Title 908 KAR — Cabinet for Health and Family Services - Department for Developmental Health, Developmental and Intellectual Disabilities

Chapter 1 Substance Abuse

908 KAR 1:300 Chemical dependency program evaluation {#sec-908-kar-1-300 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:300}

Section 1. Definitions.

(1) "Agency" is defined in KRS 222.005(2) and receiving state or federal funds.

(2) "Client" means an individual on whom a record or chart has been opened by an agency or subcontractor of an agency and for whom a treatment plan has been prepared for a primary substance abuse problem. Clients receiving only DUI education services, DUI assessment services or Clients receiving only detoxification services during the treatment episode are excluded from the definition.

(3) "Client identifier" means a unique code used by agencies and the department to identify clients in a departmental data set.

(4) "Commissioner" means the Commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities Services, or designee.

(5) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities Services within the Cabinet.

(6) "Discharge" means a date which is ninety (90) days following the last date on which a client received a treatment service from the agency.

(7) "Division" means the Division of Behavioral Health within the Department for Behavioral Health, Developmental and Intellectual Disabilities Services.

(8) "Evaluator" means the independent organization determined by the department to be qualified to conduct an outcome study.

(9) "Instrument" means the electronically-recorded baseline survey tool adopted for use in the study.

(10) "Outcome study" means a department defined study of clients to assess their progress twelve (12) months after discharge from substance abuse treatment.

Section 2. Agency Responsibilities.

(1) An agency shall explain the purpose, design, and procedures of the outcome study to the client.

(2) An agency shall ask the client to participate in the outcome study. An agency shall obtain informed consent from the client who agrees to participate. An agency shall allow the client the right to refuse to participate without risk of penalty or effect in the delivery of treatment services.

(3) An agency shall use the instrument required by the department to gather client information upon admission to treatment in an agency. The instrument shall be administered to the client within seventy-two (72) hours of admission to a residential or transitional care program, or within three (3) visits to outpatient or intensive outpatient care program.

(4) An agency shall:

(a) Report by the tenth of each month admission information gathered using the instrument to the evaluator using a specified electronic data format; and

(b) Gather and report informed consent, assent, and parental consent forms to the evaluator by the tenth of the month following the month of discharge.

(5) An agency shall designate a coordinator for the study and shall notify the division and the evaluator in writing of the name of the designated coordinator.

Section 3. Evaluator Responsibilities.

(1) The evaluator shall receive and process the outcome study data generated by each agency.

(2) The evaluator shall monitor compliance with the reporting requirements and advise the agency and the division when corrective action is necessary.

(3) The evaluator shall provide all necessary training of agency and department staff in regards to the outcome study and its administration.

(4) The evaluator shall provide ongoing technical assistance to the agency and the division in regards to the outcome study and its administration.

(5) The evaluator shall provide reports to the division on a quarterly basis of summaries of admission and discharge information gathered from the agencies. The evaluator shall also respond to specific data analysis requests by the division.

(6) The evaluator shall provide the division with copies of data files containing the collected admission and discharge information.

(7) The evaluator shall produce and provide to the division an annual report on the outcome study which includes the elements required by KRS 222.475.

(8) The evaluator shall provide security for all paper and electronic records which it holds in order to prevent unauthorized access to confidential client information.

(9) All paper and electronic records remain the property of the division and shall be maintained by the evaluator until disposal is directed by the division.

(10) The evaluator shall be responsible for any necessary revision of forms, software design, protocols, and procedures which govern the outcome study and its implementation.

(11) The evaluator shall contact a statistically valid representative sample of clients for each agency following the client's discharge from substance abuse treatment.

(a) The follow-up contact shall be one (1) year from the date of discharge.

(b) The methods of contact may include telephone, mail, and face to face interview.

(c) Each selected client shall be asked to answer a series of standard questions on a survey instrument designed to measure certain treatment outcomes.

Section 4. Confidentiality. The evaluator and the agency shall follow the standards protecting and guiding confidentiality of client identifiable information as found in 908 KAR 1:320. Confidential record of treatment for federally assisted alcohol and other drug abuse programs.

Section 5. Monitoring and Penalties for Noncompliance.

(1) The division shall monitor compliance of the evaluator and the agency.

(2) If an agency is determined to be noncompliant with any of the provisions of the administrative regulation, its state substance abuse payments, if any, shall be held by the department as provided in KRS 222.470 until the agency has met the requirements.

(3) A determination to hold payment shall be made by the commissioner.

(4) A notice of the determination shall be sent to the agency thirty (30) days prior to its implementation.

(5) Notice of determination. A notice of determination shall be in writing, mailed to the agency, and contain the following information:

(a) The reason for the determination;

(b) The effective date of the determination; and

(c) The agency's hearing rights in accordance with Section 6 of this administrative regulation.

Section 6. Appeal of Penalties for Noncompliance.

(1) An agency may appeal any determination made by the department in the application of the provisions of Section 5(2) and (3) of this administrative regulation.

(2) A written notice of appeal shall be submitted to the commissioner no later than thirty (30) days after an agency has been notified of a determination affecting payment. The notice of appeal shall:

(a) Specify the determination being appealed;

(b) Specify the reasons the agency believes the determination is unwarranted;

(c) Include any documentation the agency considers relevant to support the appeal; and

(d) Specify an alternative determination that should be made.

(3) The commissioner shall cause the appeal to be reviewed and evaluated with consideration of the provisions of applicable laws and regulations.

(4) The commissioner shall issue a written decision including findings of fact and conclusions on the appeal no later than thirty (30) days after receipt of a notice of appeal unless the commissioner determines that a conference may result in a mutually satisfactory resolution of the appeal.

(5) If the commissioner determines that a conference shall be held, the commissioner shall schedule a conference no later than thirty (30) days after receipt of a notice of appeal or at a later time agreeable to the commissioner and the agency.

(6) The conference shall be conducted according to the following procedures:

(a) The commissioner shall preside over the conference.

(b) The conference shall be recorded and a transcription made.

(c) The agency, or the agency's authorized representative may present any oral arguments or documentation which he considers relevant to support the contention that the department should not take the appealed action or should rescind an action already taken.

(d) Department staff who are knowledgeable of applicable laws and regulations shall explain the department's determination and may present any documentation which supports the department's determination or which demonstrates if the department's determination and actions are consistent with applicable laws and administrative regulations.

(e) If the appealed determination is based upon reports provided by persons other than department employees, those individuals may attend the conference, explain the reports and the basis of those reports.

(f) The commissioner may question any of the participants and may permit any questions or discussion among participants if that will contribute to a decision on the appeal consistent with applicable laws and regulations.

(7) If an agency conference is held the commissioner shall issue a written decision on the appeal no later than thirty (30) days after the agency conference. The written decision shall include findings of fact and conclusions.

(8) If an agency disagrees with the commissioner's decision on an appeal he shall have the right to an administrative hearing.

(9) The agency may appeal the decision (and underlying program issue) by submitting a request for an administrative hearing to the commissioner within thirty (30) days after receipt of the decision.

(10) The commissioner shall forward the request to the Office of Personnel and Budget, Administrative Hearing Branch within five (5) working days of receipt.

(11) The scope of the administrative hearing shall be restricted to the issues raised pursuant to this administrative regulation.

(12) The administrative hearing shall be in accordance with KRS Chapter 13B.

Section 7. Material Incorporated by Reference.

(1) The following forms from the University of Kentucky Center for Drug and Alcohol Research are hereby incorporated by reference:

(a) Baseline Survey Instrument (Electronic Format) (March 15, 1996 edition);

(b) Baseline Survey Instrument (Optical Scan Format) (March 15, 1996 edition);

(c) Consent to Participate in a Treatment Outcome Study (April 18, 1996 edition);

(d) Parental Consent for a Minor to Participate in a Treatment Outcome Study (April 18, 1996 edition);

(e) Assent to Participate in a Treatment Outcome Study (April 18, 1996 edition); and

(f) Follow-Up Contact Survey Instrument (Telephone Script) (March 15, 1996 edition).

(2) Copies of the incorporated material may be inspected, copied or obtained at the Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main Street, Frankfort, Kentucky 40621, 8 a.m. through 4:30 p.m., Monday through Friday.

History

• RELATES TO: KRS 222.460-222.475
• STATUTORY AUTHORITY: KRS 194A.050, 222.460-222.475, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 194.050 and 222.460 to 222.475 authorizes the cabinet to promulgate administrative regulations governing the gathering of information on clients discharged from publicly funded chemical dependency treatment agencies and the format of reports of this information to the cabinet in order to assess treatment effectiveness.
• History: 18 Ky.R. 1782; eff. 1-10-1992; Am. 23 Ky.R. 1045; eff. 9-18-1996; TAm eff. 4-27-2016; Crt eff. 1-7-2020.

908 KAR 1:310 Certification standards and administrative procedures for driving under the influence programs {#sec-908-kar-1-310 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:310}

Section 1. Definitions.

(1) "Accredited college or university" means an institution listed in the most recent College Handbook published by College Board Publications, P.O. Box 886, New York, New York 10023-0886.

(2) "Affidavit of indigency" is defined by KRS 31.120(3).

(3) "Alcohol and other drug-free work place" means a program's policy to:

(a) Prohibit the unlawful manufacture, distribution, possession, or use of a controlled substance; and

(b) Establish the disciplinary action to be taken if the policy is violated.

(4) "Assessment" means a procedure administered to an individual convicted of DUI that includes the administration of the PC-based or the online Kentucky DUI Assessment Instrument, a clinical interview, a determination by the assessor of a client's needs, a discussion of available options, and referral to services that provide an appropriate level of care in relation to the client's needs.

(5) "Cabinet" is defined by KRS 222.005(4) and means the Office of Inspector General, Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621.

(6) "Case coordination" means the monitoring of a client's progress, including consultation with other service providers and the court, to ensure the coordination of a client's services from assessment to completion.

(7) "Certification" means the process by which the division recognizes and authorizes a program, assessor, or instructor to provide services to a client convicted of DUI.

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

(9) "Certified assessor" means an individual who has been trained and approved by the division to evaluate the needs of a client and to recommend appropriate services by conducting assessments in a DUI program.

(10) "Certified instructor" means an individual who has been trained and approved by the division to provide education services in a DUI program.

(11) "Certified program" means a public or private entity approved by the division to deliver assessment, education, or treatment services to a client convicted of DUI.

(12) "Client" means an individual who receives services in a DUI program.

(13) "Clinical services supervisor" means an individual responsible for monitoring and directing assessment and treatment services and providing consultation and instruction to clinical staff.

(14) "Conflict of interest" means a private relationship exists between a client and a program that will result in:

(a) A conflict between the program's interests and the interests of the client; or

(b) A situation in which a program's personal or financial interest conflicts with professional responsibility.

(15) "Court" means the court in which the client was convicted of DUI.

(16) "Courtnet disposition system" means a statewide database maintained by the Kentucky Administrative Office of the Courts that contains criminal conviction data from both state and local law enforcement agencies in Kentucky.

(17) "Detoxification" means a twenty-four (24) hour medical or nonmedical program providing:

(a) Supervised management of physical and psychological withdrawal symptoms from a substance to which an individual has been addicted or abusing; and

(b) An assessment of the individual's need for further care or referral to appropriate resources.

(18) "Division" means the Division of Behavioral Health, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, 275 East Main Street, Frankfort, KY 40621.

(19) "DUI" means driving under the influence of alcohol or other drugs in violation of KRS 189A.010.

(20) "DUI services" means assessment, education, or treatment services provided to a client convicted pursuant to KRS 189A.010.

(21) "Education" means a curriculum approved by the division that provides information about the risks of alcohol and other drugs.

(22) "Education agreement" means a written plan outlining what a client referred for education is required to complete to satisfy the program's requirements.

(23) "Enrollment" means the act of registering at a certified DUI program and receiving an assessment.

(24) "Facility" means the physical area including the grounds and building in which a program delivers services.

(25) "Fee agreement" means a written statement of charges to a client for services delivered by a program that specifies the arrangements for payment of the fees.

(26) "First offender" means a person who was convicted of a first offense under KRS 189A.010(5)(a).

(27) "Immediate danger" means a condition in the program which could or has caused death or serious physical injury.

(28) "Indigent person" is defined by KRS 31.100(3).

(29) "Inpatient" means a hospital-based residential service provided postwithdrawal, to an individual with a primary or secondary diagnosis of alcohol or other drug abuse or dependency that is designed to reduce or eliminate alcohol or other drug abuse behavior and dependency.

(30) "Intensive outpatient" means a structured comprehensive program of individual and group therapeutic activities delivered in a nonresidential setting, where a client is assisted in recovery from alcohol or other drug abuse on a scheduled and intense basis.

(31) "Location code" means a six (6) digit number issued by the United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration to each of a program's facilities.

(32) "Means test" means an objective method used by a program to determine a client's income and resources to evaluate a client's ability to pay for services received.

(33) "Memorandum of understanding" means a written agreement between two (2) programs that outlines the duties and responsibilities of a program regarding a client referral that remains in effect until one (1) of the programs terminates the agreement in writing.

(34) "Multiple offender" means a person who was convicted of a second, third or subsequent offense under KRS 189A.010.

(35) "Off the grounds" means a facility is separated from another facility by a public road.

(36) "Outpatient" means individual and group therapeutic activities assisting a client in recovery from alcohol or other drug abuse, provided in a nonresidential setting on a scheduled and unscheduled basis.

(37) "Plan of correction" means a program's written plan, including the planned correction and a date when a correction will be made, that is submitted to the division by a program if deficiencies are cited by the division in a program review.

(38) "Program administrator" means an individual, or the designee of the individual, in charge of the operation of a program who is responsible for the services provided in a program and who has responsibility for determining if a client satisfactorily completes the required services.

(39) "Program code" means an alphanumeric identifier that is issued to a program by the division at the time a program is certified.

(40) "Progress note" means a written entry in a client's record to document client contacts, the delivery of services, and how the goals of a client's treatment plan are being addressed.

(41) "Regional program manager" means an individual responsible for the management of a program's county offices if a program operating statewide has multiple county locations.

(42) "Residential" means a set of organized and intensive individual and group therapeutic activities, provided in a twenty-four (24) hour setting, which assists a client in recovering from alcohol or other drug abuse.

(43) "Residential transitional living" means a therapeutic group setting, in which:

(a) Counseling is provided either on site by staff or off site; and

(b) A client:

1. Resides twenty-four (24) hours a day; and

2. Makes a social and vocational adjustment prior to returning to family or independent living in the community.

(44) "Revocation" means withdrawal by the division of a program's or an individual's right to deliver services to a client convicted of DUI.

(45) "Self-help group" means activities provided in a self-directed peer group setting, for a person recovering from alcohol or other drug abuse or the effects of another person's alcohol or other drug abuse, in which support and direction in achieving or maintaining an alcohol and drug-free lifestyle or in learning to cope with a problem related to another person's alcohol or other drug abuse is provided.

(46) "Sliding fee scale" means a program's formula for providing a service to a client at a rate lower than the program's maximum published fee.

(47) "Treatment" is defined by KRS 222.005(14).

(48) "Treatment plan" means the written product of the process by which a client and a clinician identify and rank a client's problems needing resolution, establish agreed-upon immediate and long-term specific and measurable goals, and decide on a treatment process and the resources to be utilized.

(49) "Twenty (20) hour education" means an education curriculum:

(a) For first offenders assessed as low risk, that do not have an alcohol or other drug problem requiring treatment; or

(b) As a supplement to treatment for a first or multiple offender assessed as needing treatment.

(50) "Uniform citation" is defined by KRS 431.450.

Section 2. Licensing Requirements.

(1) An individual or other entity shall not provide DUI assessment, education, or treatment services unless the service is in a program or facility:

(a) Licensed by the cabinet in accordance with 908 KAR 1:370;

(b) Conducted in a licensed federal hospital subject to federal licensure and regulatory requirements pursuant to 38 U.S.C. 301, 38 U.S.C. 1720(a), 38 U.S.C. 7333, or 38 U.S.C. 7334; or

(c) Conducted on the grounds of a hospital licensed by the cabinet pursuant to 902 KAR 20:160 or 902 KAR 20:180.

(2) A hospital licensed by the cabinet pursuant to 902 KAR 20:160 or 902 KAR 20:180 that operates a DUI program in a facility off the grounds of the hospital shall have the separate facility in which the DUI program is located licensed by the cabinet in accordance with subsection (1) of this section.

(3) A DUI program established, conducted, and maintained in a jail, prison, or correctional facility shall be licensed by the cabinet in accordance with subsection (1) of this section.

Section 3. Program Certification Requirements.

(1) General requirements.

(a) A licensed entity desiring to provide DUI assessment or education services shall be certified by the division as a DUI program before providing a service at any location.

(b) A certified DUI program may deliver assessment, education, or treatment services statewide if the program is:

1. Licensed in accordance with Section 2 of this administrative regulation; and

2. Certified by the division at each service location.

(c) A program may be certified to provide only assessment or only education services or both assessment and education services at a location.

(d) The division shall not certify a program desiring to provide only education at all locations.

(e) A treatment program or facility licensed by the cabinet to provide treatment pursuant to 902 KAR 20:160, 902 KAR 20:180, or 908 KAR 1:370, an out-of-state treatment facility licensed by the state where the facility is located, or a federally-licensed hospital may provide treatment services to a client referred by a certified DUI program without receiving DUI program certification from the division.

(f) The division shall notify a program, in writing, if certification is issued, renewed, or revoked.

(g) The division shall notify the Transportation Cabinet, in writing, if an action is taken to revoke a DUI program's certification or if an action by the division is appealed by a program.

(h) If more than one (1) certified DUI program is operated at the same location, each program shall maintain a separate organizational identity by:

1. Conspicuously posting in a public area:

a. Each program's license;

b. Each program's DUI Program Certification Certificate; and

c. A sign showing the name of each program;

2. Using a separate logo or letterhead on written materials;

3. Maintaining client records in a separate and secure cabinet; and

4. Conducting DUI services separate from another DUI program located at the same location.

(i) A certified DUI program shall conspicuously post, in a public area of each facility where DUI services are delivered by the program, its license and DUI Program Certification Certificate.

(j) A certified DUI program shall:

1. Deliver education and treatment services in a facility that provides at least seven (7) square feet of individual space for a client while receiving a service;

2. Maintain an alcohol and other drug-free work place;

3. Obtain a criminal background check from the Administrative Office of the Court's Courtnet Disposition System for the administrator, and all clinical or certified staff, that begin working in the program after April 12, 2000;

4. Ensure that an owner, program administrator, and all clinical or certified staff that begin working in a program after April 12, 2000 have not been released from incarceration or probation or parole for the conviction of a violent crime, hate crime, or sex crime within two (2) years from his or her date of employment with the program; and

5. Maintain professional malpractice insurance to cover all clinical or certified staff in the minimum amount of $100,000 per occurrence.

(2) Staffing requirements.

(a) General requirements.

1. A program shall have staff certified by the division in accordance with Section 4 of this administrative regulation to deliver assessment and education services.

2. Certified, clinical or administrative staff shall not currently be employed as:

a. A law enforcement officer;

b. A correctional officer, other than in a certified DUI program that is located in a jail, prison or correctional facility;

c. A probation and parole officer;

d. An attorney;

e. An employee of the Administrative Office of the Courts;

f. An employee of the division; or

g. A judge.

(b) Program administrator.

1. A program administrator shall be responsible for the services delivered in a program and knowledgeable of:

a. The requirements established in this administrative regulation, and KRS 189A.040 and 189A.045;

b. In a federally assisted program, the requirements for confidentiality established in 908 KAR 1:320; and

c. In a nonfederally assisted program, the requirements for confidentiality established in KRS 222.271(1).

2. A program administrator shall ensure:

a. A program implements and complies with all applicable administrative regulations and statutes;

b. Staff having primary responsibility for delivering DUI services, including regional program managers, comply with:

(i) The requirements established in this administrative regulation, and KRS 189A.040 and 189A.045;

(ii) In a federally assisted program, the requirements for confidentiality established in 908 KAR 1:320; and

(iii) In a nonfederally assisted program, the requirements for confidentiality established in KRS 222.271(1);

c. An individual involved in the operation of the program or in the delivery of client services engages in ethical practices and abides by the Code of Ethics contained on the Application for DUI Program Certification or the Application for DUI Program Recertification, whichever is applicable;

d. A program shall not accept a client if a conflict of interest exists between the program and the client;

e. Staff providing assessment and education services are certified by the division and that they complete training required by the division; and

f. Attendance by a client is documented in the client's record.

3. A program administrator shall:

a. Investigate a complaint received from the division and shall, upon request, provide the division with records pertaining to the complaint;

b. Personally attend, or have a representative of the program attend, at least one (1) statewide DUI meeting annually. The division shall conduct statewide DUI meetings on a semiannual basis; and

c. Maintain a written record of quarterly face to face meetings with the clinical services supervisor to document review of the clinical supervision notes.

(c) Clinical services supervisor. There shall be clinical supervision provided at all locations by a clinical services supervisor who meets the requirements established in paragraph (d) or (f) of this subsection.

(d) Except as provided in paragraph (f) of this subsection, the clinical services supervisor shall be:

1. A certified alcohol and drug counselor certified pursuant to KRS 309.080 to 309.089, who has 4,000 hours of clinical work experience postcertification; or

2. An individual who is licensed or certified as one (1) of the following and who meets the requirements of paragraph (e) of this subsection:

a. Physician 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;

b. 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.;

c. Licensed psychologist licensed to practice psychology by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.050;

d. Certified psychologist with autonomous functioning certified to function without supervision in an area specified by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.056;

e. Certified psychologist with 6,000hours of postcertification practice certified by the Kentucky Board of Examiners of Psychology in accordance with the requirements and limitations established in KRS 319.056;

f. Psychological associate with 6,000hours of postcertification practice certified by the Kentucky Board of Examiners of Psychology in accordance with the requirements and limitations established in KRS 319.064;

g. Licensed clinical social worker licensed for the independent practice of clinical social work by the Kentucky Board of Social Work in accordance with KRS 335.100;

h. Certified social worker with 6,000hours of postcertification clinical practice in psychiatric social work licensed by the Kentucky Board of Social Work in accordance with KRS 335.080;

i. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a master's degree in psychiatric nursing from an accredited college or university and 6,000hours of clinical experience in psychiatric nursing;

j. Registered nurse who:

(i) Is licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a bachelor's degree in nursing from an accredited college or university;

(ii) Is certified as a psychiatric and mental health nurse by the American Nurses Association; and

(iii) Has 6,000hours of clinical experience in psychiatric nursing;

k. Licensed marriage and family therapist licensed by the Kentucky Board of Licensure of Marriage and Family Therapists in accordance with the provisions of KRS 335.330;

l. Licensed professional clinical counselor licensed by the Kentucky Board of Licensed Professional Counselors in accordance with the provisions of KRS 335.525(1); or

m. Licensed professional art therapist licensed by the Kentucky Board of Licensure for Professional Art Therapists in accordance with the provisions of KRS 309.130.

(e) A certified or licensed professional meeting the requirements established in paragraph (d)2 of this subsection shall have:

1. Completed eighty (80) hours of training in alcohol and other drug abuse counseling, within four (4) years immediately prior to the date of assuming responsibility as a clinical services supervisor in a DUI program or within two (2) years immediately after assuming responsibility as a clinical services supervisor in a DUI program; and

2. 4,000 hours of work experience in the alcohol and other drug treatment field postdegree.

(f) A person shall qualify as a clinical services supervisor under this administrative regulation if, on April 12, 2000, the person:

1. Met the requirements for clinical services supervisor as established in 908 KAR 1:050 and 908 KAR 1:190;

2. Had been a clinical services supervisor for at least five (5) years; and

3. Was employed as a clinical services supervisor in a DUI program certified by the division.

(g) A clinical services supervisor shall complete:

1. A division approved twelve (12) hour training in clinical supervision, within six (6) months of assuming responsibility as the clinical services supervisor in a DUI program; and

2. Twenty (20) hours of training in alcohol and other drug abuse treatment annually.

(h) A clinical services supervisor shall:

1. Assist a program administrator in the investigation of a complaint against a program if a complaint concerns an assessment, education, or treatment service;

2. Provide clinical supervision to no more than six (6) staff delivering assessment and treatment services to clients convicted of DUI; and

3. Maintain clinical supervision notes to document each supervisory session including the length of the session, content of the session, all observations of assessment and treatment services, and recommendations for improvement of knowledge base and facilitation skills.

(3) Application for program certification.

(a) An individual or other entity seeking DUI program certification shall:

1. Submit a completed Application for DUI Program Certification to the division;

2. Submit a Program Survey Form for each location where the applicant desires to provide DUI assessment, education or treatment services and all documentation required by the division; and

3. Sign the application, with his or her signature certifying compliance with:

a. The Code of Ethics contained on the Application for DUI Program Certification;

b. The requirements established in this administrative regulation, and KRS 189A.040, and 189A.045; and

c. The requirements for confidentiality established in:

(i) 908 KAR 1:320 for a federally-assisted program; or

(ii) KRS 222.271(1) for a nonfederally-assisted program.

(b) A Program Survey Form shall be completed for each location:

1. At the time of application for program certification or recertification; or

2. If a program opens a new location.

(c) A Program Survey Form shall contain the:

1. Type of services provided;

2. Maximum fee for a service;

3. Name of the curriculum delivered at the location;

4. Name and telephone number of the contact person for the location;

5. Hours of operation when an office is staffed;

6. Address of the office where the client files for the location are maintained and stored;

7. Name and title of each certified staff person providing assessment or education services at the location; and

8. Name of the clinical services supervisor for the location.

(d) The division shall review an application, verify the information, and certify a program if the program:

1. Submits a completed Application for DUI Program Certification to the division;

2. Is a licensed entity in accordance with Section 2 of this administrative regulation; and

3. Has staff certified by the division to deliver the required services.

(e) The division shall assign a program code and issue a letter and DUI Program Certification Certificate if a program is certified. The program code shall be used for verification of program certification on correspondence to the court, the Transportation Cabinet, and the division.

(f) Each program location shall have an additional location code issued by the division that shall be used in conjunction with a program code to identify a program and the exact location where a service is delivered.

(g) Program certification shall be issued by the division for a period of two (2) years, and shall be renewable unless previously revoked.

(h) Program certification shall not be transferred and shall apply to the individual or other entity named in the Application for DUI Program Certification or the Application for DUI Program Recertification, whichever is applicable, approved by the division.

(i) If there is a change of ownership, the new owner shall apply for program certification in accordance with the requirements established in this subsection.

(4) Application for DUI program recertification.

(a) A program administrator shall request program recertification on a completed Application for DUI Program Recertification at least thirty (30) calendar days prior to the expiration of the program's certification.

(b) If program certification expires, a program administrator shall submit a completed Application for DUI Program Recertification within sixty (60) calendar days of the expiration date. The program shall be considered a new applicant if the Application for DUI Program Recertification is not made within sixty (60) calendar days of the expiration date.

(c) If program certification lapses for sixty (60) calendar days or more, the division shall notify a program administrator, in writing, that the program is not eligible to deliver DUI services and the program shall:

1. Notify active clients in writing;

2. Refer a client and transfer case coordination responsibility of a client's case to a program of the client's choice; and

3. Submit to the division a list of active clients with a copy of each client's referral form stating the name of the program to which each client was referred.

(d) A program administrator shall meet the requirements established in paragraph (a) of this subsection before a program is recertified.

(5) Denial of program certification and recertification. The division shall deny a program's application for certification or recertification if:

(a) A program fails to meet certification requirements;

(b) Program certification has been denied or revoked by the division within the last three (3) years;

(c) A current owner, program administrator, clinical services supervisor, or other principal had his or her assessor, instructor, or program administrator certification revoked by the division within the last three (3) years; or

(d) The division is in the administrative hearing process to revoke the assessor, instructor, or program administrator certification of a current owner, program administrator, or clinical services supervisor.

(6) Program changes.

(a) A program administrator shall notify the division and the cabinet, in writing, if there is a change in ownership, program name, or program location.

(b) A program administrator shall notify the division, in writing, on a Report of Change Form if there is a change at a location in:

1. Services delivered;

2. Maximum fee charged for a service;

3. Hours of operation when an office is staffed;

4. Location of client records;

5. Scheduling telephone number;

6. Contact person;

7. Clinical services supervisor; or

8. Other program information printed in the DUI directory.

(7) Records.

(a) General requirements.

1. A program shall designate on a Program Survey Form, at the time of application for program certification, where the client records for each location and the administrative records for the program will be maintained and stored.

2. A program administrator shall notify the division, in writing, on a Report of Change Form, if the program changes the location where client or administrative records are maintained and stored.

3. A program administrator shall ensure that written and electronic client and administrative records are:

a. Stored in a locked cabinet or computer only accessible to authorized staff;

b. Kept confidential:

(i) In a federally assisted program pursuant to 908 KAR 1:320; or

(ii) In a nonfederally assisted program pursuant to KRS 222.271(1);

c. Retained for at least five (5) years from the last date of service or action taken; and

d. If destroyed after a five (5) year period of retention, either burned, shredded or deleted electronically in a manner that is unrecoverable.

4. A program shall maintain a record of fees paid by a client.

(b) Administrative records. A program shall maintain administrative records that include:

1. Policy and procedure manual;

2. Copies of curricula, handouts, and videos;

3. Hours of operation for each location;

4. Fee schedule and means test for determining indigency;

5. Cabinet report from most recent licensure inspection;

6. Memoranda of understanding;

7. Copies of the division's certification letters for assessors, instructors, and program administrators on staff;

8. Complaint file;

9. Assessment, education, and treatment rosters or sign in sheets; and

10. Clinical supervision notes.

(c) Client records.

1. A program shall release a client's record or disclose confidential information about the client in accordance with the client's written permission through a signed authorization for release of information.

2. A program shall release a client's record, with the client's written authorization for release of information, if:

a. The division or its designee requests release of a record; or

b. A client is referred to another program for education or treatment services.

3. A program shall release a client's record upon receipt of a court order.

4. A program shall open a separate written or electronic record for a client at the time of assessment, or upon enrollment in education or admission to treatment, if the client is referred to another program after receiving an assessment.

5. Client records shall include the following forms developed by the program and signed by the client:

a. Client rights statement;

b. Client notice of confidentiality and confidentiality agreement;

c. Fee agreement;

d. Authorization for release or disclosure of information; and

e. As applicable, the information required by subparagraphs 6, 7, or 8 of this paragraph.

6. If a client receives an assessment, his or her record shall include:

a. The items required by subparagraph 5 of this paragraph;

b. An AOC 494 form (Notice to Attend Alcohol Driver Education Program) or a court order;

c. Uniform citation;

d. Kentucky DUI Assessment Instrument printout;

e. Clinical interview and interview notes;

f. Freedom of choice statement;

g. Confirmation and acceptance of assessment statement;

h. Referral agreement, if applicable;

i. Certificate of enrollment;

j. Case coordination contacts; and

k. Certificate of completion or notice of noncompliance.

7. If a client receives education, his or her record shall include:

a. The items required by subparagraph 5 of this paragraph;

b. An education agreement signed by the client; and

c. A record of attendance.

8. If a client receives treatment, his or her record shall include:

a. The items required by subparagraph 5 of this paragraph;

b. A treatment plan signed by the client and the clinician and treatment plan reviews signed by the clinician;

c. Progress notes signed and dated by the clinician, recorded after each client contact documenting the type of contact or service provided, and the client's participation; and

d. A discharge summary documenting completion or noncompliance signed and dated by the clinician.

(8) Fees. The fee for assessment, education, or treatment shall be established by a program and paid by a client pursuant to KRS 189A.040 in accordance with this subsection.

(a) A fee for assessment shall include all fees associated with screening, intake, clinical interview, client transfers, monitoring of client progress, and all other case coordination activities including exit or discharge interviews.

(b) A fee for education shall include only those costs associated with the delivery of the Prime for Life Risk Reduction Program (PRI) Twenty (20) Hour Curriculum including any cost for participant manuals.

(c) A fee for treatment shall:

1. Include those costs involved in delivering individual or group counseling and the fee for treatment plan reviews; and

2. Not include a separate fee for case coordination activities.

(d) A DUI program shall not charge a fee for group outpatient sessions not attended.

(e) The fee schedule published in the DUI directory shall be posted in a public area of each facility visible to a client.

(f) The fee a client is charged shall not exceed a program's maximum published fee.

(g) A program shall explain the program's fee and payment requirements to the client at the time of the assessment or upon enrollment in education or admission to treatment, if the client is referred to another program after receiving an assessment.

(h) A program shall not charge a client a fee unless the client has signed a fee agreement.

(i) A program's sliding fee scale shall be based on a means test and applied objectively to a client to determine a client's ability to pay.

(j) If a client states that he or she is an indigent person, a program shall refer the client to the court to have an affidavit of indigency executed by the court. A program shall:

1. Accept a client determined indigent by the court; and

2. Deliver services free of charge or for the amount specified by the court.

(9) DUI directory.

(a) The division shall:

1. Publish annually on July 1 of each year a directory of all certified DUI programs; and

2. Issue additions, revisions, and corrections quarterly on October 1, January 1, and April 1, of each year as changes occur.

(b) The directory shall include DUI programs certified to provide DUI assessments and shall be distributed upon request to the following:

1. District court judges;

2. Circuit clerks;

3. Certified DUI programs; and

4. The public.

(c) The directory shall have a county section that includes:

1. The location of each program having an assessment center in a county;

2. The services provided at each program location;

3. The maximum fee for a service; and

4. Specific terms and conditions related to DUI services that are required by a program.

(d) A program administrator shall report changes for the directory to the division, on a Report of Change Form, at least thirty (30) calendar days prior to the publication dates established in paragraph (a) of this subsection. If the division does not receive a Report of Change Form by the deadline date, the division shall hold a change until the next scheduled publication of the directory.

Section 4. Assessor, Instructor, and Program Administrator Certification Requirements.

(1) General requirements.

(a) Only an individual holding valid certification from the division shall provide DUI assessment or education services. An individual certified by the division shall not provide DUI assessment or education services except in a program that is certified by the division.

(b) An individual desiring to provide assessment, program administration, or education services shall apply for certification to the division. To be certified, an individual shall:

1. Meet the requirements for certification established in this section; and

2. Complete the training required by subsection (3) of this section.

(c)

1. Certification for an assessor, program administrator, or instructor shall be for a period of five (5) years from the date of an individual's initial certification as an assessor, program administrator, or instructor.

2. An assessor, program administrator, or instructor shall renew his or her certification in accordance with subsection (4) of this section every five (5) years.

3. Certification that is not renewed or revoked prior to the end of the five (5) year period shall automatically expire at the end of that time period.

(2) Credentials for assessors, program administrators, and instructors.

(a) Assessors. An individual desiring certification as an assessor shall complete twenty (20) hours of training in alcohol and other drug abuse counseling annually and, except as provided in paragraph (c) of this subsection, shall be:

1. A certified alcohol and drug counselor certified pursuant to KRS 309.080 to 309.089;

2. An individual who is licensed or certified as one (1) of the following and who meets the requirements of paragraph (b) of this subsection:

a. Physician 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;

b. 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.;

c. Licensed psychologist licensed to practice psychology by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.050;

d. Certified psychologist with autonomous functioning certified by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.056;

e. Certified psychologist certified by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.056;

f. Psychological associate certified by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.064;

g. Licensed clinical social worker licensed for the independent practice of clinical social work by the Kentucky Board of Social Work in accordance with KRS 335.100;

h. Certified social worker certified by the Kentucky Board of Social Work in accordance with KRS 335.080;

i. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a master's degree in nursing from an accredited college or university;

j. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with one (1) of the following combinations of education and work experience:

(i) Bachelor of science in nursing from a four (4) year program from an accredited college or university and 2,000 hours of clinical work experience in the substance abuse or mental health field;

(ii) Diploma graduate in nursing from a three (3) year program and 4,000 hours of clinical work experience in the substance abuse or mental health field; or

(iii) Associate degree in nursing from a two (2) year program from an accredited college or university and 6,000 hours of clinical work experience in the substance abuse or mental health field;

k. Advanced practice registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS 314.042;

l. Licensed marriage and family therapist licensed by the Kentucky Board of Licensure of Marriage and Family Therapists in accordance with the provisions of KRS 335.330;

m. Licensed professional clinical counselor licensed by the Kentucky Board of Licensed Professional Counselors in accordance with the provisions of KRS 335.525(1); or

n. Licensed professional art therapist licensed by the Kentucky Board of Licensure for Professional Art Therapists in accordance with the provisions of KRS 309.130; or

3. An individual who will meet the requirements of a licensed or certified professional established in subparagraph 1 or 2 of this paragraph within three (3) years of the date of his or her application for certification as a DUI assessor and who has:

a. A master's degree from an accredited college or university in a program that required completion of a clinical practicum; or

b. A bachelors degree or greater from an accredited college or university, plus one (1) year full-time supervised clinical work experience in the licensed treatment program where the individual is currently employed.

(b) A certified or licensed professional meeting the requirements established in paragraph (a)2 of this subsection shall have completed eighty (80) hours of training in alcohol and other drug abuse counseling, within four (4) years immediately prior to the date of his or her application for DUI assessor certification.

(c) A person shall qualify as a DUI assessor under this administrative regulation if, on April 12, 2000, the person:

1. Met the requirements for a certified DUI assessor established in this administrative regulation as those requirements existed on January 1, 2000;

2. Had been a certified DUI assessor for at least five (5) years; and

3. Was employed as a certified assessor in a DUI program certified by the division.

(d) Instructors. An individual desiring certification as an instructor shall meet one (1) of the following requirements:

1. Have a bachelors degree or greater from an accredited college or university;

2. Have an associate degree from an accredited college or university, with 4,000 hours of supervised work experience in direct client services in the substance abuse field;

3. Have a high school diploma or a general education development equivalency certificate from a state board of education, with 8,000 hours of supervised work experience in direct client services in the substance abuse field;

4. Meet the requirements for a certified assessor established in paragraph (a) or (c) of this subsection; or

5. Meet the requirements for a clinical services supervisor established in Section 3(2)(d) or (f) of this administrative regulation.

(e) Program administrator. An individual applying for certification as a program administrator shall meet one (1) or more of the following requirements:

1. Have a bachelors degree or greater from an accredited college or university with 2,000 hours of work experience in the alcohol and other drug treatment field;

2. Have an associate degree from an accredited college or university with 4,000 hours of supervised work experience in the direct client services in the alcohol and other drug treatment field;

3. Have a high school diploma or a general education development equivalency certificate from a state board of education with 8,000 hours of supervised work experience in direct client services in the alcohol and other drug treatment field;

4. Meet the requirements for a certified DUI assessor established in paragraph (a) of this subsection; or

5. Be an individual who, on the effective date of this administrative regulation:

a. Had been a program administrator for at least five (5) years; and

b. Was employed as a program administrator in a DUI program certified by the division.

(3) Assessor, instructor, and program administrator certification and recertification training.

(a) General training requirements.

1. Only training approved by the division shall suffice as acceptable training for DUI assessor, instructor, and program administrator certification or recertification.

2. An individual desiring certification or recertification as an assessor, instructor, or program administrator shall submit a completed DUI Assessor Certification Application, DUI Assessor Recertification Application, DUI Instructor Certification Application, or DUI Instructor Recertification Application, DUI Program Administrator Certification Application, or DUI Program Administrator Recertification Application, whichever is applicable, to the division no later than the deadline date indicated on the training announcement issued by the division.

3. The application shall be accompanied by a copy of the following:

a. Official transcripts;

b. Diplomas;

c. Certificates;

d. Documentation of certification or licensure; and

e. Documentation of work experience.

4. Assessor, instructor, or program administrator certification or recertification shall not be issued by the division until the fee for training is paid in full.

5. If an individual making application for an assessor, instructor, or program administrator certification or recertification training fails to meet the established requirements, the division shall deny the application and notify the applicant, in writing, of the reason for the denial.

6. Within thirty (30) calendar days after completion of an assessor, instructor, or program administrator training, the division shall notify the program and the individual, in writing:

a. That the individual has:

(i) Satisfactorily completed a training;

(ii) Met the requirements for certification or recertification; and

(iii) Been certified or recertified; or

b.

(i) Of an observed deficiency as it relates to assessor, instructor, or program administrator certification; and

(ii) The reason for withholding certification or recertification.

(b) Training requirements for assessors. An individual desiring certification as an assessor who has the necessary education and work experience shall:

1. Attend and participate in all sessions of an assessor certification training offered by the division;

2. Obtain an overall score of eighty (80) percent or better on performance in each of the following areas:

a. A written posttest on general course content;

b. A written posttest on the Kentucky DUI Assessment Instrument; and

c. A demonstration of ability to make an appropriate client referral based on a written case study;

3. Receive a written recommendation from both the trainer and the division representative; and

4. Sign the application, with his or her signature certifying compliance with:

a. The Code of Ethics contained on the application; and

b. The requirements established in this administrative regulation.

(c) Training requirements for instructors. An individual desiring certification as an instructor who has the necessary education and work experience shall:

1. Attend and participate in all sessions of a division approved instructor certification training;

2. Complete training in the Prime for Life Risk Reduction Program (PRI) Twenty (20) Hour Curriculum approved by the division;

3. Obtain a score of eighty (80) percent or better on a written posttest;

4. Demonstrate ability to make an oral presentation of assigned material;

5. Receive a written recommendation from both the trainer and the division representative; and

6. Sign the application, with his or her signature certifying compliance with:

a. The Code of Ethics contained on the application; and

b. The requirements established in this administrative regulation.

(d) Training requirements for program administrator certification. An individual applying for initial certification as a program administrator, who has the necessary education and work experience in accordance with subsection (2)(e) of this section, shall:

1. Sign the application, with his or her signature in the Applicant's Statement portion certifying compliance with:

a. The Code of Ethics contained on the application; and

b. The requirements established in this administrative regulation; and

2. Complete six (6) hours of training conducted by the division within one (1) year of signing the Applicant's Statement.

(4) Assessor, instructor, and program administrator recertification.

(a) An individual desiring recertification as an assessor shall:

1. Meet the requirements for a DUI assessor established in subsection (2)(a) or (c) of this section, on the date of his or her application for assessor recertification; and

2. Submit to the division a DUI Assessor Recertification Application and the other forms required by subsection (3)(a)3. of this section by October 1 of the calendar year in which his or her certification expires.

(b) An individual desiring recertification as an instructor shall:

1. Meet the requirements for a DUI instructor established in subsection (2)(d) of this section;

2. Submit to the division a DUI Instructor Recertification Application and the other forms required by subsection (3)(a)3. of this section by October 1 of the calendar year in which his or her certification expires; and

3. Complete a training authorized by the division.

(c) An individual desiring recertification as a program administrator shall:

1. Meet the education, work experience, and credentialing requirements in accordance with subsection (2)(e) of this section; and

2. Submit to the division a completed DUI Program Administrator Recertification Application and the other forms required by subsection (3)(a)3. of this section by October 1 of the calendar year in which his or her certification expires.

(d) If an individual's assessor, instructor, or program administrator certification lapses for sixty (60) days or more, the individual's application for assessor, instructor, or program administrator recertification shall be processed as a new application and the individual shall complete the requirements for initial certification established in subsections (2) and (3) of this section.

(e) If an individual does not meet the requirements for an assessor, instructor, or program administrator at the time of his or her application for recertification:

1. The division shall deny the application for recertification and notify the individual and the program, in writing, of the reason for denial; and

2. The individual's currently held certification shall expire pursuant to subsection (1)(c)3 of this section.

(5) Revocation of assessor, instructor, or program administrator certification.

(a) The division shall revoke assessor, instructor, or program administrator certification if an individual:

1. Fails to comply with the requirements established in this administrative regulation;

2. Violates the Code of Ethics contained on the application for assessor, instructor, or program administrator certification;

3. Is convicted while holding certification from the division of a violent crime, hate crime, or sex crime;

4. Falsifies information on an application for DUI certification or recertification; or

5. Engages in behavior that would lead the division to determine that the safety of a client is threatened.

(b) The revocation of an individual's assessor, instructor, or program administrator certification shall be for a period of three (3) years and shall be effective on the date stated in the notice sent to the individual assessor, instructor, or program administrator by the division.

Section 5. Certified Program, Assessor, Instructor, or Program Administrator Complaints and Program Monitoring.

(1) Complaints.

(a) An individual may submit a complaint related to a certified program, a certified assessor, a certified instructor, or a program administrator that is not resolved by a program through its grievance procedure to the division.

(b) A program shall be responsive and make an effort to resolve a client's complaint through its grievance procedure.

(c) A complaint shall be submitted to the division, in writing, on a DUI Complaint Form or in a letter.

(d) The division shall investigate a complaint, notify the complainant and the program, in writing, of the results of the investigation and take any necessary action.

(e) The division shall notify a professional licensing or certification board, in writing, at the conclusion of an investigation of the results of the investigation if a complaint is related to a violation of a standard established by a professional board or a statutory violation relating to the board's jurisdiction.

(2) Program reviews.

(a) The division shall conduct periodic program reviews to determine if a program is in compliance with the requirements established in this administrative regulation, and KRS 189A.040 and 189A.045.

(b) A program review shall consist of one (1) or more of the following:

1. An interview with either a program administrator or a clinical services supervisor;

2. Completion of a Comprehensive DUI Program Review Form;

3. A review of administrative records;

4. A review of client records using the Client Record Review form;

5. Off-site monitoring by division staff of assessment records submitted by a program;

6. Observation of an assessment, education, or treatment service using the Assessment Observation Form, Education Observation Form, or Treatment Observation Form, as indicated by the type of service observed;

7. Client interviews using the Client Evaluation of Assessment Program, the Client Evaluation of Treatment Program, or the PRI Client's Evaluation of Education Services Received;

8. The review of other materials necessary to determine compliance with this administrative regulation, and KRS 189A.040 and 189A.045; or

9. Physical inspection of a program's facility.

(c) The division shall notify a program, in writing, at least two (2) weeks prior to the date of an announced program review.

(d) A program review may be made at any of a program's locations and may be unannounced.

(e) A program shall:

1. Allow a division representative access to a facility;

2. Provide a copy of records and materials requested; and

3. Allow a division representative to attend and observe an assessment, education class, or treatment session conducted by the program.

(f) The division shall issue a written report of findings and provide a copy of the results of its program review to the program within ninety (90) calendar days after completion of a program review.

(3) Plan of correction.

(a) The division shall require a program that is not in compliance with the requirements established in this administrative regulation, and KRS 189A.040 or 189A.045 to submit an acceptable plan of correction to the division within thirty (30) calendar days from the date a program receives a report of findings from the division.

(b) The plan of correction shall:

1. Be developed with participation of the program administrator, the clinical services supervisor, and any staff responsible for the implementation of the corrective action for the deficiencies noted in the program review;

2. Contain a descriptive plan of action including a time schedule for achieving implementation of the corrective actions for the deficiencies;

3. Be accompanied by copies of any forms developed and utilized to bring the program into compliance, including those forms required by Section 3(7)(c)5. to 8. of this administrative regulation; and

4. Be signed by the DUI Program Administrator and any staff involved in the development of the plan of correction and for the implementation of the corrective action for the deficiencies.

(c) The division may conduct a follow-up program review to ensure:

1. The plan of correction has been implemented; and

2. The program is in compliance with this administrative regulation, and KRS 189A.040 and 189A.045.

(d) If the division conducts a follow-up program review, a copy of the Follow-up DUI Program Review form shall be issued to the program within ninety (90) calendar days of the completion of the follow-up program review.

(e) If a plan of correction has not been implemented, the division shall take action to revoke program certification.

(4) Voluntary closure.

(a) A program desiring to close voluntarily shall:

1. Notify the division, in writing, that it will voluntarily surrender its program certification by mailing to the division its DUI Program Certification Certificate;

2. Stop accepting client referrals;

3. Notify active clients in writing;

4. Refer a client and transfer case coordination responsibility of a client's case to a program of his or her choice; and

5. Submit to the division, within ten (10) calendar days of the notification made under subparagraph 1 of this paragraph, a list of active clients and a copy of the following information for each client:

a. Name, address and telephone number;

b. Date of birth and either the client's Social Security or driver's license number;

c. DUI conviction number;

d. Date of assessment and referral information including level of care and agency to which a client is referred;

e. Number of sessions completed;

f. Date of last attendance; and

g. Reason for noncompliance if a client is noncompliant.

