The Behavioral Health Policy Team is comprised of subject matter experts for behavioral health services who provide policy guidance for the provider types and regulations listed below.
Behavioral Health Regulations and Provider Types
PT- 03 - Behavioral Health Service Organization (BHSO)
PT-04 - Psychiatric Residential Treatment Facility (PRTF)
PT-05 - Psychiatric Residential Treatment Facility (PRTF) Level II
PT-06 - Chemical Dependency Treatment Center (CDTC)
PT-26 - Residential Crisis Stabilization Unit
PT-30 - Community Mental Health Center (CMHC)
PT-62 - Licensed Professional Art Therapist (LPAT)
PT-62(9) - Licensed Professional Art Therapist Group (LPATG)
PT-63 - Applied Behavior Analyst (ABA)
PT-63(9) - Applied Behavior Analyst Group (ABAG)
PT-66 - Behavioral Health Multi-Specialty Group (BHMSG)
PT-67 - Licensed Clinical Alcohol and Drug Counselor (LCADC)
PT-67(9) - Licensed Clinical Alcohol and Drug Counselor Group (LCADCG)
PT-81 - Licensed Professional Clinical Counselor (LPCC)
PT-81(9) - Licensed Professional Clinical Counselor Group (LPCCG)
PT-82 - Licensed Clinical Social Worker (LCSW)
PT-82(9) - Licensed Clinical Social Worker Group (LCSWG)
PT-83 - Licensed Marriage and Family Therapist (LMFT)
PT-83(9) - Licensed Marriage and Family Therapist Group (LMFTG)
PT-84 - Licensed Psychological Practitioner (LPP)
PT-84(9) - Licensed Psychological Practitioner Group (LPPG)
PT-89 - Psychologist
PT-89(9) - Psychologist Group (PG)
Kentucky Administrative Regulations
Title 907 Chapter 015 - Behavioral Health
907 KAR 9:005 Non-outpatient Level I and II Psychiatric Residential
907 KAR 9:010 Reimbursement for Non-outpatient Level I and II Residential
907 KAR 9:015 Outpatient Services Level I and II Psychiatric Residential
907 KAR 9:020 Reimbursement for Outpatient Level I and II Psychiatric Residential
907 KAR 1:044 CMHC Coverage Provisions and Requirements
907 KAR 1:045 CMHC Reimbursement Provisions and Requirements
Contact the Behavioral Health Policy Team-
DMS Issues
Pilots, Grants, and Demonstrations
Kentucky Medicaid supports the expansion of behavioral health services and the Behavioral Health Policy Team oversees a variety of pilots, grants and demonstrations designed to increase access and quality of care for Kentuckians.
KY HEALTH 1115 and SUD 1115 Demonstration
Section 1115 Demonstration, Kentucky Helping to Engage and Achieve Long-Term Health (KY HEALTH), aimed to transform the Kentucky Medicaid program to empower beneficiaries and improve their overall health, was approved in January 2018. Eligibility was extended under the Kentucky HEALTH program for adults who do not qualify for Medicaid based on disability as a condition of participating in community engagement requirements while providing incentives for healthy behavior; several exemption categories that would prevent an individual from complying with established requirements. Pregnant women and medically frail individuals were included.
KY HEALTH includes a Substance Use Disorder (SUD) Section 1115 demonstration available to all Kentucky Medicaid beneficiaries to ensure a broad continuum of care is available across the commonwealth for individuals with SUD. Kentucky received approval in October 2018 for the SUD 1115 demonstration protocol and began implementation on July 1, 2019. Under the SUD Section 1115, Medicaid expanded access to critical levels of care and adopted the American Society for Addiction Medicine (ASAM) criteria as the standard evidence-based treatment for SUD. The demonstration defines SUD residential treatment as a statewide average length of stay of 30 days and effective 2019 includes waiving of the IMD exclusion to allow reimbursement for up to 96 beds for programs meeting established provider qualifications, such as ensuring access to medication-assisted treatment and obtaining the newly established residential ASAM level-of-care certification.
Kentucky added methadone for SUD treatment to the State Plan. Under the demonstration, Kentucky received approval to waive non-emergency medical transportation (NEMT) for individuals receiving methadone in an opioid treatment facility, with exemptions for pregnant women or former foster care youth.
The KY HEALTH demonstration also includes aligning Medicaid beneficiary annual redetermination with their employer-sponsored insurance open enrollment period and extends eligibility for Medicaid to former foster care youth younger than 26 and who were in foster care under the responsibility of another state.
In December 2019, the commonwealth rescinded the Kentucky HEALTH program, keeping the following components of the KY HEALTH demonstration: SUD 1115, waiving of NEMT for methadone treatment, eligibility for out-of-state former foster care youth and alignment of ESI open enrollment dates.
