Kentucky Administrative Regulations (Last Updated: August 1, 2016)

TITLE 902. CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR PUBLIC HEALTH

Chapter 22. Kentucky Board of Family Health Care Providers

902 KAR 22:030. Midlevel health care practitioner

Latest version.

Section 1. Definition. "Midlevel health care practitioner (MAP)" means a person certified by the Kentucky Board of Family Health Care Providers to provide limited management of chronic conditions to patients in a licensed network following treatment protocols reviewed and approved by the board pursuant to KRS 216.925.

Section 2. Application for Certification. (1) The application form as shown in these administrative regulations for the general practice of midlevel health care practitioners (MLPs) shall be completed in its entirety by all applicants.

(2) The application forms shall be obtained through the Kentucky Board of Family Health Care Providers, c/o Division of Vital Records and Health Development, Department for Public Health, 275 East Main Street, Frankfort, Kentucky 40621.

(3) The application shall be executed and sworn before a notary and returned to the Kentucky Board of Family Health Care Providers with a postmark of at least sixty (60) days prior to the scheduled examination with the fee of fifty (50) dollars.

(4) The Kentucky Board of Family Health Care Providers may reject an application for the following reasons:

(a) Applicant has been convicted of a misdemeanor involving moral turpitude or a felony;

(b) Applicant has had a health care profession license or certificate denied or revoked in any state or territory;

(d) Applicant has misrepresented any facts on the application;

(e) Applicant has failed to provide additional information requested by the Kentucky Board of Family Health Care Providers;

(f) Applicant has not properly completed or sworn to the information to meet all the requirements pursuant to KRS Chapter 216.

(5) The Kentucky Board of Family Health Care Providers shall notify the candidate of acceptance or rejection of the application and/or date, time, place of the examination at least thirty (30) days prior to the examination.

Section 3. Approved Qualifying Examinations. (1) The examination for certification as a midlevel health care practitioner shall consist of a written portion and a clinical/skills practicum portion.

(2) The qualifying examination for certification as a midlevel health care practitioner shall consist of the following components as approved by the Kentucky Board of Family Health Care Providers:

(a) The written portion of the examination shall consist of items based on medical treatment protocols developed and approved by the Kentucky Board of Family Health Care Providers.

(b) The clinical practicum portion of the examination shall test the applicant's skills and shall be based on the medical treatment protocols developed and/or approved by the Kentucky Board of Family Health Care Providers.

(c) A score of seventy (70) percent shall be achieved on the written portion of the qualifying examination and a score of 100 percent shall be achieved on the clinical/skills portion of the examination for certification as a midlevel health care practitioner.

(3) The board shall recognize the national or state qualifying examinations for certification or licensure of advanced registered nurse practitioners, physician assistants and registered nurses as the qualifying examination for the certified midlevel health care practitioner.

Section 4. Qualifying Examination Administration. (1) Examination sites and examination frequency shall be designated by the Kentucky Board of Family Health Care Providers and published annually.

(2) There shall be no limit on the number of times a candidate can take the examination for certification.

(3) The candidate shall notify the Kentucky Board of Family Health Care Providers if a new test date is desired.

Section 5. Initial Certification of Midlevel Health Care Practitioners. (1) To be certified by the Kentucky Board of Family Health Care Providers as a midlevel health care practitioner, a person shall:

(a) Be a health care professional who, by license or certification directly deals with physical or psychological illness of a patient;

(b) Submit a completed application with the required fee;

(d) Meet the requirement for application pursuant to KRS 216.925;

(e) Have passed an examination approved by the Kentucky Board of Family Health Care Providers.

(2) The certified midlevel health care practitioner shall practice only in licensed networks following the guidelines pursuant to KRS 216.925.

(3) Certification shall begin on or before July 1, 1992, and completion of the qualifying examination is required every five (5) years thereafter.

(4) Interagency cooperation.

(a) The board shall notify in writing other health care profession licensing or certifying agencies of an individual's additional certification as a midlevel health care practitioner.

(b) The board shall request that if the other health care profession licensing or certifying agency revokes the midlevel health care practitioner's license or certification, that notice of the revocation be sent to the Cabinet for Health Services within ten (10) days of the agency's action.

Section 6. Recertification of Midlevel Health Care Practitioners. (1) The application form as shown in these administrative regulations for the general practice of midlevel health care practitioners (MLPs) shall be completed in its entirety by all applicants.

(3) The application shall be executed and sworn before a notary and returned to the Kentucky Board of Family Health Care Providers with a postmark of at least sixty (60) days prior to the end of the licensure period with the fee of fifty (50) dollars.