(b)

1. A program that voluntarily surrenders its certification in compliance with the requirements established in paragraph (a) of this subsection may reapply for program certification at any time.

2. The division shall revoke the program certification of a program that voluntarily surrenders its certification if the program fails to comply with the requirements established in paragraph (a) of this subsection. The revocation shall be in accordance with the requirements established in subsection (5)(d) of this section.

3. If a program voluntarily surrenders its certification following an action by the division to revoke the program's certification, revocation shall be in accordance with subsection (5)(d) of this section.

(5) Revocation of program certification.

(a) The division shall revoke the certification of a program that is not in compliance with the requirements established in this administrative regulation, and KRS 189A.040 or 189A.045.

(b) The division shall immediately revoke a program's certification if it determines there is an immediate danger to clients.

(c) The division shall revoke the certification of a program that has failed to implement the plan of correction submitted to the division as a result of a program review.

(d) The revocation of program certification shall be:

1. For a period of three (3) years; and

2. Effective on the date stated in the notice sent to the program by the division.

(e) If the division revokes program certification, a program shall:

1. Stop providing DUI services;

2. Stop accepting client referrals;

3. Notify active clients in writing;

4. Refer a client and transfer case coordination responsibility of a client's case to a program of his or her choice; and

5. Submit to the division, within ten (10) calendar days of the notification from the division, a list of active clients and a copy of the following information for each client:

a. Name, address and telephone number;

b. Date of birth and either the client's Social Security or driver's license number;

c. DUI conviction number;

d. Date of assessment and referral information including level of care and the name of the program to which a client is referred;

e. Number of sessions completed;

f. Date of last attendance; and

g. Reason for noncompliance if a client is noncompliant.

Section 6. Assessment Requirements.

(1) Assessment process.

(a)

1. Except as provided in subparagraph 2 of this paragraph, a program providing assessment services shall administer the Kentucky DUI Assessment Instrument to a client receiving a DUI assessment. A program may use supplemental assessments in addition to the Kentucky DUI Assessment Instrument.

2. A program shall have six (6) months from the 2011 effective date of this administrative regulation to comply with the requirement that the Web-based Kentucky DUI Assessment Instrument be administered in every DUI assessment. During this six (6) month transitional period, a program shall:

a. Meet the requirements for a DUI assessment established in this administrative regulation; and

b. Enter all new assessment records via the Internet.

3. For users of the PC-based Kentucky DUI Assessment Instrument, the Kentucky DUI Assessment Instrument records and the completion and noncompliance reports shall be electronically downloaded and sent either on removable computer media, or via email to the division, or its designee, on a monthly basis. Written notification shall be sent to the division or its designee, in lieu of electronic records if records or reports are not available for download.

4. For users of the Web-based Kentucky DUI Assessment Instrument, new assessment records shall be entered via the internet within three (3) business days of the assessment. Completion and noncompliance information shall be entered within three (3) business days of a client's completion or noncompliance.

(b) The Kentucky DUI Assessment Instrument printout generated at a client's assessment shall:

1. Be signed and dated by the assessor and client;

2. Contain comments by the assessor explaining the referral decision; and

3. Be placed in the client's file at least thirty (30) calendar days after the client's assessment.

(c) An assessment shall be conducted:

1. At a program's certified location; or

2. If a court orders an assessment of an individual that is incarcerated, in a jail or a prison.

(d) A DUI assessment shall be conducted in person, and shall include:

1. Administration of the Kentucky DUI Assessment Instrument;

2. A private face-to-face clinical interview conducted by a certified DUI assessor, using the assessor's own clinical interview with the findings of the interview recorded on the check list provided in the Kentucky DUI Assessment Instrument;

3. Consideration of referral options and the client's resources that are documented in the Kentucky DUI Assessment Instrument;

4. A determination of the severity of the client's problem;

5. Referral to a program of the client's choice that offers a service at the level of care appropriate to the severity of the client's problem; and

6. The cosigning by the client and assessor of the following forms developed by the program:

a. Fee agreement;

b. Client rights statement;

c. Confidentiality statement;

d. Freedom of choice statement and a referral agreement;

e. Confirmation that a client received an assessment statement;

f. Authorization for release of information;

g. Certificate of enrollment; and

h. Kentucky DUI Assessment Instrument printout.

(e)

1. Except as provided in subparagraph 2 of this paragraph, a DUI assessment shall be conducted by an assessor holding valid certification from the division.

2. The screening instrument portion of the Kentucky DUI Assessment Instrument shall be either self-administered via a hard copy of the paper and pencil version of the AUDIT/DAST or administered by a certified or noncertified individual.

(f) The screening instrument portion of the Kentucky DUI Assessment Instrument shall be administered individually or in a group.

(g) A program shall maintain a Roster of Assessments that includes:

1. Client name, date of birth and Social Security or driver's license number;

2. Assessment date; and

3. Type of referral and referral program.

(h) A certified DUI assessor shall demonstrate knowledge, skills, and competence in the following essential clinical areas:

1. Classifying mental or substance abuse disorders using the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association;

2. Progression and characteristic of substance abuse disorder;

3. Range of life areas to be assessed and the effects of substance use on those areas;

4. Continuum of care, the available range of treatment modalities, and referral resources;

5. Administration and interpretation of screening instruments;

6. Assessment of a client's readiness and motivation to take responsibility and address substance abuse issues; and

7. Communication of recommendations to the client and accurate documentation of the referral process.

(2) Client referrals. A DUI program shall accept a client referral from another program or a court.

(a) Court referral of DUI offenders.

1. An individual convicted of DUI in Kentucky shall obtain an assessment at a certified program of his choice or her listed in a directory published by the division in accordance with Section 3(9) of this administrative regulation.

2. Before accepting a client for an assessment, a program shall:

a. Obtain an AOC 494 form or a court order; or

b. Document the client's file to show the reason one (1) of these forms could not be obtained.

3. If a client has received an assessment for a conviction at another DUI program, a program shall not conduct a subsequent assessment for the client without obtaining a new court order.

(b) Program referral of DUI offenders.

1. A program desiring to make or receive a client referral shall execute a written Memorandum of Understanding with the in-state or out-of-state programs with which it will make or receive referrals.

2. A memorandum of understanding shall include the:

a. Name of both programs;

b. Date it is executed;

c. Duties and responsibilities of each program to include the requirements for case coordination contacts between the programs;

d. Purpose of the agreement;

e. Terms for termination of the agreement; and

f. Signatures of each program's program administrator.

3. A program may refuse a client referral because of:

a. Inadequate staff;

b. Lack of an appropriate service;

c. A client waiting list; or

d. A program's previous unsuccessful attempt to treat a client.

4. A program shall not accept a client referral from another program without first obtaining a copy of the client's assessment and other available records pertinent to the client's assessment, education, or treatment.

5. A program shall inform a client at the time of the assessment that if the client fails to disclose all outstanding DUI convictions, the services the client receives will not meet the requirements for reinstatement of a driver's license.

6. A program shall refer a client to a program of the client's choice, at an appropriate level of care based on the client's assessment. A program shall have a client sign a referral agreement stating the client has been given freedom of choice in the selection of a program.

7. A program shall:

a. Allow a client freedom of choice in the selection of a program in which the client will receive education or treatment services; and

b. Not allow a client to select the level of care or type of service, which shall be based on the results of the client's assessment and the availability of services.

8. A program shall transfer a client's assessment results and the referral form generated by the Kentucky DUI Assessment Instrument to a program of the client's choice offering service at the level of care needed by the client.

(3) Case coordination requirements.

(a) A program that conducts a client's assessment shall be responsible for case coordination whether the client receives education or treatment services at the program that conducted the assessment or at another program.

(b) . To determine if a client is compliant or noncompliant, case coordination shall be conducted and include:

1. Having regular contact with the program receiving a client referral to determine a client's compliance with the recommended education or treatment;

2. Documentation in an assessment record of actions and contacts related to follow up on a client;

3. Sending a certificate of enrollment to the court after a client is assessed pursuant to KRS 189A.045;

4. Providing information on a client's progress to the court upon request;

5. Notifying the circuit clerk of the court within three (3) working days after making a determination or receiving notice that a client is noncompliant of the need to schedule a show-cause hearing;

6. Sending a completion report to the Transportation Cabinet and the court within three (3) working days after making a determination or receiving notice that a client is compliant;

7. Providing a certificate of completion to a client who satisfactorily completes the required services; and

8. Sending completed Kentucky DUI assessment records in accordance with subsection (1)(a)3. and 4. of this section on a monthly basis to the division or its designee on removable computer media or via online submission.

(c) A program administrator shall notify the court within three (3) working days of the date specified in the client's fee agreement, if a client fails to pay for an assessment within the time stated in the fee agreement.

Section 7. Additional Client Considerations.

(1) Out of state clients and program.

(a) A non-Kentucky licensee convicted of DUI in Kentucky may attend an out of state program without referral. Notification to or approval by the division shall not be required. The client shall bear the burden of demonstrating to the satisfaction of the court and Kentucky Transportation Cabinet that the out of state program:

1. Is licensed or otherwise authorized to provide DUI services;

2. Complies at a minimum with the requirements of this administrative regulation; and

3. Satisfies the requirements of KRS Chapter 189A.

(b) If a client receives an assessment from the Kentucky Certified DUI Program and chooses education or treatment services in another state, the Kentucky Certified DUI Program shall:

1. Locate an out of state program;

2. Contact the out of state program to arrange the client's enrollment;

3. Send the program receiving the referral a DUI Referral Report Form and a Case Coordination Form, which are part of the Kentucky DUI Assessment Instrument; and

4. Provide case coordination.

(c) A Kentucky licensed driver and resident convicted of DUI pursuant to KRS 189A.010(1)(a) through (f) shall receive a DUI assessment in Kentucky. Referral to an out of state program may be allowed if the program is licensed to provide services at the level of care necessary to satisfy Kentucky's requirements.

(d) If a non-Kentucky licensee with an out of state conviction attends a Kentucky Certified DUI Program, compliance reporting and case coordination shall be in accordance with the requirements of the convicting state.

(2) Clients with special needs.

(a) If a client is identified as having a special need at the time of assessment, a program shall provide services either directly or through referral according to the following:

1. Questions and instructions shall be read orally to a client who is unable to read and responses shall be recorded for a client who is unable to write;

2. A qualified interpreter shall be provided for a deaf client;

3. Reasonable accommodations shall be made for a client who is unable to communicate in English; and

4. A pregnant client shall be referred for prenatal care.

(b) A program shall document in a client's record special needs services the client receives.

(c) Responsibility for payment of a special need service shall be according to the following:

1. A program shall be responsible for payment of interpreter services pursuant to KRS 30A.415; and

2. A client shall be responsible for payment of other services required because of a special need pursuant to KRS 189A.040.

(d) A program shall comply with the rules of confidentiality established in:

1. 908 KAR 1:320 if providing interpreter services to a client in a federally-assisted program; or

2. KRS 222.271(1) if providing interpreter services to a client in a nonfederally-assisted program.

(3) A client that receives treatment before an assessment. If a client receives treatment after being charged with DUI, without first receiving an assessment, a program shall:

(a) Obtain a copy of a court order from the court and a copy of the client's uniform citation;

(b) Conduct an assessment and case coordination in accordance with Section 6(1) and (3) of this administrative regulation; and

(c) Give the client credit for treatment received since his or her DUI arrest if it can be documented that the treatment was at the level of care needed by the client based on the assessment conducted pursuant to paragraph (b) of this subsection.

(4) A client with multiple DUI convictions. If a client presents for an assessment with multiple unresolved DUI convictions, a program shall:

(a) Obtain a copy of the client's uniform citation and an AOC 494 form or court order for each conviction;

(b) Conduct one (1) assessment and case coordination in accordance with Section 6(1) and (3) of this administrative regulation;

(c) Refer the client to treatment at a level of care appropriate to satisfy the client's clinical needs and all of the client's DUI convictions; and

(d) Complete a separate completion report for each of the client's convictions.

(5) A client convicted of DUI while enrolled in a program. If a client receives a subsequent conviction for DUI while enrolled in an education or treatment program, a program shall:

(a) Obtain a copy of the client's uniform citation and an AOC 494 form or court order for the subsequent conviction;

(b) Conduct another assessment and case coordination in accordance with Section 6(1) and (3) of this administrative regulation;

(c) Refer the client to a level of care appropriate to satisfy the client's clinical needs and all of the client's DUI convictions;

(d) Document the client's file to show that the client's admission to treatment began at the time the client was reassessed; and

(e) Complete a separate completion report for each of the client's convictions.

(6) Prior services received by a client. If a client requests services after being reported noncompliant, a program shall:

(a) Refer the client back to the court for a new court order;

(b) Conduct a DUI assessment; and

(c) Give the client credit for prior services if it can be documented that:

1. The services were at the level of care indicated by the assessment;

2. The services were received within the last six (6) months; and

3. The client is progressing in accordance with the completion requirements.

(7) Early release of a second offender. If the program responsible for a client's case coordination determines a second offender, who has completed at least six (6) months of the treatment that was recommended based on the client's assessment, has completed a program prior to the end of the one (1) year period ordered by the court, the administrator of the program shall send a written report notifying the court that the client has completed the program.

(8) A client under twenty-one (21) years of age. If a client is under twenty-one (21) years of age, a program shall deliver services:

(a) In accordance with the requirements established in this administrative regulation if the client is convicted of DUI pursuant to KRS 189A.010(1)(a) through (d); or

(b) In accordance with a court order, not subject to the requirements established in this administrative regulation, if the client is convicted pursuant to KRS 189A.010(1)(e).

(9) Early release of a first offender referred to treatment. A first offender referred to treatment may be deemed appropriate for release prior to the expiration of the ninety (90) day requirement if the offender:

(a) Has achieved all goals and objectives stated in the treatment plan;

(b) Has completed a minimum of two (2) months in treatment;

(c) Has received the recommendation of the assessor providing case coordination; and

(d) Has met all completion requirements.

(10) Clients under the influence of alcohol or other drugs. If a client presents for services under the influence of alcohol or other drugs:

(a) The DUI program staff shall protect the safety and welfare of all clients by arranging for the impaired client's removal from the facility;

(b) The DUI program administrator or the clinical services supervisor shall contact the case coordinator; and

(c) The case coordinator shall re-evaluate the level of care appropriate to address the client's problem.

Section 8. Education Requirements.

(1) Approved curriculum. A DUI program desiring to provide education services shall ensure that:

(a) The education delivered within the program is the twenty (20) hour curriculum approved by the division, the PRIME for Life Risk Reduction Program (PRI) Twenty (20) Hour Curriculum;

(b) Education is provided:

1. In person by an instructor holding valid DUI instructor certification from the division for the particular education session to be delivered; or

2. For a program that delivered education via video telecommunication equipment on the effective date of this administrative regulation, either in person or through continued use of video telecommunication equipment for education delivery, by an instructor holding valid DUI instructor certification from the division. To deliver education via video telecommunication equipment under this subparagraph, the program shall:

a. Notify the division in writing within fourteen (14) days following the effective date of this administrative regulation of its preference to continue to use video telecommunication equipment in the delivery of education; and

b. Receive written approval from the Division within thirty (30) days of the effective date of this administrative regulation;

(c) A certified instructor delivers a curriculum in accordance with the curriculum delivery standards established by subsection (2) of this section and was taught at a DUI instructor certification training conducted by the Prevention Research Institute, Inc.;

(d) A certified DUI instructor demonstrates knowledge, communication, and facilitation skills as evidenced by:

1. Delivery of key supporting points of the curriculum;

2. Exhibiting skill in processing curriculum and participant journal activities;

3. Exhibiting fluency with curriculum content;

4. Ability to maintain class focus on subject of session;

5. Ability to engage each participant in discussions;

6. Ability to manage client defense and resistance;

7. Exhibiting sensitivity to individual client learning styles; and

8. Communicating a belief in the accuracy and importance of the curriculum; and

(e) A certified DUI instructor who is observed to lack the necessary skills outlined in paragraph (d) of this subsection receives additional instructor development to elevate his or her skill level to the extent necessary to perform as required by paragraph (d) of this subsection.

(2) Delivery standards.

(a) The twenty (20) hour curriculum shall:

1. Be for a first offender assessed as needing only education or as a supplement to treatment if delivered to a first or multiple offender assessed as needing treatment;

2. Consist of twenty (20) hours of instruction and group interaction that increases a client's awareness and knowledge about the risks of alcohol and other drug use and helps develop skills to change a client's attitude and behavior in relation to alcohol and other drug abuse; and

3. Be delivered no more than:

a. Three (3) hours per day; and

b. Three (3) times per week.

(b) A program may enroll first offenders and multiple offenders in the same session.

(c) A program administrator shall ensure that:

1. There are no more than twenty (20) and no less than two (2) clients in a session;

2. A curriculum is delivered in accordance with the delivery standards established in this subsection;

3. Required manuals for a curriculum are distributed to and used by a client;

4. A client is given the manual for personal use after completion of an education service;

5. Videos required in a curriculum are shown to a client;

6. Supplemental videos and speakers that are not approved as part of a curriculum are not used for an education service; and

7. Evaluation of DUI educational classes are completed by the participants and submitted to the division at the conclusion of each twenty (20) hour education course.

(3) Documentation and completion requirements for education sessions.

(a) A program shall maintain a sign-in sheet for an education session that includes the:

1. Name of the curriculum;

2. Title and number of the session;

3. Date, time, location, and name of the instructor; and

4. Client name and signature.

(b) A program shall require a client to:

1. Attend and participate in each session of a curriculum;

a. If the client is a first offender, attend each session of the curriculum in any order; or

b. If the client is a multiple offender, except as provided by paragraph (c) of this subsection, attend sessions in sequence beginning with chapter 1;

3. Comply with a program's rules of conduct; and

4. Pay required fees.

(c) If a client who is a multiple offender cannot attend a session, due to an emergency, a program shall allow the client to attend a session out of sequence the next time the chapter is presented by a program. Documentation of the emergency shall be maintained in the client's file.

(d) If a client is receiving education at a program other than the program from which the assessment was received, the program administrator shall notify the individual responsible for the client's case coordination if the client:

1. Demonstrates a need for service at a different level of care;

2. Satisfactorily completes education; or

3. Is noncompliant.

(e) If a client is receiving education at the program from which the assessment was received, the program administrator shall:

1. Determine if the client has satisfactorily completed the DUI education service; and

2. Report compliance or noncompliance in accordance with Section 6(3)(a)2 of this administrative regulation.

(f) A program administrator shall ensure that a client's record contains documentation showing compliance with the requirements established in this subsection.

Section 9. Treatment Requirements.

(1) General requirements.

(a) A DUI program desiring to provide treatment services shall:

1. Comply with the licensing requirements established in Section 2 of this administrative regulation;

2. Employ treatment staff who meet the requirements established in 908 KAR 1:370, Section 8; and

3. Ensure that all treatment staff have knowledge, skill, and abilities demonstrating competence as evidenced by;

a. Communicating in a non-judgmental and respectful attitude toward clients;

b. Engaging clients in the treatment process;

c. Ability to facilitate group interaction;

d. Demonstrating knowledge of substance abuse related life issues;

e. Demonstrating knowledge of the signs and symptoms of relapse;

f. Utilizing techniques to assist clients in meeting goals;

g. Ability to deal effectively with resistance;

h. Ability to address individual client differences and needs;

i. Demonstrating knowledge of the physical and psychological complications of alcohol and other drug abuse; and

j. Demonstrating the ability to develop treatment plans and document progress notes in accordance with the standards established in subsection (2) of this section.

(b) A program shall ensure that the treatment a client receives is based on that client's assessment. A client may be referred to outpatient, intensive outpatient, inpatient, residential, residential transitional living, or detoxification treatment services in a licensed treatment program in state or out of state pursuant to the requirements established in this administrative regulation.

(c) A program shall deliver treatment services in person according to the requirements established in this paragraph.

1. A client shall receive individual or group treatment.

2. A treatment group may include first and multiple offenders in the same session.

3. A sign in sheet shall be maintained which contains the date and location of the services and the signature of each client in attendance.

4. The maximum number of clients in a treatment group shall not exceed fifteen (15).

5. A client may be referred to a self-help group to supplement but not to replace treatment services.

6. A client referred to outpatient treatment shall receive at least one (1) hour of individual or one and one-half (1 1/2) hours of group treatment each week.

7. A client referred to intensive outpatient treatment shall receive at least six (6) hours of treatment over a period of two (2) or more days weekly in a program licensed for intensive outpatient treatment.

8. If a client receives treatment less often than the requirements established in subparagraphs 6 and 7 of this paragraph, to meet his or her individual clinical needs, a clinical rationale shall be documented in the client's record.

9. A client referred for inpatient or residential treatment shall receive this treatment in a program licensed for inpatient or residential treatment.

(2) Treatment plan.

(a) A clinician or treatment planning team shall be responsible for developing a treatment plan for a client accepted for treatment services by the client's fourth session.

(b) A treatment plan shall:

1. Be developed with a client's participation and be individualized for the needs of the client;

2. Include a written statement of the client's problem with alcohol and other drugs and any other problem that contributes to or is related to the client's use of alcohol and other drugs;

3. Include a written statement of treatment goals and measurable objectives with a time schedule for achieving the goals and a written statement of whether the client agrees with the treatment plan;

4. Be signed by the client and the clinician if there is a change documented in the client's treatment plan; and

5. Be reviewed and signed by the clinician at least every:

a. Forty-five (45) calendar days for a first offender attending treatment;

b. 180 days for a multiple offender attending treatment; or

c. Thirty (30) days for a client receiving intensive outpatient treatment.

(c) A client's progress toward meeting the goals stated in the treatment plan shall be documented in the client's record by a clinician at least weekly.

(d) If the twenty (20) hour education curriculum is delivered as a supplement to treatment to a first or multiple offender assessed as needing treatment, it shall be included in a client's treatment plan.

(3) Completion requirements.

(a) To complete a treatment service, a client shall:

1. Comply with all attendance requirements;

2. Achieve the goals stated in the treatment plan;

3. Comply with a program's rules of conduct; and

4. Pay required fees.

(b) If a client is receiving treatment at a program other than the program from which the assessment was received, the program administrator of the treatment program shall notify the individual responsible for the client's case coordination if a client:

1. Demonstrates a need for service at a different level of care;

2. Satisfactorily completes treatment; or

3. Is noncompliant.

(c) If a client is receiving treatment at the program from which the assessment was received, the program administrator shall be responsible for:

1. Final approval that the client has satisfactorily completed a treatment service; and

2. Reporting compliance or noncompliance in accordance with Section 6(3)(a)2 of this administrative regulation.

(d) A program administrator shall ensure that a client's record contains documentation showing compliance with the requirements established in this subsection.

Section 10. Administrative Hearing Requirements.

(1) If the division takes action to deny or revoke a DUI program's certification or an individual's assessor, instructor, or program administrator certification, the division shall:

(a) Notify the program or individual assessor, instructor, or program administrator in writing;

(b) State a reason for the adverse action; and

(c) Notify the program or individual assessor, instructor, or program administrator of the right to appeal the action pursuant to KRS Chapter 13B.

(2) A program or individual assessor or instructor shall appeal a negative certification action taken by the division by notifying the division, in writing, postmarked within twenty (20) calendar days from the date of notice of action from the division.

(3) Upon receipt of an appeal, the secretary or the secretary's designee shall give notice of the hearing to a program or an individual assessor, instructor, or program administrator, in writing, not less than twenty (20) calendar days in advance of the date set for the hearing and the notice shall be sent in accordance with KRS Chapter 13B.

(4) The secretary, or the secretary's designee, shall appoint a hearing officer to conduct a hearing and the hearing shall be conducted pursuant to KRS Chapter 13B.

(5) The division shall retain all records related to a hearing for a period of at least five (5) years.

Section 11. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "Application for DUI Program Certification", October 2011;

(b) "Application for DUI Program Recertification", October 2011;

(c) "Assessment Observation Form", October 2011;

(d) "Client Evaluation of Assessment Program", October 2011;

(e) "Client Evaluation of Treatment Program", October 2011;

(f) "Client Record Review", October 2011;

(g) "Comprehensive DUI Program Review Form", October 2011;

(h) "DUI Complaint Form", October 2011;

(i) "DUI Assessor Certification Application", October 2011;

(j) "DUI Assessor Recertification Application", October 2011;

(k) "DUI Program Certification Certificate", October 2011;

(l) "DUI Instructor Certification Application", October 2011;

(m) "DUI Instructor Recertification Application", October 2011;

(n) "DUI Program Administrator Certification Application", October 2011;

(o) "DUI Program Administrator Recertification Application", October 2011;

(p) "Education Observation Form", October 2011;

(q) "Follow-up DUI Program Review", October 2011;

(r) "PRI Client's Evaluation of Education Services Received", October 2011;

(s) "Program Survey Form", October 2011;

(t) "Report of Change Form", October 2011;

(u) "Treatment Observation Form", October 2011;

(v) AOC-494, "Notice to Attend Alcohol Driver Education Program", May 1996;

(w) "Memorandum of Understanding", October 1, 1998;

(x) "Roster of Assessments", October 1, 1998;

(y) "Kentucky DUI Assessment Instrument", October 2011; and

(z) "Prime for Life Risk Reduction Program (PRI) Twenty (20) Hour Curriculum", February 1, 2005.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright laws, at the Department for Behavioral Health, Developmental and Intellectual Disabilities, Division of Behavioral Health, 275 East Main Street, Frankfort, KY 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

• RELATES TO: KRS 189A.010, 189A.040, 189A.045, 189A.070, 222.003, 222.005, 222.221, 222.231, 222.271, 222.990
• STATUTORY AUTHORITY: KRS 189A.040(6), 194A.030(5), 194A.050(1)
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 189A.040(6) requires the Cabinet to promulgate administrative regulations to prescribe standards for the licensing and operation of the alcohol or substance abuse education and treatment facilities and programs that provide assessment, education, and treatment services to offenders convicted of driving under the influence pursuant to KRS 189A.010. This administrative regulation establishes certification requirements and minimum standards for an individual or other entity operating a DUI program.
• History: 18 Ky.R. 2086; Am. 2586; eff. 3-7-1992; 19 Ky.R. 2341; 2655; 20 Ky.R. 88; eff. 6-16-1993; 25 Ky.R. 2017; 2632; 26 Ky.R. 1808; eff. 4-12-2000; 38 Ky.R. 395; 970; 1147; eff. 12-7-2011; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 1:315 Zero tolerance program requirements {#sec-908-kar-1-315 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:315}

Section 1. Definitions.

(1) "AODE" means a nonmedical and nonhospital-based alcohol and other drug abuse treatment entity licensed in accordance with 908 KAR 1:370.

(2) "Case coordination" means facilitating the provision of court-ordered services to an offender, including communicating with other service providers and the court.

(3) "Prevention assessment" means a process designed to separate a person who requires substance abuse prevention services, from a person who needs a referral to an AODE, by the administration of an assessment tool which has been validated for use with the population being served.

(4) "Preventionist" means an individual or certified prevention professional who receives remuneration for an alcohol or other drug prevention program.

(5) "Prevention program" means a holder of a license issued in accordance with 908 KAR 1:380.

(6) "Qualified early intervention specialist" means a preventionist who:

(a) Specializes in providing services to an individual who is at higher risk for developing a substance abuse disorder, than the individual's age group cohort; and

(b) Meets the requirements of 908 KAR 1:380, Section 4(2)(a).

(7) "Risk-reduction curriculum" means a curriculum that has been demonstrated to promote behavioral change that halts progression toward substance dependency, and reduces risk for other alcohol or drug-related problems, in specified target populations.

(8) "Zero tolerance offender" or "offender" means a person who has been convicted of violating KRS 189A.010(1)(e), and has been sentenced in accordance with KRS 189A.040(1).

(9) "Zero tolerance program" or "program" means a prevention program which provides court-ordered substance abuse services to a person who is convicted of violating KRS 189A.010(1)(e), in accordance with this administrative regulation.

Section 2. License Requirement.

(1) An individual or other entity shall not provide a zero tolerance program, unless the program is operated by a licensed prevention program.

(2) An AODE may provide the substance abuse services recommended by a zero tolerance program, based on the assessment required by Section 3 of this administrative regulation, if a zero tolerance program refers an offender to the AODE.

Section 3. Offender Enrollment Process.

(1) A program shall perform a prevention assessment on an offender who:

(a) Is ordered by a court to attend a zero tolerance program; or

(b) Requests enrollment in the program.

(2) A zero tolerance program shall notify an offender, in writing, and prior to enrollment, of the rules established in accordance with Section 4 of this administrative regulation.

(3) A zero tolerance program shall enroll an offender who:

(a) Agrees in writing, to participate in the program;

(b) Authorizes the program, in writing, to disclose information to the sentencing court, including:

1. The results of a prevention assessment;

2. The offender's compliance, or non-compliance with program rules;

3. The date of completion of the program, if applicable; and

4. Other information required by an order of the sentencing court; and

(c) Agrees, in writing, to comply with the program rules established in accordance with Section 4 of this administrative regulation.

Section 4. Program Rules.

(1) A zero tolerance program shall establish written rules for participation in the program which specify:

(a) Requirements for attendance, including attendance at services provided by an AODE, if a referral is made in accordance with Section 5(2) of this administrative regulation;

(b) Requirements for payment of fees, in accordance with KRS 189A.040(1)(b);

(c) Standards for enrollment in the program;

(d) Standards for successful completion of the program;

(e) Rules of conduct;

(f) Procedures for sharing information with the sentencing court or its designee;

(g) Procedures for payment of a fee;

(h) A requirement for an offender to authorize an AODE to disclose information needed by the zero tolerance program; and

(i) Other requirements, which are not inconsistent with the requirements of KRS 189A.040, or this administrative regulation, that the program determines to be necessary for the orderly and effective administration of the program.

(2) A zero tolerance program shall establish criteria for involuntary discharge from the program, for violation of program rules.

(3) A program that discharges an offender in accordance with the criteria required by subsection (2) of this section, shall notify the sentencing court, in writing of:

(a) The date the offender is discharged; and

(b) The criteria for involuntary discharge that the offender met.

(4) The notice required by subsection (3) of this section shall be made no later than three (3) days after the decision is made to discharge the offender.

Section 5. Services Required.

(1) A zero tolerance program shall provide the following services:

(a) Prevention assessment;

(b) Case coordination;

(c) Preventive education; and

(d) Referral to an AODE, if indicated by the results of a prevention assessment.

(2) If a zero tolerance program makes a referral in accordance with subsection (1)(d) of this section, it shall:

(a) Notify the offender of the results of the prevention assessment;

(b) Provide the offender with a list of AODE programs which are geographically accessible to the offender; and

(c) Provide the offender with a written referral to:

1. The AODE the offender prefers, if an offender states a preference, from the programs identified in paragraph (b) of this subsection; or

2. An AODE on the list specified in paragraph (b) of this subsection, if the offender does not state a preference.

(3) An offender shall:

(a) Enroll in an AODE identified in subsection (2)(b) of this section no later than seven (7) days after the date of the referral; and

(b) Notify the zero tolerance program of the name of the AODE in which the offender enrolls.

(4) The zero tolerance program shall, no later than seven (7) days after the date of the referral made in accordance with subsection (2)(c) of this section, contact the program identified in subsection (3)(b) of this section, to determine if the offender is enrolled in that program.

(5) A zero tolerance program shall assure that offenders under the age of eighteen (18) receive services provided separately from services provided to individuals who are convicted of violating KRS 189A.010(a), (b), (c), or (d).

Section 6. Standards for Required Services.

(1) A prevention assessment shall be performed by a qualified early intervention specialist who shall be:

(a) Employed by the zero tolerance program; or

(b) Under contract to the zero tolerance program.

(2) Preventive education services shall be provided:

(a) In accordance with a risk-reduction curriculum validated as effective for persons under twenty-one (21) years of age, who are at a higher risk than the general public for developing a substance abuse disorder; and

(b) By an individual who has been authorized, in writing, to use the curriculum, by the author of the curriculum.

(3) A zero tolerance program shall:

(a) Use the written or visual material, included in a curriculum identified in subsection (2)(a) of this section, unless the use of other material has been approved, in writing, by the author of the curriculum, or the Behavioral Health, Developmental and Intellectual Disabilities; and

(b) Follow the sequence of presentation specified in the curriculum used, if a sequence is specified in the curriculum, unless the author of the curriculum grants approval, in writing, to deviate from the specified sequence.

(4) A zero tolerance program shall provide case coordination services to a zero tolerance offender who is enrolled, including an offender who is referred to an AODE.

(5) Case coordination shall be performed by a qualified early intervention specialist.

(6) Case coordination shall include:

(a) A review of an offender's progress once every two (2) weeks; and

(b) Provision of the reports required by KRS 189A.040(7).

History

• RELATES TO: KRS 189A.010, 189A.040
• STATUTORY AUTHORITY: KRS 189A.040(6), EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. The 2000 session of the General Assembly enacted amendments to KRS Chapter 189A to specify penalties and service requirements for persons under the age of twenty-one (21) years who are convicted of being in control of a motor vehicle while having a blood alcohol concentration between.02 and.08 grams of alcohol per 100 milliliters of blood, or per 210 liters of breath. KRS 189A.040(6) requires the cabinet to promulgate administrative regulations for the licensure of education and treatment facilities and programs for offenders receiving education or treatment under KRS 189A.040. This administrative regulation establishes licensing requirements and standards for facilities and programs that provide services to persons convicted of violating KRS 189A.010(1)(e).
• History: 27 Ky.R. 2622; Am. 3109; eff. 5-14-2001; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 1:320 Confidential record of treatment for federally-assisted alcohol and other drug abuse programs {#sec-908-kar-1-320 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:320}

Section 1. Definitions.

(1) "AOD agency" means an alcohol or other drug abuse agency licensed pursuant to KRS 222.231.

(2) "Federally-assisted" is defined at 42 CFR Part 2, confidentiality of alcohol and drug abuse patient records, (October 1, 1994 edition).

Section 2. Applicability. An AOD agency, which is federally-assisted, shall maintain a confidential record of treatment for all clients pursuant to 42 CFR Part 2, confidentiality of alcohol and drug abuse patient records (October 1, 1994 edition), as amended at 60 Federal Register 22,296-22,297 (1995).

Section 3. Material Incorporated by Reference.

(1) 42 CFR Part 2, Confidentiality of alcohol and drug abuse patient records, (October 1, 1994 edition), 42 CFR Part 2, 2.11 and 2.12, as amended at 60 Federal Register 22,296-22,297 (1995) are hereby incorporated by reference.

(2) Copies of the incorporated material may be inspected, copied or obtained at the Department for Behavioral Health, Developmental and Intellectual Disabilities Services, 275 East Main Street, Fourth Floor, Frankfort, Kentucky 40621, 8 a.m. through 4:30 p.m., Monday through Friday.

History

• RELATES TO: KRS 222.271, 42 C.F.R. Parts 2, 2.11, 2.12
• STATUTORY AUTHORITY: KRS 194.050, 222.271, 42 C.F.R. Parts 2, 2.11, 2.12, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health Services and Family and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 222.271 mandates the cabinet to establish standards to ensure the confidentiality of alcohol and other drug abuse client records. This administrative regulation establishes confidentiality standards for federally-assisted programs.
• History: 22 Ky.R. 831; Am. 1086; eff. 11-15-95, TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 1:370 Licensing procedures, fees, and general requirements for nonhospital-based alcohol and other drug treatment entities {#sec-908-kar-1-370 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:370}

Section 1. Definitions.

(1) "Agency" is defined by KRS 222.005(2).

(2) "Adverse action" means action taken by the cabinet to deny, suspend, or revoke an alcohol and other drug treatment entity's license to operate.

(3) "Alcohol and other drug treatment entity" or "AODE" means a nonhospital-based agency owned by an individual or entity that provides one (1) or more of the following services or operates one (1) or more of the following programs:

(a) Outpatient treatment services;

(b) Intensive outpatient services;

(c) Partial hospitalization;

(d) Withdrawal management services, including medication-assisted treatment;

(e) A non-physician owned facility that employs or has an affiliation with a physician or advanced practice registered nurse who provides office-based opiate treatment services to fifty (50) percent or more of the facility's patients;

(f) A narcotic treatment program (NTP) utilizing methadone, buprenorphine, or other FDA-approved drug formulations;

(g) A residential treatment program;

(h) A family residential program;

(i) A residential transitional living program; or

(j) An adolescent residential program.

(4) "Cabinet" is defined by KRS 222.005(4).

(5) "Case management" means a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet a client's and his or her family's needs through communication and available resources to promote quality, cost-effective outcomes.

(6) "Co-occurring disorder" means concurrent substance use disorder and mental health disorder and shall not carry implication as to:

(a) Which disorder is primary and which secondary;

(b) Which disorder occurred first; or

(c) Whether one disorder caused the other.

(7) "Outpatient service" means an organized nonresidential service in which addiction and mental health treatment personnel provide professionally directed evaluation and treatment for substance-related, addictive, and mental disorders.

(8) "Residential" means a setting that provides twenty-four (24) hour structure and support in which addiction and mental health treatment personnel provide organized and intensive individual and group therapeutic activities to strengthen a client's recovery skills.

(9) "Significant financial interest" means lawful ownership of an AODE, whether by share, contribution, or otherwise in an amount equal to or greater than twenty-five (25) percent of total ownership of the AODE.

Section 2. Licensure Application and Fees.

(1) Unless exempt in accordance with subsection (2) of this section, any person, organization, corporation, community mental health center, or driving under the influence program planning to operate an outpatient or residential AODE shall submit the following to the cabinet:

(a) A completed Application for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE) and any required documentation;

(b) A licensure fee of $500; and

(c) A fee of eighty (80) dollars per outpatient AODE extension site that is:

1. Separate from the outpatient parent facility; and

2. Not located in a school or other community-based setting that is not operated by the outpatient AODE.

(2) The following settings shall be exempt from licensure as an AODE:

(a) A program or activity of a voluntary self-help organization or community group exempt in accordance with KRS 222.003(1) or (2);

(b) A licensed chemical dependency treatment service exempt in accordance with KRS 222.231(1);

(c) A department, agency, or institution of the federal government exempt in accordance with KRS 222.231(1);

(d) A federally certified rural health clinic or a federally qualified health center that provides services to patients with behavioral health or psychiatric conditions, including substance use disorder;

(e) The private office or clinic of a practitioner in accordance with KRS 216B.020(2);

(f) A licensed psychiatric residential treatment facility that provides outpatient behavioral health services to individuals who are age twenty-one (21) or younger and have been diagnosed with substance use disorder; or

(g) A residential crisis stabilization unit licensed in accordance with 902 KAR 20:440.

(3) An outpatient or residential AODE program shall not admit clients until the program has obtained a license from the cabinet to operate the specific modality or modalities of treatment referenced on its application.

(4) An entity shall be subject to penalties in accordance with KRS 222.990(2) if the program operates a private facility without obtaining licensure as required by KRS 222.231(1).

(5) Once licensed, an outpatient or residential AODE shall submit a completed Application for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE) accompanied by the same licensure fee identified in subjection (1)(b) and (c) of this section to the cabinet annually for license renewal.

(6) Extension site locations shall not be allowed for the following levels of care:

(a) A residential AODE program that operates in accordance with this administrative regulation and 908 KAR 1:372;

(b) A non-physician owned facility that provides office-based opiate treatment services in accordance with this administrative regulation and 908 KAR 1:374, Section 6; or

(c) An NTP that operates in accordance with this administrative regulation and 908 KAR 1:374, Section 7.

Section 3. Licenses and Authority to Enter Upon Premises.

(1) A license shall be conspicuously posted in a public area of the outpatient or residential AODE at all times.

(2) If more than one (1) AODE operates at the same location, each AODE shall maintain a separate organizational identity by:

(a) Conspicuously posting a sign in a public area showing the name of the AODE;

(b) Using a separate logo or letterhead on written materials;

(c) Maintaining client records in a separate and secure cabinet; and

(d) Providing treatment services separate from another AODE located at the same location.

(3) A survey visit or complaint investigation by cabinet staff shall be unannounced.

(4) An outpatient or residential AODE shall be subject to an annual survey visit.

(5) Nothing in this administrative regulation shall prevent the cabinet from:

(a) Conducting an investigation related to a complaint; or

(b) Making an on-site survey of an AODE more often if the cabinet deems necessary.

(6) For an outpatient AODE program operating an NTP, unannounced monitoring visits may occur in conjunction with the Center for Substance Abuse Treatment (CSAT) and the Drug Enforcement Administration (DEA).

(7)

(a) A representative of the cabinet shall have access to the AODE during business hours.

(b) An applicant for licensure or a current licensee shall not deny access to a representative of the cabinet, after proper identification, to make an inspection for determining compliance with the licensure requirements under:

1. 908 KAR 1:370;

2. 908 KAR 1:372; or

3. 908 KAR 1:374.

(c)

1. Denial of access, including any effort to delay, interfere with, or obstruct an effort by a representative of the cabinet to enter the AODE, or deny access to records relevant to the inspection shall result in disciplinary action, including denial, revocation, modification, or suspension of the AODE's license.

2. Denial, revocation, modification, or suspension of an AODE's license shall be subject to appeal in accordance with KRS 222.231(6).

(d) An inspection of an AODE shall be conducted as follows:

1. The inspection shall be made at any time during the licensee's hours of operation;

2. The inspection shall be limited to ensure compliance with the standards set forth in 908 KAR 1:370, 908 KAR 1:372 or 908 KAR 1:374, and KRS Chapter 222; and

3. The inspection, if based on a complaint or a follow-up visit, shall not be limited in scope to the basis of the complaint or the implementation of a plan of correction.

Section 4. Change of Status.

(1) Name change.

(a) An outpatient or residential AODE shall:

1. Notify the cabinet in writing within ten (10) calendar days of the effective date of a change in the facility's name; and

2. Submit a processing fee of twenty-five (25) dollars.

(b) The cabinet shall issue a new license for the remainder of the licensure period unless the AODE is under investigation that may result in a negative licensure action in accordance with Section 20 of this administrative regulation.

(2) Change of location. An AODE shall not change the location where a program is operated, including a change in an outpatient extension site's location, until an Application for Licensure to Operate an Alcohol or Drug Treatment (AODE) accompanied by a processing fee of eighty (80) dollars is filed with the cabinet.

(3) Change of ownership.

(a) The new owner of an AODE shall submit to the cabinet an Application for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE) accompanied by a fee of $500 within ten (10) calendar days of the effective date of the ownership change.

(b) A change of ownership shall be deemed to occur if more than twenty-five (25) percent of an existing AODE or capital stock or voting rights of a corporation is purchased, leased, or otherwise acquired by one (1) person from another.

(c) An individual, shareholder, or legal entity shall not acquire a significant financial interest in an AODE if that individual, shareholder, or legal entity previously held a significant financial interest in a licensed facility that had its license or certificate to operate denied, suspended, revoked, or voluntarily relinquished as the result of an investigation or adverse action that placed patients, residents, or clients at risk of death or serious harm within the preceding seven (7) years.

(4) Voluntary closure. If an outpatient or residential AODE voluntarily ceases to operate, the AODE shall notify the cabinet in writing within ten (10) calendar days of closure.

Section 5. Violations.

(1) The cabinet shall notify an outpatient or residential AODE in writing of a regulatory violation identified during an inspection.

(2) The outpatient or residential AODE shall submit to the cabinet, within ten (10) calendar days of the notice, a written plan for the correction of the regulatory violation.

(3) The plan of correction shall be signed by the AODE's administrator, the licensee, or a person designated by the licensee and shall specify:

(a) The date by which the violation shall be corrected;

(b) The specific measures utilized to correct the violation; and

(c) The specific measures utilized to ensure the violation will not recur.

(4) The cabinet shall review the plan of correction and notify the AODE in writing of the decision to:

(a) Accept the plan;

(b) Not accept the plan; or

(c) Deny, suspend, or revoke the license for a substantial regulatory violation in accordance with KRS 222.231(6).

(5) The notice specified in subsection (4)(b) of this section shall:

(a) State the specific reasons the plan is unacceptable; and

(b) Require an amended plan of correction within ten (10) calendar days of receipt of the notice by the AODE.

(6) The cabinet shall review the amended plan of correction and notify the AODE in writing of the decision to:

(a) Accept the plan;

(b) Deny, suspend, or revoke the license for a substantial regulatory violation in accordance with KRS 222.231(6); or

(c) Require the AODE to submit an acceptable plan of correction.

(7) An AODE that fails to submit an acceptable amended plan of correction may be notified that the license will be denied, suspended, or revoked in accordance with KRS 222.231(6).

Section 6. Governing Authority.

(1) An outpatient or residential AODE shall have a governing authority that shall be legally responsible for the management, operation, and financial viability of the AODE.

(2) The governing authority shall:

(a) Establish the AODE's mission and purpose;

(b) Ensure that the AODE is operating in accordance with its mission and in the case of a non-profit, the purpose for which it was granted tax-exemption;

(c) Appoint an administrator who shall:

1. Be principally responsible for the day-to-day operation of the AODE; and

2. Ensure that information is provided in response to a request by the cabinet for data collected in accordance with KRS 222.462(2)(b);

(d) Establish a client fee schedule;

(e) Ensure that the client fee schedule is posted in a public area of the outpatient or residential AODE;

(f) Maintain financial records regarding the assessment and payment of client fees;

(g) Oversee the implementation of policies and procedures, and ensure that they are available to all personnel and maintained electronically or in hard copy at the AODE's administrative office; and

(h) Ensure that an AODE's policies and procedures are reviewed every two (2) years and revised as needed.

Section 7. Quality Assurance and Utilization Review.

(1) An outpatient or residential AODE shall have a quality assurance and utilization review program designed to:

(a) Enhance treatment and care through the ongoing objective assessment of services provided, including the correction of identified problems; and

(b) Provide an effective mechanism for review and evaluation of the service needs of clients.

(2) An outpatient or residential AODE shall have a utilization review team that shall:

(a) Be made up of a representative sample of the AODE's clinical staff responsible for providing services;

(b) Assess the appropriateness and clinical necessity of client admissions;

(c) Evaluate the need for continuing services immediately upon a change in a client's service needs or a change in the client's condition to ensure that proper arrangements have been made for:

1. Discharge;

2. Transfer; or

3. Referral to another service provider, if appropriate; and

(d) Submit a written record of findings related to inappropriate patterns of service accompanied by recommended action for correcting a problem to the administrator or other individual with overall responsibility for the program's treatment services.

Section 8. Co-occurring Services.

(1) An outpatient or residential AODE shall:

(a) Screen for co-occurring disorders; and

(b) Treat or refer a client in need of co-occurring services.

(2) An outpatient or residential AODE that provides substance use disorder treatment to clients diagnosed with a co-occurring disorder shall have clearly written policies and procedures that:

(a) Govern the integrated treatment of substance use and mental health treatment, which shall include screening, assessment, diagnosis, and service provision;

(b) Allow for the use of psychiatric medication when indicated;

(c) Include developing and maintaining affiliation agreements, case consultation, and a referral mechanism to mental health treatment services in order to facilitate the provision of integrated treatment services; and

(d) Include the qualifications of clinical staff responsible for screening, assessing, diagnosing, and treating clients with co-occurring disorders as follows:

1. Only licensed individuals whose scope of practice allows them to render a diagnosis for both mental health disorder and substance use disorder may assess and diagnose clients with co-occurring disorders; and

2. The AODE shall ensure that clinical supervision is provided by staff possessing clinical credentials necessary to provide clinical supervision to any staff person who renders treatment and services to clients diagnosed with co-occurring disorders.

Section 9. Implementation of Policies and Procedures.

(1) An outpatient or residential AODE shall have written policies and procedures to:

(a) Establish a system for responding to an:

1. Accident or injury that requires hospitalization or results in death; or

2. Incident that involves fire damage, a natural disaster, or threat to security that substantially interrupts the delivery of services;

(b) Document the accident, injury, or incident in an incident file maintained electronically or in hard copy at the AODE's administrative office; and

(c) Report an incident, injury, or accident to the:

1. AODE's administrator;

2. Parent or guardian of a client under the age of eighteen (18); and

3. Cabinet for Health and Family Services if the report is required by:

a. KRS 620.030 in the case of suspected child dependency, abuse, or neglect; or

b. KRS 209.030 in the case of suspected adult abuse, neglect, or exploitation.

