907 KAR 15:010 - Coverage provisions and requirements regarding behavioral health services provided by individual approved behavioral health practitioners, behavioral health provider groups, and behavioral health multi-specialty groups
RELATES TO: KRS 205.520, 205.622, 309.0831, Chapter 319, 369.101-369.120, 42 C.F.R. Part 2, 431.17, 45 C.F.R. Parts 160, 164, 20 U.S.C. 1400 et seq., 21 U.S.C 823(g)(2), 29 U.S.C. 701 et seq., 42 U.S.C. 290ee-3, 1320d-2 - 1320d-8, 1396a(a)(10)(B), 1396a(a)(23), 12101 et seq.
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services, has a responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the coverage provisions and requirements regarding Medicaid Program behavioral health services provided by certain licensed individual behavioral health professionals who are independently enrolled in the Medi-caid Program, practitioners working for or under the supervision of the individual behavioral health providers, and individual behavioral health professionals and practitioners under supervision working in behavioral health provider groups or in behavioral health multi-specialty groups.
Section
1. General Coverage Requirements.
(1) For the department to reimburse for a
service covered under this administrative regulation, the service shall:
(a) Be medically necessary;
(b) Meet the coverage requirements
established in Section 3 of this administrative regulation;
(c) Be provided to a recipient by:
1. An individual approved behavioral health
practitioner who:
a. Is enrolled in the
Kentucky Medicaid Program in accordance with
907
KAR 1:672;
b. Except as established in Section 2(1) of
this administrative regulation, currently participates in the Kentucky Medicaid
Program in accordance with
907
KAR 1:671; and
c. Is an approved behavioral health practitioner;
2. An individual approved
behavioral health practitioner who is working for:
a. A behavioral health provider group that
is:
(i) Currently enrolled in the Kentucky
Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671; or
b. A behavioral health multi-specialty group
that is:
(i) Currently enrolled in the
Kentucky Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671;
3. An approved behavioral health practitioner
under supervision working for:
a. An
individual approved behavioral health practitioner who is:
(i) Currently enrolled in the Kentucky
Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671;
b. A behavioral health provider group that
is:
(i) Currently enrolled in the Kentucky
Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671; or
c. A behavioral health multi-specialty group
that is:
(i) Currently enrolled in the
Kentucky Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671;
4. An adult peer support specialist, family
peer support specialist, youth peer support specialist, or registered alcohol
and drug peer support specialist working for:
a. A behavioral health provider group that
is:
(i) Currently enrolled in the Kentucky
Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671; or
b. A behavioral health multi-specialty group
that is:
(i) Currently enrolled in the
Kentucky Medicaid Program in accordance with
907
KAR 1:672; and
(ii) Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671; or
5. A community support associate working for
a behavioral health multi-specialty group that is:
a. Currently enrolled in the Kentucky
Medicaid Program in accordance with
907
KAR 1:672; and
b. Except as established in Section 2(1) of
this administrative regulation, currently participating in the Kentucky
Medicaid Program in accordance with
907
KAR 1:671; and
(d) Be billed to the department by the:
1. Individual approved behavioral health
practitioner who provided the service or under whose supervision the service
was rendered in accordance with Section 3 of this administrative
regulation;
2. Behavioral health
provider group on behalf of which the service was rendered in accordance with
Section 3 of this administrative regulation; or
3. Behavioral health multi-specialty group on
behalf of which the service was rendered in accordance with Section 3 of this
administrative regulation.
(2)
(a)
Direct contact between a provider or practitioner and a recipient shall be
required for each service except for:
1.
Collateral outpatient therapy for a child under the age of twenty-one (21)
years if the collateral outpatient therapy is in the child's plan of
care;
2. A family outpatient
therapy service in which the corresponding current procedural terminology code
establishes that the recipient is not present;
3. A psychological testing service comprised
of interpreting or explaining results of an examination or data to family
members or others in which the corresponding current procedural terminology
code establishes that the recipient is not present; or
4. A service planning activity in which the
corresponding current procedural terminology code establishes that the
recipient is not present.
(b) A service that does not meet the
requirement in paragraph (a) of this subsection shall not be covered.
(3) A billable unit of service
shall be actual time spent delivering a service in an encounter.
(4) A service shall be:
(a) Stated in a recipient's plan of care;
and
(b) Provided in accordance with
a recipient's plan of care.
(5)
(a) A
provider shall establish a plan of care for each recipient receiving services
from the provider.
(b) A plan of
care shall:
1. Describe the services to be
provided to the client, including the frequency of services;
2. Contain measurable goals for the client to
achieve, including the expected date of achievement for each goal;
3. Describe the client's functional abilities
and limitations, or diagnosis listed in the current edition of the American
Psychiatric Association Diagnostic and Statistical Manual of Mental
Disorders;
4. Specify each staff
member assigned to work with the client;
5. Identify methods of involving the client's
family or significant others if indicated;
6. Specify criteria to be met for termination
of treatment;
7. Include any
referrals necessary for services not provided directly by that provider;
and
8. Include the date scheduled
for review of the plan.
(c) A separate plan of care shall be
established for each recipient receiving services for substance use disorder
treatment in accordance with the plan of care requirements established in
908
KAR 1:370, Section 19.
Section 2. Provider Participation.
(1) In accordance with
907
KAR 17:015, Section 3(3), a provider of a service to
an enrollee shall not be required to be currently participating in the
fee-for-service Medicaid Program.
(2) A provider shall:
(a) Agree to provide services in compliance
with federal and state laws regardless of age, sex, race, creed, religion,
national origin, handicap, or disability; and
(b) Comply with the Americans with
Disabilities Act (42 U.S.C.
12101 et seq.) and any amendments to the
Act.
(3)
(a) A behavioral health multi-specialty group
that is providing services for substance use disorder or co-occurring disorders
shall possess an alcohol and other drug entity license pursuant to
908
KAR 1:370 and
908
KAR 1:374.
(b) A behavioral health multi-specialty group
that does not possess an alcohol and other drug entity license pursuant to
908
KAR 1:370 and
908
KAR 1:374 may provide services for co-occurring mental
health and substance use disorders, if the:
1.
