902 KAR 20:410. Specialty intermediate care clinics

Link to law: http://www.lrc.ky.gov/kar/902/020/410.htm
Published: 2015

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      902 KAR 20:410. Specialty intermediate

care clinics.


RELATES TO: KRS 198B.260, 209, 216B.010-216B.131,

216B.990, 218A, 311, 314, 507.020, 507.030, 507.040, 508.010-508.032, 509-511,

513, 514.030, 530, 531, 45 C.F.R. 160, 164





216B.042 requires the Cabinet for Health and Family Services to promulgate

administrative regulations necessary for the proper administration of the

licensure function, which includes establishing licensure standards and

procedures to ensure safe, adequate, and efficient health facilities and health

services. This

administrative regulation provides minimum licensure requirements for the

operation of specialty intermediate care clinics.



1. Definitions. (1) "Clinic" or "specialty intermediate care

(IC) clinic" means a clinic located on the grounds of a state-owned

facility licensed pursuant to 902 KAR 20:086 as an intermediate-care facility for the

intellectually and developmentally disabled.

      (2) "Developmental disability" is defined by 42

U.S.C. 15002(8)(A) as a severe, chronic disability of an individual


      (a) Is attributable to a mental or physical impairment or

combination of mental and physical impairments;

      (b) Is manifested before the individual attains age

twenty-two (22);

      (c) Is likely to continue indefinitely;

      (d) Results in substantial functional limitations in three

(3) or more areas of major life activity, including:

      1. Self-care;

      2. Receptive and expressive language;

      3. Learning;

      4. Mobility;

      5. Self direction;

      6. Capacity for independent living; or

      7. Economic self-sufficiency; and

      (e) Reflects the individual’s need for a combination and sequence

of special, interdisciplinary, or generic services, individualized supports, or

other forms of assistance that are of lifelong or extended duration and are

individually planned and coordinated.


"Intellectual disability" means an

individual has:

      (a) Significantly sub-average intellectual functioning;

      (b) An intelligence quotient of seventy (70) or below;

      (c) Concurrent deficits or impairments in present adaptive

functioning in at least two (2) of the following areas:

      1. Communication;

      2. Self-care;

      3. Home living;

      4. Social or interpersonal skills;

      5. Use of community resources;

      6. Self-direction;

      7. Functional academic skills;

      8. Work;

      9. Leisure; or

      10. Health and safety; and

      (d) Had an onset prior to eighteen (18) years of age.


"Patient" means an individual who receives services provided by a

specialty IC clinic and who:


Is not a

resident of, but qualifies for admission to an intermediate-care facility for

the intellectually and developmentally disabled by meeting the patient

status criteria established in 907 KAR 1:022, Section 4; or


Is a resident of an intermediate-care facility for the intellectually and

developmentally disabled which contracts with, or makes arrangements with the

specialty IC clinic for outpatient services.



2. Licensure Application and Fee. (1) An applicant for licensure as a specialty

IC clinic shall complete

and submit to the Office of the Inspector General an Application for License to

Operate a Health Facility or Service, pursuant to 902 KAR 20:008, Section 2(2)(f).


The initial and annual fee for licensure as a specialty clinic shall be $500.


      Section 3. Scope of

Operations and Services. (1) Services provided by a specialty IC clinic shall

be individualized to meet the treatment needs of each of the specialty IC clinic’s

patients. Patients may receive one (1) or more of the following services from

the clinic:


Dental services;


Psychiatric services;


Psychological services;


Psychotropic medication management;






Preventive health care;


Medical assessment and treatment;


Occupational therapy;


Physical therapy;


Speech therapy;


Nutritional or dietary consultation;


Mobility evaluation or treatment;


Behavioral support services;








Medication consultation;


Medication management;


Seizure management;


Behavioral support services;


Diagnostic services;


Clinical laboratory services;


Physician services; or


Laboratory services.


Off-site services.


