Kentucky

(1) "Mentally retarded person" means a person with significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period.

(2) "Mental illness" means a diagnostic term that covers many clinical categories, typically including behavioral or psychological symptoms, or both, along with impairment of personal and social function, and specifically defined and clinically interpreted through reference to criteria contained in the Diagnostic and Statistical Manual of Mental Disorders (Third Edition) and any subsequent revision thereto, of the American Psychiatric Association.

(3) "Chronic" means that clinically significant symptoms of mental illness have persisted in the individual for a continuous period of at least two (2) years, or that the individual has been hospitalized for mental illness more than once in the last two (2) years, and that the individual is presently significantly impaired in his ability to function socially or occupationally, or both.

(4) "Cabinet" means the Cabinet for Health Services.

(5) "Deaf or hard-of-hearing" means having a hearing impairment so that a person cannot hear and understand speech clearly through the ear alone, irrespective of the use of any hearing aid device.

(6) "Secretary" means the secretary of the Cabinet for Health Services.

210.010 Rules and regulations

The secretary for health services shall have authority to prescribe rules and regulations for the administration of the cabinet and of the institutions under the control of the cabinet, including power to regulate the payment of money to patients in mental institutions for work performed.

210.020 Qualifications of commissioner and other personnel; compensation-- Repealed

210.030 Advisory council of mental health--Repealed

210.031 Advisory committee on need for services for deaf or hard-of-hearing persons

(1) The cabinet shall establish an advisory committee of sixteen (16) members to advise the Department for Mental Health and Mental Retardation Services of the need for particular services for persons who are deaf or hard-of-hearing.

(a) At least eight (8) members shall be deaf or hard-of-hearing and shall be appointed by the secretary. Four (4) deaf or hard-of-hearing members, representing one (1) of each of the following organizations, shall be appointed from a list of at least two (2) nominees submitted from each of the following organizations:

1. The Kentucky Association of the Deaf;

2. The A.G. Bell Association;

3. The Kentucky School for the Deaf Alumni Association; and

4. Self Help for the Hard of Hearing.

The remaining four (4) deaf or hard-of-hearing members shall be appointed by the secretary from a list of at least eight (8) nominees submitted by the

Kentucky Commission on the Deaf and Hard of Hearing.

(b) One (1) member shall be a family member of a deaf or hard-of-hearing consumer of mental health services and shall be appointed by the secretary from a list of nominees accepted from any source.

1. The Cabinet for Health Services, Department for Mental Health and Mental Retardation Services;

2. The Cabinet for Workforce Development, Department of Vocational Rehabilitation;

3. The Cabinet for Health Services, Office of Aging Services;

4. The Education, Arts, and Humanities Cabinet, Commission on the Deaf and Hard of Hearing;

5. The Kentucky Registry of Interpreters for the Deaf; and

6. A Kentucky School for the Deaf staff person involved in education.

(d) The remaining member shall be a representative of a regional mental health/mental retardation board, appointed by the commissioner of the Department for Mental Health and Mental Retardation Services from a list composed of two (2) names submitted by each regional mental health/mental retardation board.

(2) Of the members defined in subsection (1)(a) and (b) of this section, three (3) shall be appointed for a one (1) year term, three (3) shall be appointed for a two (2) year term, and three (3) shall be appointed for a three (3) year term; thereafter, they shall be appointed for three (3) year terms. The members defined under subsection (1)(c) and (d) of this section shall serve with no fixed term of office.

(3) The members defined under subsection (1)(a) and (b) of this section shall serve without compensation but shall be reimbursed for actual and necessary expenses; the members defined under subsection (1)(c) and (d) shall serve without compensation or reimbursement of any kind.

(4) The Department for Mental Health and Mental Retardation Services shall make available personnel to serve as staff to the advisory committee.

(5) The advisory committee shall meet quarterly at a location determined by the committee chair.

(6) (a) The advisory committee shall prepare a biennial report which:

1. Describes the accommodations and the mental health, mental retardation, development disability, and substance abuse services made accessible to deaf and hard-of-hearing persons;

2. Reports the number of deaf or hard-of-hearing persons served;

3. Identifies additional service needs for the deaf and hard-of-hearing; and

4. Identifies a plan to address unmet service needs.

(b) The report shall be submitted to the secretary, the commissioner of the Department for Mental Health and Mental Retardation Services, and the Interim Joint Committee on Health and Welfare by July 1 of every odd-numbered year.

210.035 Medical school-mental health coordinating committee; functions-- Repealed

210.040 Powers and duties of cabinet

The Cabinet for Health Services shall:

(1) Exercise all functions of the state in relation to the administration and operation of the state institutions for the care and treatment of persons with mental illness;

(2) Establish or acquire, in accordance with the provisions of KRS 56.440 to 56.550, other or additional facilities for psychiatric care and treatment of persons who are or may become state charges;

(3) Cooperate with other state agencies for the development of a statewide mental health program looking toward the prevention of mental illness and the post-institutional care of persons released from public or private mental hospitals;

(4) Provide for the custody, maintenance, care, and medical and psychiatric treatment of the patients of the institutions operated by the cabinet;

(5) Provide psychiatric consultation for the state penal and correctional institutions, and for the state institutions operated for children or for persons with mental retardation;

(6) Administer and supervise programs for the noninstitutional care of persons with mental illness;