Substance use disorder diagnosis is secondary to a primary mental health
diagnosis; and
2. Services are
provided by an independently licensed practitioner who could independently
practice and provide treatment for a co-occurring disorder. A qualifying
practitioner shall include:
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; or
j. A
licensed marriage and family therapist.
Section 3. Covered
Services.
(1) Except as specified in the
requirements stated for a given service, the services covered may be provided
for a:
(a) Mental health disorder;
(b) Substance use disorder; or
(c) Co-occurring mental health and substance
use disorders.
(2)
Services shall be covered under this administrative regulation in accordance
with the requirements established in this section.
(3)
(a) A
screening shall:
1. Determine the likelihood
that an individual has a mental health disorder, substance use disorder, or
co-occurring disorders;
2. Not
establish the presence or specific type of disorder;
3. Establish the need for an in-depth
assessment;
4. Be provided
face-to-face or via telehealth as appropriate pursuant to
907
KAR 3:170; and
5. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(b) An assessment shall:
1. Include gathering information and engaging
in a process with the individual that enables the provider to:
a. Establish the presence or absence of a
mental health disorder, substance use disorder, or co-occurring
disorders;
b. Determine the
individual's readiness for change;
c. Identify the individual's strengths or
problem areas that may affect the treatment and recovery processes;
and
d. Engage the individual in
developing an appropriate treatment relationship;
2. Establish or rule out the existence of a
clinical disorder or service need;
3. Include working with the individual to
develop a treatment and service plan;
4. Not include psychological or psychiatric
evaluations or assessments;
5. Be
provided face-to-face or via telehealth as appropriate pursuant to
907
KAR 3:170;
6. If being made for the treatment of a
substance use disorder, utilize a multidimensional assessment tool that
complies with the most current edition of the ASAM Criteria to determine the
most appropriate level of care; and
7. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(c) Psychological testing
shall:
1. Include:
a. A psychodiagnostic assessment of
personality, psychopathology, emotionality, or intellectual disabilities;
and
b. Interpretation and a written
report of testing results;
2. Be performed by an individual who has met
the requirements of KRS Chapter 319 related to the necessary credentials to
perform psychological testing;
3.
Be provided face-to-face or via telehealth as appropriate pursuant to
907
KAR 3:170; and
4. Be provided by:
a. A licensed psychologist;
b. A licensed psychological
practitioner;
c. A licensed
psychological associate under supervision;
d. A certified psychologist with autonomous
functioning; or
e. A certified
psychologist under supervision.
(d) Crisis intervention:
1. Shall be a therapeutic intervention for
the purpose of immediately reducing or eliminating the risk of physical or
emotional harm to:
a. The recipient; or
b. Another
individual;
2. Shall
consist of clinical intervention and support services necessary to provide
integrated crisis response, crisis stabilization interventions, or crisis
prevention activities for individuals;
3. Shall be provided:
a. As an immediate relief to the presenting
problem or threat; and
b. In a
one-on-one encounter between the provider and the recipient, which is delivered
either face-to-face or via telehealth as appropriate pursuant to
907
KAR 3:170;
4. May include:
a. Further service prevention planning
including:
(i) Lethal means reduction for
suicide risk; or
(ii) Substance use
disorder relapse prevention; or
b. Verbal de-escalation, risk assessment, or
cognitive therapy;
5.
Shall be followed by a referral to noncrisis services if applicable;
and
6. Shall be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(e)
1. Service planning shall:
a. Involve assisting a recipient in creating
an individualized plan for services and developing measurable goals and
objectives needed for maximum reduction of a mental health disorder, substance
use disorder, or co-occurring disorders;
b. Involve restoring a recipient's functional
level to the recipient's best possible functional level; and
c. Be performed using a person-centered
planning process.
2. A
service plan:
a. Shall be directed and signed
by the recipient;
b. Shall include
practitioners of the recipient's choosing; and
c. May include:
(i) A mental health advance directive being
filed with a local hospital;
(ii) A
crisis plan; or
(iii) A relapse
prevention strategy or plan.
3. Service planning shall be provided
face-to-face.
4. Service planning
shall be provided by:
a. An approved
behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision.
(f) Individual outpatient therapy shall:
1. Be provided to promote the:
a. Health and well-being of the recipient;
and
b. Restoration of a recipient
to their best possible functional level from a substance use disorder, mental
health disorder, or co-occurring disorders;
2. Consist of:
a. A one-on-one encounter between the
provider and the recipient, which is delivered either face-to-face or via
telehealth as appropriate pursuant to
907
KAR 3:170; and
b. A behavioral health therapeutic
intervention provided in accordance with the recipient's identified plan of
care;
3. Be aimed at:
a. Reducing adverse symptoms;
b. Reducing or eliminating the presenting
problem of the recipient; and
c.
Improving functioning;
4.
Not exceed three (3) hours per day alone or in combination with any other
outpatient therapy per recipient unless additional time is medically necessary;
and
5. Be provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(g)
1. Family outpatient therapy shall consist of
a face-to-face or appropriate telehealth, pursuant to
907
KAR 3:170, behavioral health therapeutic intervention
provided:
a. Through scheduled therapeutic
visits between the therapist and the recipient and at least one (1) member of
the recipient's family; and
b. To
address issues interfering with the relational functioning of the family and to
improve interpersonal relationships within the recipient's home
environment.
2. A family
outpatient therapy session shall be billed as one (1) service regardless of the
number of individuals (including multiple members from one (1) family) who
participate in the session.
3.
Family outpatient therapy shall:
a. Be
provided to promote the:
(i) Health and
wellbeing of the recipient; and
(ii) Restoration of a recipient to their best
possible functional level from a substance use disorder, mental health
disorder, or co-occurring related disorders; and
b. Not exceed three (3) hours per day alone
or in combination with any other outpatient therapy per individual unless
additional time is medically necessary.
