902 KAR 20:180. Psychiatric hospitals; operation and services

Link to law: http://www.lrc.ky.gov/kar/902/020/180reg.htm
Published: 2015

CABINET FOR HEALTH AND

FAMILY SERVICES

Office of Inspector General

Division of Health Care

(Amendment)

 

      902 KAR 20:180. Psychiatric

hospitals; operation and services.

 

      RELATES

TO: KRS 200.503, Chapter 202A, Chapter 202B, 210.005, 216.380(7) and (8),

216B.010-216B.131, 216B.175, 216B.990, 309.080, 309.130 311.560[(3),

(4)], 311.571, 311.840 – 311.862, 314.011(8), 314.042, 319.050,

319.056, 319.064, 319C.010, 320.240(14), 335.100, 335.300, 335.080,

335.500, 42 C.F.R. Part 2, 45 C.F.R. 160, 164, 42 U.S.C. 1320d-2 – 1320d-8, 42

U.S.C. 290ee-3

      STATUTORY

AUTHORITY: KRS [202B.060,] 216B.042[(1)(a)], 216B.175(4)

      NECESSITY,

FUNCTION, AND CONFORMITY: KRS 216B.042 requires the Cabinet for Health and

Family Services[require the Kentucky Cabinet for Health Services] to

regulate health facilities and health services. This administrative regulation

establishes minimum licensure requirements for the operation and services of psychiatric

hospitals and for the provision of psychiatric services in general acute

care hospitals or critical access hospitals which have a psychiatric

unit. In addition, this administrative regulation establishes requirements

for psychiatric hospitals and general acute care hospitals or critical access

hospitals that have a psychiatric unit and elect to provide outpatient

behavioral health services.

 

      Section

1. Definitions. (1) "Behavioral health professional" means:

      (a)

A psychiatrist licensed under the laws of Kentucky to practice medicine or

osteopathy or a medical officer of the government of the United States while

engaged in the performance of official duties who is certified or eligible to

apply for certification by the American Board of Psychiatry and Neurology, Inc;

      (b)

A physician licensed in Kentucky to practice medicine or osteopathy in

accordance with KRS 311.571;

      (c)

A psychologist licensed and practicing in accordance with KRS 319.050;

      (d)

A certified psychologist with autonomous functioning or licensed psychological

practitioner practicing in accordance with KRS 319.056;

      (e)

A clinical social worker licensed and practicing in accordance with KRS

335.100;

      (f)

An advanced practice registered nurse licensed and practicing in accordance

with KRS 314.042;

      (g)

A physician assistant licensed under KRS 311.840 to 311.862;

      (h)

A marriage and family therapist licensed and practicing in accordance with KRS

335.300;

      (i)

A professional clinical counselor licensed and practicing in accordance with

KRS 335.500; or

      (j)

A licensed professional art therapist as defined by KRS 309.130(2).

      (2)

"Behavioral health professional under clinical supervision" means a:

      (a)

Psychologist certified and practicing in accordance with KRS 319.056;

      (b)

Licensed psychological associate licensed and practicing in accordance with KRS

319.064;

      (c)

Marriage and family therapist associate as defined by KRS 335.300(3);

      (d)

Social worker certified and practicing in accordance with KRS 335.080;

      (e)

Licensed professional counselor associate as defined by KRS 335.500(4); or

      (f)

Licensed professional art therapist associate as defined by KRS 309.130(3).

      (3)

"Cabinet" means the Cabinet for Health and Family Services.

      (4)

"Certified alcohol and drug counselor" is defined by KRS 309.080(2).

      (5)

"Chemical restraint" means the use of a

drug that:

      (a) Is administered to manage a patient's behavior in a way

that reduces the safety risk to the patient or others;

      (b) Has the temporary effect of restricting the patient's

freedom of movement; and

      (c) Is not a standard treatment for the patient's medical

or psychiatric condition.

      (6)

"Child with a severe emotional disability" is defined by KRS

200.503(3).

      (7)

"Community support associate" means a paraprofessional who meets the

application, training, and supervision requirements of 908 KAR 2:250.

      (8)

"Governing authority" means the individual, agency, partnership, or

corporation in which the ultimate responsibility and authority for the conduct

of the hospital[institution] is vested.

      (9)

"Licensed assistant behavior analyst" is defined by KRS 319C.010(7).

      (10)

"Licensed behavior analyst" is defined by KRS 319C.010(6).

      (11)

"Mechanical restraint" means any device attached or adjacent to a

patient's body that he or she cannot easily remove that restricts freedom of

movement or normal access to his or her body.

      (12)

"Peer support specialist" means a paraprofessional who meets the

application, training, examination, and supervision requirements of 908 KAR

2:220, 908 KAR 2:230, or 908 KAR 2:240.

      (13)

"Personal restraint" means the application of physical force without

the use of any device for the purpose of restraining the free movement of a patient's

body and does not include briefly holding without undue force a patient in

order to calm or comfort him or her or holding a patient's hand to safely

escort him or her from one (1) area to another.

      (14) "Professional

staff" means psychiatrists and other physicians, psychologists,

psychiatric nurses and other nurses, social workers and other professionals

with special education or experience in the care of persons with mental illness

and who are involved in the diagnosis and treatment of patients with mental

illness.

      (15)[(3)]

"Psychiatric unit" means a department of a critical access

hospital with a maximum of ten (10) psychiatric beds or general acute care hospital

consisting of eight (8) or more psychiatric beds organized for the purpose of

providing psychiatric services.

      (16)

"Seclusion" means the involuntary confinement of a patient alone in a

room or in an area from which the patient is physically prevented from leaving.

      (17) "Severe mental

illness" means the conditions defined by KRS 210.005(2) and (3). [(4) "Restraint"

means the application of a physical device, the application of physical body

pressure by another person in such a way as to control or limit physical

activity, or the intravenous, intramuscular, or subcutaneous administration of

a pharmacologic or chemical agent to a patient with a mental illness, with the

sole or primary purpose of controlling or limiting the physical activities of

the patient.

      (5)

"Seclusion" means the confinement of a patient with a mental illness

or mental retardation alone in a locked room.]

 

      Section

2. Applicability. (1)(a) A general acute care hospital or a critical access

hospital with a psychiatric unit shall:

      1.

Designate the location and number of beds for which licensure is sought;

      2.

Meet the requirements of 902 KAR 20:016; and

      3.

Meet the requirements of this administrative regulation.

      (b)

A facility requesting licensure[as an] exclusively as a psychiatric

hospital shall be[is] subject to the requirements of this

administrative regulation.

      (2)[(a)]

A facility shall not be licensed as, or be called, a psychiatric hospital unless

the facility:

      (a)[it]

Provides the full range of services required by Section 5 of this administrative

regulation; and

      (b)

Provides for the treatment of a variety of mental illnesses.

      (3)

A psychiatric hospital and a general acute care hospital or critical access

hospital with a psychiatric unit[(b)1. A facility with a certificate of

need that is licensed after the effective date of this administrative

regulation and] that has a mean daily census of patients whose primary diagnosis[illness]

is chemical dependency exceeding ten (10) percent of the licensed bed capacity

shall:

      (a)

Apply for a certificate of need in order to convert the necessary number of

beds to chemical dependency services;

      (b)

Meet the[. 2.] licensure requirements[are] established in 902

KAR 20:160; and

      (c)

Report the[. 3.] mean daily census[shall be as reported] in

the[last] Annual Hospital Utilization Report.

      (4)

If a psychiatric hospital or a general acute care hospital or a critical access

hospital with a psychiatric unit provides outpatient behavioral health services

as described in Section 6 of this administrative regulation:

      (a)

The outpatient behavioral health services shall be provided:

      1.

On a separate floor, in a separate wing, or in a separate building on the

hospital’s campus; or

      2.

At an extension off the campus of the hospital;

      (b)

The hospital shall pay a fee in the amount of $250 per off-campus extension

providing outpatient behavioral health services, submitted to the Office of

Inspector General at the time of:

      1.

