WITHDRAWN

This document is no longer current.

CABINET FOR HEALTH AND FAMILY SERVICES

Department for Medicaid Services

Division of Policy and Operations

(New Administrative Regulation)

907 KAR 15:090.Crisis continuum services provided or mediated by an administrative service organization.

RELATES TO:

KRS 205.520, 42 U.S.C. 1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23)

STATUTORY AUTHORITY:

KRS 194A.030(2), 194A.050(1), 205.520(3)

NECESSITY, FUNCTION, AND CONFORMITY:

The Cabinet for Health and Family Services, Department for Medicaid Services, has a responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation, to comply with any requirement that may be imposed or opportunity presented by federal law to qualify for federal Medicaid funds. This administrative regulation establishes a continuum of expanded behavioral health services that will be available to people experiencing a behavioral health crisis.

Section 1.

General Requirements. For the department to reimburse for a service covered under this administrative regulation, the service shall be:

(1)

Medically necessary;

(2)

Provided if a:

(a)

Mobile crisis intervention service, by a community based mobile crisis intervention service provider that meets the requirements of Section 3 of this administrative regulation;

(b)

Crisis observation stabilization service, by a crisis observation stabilization service unit that meets the requirements of Section 4 of this administrative regulation;

(c)

Behavioral health crisis transport service, by a behavioral health crisis transport provider to a recipient that is alleged to be in a behavioral health crisis and that meets the requirements of Section 5 of this administrative regulation; and

(d)

Residential crisis service, by a residential crisis stabilization unit or a community mental health center operating in accordance with the requirements established in 907 KAR 15:070 and Section 6 of this administrative regulation; and

(3)

Mediated or coordinated by an administrative service organization.

(4)

(a)

This administrative regulation shall not become operational until an administrative service organization is contracted with the cabinet and has entered into a sufficient network of provider contracts.

(b)

If necessary, the department and administrative service organization shall implement the administrative regulation on a region-by-region basis as sufficient networks of providers are contracted.

Section 2.

Administrative Service Organization (ASO) Requirements.

(1)

Any provider providing services pursuant to Sections 1, 3, 4, or 5 of this administrative regulation shall be contracted with the contracted administrative service organization.

(2)

An ASO shall be responsible for ensuring that all services established pursuant to this administrative regulation are available to a standard established by the department. This may include an enhanced standard for an ASO and a contracted provider relating to the coordination of continuing care for a recipient.

(3)

An ASO may establish a reimbursement structure that involves directly reimbursing providers of services under Sections 3, 4, or 5 of this administrative regulation or may otherwise facilitate reimbursement by the department to providers.

(4)

The department shall monitor the performance of the contracted ASO.

Section 3.

Community-Based Mobile Crisis Intervention Services.

(1)

A community-based mobile crisis intervention service (MCIS) shall include a dispatch:

(a)

Of a mobile crisis team that is based in the community; and

(b)

To the location of an individual experiencing a behavioral health crisis.

(2)

A MCIS shall have the goal of:

(a)

Alleviating symptoms of a behavioral health crisis;

(b)

Harm reduction; or

(c)

Safely transitioning an individual in an acute crisis to the appropriate level of care.

(3)

Each delivery of a MCIS shall include:

(a)

Conducting a crisis screening and assessment;

(b)

Stabilization;

(c)

De-escalation;

(d)

Coordination with post-crisis follow-up services, which shall include referrals to health, social, and other support services as needed; and

(e)

Follow-up with the individual.

(4)

MCIS shall be:

(a)

Available on a twenty-four (24) hours per day, seven (7) days per week, 365 days per year basis; and

(b)

Provided outside of a hospital or other facility.

(5)

A mobile crisis team providing MCIS shall consist of, at a minimum:

(a)

A two (2) person team that shall actively participate in the crisis response;

(b)

1.

One mobile crisis team member physically at the location of the individual; and

2.

Other members of the mobile crisis team who may be available by telehealth or in the same physical location.

(6)

A MCIS provider shall:

(a)

1.

Be a licensed:

a.

Community mental health center;

b.

Behavioral health services organization; or

2.

A state certified community behavioral health center; and

(b)

Have:

1.

Capacity to employ practitioners and coordinate service provision among rendering providers;

2.

Capacity to provide the full range of services established pursuant to this section; and

3.

Access to a board certified or board eligible psychiatrist on a twenty-four (24) hours per day, seven (7) days per week, 365 days per year basis.

(c)

Be contracted with the ASO.