4. Family outpatient therapy shall be
provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(h)
1. Group outpatient therapy shall:
a. Be a behavioral health therapeutic
intervention provided in accordance with a recipient's identified plan of
care;
b. Be provided to promote
the:
(i) Health and well-being of the
recipient; and
(ii) Restoration of
a recipient to their best possible functional level from a substance use
disorder, mental health disorder, or co-occurring disorders;
c. Consist of a face-to-face
behavioral health therapeutic intervention provided in accordance with the
recipient's identified plan of care;
d. Be provided to a recipient in a group
setting:
(i) Of nonrelated individuals except
for multi-family group therapy; and
(ii) Not to exceed twelve (12) individuals in
size;
e. Focus on the
psychological needs of the recipients as evidenced in each recipient's plan of
care;
f. Center on goals including
building and maintaining healthy relationships, personal goals setting, and the
exercise of personal judgment;
g.
Not include physical exercise, a recreational activity, an educational
activity, or a social activity; and
h. Not exceed three (3) hours per day alone
or in combination with any other outpatient therapy per recipient unless
additional time is medically necessary.
2. The group shall have a:
a. Deliberate focus; and
b. Defined course of treatment.
3. The subject of group
outpatient therapy shall be related to each recipient participating in the
group.
4. The provider shall keep
individual notes regarding each recipient within the group and within each
recipient's health record.
5. Group
outpatient therapy shall be provided by:
a. An
approved behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision.
(i)
1.
Collateral outpatient therapy shall:
a.
Consist of a face-to-face or appropriate telehealth, pursuant to
907
KAR 3:170, behavioral health consultation:
(i) With a parent or caregiver of a
recipient, household member of a recipient, legal representative of a
recipient, school personnel, treating professional, or other person with
custodial control or supervision of the recipient; and
(ii) That is provided in accordance with the
recipient's plan of care; and
b. Not be reimbursable if the therapy is for
a recipient who is at least twenty-one (21) years of age.
2. Consent to discuss a recipient's treatment
with any person other than a parent or legal guardian shall be signed and filed
in the recipient's health record.
3. Collateral outpatient therapy shall be
provided by:
a. An approved behavioral health
practitioner; or
b. An approved
behavioral health practitioner under supervision.
(j) Screening, brief intervention, and
referral to treatment for a substance use disorder shall:
1. Be an evidence-based early intervention
approach for an individual with non-dependent substance use to provide an
effective strategy for intervention prior to the need for more extensive or
specialized treatment;
2. Consist
of:
a. Using a standardized screening tool to
assess an individual for risky substance use behavior;
b. Engaging a recipient who demonstrates
risky substance use behavior in a short conversation and providing feedback and
advice to the recipient; and
c.
Referring a recipient to additional mental health disorder, substance use
disorder, or co-occurring disorders services if the recipient is determined to
need other additional services to address the recipient's substance
use;
3. Be provided
face-to-face or via telehealth as appropriate pursuant to
907
KAR 3:170; and
4. Be provided by:
a. An approved behavioral health
practitioner, except for a licensed behavior analyst; or
b. An approved behavioral health practitioner
under supervision, except for a licensed assistant behavior
analyst.
(k)
1. Day treatment shall be a nonresidential,
intensive treatment program designed for a child under the age of twenty-one
(21) years who has:
a. A mental health
disorder, substance use disorder, or co-occurring disorders; and
b. A high risk of out-of-home placement due
to a behavioral health issue.
2. Day treatment shall:
a. Consist of an organized, behavioral health
program of treatment and rehabilitative services;
b. Include:
(i) Individual outpatient therapy, family
outpatient therapy, or group outpatient therapy;
(ii) Behavior management and social skills
training;
(iii) Independent living
skills that correlate to the age and development stage of the recipient;
or
(iv) Services designed to
explore and link with community resources before discharge and to assist the
recipient and family with transition to community services after discharge; and
c. Be provided:
(i) In collaboration with the education
services of the local education authority including those provided through
20 U.S.C.
1400 et seq. (Individuals with Disabilities
Education Act) or
29 U.S.C.
701 et seq. (Section 504 of the
Rehabilitation Act);
(ii) On school
days and during scheduled breaks;
(iii) In coordination with the recipient's
individualized education program if the recipient has an individualized
education program;
(iv) With a
linkage agreement with the local education authority that specifies the
responsibilities of the local education authority and the day treatment
provider; and
(v) Face-to-face.
3. To provide
day treatment services, a provider shall have:
a. The capacity to employ staff authorized to
provide day treatment services in accordance with this section and to
coordinate the provision of services among team members; and
b. Knowledge of substance use disorders,
mental health disorders, and co-occurring disorders.
4. Day treatment shall not include a
therapeutic clinical service that is included in a child's individualized
education program.
5. Day treatment
shall be provided by:
a. An approved
behavioral health practitioner; or
b. An approved behavioral health practitioner
under supervision.
6.
Day treatment support services conducted by a behavioral health multi-specialty
group or a behavioral health provider group by an individual working under the
supervision of an approved behavioral health practitioner may be provided by:
a. A registered alcohol and drug peer support
specialist;
b. An adult peer
support specialist;
c. A family
peer support specialist; or d. A youth peer support specialist.
(l)
1. Comprehensive community support services
shall:
a. Be activities necessary to allow an
individual to live with maximum independence in the community;
b. Be intended to ensure successful community
living through the utilization of skills training as identified in the
recipient's plan of care; and
c.
Consist of using a variety of psychiatric or behavioral rehabilitation
techniques to:
(i) Improve emotional
regulation skills;
(ii) Improve
crisis coping skills;
(iii) Develop
and enhance interpersonal skills;
(iv) Improve daily living skills;
and
(v) Improve self-monitoring of
symptoms and side effects.
2. To provide comprehensive community support
services, a provider shall:
a. Have the
capacity to employ staff authorized pursuant to
908
KAR 2:250 to provide comprehensive community support
services and to coordinate the provision of services among team members; and
b. Meet the requirements for
comprehensive community support services established in
908
KAR 2:250.
3. Comprehensive community support services
shall be provided face-to-face.
4.
Comprehensive community support services shall be provided by:
a. An approved behavioral health
practitioner, except for a licensed clinical alcohol and drug counselor; or
b. An approved behavioral health
practitioner under supervision, except for a:
(i) Certified alcohol and drug counselor;
or
(ii) Licensed clinical alcohol
and drug counselor associate.