Initial licensure, if applicable;

      2.

The addition of a new outpatient behavioral health services extension to the

hospital’s license; and

      3.

Renewal;

      (c)

Each off-campus extension or on-campus program of outpatient behavioral health

services shall:

      1.

Be listed on the hospital’s license;

      2.

Have a program director who shall be a:

      a.

Psychiatrist;

      b.

Physician;

      c.

Certified or licensed psychologist;

      d.

Licensed psychological practitioner;

      e.

Psychiatric nurse;

      f.

Advanced practice registered nurse;

      g.

Licensed professional clinical counselor;

      h.

Licensed marriage and family therapist;

      i.

Licensed professional art therapist;

      j.

Licensed board certified behavioral analyst; or

      k.

Licensed clinical social worker; and

      3.

Employ directly or by contract a sufficient number of personnel to provide

outpatient behavioral health services; and

      (d)

An off-campus extension or a separate building on the campus of the hospital

where outpatient behavioral health services are provided shall comply with the

physical environment requirements of Section 7 of this administrative

regulation and be approved by the State Fire Marshal's office prior to:

      1.

Initial licensure;

      2.

The addition of the extension or on-campus program of outpatient behavioral

health services in a separate building; or

      3.

A change of location.

 

      Section

3. Administration and Operation. (1) General requirements. A psychiatric

hospital and a general acute care hospital or critical access hospital with

a psychiatric unit shall comply with:

      (a)

This section;

      (b)

902 KAR 20:016, Section 3; and

      (c)

KRS Chapters 202A and 202B.

      (2)

Professional staff. A facility requesting licensure[as an] exclusively as

a psychiatric hospital[that operates with an organized professional

staff] shall comply with the following staffing requirements[in

this subsection] rather than those in 902 KAR 20:016, Section 3(8):

      (a)

The psychiatric[A] hospital shall have a professional staff:

      1.

Organized under bylaws approved by the governing authority;

      2.

Responsible to the governing authority for the quality of clinical care

provided to patients;[and]

      3.

Responsible for the ethical conduct and professional practice of its members;

and

      4.

Responsible for developing and adopting[. (b) The professional staff

shall develop and adopt] bylaws, subject to the approval of the governing

authority, which shall:

      a[1.]

Require that a licensed physician be responsible for admission, diagnosis, all

medical care and treatment, and discharge;

      b.[2.]

State the necessary qualifications for professional staff membership;

      c.[3.]

Define and describe the responsibilities and duties of each category of

professional staff (e.g., active, associate, courtesy, consulting, or honorary);

      d.[,]

Delineate the clinical privileges of staff members;

      e.[,

and] Establish a procedure for granting and withdrawing staff privileges, including[to

include] credentials review;

      f.[4.]

Provide a mechanism for appeal of decisions regarding staff membership and

privileges;

      g.[5.]

Provide a method for the selection of officers of the professional staff;

      h.[6.]

Establish requirements regarding the frequency of, and attendance at, general

staff and department or service meetings of the professional staff;

      i.[7.]

Provide for the appointment of standing and special committees, which may

include the following:

      (i)

Executive committee;

      (ii)

Credential committee;

      (iii)

Medicaid audit committee;

      (iv)

Medical records committee;

      (v)

Infections control committee;

      (vi)

Pharmacy and therapeutic committee;

      (vii)

Utilization review committee;

      (viii)

Quality assurance committee; and

      (ix)

Behavioral health committee;

      j.

Establish the[and include requirements for] composition and

organization of the standing and special committees, and assure that

the committees’ minutes and reports[which] shall be part of the

permanent records of the hospital; and

      k.[.

Committees may include: executive committee, credentials committee, medical

audit committee, medical records committee, infections control committee,

pharmacy and therapeutic committee, utilization review committee, and quality

assurance committee; and

      8.]

Establish a policy requiring a physician, or other member of the professional

staff permitted to order diagnostic testing and treatment, to sign telephone

orders for diagnostic testing and treatment within seventy-two (72) hours of

the time the order was given.

      (b)

A psychiatric[(c) A] hospital shall develop a process of appointment

to the professional staff which shall ensure that the individual[will

assure that the person] requesting staff membership is appropriately

licensed, certified, registered, or experienced, and qualified for the

privileges and responsibilities sought.

      (3)

Background checks.

      (a)

All personnel of a state-owned and operated

psychiatric hospital and all personnel of a privately operated psychiatric

center under contract with the Department for Behavioral Health, Developmental

and Intellectual Disabilities who are hired after the effective date of this

administrative regulation and have duties that involve or may involve

one-on-one contact with a patient or client shall:

      1. Have a criminal record check performed upon initial

hire through the Administrative Office of the Courts or the Kentucky State

Police;

      2. Not have a criminal conviction, or plea of guilty, to

a:

      a. Sex crime as specified in KRS 17.500;

      b. Violent crime as specified in KRS 439.3401;

      c. Criminal offense against a minor as specified in KRS

17.500; or

      d. Class A felony; and

      3. Not be listed on the following:

      a. Central registry established by 922 KAR 1:470;

      b. Nurse aide or home health aide abuse

registry established by 906 KAR 1:100; or

      c. Caregiver misconduct registry required by KRS 209.032

and established by 922 KAR 5:120.

      (b) A state-owned and operated psychiatric hospital, or a

privately operated psychiatric center under contract with the Department for

Behavioral Health, Developmental and Intellectual Disabilities, may use

Kentucky’s national background check system established by 906 KAR 1:190 to

satisfy the background check requirements of paragraph (a) of this subsection.

      (c) A state-owned and operated psychiatric hospital and a

privately operated psychiatric center under contract with the Department for

Behavioral Health, Developmental and Intellectual Disabilities shall perform

annual criminal record and registry checks as described in paragraph (a) of

this subsection on a random sample of at least fifteen (15) percent of all

personnel.

      (4)

Policies for psychiatric hospitals and general acute care hospitals or critical

access hospitals with a psychiatric unit.

      (a)[A

hospital's] Written admission and discharge policies shall be consistent

with the requirements of KRS Chapters 202A and 202B.

      (b)[A

hospital shall have] Written policies pertaining to patient rights and the

use of restraints and seclusion shall be[,] consistent with KRS

Chapters 202A and 202B.

      (c)[A

hospital shall have] Written policies concerning the use of special

treatment procedures as described in Section 4(3) of this administrative

regulation[that may have abuse potential, or be life-threatening, and]

shall specify the qualifications required for professional staff using special

treatment procedures.

      (5)[(4)]

Patient rights. A psychiatric hospital and a general acute care

hospital or critical access hospital with a psychiatric unit shall assure

that patient rights are provided for pursuant to KRS Chapters 202A and 202B.

      (6)[(5)]

Medical records.

      (a)

Ownership.

      1.

Medical records shall be the property of the hospital.

      2.

The original medical record shall not be removed from the facility except by

court order or subpoena.

      3.

Copies of a medical record or portions of the record may be used and disclosed.

Use and disclosure shall be as established in this administrative regulation.

      (b) Confidentiality and

security: use and disclosure.

      1.

The psychiatric hospital and general acute care hospital or critical access

hospital with a psychiatric unit shall maintain the confidentiality and

security of medical records in compliance with the Health Insurance Portability

and Accountability Act of 1996 (HIPAA), 42 U.S.C. 1320d-2 to 1320d-8, and 45

C.F.R. Parts 160 and 164, as amended, including the security requirements

mandated by subparts A and C of 45 C.F.R. Part 164, or as provided by

applicable federal or state law, including 42 U.S.C. 290ee-3, and the Confidentiality

of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2.

      2.

The psychiatric hospital and general acute care hospital or critical access

hospital with a psychiatric unit may use and disclose medical records. Use and

disclosure shall be as established or required by:

      a.

HIPAA, 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164; or

      b.