(7) Administer and supervise programs for the care of persons with chronic mental illness, including but not limited to provision of the following:

(a) Identification of persons with chronic mental illness residing in the area to be served;

(b) Assistance to persons with chronic mental illness in gaining access to essential mental health services, medical and rehabilitation services, employment, housing, and other support services designed to enable persons with chronic mental illness to function outside inpatient institutions to the maximum extent of their capabilities;

twenty-four (24) hour supervision and community-based cooperative facilities with part-time supervision; provided that, no more than either one (1) transitional facility or one (1) cooperative facility may be established in a county containing a city of the first class or consolidated local government with any funds available to the cabinet;

(d) Assurance of the availability of a case manager for each person with chronic mental illness to determine what services are needed and to be responsible for their provision; and

(e) Coordination of the provision of mental health and related support services with the provision of other support services to persons with chronic mental illness;

(8) Require all providers who receive public funds through state contracts, state grants, or reimbursement for services provided to have formalized quality assurance and quality improvement processes, including but not limited to a grievance procedure; and

(9) Supervise private mental hospitals receiving patients committed by order of a court.

210.042 Funding for nonprofit agency; matching funds

(1) The Cabinet for Health Services may provide, to the extent funds are available under KRS 210.040 and under conditions and standards established by the cabinet, funds to any nonprofit agency recognized as operating in the field of mental health and whose objectives are to carry out the purposes of KRS 210.040.

(2) The funds, if provided, may be matched on a fifty-fifty (50-50) basis by the nonprofit agency receiving such funds. The cabinet shall determine whether the match may be in money or in kind services or other match.

210.045 Additional duties; requirements as to closure of certain state- owned or state-operated mental facilities

(1) The Cabinet for Health Services shall:

(a) Maintain, operate, and assume program responsibility for all state institutions and facilities for mental retardation;

(b) Provide rehabilitation services for mentally retarded persons through educational and training programs;

(d) Encourage and assist communities to develop programs and facilities in the field of mental retardation;

(e) Sponsor or carry out research, or both, in the field of mental retardation;

(f) Assist other governmental and private agencies in the development of programs and services for mentally retarded persons and their families and for the prevention of mental retardation, and coordinate programs and services so developed;

(g) Provide written notice to the Legislative Research Commission of its intent

to propose legislation to permit immediate or gradual closure of any state- owned or state-operated facility that provides residential services to persons with mental retardation or other developmental disabilities at least sixty (60) days prior to the next legislative session; and

(h) 1. Provide written notice by registered mail to each resident, his or her immediate family, if known, and his or her guardian of its intent to propose legislation to permit immediate or gradual closure of any state-operated facility that provides residential services to persons with mental retardation or other developmental disabilities at least sixty (60) days prior to the next legislative session; and

2. Include in the written notice provided under this paragraph that the resident, the resident's immediate family, his or her guardian, or any other interested party with standing to act on behalf of the resident has the right to pursue legal action relating to the notice provisions of this paragraph and relating to the closure of the facility.

(2) Any state-owned or state-operated facility or group home that provides residential services to persons with mental retardation or other developmental disabilities and that has been funded by the General Assembly in a specific biennium, shall not be closed, nor shall the Cabinet for Health Services

announce the pending closure of the facility, during the same biennium except through the provisions specified by subsection (1) of this section.

(3) The Cabinet for Health Services may close any state-owned or state- operated facility that provides residential services to persons with mental retardation or other developmental disabilities upon the effective date of an adopted act of legislation.

(4) When a demonstrated health or safety emergency exists for a facility or a federal action that requires or necessitates a gradual or immediate closure exists for the facility, the cabinet may seek relief from the requirements of this section in the Circuit Court of the county where the facility is located. In these situations:

(a) The cabinet shall provide written notice by registered mail to each resident, the resident's immediate family, if known, and his or her guardian, at least ten (10) days prior to filing an emergency petition in the Circuit Court; and

(b) All interested parties, including the cabinet, the resident, his or her immediate family, his or her guardian, or other interested parties with standing to act on behalf of the resident shall have standing in the

proceedings under this subsection.

(5) Any resident, family member or guardian, or other interested parties, as defined by KRS 387.510(12) with standing to act on behalf of the resident who wishes to challenge the decision or actions of the Cabinet for Health Services regarding the notice requirements of subsection (1) of this section shall have a cause of action in the Circuit Court of the county in which the facility is located, or in Franklin Circuit Court. In addition to other relief allowable by law, the resident, family member or guardian, or other interested party with standing to act on behalf of the resident may seek compensatory damages and attorney fees. Punitive damages shall not be allowable under this section.

(6) Any resident, family member or guardian, or other interested parties, as defined by KRS 387.510(12) with standing to act on behalf of the resident may challenge the decision of the state to close a facility in a de novo hearing in the Circuit Court of the county in which the facility is located, or in Franklin Circuit Court. In addition to other relief allowable by law, the resident, family member or guardian, or other interested party with standing to act on behalf of the resident may seek compensatory damages and attorney fees.

Punitive damages shall not be allowable under this section.