5. Support services for comprehensive
community support services conducted by a behavioral health multi-specialty
group or a behavioral health provider group by an individual working under the
supervision of an approved behavioral health practitioner may be provided by a
community support associate.
(m)
1. Peer
support services shall:
a. Be emotional
support that is provided by:
(i) An individual
who has been trained and certified in accordance with
908 KAR
2:220 and who is experiencing or has experienced a
mental health disorder, substance use disorder, or co-occurring mental health
and substance use disorders to a recipient by sharing a similar mental health
disorder, substance use disorder, or co-occurring mental health and substance
use disorders in order to bring about a desired social or personal
change;
(ii) A parent or other
family member who has been trained and certified in accordance with
908 KAR
2:230 of a child having or who has had a mental health
disorder, substance use disorder, or co-occurring mental health and substance
use disorders to a parent or family member of a child sharing a similar mental
health disorder, substance use disorder, or co-occurring mental health and
substance use disorders in order to bring about a desired social or personal
change;
(iii) An individual who has
been trained and certified in accordance with
908 KAR
2:240 and identified as having experienced as a child
or youth an emotional, social, or behavioral disorder that is defined in the
current version of the Diagnostic and Statistical Manual for Mental Disorders;
or
(iv) A registered alcohol and
drug peer support specialist who is experiencing or has experienced a substance
use disorder to a recipient by sharing a similar substance use disorder in
order to bring about a desired social or personal change;
b. Be an evidence-based practice;
c. Be structured and scheduled nonclinical
therapeutic activities with an individual recipient or a group of
recipients;
d. Promote
socialization, recovery, self-advocacy, preservation, and enhancement of
community living skills for the recipient;
e. Except for the engagement into substance
use disorder treatment conducted through emergency department bridge clinics,
be coordinated within the context of a comprehensive, individualized plan of
care developed through a person-centered planning process;
f. Be identified in each recipient's plan of
care;
g. Be designed to directly
contribute to the recipient's individualized goals as specified in the
recipient's plan of care; and
h. Be
provided face-to-face.
2. To provide peer support services, a
provider shall:
a. Have demonstrated:
(i) The capacity to provide peer support
services for the behavioral health population being served including the age
range of the population being served; and
(ii) Experience in serving individuals with
behavioral health disorders;
b. Employ:
(i) Adult peer support specialists, family
peer support specialists, or youth peer support specialists who are qualified
to provide peer support services in accordance with
908 KAR
2:220,
908 KAR
2:230, or
908 KAR
2:240; or
(ii) Registered alcohol and drug peer support
specialists who are qualified to provide peer support services in accordance
with
KRS
309.0831;
c. Use an approved behavioral health
practitioner to supervise adult peer support specialists, family peer support
specialists, or youth peer support specialists; and
d. Require that:
(i) Individuals providing peer support
services to recipients provide no more than thirty (30) hours per week of
direct recipient contact; and
(ii)
Peer support services provided to recipients in a group setting not exceed
eight (8) individuals within any group at one time.
3. Peer support shall only be
covered if provided by a behavioral health:
a.
Provider group; or
b.
Multi-specialty group.
(n)
1.
Intensive outpatient program services shall:
a. Be an alternative to or transition from a
higher level of care for a mental health or substance use disorder, or
co-occurring disorders;
b. Offer a
multi-modal, multi-disciplinary structured outpatient treatment program that is
significantly more intensive than individual outpatient therapy, group
outpatient therapy, or family outpatient therapy;
c. For an intensive outpatient program
providing services for SUD treatment, meet the service criteria including
components for support systems, staffing, and therapies outlined in the most
current edition of The ASAM Criteria for intensive outpatient level of care
services;
d. Be provided
face-to-face;
e. Be provided at
least three (3) hours per day at least three (3) days per week for
adults;
f. Be provided at least six
(6) hours per week for adolescents; and
g.
Include:
(i) Individual
outpatient therapy;
(ii) Group
outpatient therapy;
(iii) Family
outpatient therapy unless contraindicated;
(iv) Crisis intervention; or
(v) Psycho-education, related to identified
goals in the recipient's treatment plan.
2. During psycho-education, the recipient or
recipient's family member shall be:
a.
Provided with knowledge regarding the recipient's diagnosis, the causes of the
condition, and the reasons why a particular treatment might be effective for
reducing symptoms; and
b. Taught
how to cope with the recipient's diagnosis or condition in a successful
manner.
3. An intensive
outpatient program services treatment plan shall:
a. Be individualized; and
b. Focus on stabilization and transition to a
lesser level of care.
4.
To provide intensive outpatient program services, a provider shall:
a. Be employed by a behavioral health
multi-specialty group or behavioral health provider group; and
b. Have:
(i) Access to a board-certified or
board-eligible psychiatrist for consultation;
(ii) Access to a psychiatrist, other
physician, or advanced practice registered nurse for medication
management;
(iii) The capacity to
provide services utilizing a recognized intervention protocol based on
nationally accepted treatment principles;
(iv) The capacity to employ staff authorized
to provide intensive outpatient program services in accordance with this
section and to coordinate the provision of services among team
members;
(v) The capacity to
provide the full range of intensive outpatient program services as stated in
this paragraph;
(vi) Demonstrated
experience in serving individuals with behavioral health disorders;
(vii) The administrative capacity to ensure
quality of services;
(viii) A
financial management system that provides documentation of services and costs;
and
(ix) The capacity to document
and maintain individual case records.
5. Intensive outpatient program services
shall be provided in a setting with a minimum recipient-to-staff ratio of ten
(10) to one (1).
6. Intensive
outpatient program services shall be provided by:
a. An approved behavioral health
practitioner, except for a licensed behavior analyst; or
b. An approved behavioral health practitioner
under supervision, except for a licensed assistant behavior analyst.
7. Intensive outpatient program
services shall only be covered if provided by a behavioral health:
a. Provider group; or
b. Multi-specialty group.
(o)
1. Therapeutic rehabilitation program
services shall be:
a. Face-to-face, on-site,
psychiatric rehabilitation and supports for an individual with a severe and
persistent mental illness or an individual under the age of twenty-one (21)
years who has a severe emotional disability; and
b. Designed to maximize the reduction of a
mental health disorder and the restoration of the individual's functional level
to the individual's best possible functional level.
