STATEMENT OF EMERGENCY
902 KAR 20:320E
This
emergency administrative regulation is being promulgated to address statutory
changes to existing psychiatric residential treatment facility (
ERNIE
FLETCHER, Governor
JAMES
W. HOLSINGER, Jr., M.D., Secretary
CABINET FOR HEALTH AND FAMILY SERVICES
Office of Inspector General
(Emergency Amendment)
902 KAR 20:320E. Psychiatric residential
treatment facility operation and services.
RELATES TO: KRS 216B.010-216B.130, 216B.450-216B.459, 216B.990, 42
C.F.R. 441.156
STATUTORY AUTHORITY: KRS 216B.042, 216B.105, 216B.450-216B.459, 314.011(8), 314.042(8), 320.240(14), EO 2004-726
[96-862]
EFFECTIVE:
NECESSITY, FUNCTION, AND CONFORMITY: KRS 216B.042, 216B.105 and 216B.450-216B.459
mandate that the 96-862,
effective July 2, 1996, reorganizes the Cabinet for Human Resources and places]
the Office of Inspector General and its regulatory authority [programs]
under the Cabinet for Health and Family Services.
Section 1.
Definitions.
(1) "Chemical restraint" means the use of a drug that:
1.
Is administered to manage a resident's behavior in a way that reduces the
safety risk to the resident or others;
2.
Has the temporary effect of restricting the resident's freedom of movement; and
3.
Is not a standard treatment for the resident's medical or psychiatric
condition.
(2) "Clinical
privileges" means authorization by the
governing body to provide certain resident care and treatment services in the
facility specified by the governing body within well-defined limits, based on
the individual's license, education, training, experience, competence, and
judgment.
(3) [(2)]
"Direct-care staff" means
residential or child-care workers who directly supervise residents.
(4) [(3)]
"Freestanding" is defined in KRS 216B.450(3) [means a completely detached building].
(5) [(4)]
"Governing body" means the
individual, agency, partnership, or corporation, in which the ultimate
responsibility and authority for the conduct of the facility is vested.
[(5) "Holding" means forced positioning of a
resident by staff without use of mechanical devices.]
(6) "Licensure agency" means
the Cabinet for Health and Family Services, Office of Inspector General
[Division of Licensing and Regulation in the Office of the Inspector
General, Cabinet for Health Services].
(7) "Living
unit" means the area within a single
building that is supplied by the facility for daily living and therapeutic
interaction of the residents. There shall be no more than nine (9) [eight
(8)] residents per living unit.
(8) "Mechanical
restraint" means
any device attached or adjacent to a resident's body that he or she cannot
easily remove that restricts freedom of movement or normal access to his or her
body.
(9) [(8)] "Mental
health associate" is an individual
with a minimum of a bachelor's degree in a mental health related field; a
registered nurse with at least one (1) year's experience in a psychiatric
inpatient or residential treatment setting for children; or an individual with
a high school diploma or an equivalence certificate and at least two (2)
[five (5)] years work experience in a psychiatric inpatient or
residential treatment setting for children [, two (2) years of which shall
be in a supervisory role, and shall have successfully completed the medicine
administration course approved by the Kentucky Board of Nursing for use in
child caring facilities].
(10) [(9)]"Mental
health professional" is defined in
KRS 645.020 [means
a person employed and meeting requirements for a position on the professional
staff of a PRTF on the effective date of this administrative regulation
until December 31, 2001; a qualified mental health professional as defined by
KRS 202A.011; a professional art therapist who is certified pursuant to KRS
309.133; a marriage and family therapist who is certified pursuant to KRS
335.330; a professional counselor who is certified pursuant to KRS 335.525; or
a licensed registered nurse with two (2) years experience in a mental health
setting].
(11)
"Personal restraint" means the application of physical force without the use of any device,
for the purposes of restraining the free movement of a resident's body and does
not include briefly holding without undue force a resident in order to calm or
comfort him or her or holding a resident's hand to safely escort him or her
from one (1) area to another.
(12) [(10)]
"Psychiatric residential treatment facility" or "(4)].
[(11) "Restraint" means the use of a mechanical
device to involuntarily restrain movement of the whole or a portion of a
resident's body as a means of controlling a resident's physical activities to
protect the resident or others from injury or the use of intravenous,
intramuscular, or subcutaneous administration of any pharmacologic or chemical
agent to the resident with the sole or primary purpose of controlling or
limiting the physical activities of the resident. Restraint is differentiated from
mechanisms usually and customarily employed during medical, diagnostic, or
surgical procedures.]