210.047 Facility closure hearing; required considerations

A court hearing as provided under KRS 210.045(6) shall consider each of the following items relevant to the closure of the facility:

(1) Estimated timelines for the implementation of the closure of the facility;

(2) The types and array of available and accessible community-based services for individuals with mental retardation and other developmental disabilities and their families;

(3) The rights of individuals with mental retardation and other developmental disabilities;

(4) The process used to develop a community living plan;

(5) Individual and community monitoring and safeguards to protect health and

safety;

(6) The responsibilities of state and local governments;

(7) The process used to transfer ownership or the state's plan to reuse the property; and

(8) Other issues identified by the cabinet, the resident, family member or guardian, or other interested party with standing to act on behalf of the resident that may affect the residents, their families, employees, and the community.

210.049 Applicability of notice provisions to pre-existing closure announcements; delay of hearings

For any facility that the cabinet has announced plans for closure prior to April 5, 2000, the cabinet shall be subject to the notice provisions of KRS 210.045 within ten (10) days of April 5, 2000. The cabinet shall delay proceedings toward closure until the proceedings for all hearings permitted under KRS 210.045 have been completed.

210.050 Administrative organization of department--Repealed

210.055 Additional powers

The Cabinet for Health Services may:

(1) Promulgate reasonable rules and regulations for the purposes of carrying out the provisions of KRS 210.045, including regulations establishing the minimum and maximum ages within which mentally retarded persons are eligible:

(a) To participate in programs operated by the cabinet;

(b) To become patients in institutions operated by the cabinet;

(2) Participate in the education and training of professional and other persons in the field of mental retardation, and may encourage and assist private and public agencies and institutions to participate in similar education and training;

(3) Do all other things reasonably necessary to carry out the provisions of KRS 210.045.

210.057 Powers and duties as to research on controlled substances

(1) The Cabinet for Health Services shall conduct research into all aspects of controlled substances as defined in KRS 218A.010 in coordination with the Kentucky Board of Pharmacy.

(2) The Cabinet for Health Services may authorize persons engaged in research on the use and effects of dangerous substances to withhold the names and other identifying characteristics of persons who are subjects of such research. Persons who obtain this authorization may not be compelled in any state civil, criminal, administrative, legislative, or other proceeding to identify the subjects of research for which such authorization was obtained.

(3) The Cabinet for Health Services may authorize the possession and distribution of controlled dangerous substances by persons engaged in research. Persons who obtain this authorization shall be exempt from state prosecution for possession and distribution of dangerous substances to the extent authorized by the Cabinet for Health Services.

210.090 Partisan political activity prohibited

Neither the commissioner of the Department for Mental Health and Mental Retardation of the Cabinet for Health Services nor his deputy nor any superintendent or director of an institution of the Department for Mental Health and Mental Retardation shall be permitted to engage in any partisan political activity.

210.100 Exemption of institutional officers and employees from personal attendance as witness

No officer or employee of any institution operated by the Cabinet for Health Services shall be required to give personal attendance as a witness in any civil suit out of the county in which the institution is located, but his deposition shall be taken in lieu thereof.

210.110 Officers, employees, and agents of Cabinet for Health Services and regional community mental health-mental retardation programs not to sell to or make contracts with institutions, facilities, or organizations under cabinet's control if conflict of interest involved

(1) No officer, employee, or agent of the Cabinet for Health Services, a regional community mental health-mental retardation board or a nonprofit corporation administering a regional community mental health-mental retardation program shall sell anything to any institution, facility, or organization under the control of the cabinet nor participate in selection, or in the award or administration of a contract supported by state or federal funds if a conflict of interest, real or apparent, would be involved.

(2) Such a conflict of interest would arise when:

(a) The employee, officer, or agent;

(b) Any member of his immediate family;

(d) An organization which employs, or is about to employ, any of the above,

has a financial or other interest in the firm selected for award.

210.120 Officers and employees not to accept outside compensation; exceptions

No physician or doctor employed by the Cabinet for Health Services shall receive or accept any compensation for personal services other than that paid by the state, except that the secretary, and other physicians and doctors when so authorized by the secretary, may be employed in, and receive compensation from outside activities such as teaching, research, or community service work, to an extent that will not interfere with the performance of the duties of their office or employment.

210.130 Religious instruction and ministration

Religious instruction and ministration for patients of the institutions operated by the Cabinet for Health Services shall be provided.

210.140 Transfer of patient or inmate to institution operated by different cabinet

(1) Pursuant to agreement entered into by the heads of the cabinets concerned, a patient or inmate of a state institution operated by one (1) state cabinet may be transferred to a state institution operated by another state cabinet, except that:

(a) An inmate may be transferred from a penal or correctional institution as provided in KRS Chapter 202A or in any regulation promulgated under such chapter, provided that no transfer shall be made to a correctional facility located on the grounds of a state mental hospital;

(b) No patient or inmate may be transferred to a penal or correctional institution unless he has been committed to such institution by judgment of a court; and

(c) No patient or inmate may be transferred to an institution for the mentally ill or mentally retarded except for a period of observation not to exceed sixty (60) days, unless he has been hospitalized in accordance with KRS 202A.051.

(2) When a patient or inmate hospitalized by court order to one (1) institution is transferred to another institution pursuant to this section, the order of hospitalization shall be deemed to apply to the institution to which transferred.

210.220 Correspondence by patients with secretary or attorneys

No patient of any of the institutions operated by the Cabinet for Health Services shall be denied the right to correspond with an attorney or with the secretary.