2. A recipient in a therapeutic
rehabilitation program shall establish the recipient's own rehabilitation goals
within the plan of care.
3. A
therapeutic rehabilitation program shall:
a.
Be delivered using a variety of psychiatric rehabilitation
techniques;
b. Focus on:
(i) Improving daily living skills;
(ii) Self-monitoring of symptoms and side
effects;
(iii) Emotional regulation
skills;
(iv) Crisis coping skills;
and
(v) Interpersonal skills;
and
c. Be delivered
individually or in a group.
4. Therapeutic rehabilitation programs shall
include:
a. An individualized plan of care
identifying measurable goals and objectives, including a discharge and relapse
prevention plan; and
b.
Coordination of services the individual may be receiving and referral to other
necessary support services as needed.
5. Program staffing for a therapeutic
rehabilitation program shall include:
a.
Licensed clinical supervision, consultation, and support to direct care staff;
and
b. Direct care staff to provide
scheduled therapeutic activities, training, and support.
6. Therapeutic rehabilitation services shall
be provided by:
a. An approved behavioral
health practitioner, except for a licensed clinical alcohol and drug counselor;
or
b. An approved behavioral health
practitioner under supervision, except for a:
(i) Certified alcohol and drug counselor;
or
(ii) Licensed clinical alcohol
and drug counselor associate.
7. If not provided by an allowed practitioner
pursuant to subparagraph 6. of this paragraph, support services for therapeutic
rehabilitation services shall be conducted by a provider:
a. Working under the supervision of an
approved behavioral health practitioner; and
b. Who is:
(i) An adult peer support
specialist;
(ii) A family peer
support specialist; or
(iii) A
youth peer support specialist.
(p)
1.
Withdrawal management services shall:
a. Be
provided face-to-face for recipients with a substance use disorder or
co-occurring disorder and incorporated into a recipient's care along the
continuum of care as needed;
b.
Meet service criteria in accordance with the most current version of the ASAM
Criteria for withdrawal management levels in an outpatient setting;
c. Be provided by:
(i) A behavioral health multi-specialty
group;
(ii) A behavioral health
provider group; or
(iii) An
approved behavioral health practitioner or behavioral health practitioner under
supervision with oversight by a physician, advanced practice registered nurse,
or physician assistant; and
d. If provided in an outpatient setting,
comply with
908
KAR 1:374, Section 2.
2. A recipient who is receiving withdrawal
management services shall meet the most current edition of diagnostic criteria
for substance withdrawal management as established by the most recent version
of the Diagnostic and Statistical Manual of Mental Disorders.
3. Withdrawal management services in an
outpatient setting shall be provided by:
a. A
physician;
b. A
psychiatrist;
c. A physician
assistant;
d. An advanced practice
registered nurse; or
e. An
approved behavioral health practitioner or behavioral health practitioner under
supervision with oversight by a physician, advanced practice registered nurse,
or physician assistant.
(q)
1.
Medication assisted treatment services shall be provided by an authorized
prescribing provider who:
a. Is:
(i) A physician;
(ii) An advanced practice registered nurse;
or
(iii) A psychiatrist;
c. Maintains a current waiver under
21 U.S.C.
823(g)(2) to prescribe
buprenorphine products; and
d. Has
experience and knowledge in addiction medicine.
2. Medication assisted treatment supporting
behavioral health services shall:
a. Be
co-located within the same practicing site as the practitioner who maintains a
current waiver under
21 U.S.C.
823(g)(2) to prescribe
buprenorphine products or via telehealth as appropriate pursuant to
907
KAR 3:170; or
b. Have agreements in place for linkage to
appropriate behavioral health treatment providers who specialize in substance
use disorders and are knowledgeable in biopsychosocial dimensions of alcohol
and other substance use disorders, such as:
(i) A licensed behavioral health services
organization;
(ii) A
multi-specialty group;
(iii) A
provider group; or
(iv) An
individual behavioral health practitioner.
3. Medication assisted treatment may be
provided in a provider group or multi-specialty group operating in accordance
with
908
KAR 1:374, Section 7.
4. A medication assisted treatment program
shall:
a. Assess the need for treatment
including:
(i) A full patient history to
determine the severity of the patient's substance use disorder; and
(ii) Identifying and addressing any
underlying or co-occurring diseases or conditions, as necessary;
b. Educate the patient about how
the medication works, including:
(i) The
associated risks and benefits; and
(ii) Overdose prevention;
c. Evaluate the need for medically
managed withdrawal from substances;
d. Refer patients for higher levels of care
if necessary; and
e. Obtain
informed consent prior to integrating pharmacologic or nonpharmacologic
therapies.
(r)
1. Applied behavior analysis services shall
produce socially significant improvement in human behavior via the:
a. Design, implementation, and evaluation of
environmental modifications;
b. Use
of behavioral stimuli and consequences; or
c. Use of direct observation, measurement,
and functional analysis of the relationship between environment and
behavior.
2. Applied
behavior analysis shall be based on scientific research and the direct
observation and measurement of behavior and environment, which utilize
contextual factors, establishing operations, antecedent stimuli, positive
reinforcement, and other consequences to assist recipients in:
a. Developing new behaviors;
b. Increasing or decreasing existing
behaviors; and
c. Eliciting
behaviors under specific environmental conditions.
3. Applied behavior analysis services may
include principles, methods, and procedures of the experimental analysis of
behavior and applied behavior analysis, including applications of those
principles, methods, and procedures to:
a.
Design, implement, evaluate, and modify treatment programs to change the
behavior of individuals;
b. Design,
implement, evaluate, and modify treatment programs to change the behavior of
individuals that interact with a recipient;
c. Design, implement, evaluate, and modify
treatment programs to change the behavior of a group or groups that interact
with a recipient; or
d. Consult
with individuals and organizations.
4.
a.
