(c)
Include developing and maintaining affiliation agreements, case consultation,
and a referral mechanism to mental health treatment services in order to
facilitate the provision of integrated treatment services; and
(d) Include the qualifications of clinical
staff responsible for screening, assessing, diagnosing, and treating clients
with co-occurring disorders as follows:
1.
Only licensed individuals whose scope of practice allows them to render a
diagnosis for both mental health disorder and substance use disorder may assess
and diagnose clients with co-occurring disorders; and
2. The AODE shall ensure that clinical
supervision is provided by staff possessing clinical credentials necessary to
provide clinical supervision to any staff person who renders treatment and
services to clients diagnosed with co-occurring disorders.
Section 9.
Implementation of Policies and Procedures.
(1)
An outpatient or residential AODE shall have written policies and procedures
to:
(a) Establish a system for responding to
an:
1. Accident or injury that requires
hospitalization or results in death; or
2. Incident that involves fire damage, a
natural disaster, or threat to security that substantially interrupts the
delivery of services;
(b) Document the accident, injury, or
incident in an incident file maintained electronically or in hard copy at the
AODE's administrative office; and
(c) Report an incident, injury, or accident
to the:
1. AODE's administrator;
2. Parent or guardian of a client under the
age of eighteen (18); and
3.
Cabinet for Health and Family Services if the report is required by:
a.
KRS
620.030 in the case of suspected child
dependency, abuse, or neglect; or
b.
KRS
209.030 in the case of suspected adult abuse,
neglect, or exploitation.
(2) An outpatient or residential AODE shall
have a written emergency plan for responding to a disaster at the facility,
including safety procedures in the event of a fire, severe weather, or other
threatening situation as follows:
(a) The
emergency plan shall be conspicuously posted in a public area of each
AODE;
(b) A copy of the emergency
plan shall be provided to all personnel;
(c) The AODE shall provide training for all
personnel on how to:
1. Report a
fire;
2. Extinguish a small fire;
and
3. Evacuate a building;
and
(d) The AODE shall
maintain a written record of practiced fire drills.
(3)
(a) An
outpatient or residential AODE shall have written policies and procedures that:
1. Establish a system to effectively respond
to problems associated with domestic violence among clients served in the AODE;
and
2. Include the requirements
established in paragraphs (b), (c), and (d) of this section.
(b) The AODE shall provide
training for clinical staff on the dynamics of domestic violence, including:
1. The effect of domestic violence on adult
and child victims;
2. Legal
remedies for protection;
3. Safety
and risk issues;
4. Available
community services;
5. Victim
services; and
6. Applicable
reporting requirements.
(c) The AODE shall assess a client with a
history of domestic violence for current safety risks.
(d) The AODE shall implement measures to
reduce safety risks to:
1. A client with a
history of domestic violence;
2.
Other clients; and
3.
Staff.
(4) An
outpatient or residential AODE shall have written policies and procedures that
include:
(a) A written description of each
program, including philosophy, mission statement, goals, objectives, and
staffing;
(b) Admission,
readmission, discharge, and transfer criteria; and
(c) Procedures for making a referral within
the AODE or to another service provider, if appropriate.
(5) An outpatient or residential AODE shall
have written policies and procedures for implementation of a language access
plan to:
(a) Address reasonable accommodation
for communication access services for a client who:
1. Has a visual impairment;
2. Is deaf or hard of hearing;
3. Is unable to comprehend or communicate due
to a language barrier; or
4. Has a
different linguistic background;
(b) Provide for appropriate auxiliary aids
and services, including assistive listening devices, realtime captioning, or
sign language interpreters, if needed;
(c) Ensure that programs and activities
provided through electronic and information technology are accessible to a
client with a disability; and
(d)
Allow for language assistance services, including oral language assistance or
written translation for a client with a different linguistic
background.
(6) An
outpatient or residential AODE shall have a written personnel policy that
includes a:
(a) Job description and
qualifications for each personnel category, including duties and reporting
supervisor;
(b) Description of the
duties and supervision of volunteers and student interns; and
(c) Written plan that describes a coordinated
program for staff education, including:
1.
Orientation of personnel to the policies and objectives of the
organization;
2. On-the-job
training, if necessary; and
3.