(4) The Kentucky Board of Family Health Care Providers may reject an application for the following reasons:

(a) Applicant has been convicted of a misdemeanor involving moral turpitude or a felony;

(b) Applicant has had a health care profession license or certificate denied or revoked in any state or territory;

(d) Applicant has misrepresented any facts on the application;

(e) Applicant has failed to provide additional information requested by the Kentucky Board of Family Health Care Providers;

(f) Applicant has not properly completed or sworn to the information to meet all the requirements pursuant to KRS Chapter 216;

(g) Applicant has failed to complete mandatory education requirements.

(5) The midlevel health care practitioner shall provide evidence of having completed the required ten (10) medical education hours annually for recertification.

(6) The Kentucky Board of Family Health Care Providers shall notify the candidate of acceptance or rejection of the application and/or date, time, place of the examination at least thirty (30) days prior to the examination.

Section 7. Revocation of Certification. (1) A midlevel health care practitioner's certification may be revoked for the following reasons:

(a) Conviction of a misdemeanor involving moral turpitude or felony;

(b) Any other health care profession license or certificate is denied or revoked in any state or territory;

(d) Misrepresentation of any facts during the application, testing and certification process or at any time while practicing as a midlevel health care practitioner in a licensed network;

(e) Failure to complete the ten (10) required medical education hours recognized by the board.

(2) The board shall request in writing to the supervising physician of the licensed network where the midlevel health care practitioner is employed that notification be provided to the designated Cabinet for Human Resources staff of the occurrence of any of the above.

(3) Administrative hearings due to appeal or denial shall be held in accordance with 902 KAR 1:400.

Section 8. Mandatory Continuing Education Requirements. (1) Any human immunodeficiency virus education courses shall be in accordance with 902 KAR 2:160, Human immunodeficiency virus education continuing education for professionals.

(2) Courses shall utilize organized learning experiences through personal professional presentations or educational programs meeting the criteria for AMA Category 1 or the Kentucky Board of Nursing requirements.

(3) Continuing education courses approved by any other health care profession licensing or certifying agency shall be considered for relevance to the role of midlevel health care practitioners and for approval as continuing education courses for midlevel health care practitioners by the Kentucky Board of Family Health Care Providers.

(a) The potential provider of continuing education requirements for the midlevel health care practitioner shall request an application for approval as a provider and the board shall assign the potential provider of continuing education a permanent, nontransferable number. The provider of continuing education number shall be used to identify all communications, offering announcements, records, and reports.

(b) Applications for approval as a provider of continuing education may be submitted at any time during the year.

(c) If the potential provider of continuing education meets the board's standards and criteria, approval shall be granted.

(4) At the time of recertification the certified midlevel health care practitioner shall submit to the Kentucky Board of Family Health Care Providers in the form of certificates, examinations, signed forms, etc., proof of completion of ten (10) approved medical education hours per year to the following address: Kentucky Board of Family Health Care Providers, c/o Division of Vital Records and Health Development, Department for Public Health, 275 East Main Street, Frankfort, Kentucky 40621.

(See Forms on following two pages)

I hereby submit a photograph of myself taken within the past six (6) months. Further, I swear that the statements herein contained are strictly true in every respect; that I have never been convicted of a felony or a misdemeanor involving moral turpitude; that I am not addicted to alcohol or other chemicals; that I have read and understand this affidavit; and that if this petition is granted and certification is subsequently issued to me, I will comply with the laws governing the practice of midlevel health care practitioner in the Commonwealth of Kentucky and do my utmost to uphold and maintain professionalism in the health care field.

Signature of Applicant:

Signed and sworn to before me this ______ day of _____, 19__.

Official designating officer administering oath:

On this ________ day of _____, 19__, personally appeared before me, referred to in the foregoing application for admission to an examination to demonstrate his qualifications to practice as a midlevel health care provider in the Commonwealth of Kentucky. I hereby certify that the accompanying photograph is that of the person making this application for examination for certification to practice as a midlevel health care provider.

Signature:

Official Title:

AFFIDAVIT

State of:

County of:

(Attach photograph in space provided on form.)

Examination Date _________________________ Application No. ________________________

APPLICATIONS MUST BE TYPED OR FILLED OUT IN INK

APPLICATION FOR CERTIFICATION CHECK APPROPRIATE BOX

KENTUCKY BOARD OF FAMILY HEALTH CARE PROVIDERS

FOR CERTIFICATION TO PRACTICE □ Applicant for Examination

Commonwealth of Kentucky □ Certified or licensed PA, ARNP,

Frankfort, Kentucky 40621 RN applicant for certification

AN EQUAL OPPORTUNITY EMPLOYER M/F/H □ Recertification

To the Kentucky Board of Family Health Care Providers:

I hereby apply for permission to take an examination at the next scheduled examination to demonstrate my qualifications to practice as a midlevel health care practitioner in the Commonwealth of Kentucky. I enclose herewith the required fee of fifty ($50) dollars (certified check or money order) and furnish below the information to which my affidavit is added at the end.

Social Security No. ____________________________ Home Phone No.________________Work Phone No._______________

□ Mr.