(2) An outpatient or residential AODE shall have a written emergency plan for responding to a disaster at the facility, including safety procedures in the event of a fire, severe weather, or other threatening situation as follows:

(a) The emergency plan shall be conspicuously posted in a public area of each AODE;

(b) A copy of the emergency plan shall be provided to all personnel;

(c) The AODE shall provide training for all personnel on how to:

1. Report a fire;

2. Extinguish a small fire; and

3. Evacuate a building; and

(d) The AODE shall maintain a written record of practiced fire drills.

(3)

(a) An outpatient or residential AODE shall have written policies and procedures that:

1. Establish a system to effectively respond to problems associated with domestic violence among clients served in the AODE; and

2. Include the requirements established in paragraphs (b), (c), and (d) of this section.

(b) The AODE shall provide training for clinical staff on the dynamics of domestic violence, including:

1. The effect of domestic violence on adult and child victims;

2. Legal remedies for protection;

3. Safety and risk issues;

4. Available community services;

5. Victim services; and

6. Applicable reporting requirements.

(c) The AODE shall assess a client with a history of domestic violence for current safety risks.

(d) The AODE shall implement measures to reduce safety risks to:

1. A client with a history of domestic violence;

2. Other clients; and

3. Staff.

(4) An outpatient or residential AODE shall have written policies and procedures that include:

(a) A written description of each program, including philosophy, mission statement, goals, objectives, and staffing;

(b) Admission, readmission, discharge, and transfer criteria; and

(c) Procedures for making a referral within the AODE or to another service provider, if appropriate.

(5) An outpatient or residential AODE shall have written policies and procedures for implementation of a language access plan to:

(a) Address reasonable accommodation for communication access services for a client who:

1. Has a visual impairment;

2. Is deaf or hard of hearing;

3. Is unable to comprehend or communicate due to a language barrier; or

4. Has a different linguistic background;

(b) Provide for appropriate auxiliary aids and services, including assistive listening devices, realtime captioning, or sign language interpreters, if needed;

(c) Ensure that programs and activities provided through electronic and information technology are accessible to a client with a disability; and

(d) Allow for language assistance services, including oral language assistance or written translation for a client with a different linguistic background.

(6) An outpatient or residential AODE shall have a written personnel policy that includes a:

(a) Job description and qualifications for each personnel category, including duties and reporting supervisor;

(b) Description of the duties and supervision of volunteers and student interns; and

(c) Written plan that describes a coordinated program for staff education, including:

1. Orientation of personnel to the policies and objectives of the organization;

2. On-the-job training, if necessary; and

3. Orientation and basic education about the prevalence of trauma, including training that:

a. Covers the dynamics of retraumatization;

b. Helps create a trauma-informed environment to ensure that all staff are knowledgeable in evidence-based practices that avoid institutional processes that may retraumatize a client with a history of trauma; and

c. Assists in the implementation of trauma-informed practices across domains and standards, which may include:

(i) Admissions;

(ii) Environmental standards;

(iii) Screening and assessment processes;

(iv) Referrals to other services;

(v) Treatment planning;

(vi) Confidentiality;

(vii) Ethics;

(viii) Overdose prevention; and

(ix) Discharge.

(7) An outpatient or residential AODE shall have written policies and procedures governing client grievances, including:

(a) Identification of an AODE ombudsman;

(b) A process for filing a written client grievance;

(c) An appeals process with time frames for filing and responding to a grievance in writing;

(d) Protection of a client from interference, coercion, discrimination, or reprisal; and

(e) Conspicuous posting of the grievance procedures in a public area to inform a client of:

1. His or her right to file a grievance;

2. The process for filing a grievance; and

3. The address and telephone number of the AODE's and cabinet's ombudsman.

(8) If alcohol or drug testing is conducted as part of assessment, treatment, or discharge, an outpatient or residential AODE shall have written policies and procedures that outline the screening process and the indications for testing positive.

(9)

(a) An AODE shall have a written policy to address the:

1. Use and misuse of alcohol or illegal drugs; and

2. Misuse of prescription drugs.

(b) The policy shall apply to all clients and their visitors while on the campus of the program.

(10) An AODE that provides services to clients under age eighteen (18) shall have written policies and procedures to ensure that:

(a) Services and educational materials are developmentally appropriate; and

(b) The client's family is involved in his or her treatment to the extent possible and appropriate with the written consent of a client.

Section 10. Qualifications and Responsibilities of the Clinical Services Supervisor.

(1) A clinical services supervisor hired by an AODE shall complete:

(a) Twelve (12) hours of specialized training in clinical supervision within six (6) months from the date of assuming the position of supervisor;

(b) At least three (3) hours of training in clinical supervision annually; and

(c) At least ten (10) hours of training in alcohol and other drug abuse counseling annually.

(2) The clinical services supervisor:

(a) May provide supervision at more than one (1) AODE facility;

(b) Shall not supervise a spouse, child, stepchild, sibling, parent, stepparent, grandparent, grandchild, aunt, uncle, niece, nephew, or in-law;

(c) Shall be responsible for all treatment services provided by the AODE;

(d) Shall ensure that the client treatment plan required by Section 19 of this administrative regulation addresses both of the client's co-occurring disorders, if applicable; and

(e) Shall maintain documentation of each clinical supervisory session with each clinician under supervision, including the:

1. Date;

2. Length of the session; and

3. Content of the supervision.

(3) The clinical services supervisor shall be:

(a) A certified alcohol and drug counselor (CADC) as defined by KRS 309.080(2) with 4,000 hours of clinical work experience post certification;

(b) A licensed clinical alcohol and drug counselor (LCADC) as defined by KRS 309.080(4); or

(c) An individual who meets the training requirements of subsection (4) of this section and is licensed or certified as one (1) of the following:

1. Physician licensed in Kentucky to practice medicine or osteopathy in accordance with KRS 311.571, or a medical officer of the government of the United States while engaged in the performance of official duties;

2. 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.;

3. Psychologist licensed and practicing in accordance with KRS 319.050;

4. Certified psychologist with autonomous functioning or a licensed psychological practitioner practicing in accordance with KRS 319.056;

5. Person currently authorized to use the title of "certified psychologist" under KRS 319.056(3) and has 6,000 hours of postcertification practice certified by the Kentucky Board of Examiners of Psychology;

6. Psychological associate practicing in accordance with KRS 319.064 and has 6,000 hours of postcertification practice certified by the Kentucky Board of Examiners of Psychology;

7. Clinical social worker licensed and practicing in accordance with KRS 335.100;

8. Social worker certified and practicing in accordance with KRS 335.080 and has 6,000 hours of postcertification clinical practice in psychiatric social work;

9. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a masters degree in psychiatric nursing from an accredited college or university and 6,000 hours of clinical experience in psychiatric nursing;

10. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a bachelor's degree in nursing from an accredited college or university, who is certified as a psychiatric and mental health nurse by the American Nurses Association, and who has 6,000 hours of clinical experience in psychiatric nursing;

11. Marriage and family therapist licensed and practicing in accordance with KRS 335.300;

12. Professional clinical counselor licensed and practicing in accordance with KRS 335.500; or

13. Licensed professional art therapist as defined by KRS 309.130(2).

(4) A clinical services supervisor who is a licensed or certified health care professional as described by subsection (3)(c) of this section shall:

(a) Complete eighty (80) hours of training in alcohol and other drug abuse counseling within:

1. Four (4) years immediately prior to the date of assuming responsibility as a clinical services supervisor in the AODE; or

2. Two (2) years immediately after assuming responsibility as a clinical services supervisor in the AODE; and

(b) Have 4,000 hours of work experience in the alcohol and other drug treatment field post degree.

Section 11. Qualifications and Responsibilities of Clinicians.

(1) An outpatient or residential AODE shall hire clinicians who:

(a) Shall be responsible for conducting assessments and treatment planning;

(b) Shall be responsible for leading counseling sessions; and

(c) May be responsible for providing case management.

(2) A clinician shall complete a minimum of ten (10) hours of training in alcohol and other drug abuse counseling annually.

(3) In addition to the annual training required by subsection (2) of this section, a clinician who provides case management shall complete twelve (12) hours of specialized training in case management within six (6) months from the date of assuming responsibility for case management services.

(4) A clinician shall be:

(a) An LCADC as defined by KRS 309.080(4);

(b) A CADC as defined by KRS 309.080(2);

(c) An individual who meets the training requirements of subsection (5) of this section and is licensed or certified as one (1) of the following:

1. Physician licensed in Kentucky to practice medicine or osteopathy in accordance with KRS 311.571, or a medical officer of the government of the United States while engaged in the performance of official duties;

2. 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.;

3. Psychologist licensed and practicing in accordance with KRS 319.050;

4. Certified psychologist with autonomous functioning or a licensed psychological practitioner practicing in accordance with KRS 319.056;

5. Person currently authorized to use the title of certified psychologist in accordance with KRS 319.056(3);

6. Psychological associate practicing in accordance with KRS 319.064;

7. Clinical social worker licensed and practicing in accordance with KRS 335.100;

8. Social worker certified and practicing in accordance with KRS 335.080;

9. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a masters degree in psychiatric nursing from an accredited college or university;

10. Registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with one (1) of the following combinations of education and work experience:

a. Bachelor of science in nursing from a four (4) year program from an accredited college or university and 2,000 hours of clinical work experience in the substance abuse or mental health field;

b. Diploma graduate in nursing from a three (3) year program and 4,000 hours of clinical work experience in the substance abuse or mental health field; or

c. Associate degree in nursing from a two (2) year program from an accredited college or university and 6,000 hours of clinical work experience in the substance abuse or mental health field;

11. Advanced practice registered nurse as defined by KRS 314.011(7);

12. Marriage and family therapist licensed and practicing in accordance with KRS 335.300;

13. Professional clinical counselor licensed and practicing in accordance with KRS 335.500;

14. Licensed professional art therapist as defined by KRS 309.130(2); or

15. Physician assistant as defined by KRS 311.840(3); or

(d) An individual who has a bachelor's degree in any field from an accredited college or university and meets the following requirements:

1. Works under the supervision of a clinical services supervisor;

2. Receives at least four (4) hours of face-to-face clinical supervision monthly during at least two (2) supervisory meetings;

3. Meets the training requirements of subsection (5) of this section;

4. Has all treatment plans cosigned by the clinical services supervisor within ten (10) business days; and

a. Obtains temporary certification as an alcohol and drug counselor (TCADC) from the Kentucky Board of Alcohol and Drug Counselors within two (2) months of the date of employment as a clinician, if the clinician's bachelor's degree is in an area other than the field of human services; or

b. Was employed as a clinician by an AODE prior to the effective date of this administrative regulation and has maintained continuous employment as a clinician.

(5) A clinician as described by subsection (4)(c) or (d) of this subsection shall complete eighty (80) hours of training in alcohol and other drug abuse counseling within:

(a) Four (4) years immediately prior to the date of assuming responsibility as a clinician in the AODE; or

(b) Two (2) years immediately after assuming responsibility as a clinician in the AODE.

Section 12. Qualifications and Responsibilities of Case Managers.

(1) A case manager employed by an outpatient or residential AODE shall:

(a)

1. Have a bachelor's degree from an accredited college or university; or

2. Be a CADC as defined by KRS 309.080(2);

(b) Successfully complete a department-approved case management training within six (6) months of employment as a case manager; and

(c) Successfully complete ten (10) hours of continuing education in alcohol and other drug-relevant training annually.

(2) Case management services shall be based on the:

(a) Goals established in the client's clinical assessment; and

(b) Development of an individualized person-centered treatment plan that identifies the case management activities that support implementation of the plan.

(3) A case manager shall not exceed a case load size of thirty (30) unique clients.

Section 13. Peer Support Specialists. A peer support specialist employed by an outpatient or residential AODE shall:

(1) Complete six (6) hours of training in the area of substance use disorder annually;

(2) Attest in writing to at least one (1) year of recovery; and

(3)

(a) Be a registered alcohol and drug peer support specialist in accordance with KRS 309.0831; or

(b) Meet the requirements of:

1. 908 KAR 2:220;

2. 908 KAR 2:230; or

3. 908 KAR 2:240.

Section 14. Personnel records. A personnel record shall be kept at the outpatient or residential AODE's administrative office on each staff member and contain the following information:

(1) Name and address;

(2) Verification of all training and experience, including licensure, certification, registration, or renewals;

(3) Verification of submission to the background check requirements of Section 15 of this administrative regulation;

(4) Annual performance appraisals; and

(5) Employee incident reports.

Section 15. Background checks.

(1) All staff of an outpatient or residential AODE who have job duties that involve providing services to a client, or who may have one-on-one contact with a client shall:

(a) Have a criminal record check performed upon initial hire through the Administrative Office of the Courts or the Kentucky State Police; and

(b) Not have a criminal conviction, or plea of guilty, to a:

1. Sex crime as specified in KRS 17.500;

2. Criminal offense against a minor as specified in KRS 17.500; or

3. Felony offense related to neglect, physical abuse, sexual abuse, or exploitation of a child.

(2) An outpatient or residential AODE that provides services to clients under age eighteen (18) shall not employ as clinical personnel anyone listed on the central registry established by 922 KAR 1:470.

(a) If a central registry check has been submitted for an individual and is pending, the individual:

1. May be hired pending the results of the registry check; and

2. Shall not be left unsupervised with a client under eighteen (18) years of age.

(b) An employee shall be dismissed immediately if the results of the check show the individual is listed on the central registry.

(3) An outpatient or residential AODE shall perform annual criminal record checks as described in paragraph (a) of this subsection on a random sample of at least twenty-five (25) percent of all personnel.

Section 16. Client Rights.

(1) An outpatient or residential AODE shall establish, implement, and conspicuously post written policies and procedures regarding the rights of clients.

(2) The notice of client rights shall include the address and telephone number of the:

(a) Cabinet's ombudsman; and

(b) AODE's ombudsman or personnel responsible for handling client grievances.

(3) A client shall not be unlawfully discriminated against in determining eligibility for a treatment program.

(4) During an outpatient or residential AODE's intake procedures, a client shall sign a statement that specifies that the client has the right to:

(a) Give informed consent to receive a service, in which case:

1. An adult shall sign an informed consent to receive a service; or

2. A client under age eighteen (18) who suffers from substance use disorder or a parent, caregiver, or person who has custodial control of a client under age eighteen (18) shall sign an informed consent for the client to receive a service in accordance with KRS 222.441;

(b) Have input into his or her treatment plan and be informed of the plan's content;

(c) Receive individualized treatment;

(d) File a grievance, recommendation, or opinion regarding the services the client receives;

(e) Give informed written consent regarding participation in a research study, with the exception of a client under age eighteen (18) whose parent or guardian shall give informed written consent;

(f) Confidentiality of information in accordance with the following:

1. A federally-assisted AODE in accordance with 908 KAR 1:320; or

2. A nonfederally-assisted AODE in accordance with KRS 222.271(1);

(g) Request a written statement of charges for services and be informed of the policy for the assessment and payment of client fees;

(h) Be informed of the rules of client conduct, including the consequences for using alcohol or other drugs, or other infractions that may result in:

1. Further assessment;

2. Modification of the treatment approach;

3. Transfer to a higher intensity level of treatment; or

4. Disciplinary action or discharge, after review and consideration of alternative interventions, which shall be documented in the client's record with an explanation for any decision involving disciplinary action or discharge;

(i) Be treated with consideration, respect, and personal dignity;

(j) Review his or her client record in accordance with the AODE's policy; and

(k) Receive one (1) free copy of his or her client record in accordance with KRS 422.317.

(5) The statement of client rights shall be:

(a) Provided to the client;

(b) Provided to the client's parent, guardian, or other legal representative, in addition to the client, and upon consent of the client, if the client is under the age of eighteen (18) or incapacitated; and

(c) Read to the client or upon consent of the client, read to the client's parent, guardian, or other legal representative, if requested.

(6) A residential AODE providing twenty-four (24) hour care shall specify on the client rights statement that a client has the right to:

(a) Vote in a political election, if age eighteen (18) or over;

(b) Reasonable accommodations to afford privacy in bathing and toileting; and

(c) Privileges in accordance with KRS 222.271(2).

(7) An outpatient AODE that operates an NTP shall specify on the client rights statement that a client has the right to:

(a) Request a hearing, if the client is involuntarily discharged, so long as the hearing is requested within forty-eight (48) hours of receipt of written notice of discharge;

(b) Continued treatment pending the outcome of the hearing; and

(c) Representation at the hearing by an attorney or other person chosen by the client.

(8) If a client is restricted from exercising a client right because it is contraindicated by the client's physical or mental condition, there shall be documentation in the client record stating the reason for the restriction and the explanation given to the client.

Section 17. Client Records.

(1) A client record shall be maintained for each individual receiving services.

(2) Each entry shall be signed and include the date the service was provided.

(3) All information regarding a client's human immunodeficiency virus status shall be kept confidential in accordance with KRS 214.181 and 214.625.

(4) Each client record shall contain:

(a) An identification sheet, including:

1. Client's name, address, age, gender, and marital status;

2. Expected source of payment; and

3. Referral source;

(b) Consent of appropriate family members or guardians for admission, evaluation, and treatment, if applicable;

(c) Application for admission, including intake information;

(d) A biopsychosocial assessment;

(e) Health status questionnaire or a copy of the record of a physical health examination;

(f) Consent form, fee agreement, and statement of client rights, each signed by the client;

(g) Client's treatment plan;

(h) Progress notes;

(i) Aftercare plan;

(j) Authorization for release of information, signed by the client; and

(k) Discharge summary.

(5) Ownership.

(a) Client records shall be the property of the AODE.

(b) The original client record shall not be removed from the AODE except by court order or subpoena.

(c) Copies of a client record or portions of the record may be used and disclosed in accordance with subsection (7) of this section.

(6) Retention of records. After a client's death or discharge, the completed client record shall be placed in an inactive file and:

(a) Retained for six (6) years; or

(b) Three (3) years after the client reaches the age of majority under state law, if a minor, whichever is the longer.

(7) Confidentiality and Security: Use and Disclosure.

(a) The AODE shall maintain the confidentiality and security of client 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. 290 ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2.

(b) The AODE may use and disclose client records in accordance with:

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

2. 42 U.S.C. 290 ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2.

(c) An AODE may establish 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. 290 ee-3, and the Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2.

Section 18. Client Assessment.

(1) Except in a residential transitional living program where counseling services are not provided on-site, a clinician operating within the clinician's professional scope of practice in an AODE shall complete a comprehensive biopsychosocial assessment of each client at the time of admission and document the following:

(a) Medical status;

(b) History of alcohol, tobacco, or other drug use, including any interventions;

(c) Acute intoxication and withdrawal potential;

(d) Pregnancy status and test results if completed;

(e) Current or history of psychological problems or psychiatric disorders and treatment received, including:

1. Previous psychiatric admissions;

2. History of suicidal or homicidal ideation and attempts;

3. Outpatient psychiatric treatment; and

4. Psychotropic medications;

(f) Any legal proceedings involving the client;

(g) The client's family and relationships;

(h) The client's current living situation and any housing needs;

(i) Behavioral risk factors for human immunodeficiency virus (HIV) and Hepatitis, including the provision of information on HIV and AIDS to each client who shall also be offered testing for HIV infection;

(j) Readiness to change;

(k) Recreational interests;

(l) Cultural, ethnic, and spiritual beliefs or practices; and

(m) Employment and support, including assessment of the client's:

1. Employment status, current work or vocational skills, and potential for improving those skills or developing new ones;

2. Educational status and skills;

3. Aptitudes, interests, and motivation;

4. Physical abilities, impairments, or disabilities;

5. Relationships with co-workers and supervisors; and

6. Current and prior work or school related problems, including problems related to substance use disorder.

(2) To ensure that a client is placed in the appropriate treatment facility, the client shall be assessed for a level of care determination based upon the most recent version of The American Society of Addiction Medicine (ASAM) Criteria.

(3) Each biopsychosocial assessment shall be documented by the outpatient or residential AODE in the client record and include the following:

(a) The client's diagnosis as made by a clinician operating within the clinician's professional scope of practice, in accordance with the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for alcohol, tobacco, and other drug use;

(b) Screening for other co-occurring disorders;

(c) The ASAM level of care determination; and

(d) Referral for a full diagnostic evaluation and treatment planning, if appropriate.

(4) If the biopsychosocial assessment indicates that a client should be referred to another treatment program or level of care, the outpatient or residential AODE shall coordinate the client's referral to another program.

(5) If transfer to another facility or level of care is indicated, the outpatient or residential AODE shall provide services that are responsive at the client's current level of care until the transfer is made.

(6) A residential AODE shall ensure that a full physical examination is completed within seventy-two (72) hours of admission and includes:

(a) Certification by the examining physician or appropriate health care practitioner that the level of care needed by the client is available through the facility; and

(b) The results of the following laboratory tests and evaluations, subject to the client's written consent:

1. Blood work for chronic, incurable, or communicable diseases or conditions as indicated by the client's medical history and the health care practitioner's evaluation;

2. Serologic tests for syphilis, smears, and cultures for gonorrhea and other sexually transmitted diseases, as medically indicated;

3. Routine urinalysis, including pregnancy testing if medically indicated or requested;

4. HIV antibody testing, as medically indicated, for which the residential AODE shall obtain a separate written consent and ensure that:

a. Each client receives HIV pre-test counseling and post-test counseling if the client elects to be tested; and

b. If HIV testing is performed, the residential AODE shall:

(i) Report positive results and maintain client confidentiality in accordance with KRS 214.645; and

(ii) Meet the registration and testing requirements of KRS 214.625(7);

5. Testing for Hepatitis A, Hepatitis B, and Hepatitis C, as medically indicated; and

6. Tuberculosis screening, testing, and treatment, as medically indicated.

Section 19. Client Treatment Planning.

(1) An outpatient or residential AODE shall establish a treatment plan for each client that:

(a) Is specific, measurable, and outcomes-focused;

(b) Is based on the biopsychosocial assessment made of the client in accordance with Section 18 of this administrative regulation;

(c) Is initiated upon the client's admission;

(d) If applicable, includes pharmacological treatment modalities to manage opioid use disorder;

(e) Is entered into the client's record within:

1. Seventy-two (72) hours following the client's admission to a residential AODE program; and

2. Thirty (30) days following the client's admission to an outpatient AODE program;

(f) Is reviewed at least:

1. Every two (2) weeks in a residential AODE program;

2. Quarterly in an outpatient AODE program providing intensive outpatient services or partial hospitalization; and

3. Every thirty (30) days for:

a. Outpatient treatment services;

b. Ambulatory withdrawal management services;

c. Office-based opiate treatment services; or

d. A narcotic treatment program;

(g) Is rewritten every six (6) months; and

(h) Is revised as necessary based on a change in treatment needs.

(2) Each client shall be continually assessed by the outpatient or residential AODE using the most recent version of the ASAM criteria to assess level of care and needs.

(3) Problems, strengths, and needs identified in the placement, assessment, and treatment planning shall be addressed:

(a) Directly by the outpatient or residential AODE; or

(b) Through referral to appropriate services.

(4) An outpatient or residential AODE shall provide the following services in accordance with a client's treatment plan:

(a) Orders for medication, medical treatment, and other services, including the type and frequency of contact, if applicable;

(b) Treatment for substance use disorder, including a plan to:

1. Reduce symptoms and severity; and

2. Improve treatment outcomes;

(c) Integrated treatment of co-occurring disorders, either on-site or through the coordination of treatment services with an appropriate mental health facility, if applicable;

(d) Vocational and educational services if needed, either on-site or by referral to community resources;

(e) Opportunities for the client to voluntarily participate in support group meetings during treatment; and

(f) Family supports, recovery supports, spiritual, housing, and social support services as needed.

(5) An outpatient or residential AODE shall document in the client's record:

(a) Evidence of client participation in the development and implementation of the treatment plan;

(b) The staff responsible for implementation of the treatment plan;

(c) Dated signatures of the client and participating multidisciplinary team members;

(d) Long-term and short-term goals with timeframes for achievement;

(e) The assessment measures for determining the effectiveness of, and client satisfaction with, treatment or services including assessments of client adherence to and engagement with treatment and recovery support services;

(f) The time intervals for review of the client's response to treatment or services;

(g) Discharge plans; and

(h) Transfer plans, if applicable.

(6) Practitioners in each of the services providing care to a client shall participate in the development of the treatment plan relative to the services the practitioner shall provide.

(7) The client and the client's family, with consent from the client, if considered appropriate, shall participate in the development of the client treatment plan, which shall include an aftercare plan to prepare the client for life after leaving rehabilitation.

(8) If a physician or other clinician documents in the client's clinical record that the client's participation in the development of the client treatment plan is medically contraindicated, a member of the multidisciplinary team providing services to the client shall:

(a) Review the client's treatment plan with the client prior to implementation; and

(b) Inform the client's family or legal guardian of the treatment plan with consent of the client.

(9) If the family or legal guardian of a client does not agree to participate in the treatment planning, the outpatient or residential AODE shall document the:

(a) Attempt to engage the family or legal guardian, with the client's consent, in the treatment planning process; and

(b) Refusal to participate.

(10) The multidisciplinary team shall review the treatment plan and client treatment progress at least every thirty (30) days with the review and any revisions documented in the client's clinical record.

(11) Any revision of the treatment plan shall be based upon:

(a) The client's response to the care provided;

(b) The client's abilities and disabilities; and

(c) Each team member's continuing reassessment of services rendered.

(12) Results of random drug and alcohol screening shall be incorporated into therapeutic interventions and the treatment planning process.

Section 20. Denial, Emergency Suspension, and Revocation.

(1) The cabinet shall deny or revoke a license if it finds that:

(a) There has been substantial failure in accordance with KRS 222.231(6) by the AODE to comply with the provisions of:

1. KRS Chapter 222; or

2. AODE licensure administrative regulations under 908 KAR Chapter 1;

(b) The AODE fails to submit an acceptable plan of correction or fails to submit an acceptable amended plan of correction within the timeframes required by Section 5(2) or (5)(b) of this administrative regulation;

(c) The AODE fails to comply with the annual renewal process;

(d) The AODE denies access to the cabinet in accordance with Section 3(7) of this administrative regulation;

(e) The AODE's certification as a driving under the influence program is denied, revoked, or voluntarily relinquished as the result of an investigation or adverse action that placed clients at risk of death or serious harm;

(f) An individual having a significant financial interest in the AODE has, within the seven (7) year period prior to the application date, had significant financial interest in a facility or service that was licensed or certified by the cabinet, and the license or certificate to operate was denied, suspended, revoked, or voluntarily relinquished as the result of an investigation or adverse action that placed patients, residents, or clients at risk of death or serious harm;

(g) An individual having significant financial interest in the AODE has been:

1. Previously discontinued or disqualified from participation in any governmental assistance program due to fraud or abuse of the program; or

2. The subject of disciplinary action taken against the individual by a professional licensing board for misconduct related to endangering a patient or client; or

(h) The cabinet finds that the applicant misrepresented or submitted false information on the application.

(2) For an outpatient AODE that operates an NTP, the cabinet shall deny or revoke a license in accordance with subsection (1) of this section or if it finds that:

(a) Take-home doses inconsistent with the dosage allowed by 908 KAR 1:374 Section 7 were issued without specific CSAT, DEA, or State Narcotic Authority (SNA) approval prior to issuance of the take-home doses;

(b) Take-home doses were outside the allowable difference between the labeled dosage of the approved controlled substance and the actual dosage as determined by the United States Pharmacopeia error rate;

(c) More than five (5) percent of the medical and dosing records reviewed are out of compliance with the requirements of 908 KAR 1:374 Section 7;

(d) There are discrepancies in the inventory reconciliation greater than five (5) percent;

(e) Clients were issued doses prior to completion of the intake procedures, including physical exam, except under SNA-approved circumstances;

(f) There is evidence in the client's record that the physician is not in control of the client's treatment;

(g) There is a pattern of issuing doses to clients before obtaining a signed consent to treatment with controlled substances; or

(h) There is a pattern of failing to perform the drug screening required by 908 KAR 1:374, Section 7.

(3) The denial or revocation of an AODE's license shall be issued in accordance with KRS 222.231(6).

(4) In accordance with KRS 222.231(6), the denial or revocation shall become final and conclusive thirty (30) days after notice is given, unless the applicant or licensee submits a written request for a hearing within the thirty (30) day period.

(5) If an AODE requests a hearing in accordance with the timeframe established by KRS 222.231(6) and subsection (4) of this section, the cabinet shall:

(a) Appoint a hearing officer; and

(b) Proceed in accordance with KRS 13B.050 and KRS 222.231(7).

(6) Emergency action to suspend a license.

(a) The cabinet shall take emergency action in accordance with KRS 13B.125 to suspend an AODE's license if the cabinet has probable cause to believe that the continued operation of the AODE would constitute an immediate danger to the health, welfare, or safety of its clients.

(b) Notice of an emergency suspension shall identify the particular reasons for the action.

(c) If requested, an emergency hearing shall take place in accordance with the requirements of KRS 13B.125(3).

(d) The sole issue of the hearing shall be whether there is immediate danger.

(e) The decision shall be rendered in accordance with KRS 13B.125(4).

Section 21. Incorporation by Reference.

(1) "Application for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE)", 12/2018 edition, is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

• RELATES TO: KRS 13B.050, 13B.125, 17.500, 209.030, 214.181, 214.625, 216B.020(2), 222.003, 222.005, 222.231, 222.271, 222.441, 222.462, 222.990, 309.080, 309.0831, 309.130, 311.571, 311.840(3), 314.011, 319.050, 319.056, 319.064, 335.080, 335.100, 335.300, 335.500, 422.317, 439.3401, 620.030, 42 C.F.R. Part 2, 45 C.F.R. Parts 160, 164, 42 U.S.C. 1320d-2–1320d-8, 42 U.S.C. 290ee-3
• STATUTORY AUTHORITY: KRS 222.231(2)
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 222.231(2) requires the cabinet to promulgate administrative regulations to establish requirements and standards for treatment programs, including licensing fees, application, procedures for renewal and revocation, procedures for program evaluation, and minimum operating, training, and maintenance of patient records standards. This administrative regulation establishes licensing procedures, fees, responsibilities of the governing authority, quality assurance and utilization review, policies and procedures, staff qualifications and training, client rights, client records, assessment, treatment planning, and adverse action procedures for outpatient and residential alcohol and other drug treatment entities.
• History: 24 Ky.R. 2485; 25 Ky.R. 355; 26 Ky.R. 1826; eff. 4-12-2000; TAm eff. 4-27-2016; 45 Ky.R. 2500, 3195; TAm eff. 8-19-2019; 46 Ky.R. 441; eff. 8-19-2019; TAm eff. 3-17-2020; TAm eff. 10-28-2020; Crt eff. 7-1-2026.

908 KAR 1:372 Licensure of residential alcohol and other drug treatment entities {#sec-908-kar-1-372 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:372}

Section 1. General Requirements. Each type of residential AODE program as described in Section 2 through Section 6 of this administrative regulation shall implement written policies for separate housing of adult and adolescent clients, and male and female clients in accordance with the following:

(1) Adult and adolescent clients shall be physically separated by floor, wing, or other physical barriers; and

(2) Male and female sleeping quarters shall be physically separated by floor, wing, or other adequate physical barriers, ensuring the clients' rights to privacy and dignity in treatment.

Section 2. Clinically Managed Residential Withdrawal Management.

(1) In addition to the licensing requirements of 908 KAR 1:370, a program offering clinically managed residential withdrawal management shall accept and provide services only to clients meeting the:

(a) Diagnostic criteria for substance-related disorder as established by the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for alcohol, tobacco, and other drug use; and

(b) Dimensional criteria for clinically managed residential withdrawal management as established in the most recent version of The American Society of Addiction Medicine (ASAM) Criteria.

(2) Clinically managed residential withdrawal management services shall:

(a) Be delivered by staff who:

1. Are qualified to meet the needs of clients; and

2. Provide twenty-four (24) hour supervision, observation, and support for clients who are intoxicated or experiencing withdrawal;

(b) Include care for clients whose intoxication and withdrawal signs and symptoms require twenty-four (24) hour structure and support without the need for medically monitored inpatient withdrawal management services; and

(c) Include:

1. Use of established clinical protocols to identify clients who are in need of:

a. Medical services beyond the capacity of the facility; and

b. Transfer to an appropriate level of care;

2. Availability of specialized clinical consultation and supervision for biomedical, emotional, behavioral, and cognitive problems;

3. Protocols that shall be developed and supported by a physician knowledgeable in addiction medicine for use in determining the nature of any medical or nursing interventions required if a client's condition deteriorates and the client appears to need the care of a physician or nurse;

4. Availability of medical evaluation and consultation twenty-four (24) hours per day;

5. Affiliation with other levels of care; and

6. Ability to arrange for appropriate laboratory and toxicology tests.

(3) Staff shall include clinical staff trained and competent to implement physician-approved protocols for:

(a) Patient observation and supervision;

(b) Determination of appropriate level of care; and

(c) Facilitation of the client's transition to continuing care.

(4) Each clinician who is responsible for assessing and treating clients shall be able to obtain and interpret information regarding the needs of the clients, including:

(a) The signs and symptoms of alcohol and other drug intoxication and withdrawal;

(b) Appropriate treatment and monitoring of intoxication and withdrawal; and

(c) How to facilitate entry into ongoing care.

(5) A program providing clinically managed residential withdrawal management that supervises self-administration of medication shall have written policies and procedures on the steps involved for self-administration, including:

(a) Identification in the client record of medication that requires physician approval prior to use; and

(b) The name of the staff person who monitored the self-administration of the medication.

(6) Therapies offered by a program providing clinically managed residential withdrawal management shall include:

(a) Daily clinical services to assess and address the needs of each client, including the following if needed:

1. Medical services, including:

a. Medically assisted withdrawal; or

b. Medication assisted treatment, provided onsite or through referral;

2. Individual counseling;

3. Group counseling; or

4. Withdrawal support;

(b) A range of cognitive, behavioral, medical, mental health, and other therapies as needed to enhance a client's understanding of:

1. Addiction;

2. Co-occurring disorders;

3. Completion of the withdrawal management process; and

4. Referral to an appropriate level of care for continuing treatment;

(c) Withdrawal rating scale tables and flow sheets that include tabulation of vital signs if needed;

(d) Interdisciplinary individualized assessment and treatment;

(e) Health education services; and

(f) Services to families and significant others.

(7) Elements of the assessment and treatment planning shall include:

(a) An individualized treatment plan established in accordance with 908 KAR 1:370, Section 19, including:

1. Problem identification in dimensions two (2) through six (6) of the most recent version of the ASAM criteria;

2. Development of treatment goals and measurable treatment objectives; and

3. Activities designed to meet the treatment objectives and management of withdrawal symptoms;

(b) Daily assessment of:

1. Progress during withdrawal management; and

2. Any treatment changes;

(c) Transfer and discharge planning, beginning at the point of admission; and

(d) Referral and linkage arrangements for:

1. Counseling;

2. Medical care, including medication assisted treatment if not provided onsite;

3. Psychiatric care; and

4. Continuing care.

(8) Progress notes shall:

(a) Be maintained in the client record in accordance with 908 KAR 1:370, Section 17(4)(h);

(b) Reflect implementation of the treatment plan;

(c) Document the client's response to treatment; and

(d) Include each amendment of the treatment plan.

(9) A client shall continue with clinically managed residential withdrawal management until:

(a) Withdrawal signs and symptoms are sufficiently resolved so that the client can be safely managed at a less intensive level of care;

(b) The client's signs and symptoms of withdrawal have:

1. Failed to respond to treatment; or

2. Intensified so that transfer to a more intensive level of withdrawal management is indicated; or

(c) The client is unable to complete clinically managed residential withdrawal management despite an adequate trial, due to increasing depression, suicidal impulses, or other severe complication.

Section 3. General Residential Treatment Programs.

(1) In addition to the licensing requirements in 908 KAR 1:370, a residential treatment program:

(a) Shall evaluate the client's need for each of the following at admission:

1. Alcohol and other drug abuse services;

2. Employment services;

3. Vocational education, training, or rehabilitation services;

4. Disability services;

5. Other health and human services; and

6. Assistance in developing daily living skills;

(b) Shall establish and implement a policy for off-site supervision and transportation of clients to services provided outside of the facility, which shall:

1. Indicate the method of transportation;

2. Address the security and accountability for each client and his or her personal possessions;

3. Address the transfer of client information to and from the provider of services;

4. Ensure that a copy of current registration and current insurance information is maintained on file for each vehicle used to transport clients;

5. Ensure that the name of each driver responsible for transporting clients is maintained on file;

6. Identify the employee who accompanies the client, if appropriate; and

7. Identify the destination for each client; and

(c) May provide clinically managed residential withdrawal management as established in Section 2 of this administrative regulation.

(2) A residential treatment program shall provide each client with education regarding:

(a) The disease of addiction;

(b) The client's diagnosis;

(c) The effects of alcohol and other drug abuse;

(d) The risks of exposure to human immunodeficiency virus (HIV), hepatitis, and other health consequences of substance use disorder;

(e) Family issues related to substance use disorder;

(f) Recovery support groups specific to addiction recovery;

(g) Medication assisted treatment; and

(h) Understanding the interactions between mental health and addiction, including the most common types of co-occurring disorders.

(3) Information or education about alcohol and other drug abuse, including recovery shall be made available to a client's family or significant other.

(4) A client shall have access to printed materials, appropriate to the client's literacy level, and audio and video materials that are:

(a) Presented multi-lingually on the basis of client composition of the facility; and

(b) Related to the treatment of alcohol and other drug abuse.

(5) A residential treatment program client shall receive at least six (6) hours each day in structured activities, including participation in any of the following activities:

(a) Alcohol and other drug abuse education;

(b) Individual, group, or family counseling in which the client shall participate a minimum of ten (10) hours each week;

(c) On-site or off-site recovery support meetings;

(d) Life skills training;

(e) Vocational training or an educational activity; or

(f) Recreation.

(6) If counseling is provided in a group, there shall be a maximum of twelve (12) clients per clinician.

(7)

(a) A residential treatment program shall provide a planned, diversified program of organized recreational activities that allow clients to participate on an individual or group basis as specified in the client treatment plan and coordinated with other client care services.

(b) Recreational activities shall be provided under the direction of staff as part of the client's schedule.

(8)

(a) Progress notes shall be recorded in the client's record following the delivery of a clinical service or individual counseling session and shall include:

1. The type of service provided, including the:

a. Date of the service; and

b. Length of the service;

2. A description of the client's response to the service; and

3. Clinical impressions including the clinician's assessment of the client's progress or lack of progress toward achieving the objectives established in the treatment plan.

(b) In addition to paragraph (a) of this subsection, a progress note shall be made each week to document the client's progress in:

1. Employment;

2. Pursuing employment;

3. Participation in vocational education, training, or rehabilitation activities;

4. Participation in recovery support groups;

5. Training in daily living and recovery supports; and

6. Following through on referrals to services, if needed.

(9) A written recovery plan shall be:

(a) Developed by the client and the treatment team to identify and promote aspects of continuing care for substance use disorder that are associated with success in recovery;

(b) Provided to the client after he or she has achieved the initial stabilization goals of treatment; and

(c) Based on the client's needs at discharge, including activities and any referrals to support recovery.

(10) A discharge summary shall be completed within thirty (30) calendar days of discharge, including the client's:

(a) Date of admission;

(b) Date of discharge;

(c) Presenting problem;

(d) Evaluation of alcohol and other drug abuse or dependency;

(e) Summary of treatment;

(f) Response to treatment;

(g) Referrals made to other organizations or providers; and

(h) Reason for discharge.

(11) Other than a personal care or housekeeping task, if a client performs work in the residential treatment program that is part of a therapeutic activity, the work shall be voluntary and consistent with the treatment plan.

(12) A residential treatment program shall have written policies and procedures on the use of medication, including:

(a) Documentation in the client record of any medications the client is currently prescribed and taking;

(b) Documentation in the client record of any over-the-counter medication the client is taking;

(c) Steps involved for self-administration of over-the-counter medication, including identification in the client record of medication that requires physician approval prior to use;

(d) Documentation that any medications brought into the facility by a resident are not administered or allowed to be self-administered unless the medication has been identified and a written order to administer or allow for self-administration of the specific drug is given by the responsible prescribing practitioner;

(e) Documentation of the physician's verification in the client's record;

(f) Storage of all medications to ensure that all medications be kept in a locked, secure location inaccessible to clients;

(g) Administration of medication, including establishment of the times for administration of medication;

(h) Documentation in the client's record of self-administration of prescription or over-the-counter medication, including the:

1. Name of the medication;

2. Date and time of self-administration;

3. Dosage and amount of medication; and

4. Name of the staff person who monitored the self-administration of the medication.

(13) A residential treatment program shall have a first-aid kit with supplies necessary for use in responding to minor injury or illness.

(14)

(a) If the program prepares meals on-site for a client, food services shall be provided in accordance with 902 KAR 45:005.

(b) A copy of the food service permit shall be maintained on site.

(c) There shall be documentation that meal planning is approved by a registered dietician.

(d) If clients prepare their own meals on-site or are otherwise responsible for their meals, a food service permit shall not be required.

(e) Drinking water shall be freely available throughout the day, including mealtime.

(15) A residential treatment program shall be staffed twenty-four (24) hours per day, seven (7) days per week and have:

(a) A program manager, supervisor, or coordinator, including a designated staff person responsible for managing a program in the absence of the manager, supervisor, or coordinator;

(b) A sufficient number of personnel to meet client needs based on the:

1. Number of clients;

2. Need for assistance; and

3. Services delivered; and

(c) At least one (1) staff person on duty and awake at all times who is trained in:

1. Crisis intervention;

2. Cardiopulmonary resuscitation; and

3. Standard first aid.

(16) A residential treatment program shall ensure that in addition to the clients' rights established by 908 KAR 1:370, Section 16, the following clients' rights shall be fully protected:

(a) The right to visitation with family and friends, subject to written visiting rules and hours established by the program, except as provided in subsections (17) and (18) of this section;

(b) The right to conduct private telephone conversations, subject to written rules and hours established by the program, except as provided in subsections (17) and (18) of this section;

(c) The right to send and receive uncensored and unopened mail;

(d) The right to wear his or her own clothing subject to written program rules;

(e) The right to bring personal belongings, subject to limitation or supervision by the program;

(f) The right to communicate with his or her personal physician; and

(g) The right to practice his or her personal religion or attend religious services, within the program's policies and written policies for attendance at outside religious services.

(17) The administrator, program manager, or designee may impose limitations on any of the visitation or phone call procedures if limitations are:

(a) Therapeutically necessary; and

(b) Recorded in the client's record.

(18) The residential treatment program may require the client to open mail or packages in the presence of program staff for inspection.

(19) If more than one (1) type of residential AODE program operates in the same facility, staff may provide services in each program.

Section 4. Family Residential Program.

(1) In addition to the requirements of 908 KAR 1:370 and Section 3 of this administrative regulation, a family residential program in which a client's children reside with the client:

(a) Shall provide parenting education to the client if identified in the client's treatment plan;

(b) Shall ensure and document that the children:

1. Are immunized at admission;

2. Show no signs of illness; and

3. Continue to receive primary medical care as needed during their stay at the facility;

(c) Shall develop and implement written policies to:

1. Include the maximum number of children permitted to reside in the facility at one (1) time;

2. Include the age of children permitted to reside in the facility;

3. Ensure that the needs of the children are assessed and met during treatment;

4. Ensure that the health, safety, and well-being of the children is protected; and

5. Require the client to sign a statement that outlines the client's responsibility for care of the client's child, including that:

a. The client shall have primary responsibility for ensuring the child's needs are met regarding:

(i) Food;

(ii) Clothing;

(iii) Hygiene;

(iv) Safety;

(v) Discipline;

(vi) Supervision; and

(vii) Obtaining services in response to a referral made on behalf of the child; and

b. The client shall make prior arrangements for the care of the child before leaving the facility without the child; and

(d) May provide clinically managed residential withdrawal management as established by Section 2 of this administrative regulation.

(2) A family residential program shall:

(a) Identify and provide information to the client regarding community resources, including education and child care;

(b) Provide education about the effect on families and children regarding abuse of alcohol or other drugs; and

(c) Provide organized recreational activities:

1. Under the direction of staff; and

2. Posted on a schedule.

Section 5. Residential Transitional Living Program.

(1) In addition to the licensing requirements of 908 KAR 1:370, a residential transitional living program that provides counseling services on-site shall:

(a) Comply with the requirements established for general residential treatment programs in Section 3(1), (6), and (8) to (17) of this administrative regulation;

(b) Ensure that each client participates in counseling and planned clinical program activities a minimum of five (5) hours per week. Client participation in any combination of individual, group, or family counseling shall be scheduled for no less than two (2) of the five (5) hours of weekly program activities; and

(c) Enable each client to attend recovery support meetings.

(2) A residential transitional living program that does not provide counseling services on-site shall:

(a) Comply with the requirements established for general residential treatment programs in Section 3(1)(a) and (b) and (d) through (f), and (8) through (17) of this administrative regulation;

(b) Ensure that a comprehensive biopsychosocial assessment is obtained on behalf of the client;

(c) Ensure that each client participates in counseling and planned clinical program activities a minimum of five (5) hours per week. Client participation in any combination of individual, group, or family counseling shall be scheduled for no less than two (2) of the five (5) hours of weekly program activities;

(d) Enable each client to attend recovery support meetings;

(e) Have a program manager who may be responsible for more than one (1) facility and shall:

1. Be responsible for the day-to-day management of the program, including:

a. Supervising caseworkers; and

b. Monitoring the implementation of program policies and procedures;

2. Complete training in accordance with 908 KAR 1:370, Section 10(1); and

3. Meet the education and experience requirements of a clinical services supervisor in accordance with 908 KAR 1:370, Section 10(3), or have at least a bachelor's degree from an accredited college or university, in addition to:

a. 4,000 hours of work experience in the alcohol and other drug treatment field post degree; and

b. Eighty (80) hours of alcohol and other drug abuse training within four (4) years immediately prior to the date of assuming responsibility as a program manager or no longer than two (2) years immediately after assuming responsibility as a program manager;

(f) Have sufficient staff to ensure that a staff person that meets the minimum requirements of a program manager is responsible for managing a program in the absence of the program manager; and

(g) Have caseworkers who:

1. Shall be responsible for:

a. Coordinating clinical services in accordance with a client's treatment plan;

b. Monitoring a client's progress in relation to the treatment plan;

c. Conducting training on daily living and recovery supports; and

d. Making referrals; and

2. Meet the training, education, and experience requirements of 908 KAR 1:370, Section 11(2) to (5).

Section 6. Adolescent Residential Treatment Program.

(1) An adolescent residential treatment program shall be a freestanding residential facility or a distinct part of a facility in which care is provided to two (2) or more adolescent clients who are:

(a) Under eighteen (18) years of age; or

(b) Eighteen (18) to twenty-one (21) years of age, if placement in an adolescent program is determined to be the appropriate level of care upon completion of the assessment described by 908 KAR 1:370, Section 18(1) and (2).

(2) In addition to the requirements of 908 KAR 1:370 and Section 3 of this administrative regulation, an adolescent residential treatment program:

(a) Shall admit adolescents only to areas within the facility approved by the cabinet for adolescent occupancy;

(b) Shall ensure that areas for adolescents are physically separated from any part of a facility occupied by or accessible to adult clients;

(c) Shall ensure that adolescent clients in the facility be separated if the age range is more than five (5) years;

(d) Shall have no fewer than two (2) staff members present and on site at all times:

(e) Shall have at least one (1) staff member within sight and sound and responsible for the supervision of no more than:

1. Ten (10) adolescent clients during waking hours; and

2. Twenty (20) adolescent clients during sleeping hours;

(f) Shall provide or coordinate the provision of educational services; and

(g) May provide clinically managed residential withdrawal management as established in Section 2 of this administrative regulation.

(3) An adolescent residential treatment program shall:

(a) Make every effort to identify the resident's family dynamics, including family structure and patterns of relating, or interactions between family members;

(b) Engage and include the family in the resident's treatment as early as possible in accordance with 908 KAR 1:370, Section 9(9);

(c) Provide single family therapy, multi-family group therapy, and parental education sessions as clinically appropriate and as specified in the client's treatment plan;

(d) Assist the resident in developing a support system to help reinforce behavioral gains made during treatment; and

(e) Provide ongoing support with an emphasis on recovery supports.