Applied behavior analysis services shall be provided by:
(i) A licensed behavior analyst;
(ii) A licensed assistant behavior
analyst;
(iii) An approved
behavioral health practitioner with documented training in applied behavior
analysis; or
(iv) An approved
behavioral health practitioner under supervision with documented training in
applied behavior analysis.
b. A registered behavior technician under the
supervision of an appropriate practitioner pursuant to clause a. of this
subparagraph may provide support services under this
paragraph.
(4)
(a)
Laboratory services shall be reimbursable in accordance with
907
KAR 1:028 when provided by a behavioral health
provider group or behavioral health multi-specialty group if:
1. The behavioral health provider group or
behavioral health multi-specialty group has the appropriate CLIA certificate to
perform laboratory testing pursuant to
907
KAR 1:028; and
2. The services are prescribed by a
physician, advanced practice registered nurse, or physician assistant who has a
contractual relationship with the behavioral health provider group or
behavioral health multi-specialty group.
(b) Laboratory services may be administered,
as appropriate, by:
1. An approved behavioral
health practitioner; or
2. An
approved behavioral health practitioner under supervision.
Section 4. Additional
Limits and Noncovered Services or Activities.
(1) The following services or activities
shall not be covered under this administrative regulation:
(a) A service provided to:
1. A resident of:
a. A nursing facility; or
b. An intermediate care facility for
individuals with an intellectual disability;
2. An inmate of a federal, local, or state:
a. Jail;
b. Detention center; or
c. Prison; or
3. An individual with an intellectual
disability without documentation of an additional psychiatric
diagnosis;
(b)
Psychiatric or psychological testing for another agency, including a court or
school, that does not result in the individual receiving psychiatric
intervention or behavioral health therapy from the provider;
(c) A consultation or educational service
provided to a recipient or to others;
(d) Collateral therapy for an individual aged
twenty-one (21) years or older;
(e)
A telephone call, an email, a text message, or other electronic contact that
does not meet the requirements stated in the definition of face-to-face, unless
the electronic contact is appropriate as a comparable telehealth service
pursuant to
907
KAR 3:170;
(f) Travel time;
(g) A field trip;
(h) A recreational activity;
(i) A social activity; or
(j) A physical exercise activity
group.
(2)
(a) A consultation by one (1) provider or
professional with another shall not be covered under this administrative
regulation except regarding collateral outpatient therapy as specified in
Section 3(3)(i) of this administrative regulation.
(b) A third party contract shall not be
covered under this administrative regulation.
(3)
(a)
Except as established in paragraph (b) of this subsection, unless a diagnosis
is made and documented in the recipient's medical record within three (3)
visits, the service shall not be covered.
(b) The requirement established in paragraph
(a) of this subsection shall not apply to:
1.
Crisis intervention;
2. A
screening;
3. An assessment;
or
4. Peer support services for the
engagement into substance use disorder treatment within an emergency department
bridge clinic.
(4) The department shall not reimburse for
both a screening and an SBIRT (screening, brief intervention, and referral to
treatment for a substance use disorder) provided to a recipient on the same
date of service.
(5) A billing
supervisor arrangement between a billing supervisor and a behavioral health
practitioner under supervision shall not:
(a)
Violate the clinical supervision rules or policies of the respective
professional licensure boards governing the billing supervisor and the
behavioral health practitioner under supervision; or
(b) Substitute for the clinical supervision
rules or policies of the respective professional li-censure boards governing
the billing supervisor and the behavioral health practitioner under
supervision.
Section
5. Duplication of Service Prohibited.
(1) The department shall not reimburse for a
service provided to a recipient by more than one (1) provider, of any program
in which the service is covered, during the same time period.
(2) For example, if a recipient is receiving
a behavioral health service from an individual behavioral health provider, the
department shall not reimburse for the same service provided to the same
recipient during the same time period by a behavioral health services
organization.
Section 6.
Records Maintenance, Documentation, Protection, and Security.
(1) An individual provider, a behavioral
health provider group, or a behavioral health multi-specialty group shall
maintain a current health record for each recipient.
(2) A health record shall document each
service provided to the recipient including the date of the service and the
signature of the individual who provided the service.
(3) A health record shall:
(a) Include:
1. An identification and intake record
including:
a. Name;
b. Social Security number;
c. Date of intake;
d. Home (legal) address;
e. Health insurance information;
f. If applicable, the referral source's name
and address;
g. Primary care
physician's name and address;
h.
The reason the individual is seeking help including the presenting problem and
diagnosis;
i. Any physical health
diagnosis, if a physical health diagnosis exists for the individual, and
information regarding:
(i) Where the
individual is receiving treatment for the physical health diagnosis;
and
(ii) The physical health
provider's name; and
j.
The name of the informant and any other information deemed necessary by the
provider to comply with the requirements of:
(i) This administrative regulation;
(ii) The provider's licensure board, if
applicable;
(iii) State law;
or
(iv) Federal
law;
2.
Documentation of the:
a. Screening;
b. Assessment;
c. Disposition if a disposition was
performed; and
d. Six (6) month
review of a recipient's plan of care each time a six (6) month review occurs,
and as needed;
3. A
complete history including mental status and previous treatment;
4. An identification sheet;
5. A consent for treatment sheet that is
accurately signed and dated; and
6.
The individual's stated purpose for seeking services; and
(b) Be:
1.
Maintained in an organized central file;
2. Furnished upon request to the:
a. Cabinet for Health and Family Services; or
b. For an enrollee, managed care
organization in which the recipient is enrolled or has been enrolled in the
past;
3. Made available
for inspection and copying by:
a. Cabinet for
Health and Family Services' personnel; or
b. Personnel of the managed care organization
in which the recipient is enrolled if applicable;
4. Readily accessible; and
5. Adequate for the purpose of establishing
the current treatment modality and progress of the recipient if the recipient
received services beyond a screening.
(4) Documentation of a screening shall
include:
(a) Information relative to the
individual's stated request for services; and
(b) Other stated personal or health concerns
if other concerns are stated.
(5)
(a) A
behavioral health practitioner's service notes regarding a recipient shall:
1. Be made within forty-eight (48) hours of
each service visit;
2. Indicate if
the service was provided face-to-face or via telehealth as appropriate pursuant
to
907
KAR 3:170; and
3. Describe the:
a. Recipient's symptoms or behavior, reaction
to treatment, and attitude;
b.