42 U.S.C. 290ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient

Records, 42 C.F.R. Part 2.

      3.

This administrative regulation shall not be construed to forbid the hospital

from establishing higher levels of confidentiality and security than required

by HIPAA, 42 U.S.C. 1320d-2 to 1320d-8, and 45 C.F.R. Parts 160 and 164, or 42

U.S.C. 290ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient

Records, 42 C.F.R. Part 2.

      (c)

Patient information.[shall be released only on written consent of the

patient or the patient's authorized representative, or as otherwise authorized

by law. The written consent shall contain the following information:

      1.

The name of the person, agency or organization to which the information is to

be disclosed;

      2.

The specific information to be disclosed;

      3.

The purpose of disclosure; and

      4.

The date the consent was signed and the signature of the individual witnessing

the consent.

      (b)

In addition to the requirements of 902 KAR 20:016, Section 3(11)(d)] The

medical record shall contain:

      1.

Appropriate court order or consent of patient, authorized family member or

guardian for admission, evaluation, and treatment;

      2.

A provisional or admitting diagnosis which includes a physical diagnosis, if

applicable, and a[psychiatric] diagnosis of mental health disorder,

substance use disorder, or co-occurring disorder;

      3.

Results of the psychiatric evaluation;

      4.

A complete social history;

      5.

An individualized comprehensive treatment plan;

      6.

Progress notes, dated and signed by physician, nurse, social worker,

psychologist, or other individuals involved in treatment of patient. Progress

notes shall document services and treatments provided and the patient's progress

in response to the services and treatments;

      7.

A record of the patient's weight;

      8.

Special clinical justification for the use of special treatment procedures described

in Section 4(3)[specified in Section 5(3)] of this administrative

regulation;

      9.

A discharge summary which includes a:

      a.

Recapitulation of the patient's hospitalization and recommendations from

appropriate services concerning follow-up or after care;[,] and

      b.[a]

Brief summary of the patient's condition on discharge;

      10.

If a patient dies, a summation statement in the form of a discharge summary,

including events leading to the death, signed by the attending physician; and

      11.

If an autopsy is performed, a provisional anatomic diagnosis shall be included

in the patient's record within seventy-two (72) hours[,] with the

complete summary and pathology report, including cause of death, recorded

within three (3) months.

 

      Section

4. Patient Management. (1) Assessment. A psychiatric hospital and a general

acute care hospital or critical access hospital with a psychiatric unit

shall be responsible for conducting a complete assessment of each patient.

      (a)

A provisional or admitting diagnosis, which includes the diagnosis of physical

diseases, if applicable, and the psychiatric diagnosis, shall be made for each

patient at the time of admission.

      (b)

A history and physical examination shall be conducted according to the

requirements of KRS 216B.175(2).

      1.

The history and physical examination shall include:

      a.

A description of the patient's chief complaint, the major reason for

hospitalization;

      b.

A history of the patient's:

      (i)

Present illness;

      (ii)

Past illnesses;

      (iii)

Surgeries;

      (iv)

Medications;

      (v)

Allergies;

      (vi)

Social history; and

      (vii)

Immunizations;

      c.

A review of the patient's anatomical systems and level of function at the time

of the exam;

      d.

A patient's vital signs; and

      e.

A general observation of the patient's:

      (i)

Alertness;

      (ii)

Debilities; and

      (iii)

Emotional behavior.

      2.

The results of the history and physical examination shall be recorded, reviewed

for accuracy, and signed by the practitioner conducting the examination.

(c)

A psychiatric evaluation for each patient shall:

      1.

Be completed within seventy-two (72) hours of admission; and

      2.[.

It shall] Include the following:

      a.

A medical history;

      b.

A record of mental status;

      c.

Details regarding onset of illness and circumstances leading to admission;

      d.

A description of attitudes and behavior;

      e.

An estimate of intellectual functioning, memory functioning, and orientation;

and

      f.

An inventory of the patient's assets in a descriptive, not interpretative,

fashion.

      (d)

A social assessment of each patient shall be recorded.

      (e)

An activities assessment of each patient shall be prepared and shall include

information relating to the patient's current skills, talents, aptitudes, and

interest.

      (f)1.

If[When] appropriate, nutritional, vocational, and legal assessments

shall be conducted.

      2.

The legal assessment shall be used to determine the extent to which the

patient's legal status will influence progress in treatment.

      (2)

Treatment plans.

      (a)

Each patient shall have a written individualized treatment plan that is based

on assessments of the patient’s[his] clinical needs and approved

by the patient's attending physician.

      (b)

Overall development and implementation of the treatment plan shall be assigned

to appropriate members of the professional staff.

      (c)[(a)]

Within seventy-two (72) hours following admission, a designated member of the

professional staff shall develop an initial treatment plan that is based on an

assessment of the patient's:

      1.

Presenting problems;

      2.[,]

Physical health;

      3.[,]

Emotional and behavioral status;[,] and

      4.

Other relevant factors.

      (d)

Appropriate therapeutic efforts shall begin before a master treatment plan is

finalized.[(b)] A master treatment plan shall:

      1.

Be developed by a multidisciplinary team within ten (10) days for any patient

remaining in treatment beyond the initial evaluation;

      2.[.

It shall] Be based on a comprehensive assessment of the patient's needs;[and]

    

      3.

Include a substantiated diagnosis;

      4.

Include[and the] short-term and long-range treatment needs; [and]

      5.

Address the specific treatment modalities required to meet the patient's needs;

      6.[.

1. The treatment plan shall] Include referrals for services not provided

directly by the facility;

      7.[.

2. The treatment plan shall] Contain specific and measurable goals for the

patient to achieve;

      8.[.

3. The treatment plan shall] Describe the services, activities, and

programs to be provided to the patient;

      9.[,

and shall] Specify staff members assigned to work with the patient and[also]

the time and frequency for each treatment procedure;

      10.[.

4. The treatment plan shall] Specify criteria to be met for termination of

treatment;

      11.[.

5. The] Include participation by the patient[shall participate]

to the maximum extent feasible in the development of the patient’s[his]

treatment plan[,] and document patient[such] participation[shall

be documented] in the patient's record;

      12.[.

6.] Include a specific plan for involving the patient's family or

significant others[shall be included] in development of the treatment

plan if[when] indicated; and

      13.[.

7. The treatment plan shall] Be reviewed and updated through

multidisciplinary case conferences as frequently as clinically indicated

and in accordance with the following:

      a.

The[, but in no case shall this] review and update shall be

completed:

      (i)

No later than thirty (30) days following the first ten (10) days of

treatment; and

      (ii)

Every sixty (60) days thereafter for the first year of treatment; and[.]

      b.[8.]

Following one (1) year of continuous treatment, the review and update may be

conducted at three (3) month intervals.

      (3)

Special treatment procedures.

      (a)

Special documentation shall be included in the patient's medical record

concerning the use of chemical, personal, or mechanical restraints or[,]

seclusion[and other special treatment procedures which may have abuse

potential or be life threatening].

      (b)

The documentation shall include:

      1.

The written order of a physician, advanced practice registered nurse, or

physician's assistant;

      2.

Justification for the use of the restraint or seclusion[procedure];

      3.

The required consent forms;

      4.

A description of procedures employed to protect the patient's safety and

rights; and

      5.

A description of the procedure used.

      (c)

The use of chemical, personal, or mechanical[physical] restraints

and seclusion shall be governed by the following:

      1.

Restraint or seclusion shall be used only to prevent:

      a.

A patient from injuring himself, herself, or others;[,] or

      b.[to

prevent] Serious disruption of the therapeutic program;

      2.

A written, time-limited order from a physician, advanced practice registered nurse,

or physician assistant shall be required for the use of restraint or seclusion;

      3.

The head of the medical staff shall give written approval when restraint or

seclusion is utilized for longer than twenty-four (24) hours;

      4.

PRN orders shall not be used to authorize the use of restraint or seclusion;

      5.

