2014 Kentucky Revised Statutes CHAPTER 216B - LICENSURE AND REGULATION OF HEALTH FACILITIES AND SERVICES 216B.457 Certificate-of-need requirement for Level II psychiatric residential treatment facilities -- Beds and locations permitted -- Contents of certificate application -- Criteria -- Staffing requirements -- Criminal records check -- Treatment plan -- Duties of Level II facility -- Administrative regulations -- Annual report.
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216B.457 Certificate-of-need requirement for Level II psychiatric residential
treatment facilities -- Beds and locations permitted -- Contents of
certificate application -- Criteria -- Staffing requirements -- Criminal
records check -- Treatment plan -- Duties of Level II facility -Administrative regulations -- Annual report.
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A certificate of need shall be required for all Level II psychiatric residential
treatment facilities. The need criteria for the establishment of Level II
psychiatric residential treatment facilities shall be in the state health plan.
An application for a certificate of need for Level II psychiatric residential
treatment facilities shall not exceed fifty (50) beds. Level II facility beds may be
located in a separate part of a psychiatric hospital, a separate part of an acute
care hospital, or a Level I psychiatric residential treatment facility if the Level II
beds are located on a separate floor, in a separate wing, or in a separate
building. A Level II facility shall not refuse to admit a patient who meets the
medical necessity criteria and facility criteria for Level II facility services.
Nothing in this section and KRS 216B.450 and 216B.455 shall be interpreted to
prevent a psychiatric residential treatment facility from operating both a Level I
psychiatric residential treatment facility and a Level II psychiatric residential
treatment facility.
The application for a Level II psychiatric residential treatment facility certificate
of need shall include formal written agreements of cooperation that identify the
nature and extent of the proposed working relationship between the proposed
Level II psychiatric residential treatment facility and each of the following
agencies, organizations, or entities located in the service area of the proposed
facility:
(a) Regional interagency council for children with emotional disability or
severe emotional disability created under KRS 200.509;
(b) Community board for mental health or individuals with an intellectual
disability established under KRS 210.380;
(c) Department for Community Based Services;
(d) Local school districts;
(e) At least one (1) psychiatric hospital; and
(f) Any other agency, organization, or entity deemed appropriate by the
cabinet.
The application for a certificate of need shall include:
(a) The specific number of beds proposed for each age group and the
specific, specialized program to be offered;
(b) An inventory of current services in the proposed service area; and
(c) Clear admission and discharge criteria, including age, sex, and other
limitations.
All Level II psychiatric residential treatment facilities shall comply with the
licensure requirements as set forth in KRS 216B.105.
All Level II psychiatric residential treatment facilities shall be certified by the
Joint Commission on Accreditation of Healthcare Organizations, or the Council
on Accreditation of Services for Families and Children, or any other accrediting
body with comparable standards that are recognized by the Centers for
Medicare and Medicaid Services.
(7) A Level II psychiatric residential treatment facility shall be under the clinical
supervision of a qualified mental health professional with training or experience
in mental health treatment of children and youth.
(8) Treatment services shall be provided by qualified mental health professionals
or qualified mental health personnel. Individual staff who will provide
educational programs shall meet the employment standards outlined by the
Kentucky Board of Education and the Education Professional Standards Board.
(9) A Level II psychiatric residential treatment facility shall meet the following
requirements with regard to professional staff:
(a) A licensed psychiatrist, who is board-eligible or board-certified as a child
or adult psychiatrist, shall be employed or contracted to meet the
treatment needs of the residents and the functions that shall be performed
by a psychiatrist;
(b) If a Level II psychiatric residential treatment facility has residents ages
twelve (12) and under, the licensed psychiatrist shall be a board-eligible
or board-certified child psychiatrist; and
(c) The licensed psychiatrist shall be present in the facility to provide
professional services to the facility's residents at least weekly.
(10) A Level II psychiatric residential treatment facility shall:
(a) Prepare a written staffing plan that is tailored to meet the needs of the
specific population of children and youth that will be admitted to the facility
based on the facility's admission criteria. The written staffing plan shall
include but not be limited to the following:
1.
Specification of the direct care per-patient staffing ratio that the
facility shall adhere to during waking hours and during sleeping
hours;
2.
Delineation of the number of direct care staff per patient, including
the types of staff and the mix and qualifications of qualified mental
health professionals and qualified mental health personnel, that shall
provide direct care and will comprise the facility's per-patient staffing
ratio;
3.
Specification of appropriate qualifications for individuals included in
the per-patient staffing ratio by job description, education, training,
and experience;
4.
Provision for ensuring compliance with its written staffing plan, and
specification of the circumstances under which the facility may
deviate from the per-patient staffing ratio due to patient
emergencies, changes in patient acuity, or changes in patient
census; and
5.
Provision for submission of the written staffing plan to the cabinet for
approval as part of the facility's application for initial licensure.
No initial license to operate as a Level II psychiatric residential treatment
facility shall be granted until the cabinet has approved the facility's written
staffing plan. Once a facility is licensed, it shall comply with its approved
written staffing plan and, if the facility desires to change its approved
per-patient staffing ratio, it shall submit a revised plan and have the plan
approved by the cabinet prior to implementation of the change;
(b) Require full-time professional and direct care staff to meet the continuing
education requirements of their profession or be provided with forty (40)
hours per year of in-service training; and
(c) Develop and implement a training plan for all staff that includes but is not
limited to the following:
1.
Behavior-management procedures and techniques;
2.
Physical-management procedures and techniques;
3.
First aid;
4.
Cardiopulmonary resuscitation;
5.
