AN ACT relating to the medical treatment of high acuity youth.

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AN ACT relating to the medical treatment of high acuity youth. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
SECTION 1. A NEW SECTION OF KRS CHAPTER 200 IS CREATED TO 3
READ AS FOLLOWS: 4
(1) As used in this section: 5
(a) "Behavioral assessment" means an evaluation of a child by a clinical 6
professional, which may occur in person, remotely, or through the rev iew of 7
clinical records; 8
(b) "Clinical professional" means a licensed clinician employed by, or 9
associated with, an inpatient psychiatric hospital or pediatric teaching 10
hospital, who is qualified to make a clinical determination whether a child 11
meets criteria for admission to an inpatient psychiatric hospital or pediatric 12
teaching hospital for inpatient psychiatric care; 13
(c) "Department" means the Department for Behavioral Health, 14
Developmental and Intellectual Disabilities; 15
(d) "High acuity youth" means a child who has been determined by a clinical 16
professional, following a behavioral assessment, to need an environment 17
and sp ecialized treatment capable of addressing manifest aggression, 18
violence toward persons, or property destruction; 19
(e) "Inpatient psychiatric hospital" means a hospital, other than a state mental 20
hospital, that is licensed pursuant to KRS Chapter 216B to pr ovide inpatient 21
psychiatric services; and 22
(f) "Pediatric teaching hospital" has the same meaning as in KRS 205.565. 23
(2) A child who is charged with a public offense or subject to a court order to receive 24
inpatient psychiatric treatment pursuant to the Kent ucky Unified Juvenile Code 25
shall, prior to being admitted to an inpatient psychiatric hospital or pediatric 26
teaching hospital, undergo a behavioral assessment by a clinical professional to 27
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determine whether the child qualifies as a high acuity youth. 1
(3) (a) If a clinical professional determines that the child qualifies as a high acuity 2
youth following a behavioral assessment, the clinical professional shall 3
contact the: 4
1. Designated representative of the department or other designated 5
representative of the cabinet; and 6
2. Designated representative of the Department of Juvenile Justice; 7
to discuss the immediate treatment plan for the child. 8
(b) The clinical professional shall prepare an affidavit, with any documents in 9
support of the affidavit, for submiss ion to the department, the Department 10
of Juvenile Justice, and the court. The affidavit shall include: 11
1. A summary of the clinical evidence that the clinical professional relied 12
upon for the determination that the child qualifies as a high acuity 13
youth; 14
2. A recommendation of the appropriate location for any recommended 15
treatment services for the high acuity youth and the basis for the 16
recommendation based upon the child's needs and the capabilities of 17
the inpatient psychiatric hospital or pediatric teach ing hospital, or 18
whether treatment on an outpatient basis may be provided at a 19
detention facility for a child in the custody of the Department of 20
Juvenile Justice or at a location specified by the department if the 21
child is in the custody of the cabinet; and 22
3. Contact information from the inpatient psychiatric hospital or 23
pediatric teaching hospital for one (1) or more clinical professionals 24
who can provide the types of services for the high acuity youth at a 25
detention facility or location designated by th e department if it is 26
determined in the best interests of the child that the child should 27
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receive psychiatric services other than inpatient treatment services. 1
(4) (a) If the representative of the department and the representative of the 2
Department of Juve nile Justice agree with the recommendations of the 3
clinical professional, a conference affidavit establishing an initial treatment 4
plan shall be submitted to the court on a form provided by the 5
Administrative Office of the Courts within twenty -four (24) ho urs of the 6
delivery of the initial affidavit under subsection (3) of this section. 7
(b) If the representative of the department and the representative of the 8
Department of Juvenile Justice do not agree to the treatment 9
recommendations of the clinical profes sional, either party or both parties 10
shall submit an affidavit of dissent to the court on a form provided by the 11
Administrative Office of the Courts that states the clinical basis for the 12
objection, and may include a recommendation for an alternate plan, facility, 13
or assessment. The dissenting affidavit shall be signed by a physician who 14
can speak directly to the clinical basis for submitting the dissenting 15
affidavit. 16
(5) Following submission of a conference affidavit or an affidavit of dissent, the 17
court shall enter an order regarding the course of treatment or may schedule a 18
hearing to determine a treatment plan for the high acuity youth. 19
(6) Notwithstanding any other law to the contrary, the court shall not order a high 20
acuity youth for inpatient treatmen t within an inpatient psychiatric hospital or 21
pediatric teaching hospital without agreement of the hospital, the department, 22
and the Department of Juvenile Justice unless the court determines by clear and 23
convincing evidence that the inpatient psychiatric hospital or pediatric teaching 24
hospital has the resources and capabilities to treat the high acuity youth in a 25
manner that does not pose a danger to the high acuity youth or the hospital's 26
patients and staff. This subsection shall not be construed to requi re an inpatient 27
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psychiatric hospital or pediatric teaching hospital to admit a child if doing so 1
