908 KAR 2:260 - Targeted case manager: eligibility and training

RELATES TO: KRS 200.503(3), 210.005(2), (3)

NECESSITY, FUNCTION AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 requires the secretary to promulgate administrative regulations governing qualifications of personnel and standards for personnel management for community programs for behavioral health or individuals with an intellectual disability. KRS 222.211 authorizes the cabinet to promulgate administrative regulations to assure that there is the provision of prevention, intervention, and treatment services for both juveniles and adults to address the problems of addiction to alcohol and other drug abuse within individuals, families, and communities. This administrative regulation establishes the minimum eligibility and training requirements for individuals providing behavioral health targeted case management services to a targeted behavioral health population.

Section 1. Definitions.

(1) "Behavioral health practitioner under supervision" means an individual who is:

(a)

1. A licensed professional counselor associate;

2. A licensed assistant behavior analyst;

3. A certified social worker;

4. A marriage and family therapy associate;

5. A licensed professional art therapist associate;

6. A physician assistant; or

7. A certified alcohol and drug counselor; and

(b) Employed by or under contract with the same billing provider as the billing supervisor.

(2) "Behavioral health professional" means:

(a) An advanced practice registered nurse as defined by KRS 314.011(7);

(b) A licensed clinical social worker as defined by KRS 335.100;

(c) A licensed marriage and family therapist as defined by KRS 335.300(2);

(d) A licensed professional clinical counselor as defined by KRS 335.500(3);

(e) A licensed psychological practitioner as defined by KRS 319.053;

(f) A licensed psychologist as defined by KRS 319.010(6) and 201 KAR Chapter 26;

(g) A licensed professional art therapist as defined by KRS 309.130(2);

(h) A physician as defined by KRS 205.510(11);

(i) A psychiatrist;

(j) A behavioral health practitioner under supervision;

(k) A registered nurse as defined by KRS 314.011(5) working under the supervision of a physician or advanced practice registered nurse;

(l) A certified alcohol drug counselor as defined by KRS 309.083;

(m) A certified psychologist as defined by 201 KAR Chapter 26;

(n) A certified psychologist with autonomous functioning as defined by KRS 319.056;

(o) A certified social worker as defined by KRS 335.080

(p) A licensed professional art therapist associate as defined by KRS 309.130(3);

(q) A licensed psychological associate as defined by KRS 319.010(6) and 201 KAR Chapter 26;

(r) A marriage and family therapy associate as defined by KRS 335.300(3);

(s) A physician assistant as defined by KRS 311.840(3);

(t) A licensed clinical alcohol and drug counselor as defined by KRS 309.080(4);

(u) A licensed clinical alcohol and drug counselor associate as defined by KRS 309.080(5); or

(v) An individual with a bachelor's degree in a behavioral science as defined in subsection (3) of this section who:

1. Is working under the supervision of a billing supervisor; and

2. Has at least five (5) years of documented full-time experience providing specialized case management services for the target population.

(3) "Behavioral science" means:

(a) Psychology;

(b) Sociology;

(c) Social work;

(d) Family studies;

(e) Human services;

(f) Counseling;

(g) Nursing;

(h) Behavioral analysis;

(i) Public health;

(j) Special education;

(k) Gerontology;

(l) Recreational therapy;

(m) Education;

(n) Occupational therapy;

(o) Physical therapy;

(p) Speech-language pathology;

(q) Rehabilitation counseling; or

(r) Faith-based education.

(4) "Case load" means the number of distinct individuals for whom a targeted case manager bills for services from any payor, per month.

(5) "Certification" means successful completion of the training requirements in this administrative regulation as documented by notice of successful training completion submitted to the department from the training provider.

(6) "Chronic or complex physical health condition" means that:

(a) Significant symptoms of a physical health condition have persisted in a client for a continuous period of at least six (6) months;

(b) The symptoms of the physical health condition significantly impair the client's ability to function:

1. Socially, or

2. Occupationally which, for individuals under the age of twenty-one (21), includes impairment in an educational setting; and

(c) The physical health conditions include disorders under the following categories:

1. Cardiovascular disorders;

2. Respiratory disorders;

3. Genitourinary disorders;

4. Endocrine disorders;

5. Musculoskeletal disorders;

6. Neurological disorders;

7. Immune system disorders;

8. Gastrointestinal;

9. Cancer; or

10. Hematological.

(7) "Client" means an individual identified within a target population.

(8) "Continuing education requirement" means successful completion of the on-going training requirements every three (3) years after the date of certification.

(9) "Core components" means the minimum knowledge and skills listed in Section 3(1) of this administrative regulation that an individual must demonstrate in order to successfully complete the training and meet eligibility requirements to provide targeted case management services.