210.230 Records and forms

The secretary of the Cabinet for Health Services may prescribe appropriate records to be maintained covering the operations of the cabinet and of the institutions operated by it, and covering involuntary hospitalization procedures. Any record forms applicable to involuntary hospitalization procedures shall be furnished to each court having jurisdiction to order hospitalization of mentally ill or retarded persons, and the records contemplated by such forms shall thereafter be made by the hospitalizing courts.

210.235 Confidential nature of records

All applications and requests for admission and release, and all certifications, records, and reports of the Cabinet for Health Services which directly or indirectly identify a patient or former patient or a person whose hospitalization has been sought, shall be kept confidential and shall not be disclosed by any person, except insofar as:

(1) The person identified or his guardian, if any, shall consent; or

(2) Disclosure may be necessary to carry out the provisions of the Kentucky Revised Statutes, and the rules and regulations of cabinets and agencies of the Commonwealth of Kentucky; or

(3) Disclosure may be necessary to comply with the official inquiries of the departments and agencies of the United States government; or

(4) A court may direct upon its determination that disclosure is necessary for the conduct of proceedings before it and failure to make such disclosure would be contrary to the public interest. Nothing in this section shall preclude the disclosure, upon proper inquiry of the family or friends of a patient, of information as to the medical condition of the patient.

210.240 Training schools

The secretary of the Cabinet for Health Services is authorized to establish training schools within the cabinet or within any of the institutions operated by the cabinet, for the training of necessary personnel for the institutions, or may arrange for the training of employees or prospective employees in any public or private school or institution having available facilities for that purpose. Funds of the cabinet may be used to pay salaries to employees, or to pay tuition and subsistence for employees or prospective employees, while receiving such training. Any employee or prospective employee who is paid a salary, or for whom tuition and subsistence are furnished, while receiving such training, shall be required to enter into a contract, prior to receiving such training, that unless he continues in the employ of the cabinet for at least a period equivalent to the training period, immediately following the completion of such training, he will reimburse to the cabinet the sum paid to or for him by the cabinet during the period of training.

210.270 Custodial care of mental patients in private homes, private nursing homes, and private institutions; transfer or reclassification of patient; procedure

(1) The secretary of the Cabinet for Health Services is authorized to designate those private homes, private nursing homes, and private institutions that he deems, after a thorough investigation of the personal and financial qualifications of the owners and tenants, the facilities and management, and the desirability of the location of the homes, suitable for the placement of patients, including individuals with mental illness or mental retardation of all ages, outside of the state mental hospitals. The secretary of the Cabinet for Health Services may promulgate, by administrative regulation, standards for the selection and operation of private homes, private nursing homes, and private institutions designated for the placement of patients. No home of an officer or employee of the Cabinet for Health Services or of a member of his immediate family shall be designated for the placement of patients.

(2) Whenever the staff of a state mental hospital has determined that a

patient who is not being held on an order arising out of a criminal offense has sufficiently improved and is not dangerous to himself or other persons, and that it would be in the patient's best interest to be placed outside of the hospital in a private home or private nursing home, the hospital shall so certify and authorize the patient to be transferred to a designated private home or private nursing home for care and custody for a length of time that the hospital deems advisable.

(3) No patient with mental retardation lodged in a state institution may have his level of care reclassified nor may he be transferred to a private nursing home or other private institution without first providing ten (10) days' notice by certified mail, return receipt requested, to the patient's parents or guardian that a reclassification of the patient's level of care or a transfer in the place of residence is being considered.

(4) Any parent or guardian of any patient with mental retardation lodged in a state institution may participate in any evaluation procedure which may result in a reclassification of the patient's level of care or in a transfer in the place of residence of the patient. Participation may include the submission by the parents or guardian of medical evidence or any other evidence deemed

relevant by the parents or guardian to the possible reclassification or transfer of the patient.

(5) If the decision to reclassify or transfer any patient with mental retardation is adverse to the best interests of the patient as expressed by the parents or guardian, they shall be given notice by certified mail, return receipt requested, that they are entitled to a thirty (30) day period from the receipt of such notice to file with the secretary of the Cabinet for Health Services a notice of appeal and application for a hearing. Upon receipt of an application for a hearing, a hearing shall be conducted in accordance with KRS Chapter 13B.

(6) The appeal shall be heard by a three (3) member panel composed of a designated representative of the Cabinet for Health Services, a designated representative of the state institution where the patient with mental retardation is presently lodged, and a designated neutral representative appointed by the county judge/executive wherein the institution in question is located. The secretary may appoint a hearing officer to preside over the conduct of the hearing.

(7) Decisions made by the panel may be appealed to the Circuit Court of the county in which the state institution in question is located, to the Circuit Court of the county in which either of the parents or guardians or committee of the patient in question is domiciled at the time of the decision, or to Franklin Circuit Court in accordance with KRS Chapter 13B.

(8) All parents or guardians or committee of a patient with mental retardation lodged in a state institution shall be fully apprised by the Cabinet for Health Services of their rights and duties under the provisions of subsections (3), (4), (5), (6), and (7) of this section.

(9) The provisions of KRS 210.700 to 210.760 shall apply to patients transferred to designated private homes and private nursing homes as though the patients were residing in a state mental hospital.