Orientation and basic education about the prevalence of trauma, including
training that:
a. Covers the dynamics of
retraumatization;
b. Helps create a
trauma-informed environment to ensure that all staff are knowledgeable in
evidence-based practices that avoid institutional processes that may
retraumatize a client with a history of trauma; and
c. Assists in the implementation of
trauma-informed practices across domains and standards, which may include:
(i) Admissions;
(ii) Environmental standards;
(iii) Screening and assessment
processes;
(iv) Referrals to other
services;
(v) Treatment
planning;
(vi)
Confidentiality;
(vii)
Ethics;
(viii) Overdose prevention;
and
(ix)
Discharge.
(7) An outpatient or residential AODE shall
have written policies and procedures governing client grievances, including:
(a) Identification of an AODE
ombudsman;
(b) A process for filing
a written client grievance;
(c) An
appeals process with time frames for filing and responding to a grievance in
writing;
(d) Protection of a client
from interference, coercion, discrimination, or reprisal; and
(e) Conspicuous posting of the grievance
procedures in a public area to inform a client of:
1. His or her right to file a
grievance;
2. The process for
filing a grievance; and
3. The
address and telephone number of the AODE's and cabinet's ombudsman.
(8) If alcohol or drug
testing is conducted as part of assessment, treatment, or discharge, an
outpatient or residential AODE shall have written policies and procedures that
outline the screening process and the indications for testing
positive.
(9)
(a) An AODE shall have a written policy to
address the:
1. Use and misuse of alcohol or
illegal drugs; and
2. Misuse of
prescription drugs.
(b)
The policy shall apply to all clients and their visitors while on the campus of
the program.
(10) An
AODE that provides services to clients under age eighteen (18) shall have
written policies and procedures to ensure that:
(a) Services and educational materials are
developmentally appropriate; and
(b) The client's family is involved in his or
her treatment to the extent possible and appropriate with the written consent
of a client.
Section
10. Qualifications and Responsibilities of the Clinical Services
Supervisor.
(1) A clinical services supervisor
hired by an AODE shall complete:
(a) Twelve
(12) hours of specialized training in clinical supervision within six (6)
months from the date of assuming the position of supervisor;
(b) At least three (3) hours of training in
clinical supervision annually; and
(c) At least ten (10) hours of training in
alcohol and other drug abuse counseling annually.
(2) The clinical services supervisor:
(a) May provide supervision at more than one
(1) AODE facility;
(b) Shall not
supervise a spouse, child, stepchild, sibling, parent, stepparent, grandparent,
grandchild, aunt, uncle, niece, nephew, or in-law;
(c) Shall be responsible for all treatment
services provided by the AODE;
(d)
Shall ensure that the client treatment plan required by Section 19 of this
administrative regulation addresses both of the client's co-occurring
disorders, if applicable; and
(e)
Shall maintain documentation of each clinical supervisory session with each
clinician under supervision, including the:
1.
Date;
2. Length of the session;
and
3. Content of the
supervision.
(3) The clinical services supervisor shall
be:
(a) A certified alcohol and drug counselor
(CADC) as defined by
KRS
309.080(2) with 4,000 hours
of clinical work experience post certification;
(b) A licensed clinical alcohol and drug
counselor (LCADC) as defined by
KRS
309.080(4); or
(c) An individual who meets the training
requirements of subsection (4) of this section and is licensed or certified as
one (1) of the following:
1. Physician
licensed in Kentucky to practice medicine or osteopathy in accordance with
KRS
311.571, or a medical officer of the
government of the United States while engaged in the performance of official
duties;
2. Psychiatrist licensed
under the laws of Kentucky to practice medicine or osteopathy, or a medical
officer of the government of the United States while engaged in the performance
of official duties, who is certified or eligible to apply for certification by
the American Board of Psychiatry and Neurology, Inc.;
3. Psychologist licensed and practicing in
accordance with
KRS
319.050;
4. Certified psychologist with autonomous
functioning or a licensed psychological practitioner practicing in accordance
with
KRS
319.056;
5. Person currently authorized to use the
title of "certified psychologist" under
KRS
319.056(3) and has 6,000
hours of postcertification practice certified by the Kentucky Board of
Examiners of Psychology;
6.
