STATEMENT OF EMERGENCY

908 KAR 2:250E

 

      This emergency administrative regulation is being promulgated to establish the eligibility criteria and training requirements for community support associates, thereby by increasing the number of individuals qualified to provide services in community-based programs designed to enhance patient access to behavioral health services and prevent unnecessary admissions to facility-based care. In addition, this emergency administrative regulation helps ensure compliance with the Interim Settlement Agreement between the Cabinet for Health and Family Services and Kentucky Protection and Advocacy. Signed on August 15, 2013, the Agreement seeks to improve the lives of individuals with mental illness, substance use disorder, or developmental disabilities by providing new community-based services and supports necessary to transition individuals from personal care homes and assist individuals living in community-based supported housing. This action must be implemented on an emergency basis in accordance with KRS 13A.190(1)(a) to enhance patient access to behavioral health services statewide, help address the behavioral health workforce shortage, and assure compliance with the Interim Settlement Agreement. This emergency administrative regulation shall be replaced by an ordinary administrative regulation filed with the Regulations Compiler. The ordinary administrative regulation is identical to this emergency administrative regulation.

 

STEVEN L. BESHEAR, Governor

AUDREY TAYSE HAYNES, Secretary

 

CABINET FOR HEALTH AND FAMILY SERVICES

Department for Behavioral Health, Developmental and Intellectual Disabilities

Division for Behavioral Health

(New Emergency Administrative Regulation)

 

      908 KAR 2:250E. Community support associate; eligibility criteria and training.

 

      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

      EFFECTIVE: February 6, 2014

      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.

 

      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 entity" means a rendering practitioner, group of practitioners, or entity which meets the following criteria:

      (a) Demonstrates capacity to employ qualified staff and coordinate the provision of services;

      (b) Demonstrates capacity to provide comprehensive community support services;

      (c) Has experience serving individuals who have a mental health disorder, substance use disorder, intellectual disability, or co-occurring disorders;

      (d) Demonstrates administrative capacity to insure quality of services in accordance with state and federal requirements;

      (e) Maintains a financial management system that provides documentation of services and costs; and

      (f) Documents and maintains individual case records in accordance with state and federal requirements.

      (4) "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) Reminders for medications and recognizing symptoms and side effects;

      (c) Therapeutic 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.

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

      (6) "Mental health associate" means an individual who:

      (a) Has a minimum of a bachelor’s degree in:

      1. Psychology;

      2. Sociology;

      3. Social work; or

      4. A human services-related field; and

      (b) Works under the supervision of a qualified mental health professional.

      (7) "Professional equivalent" means an individual who has:

      (a)1. A bachelor’s degree in:

      a. Psychology;

      b. Sociology;

      c. Social work, or

      d. A human services-related field; and

      2. Three (3) years of full-time supervised experience;

      (b)1. A master’s degree in:

      a. Psychology;

      b. Sociology;

      c. Social work;

      d. Pastoral counseling; or

      e. A human services-related field; and

      2. Six (6) months of full-time supervised experience; or

      (c) A doctoral degree in:

      1. Psychology;

      2. Sociology;

      3. Social work;

      4. Pastoral counseling; or

      5. A human services-related field.

      (8) "Qualified mental health professional" is defined by KRS 202A.011(12).

      (9) "Qualified substance abuse treatment professional" means an individual who is:

      (a) An alcohol and drug counselor certified by the Kentucky Board of Certification for Alcohol and Drug Counselors as required by KRS 309.080 to 309.089;

      (b) An individual certified or licensed as one (1) of the following:

      1. A Kentucky physician licensed in accordance with KRS 311.571 to practice medicine or osteopathy or a medical officer of the government of the United States while engaged in the performance of official duties;

      2. A psychiatrist licensed in accordance with KRS 311.571 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 with the American Board of Psychiatry and Neurology;

      3. A licensed psychologist who holds the health service provider designation in accordance with KRS 319.050;

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

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

      6. A licensed psychological practitioner licensed by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.056;

      7. A licensed psychological associate licensed by the Kentucky Board of Examiners of Psychology in accordance with KRS 319.064;

      8. A 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;

      9. A social worker certified by the Kentucky Board of Examiners of Social Work in accordance with KRS 335.080;

      10. An advanced practice registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS 314.042 with scope of practice in psychiatric or mental health nursing;

      11. A 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 two (2) years of full-time clinical experience in psychiatric nursing;

      12. A registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314 with a bachelor of science 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 three (3) years of full-time clinical experience in psychiatric nursing;

      13. A registered nurse licensed by the Kentucky Board of Nursing in accordance with KRS Chapter 314, and who has one (1) of the following combinations of education and work experience:

      a. A bachelor of science in nursing from a four (4) year program from an accredited college or university and one (1) year clinical work experience in the substance abuse or mental health field;

      b. A diploma graduate in nursing and two (2) years clinical work experience in the substance abuse or mental health field; or

      c. An associate degree in nursing from a two (2) year program from an accredited college or university and three (3) years clinical work experience in the substance abuse or mental health field;

      14. A marriage and family therapist licensed by the Kentucky Board of Licensure of Marriage and Family Therapists in accordance with the provisions of KRS 335.300 to 335.399;

      15. A professional counselor licensed by the Kentucky Board of Licensed Professional Counselors in accordance with the provisions of KRS 335.500 to 335.599; or

      16. A professional art therapist certified by the Kentucky Board of Certification for Professional Art Therapists in accordance with the provisions of KRS 309.130 to 309.1399; or

      (c) A qualified mental health professional with eighty (80) hours of substance abuse training.

