907 KAR 1:515. Targeted case management services for adults with chronic mental illness.
RELATES TO: KRS 205.520
STATUTORY AUTHORITY: KRS 194A.030(2), 194A.050(1), 205.520(3), 42 U.S.C. 1396a-d, n, 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 Medicaid Services and the Medicaid Program under the Cabinet for Health and Family Services. The Cabinet for Health and Family Services has responsibility to administer the program of Medical Assistance. KRS 205.520(3) empowers the cabinet, by administrative regulation, to comply with any requirement that may be imposed, or opportunity presented, by federal law for the provision of medical assistance to Kentucky's indigent citizenry. This administrative regulation sets forth provisions relating to the coverage of targeted case management services for adults with chronic mental illness.
Section 1. Definition. (1) "Case management services" means services necessary to assist the targeted recipient in gaining access to needed medical, social, educational, and other services.
(2) "Chronic mental illness" means the same as the definition contained in KRS 210.005(3).
(3) "Target group" means the group of Medicaid eligible individuals that are chronically mentally ill (as defined in KRS 210.005) adults, with a diagnosis of a major mental disorder (other than substance abuse or an intellectual disability as the sole diagnosis) included in the DSM-III R classification.
(4) "Targeted recipient" means a recipient within the target group of chronically mentally ill adults for whom case management services are provided.
Section 2. Case Management Services. The following services shall be covered as case management services when provided by a qualified case manager to a Medicaid eligible recipient in the target group:
(1) Assessment of the client;
(2) Participation in development of the client's service plan;
(3) Referrals, linkage, and coordination of Medicaid and non-Medicaid services;
(6) Reassessment and follow-up;
(7) Establishment and maintenance of case record; and
(8) Crisis assistance planning.
Section 3. Excluded Activities. The following activities shall not be considered case management activities:
(1) The actual provision of mental health or other Medicaid covered services or treatments;
(2) Outreach to potential recipients;
(3) Administrative activities related to Medicaid eligibility determinations; and
(4) Institutional discharge planning.
Section 4. Provider Qualifications. Provider participation shall be limited to the fourteen (14) regional mental health intellectual disability centers, licensed in accordance with 902 KAR 20:091.
Section 5. Case Manager Qualifications and Supervision Requirements. (1) Case management qualifications. Each case manager shall be required to meet the following minimum requirements:
(a) Have a bachelor of arts or bachelor of science degree in any of the behavioral sciences, from an accredited institution; and
(b) Have one (1) year of experience in performing case management or working with chronically mentally ill (except that a master's degree in a human services field may be substituted for the one (1) year of experience); and
(c) Have completed a case management certification program (within six (6) months) offered or approved by the Department for Behavioral Health, Intellectual and Developmental Disabilities; and
(d) Have supervision by a mental health professional (psychiatrist, psychologist, master's degree social worker, psychiatric nurse, or professional equivalent as determined by the cabinet) for a minimum of one (1) year.
(2) Case manager supervision requirement. For one (1) year, each case manager shall have supervision performed at least once a month, both individually (per case plan) and in group (resource development).
Section 6. Implementation Date. The provisions of this administrative regulation shall be applicable with regard to services provided on or after July 1, 1991. (18 Ky.R. 602; Am. 1053; eff. 10-6-91; TAm 7-16-2013.)