The head of the medical staff or his or her designee shall:

      a.

Review daily all uses of restraint or seclusion; and

      b.[shall]

Investigate unusual or possibly unwarranted patterns of utilization;

      6.

Restraint or seclusion shall not be used in a manner that causes undue physical

discomfort, harm, or pain to the patient;

      7.a.

Appropriate attention shall be paid every fifteen (15) minutes to a patient in

restraint or seclusion, including attention[especially] in regard

to regular meals, bathing, and use of the toilet; and

      b.

Staff shall document in the patient's record that the attention was given to

the patient.

      (d)

Locking mechanical restraints may be used pursuant to[in the

circumstances outlined in] subparagraph 5 of this paragraph[,] if

the cabinet has previously found that the facility has instituted policies

which comply with the provisions of paragraph (c) of this subsection and the

following requirements:

      1.

Keys. A facility's direct care nursing staff shall:

      a.

Have in their possession at least two (2) keys to a locking restraint so that

the restraint can be removed immediately in the case of an emergency;

      b.

Have a plan which designates[designating] nursing staff responsible

for the keys; and

      c.

Follow written policy which explains[An explanation of] how the

keys are to be used.

      2.

An order for a locking mechanical restraint[Orders for the locking

restraints] shall be time-limited as follows:

      a.

Four (4) hours for adults eighteen (18) years of age or older up to a

maximum of twenty-four (24) hours, during which time the continued need for the

restraint shall be evaluated at fifteen (15) minute intervals until the maximum

time is reached;

      b.

Two (2) hours for children and adolescents ages nine (9) to seventeen (17) up

to a maximum of twenty-four (24) hours, during which time the continued need

for the restraint shall be evaluated at fifteen (15) minute intervals until the

maximum time is reached;

      c.

One (1) hour for patients under the age of nine (9) up to a maximum of

twenty-four (24) hours, during which time the continued need for the restraint

shall be evaluated at fifteen (15) minute intervals until the maximum time is

reached; and

      d.

Orders pursuant to this paragraph shall specify the restraint type and criteria

for release in the patient's medical record.

      3.a.

If, after twenty-four (24) hours, a patient still appears to need restraint,

the patient shall receive a face-to-face reassessment by a licensed physician.

      b.

If the physician determines that continued restraint is necessary, the

physician shall write a time-limited order according to the time frames set out

in subparagraph 2 of this paragraph[subsection (2) of this section];

      4.

A facility may reinstitute the use of a restraint that has been discontinued if

the time frame limited order for the restraint has not expired; and

      5.

A facility found to be in compliance with this section may use locking mechanical

restraints only under the following circumstances:

      a.

For the transport of forensic or other impulsively violent patients;

      b.

For the crisis situation stabilization of forensic and other impulsively

violent patients;

      c.

To prevent a patient who has demonstrated the ability to escape from a

nonlocking mechanical restraint on one (1) or more occasions; or

      d.

For a patient requiring ambulatory restraints as approved by a behavioral

health management team.

 

      Section

5. Provision of Services. (1) Psychiatric and general medical services.

      (a)

Psychiatric services shall be under the supervision of a clinical director,

service chief, or equivalent, who is qualified as follows to provide the

leadership required for an intensive treatment program:[.]

      1.

The clinical director, or equivalent, shall be certified by the American Board

of Psychiatry and Neurology, or shall meet the training and experience

requirements for examination by the board.

      2.

If the psychiatrist in charge of the clinical program is not board certified,

there shall be evidence that consultation is given to the clinical program on a

continuing basis by a psychiatrist certified by the American Board of

Psychiatry and Neurology.

      (b)

General medical services provided in the psychiatric hospital or general

acute care hospital or a critical access hospital with a psychiatric unit

shall be under the direction of a physician member of the professional staff in

accordance with staff privileges granted by the governing authority.

      1.a.

The attending physician shall assume full responsibility for diagnosis and care

of his or her patient.

      b.

Services provided by a physician assistant or advanced practice registered

nurse shall be provided within the practitioner’s[Physician assistants

and advanced practice registered nurses may provide services in accordance with

their] scope of practice and the hospital's protocols and bylaws.

      2.a.

Incidental medical services necessary for the care and support of patients

shall be provided by in-house staff or through agreement with outside

resources.

      b.

If a patient's condition requires services not available in the hospital, the

patient, on physician's orders, shall be transferred promptly to an appropriate

level of care.

      c.

A physician's order is not necessary in the case of an emergency.

      3.

There shall be a written plan delineating the manner in which emergency

services are provided by the hospital or through clearly defined arrangements

with another facility. The plan shall clearly specify the following:

      a.

The arrangement[arrangements] the hospital has made to assure

that the patient being transferred for emergency services to a nonpsychiatric

facility will continue to receive further evaluation or treatment of the

psychiatric problem, as needed;

      b.

The policy for referring a patient in need of[needing] continued

psychiatric care after emergency services back to the referring facility; and

      c.

The policy for notifying a patient's family of an emergency and[of]

arrangements that have been made for referring or transferring the patient to

another facility for emergency service.

      (c)

Physician services shall be available twenty-four (24) hours a day on at least

an on-call basis.

      (d)

There shall be sufficient physician staff coverage for all psychiatric and

medical services of the hospital, in keeping with their size and scope of

activity.

      (e)

The attending physician shall state the final diagnosis, complete the discharge

summary, and sign the records within fifteen (15) days following the patient's

discharge.

      (2)

Nursing services.

      (a)

The hospital shall have a nursing department organized to meet the nursing care

needs of the patients and maintain established standards of nursing practice.

      (b)

The psychiatric nursing service shall be under the direction of a registered

nurse who:

      1.

Has a master's degree in psychiatric or mental health nursing, or its

equivalent, from a school of nursing accredited by the National League for

Nursing; or

      2.

Has a baccalaureate degree in nursing with two (2) years' experience in nursing

administration or supervision and experience in psychiatric nursing.

      (c)

There shall be a registered nurse on duty twenty-four (24) hours a day.

      (d)

There shall be an adequate number of registered nurses, licensed practical

nurses, and other nursing personnel to provide the nursing care necessary under

each patient's active treatment program.

      (e)

There shall be continuing in-service and staff development programs to prepare

nursing personnel for active participation in interdisciplinary meetings

affecting the planning or implementation of nursing care plans for patients.

      (3)

Psychological services.

      (a)

The hospital shall provide psychological services to meet the needs of

patients.

      (b)

Psychological services shall be provided under the direction of a licensed

psychologist.

      (c)

There shall be an adequate number of psychologists, consultants, and supporting

personnel to:

      1.

Assist in essential diagnostic formulations;

      2.[,

and to] Participate in program development;

      3.

Participate in the[and] evaluation of program effectiveness; and

      4.

Participate[,] in training activities and in therapeutic interventions.

      (4)

Therapeutic activities.

      (a)

The hospital shall provide a therapeutic activities program that shall:

      1.

Be appropriate to the needs and interests of the patients; and

      2.

Directed toward restoring and maintaining optimal levels of physical and

psychosocial functioning.

      (b)

The number of qualified therapists, support personnel, and consultants shall be

adequate to provide comprehensive therapeutic activities, including[such

as] occupational, recreational, and physical therapy, consistent with each

patient's active treatment program.

      (5)

Pharmaceutical services. The hospital shall comply with requirements of 902 KAR

20:016, Section 4(5), and the following requirements:

      (a)

Medication shall be administered by one (1) of the following:

      1.[a]

Registered nurse;

      2.[,

a] Physician;

      3.[,

a] Dentist;

      4.[,

a] Physician's assistant;[,] or

      5.[an]

Advanced practice registered nurse, except in the case of a licensed practical

nurse under the supervision of a registered nurse.

      (b)1.

Medication shall be given only by written order signed within seventy-two

(72) hours by one (1) of the following:

      a.[a]

Physician;

      b.[,]

Dentist;

      c.[,]

Advanced practice registered nurse;

      d.[,]

Therapeutically-certified optometrist;[,] or

      e.

