The IMPACT Plus emergency regulations (E-regs) were signed by Governor Paul Patton in July 2000. The regulations are rather lengthy and due to the space in the KPFC newsletter, an abbreviated version of sections 3 (Eligibility), 4 (Criteria for At Risk of Institutionalization), 5 (Standards for a Covered Service), and 6 (Covered Services) are below.

“Section 3. Eligibility. A recipient under twenty-one years of age shall be eligible to receive a medically necessary service covered in Section 6 of this administrative regulation if the recipient:

1. Is in, or is at risk of being in, the custody or under the supervision of the state; and
2. Meets one of the following:
   1. is in a hospital or psychiatric residential treatment facility and would meet the criteria of Section 4 of this administrative regulation if discharged;
   2. is at risk of institutionalization as specified in Section 4 of this administrative regulation; or
   3. has been determined by the department, prior to the effective date of this administrative regulation, to be an individual at risk of institutionalization. IMPACT Plus eligibility and the prior approved services shall remain valid for the period of prior approval. The individual shall be reassessed if a service requires reauthorization or within ninety (90) calendar days from the effective date of the administrative regulation to determine continuing eligibility in accordance with Section 4 of this administrative regulation.
3. Has been prior authorized by the department as eligible to receive IMPACT Plus services and continues to meet the eligibility criteria specified in this Section.”

“Section 4. Criteria for At Risk of Institutionalization.
(1) A recipient shall be at risk of institutionalization if the recipient: (a) has been individually assessed by a qualified behavioral health professional and determined to require immediate short-term residential crisis stabilization as the sole service in accordance with Section 6 (15) of this administrative regulation; or (b) has a severe, persistent, clinically significant behavioral health disorder, other than mental retardation, dementia, or a personality disorder, established in the ‘Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)” that has been documented for the past six months, and requires a coordinated plan of medically necessary community based behavioral health services to prevent worsening of the disorder that may result in institutionalization.
“(2)A recipient shall be considered no longer at risk of institutionalization and not eligible for IMPACT Plus services if” the only service required was immediate short-term residential crisis stabilization until the recipient no longer needed such service or ten (10) days were provided; or the recipient no longer meets the criteria specified in previously in this section.”

Section 5. Standards for a Covered Service. (Subsection 5 of Section 5)
(5) Except for immediate residential crisis stabilization provided as the only service pursuant to Section 4 of this administrative regulation, a covered service shall be provided in accordance with a collaborative service plan, that:
(a) Supports the level and type of care to be provided;
(b) Is recommended by a team that shall include: parent/guardian/caregiver if recipient is under 18 years of age, a behavioral health professional, a provider of targeted case management, and a representative of another child serving agency (school personnel, Department for Community Based Services, Department for Juvenile Justice, etc.).
(c) Describes a coordinated plan of medically necessary community based behavioral health services, that specifies an amount, scope, frequency, and duration, sufficient to maintain the recipient in the community; and (d) Identifies the following: a goal for transitioning to a lower intensity of services; a program of actions designed to meet the goal; interventions by caregivers in the home, school, and community setting that support a recipient’s ability to be maintained in the community; a behavioral health professional who shall manage the continuity of care; and the action to be taken by the parent/guardian/caregiver for the recipient in case of crisis.

Section 6. Covered Services (Subsection 1a of Section 6)
“(1) Targeted case management.
(a) A targeted case management service shall be a set of activities that assist a recipient in accessing needed medical, social, educational, and other support services that shall include the following:

1. An assessment of family strengths and needs;
2. Assistance in developing, coordinating, and accessing services in the collaborative service plan;
3. Coordination of collaborative team meetings to develop, modify, and review a collaborative service plan;
4. Facilitation of the implementation of a collaborative service plan;
5. Four (4) documented contacts per month including one face to face contact with a recipient and one face to face contact with parent/guardian/caregiver;
6. Monitoring of a recipient’s progress and advocating to ensure appropriate, timely, and effective treatment and support services;
7. Participation in the development of other human service plans for the recipient;
8. Development of an appropriate plan for discharge from IMPACT Plus services for a recipient nineteen years of age or older;
9. Provision to a recipient of a list of subcontractors authorized to provide a service pursuant to a collaborative service plan for the purpose of selecting a provider; and
10. Provision to a recipient of information about the availability of a service pursuant to 907 KAR 1:034 if a service pursuant to this administrative regulation is not available.”

If your child is currently identified as IMPACT Plus eligible, he/she will be reassessed at the end of his/her current service period, when reauthorization is required, or within ninety calendar days from July 20, 2000. Continuing eligibility will be based on these new regulations. A fourth team member was added to the collaborative service team to include a representative from a child serving agency, such as school personnel, Department for Community Based Services, Department for Juvenile Justice, or another child serving agency. For school-age children, school personnel would be the most likely candidate that should be encouraged to attend. Other options can include, but are not limited to scout leaders, clergy persons, community mentors, Vocational Rehabilitation representative, and Job Corps representative. KPFC recommends that the person should be someone who is currently involved with the recipient and his/her family, or a representative from an agency that can offer appropriate services/resources to the recipient and his/her family. If your child is currently being served by IMPACT Plus, let your service coordinator know who you would like to see invited as the fourth member of the service team.

If you have questions about the regulations or would like to receive a copy of the complete regulations, you can contact Carla Mahan at (502)564-7610.