Pending Amendments
In November 2020, Kentucky Medicaid, in partnership with the Department of Corrections, filed an amendment to the KY HEALTH Demonstration requesting approval to allow the state to reimburse for SUD treatment to eligible individuals while incarcerated. Pending approval, services would be provided to Medicaid-eligible individuals participating in the established DOC SUD treatment programs to ensure these individuals receive needed treatment and begin coordination of care 30 days before release.
Section 1115 Demonstration Amendment
In accordance with 42 CFR 431.408, the Cabinet for Health and Family Services, Department for Medicaid Services (DMS) announces its intention to file a Section 1115(a) Demonstration Amendment Application with the Centers for Medicare and Medicaid Services (CMS). DMS is requesting an amendment to the Commonwealth's 1115 Demonstration, entitled “TEAMKY (formally known as Kentucky Helping to Engage and Achieve Long Term Health (KY HEALTH))", to authorize the provision of certain reentry transitional services for identified individuals who are soon-to-be former inmates of a public institution, as well as limited services for eligible individuals participating in the Kentucky Behavioral Health Conditional Dismissal Program.
Public Notice
Amendment Application.
Nov. 27, 2023 Reentry Public Forum (recording)
Dec. 1, 2023 Reentry Public Forum (recording)
Reentry Public Forum Presentation (slides)
Reentry Demonstration Public Comments
Reentry 1115 Demonstration Waiver Application (submitted Dec. 31)
Reentry 1115 Letter of Completeness (CMS)
Future Initiatives
SJR 72 signed on March 30, 2022, directs the Cabinet for Health and Family Services (CHFS) to apply for a Medicaid waiver for individuals with severe mental illness to provide supported housing, medical respite care and supported employment. CHFS and DMS are preparing a report for the Health, Welfare and Family Committee.
DMS currently is preparing an extension request to extend the KY HEALTH demonstration beyond September 2023. Please see the document library for more information.
Contact
Angela Sparrow, KY Health 1115 project manager.
1915(i) State Plan Amendment
To meet the needs of Kentucky citizens living with serious mental illness (SMI) or substance use disorder (SUD) and address the priorities included in Senate Joint Resolution (SJR) 72, Kentucky Medicaid is developing a 1915(i) State Plan Amendment (SPA). The SPA is a companion to the KY HEALTH 1115 demonstration and will provide home and community based services to individuals who do not yet meet institutional level of care, will be available statewide, and will not have capped slots.
Individuals may be eligible for the SPA if:
- They are age 18 older and have a primary diagnosis of either SMI or SUD.
- They have functional impairment.
- They meet duration / episodic criteria.
The SPA will offer a variety of services including: housing-related supports, supported education and employment, transportation, medication management, caregiver respite, assistive technology and case management. To receive some of these services, participants will need to meet certain assessment tool thresholds and risk factors.
Kentucky Medicaid is working toward submitting the SPA to the Centers for Medicare and Medicaid Services for approval. Activities to date include reviewing and comparing similar programs in other states, interviewing the leaders of those programs, interviewing SMI and SUD stakeholders in Kentucky, the SPA design and drafting process, and public comment. To learn more about the SPA, review the following materials.
To contact DMS about the SPA, email Kentucky Medicaid or call (855) 459-6328.
Multisystemic Therapy Pilot
Kentucky Medicaid entered into a three-year pilot project on July 1, 2021 to deliver multisystemic therapy (MST). MST is an evidence-based, intensive treatment process that focuses on diagnosed behavioral health disorders and environmental systems (family, school, peer groups, culture, neighborhood and community) that contribute to or influence an individual’s involvement or potential involvement in the juvenile justice system. MST uses family strengths to promote positive coping activities and works with caregivers to reinforce positive behaviors, reduce negative behavior and increase family accountability and problem-solving.
Kentucky Medicaid and the Department for Community Based Services (DCBS) have partnered with three pilot providers licensed by the MST Institute to deliver this intensive service:
- Home of the Innocents
- CHNK Behavioral Health
- KVC Kentucky
Myers and Stauffer are engaged to evaluate the MST pilot project for programmatic and financial sustainability.
Contact
Sherri Staley, MST project manager.
Certified Community Behavioral Health Clinic
Section 223 of the Protecting Access to Medicare Act of 2014 outlines the creation of a demonstration program to implement Certified Community Behavioral Health Clinics (CCBHC) and assess their effectiveness through the Substance Abuse and Mental Health Services Administration demonstration program. Eight states were selected to participate in the original demonstration program in December 2016. In August 2020, Kentucky and Michigan were selected as part of a two-state expansion of the demonstration included in the passage of the Coronavirus Aid, Relief and Economic Security Act. CCBHCs were developed to provide comprehensive quality care reimbursed through a prospective rate based on historical costs. The demonstration period is two years. The first demonstration year for Kentucky is Jan. 1, 2022, through Dec. 31, 2022. Demonstration year two is Jan. 1, 2023, through Dec. 31, 2023.