Psychological associate practicing in accordance with
KRS
319.064 and has 6,000 hours of
postcertification practice certified by the Kentucky Board of Examiners of
Psychology;
7. Clinical social
worker licensed and practicing in accordance with
KRS
335.100;
8. Social worker certified and practicing in
accordance with
KRS
335.080 and has 6,000 hours of
postcertification clinical practice in psychiatric social work;
9. Registered nurse licensed by the Kentucky
Board of Nursing in accordance with KRS Chapter 314 with a masters degree in
psychiatric nursing from an accredited college or university and 6,000 hours of
clinical experience in psychiatric nursing;
10. Registered nurse licensed by the Kentucky
Board of Nursing in accordance with KRS Chapter 314 with a bachelor's degree in
nursing from an accredited college or university, who is certified as a
psychiatric and mental health nurse by the American Nurses Association, and who
has 6,000 hours of clinical experience in psychiatric nursing;
11. Marriage and family therapist licensed
and practicing in accordance with
KRS
335.300;
12. Professional clinical counselor licensed
and practicing in accordance with
KRS
335.500; or
13. Licensed professional art therapist as
defined by
KRS
309.130(2).
(4) A clinical services
supervisor who is a licensed or certified health care professional as described
by subsection (3)(c) of this section shall:
(a) Complete eighty (80) hours of training in
alcohol and other drug abuse counseling within:
1. Four (4) years immediately prior to the
date of assuming responsibility as a clinical services supervisor in the AODE;
or
2. Two (2) years immediately
after assuming responsibility as a clinical services supervisor in the AODE;
and
(b) Have 4,000 hours
of work experience in the alcohol and other drug treatment field post
degree.
Section
11. Qualifications and Responsibilities of Clinicians.
(1) An outpatient or residential AODE shall
hire clinicians who:
(a) Shall be responsible
for conducting assessments and treatment planning;
(b) Shall be responsible for leading
counseling sessions; and
(c) May be
responsible for providing case management.
(2) A clinician shall complete a minimum of
ten (10) hours of training in alcohol and other drug abuse counseling
annually.
(3) In addition to the
annual training required by subsection (2) of this section, a clinician who
provides case management shall complete twelve (12) hours of specialized
training in case management within six (6) months from the date of assuming
responsibility for case management services.
(4) A clinician shall be:
(a) An LCADC as defined by
KRS
309.080(4);
(b) A CADC as defined by
KRS
309.080(2);
(c) An individual who meets the training
requirements of subsection (5) of this section and is licensed or certified as
one (1) of the following:
1. Physician
licensed in Kentucky to practice medicine or osteopathy in accordance with
KRS
311.571, or a medical officer of the
government of the United States while engaged in the performance of official
duties;
2. Psychiatrist licensed
under the laws of Kentucky to practice medicine or osteopathy, or a medical
officer of the government of the United States while engaged in the performance
of official duties, who is certified or eligible to apply for certification by
the American Board of Psychiatry and Neurology, Inc.;
3. Psychologist licensed and practicing in
accordance with
KRS
319.050;
4. Certified psychologist with autonomous
functioning or a licensed psychological practitioner practicing in accordance
with
KRS
319.056;
5. Person currently authorized to use the
title of certified psychologist in accordance with
KRS
319.056(3);
6. Psychological associate practicing in
accordance with
KRS
319.064;
7. Clinical social worker licensed and
practicing in accordance with
KRS
335.100;
8. Social worker certified and practicing in
accordance with
KRS
335.080;
9. Registered nurse licensed by the Kentucky
Board of Nursing in accordance with KRS Chapter 314 with a masters degree in
psychiatric nursing from an accredited college or university;
10. Registered nurse licensed by the Kentucky
Board of Nursing in accordance with KRS Chapter 314 with one (1) of the
following combinations of education and work experience:
a. Bachelor of science in nursing from a four
(4) year program from an accredited college or university and 2,000 hours of
clinical work experience in the substance abuse or mental health
field;
b. Diploma graduate in
nursing from a three (3) year program and 4,000 hours of clinical work
experience in the substance abuse or mental health field; or
c. Associate degree in nursing from a two (2)
year program from an accredited college or university and 6,000 hours of
clinical work experience in the substance abuse or mental health
field;
11. Advanced
practice registered nurse as defined by
KRS
314.011(7);
12. Marriage and family therapist licensed
and practicing in accordance with
KRS
335.300;
13. Professional clinical counselor licensed
and practicing in accordance with
KRS
335.500;
14. Licensed professional art therapist as
defined by
KRS
309.130(2); or
15. Physician assistant as defined by
KRS
311.840(3); or
(d) An individual who has a
bachelor's degree in any field from an accredited college or university and
meets the following requirements:
1. Works
under the supervision of a clinical services supervisor;
2. Receives at least four (4) hours of
face-to-face clinical supervision monthly during at least two (2) supervisory
meetings;
3. Meets the training
requirements of subsection (5) of this section;
4. Has all treatment plans cosigned by the
clinical services supervisor within ten (10) business days; and
5.
a.