Physician assistant.

      2.

A telephone order for medication shall be given to only a:

      a.

Licensed practical nurse;

      b.[or]

Registered nurse; [,] or

      c.[a]

Pharmacist.

      3.[The

order shall be signed by the ordering physician, dentist, advanced registered

nurse practitioner, therapeutically-certified optometrist, or physician

assistant within seventy-two (72) hours from the time the order is given.]

A telephone order may be given to a licensed physical, occupational, speech, or

respiratory therapist in accordance with the therapist's scope of practice and

the hospital's protocol.

      (6)

Laboratory services. A hospital shall comply with 902 KAR 20:016, Section 4(4),

concerning the provision of laboratory and pathology services.

      (7)

Social services.

      (a)

A hospital shall provide social services to meet the need of the patients.

      (b)

There shall be a director of social services who has a master's degree from an

accredited school of social work.

      (c)

There shall be an adequate number of social workers, consultants, and other

assistants or case aides to perform the following functions:

      1.

Secure information about a patient's development and current life situation in

order to provide psychosocial data for diagnosis and treatment planning and for

direct therapeutic services to a patient, patient group, or family;

      2.

Identify or develop community resources including family or foster care

programs;

      3.

Participate in interdisciplinary conferences and meetings concerning diagnostic

formulation, treatment planning and progress reviews; and

      4.

Participate in discharge planning, arrange for follow-up care, and develop a

mechanism for exchange of appropriate information with a source outside the

hospital.

      (8)

Dietary services. A hospital shall comply with 902 KAR 20:016, Section 4(3),

pertaining to the provision of dietary services, and requirements contained in

this subsection.

      (a)

Dietary service personnel who have personal contact with the patients shall be

made aware that emotional factors may cause patients to change their food

habits and shall inform appropriate members of the professional staff of any

change.

      (b)

Meals shall be provided in central dining areas for ambulatory patients.

      (9)

Radiology services.

      (a)

If radiology services are provided within the facility, the hospital shall

comply with 902 KAR 20:016, Section 4(6), concerning the provision of

radiology services.

      (b)1.

If radiology services are not provided within the facility, the hospital shall

have an arrangement with an outside source.

      2.

The arrangement shall be outlined in a written plan.

      3.

The outside radiology service shall have a current license or registration

pursuant to KRS 211.842 to 211.852 and relevant administrative regulations.

      (10)

Other services. If surgery, anesthesia, physical therapy or outpatient services

are provided within the facility, the hospital shall comply with the applicable

sections of 902 KAR 20:016.

      (11)

Chemical dependency treatment services. A psychiatric hospital providing

chemical dependency treatment services shall meet the requirements of 902 KAR

20:160, Sections 3 and 4, and shall designate the location and number of beds

to be used for this purpose.

 

      Section

6. Outpatient behavioral health services. (1) A psychiatric hospital or general

acute care or critical access hospital with a psychiatric unit may provide one

(1) or more of the following outpatient behavioral health services on the

campus of the hospital if provided on a separate floor, in a separate wing, in

a separate building on the hospital’s campus, or at an off-site extension

location:

      (a)

Screening which shall be provided by a behavioral health professional,

behavioral health professional under clinical supervision, or certified alcohol

and drug counselor to determine the:

      1.

Likelihood that an individual has a mental health, substance use, or

co-occurring disorder; and

      2.

Need for an assessment;

      (b)

Assessment which shall:

      1.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor who gathers information and engages

in a process with the client, thereby enabling the professional to:

      a.

Establish the presence or absence of a mental health, substance use, or

co-occurring disorder;

      b.

Determine the client’s readiness for change;

      c.

Identify the client’s strengths or problem areas which may affect the treatment

and recovery processes; and

      d.

Engage the client 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 client to develop a plan of care if a clinical

disorder or service need is assessed; and

      4.

Not include psychological or psychiatric evaluations or assessments;

      (c)

Psychological testing which shall:

      1.

Be performed by a licensed psychologist, licensed psychological associate, or

licensed psychological practitioner; and

      2.

Include a psychodiagnostic assessment of personality, psychopathology,

emotionality, or intellectual disabilities and interpretation and written

report of testing results;

      (d)

Crisis intervention which:

      1.

Shall be a therapeutic intervention for the purpose of immediately reducing or

eliminating the risk of physical or emotional harm to the client or another

individual;

      2.

Shall consist of clinical intervention and support services necessary to

provide integrated crisis response, crisis stabilization interventions, or

crisis prevention activities;

      3.

Shall be provided:

      a.

On-site at the facility;

      b.

As an immediate relief to the presenting problem or threat; and

      c.

In a face-to-face, one (1) on one (1) encounter;

      4.

May include verbal de-escalation, risk assessment, or cognitive therapy;

      5.

Shall be provided by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Certified alcohol and drug counselor;

      6.

Shall be followed by a referral to noncrisis services, if applicable; and

      7.

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;

      (e)

Mobile crisis services which shall:

      1.

Be available twenty-four (24) hours a day, seven (7) days a week, every day of

the year;

      2.

Be provided for a duration of less than twenty-four (24) hours;

      3.

Not be an overnight service; and

      4.

Be a multi-disciplinary team based intervention that ensures access to acute

mental health and substance use services and supports to:

      a.

Reduce symptoms or harm; or

      b.

Safely transition an individual in an acute crisis to the appropriate, least

restrictive level of care;

      5.

Involve all services and supports necessary to provide:

      a.

Integrated crisis prevention;

      b.

Assessment and disposition;

      c.

Intervention;

      d.

Continuity of care recommendations; and

      e.

Follow-up services;

      6.

Be provided face-to-face in a home or community setting by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Certified alcohol and drug counselor; and

      7.

Ensure access to a board certified or board-eligible psychiatrist twenty-four

(24) hours a day, seven (7) days a week, every day of the year;

      (f)

Day treatment which shall:

      1.

Be a nonresidential, intensive treatment program designed for children who:

      a.

Have a substance use disorder, mental health disorder, or co-occurring

disorder;

      b.

Are under twenty-one (21) years of age; and

      c.

Are at high risk of out-of-home placement due to a behavioral health issue;

      2.

Consist of an organized behavioral health program of treatment and

rehabilitative services for substance use disorder, mental health disorder, or

a co-occurring disorder;

      3.

Have unified policies and procedures that address the organization’s

philosophy, admission and discharge criteria, admission and discharge process,

staff training, and integrated case planning;

      4.

Include the following:

      a.

Individual outpatient therapy, family outpatient therapy, or group outpatient

therapy;

      b.

Behavior management and social skill training;

      c.

Independent living skills that correlate to the age and development stage of

the client; and

      d.

Services designed to explore and link with community resources before discharge

and to assist the client and family with transition to community services after

discharge;

      5.

Be provided as follows:

      a.

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);

      b.

On school days and during scheduled school breaks;

      c.

In coordination with the child’s individual educational plan or Section 504

plan if the child has an individual educational plan or Section 504 plan;

      d.

By personnel that includes a behavioral health professional, a behavioral

health professional under clinical supervision, a certified alcohol and drug

counselor, or a peer support specialist; and

      e.

According to a linkage agreement with the local education authority that

specifies the responsibilities of the local education authority and the day

treatment provider; and

      6.

Not include a therapeutic clinical service that is included in a child’s

individualized education plan;

      (g)

Peer support which shall:

      1.

Be provided by a peer support specialist;

      2.

Be structured and scheduled nonclinical therapeutic activity with a client or

group of clients;

      3.

Promote socialization, recovery, self-advocacy, preservation, and enhancement

of community living skills; and

      4.