Kentucky identified four Community Mental Health Centers (CMHC) to participate in the demonstration as an additional provider types: Pathways, NorthKey, Seven Counties and New Vista. Provider Type 16-CCBHC was established for use in the demonstration, This is a specific provider type separate from operation as a CMHC (PT30). The CMHCs participating in the demonstration currently are provisionally certified and enrolled as Provider Type 16-CCBHC. Kentucky expects when a CMHC enrolls as a Provider Type 16-CCBHC all outpatient services are provided under this provider type.
CCBHCs are required to provide the following comprehensive scope of services: crisis mental health services; screening, assessment and diagnosis; outpatient mental health and SUD treatment; person-centered treatment planning; primary care screening and monitoring of key health indicators; targeted case management; psychiatric rehabilitation; peer support, including family and youth; and community-based mental health care for members of the armed forces and veterans. A CCBHC may partner with existing community-based organizations (known as designated collaborating organizations) to fulfill this requirement.
As a condition of participation in the federal demonstration program, Kentucky Medicaid is required to collect and report on encounters, clinical outcomes and quality improvement data. The data reporting requirements are designed to ensure improved access to care and high-quality services.
Contact
Dana McKenna, CCBHC project manager.
Mobile Crisis Intervention Services Planning Grant
In September 2021, Kentucky was awarded $796,894 under the American Rescue Plan Act of 2021: Section 9813 – State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services. The purpose of the Kentucky Mobile Crisis Intervention (MCI) Planning Grant Project is to expand and strengthen Kentucky’s mobile crisis services to better assist those experiencing a behavioral health crisis and divert them from hospitals, jails and prisons. To achieve its goal, the Kentucky MCI planning grant team will establish a unifying strategy common to state agencies and community partners to provide a comprehensive and coordinated infrastructure to support 24/7/365 mobile crisis intervention services. The result will be a comprehensive statewide model of mobile crisis services.
CHFS is committed to providing high-quality behavioral health care through a comprehensive delivery system that is inclusive and promotes the use of evidence-based practices to improve outcomes for Medicaid beneficiaries suffering a behavioral health crisis. This includes ensuring that appropriate programs, services and providers are available and well coordinated to meet the mobile crisis response needs of persons in crisis in the communities where they reside.
In October 2021, DMS partnered with Myers and Stauffer to assist with the programmatic steps of the planning grant along with stakeholder engagement, needs assessment, strategic planning and implementation planning.
For more information about mobile crisis services, check out this presentation.
Mobile Crisis Intervention Services Defined
Mobile crisis services are available 24/7/365, including crisis call center availability, dispatch of MCI multi-disciplinary team and short-term crisis stabilization
Individual in Crisis
A behavioral health crisis is defined as any behavioral, SUD or psychiatric situation perceived to be a crisis by the individual experiencing the crisis, family members or others who closely observe the individual that, if left untreated, could result in the urgent or emergent placement of the person in a more restrictive, less clinically appropriate setting including but not limited to inpatient hospitalization or at the very least, significantly reduced levels of functioning in primary activities of daily living.
Composition of the multi-disciplinary team (MCT)
- Minimum two-person team for safety and optimal engagement
- Minimum of one approved behavioral health practitioner or approved behavioral health practitioner under supervision
- Paraprofessionals under supervision including but not limited to certified peer support specialists, community support associates and targeted case managers
- MCT trained in:
- Trauma-informed care
- De-escalation strategies
- Harm reduction
- Personal safety protocols
- When not on the scene, licensed staff are available on call to provide consultation and higher-level interventions.
Service location/services provided
- Outside of a hospital or Medicaid-recognized facility setting.
- Wherever the person in crisis is located, including at home, work or anywhere else in the community where the person is experiencing a behavioral health crisis.
Service delivery methods
- Face-to-face, defined as in-person
- Hybrid (face-to-face and telehealth) - one team member is on the scene while the one approved behavioral health practitioner or approved behavioral health practitioner under supervision is available by telehealth.
Services delivered
- Screening and assessment
- Stabilization and de-escalation
- Coordination with post-crisis follow-up services, including referrals to health, social and other services and supports as needed
Follow up
- Within 72 hours post crisis.
Timely/rapid response
- Once MCT dispatch is indicated, provider response time for initial contact, via phone or arrival, should not be longer than 60 minutes.
Mobile Crisis Planning Grant Community Stakeholders
Along with DMS and Myers and Stauffer, the Kentucky MCI services planning grant created advisory groups to assist with the grant. The advisory groups include a project team comprised of key personnel and decision makers, a core team comprised of Medicaid, the Department for Behavioral Health and Developmental and Intellectual Disabilities (DBHDID), the 988 State Planning Team, CMHC and CCBHC representatives, community members and additional subject matter experts.
An executive governance committee is comprised of the core team and commissioners from DMS, DBHDID, Department for Aging and Independent Living and DCBS.
Mobile Crisis Planning Grant CMS Reporting
As a requirement of the planning grant, DMS must prepare quarterly reports on the activities of the grant which can be found under the MCI Additional Information section of this page.
Contact
Leigh Ann Fitzpatrick, MCIS Project Manager.