Obtains temporary certification as an alcohol and drug counselor (TCADC) from
the Kentucky Board of Alcohol and Drug Counselors within two (2) months of the
date of employment as a clinician, if the clinician's bachelor's degree is in
an area other than the field of human services; or
b. Was employed as a clinician by an AODE
prior to the effective date of this administrative regulation and has
maintained continuous employment as a clinician.
(5) A clinician as described by
subsection (4)(c) or (d) of this subsection shall complete eighty (80) hours of
training in alcohol and other drug abuse counseling within:
(a) Four (4) years immediately prior to the
date of assuming responsibility as a clinician in the AODE; or
(b) Two (2) years immediately after assuming
responsibility as a clinician in the AODE.
Section 12. Qualifications and
Responsibilities of Case Managers.
(1) A case
manager employed by an outpatient or residential AODE shall:
(a)
1. Have
a bachelor's degree from an accredited college or university; or
2. Be a CADC as defined by
KRS
309.080(2);
(b) Successfully complete a
department-approved case management training within six (6) months of
employment as a case manager; and
(c) Successfully complete ten (10) hours of
continuing education in alcohol and other drug-relevant training
annually.
(2) Case
management services shall be based on the:
(a)
Goals established in the client's clinical assessment; and
(b) Development of an individualized
person-centered treatment plan that identifies the case management activities
that support implementation of the plan.
(3) A case manager shall not exceed a case
load size of thirty (30) unique clients.
Section 13. Peer Support Specialists. A peer
support specialist employed by an outpatient or residential AODE shall:
(1) Complete six (6) hours of training in the
area of substance use disorder annually;
(2) Attest in writing to at least one (1)
year of recovery; and
(3)
(a) Be a registered alcohol and drug peer
support specialist in accordance with
KRS
309.0831; or
(b) Meet the requirements of:
Section 14. Personnel records. A personnel
record shall be kept at the outpatient or residential AODE's administrative
office on each staff member and contain the following information:
(1) Name and address;
(2) Verification of all training and
experience, including licensure, certification, registration, or
renewals;
(3) Verification of
submission to the background check requirements of Section 15 of this
administrative regulation;
(4)
Annual performance appraisals; and
(5) Employee incident reports.
Section 15. Background checks.
(1) All staff of an outpatient or residential
AODE who have job duties that involve providing services to a client, or who
may have one-on-one contact with a client shall:
(a) Have a criminal record check performed
upon initial hire through the Administrative Office of the Courts or the
Kentucky State Police; and
(b) Not
have a criminal conviction, or plea of guilty, to a:
1. Sex crime as specified in
KRS
17.500;
2. Criminal offense against a minor as
specified in
KRS
17.500; or
3. Felony offense related to neglect,
physical abuse, sexual abuse, or exploitation of a child.
(2) An outpatient or residential
AODE that provides services to clients under age eighteen (18) shall not employ
as clinical personnel anyone listed on the central registry established by 922
KAR
1:470.
(a) If a central registry check has
been submitted for an individual and is pending, the individual:
1. May be hired pending the results of the
registry check; and
2. Shall not be
left unsupervised with a client under eighteen (18) years of age.
(b) An employee shall be dismissed
immediately if the results of the check show the individual is listed on the
central registry.
(3) An
outpatient or residential AODE shall perform annual criminal record checks as
described in paragraph (a) of this subsection on a random sample of at least
twenty-five (25) percent of all personnel.
Section 16. Client Rights.
(1) An outpatient or residential AODE shall
establish, implement, and conspicuously post written policies and procedures
regarding the rights of clients.
(2) The notice of client rights shall include
the address and telephone number of the:
(a)
Cabinet's ombudsman; and
(b) AODE's
ombudsman or personnel responsible for handling client grievances.
(3) A client shall not be
unlawfully discriminated against in determining eligibility for a treatment
program.