(4) Educational services shall be provided by:

(a) The local school district in which the facility is located;

(b) An accredited private educational institution in the community; or

(c) An on-site school that:

1. Is operated by the facility and approved by the Kentucky Department of Education;

2. Is designed to maintain the educational and intellectual development of the adolescent;

3. If indicated, provides opportunities to remedy deficits in the educational level of an adolescent who has fallen behind as a result of involvement with substance use; and

4. Includes at least three (3) hours of instruction on days that education services are provided.

(5) Regardless of the method by which the educational services are delivered to clients, staff of the adolescent residential treatment program shall:

(a) Confer with teachers or their principals on the progress of each client; and

(b) If appropriate, encourage clients to become active in extracurricular school activities and make arrangements necessary to enable the client to participate.

(6) The adolescent residential treatment program shall ensure that any adolescent who legally is not attending school participates in a training program that provides:

(a) Necessary life skills;

(b) Vocational training; and

(c) Training on methods of job acquisition.

(7) Each resident shall be limited to no more than two (2) hours of entertainment-based screen time per day.

(8) Structured activities shall be developmentally appropriate to the resident.

(9) Food shall be served to residents in a common eating area and shall:

(a) Include at least three (3) meals per day, served with not more than a fifteen (15) hour span between the substantial evening meal and breakfast;

(b) Include between-meal and unscheduled snacks;

(c) Not be withheld as punishment and shall not be used as a reward;

(d) Take into account the special dietary needs and tastes of residents, such as diabetes and allergies;

(e) Be served in an amount appropriate to the age of the resident and include second servings, if requested; and

(f) Not be served while viewing television or using electronics.

(10) The following practices shall be expressly forbidden:

(a) Corporal punishment;

(b) Use of restraints of any sort;

(c) Use of a behavior management room; and

(d) Sanctions that include verbal, mental, or physical abuse.

(11)

(a) Computer and internet usage shall be monitored.

(b) Blocking software or other controls shall be used to restrict access to inappropriate web sites.

(12) A resident shall receive assistance with personal care and hygiene based upon his or her developmental skills.

Section 7. Infection Control. Each type of residential AODE program shall implement written policies and procedures for an infection control system, including orientation for all new personnel and annual in-service training for all personnel on proper hygiene related to infections prevalent among persons who use drugs.

Section 8. Physical Environment.

(1) Each type of residential AODE program shall:

(a) Comply with building codes, ordinances, and administrative regulations that are enforced by city, county, or state jurisdictions;

(b) Be approved by the State Fire Marshal's office:

1. Prior to initial licensure; or

2. If the AODE changes locations;

(c) Within the program's total square footage, have at least 120 square feet of space for each client residing in the facility;

(d) Have at least one (1) toilet and one (1) sink per eight (8) clients;

(e) Have at least one (1) shower or tub per fifteen (15) clients;

(f) Provide space for a client to store clothing, linens, and personal belongings, including a receptacle that may be locked for the storage of personal property; and

(g) Have separate rooms for the following:

1. Sleeping;

2. Dining;

3. Bathing and toileting;

4. Living and recreation;

5. Laundry;

6. Visiting; and

7. Private consultation and counseling, which shall be conducted in an area where a client is assured privacy and confidentiality.

(2) A client's bed shall have:

(a) A clean mattress; and

(b) Two (2) sheets, a pillow, and bed covering of sufficient quality to maintain resident comfort.

(3) The premises shall be well kept and in good repair and meet the following requirements:

(a) The facility shall ensure that the grounds are well kept and the exterior of the building, including the sidewalks, steps, porches, ramps, and fences are in good repair;

(b) The interior of the building including walls, ceilings, floors, windows, window coverings, doors, plumbing, and electrical fixtures shall be in good repair; and

(c) 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.

Section 9. Client Care Environment.

(1) Each type of residential AODE program shall meet the following housekeeping and sanitation conditions and implement policies that reflect the following:

(a) The facility and its contents shall be clean to sight and touch and free of dirt and debris;

(b) All rooms shall be free of condensation, mold growth, and noxious odors;

(c) All equipment and materials necessary for cleaning, disinfecting, and sterilizing shall be available in the facility at all times, except as provided in subsection (3)(b) of this section;

(d) Thermometers, which are accurate to within three (3) degrees Fahrenheit shall be kept in a visible location in refrigerators, freezers, and storerooms used for perishable and other items subject to deterioration;

(e) Articles in storage shall be elevated from the floor and away from walls, ceilings, and air vents;

(f) Aisles in storage areas shall be kept unobstructed;

(g) Pest control methods that are safe for clients and staff shall be used to:

1. Minimize and eliminate the presence of rodents, flies, roaches, and other vermin in the facility; and

2. Prevent the breeding, harborage, or feeding of vermin;

(h) All openings to the outer air shall be effectively protected against the entrance of insects and other vermin;

(i) Toilet tissue, soap, and disposable towels or air driers shall be provided in each bathroom at all times, with soap and disposable towels or air driers provided at each hand washing sink;

(j) Bathrooms with multiple hand washing sinks shall provide at least one (1) soap dispenser and one (1) disposable towel dispenser or air drier for every two hand washing sinks;

(k) Except as provided in paragraph (j) of this subsection, a soap dispenser and towel dispenser shall be provided by each hand washing sink and utility sink throughout the facility;

(l) Mattresses, pillows, blankets, draperies, upholstery, and other fabrics or decorations shall be fire-resistant and flameproof;

(m) Latex foam pillows shall be prohibited;

(n) Equipment requiring drainage shall be drained to a sanitary connection;

(o) The temperature within client areas of the facility shall:

1. Be maintained at a minimum of seventy-two (72) degrees Fahrenheit; and

2. Not exceed eighty-two (82) degrees Fahrenheit;

(p) The facility shall maintain adequate ventilation in all areas used by clients; and

(q) The facility shall establish a written heat emergency action plan to be implemented if the indoor air temperature is eighty-two (82) degrees Fahrenheit or higher for four (4) consecutive hours.

(2) Each type of residential AODE program shall meet the following safety conditions and implement policies that reflect the following:

(a) Non-skid wax shall be used on all waxed floors;

(b) Throw rugs or scatter rugs shall not be used;

(c) All equipment shall be located in an unobstructed space that has been provided for operation;

(d) All household and cleaning products in the facility shall be identified, labeled, and securely stored in a cabinet, closet, or room that is inaccessible to clients;

(e) All furnishings shall be clean and in good repair, and mechanical equipment shall be in good working order; and

(f) All smoke detectors shall be fully operational.

(3) Each family residential program shall meet the following safety conditions in addition to the provisions set forth in subsections (1) and (2) of this section:

(a) Children shall not be exposed to lead-based paint hazards;

(b) Toxic chemicals, including cleaning agents shall be stored in locked cabinets or enclosed in areas not accessible to the children;

(c) All electrical outlets shall have protective covers;

(d) All fluorescent and incandescent light bulbs shall have protective covers or shields;

(e) All windows and other glass surfaces that are not made of safety glass and that are located three (3) feet above the floor or lower shall have protective guards;

(f) Non-permanent safety barriers shall be installed if the facility has stairs, ramps, balconies, porches, or elevated play areas;

(g) Materials and furniture for indoor and outdoor use shall be of sturdy and safe construction, be easy to clean and free of hazards;

(h) Children shall be kept away from hot stoves, irons and ironing boards, knives, glassware and other equipment within the facility that may cause injury;

(i) Poisons, insect traps, rodent traps, and similar products shall be kept out of reach of children; and

(j) All indoor and outdoor areas are maintained in a safe and sanitary manner.

History

• RELATES TO: KRS 222.231, 309.080(2)
• STATUTORY AUTHORITY: KRS 222.231(2)
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 222.231(2) requires the cabinet to promulgate administrative regulations to establish requirements and standards for treatment programs, including health and safety standards, patient care standards, and classification of alcohol and other drug programs according to type, range of services, and level of care provided. This administrative regulation establishes standards for residential alcohol and other drug treatment entities (AODE) that provide services to adult men, adult women, women with dependent children, or adolescents. Residential AODE programs include twenty-four (24) hour clinically managed residential withdrawal management, general residential treatment, family residential, residential transitional living, and adolescent residential treatment programs.
• History: 45 Ky.R. 2539, 3215, 46 Ky.R. 459; eff. 8-19-2019; TAm eff. 3-17-2020; Crt eff. 7-1-2026.

908 KAR 1:374 Licensure of nonhospital-based outpatient alcohol and other drug treatment entities {#sec-908-kar-1-374 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:374}

Section 1. Definitions.

(1) "Approved controlled substance" means the drugs methadone, buprenorphine, or other FDA-approved medication for opioid use disorder (MOUD) used in the treatment of opioid addiction in a Narcotic Treatment Program.

(2) "CHFS" or "cabinet" means the Cabinet for Health and Family Services.

(3) "Central Registry" means a cabinet-approved electronic system used to register patients at a licensed narcotic treatment program (NTP) for the purpose of preventing simultaneous enrollment in other NTPs, gathering program-compliance information, and monitoring performance data.

(4) "Correctional Facility" means a jail, prison, or other place of incarceration by a government official.

(5) "CSAT" means the Center for Substance Abuse Treatment.

(6) "DEA" means the Drug Enforcement Administration.

(7) "Dose" means a one (1) day quantity of an approved controlled substance administered on site at a narcotic treatment program.

(8) "Drug screening" means the process by which a program determines the presence or the absence of drugs in the body fluids.

(9) "Main program" means the location where all administrative and medical information related to a narcotic treatment program is retained for the purpose of on-site reviews by federal agencies or the state narcotic authority.

(10) "Medication station" means any dosing location that is defined and authorized as a medication unit in 42 C.F.R. 8. Medication stations are not extension sites as established in 908 KAR 1:370 Section 2(1)(c).

(11) "Mobile unit" means means a narcotic treatment program (NTP) operating from a motor vehicle that:

(a) Serves as a mobile component for an existing licensed NTP;

(b) Operates under the registration of the NTP; and

(c) Engages in maintenance or detoxification treatment with narcotic drugs in schedules II-V at a location or locations remote from its registered and licensed location in Kentucky.

(12) "Program prescriber" means:

(a) A practitioner as defined in KRS 218A.010(40); and

(b) Is authorized to prescribe Schedule II–V controlled substances by state and federal requirements;

(13) "SNA" means the state narcotic authority and is synonymous with state opioid treatment authority (SOTA). The Department for Behavioral Health, Developmental and Intellectual Disabilities is the SNA, or SOTA, for Kentucky.

(14) "Take-home dose" means a quantity of an approved controlled substance, which the patient is eligible to take off the premises of a narcotic treatment program.

(15) "Treatment phase" means a stage in the patient's progress through a narcotic treatment program's sequential treatment system.

(16) "Voluntary withdrawal management" means a medically supervised withdrawal from the approved controlled substance requested by a patient of a narcotic treatment program.

Section 2. Ambulatory Withdrawal Management.

(1) In addition to the licensing requirements of 908 KAR 1:370, an outpatient AODE that provides ambulatory withdrawal management or maintenance services shall accept and provide services only to patients meeting the:

(a) Diagnostic criteria for a substance-related disorder for alcohol, tobacco, and other drug use as established by the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); and

(b) Dimensional criteria for outpatient services as established in the most recent version of The American Society of Addiction Medicine (ASAM) Criteria.

(2) Ambulatory withdrawal management services shall:

(a) Be provided in regularly scheduled sessions;

(b) Be delivered in accordance with:

1. Clinical protocols established for ambulatory withdrawal management in the most recent version of The ASAM Criteria; or

2. Nationally recognized, evidence-based clinical protocols approved by the cabinet; and

(c) Include the following features:

1. Specialized psychological and psychiatric consultation and supervision for biomedical, emotional, behavioral, and cognitive problems as indicated;

2. Completion of a comprehensive medical history and physical examination of the patient at admission;

3. Affiliation with other levels of care, including other levels of specialty addiction treatment for additional problems identified through the comprehensive biopsychosocial assessment required by 908 KAR 1:370, Section 18;

4. Appropriate laboratory and drug screening; and

5. Twenty-four (24) hour access to emergency medical consultation services if needed.

(3) Staff shall include:

(a) Physicians and licensed health practitioners acting within their scope of practice who, if not present on-site at the time of admission, shall be readily available to evaluate and confirm that ambulatory withdrawal management is safe for the patient; and

(b) Clinical staff who shall be knowledgeable about the biopsychosocial dimensions of alcohol, tobacco, and other substance use disorders, including the signs and symptoms of alcohol and other drug intoxication and withdrawal.

(4) Therapies offered by ambulatory withdrawal management services shall include:

(a) Individual assessment;

(b) Medication or non-medication methods of withdrawal management;

(c) Monitoring, assessment, and management of signs and symptoms of intoxication and withdrawal by a physician or licensed health practitioner acting within their scope of practice;

(d) Patient education;

(e) Non-pharmacological clinical support;

(f) Involvement of family members or significant others in the withdrawal management process; and

(g) Discharge or transfer planning, including referral for counseling and involvement in community recovery support groups.

(5) A program shall establish an individualized treatment plan in accordance with 908 KAR 1:370, Section 19 that includes:

(a) Problem identification in dimensions two (2) through six (6) of the most recent version of The ASAM Criteria;

(b) Development of treatment goals and measurable treatment objectives;

(c) Activities designed to meet the treatment objectives and management of withdrawal syndrome;

(d) Daily assessment of:

1. Progress during withdrawal management; and

2. Any treatment changes;

(e) Transfer and discharge planning, beginning at the point of admission; and

(f) Referral and linkage arrangements for:

1. Counseling;

2. Medical care;

3. Psychiatric care; and

4. Continuing care.

(6) Progress notes shall:

(a) Be maintained in the patient record in accordance with 908 KAR 1:370, Section 17(4)(h);

(b) Reflect implementation of the treatment plan;

(c) Document the patient's response to treatment; and

(d) Include each amendment of the treatment plan.

(7) Withdrawal rating scale tables and flow sheets that include tabulation of vital signs shall be used as needed.

(8) Treatment of a patient shall continue until:

(a) Withdrawal signs and symptoms are sufficiently resolved so that the patient can participate in:

1. Self-directed recovery; or

2. Ongoing treatment without the need for further medical or nursing withdrawal management monitoring;

(b) The patient's signs and symptoms of withdrawal have:

1. Failed to respond to treatment; and

2. Intensified so that transfer to a more intensive level of withdrawal management is indicated; or

(c) Ambulatory withdrawal management is not adequate to meet the severity of the patient's substance use disorder.

Section 3. Outpatient Treatment Services.

(1) In addition to the licensing requirements of 908 KAR 1:370, an outpatient AODE that offers outpatient treatment services:

(a) Shall provide alcohol and other drug use counseling to each patient, with counseling provided to no more than twelve (12) patients per clinician if provided in a group;

(b) Shall provide each patient with education regarding:

1. The disease of addiction;

2. The patient's diagnosis;

3. The effects of alcohol and other drug use;

4. The risks of exposure to human immunodeficiency virus (HIV), hepatitis, and other health consequences of substance use disorder;

5. Family issues related to substance use disorder; and

6. Relapse prevention;

(c) Shall refer each patient to services specific to addiction treatment and recovery, which may include:

1. Support groups;

2. Peer support;

3. Recovery housing;

4. Community supports;

5. Supported employment;

6. Co-occurring disorders; and

7. Medications for addiction treatment;

(d) Shall have a direct affiliation with, or close coordination through referral to more intensive levels of care and medication management;

(e) Shall have a procedure to inform patients of the availability of emergency services available twenty-four (24) hours a day, seven (7) days a week; and

(f) May provide additional therapies including:

1. Motivational enhancement;

2. Occupational and recreational therapy;

3. Psychotherapy; or

4. Medications for addiction treatment.

(2) Staff who provide outpatient treatment services:

(a) Shall be able to obtain and interpret information regarding the patient's biopsychosocial needs;

(b) Shall be knowledgeable about the biopsychosocial dimensions of alcohol, tobacco, and other substance use disorders, including assessment of the patient's stage of readiness to change;

(c) Shall be capable of monitoring stabilized mental health problems and recognizing any instability in a patient with co-occurring disorders; and

(d) May include physicians and other licensed health care practitioners acting within their scope of practice on staff if medications for addiction treatment are provided.

(3) Progress notes shall:

(a) Be maintained in the patient record in accordance with 908 KAR 1:370, Section 17(4)(h);

(b) Reflect implementation of the treatment plan;

(c) Document the patient's response to therapeutic interventions for all disorders treated; and

(d) Include each amendment of the treatment plan.

(4) The patient's discharge summary shall be completed within thirty (30) calendar days of discharge.

Section 4. Intensive Outpatient Program.

(1) In addition to the licensing requirements of 908 KAR 1:370 and Section 3 of this administrative regulation, an outpatient AODE that offers intensive outpatient services shall ensure that the program provides a multi-modal, multi-disciplinary structured approach to services that:

(a) Are more intensive than outpatient treatment services; and

(b) Provide a minimum of services:

1. For adults:

a. Nine (9) hours per week; and

b. Given on no less than three (3) days per week; or

2. For adolescents:

a. Six (6) hours per week; and

b. Given on no less than two (2) days per week.

(2) Services shall include:

(a) Individual outpatient therapy;

(b) Group outpatient therapy;

(c) Family outpatient therapy, unless contraindicated;

(d) Crisis intervention; and

(e) Psycho-education during which the patient or patient's family member shall be provided with information regarding:

1. The patient's diagnosis;

2. Reasons why a particular treatment might be effective for reducing symptoms; and

3. How to cope with the patient's diagnosis or condition in a successful manner.

(3) A program shall:

(a) Maintain a patient-to-staff ratio of no more than ten (10) patients to one (1) staff;

(b) Establish an individualized treatment plan for each patient in accordance with 908 KAR 1:370, Section 19 that focuses on stabilization and transition to a lower level of care;

(c) Provide access to a:

1. Board-certified or board-eligible psychiatrist for consultation, which may be delivered through the use of telehealth technology; and

2. Psychiatrist, other physician, or advanced practice registered nurse for medication prescribing and monitoring; and

(d) Provide each patient with a schedule of all planned therapeutic activities or otherwise ensure that the schedule is conspicuously posted in a public area of the facility.

(4)

(a) If the program prepares meals on-site for a patient who receives services for at least five (5) or more consecutive hours, the program shall be subject to inspection in accordance with 902 KAR 45:005.

(b) If patients prepare their own meals on-site or are otherwise responsible for their meals, a food service permit shall not be required.

Section 5. Partial Hospitalization.

(1) In addition to the licensing requirements of 908 KAR 1:370, an outpatient AODE that offers partial hospitalization services shall be fully accredited by at least one (1) of the following:

(a) Joint Commission;

(b) Commission on Accreditation of Rehabilitation Facilities;

(c) Council on Accreditation; or

(d) Other nationally recognized accrediting organization with comparable standards.

(2) Partial hospitalization services shall:

(a) Be short-term, four (4) to six (6) weeks on average;

(b) Meet the same standards required for intensive outpatient services, except for Section 4(1)(b) of this administrative regulation;

(c) Be provided at least five (5) hours a day and at least four (4) days per week; and

(d) Provide access to educational services for adolescent patients.

(3) An AODE program that provides partial hospitalization shall comply with 902 KAR 45:005 if the program provides meals directly to its patients.

Section 6. Office-based Opioid Treatment Services.

(1) Excluding methadone-based treatment, a facility shall be licensed as an outpatient AODE that provides office-based opioid treatment (OBOT) services if:

(a) Any individual with ownership interest in the facility is not a Kentucky-licensed physician; and

(b) The facility employs or has an affiliation with a physician, physician assistant, or advanced practice registered nurse who prescribes FDA-approved medications for the treatment of opioid use disorder to fifty (50) percent or more of the facility's patients.

(2) In addition to the licensing requirements of 908 KAR 1:370, an OBOT shall:

(a) Designate a medical director who shall:

1. Be responsible for the supervision of all medical staff and the administration of all medical services at the facility, including compliance with all federal, state, and local laws and administrative regulations regarding the medical treatment of opioid use disorder;

2. Be physically present at the facility at least twenty-five (25) percent of the time the facility is open to the public each week;

3. Conduct a monthly review of ten (10) percent of the medical charts for patients currently admitted at the facility and document each chart review; and

4. Not serve as medical director of more than three (3) OBOT facilities;

(b) Have sufficient medical staff on-site to provide the medical treatment and oversight necessary to serve patient needs, including a practitioner authorized to prescribe FDA-approved medicationsfor the treatment of opioid use disorder on-site during fifty (50) percent of clinic weekly hours of operation;

(c) Ensure that each practitioner authorized to prescribe complies with the prescribing and dispensing standards in accordance with 201 KAR 9:270 or 201 KAR 20:065 respectively for FDA-approved medications used for the treatment of opioid addiction;

(d) Ensure that a practitioner authorized to prescribedocuments in the patient's record whether or not the patient is compliant with prescribed dosing as evidenced by the results of:

1. A KASPER report released in accordance with KRS 218A.202(7)(e); and

2. Drug screening;

(e) Offer individual and group outpatient therapy;

(f) Monitor compliance with recommended non-medication therapies;

(g) Provide case management or care coordination services; and

(h) Implement pre-employment and ongoing random drug screening of all facility employees.

(3) Admission and discharge.

(a) Each patient shall be evaluated to determine and document whether or not the patient meets the diagnostic criteria for an opioid use disorder as defined in the most recent version of the DSM.

(b) The OBOT facility shall use evidence-based assessment and evaluation tools that have been peer reviewed and validated, including the most recent edition of:

1. ASAM placement criteria;

2. Addiction Severity Index;

3. Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Improvement Protocol; or

4. Any other equivalent assessment and evaluation tool.

(c) Prior to receiving treatment at the facility, the patient shall acknowledge in writing having received education on:

1. Treatment options, including withdrawal management, and the benefits and risks associated with each treatment option;

2. The risk of neonatal abstinence syndrome and use of voluntary long-acting reversible contraception for all female patients of child-bearing age and potential;

3. Prevention and treatment of chronic viral illnesses, such as HIV and hepatitis;

4. Expected therapeutic benefits and adverse effects of treatment medication;

5. Risks for overdose, including drug interactions with central nervous system depressants, and return to use after a period of abstinence from opioids; and

6. Overdose prevention and reversal agents.

(d) An OBOT facility shall not provide any type of reward to a third party for referral of potential patients to the clinic.

(4) Comprehensive assessment. The facility shall complete a comprehensive assessment in accordance with 908 KAR 1:370, Section 18 and in accordance with peer-reviewed opioid use disorder treatment guidelines developed by nationally recognized organizations, such as SAMHSA and the American Society of Addiction Medicine.

(5) Treatment planning. An OBOT facility shall complete an individualized treatment plan for each patient in accordance with 908 KAR 1:370, Section 19, featuring a plan for aftercare that includes the development of a list of appropriate treatment resources available to the patient in their community.

(6) Discharge.

(a) A discharge plan shall be completed at the time of the patient's discharge by the staff person who has primary responsibility for coordinating or providing for the care of the patient, including a final assessment of the patient's status at the time of discharge.

(b) If applicable, a parent, guardian, family member, or responsible person may participate in aftercare and discharge planning.

(c) The reason for any patient not participating in aftercare and discharge planning shall be documented in the patient's record.

(d) The OBOT facility shall document if a patient discontinues services.

(e) Determination of the events that constitute a patient's discontinuation of services at an OBOT shall be at the discretion of the facility.

Section 7. Narcotic Treatment Programs.

(1) In addition to the licensing requirements of 908 KAR 1:370, an outpatient AODE that operates a narcotic treatment program (NTP) using an FDA-approved medication to treat individuals with substance use disorder shall comply with:

(a) 42 C.F.R. Part 8;

(b) The requirements of this section; and

(c) Submit and maintain all required data to:

1. The Central Registry; and

2. KASPER as required by KRS 218A.202 and 902 KAR 55:110.

(2) An NTP requesting a change of location shall:

(a) Comply with 908 KAR 1:370, Section 4; and

(b) Provide information regarding any:

1. Dosing procedural changes; and

2. Drug distribution problems that could occur due to the relocation.

(3) Organization and operation.

(a) In addition to meeting the requirements of 908 KAR 1:370, Section 9, an NTP shall develop and comply with policies and procedures that include:

1. Waiting list criteria;

2. Data collection for participation in the program in accordance with 908 KAR 1:300;

3. A protocol that ensures the integrity of the chain of custody for all drug screens;

4. A protocol for voluntary and involuntary termination of a patient's participation in the program, including reasons for termination for cause;

5. Requirements for the preparation and labeling of patient doses in accordance with the requirements of subsection (10) of this section;

6. Quality assurance and utilization review;

7. A patient identification system;

8. A system to prevent multiple program registrations;

9. Inventory maintenance;

10. A protocol for daily dosing schedules; and

11. Drug screening procedures that utilize random selection or unannounced collection.

(b) An NTP shall order approved controlled substances from the manufacturer or approved wholesalers in accordance with 42 C.F.R. Part 8.

(c) Policies for voluntary withdrawal management and involuntary termination from NTP treatment shall be in accordance with 42 C.F.R. Part 8.12.

(d) An NTP shall have and follow policies that prohibit recruitment of new patients into the program by offering:

1. A bounty;

2. Monetary, equipment, or merchandise rewards; or

3. Free services for individuals.

(e) An NTP shall implement the system of treatment phases established in subsection (12) of this section.

(f) An NTP shall be open for dosing services at least six (6) days a week with the optional exception of:

1. New Year's Day, January 1;

2. Presidents Day;

3. Martin Luther King Day;

4. Easter Sunday;

5. Memorial Day, last Monday in May;

6. Independence Day, July 4;

7. Labor Day, first Monday in September;

8. Thanksgiving Day, fourth Thursday in November;

9. Christmas Day, December 25; and

10. Any observed federal holiday.

(g) An NTP shall have dosing times sufficient to meet the needs of its patients.

(h) An NTP shall have a written emergency plan that complies with 908 KAR 1:370, Section 9, establishing the course of action in the event of a natural or manmade disaster or any sudden closing. The plan shall also include:

1. Alternate providers for each payment type that the NTP accepts; and

2. A communication plan to reach each patient and provide information and instructions.

(i) The initial drug screens and confirmatory tests for drugs tested on behalf of the NTP shall meet federal standards for the following:

1. Cocaine metabolites;

2. Opioid metabolites;

3. Amphetamines;

4. Barbiturates;

5. Benzodiazepines;

(j) An NTP that dispenses buprenorphine shall:

1. Have sufficient medical providers on-site to provide the medical treatment and oversight necessary to serve patient needs;

2. Ensure that each practitioner authorized to prescribe or dispense complies with the prescribing and dispensing standards in accordance with 201 KAR 9:270 or 201 KAR 20:065 respectively for FDA-approved medications used for the treatment of opioid use disorder;

3. Ensure that a practitioner authorized to prescribe or dispense documents in the patient's record whether or not the patient is compliant with prescribed dosing as evidenced by the results of:

a. A KASPER report released in accordance with KRS 218A.202(7)(e); and

b. Drug screening;

c. Provide patient dosing of buprenorphine which is exempt from treatment protocol phasing as outlined in subsection (12) of this section.

(4) Medication stations.

(a) Medication stations shall not require a separate license.

(b) To establish a medication station, the NTP shall submit to the SNA, an Application for License to Operate a Nonhospital-based Alcohol and Other Drug Treatment Entity (AODE) form incorporated by reference in 908 KAR 1:370.

(c) The medication station shall provide the following services:

1. Dosing; and

2. Drug screen collection.

(d) The program director shall develop a system to prevent patients from dosing at both the main NTP and the medication station.

(5) Personnel.

(a) An NTP shall have a program director who shall:

1. Have at least two (2) years of experience in the treatment of addiction; and

a. Be certified by the Board of Certification of Alcohol and Drug Counselors;

b. Hold at least a master's degree in the field of addiction or a related field; or

c. Be a physician, registered nurse, physician assistant, pharmacist, or nurse practitioner certified by the licensing subspecialty.

(b) The program director may be the program sponsor as required by 42 C.F.R., Part 8.

(c) The program director shall:

1. Be responsible for ensuring compliance with federal, state, and local laws and administrative regulations pertaining to the operation of the facility;

2. Provide onsite supervision of employees;

3. Ensure the laboratory performing the testing required under this administrative regulation is approved by the SNA and is certified by the Centers for Medicare and Medicaid Services as a Clinical Laboratory Improvement Amendments (CLIA) certified laboratory; and

4. Ensure that initial drug screens and confirmatory tests for drugs tested on behalf of the program meet the standards in subsection (3)(i) of this section.

(d) An NTP shall have a medical director who shall be:

1. Licensed by the Commonwealth of Kentucky to practice medicine within the Commonwealth; and

a. A board eligible psychiatrist with at least three (3) years of experience in the provision of services to persons who have a substance use disorder; or

b. Board-certified as an addiction medicine specialist.

(e) The medical director shall function autonomously within an NTP free from any protocol imposed by an NTP, director, or any other entity except under the guidelines established in 42 C.F.R. Part 8 and this administrative regulation.

(f) The medical director shall be responsible for the NTP's adherence to federal, state, and local laws and administrative regulations pertaining to the operation of the facility.

(g) An NTP may have a program physician. If an NTP has a program physician, the physician shall be:

1. Licensed by the Commonwealth of Kentucky to prescribe controlled substances ; and

a. Board-certified as an addiction medicine specialist; or

b. A person who has at least one (1) year of experience in providing service to individuals with a substance use disorder.

(h) A program physician shall be under the supervision of the medical director and shall function autonomously within the NTP free from any protocol imposed by any NTP, director, or any other entity except under the guidelines imposed by 42 C.F.R. Part 8 and this administrative regulation.

(i) An NTP may have a program prescriber. If an NTP has a program prescriber, the program prescriber shall be:

1. Licensed by the Commonwealth of Kentucky to prescribe controlled substances;

2. A person who has at least one (1) year of experience in providing services to individuals with a substance use disorder; and

3. Under the supervision of the medical director or program physician.

(j) The medical director may be the program physician.

(k) There shall be a minimum of one (1) medical director, program physician, or program prescriber on staff.

(l) The medical director, program physician or prescriber shall:

1. Ensure all patients admitted to the NTP meet the most recent version of DSM criteria for opioid use disorder;

2. Ensure that any exceptions to admissions criteria are approved by the SNA and documented in the patient's record before the first dose is administered;

3. Ensure that appropriate medical histories and physical examinations have been performed before the first dose shall be administered;

4. Ensure that appropriate laboratory studies have been performed;

5. Review all laboratory testing results and documents;

6. Document, sign, or cosign all medical orders, within forty-eight (48) hours, including the first dose of an approved controlled substance;

7. Document, sign, or cosign all subsequent medication orders within forty-eight (48) hours, including dose increases and decreases, changes in frequency of take-home doses, emergency situations, or special circumstances;

8. Ensure that a review and cosignature of all telephone or other verbal orders are documented within forty-eight (48) hours of the order;

9. Supervise staff responsible for preparation and administration of the approved controlled substances;

10. Ensure compliance with program procedures and administrative regulations; and

11. Order through the licensed NTP all:

a. Initial doses; and

b. Increases or decreases.

(m) An NTP shall hire dosing personnel who shall:

1. Hold a license as a registered nurse, licensed practical nurse, or pharmacist; and

2. Not be dually assigned as clinicians.

(n) An NTP shall provide dosing personnel in sufficient numbers to meet the needs of the patients during dosing hours.

(o) Dosing prescribers and pharmacists shall comply with KRS 218A.180 related to labeling if preparing doses to be taken outside the program site.

(p) An NTP shall hire clinicians who meet the requirements of 908 KAR 1:370, Section 11.

(q) There shall be at least one (1) clinician for every fifty-five (55) patients in the program.

(6) Security and control.

(a) The program director and dosing nurse supervisor or pharmacist shall conduct quarterly reviews to ensure compliance with this subsection and 42 C.F.R. Part 8.12.

(b) Security of the controlled substance safe and the building perimeter shall be checked at least quarterly with the contracted security company.

(c) The safe shall be locked at all times while staff are not obtaining, restocking, or inventorying controlled substances.

(d)

1. Inventory reconciliation shall be conducted at least quarterly;

2. All reconciliation documents shall be retained by the program for at least five (5) years; and

3. All DEA and federal regulations concerning inventory discrepancies shall be followed, and any inventory discrepancy required to be reported to the DEA offices shall also be reported to the SNA within forty-eight (48) hours of reconciliation.

(e) Dosing personnel shall count all new bottles of controlled substance tablets before removing any for patient doses.

(f) Any discrepancies in controlled substance tablet count shall be reported to the SNA, DEA, CSAT, and the cabinet within forty-eight (48) hours of the event.

(g) A system shall be in place to assure the NTP completes the DEA biennial inventory of controlled substance on hand.

(h) Order forms for controlled substances, the dosing records, and inventory reconciliation records shall conform with 42 C.F.R. Part 8.12 and shall be maintained in a locked, secured area separate from the storage site of the controlled substances.

(i) Quarterly, the program director or designee shall review a ten (10) percent random sample of patient records for:

1. A consent to treatment form signed by the patient; and

2. A release of information form signed by the patient that includes:

a. A description of the specific type of confidential information to be obtained or released; and

b. The specific dates that the release is to cover.

(j) If the program director serves as a clinician, the medical director shall review a ten (10) percent random sample of the program director's patient records for inclusion of the documents listed in paragraph (i) of this subsection.

(k) An NTP shall retain on file documentation that quarterly reviews were conducted, which shall be available for review by regulatory agencies for at least five (5) years.

(7) Admission policies.

(a) The admitting physician or licensed health practitioners acting within their scope of practice for the NTP shall comply with the admission requirements of 42 C.F.R. Part 8.12.

(b) When a patient applies for admission to an NTP, the patient shall be required to sign a release of information that authorizes a program to release or solicit information regarding the patient's status in any other substance use disorder treatment program.

(c) In addition to complying with the requirements of 908 KAR 1:370, Section 16, an NTP shall:

1. Provide each patient written information describing all facets of the program in a manner that the patient understands; and

2. Explain the contents of all required federal forms to the patient before he or she is asked to sign.

(d) At admission, readmission, and at six (6) month intervals for the first two (2) years of treatment, and as indicated clinically after two (2) years, an NTP shall give the patient information on communicable diseases including:

1. Tuberculosis;

2. Hepatitis;

3. Sexually transmitted diseases; and

4. HIV/AIDS.

(e) A patient shall have access to voluntary HIV testing at admission and if clinically indicated thereafter and shall receive HIV/AIDS pre-test and post-test counseling if the patient elects to be tested.

(f) In order for an NTP to admit or continue to treat a patient who is pregnant, the medical director, program physician, or program prescriber shall determine and document in the patient's record that the patient is medically able to participate in the program.

(g) Pregnant individuals with an opioid use disorder shall be given priority for admission and services if the NTP has a waiting list.

(8) Patient transfers and guest dosing.

(a) An NTP may accept patients transferring from another NTP if the patient meets the criteria for admission in subsection (7) of this section and in accordance with this subsection.

(b) The program prescriber, program physician, or medical director at the receiving NTP shall review the patient's records on an individual basis to determine the patient's placement on the receiving program's patient listing. Reviews for proposed transfers shall determine the patient's:

1. Need;

2. Program placement availability; and

3. Circumstances for the transfer request.

(c) If a patient transfers from an existing narcotic treatment program, the NTP shall ensure, if clinically indicated, the patient remains in their confirmed current phase from the sending NTP.

(d) The sending NTP shall:

1. Forward all relevant patient records to the receiving NTP within seventy-two (72) hours of receipt of a request to transfer, excluding any day the NTP is closed; and

2. Continue dosing until the patient is enrolled at the receiving NTP.

(e) The receiving NTP shall:

1. Contact the sending NTP to confirm the patient's enrollment prior to administering the patient's initial dose at the receiving NTP; and

2. Include documentation in the patient's medical record of the:

a. Date of receipt of the patient's records from the sending NTP, including reason for transfer; and

b. Verification that the patient meets the admission criteria in subsection (7) of this section.

(f) An NTP may provide guest dosing to patients who are not eligible for take home doses.

(g) The NTP may develop policies based upon federal guidelines and best practices.

(h) The NTP shall check the individual's enrollment in the central registry.

(i) The NTP shall confirm and provide the correct guest dosing arrangement with the home NTP.

(9) Drug screens.

(a) Drug screen sample collection policies intended to prevent falsification shall be developed and followed.

(b) Drug screens shall be analyzed for the following drugs:

1. Approved controlled substance;

2. Cocaine;

3. Opioids;

4. Amphetamines;

5. Barbiturates;

6. Benzodiazepines;

7. Any other drug or drugs that has been determined by the NTP or the SNA to be misused in that program's locality; and

8. Any other drugs that could have been misused by the patient.

(c) Drug screens shall be reviewed by the treatment team monthly to determine the patient's reduction in the use of unauthorized medications.

(d) Controlled substance medications shall be considered unapproved usage if they are being used by the patient without a valid prescription.

(e) A drug screen that is negative for the approved controlled substances allowed to be used in the NTP shall be considered positive for unauthorized drug use.

(f) An NTP shall not use drug screens as the sole criteria for involuntarily terminating a patient's participation in the program.

(g) When drug screening results are used, presumptive laboratory results shall be distinguished in the patient record from results that are definitive.

(h) Samples used for drug screening purposes shall be handled in a manner that ensures patient confidentiality.

(10) Dosing requirements.

(a) The dose prepared for a patient shall be the quantity of approved controlled substances that is indicated on the patient's narcotic sheet within the medical record.

(b) The dose shall be labeled with the exact quantity of narcotic drug ordered.

(c) Take-home doses shall be formulated in a manner that reduces the likelihood of injecting the dose.

(d) Take-home doses of the approved controlled substances shall be packaged in containers in accordance with 15 U.S.C. 1471.

(e) The label of take-home doses shall include the:

1. Name of the program;

2. Address and telephone number of the program;

3. Name of the controlled substance;

4. Name of the patient;

5. Name of the prescriber ordering the substance;

6. Quantity of the controlled substance, unless the patient has requested in writing that the quantity of the substance not be revealed to him or her;

7. Date of filling order; and

8. Instructions for medicating, including dosage amount and dates medication is to be taken.

(f) Dosing personnel shall not alter patient doses without the medical director, program physician, or program prescriber's order.

(g) Verbal dosing orders shall be reduced to writing and signed by the medical director, program physician, or program prescriber within forty-eight (48) hours of the order's receipt.

(h) The medical record shall indicate any reason for dose changes and shall be signed by the medical director, program physician, or program prescriber within forty-eight (48) hours of the order's receipt.

(11) Patients who are pregnant.

(a) If the medical director, program physician, or program prescriber does not accept the responsibility for providing prenatal care for the term of the patient's pregnancy, then the medical director, program physician, or program prescriber shall refer the patient to:

1. A primary care physician who practices obstetrics; or

2. An obstetrician.

(b) The medical director, program physician, or program prescriber shall inform the prescriber accepting the referral of the patient's participation in the NTP.

(c) The medical director, program physician, or program prescriber shall ensure that appropriate arrangements have been made for the medical care of both the patient and the child following the birth of the child.

(d) The medical director, program physician, or program prescriber shall notify the pregnant patient's primary care physician or obstetrician of any changes in the patient's treatment.

(e) The program shall ensure that the following services are available for pregnant individuals and are a part of the treatment plan:

1. Nutritional counseling; and

2. Parenting training that includes information about:

a. Newborn care;

b. Handling a newborn;

c. Newborn health; and

d. Newborn safety.

(12) Treatment protocol phases.

(a) In accordance with 42 C.F.R. Part 8.12, NTPs shall comply with the treatment phase system as outlined in paragraphs (e) through (j) of this subsection for the dosing of methadone for treatment of opioid use disorder .

(b) Program infractions shall include:

1. Disruptive behavior at the clinic site; or

2. Threats to staff or other patients.

(c) Program non-compliance shall include:

1. Non-compliant drug screens; or

2. Failure to attend scheduled dosing or counseling appointments.

(d) Patient treatment plans shall be:

1. Established, reviewed, and updated in accordance with 908 KAR 1:370, Section 19; and

2. Reflect a patient's current needs for:

a. Medical, social, and psychological services; and

b. Education, vocational rehabilitation, and employment services.

(e) The medical director, program physician, or program prescriber shall sign the treatment plan within thirty (30) days.

(f) A patient shall successfully complete current treatment protocol phase before entering the subsequent treatment protocol phase with no non-compliance issues, unless excused pursuant to paragraph (n) of this subsection, for at least ninety (90) consecutive days.

(g) Phase one (1). Days one (1) to ninety (90) in treatment, all patients shall:

1. Attend clinic six (6) times each week for observed ingestion of an approved controlled substance at the clinic site;

2. Be eligible to receive a one (1) day take-home dose of an approved controlled substance;

3. Be provided counseling sessions to support the implementation of their treatment plan as clinically indicated;

4. Be informed about appropriate support groups; and

5. Provide a drug screen sample one (1) time per month on a random basis.

(h) Phase two (2). Days ninety-one (91) to 180.Once the patient enters phase two (2) the patient shall:

1. Attend clinic five (5) times each week for observed ingestion of an approved controlled substance;

2. Be eligible to receive a two (2) day take-home dose of an approved controlled substance;

3. Be provided counseling sessions to support the implementation of their treatment plan as clinically indicated;

4. Provide a drug screen sample on a random basis at least monthly or more frequently if their treatment plan requires; and

5. Be encouraged to attend appropriate support groups .

(i) Phase three (3). Days 181 to 270.

1. In order for a patient to enter phase three (3)[t, the patient shall have successfully completed phase two (2).

2. Patients in phase three (3) shall:

a. Attend clinic four (4) times each week for observed ingestion of an approved controlled substance;

b. Be eligible to receive up to three (3) days of take-home doses of an approved controlled substance;

c. Provide a drug screen sample randomly on a monthly basis, or more frequently if their treatment plan requires;

d. Be provided counseling sessions, as clinically indicated; and

e. Be encouraged to attend appropriate support groups outside the clinic.

(j) Phase 4. Days 271 to 365.

1. In order for the patient to enter phase four (4), the patient shall:

a. Have completed phase 3; and

b. Have met the same entry criteria requirements as established in phase three (3).

2. Patients in phase four (4) shall:

a. Attend clinic one (1) time each week for observed ingestion of an approved controlled substance;

b. Be eligible to receive up to six (6) days of take-home doses of an approved controlled substance;

c. Provide eight (8) random drug screen samples within a twelve (12) month period, or more frequently if their treatment plan requires;

d. Be provided counseling sessions, as clinically indicated; and

e. Be encouraged to attend appropriate support groups outside the clinic.

(k) Phase 5. Days 365 to 730.

1. In order for the patient to enter phase five (5), the patient shall have:

a. Successfully completed phase four (4); and

b. Adhered to the requirements of the maintenance treatment program for at least 365 days.

2. Patient in phase five (5) shall:

a. Be dosed at the clinic site at least once every fifteen (15) days for observed ingestion of an approved controlled substance;

b. Be eligible for up to fourteen (14) days of take-home doses of an approved controlled substance;

c. Be provided an appropriate number of counseling sessions, which shall be based on the clinical judgement of the program physician and program staff; and

d. Provide eight (8) random drug screen samples within a twelve month period, or more frequently if their treatment plan requires.

(l) Phase 6. Days 731 and up.

1. In order for the patient to enter phase six (6), the patient shall have:

a. Successfully completed phase five (5); and

b. Adhered to the requirements of the maintenance treatment program for at least 731 days.

2. Patients[C in phase six (6) shall:

a. Be dosed at the clinic site at least one (1) day per month for observed ingestion of an approved controlled substance;

b. Be eligible for up to thirty one days of take-home doses of an approved controlled substance;

c. Be provided an appropriate number of counseling sessions, which shall be based on the clinical judgement of the program prescriber and program staff; and

d. Provide eight (8) random drug screen samples within a twelve month period, or more frequently if their treatment plan requires.

(m) The medical director may excuse a non-compliance issue on a case-by-case basis focusing on the following:

1. The interactions between a positive drug screen and the medication used for treatment;

2. Past history of non-compliance issues;

3. Employment issues; and

4. Length of time in program.

(n) If the medical director excuses a non-compliance issue, as specified in paragraph (m) of this subsection, the non-compliance issue excused shall not be used to:

1. Move a patient out of a phase; or

2. Keep a patient from advancing phases.

(o) The medical director shall document the non-compliance excuse in the patient's medical record.

(13) Take home dose restrictions and terminations.

(a) In determining the patient's take-home medications, the medical director, program physician, or program prescriber shall act in accordance with 42 C.F.R. Part 8.12 and subsections (7) through (12) of this section.

(b) An NTP shall restrict a patient's take-home dosage by moving the patient back on the take-home dosage schedule if the medical director, program physician, or program prescriber concludes that the patient is no longer a suitable candidate for take-home privileges as presently scheduled.

(c) An NTP shall revoke a patient's take-home privileges for not less than thirty (30) days and shall require the patient to ingest each dosage at the facility for any of the following reasons:

1. The patient's drug screening discloses an absence of the controlled substance prescribed by the program;

2. The patient is discovered to be misusing medication, as established in subparagraph 5. of this paragraph;

3. The patient attempts to enroll in another NTP;

4. The patient alters or attempts to alter a drug screen; or

5. The patient is not satisfactorily adhering to the requirements of the NTP by the following:

a. The patient has not complied with the rules of the NTP;

b. The patient is sharing, giving away, selling, or trading their approved controlled substance dosage; or

c. The patient is not ingesting their approved controlled substance dose in accordance with treatment program rules.

(d) A patient whose daily dosage is twenty-five (25) milligrams or less shall be exempt from paragraph (c). of this subsection.

(e) A patient whose take-home privileges were revoked or restricted may regain take-home privileges according to the following schedule:

1. Phase one (1) – satisfactory adherence for at least thirty (30) days;

2. Phase two (2) – satisfactory adherence for at least thirty (30) days after regaining phase one (1) privileges;

3. Phase three (3) – satisfactory adherence for at least thirty (30) days after regaining phase two (2) privileges;

4. Phase four (4) – satisfactory adherence for at least thirty (30) days after regaining phase three (3) privileges;

5. Phase five (5) – satisfactory adherence for at least thirty (30) days after regaining phase four (4) privileges; and

6. Phase six (6) - satisfactory adherence for at least thirty (30) days after regaining phase five (5) privileges.

(f) This subsection shall not be used to circumvent the requirements of this administrative regulation. A patient shall not be advanced to a phase level pursuant to this subsection unless the patient has previously been at that phase level after having satisfied the requirements of each phase.

(g) Treatment shall be continued as long as it is medically necessary based upon the clinical judgment of the medical director, program physician, or program prescriber and staff.

(h) Scheduled withdrawal shall be under the immediate direction of the medical director, program physician, or program prescriber and shall be individualized.

(i) A patient may voluntarily terminate participation in an NTP even if termination is against the advice of the NTP.

(j) Except as established in subsection (15)(e) of this section, either voluntary or involuntary termination shall take place over a period of time not less than fifteen (15) days, unless:

1. The medical director, program physician, or program prescriber deems it clinically necessary to terminate participation sooner and documents the reason in the patient's record; or

2. The patient requests in writing a shorter termination period.

(k) Patients who are voluntarily and involuntarily terminated shall be offered the following prior to discharge:

1. Overdose education;

a. A Federal Drug Administration approved opioid overdose reversal agent; or

b. A Federal Drug Administration approved opioid overdose reversal agent prescription; and

3. Referral with appointment to the level-of-care appropriate and accessible to the patient.

(14) Exceptions.

(a) The medical director, program physician, or program prescriber may grant an exception to the criteria for take-home dosages for any of the following reasons:

1. The patient has a serious physical disability that would prevent frequent visits to the program facility; or

a. The patient is subject to an exceptional circumstance such as acute illness, family crisis, or necessary travel; and

b. Hardship would result from requiring exact compliance with the phase level schedule established in subsection (12) of this section.

(b) Exception to the criteria for take-home dosages shall:

1. Be subject to the limitations in this administrative regulation; and

2. Have written approval from the SNA that shall be filed in the patient record.

(c) If a patient is required to travel out of the program area, the medical director, program physician, or program prescriber shall attempt to arrange for the patient's daily dosage to be received at another program in lieu of increasing take-home dosages.