210.271 State hospital patients to be discharged to registered boarding homes only; quarterly follow-up visits by cabinet

(1) No patient in an institution for the mentally ill or the mentally retarded operated by the Cabinet for Health Services shall be discharged to a boarding home as defined in KRS 216B.300 unless the boarding home is registered pursuant to KRS 216B.305.

(2) The cabinet shall conduct a quarterly follow-up visit, using cabinet personnel or through contract with the Regional Community Mental Health Centers, of all patients of state mental health or mental retardation facilities that are discharged to boarding homes. Any resident found to have needs that cannot be met by the boarding home shall be referred to the Department for Community Based Services for appropriate placement. Any boarding home suspected of operating as an unlicensed personal care facility or housing residents with needs that cannot be met by the boarding home shall be reported to the Division of Community Health Services for investigation.

210.285 Powers of cabinet; forms; reports; rules and regulations

In addition to the specific authority granted by other provisions of KRS Chapters 202A, 202B, and 210, the Cabinet for Health Services shall have authority to prescribe the form of applications, records, reports, and medical certificates provided for under KRS Chapters 202A, 202B, and 210 and the information required to be contained therein; to require reports from the head of any hospital relating to the admission, examination, diagnosis, release, or discharge of any patient; to visit hospitals regularly to review the hospitalization procedures of all new patients admitted between visits; to investigate by personal visit complaints made by any persons on behalf of any patients or by any patients themselves; and to adopt such rules and regulations not inconsistent with the provisions of KRS Chapters 202A, 202B, and 210 as it may find to be reasonably necessary for proper and efficient hospitalization of the mentally ill.

210.290 Cabinet may act as fiduciary; duties; powers

(1) The Cabinet for Families and Children may be appointed and act as executor, administrator, guardian, limited guardian, conservator, or limited conservator as provided in this section. In this capacity the cabinet may transact business in the same manner as any individual and for this purpose may sue and be sued in any of the courts of the state. Bond shall not be required of the cabinet.

(2) Whenever a resident of the state is adjudged partially disabled or disabled and no other suitable person or entity is available and willing to act as limited guardian, guardian, limited conservator, or conservator, the cabinet, acting through its designated officer, may apply to the District Court of the county in which the adjudication is made for appointment as limited guardian, guardian, limited conservator, or conservator for such partially disabled or disabled person.

(3) Upon the death of a person for whom the cabinet has been appointed

guardian or conservator, or upon the death of a person who has been committed to the cabinet leaving an estate and having no relatives at the time residing within the state, the cabinet may apply for appointment as administrator and upon appointment shall close the administration of the estate.

(4) The cabinet may invest funds held as fiduciary in bonds or other securities guaranteed by the United States, and may sell or exchange such securities in its discretion.

(5) The cabinet shall receive such fees for its fiduciary services as provided by law. These fees shall be placed in a trust and agency account, from which may be drawn expenses for filing fees, court costs, and other expenses incurred in the administration of estates. Claims of the cabinet against the estates shall be considered in the same manner as any other claim.

(6) An officer designated by the secretary may act as legal counsel for any patient in a state mental hospital or institution against whom a suit of any nature has been filed, without being appointed as guardian, limited guardian, conservator, or limited conservator.

(7) Patients hospitalized pursuant to KRS Chapters 202A and 202B who are not adjudged disabled or partially disabled may authorize the Cabinet for Families and Children to handle personal funds received by them at the hospital in the same manner as prescribed in subsections (4) and (5) of this section.

210.300 Designation of hospital districts

The secretary of the Cabinet for Health Services shall prescribe from time to time, by regulations, for the designation of hospital districts, for the purpose of determining to which of the state institutions for the mentally ill the persons admitted from each county shall initially be sent.

210.330 Employment of attorney; cost of litigation; limitation of action

(1) The cabinet may employ counsel, upon the advice and approval of the Attorney General, to institute or defend such actions or proceedings as it deems necessary or proper to enforce the payment or reimbursement for board and maintenance of patients. In case of failure of suits, the expense thereof shall be certified by the secretary of the Finance and Administration Cabinet which shall provide for its payment out of the funds appropriated for the use of the cabinet.

(2) The statute of limitation providing the time in which actions for such recovery may be instituted shall not run against recovery provided for in this chapter until from and after the time at which the estate is acquired.

210.340 Extradition of nonresident patient

Any nonresident who has been committed to a mental institution in another state and who escapes therefrom and is found in this state may be apprehended upon notice from the other state and returned thereto by personnel of the cabinet at the cabinet's expense.

210.350 Return of nonresidents; expense

If an order is issued by a judge committing to a state institution a person who has not acquired a legal residence in this state, the cabinet shall return such person, either before or after his admission to the institution, to the country or state to which he belongs and for such purposes may expend so much of the money appropriated to it as is necessary.

210.360 Mental examination of persistent felony offenders

(1) When a person who has been twice previously convicted of a felony is indicted by a grand jury as a persistent felony offender, the circuit clerk of the court in which he is indicted shall give notice of the indictment to the secretary of the Cabinet for Health Services within seven (7) days after the indictment is returned by the grand jury. The secretary shall cause such person to be examined by a psychiatrist or licensed clinical psychologist already in the employ of the cabinet, to determine his mental condition and the existence of any mental illness or retardation which would affect his criminal responsibility. This examination shall be made without expense other than the amount to cover necessary travel, as provided by law for any other employee of the state traveling on official business.