(10) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID).

(11) "Face-to-face" means in person, in the same location, and not through an electronic method.

(12) "Serious mental illness", "severe mental illness", or "SMI" means a diagnosis of a major mental disorder as included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders under:

(a) Schizophrenia spectrum and other psychotic disorders;

(b) Bipolar and related disorders;

(c) Depressive disorders; or

(d) Post-traumatic stress disorders (under trauma and stress or related disorders).

(13) "Severe emotional disability" or "SED" is defined by KRS 200.503(3).

(14) "Substance use disorder" or "SUD" means a primary moderate or severe substance use disorder diagnosis or co-occurring moderate to severe substance use disorder and mental health diagnosis as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(15) "Targeted case management services" means services furnished to assist a client in gaining access to needed medical, social, educational, or other needed services and supports, including:

(a) Assessment of the client's medical, social, and functional status and identification of the client's strengths and needs;

(b) Arranging for service delivery from the client's, the client's legal guardian, or the client's custodial parent's chosen provider to insure access to required services;

(c) Facilitating access to needed services by explaining the need and importance of services in relation to the client's condition;

(d) Facilitating access, quality, and delivery of necessary services; and

(e) Preparation and maintenance of case record documentation to include care plans, forms, reports, and narratives as appropriate.

(16) "Targeted case manager" means an individual who is:

(a) Trained and supervised to perform targeted case management services in accordance with Section 2 of this administrative regulation;

(b) Responsible for conducting a comprehensive assessment and a periodic reassessment of an individual's strengths and needs; and

(c) Responsible for assisting an individual to gain access to identified medical, social, educational, and other service needs.

(17) "Targeted population" means an individual who meets the criteria through diagnosis, duration, and disability for:

(a) SMI;

(b) SED;

(c) SUD; or

(d) SMI, SED, or SUD and a co-occurring chronic or complex physical health condition.

(18) "Training curriculum" means a total package of learning activities designed to achieve the goals of the training program with:

(a) The objective that trainees will acquire the specific knowledge and skills (competencies) needed to perform the duties of a targeted case manager; and

(b) Four (4) primary components, including:

1. Content or information to be transmitted, including:

a. Theoretical framework;

b. Conceptual rationale;

c. Best standards of practice;

d. Application to direct practice; and

e. Congruence between and within sections;

2. Organization of the curriculum, including structure, format, and sequencing, incorporating:

a. Concordance with the natural learning process;

b. Design of each section linked to specific learning objectives, with adequate time provided for each;

c. Linkages between sections;

d. Knowledge and skills that are conceptually related, or that are performed together on the job, are taught together; and

e. Retention and understanding facilitated by principles of sequencing (from simple to complex, from the universal to the exception, and from fundamental to more refined applications) and repetition;

3. Training methods appropriate to adult learners in an applied setting, in each section or topic area, including:

a. Discussion to promote exploration and understanding of the topic;

b. Experiential exercises or simulations; and c. Presentation of the same concepts using a variety of learning strategies (for example, hearing, seeing, modeling, and then practicing) to ensure that trainees with different learning styles can assimilate the knowledge; and

4. Evaluation methods, including:

a. Trainee knowledge assessment through testing, with achievement of a passing aggregate assessment score of at least seventy (70) percent; and

b. Trainee performance reviews of trainers.

Section 2. Targeted Case Manager Requirements.

(1) A targeted case manager for individuals with SMI, SED, or SUD shall:

(a)

1. Possess a bachelor of arts or science degree in a behavioral science;

2. Be a certified alcohol and drug counselor who has a bachelor of arts or science degree;

3. Have provided targeted case management services to a recipient any time from April 1, 2014, to the effective date of this administrative regulation; or

4. Have supervised the provision of targeted case management services to a recipient any time from April 1, 2014, to the effective date of this administrative regulation;

(b) Have at least one (1) year of full-time employment experience after completing the educational requirements:

1. Working directly with adults in a human service setting; or

2. Working directly with individuals under the age of twenty-one (21) in a human service setting;

(c) Successfully complete a department approved targeted case management training within six (6) months of employment as a targeted case manager; and

(d) Successfully complete department approved continuing education requirements every three (3) years thereafter.

(2) A master's degree in a behavioral science may substitute for the one (1) year of full-time employment experience required by subsection (3)(b)1 of this section.