 

      Section 2. Eligibility Criteria. (1) A community support associate employed by a comprehensive community support entity 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;

      2. Substance use disorder; or

      3. Co-occurring disorder; and

      (d) Successfully complete within six (6) months of hire the department-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. Qualified mental health professional;

      2. Qualified substance abuse treatment professional;

      3. Professional equivalent;

      4. Mental health associate;

      5. Mental health case manager; or

      6. Substance use disorder case manager; and

      (b) Meet face-to-face no less than one (1) time every two (2) weeks with his or her supervisor as described in paragraph (a) of this subsection.

 

      Section 3. Initial Training Requirements. A department-approved training curriculum for a community support associate shall consist of ten (10) clock hours of planned program instruction in the following areas:

      (1) Principles of recovery;

      (2) Principles of psychosocial rehabilitation;

      (3) Effective listening and communication skills; and

      (4) Diagnosis and medication management of mental health disorders, substance use disorders, or co-occurring disorders.

 

      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 (4) of this administrative regulation.

 

MARY REINLE BEGLEY, Commissioner

AUDREY TAYSE HAYNES, Secretary

      APPROVED BY AGENCY: January 29, 2014

      FILED WITH LRC: February 6, 2014 at noon

      CONTACT PERSON: Tricia Orme, Office of Legal Services, 275 East Main Street 5 W-B, Frankfort, Kentucky 40621, phone (502) 564-7905, fax (502) 564-7573, email tricia.orme@ky.gov.

 

REGULATORY IMPACT ANALYSIS And Tiering Statement

 

Contact Persons: Natalie Kelly or IJ. Eneje

      (1) Provide a brief summary of:

      (a) What this administrative regulation does: This administrative regulation establishes the eligibility criteria and training requirements for community support associates employed by comprehensive community support entities.

      (b) The necessity of the amendment to this administrative regulation: This administrative regulation is necessary to create a process for the eligibility and training of community support associates in an effort to increase the number of individuals qualified to provide services in community-based programs designed to enhance patient access to behavioral health services and prevent unnecessary admissions to facility-based care.

      (c) How this administrative regulation conforms to the content of the authorizing statutes: This administrative regulation conforms to the content of KRS 210.450 by prescribing the standards for qualifications of personnel in community programs for mental health.

      (d) How this administrative regulation currently assists or will assist in the effective administration of the statutes: This administrative regulation will assist in the effective administration of the authorizing statutes by enhancing patient access to behavioral health services statewide.

      (2) If this is an amendment to an existing administrative regulation, provide a brief summary of:

      (a) How the amendment will change this existing administrative regulation: This is a new administrative regulation.

      (b) The necessity of the amendment to this administrative regulation: This is a new administrative regulation.

      (c) How the amendment conforms to the content of the authorizing statutes: This is a new administrative regulation.

      (d) How the amendment will assist in the effective administration of the statutes: This is a new administrative regulation.

      (3) List the type and number of individuals, businesses, organizations, or state and local government affected by this administrative regulation: Individuals seeking employment as a community support associate employed by a comprehensive community support entity will be affected by this administrative regulation.

      (4) Provide an analysis of how the entities identified in question (3) will be impacted by either the implementation of this administrative regulation, if new, or by the change, if it is an amendment, including:

      (a) List the actions that each of the regulated entities identified in question (3) will have to take to comply with this administrative regulation or amendment. Individuals seeking employment as a community support associate must meet the criteria established in this administrative regulation, including the successful completion of department-approved training.

      (b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3). Individuals seeking employment as a community support associate will not incur any costs to meet the eligibility and training requirements of this administrative regulation.

      (c) As a result of compliance, what benefits will accrue to the entities identified in question (3). This administrative regulation establishes the eligibility criteria and training requirements for individuals seeking employment as a community support associate. It creates employment opportunities for individuals statewide.

      (5) Provide an estimate of how much it will cost to implement this administrative regulation:

      (a) Initially: This administrative regulation imposes no costs on the administrative body.

      (b) On a continuing basis: This administrative regulation imposes no continuing costs on the administrative body.

      (6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation: No additional funding is necessary to implement this administrative regulation.

      (7) Provide an assessment of whether an increase in fees or funding will be necessary to implement this administrative regulation, if new, or by the change if it is an amendment. No fee or funding increase is necessary to implement this administrative regulation.

      (8) State whether or not this administrative regulation establishes any fees or directly or indirectly increases any fees: This administrative regulation does not establish or increase any fees.

      (9) Tiering: Is tiering applied? Tiering is not applicable as compliance with this administrative regulation applies equally to all individuals or entities regulated by it.

 

FISCAL NOTE ON STATE OR LOCAL GOVERNMENT

 

      1. What units, parts or divisions of state or local government (including cities, counties, fire departments, or school districts) will be impacted by this administrative regulation? This administrative regulation impacts individuals seeking training as a community support associate employed by a comprehensive community support entity.

      2. Identify each state or federal regulation that requires or authorizes the action taken by the administrative regulation. KRS 210.450

      3. Estimate the effect of this administrative regulation on the expenditures and revenues of a state or local government agency (including cities, counties, fire departments, or school districts) for the first full year the administrative regulation is to be in effect.

      (a) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for the first year? This administrative regulation will not generate revenue for state or local government.

      (b) How much revenue will this administrative regulation generate for the state or local government (including cities, counties, fire departments, or school districts) for subsequent years? This administrative regulation will not generate revenue for state or local government.

      (c) How much will it cost to administer this program for the first year? This administrative regulation imposes no costs on the administrative body.

      (d) How much will it cost to administer this program for subsequent years? This administrative regulation imposes no costs on the administrative body.

      Note: If specific dollar estimates cannot be determined, provide a brief narrative to explain the fiscal impact of the administrative regulation.

      Revenues (+/-):

      Expenditures (+/-):

      Other Explanation: