Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 15 - Behavioral Health › Section 907 KAR 15:005 - Definitions for 907 KAR Chapter 15

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.025(3),
				205.510(11),
				205.8451,
				309.080,
				309.130(2),
				(3),
				311.840(3),
				314.011(5),
				(7),
				319.053,
				319.056,
				319.064,
				319C.010(6),
				(7),
				335.080,
				335.100,
				335.300(2),
				(3),
				335.500(3),
				(4),
				42 C.F.R.
				400.203,
				438.2,
				441.540,
				29 U.S.C.
				794
NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and
				Family Services, Department for Medicaid Services, has responsibility to
				administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with a requirement that may be
				imposed or opportunity presented by federal law to qualify for federal Medicaid
				funds. This administrative regulation establishes the definitions for 907 KAR
				Chapter 15.
Section 1. Definitions.
(1) "Adult peer support specialist" means an
			 individual who meets the requirements for an adult peer support specialist
			 established in
			 908 KAR
			 2:220.
(2)
			 "Advanced practice registered nurse" or "APRN" is defined by
			 KRS
			 314.011(7).
(3) "Approved behavioral health practitioner"
			 means an independently licensed practitioner who is:
(a) A physician;
(b) A psychiatrist;
(c) An advanced practice registered
			 nurse;
(d) A physician
			 assistant;
(e) A licensed
			 psychologist;
(f) A licensed
			 psychological practitioner;
(g) A
			 certified psychologist with autonomous functioning;
(h) A licensed clinical social
			 worker;
(i) A licensed professional
			 clinical counselor;
(j) A licensed
			 marriage and family therapist;
(k)
			 A licensed professional art therapist;
(l) A licensed clinical alcohol and drug
			 counselor; or
(m) A licensed
			 behavior analyst.
(4)
			 "Approved behavioral health practitioner under supervision" means an individual
			 under billing supervision of an approved behavioral health practitioner who is:
(a)
1. A
			 licensed psychological associate working under the supervision of a
			 board-approved licensed psychologist;
2. A certified psychologist working under the
			 supervision of a board-approved licensed psychologist;
3. A marriage and family therapy
			 associate;
4. A certified social
			 worker;
5. A licensed professional
			 counselor associate;
6. A licensed
			 professional art therapist associate;
7. A licensed clinical alcohol and drug
			 counselor associate;
8. A certified
			 alcohol and drug counselor; or
9. A
			 licensed assistant behavior analyst; and
(b) Employed by or under contract with the
			 same billing provider as the billing supervisor.
(5) "ASAM Criteria" means the most recent
			 edition of "The ASAM Criteria, Treatment Criteria for Addictive,
			 Substance-Related, and Co-Occurring Conditions" published by the American
			 Society of Addiction Medicine.
(6)
			 "Behavioral health multi-specialty group" means a group of more than one (1)
			 individually licensed behavioral health practitioners of varying practitioner
			 types who form a business entity to:
(a)
			 Render behavioral health services; and
(b) Bill the Medicaid Program for services
			 rendered to Medicaid recipients.
(7) "Behavioral health provider group" means
			 a group of more than one (1) individually licensed behavioral health
			 practitioners of the same practitioner type who form a business entity to:
(a) Render behavioral health services;
			 and
(b) Bill the Medicaid Program
			 for services rendered to Medicaid recipients.
(8) "Behavioral health services organization"
			 means an entity that is licensed as a behavioral health services organization
			 pursuant to:
(a)
										902
			 KAR 20:430 for a behavioral health services
			 organization tier I (BHSO I);
(b)
										908
			 KAR 1:370 and
			 908
			 KAR 1:374 for a behavioral health services
			 organization tier II (BHSO II); or
(c)
										908
			 KAR 1:370 and
			 908
			 KAR 1:372 for a behavioral health services
			 organization tier III (BHSO III).
(9) "Billing provider" means the individual,
			 group of individual providers, or organization that:
(a) Is authorized to bill the department or a
			 managed care organization for a service; and
(b) Is eligible to be reimbursed by the
			 department or a managed care organization for a service.
