Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 1 - Medicaid Services › Section 907 KAR 1:082 - Coverage provisions and requirements regarding rural health clinic services

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				205.510,
				205.520,
				205.622,
				205.8451,
				309.080,
				309.0831,
				309.130,
				311.840,
				314.011,
				319.010,
				319.050,
				319.053,
				319C.010,
				335.080,
				335.100,
				335.300,
				335.500,
				369.101 - 369.120,
				42 C.F.R.
				400.203,
				405.2401(b),
				405.2412-405.2417,
				405.2450,
				405.2452,
				405.2468,
				431.17,
				438.2,
				440.20,
				491.1 -
				491.11,
				45 C.F.R. Part 164,
				20 U.S.C.
				1400,
				21 U.S.C. 823,
				29 U.S.C.
				701,
				42 U.S.C. 1395x(aa) and
				(hh)
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 any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. This administrative regulation establishes the Medicaid program
				coverage provisions and requirements relating to rural health clinic
				services.
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" 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;
9. A
			 behavioral health associate, as permissible pursuant to 907 KAR Chapter 15;
			 or
10. 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) "Certified alcohol and drug counselor" is
			 defined by KRS
			 309.080(4).
(7) "Certified social worker" means an
			 individual who meets the requirements established in
			 KRS
			 335.080.
(8) "Community support associate" means a
			 paraprofessional whomeets the community support associate requirements
			 established in
			 908 KAR 2:250.
(9) "Co-occurring disorder" means a mental
			 health and substance use disorder.
(10) "Department" means the Department for
			 Medicaid Services or its designee.
(11) "Enrollee" means a recipient who is
			 enrolled with a managed care organization.
(12) "Family peer support specialist" means
			 an individual who meets the requirements for a Kentucky family peer support
			 specialist established in
			 908 KAR 2:230.
(13) "Federal financial participation" is
			 defined by 42 C.F.R.
			 400.203.
(14) "Homebound recipient" is defined by
			 42 C.F.R.
			 440.20(b)(4)(iv).
(15) "In-person" means a healthcare encounter
			 occurring:
(a) Via direct consultation and
			 interaction between the individual and healthcare provider;
(b) At the same location; and
(c) Not via telehealth.
(16) "Intermittent nursing care" is defined
			 by 42 C.F.R.
			 405.2401(b).
(17) "Licensed assistant behavior analyst" is
			 defined by KRS
			 319C.010(7).
(18) "Licensed behavior analyst" is defined
			 by KRS
			 319C.010(6).
(19) "Licensed clinical alcohol and drug
			 counselor" is defined by
			 KRS
			 309.080(7).
(20) "Licensed clinical alcohol and drug
			 counselor associate" is defined by
			 KRS
			 309.080(9).
(21) "Licensed clinical social worker" means
			 an individual who meets the licensed clinical social worker requirements
			 established in KRS
			 335.100.
(22) "Licensed marriage and family therapist"
			 is defined by KRS
			 335.300(2).
(23) "Licensed professional art therapist" is
			 defined by KRS
			 309.130(2).
(24) "Licensed professional art therapist
			 associate" is defined by
			 KRS
			 309.130(3).
(25) "Licensed professional clinical
			 counselor" is defined by
			 KRS
			 335.500(3).
(26) "Licensed professional counselor
			 associate" is defined by
			 KRS
			 335.500(4).
(27) "Licensed psychological associate"
			 means:
(a) An individual who:
1. Currently possesses a licensed
			 psychological associate license in accordance with
			 KRS
			 319.010(6); and
2. Meets the licensed psychological associate
			 requirements established in 201 KAR Chapter 26; or
(b) A certified
			 psychologist.
(28)
			 "Licensed psychological practitioner" means:
(a) An individual who meets the requirements
			 established in KRS
			 319.053; or
(b) A certified psychologist with autonomous
			 functioning.
(29)
			 "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.
(30) "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.
(31) "Marriage and family therapy associate"
			 is defined by KRS
			 335.300(3).
(32) "Medically necessary" means that a
			 covered benefit or service is necessary in accordance with
			 907 KAR 3:130.
(33) "Medication assisted treatment" means
			 the treatment of a substance use disorder with approved medications in
			 combination with counseling, behavior therapies, and other supports.
(34) "Other ambulatory services" is defined
			 by 42 C.F.R.
			 440.20(c).
(35) "Part-time nursing care" is defined by
			 42 C.F.R.
			 405.2401(b).
(36) "Physician" is defined by
			 KRS
			 205.510(12).
(37) "Physician assistant" is defined by
			 KRS
			 311.840(3) and
			 42 C.F.R.
			 405.2401(b).
(38) "Recipient" is defined by
			 KRS
			 205.8451(9).
(39) "Registered alcohol and drug peer
			 support specialist" is defined by
			 KRS
			 309.080(12).
(40) "Registered behavior technician" means
			 an individual who meets the following requirements 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 January 1, 2023 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; and
3. Pass the Registered Behavior Technician
			 exam provided by an assistant assessor supervised by a Behavior Analyst
			 Certification Board certificant.
(41) "Rural health clinic" or "RHC" is
			 defined by 42 C.F.R.
			 405.2401(b).
(42) "State plan" is defined by
			 42 C.F.R.
			 400.203.
(43) "Visiting nurse services" is defined by
			 42 C.F.R.
			 405.2401(b).
(44) "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.
(45)
			 "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.