Be identified in the client’s plan of care;

      (h)

Intensive outpatient program services which shall:

      1. Offer a multi-modal, multi-disciplinary

structured outpatient treatment program that is more intensive than individual

outpatient therapy, group outpatient therapy, or family outpatient therapy;

      2. Be provided at least three (3) hours per day

at least three (3) days per week;

      3. Include the following:

      a. Individual outpatient therapy;

      b. Group outpatient therapy;

      c. Family outpatient therapy unless

contraindicated;

      d. Crisis intervention; or

      e. Psycho-education during which the client or

client’s family member shall be:

      (i) Provided with knowledge regarding the

client’s diagnosis, the causes of the condition, and the reasons why a

particular treatment might be effective for reducing symptoms; and

      (ii) Taught how to cope with the client’s

diagnosis or condition in a successful manner;

      4. Include a treatment plan which shall:

      a. Be individualized; and

      b. Focus on stabilization and transition to a

lower level of care;

      5. Be provided by a behavioral health professional,

behavioral health professional under clinical supervision, or a certified

alcohol and drug counselor;

      6. Include access to a board-certified or

board-eligible psychiatrist for consultation;

      7. Include access to a psychiatrist, other

physician, or advanced practice registered nurse for medication prescribing and

monitoring; and

      8. Be provided in a setting with a minimum

client-to-staff ratio of ten (10) clients to one (1) staff person;

      (i)

Individual outpatient therapy which shall:

      1.

Be provided to promote the:

      a.

Health and wellbeing of the client; or

      b.

Recovery from a substance related disorder;

      2.

Consist of:

      a.

A face-to-face encounter with the client; and

      b.

A behavioral health therapeutic intervention provided in accordance with the

client’s plan of care;

      3.

Be aimed at:

      a.

Reducing adverse symptoms;

      b.

Reducing or eliminating the presenting problem of the client; and

      c.

Improving functioning;

      4.

Not exceed three (3) hours per day; and

      5.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor;

      (j)

Group outpatient therapy which shall:

      1.

Be provided to promote the:

      a.

Health and wellbeing of the client; or

      b.

Recovery from a substance related disorder;

      2.

Consist of a face-to-face behavioral health therapeutic intervention provided

in accordance with the client’s plan of care;

      3.

Excluding multi-family group therapy, be provided in a group setting of

nonrelated individuals, not to exceed twelve (12) individuals in size. For

group outpatient therapy, a nonrelated individual means any individual who is

not a spouse, significant other, parent or person with custodial control,

child, sibling, stepparent, stepchild, step-brother, step-sister,

father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law,

sister-in-law, grandparent, or grandchild;

      4.

Focus on the psychological needs of the client as evidenced in the client’s

plan of care;

      5.

Center on goals including building and maintaining healthy relationships,

personal goals setting, and the exercise of personal judgment;

      6.

Not include physical exercise, a recreational activity, an educational activity,

or a social activity;7. Not exceed three (3) hours per day per client unless

additional time is medically necessary in accordance

with 907 KAR 3:130;

      8.

Ensure that the group has a deliberate focus and defined course of treatment;

      9.

Ensure that the subject of group outpatient therapy shall be related to each

client participating in the group; and

      10.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor who shall maintain individual notes

regarding each client within the group in the client’s record;

      (k)

Family outpatient therapy which shall:

      1.

Consist of a face-to-face behavioral health therapeutic intervention provided

through scheduled therapeutic visits between the therapist, at least one (1)

member of the client’s family, and the client unless the client’s presence is

not required in his or her plan of care;

      2.

Address issues interfering with the relational functioning of the family;

      3.

Seek to improve interpersonal relationships within the client’s home

environment;

      4.

Be provided to promote the health and wellbeing of the client or recovery from

a substance use disorder;

      5.

Not exceed three (3) hours per day per client unless additional time is

medically necessary in accordance with 907

KAR 3:130; and

      6.

Be provided by a behavioral health professional, a behavioral health

professional under clinical supervision, or a certified alcohol and drug

counselor;

      (l)

Collateral outpatient therapy which shall consist of a face-to-face behavioral

health consultation on behalf of a client under the age of twenty-one (21):

      1.

With a parent, caregiver, person who has custodial control, household member,

legal representative, school personnel, or treating professional;

      2.

Provided by a behavioral health professional, behavioral health professional

under clinical supervision, licensed behavior analyst, licensed assistant

behavior analyst working under the supervision of a licensed behavior analyst,

or a certified alcohol and drug counselor; and

      3.

Provided upon the written consent of a parent, caregiver, or person who has

custodial control of a client under the age of twenty-one (21). Documentation

of written consent shall be signed and maintained in the client’s record;

      (m)

Service planning which shall be provided by a behavioral health professional,

behavioral health professional under clinical supervision, licensed behavior

analyst, or licensed assistant behavior analyst working under the supervision

of a licensed behavior analyst to:

      1.

Assist a client in creating an individualized plan for services needed for

maximum reduction of the effects of a mental health disorder;

      2.

Restore a client’s functional level to the client’s best possible functional

level; and

      3.

Develop a service plan which:

      a.

Shall be directed by the client; and

      b.

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;

      (n)

Screening, brief intervention, and referral to treatment for substance use

disorders which shall:

      1.

Be an evidence-based early intervention approach for an individual with

non-dependent substance use prior to the need for more extensive or specialized

treatment;

      2.

Consist of:

      a.

Using a standardized screening tool to assess the individual for risky

substance use behavior;

      b.

Engaging a client who demonstrates risky substance use behavior in a short

conversation, providing feedback and advice;

      c.

Referring the client to therapy or other services that address substance use if

the client is determined to need additional services; and

      3.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, or a certified alcohol and drug counselor;

      (o)

Assertive community treatment for mental health disorders which shall:

      1.

Include assessment, treatment planning, case management, psychiatric services,

medication prescribing and monitoring, individual and group therapy, peer

support, mobile crisis services, mental health consultation, family support,

and basic living skills;

      2.

Be provided by a multidisciplinary team of at least four (4) professionals,

including a psychiatrist, nurse, case manager, peer support specialist and any

other behavioral health professional or behavioral health professional under

clinical supervision; and

      3.

Have adequate staffing to ensure that no caseload size exceeds ten (10)

participants per team member;

      (p)

Comprehensive community support services which shall:

      1.

Consist of activities needed to allow an individual with a mental health

disorder to live with maximum independence in the community through the use of

skills training as identified in the client’s treatment plan;

      2.

Consist of using a variety of psychiatric rehabilitation techniques to:

      a.

Improve daily living skills;

      b.

Improve self-monitoring of symptoms and side effects;

      c.

Improve emotional regulation skills;

      d.

Improve crisis coping skills;

      e.

Develop and enhance interpersonal skills; and

      f.

Be provided by a;

      (i)

Behavioral health professional;

      (ii)

Behavioral health professional under clinical supervision;

      (iii)

Community support associate;

      (iv)

Licensed behavior analyst; or

      (v)

Licensed assistant behavior analyst working under the supervision of a licensed

behavior analyst;

      (q)

Therapeutic rehabilitation program for an adult with a severe mental illness or

child with a severe emotional disability which shall:

      1.

Include services designed to maximize the reduction of mental illness or

emotional disability and restoration of the client’s functional level to the

individual’s best possible functioning;

      2.

Establish the client’s own rehabilitative goals within the person-centered plan

of care;

      3.

Be delivered using a variety of psychiatric rehabilitation techniques focused

on:

      a.

Improving daily living skills;

      b.

Self-monitoring of symptoms and side effects;

      c.

Emotional regulation skills;

      d.

Crisis coping skills; and

      e.

Interpersonal skills; and

      4.

Be provided individually or in a group by a:

      a.

Behavioral health professional;

      b.

Behavioral health professional under clinical supervision; or

      c.

Peer support specialist;

      (r)

Targeted case management services which shall:

      1.

Include services to one (1) or more of the following target groups:

      a.

An adult or a child with substance use disorder;

      b.

An adult or child with co-occurring mental health or substance use disorder and

chronic or complex physical health issues;

      c.

A child with a severe emotional disability; or

      d.