would be in violation of federal law. 2
(7) (a) If the treatment plan approved or ordered by the court involves the 3
admission of a high acuity youth to an inpati ent psychiatric hospital or 4
pediatric teaching hospital, then the provision of inpatient services by the 5
inpatient psychiatric hospital or pediatric teaching hospital shall be 6
reimbursed by the Department of Medicaid Services at no less than two 7
hundred percent (200%) of the then current inpatient psychiatric hospital's 8
or pediatric teaching hospital's Medicaid inpatient rate to account for the 9
acuity and intensity of health care items and services necessary for 10
treatment of high acuity youth, the provision s of KRS 202A.271 11
notwithstanding. 12
(b) For any admission under this subsection, the inpatient psychiatric hospital 13
or pediatric teaching hospital shall provide: 14
1. An updated treatment plan in addition to the initial treatment plan, if 15
needed, within ten (10) days from the filing of the initial affidavit; and 16
2. Status reports to the department or the Department of Juvenile Justice 17
as applicable, upon request or as ordered by the court. 18
(c) Any dispute that arises between the inpatient psychiatric hospital or 19
pediatric teaching hospital, the department, and the Department of Juvenile 20
Justice shall be resolved in the manner provided in subsections (3), (4), and 21
(5) of this section, and any party may request court review at any time 22
during the period of treatment. 23
(8) (a) If a high acuity youth is admitted to an inpatient psychiatric hospital or 24
pediatric teaching hospital for treatment pursuant to a court order issued 25
under this section, and the high acuity youth commits an act of violence or 26
incites violence against any of the hospital's patients, staff, or visitors, the 27
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inpatient psychiatric hospital or pediatric teaching hospital may file an 1
affidavit with the department or other designated representative of the 2
cabinet, or the Department of Juvenile Justice , as applicable, and with the 3
court, and the youth shall be: 4
1. Discharged from the hospital; and 5
2. Immediately returned by the department or the Department of 6
Juvenile Justice, as applicable, to the youth's last place of custody or 7
residence unless another location is ordered by the court. 8
(b) This subsection shall not preclude any person from filing a complaint in 9
reference to the youth pursuant to KRS 610.020. 10
(9) If the treatment plan approved or ordered by the court involves the provision of 11
outpatient psychiatric services to the high acuity youth at the location of a 12
detention facility, then the department or the Department of Juvenile Justice may 13
contract with a n inpatient psychiatric hospital or pediatric teaching hospital to 14
provide the outpatient psychiatric services. The inpatient psychiatric hospital or 15
pediatric teaching hospital shall be reimbursed by the Department for Medicaid 16
Services for such outpatient psychiatric services at no less than one hundred fifty 17
percent (150%) of the then current inpatient psychiatric hospital's or pediatric 18
teaching hospital's Medicaid reimbursement rate as if such services had been 19
performed in an inpatient setting, the pr ovisions of KRS 202A.271 20
notwithstanding. 21
(10) Each inpatient psychiatric hospital or pediatric teaching hospital that accepts any 22
high acuity youth under this section, the cabinet, the department, the Department 23
of Juvenile Justice, and the Court of Justi ce shall adopt and provide a protocol 24
for twenty-four (24) hour access to comply with the requirements of this section. 25
(11) When a high acuity youth has received residential treatment and the treatment 26
has improved the youth's condition to a status that t he need for continued 27
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treatment at that facility is no longer medically indicated as determined by the 1
treating physician: 2
(a) If the youth has a need for the continuum of care on an inpatient basis in 3
an inpatient psychiatric hospital, pediatric teaching hospital, or other 4
inpatient facility equipped to treat a high acuity youth, the Department for 5
Juvenile Justice, the department, and a representative of the inpatient 6
psychiatric hospital, pediatric teaching hospital, or other inpatient facility to 7
which the youth may be transferred shall proceed in accordance with 8
subsections (3), (4), and (5) of this section; 9
(b) Any additional medical care that the youth may need as part of a continuum 10
of care that requires a transfer to another facility for treatment s hall also 11
proceed in accordance with subsections (3), (4), and (5) of this section; and 12
(c) As part of the continuum of care, the same representatives from the 13
department and the Department of Juvenile Justice who have evaluated and 14
provided treatment and recommendations for the youth shall, to the extent 15
possible, continue to review the medical treatment of the youth to provide 16
stability of care with the goal of improving the life and health of the youth. 17
(12) In the event a child is delivered to an inpat ient psychiatric hospital or pediatric 18
teaching hospital for a behavioral assessment without referral by the department, 19
the cabinet, or the Department of Juvenile Justice, the clinical professional may 20
present the affidavit referenced in subsection (3) of this section to a law 21
enforcement officer, a court -designated worker, or a detention alternative 22
coordinator who shall then return the high acuity youth to the custody of the 23
custodial agency until such time as a court issues further orders regarding the 24
appropriate treatment for the high acuity youth. The inpatient psychiatric 25
hospital or pediatric teaching hospital shall then proceed according to 26
subsections (3), (4), and (5) of this section. 27