(10) "Billing supervisor" means an individual
			 who is:
(a)
1. A physician;
2. A psychiatrist;
3. An advanced practice registered
			 nurse;
4. A physician
			 assistant;
5. A licensed clinical
			 alcohol and drug counselor;
6. A
			 licensed psychologist;
7. A
			 licensed clinical social worker;
8.
			 A licensed professional clinical counselor;
9. A licensed psychological
			 practitioner;
10. A certified
			 psychologist with autonomous functioning;
11. A licensed marriage and family
			 therapist;
12. A licensed
			 professional art therapist; or
13.
			 A licensed behavior analyst; and
(b) Employed by or under contract with the
			 same billing provider as the behavioral health practitioner under supervision
			 who renders services under the supervision of the billing supervisor.
(11) "Certified alcohol and drug
			 counselor" is defined by
			 KRS
			 309.080(2).
(12) "Certified psychologist" means an
			 individual who is a certified psychologist pursuant to
			 KRS
			 319.056.
(13) "Certified psychologist with autonomous
			 functioning" means an individual who is a certified psychologist with
			 autonomous functioning pursuant to
			 KRS
			 319.056.
(14) "Certified social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.080.
(15) "Chemical dependency treatment center"
			 means an entity that is licensed as a chemical dependency treatment center
			 pursuant to
			 902
			 KAR 20:160.
(16) "Community support associate" means a
			 paraprofessional who meets the application, training, and supervision
			 requirements of
			 908
			 KAR 2:250.
(17) "Co-occurring disorder" means a mental
			 health and substance use disorder.
(18) "Department" means the Department for
			 Medicaid Services or its designee.
(19) "Electronic signature" is defined by
			 KRS
			 369.102(8).
(20) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(21) "Face-to-face" means occurring in
			 person.
(22) "Family peer support
			 specialist" means an individual who meets the requirements for a Kentucky
			 family peer support specialist established in
			 908 KAR
			 2:230.
(23) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(24) "Healthcare common procedure coding
			 system" or "HCPCS" means a collection of codes acknowledged by the Centers for
			 Medicare and Medicaid Services (CMS) that represents procedures or
			 items.
(25) "Kentucky-specific
			 Medicare Physician Fee Schedule" means the list or process by which current
			 reimbursement rates for physician services are established or published by the
			 department.
(26) "Level I
			 psychiatric residential treatment facility" means an entity that is licensed as
			 a Level I psychiatric residential treatment facility pursuant to
			 902
			 KAR 20:320.
(27) "Level II psychiatric residential
			 treatment facility" means an entity that is licensed as a Level II psychiatric
			 residential treatment facility pursuant to
			 902
			 KAR 20:320.
(28) "Licensed assistant behavior analyst" is
			 defined by
			 KRS
			 319C.010(7).
(29) "Licensed behavior analyst" is defined
			 by
			 KRS
			 319C.010(6).
(30) "Licensed clinical alcohol and drug
			 counselor" is defined by
			 KRS
			 309.080(4).
(31) "Licensed clinical alcohol and drug
			 counselor associate" is defined by
			 KRS
			 309.080(5).
(32) "Licensed clinical social worker" means
			 an individual who meets the licensed clinical social worker requirements
			 established in
			 KRS
			 335.100.
(33) "Licensed marriage and family therapist"
			 is defined by
			 KRS
			 335.300(2).
(34) "Licensed professional art therapist" is
			 defined by
			 KRS
			 309.130(2).
(35) "Licensed professional art therapist
			 associate" is defined by
			 KRS
			 309.130(3).
(36) "Licensed professional clinical
			 counselor" is defined by
			 KRS
			 335.500(3).
(37) "Licensed professional counselor
			 associate" is defined by
			 KRS
			 335.500(4).
(38) "Licensed psychological associate" means
			 an individual who meets the requirements established in
			 KRS
			 319.064.
(39) "Licensed psychological practitioner"
			 means an individual who meets the requirements established in
			 KRS
			 319.053.
(40) "Licensed psychologist" means an
			 individual who currently possesses a licensed psychologist license in
			 accordance with
			 KRS
			 319.010(6).