An adult with severe mental illness;

      2.

Be provided by a case manager as described in subsection (2), (3), or (4) of

this section; and

      3.

Include the following assistance:

      a.

Comprehensive assessment and reassessment of client needs to determine the need

for medical, educational, social, or other services. The reassessment shall be

conducted annually or more often if needed based on changes in the client’s

condition;

      b.

Development of a specific care plan which shall be based on information

collected during the assessment and revised if needed upon reassessment;

      c.

Referral and related activities, which may include:

      (i)

Scheduling appointments for the client to help the individual obtain needed

services; or

      (ii)

Activities that help link the client with medical, social, or educational

providers or other programs and services which address identified needs and

achieve goals specified in the care plan;

      d.

Monitoring which shall be face-to-face and occur no less than once every three

(3) months to determine that:

      (i)

Services are furnished according to the client’s care plan;

      (ii)

Services in the care plan are adequate; and

      (iii)

Changes in the needs or status of the client are reflected in the care plan;

and

      e.

Contacts with the client, family members, service providers, or others are

conducted as frequently as needed to help the client:

      (i)

Access services;

      (ii)

Identify needs and supports to assist the client in obtaining services; and

      (iii)

Identify changes in the client’s needs; or

      (s)

Partial hospitalization which shall:

      1.

Be provided by a behavioral health professional, behavioral health professional

under clinical supervision, professional equivalent, mental health associate,

or certified alcohol and drug counselor;

      2.

Be a short-term (average of four (4) to six (6) weeks), less than twenty-four

(24)-hour, intensive treatment program for an individual who is experiencing

significant impairment to daily functioning due to substance use disorder,

mental health disorder, or co-occurring disorder;

      3.

Be provided to an adult or a child;

      4.

Ensure that admission criteria for partial hospitalization is based on an

inability to adequately treat the individual through community-based therapies

or intensive outpatient services;

      5.

Consist of individual outpatient therapy, group outpatient therapy, family

outpatient therapy, or medication management;

      6.

Typically be provided for at least four (4) hours per day and focused on one

(1) primary presenting problem, which may include substance use, sexual

reactivity, or another problem; and

      7.

Include the following personnel for the purpose of providing medical care if

necessary:

      a.

An advanced practice registered nurse;

      b.

A physician assistant or physician available on site; and

      c.

A board-certified or board-eligible psychiatrist available for consultation.

      (2)

A case manager who provides targeted case management services pursuant to

subsection (1)(r) of this section to clients with a substance use disorder

shall:

      (a)

Be a certified alcohol and drug counselor, meet the grandfather requirements of

907 KAR 15:040, Section 4(1)(a)3, or have a bachelor’s degree in a human

services field, including:

      1.

Psychology;

      2.

Sociology;

      3.

Social work;

      4.

Family studies;

      5.

Human services;

      6.

Counseling;

      7.

Nursing;

      8.

Behavioral analysis;

      9.

Public health;

      10.

Special education;

      11.

Gerontology;

      12.

Recreational therapy;

      13.

Education;

      14.

Occupational therapy;

      15.

Physical therapy;

      16.

Speech-language pathology;

      17.

Rehabilitation counseling; or

      18.

Faith-based education;

      (b)1.

Have a minimum of one (1) year of full-time employment working directly with

adolescents or adults in a human service setting after completion of a

bachelor’s degree as described in paragraph (a) of this subsection; or

      2.

Have a master’s degree in a human services field as described in paragraph (a)

of this subsection;

      (c)1.

Have successfully completed case management training in accordance with 908 KAR

2:260; and

      2.

Successfully complete continuing education requirements in accordance with 908

KAR 2:260; and

      (d)

Be supervised by a behavioral health professional who:

      1.

Has completed case management training in accordance with 908 KAR 2:260; and

      2.

Has supervisory contact at least two (2) times per month with at least one (1)

of the contacts on an individual, in person basis.

      (3)

A case manager who provides targeted case management services pursuant to

subsection (1)(r) of this section to clients with a mental health or substance

use disorder and chronic or complex physical health issues shall:

      (a)

Meet the requirements of subsection (2)(a) of this section;

      (b)1.

After completion of a bachelor’s degree, have a minimum of five (5) years of

experience providing service coordination or referring clients with complex

behavioral health needs and co-occurring disorders or multi-agency involvement

to community based services; or

      2.

After completion of a master’s degree in a human services field as described in

subsection (2)(a) of this section, have a minimum of two (2) years of

experience providing service coordination or referring clients with complex

behavioral health needs and co-occurring disorders or multi-agency involvement

to community based services;

      (c)1.

Have successfully completed case management training in accordance with 908 KAR

2:260; and

      2.

Successfully complete continuing education requirements in accordance with 908

KAR 2:260; and

      (d)

For a bachelor’s level case manager, be supervised by a behavioral health

professional who:

      1.

Has completed case management training in accordance with 908 KAR 2:260; and

      2.

Has supervisory contact at least three (3) times per month with at least two

(2) of the contacts on an individual, in person basis.

      (4)

A case manager who provides targeted case management services pursuant to

subsection (1)(r) of this section to children with a severe emotional

disability or clients with a severe mental illness shall:

      (a)

Meet the requirements of subsection (2)(a) of this section;

      (b)1.

Have a minimum of one (1) year of full-time employment working directly with

individuals with behavioral health needs after completion of a bachelor’s

degree in a behavioral science field as described in subsection (2)(a) of this

section; or

      2.

Have a master’s degree in a human services field as described in subsection (2)(a)

of this section;

      (c)1.

Have successfully completed case management training in accordance with 908 KAR

2:260; and

      2.

Successfully complete continuing education requirements in accordance with 908

KAR 2:260; and

      (d)

Be supervised by a behavioral health professional who:

      1.

Has completed case management training in accordance with 908 KAR 2:260; and

      2.

Has supervisory contact at least two (2) times per month with at least one (1)

of the contacts on an individual, in person basis.

      (5)

Plan of care.

      (a)

Each client receiving outpatient behavioral health services from a psychiatric

hospital or general acute care or critical access hospital with a psychiatric

unit shall have an individual plan of care signed by a behavioral health

professional.

      (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 the

chemical dependency treatment program; and

      8.

State the date scheduled for review of the plan.

      (c)

The client shall participate to the maximum extent feasible in the development

of his or her plan of care, and the participation shall be documented in the

client's record.

      (d)1.

The initial plan of care shall be developed through multidisciplinary team

conferences at least thirty (30) days following the first ten (10) days of

treatment.

      2.

The plan of care for individuals receiving intensive outpatient program

services shall be reviewed every thirty (30) days thereafter and updated every

sixty (60) days or earlier if clinically indicated.

      3.

Except for intensive outpatient program services, the plan of care for

individuals receiving any other outpatient behavioral health service described

in subsection (1) of this section shall be reviewed and updated every six (6)

months or earlier if clinically indicated.

      4.

The plan of care and each review and update shall be signed by the participants

in the multidisciplinary team conference that developed it.

      (6)

Client Records.

      (a)

A client record shall be maintained for each individual receiving outpatient

behavioral health services.

      (b)

Each entry shall be current, dated, signed, and indexed according to the

service received.

      (c)

Each client record shall contain:

      1.

An identification sheet, including the client’s name, address, age, gender,

marital status, expected source of payment, and referral source;

      2.

Information on the purpose for seeking a service;

      3.

If applicable, consent of appropriate family members or guardians for

admission, evaluation, and treatment;

      4.

Screening information pertaining to the mental health or substance use

disorder;

      5.

If applicable, a psychosocial history;

      6.

If applicable, staff notes on services provided;

      7.

If applicable, the client’s plan of care;

      8.

If applicable, disposition;

      9.

If applicable, assigned status;

      10.

If applicable, assigned therapists; and

      11.

If applicable, a termination study recapitulating findings and events during

treatment, clinical impressions, and condition on termination.