Infection-control procedures;
6.
Child and adolescent growth and development;
7.
Training specific to the specialized nature of the facility;
8.
Emergency and safety procedures; and
9.
Detection and reporting of child abuse and neglect.
(11) A Level II psychiatric residential treatment facility shall require a criminal
records check to be completed on all employees and volunteers. The
employment or volunteer services of an individual shall be governed by KRS
17.165, with regard to a criminal records check. A new criminal records check
shall be completed at least every two (2) years on each employee or volunteer.
(12) (a) Any employee or volunteer who has committed or is charged with the
commission of a violent offense as specified in KRS 439.3401, a sex
crime specified in KRS 17.500, or a criminal offense against a victim who
is a minor as specified in KRS 17.500 shall be immediately removed from
contact with a child within the residential treatment center until the
employee or volunteer is cleared of the charge.
(b) An employee or volunteer under indictment, legally charged with
felonious conduct, or subject to a cabinet investigation shall be
immediately removed from contact with a child.
(c) The employee or volunteer shall not be allowed to work with the child until
a prevention plan has been written and approved by the cabinet, the
person is cleared of the charge, or a cabinet investigation reveals an
unsubstantiated finding, if the charge resulted from an allegation of child
abuse, neglect, or exploitation.
(d) Each employee or volunteer shall submit to a check of the central
registry. An individual listed on the central registry shall not be a volunteer
at or be employed by a Level II psychiatric residential treatment facility.
(e) Any employee or volunteer removed from contact with a child pursuant to
this subsection may, at the discretion of the employer, be terminated,
reassigned to a position involving no contact with a child, or placed on
administrative leave with pay during the pendency of the investigation or
proceeding.
(13) An initial treatment plan of care shall be developed and implemented for each
resident, and the plan of care shall be based on initial history and ongoing
assessment of the resident's needs and strengths, with an emphasis on active
treatment, transition planning, and after-care services, and shall be completed
within seventy-two (72) hours of admission.
(14) A comprehensive treatment plan of care shall be developed and implemented
for each resident, and the plan of care shall be based on initial history and
ongoing assessment of the resident's needs and strengths, with an emphasis
on active treatment, transition planning, and after-care services, and shall be
completed within ten (10) calendar days of admission.
(15) A review of the treatment plan of care shall occur at least every thirty (30) days
following the first ten (10) days of treatment and shall include the following
documentation:
(a) Dated signatures of appropriate staff, parent, guardian, legal custodian,
or conservator;
(b) An assessment of progress toward each treatment goal and objective
with revisions as indicated; and
(c) A statement of justification for the level of services needed, including
suitability for treatment in a less-restrictive environment and continued
services.
(16) A Level II psychiatric residential treatment facility shall provide or arrange for
the provision of qualified dental, medical, nursing, and pharmaceutical care for
residents. The resident's parent, guardian, legal custodian, or conservator may
choose a professional for nonemergency services.
(17) A Level II psychiatric residential treatment facility shall ensure that
opportunities are provided for recreational activities that are appropriate and
adapted to the needs, interests, and ages of the residents.
(18) A Level II psychiatric residential treatment facility shall assist residents in the
independent exercise of health, hygiene, and grooming practices.
(19) A Level II psychiatric residential treatment facility shall assist each resident in
securing an adequate allowance of personally owned, individualized, clean,
and seasonal clothes that are the correct size.
(20) A Level II psychiatric residential treatment facility shall assist, educate, and
encourage each resident in the use of dental, physical, or prosthetic appliances
or devices and visual or hearing aids.
(21) The cabinet shall promulgate administrative regulations that include but are not
limited to the following:
(a) Establishing requirements for tuberculosis skin testing for staff of a Level
II psychiatric residential treatment facility;
(b) Ensuring that accurate, timely, and complete resident assessments are
conducted for each resident of a Level II psychiatric residential treatment
facility;
(c) Ensuring that accurate, timely, and complete documentation of the
implementation of a resident's treatment plan of care occurs for each
resident of a Level II psychiatric residential treatment facility;
(d)
Ensuring that an accurate, timely, and complete individual record is
maintained for each resident of a Level II psychiatric residential treatment
facility;
(e) Ensuring that an accurate, timely, and complete physical examination is
conducted for each resident of a Level II psychiatric residential treatment
facility;
(f) Ensuring accurate, timely, and complete access to emergency services is
available for each resident of a Level II psychiatric residential treatment
facility; and
(g) Ensuring that there is accurate, timely, and complete administration of
medications for each resident of a Level II psychiatric residential
treatment facility.
(22) The cabinet shall, within ninety (90) days of July 15, 2010, promulgate
administrative regulations in accordance with KRS Chapter 13A to implement
this section and KRS 216B.450 and 216B.455. When promulgating the
administrative regulations, the cabinet shall not consider only staffing ratios
when evaluating the written staffing plan of an applicant, but shall consider the
applicant's overall ability to provide for the needs of patients.
(23) The cabinet shall report, no later than August 1 of each year, to the Interim
Joint Committee on Health and Welfare regarding the implementation of this
section and KRS 216B.450 and 216B.455. The report shall include but not be
limited to information relating to resident outcomes, such as lengths of stay in
the facility, locations residents were discharged to, and whether residents were
readmitted to a Level II psychiatric residential treatment facility within a twelve
(12) month period.
Effective:July 12, 2012
History: Amended 2012 Ky. Acts ch. 146, sec. 108, effective July 12, 2012. -Created 2010 Ky. Acts ch. 7, sec. 3, effective July 15, 2010.
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