907 KAR 15:005. 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) "Behavioral health practitioner" means:

      (a) An approved behavioral health services provider; or

      (b) A certified alcohol and drug counselor.

      (4) "Behavioral health practitioner under supervision" means an individual who is:

      (a)1. A licensed psychological associate;

      2. A licensed professional counselor associate;

      3. A certified social worker;

      4. A marriage and family therapy associate;

      5. A licensed professional art therapist associate;

      6. A licensed assistant behavior analyst;

      7. A physician assistant; or

      8. A certified alcohol and drug counselor; and

      (b) Employed by or under contract with the same billing provider as the billing supervisor.

      (5) "Behavioral health services organization" means an entity that is licensed as a behavioral health services organization pursuant to 902 KAR 20:430.

      (6) "Billing provider" means the individual who, group of individual providers that, or organization that:

      (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.

      (7) "Billing supervisor" means an individual who is:

      (a)1. A physician;

      2. A psychiatrist;

      3. An advanced practice registered nurse;

      4. A licensed psychologist;

      5. A licensed clinical social worker;

      6. A licensed professional clinical counselor;

      7. A licensed psychological practitioner;

      8. A licensed marriage and family therapist;

      9. A licensed professional art therapist; or

      10. A licensed behavior analyst; and

      (b) Employed by or under contract with the same billing provider as the behavioral health practitioner under supervision who renders services under the supervision of the billing supervisor.

      (8) "Certified alcohol and drug counselor" means an individual who meets the requirements established in KRS 309.083.

      (9) "Certified social worker" means an individual who meets the requirements established in KRS 335.080.

      (10) "Community support associate" means a paraprofessional who meets the application, training, and supervision requirements of 908 KAR 2:250.

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

      (12) "Electronic signature" is defined by KRS 369.102(8).

      (13) "Enrollee" means a recipient who is enrolled with a managed care organization.

      (14) "Face-to-face" means occurring:

      (a) In person; or

      (b) If authorized by 907 KAR 3:170, via a real-time, electronic communication that involves two (2) way interactive video and audio communication.

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

      (16) "Federal financial participation" is defined by 42 C.F.R. 400.203.

      (17) "Healthcare common procedure coding system" or "HCPCS" means a collection of codes acknowledged by the Centers for Medicare and Medicaid Services (CMS) that represents procedures or items.

      (18) "Licensed assistant behavior analyst" is defined by KRS 319C.010(7).

      (19) "Licensed behavior analyst" is defined by KRS 319C.010(6).

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

      (21) "Licensed marriage and family therapist" is defined by KRS 335.300(2).

      (22) "Licensed professional art therapist" is defined by KRS 309.130(2).

      (23) "Licensed professional art therapist associate" is defined by KRS 309.130(3).

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

      (25) "Licensed professional counselor associate" is defined by KRS 335.500(4).

      (26) "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. Meets the licensed psychological associate requirements established in 201 KAR Chapter 26; or

      (b) Is a certified psychologist.

      (27) "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.

      (28) "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.

      (29) "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.

      (30) "Marriage and family therapy associate" is defined by KRS 335.300(3).

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

      (32) "Peer support specialist" means an individual who meets the peer specialist qualifications established in 908 KAR 2:220.

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

      (34) "Physician" is defined by KRS 205.510(11).

      (35) "Physician assistant" is defined by KRS 311.840(3).

      (36) "Provider" is defined by KRS 205.8451(7).

      (37) "Provider abuse" is defined by KRS 205.8451(8).

      (38) "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.

      (39) "Recipient" is defined by KRS 205.8451(9).

      (40) "Recipient abuse" is defined by KRS 205.8451(10).

      (41) "Registered nurse" is defined by KRS 314.011(5).

      (42) "Residential crisis stabilization unit" means an entity that is licensed as a residential crisis stabilization unit pursuant to 902 KAR 20:440.

      (43) "Section 504 plan" means a plan developed to ensure that a child who has a disability identified under the law and is attending an elementary or secondary educational institution receives accommodations to ensure the child’s academic success and access to the learning environment.

      (44) "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. (40 Ky.R. 2064; Am. 2564; 2778; eff. 7-7-2014; 41 Ky.R. 639; 1385; 1647; eff. 2-6-2015.)

Notation

      RELATES TO: KRS 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.