Section 4.

Crisis Observation Stabilization Services.

(1)

A crisis observation stabilization services unit (COSSU) provider shall:

(a)

1.

Be licensed by the Office of Inspector General or registered with the department as a COSSU; or

2.

Be licensed as a residential crisis stabilization unit; and

(b)

Be contracted with the administrative service organization (ASO).

(c)

Have:

1.

Capacity to employ practitioners and coordinate service provision among rendering providers;

2.

Capacity to provide the full range of services established pursuant to this section;

3.

Administrative capacity to ensure quality of services;

4.

A financial management system that provides documentation of services and costs;

5.

Access to a prescriber twenty-four (24) hours a day, seven (7) days a week, each day of the year;

6.

Staff knowledgeable in mental health disorders based on the population being served; and

7.

The capacity to document and maintain individual case records.

(d)

Offer the full range of services established pursuant to subsection (2) of this section.

(e)

1.

Possess accreditation within one (1) year by one of the following:

a.

The Joint Commission;

b.

The Commission on Accreditation of Rehabilitation Facilities;

c.

The Council on Accreditation; or

d.

A nationally recognized accreditation organization.

2.

If necessary, request and receive a one (1) time extension to complete the accreditation process if the request is submitted at least ninety (90) days prior to expiration of provider enrollment.

(f)

Agree to provide services in compliance with federal and state law regardless of age, sex, race, creed, religion, national origin, handicap, or disability;

(g)

Provide services in order to:

1.

Stabilize a crisis and divert an individual from a higher level of care;

2.

Stabilize an individual and provide medication management, if applicable; or

3.

Reintegrate an individual into the individual's community or other appropriate setting in a timely fashion;

(h)

Be used when an individual:

1.

Is experiencing a behavioral health crisis that cannot be safely accommodated within the individual's community; and

2.

Needs extended care beyond outpatient services; and

(2)

A COSSU shall not:

(a)

Be a part of a hospital;

(b)

Contain less than three (3) or more than twenty (20) chairs, unless a waiver or other approval is received from the federal government;

(3)

The department shall establish a staffing ratio and may stratify it by care needs according to a day, evening, or night shift format.

(4)

Crisis observation stabilization services shall be limited to twenty-three (23) hours or less per event, and shall include the services established in this subsection.

(a)

Except as specified in the requirements stated for a given service, the services covered may be provided for a mental health disorder.

(b)

A screening shall:

1.

Determine the likelihood that an individual has a mental health disorder.

2.

Not establish the presence of a specific type of disorder.

3.

Establish the need for an in-depth assessment of the number and duration of risk factors including:

a.

Imminent danger and availability of lethal weapons;

b.

Verbalization of suicidal or homicidal risk;

c.

Need of immediate medical attention;

d.

Positive and negative coping strategies;

e.

Lack of family or social supports;

f.

Active psychiatric diagnosis; or

g.

Current drug and alcohol use.

4.

Consist of an in person, or via telehealth as appropriate pursuant to the most recent version of 907 KAR 3:170, one-on-one encounter between the provider and recipient.

5.

Be provided by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(c)

An assessment shall:

1.

Include gathering information and engaging in a process with the individual that enables the practitioner to:

a.

Establish the presence of a mental health disorder, a substance use disorder, or co-occurring disorders;

b.

Determine the individual's readiness for changes;

c.

Identify the individual's strengths or problem areas that may affect the treatment and recovery process; or

d.

Engage the individual in developing an appropriate treatment relationship;

2.

Establish or rule out the existence of a clinical disorder or service needed;

3.

Include working with the individual to develop a Crisis Intervention and Prevention Plan (CIPP);

4.

Not include psychological or psychiatric evaluations or assessments; and

5.

Be provided by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(d)

A Crisis Intervention and Prevention Plan (CIPP):

1.

Shall:

a.

Involve assisting a recipient in creating an individualized plan for COSSU services needed;

b.

Involve restoring a recipient's functional level to the recipient's best possible functional level;

c.

Be performed using a person-centered planning process;

d.

Be directed by the recipient;

e.

Include practitioners of the recipient's choosing; and

2.

May include:

a.

A mental health advanced directive being filed with a local hospital.

b.

A safety plan.

c.

A relapse prevention strategy or plan.

3.

A CIPP shall be completed by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(e)

Individual therapy shall:

1.

Be provided to promote the:

a.

Health and well-being of the individual.

b.