(2) The psychiatrist or licensed clinical psychologist making the examination shall submit a written report of his findings to the judge of the court having jurisdiction, who shall make the report available to the prosecuting attorney and the attorney for the defendant.

(3) The secretary may decline to cause such examination to be made if the number of psychiatrists or licensed clinical psychologists on duty in the cabinet is insufficient to spare one from his regular official duties, in which event the secretary shall notify the clerk of the Circuit Court to that effect within three (3) days.

210.370 Cities or counties may join in providing mental health and mental retardation program

Any combination of cities or counties of over fifty thousand (50,000) population, and upon the consent of the secretary of the Cabinet for Health Services, any combination of cities or counties with less than fifty thousand (50,000) population, may establish a regional community mental health and mental retardation services program and staff same with persons specially trained in psychiatry and related fields. Such programs and clinics may be administered by a community mental health-mental retardation board established pursuant to KRS 210.370 to 210.460, or by a nonprofit corporation.

210.380 Community mental health-mental retardation board; establishment; membership

Every combination of cities and counties establishing a regional community mental health and mental retardation services program shall, before it comes within the provisions of KRS 210.370 to 210.460, establish a community mental health-mental retardation board consisting of at least nine (9) members. When a nonprofit corporation is the administrator of such a program not established by a combination of either cities or counties, such corporation shall select a community mental health-mental retardation board which shall be representative of the groups herein enumerated, but the number of members need not be nine (9). When any combination of cities and counties establishes a regional community mental health and mental retardation services program, the chief executive officer of each participating city or county shall appoint two (2) members to a selecting committee which shall select the members of the board. Membership of the community mental health-mental retardation boards shall be representative of the elected chief executives of county governments, local health departments, medical societies, county welfare boards, hospital

boards, lay associations concerned with mental health and mental retardation as well as labor, business and civic groups and the general public.

210.400 Duties of board

Subject to the provisions of this section and the policies and regulations of the secretary of the Cabinet for Health Services, each community mental health- mental retardation board shall:

(1) Review and evaluate mental health and mental retardation services provided pursuant to KRS 210.370 to 210.460, and report thereon to the secretary of the Cabinet for Health Services, the administrator of the program, and, when indicated, the public, together with recommendations for additional services and facilities;

(2) Recruit and promote local financial support for the program from private sources such as community chests, business, industrial and private foundations, voluntary agencies, and other lawful sources, and promote public support for municipal and county appropriations;

(3) Promote, arrange, and implement working agreements with other social service agencies, both public and private, and with other educational and judicial agencies;

(4) Adopt and implement policies to stimulate effective community relations;

(5) Be responsible for the development and approval of an annual plan and budget;

(6) Act as the administrative authority of the community mental health and mental retardation program; and

(7) Oversee and be responsible for the management of the community mental health and mental retardation program in accordance with the plan and budget adopted by the board and the policies and regulations issued under KRS 210.370 to 210.480 by the secretary of the Cabinet for Health Services.

210.405 Board may act as fiduciary; duties; powers

(1) Any regional community mental health-mental retardation board established pursuant to KRS 210.380 and recognized by the secretary of the Cabinet for Health Services may be appointed and act as executor, administrator, guardian, limited guardian, conservator, or limited conservator, as provided in this section. In this capacity, the board may transact business in the same manner as any individual and for this purpose may sue and be sued in any of the courts of the state. Bond shall not be required of the board.

(2) Whenever a person who has been adjudged mentally disabled and requires mental health services has no guardian or conservator, the board, acting through its designated officer, may apply to the District Court of the county in which the adjudication was made for its appointment as guardian or conservator for such mentally disabled person. The board may also apply to be substituted as guardian or conservator for a mentally disabled person whose guardian or conservator is the Cabinet for Families and Children and who has been discharged or whose discharge is imminent from a Cabinet for Health

Services facility.

(3) Upon the death of a person for whom the board has been appointed guardian or conservator leaving an estate and having no relatives at the time residing within the state, the board may apply for appointment as administrator and upon appointment shall close the administration of the estate.

(4) The board may invest funds held as fiduciary in bonds or other securities guaranteed by the United States, and may sell or exchange such securities in its discretion.

(5) The board shall receive such fees for its fiduciary services as provided by law. These fees shall be placed in a trust and agency account, from which may be drawn expenses for filing fees, court costs, and other expenses incurred in the administration of estates. Claims of the board against the estates shall be considered in the same manner as any other claim.

210.410 State aid for regional mental health and mental retardation programs

(1) The secretary of the Cabinet for Health Services is hereby authorized to make state grants and other fund allocations from the Cabinet for Health Services to assist any combination of cities and counties, or nonprofit corporations in the establishment and operation of regional community mental health and mental retardation programs which shall provide at least the following services:

(a) Inpatient services;

(b) Outpatient services;

(d) Emergency services;

(e) Consultation and education services; and

(f) Mental retardation services.

(2) The services required in subsection (1)(a), (b), (c), (d), and (e) of this section shall be available to the mentally ill, drug abusers and alcohol abusers, and all age groups including children and the elderly. The services

required in subsection (1)(a), (b), (c), (d), (e), and (f) shall be available to the mentally retarded. The services required in subsection (1)(b) of this section shall be available to any child age sixteen (16) or older upon request of such child without the consent of a parent or legal guardian, if the matter for which the services are sought involves alleged physical or sexual abuse by a parent or guardian whose consent would otherwise be required.