Behavioral health practitioner's intervention;
c. Changes in the plan of care if changes are
made; and
d. Need for continued
treatment if deemed necessary.
(b)
1. Any
edit to notes shall:
a. Clearly display the
changes; and
b. Be initialed and
dated by the person who edited the notes.
2. Notes shall not be erased or illegibly
marked out.
(c)
1. Notes recorded by a practitioner working
under supervision shall be co-signed and dated by the supervising professional
within thirty (30) days of each service visit.
2. If services are provided by a practitioner
working under supervision, there shall be a monthly supervisory note recorded
by the supervising professional reflecting consultations with the practitioner
working under supervision concerning the:
a.
Case; and
b. Supervising
professional's evaluation of the services being provided to the
recipient.
(6) Immediately following a screening of a
recipient, the behavioral health practitioner who performed the screening shall
perform a disposition related to:
(a) A
provisional diagnosis;
(b) A
referral for further consultation and disposition, if applicable; or
(c)
1. If
applicable, termination of services and referral to an outside source for
further services; or
2. If
applicable, termination of services without a referral to further
services.
(7)
(a) A recipient's plan of care shall be
reviewed at least once every six (6) months, or as needed earlier than six (6)
months.
(b) Any change to a
recipient's plan of care shall be documented, signed, and dated by the
rendering practitioner and by the recipient or recipient's
representative.
(8)
(a) Notes regarding services to a recipient
shall:
1. Be organized in chronological
order;
2. Be dated;
3. Be titled to indicate the service
rendered;
4. State a starting and
ending time for the service; and
5.
Be recorded and signed by the rendering behavioral health practitioner and
include the practitioner's professional title (for example, licensed clinical
social worker).
(b)
Initials, typed signatures, or stamped signatures shall not be
accepted.
(c) Telephone contacts,
family collateral contacts not coverable under this administrative regulation,
or other non-reimbursable contacts shall:
1.
Be recorded in the notes; and
2.
Not be reimbursable.
(9) A termination summary shall:
(a) Be required, upon termination of
services, for each recipient who received at least three (3) service visits;
and
(b) Contain a summary of the
significant findings and events during the course of treatment including the:
1. Final assessment regarding the progress of
the individual toward reaching goals and objectives established in the
individual's plan of care;
2. Final
diagnosis of clinical impression; and
3. Individual's condition upon termination
and disposition.
(c) A
health record relating to an individual who terminated from receiving services
shall be fully completed within ten (10) days following termination.
(10) If an individual's case is
reopened within ninety (90) days of terminating services for the same or
related issue, a reference to the prior case history with a note regarding the
interval period shall be acceptable.
(11)
(a)
Except as established in paragraph (b) of this subsection, if a recipient is
transferred or referred to a health care facility or other provider for care or
treatment, the transferring provider shall, within ten (10) business days of
the transfer or referral, transfer the recipient's health record in a manner
that complies with the records' use and disclosure requirements as established
in or required by:
1.
a. The Health Insurance Portability and
Accountability Act;
(b) If a
recipient is transferred or referred to a residential crisis stabilization
unit, a psychiatric hospital, a psychiatric distinct part unit in an acute care
hospital, or an acute care hospital for care or treatment, the transferring
provider shall, within forty-eight (48) hours of the transfer or referral,
transfer the recipient's records in a manner that complies with the records'
use and disclosure requirements as established in or required by:
1.
a. The
Health Insurance Portability and Accountability Act;
(12)
(a) If an individual behavioral health
practitioner's, a behavioral health provider group's, or a behavioral health
multi-specialty group's Medicaid Program participation status changes as a
result of voluntarily terminating from the Medicaid Program, involuntarily
terminating from the Medicaid Program, or a licensure suspension, the health
records of the individual behavioral health practitioner, behavioral health
provider group, or behavioral health multi-specialty group shall:
1. Remain the property of the individual
behavioral health practitioner, behavioral health provider group, or behavioral
health multi-specialty group; and
2. Be subject to the retention requirements
established in subsection (13) of this section.
(b)
1. If
an individual behavioral health practitioner dies, the health records
maintained by the individual behavioral health practitioner shall remain the
property of the individual behavioral health practitioner.
2. An individual behavioral health
practitioner shall have a written plan addressing how to maintain health
records following the provider's death in a manner that complies with the
retention requirements established in subsection (13) of this
section.
(13)
(a) Except as established in paragraph (b) or
(c) of this subsection, an individual behavioral health practitioner, a
behavioral health provider group, or a behavioral health specialty group shall
maintain a health record regarding a recipient for at least five (5) years from
the date of the service or until any audit dispute or issue is resolved beyond
five (5) years.
(b) After a
recipient's death or discharge from services, an individual behavioral health
practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group shall maintain the recipient's record for the longest of
the following periods:
1. Five (5) years
unless the recipient is a minor; or
2. If the recipient is a minor, three (3)
years after the recipient reaches the age of majority under state
law.
(c) If the
Secretary of the United States Department of Health and Human Services requires
a longer document retention period than the period referenced in paragraph (a)
of this subsection, pursuant to
42 C.F.R.
431.17, the period established by the
secretary shall be the required period.
(14)
(a) An
individual behavioral health practitioner, a behavioral health provider group,
or a behavioral health multi-specialty group shall comply with 45 C.F.R. Part
164.
(b) All information contained
in a health record shall:
1. Be treated as
confidential;
2. Not be disclosed
to an unauthorized individual; and
3. Be disclosed to an authorized
representative of:
a. The
department;
b. Federal government;
or
c. For an enrollee, the managed
care organization in which the enrollee is
enrolled.
(c)
1. Upon request, an individual behavioral
health practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group shall provide to an authorized representative of the
department, federal government, or managed care organization if applicable,
information requested to substantiate:
a.
Staff notes detailing a service that was rendered;
b. The professional who rendered a service;
and
c. The type of service rendered
and any other requested information necessary to determine, on an individual
basis, whether the service is reimbursable by the department or the managed
care organization, if applicable.
2. Failure to provide information referenced
in subparagraph 1. of this paragraph shall result in denial of payment for any
service associated with the requested information.