Specialty IC clinic personnel as identified in Section 5(4) of this

administrative regulation may provide services off-site at a local health

department or in a health facility licensed under 902 KAR Chapter 20 if the

specialty IC clinic has an agreement to provide the off-site services at the

health department or licensed health facility’s location for the purpose of improving

patient accessibility or accommodating the patient’s individualized healthcare



A psychologist, psychiatrist, behavior specialist, or board certified behavior analyst

directly employed by, or under contract with a specialty IC clinic, may provide

behavioral assessments or consultation off-site:


In a patient’s home; or


At a day service or other service site where the patient receives services.



4. Administration and Policies. (1) The licensee shall have legal responsibility

for the specialty IC clinic, including responsibility for ensuring compliance

with federal, state, and local laws and regulations pertaining to the operation

of the clinic.


The licensee shall establish lines of authority and designate an administrator

who shall be principally responsible for the daily operation of the specialty

IC clinic.


A specialty IC clinic shall establish and follow written administrative

policies covering all aspects of operation, including:


A description of organizational structure, staffing, and allocation of

responsibility and accountability;


Policies and procedures for the guidance and control of personnel performances;


A written program narrative describing in detail the:


Services offered;


Methods and protocols for service delivery;


Qualifications of personnel involved in the delivery of the services; and


Goals of the service;


A description of how administrative and patient care records and reports are

maintained; and


Procedures to be followed if the clinic performs any functions related to the

storage, handling, and administration of drugs and biologicals.


Patient Care Policies. A specialty IC clinic shall develop patient care

policies which address:


A description of the services the clinic provides directly and those provided

through agreement;


Guidelines for the medical management of health problems which include the

conditions requiring medical consultation or patient referral; and


Procedures for the annual review and evaluation of the services provided by the




5. Personnel. (1)(a) A specialty IC clinic shall have a medical director who is

a licensed physician.


The specialty IC clinic’s medical director shall:


Be responsible for all medical aspects of the clinic and provide direct medical

services in accordance with the Medical Practice Act, KRS Chapter 311;


Provide medical direction, supervision, and consultation to the staff;


In conjunction with the registered nurse described in subsection (2) of this

section, participate in the development, execution, and periodic review of the

clinic's written policies and services;


Periodically review the clinic's patient records, provide medical orders, and

provide medical care services to patients of the clinic;


Be present

for weekly

consultation, or delegate

responsibility for weekly consultation to another physician employed by, or

under contract with the specialty IC clinic if a temporary absence is necessary;



Be available within one (1) hour through direct telecommunication for

consultation, assistance with medical emergencies, or patient referral. If a temporary absence

is necessary,

the medical director shall designate another physician who is employed by, or under contract

with the specialty IC clinic to be available within one (1) hour through direct

telecommunication for consultation, assistance with medical emergencies, or

patient referral.


A specialty IC clinic shall have at least one (1) registered nurse who shall:


Have at least one (1) year experience in treating or working with individuals with


intellectual disability and a developmental disability;


Participate in the development, execution, and periodic review of the written policies

governing the services the clinic provides;


Participate with the medical director in periodic review of patient health



Provide services in accordance with clinic policies, established protocols, the

Nurse Practice Act (KRS Chapter 314), and with administrative regulations

promulgated thereunder;


Arrange for or refer patients to needed services that cannot be provided at the

clinic; and


Assure that adequate patient health records are maintained and transferred when

patients are referred.


A specialty IC clinic shall maintain, through direct employment or contract, a

sufficient number of qualified personnel to provide effective patient care and

all other related services.


Qualified personnel directly employed by, or under contract with a specialty IC

clinic shall include:






Dental hygienists;


Physician assistants;


Nurse practitioners;


Registered nurses;














Behavior specialists;


Board certified behavior analysts;




Physical therapists;


Speech therapists;


Occupational therapists;


Physical therapist assistants; and


Occupational therapist assistants.


Prior to providing any service described in Section 3(1) of this administrative

regulation, all qualified personnel as identified in subsection (4) of this

section shall

submit to an in-state criminal background information check conducted by the

Justice and Public Safety Cabinet or Administrative Office of the Courts.