Restoration of a recipient to their best possible functional level from a mental health disorder, a substance use disorder, or co-occurring disorders;

2.

Consist of:

a.

An in person, or via telehealth as appropriate in accordance with 907 KAR 3:170, one-on-one encounter between the provider and recipient; and

b.

A behavioral health therapeutic intervention provided in accordance with the recipient's identified CIPP;

3.

Be aimed at:

a.

Reducing adverse symptoms;

b.

Reducing or eliminating the presenting problem of the recipient; and

c.

Improving functioning;

4.

Not exceed three (3) hours per day unless additional time is medically necessary; and

5.

Be provided by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(f)

Group therapy shall:

1.

Be a behavioral health therapeutic intervention provided in accordance with a recipient's identified crisis intervention and prevention plan;

2.

Be provided to promote the:

a.

Health and well-being of the individual; and

b.

Restoration of a recipient to their best possible functional level from a mental health disorder;

3.

Consist of a face-to-face, or via telehealth as appropriate pursuant to the most recent version of 907 KAR 3:170, behavioral health therapeutic intervention provided in accordance with the recipient's CIPP;

4.

Be provided to a recipient in a group setting:

a.

Of nonrelated individuals; and

b.

Not to exceed twelve (12) individuals in size;

5.

Focus on the psychological needs of the recipients as evidenced in each recipient's CIPP;

6.

Center on goals including building and maintaining healthy relationships, personal goal setting and the exercise of personal judgement;

7.

Not include physical exercise, a recreational activity, an educational activity, or a social activity;

8.

Not exceed three (3) hours per day unless additional time is medically necessary;

9.

The group shall have a:

a.

Deliberate focus; and

b.

Defined course of treatment;

10.

The subject of group therapy shall relate to each recipient within the group and within each recipient's health record; and

11.

The group therapy shall be provided by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(g)

Family Therapy shall:

1.

Consist of an in person, or via telehealth as appropriate pursuant to the most recent version of 907 KAR 3:170, encounter;

2.

Consist of scheduled therapeutic visits between the practitioner and the recipient and at least one (1) member of the recipient's family, provided in accordance with a recipient's identified crisis intervention and prevention plan;

3.

Address issues interfering with the relational functioning of the family and to improve interpersonal relationships within the recipient's home environment;

4.

Be provided to promote:

a.

The health and wellbeing of the recipient; and

b.

Restoration of a recipient to their best possible functional level from a mental health disorder;

5.

Not exceed three (3) hours per day per recipient unless additional time is medically necessary; and

6.

Be provided by:

a.

An approved behavioral health practitioner; or

b.

An approved behavioral health practitioner under supervision.

(h)

Peer Support Services:

1.

Shall be provided by a peer support specialist working under the supervision of an approved behavioral health practitioner and shall:

a.

Be social and emotional support that is provided by an individual who is experiencing a mental health disorder to a recipient by sharing a similar mental health disorder in order to bring about a desired social or personal change;

b.

Be an evidence based practice;

c.

Be structured and scheduled non-clinical therapeutic activities with an individual recipient or a group of recipients;

d.

Be provided by a self-identified consumer, parent or family member of a child consumer of mental health disorder services who has been trained and certified in accordance with 908 KAR 2:220, 908 KAR 2:230 or 908 KAR 2:240;

e.

Promote socialization, recovery, self-advocacy, preservation, and enhancement of community living skills for the recipient;

f.

Be coordinated within the context of a comprehensive, individualized CIPP developed through a person-centered planning process;

g.

Be identified in each recipient's CIPP; and

h.

Be designed to directly contribute to the recipient's individualized goals as specified in the recipient's CIPP.

2.

To provide peer support services, a COSSU shall:

a.

Employ peer support specialists who are qualified to provide peer support services in accordance with 908 KAR 2:220, 908 KAR 2:230 or 908 KAR 2:240;

b.

Have the capacity to coordinate the provision of services among team members;

c.

Have the capacity to provide ongoing continuing education and technical assistance to peer support specialists;

d.

Require individuals providing peer support services to recipients to not exceed thirty (30) hours per week of direct recipient contact; and

e.

Require individuals providing peer support services to recipients in a group setting to not exceed eight (8) individuals within any group at one (1) time.

(i)

Withdrawal management services shall:

1.

Be provided face-to-face for recipients with a substance use disorder or co-occurring disorders;

2.

Be incorporated into a recipient's CIPP as appropriate according to the continuum of care described in the most current version of The ASAM Criteria;

3.