 

      Section

7. Physical environment of an off-campus extension or separate building on the

campus of the hospital where outpatient behavioral health services are

provided. (1) Accessibility. The off-campus extension or separate building on

the campus of the hospital shall meet requirements for making buildings and

facilities accessible to and usable by individuals with physical disabilities

pursuant to KRS 198B.260 and 815 KAR 7:120.

      (2)

Physical location and overall environment.

      (a)

The program shall:

      1.

Comply with building codes, ordinances, and administrative regulations which

are enforced by city, county, or state jurisdictions;

      2.

Display a sign that can be viewed by the public that contains the facility

name, hours of operation, and a street address;

      3.

Have a publicly listed telephone number and a dedicated phone number to send

and receive faxes with a fax machine that shall be operational twenty-four (24)

hours per day;

      4.

Have a reception and waiting area;

      5.

Provide a restroom; and

      6.

Have an administrative area.

      (b)

The condition of the physical location and the overall environment shall be

maintained in such a manner that the safety and well-being of clients,

personnel, and visitors are assured.

      (3)

Prior to occupancy, the facility shall have final approval from appropriate

agencies.

 

MARYELLEN

B. MYNEAR, Inspector General

AUDREY

TAYSE HAYNES, Secretary

      APPROVED

BY AGENCY: April 9, 2015

      FILED

WITH LRC: April 10, 2015 at 1 p.m.

      PUBLIC

HEARING AND PUBLIC COMMENT PERIOD: A public hearing

on this administrative regulation shall, if requested, be held on May 22, 2015

at 9:00 a.m. in Conference Suite B, Health Services Building, First Floor, 275

East Main Street, Frankfort, Kentucky. Individuals interested in attending this

hearing shall notify this agency in writing by May 15, 2015, five (5) workdays

prior to the hearing, of their intent to attend. If no notification of intent

to attend the hearing is received by that date, the hearing may be canceled. The

hearing is open to the public. Any person who attends will be given an

opportunity to comment on the proposed administrative regulation. A transcript

of the public hearing will not be made unless a written request for a

transcript is made. If you do not wish to attend the public hearing, you may

submit written comments on the proposed administrative regulation. You may

submit written comments regarding this proposed administrative regulation until

close of business June 1, 2015. Send written notification of intent to attend

the public hearing or written comments on the proposed administrative

regulation to:

      CONTACT PERSON: Tricia Orme, Office of Legal Services, 275

East Main Street 5 W-B, Frankfort, Kentucky 40621, phone (502) 564-7905, fax

(502) 564-7573, email tricia.orme@ky.gov.

 

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

 

Contact

Person: Stephanie Brammer-Barnes

      (1)

Provide a brief summary of:

      (a)

What this administrative regulation does: This administrative regulation

establishes the minimum requirements for licensure as a psychiatric hospital.

      (b)

The necessity of this administrative regulation: This administrative regulation

is necessary to establish the minimum requirements for licensure as a

psychiatric hospital.

      (c)

How this administrative regulation conforms to the content of the authorizing

statutes: This administrative regulation conforms to the content of KRS

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

promulgate administrative regulations necessary to establish licensure

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

facilities and health services.

      (d) How this administrative regulation currently assists or

will assist in the effective administration of the statutes: This administrative

regulation assists in the effective administration of the statutes by establishing the minimum

requirements for licensure as a psychiatric hospital.

      (2)

If this is an amendment to an existing administrative regulation, provide a

brief summary of:

      (a)

How the amendment will change this existing administrative regulation: Under

this amendment, a psychiatric hospital or a general acute care or critical

access hospital with a psychiatric unit may provide designated outpatient

behavioral health services, thereby expanding the scope of services which may

be provided under the facility’s existing license and increasing access to

outpatient behavioral health services.

      (b)

The necessity of the amendment to this administrative regulation: This

amendment is necessary to expand the scope of services which may be provided

under the license of a psychiatric hospital or a general acute care or critical

access hospital. This amendment also clarifies the background check requirement

for staff in state-owned and operated psychiatric hospitals.

      (c)

How the amendment conforms to the content of the authorizing statutes: This

amendment conforms to the content of the authorizing statutes by establishing

requirements for the operation of psychiatric hospitals.

      (d)

How the amendment will assist in the effective administration of the statutes: This

amendment will assist in the effective administration of the statutes by

expanding the scope of services which may be provided under the license of a

psychiatric hospital or a general acute care or critical access hospital.

      (3)

List the type and number of individuals, businesses, organizations, or state

and local governments affected by this administrative regulation: There are

currently thirteen (13) licensed psychiatric hospitals.

      (4)

Provide an analysis of how the entities identified in question (3) will be

impacted by either the implementation of this administrative regulation, if

new, or by the change, if it is an amendment, including:

      (a)

List the actions that each of the regulated entities identified in question (3)

will have to take to comply with this administrative regulation or amendment: Psychiatric

hospitals or general acute care or critical access hospitals with a psychiatric

unit may provide designated outpatient behavioral health services.

      (b)

In complying with this administrative regulation or amendment, how much will it

cost each of the entities identified in question (3): The provision of

designated outpatient behavioral health services described in Section 6 is

optional.

      (c)

As a result of compliance, what benefits will accrue to the entities identified

in question (3): Hospitals may receive Medicaid reimbursement for outpatient

behavioral health services provided to Medicaid recipients. Additionally, the

expansion in the scope of outpatient behavioral health services which may be

provided will improve access to patient care for the treatment of substance use

disorders, mental health disorders, or co-occurring disorders.

      (5)

Provide an estimate of how much it will cost the administrative body to

implement this administrative regulation:

      (a)

Initially: The cost of implementing the amendment of this administrative

regulation is expected to be absorbable.

      (b)

On a continuing basis: The cost of implementing this administrative regulation

is expected to be absorbable.

      (6)

What is the source of the funding to be used for the implementation and

enforcement of this administrative regulation: The source of funding used for

the implementation and enforcement of this administrative regulation will be

from agency and state general funds.

      (7)

Provide an assessment of whether an increase in fees or funding will be

necessary to implement this administrative regulation, if new, or by the change

if it is an amendment: This administrative regulation does not require an

increase in fees or funding.

      (8)

State whether or not this administrative regulation established any fees or

directly or indirectly increased any fees: This administrative regulation does

not establish any fees.

      (9)

TIERING: Is tiering applied? Tiering is not applicable as compliance with this

administrative regulation applies equally to all individuals or entities who

elect to be regulated by it.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

      1.

What units, parts or divisions of state or local government (including cities,

counties, fire departments, or school districts) will be impacted by this

administrative regulation? This administrative regulation establishes standards

for the licensure of psychiatric hospitals.

      2.

Identify each state or federal statute or federal regulation that requires or

authorizes the action taken by the administrative regulation. KRS 216B.042

requires the Cabinet for Health and Family Services to promulgate

administrative regulations necessary for the proper administration of the

licensure function.

      3.

Estimate the effect of this administrative regulation on the expenditures and

revenues of a state or local government agency (including cities, counties,

fire departments, or school districts) for the first full year the

administrative regulation is to be in effect.

      (a)

How much revenue will this administrative regulation generate for the state or

local government (including cities, counties, fire departments, or school

districts) for the first year? This amendment will not generate additional

revenue.

      (b)

How much revenue will this administrative regulation generate for the state or

local government (including cities, counties, fire departments, or school

districts) for subsequent years? This amendment will not generate additional

revenue.

      (c)

How much will it cost to administer this program for the first year? The cost

of implementing this administrative regulation is expected to be absorbable.

      (d)

How much will it cost to administer this program for subsequent years? The cost

of implementing this administrative regulation is expected to be absorbable.

      Note:

If specific dollar estimates cannot be determined, provide a brief narrative to

explain the fiscal impact of the administrative regulation.

      Revenues

(+/-):

      Expenditures

(+/-):

      Other

Explanation:
Read Entire Law on www.lrc.ky.gov