(41) "Managed care organization" means an
			 entity for which the Department for Medicaid Services has contracted to serve
			 as a managed care organization as defined by
			 42
			 C.F.R. 438.2.
(42) "Marriage and family therapy associate"
			 is defined by
			 KRS
			 335.300(3).
(43) "Medicaid-covered service" means a
			 service covered by the department as established in Title 907 of the Kentucky
			 Administrative Regulations.
(44)
			 "Medically necessary" or "medical necessity" means that a covered benefit is
			 determined to be needed in accordance with
			 907
			 KAR 3:130.
(45) "Medication assisted treatment" means
			 the treatment of a substance use disorder with approved medications in
			 combination with counseling, behavioral therapies, and other
			 supports.
(46) "Physician" is
			 defined by
			 KRS
			 205.510(11).
(47) "Physician assistant" is defined by
			 KRS
			 311.840(3).
(48) "Practitioner working under supervision"
			 means:
(a) An approved behavioral health
			 practitioner under supervision;
(b)
			 A registered behavior technician;
(c) A community support associate;
			 or
(d) A peer support
			 specialist.
(49)
			 "Provider" is defined by
			 KRS
			 205.8451(7).
(50) "Provider abuse" is defined by
			 KRS
			 205.8451(8).
(51) "Psychiatric hospital" means an entity
			 licensed as a psychiatric hospital pursuant to
			 902 KAR
			 20:180.
(52) "Recipient" is defined by
			 KRS
			 205.8451(9).
(53) "Recipient abuse" is defined by
			 KRS
			 205.8451(10).
(54) "Recipient's representative" means:
(a) For a recipient who is authorized by
			 Kentucky law to provide written consent, an individual acting on behalf of, and
			 with written consent from, the recipient; or
(b) A legal guardian.
(55) "Registered alcohol and drug peer
			 support specialist" is defined by
			 KRS
			 309.080(8).
(56) "Registered behavior technician" means
			 an individual who meets the following requirements provided by the Behavior
			 Analyst Certification Board:
(a) Be at least
			 eighteen (18) years of age;
(b)
			 Have a high school diploma or its equivalent; and
(c) Within six (6) months of hire for a new
			 employee or within six (6) months of the effective date of this administrative
			 regulation for an existing employee:
1.
			 Complete a training program that is:
a.
			 Approved by the Behavior Analyst Certification Board;
b. Based on the current edition of the RBT
			 Task List endorsed by the Behavior Analyst Certification Board; and
c. Conducted by Behavior Analyst
			 Certification Board certificants;
2. Pass the Registered Behavior Technician
			 Competency Assessment administered by a Behavior Analyst Certification Board
			 certificant or by an assistant assessor overseen by a Behavior Analyst
			 Certification Board certificant; and
3. Pass the Registered Behavior Technician
			 exam provided by the Behavior Analyst Certification Board.
(57) "Registered nurse" is defined
			 by
			 KRS
			 314.011(5).
(58) "Residential crisis stabilization unit"
			 means an entity that is licensed as a residential crisis stabilization unit
			 pursuant to
			 902
			 KAR 20:440.
(59) "Section 504 plan" means a plan
			 developed:
(a) Under the auspices of Section
			 504 of the Rehabilitation Act of 1973, as amended,
			 29 U.S.C.
			 794 (Section 504); and
(b) To ensure that a child who has a
			 disability identified under the law and is attending an elementary or secondary
			 educational institution receives accommodations to ensure the child's academic
			 success and access to the learning environment.
(60) "Telehealth" is defined by
			 KRS
			 205.510(15).
(61) "Withdrawal management" means a set of
			 interventions aimed at managing acute intoxication and withdrawal based on the
			 severity of the illness and co-occurring conditions identified through a
			 comprehensive biopsychosocial assessment with linkage to addiction management
			 services, and incorporated into a recipient's care as needed throughout the
			 appropriate levels of care.
(62)
			 "Youth peer support specialist" means an individual who meets the requirements
			 established for a Kentucky youth peer support specialist established in
			 908 KAR
			 2:240.