(4) During an outpatient
or residential AODE's intake procedures, a client shall sign a statement that
specifies that the client has the right to:
(a) Give informed consent to receive a
service, in which case:
1. An adult shall sign
an informed consent to receive a service; or
2. A client under age eighteen (18) who
suffers from substance use disorder or a parent, caregiver, or person who has
custodial control of a client under age eighteen (18) shall sign an informed
consent for the client to receive a service in accordance with
KRS
222.441;
(b) Have input into his or her treatment plan
and be informed of the plan's content;
(c) Receive individualized
treatment;
(d) File a grievance,
recommendation, or opinion regarding the services the client
receives;
(e) Give informed written
consent regarding participation in a research study, with the exception of a
client under age eighteen (18) whose parent or guardian shall give informed
written consent;
(f)
Confidentiality of information in accordance with the following:
1. A federally-assisted AODE in accordance
with
908
KAR 1:320; or
2. A nonfederally-assisted AODE in accordance
with
KRS
222.271(1);
(g) Request a written statement of
charges for services and be informed of the policy for the assessment and
payment of client fees;
(h) Be
informed of the rules of client conduct, including the consequences for using
alcohol or other drugs, or other infractions that may result in:
1. Further assessment;
2. Modification of the treatment
approach;
3. Transfer to a higher
intensity level of treatment; or
4.
Disciplinary action or discharge, after review and consideration of alternative
interventions, which shall be documented in the client's record with an
explanation for any decision involving disciplinary action or
discharge;
(i) Be
treated with consideration, respect, and personal dignity;
(j) Review his or her client record in
accordance with the AODE's policy; and
(k) Receive one (1) free copy of his or her
client record in accordance with
KRS
422.317.
(5) The statement of client rights shall be:
(a) Provided to the client;
(b) Provided to the client's parent,
guardian, or other legal representative, in addition to the client, and upon
consent of the client, if the client is under the age of eighteen (18) or
incapacitated; and
(c) Read to the
client or upon consent of the client, read to the client's parent, guardian, or
other legal representative, if requested.
(6) A residential AODE providing twenty-four
(24) hour care shall specify on the client rights statement that a client has
the right to:
(a) Vote in a political
election, if age eighteen (18) or over;
(b) Reasonable accommodations to afford
privacy in bathing and toileting; and
(c) Privileges in accordance with
KRS
222.271(2).
(7) An outpatient AODE that
operates an NTP shall specify on the client rights statement that a client has
the right to:
(a) Request a hearing, if the
client is involuntarily discharged, so long as the hearing is requested within
forty-eight (48) hours of receipt of written notice of discharge;
(b) Continued treatment pending the outcome
of the hearing; and
(c)
Representation at the hearing by an attorney or other person chosen by the
client.
(8) If a client
is restricted from exercising a client right because it is contraindicated by
the client's physical or mental condition, there shall be documentation in the
client record stating the reason for the restriction and the explanation given
to the client.
Section
17. Client Records.
(1) A client
record shall be maintained for each individual receiving services.
(2) Each entry shall be signed and include
the date the service was provided.
(3) All information regarding a client's
human immunodeficiency virus status shall be kept confidential in accordance
with
KRS
214.181 and
214.625.
(4) Each client record shall contain:
(a) An identification sheet, including:
1. Client's name, address, age, gender, and
marital status;
2. Expected source
of payment; and
3. Referral
source;
(b) Consent of
appropriate family members or guardians for admission, evaluation, and
treatment, if applicable;
(c)
Application for admission, including intake information;
(d) A biopsychosocial assessment;
(e) Health status questionnaire or a copy of
the record of a physical health examination;
(f) Consent form, fee agreement, and
statement of client rights, each signed by the client;
(g) Client's treatment plan;
(h) Progress notes;
(i) Aftercare plan;
(j) Authorization for release of information,
signed by the client; and
(k)
Discharge summary.
(5)
Ownership.
(a) Client records shall be the
property of the AODE.
(b) The
original client record shall not be removed from the AODE except by court order
or subpoena.
(c) Copies of a client
record or portions of the record may be used and disclosed in accordance with
subsection (7) of this section.
(6) Retention of records. After a client's
death or discharge, the completed client record shall be placed in an inactive
file and:
(a) Retained for six (6) years;
or
(b) Three (3) years after the
client reaches the age of majority under state law, if a minor, whichever is
the longer.
