907 KAR 1:525. Targeted case management services for children with a severe emotional disability.
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 provision of targeted case management services for children with a severe emotional disability.
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) "Child with a severe emotional disability" means a child that meets the following conditions and circumstances:
(a) Child with a severe emotional disability as defined in KRS 200.503(1)(2)(a) through (c). This definition excludes those children who are singularly diagnosed as chemically dependent, mentally retarded, or developmentally delay; or
(b) The child presents impairment/behavior of short duration yet of high intensity. Included are severe emotional problems such as suicidal or psychotic trauma reactions where prognosis regarding duration of symptoms cannot be accurately assessed; and
(c) The child has been identified by a regional interagency council (RIAC) as a child with a severe emotional disability in need of case management services.
(3) "Target group" means the group of Medicaid eligible children that are children with a severe emotional disability.
(4) "Targeted recipient" means a recipient within the target group of children with a severe emotional disability 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 Medicaid eligible recipients in the target group:
(1) A written comprehensive assessment of the child's needs;
(2) Arranging for the delivery of the needed services as identified in the assessment;
(3) Assisting the child and his family in accessing needed services;
(4) Monitoring the child's progress by making referrals, tracking the child's appointments, performing follow-up on services rendered, and performing periodic reassessments of the child's changing needs;
(5) Performing advocacy activities on behalf of the child and his family;
(6) Preparing and maintaining case records documenting contacts, services needed, reports, the child's progress, etc.;
(7) Providing case consultation (i.e., consulting with the service providers/collateral's in determining child's status and progress); and
(8) Performing crisis assistance (i.e., intervention on behalf of the child, making arrangements for emergency referrals, and coordinating other needed emergency services).
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 Department for Social Services and the fourteen (14) regional mental health mental retardation centers, licensed in accordance with 902 KAR 20:091.
Section 5. Case Manager Qualifications and Supervision Requirements. (1) Case manager 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 working directly with children or performing case management services (except that a master's degree in a human services field may be substituted for the one (1) year of experience); and
(c) Have received training within six (6) months designed and provided by each participating provider directed toward the provision of case management services to the targeted population; and
(d) Have supervision for a minimum of one (1) year by a mental health professional; i.e., psychiatrist, psychologist, master's level social worker (MSW), psychiatric nurse or professional equivalent (a minimum of a bachelor's degree in a human services field, with two (2) years of experience in mental health related children's services). The supervisor shall also complete the required case management certification or training course.
(2) Case manager supervision requirement. For at least one (1) year, each case manager shall have supervision performed at least once a month for each case plan. (18 Ky.R. 604; Am. 1054; eff. 10-6-91; 3269; 19 Ky.R. 78; eff. 6-24-92.)