(d) The medical director, program physician, or program prescriber shall document in the patient's record the granting of any exception and the facts justifying the exception.

(e) Each program shall maintain a separate record for all exceptions granted.

(f) The SNA shall not grant additional exceptions, except in cases of medical emergency or natural disaster, such as fire, flood, or earthquake.

(g) Patient take home exceptions shall be entered into the Substance Abuse and Mental Health Services Administration's system in accordance with the system's requirements.

(h) Emergency Dosing.

1. Under emergency conditions a program may issue take-home doses in accordance with this subsection.

2. Within forty-eight (48) hours after administration of the first emergency dose, an NTP shall:

a. Notify the SNA in writing;

b. Submit justification of the emergency dose or doses; and

c. Request permission for any subsequent dose after the first two (2) doses.

3. Subsequent emergency doses shall not be given unless permission is received by the SNA.

4. This request shall include the:

a. Number of take-home doses requested;

b. Reason for the request;

c. Patient's standing in program phases;

d. Patient's adherence to program policies; and

e. Total length of time the patient has been enrolled at the NTP.

(15) Patient[C program compliance and infractions.

(a) If a patient has a non-compliance issue as described in section 7(12)(c) of this administrative regulation, the counseling staff shall review and modify the treatment plan to assist the patient in complying with program policies.

(b) If a patient continues to have non-compliance issues and the medical director, program physician, or program prescriber determines additional intervention is warranted, the director, program physician, or prescriber may:

1. Move the patient back to an earlier treatment phase;

2. Limit or revoke the patient's take-home privileges;

3. Increase the frequency of counseling sessions;

4. Increase the frequency of drug screen samples; or

5. Increase the medication dose to reduce cravings.

(c) If a patient commits a program infraction as described in section 7(12)(b) of this administrative regulation, the patient may be involuntarily terminated from the program based on the recommendation of the medical director, program physician, or program prescriber.

(d) A patient's participation in an NTP may be involuntarily terminated for cause. Cause shall include:

1. Polydrug use if risk of co-use outweighs risk of overdose death following termination of methadone treatment;

2. Diversion of an approved controlled substance;

3. Violence or threat of violence to program staff or other patients in the program; or

4. Dual enrollment in another NTP.

(e) If the medical director, program physician, or program prescriber determines that the patient's continued participation in the program creates a physically threatening situation for the staff or other patients, the patient's participation may be terminated immediately.

(f) A patient shall be given written notice of a decision to terminate their participation in the program, which shall include the reasons for the termination.

(16) Program monitoring. If an NTP fails to comply with the requirements in this administrative regulation, the SNA may take action in accordance with 908 KAR 1:370, Sections 5 and 20. In addition to the authority to deny, suspend, or revoke a license in accordance with 908 KAR 1:370, the SNA may:

(a) Order the NTP to discontinue all or part of the take-home doses of any approved controlled substance used in the NTP;

(b) Restrict the NTP's take-home procedures to the provision of emergency take-home doses in accordance with subsection (14) of this section; or

(c) Order the NTP to discontinue the utilization of any drug approved for use in narcotic treatment programs.

(17) Waivers. (1) The cabinet may grant a waiver to any part of this administrative regulation if:

(a) The governor declares a state of emergency; or

(b) [(2)] An NTP may request a waiver in accordance to 42C.F.R 8.11(h) from the SNA from any requirement of this administrative regulation.

(18)

(a) This application for a waiver shall:

1. Be in the form of a letter to the SNA;

2. Identify the specific sections of this administrative regulation for which a waiver is being sought; and

3. Give the rationale for the request.

(b) If a waiver pertains to a client, a copy of a waiver request and response shall become part of the client's permanent record.

(c) An application for a waiver request shall be mailed to: Kentucky State Narcotic Authority Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main Street, Frankfort, Kentucky 40621.

(d) Approval or denial of a waiver shall be based upon a review of the merits of the request, taking into consideration:

1. Public safety;

2. Practicality; and

3. The purpose of the requirement for which a waiver is requested.

(e) A waiver shall expire twelve (12) months from the date he waiver is granted unless the SNA gives an earlier expiration date.

Section 8. In-home services.

(1) An outpatient AODE may provide the following services in person, in a patient's home:

(a) One (1) or more of the outpatient services established by Sections 2 through 5 of this administrative regulation; or

(b) . Medications for addiction treatment, excluding methadone-based treatment, under the direction of a Kentucky-licensed:

1. Physician who complies with the prescribing and dispensing standards of 201 KAR 9:270; or

2. Advanced practice registered nurse who complies with the prescribing and dispensing standards of 201 KAR 20:065.

(2) An outpatient AODE that provides in-person, in-home services exclusively shall be exempt from the physical environment requirements of Section 9 of this administrative regulation if the AODE has a business office located in Kentucky.

Section 9. Physical Environment.

(1) Accessibility. An outpatient AODE shall meet requirements for making buildings and facilities accessible to and usable by individuals with physical disabilities in accordance with KRS 198B.260 and 815 KAR 7:120.

(2) Fire safety. An outpatient AODE shall be approved by the State Fire Marshal's office prior to initial licensure or if the AODE changes location.

(3) Physical location and overall environment.

(a) An outpatient AODE shall:

1. Comply with building codes, ordinances, and administrative regulations that 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;

4. Have a dedicated phone number to send and receive faxes with a fax machine that shall be operational twenty-four (24) hours per day or use encrypted electronic messaging technology;

5. Have a reception and waiting area;

6. Provide a restroom for patient use; and

7. 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 patients, personnel, and visitors shall be assured.

(4) Additional requirements for NTPs.

(a) The building used for the NTP shall meet the requirements of 21 C.F.R. 1301.74(j).

(b) The waiting area shall be separated from the dosing area to permit each patient privacy and confidentiality at the time of dosing.

(c) The dosing area shall be clean and sanitary and shall contain:

1. A sink;

2. Hot and cold running water; and

3. Pill-counting trays if tablets are being used.

(d) The security and floor plan of the dosing area shall be in accordance with 21 C.F.R. 1301.72.

(e) The facility shall have two (2) restrooms, which shall be accessible to patients with disabilities.

(f) Restrooms available to patients to provide urine specimens shall be:

1. Secure;

2. Clean; and

3. Sanitary.

(g) The building shall be secured by a local security company approved by the DEA and the SNA.

(h) There shall be a minimum of two (2) panic buttons or similar devices for each NTP with:

1. One (1) in the reception area; and

2. One (1) in the dosing area.

(i) There shall be a telephone with an outside line accessible in the dosing area.

(j) Internal security shall meet the requirements of 21 C.F.R. 1301.74(b), (h), (i), (j), (k); 1301.91; 1301.92 and shall be installed only after consultation with the DEA and the SNA.

(k) Parking spaces at the clinic site shall be adequate to accommodate the maximum number of patients expected to be at the clinic site at one (1) time.

Section 10. Incarcerated Individuals.

(1) An NTP may provide FDA-approved medications for opioid use disorder for incarcerated individuals.

(2) The NTP shall:

(a) Submit a waiver application to the SNA identifying the services the NTP can and cannot provide directly to the incarcerated individual in accordance with Section (7); or

(b) Facilitate the transfer of the incarcerated individual to a corrections based NTP, if available.

(3) Document in the incarcerated individuals record:

(a) The program physician or program director's coordination efforts with the jail; and

(b) The date(s) of incarceration, reason(s), and circumstances involved.

History

• RELATES TO: KRS 198B.260, 218A.180, 218A.202, 222.231, 222.462, 21 C.F.R. 1301.72, 1301.74, 1301.75, 1301.91, 1301.92, 42 C.F.R. Part 8, 15 U.S.C. 1471
• STATUTORY AUTHORITY: KRS 222.231(2), (12), 222.462
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 222.231(2) requires the cabinet to promulgate administrative regulations to establish requirements and standards for treatment programs, including health and safety standards, patient care standards, and classification of alcohol and other drug use programs according to type, range of services, and level of care provided. KRS 222.231(12) requires the cabinet to promulgate administrative regulations to establish standards of operation for narcotic treatment programs. KRS 222.462 requires the cabinet to develop enhanced licensure and quality standards for substance use disorder treatment and recovery. This administrative regulation establishes standards for nonhospital-based alcohol and other drug treatment entities (AODE) that provide ambulatory withdrawal management, outpatient treatment services, intensive outpatient services, partial hospitalization, or office-based opiate treatment services. This administrative regulation further establishes standards for the operation of narcotic treatment programs in accordance with KRS 222.231(12) and 42 C.F.R. Part 8.
• History: 45 Ky.R. 2546, 3222, 46 Ky.R. 464; eff. 8-19-2019; TAm eff. 3-18-2020; 49 Ky.R. 656, 1458; eff. 2-16-2023.

908 KAR 1:390 Voluntary Employer Substance Use Program (VESUP) {#sec-908-kar-1-390 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:390}

Section 1. Definitions.

(1) "Cabinet" means the Cabinet for Health and Family Services.

(2) "Employer" means any employer that agrees to participate in the Voluntary Employer Substance Use Program.

Section 2. Voluntary Employer Substance Use Program (VESUP) policy.

(1) An employer that elects to participate in VESUP shall have the following elements written in their workplace drug and alcohol policy:

(a) Policy rationale and goals that include:

1. Reason for policy;

2. Intended outcomes of the policy; and

3. How and with whom the policy was developed;

(b) Expectations and compliance elements that include:

1. When and where the policy applies;

2. Employee positions the policy applies to;

3. Expected employee behavior; and

4. Prohibited behaviors and substances;

(c) Drug screening procedures and guidelines, including:

1. A list of screened substances;

2. Screening facilities approved by the cabinet;

3. Number of times an employee shall be screened, including minimums and maximums; and

4. Screening confidentiality and privacy protocols;

(d) Resources for evidence-based substance use disorder prevention; and

(e) A process for identifying licensed substance use disorder treatment providers.

(2) An employer's VESUP policy shall be accessible upon request to all employees and the cabinet.

(3) Employee compliance with the employer's VESUP policy shall be a condition of employment.

Section 3. Employee Participation in Substance Use Disorder Treatment.

(1) Employers participating in the VESUP shall require employee participation in licensed substance use disorder treatment services as a condition of employment to work within their area of expertise or professional licensure as applicable if:

(a) An employee screens positive during an employment-related drug screening; and

(b) A biopsychosocial clinical assessment performed by a licensed substance use disorder treatment provider determines the need for substance use treatment.

(2) If a licensed substance use disorder treatment provider determines via biopsychosocial clinical assessment that substance use disorder treatment is not necessary, the employee shall comply with the recommendations deemed appropriate by the clinical assessment as a condition of employment.

(3) An employee identified in subsection (1) of this section shall follow the treatment plan as written by the licensed substance use disorder treatment provider.

Section 4. Employer Participation in Substance Use Disorder Treatment.

(1) An employer shall agree to allow the employee to follow the treatment plan written by a licensed substance use disorder treatment provider as described in Section 3(3) of this administrative regulation.

(2) An employer shall not penalize an employee for compliance with the treatment plan described in Section 3(3) of this administrative regulation.

Section 5. Records.

(1) An employer shall secure all records and information concerning an employee's substance use screening and treatment.

(2) Records as specified in subsection (1) of this section shall include:

(a) Results of employee drug screens;

(b) Documentation of employee participation and compliance in substance use disorder treatment services.

(3) Records specified in this section shall be maintained:

(a) Separately from the employee's personnel file;

(b) In a secure location; and

(c) Disposed of in accordance with all state and federal laws regarding protected health information.

(4) Records specified in this section shall be disclosed in accordance with KRS 222.215(6)(e).

Section 6. Program Requirements.

(1) An employee that violates the employer workplace drug and alcohol policy by screening positive during an employment-related drug screening, rather than being terminated or refusing hire, shall have the option to receive services from a licensed substance use disorder treatment provider for:

(a) An initial comprehensive biopsychosocial clinical assessment using a multidimensional assessment tool, that complies with the most current edition of the American Society of Addiction Medicine (ASAM) criteria to determine the appropriate level of care in accordance with 908 KAR 1:370, Section 18; and

(b) If deemed appropriate, creation of a written treatment plan pursuant to 908 KAR 1:370, Section 19.

(2) Employees specified in subsection (1) of this section, that elect to participate in this program, shall provide their employer with signed consent authorizing the employer to receive documentation confirming employee participation and compliance with recommendations of the clinical assessment.

(3) Employees specified in subsection (1) of this section, shall be informed of all FDA-approved options to treat substance use disorder from the employer or the cabinet when referred by the employer.

Section 7. Referral Information. Employers may find the following information at http://dbhdid.ky.gov/:

(1) A list of some of the licensed substance use disorder treatment providers available;

(2) Employer education on addressing substance use in the workplace; and

(3) Screening facilities approved by the cabinet.

History

• RELATES TO: KRS 222.215
• STATUTORY AUTHORITY: KRS 222.215
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 222.215 requires the cabinet to promulgate administrative regulations to implement employer-facilitated access to substance use disorder treatment for employees who screen positive during an employment-related drug screening. This administrative regulation establishes a voluntary program in which employers may facilitate employee access to substance use disorder treatment, rather than terminate or refuse hire, and sets criteria for that program.
• History: 47 Ky.R. 2222, 48 Ky.R. 441; eff. 9-22-2021.

908 KAR 1:400 Licensing and standards for substance use and misuse prevention {#sec-908-kar-1-400 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:400}

Section 1. Definitions.

(1) "Alcohol and other drug use prevention agency" or "AODP" is defined as an agency that develops, provides, and coordinates prevention services, including training and technical assistance services, that address substance use and misuse and related consequences.

(2) "Cabinet" is defined by KRS 194A.005.

(3) "Certified prevention specialist" means an individual who is certified by the Kentucky Certification Board for Prevention Professionals.

(4) "Coalition" means a partnership of community stakeholders working to reduce alcohol, tobacco, and other drug use and misuse problems and related consequences through community-wide prevention strategies.

(5) "Consumer" means the recipient of prevention services.

(6) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(7) "International Certification and Reciprocity Consortium" or "ICRC" means the organization that establishes the standards of practice in addiction counseling, prevention, and clinical supervision through testing and credentialing of addiction professionals.

(8) "Kentucky Certification Board for Prevention Professionals" or "KCBPP" means an ICRC member board that establishes competency-based certification for prevention specialists that promotes and maintains integrity and quality of service for alcohol, tobacco, and other drug prevention.

(9) "Prevention" means the act of preventing use and misuse of alcohol, tobacco, and other drugs and the related consequences.

(10) "Prevention Director" means a certified prevention specialist who manages AODP staff, serves as liaison between the AODP and the department, and is responsible for developing the annual plan and budget documents for the AODP.

(11) "Prevention Specialist " means a paid staff, excluding clerical staff, employed by an AODP actively involved in the development and implementation of substance use and misuse prevention services.

(12) "Regional Prevention Center" or "RPC" means a program funded and licensed by the department for the purpose of developing, providing, and coordinating prevention training and technical assistance services that address substance use and misuse and the related consequences.

Section 2. Licensing Procedures.

(1) An AODP receiving remuneration for any prevention program, and any RPC, shall not operate without first obtaining an AODP license from the cabinet, in accordance with the procedures of 908 KAR 1:370, unless the AODP is exempted under KRS 222.003(1) and (2).

(2) Any AODP operating a program without first obtaining a license shall be subject to penalties pursuant to KRS 222.990(2).

(3) An application for licensure, incorporated by reference in 908 KAR 1:370, shall be submitted in writing to the Office of Inspector General, 275 East Main Street, Frankfort, Kentucky 40621.

(4) An application for:

(a) Licensure shall be accompanied by a fee of $155; or

(b) Renewal shall be accompanied by a fee of eighty (80) dollars.

(5) The license shall remain in effect for one (1) year from the date of issuance and may be renewed, unless a failure to comply with licensure standards causes the license to be:

(a) Revoked; or

(b) Suspended.

(6) The license shall be conspicuously posted in a public area at the AODP and shall indicate the year the license was issued or renewed.

(7) An application for licensure or renewal may include an on-site inspection by cabinet representatives to determine compliance with licensure standards.

(8) The applicant shall provide the cabinet or its representatives access during normal hours of operation to any area of the facility and any document needed to complete the inspection.

(9) The cabinet shall notify the AODP in writing of any violation of licensure standards identified during the inspection.

(10) The AODP shall submit to the cabinet a written plan of correction within ten (10) calendar days of receipt of the notice of violation.

(11) The correction plan shall specify the:

(a) Corrective action to be taken; and

(b) Date when each violation shall be corrected.

(12) The certificate of licensure shall be the property of the cabinet and shall be returned upon closure or revocation of the license.

(13) The cabinet shall make available to the public a list of all licensed alcohol and other drug prevention agencies and may issue revisions and corrections to this list as changes occur.

Section 3. Changes in AODP Status.

(1) An AODP shall notify the cabinet within ten (10) working days of a change in:

(a) Name;

(b) Location;

(c) Ownership; or

(d) Discontinuance of services.

(2) If there is a change in AODP name, ownership, or location, the cabinet may issue a new license for the remainder of the current licensure period.

Section 4. Physical Plant. There shall be written housekeeping, sanitation, and maintenance procedures, which shall be followed at all times to ensure that the AODP shall be clean and in good repair.

Section 5. Organization and Administration. Governing body.

(1) An AODP shall have a governing body with overall authority and responsibility for the AODP's operation.

(2) The governing body shall have written documentation to show the AODP is a legal entity in the Commonwealth of Kentucky by means of a partnership agreement, articles of incorporation, legislative act, or executive order.

(3) The responsibilities of the governing body shall be specified in writing and shall include:

(a) Adopting a mission statement that outlines the AODP's purpose;

(b) Adopting a conflict of interest policy to govern participation by a governing body member in a decision that may be influenced by a member's business interest;

(c) Appointing an executive director who shall be responsible for the day-to-day operation of the AODP;

(d) Adopting an administrative structure and establishing a line of authority for all prevention programs operated by the AODP;

(e) Documenting administrative structure and lines of authority on an organizational chart, including the name of each current governing board member;

(f) Adopting written policies and procedures to direct administrative and program functions of the AODP to ensure that sufficient staff and resources are available for the successful delivery of programs;

(g) Reviewing written prevention policies and procedures at least every two (2) years and making needed revisions and incorporating relevant findings of the AODP's quality assurance system;

(h) Overseeing a system of financial management and accountability;

(i) Completing an annual training on alcohol and other drug prevention for members of a multiservice board that provide oversite to the prevention program; and

(j) Meeting as a whole at least quarterly and keeping a written record demonstrating the ongoing discharge of its responsibilities.

Section 6. Staffing and Staff Qualifications.

(1) A prevention specialist shall be certified by the Kentucky Certification Board for Prevention Professionals and ICRC as a Certified Prevention Specialist within thirty-six (36) months of initial employment.

(2) The AODP shall designate one (1) individual as the prevention director who shall:

(a) Be certified by the KCBPP as a Certified Prevention Specialist; and

(b)

1. Have a bachelor's degree plus five (5) years of work experience in prevention or the related fields of health, social science, marketing, communication, or education; or

2. Have a master's degree with two (2) years of work experience in prevention or the related fields of health, social science, marketing, communication, or education.

(3) The AODP shall designate an individual to serve as an ombudsman who shall be responsible for responding to:

(a) Staff or consumer complaints; and

(b) Staff or consumer grievances.

Section 7. Personnel and Employment Practices.

(1) The AODP shall have written policies and procedures governing employment practices for AODP employees and subcontractors which shall include:

(a) Protection from discrimination against any employee or prospective employee based on:

1. Gender;

2. Age;

3. Race;

4. Ethnicity;

5. Religious affiliation; and

6. Disability including prior history of alcohol or other drug abuse;

(b) Personnel policies addressing:

1. Recruitment;

2. Hiring;

3. Promotion;

4. Discipline; and

5. Termination;

(c) Procedures for conducting background checks on any individual working with minors to assure that there is no:

1. Record of conviction related to abuse or molestation of children from the:

a. Administrative Office of the Courts; or

b. Kentucky State Police; and

2. Individual employed listed on the central registry established by 922 KAR 1:470;

(d) Procedures for a central registry check that has been submitted for an individual and is pending, which shall include:

1. Provisional hiring of the individual pending the results of the registry check;

2. A requirement that the individual shall not be left unsupervised with a client under eighteen (18) years of age; and

3. A requirement that the individual shall be dismissed immediately if the results of the check show the individual is listed on the central registry;

(e) Procedures ensuring that criminal record checks as described in paragraph (c) of this subsection shall be completed annually on a random sample of at least twenty-five (25) percent of all personnel;

(f) Maintenance of personnel records for each staff member, which shall contain the following:

1. Application for employment;

2. Job specifications;

3. Written references;

4. Results of background check;

5. Documentation of:

a. Education;

b. Work experience;

c. Training; and

d. Status of professional licensure, certification, and registration;

6. Salary information;

7. Job performance appraisals;

8. Disciplinary actions;

9. Commendations; and

10. Employee incident reports;

(g) Written job specifications for all positions identifying the:

1. Qualifications;

2. Duties;

3. Reporting supervisor; and

4. Positions supervised;

(h) Explanation of:

1. Employee benefits;

2. Training and staff development opportunities;

3. Safety and work related injury procedures;

4. Employee grievance procedures;

5. Rules of conduct; and

6. Compensation plan;

(i) Information on equal employment opportunities and affirmative action policies;

(j) A provision for ensuring an alcohol and drug-free workplace to include actions taken when an employee is involved in the unlawful manufacture, distribution, possession, or use of alcohol or any controlled substance at the AODP;

(k) A provision for yearly job appraisal for each employee, which includes an evaluation based on objective criteria of each employee's performance in relation to their expected job duties;

(l) Ethical standards identifying acceptable employee conduct regarding consumers' rights;

(m) Conflict of interest policies governing dual relationships with other legal entities;

(n) Provisions to assure the confidentiality of personnel records;

(o) A provision for providing an employee with access to that employee's personnel record; and

(p) Provisions for the storage and retention of personnel records.

(2) A staff member shall be given access to a copy of the AODP's policies and procedures at the time of employment and shall be notified of a revision when it is made.

Section 8. AODP Staff Responsibilities.

(1) AODP staff shall:

(a) Provide prevention services, including training and technical assistance, with a primary content that specifically addresses substance use and misuse and its related consequences;

(b) Utilize the Substance Abuse and Mental Health Services Administration (SAMHSA) approved evidence-based decision-making model for delivery of prevention services;

(c) Utilize the Center for Substance Abuse Prevention's primary prevention strategies found at https://www.samhsa.gov/grants/block-grants/sabg for delivery of prevention services; and

(d) Utilize evidence-based or evidence-informed programs and activities in delivery of services.

(2) AODP and staff shall not provide intervention and recovery programs for persons who are in need of substance use and misuse treatment.

Section 9. Quality Assurance.

(1) Staff development.

(a) The AODP shall establish a system of on-going staff development to include training and supervision of all prevention staff that shall:

1. Be outlined in the AODP's policies and procedures manual; and

2. Support the attainment of the goals and objectives of the prevention program.

(b) The AODP shall make required training available to staff.

(c) The completion of each training shall be documented in staff personnel records and shall identify the:

1. Name of the training;

2. Clock hours earned; and

3. Dates attended.

(2) Program quality assurance. The AODP shall have written policies and procedures for assuring the quality of each program operated by the AODP that shall include the following:

(a) Designation of the individual responsible for monitoring and evaluating the quality assurance activities;

(b) Description of the range of activities and services provided in each program;

(c) A statement of intended program outcomes and indicators of effectiveness; and

(d) Establishment of a mechanism and a schedule for the collection, organization, and analysis of data to:

1. Be used for process evaluation;

2. Be used for outcome evaluation; and

3. Determine the quality of the service.

Section 10. Consumer Rights. An AODP shall have written policies and procedures for ensuring the rights of the consumer that shall include:

(1) An assurance that there shall be no unlawful discrimination in determining eligibility for admission to a prevention program;

(2) A statement of consumer rights posted in the AODP with the name, address, and telephone number of the AODP's ombudsman;

(3) Assurance of the confidentiality of consumer's substance use and misuse; and

(4) Posting of the grievance procedure in the AODP, which shall include at a minimum:

(a) The period for reviewing and responding to a consumer complaint;

(b) A requirement for documentation of a grievance in the:

1. Consumer record; and

2. Central AODP incident file; and

(c) A requirement that a grievance alleging abuse or neglect be referred in accordance with:

1. KRS 209.030 regarding the abuse or neglect of an adult; and

2. KRS 620.030 regarding the abuse or neglect of a minor.

Section 11. Complaints.

(1) A suspected violation of a licensure standard shall be reported to the cabinet.

(2) The complainant and information related to a suspected violation shall be kept confidential and shall not be disclosed publicly during an investigation. Once the investigation is complete, disclosure of the information shall be subject to the provisions of KRS 61.870 to 61.884.

(3) The cabinet shall conduct an investigation and inspections based upon a complaint.

Section 12. Denial, Revocation, and Reapplication. The cabinet shall deny or revoke a license if:

(1) It finds that there has been a failure with the provisions of this administrative regulation and an acceptable corrective action plan is not completed;

(2) Access is denied to the cabinet or its representatives during normal hours of operation to any area of the facility and any document needed to complete an inspection;

(3) The cabinet finds that the licensee misrepresented or submitted false information to the cabinet;

(4) The cabinet has probable cause to believe that continued operation would constitute an immediate danger to the health, welfare, or safety of clients;

(5) The AODE fails to comply with the annual renewal process;

(6) An individual having a significant financial interest in the AODP has, within the seven (7) year period prior to the application date, had significant financial interest in a facility or service that was licensed or certified by the cabinet, and the license or certificate to operate was denied, suspended, revoked, or voluntarily relinquished as the result of an investigation or adverse action that placed patients, residents, or clients at risk of death or serious harm;

(7) An individual having significant financial interest in the AODP has been:

(a) Previously discontinued or disqualified from participation in any governmental assistance program due to fraud or abuse of the program; or

(b) The subject of disciplinary action taken against the individual by a professional licensing board for misconduct related to endangering a patient or client;

(8) The licensee commits fraud in obtaining a license or in connection with a service provided; or

(9) The licensee fails to comply with a cabinet approved corrective action plan.

Section 13. Penalties.

(1) Denial or revocation of a license.

(a) Plan of correction.

1. An AODP shall submit to the cabinet, within ten (10) calendar days of a notice of a violation, a written plan for the correction of the regulatory violation.

2. The plan of correction shall be signed by the AODP's administrator, the licensee, or a person designated by the licensee and shall specify:

a. The date by which the violation shall be corrected;

b. The specific measures utilized to correct the violation; and

c. The specific measures utilized to ensure the violation will not recur.

3. The cabinet shall review the plan of correction and notify the AODP in writing of the decision to:

a. Accept the plan;

b. Not accept the plan; or

c. Deny, suspend, or revoke the license for a substantial regulatory violation in accordance with KRS 222.231(6).

4. If the cabinet finds the statement of correction unacceptable, the cabinet shall notify the AODP:

a. Of the specific reasons the plan is unacceptable; and

b. That an amended plan of correction is required within ten (10) calendar days of receipt of the notice by the AODP.

5. The cabinet shall review the amended plan of correction and notify the AODP in writing of the decision to:

a. Accept the plan;

b. Deny, suspend, or revoke the license for a substantial regulatory violation; or

c. Require the AODE to submit an acceptable plan of correction.

6. An AODP that fails to submit an acceptable amended plan of correction may be notified that the license will be denied, suspended, or revoked.

(b) Denial of an application for licensure. If an application for licensure is denied, the legal entity named in the application may reapply for a license in accordance with Section 2 of this administrative regulation after a period of:

1. One (1) year from the date of denial; or

2. Thirty (30) days from the date an application for licensure was withdrawn by the AODP.

(2) Reapplication. The legal entity named in the application may reapply for a license in accordance with Section 2 of this administrative regulation after a period of one (1) year from the date of revocation.

Section 14. Appeals.

(1) If the cabinet takes action to deny or revoke an AODP license in accordance with KRS 222.231(6), the cabinet shall notify the AODP in writing stating the reason for the adverse action and the AODP's right to appeal to the cabinet.

(2) The cabinet shall conduct the hearing in accordance with KRS Chapter 13B.

(3) An AODP that continues to operate after the closing date established by the secretary, or designee, shall be subject to action by the cabinet as provided by law.

History

• RELATES TO: KRS Chapter 13B, 61.870 to 61.884, 194A.005, 194A.070, 209.030, 222.003, 222.005(2), 222.221, 222.990, 223.231, 620.030
• STATUTORY AUTHORITY: 194A.050, KRS 222.211, 222.231
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050 and 222.231 require the Cabinet for Health and Family Services to promulgate administrative regulations necessary to establish requirements and standards for licensing alcohol and other drug prevention (AODP) agencies. KRS 194A.050 requires the secretary to promulgate, administer, and enforce those administrative regulations necessary to implement programs mandated by federal law, or to qualify for the receipt of federal funds and necessary to cooperate with other state and federal agencies for the proper administration of the cabinet and its programs. This administrative regulation establishes licensing requirements for AODP.
• History: 39 Ky.R. 1348; 1706; eff. 3-8-2013; TAm eff. 4-27-2016; Crt eff. 12-18-2019; 47 Ky.R. 456, 1404; eff. 2-4-2021.

908 KAR 1:410 Recovery housing {#sec-908-kar-1-410 omnilex-key=us-ky-regs-official--title-908--908 KAR 1:410}

Section 1. Definitions.

(1) "Applicant" means the owner, operator, or agency that submits an application for the certification of a recovery residence.

(2) "Cabinet" is defined by KRS 222.500(1).

(3) "Certified recovery residence" means a recovery residence that has met the required standards recognized and approved by the Cabinet for Health and Family Services.

(4) "Certifying organization" is defined by KRS 222.500(2).

(5) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(6) "Kentucky Recovery Housing Network" means the organization recognized by the National Alliance for Recovery Residences (NARR) as the state affiliate.

(7) "Local government" is defined by KRS 222.500 (3).

(8) "National Alliance for Recovery Residence Standards" or "NARR standards" means a set of published national standards for all levels of recovery residences and is available on the NARR Web site at https://narronline.org/affiliate-services/standards-and-certification-program/.

(9) "Recovery residence" is defined by KRS 222.500(5).

(10) "Recovery support services" is defined by KRS 222.500(6).

Section 2. Application Process for Certification of Recovery Residences.

(1) Entities required by KRS 222.502 to obtain certification as a recovery residence shall submit:

(a) A Recovery Housing Certification Application that includes full, complete, and accurate information for each residence;

(b) A completed Recovery Housing Assurances for each residence;

(c) A signed Recovery Housing Code of Ethics;

(d) A signed, notarized statement granting permission by the property owner of record, if other than the applicant, to operate a recovery residence on the owner's property;

(e) Proof of fire, liability, and hazard insurance coverage on the building in which the residence is located;

(f) Proof of current registration with the Kentucky Secretary of State;

(g) A copy of resident program policies that include:

1. Terms of occupancy, including policies related to residents' prescription and non-prescription medication usage and storage;

2. Financial obligations, including any fees, charges, or rents that may accrue to the resident and the process, time frame, and requirements for the collection of the obligations;

3. Financial deposits that may be collected, if any, and the time frame process, and requirements for the return of the deposits; and

4. Any circumstances under which the resident may be entitled to a refund of any amount for financial obligations collected by the recovery residence, if applicable;

(h) A copy of the emergency preparedness plan for the recovery house, that includes:

1. Emergency contact numbers;

2. An evacuation plan and map;

3. An emergency relocation plan that specifies where residents may live temporarily; and

4. A continuity of operations plan; and

(i) If applicable, any forms, documents, and guides used to mentor each resident or monitor each resident's participation in the development of the resident's recovery plan.

(2) If an application is incomplete or inaccurate, the certifying organization:

(a) Shall return the application within ten (10) business days to the applicant with written instructions regarding proper completion and resubmission of the application within a specified time frame; and

(b) May conduct a pre-inspection site visit.

(3) The cabinet or certifying organization may conduct an inspection of the residence at any time without prior notice, including inspecting and copying financial and resident records.

(4) Required entities, as established by KRS 222.502, shall submit a Kentucky Recovery Housing Application with the required supporting documentation identified in Section 2(1) to the Department for Behavioral Health, Developmental, and Intellectual Disabilities, attention: Kentucky Recovery Housing Certification Program by:

(a) Electronic mail to kyrecoveryhousing@ky.gov; or

(b) Written mail to 275 E. Main Street, 4W, Frankfort, Kentucky 40621.

Section 3. Approval or Denial of the Application for Recovery Residence Certification.

(1) The certifying organization shall conduct a site visit after the completed application and required documentation is received to determine if the application for certification for a recovery residence is:

(a) Approved;

(b) Provisionally approved; or

(c) Denied.

(2) The certifying organization shall grant approval for certification for a period of twelve (12) months if the applicant is in compliance with the NARR standards.

(3) The certifying organization may grant provisional approval of the application for initial certification of a recovery residence if:

(a) The certifying organization has identified deficiencies with respect to specific NARR standards; and

(b) The identified deficiencies do not pose an imminent risk to the health, safety, or welfare of a resident.

(4) The certifying organization shall deny the application for certification of a recovery residence if:

(a) The applicant is in noncompliance with the NARR standards;

(b) One (1) or more deficiencies have been identified that pose an imminent risk to the health, safety, or welfare of the residents; or

(c) Information contained on the application reveals that there would be an unreasonable risk of harm to the residents if certification were granted.

(5) The certifying organization may deny the application for certification of a recovery residence if the applicant has previously discontinued operations of a recovery residence without prior notification to staff, residents, and the certifying organization, and without implementation of a transition plan for residents to alternative living arrangements.

(6) If provisional approval is granted, it shall:

(a) Be for a period of six (6) months from the date of the issuance of the provisional approval;

(b) Require the entity to request the certifying organization to conduct a site visit for reconsideration of certification prior to the expiration of the provisional approval; and

(c) Require the entity to submit documentation that demonstrates that the identified deficiencies have been eliminated.

(7)

(a) Provisional approval may be granted two consecutive times, for a maximum of twelve (12) months, at the end of which time the application for certification shall be denied;

(b) The entity shall have up to thirty (30) days to continue to operate and assist residents in securing alternative housing;

(c) The entity shall cease all operations by the thirty-first day after the date of notification of denial; and

(d) The entity shall submit a new application for certification as a recovery residence.

(8) Certification, if granted, shall be valid for the residence and address for which the original certification is issued.

(9) Recovery residence certification is not transferable, if the sale or transfer of a recovery residence causes a change in at least twenty-five (25) percent of ownership, the new owner shall apply for certification as established in Section 2 of this administrative regulation.

Section 4. Recertification.

(1) An entity that has been granted certification as a recovery residence, shall submit an application for recertification to the certifying organization at least sixty (60) days prior to the expiration date of the current certification.

(2) The certifying organization shall conduct a site visit as part of the recertification process.

(3)

(a) Recertification shall be granted for a period of two (2) years if the applicant is currently certified and is in compliance with the NARR standards; or

(b) Subsequent to the issuance of provisional recovery residence certification, the identified deficiencies on the basis of which the provisional certification was granted have been fully and satisfactorily remediated.

(4) Provisional approval shall be granted of the application for recertification of a recovery residence if:

(a) The certifying organization has identified deficiencies with respect to specific NARR standards; and

(b) The identified deficiencies do not pose an imminent risk to the health, safety, or welfare of a resident.

(5) If provisional approval is granted during recertification, it shall be granted once and for a period not to exceed six (6) months.

(6) If an applicant is granted provisional approval during the recertification process before being granted certification, then certification shall be for a period of one (1) year.

(7) An application for recertification shall be denied if:

(a) The applicant is in noncompliance with the NARR standards;

(b) One (1) or more deficiencies have been identified that pose an imminent risk to the health, safety, or welfare of the residents; or

(c) The application reveals that there would be an unreasonable risk of harm to the residents if certification were granted.

(8) If the applicant has discontinued operations of a recovery residence without complying with the provisions of this administrative regulation an application for recertification may be denied.

(9) If the certifying organization does not conduct a site visit before the expiration of certification, the certifying organization shall issue a written notification to the owner or operator of the recovery residence that extends certification for a period of up to ninety (90) days or until the certifying organization is able to conduct a site visit of the recovery residence.

(10) The certifying organization shall notify the department of the organizations determination of an application for certification within ten (10) business days from the date of notification to the applicant.

Section 5. Department Responsibilities.

(1) The department shall:

(a) Require certified recovery residences to provide proof of certification at least annually;

(b) Require certified recovery residences to notify the department of any change in their certification status by a certifying organization;

(c) Require separate proof of certification for each recovery residence owned or operated by an individual or entity in the commonwealth;

(d) Post on its Web site the name, telephone number, and location by local jurisdiction of each certified recovery residence and shall update the list at least quarterly;

(e) Post on its Web site the name of each certifying organization approved by the cabinet; and

(f) Notify local governments with appropriate jurisdiction of receipt of proof of certification from a recovery residence within thirty (30) days of receipt of proof of certification.

(2) The department may seek legal action, up to and including cessation of operations and monetary penalties, against a recovery residence that fails to meet the requirements of this administrative regulation.

(3) The department, or certifying organization, shall not disclose the address of a recovery residence except to local governments, local law enforcement, and emergency personnel.

Section 6. Recovery Residence Owner or Operator Responsibilities. The owner or operator of a certified recovery residence shall ensure:

(1) The residence and its operations are in compliance with the NARR standards;

(2) The residence develops and adheres to a written policy regarding the criminal history, including substantiated abuse or neglect of a child or vulnerable adult, of any staff member, employee, peer, or volunteer who serves in a staff capacity with the recovery residence and, in that capacity, has direct and regular interaction with residents; and

(3) If the certified recovery residence plans to discontinue operations, the owner or operator submits, at least sixty (60) calendar days before the residence intends to cease operations, to the certifying organization, a written plan that includes:

(a) Date operations will cease; and

(b) Notification to residents of the planned discontinuation of operations and of other certified recovery residences and housing options.

Section 7. Background Checks.

(1) All staff of a recovery residence shall:

(a) Have a criminal record check performed upon initial hire through the Administrative Office of the Courts or the Kentucky State Police; and

(b) Not have a criminal conviction, or plea of guilty, to a:

1. Sex crime as specified in KRS 17.500;

2. Criminal offense against a minor as specified in KRS 17.500; or

3. Felony offense related to neglect, physical abuse, sexual abuse, or exploitation of a child or adult.

(2) A recovery residence that houses individuals under the age of eighteen (18) shall not employ anyone listed on the central registry established by 922 KAR 1:470.

Section 8. Request for Reconsideration.

(1) An applicant for certification dissatisfied by a decision of the cabinet, or certifying agency, may submit a request for reconsideration, in writing, to the commissioner for the department, or designee, within ten (10) days following notice of the decision.

(2) The written request shall include:

(a) The application for certification that was denied; and

(b) Documentation that addresses the reasons the application for certification was denied.

(3) Upon receipt of a request for reconsideration, the commissioner or designee, shall:

(a) Review the request; and

(b) Render a written decision on the request for reconsideration within thirty (30) calendar days unless an extension is granted by the commissioner or designee:

1. Due to extenuating circumstances that prolong the review; and

2. With notice provided to the applicant for certification.

Section 9. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "Kentucky Recovery Housing Assurances", 07/24;

(b) "Kentucky Recovery Housing Certification Application", 07/24;

(c) "Kentucky Recovery Housing Code of Ethics", 07/24; and

(d) "NARR Standard 3.0", 2018.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Community Based Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. This material may also be viewed on the departments Web site at https://www.chfs.ky.gov/agencies/dbhdid/Pages/default.aspx.

(3) This material is also available at https://narronline.org/affiliate-services/standards-and-certification-program/.

History

• RELATES TO: 26 U.S.C. 501(c), 42 U.S.C. 3607, 12187
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450, 222.211, 222.500-510
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 222.504(3) authorizes the cabinet to promulgate administrative regulations governing recovery housing certification. This administrative regulation establishes the standards and requirements for recovery housing certification.
• History: 50 Ky.R. 1441, 2086; eff. 7-30-2024.

Chapter 2 Mental Health

908 KAR 2:010 Local board authority {#sec-908-kar-2-010 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:010}

Section 1. Grants. All grants for local programs in behavioral health, developmental and intellectual disabilities implemented under the auspices of the cabinet shall be directed to agencies recognized as regional behavioral health, developmental and intellectual disabilities boards by the Cabinet for Health and Family Services, Department for Behavioral Health, Developmental and Intellectual Disabilities. For purposes of implementing the delegated regional responsibilities of the Department for Behavioral Health, Developmental and Intellectual Disabilities, the regional behavioral health, developmental and intellectual disabilities boards shall become the local authority. Recognition as local authority shall be renewed annually provided the board is in compliance with applicable federal and state laws, and administrative regulations relating to behavioral health, developmental and intellectual disabilities boards.

Section 2. Policies. All regional behavioral health, developmental and intellectual disabilities boards shall comply with the policies issued by the cabinet to insure compliance with applicable federal and state laws and regulations. Policies shall include planning, budgeting, reporting, operating procedures and other administrative functions.

History

• RELATES TO: KRS 210.440, 210.450
• STATUTORY AUTHORITY: KRS 210.450, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 210.440 and 210.450 authorize the Cabinet for Health and Family Services to establish regional behavioral health, developmental and intellectual disabilities boards to act as the authority for planning and administration of grants for all local programs relating to behavioral health, developmental and intellectual disabilities. This administrative regulation is to provide for recognition of regional behavioral health, developmental and intellectual disabilities boards as the local authority for implementing delegated responsibilities and to insure compliance with applicable policies issued by the cabinet.
• History: Recodified from 902 KAR 6:010, 3-7-1989; Am. 20 Ky.R. 2257; eff. 3-14-1994; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 2:020 Personnel rules of local board {#sec-908-kar-2-020 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:020}

Section 1. Personnel Files. A personnel file shall be established and maintained by the center for each employee of the district board. The minimum contents of a personnel file shall be:

(1) Application for employment completed by the employee. A center may design its own form or may use the state personnel application form supplied upon request.

(2) Professional credentials reflecting training and experience adequate for position qualification. If an employee is in a position which requires a license, registration or certificate, a current copy shall be included.

(3) Advice of appointment or the suitable document or memorandum from the appropriate center official appointing the applicant to the position. The document shall contain conditions or terms of employment with signatures of the employer and employee.

(4) All forms used for participation in Kentucky's Employees' Retirement System or other retirement system.

(5) Personnel action report form to reflect any change in the status of the employee (salary change, transfer, promotion, leave, leave without pay, reclassification, change in position title, etc.).

(6) Personnel action form reflecting termination of employment, e.g., resignation, dismissal, etc., shall appear in each terminated personnel file.

(7) The employee position description shall include:

(a) The title of the position;

(b) The duties of the position;

(c) Requirements of training and experience necessary to qualify for the position; and

(d) A brief description of additional skills or special knowledge desirable which the applicant should possess.

(8) These documents shall be subject to state and federal examination.

Section 2. Personnel Policies. Each district board shall maintain a set of personnel policies for the governance of all center staff. A copy of these policies shall be filed with the Cabinet for Health and Family Services together with revisions as they occur. Personnel policies shall indicate compliance with appropriate federal and state laws and regulations and shall include the following areas of personnel administration:

(1) Leave policies;

(2) Salary policy; wage and price administration;

(3) Conditions of termination;

(4) Outside practice for professionals;

(5) Staff development and continuing education provisions;

(6) Fringe benefits;

(7) Reimbursable expenses;

(8) Employee grievance procedures;

(9) Employee performance evaluations; and

(10) Method of salary increments.

Section 3. Additional Statements.

(1) Copies of state statutes relevant to behavioral health, developmental and intellectual disabilities boards may be obtained from the Secretary of the Cabinet and kept on file by the behavioral health, developmental and intellectual disabilities board.

(2) Copies of administrative regulations promulgated by the secretary under provisions of the above statutes shall be obtained from the Secretary of the Cabinet and kept on file by the behavioral health, developmental and intellectual disabilities board.

(3) Time and attendance records shall be maintained by each center certifying days or hours worked and leave taken for all employees of the center. These records shall be subject to state and federal audit.

(4) An organizational chart by each organization indicating administrative authority and clinical authority shall be on file.

(5) Any employee shall be provided access to any reasonable document pertaining to the corporation or to the employee's rights as an employee.

Section 4. Classification and Compensation.

(1) Each board shall prepare and maintain a classification plan based on the duties and responsibilities assigned to each classification. The plan shall include for each classification:

(a) An appropriate title;

(b) Description of duties and responsibilities;

(c) Required education and experience; and

(d) Other qualifications.

(2) Each board shall adopt a compensation plan that specifies salary ranges of various classifications. All positions in each class shall be assigned the same salary range.

History

• RELATES TO: KRS 210.120, 210.370, 210.450
• STATUTORY AUTHORITY: KRS 210.450, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 210.450 authorizes the Cabinet for Health and Family Services to set the standards and administrative regulations for the community behavioral health, developmental and intellectual disabilities center personnel files.
• History: Recodified from 902 KAR 6:020, 3-7-1989; Am. 20 Ky.R. 2258; eff. 3-14-1994; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 2:030 Board structure and operation; eligibility for state grants {#sec-908-kar-2-030 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:030}

Section 1. Definitions.

(1) "Board of directors" or "board" means the group of persons vested with the management of the affairs of the corporation regardless of the name by which the group is designated except as provided in Section 8 of this administrative regulation.

(2) "Director" means a member of the "board of directors."

(3) "Articles of incorporation" means the original or restated articles of incorporation or articles of consolidation and all amendments, including articles of merger.

(4) "Bylaws" means the codes or rules adopted for the administrative regulation or management of the affairs of the corporation regardless of the names by which the rules are designated.

Section 2. Requirements for Recognition. A nonprofit corporation requesting recognition from the Secretary of the Cabinet as a district behavioral health, developmental and intellectual disabilities board for the purpose of obtaining state funds, shall annually submit to the secretary, not later than the first day of April of the year preceding the fiscal year for which applicant requests recognition, an application approved by its board of directors, which contains documentation and agreements satisfying the following requirements:

(1) Articles of incorporation as a nonprofit corporation in compliance with Kentucky statutes;

(2) Written statement by the applicant that it shall provide those service prerequisites set forth in KRS 210.410, and that the services shall be available to each of the geographic catchment areas, as established by the Cabinet for Health and Family Services plan, in which the board proposed to provide service;

(3) Written agreements to operate in accordance with the administrative regulations and statutes affecting operations, and to comply with Title VI of the 1964 Federal Civil Rights Law; and

(4) Articles of Incorporation or corporate bylaws which meet the requirements of this administrative regulation as set forth in this subsection:

(a) A provision establishing the location of a principal office of business of the organization;

(b) A provision declaring the purposes of organization to include concern for behavioral health, developmental and intellectual disabilities, alcoholism, drug abuse, or addiction, and the implementation of all functions set forth in KRS 210.400 including that the board will act as administrator of the program; and

(c) A provision setting forth the organization, duties and powers of the board of directors.

(5) In the interim period between annual requests for recognition from the cabinet, the board shall submit, within ten (10) days after adoption, any additions, deletions, and changes in their articles of incorporation or corporate bylaws;

(6) Following the election of any officer(s) of the board or selection of any new directors the board shall submit to the Secretary of the Cabinet for Health and Family Services within ten (10) days the names and addresses of the above, whenever it shall occur;

(7) If an applicant is not in conformity with these requirements, the applicant may be authorized to receive state funds for a probationary period upon assurance of the applicant that it shall bring its operations, bylaws and Articles of Incorporation into compliance with the required standards. The duration of the probationary period shall be set by the Secretary of the Cabinet for Health and Family Services.

Section 3. Membership Criteria for the Board.

(1) All nonprofit behavioral health, developmental and intellectual disabilities boards shall be appointed in accordance with KRS 210.380 and applicable federal regulations.

(a) The provisions of paragraph (b) of this subsection notwithstanding, an individual board member may represent more than one (1) category provided, however, in no event shall an individual board member represent more than three (3) categories as specified in KRS 210.380 for the purpose of certifying board composition.

(b) A board shall be deemed representative of each of the categories, organizations or associations specified in KRS 210.380 provided there is on the board one (1) representative of each category.