(13) [(12)]
"Seclusion" means the involuntary
confinement of a resident in a room or in an area from [,] which the
resident is physically prevented from leaving [, for any period of time].
(14) [(13)]
"Special treatment procedures" means any
procedure such as chemical restraint, mechanical restraint, personal
restraint or seclusion [and holding] which may have abuse potential or
be life threatening.
(15) [(14)]
"Unusual treatment" means any
procedure not readily accepted as a standard method of treatment by the
relevant professional.
Section 2.
Applicability.
(1) A psychiatric residential treatment facility shall be located
in a freestanding structure [eight (8) bed facility.
(a) An entity which was licensed as a PRTF prior to April 9, 1992, may be licensed within a single building for a maximum of
sixteen (16) beds, but shall have a minimum of two (2) separate living units. A
living unit in a sixteen (16) bed PRTF shall
have no more than eight (8) beds.
(b) An entity which has obtained approval for a certificate
of need for a sixteen (16) bed PRTF prior to March 26, 1992, may be licensed by the cabinet as two (2) freestanding
eight (8) bed PRTFs located on a common campus.
(c) An eight (8) bed PRTF may be
located on a common campus with an existing eight (8) bed PRTF, but each
shall be freestanding].
(2) Multiple
(3) [(2)] If
a psychiatric residential treatment facility is located on grounds shared by
another licensed facility other than a
(a) The residents of the conducted
by a school operated by the local educational authority for residents for whom
it is determined by the local educational authority that the program provided
by the school is appropriate for all residents in the program and is provided
in accordance with Section 12(6) of this administrative regulation, or]
organized recreational activities, or group therapy for children with
similar treatment needs;
(b) Direct-care staff of the licensed
facility with which the
(c) For continuity of care, at least
fifty (50) percent of direct care staff of the ;
(d) If the provisions of
paragraph (a) of this subsection are met, the only services or components of
the physical plant that may be shared are those related to housekeeping,
maintenance, dietary and recreational facilities or grounds].
(4) [(3)] on the same
grounds in accordance with subsection (1) of this section] may share joint
activities and staff.
Section 3.
Licensure.
A [The] psychiatric
residential treatment facility shall comply with all the conditions for
licensure contained in 902
KAR 20:008.
Section 4.
Governing Body. A Each
facility] shall have a governing body with overall authority and
responsibility for the facility's operation.
(1) The governing body shall be a legally constituted entity
in the
(2) A facility that is part of a multifacility system or is
operated by a government agency shall have a written description of the
system's administrative structure and lines of authority.
(3) The authority and responsibility of any person
designated to function as the governing body shall be specified in writing.
(4) If a business relationship exists between a governing
body member [member(s)] and the organization, there shall be a
conflict-of-interest policy that governs the member's participation in
decisions influenced by the business interest.
(5) The responsibilities of the governing body shall be
stated in writing and shall describe the process for the following:
(a) Adopting policies and procedures;
(b) Providing sufficient funds, staff,
equipment, supplies, and facilities to assure that the facility is capable of
providing appropriate and adequate services to residents;
(c) Overseeing the system of financial
management and accountability;
(d) Adopting a program to monitor and
evaluate the quality of all care provided and to appropriately address
identified problems in care;
(e) Electing, appointing, or employing
the clinical and administrative leadership personnel of the facility, and
defining the qualifications, authority, responsibility, and function of such
positions; and
(f) Approving employment of mental
health professional staff.
(6) The governing body shall meet as a whole at least
quarterly and keep records that demonstrate the ongoing discharge of its
responsibilities.
(7) When a facility is a component of a larger organization,
the facility staff, subject to the overall authority of the governing body,
shall be given the necessary authority to plan, organize, and operate the
program.
Section 5.
Program Director.
(1) A [The] program director shall be
responsible for the administrative management of the facility.
(2) A program director:
(a) [The program director] Shall
be qualified by training and experience to direct a treatment program for
children and adolescents with emotional problems; [.]
(b) Shall at least have minimum
qualifications of [Minimum qualifications shall be] a master's
degree or bachelor's degree in the human services field including:
1. Social work;
2. Sociology;
3. Psychology;
4. Guidance and counseling;
5. Education;
6. Religion;
7. Business administration;
8. Criminal justice;
9. Public administration;
10. Child care administration;