Section 7. Medicaid
Program Participation Compliance.
(1) An
individual behavioral health practitioner, a behavioral health provider group,
or a behavioral health multi-specialty group shall comply with:
(a)
907
KAR 1:671;
(b)
907
KAR 1:672; and
(c) All applicable state and federal
laws.
(2)
(a) If an individual behavioral health
practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group receives any duplicate payment or overpayment from the
department, regardless of reason, the individual behavioral health
practitioner, behavioral health provider group, or behavioral health
multi-specialty group shall return the payment to the department.
(b) Failure to return a payment to the
department in accordance with paragraph (a) of this subsection may be:
1. Interpreted to be fraud or abuse;
and
2. Prosecuted in accordance
with applicable federal or state law.
(3)
(a) When
the department makes payment for a covered service and the individual
behavioral health practitioner, behavioral health provider group, or behavioral
health multi-specialty group accepts the payment:
1. The payment shall be considered payment in
full;
2. A bill for the same
service shall not be given to the recipient; and
3. Payment from the recipient for the same
service shall not be accepted by the individual behavioral health practitioner,
a behavioral health provider group, or behavioral health multi-specialty
group.
(b)
1. An individual behavioral health
practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group may bill a recipient for a service that is not covered by
the Kentucky Medicaid Program if the:
a.
Recipient requests the service; and
b. Individual behavioral health practitioner,
behavioral health provider group, or behavioral health multi-specialty group
makes the recipient aware in advance of providing the service that the:
(i) Recipient is liable for the payment; and
(ii) Department is not covering the
service.
2.
If a recipient makes payment for a service in accordance with subparagraph 1.
of this paragraph, the:
a. Individual
behavioral health practitioner, behavioral health provider group, or behavioral
health multi-specialty group shall not bill the department for the service; and
b. Department shall not:
(i) Be liable for any part of the payment
associated with the service; and
(ii) Make any payment to the individual
behavioral health practitioner, behavioral health provider group, or behavioral
health multi-specialty group regarding the service.
(4)
(a) An individual behavioral health
practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group shall attest by the individual behavioral health
practitioner's signature or signature of an individual on behalf of a
behavioral health provider group or behavioral health multi-specialty group
that any claim associated with a service is valid and submitted in good
faith.
(b) Any claim and
substantiating record associated with a service shall be subject to audit by
the:
1. Department or its designee;
2. Cabinet for Health and Family Services,
Office of Inspector General or its designee;
3. Kentucky Office of Attorney General or its
designee;
4. Kentucky Office of the
Auditor for Public Accounts or its designee; or
5. United States General Accounting Office or
its designee.
(c) If an
individual behavioral health practitioner, a behavioral health provider group,
or a behavioral health multi-specialty group receives a request from the
department to provide a claim, related information, related documentation, or
record for auditing purposes, the individual behavioral health practitioner,
behavioral health provider group, or behavioral health multi-specialty group
shall provide the requested information to the department within the timeframe
requested by the department.
(d)
1. All services provided shall be subject to
review for recipient or provider abuse.
2. Willful abuse by an individual behavioral
health practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group shall result in the suspension or termination of the
individual behavioral health practitioner, behavioral health provider group, or
behavioral health multi-specialty group from Medicaid Program
participation.
(5)
(a) If
an individual behavioral health practitioner, a behavioral health provider
group, or a behavioral health multi-specialty group renders a Medicaid-covered
service to a recipient, regardless of if the service is billed through the
individual behavioral health practitioner's, behavioral health provider
group's, or behavioral health multi-specialty group's Medicaid provider number
or any other entity or individual including a non-Medicaid provider, the
recipient shall not be charged or billed for the service.
(b) The department shall terminate from
Medicaid Program participation an individual behavioral health practitioner, a
behavioral health provider group, or a behavioral health multi-specialty group
that:
1. Charges or bills a recipient for a
Medicaid-covered service; or
2.
Participates in an arrangement in which an entity or individual bills a
recipient for a Medi-caid-covered service rendered by the individual behavioral
health practitioner, behavioral health provider group, or behavioral health
multi-specialty group.
Section 8. Third Party Liability. An
individual behavioral health practitioner, a behavioral health provider group,
or a behavioral health multi-specialty group shall comply with
KRS
205.622.
Section 9. Use of Electronic Signatures.
(1) The creation, transmission, storage, and
other use of electronic signatures and documents shall comply with the
requirements established in
KRS
369.101 to
369.120.
(2) An individual behavioral health
practitioner, a behavioral health provider group, or a behavioral health
multi-specialty group that chooses to use electronic signatures shall:
(a) Develop and implement a written security
policy that shall:
1. Be adhered to by each of
the practitioner's employees, officers, agents, or contractors;
2. Identify each electronic signature for
which an individual has access; and
3. Ensure that each electronic signature is
created, transmitted, and stored in a secure fashion;
(b) Develop a consent form that shall:
1. Be completed and executed by each
individual using an electronic signature;
2. Attest to the signature's authenticity;
and
3. Include a statement
indicating that the individual has been notified of his responsibility in
allowing the use of the electronic signature; and
(c) Provide the department, immediately upon
request, with:
1. A copy of the individual
behavioral health practitioner's, behavioral health provider group's, or
behavioral health multi-specialty group's electronic signature
policy;
2. The signed consent form;
and
3. The original filed
signature.
Section 10. Auditing Authority. The
department shall have the authority to audit any:
(1) Claim;
(2) Medical record; or
(3) Documentation associated with any claim
or medical record.
Section
11. Federal Approval and Federal Financial Participation. The
department's coverage of services pursuant to this administrative regulation
shall be contingent upon:
(1) Receipt of
federal financial participation for the coverage; and
(2) Centers for Medicare and Medicaid
Services' approval for the coverage.
Section 12. Appeals.
(1) An appeal of an adverse action by the
department regarding a service and a recipient who is not enrolled with a
managed care organization shall be in accordance with
907
KAR 1:563.
(2) An appeal of an adverse action by a
managed care organization regarding a service and an enrollee shall be in
accordance with
907
KAR 17:010.
Notes
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 205.6311
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.