_________________________________________________________________________________________________

Last Name First Name Middle Name Maiden Name (if any)

□ Ms.

Address: _________________________________________________________________________________________________

Street, R.F.D., or Box No. State City Zip Code

Date of Birth: _________________________________

Month Day Year

PREVIOUS EDUCATION

EDUCATION AND TRAINING: Please circle highest grade completed. college transcripts are required. Grade School High School College Graduate School Have you passed a G.E.D. Test? Yes No If yes 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 1 2 3 4 If yes attach a copy of the scores or the G.E.D. certificate
School	Name and Address of School	Dates Attended		Date of Graduation	Number of Hours		Fields of Study		Degree, Diploma, or Certificate Earned
School	Name and Address of School	From	To	Date of Graduation	Com-pleted	Now Earning	Major	Minor	Degree, Diploma, or Certificate Earned
High School				mo/yr					Diploma: Yes □ No □
Graduate College or University		mo/yr	mo/yr	mo/yr	*	*			Degree:
Graduate College or University		mo/yr	mo/yr	mo/yr	*	*			Degree:
Vocational, Business, Technical		mo/yr	mo/yr	Clock hours weekly:	Clock hours completed			Must provide copy of certificate	Certificate Earned:
Apprentice-ship	Type:	mo/yr	mo/yr	Length:		Journeyman: Yes □ No □			Must provide copy of certificate

*Please indicate if quarter hours

PREVIOUS EXPERIENCE

LICENSES OR CERTIFICATES; Date, number and sources of any previous licenses to practice in any health field in any state or territory.

Name of Trade or Profession	Original License Issue Date	Current License Expiration Date	Name and Address of Licensing Agency
License:
License:
License:

EMPLOYMENT HISTORY: Begin with your present or most recent job and list fully and accurately the details of each job you have held. Include Volunteer work. If you moved to a different position within the same organization so that your duties changed, then describe that as a separate job. Resumes must follow the format shown below. PLEASE NOTE IF YOU WORKED UNDER A DIFFERENT NAME. (Attach additional sheets if necessary).

Mo. Day Yr. Mo. Day Yr.

Employed: From: ______________ To:_______________

Title of Position _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

Street

____________________________________________________

City State Zip

Name and title of you immediate supervisor _________________

____________________________________________________

A description of jobs MUST be given:

Mo. Day Yr. Mo. Day Yr.

Employed: From: ______________ To:_______________

Title of Position _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

Street

____________________________________________________

City State Zip

Name and title of you immediate supervisor _________________

____________________________________________________

A description of jobs MUST be given:

Mo. Day Yr. Mo. Day Yr.

Employed: From: ______________ To:_______________

Title of Position _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

Street

____________________________________________________

City State Zip

Name and title of you immediate supervisor _________________

____________________________________________________

A description of jobs MUST be given:

If you have ever been examined and refused a license as a health care professional or if you have ever had a health care professional license canceled or revoked, give full particulars.

____________________________________________________________________________________________________________________

I hereby submit a photograph of myself taken within the past six months. Further, I swear that the statements herein contained are strictly true in every respect; that I have never been convicted of a felony or a misdemeanor involving moral turpitude; that I am not addicted to alcohol or other chemicals; that I have read and understand this affidavit; and that if this petition is granted and certification is subsequently issued to me, I will comply with the laws governing the practice of midlevel health care practitioner in the Commonwealth of Kentucky and do my utmost to uphold and maintain professionalism in the health care field.

____________________________________________________________________________________________________________________

(Signature of applicant)

Signed and sworn to before me this ________________ day of _______________________, 19______

____________________________________________________________________________________________________________________

(Official designating officer and administering oath)

On this _________day of ___________________, 19 _______, personally appeared before me, referred to in the foregoing application for admission to an examination to demonstrate his qualifications to practice as a midlevel health care provider in the Commonwealth of Kentucky. I hereby certify that that the accompanying photograph is that of the person making this application for examination for certification to practice as a midlevel health care provider.

Signature __________________________________________________

Official Title ________________________________________________

AFFIDAVIT

State of ___________________________________________________

County of _________________________________________________

(Attach photograph in space below.)

(18 Ky.R. 2502; Am. 2857; 2921; eff. 3-26-1992; 22 Ky.R. 2428; eff. 8-1-1996.)

Notation

RELATES TO: KRS 216.900-216.930

STATUTORY AUTHORITY: KRS Chapter 13B, 216.920, 216.925

NECESSITY, FUNCTION, AND CONFORMITY: KRS Chapter 216 mandates that the Kentucky Board of Family Health Care Providers promulgate administrative regulations necessary to implement their duties and responsibilities. The administrative regulation responds to provisions of KRS 216.920 which requires the Kentucky Board of Family Health Care Providers to certify and recertify midlevel health care practitioners; develop and administer qualifying examinations for midlevel health care practitioners; identify continuing education requirements for midlevel health care practitioners.

                    
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