210.420 Limits on state general fund grants; purpose for which made; distribution formula

(1) Except as hereinafter provided, grants from state general funds for any program shall not exceed fifty percent (50%) of the total expenditures for:

(a) Salaries;

(b) Contract facilities and services;

(d) Per diem and travel expenses for members of the community mental health- mental retardation boards; and

(e) Other expenditures specifically approved by the secretary for health services.

No grants from state general funds shall be made for capital expenditures. Grants from state general funds may be made for expenditures for mental health and mental retardation services whether provided by operation of a local facility or through contract with other public or private agencies.

(2) The secretary of the Cabinet for Health Services shall distribute to community mental health-mental retardation boards those general funds appropriated to the cabinet for the operation of regional community mental health-mental retardation programs. This distribution shall be by a formula which includes provisions for:

(a) Per capita allocations;

(b) Incentive allocations which require local matching funds based on the per capita wealth of the area served; and

The formula for allocation of community mental health-mental retardation program general funds shall be prescribed by administrative regulations.

210.450 Additional powers and duties of secretary as to regional programs

In addition to the powers and duties already conferred upon him by the law, the secretary of the Cabinet for Health Services shall:

(1) Promulgate policies and regulations governing eligibility of community mental health and mental retardation programs to receive state grants and other fund allocations from the Cabinet for Health Services, prescribing standards for qualification of personnel and quality of professional service and for in- service training and educational leave programs for personnel, governing eligibility for service so that no person will be denied service on the basis of race, color or creed, or inability to pay, providing for establishment of fee schedules which shall be based upon ability to pay, regulating fees for diagnostic services, which services may be provided for anyone without regard to his financial status, when referred by the courts, schools, or health and welfare agencies whether public or private, governing financial record keeping, prescribing standards for personnel management operations, providing for

financial and program reporting requirements, and such other policies and regulations as he deems necessary to carry out the purposes of KRS 210.370 to 210.460;

(2) Review and evaluate local programs and the performance of administrative and psychiatric personnel and make recommendations thereon to community mental health-mental retardation boards and program administrators;

(3) Provide consultative service, by mental health and mental retardation professionals qualified by education and training, to communities to assist in ascertaining local needs and in planning and establishing community mental health and mental retardation programs;

(4) Employ necessary and qualified personnel to implement KRS 210.370 to 210.460; and

(5) Review annually the community mental health-mental retardation boards' personnel policies, procedures, and personnel compensation plans and disapprove if not consistent with accepted standards of personnel and salary administration prescribed by the cabinet.

210.500 Legislative findings on planning for mental health and substance abuse servicesThe General Assembly of the Commonwealth of Kentucky hereby finds and declares that:

(1) National initiatives, including the 1999 White House Conference on Mental Health and the 1999 United States Surgeon General's Report on Mental Health, have promoted the concept that mental health is fundamental to health care.

(2) It has been found that:

(a) The leading causes of disability for individuals age five (5) and older are mental disorders;

(b) The current mental health and substance abuse system is lacking a comprehensive state plan that would improve the mental health status of the citizens of the Commonwealth; and

substance abuse services.

210.502 Kentucky Commission on Services and Support for Individuals with Mental Illness, Alcohol and Other Drug Abuse Disorders, and Dual Diagnoses

(1) There is created the Kentucky Commission on Services and Supports for Individuals with Mental Illness, Alcohol and Other Drug Abuse Disorders, and Dual Diagnoses. The commission shall consist of:

(a) The secretary of the Cabinet for Health Services;

(b) The secretary of the Cabinet for Families and Children;

(d) The commissioner of the Department for Mental Health and Mental Retardation Services;

(e) The commissioner of the Department for Medicaid Services;

(f) The commissioner of the Department of Corrections;

(g) The commissioner of the Department of Juvenile Justice;

(h) The commissioner of the Department of Education;

(i) The commissioner of the Department of Vocational Rehabilitation;

(j) The director of the Protection and Advocacy Division of the Public Protection and Regulation Cabinet;

(k) The director of the Office of Family Resource and Youth Services Centers;

(l) The executive director of the Office of Aging Services of the Cabinet for Health Services;

(m) The executive director of the Kentucky Agency for Substance Abuse Policy;

(n) The executive director of the Criminal Justice Council;

(o) The director of the Administrative Office of the Courts;

(p) The chief executive officer of the Kentucky Housing Corporation;

(q) The executive director of the Office of Transportation Delivery of the Transportation Cabinet;

(r) The commissioner of the Department of Public Health;

(s) Three (3) members of the House of Representatives who are members of the Health and Welfare Committee or the Appropriations and Revenue Committee, appointed by the Speaker of the House;

(t) Three (3) members of the Senate who are members of the Health and Welfare Committee or the Appropriations and Revenue Committee, appointed by the Senate President;

(u) A chairperson and one (1) alternate who is a chairperson of a regional planning council appointed by the secretary of the Cabinet for Health Services from a list of five (5) chairpersons submitted by the Kentucky Association of Regional Mental Health/Mental Retardation Programs;

(v) A consumer and one (1) alternate who is a consumer of mental health or substance abuse services, who is over age eighteen (18), appointed by the secretary of the Cabinet for Health Services from a list of up to three (3) consumers submitted by any consumer advocacy organization operating within Kentucky or submitted by any regional planning council established under KRS 210.506; and

(w) An adult family member and one (1) alternate who is an adult family member of a consumer of mental health or substance abuse services appointed by the secretary of the Cabinet for Health Services from a list of up to three (3) persons submitted by any family advocacy organization operating within Kentucky or submitted by any regional planning council established under KRS 210.506.