Be in accordance with the most current version of The ASAM Criteria for withdrawal management levels in an outpatient setting;

4.

A recipient who is receiving withdrawal management services shall meet the:

a.

Most current edition of diagnostic criteria for substance withdrawal management found in the Diagnostic and Statistical Manual of Mental Disorders; and

b.

Current dimensional admissions criteria for withdrawal management level of care as found in The ASAM Criteria; and

5.

Withdrawal management services shall be provided by:

a.

A physician;

b.

A psychiatrist;

c.

A physician assistant;

d.

An advanced practice registered nurse; or

e.

Any other approved behavioral health practitioner with oversight by a physician, advanced practice registered nurse, or a physician assistant.

(j)

Medication assisted treatment services shall:

1.

Be provided by an authorized prescribing provider who:

a.

Is:

(i)

A physician licensed to practice medicine under KRS Chapter 311; or

(ii)

An advanced practice registered nurse (APRN); or

(iii)

A physician assistant licensed to practice medicine under KRS Chapter 311;

b.

Meets standards in accordance with 201 KAR 9:270 or 201 KAR 20:065.

c.

Maintains a current waiver under 21 U.S.C. 823(g)(2) to prescribe buprenorphine products, including any waiving or expansion of buprenorphine prescribing authority by the federal government; and

d.

Has experience and knowledge in addiction medicine.

2.

Be conducted with associated behavioral health therapies that shall:

a.

(i)

Be co-located within the same practicing site, or via telehealth as appropriate in accordance with 907 KAR 3:170, as the practitioner with a waiver pursuant to subparagraph 1.c. of this paragraph; or

(ii)

Be conducted with agreements in place for linkage to appropriate behavioral health treatment providers who specialize in substance use disorders and are knowledgeable in the biopsychosocial dimensions of alcohol or other substance use disorders;

b.

Assess the need for treatment including:

(i)

A full patient history to determine the severity of the patient's substance use disorder, and

(ii)

Identifying and addressing any underlying or co-occurring disease or conditions, as necessary;

c.

Educate the patient about how the medication works, including:

(i)

The associated risks and benefits, and

(ii)

Overdose prevention;

d.

Evaluate the need for medically monitored withdrawal from substances;

e.

Refer patients for higher levels of care if necessary; and

f.

Obtain informed consent prior to integrating pharmacologic or nonpharmacologic therapies.

3.

Be conducted with care coordination that shall include at minimum:

a.

Referring the recipient to appropriate community services;

b.

Facilitating medical and behavioral health follow-ups or linkage to current providers; and

c.

Linking to appropriate levels of behavioral health treatment in order to provide ongoing support; and

4.

The department shall not reimburse for a service billed by or on behalf of an entity or individual who is not a billing provider.

Section 5.

Behavioral Health Crisis Transportation.

(1)

Provider requirements:

(a)

A behavioral health crisis transport provider shall meet the state transportation benefit requirements established to obtain a motor carrier certification.

(b)

A behavioral health crisis transport provider shall enroll with the department;

(c)

A behavioral health crisis transport provider shall meet any relevant state or federal law relating to transporting recipients for profit;

(d)

A behavioral health crisis transport provider shall be available twenty-four (24) hours each day, seven (7) days per week, and 365 days per year;

(e)

Each behavioral health crisis transport provider vehicle shall be staffed by two (2) employees, one of which shall be a driver and one of which shall be a support staff person. Each provider staff person shall meet the training requirements in subsection (6) of this section;

(f)

A behavioral health crisis transport provider shall provide and document staff training in the following amounts and on the following subjects:

1.

Four (4) hours of evidence-based training on the de-escalation of conflicts;

2.

Eight (8) hours of evidence-based training concerning behavioral health, which shall include:

a.

Suicide risk assessment and intervention;

b.

Opioid overdose response including the use of naloxone; and

c.

Awareness of issues relating to mental health and substance use disorders; and

3.

Cardiopulmonary resuscitation (CPR) certification; and

(g)

A behavioral health crisis transport provider shall be contracted with the ASO.

(2)

Service delivery:

(a)

A behavioral health crisis transport provider may provide behavioral health crisis transportation to a recipient alleged to be in a behavioral health crisis;

(b)

A mobile crisis team shall perform an assessment of a recipient prior to transport that complies with Section 3 of this administrative regulation;

(c)

A recipient shall be transported to the nearest, most appropriate provider or facility;

(d)

If the mobile crisis team assessment determines that the recipient requires a higher level of care, the recipient shall be transported, as appropriate, to the most appropriate level of care;

(e)

A behavioral health crisis transportation service may be utilized to transport recipients to another facility for recipients who:

1.

