Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 9 - Psychiatric Residential Treatment Facility Services and Reimbursement › Section 907 KAR 9:020 - Reimbursement provisions and requirements regarding outpatient behavioral health services provided by Level I or Level II psychiatric residential treatment facilities

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.520,
				42 U.S.C.
				1396a(a)(10)(B),
				42 U.S.C.
				1396a(a)(23)
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 reimbursement
				provisions and requirements regarding Medicaid Program outpatient behavioral
				health services provided by Level I or Level II psychiatric residential
				treatment facilities to Medicaid recipients who are not enrolled with a managed
				care organization.
Section 1.
			 Definitions.
(1) "Advanced practice
			 registered nurse" or "APRN" is defined by
			 KRS
			 314.011(7).
(2) "Behavioral health practitioner under
			 supervision" means an individual who is:
(a)
1. A licensed professional counselor
			 associate;
2. A certified social
			 worker;
3. A marriage and family
			 therapy associate;
4. A licensed
			 professional art therapist associate;
5. A licensed assistant behavior
			 analyst;
6. A physician
			 assistant;
7. A certified alcohol
			 and drug counselor; or
8. A
			 licensed clinical alcohol and drug counselor associate in accordance with
			 Section 5 of this administrative regulation; and
(b) Employed by or under contract with the
			 same billing provider as the billing supervisor.
(3) "Billing provider" means the individual
			 who, group of individual providers that, or organization that:
(a) Is authorized to bill the department or a
			 managed care organization for a service; and
(b) Is eligible to be reimbursed by the
			 department or a managed care organization for a service.
(4) "Billing supervisor" means an individual
			 who is:
(a)
1. A physician;
2. A psychiatrist;
3. An advanced practice registered
			 nurse;
4. A licensed
			 psychologist;
5. A licensed
			 clinical social worker;
6. A
			 licensed professional clinical counselor;
7. A licensed psychological
			 practitioner;
8. A certified
			 psychologist with autonomous functioning;
9. A licensed marriage and family
			 therapist;
10. A licensed
			 professional art therapist; or
11.
			 A licensed behavior analyst; and
(b) Employed by or under contract with the
			 same billing provider as the behavioral health practitioner under supervision
			 who renders services under the supervision of the billing supervisor.
(5) "Certified alcohol and drug
			 counselor" means an individual who meets the requirements established in
			 KRS
			 309.083.
(6) "Certified psychologist" means an
			 individual who is a certified psychologist pursuant to
			 KRS
			 319.056.
(7) "Certified psychologist with autonomous
			 functioning" means an individual who is a certified psychologist with
			 autonomous functioning pursuant to
			 KRS
			 319.056.
(8) "Certified social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.080.
(9) "Department" means the Department for
			 Medicaid Services or its designee.
(10) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(11) "Healthcare common procedure coding
			 system" or "HCPCS" means a collection of codes acknowledged by the Centers for
			 Medicare and Medicaid Services (CMS) that represents procedures or
			 items.
(12) "Level I PRTF" means a
			 psychiatric residential treatment facility that meets the criteria established
			 in
			 KRS
			 216B.450(5)(a).
(13) "Level II PRTF" means a psychiatric
			 residential treatment facility that meets the criteria established in
			 KRS
			 216B.450(5)(b).
(14) "Licensed assistant behavior analyst" is
			 defined by
			 KRS
			 319C.010(7).
(15) "Licensed behavior analyst" is defined
			 by
			 KRS
			 319C.010(6).
(16) "Licensed clinical alcohol and drug
			 counselor" is defined by
			 KRS
			 309.080(4).
(17) "Licensed clinical alcohol and drug
			 counselor associate" is defined by
			 KRS
			 309.080(5).
(18) "Licensed clinical social worker" means
			 an individual who meets the licensed clinical social worker requirements
			 established in
			 KRS
			 335.100.
(19) "Licensed marriage and family therapist"
			 is defined by
			 KRS
			 335.300(2).
(20) "Licensed professional art therapist" is
			 defined by
			 KRS
			 309.130(2).
(21) "Licensed professional art therapist
			 associate" is defined by
			 KRS
			 309.130(3).
(22) "Licensed professional clinical
			 counselor" is defined by
			 KRS
			 335.500(3).
(23) "Licensed professional counselor
			 associate" is defined by
			 KRS
			 335.500(4).
(24) "Licensed psychological associate" means
			 an individual who:
(a) Currently possesses a
			 licensed psychological associate license in accordance with
			 KRS
			 319.010(6); and
(b) Meets the licensed psychological
			 associate requirements established in 201 KAR Chapter 26.
(25) "Licensed psychological practitioner"
			 means an individual who meets the requirements established in
			 KRS
			 319.053.
(26) "Licensed psychologist" means an
			 individual who:
(a) Currently possesses a
			 licensed psychologist license in accordance with
			 KRS
			 319.010(6); and
(b) Meets the licensed psychologist
			 requirements established in 201 KAR Chapter 26.
(27) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined in
			 42
			 C.F.R. 438.2.
(28) "Marriage and family therapy associate"
			 is defined by
			 KRS
			 335.300(3).
(29) "Physician" is defined by
			 KRS
			 205.510(11).
(30) "Physician assistant" is defined by
			 KRS
			 311.840(3).
(31) "Provider" is defined by
			 KRS
			 205.8451(7).