An out-of-state criminal background information check shall be obtained for any

qualified personnel who have resided or been employed outside Kentucky.


A clinic shall not knowingly employ any person who has been convicted of a

felony offense under:


KRS Chapter 209;


KRS Chapter 218A;


KRS 507.020, 507.030, and 507.040;


KRS Chapter 509;


KRS Chapter 510;


KRS Chapter 511;


KRS Chapter 513;


KRS 514.030;


KRS Chapter 530;


KRS Chapter 531;


KRS 508.010, 508.020, 508.030, and 508.032;


A criminal statute of the United States or another state similar to subparagraphs

1 to 11 of this paragraph; or


A violation of the uniform code of military justice or military regulation

similar to subparagraphs 1 to 11 of this paragraph which has caused the person

to be discharged from the Armed Forces of the United States.


A person who has received a pardon for an offense specified in paragraph (c) or

has had the record of the offense expunged may be employed.

      (6) A specialty IC clinic

shall maintain written personnel policies which shall be available to all



A specialty IC clinic shall maintain a written job description for each

position which shall be reviewed and revised as necessary.


A specialty

IC clinic shall maintain current personnel records for each employee. An

employee's personnel record shall include the following:


Employee's name and address;


Evidence that the health care professional has a valid license or other valid

credential required for the professional to be able to practice;


Record of training and experience; and


Record of performance evaluations.

      (9)(a) Specialty IC clinic

personnel shall attend in-service training programs relating to their

respective job duties. These training programs shall include:


Thorough job orientation for new personnel;


Regular in-service training programs;


Behavior management procedures and techniques;


Training in the detection and reporting of suspected abuse or neglect of a

child or adult;


Training in the field of intellectual and developmental disabilities; and


Emergency and safety procedures.


A written document describing the training programs completed by all clinic

employees shall be maintained on the premises of the clinic.


      Section 6. Medical Records.

(1) A specialty IC clinic shall maintain medical records which contain the



Name of the patient;



of each medical visit or contact, including:


Date of the visit;


Condition or reason for the visit;


Name of health care practitioner providing the service;


Description of the services provided; and


Any medications or treatments prescribed;


Medical or social history relevant to the services provided, including data

obtained from other providers;


Names of referring physicians, if any, and physicians orders for special

diagnostic services; and


Documentation of all referrals made, including the reason for the referral and

to whom the patient was referred.


A specialty

IC clinic shall maintain confidentiality of patient records at all times

pursuant to and in accordance with federal, state and local laws and

administrative regulations, including the privacy standard promulgated pursuant

to Health Insurance Portability and Accountability Act (HIPAA), 45 C.F.R. 160

and 164.

      (3) A specialty IC clinic



Establish systematic procedures to assist in continuity of care if the patient

moves to another source of care;


Transfer medical records or an abstract upon request, subject to required

releases and authorizations; and


Have a specific location designated for the storage and maintenance of the

clinic’s medical records, maintain scanned copies of the original medical

records in an electronic format, or maintain electronic health records,

available for copying to a disk or printing at the clinic.

      (4)(a) Medical records shall be

maintained by the clinic for a period of six (6) years following the last

treatment, assessment, or visit made by the patient, or three (3) years after

the patient reaches age eighteen (18), whichever is longer.

      (b) A provision shall be

made for written designation of a specific location for the storage of medical

records if the specialty IC clinic ceases to operate because of disaster, or

for any other reason.


A specialty IC clinic shall safeguard each clinic's medical records and content

against loss, defacement, and tampering.


      Section 7. Provision of

Services. (1) Equipment. Equipment used for direct patient care shall comply

with the following:


The licensee shall establish and follow a written preventive maintenance

program to ensure that equipment shall be operative, properly calibrated, and

cleaned regularly;


All personnel engaged in the operation of diagnostic equipment shall have

adequate training and be currently licensed, registered or certified in

accordance with applicable state statutes and administrative regulations; and


A written

plan shall be developed and maintained to provide for training of personnel in

the safe and proper usage of the equipment.