(2) The board of a nonprofit corporation, serving as administrator and not established by a combination of either cities or counties shall number not less than fifteen (15) nor more than forty (40) members (except in the case of multiple catchment area boards). The members shall have demonstrated an interest in behavioral health, developmental and intellectual disabilities, developmental disabilities, alcoholism, drug abuse or addiction. At least one-fourth (1/4) of the members shall have indicated their primary interest as behavioral health, developmental and intellectual disabilities.

(3) All directors shall reside within the geographic catchment areas; directors shall be selected to provide at least one (1) representative from each county encompassed.

(4) If an applicant proposes to serve a district containing multiple catchment or grant areas, the membership requirement of the board of directors shall be as follows:

(a) Not less than fifteen (15) nor more than forty (40) members.

(b) All directors selected shall reside within and represent the respective geographic catchment areas.

(c) The board of directors shall contain at least one (1) director from each county in each catchment area.

(5) One-fourth (1/4) of the membership of the board of directors shall be elected annually. A maximum of two (2) consecutive four (4) year terms may be served by any director.

(6) No member of the immediate family of a board member shall be employed in a service funded by the board. Immediate family shall be construed to include a spouse, sons, daughters, mother, father, brothers, sisters, and grandparents. This provision shall not apply retroactively to the effective date of this administrative regulation, nor to any person employed prior to the appointment of the board member.

Section 4. Conduct of the Board. The board of directors shall:

(1) Meet at least twelve (12) times per year except that the regional board of a multiple catchment area shall meet at least six (6) times per year;

(2) Specify in the minutes of the board an annual meeting date for election of officers;

(3) Establish quorum requirements for meeting of the board of directors;

(4) Establish restrictions on compensation of board members including the prohibition against any board member contracting with the board to perform personal services; and

(5) Establish procedures for removal of directors who are excessively absent from board meetings.

(6) Establish procedures for filling of vacancies at times other than annual meetings including the role of the nominating committee.

Section 5. Election and Functioning of Officers. The selection and functioning of officers of the applicant shall include the following:

(1) Designation of the officers of the applicant.

(2) Specifications of the duties and terms of officers.

(3) Specifications of the method by which officers shall be selected, including a requirement that all officers be elected from the membership of the board of directors.

(4) Designation of dates for the assumption of duties by officers.

(5) A restriction prohibiting any board member participating in any matter in which there is a potential conflict of interest or serving as chairman of more than one (1) of the standing committees.

Section 6. Standing Committees. The board shall establish the following standing committees (as a minimum), including a description of their functions and responsibilities, meeting schedules, and the procedures for designating their members:

(1) Executive committee: composed of at least twenty-five (25) percent of the membership of the board of directors and shall include all officers and chairmen of standing committees of the board.

(2) Finance committee: composed of at least the treasurer and three (3) other members of the board.

(3) Personnel committee: composed of at least twenty (20) percent of the membership of the board. When a board operates multiple catchment area programs, the personnel committee membership shall reflect as equal a representation of the catchment areas as is mathematically possible.

(4) Staff development and training committee: composed of not less than three (3) nor more than eleven (11) board members. The committee shall assure implementation and development of individual and team in-service training in behavioral health, developmental and intellectual disabilities, alcoholism and drug addiction-related disciplinary skills.

(5) At the discretion of the board, the personnel committee and the staff development and training committee may be combined into a single committee.

(6) Nominating committee: composed of not less than six (6) persons. The function and responsibility of this committee shall include ensuring public advertisement of the eligibility criteria and procedures for nomination for election to the board and the setting of time schedules for such public announcement. The committee shall present nominations for one-fourth (1/4) membership of the board (annually or biennially) and shall present nominations to fill vacancies as they occur. In addition to general nominating procedures and public advertising the nominating committee shall establish procedures providing for nominations by petition. Any person not placed in nomination by the committee but who is qualified, may be placed on the list of nominees by presenting a petition for nomination signed by twenty-five (25) registered voters of the region. Applicants shall be allowed sufficient time to prepare and execute petitions prior to the date of the election and after initial public advertising has been placed. The board shall vote on a petitioning nominee as well as on the slate placed nomination by the committee.

(7) Program planning and evaluation committee. In single catchment areas, the composition shall be at least four (4) board members. In multiple catchment areas, the composition shall be the chairmen of the catchment area boards and at least four (4) other board members. The committee shall function as the overall committee concerned with the efficacy of the existing program and the future service needs of the regional programs in behavioral health, developmental and intellectual disabilities, alcoholism and drug abuse education and treatment, and the relationship of the regional program to the regional community.

Section 7. Special and Ad Hoc Committees. Intermittently the board may establish special or ad hoc committees it shall deem advisable and shall specify the charge and function of the committees.

Section 8. Catchment Area Boards. If more than one (1) catchment area program shall be administered by a single board of directors, this board may provide for one (1) catchment area board for each geographic catchment area served. The catchment area board shall meet at least twelve (12) times per year. Upon provision for catchment area boards, the single board shall designate itself as the regional behavioral health, developmental and intellectual disabilities board and shall appoint an equal number of its members to each separate catchment area board. No more than twenty-five (25) percent of regional board members appointed to a catchment area board may reside outside of the catchment area. Each catchment area board shall, otherwise, be representative of the individuals who reside in the catchment area, and at least fifty (50) percent of the catchment area board members shall not be providers of health care. The catchment area board shall be responsible for establishing general policies for the catchment area program, approving the budget and expenditure of funds and approving the selection of the center director. The regional behavioral health, developmental and intellectual disabilities board shall be responsible for reviewing and approving the annual plan and budget prepared by a catchment area board and shall be responsible for all personnel policies, contractual obligations and insurance of the quality of direct patient services for the entire region. The catchment area board shall have authority and responsibility as may be delegated to it by the board. The authority and responsibility may include the following:

(1) The general and specific functions and responsibilities of the catchment area board;

(2) The process by which a representative catchment area board shall be selected and maintained;

(3) The process by which appropriate training shall be made available to catchment area board members to enhance their effectiveness;

(4) The organizational and administrative relationships between the catchment area board and the center director, the professional advisory council and any superordinate governing structure;

(5) The procedures the catchment area board shall utilize to review the center program, the quality of its services and the results of center evaluation data;

(6) The procedures the catchment area board shall utilize in reporting and disseminating to the public information on the center's programs and services; and

(7) The procedures the catchment area board shall utilize to ensure that the governing body shall have adequate administrative support and capacity to carry out its functions.

Section 9. State and Federal Funding. The cabinet may provide state and federal funding to behavioral health, developmental and intellectual disabilities boards by contract.

History

• RELATES TO: KRS 210.400, 210.410, 210.450
• STATUTORY AUTHORITY: KRS 210.450, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 210.450 authorizes the secretary of the cabinet to promulgate administrative regulations governing eligibility of community behavioral health, developmental and intellectual disability boards to receive state funds. This administrative regulation establishes the minimum eligibility requirements for receipt of state funds for community behavioral health, developmental and intellectual disability programs.
• History: Recodified from 902 KAR 6:030, 3-7-1989; Am. 20 Ky.R. 2259; 3-14-1994; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 2:040 Hospital district assignments {#sec-908-kar-2-040 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:040}

Section 1.

(1)

(a) The state mental hospital districts shall be the districts established in subsections (2) through (5) of this section.

(b) Except as provided by Sections 2 through 5 of this administrative regulation, an involuntarily or voluntarily hospitalized person shall be admitted to the state hospital serving the district in which the person resides. In times of high patient count, a state hospital director may send a patient to another state hospital or to another hospital in the district.

(2) District I shall include Western State Hospital, Hopkinsville, Kentucky, and shall serve the counties of: Allen, Ballard, Barren, Butler, Caldwell, Calloway, Carlisle, Christian, Crittenden, Daviess, Edmonson, Fulton, Graves, Hancock, Hart, Henderson, Hickman, Hopkins, Livingston, Logan, Lyon, McCracken, McLean, Marshall, Metcalfe, Monroe, Muhlenberg, Ohio, Simpson, Todd, Trigg, Union, Warren, and Webster.

(3) District II shall include Central State Hospital, Anchorage, Kentucky, and shall serve the counties of: Bullitt, Breckinridge, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.

(4) District III shall include Eastern State Hospital, Lexington, Kentucky, and shall serve the counties of: Adair, Anderson, Bath, Boone, Bourbon, Boyd, Boyle, Bracken, Campbell, Carroll, Carter, Casey, Clark, Clinton, Cumberland, Elliott, Estill, Fayette, Fleming, Franklin, Gallatin, Garrard, Grant, Green, Greenup, Harrison, Jessamine, Kenton, Lawrence, Lewis, Lincoln, McCreary, Madison, Mason, Menifee, Mercer, Montgomery, Morgan, Nicholas, Owen, Pendleton, Powell, Pulaski, Robertson, Rowan, Russell, Scott, Taylor, Wayne, and Woodford.

(5) District IV shall include Appalachian Regional Healthcare Regional Medical Center, Hazard, Kentucky, and shall serve the counties of: Bell, Breathitt, Clay, Floyd, Harlan, Jackson, Johnson, Knott, Knox, Laurel, Lee, Leslie, Letcher, Magoffin, Martin, Owsley, Perry, Pike, Rockcastle, Whitley, and Wolfe.

Section 2. An inmate of a state penal or correctional institution transferred to the Cabinet for Health and Family Services shall be admitted to the Kentucky Correctional Psychiatric Center in La Grange, Kentucky.

Section 3.

(1) Individuals charged with a felony and requiring psychiatric evaluation or treatment pursuant to KRS Chapter 504 shall be served upon court order by a forensic psychiatric facility. Admission to the forensic psychiatric facility shall be coordinated and scheduled through that facility's admissions department.

(2) Individuals admitted upon court order to the Kentucky Correctional Psychiatric Center, La Grange, Kentucky, may be transferred to other state institutions for the mentally ill or to a psychiatric unit in a local general hospital.

Section 4.

(1) A person may be admitted to a hospital other than the hospital in the district of his or her residence upon verbal or written permission of the Commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities or authorized designee if:

(a) A patient has specific needs or treatments that are better addressed at another hospital;

(b) A hospital has staffing or facility issues limiting admittance; or

(c) Placement would cause undue hardship on affected stakeholders.

(2) If verbal permission is given, then written confirmation shall follow within five (5) working days of the admission.

Section 5. A person may be admitted to a psychiatric unit in a local general hospital if that unit has had prior approval of the Commissioner of the Department for Behavioral Health, Developmental and Intellectual Disabilities or authorized designee assuring the unit has the proper resources.

History

• RELATES TO: KRS Chapter 202A, 210.300, Chapter 504
• STATUTORY AUTHORITY: KRS 202A.008, 202A.201(2), 210.300
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.300 requires the secretary for the cabinet to promulgate administrative regulations designating hospital districts for the purpose of determining to which of the state institutions for the mentally ill the persons admitted from each county shall initially be sent. KRS 202A.201(2) authorizes the transfer of a mentally ill inmate of any penal or correctional institution to the state hospital service designated by the secretary for that purpose. This administrative regulation establishes hospital district assignments.
• History: Recodified from 902 KAR 6:040, 3-7-1989; Am. 19 Ky.R. 2154; eff. 4-21-1993; TAm eff. 4-27-2016; 43 Ky.R. 813, 1182; eff. 2-3-2017; Cert eff. 1-16-2024.

908 KAR 2:050 Formula for allocation of funds {#sec-908-kar-2-050 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:050}

Section 1. Definitions.

(1) "Cabinet" means Cabinet.

(2) "Local tax match" means revenue raised locally by a behavioral health, developmental and intellectual disabilities board from:

(a) A behavioral health, developmental and intellectual disabilities tax (KRS 210.460, 210.470, 210.480); and

(b) A county fiscal court appropriation or an appropriation by a city legislative body, including in-kind contributions at fair market value.

(3) "Other local match" means revenue raised locally by a behavioral health, developmental and intellectual disabilities board, but shall be limited to:

(a) In-kind contributions other than those from a county fiscal court or city legislative body;

(b) Cash donations and contributions;

(c) Sales of workshop products;

(d) Interest income;

(e) Rental income; and

(f) Funds provided by affiliates derived from the sources specified in this subsection, limited to the extent that the funds shall be used to finance programs endorsed by the board in its annual plan and budget.

(4) "Per capita wealth" means the current total assessed value of property, as adjusted and recorded by the Kentucky Department of Revenue, divided by the population of a given area.

(5) "Region" means that geographic locality determined by incorporation for the purpose of delivery of comprehensive behavioral health, developmental and intellectual disabilities services under KRS 210.370 as controlled by a board of directors.

Section 2. Population.

(1) Population figures used by the secretary to determine the formula allocations shall come from the U.S. Department of Commerce, Bureau of the Census, as reported in the most recent edition of the Urban Studies Center, University of Louisville, Population Research Unit Report.

(2) Any geographic breakdown in population shall be in accordance with KRS 210.370.

Section 3. Formula for Allocation of State Appropriated Funds. The formula for allocation of state appropriated funds shall be as follows:

(1) Per capita allocations. Of the total general funds appropriated by the General Assembly for a fiscal year for the community behavioral health, developmental and intellectual disabilities services programs, fifteen (15) percent shall be distributed based on per capita allocations. The sum available to each region shall be determined by dividing the total funds available in the per capita allocation by the total population of the Commonwealth, multiplied by the population of each region; provided, however, that the payment of the sum shall be on a cost related fee for service basis following receipt of appropriate and timely billings submitted by each board.

(2) Discretionary allocations. The discretionary allocations available to the secretary to maintain essential services pursuant to KRS 210.410 shall be equal to ten (10) percent of the general funds appropriated by the General Assembly for a fiscal year for community behavioral health, developmental and intellectual disabilities programs.

(3) Cost-related fee for service allocations. Of the total general funds appropriated by the General Assembly for a fiscal year for the community behavioral health, developmental and intellectual disabilities services program sixty (60) percent shall be allocated based on service units reported in the board's annual plan and budget as approved by the secretary including approved amendments; provided, however, payment shall be on a cost-related fee for service basis following receipt of appropriate and timely billings submitted by the board. If any board fails to report sufficient service units to access its cost-related fee for service allocation, these funds shall be reallocated on a cost-related fee for service basis to those regions whose reported service units exceed their allocation.

(4) Incentive allocations.

(a) Of the total general funds appropriated for community behavioral health, developmental and intellectual disabilities programs, fifteen (15) percent shall be allocated to the regions based on local tax match and other local match weighted to reflect the per capita wealth of the region. Local tax match and other local match shall be based upon the preceding fiscal year's local collections as determined by the independent auditor of each board and certified by the cabinet.

(b) The cabinet shall adjust the local tax match revenue and other local match revenue by applying a per capita wealth adjustment factor. The adjustment factor shall be computed by dividing the per capita wealth of the state by the per capita wealth of a region.

(c) The matching rates shall be thirty-five (35) cents for each dollar of local tax match after per capita adjustment and fifteen (15) cents for each dollar of other local funds after per capita wealth adjustment. The preceding totals shall equal the total state funds earned by each board under the incentive allocation provided there are sufficient funds appropriated and allocated to the incentive allocation.

(d) An initial incentive ceiling shall be calculated for each board by dividing the local incentive funds available (fifteen (15) percent of the total general funds appropriated) by the population of the state, multiplied by the population of each region. If one (1) or more boards fails to report sufficient local tax match and other local match funds to attain their ceiling, the amount they are under the ceiling shall be returned to the incentive allocation for reallocation to regions that exceeded their ceiling. If through this method all incentive funds cannot be allocated, the remaining funds shall be placed in the cost-related fee for service fund to be allocated on a cost-related fee for service basis.

(e) Incentive funds shall be adjusted following the receipt of actual collections for the previous fiscal year. The report of actual collections shall be submitted by the independent auditor in conjunction with each annual audit report of each board.

History

• RELATES TO: KRS 210.420, 210.440
• STATUTORY AUTHORITY: KRS 210.420, 210.450, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 210.440 requires the secretary of the cabinet to allocate funds to the behavioral health, developmental and intellectual disabilities boards at the beginning of each fiscal year. KRS 210.420 requires the Secretary to prescribe, by administrative regulation, a formula for the allocation of these funds, including provisions for per capita allocations, incentive allocations which require local matching funds based on per capita wealth of the area served, and discretionary allocations to be available to the secretary to maintain essential services pursuant to KRS 210.410. This administrative regulation prescribes the formula for allocation of these funds.
• History: Recodified from 902 KAR 6:050, 3-7-1989; Am. 20 Ky.R. 2261; eff. 3-14-1994; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 2:060 Behavioral health, developmental and intellectual disabilities manuals for funding instructions, program policies and standards, and reimbursement guidelines {#sec-908-kar-2-060 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:060}

Section 1. Request for Funding Instructions Manual. The Cabinet for Health and Family Services incorporates the Request for Funding Instructions Manual, September 1, 1995, by reference. Community behavioral health, developmental and intellectual disabilities boards shall follow these instructions when preparing and submitting the annual plan and budgets to the cabinet. The manual includes the following: rate and allocation schedules, program plan, fiscal plan, waiver request, and addenda.

Section 2. Program Policies and Standards. Manual. The Cabinet for Health and Family Services incorporates the September 1, 1995 edition of the Program Policies and Standards Manual by reference. The manual relates to general operating standards and particular service standards for services funded by the department. The standards contained shall be followed by those community behavioral health, developmental and intellectual disabilities boards contracting with the cabinet.

Section 3. Cabinet for Health and Family Services Community Behavioral Health, Developmental and Intellectual Disabilities Reimbursement Manual, January 1, 1997. The Cabinet for Health and Family Services incorporates this manual by reference. This manual relates to the following: scope of services, requirements and limitations of participation, method and principles of reimbursement. The manual shall be adhered to by those community behavioral health, developmental and intellectual disabilities boards contracting with the cabinet.

Section 4. Copies of the manuals are on file for inspection in the Department of Behavioral Health, Developmental and Intellectual Disabilities, Fourth Floor, 275 East Main Street, Frankfort, Kentucky 40621.

History

• RELATES TO: KRS 210.370-210.460
• STATUTORY AUTHORITY: KRS 210.440-210.450, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, reorganized the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. The cabinet is directed by KRS 210.370 to 210.460 to allocate available funds to behavioral health, developmental and intellectual disabilities boards in accordance with approved plans and budgets. KRS 210.440 and 210.450 authorize the secretary to promulgate policies and administrative regulations as to the operations, budgets and expenditures of community programs and to require reporting management and financial programs as necessary to carry out the purposes of KRS 210.370 to 210.460.
• History: Recodified from 902 KAR 6:060, 3-7-1989; Am. 20 Ky.R. 666; eff. 10-21-1993; 2263; eff. 3-14-1994; 21 Ky.R. 680; eff. 9-21-1994; 22 Ky.R. 996; 1313; eff. 1-8-1996; 1909; eff. 6-6-1996; 23 Ky.R. 3454; eff. 6-18-1997; TAm eff. 4-27-2016; Crt eff. 12-18-2019; Crt eff. 7-1-2026.

908 KAR 2:065 Community transition for individuals with serious mental illness {#sec-908-kar-2-065 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:065}

Section 1. Definitions.

(1) "Assertive community treatment" or "ACT" means an evidence-based practice model designed to provide treatment, rehabilitation, and support services, using a multidisciplinary approach, to individuals who are diagnosed with a serious mental illness. These services shall be provided in accordance with 907 KAR 15:020, Section 3(2)(j).

(2) "Case management" means those services provided pursuant to 907 KAR Chapter 15 by a targeted case manager eligible and trained to provide those services pursuant to 908 KAR 2:260.

(3) "Community integration supplementation" or "CIS" means supplementation as set forth in 921 KAR 2:015, Section 6.

(4) "Crisis services" means services that are timely and accessible and provide supports to those individuals experiencing a behavioral health crisis as provided in 907 KAR Chapter 15. The services may include mobile crisis teams, residential crisis services, and twenty-four (24) hours per day/seven (7) days per week crisis telephone lines. The services shall be offered in the least restrictive setting possible.

(5) "Housing assistance" means assistance in gaining access to housing in the community in accordance with Section 3(1) of this administrative regulation. Housing in the community does not include a personal care home, group home, nursing facility, boarding home, assisted living residence, supervised living setting, or any setting required to be licensed.

(6) "Peer support services" means the social and emotional support that is provided by persons having a mental health, substance use, or co-occurring disorder to others with a similar disorder, in order to bring about a desired social or personal change as provided in 907 KAR Chapter 15.

(7) "Person centered recovery plan" means a treatment and recovery plan created for adults with SMI, which is developed with the individual, the designated clinician, and any other parties designated by the individual. This plan shall build upon identified strengths, wants, and needs of each individual.

(8) "Personal care home" or "PCH" means a facility licensed as a personal care home and regulated by 902 KAR 20:031 and 902 KAR 20:036.

(9) "Provider" means a community mental health center (CMHC), its affiliate provider organizations, and any individual or organization qualified to provide behavioral health service, including behavioral health services organizations (BHSO).

(10) "Serious mental illness" or "SMI" means a mental illness or disorder (but not a primary diagnosis of Alzheimer's disease or dementia), that is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 5th Edition, or the DSM currently in use, that impairs or impedes functioning in one (1) or more major areas of living and is unlikely to improve without treatment, services, or supports.

(11) "Supported employment services" means services that will assist individuals in preparing for, identifying, and maintaining integrated, paid, competitive employment. Services may include job coaching, transportation, assistive technology, specialized job training, person centered employment plans, job development, and individually-tailored supports.

(12) "Tenancy rights" means rights created by a landlord/tenant relationship whether through a direct lease or sublease in which the individual is identified as the tenant.

Section 2. Eligibility. An adult with a serious mental illness shall be considered eligible for housing assistance and supported employment services in addition to other services found to be medically necessary under this administrative regulation if the individual:

(1) Has expressed a desire to live in permanent housing with tenancy rights;

(2) Is eligible for Medicaid services;

(3) Is at least eighteen (18) years of age;

(4) Is living in or at risk of living in a personal care home; and

(5) Is categorically eligible for community integration supplementation pursuant to 921 KAR 2:015, Section 6.

Section 3. Services.

(1) Housing assistance under this administrative regulation shall:

(a) Allow choice in activities of daily living, social interaction, and access to the community; and

(b) Be offered to enable individuals to attain and maintain integrated, affordable housing that:

1. Is scattered site housing, where no more than twenty-five (25) percent of the units in any development are occupied by individuals with a disability, as defined by the Americans with Disabilities Act, actually known to the cabinet; and

2. Does not limit access to community activities.

(2) Supportive services in accordance with a person centered recovery plan developed pursuant to Section 4 of this administrative regulation may include:

(a) ACT;

(b) Case Management;

(c) Covered services as set forth in 907 KAR 3:130;

(d) Crisis services;

(e) Peer support services; or

(f) Supported employment services.

Section 4. Transition Process. An individual shall:

(1) Be evaluated by a qualified mental health provider to determine eligibility for and the clinical appropriateness of the transition;

(2) Receive information about available services under this administrative regulation including CIS eligibility pursuant to 921 KAR 2:015, Section 6;

(3) Work with a team to develop a person centered recovery plan that shall include all necessary services, objectives, plans, and interventions; and

(4) Be offered assistance in developing an advance directive for mental health treatment and wellness and crisis plans.

Section 5. Appeal Rights. An individual may appeal a department decision pursuant to this administrative regulation in accordance with 907 KAR 1:563.

History

• RELATES TO: KRS 205.245, 216.765(2), 216B.303, 216B.305
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 requires the secretary to promulgate administrative regulations governing qualifications of personnel and standards for personnel management for community programs for behavioral health or individuals with an intellectual disability. This administrative regulation establishes housing assistance guidelines and the range of community transition services to be made available to qualified individuals diagnosed with serious mental illness residing in, or at risk of residing in, personal care homes.
• History: 42 Ky.R. 2309, 2608, 2794; eff. 6-3-2016; Cert. eff. 4-21-2023.

908 KAR 2:090 Decriminalization of mental illness {#sec-908-kar-2-090 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:090}

Section 1. Definitions.

(1) "Community behavioral health, developmental and intellectual disabilities center" or "center" means a facility licensed by the cabinet pursuant to KRS Chapter 216B that provides inpatient, outpatient, psychosocial rehabilitation, emergency, consultation, and education services to persons needing behavioral health, developmental and intellectual disabilities, and substance abuse services as provided within KRS 210.410 and 908 KAR 2:010.

(2) "Evaluation" means a mental health evaluation performed by a qualified mental health professional, as defined in KRS 202A.011 and 600.020, conducted to determine if an individual meets the criteria for involuntary hospitalization as defined in KRS 202A.026 or 645.090.

(3) "Facility" means any hospital or psychiatric facility as defined in KRS 202A.011 or a mental health facility as defined in KRS 645.020 used for the purpose of conducting an evaluation pursuant to KRS Chapters 202A or 202B or 645.120.

(4) "Hold", "held" or "holding" means the detainment of an individual by a peace officer or a provider of transportation services authorized by the peace officer.

(5) "Individual" means a person who is being held and evaluated under KRS Chapters 202A, 202B or 645.

(6) "Peace officer" means a law enforcement officer as defined in KRS 446.010(24).

(7) "Providers of transportation services" or "providers" means peace officers and ambulance services designated by the cabinet, service providers, or agencies on contract with the cabinet. The providers of emergency or nonemergency transportation services include those service providers or agencies that are approved by the Department for Medicaid Services or the centers.

Section 2. Crisis Stabilization Unit.

(1) Centers may establish crisis stabilization units for the purpose of reducing hospitalization in the treatment of mental illness. Services shall include:

(a) Evaluations;

(b) Crisis intervention and emergency mental health services; and

(c) Referral for follow-up care.

(2) Crisis stabilization units shall be operated as twenty-four (24) hour per day, seven (7) days per week facilities.

(3) Crisis stabilization units may admit individuals who voluntarily seek mental health services or who are in need of evaluation pursuant to KRS Chapters 202A or 202B or 645.120.

Section 3. Transportation.

(1) A peace officer shall:

(a) Transport an individual pursuant to KRS Chapter 202A or 645.120 for evaluation; and

(b) Hold the individual until the evaluation is completed, unless the facility agrees to hold the individual.

(2) Following the evaluation, the provider shall transport the individual to:

(a) A hospital if the evaluation criteria are met and so ordered by the court; or

(b) The location of the individual's choice in either the individual's home county or county where the holding originated, if the evaluation criteria are not met.

(3) The provider shall not use sirens or emergency lights of any kind except in a bona fide emergency.

(4) The peace officer who has taken the individual into custody under KRS 202A.041 shall:

(a) Document the behavior of the individual by describing:

1. How the situation was brought to the attention of the peace officer; and

2. The behavior of the individual that was considered a danger to self or others; and

(b) Provide this documentation to the qualified mental health professional evaluating the individual.

(5) Reimbursement of transportation costs may be negotiated by the center in accordance with the center's contract with the cabinet.

(6) Reimbursement for the individual transported to a facility shall be paid by the center if:

(a) The individual is transported pursuant to KRS 202A.028, 202A.041, 202A.051, or 645.120; and

(b) A center or a designated subcontractor of the center conducts the evaluation.

(7) Transportation provided to the individual upon discharge from the hospital to their home county shall be:

(a) Reimbursed by the center, if a provider is the most appropriate means of transportation; or

(b) The responsibility of the hospital, if the hospital determines that an alternate form of transportation is more appropriate.

(8) No payment shall be made by the center if reimbursement of these costs is otherwise available from:

(a) Private insurance;

(b) Other source of payment;

(c) Medicare; or

(d) The Department for Medicaid Services.

(9) The authority of the cabinet to negotiate rates of reimbursement and enter into contracts with providers may be delegated to the center.

Section 4. Use of Restraints.

(1) A peace officer, ambulance provider, physician or facility may use restraints only if the individual exhibits or is threatening to exhibit assaultive or self-injurious behavior.

(2) Restraints may be applied through physical contact or devices used by peace officers, ambulance providers, or facilities in a manner consistent with the practice of each profession. Restraint may also be applied through the appropriate use of medications ordered by a licensed physician and administered by a qualified health care professional.

(3) The peace officers, ambulance providers, physician or facility shall document in writing the use of any restraint. The documentation shall include:

(a) The reason for using the restraint;

(b) Type of restraint used;

(c) When the restraint was initiated; and

(d) Length of time the restraint was used, or if medication was used, name of medications, dosage and effect on individual.

(4) Documentation concerning the use of restraint shall be given to:

(a) The qualified mental health professional who performs the evaluation; and

(b) The facility, crisis stabilization unit, or intermediate care facility where the individual is being held or treated.

Section 5. Privacy.

(1) A provider or facility shall not disclose the psychiatric condition or other personal information regarding the individual except to:

(a) Persons acting under the provisions of KRS Chapters 202A, 202B and 645;

(b) The individual;

(c) The individual's legal guardian;

(d) The individual's parent(s) or person exercising custodial control or supervision of the individual, if a minor; or

(e) Any person given legal authority to receive that information on the individual's behalf.

(2) Facilities shall maintain the individual's privacy during the holding period.

(3) The qualified mental health professional shall evaluate the individual in an examining room or clinician's office.

(4) The individual or the other persons identified in subsection (1) of this section may receive copies of all documents generated during the transportation and holding as provided in KRS 61.878 and 61.884.

(5) The qualified mental health professional who performed the evaluation or other facility staff shall inform the individual of the availability of the documents and the opportunity to review the individual's medical record.

Section 6. Communication.

(1) At the time of holding, the provider shall inform the individual that reasonable access to telephone communication shall be offered at the facility.

(2) The facility shall:

(a) Inform the individual of the availability of phone calls;

(b) Provide telephone communications to the individual at the earliest opportunity available;

(c) Assist the individual in completing phone calls to persons of their choice; and

(d) Pay for no more than two (2) completed long distance phone calls, if the individual has insufficient funds.

Section 7. Community Behavioral Health, Developmental and Intellectual Disabilities Centers Responsibilities.

(1) Under the authority of KRS 210.040(7) and (8), the cabinet may delegate to the community behavioral health, developmental and intellectual disabilities centers the responsibility to plan, prepare written protocols, and coordinate services as provided within KRS Chapters 202A and 202B and 645.120.

(2) The center shall:

(a) Designate facilities for the purpose of conducting evaluations by qualified mental health professionals;

(b) Notify providers of transportation services, district judges and the cabinet of the identity and location of the facilities that are designated for the purpose of evaluating individuals;

(c) Make qualified mental health professionals available twenty-four (24) hours per day, seven (7) days per week at designated facilities to perform evaluations;

(d) Conduct evaluation requested by facilities within three (3) hours of the time of the request unless extensions of time are negotiated between the facility and the centers; and

(e) Assist the facility in referring the individual to a hospital for treatment if the evaluation criteria are met and the individual has not been admitted to the hospital where the evaluation is conducted.

History

• RELATES TO: KRS Chapters 202A, 202B, 645
• STATUTORY AUTHORITY: KRS 194A.050, 202A.008, 202A.028(3), (4), 202A.041(1), 202A.051(6), 202A.101(3), 202A.241, 645.120, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. This administrative regulation sets forth the cabinet's services and procedures for: providing crisis stabilization units; transporting and holding individuals; using restraints; providing privacy to individuals who are held for evaluation; identifying rights for individuals held to communicate by phone; and planning and coordinating the required services.
• History: 21 Ky.R. 2008; Am. 2718; eff. 5-17-1995; TAm eff. 4-27-2016; Crt eff. 7-1-2026.

908 KAR 2:220 Adult peer support specialist {#sec-908-kar-2-220 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:220}

Section 1. Definitions.

(1) "Adult peer support" means emotional support that is provided by an adult peer support specialist to others with similar mental health, substance use, or co-occurring mental health and substance use disorders in order to achieve a desired social or personal change.

(2) "Adult peer support specialist" means a self-identified consumer of mental health, substance use, or co-occurring mental health and substance use disorder services who has successfully completed the adult peer support specialist training.

(3) "Adult peer support specialist services" means structured and scheduled non-clinical, therapeutic activities provided to a consumer by an adult peer support specialist in accordance with this administrative regulation.

(4) "Consumer" means an individual who receives adult peer support services.

(5) "Department" or "DBHDID" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(6) "Recovery" means a process of change through which a consumer improves in health and wellness, lives a self-directed life, and strives to reach full potential.

(7) "Regional community mental health center" or "CMHC" means the board established by KRS 210.380 and governed by KRS 210.370 to 210.485.

(8) "Training curriculum" means a total package of learning activities designed to achieve the goals of the training program with:

(a) The objective that trainees will acquire the specific knowledge and skills (competencies) needed to perform the duties of an adult peer support specialist; and

(b) Four (4) primary components, including:

1. Content or information to be transmitted, including:

a. Theoretical framework;

b. Conceptual rationale;

c. Best standards of practice;

d. Application to direct practice; and

e. Congruence between and within sections;

2. Organization of the curriculum, including structure, format, and sequencing, incorporating:

a. Concordance with the natural learning process;

b. Design of each section linked to specific learning objectives, with adequate time provided for each;

c. Linkages between sections;

d. Knowledge and skills that are conceptually related, or that are performed together on the job, are taught together; and

e. Retention and understanding facilitated by principles of sequencing (from simple to complex, from the universal to the exception, and from fundamental to more refined applications) and repetition;

3. Training methods appropriate to adult learners in an applied setting, in each section or topic area, including:

a. Discussion to promote exploration and understanding of the topic;

b. Experiential exercises or simulations; and

c. Presentation of the same concepts using a variety of learning strategies (for example, hearing, seeing, modeling, and then practicing) to ensure that trainees with different learning styles can assimilate the knowledge; and

4. Evaluation methods, including:

a. Trainee knowledge assessment through testing, with achievement of a passing aggregate assessment score of at least seventy (70) percent; and

b. Trainee performance reviews of trainers.

Section 2. Eligibility. An adult peer support specialist shall:

(1) Be eighteen (18) years of age or older;

(2) Have a current or past diagnosis of a mental health, substance use, or co-occurring mental health and substance use disorders;

(3) Have received or be receiving treatment;

(4) Have a minimum educational requirement of a high school diploma or General Equivalence Diploma (GED) certificate;

(5) Demonstrate a pattern of recovery from a mental health, substance use, or co-occurring mental health and substance use disorders;

(6) Successfully complete adult peer support specialist training approved by the department or receive a training waiver for this requirement in accordance with Section 5 of this administrative regulation; and

(7) Successfully complete, maintain, and submit to the department documentation of a minimum of six (6) hours of related training or education in each subsequent year.

Section 3. Department Responsibilities.

(1) The department shall, within twenty (20) business days, approve or deny at least a thirty (30) hour adult peer support specialist training curriculum based on a nationally recognized model, which shall include modules on the following:

(a) Problem solving;

(b) Wellness recovery action plan;

(c) Stages in the recovery process;

(d) Effective listening skills;

(e) Establishing recovery goals; and

(f) Using support groups to promote and sustain recovery.

(2) The department shall maintain a record of all approved adult peer support training providers on the department's Web site.

(3) Providers of approved curricula shall notify the department within twenty (20) business days of a trainee's successful completion of an adult peer support training.

(4) The department shall maintain a record of all individuals who have successfully completed the adult peer support specialist training or who have received a training waiver in accordance with subsection (5) of this section and Section 5 of this administrative regulation.

(5) The department shall review all requests to waive the training requirement and shall, within twenty (20) business days:

(a) Approve, in writing, the request based on the documentation provided by the individual; or

(b) Deny, in writing, the request if the individual fails to demonstrate compliance with any portion of this administrative regulation.

Section 4. Adult Peer Support Specialist Responsibilities. An adult peer support specialist shall:

(1) Use relevant personal stories to assist other consumers through experience;

(2) Serve as a role model to a consumer;

(3) Encourage consumer voice and choice during development and implementation of plans;

(4) Support a consumer by:

(a) Attending team meetings on behalf of the consumer at the request of the consumer; or

(b) Accompanying the consumer to meetings upon the consumer's request;

(5) Empower a consumer to have the confidence to be a self-advocate;

(6) Help providers or other individuals understand the importance of integrating consumer voice and choice in services and support within a system of care;

(7) Promote socialization, recovery, self-advocacy preservation, and enhancement of community living skills for consumers; and

(8) Complete and maintain documentation of a minimum of six (6) hours of related training or education in each subsequent year after successful completion of the adult peer support specialist training or receipt of waiver, and shall submit a list of all trainings in which the adult peer support specialist participated, the provider or presenter of the training, and the number of hours of each training to the department every three (3) years. The submission due date shall be the last day of the month of which the adult peer support specialist's initial training was completed.

Section 5. Request to Waive the Adult Peer Support Specialist Training.

(1) An individual requesting to waive the adult peer support specialist training shall:

(a) Provide documentation to the department, on the department's Web site, of successful completion of an adult peer support specialist training sponsored by a federal entity or by another state that is comparable to the adult peer support specialist training in this administrative regulation; and

(b) Provide documentation to show that the training has occurred within five (5) years of the waiver request.

(2) The department shall review all requests to waive the training requirement and shall, within twenty (20) business days:

(a) Approve, in writing, the request based on the documentation provided by the individual; or

(b) Deny, in writing, the request if the individual fails to demonstrate compliance with any portion of this administrative regulation.

(3) If an individual is denied a training waiver, the individual may complete the adult peer support specialist training in accordance with the requirements in Section 2 of this administrative regulation.

Section 6. Supervision of an Adult Peer Support Specialist.

(1) Adult peer support specialist services shall be provided under the supervision of one (1) of the following professionals:

(a) Physician;

(b) Psychiatrist;

(c) Advanced practice registered nurse;

(d) Physician assistant;

(e) Licensed psychologist;

(f) Licensed psychological practitioner including a certified psychologist or a certified psychologist with autonomous functioning;

(g) Licensed clinical social worker;

(h) Licensed professional clinical counselor;

(i) Licensed marriage and family therapist;

(j) Licensed psychological associate;

(k) Marriage and family therapy associate;

(l) Certified social worker;

(m) Licensed professional counselor associate;

(n) Licensed professional art therapist;

(o) Licensed professional art therapist associate;

(p) Professional equivalent working within a CMHC;

(q) Licensed clinical alcohol and drug counselor;

(r) Licensed clinical alcohol and drug counselor associate;

(s) Certified alcohol and drug counselor; or

(t) Psychiatric nurse working in a CMHC.

(2) Supervision meetings between the supervising professional and adult peer support specialist shall:

(a) Be conducted face-to-face;

(b) Occur no less than twice per month, at least one (1) of which shall be individual; and

(c) Be at least thirty (30) minutes in length.

(3) The supervising professional shall maintain a written record of supervision that:

(a) Is dated and signed by the adult peer support specialist and the supervisor for each meeting; and

(b) Includes a description of each supervision meeting that specifies:

1. The topic discussed;

2. Specific action to be taken;

3. An update for any issue previously discussed that required follow-up; and

4. A plan for additional training needs if any were identified.

History

• RELATES TO: KRS 210.010, 210.040, 210.370-485
• STATUTORY AUTHORITY: KRS 12.455, 194A.030, 194A.050, 210.450, 222.211
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 authorizes the secretary to promulgate administrative regulations governing qualifications of personnel, standards for personnel management operations and consultation in ascertaining local needs for community programs for mental health or individuals with an intellectual disability. KRS 222.211 authorizes the secretary to promulgate administrative regulations to assure that there is the provision of prevention, intervention, and treatment services for both juveniles and adults to address the problems of addiction to alcohol and other drug abuse within individuals, families, and communities. This administrative regulation establishes the minimum eligibility, training, and supervision requirements for an adult peer support specialist.
• History: 34 Ky.R. 689; Am. 1984; eff. 2-14-2008; 41 Ky.R. 1925; 2273, 2560; eff. 6-17-2015; TAm eff. 4-27-2016; Cert. eff. 12-28-2021.

908 KAR 2:230 Kentucky family peer support specialist {#sec-908-kar-2-230 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:230}

Section 1. Definitions.

(1) "Child-serving agency" means an agency represented by the State Interagency Council.

(2) "Client" means a child or youth with a mental health, substance use, or co-occurring mental health and substance use disability whose parent or family member is receiving family peer support services on behalf of the child or youth.

(3) "Core competency" means the knowledge and skills in Section 3(3) of this administrative regulation that an individual must demonstrate in order to successfully complete the Kentucky family peer support specialist training.

(4) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(5) "Kentucky Family Leadership Academy" or "KFLA" means a prerequisite training to a KFPSS core competency training designed for parents, family members, caregivers, and youth leaders that fosters initial leadership development.

(6) "Kentucky family peer support specialist" or "KFPSS" means an eligible parent, or other family member who has fulfilled the requirements in Section 2 of this administrative regulation.

(7) "Lived Experience" means the experience of a parent or other family member in navigating the receipt of services and supports for a child or youth that are directly related to that child's or youth's mental health, substance use, or co-occurring mental health and substance use disability as defined in the current edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM).

(8) "Regional community mental health center" or "CMHC" means the board established by KRS 210.380 and governed by KRS 210.370 to 210.485.

(9) "State Interagency Council" is defined by KRS 200.505.

(10) "Training curriculum" means a total package of learning activities designed to achieve the goals of the training program with:

(a) The objective that trainees will acquire the specific knowledge and skills (competencies) needed to perform the duties of a Kentucky peer support specialist; and

(b) Four (4) primary components, including:

1. Content or information to be transmitted, including:

a. Theoretical framework;

b. Conceptual rationale;

c. Best standards of practice;

d. Application to direct practice; and

e. Congruence between and within sections;

2. Organization of the curriculum, including structure, format, and sequencing, incorporating:

a. Concordance with the natural learning process;

b. Design of each section linked to specific learning objectives, with adequate time provided for each;

c. Linkages between sections;

d. Knowledge and skills that are conceptually related, or that are performed together on the job, are taught together; and

e. Retention and understanding facilitated by principles of sequencing (from simple to complex, from the universal to the exception, and from fundamental to more refined applications) and repetition;

3. Training methods appropriate to adult learners in an applied setting, in each section or topic area, including:

a. Discussion to promote exploration and understanding of the topic;

b. Experiential exercises or simulations; and

c. Presentation of the same concepts using a variety of learning strategies (for example, hearing, seeing, modeling, and then practicing) to ensure that trainees with different learning styles can assimilate the knowledge; and

4. Evaluation methods, including:

a. Trainee knowledge assessment through testing, with achievement of a passing aggregate assessment score of at least seventy (70) percent; and

b. Trainee performance reviews of trainers.

Section 2. Eligibility Criteria. A family peer support specialist shall:

(1) Be eighteen (18) years of age or older;

(2) Be a self-identified parent or other family member who has lived experience with a client who has received services related to a mental health, substance use, or co-occurring mental health and substance use disability from at least one (1) child serving agency;

(3) Have a minimum educational requirement of a high school diploma or General Equivalency Diploma (GED) certificate;

(4) Have successfully completed a KFLA training approved by the department;

(5) Successfully complete a KFPSS core competency training approved by the department or receive a training waiver for this requirement in accordance with Section 5 of this administrative regulation; and

(6) Successfully complete, maintain, and submit to the department documentation of a minimum of six (6) hours of related training or education in each subsequent year.

Section 3. Department's Responsibility.

(1) The department shall, within twenty (20) business days, approve or deny a KFLA training based on a standard fifteen (15) hour training curriculum that is submitted to the department using the department's Web site, that includes at a minimum:

(a) Leadership roles;

(b) Communication skills;

(c) Decision making skills;

(d) Dealing with conflict;

(e) Effective advocacy; and

(f) Collaboration and partnership.

(2) The department shall maintain a record of all approved training providers on the department's Web site.

(3) The department shall, within twenty (20) business days, approve or deny at least a thirty (30) hour training curriculum to provide KFPSS core competency training based on a standard training curriculum that includes the following:

(a) Problem solving;

(b) Wellness recovery action plan;

(c) Stages in the recovery process;

(d) Effective listening skills;

(e) Establishing recovery goals; and

(f) Using a support group to promote and sustain recovery;

(4) Providers of approved KFPSS and KFLAA curricula shall notify the department within twenty (20) business days of a trainee's successful completion of a training program.

(5) The department shall maintain a record of all individuals who have successfully completed an applicant's successful completion of the KFPSS and KFLA training or who have received a training waiver in accordance with subsection (6) of this section and Section 5 of this administrative regulation.

(6) The department shall review all requests to waive the training requirement and may:

(a) Approve, in writing, the request based on the documentation provided by the individual; or

(b) Deny, in writing, the request if the individual fails to demonstrate compliance with any portion of this administrative regulation.

Section 4. Kentucky Family Peer Support Specialist Responsibilities. A Kentucky family peer support specialist shall:

(1) Use relevant personal stories to teach through experience;

(2) Serve as a role model for clients and their families;

(3) Encourage client and family voice and choice during development and implementation of plans;

(4) Support clients and their families by attending team meetings with them upon request;

(5) Empower a client and family to have the confidence to be self-advocates;

(6) Help providers or other individuals who are working with a client's family understand the importance of integrating family and youth voice and choice in services and supports within a system of care;

(7) Help clients and families enhance relationships with community partners; and

(8) Complete and maintain documentation of a minimum of six (6) hours of related training or education in each subsequent year after successful completion of the family peer support specialist training or receipt of waiver, and shall submit a list of all trainings in which the family peer support specialist participated, the provider or presenter of the training, and the number of hours of each training to the department every three (3) years. The submission due date shall be the last day of the month of which the family peer support specialist's initial training completion or waiver receipt was completed.

Section 5. Request to Waive the Family Peer Support Specialist Training.

(1) An individual may request to waive the family peer support specialist training by providing documentation to the department on the department's Web site:

(a) Of completion of a family peer support specialist training sponsored by a federal entity or by another state with core competencies consistent with that of the Kentucky family peer support specialist training; and

(b) To show that the training has occurred within five (5) years before the waiver request date.

(2) The department shall review all requests to waive the training requirement and shall, within twenty (20) business days:

(a) Approve, in writing, the request based on the documentation provided by the individual; or

(b) Deny the request in writing if the individual fails to demonstrate compliance with any portion of this administrative regulation.

(3) If an individual is denied a training waiver, the individual may complete the Kentucky family peer support specialist core competency training in accordance with the requirements in Section 3(3) of this administrative regulation.

Section 6. Supervision of a Family Peer Support Specialist.

(1) Kentucky family peer support services shall be provided under the supervision of one (1) of the following professionals:

(a) Physician;

(b) Psychiatrist;

(c) Advanced practice registered nurse;

(d) Physician assistant;

(e) Licensed psychologist;

(f) Licensed psychological practitioner including certified psychologist or certified psychologist with autonomous functioning;

(g) Licensed clinical social worker;

(h) Licensed professional clinical counselor;

(i) Licensed marriage and family therapist;

(j) Licensed psychological associate;

(k) Marriage and family therapy associate;

(l) Certified social worker;

(m) Licensed professional counselor associate;

(n) Licensed professional art therapist;

(o) Licensed professional art therapist associate;

(p) Professional equivalent working in a regional community mental health center;

(q) Licensed clinical alcohol and drug counselor;

(r) Licensed clinical alcohol drug and counselor associate;

(s) Certified alcohol and drug counselor; or

(t) Psychiatric nurse working in a Community Mental Health Center.

(2) Supervision meetings between the supervising professional and family peer support specialist shall:

(a) Be conducted face-to-face;

(b) Occur no less than twice per month, at least one (1) of which shall be individual;

(c) Be at least thirty (30) minutes in length; and

(d) Be documented in accordance with subsection (3) of this section.

(3) The supervising professional shall maintain a written record of supervision that:

(a) Is dated and signed by a KFPSS and supervisor for each meeting; and

(b) Includes a description of each meeting that specifies:

1. The topic discussed;

2. Specific action to be taken;

3. An update for an issue that required follow-up; and

4. A plan for additional training needs if any were identified.

History

• RELATES TO: KRS 200.505, 210.010, 210.040, 210.370-485, 222.211
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450, 222.211
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 requires the secretary to promulgate administrative regulations governing qualifications of personnel and standards for personnel management for community programs for mental health or individuals with an intellectual disability. KRS 222.211 authorizes the secretary of the cabinet to promulgate administrative regulations to assure that there is the provision of prevention, intervention, and treatment services for both juveniles and adults to address the problems of addiction to alcohol and other drug abuse within individuals, families, and communities. This administrative regulation establishes the minimum eligibility, training, and supervision requirements for a Kentucky family peer support specialist.
• History: 37 Ky.R. 1366; Am. 1689; eff. 2-4-2011; 41 Ky.R. 1929; 2277; 2562; eff. 6-17-2015; Cert. eff. 12-28-2021.

