CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Commissioner’s Office

(As Amended at ARRS, May 13, 2014)

 

      907 KAR 15:005. Definitions for 907 KAR Chapter 15.

 

      RELATES TO: 194A.025(3)

      STATUTORY AUTHORITY: KRS 194A.010(1), 194A.030(2), 194A.050(1), 205.520(3), 42 U.S.C. 1396a

      NECESSITY, FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services, Department for Medicaid Services, has responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with a requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes the definitions for 907 KAR Chapter 15.

 

      Section 1. Definitions. (1) "Advanced practice registered nurse” or “APRN” is defined by KRS 314.011(7).

      (2) “Approved behavioral health services provider” means a provider that is:

      (a) A physician;

      (b) A psychiatrist;

      (c) An advanced practice registered nurse;

      (d) A physician assistant;

      (e) A licensed psychologist;

      (f) A licensed psychological practitioner;

      (g) A licensed clinical social worker;

      (h) A licensed professional clinical counselor;

      (i) A licensed marriage and family therapist;

      (j) A licensed psychological associate;

      (k) A marriage and family therapy associate;

      (l) A certified social worker;

      (m) A licensed professional counselor associate;

      (n) A licensed professional art therapist; or

      (o) A licensed professional art therapist associate.

      (3) “Billing provider" means the individual who or group of individual providers that[entity who]:

      (a) Is authorized to bill the department or a managed care organization for a service; and

      (b) Is eligible to be reimbursed by the department or a managed care organization for a service.

      (4)[(3)] "Certified social worker" means an individual who[:

      (a)] meets the requirements established in KRS 335.080[; and

      (b) Has at least a master’s degree in social work].

      (5)[(4)]["Community support associate" means an individual who meets the community support associate requirements established in 908 KAR 2:250.

      (5)] "Department" means the Department for Medicaid Services or its designee.

      (6)[(5)][(6)] "Electronic signature" is defined by KRS 369.102(8).

      (7)[(6)][(7)] "Enrollee" means a recipient who is enrolled with a managed care organization.

      (8)[(7)][(8)] "Face-to-face" means occurring:

      (a) In person; or

      (b) Via a real-time, electronic communication that involves two (2) [-]way interactive video and audio communication.

      (9)[(8)][(9)] "Family peer support specialist" means an individual who meets the requirements for a Kentucky family peer support specialist established in 908 KAR 2:230.

      (10)[(9)][(10)] "Federal financial participation" is defined by 42 C.F.R. 400.203.

      (11)[(10)][(11)] "Licensed assistant behavior analyst” is defined by KRS 319C.010(7).

      (12) “Licensed behavior analyst” is defined by KRS 319C.010(6).

      (13) “Licensed clinical social worker" means an individual who meets the licensed clinical social worker requirements established in KRS 335.100.

      (14)(11)][(12)] "Licensed marriage and family therapist" is defined by KRS 335.300(2).

      (15)[(12)][(13)] "Licensed professional art therapist” is defined by KRS 309.130(2).

      (16) “Licensed professional art therapist associate” is defined by KRS 309.130(3).

      (17) “Licensed professional clinical counselor" is defined by KRS 335.500(3).

      (18)[(13)][(14)] "Licensed professional counselor associate" is defined by KRS 335.500(4)[335.500(3)].

      (19)[(14)][(15)] "Licensed psychological associate" means an individual who:

      (a)1. Currently possesses a licensed psychological associate license in accordance with KRS 319.010(6); and

      2.[(b)] Meets the licensed psychological associate requirements established in 201 KAR Chapter 26; or

      (b) Is a certified psychologist.

      (20)[(15)][(16)] "Licensed psychological practitioner" means an individual who:

      (a) Meets the requirements established in KRS 319.053; or

      (b) Is a certified psychologist with autonomous functioning.

      (21)[(16)][(17)] "Licensed psychologist" means an individual who:

      (a) Currently possesses a licensed psychologist license in accordance with KRS 319.010(6); and

      (b) Meets the licensed psychologist requirements established in 201 KAR Chapter 26.

      (22)[(17)][(18)] "Managed care organization" means an entity for which the Department for Medicaid Services has contracted to serve as a managed care organization as defined in 42 C.F.R. 438.2.

      (23)[(18)][(19)] "Marriage and family therapy associate" is defined by KRS 335.300(3).

      (24)[(19)][(20)] "Medically necessary" or "medical necessity" means that a covered benefit is determined to be needed in accordance with 907 KAR 3:130.

      (25)[(20)][(21)] "Peer support specialist" means an individual who meets the peer specialist qualifications established in 908 KAR 2:220.

      (26)[(21)] "Person-centered service plan" means a plan of services for a recipient that meets the requirements established in 42 C.F.R. 441.540.

      (27)[(22)] "Physician" is defined by KRS 205.510(11)[and 42 C.F.R. 405.2401(b)].

      (28)[(23)] "Physician assistant" is defined by KRS 311.840(3)[and 42 C.F.R. 405.2401(b)].

      (29)[(24)] "Provider" is defined by KRS 205.8451(7).

      (30)[(25)] "Provider abuse" is defined by KRS 205.8451(8).

      (31)[(26)] "Provider group" means a group of more than one (1) individually licensed practitioners who form a business entity to:

      (a) Render health services; and

      (b) Bill the Medicaid Program for services rendered to Medicaid recipients.

      (32)[(27) "Qualified mental health professional" means an individual who meets the requirements established in KRS 202A.011(12).

      (28)] "Recipient" is defined by KRS 205.8451(9).

      (32)[(29)][(27)] "Recipient abuse" is defined by KRS 205.8451(10).

      (33)[(30)][(28)] "Registered nurse" is defined by KRS 314.011(5).

      (34)[(31)][(29)] "Youth peer support specialist" means an individual who meets the requirements established for a Kentucky youth peer support specialist established in 908 KAR 2:240.

 

LAWRENCE KISSNER, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: December 19, 2013

      FILED WITH LRC: December 26, 2013 at 4 p.m.

      CONTACT PERSON: Tricia Orme, tricia.orme@ky.gov, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40601, phone (502) 564-7905, fax (502) 564-7573.