Are present in a facility, including a hospital emergency department; and

2.

Meet a crisis observation stabilization level of care or higher;

(f)

Except in the case of a recipient that requires a caregiver or legal guardian due to a cognitive impairment, an intellectual, physical, or developmental disability, a family member or unaccredited agent shall not ride in the vehicle with the recipient; and

(3)

Prior authorization shall not be required for a behavioral health crisis transportation service.

Section 6.

Reimbursement.

(1)

The department shall establish and update a reimbursement table for each of the following service and provider categories. The reimbursement shall be available when billed through an ASO for:

(a)

1.

An administrative services organization;

2.

A community based mobile crisis intervention services provider;

3.

A crisis observation stabilization services unit;

4.

A behavioral health crisis transportation service provider; and

5.

A residential crisis stabilization unit.

(b)

For fee-for-service claims involving a community mental health center, reimbursement for mobile crisis intervention services and residential crisis stabilization unit services shall be governed by and consistent with 907 KAR 1:045.

(2)

The department may establish and increase a per diem rate for any service or provider in order to ensure provider availability and programmatic stability.

(3)

Each reimbursement table shall be available at: https://www.chfs.ky.gov/agencies/dms/Pages/feesrates.aspx.

Section 7.

Federal Approval and Federal Financial Participation. The department's reimbursement for services pursuant to this administrative regulation shall be contingent upon:

(1)

Receipt of federal financial participation for the reimbursement; and

(2)

Centers for Medicare and Medicaid Services' approval for the reimbursement.

Section 8.

Appeal Rights.

(1)

An appeal of a negative action regarding a Medicaid recipient shall be in accordance with 907 KAR 1:563.

(2)

An appeal of a negative action regarding Medicaid eligibility of an individual shall be in accordance with 907 KAR 1:560.

(3)

An appeal of a negative action regarding a Medicaid provider shall be in accordance with 907 KAR 1:671.

LISA D. LEE, Commissioner

ERIC FRIEDLANDER, Secretary

APPROVED BY AGENCY: November 22, 2023

FILED WITH LRC: December 6, 2023 at 1:20 p.m.

PUBLIC HEARING AND COMMENT PERIOD: A public hearing on this administrative regulation shall, if requested, be held on February 26, 2024, at 9:00 a.m. using the CHFS Office of Legislative and Regulatory Affairs Zoom meeting room. The Zoom invitation will be emailed to each requestor the week prior to the scheduled hearing. Individuals interested in attending this virtual hearing shall notify this agency in writing by February 19, 2024, five (5) workdays prior to the hearing, of their intent to attend. If no notification of intent to attend the hearing is received by that date, the hearing may be canceled. This hearing is open to the public. Any person who attends virtually will be given an opportunity to comment on the proposed administrative regulation. A transcript of the public hearing will not be made unless a written request for a transcript is made. If you do not wish to be heard at the public hearing, you may submit written comments on this proposed administrative regulation until February 29, 2024. Send written notification of intent to attend the public hearing or written comments on the proposed administrative regulation to the contact person. Pursuant to KRS 13A.280(8), copies of the statement of consideration and, if applicable, the amended after comments version of the administrative regulation shall be made available upon request.

CONTACT PERSON: Krista Quarles, Policy Analyst, Office of Legislative and Regulatory Affairs, 275 East Main Street 5 W-A, Frankfort, Kentucky 40621; Phone: 502-564-7476; Fax: 502-564-7091; CHFSregs@ky.gov.

REGULATORY IMPACT ANALYSIS AND TIERING STATEMENT

Contact Person:

Krista Quarles

(1) Provide a brief summary of:

(a) What this administrative regulation does:

This administrative regulation establishes the Department for Medicaid Services’ (DMS’s) reimbursement provisions and requirements regarding a continuum of care for behavioral health crisis services. This will involve implementing an administrative services organization, and providers who can provide community based mobile crisis intervention services, crisis observation stabilization services, behavioral health crisis transportation services, and any needed residential services related to a treated behavioral health crisis.

(b) The necessity of this administrative regulation:

This administrative regulation is necessary to establish an updated, dynamic and responsive continuum of crisis services.

This administrative regulation conforms to the content of the authorizing statutes by establishing a coordinated grouping of services to meet behavioral health crisis care needs.