      (2) Diagnostic services. Diagnostic

services shall be performed in accordance with the specialty IC clinic’s



Protocols for diagnostic examinations shall be developed by the medical



Diagnostic services shall be provided under the supervision of a physician who

is qualified by advanced training and experience in the use of the specific

technique utilized for diagnostic purposes.


Physical examination services shall be nonabusive and provided in a manner

which ensures the greatest amount of safety and security for the patient.


Personnel performing physical examinations shall have adequate training and be

currently licensed, registered, or certified in accordance with applicable

Kentucky statutes and administrative regulations.


Personnel performing physical examinations shall be limited by the relevant

scope of practice of state licensure.


Referrals. A specialty IC clinic shall refer a patient for services that cannot

be provided at the clinic.




A specialty IC clinic shall promote a restraint free environment and ensure

that restraints are used only for medical emergencies or if the resident poses

an immediate risk to self or others.


Use of any type of restraint as a health-related protection shall be prescribed

by a physician if necessary during the conduct of specific medical procedure.


The specialty IC clinic shall have a system to monitor and decrease the use of

physical restraint and pre-sedation.



8. Physical Environment. (1) Accessibility. A specialty IC clinic shall meet

requirements for making buildings and facilities accessible to and usable by individuals

with physical disabilities pursuant to KRS 198B.260 and administrative

regulations promulgated thereunder.


Fire safety. A specialty IC clinic shall be approved by the State Fire

Marshal's office prior to initial licensure.


Housekeeping and maintenance services.


Housekeeping. A specialty IC clinic shall maintain a clean and safe facility

free of unpleasant odors. Odors shall be eliminated at their source by prompt

and thorough cleaning of commodes, urinals, bedpans and other sources.


Maintenance. The premises shall be well kept and in good repair as follows:


The clinic shall insure that the grounds are well kept and the exterior of the

building, including the sidewalks, steps, porches, ramps, and fences are in

good repair;


The interior of the building including walls, ceilings, floors, windows, window

coverings, doors, plumbing and electrical fixtures shall be in good repair.

Windows and doors which can be opened for ventilation shall be screened;


Garbage and trash shall be stored in areas separate from those used for the

preparation and storage of food and shall be removed from the premises

regularly. Containers shall be cleaned regularly;


A pest control program shall be in operation in the clinic. Pest control

services shall be provided by maintenance personnel of the facility or by

contract with a pest control company. The compounds shall be stored under lock;


Sharp wastes, such as broken glass, scalpel blades, and hypodermic needles

shall be segregated from other wastes and aggregated in rigid disposable

containers immediately after use. Needles and syringes shall not be cut,

dismantled, or destroyed after use but shall be placed intact directly into a

rigid container. The rigid containers of sharp wastes shall either be

incinerated, on site or off site, or disposed of in a sanitary landfill

approved pursuant to 401 KAR 47:080; and


The clinic shall establish a written policy for the handling and disposal of

all infectious, pathological, and contaminated waste if the clinic generates

them. Any incinerator used for the disposal of waste shall be in compliance

with 401 KAR 59:020 or 61:010.


Infectious waste shall be placed in double impervious plastic bags and each bag

shall be two (2) mils in thickness.


A bag, if full, shall not exceed twenty five (25) pounds.


All bags shall be securely closed and a tag, which reads "INFECTIOUS

WASTE" and identifies the clinic from which the waste is being removed and

shall be attached to the bag in a conspicuous manner.


All unpreserved tissue specimens procedures shall be incinerated on or off



The following wastes shall be sterilized before disposal or be disposed of by

incineration if they are combustible:


Dressings and materials from open or contaminated wounds;


Waste materials and disposable linens from isolation rooms;


Culture plates;


Test tubes;


Sputum cups; and


Contaminated sponges and swabs. (37 Ky.R. 1142; 1731; 2019; eff. 3-4-2011; TAm eff. 12-10-2012.)