908 KAR 2:240 Kentucky youth peer support specialist {#sec-908-kar-2-240 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:240}

Section 1. Definitions.

(1) "Applicant" means an individual seeking to complete the Kentucky Youth Peer Support Specialist training.

(2) "Application" means completing the Kentucky Youth Peer Support Specialist Core Competency Training Application form and submitting it to the department.

(3) "Child-serving agency" means an agency represented by the State Interagency Council.

(4) "Client" means a child with an emotional disability as defined by KRS 200.503(1) or who is at risk of developing an emotional disability.

(5) "Core Competency" means the knowledge and skills listed in Section 3(4) of this administrative regulation that all applicants must demonstrate in order to successfully complete the Kentucky youth peer support specialist training.

(6) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(7) "Kentucky Family Leadership Academy" or "KFLA" means a prerequisite training designed for parents, caregivers, and youth leaders that fosters initial leadership development.

(8) "Kentucky youth peer support specialist" or "KYPSS" means an eligible youth who has completed the requirements of this administrative regulation.

(9) "Lived Experience" means an experience of a child or youth with an emotional, social, behavioral, or substance use disability that is defined in the current version of The Diagnostic and Statistical Manual for Mental Disorders.

(10) "Professional Equivalent" means a person who meets the professional equivalent requirements established in the Community Mental Health Center Services Manual that is incorporated by reference in 907 KAR 1:044.

(11) "State family organization" means an organization with whom the department contracts to carry out the activities associated with statewide advocacy and support for children and youth with severe emotional disabilities.

(12) "State Interagency Council" is the State Interagency Council for Services to Children with an Emotional Disability as defined by KRS 200.505.

(13) "Youth Peer Support 101" means a training designed for Kentucky youth peer support specialists and their supervisors that provides an orientation to the position.

Section 2. Eligibility Criteria. An applicant shall:

(1) Be an individual who is at least eighteen (18) years of age and is not older than thirty-five (35) years of age;

(2) Have lived experience;

(3) Be receiving or have received from at least one (1) child-serving agency a state-funded service that is related to the youth's emotional, social, behavioral, or substance abuse disability;

(4) Have a high school diploma or general equivalency diploma (GED) certificate;

(5) Have successfully completed the KFLA training approved by the department;

(6) Discuss the experience of receiving state-funded services from at least one (1) child-serving agency on the applicant's responses on the short-essay form;

(7) Demonstrate experience with leadership and advocacy in the field of behavioral health; and

(8) Demonstrate the applicant's own efforts at self-directed leadership development.

Section 3. Department's Responsibilities. The Department shall:

(1) Ensure that the KYPSS Core Competency Training Application is available to eligible applicants through:

(a) A written or verbal request to the department;

(b) The department Web site;

(c) Member agencies of the State Interagency Council; and

(d) The statewide family organization;

(2) Approve the KFLA training based on a standard curriculum that includes at a minimum:

(a) Leadership roles;

(b) Communication skills;

(c) Decision making skills;

(d) Dealing with conflict;

(e) Effective advocacy; and

(f) Collaboration and partnerships;

(3) Provide notification of KYPSS training to include:

(a) Date;

(b) Time;

(c) Location of the training; and

(d) Prerequisites for training participants as established by Section 2 of this administrative regulation;

(4) Approve KYPSS training based on a standard curriculum that includes at a minimum the following core competencies:

(a) System of Care Philosophy;

(b) Wraparound Process;

(c) Youth Support;

(d) Group Process;

(e) Cultural and Linguistic Competence;

(f) Communication;

(g) Organization;

(h) Self-Care;

(i) Leadership; and

(j) Ethics and Values;

(5) Maintain documentation of an applicant's successful completion of the KYPSS training, including the applicant's:

(a) Application;

(b) Completion of the KFLA;

(c) Competency examination; and

(d) Examination results;

(6) Maintain a database with the names of Kentucky youth peer support specialists; and

(7) Approve Youth Peer Support 101 training based on a standard curriculum that includes at a minimum:

(a) Position description;

(b) Role expectations;

(c) Supervision requirements;

(d) Coaching; and

(e) Other professional opportunities.

Section 4. Kentucky Youth Peer Support Specialist Duties and Responsibilities. A Kentucky youth peer support specialist shall:

(1) Use relevant personal stories to teach through experience;

(2) Serve as a role model for clients;

(3) Ensure and empower client voice and choice during development and implementation of plans;

(4) Support clients by attending team meetings, upon request;

(5) Support clients by improving their confidence to be a self-advocate;

(6) Help individuals working with youth to understand youth culture; and

(7) Help clients enhance their relationships with community partners.

Section 5. Training Requirements. An applicant seeking to provide youth peer support specialist services shall:

(1) Complete and submit the KYPSS Core Competency Training Application to the department;

(2) Complete a department approved KYPSS training as defined in Section 3(4) of this administrative regulation;

(3) Successfully complete the oral and written examination following the training;

(4) Complete and maintain documentation of a minimum of six (6) hours of related training or education in each subsequent year; and

(5) After employment as a KYPSS, complete the department approved Youth Peer Support 101 training as defined in Section 3(7) of this administrative regulation.

Section 6. Request to Waive the Kentucky Youth Peer Support Specialist Training Requirements.

(1) An applicant may request to waive the Kentucky youth peer support specialist training requirements. To request a waiver, an applicant shall provide the following to the department:

(a) Completion of the KYPSS Core Competency Training Application;

(b) Documentation of completion of a youth peer support specialist training sponsored by a federal entity or by another state with core competencies consistent with that of the KYPSS program; and

(c) Documentation to show that the training has occurred within five (5) years of the application date.

(2) The department shall review all requests to waive the training requirement and shall:

(a) Approve the request in writing based on the documentation provided by the applicant;

(b) Approve the request in writing pending successful completion of the KYPSS Core Competency Training exam; or

(c) Deny the request in writing if the applicant fails to demonstrate compliance with any provision of this administrative regulation.

(3) If an applicant is denied a training waiver, the applicant may apply to complete the KYPSS training in accordance with Section 5 of this administrative regulation.

Section 7. Kentucky Youth Peer Support Specialist Supervision.

(1) Kentucky youth peer support services shall be provided under the supervision of one (1) of the following professionals who shall complete the department approved Youth Peer Support 101 training as defined in Section 3(7) of this administrative regulation:

(a) Physician;

(b) Psychiatrist;

(c) Advanced practice registered nurse;

(d) Physician assistant;

(e) Licensed psychologist;

(f) Licensed psychological practitioner;

(g) Licensed clinical social worker;

(h) Licensed professional clinical counselor;

(i) Licensed marriage and family therapist;

(j) Certified psychologist;

(k) Certified psychologist with autonomous functioning;

(l) Licensed psychological associate;

(m) Marriage and family therapy associate;

(n) Certified social worker;

(o) Licensed professional counselor associate;

(p) Licensed professional art therapist;

(q) Professional equivalent;

(r) Certified alcohol and drug counselor; or

(s) Psychiatric nurse.

(2) Individual supervision meetings shall:

(a) Be conducted face to face;

(b) Occur no less than once a week for the first year and monthly thereafter; and

(c) Be documented in accordance with subsection (3) of this section.

(3) The supervising professional shall maintain a written record for supervision that:

(a) Is dated and signed by both the KYPSS and supervisor for each meeting; and

(b) Includes a description of the encounter that specifies:

1. The topic discussed;

2. Any specific action to be taken;

3. An update for any issue previously discussed that required follow-up; and

4. A plan for additional training needs if any were identified.

Section 8. Incorporation by Reference.

(1) "Kentucky Youth Peer Support Specialist Core Competency Training Application", May 2014, is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main, Fourth Floor, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

• RELATES TO: KRS 200.505, 210.010, 210.040, 210.370-210.485
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450, 12.455
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 requires the secretary to promulgate administrative regulations governing qualifications of personnel and standards for personnel management for community programs for mental health or individuals with an intellectual disability. This administrative regulation establishes the minimum eligibility and training requirements for a Kentucky youth peer support specialist.
• History: 40 Ky.R. 2234; Am. 2793; eff. 6-18-2014; TAm eff. 4-27-2016; Cert eff. 5-10-2021.

908 KAR 2:250 Community support associate; eligibility criteria and training {#sec-908-kar-2-250 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:250}

Section 1. Definitions.

(1) "Client" means an adult or child who receives comprehensive community support services and has a primary mental health disorder diagnosis or a co-occurring disorder.

(2) "Co-occurring disorder" means the primary diagnosis of a mental health disorder and one (1) or more of the following:

(a) Substance use disorder;

(b) Intellectual disability; or

(c) Physical health disorder or condition.

(3) "Comprehensive community support services" means activities necessary to allow clients to live with maximum independence in the community and consists of one (1) or more of the following:

(a) Skills training, cueing, or supervision as identified in the client's individualized treatment plan;

(b) Medication adherence and recognizing symptoms and side effects;

(c) Non-clinical but therapeutic behavioral intervention, support, and skills training;

(d) Assistance in accessing and utilizing community resources;

(e) Emotional regulation skills;

(f) Crisis coping skills; and

(g) Developing and enhancing interpersonal skills.

(4) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities.

(5) "Professional equivalent" means a person who meets the professional equivalent requirements established in the Community Mental Health Services Manual that is incorporated by reference in 907 KAR 1:044.

(6) "Qualified mental health professional" is defined by KRS 202A.011(12).

Section 2. Eligibility Criteria.

(1) A community support associate shall:

(a) Be eighteen (18) years of age or older;

(b) Have a high school diploma, a general equivalency diploma (GED), or qualifying documentation from a comparable educational entity;

(c) Have one (1) year of full-time experience working with individuals who receive services for treatment of a:

1. Mental health disorder; or

2. Co-occurring disorder; and

(d) Successfully complete within six (6) months of hire the department-led or approved training program described in Section 3 of this administrative regulation.

(2) Supervision. A community support associate shall:

(a) Work under the supervision of one (1) of the following:

1. Physician;

2. Psychiatrist;

3. Advanced practice registered nurse;

4. Physician assistant;

5. Licensed psychologist;

6. Licensed psychological practitioner;

7. Licensed clinical social worker;

8. Licensed professional clinical counselor;

9. Licensed marriage and family therapist;

10. Certified psychologist;

11. Certified psychologist with autonomous functioning;

12. Licensed psychological associate;

13. Marriage and family therapy associate;

14. Certified social worker;

15. Licensed professional counselor associate;

16. Licensed professional art therapist;

17. Professional equivalent;

18. Certified alcohol and drug counselor;

19. Psychiatric nurse; or

20. Licensed board certified behavior analyst; and

(b) Meet face-to-face no less than one (1) time every two (2) weeks with the community support associate's supervisor as described in paragraph (a) of this subsection.

(3) The supervisor shall maintain a written record of supervision that:

(a) Is dated and signed by the supervisor for each meeting; and

(b) Includes a description of the encounter that specifies:

1. The topic discussed;

2. Any specific action to be taken;

3. An update for any issue previously discussed that required follow-up; and

4. A plan for additional training needs if any were identified.

Section 3. Initial Training Requirements. A department-led or approved training curriculum for a community support associate shall consist of ten (10) clock hours of planned program instruction at a minimum in the following areas:

(1) Principles of recovery and resilience;

(2) Principles of psychiatric rehabilitation;

(3) Effective listening and communication skills;

(4) Diagnosis and medication management of mental health disorders or co-occurring disorders; and

(5) Crisis coping skills.

Section 4. Annual Training. During each subsequent year of employment, a community support associate shall complete and maintain documentation of a minimum of six (6) hours of training or education related to the specification described in Section 3(1) through (5) of this administrative regulation.

History

• RELATES TO: KRS 202A.011(12), 210.010, 210.040, 210.370 – 210.485, 309.080 – 309.089, 309.130 – 309.1399, 311.571, 314.042, 319.050, 319.056, 319.064, 335.100, 335.080, 335.500 – 335.599
• STATUTORY AUTHORITY: KRS 210.450
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.450 authorizes the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations which prescribe standards for qualifications of personnel in community programs for mental health. This administrative regulation establishes the eligibility criteria and training requirements for community support associates employed by an entity which provides comprehensive community support services.
• History: 40 Ky.R. 2236; 2795; eff. 6-18-2014; TAm eff. 4-27-2016; TAm eff. 9-17-2018; Cert eff. 5-10-2021.

908 KAR 2:260 Targeted case manager: eligibility and training {#sec-908-kar-2-260 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:260}

Section 1. Definitions.

(1) "Behavioral health practitioner under supervision" means an individual who is:

(a)

1. A licensed professional counselor associate;

2. A licensed assistant behavior analyst;

3. A certified social worker;

4. A marriage and family therapy associate;

5. A licensed professional art therapist associate;

6. A physician assistant; or

7. A certified alcohol and drug counselor; and

(b) Employed by or under contract with the same billing provider as the billing supervisor.

(2) "Behavioral health professional" means:

(a) An advanced practice registered nurse as defined by KRS 314.011(7);

(b) A licensed clinical social worker as defined by KRS 335.100;

(c) A licensed marriage and family therapist as defined by KRS 335.300(2);

(d) A licensed professional clinical counselor as defined by KRS 335.500(3);

(e) A licensed psychological practitioner as defined by KRS 319.053;

(f) A licensed psychologist as defined by KRS 319.010(6) and 201 KAR Chapter 26;

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

(h) A physician as defined by KRS 205.510(11);

(i) A psychiatrist;

(j) A behavioral health practitioner under supervision;

(k) A registered nurse as defined by KRS 314.011(5) working under the supervision of a physician or advanced practice registered nurse;

(l) A certified alcohol drug counselor as defined by KRS 309.083;

(m) A certified psychologist as defined by 201 KAR Chapter 26;

(n) A certified psychologist with autonomous functioning as defined by KRS 319.056;

(o) A certified social worker as defined by KRS 335.080

(p) A licensed professional art therapist associate as defined by KRS 309.130(3);

(q) A licensed psychological associate as defined by KRS 319.010(6) and 201 KAR Chapter 26;

(r) A marriage and family therapy associate as defined by KRS 335.300(3);

(s) A physician assistant as defined by KRS 311.840(3);

(t) A licensed clinical alcohol and drug counselor as defined by KRS 309.080(4);

(u) A licensed clinical alcohol and drug counselor associate as defined by KRS 309.080(5); or

(v) An individual with a bachelor's degree in a behavioral science as defined in subsection (3) of this section who:

1. Is working under the supervision of a billing supervisor; and

2. Has at least five (5) years of documented full-time experience providing specialized case management services for the target population.

(3) "Behavioral science" means:

(a) Psychology;

(b) Sociology;

(c) Social work;

(d) Family studies;

(e) Human services;

(f) Counseling;

(g) Nursing;

(h) Behavioral analysis;

(i) Public health;

(j) Special education;

(k) Gerontology;

(l) Recreational therapy;

(m) Education;

(n) Occupational therapy;

(o) Physical therapy;

(p) Speech-language pathology;

(q) Rehabilitation counseling; or

(r) Faith-based education.

(4) "Case load" means the number of distinct individuals for whom a targeted case manager bills for services from any payor, per month.

(5) "Certification" means successful completion of the training requirements in this administrative regulation as documented by notice of successful training completion submitted to the department from the training provider.

(6) "Chronic or complex physical health condition" means that:

(a) Significant symptoms of a physical health condition have persisted in a client for a continuous period of at least six (6) months;

(b) The symptoms of the physical health condition significantly impair the client's ability to function:

1. Socially, or

2. Occupationally which, for individuals under the age of twenty-one (21), includes impairment in an educational setting; and

(c) The physical health conditions include disorders under the following categories:

1. Cardiovascular disorders;

2. Respiratory disorders;

3. Genitourinary disorders;

4. Endocrine disorders;

5. Musculoskeletal disorders;

6. Neurological disorders;

7. Immune system disorders;

8. Gastrointestinal;

9. Cancer; or

10. Hematological.

(7) "Client" means an individual identified within a target population.

(8) "Continuing education requirement" means successful completion of the on-going training requirements every three (3) years after the date of certification.

(9) "Core components" means the minimum knowledge and skills listed in Section 3(1) of this administrative regulation that an individual must demonstrate in order to successfully complete the training and meet eligibility requirements to provide targeted case management services.

(10) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID).

(11) "Face-to-face" means in person, in the same location, and not through an electronic method.

(12) "Serious mental illness", "severe mental illness", or "SMI" means a diagnosis of a major mental disorder as included in the current edition of the Diagnostic and Statistical Manual of Mental Disorders under:

(a) Schizophrenia spectrum and other psychotic disorders;

(b) Bipolar and related disorders;

(c) Depressive disorders; or

(d) Post-traumatic stress disorders (under trauma and stressor related disorders).

(13) "Severe emotional disability" or "SED" is defined by KRS 200.503(3).

(14) "Substance use disorder" or "SUD" means a primary moderate or severe substance use disorder diagnosis or co-occurring moderate to severe substance use disorder and mental health diagnosis as defined in the current edition of the Diagnostic and Statistical Manual of Mental Disorders.

(15) "Targeted case management services" means services furnished to assist a client in gaining access to needed medical, social, educational, or other needed services and supports, including:

(a) Assessment of the client's medical, social, and functional status and identification of the client's strengths and needs;

(b) Arranging for service delivery from the client's, the client's legal guardian, or the client's custodial parent's chosen provider to insure access to required services;

(c) Facilitating access to needed services by explaining the need and importance of services in relation to the client's condition;

(d) Facilitating access, quality, and delivery of necessary services; and

(e) Preparation and maintenance of case record documentation to include care plans, forms, reports, and narratives as appropriate.

(16) "Targeted case manager" means an individual who is:

(a) Trained and supervised to perform targeted case management services in accordance with Section 2 of this administrative regulation;

(b) Responsible for conducting a comprehensive assessment and a periodic reassessment of an individual's strengths and needs; and

(c) Responsible for assisting an individual to gain access to identified medical, social, educational, and other service needs.

(17) "Targeted population" means an individual who meets the criteria through diagnosis, duration, and disability for:

(a) SMI;

(b) SED;

(c) SUD; or

(d) SMI, SED, or SUD and a co-occurring chronic or complex physical health condition.

(18) "Training curriculum" means a total package of learning activities designed to achieve the goals of the training program with:

(a) The objective that trainees will acquire the specific knowledge and skills (competencies) needed to perform the duties of a targeted case manager; and

(b) Four (4) primary components, including:

1. Content or information to be transmitted, including:

a. Theoretical framework;

b. Conceptual rationale;

c. Best standards of practice;

d. Application to direct practice; and

e. Congruence between and within sections;

2. Organization of the curriculum, including structure, format, and sequencing, incorporating:

a. Concordance with the natural learning process;

b. Design of each section linked to specific learning objectives, with adequate time provided for each;

c. Linkages between sections;

d. Knowledge and skills that are conceptually related, or that are performed together on the job, are taught together; and

e. Retention and understanding facilitated by principles of sequencing (from simple to complex, from the universal to the exception, and from fundamental to more refined applications) and repetition;

3. Training methods appropriate to adult learners in an applied setting, in each section or topic area, including:

a. Discussion to promote exploration and understanding of the topic;

b. Experiential exercises or simulations; and

c. Presentation of the same concepts using a variety of learning strategies (for example, hearing, seeing, modeling, and then practicing) to ensure that trainees with different learning styles can assimilate the knowledge; and

4. Evaluation methods, including:

a. Trainee knowledge assessment through testing, with achievement of a passing aggregate assessment score of at least seventy (70) percent; and

b. Trainee performance reviews of trainers.

Section 2. Targeted Case Manager Requirements.

(1) A targeted case manager for individuals with SMI, SED, or SUD shall:

(a)

1. Possess a bachelor of arts or science degree in a behavioral science;

2. Be a certified alcohol and drug counselor who has a bachelor of arts or science degree;

3. Have provided targeted case management services to a recipient any time from April 1, 2014, to the effective date of this administrative regulation; or

4. Have supervised the provision of targeted case management services to a recipient any time from April 1, 2014, to the effective date of this administrative regulation;

(b) Have at least one (1) year of full-time employment experience after completing the educational requirements:

1. Working directly with adults in a human service setting; or

2. Working directly with individuals under the age of twenty-one (21) in a human service setting;

(c) Successfully complete a department approved targeted case management training within six (6) months of employment as a targeted case manager; and

(d) Successfully complete department approved continuing education requirements every three (3) years thereafter.

(2) A master's degree in a behavioral science may substitute for the one (1) year of full-time employment experience required by subsection (3)(b)1 of this section.

(3) A targeted case manager for individuals with SMI, SED, or SUD and a co-occurring chronic or complex physical health condition shall be an individual with:

(a) A master's degree in a behavioral science from an accredited college or university and two (2) years of full-time employment experience providing service coordination or linking/referring for community based services for individuals with SMI, SED, or SUD and co-occurring physical or behavioral health disorders or multi-agency involvement; or

(b) A bachelor of arts or science degree from an accredited college or university in a behavioral science and who has:

1. At least five (5) years of full-time employment experience working with an individual with SMI, SED, or SUD and a co-occurring chronic or complex physical health condition;

2. Successful completion of a department approved targeted case management training within six (6) months of employment as a case manager; and

3. Successful completion of continuing education requirements every three (3) years thereafter.

(4) Targeted case managers who are serving individuals with SED, SMI, or SUD shall have:

(a) Individual face-to-face supervision which shall be provided at least monthly for at least one (1) year by a behavioral health professional who has completed the targeted case management training approved by the department; and

(b) Group supervision which shall be provided at least monthly for the duration of employment as a targeted case manager.

(5) The supervisor of a targeted case manager shall maintain documentation of the supervision.

(6) Targeted case managers who are serving an individual with an SED, SMI, or SUD and a co-occurring chronic or complex physical health condition shall have:

(a) Individual supervision which shall be provided at least three (3) times per month, with at least two (2) of these supervisory contacts on an individual face-to-face basis, for at least three (3) years by a behavioral health professional who has completed the targeted case management training approved by the department; and

(b) Group supervision which shall be provided at least monthly for the duration of employment as a targeted case manager.

(7) Beginning October 1, 2015, a targeted case manager shall not exceed a case load size of twenty-five (25) unique clients receiving any service, excluding a client receiving mobile crisis services, crisis intervention services, or screenings.

(8) A targeted case manager shall:

(a) Only provide targeted case management services to the targeted population for which the targeted case manager meets the educational, experiential, and training requirements; and

(b) Not provide other behavioral health services in addition to targeted case management services for the same client.

Section 3. Training Requirements.

(1) To receive certification to provide behavioral health targeted case management services, a targeted case manager shall successfully complete the department approved training and continuing education requirements established by this section.

(a) The core components of the targeted case management training curriculum shall be at least twelve (12) hours and shall include:

1. Core targeted case management functions and guiding principles;

2. Engaging consumers and family members;

3. Behavioral health crisis management;

4. Strengths-based case management;

5. Ethics;

6. Behavioral health diagnosis and understanding treatment;

7. Integrated care;

8. Advocacy skills and empowering consumers and families;

9. Cultural awareness;

10. Developmental perspectives across the life span; and

11. Documentation and billing.

(b) At least an additional six (6) hours of specialized training for the target population the targeted case manager is serving, which shall include the skills required to address the specific needs of each respective target population.

(c) Providers of approved training curricula shall notify the department within twenty (20) business days of a trainee's successful completion of a targeted case manager training.

(2) A targeted case manager shall complete continuing education requirements every three (3) years.

(3) Required continuing education shall consist of acquiring at least six (6) hours of relevant continuing education each year in training topics directly related to:

(a) Case management;

(b) Behavioral health; or

(c) Each respective target population.

(4) A targeted case manager shall submit a list of all continuing education trainings in which the targeted case manager participated, the provider or presenter of the training, and the number of hours of each training to the Department every three (3) years through the department's Web site. The submission due date shall be the last day of the month of which the targeted case manager's initial certification was completed.

(5) Targeted case managers certified prior to the effective date of this administrative regulation shall submit documentation of continuing education hours prior to May 2018.

Section 4. Department Responsibilities. The department shall:

(1) Within twenty (20) business days, approve or deny training curricula submitted by providers wishing to provide training to a targeted case manager or a prospective targeted case manager based on the training curriculum requirements established by Section 3(1)(a) of this administrative regulation;

(2) Maintain a record of approved targeted case management training curricula, including contact information for providers of the trainings on the department's Web site;

(3) Maintain a record of targeted case managers who have received a certificate of successful completion of a department approved targeted case management training on the department's Web site;

(4) Create and make available a process for recording continuing education of targeted case managers on the department's Web site; and

(5) Maintain a record of targeted case managers who have been certified or completed continuing education to provide targeted case management services on the department's Web site.

Section 5. Supervision of a Targeted Case Manager.

(1) A targeted case manager shall provide services under the supervision of a behavioral health professional in accordance with 907 KAR 15:040, 907 KAR 15:050, and 907 KAR 15:060;

(2) The supervising behavioral health professional shall complete the training requirements as described in Section 3(1) and (2) of this administrative regulation; and

(3) The supervisor of a targeted case manager shall provide and maintain documentation of the supervision, as specified in Section 2(4), (5), and (6) of this administrative regulation.

History

• RELATES TO: KRS 200.503(3), 210.005(2), (3)
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 210.450, 222.211
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050(1) requires the secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to protect the health of Kentucky citizens and to implement programs mandated by federal law or to qualify for the receipt of federal funds. KRS 210.450 requires the secretary to promulgate administrative regulations governing qualifications of personnel and standards for personnel management for community programs for behavioral health or individuals with an intellectual disability. KRS 222.211 authorizes the cabinet to promulgate administrative regulations to assure that there is the provision of prevention, intervention, and treatment services for both juveniles and adults to address the problems of addiction to alcohol and other drug abuse within individuals, families, and communities. This administrative regulation establishes the minimum eligibility and training requirements for individuals providing behavioral health targeted case management services to a targeted behavioral health population.
• History: 41 Ky.R. 1945; Am. 2280; 2656; eff. 6-17-2015, TAm eff. 4-27-2016; Cert. eff. 12-28-2021.

908 KAR 2:270 Community behavioral health training {#sec-908-kar-2-270 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:270}

Section 1. Definitions.

(1) "Cabinet" means the Cabinet for Health and Family Services.

(2) "Community behavioral health training" means training to identify and assist individuals who may have or may be developing or experiencing a:

(a) Mental health disorder;

(b) Substance use disorder; or

(c) Mental health or substance use crisis.

Section 2. Training. The cabinet shall provide community behavioral health training information at http://dbhdid.ky.gov/kdbhdid/default.aspx.

Section 3. Grants.

(1) Subject to funding, the cabinet shall provide training grants for community behavioral health training provided by certified trainers.

(2) all information for grant application shall be provided at http://dbhdid.ky.gov/kdbhdid/default.aspx.

History

• RELATES TO: KRS 210.053
• STATUTORY AUTHORITY: KRS 210.053
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.053 requires the cabinet to promulgate administrative regulations to establish and administer the community behavioral health training program. This administrative regulation establishes the community behavioral health training program and the awarding of training grants.
• History: 47 Ky.R. 1328, 2011; eff. 6-16-2021.

908 KAR 2:300 Kentucky problem gambling assistance account {#sec-908-kar-2-300 omnilex-key=us-ky-regs-official--title-908--908 KAR 2:300}

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. or the American Osteopathic Board of Neurology and Psychiatry;

(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 through 311.862;

(h) A "licensed marriage and family therapist" as defined by KRS 335.300;

(i) A "licensed professional clinical counselor" as defined by KRS 335.500;

(j) A "licensed professional art therapist" as defined by KRS 309.130(2);

(k) A "licensed behavior analyst" as defined by KRS 319C.010(6); or

(l) A licensed clinical alcohol and drug counselor in accordance with KRS 309.0832.

(2) "Behavioral health professional under clinical supervision" means a:

(a) Psychologist certified and practicing in accordance with KRS 319.056;

(b) Licensed psychological associate 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);

(f) "Licensed professional art therapist associate" as defined by KRS 309.130(3);

(g) Registered behavior technician under the supervision of a licensed behavior analyst; or

(h) A certified alcohol and drug counselor in accordance with KRS 309.083.

(3) "Behavioral Health Services Organization" or "BHSO" means a program licensed in accordance with 902 KAR 20:430.

(4) "Community mental health center" or "CMHC" or "center" means a program established pursuant to KRS Chapter 210.

(5) "Department" means the Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services, 275 East Main Street, Frankfort, Kentucky 40621.

Section 2. Eligibility.

(1) The following organizations and individuals shall be eligible to apply for funding, to the extent funds are available, from the Kentucky problem gambling assistance account:

(a) A CMHC licensed in accordance with 902 KAR 20:091;

(b) A BHSO licensed in accordance with 902 KAR 20:430:

(c) A Behavioral health professional;

(d) A behavioral health professional under clinical supervision;

(e) A health department established pursuant to KRS 211.185;

(f) A federally designated 501(c)3 organization; or

(g) A Certified Community Behavioral Health Clinic participating in the Center for Medicaid or Medicare Services Section 223 CCBHC Demonstration.

(2) A Kentucky Gambling Assistance Application shall only be filed for the purpose of requesting funds for:

(a) Providing support to agencies, groups, organizations, and persons that provide education, assistance, and counseling to persons and families who experience difficulty as a result of substance use disorder or problem or compulsive gambling;

(b) Promoting public awareness of, and providing education about, problem gambling;

(c) Establishing and funding programs to certify problem gambling counselors;

(d) Promoting public awareness of assistance programs for those experiencing consequences of problem gambling; or

(e) Paying the costs associated with the treatment of addictions.

Section 3. Application for Funding. Entities that meet the eligibility requirements established in Section 2(1) of this administrative regulation shall submit a Kentucky Gambling Assistance Application with the required supporting documentation to the Department for Behavioral Health, Developmental, and Intellectual Disabilities, attention: Problem Gambling Assistance Account:

(1) In writing to 275 East Main Street, mail-stop 4W-G, Frankfort, Kentucky 40621; or

(2) Via electronic mail to kyproblemgamblingassistance@ky.gov.

Section 4. Monitoring.

(1) Recipients of funds from the Kentucky problem gambling assistance account shall:

(a) Establish and conduct evaluation measures that assess the efficacy of services provided;

(b) Collect and report the:

1. Number of individuals served;

2. Types of services provided to individuals served; and

3. Detailed costs for the number of individuals served and the services provided during the reporting period; and

(c) Submit quarterly reports meeting the requirements established in this section of the administrative regulation:

1. To the Department for Behavioral Health, Developmental, and Intellectual Disabilities, attention: Problem Gambling Assistance Account, 275 East Main Street, mail-stop 4W-G, Frankfort, Kentucky 40621; or

2. Via electronic mail to kyproblemgamblingassistance@ky.gov.

Section 5. Treatment Professional Certification.

(1) Qualified behavioral health providers seeking certification from a cabinet-approved or nationally or internationally recognized certifying organization shall:

(a) Have at a minimum a bachelor's degree or equivalent in a behavioral health field;

(b) Have current Kentucky licensure in substance use disorder counseling, mental health counseling, or equivalent work experience;

(c) Complete thirty (30) hours of training on problem gambling prevention, assessment, and co-occurring issues for individuals and families by an approved trainer through a certifying organization;

(d) Complete 100 direct contact hours addressing the issues, prevention, and early intervention, co-occurring and under what conditions to refer for individuals and families who experience problem gambling;

(e) Complete a minimum of four (4) consultation hours with a consultant approved through the certifying organization's board;

(f) Complete all application materials, ethical statement, and directory authorization forms required by the certifying organization;

(g) Pass any examination required by the cabinet-approved certifying organization; and

(h) Pay applicable fees associated for the completion of certification to the certifying organization.

(2) To the extent funds are available, individuals may apply for reimbursement for any fees paid after successful completion of certification from a cabinet-approved certifying organization by submitting an application to the department for reimbursement.

Section 6. Department Responsibilities. The department shall publish on the department Web site:

(1) Certified treatment providers for individuals experiencing the consequences of problem gambling; and

(2) Problem gambling treatment and recovery services and resources.

Section 7. Incorporation by reference.

(1) "Kentucky Gambling Assistance Application", 07/23, is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Community Based Services, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. This material may also be viewed on the departments Web site at https://www.chfs.ky.gov/agencies/dbhdid/Pages/default.aspx.

History

• RELATES TO: KRS 194A.005(1), Chapter 210, 211.185, 230.826, 309.080(2), 309.083, 309.0832, 309.130(2), (3), 311.571, 311.840 – 311.862, 314.042, 319.050, 319.056, 319.064, 319C.010(6), 335.080, 335.100, 335.300, 335.500
• STATUTORY AUTHORITY: KRS 230.826
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 230.826(2) requires the Cabinet for Health and Family Services to promulgate administrative regulations to establish criteria for the expenditure of funds from the Kentucky problem gambling assistance account to: provide support to agencies, groups, organizations, and persons that provide education, assistance, and counseling to persons and families experiencing difficulty as a result of problem gambling, or substance use disorder; and promote public awareness and assistance of education and programs to reduce the consequences of problem gambling and pay for the costs and expenses associated with treatment of and recovery from problem gambling. KRS 230.826 also requires the establishment of procedures for the submission, evaluation, and review of applications for funding, the awarding of funds, and the cabinet's monitoring of fund expenditures. This administrative regulation establishes the standards for the types of agencies, groups, organizations, and persons eligible to receive funding from the Kentucky problem gambling assistance account, types of eligible activities, required documentation, and the development of performance measures and evidence of successful expenditures of awarded funds.
• History: 50 Ky.R. 756, 1357, 1546; eff. 1-18-2024.

Chapter 3 Institutional Care

908 KAR 3:010 Patient's rights {#sec-908-kar-3-010 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:010}

Section 1. Definitions.

(1) "Authorized representative" means the patient's attorney, guardian of a disabled adult, parent or guardian of a juvenile, or an individual authorized in writing by the patient to act in the patient's behalf.

(2) "Emergency situation" means the presence of a situation in which a patient's behavior in the present environment presents an immediate and substantial danger, or threat of immediate or substantial danger, to that person or to others, such as:

(a) Verbal threats or abuse toward other patients that creates a substantial risk that other patients may react in a manner that poses an immediate substantial danger, or threat of immediate substantial danger, to themselves or others, or that interferes in a substantial manner with the realistic opportunity of other patients to improve their own level of functioning through care and treatments in a hospital or residential treatment center; and

(b) Substantial deviation from an individual treatment plan that has been formulated with the mutual consent of the staff and the patient or approved pursuant to a court hearing, or the overt or repetitious violation of rules and procedures of the hospital or residential treatment center by the patient that presents an immediate and substantial danger to that person or to others if the patient has previously been fully informed as to the content of the patient's individual treatment plan and as to the rules and procedures which may be applicable to the patient's behavior.

(3) "Individual treatment plan" means a written document that is a part of each patient's medical record and that contains information, such as:

(a) A statement of the diagnosis of the patient;

(b) The short and long-range objectives of care and treatment;

(c) The methods of treatment to be employed; and

(d) The names of persons responsible for preparing and implementing the plan.

(4) "Restraint" means the application of any physical device, the application of physical body pressure by another to control or limit physical activity, or the intravenous, intramuscular, or subcutaneous administration of any pharmacologic or chemical agent to an individual with mental illness, developmental or intellectual disabilities resident with the sole or primary purpose of controlling or limiting the physical activities of the patient or resident.

(5) "Seclusion" means the confinement of an individual with mental illness, developmental or intellectual disabilities patient alone in a locked room.

(6) "Substantive changes" means those changes that reflect distinct changes in goals of treatment, methods to be employed, and the names of persons primarily responsible for overall review or implementation of the individual treatment plan, except for:

(a) Changes in the amount, frequency of administration, or specific type of medication, unless the changes involve introduction of new classes of medication, including antipsychotic or anticonvulsant drugs; and

(b) Changes in the frequency, duration, place, or supervision of daily activities, unless the changes exclude participation in the activities previously identified in the treatment plan or initiation of new activities that could not be reasonably anticipated on the basis of short and long-term treatment goals.

Section 2. Right to be Adequately Informed. Each patient shall be informed as to the patient's individual treatment plan.

(1) A written individual treatment plan shall be prepared and entered into the medical record of each patient. The treatment plan shall be subject to periodic review and shall be modified if there are substantive changes.

(2) Each patient and the patient's authorized representative shall have access to a written copy of the patient's individual treatment plan.

(3) Upon written request, each patient and the patient's authorized representative shall also be provided access to the patient's entire medical record. If full access to the medical record is refused, the patient shall be given a response in writing documenting the reasons for the refusal.

(4) If there are minors or other persons who appear incapable of reading or understanding a written treatment plan, a summary of pertinent features of the treatment plan may be presented orally, and the responses of parents, guardians, or other members of the immediate family shall be entered into the medical record, if these persons can be located.

Section 3. Right to Assist in Treatment Plan. Each patient shall have the right to assist in the planning of the treatment program.

(1) Each patient shall be informed of the contents of the patient's individual treatment plan, and the verbal, written, or behavioral responses to this information shall be entered in the medical records. If possible, the responses of a patient to the patient's treatment plan shall be used to review and modify its contents, such as the objectives and methods of treatment to be employed.

(2) If there are minors and other patients who appear incapable of reading or understanding their treatment plans, the responses of parents, guardians, or other members of the immediate family shall be entered into the medical records if these persons can be located.

Section 4. Right to Refuse Treatment.

(1) Patients may, under certain conditions, refuse treatment offered to them by the hospital. The refusal shall be clearly documented in the medical records.

(a) All patients, whether admitted voluntarily, or committed on an involuntary basis as the result of a hearing held pursuant to KRS Chapter 202A or 202B, shall have the right to refuse treatment. A patient who refuses treatment shall not be forcibly treated unless the treatment is pursuant to a court order after a de novo review as set forth in KRS 202A.196.

(b) If no court findings exist to support the implementation of a specific treatment plan that is unacceptable to the patient, the treatment may be implemented or continued only in an emergency situation documented in the medical records of the patient. The hospital or residential treatment center shall seek to develop an alternative plan of treatment acceptable to both the hospital or residential treatment center and the patient or secure a court order sanctioning forced treatment. If the hospital or residential treatment center and a voluntarily admitted patient cannot agree on an acceptable alternative plan of treatment, the hospital or residential treatment center may discharge the patient or pursue other remedies under law as may be necessary. If the hospital or residential treatment center prior to obtaining a judicial order for forced treatment determines that an emergency exists and that the patient presents an immediate and substantial danger or threat of immediate and substantial danger to self or others, the hospital or residential treatment center may intervene in the least intrusive manner possible while simultaneously seeking a de novo review.

(2) Refusal to participate in the treatment plan shall be clearly documented in the medical record and shall be honored unless an emergency situation exists or the activity has been reviewed and approved in a court hearing.

(3) In the absence of an emergency situation, the patient shall not be subjected to loss of any other privileges which the patient has at the time of refusal unless these privileges are clearly documented in the individual treatment plan as being contingent upon participation in that area where participation has been refused.

(4) If the emergency situation persists for a period of more than seventy-two (72) hours, the treatment team shall evaluate the treatment plan and make changes necessary to meet the needs of the patient. If the patient refuses the revised treatment program, emergency treatment may continue as long as the emergency continues to be documented in the patient's record and the treatment review committee shall be informed and shall proceed according to law.

Section 5. Right to Personal Effects.

(1) Each patient shall have the right to maintain, keep, and use personal effects, items, or money except in the following instances:

(a) Retention of the item would be contrary to the patient's individual treatment plan;

(b) Retention of the item poses a threat of subjecting the patient or others to substantial physical harm;

(c) Retention of the item would subject it to a substantial risk of loss, theft, or destruction by the patient or other persons;

(d) Retention of the item would substantially impair the opportunity of the patient or other patients to benefit from care and treatment in the hospital; or

(e) Retention of the item is contrary to rules and administrative regulations of the hospital that are reasonably related to the health and safety of the patient or other patients, except that the rules and administrative regulations shall be waived if possession of the item is a part of the patient's individual written treatment plan.

(2) After written notice to a discharged patient, hospitals and residential treatment centers may dispose of all unclaimed personal items 180 days after discharge. Any proceeds from the sale of the items shall be used for the benefit of persons residing at the hospital or residential treatment center.

Section 6. Right to Receive Visitors.

(1) All patients shall have the right to meet with friends and relatives. This right shall not be waived except in the following instances:

(a) Exercise of the right would be inconsistent with the written provisions of the individual treatment plan; or

(b) An emergency situation exists.

(2) Each hospital or residential treatment center shall establish, and post conspicuously, rules governing visitors and visiting hours.

(3) All patients shall also have the right to refuse to meet with friends or relatives except that the right may be waived if the meetings are prescribed in the patient's individual treatment plan.

(4) Patients shall have the right to meet their authorized representative during nonvisitation hours, if suitable arrangements are made in advance with the hospital or residential treatment centers.

(5) All patients shall have the right to name an essential personal care visitor as defined and established in 900 KAR 14:010.

Section 7. Right to Receive Compensation for Work Done. Each patient shall have the right to receive payment for work performed on behalf of the hospital.

(1) All patients shall be provided compensation as designated by the Fair Labor Standards Act, 201 U.S.C. 201-219, for work performed at a hospital or residential treatment center where the work is of consequential economic benefit to the hospital or residential treatment center, any person, agency, or organization outside the hospital or the Commonwealth of Kentucky.

(2) The patient shall have the absolute right to refuse to perform any work, except activities of immediate and direct benefit to the patient and the patient's personal comfort.

Section 8. Right to De Novo Review. Involuntarily committed patients shall not be treated with electroshock therapy or psychosurgery unless the treatment is pursuant to a court order after a de novo review as set forth in KRS 202A.196.

Section 9. Use of Seclusion and Restraint. The use of seclusion and other mechanical restraints in hospitals or residential treatment facilities shall be limited and shall be carried out only with the precautions in this section.

(1) Seclusion and other mechanical restraints used for the sole or principal purpose of controlling behavior that is the result of mental illness shall be instituted only if part of an individual treatment plan or in an emergency situation.

(2) If use of seclusion or restraints is warranted under this section, the following rules shall apply:

(a) The medical records shall document the conditions that prevail at the time of the use of these treatments and shall include the order of a licensed physician prescribing or justifying the treatment;

(b) Mentally ill persons placed in seclusion or subjected to the use of mechanical restraints, other than to prevent or treat self-inflicted injury or to treat a concomitant medical or surgical disorder, shall be individually observed. The need for continuing restraints or seclusion shall be determined by a hospital or residential treatment facility employee at least every fifteen (15) minutes. In addition, the patient shall be seen daily by a physician, and the reasons for continued use of this treatment procedure shall be documented in the medical records; and

(c) The patients shall be permitted access to toilet facilities at least every two (2) hours and to bathing facilities every forty-eight (48) hours;

(3) An Order by a licensed physician for seclusion or use of mechanical restraints shall not be effective longer than twenty-four (24) hours after the treatment is implemented, and shall be renewed if the treatment continues to be necessary, except if the treatment is prescribed to prevent or treat self-inflicted injury or a concomitant medical or surgical disorder and if any renewal order states the necessity for the continued treatment.

(4) Restraints or seclusion shall not be used, under any circumstances, principally or solely for the treatment of mental illness, except:

(a) As part of the documented individual treatment plan; or

(b) In response to a documented emergency, unless the treatment has received a review and approval by the court.

History

• RELATES TO: KRS Chapters 202A, 202B
• STATUTORY AUTHORITY: KRS 194.050, 202A.191, 202B.060, EO 2004-726, SB 100 2022 Regular Session
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 202A.191 and 202B.060 require the Secretary for the Cabinet for Health and Family Services to promulgate administrative regulations that insure proper administration and enforcement of KRS Chapter 202A and KRS Chapter 202B. This administrative regulation establishes requirements relating to the rights of an individual patient with mental illness, developmental or intellectual disabilities and requirements relating to the use of seclusion, restraint, and treatment under emergency situations concerning these patients.
• History: Recodified from 902 KAR 12:020, 3-7-1989; 18 Ky.R. 1685; eff. 1-10-1992; TAm eff. 11-3-2004; TAm eff. 4-27-2016; Crt eff. 12-18-2019; 48 Ky.R. 2639; 49 Ky.R. 370; eff. 9-28-2022.

908 KAR 3:020 Care and treatment of inmates of penal institutions {#sec-908-kar-3-020 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:020}

Section 1. Care and Treatment of Inmates. In the event that an inmate of any penal or correctional institution is transferred to a hospital, forensic psychiatric facility or residential treatment center pursuant to KRS 202A.201, the following rules shall apply:

(1) If the inmate voluntarily agrees to receive treatment in accordance with the individual treatment plan, the treatment may be provided until it is determined that treatment is no longer necessary or until the patient refuses continued treatment;

(2) If the inmate refuses to receive treatment, proceedings for involuntary hospitalization may be instituted in accordance with the provisions of KRS Chapters 202A and 202B and 501 KAR 6:020 addressing involuntary transfer proceedings pursuant to Vitek v. Jones, 445 U.S. 480, 100 S.Ct. 1254, 63 L.Ed.2d 552 (1980).

(3) Patients in a forensic psychiatric facility shall have the same rights as set forth in 908 KAR 3:010; provided, however, that locking patients in their cells for sleeping or census count purposes and restraints used for transportation or prevention of escape shall not be considered as seclusion or restraint as defined in the patient's bill of rights.

History

• RELATES TO: KRS 202A.201
• STATUTORY AUTHORITY: KRS Chapter 13A, 194.050, 202A.191, 202B.060, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS Chapters 202A and 202B, relating to the hospitalization of an individual with mental illness, developmental and intellectual disabilities, direct that the Secretary for the Cabinet for Health and Family Services shall adopt rules and administrative regulations to effectuate the purposes of that chapter, including, but not limited to, the transfer of mental patients and alternate methods for involuntary hospitalization. The function of this administrative regulation is to prescribe the procedure to be employed in the hospitalization, care and treatment of an inmate of a penal institution who has been transferred to a hospital, forensic psychiatric facility or residential treatment center.
• History: Recodified from 902 KAR 12:030, 3-7-1989; Am. 18 Ky.R. 2062; eff. 2-7-1992; TAm eff. 4-27-2016; Crt eff. 12-18-2019.

908 KAR 3:025 Notification of discharge, transfer or escape of violent offenders {#sec-908-kar-3-025 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:025}

Section 1. Definitions.

(1) "Facility administrator" means the director of the facility or designee.

(2) "State psychiatric facility" or "facility" means a hospital operated or contracted by the Department for Behavioral Health, Developmental and Intellectual Disabilities Services.

(3) "Violent offender" is defined in KRS 439.3401.

Section 2. Identification of Violent Offenders.

(1) If a person is committed to a state psychiatric facility pursuant to a court order issued in accordance with KRS 202A.101 and the order indicates that the person has been charged with or convicted of a violent crime as defined in KRS 439.3401, the facility staff person who authorized admission to the facility shall determine if the requirements of KRS 202A.101(5) have been met.

(2) Upon admission of a violent offender who has been involuntarily committed to a state psychiatric facility, the facility staff person who authorized the admission shall notify the facility administrator that the violent offender has been admitted. The notification shall specify:

(a) The offender's name;

(b) The offender's date of birth;

(c) The criminal charge pending against the offender, if applicable;

(d) The criminal charge for which the offender has been convicted, if applicable;

(e) The county in which the offense occurred; and

(f) The location where the offender is housed within the facility.

Section 3. Required Procedures for Notification of Transfer or Discharge.

(1) Prior to the discharge or transfer of a violent offender who has been involuntarily committed, the facility administrator shall notify officials specified in KRS 202A.410 in the following manner:

(a) The Department of Corrections in accordance with the provisions of 501 KAR 14:010;

(b) The prosecutor in the county where the violent crime was committed by sending a certified or registered letter; and

(c) The law enforcement agency with jurisdiction in the area to which the violent offender is discharged or transferred by sending a certified or registered letter.

(2) Notification of prosecutors and law enforcement agencies shall:

(a) Include the date of discharge or transfer;

(b) The name and address of the facility to which a violent offender is transferred if applicable; and

(c) The information specified in Section 2(2)(a) through (e) of this administrative regulation.