(7)
Confidentiality and Security: Use and Disclosure.
(a) The AODE shall maintain the
confidentiality and security of client records in compliance with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA),
42
U.S.C.
1320d-
2
to
1320d-8, and 45
C.F.R. Parts
160 and
164, as amended, including the security requirements
mandated by subparts A and C of 45 C.F.R. Part
164 , or as provided by
applicable federal or state law, including
42
U.S.C.
290 ee-3, and the Confidentiality of
Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part
2.
(b) The AODE may use and disclose client
records in accordance with:
2.
42
U.S.C.
290 ee-3, and the Confidentiality of
Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part
2.
(c) An AODE may establish higher levels of
confidentiality and security than required by HIPAA,
42
U.S.C.
1320d-
2
to
1320d-8, and 45
C.F.R. Parts
160 and
164, or
42
U.S.C.
290 ee-3, and the Confidentiality of
Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part
2 .
Section 18. Client Assessment.
(1) Except in a residential transitional
living program where counseling services are not provided on-site, a clinician
operating within the clinician's professional scope of practice in an AODE
shall complete a comprehensive biopsychosocial assessment of each client at the
time of admission and document the following:
(a) Medical status;
(b) History of alcohol, tobacco, or other
drug use, including any interventions;
(c) Acute intoxication and withdrawal
potential;
(d) Pregnancy status and
test results if completed;
(e)
Current or history of psychological problems or psychiatric disorders and
treatment received, including:
1. Previous
psychiatric admissions;
2. History
of suicidal or homicidal ideation and attempts;
3. Outpatient psychiatric treatment;
and
4. Psychotropic
medications;
(f) Any
legal proceedings involving the client;
(g) The client's family and
relationships;
(h) The client's
current living situation and any housing needs;
(i) Behavioral risk factors for human
immunodeficiency virus (HIV) and Hepatitis, including the provision of
information on HIV and AIDS to each client who shall also be offered testing
for HIV infection;
(j) Readiness to
change;
(k) Recreational
interests;
(l) Cultural, ethnic,
and spiritual beliefs or practices; and
(m) Employment and support, including
assessment of the client's:
1. Employment
status, current work or vocational skills, and potential for improving those
skills or developing new ones;
2.
Educational status and skills;
3.
Aptitudes, interests, and motivation;
4. Physical abilities, impairments, or
disabilities;
5. Relationships with
co-workers and supervisors; and
6.
Current and prior work or school related problems, including problems related
to substance use disorder.
(2) To ensure that a client is placed in the
appropriate treatment facility, the client shall be assessed for a level of
care determination based upon the most recent version of The American Society
of Addiction Medicine (ASAM) Criteria.
(3) Each biopsychosocial assessment shall be
documented by the outpatient or residential AODE in the client record and
include the following:
(a) The client's
diagnosis as made by a clinician operating within the clinician's professional
scope of practice, in accordance with the most recent version of the Diagnostic
and Statistical Manual of Mental Disorders (DSM) for alcohol, tobacco, and
other drug use;
(b) Screening for
other co-occurring disorders;
(c)
The ASAM level of care determination; and
(d) Referral for a full diagnostic evaluation
and treatment planning, if appropriate.
(4) If the biopsychosocial assessment
indicates that a client should be referred to another treatment program or
level of care, the outpatient or residential AODE shall coordinate the client's
referral to another program.
(5) If
transfer to another facility or level of care is indicated, the outpatient or
residential AODE shall provide services that are responsive at the client's
current level of care until the transfer is made.
(6) A residential AODE shall ensure that a
full physical examination is completed within seventy-two (72) hours of
admission and includes:
(a) Certification by
the examining physician or appropriate health care practitioner that the level
of care needed by the client is available through the facility; and
(b) The results of the following laboratory
tests and evaluations, subject to the client's written consent:
1. Blood work for chronic, incurable, or
communicable diseases or conditions as indicated by the client's medical
history and the health care practitioner's evaluation;
2. Serologic tests for syphilis, smears, and
cultures for gonorrhea and other sexually transmitted diseases, as medically
indicated;
3. Routine urinalysis,
including pregnancy testing if medically indicated or requested;
4. HIV antibody testing, as medically
indicated, for which the residential AODE shall obtain a separate written
consent and ensure that:
a. Each client
receives HIV pre-test counseling and post-test counseling if the client elects
to be tested; and
b. If HIV testing
is performed, the residential AODE shall:
(i)
Report positive results and maintain client confidentiality in accordance with
KRS
214.645; and
(ii) Meet the registration and testing
requirements of
KRS
214.625(7);
5. Testing for
Hepatitis A, Hepatitis B, and Hepatitis C, as medically indicated;
and
6. Tuberculosis screening,
testing, and treatment, as medically indicated.