(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 establishing a clear grouping of covered services, providers, and reimbursements related to behavioral health crises.

(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.

(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 governments affected by this administrative regulation:

DMS will establish 4 regions and contract an ASO for each region. The department will require staffing to correspond to a mobile crisis team response within 60 minutes in an urban area and 90 minutes in a rural area throughout each of the 4 regions. DMS anticipates that existing behavioral health services organizations and residential crisis stabilization units will expand to provide additional services as COSSUs.

(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:

Regulated entities will need to contract or associate with an administrative services organization, and meet the regulatory requirements established for each provider type.

(b) In complying with this administrative regulation or amendment, how much will it cost each of the entities identified in question (3):

There will be no additional costs experienced by affected providers.

The entities will be able to provide and receive reimbursement for an expanded community based continuum of mobile crisis services.

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

(a) Initially:

The department shall meet its budget obligations pursuant to HB 1 of the 2022 Regular Session.

(b) On a continuing basis:

The department shall meet its budget obligations pursuant to HB 1 of the 2022 Regular Session.

(6) What is the source of the funding to be used for the implementation and enforcement of this administrative regulation:

Sources of funding to be used for the implementation and enforcement of this administrative regulation are federal funds authorized under Title XIX and Title XXI of the Social Security Act, and state matching funds of general and agency appropriations.

(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:

At this time, DMS does not assess that an increase in fees or funding 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 neither establishes nor increases any fees.

(9) TIERING: Is tiering applied?

Tiering was not appropriate in this administrative regulation because the administration regulation applies equally to all those individuals or entities regulated by it.

FISCAL NOTE

(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?

DMS will be affected by this administrative regulation.

(2) Identify each state or federal statute or federal regulation that requires or authorizes the action taken by the administrative regulation.

KRS 194A.030(2), 194A.050(1), 205.520(3)

(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 is not expected to 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 is not expected to generate revenue for state or local government.

The department shall meet its budget obligations pursuant to HB 1 of the 2022 Regular Session.

(d) How much will it cost to administer this program for subsequent years?

The department shall meet its budget obligations pursuant to HB 1 of the 2022 Regular Session.

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:

(4) Estimate the effect of this administrative regulation on the expenditures and cost savings of regulated entities for the first full year the administrative regulation is to be in effect.

(a) How much cost savings will this administrative regulation generate for the regulated entities for the first year?

DMS anticipates that the regulation will establish a new continuum of care for mobile crisis services. DMS anticipates that the entities will generate revenue from the new services available to be provided.

(b) How much cost savings will this administrative regulation generate for the regulated entities for subsequent years?

DMS anticipates that the regulation will continue to establish a new continuum of care for mobile crisis services. DMS anticipates that the entities will continue to generate revenue from the new services available to be provided in subsequent years.

DMS does not anticipate that regulated entities will incur costs in the first year as a result of this new administrative regulation.

(d) How much will it cost the regulated entities for subsequent years?

DMS does not anticipate that regulated entities will incur costs as a result of this new administrative regulation in subsequent years.

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

Cost Savings (+/-):

Expenditures (+/-):

Other Explanation:

(5) Explain whether this administrative regulation will have a major economic impact, as defined below.

"Major economic impact" means an overall negative or adverse economic impact from an administrative regulation of five hundred thousand dollars ($500,000) or more on state or local government or regulated entities, in aggregate, as determined by the promulgating administrative bodies. [KRS 13A.010(13)] The administrative regulation will not have a major economic impact – as defined by KRS 13A.010 – on regulated entities.

FEDERAL MANDATE ANALYSIS COMPARISON

(1) Federal statute or regulation constituting the federal mandate.

42 U.S.C. 1396w-6

(2) State compliance standards.

States have the option under federal law to establish community-based mobile crisis intervention services.

(3) Minimum or uniform standards contained in the federal mandate.

42 U.S.C. 1396w-6 establishes a state plan option to establish mobile crisis intervention services. 42 U.S.C. 1396a(a)(30)(A) requires Medicaid state plans to: "...provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan (including but not limited to utilization review plans as provided for in section 1903(i)(4)) as may be necessary to safeguard against unnecessary utilization of such care and services and to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area."

(4) Will this administrative regulation impose stricter requirements, or additional or different responsibilities or requirements, than those required by the federal mandate?

The administrative regulation does not impose stricter or different responsibilities than the federal requirements.

(5) Justification for the imposition of the stricter standard, or additional or different responsibilities or requirements.