(3) If a violent offender is ordered to be transferred to a psychiatric facility in accordance with KRS 202A.201, the psychiatric facility shall not transfer or discharge the offender except in accordance with KRS 202A.201(3).

Section 4. Required Procedures for Notification of Escape.

(1) If a violent offender who has been involuntarily committed escapes from a psychiatric facility, the facility administrator shall notify the officials specified in KRS 210.410 no later than one (1) hour after an escape is discovered. The notification process shall be to the following entities as follows:

(a) The Department of Corrections in accordance with the provisions of 501 KAR 14:010;

(b) The prosecutor in the county where the violent crime was committed, by telephone, facsimile transmission, or other electronic device; and

(c) A local law enforcement agency that has jurisdiction in the area in which the facility is located, by telephone, facsimile transmission, or other electronic device.

(2) Notification of prosecutors and law enforcement agencies shall include:

(a) The date and time the escape was discovered; and

(b) The information specified in Section 2(2)(a) through (e) of this administrative regulation.

Section 5. Internal Procedures for Implementation. The facility administrator shall establish internal procedures to assure the proper and effective implementation of this administrative regulation. The internal procedures shall specify:

(1) Staff designated to make the notifications required by Sections 3 and 4 of this administrative regulation;

(2) Requirements for documentation of a discharge, transfer, or escape of a violent offender;

(3) Requirements for notifying the facility administrator if a violent offender is transferred, is discharged or escapes;

(4) Methods of monitoring the movement of violent offenders within the facility; and

(5) Methods for discovering, reporting, and documenting the escape of a violent offender.

History

• RELATES TO: KRS 202A.026, 202A.051, 202A.101, 202A.201, 202A.241, 202A.410, 439.3401
• STATUTORY AUTHORITY: KRS 194A.030, 194A.050, 202A.008, 202A.410(5), EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS 194A.050 authorizes the Cabinet for Health and Family Services to establish policies, procedures and administrative regulations necessary to carry out health programs. KRS 202A.410 requires the cabinet to notify law enforcement and correctional authorities of the discharge, transfer or escape of a violent offender from a psychiatric facility. This administrative regulation establishes the procedures for notifying law enforcement authorities that a violent offender has been discharged, transferred or has escaped from a state psychiatric facility.
• History: 25 Ky.R. 2082; Am. 2399; eff. 4-21-1999; TAm eff. 4-27-2016; Crt eff. 12-18-2019.

908 KAR 3:030 Convalescent patient status {#sec-908-kar-3-030 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:030}

Section 1. Definition. For purposes of this administrative regulation, the term "less confining environment" shall include, but not be limited to, a personal residence, a skilled nursing facility, an intermediate care or personal care facility, or any other facility providing a supervised residential living situation.

Section 2. Release on Convalescent Status. An authorized staff physician may release from a hospital an involuntarily committed mentally ill person on convalescent status, or an authorized staff person may release from a residential treatment center an involuntarily committed individual with developmental or intellectual disabilities on convalescent status, if the staff member concludes that the person would not present danger or threat of danger to self or others if provided continued medical supervision in a less confining environment. While on convalescent status the patient shall remain the responsibility of the hospital or residential treatment center from which the patient was released.

Section 3. Rights of Patients on Convalescent Status. Patients on convalescent status shall enjoy all the rights and privileges afforded to an involuntarily committed patient except that patients on convalescent status who have been directly committed to convalescent status under this section may be involuntarily admitted to a hospital or residential treatment center only upon a further court hearing and order.

Section 4. Termination of Convalescent Status. The convalescent status of a patient shall terminate upon the cessation of care and treatment or when the court order governing the patient's hospital admission or placement in convalescent status expires or is terminated.

History

• RELATES TO: KRS 202A.181
• STATUTORY AUTHORITY: KRS 194.050, 202A.191, 202B.060, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS Chapters 202A and 202B, relating to the hospitalization of an individual with mental illness, developmental, or intellectual disabilities, direct that the Secretary of the Cabinet for Health and Family Services shall adopt rules and administrative regulations relating to the release of patients to less restrictive alternative modes of treatment on convalescent status. The function of this administrative regulation is to establish standards to be employed in determining whether a person should be released on convalescent status.
• History: Recodified from 902 KAR 12:040, 3-7-1989; 18 Ky.R. 1689; eff. 1-10-1992; TAm eff. 4-27-2016; Crt eff. 12-18-2019.

908 KAR 3:040 Transfer of patients to other facilities {#sec-908-kar-3-040 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:040}

Section 1. Transfer of Patients. A patient may be transferred between hospitals, between hospitals and forensic psychiatric facilities, between hospitals and residential treatment centers or between residential treatment centers upon the mutual agreement of the administrative officer, designated representative or an authorized staff physician of each facility, provided such agreement is based upon one (1) of the following findings by the officers, representatives or physicians:

(1) That the transfer will improve the opportunities of the patient to receive care and treatment most likely to be of benefit to him; or

(2) That the transfer will permit the patient to receive care and treatment in the least restrictive alternative mode of treatment, considering the degree of danger or threat of danger to self or others which the patient presents; or

(3) That the transfer is part of an individual treatment plan which has been reviewed and approved by a court.

History

• RELATES TO: KRS Chapters 202A, 202B
• STATUTORY AUTHORITY: KRS 194.050, 202A.191, 202B.060, EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental and Intellectual Disabilities within the cabinet. KRS Chapters 202A and 202B, relating to the hospitalization of an individual with mental illness, developmental, or intellectual disabilities, direct that the Secretary of the Cabinet for Health and Family Services shall adopt rules and administrative regulations relating to the transfer of mental patients. The function of this administrative regulation is to prescribe the standards to be used in determining whether a patient should be transferred to another hospital, forensic psychiatric facility or residential treatment center.
• History: 3 Ky.R. 736; eff. 6-1-1977; 9 Ky.R. 502; 685; eff. 11-3-1982; Recodified from 902 KAR 12:050, 3-7-1989; TAm eff. 4-27-2016; Crt eff. 12-18-2019.

908 KAR 3:060 ''Means test'' for determining patient liability and per diem rates {#sec-908-kar-3-060 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:060}

Section 1. Definitions.

(1) "Allowed deduction" means an amount disregarded or deducted from income and assets for the purpose of determining the ability to pay for services rendered by a facility.

(2) "Available assets" means resources of the patient or person responsible for the patient in accordance with KRS 210.720(3), less the allowed deductions.

(3) "Deductible" means an amount that a patient or person responsible for the patient is expected to pay toward the patient's care by a third-party payor such as Medicare or a private insurance company.

(4) "Facility" is defined in KRS 210.710(2).

(5) "Income" means funds received by the patient or person responsible for the patient and includes the following:

(a) Salaries;

(b) Wages;

(c) Self-employed gross revenues, less operating expenses;

(d) Benefit payments, except for Supplemental Security Income payments;

(e) Social Security payments;

(f) Rents;

(g) Royalties;

(h) Pensions;

(i) Retirement payments;

(j) Veteran's Administration payments;

(k) Black lung benefits;

(l) Railroad retirement benefits;

(m) Gifts;

(n) Settlements;

(o) Trust receipts;

(p) Alimony, but does not include child support payments;

(q) Interest income; and

(r) Income from investments.

(6) "Patient" means a person admitted to a facility.

(7) "Person responsible for the patient" is defined in KRS 210.710(5).

(8) "Personal Needs Allowance" means an amount of resources deducted from income for the patient's personal needs, including clothing and other miscellaneous items required by the patient.

(9) "Poverty Guidelines" means the federal poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services, under the authority of 42 U.S.C. 9902(2).

Section 2. Determination of the Ability to Pay for Services Rendered at Facilities.

(1) The facility shall apply the means test to each patient who is admitted to the facility for treatment.

(2)

(a) The means test shall include a determination of the responsible party or parties to pay for the patient's care, which shall be documented using the Patient or Responsible Party Financial Record form.

(b) This form shall be explained to the patient or person responsible for the patient and signed by all parties.

(c) If the patient or person responsible for the patient refuses to sign, this refusal shall be noted on the form along with the date the form was discussed.

(d) Refusal to sign the form shall not absolve the liability of the patient or person responsible for the patient to pay for services rendered.

(3) The amount a patient or person responsible for the patient is required to pay for services shall be the lesser of:

(a) The cost per patient day in accordance with Section 7 of this administrative regulation, less any amount paid by Medicare, Medicaid, and other third-party payment sources; or

(b) The amount the patient is able to pay calculated in accordance with this administrative regulation.

(4) The facility shall determine the financial resources available to the patient or person responsible for the patient including:

(a) Insurance and third-party payors;

(b) Income received or expected to be received during the period of hospitalization; and

(c) Available assets.

(5) Allowed deductions shall be calculated as the patient and the number of the patient's dependents.

(a) A patient's legally-recognized spouse and each individual less than eighteen (18) years of age who is in the patient's care shall be classified as dependents for purposes of calculating the poverty guidelines.

(b) Allowed deductions for the patient plus the patient's dependents shall be as follows:

1. One (1) shall be $2,000;

2. Two (2) shall be $4,000; or

3. Three (3) or more shall be $4,000 plus fifty (50) dollars added for each additional member over the initial two (2).

(6) The following shall be allowed deductions from income:

(a) Federal income taxes;

(b) State income taxes;

(c) Social security taxes;

(d) Normal retirement contributions;

(e) Unpaid medical and dental bills;

(f) Health insurance premiums;

(g) Medicare Part B insurance premiums;

(h) Long-term care insurance premiums;

(i) A personal needs allowance of forty (40) dollars per month;

(j) Student loan payments;

(k) Bed-hold reservation costs at another facility for up to fourteen (14) days as long as the patient's stay is expected to be shorter than the reservation period;

(l) Child support payments;

(m) Life insurance premiums if the patient's estate or a funeral home is the named beneficiary on the policy; and

(n) A basic maintenance allowance, derived from the current Poverty Guidelines, for the size of the patient's family, if the following conditions are met:

1. The patient was maintaining a residence immediately prior to admission;

2. The residence will continue to be maintained during the period of hospitalization and resources of the patient are needed for this effort; and

3. Facility staff expects the patient's hospital stay to be three (3) months or less in duration.

(7) An estimated income tax related deduction of twenty-five (25) percent of total income shall be allowed instead of the actual wage taxes contained in subsection (6) of this section. A patient or person responsible for the patient may request that actual tax amounts be used instead of the estimated deduction, if the person can substantiate the actual tax amounts.

(8) The following shall be excluded from the calculation of available assets:

(a) Prepaid burial plans of up to $1,500 per family member;

(b) Automobiles;

(c) Housing structures;

(d) Land;

(e) Retirement accounts;

(f) Pension funds;

(g) Trust funds that cannot be accessed;

(h) The applicable allowed deduction; and

(i) Other assets that are exempted under state law, if any.

Section 3. Calculation of the Amount the Patient or Person Responsible for the Patient is Able to Pay.

(1) The facility shall calculate the ability to pay amount utilizing either the Ability to Pay Worksheet or the Deductible Ability to Pay Worksheet as appropriate and by using the following formula:

(a) Determine the total amount of income of the patient or person responsible for the patient;

(b) Determine the amount of allowed deductions from income in accordance with Section 2(5) and (6) of this administrative regulation;

(c) Subtract the allowed deductions from income; and

(d) The remaining available income shall be divided by 365 to obtain the average daily income of the patient or person responsible for the patient.

(2) If the patient or person responsible for the patient has available assets, the facility shall:

(a) Determine the amount of available assets; and

(b) Include available assets that remain after the deduction in the patient or person responsible for the patient's ability to pay amount.

(3) Payments to be made on behalf of the patient by a third-party, such as Medicare, Medicaid, or private insurance companies, shall be subtracted from the facility's per diem rate as contained in Section 7 of this administrative regulation. Any remaining liability shall be satisfied as follows, with the exception of ability to pay amounts arising from deductibles:

(a) The available income of the patient or person responsible for the patient shall first be applied to the patient's liability for services;

(b) Any liability that remains after application of the average available income shall be satisfied by available assets; and

(c) The applicable average income per day and available asset amount per day shall be combined to determine the ability to pay amount. The ability to pay amount shall be charged for each day the patient is in the facility.

(4) Ability to pay liabilities arising from deductibles shall first be applied to available assets of the patient or person responsible for the patient with any remaining liability being satisfied with available income.

(5) If the Department for Medicaid Services performs an income assessment for a Medicaid patient residing in a nursing facility, intermediate care facility for an individual with an intellectual disability, or psychiatric hospital in accordance with 907 KAR 20:035, that Medicaid income assessment shall be relied upon instead of the ability to pay provisions established in this administrative regulation.

(6)

(a) After the ability to pay is determined for the patient or person responsible for the patient, a Patient or Responsible Party Financial Agreement and Assignment form shall be completed.

(b) This form shall be explained to the patient or person responsible for the patient and signed by all parties.

(c) If the patient or person responsible for the patient refuses to sign, this refusal shall be noted on the form including the date the form was discussed.

(d) Refusal to sign the form shall not absolve the liability of the patient or person responsible for the patient to pay for services rendered.

(7) The patient liability shall be calculated based on the United States Department of Health and Human Services poverty guidelines.

Section 4. Revisions to Ability to Pay Amounts.

(1) Facility staff shall update a patient's ability to pay amount to incorporate changes that take place subsequent to the initial determination. These changes may include:

(a) Income revisions;

(b) Asset revisions, including exhaustion of available assets;

(c) Change in allowed deductions;

(d) Change in a dependent of the patient or person responsible for the patient; or

(e) Change regarding the status of the person responsible for the patient.

(2) Upon a change to the ability to pay information, a revised Ability to Pay Worksheet or Deductible Ability to Pay Worksheet shall be prepared along with a revised Patient or Responsible Party Financial Record form and a revised Patient or Responsible Party Financial Agreement and Assignment form. The revised forms shall be presented to the patient or person responsible for the patient in the same manner as the original forms.

Section 5. Failure to Provide Financial Information or to Assign Benefits.

(1) If the patient or person responsible for the patient fails to or will not provide the information necessary to calculate the ability to pay amount, the maximum charge provided in Section 2(3)(a) of this administrative regulation shall be assessed.

(2) If the patient or person responsible for the patient fails to sign the assignment provision contained in the Patient or Responsible Party Financial Agreement and Assignment form, the maximum charge provided in Section 2(3)(a) of this administrative regulation shall be assessed.

Section 6. Payment Hardship, Appeal and Waiver Procedures.

(1) Payment hardships.

(a) If the patient or person responsible for the patient believes that payment of the ability to pay amount results in a financial hardship, the patient or person responsible for the patient may request to make installment payments.

(b) This request shall be made in writing to the facility's patient billing supervisor and shall include documentation to support the claimed hardship.

(c) The patient billing supervisor shall review the financial hardship request and render a payment plan decision within fifteen (15) days from the receipt of the hardship request. If there is financial hardship, the patient billing supervisor shall allow minimum monthly payments based on what the patient can reasonably afford.

(2) Appeals.

(a) If the patient or person responsible for the patient is aggrieved by the facility charges or a payment plan determined in accordance with this administrative regulation, that person may appeal the determination to the facility director or the facility director's designee for informal resolution within thirty (30) days of the ability to pay amount or payment plan being calculated.

(b) The facility director or the facility director's designee shall review the appeal and issue a determination within thirty (30) days of receipt.

(c) If the patient or person responsible for the patient is dissatisfied with the informal resolution, that person may file an appeal within thirty (30) days of the facility's response to the Director of the Division of Administration and Financial Management, Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 E Main Street, Frankfort, Kentucky 40621. The director shall arrange for an administrative hearing in accordance with KRS Chapter 13B.

(d) The appeal request shall fully explain the patient's, or person responsible for the patient's, position and shall include all relevant documentation supporting the claim of financial hardship.

(3) Waivers.

(a) The director of each facility may waive payment of the facility's charges under this administrative regulation if waiver is in the best interest of all parties, based on the factors provided in paragraph (c) of this subsection.

(b) The Director of the Division of Administration and Financial Management shall have the authority to waive payment at any facility within the department if waiver is in the best interest of all parties, based on the factors provided in paragraph (c) of this subsection.

(c) When making a waiver determination, the following factors shall be considered:

1. Income;

2. Overall family debt;

3. Assets; and

4. Other information relating to the current financial situation of the patient or the person responsible for the patient.

Section 7. Per Diem Rates.

(1) Facilities owned by the state shall charge a per diem rate for room and board and a separate charge for each treatment service listed in subsection (3) of this section.

(2) The per diem rate for room and board for each facility shall be calculated using the equations on the Kentucky Facility Per Diem Rate Form.

(3) A separate charge shall be imposed if the following treatment services are provided at a Department for Behavioral Health, Developmental and Intellectual Disabilities facility:

(a) Physician's services;

(b) EEG;

(c) EKG;

(d) Occupational therapy;

(e) Physical therapy;

(f) X-ray;

(g) Laboratory;

(h) Speech therapy;

(i) Hearing therapy;

(j) Psychology;

(k) Pharmacy;

(l) Respiratory therapy;

(m) Anesthesia;

(n) Electroshock therapy;

(o) Physician assistant;

(p) Advanced practice registered nurse; and

(q) Outpatient clinic services.

Section 8. Board, Maintenance, and Treatment Charges. The cost per day for board, maintenance, and treatment charges shall be established using the last available Behavioral Health, Developmental and Intellectual Disability (BHDID) annual finance report. Current rates shall be posted at http://dbhdid.ky.gov/kdbhdid and at each facility.

Section 9. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "DBHDID 3:060-1 Ability to Pay Worksheet", November 2016;

(b) "DBHDID 3:060-2 Deductible Ability to Pay Worksheet", November 2016;

(c) "DBHDID 3:060-3 Patient or Responsible Party Financial Agreement and Assignment", November 2016;

(d) "DBHDID 3:060-4 Patient or Responsible Party Financial Record", November 2016; and

(e) "Kentucky Facility Per Diem Rate Form", November 2016.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Behavioral Health, Developmental and Intellectual Disabilities, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

• RELATES TO: KRS Chapter 13B, 210.710, 210.720, 210.730
• STATUTORY AUTHORITY: KRS 194A.050, 210.710(4), 210.720(2), 210.720(3), 210.750
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 194A.050 requires the Secretary of the Cabinet for Health and Family Services to promulgate administrative regulations necessary to operate the programs and fulfill the responsibilities vested in the cabinet. KRS 210.720(2) requires the secretary of the Cabinet for Health and Family Services to establish the patient cost per day for board, maintenance, and treatment for state owned facilities at frequent intervals which shall be the uniform charge for persons receiving those services. KRS 210.750 authorizes the secretary to promulgate administrative regulations to carry out the provisions of KRS 210.710 to 210.760. KRS 210.710(4) and 210.720(3) require the secretary to adopt a "Means test" for determining the ability to pay of the patient or person responsible for the patient for board, maintenance, and treatment at a facility owned by the state. This administrative regulation establishes the "Means test" for making that determination and establishes the patient cost per day for board, maintenance, and treatment at state owned facilities.
• History: 3 Ky.R. 736; eff. 6-1-1977; 9 Ky.R. 502; 685; eff. 11-3-1982; Recodified from 902 KAR 12:050, 3-7-1989; TAm eff. 4-27-2016; 43 Ky.R. 1689; eff. 6-2-2017.; Cert eff. 4-17-2024

908 KAR 3:190 Drug testing procedures at a state-operated facility for an individual with mental illness, developmental, or intellectual disabilities {#sec-908-kar-3-190 omnilex-key=us-ky-regs-official--title-908--908 KAR 3:190}

Section 1. Definitions.

(1) "Administrator on duty" means a facility employee charged with decision-making authority for the facility during the employee's given work shift.

(2) "Applicant" means an individual seeking employment in a test-designated position at a facility operated by the department.

(3) "Appointing authority" means the Secretary of the Cabinet for Health and Family Services or designee

(4) "Commissioner" means the Commissioner of the Department for Behavioral Health, Developmental, or Intellectual Disabilities or the commissioner's designee.

(5) "Confirmatory test" means a second analytical procedure to identify the presence of a specific drug or metabolite which is independent of the initial test and which uses a different technique and chemical principle from that of the initial test in order to ensure reliability and accuracy

(6) "Controlled substance" is defined in KRS 218A.010(5).

(7) "Department" means the Department for Behavioral Health, Developmental, or Intellectual Disabilities.

(8) "Dilute specimen" means a drug test urine specimen in which the creatinine concentration is less than 20 mg/dL and the specific gravity is less than 1.003.

(9) "Donor" means the individual from whom a urine specimen is collected.

(10) "Drug" is defined in KRS 218A.010(11).

(11) "Employee" means a person employed at or by a facility for the care and treatment of an individual with mental illness, developmental, or intellectual disabilities operated by the department.

(12) "Initial test" means an immunoassay test to eliminate negative urine specimens from further consideration and to identify the presumptively positive specimens that require confirmation or further testing.

(13) "Failed drug test" means a circumstance in which a test-designated employee, who is directed to submit to a drug test, engages in any of the following actions:

(a) Fails to submit to or complete a drug test;

(b) Interferes with a drug test procedure;

(c) Tampers with a drug test specimen; or

(d) Has a second drug test conducted pursuant to Section 13(1) of this administrative regulation reported as a dilute specimen.

(14) "Negative drug test" means the results of a drug test administered with a test-designated employee in which the drug test specimens test below the cutoff levels as specified in the "Mandatory Guidelines for Federal Workplace Drug Testing Programs"

(15) "Officer" means the Drug Testing Coordinating Officer designated by each department operated facility or the officer's designee.

(16) "On duty" means being engaged in the performance of work responsibilities for the employer.

(17) "Positive drug test" means the results of a drug test administered with a test-designated employee in which the drug test specimens test at or above the cutoff levels as specified in the "Mandatory Guidelines for Federal Workplace Drug Testing Programs".

(18) "Random selection" means a statistically valid computer generated procedure utilized to determine test-designated employees selected to submit to random drug testing.

(19) "Reasonable suspicion" means the quantity of proof or evidence, based on specific, objective facts and rationally derived inferences from those facts about the conduct of an individual that would lead a reasonable person, based upon training and experience, to suspect that the individual has been misusing or abusing a controlled substance or a prescription or nonprescription medication in violation of this administrative regulation.

(20) "Return to duty" means the circumstances and conditions under which a test-designated employee is allowed to resume the employee's regular work duties if the employees has had a positive or failed drug test result reported or has voluntarily disclosed the abuse or misuse of a controlled substance, prescription medication, or nonprescription medication, and has met the criteria specified in Section 5(3) of this administrative regulation.

(21) "Sample" means a representative portion of a urine specimen or quality control sample used for testing.

(22) "Specimen" means the portion of urine that is collected from a donor during a drug test.

(23) "Test-designated employee" means an individual employed at or by a facility for the care and treatment of an individual with mental illness, developmental, or intellectual disabilities operated by the department and who meets any of the following conditions:

(a) Provides direct health care or treatment services to a resident of the facility;

(b) Has regular unsupervised access to residents of the facility; or

(c) Has unsupervised access to controlled substances.

(24) "Voluntary disclosure" means the willful and uncoerced admission by a test-designated employee concerning the employee's misuse or abuse of a controlled substance or prescription or nonprescription medication or that the employee has entered into substance abuse treatment.

Section 2. Applicability.

(1) The department shall implement a test-designated facility employee drug testing program in accordance with the provisions of this administrative regulation and the "Mandatory Guidelines for Federal Workplace Drug Testing Programs".

(2) This administrative regulation applies to test-designated applicants and test-designated employees at a facility for the care and treatment of an individual with mental illness, developmental, or intellectual disabilities operated by the department.

Section 3. Facility Drug Testing Program.

(1) Each department-operated facility shall establish and operate a test-designated employee drug testing program. This program shall be implemented in accordance with this administrative regulation.

(2) As part of this program, each facility shall designate a drug testing coordinating officer.

(3) Each officer shall:

(a) Serve as the primary point of contact for facility test-designated employee drug testing purposes between the officer's respective facility and the department and between the officer's respective facility and the drug testing vendor;

(b) Coordinate all facility test-designated employee drug testing activities for the officer's respective facility;

(c) Prepare and update approximately quarterly a master roster of all test-designated employees at the officer's respective facility. This roster shall include both state employees and contract employees;

(d) Submit the initial and updated master rosters approximately quarterly to the designated contact person with the contracted vendor of drug testing services;

(e) Serve as the employee designated at each facility to receive drug testing results from the drug testing vendor;

(f) Ensure that an appropriate on-site drug testing area is prepared and maintained at the facility; and

(g) Maintain all records pertaining to the facility's drug testing program in a secure and confidential manner. Information contained in these records shall not be disclosed unless authorized by subsection (7) of this section.

(4) The roster prepared pursuant to subsection (3)(c) of this section, shall include the following information concerning each employee:

(a) The employee's name;

(b) The employee's job title; and

(c) The employee's regularly scheduled work shift.

(5) The officer shall, within two (2) working days of receiving drug testing results or notice of a voluntary disclosure, report these results in writing to their facility director. The officer shall also report in writing to the commissioner within two (2) working days of receiving the drug testing results or notice of a voluntary disclosure, the following information concerning a facility employee who had a positive drug test result reported, failed a drug test or voluntarily disclosed the employee's misuse or abuse of a controlled substance or prescription or nonprescription medication:

(a) The employee's name;

(b) The employee's job title;

(c) The results of the employee's drug test;

(d) The type of drug test that occurred;

(e) The date the employee was placed on directed sick leave status; and

(f) Whether disciplinary action will be pursued.

(6) Except as provided in Section 5(3)(b) of this administrative regulation, all costs associated with conducting preemployment drug testing of prospective test-designated state employees and random and reasonable suspicion drug testing shall be borne by the respective facility requesting the drug testing. Beginning July 1, 2006, all costs associated with conducting preemployment drug testing of prospective test-designated contract employees shall be borne by the contract agency.

(7) Except as required by KRS 61.870 - 61.884 or expressly authorized or required in this section, the appointing authority or anyone with knowledge shall not release employee information that is contained in the records maintained pursuant to this administrative regulation.

(8) An employee subject to testing shall be entitled, upon written request, to obtain copies of records pertaining to the employee's drug tests. The appointing authority shall promptly provide the records requested by the employee.

(9) The appointing authority may disclose information required to be maintained under this administrative regulation pertaining to an employee to that employee or to the decision-maker in a lawsuit, grievance, or other proceeding initiated by the employee, and arising from the results of a drug test administered under the provisions of this administrative regulation, or from the appointing authority's determination that the employee engaged in prohibited conduct (including a worker's compensation, unemployment compensation, or other proceeding relating to a benefit sought by the employee).

(10) The appointing authority shall release information regarding an employee's records as directed by the specific, written consent of the employee authorizing release of the information to an identified person. Release of this information shall be in accordance with the terms of the employee's consent.

Section 4. Testing of Test-designated Facility Employees.

(1) The appointing authority shall require a test-designated employee, as a condition of prospective or continued employment, to be subject to a drug test as provided in this administrative regulation.

(2) Tests authorized. The following categories of test-designated employee drug testing shall be authorized in accordance with Section 9 of this administrative regulation:

(a) Reasonable suspicion testing;.

(b) Preappointment testing;.

(c) Follow-up testing; and.

(d) Random selection testing;.

Section 5. Positive Drug Test Results or Failed Drug Test.

(1) A test-designated employee who has a positive drug test result reported or who failed a drug test shall be immediately removed from work duties and the employee shall be subject to disciplinary action, up to and including dismissal.

(2) A test-designated employee who has a positive drug test result or who failed a drug test shall be:

(a) Informed of the positive drug test result or the failed drug test;

(b) Informed that the facility director is placing the employee on directed sick leave status if a state employee;

(c) Instructed to leave the facility campus immediately. A state employee shall receive the notice of directed sick leave prior to being instructed to leave the facility campus; and

(d) Informed that disciplinary action, up to and including dismissal, shall be initiated.

(3) If the resulting disciplinary action specified in subsection (2)(d) of this section is less than dismissal, the employee shall be allowed to return to duty if the employee provides:

(a) Written documentation, sent directly to the officer from a substance abuse treatment provider verifying that the employee has been evaluated, is compliant with the recommendations of the provider, and that the employee is safe to return to work. The officer shall offer to assist the employee in obtaining substance abuse treatment services; and

(b) Written documentation the employee's has successfully passed, at the employee's own expense, a drug test from a vendor approved by the officer. This return to duty documentation shall be sent directly from the vendor to the officer.

(4) An employee who was subject to the conditions of Section 4(2) of this administrative regulation and subsection (2)(d) of this section and who subsequently has a second positive drug test result or who fails a drug test shall be:

(a) Informed of the positive drug test result or the failed drug test;

(b) Informed that the facility director is placing them on directed sick leave status if a state employee;

(c) Instructed to leave the facility campus immediately. A state employee shall receive the notice of directed sick leave prior to being instructed to leave the facility campus; and

(d) Informed that disciplinary action to seek dismissal is being initiated.

(5) this administrative regulation shall not alter the contract agreement between each facility and their contract vendors.

Section 6. Prohibited Behavior. An employee shall not engage in the following activities while on duty or on facility grounds:

(1) The unlawful manufacture, distribution, sale, dispensation, possession, or use of a controlled substance;

(2) Consuming or under the influence of a controlled substance illegally obtained;

(3) The use, misuse, or abuse of prescription or nonprescription medication in a quantity or manner sufficient to impair a test-designated employee's ability to perform assigned duties or in any way that places patient or fellow employee safety at risk; or

(4) Interfering with a testing procedure or tampering with a test sample.

Section 7. Voluntary Disclosure.

(1) A test-designated state employee who voluntarily discloses the misuse or abuse of a controlled substance or prescription or nonprescription medication shall:

(a) Not be disciplined for self disclosure reporting provided that the self disclosure occurred prior to either of the following:

1. A determination being made that reasonable suspicion drug testing is to occur; or

2. The employee being selected for follow-up or random drug testing;

(b) Receive written notice that the employee is being placed on directed sick leave status if a state employee;

(c) Be directed to leave the facility campus immediately; and

(d) Be subject to the provisions of Sections 4(2)(c) and 5 and of this administrative regulation.

(2) A test-designated state employee who voluntarily discloses entering substance abuse treatment shall:

(a) Not be disciplined for self disclosure reporting provided that the self disclosure occurred prior to either of the following:

1. A determination being made that reasonable suspicion drug testing shall occur; or

2. The employee being selected for follow-up or random drug testing;

(b) Be informed that the employee shall be required to submit to follow-up drug testing; and

(c) Not provide direct care services until the follow-up drug test results are reported.

(3) A test-designated state employee may take advantage of opportunities specified in subsection (1) of this section no more often than two (2) times while employed at a facility. A state employee making a voluntary disclosure shall not be excused from a subsequent drug test or from otherwise complying in full with this administrative regulation. A state employee making a voluntary disclosure shall remain subject to drug testing requirements after making the disclosure and shall be subject to disciplinary action as a result of a subsequent positive drug test result report or a failed drug test.

(4) A test-designated employee of a contract agency who:

(a) Voluntarily discloses the misuse or abuse of a controlled substance or prescription or nonprescription medication or entering substance abuse treatment shall be informed that the employing agency shall be notified of the employee's self disclosure;

(b) Voluntarily discloses the misuse or abuse of a controlled substance or prescription or nonprescription medication or entering substance abuse treatment and dismissal does not occur shall be subject to follow-up drug testing;

(c) Voluntarily discloses the misuse or abuse of a controlled substance or prescription or nonprescription medication shall be instructed to leave the facility campus immediately and shall be informed that the employee shall not be allowed to return to work until the employee is in compliance with Section 5(3) of this administrative regulation.

(5) An employing agency, having been notified pursuant to subsection (4)(a) of this section, shall make a determination as to what disciplinary action, if any, shall be initiated with its employee, as well as any other condition for continued employment with the agency.

(6) The officer shall offer to assist a test-designated employee who voluntarily discloses the misuse or abuse of a controlled substance or prescription or nonprescription medication in obtaining substance abuse treatment services.

Section 8. Facility Employee Notification.

(1) New test-designated facility employees shall receive information and training concerning this administrative regulation as part of the employee's initial orientation training.

(2) Current test-designated facility employees shall receive information and training concerning this administrative regulation prior to implementation of the test-designated employee drug testing program.

(3) Information and training provided pursuant to subsections (1) and (2) of this section shall include:

(a) Information regarding the type and nature of services and supports available through the Kentucky Employee Assistance Program;

(b) How to access these services and supports; and

(c) The availability of and how to access other local or regional substance abuse treatment services.

(4) The human resources office within each facility shall maintain documentation that all employees have received information and training concerning this administrative regulation.

(5) A test-designated facility employee shall sign a document certifying:

(a) Receipt of information and training concerning this administrative regulation;

(b) An understanding of the requirements, limitations, and restrictions on facility employee conduct contained in this administrative regulation; and

(c) An understanding of the potential consequences, up to and including dismissal, for violation of this administrative regulation.

Section 9. Drug Testing Guidelines.

(1) Random drug testing of test-designated employees shall occur under the following guidelines:

(a) On-site random drug testing of test-designated employees shall occur on approximately a quarterly basis;

(b)

1. The commissioner shall determine:

a. The number and rate of test-designated employees who shall be directed to submit to random drug testing; and

b. The number of random drug tests to be conducted in a given facility in any one (1) year;

2. The number of random drug tests conducted in a given facility shall not exceed fifteen (15) percent of the number of all test-designated employees within the facility in any one (1) year.

(c) Following consultation with and approval by the officer's respective facility director and the commissioner, the officer shall contact the designated contract vendor contact person to schedule and make arrangements for the next session of on-site random drug testing;

(d) The contract vendor shall provide the officer with a roster of the names of employees randomly selected to participate in the next session of on-site random drug testing at least two (2) weeks prior to the scheduled testing date. This roster shall include a sufficient number of alternate selections so as to allow for those employees originally selected to submit to random drug testing and who, for whatever reason, did not report to work on the scheduled testing date. The officer shall not disclose to any test-designated employee selected for testing the date and time of the scheduled random drug test prior to the date and time the employee is to report for testing;

(e) The officer, following consultation with and approval by the facility director, shall make adequate arrangements to ensure the ongoing orderly operation of the facility while the random drug testing is occurring. These arrangements shall include a master schedule of the order and time when selected employees shall be tested. This information shall not be shared with any employee or supervisor prior to the test date except in accordance with paragraph (f) of this subsection;

(f) The officer shall inform only those facility employees deemed to be absolutely necessary as to date and time of the next scheduled session of on-site random drug testing. A test-designated employee scheduled for testing shall not be notified the employee has been selected for testing until the specified time and date the employee is to report for testing;

(g) Upon the date of the next scheduled session of on-site random drug testing, the officer shall inform a test-designated employee selected for random drug testing the employee has been selected to submit to on-site random drug testing. This notification shall be made utilizing the highest possible degree of discretion and respect for the employee;

(h) The officer shall ensure that each test-designated employee selected for random drug testing shall arrive at the facility drug testing site at the scheduled time and shall monitor throughout the donor process; and

(i) A test-designated employee selected for random drug testing shall return to regularly assigned job duties upon successful completion of the donor process.

(2) Reasonable suspicion drug testing of test-designated employees shall occur under the following guidelines:

(a) A test-designated employee shall be subject to drug testing if there is reasonable suspicion that the employee has abused or misused a controlled substance, prescription medication, or nonprescription medication as prohibited in this administrative regulation;

(b) Reasonable suspicion drug testing shall take place as soon as possible following the determination that reasonable suspicion exists. This testing shall take place on-site at the facility;

(c) A test-designated employee required to submit to reasonable suspicion drug testing shall not provide direct care services until the drug test results have been reported;

(d) A determination that reasonable suspicion exists to require a test-designated employee to submit to drug testing shall be based on specific, immediate and clearly describable observations concerning the employee's appearance, behavior, speech or body odors. Observations may include indications of the chronic and withdrawal effects of controlled substances;

(e) A reasonable suspicion determination shall be made only under the following conditions:

1. An initial reasonable suspicion determination is made concerning a test-designated employee by an individual in a position of supervisory authority at the facility;

2. The initial reasonable suspicion determination is verified by the administrator on duty or the officer; and

3. Prior to a facility employee making an initial reasonable suspicion determination or a reasonable suspicion determination verification, the employee shall have first received department approved training and instruction on how to make a reasonable suspicion determination.

(3) Preappointment testing.

(a) An individual applying for employment at a department-operated facility shall first submit to and successfully pass a drug test prior to gaining employment at the facility. Testing shall take place at an off-site testing site approved by the officer.

(b) An individual shall not begin employment at a facility if a positive drug test result or a failed drug test has been reported for the individual.

(c) An applicant who has a positive preappointment drug test result or who fails a preappointment drug test shall not be subsequently considered for appointment at a department operated facility for a period of at least one (1) year.

(4) Follow-up testing.

(a) A test-designated employee shall submit to unscheduled follow-up drug testing if the employee has engaged in any of the following within the previous twenty-four (24) months:

1. Voluntarily disclosed the misuse or abuse of a controlled substance or prescription or nonprescription medication;

2. Entered into or completed a rehabilitation program for drug abuse;

3. Had a positive drug test result reported or failed a drug test and dismissal did not occur;

4. Reports a criminal drug statute conviction; or

5. Been disciplined for violating this administrative regulation.

(b) A test-designated employee who is subject to follow-up drug testing shall not be required to submit to more than six (6) unscheduled follow-up drug tests within any twelve (12) month period.

(c) Follow-up drug testing shall take place at an off-site testing site as directed by the officer.

Section 10. Drugs Included.

(1) If a drug test is administered pursuant to this administrative regulation on or after July 1, 2006, the department shall, at a minimum, test for:

(a) Marijuana;

(b) Cocaine;

(c) Opiates;

(d) Amphetamines;

(e) Phencyclidine;

(f) Morphine;

(g) MDMA (Ecstasy);

(h) Methadone;

(i) Benzodiazepines;

(j) Barbiturates; and

(k) Oxycodone.

(2)

(a) If conducting reasonable suspicion drug testing, the department may test for any drug listed in Schedule 1 or 2 as defined in KRS Chapter 218A.

(b) Before the department tests for other drugs, it shall first obtain approval from the appointing authority.

(c) If requesting approval for the testing of other drugs, the department shall first submit to the appointing authority the agency's proposed initial test methods, testing levels, and proposed performance test program.

(3) This administrative regulation shall not limit a contract agency which is specifically authorized by law to include additional categories of drugs in the drug testing of its own employees.

(4) Initial and confirmatory drug testing conducted pursuant to this administrative regulation shall utilize cutoff levels as specified in the federal "Mandatory Guidelines for Federal Workplace Drug Testing Programs".

(5) Drug test specimens that meet or exceed the cutoff levels as specified in subsection (5) of this section shall be reported as a positive test result.

(6) Drug test specimens that test below the cutoff levels as specified in subsection (5) of this section shall be reported as a negative test result and shall constitute a passed drug test. Further testing of a negative specimen for drugs shall not be permitted, and the negative specimen shall be discarded or pooled for use in a laboratory's internal quality control program.

Section 11. Employee Duty to Report Convictions. A test-designated employee shall report a criminal drug statute violation for which the employee was convicted within five (5) working days of the conviction to the facility's human resources office. A test-designated employee who reports a criminal drug statute conviction shall be subject to follow-up drug testing.

Section 12. Prescription and Nonprescription Medications.

(1) A facility employee taking a prescription or nonprescription medication prior to or during the employee's work shift shall immediately inform the employee's supervisor of this fact if:

(a) The instructions, indications, and contraindications associated with the medication give the employee reason to believe that the medication may in some way impair work performance; or

(b) Having once taken the medication, the employee begins to experience an unexpected, atypical, or adverse reaction to the medication, which impairs work performance.

(2) An employee who fails to comply with subsection (1) of this section shall be subject to disciplinary action, up to and including dismissal.

(3) Having been notified by an employee pursuant to subsection (1) of this section, the employee's supervisor shall closely monitor the employee's work performance throughout the employee's work shift. If the supervisor determines that there is a sufficient perceived impairment of the employee's work performance so as to raise concerns related to employee or patient safety, the supervisor shall notify the facility's administrator on duty or designee concerning the employee's impaired work performance. The administrator on duty shall then conduct an assessment and make a determination regarding the employee's impaired work performance.

(4) If the results of an assessment conducted pursuant to subsection (3) of this section indicate that the employee's work performance is impaired so as to raise concerns related to employee or patient safety, the administrator on duty shall:

(a) Temporarily assign the employee to nonpatient related duties, if the temporary reassignment does not place the employee at risk of injury or otherwise jeopardize the orderly operation of the facility; or

(b) Allow the employee to leave from work utilizing accumulated leave time.

(5) The employee shall be allowed to return to regular work duties if the results of an assessment conducted pursuant to subsection (3) of this section indicate that the employee's work performance is not impaired.

Section 13. Dilute Specimen.

(1) If a drug test is conducted in accordance with this administrative regulation and the test result is reported by the drug testing vendor as a dilute specimen, the officer shall:

(a) Inform the donor of the drug test result;

(b) Inform the donor that the donor shall be allowed one (1) opportunity to take a second drug test;

(c) Direct the donor to take the second drug test as soon as possible; and

(d) Direct the donor not to ingest an excessive quantity of liquids prior to taking the second drug test.

(2) A second drug test administered pursuant to subsection (1) of this Section in which the test result is reported by the drug testing vendor as a dilute specimen shall be considered a failed drug test.

Section 14. Incorporation by Reference.

(1) "Mandatory Guidelines for Federal Workplace Drug Testing Programs", November 1, 2004, edition is incorporated by reference.

(2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Department for Behavioral Health, Developmental, or Intellectual Disabilities, 275 East Main Street, 4th floor, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.

History

• RELATES TO: KRS 218A.050, 218A.070, 41 U.S.C. 701 -707
• STATUTORY AUTHORITY: KRS 194A.050, 210.010, 210.040, 210.055, 210.285
• NECESSITY, FUNCTION, AND CONFORMITY: KRS 210.010 authorizes the secretary of the Cabinet for Health and Family Services to prescribe administrative regulations for the administration of the cabinet and of the institutions under the control of the cabinet. KRS 194A.050 also empowers the secretary to promulgate administrative regulations to carry out cabinet programs. This administrative regulation establishes the procedures for the drug testing of employees and contractors of state-operated institutions for an individual with mental illness, developmental, or intellectual disabilities.
• History: 32 Ky.R. 1352; 33 Ky.R. 261; 796; eff. 9-20-2006; TAm eff. 4-27-2016; Crt eff. 12-18-2019; TAm eff. 3-17-2020; Crt eff. 7-1-2026.

Chapter 5 State Interagency Council For Service To Children With Emotional Disabilities

908 KAR 5:010 Disclosure of confidential client information for state and regional interagency councils {#sec-908-kar-5-010 omnilex-key=us-ky-regs-official--title-908--908 KAR 5:010}

Section 1. Definitions.

(1) "Confidential information" means information about a child or the parent or legal guardian of the child which is obtained by a mental health professional or health care provider, if there is a reasonable expectation that, because of the relationship between the child or the parent or legal guardian of the child and the mental health professional or health care provider, or the circumstances under which the information was revealed or obtained, the information will not be disclosed by the mental health professional or health care provider without an authorization to release signed by the parent or legal guardian of the child or as mandated by law.

(2) "Interagency meeting" means a face-to-face meeting, whether conducted in person or by two (2) way interactive video via a secured electronic connection, where two (2) or more persons who represent different organizations may discuss or disclose information of a confidential nature for the purpose of coordinating services to a child pursuant to KRS 200.509(3)(b).

(3) "Local interagency council" means the council established pursuant to KRS 200.509(5).

(4) "Parent representative" means an adoptive or biological parent of a child with an emotional disability who is a consumer of state-funded service for children with an emotional disability, who is appointed to serve as a representative on:

(a) A state interagency council pursuant to KRS 200.505(1)(b); or

(b) A regional interagency council pursuant to KRS 200.509 (1)(d).

(5) "State Interagency Council" means the council established pursuant to KRS 200.505.

Section 2. Release of Confidential Information to Interagency Councils.

(1) If the state interagency council requires confidential information to coordinate services in accordance with KRS 200.505(2)(d), it shall request a copy of the authorization to release executed by the parent or other legal guardian to release the information using the Kentucky IMPACT Program State Interagency Council Parent/Guardian Release of Information Form.

(2) If a regional interagency council requires confidential information to coordinate services pursuant to KRS 200.509(3)(a), (b), (c), (d), (g), or (h), it shall request a copy of the authorization to release executed by the parent or other legal guardian to release the information using the Kentucky IMPACT Program State Interagency Council Parent/Guardian Release of Information form.

(3) An authorization to release executed by a parent or other legal guardian to release information to a state or regional interagency council pursuant to this administrative regulation shall remain valid for up to one (1) year from the date of authorization by the parent or other legal guardian.

(4) The parent or other legal guardian may revoke authorization to release of information by notifying in writing the interagency council that received the release. The revocation shall specify the:

(a) Child's name;

(b) Child's Social Security number;

(c) Child's date of birth;

(d) Parent or other legal guardian's name;

(e) Statement that the authorization to release information is revoked;

(f) Signature of the parent or other legal guardian; and

(g) Date of signature by the parent or other legal guardian.

Section 3. Interagency Council Meetings. Each person who attends a local, regional, or state interagency council meeting shall agree to maintain the confidentiality of a child's information by completing and signing the Kentucky IMPACT Program State Interagency Council Statement of Confidentiality.

Section 4. Consent to Contact.

(1) If a regional interagency council accepts a child for coordination of services pursuant to KRS 200.509(3)(a), the regional interagency council shall request the parent or other legal guardian to consent to be contacted by a parent representative, using the Kentucky IMPACT Program State Interagency Council Consent for Contact by a parent representative.

(2) If the parent consents to be contacted by a parent representative in accordance with subsection (1) of this section, the regional interagency council shall provide the name, address, and telephone number of the consenting parent or other legal guardian to the parent representative.

(3) A parent or other legal guardian who refuses consent for contact shall not be denied the coordination of a service by a regional interagency council.

(4) A parent or other legal guardian may revoke consent for contact by notifying in writing the regional interagency council that received the consent. The revocation shall specify the:

(a) Child's name;

(b) Child's Social Security number;

(c) Child's date of birth;

(d) Parent or other legal guardian's name

(e) Statement that the consent to contact is revoked;

(f) Signature of the parent and or other legal guardian; and

(g) Date of signature by the parent or other legal guardian.

Section 5. Incorporation by Reference.

(1) The following material is incorporated by reference:

(a) "Kentucky IMPACT Program State Interagency Council Parent/Legal Guardian Release of Information", May 2003;

(b) "Kentucky IMPACT Program State Interagency Council Statement of Confidentiality", May 2003; and

(c) "Kentucky IMPACT Program; State Interagency Council Consent for Contact by a Parent Representative", May 2003.

(2) This material may be obtained, inspected, or copied, subject to applicable copyright law, at the Division of Mental Health, Department for Behavioral Health, Developmental, and Intellectual Disabilities, 275 East Main Street, Frankfort, Kentucky 40621, Monday through Friday, 8:30 a.m. to 4:30 p.m.

History

• RELATES TO: KRS 200.505(2)(c), 200.509
• STATUTORY AUTHORITY: KRS 200.505(3), EO 2004-726
• NECESSITY, FUNCTION, AND CONFORMITY: EO 2004-726, effective July 9, 2004, created the Cabinet for Health and Family Services and placed the Department for Behavioral Health, Developmental, and Intellectual Disabilities within the cabinet. KRS 200.505(2)(c) requires the State Interagency Council for Service to Children with an Emotional Disability to develop a form to be signed by the parent or other legal guardian of a child referred for services to a state interagency council and regional interagency council for children with an emotional disability. KRS 200.505(3) authorizes the State Interagency Council for Services to Children with an Emotional Disability to promulgate administrative regulations necessary to comply with the requirements of KRS 200.501 to 200.509. This administrative regulation establishes requirements for protect the confidentiality of information about a child and incorporates by reference the confidentiality form.
• History: 29 Ky.R. 3004; Am. 30 Ky.R. 300; eff. 8-13-2003; TAm eff. 4-27-2016; Crt eff. 12-18-2019.