Section 19. Client Treatment
Planning.
(1) An outpatient or residential
AODE shall establish a treatment plan for each client that:
(a) Is specific, measurable, and
outcomes-focused;
(b) Is based on
the biopsychosocial assessment made of the client in accordance with Section 18
of this administrative regulation;
(c) Is initiated upon the client's
admission;
(d) If applicable,
includes pharmacological treatment modalities to manage opioid use
disorder;
(e) Is entered into the
client's record within:
1. Seventy-two (72)
hours following the client's admission to a residential AODE program;
and
2. Thirty (30) days following
the client's admission to an outpatient AODE program;
(f) Is reviewed at least:
1. Every two (2) weeks in a residential AODE
program;
2. Quarterly in an
outpatient AODE program providing intensive outpatient services or partial
hospitalization; and
3. Every
thirty (30) days for:
a. Outpatient treatment
services;
b. Ambulatory withdrawal
management services;
c.
Office-based opiate treatment services; or
d. A narcotic treatment program;
(g) Is rewritten every
six (6) months; and
(h) Is revised
as necessary based on a change in treatment needs.
(2) Each client shall be continually assessed
by the outpatient or residential AODE using the most recent version of the ASAM
criteria to assess level of care and needs.
(3) Problems, strengths, and needs identified
in the placement, assessment, and treatment planning shall be addressed:
(a) Directly by the outpatient or residential
AODE; or
(b) Through referral to
appropriate services.
(4) An outpatient or residential AODE shall
provide the following services in accordance with a client's treatment plan:
(a) Orders for medication, medical treatment,
and other services, including the type and frequency of contact, if
applicable;
(b) Treatment for
substance use disorder, including a plan to:
1. Reduce symptoms and severity;
and
2. Improve treatment
outcomes;
(c) Integrated
treatment of co-occurring disorders, either on-site or through the coordination
of treatment services with an appropriate mental health facility, if
applicable;
(d) Vocational and
educational services if needed, either on-site or by referral to community
resources;
(e) Opportunities for
the client to voluntarily participate in support group meetings during
treatment; and
(f) Family supports,
recovery supports, spiritual, housing, and social support services as
needed.
(5) An
outpatient or residential AODE shall document in the client's record:
(a) Evidence of client participation in the
development and implementation of the treatment plan;
(b) The staff responsible for implementation
of the treatment plan;
(c) Dated
signatures of the client and participating multidisciplinary team
members;
(d) Long-term and
short-term goals with timeframes for achievement;
(e) The assessment measures for determining
the effectiveness of, and client satisfaction with, treatment or services
including assessments of client adherence to and engagement with treatment and
recovery support services;
(f) The
time intervals for review of the client's response to treatment or
services;
(g) Discharge plans;
and
(h) Transfer plans, if
applicable.
(6)
Practitioners in each of the services providing care to a client shall
participate in the development of the treatment plan relative to the services
the practitioner shall provide.
(7)
The client and the client's family, with consent from the client, if considered
appropriate, shall participate in the development of the client treatment plan,
which shall include an aftercare plan to prepare the client for life after
leaving rehabilitation.
(8) If a
physician or other clinician documents in the client's clinical record that the
client's participation in the development of the client treatment plan is
medically contraindicated, a member of the multidisciplinary team providing
services to the client shall:
(a) Review the
client's treatment plan with the client prior to implementation; and
(b) Inform the client's family or legal
guardian of the treatment plan with consent of the client.
(9) If the family or legal guardian of a
client does not agree to participate in the treatment planning, the outpatient
or residential AODE shall document the:
(a)
Attempt to engage the family or legal guardian, with the client's consent, in
the treatment planning process; and
(b) Refusal to participate.
(10) The multidisciplinary team
shall review the treatment plan and client treatment progress at least every
thirty (30) days with the review and any revisions documented in the client's
clinical record.
(11) Any revision
of the treatment plan shall be based upon:
(a)
The client's response to the care provided;
(b) The client's abilities and disabilities;
and
(c) Each team member's
continuing reassessment of services rendered.