(3) A targeted case manager for individuals with SMI, SED, or SUD and a co-occurring chronic or complex physical health condition shall be an individual with:

(a) A master's degree in a behavioral science from an accredited college or university and two (2) years of full-time employment experience providing service coordination or linking/referring for community based services for individuals with SMI, SED, or SUD and co-occurring physical or behavioral health disorders or multi-agency involvement; or

(b) A bachelor of arts or science degree from an accredited college or university in a behavioral science and who has:

1. At least five (5) years of full-time employment experience working with an individual with SMI, SED, or SUD and a co-occurring chronic or complex physical health condition;

2. Successful completion of a department approved targeted case management training within six (6) months of employment as a case manager; and

3. Successful completion of continuing education requirements every three (3) years thereafter.

(4) Targeted case managers who are serving individuals with SED, SMI, or SUD shall have:

(a) Individual face-to-face supervision which shall be provided at least monthly for at least one (1) year by a behavioral health professional who has completed the targeted case management training approved by the department; and

(b) Group supervision which shall be provided at least monthly for the duration of employment as a targeted case manager.

(5) The supervisor of a targeted case manager shall maintain documentation of the supervision.

(6) Targeted case managers who are serving an individual with an SED, SMI, or SUD and a co-occurring chronic or complex physical health condition shall have:

(a) Individual supervision which shall be provided at least three (3) times per month, with at least two (2) of these supervisory contacts on an individual face-to-face basis, for at least three (3) years by a behavioral health professional who has completed the targeted case management training approved by the department; and

(b) Group supervision which shall be provided at least monthly for the duration of employment as a targeted case manager.

(7) Beginning October 1, 2015, a targeted case manager shall not exceed a case load size of twenty-five (25) unique clients receiving any service, excluding a client receiving mobile crisis services, crisis intervention services, or screenings.

(8) A targeted case manager shall:

(a) Only provide targeted case management services to the targeted population for which the targeted case manager meets the educational, experiential, and training requirements; and

(b) Not provide other behavioral health services in addition to targeted case management services for the same client.

Section 3. Training Requirements.

(1) To receive certification to provide behavioral health targeted case management services, a targeted case manager shall successfully complete the department approved training and continuing education requirements established by this section.

(a) The core components of the targeted case management training curriculum shall be at least twelve (12) hours and shall include:

1. Core targeted case management functions and guiding principles;

2. Engaging consumers and family members;

3. Behavioral health crisis management;

4. Strengths-based case management;

5. Ethics;

6. Behavioral health diagnosis and understanding treatment;

7. Integrated care;

8. Advocacy skills and empowering consumers and families;

9. Cultural awareness;

10. Developmental perspectives across the life span; and

11. Documentation and billing.

(b) At least an additional six (6) hours of specialized training for the target population the targeted case manager is serving, which shall include the skills required to address the specific needs of each respective target population.

(c) Providers of approved training curricula shall notify the department within twenty (20) business days of a trainee's successful completion of a targeted case manager training.

(2) A targeted case manager shall complete continuing education requirements every three (3) years.

(3) Required continuing education shall consist of acquiring at least six (6) hours of relevant continuing education each year in training topics directly related to:

(a) Case management;

(b) Behavioral health; or

(c) Each respective target population.

(4) A targeted case manager shall submit a list of all continuing education trainings in which the targeted case manager participated, the provider or presenter of the training, and the number of hours of each training to the Department every three (3) years through the department's Web site. The submission due date shall be the last day of the month of which the targeted case manager's initial certification was completed.

(5) Targeted case managers certified prior to the effective date of this administrative regulation shall submit documentation of continuing education hours prior to May 2018.

Section 4. Department Responsibilities. The department shall:

(1) Within twenty (20) business days, approve or deny training curricula submitted by providers wishing to provide training to a targeted case manager or a prospective targeted case manager based on the training curriculum requirements established by Section 3(1)(a) of this administrative regulation;

(2) Maintain a record of approved targeted case management training curricula, including contact information for providers of the trainings on the department's Web site;

(3) Maintain a record of targeted case managers who have received a certificate of successful completion of a department approved targeted case management training on the department's Web site;

(4) Create and make available a process for recording continuing education of targeted case managers on the department's Web site; and

(5) Maintain a record of targeted case managers who have been certified or completed continuing education to provide targeted case management services on the department's Web site.

Section 5. Supervision of a Targeted Case Manager.

(1) A targeted case manager shall provide services under the supervision of a behavioral health professional in accordance with 907 KAR 15:040, 907 KAR 15:050, and 907 KAR 15:060;

(2) The supervising behavioral health professional shall complete the training requirements as described in Section 3(1) and (2) of this administrative regulation; and

(3) The supervisor of a targeted case manager shall provide and maintain documentation of the supervision, as specified in Section 2(4), (5), and (6) of this administrative regulation.

Notes

908 KAR 2:260

41 Ky.R. 1945; Am. 2280; 2656; eff. 6-17-2015, TAm eff. 4-27-2016.

STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450, 222.211