(12) Results of random drug and alcohol
screening shall be incorporated into therapeutic interventions and the
treatment planning process.
Section
20. Denial, Emergency Suspension, and Revocation.
(1) The cabinet shall deny or revoke a
license if it finds that:
(a) There has been
substantial failure in accordance with
KRS
222.231(6) by the AODE to
comply with the provisions of:
1. KRS Chapter
222; or
2. AODE licensure
administrative regulations under 908 KAR Chapter 1;
(b) The AODE fails to submit an acceptable
plan of correction or fails to submit an acceptable amended plan of correction
within the timeframes required by Section 5(2) or (5)(b) of this administrative
regulation;
(c) The AODE fails to
comply with the annual renewal process;
(d) The AODE denies access to the cabinet in
accordance with Section 3(7) of this administrative regulation;
(e) The AODE's certification as a driving
under the influence program is denied, revoked, or voluntarily relinquished as
the result of an investigation or adverse action that placed clients at risk of
death or serious harm;
(f) An
individual having a significant financial interest in the AODE has, within the
seven (7) year period prior to the application date, had significant financial
interest in a facility or service that was licensed or certified by the
cabinet, and the license or certificate to operate was denied, suspended,
revoked, or voluntarily relinquished as the result of an investigation or
adverse action that placed patients, residents, or clients at risk of death or
serious harm;
(g) An individual
having significant financial interest in the AODE has been:
1. Previously discontinued or disqualified
from participation in any governmental assistance program due to fraud or abuse
of the program; or
2. The subject
of disciplinary action taken against the individual by a professional licensing
board for misconduct related to endangering a patient or client; or
(h) The cabinet finds that the
applicant misrepresented or submitted false information on the
application.
(2) For an
outpatient AODE that operates an NTP, the cabinet shall deny or revoke a
license in accordance with subsection (1) of this section or if it finds that:
(a) Take-home doses inconsistent with the
dosage allowed by
908
KAR 1:374 Section 7 were issued without specific CSAT,
DEA, or State Narcotic Authority (SNA) approval prior to issuance of the
take-home doses;
(b) Take-home
doses were outside the allowable difference between the labeled dosage of the
approved controlled substance and the actual dosage as determined by the United
States Pharmacopeia error rate;
(c)
More than five (5) percent of the medical and dosing records reviewed are out
of compliance with the requirements of
908
KAR 1:374 Section 7;
(d) There are discrepancies in the inventory
reconciliation greater than five (5) percent;
(e) Clients were issued doses prior to
completion of the intake procedures, including physical exam, except under
SNA-approved circumstances;
(f)
There is evidence in the client's record that the physician is not in control
of the client's treatment;
(g)
There is a pattern of issuing doses to clients before obtaining a signed
consent to treatment with controlled substances; or
(h) There is a pattern of failing to perform
the drug screening required by
908
KAR 1:374, Section 7.
(3) The denial or revocation of an AODE's
license shall be issued in accordance with
KRS
222.231(6).
(4) In accordance with
KRS
222.231(6), the denial or
revocation shall become final and conclusive thirty (30) days after notice is
given, unless the applicant or licensee submits a written request for a hearing
within the thirty (30) day period.
(5) If an AODE requests a hearing in
accordance with the timeframe established by
KRS
222.231(6) and subsection
(4) of this section, the cabinet shall:
(a)
Appoint a hearing officer; and
(b)
Proceed in accordance with
KRS
13B.050 and
KRS
222.231(7).
(6) Emergency action to suspend a
license.
(a) The cabinet shall take emergency
action in accordance with
KRS
13B.125 to suspend an AODE's license if the
cabinet has probable cause to believe that the continued operation of the AODE
would constitute an immediate danger to the health, welfare, or safety of its
clients.
(b) Notice of an emergency
suspension shall identify the particular reasons for the action.
(c) If requested, an emergency hearing shall
take place in accordance with the requirements of
KRS
13B.125(3).
(d) The sole issue of the hearing shall be
whether there is immediate danger.
(e) The decision shall be rendered in
accordance with
KRS
13B.125(4).
Section 21.
Incorporation by Reference.
(1) "Application
for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment
Entity (AODE)", 12/2018 edition, is incorporated by reference.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Department for
Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main
Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30
p.m.