(2) The secretary of the Cabinet for Health Services and one (1) member of the General Assembly appointed to the commission shall serve as co-chairs of the commission.

(3) Members designated in paragraphs (a) to (t) of subsection (1) of this section shall serve during their terms of office.

(4) Members and alternates designated in paragraphs (u) to (w) of subsection

(1) of this section shall serve a term of two (2) years and may be reappointed for one (1) additional term. These members may be reimbursed for travel expenses in accordance with administrative regulations governing reimbursement for travel for state employees.

210.504 Commission meetings; duties; development of comprehensive state plan

(1) The commission created in KRS 210.502 shall meet as often as necessary to accomplish its purpose but shall meet at least quarterly or upon the call of either co-chair, the request of four (4) or more members, or the request of the Governor.

(2) The commission shall receive, integrate, and report the findings and recommendations of the regional planning councils established under KRS 210.506. The regional planning councils shall provide additional information or study particular issues upon request of the commission.

(3) The commission:

(a) May establish work groups to develop statewide recommendations from information and recommendations received from the regional planning councils;

(b) May establish work groups to address issues referred to the commission; and

(c) Shall ensure that the regional planning councils have an opportunity to receive, review, and comment on any recommendation or product issued by a work group established under this subsection before the commission takes any formal action on a recommendation or product of a work group.

(4) The commission shall serve in an advisory capacity to accomplish the following:

(a) Based on information provided under subsection (2) of this section:

1. Assess the needs statewide of individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses;

2. Assess the capabilities of the existing statewide treatment delivery system including gaps in services and the adequacy of a safety net system; and

3. Assess the coordination and collaboration of efforts between public and private facilities and entities, including but not limited to the Council on Postsecondary Education when assessing workforce issues, and the roles of the Department for Mental Health and Mental Retardation and the regional community mental health centers, state hospitals, and other providers;

(b) Identify funding needs and related fiscal impact, including Medicaid reimbursement, limitations under government programs and private insurance, and adequacy of indigent care;

(c) Recommend comprehensive and integrated programs for providing mental health and substance abuse services and preventive education to children and youth, utilizing schools and community resources;

(d) Develop recommendations to decrease the incidence of repeated arrests, incarceration, and multiple hospitalizations of individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses; and

(e) Recommend an effective quality assurance and consumer satisfaction monitoring program that includes recommendations as to the appropriate role of persons with mental illness, alcohol and other drug abuse disorders, and dual diagnoses, family members, providers, and advocates in quality assurance efforts.

(5) The commission shall develop a comprehensive state plan that provides a template for decision-making regarding program development, funding, and the use of state resources for delivery of the most effective continuum of services in integrated statewide settings appropriate to the needs of the individual with mental illness, alcohol and other drug abuse disorders, and dual diagnoses. The state plan shall also include strategies for increasing public awareness and reducing the stigma associated with mental illness and substance abuse disorders.

(6) The state plan shall advise the Governor and the General Assembly concerning the needs statewide of individuals with mental illness, alcohol and other drug disorders, and dual diagnoses and whether the recommendations should be implemented by administrative regulations or proposed legislation for the General Assembly.

(7) The commission shall develop a two (2) year work plan, beginning in 2003, that specifies goals and strategies relating to services and supports for individuals with mental illness and alcohol and other drug disorders and dual diagnoses and efforts to reduce the stigma associated with mental illness and substance abuse disorders.

(8) The commission shall review the plan and shall submit annual updates no later than October 1 to the Governor and the Legislative Research Commission.

210.506 Regional planning councils; groups to be invited to join council

(1) The regional community mental health-mental retardation boards established under KRS 210.370 shall institute regional planning councils for the purpose of conducting assessment and strategic planning. The councils shall be attached to the community mental health-mental retardation boards for administrative purposes.

(2) A member of the regional community mental health-mental retardation board shall serve as chair of the regional planning council.

(3) The board shall issue invitations to join the council to no less than two (2) representatives of each of the following groups:

(a) Family members of individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses;

(b) Consumers of mental health and substance abuse services;

(d) Health departments and primary care physicians;

(e) Advocates and community organizations;

(f) Educators and school personnel;

(g) Regional interagency councils established under KRS Chapter 200;

(h) Law enforcement and court personnel;

(i) Public and private organizations, agencies, or facilities that provide services for mental health and substance abuse in the region that represent inpatient services, outpatient services, residential services, and community- based supportive housing programs;

(j) Individuals who provide mental health and substance abuse services in the region; and

(k) Public and private hospitals that provide mental health and substance abuse services.

(4) The regional planning councils may establish bylaws and procedures to assist in the operation of the councils.

210.509 Meeting and duties of regional planning councils

(1) The regional planning councils shall meet as often as necessary to accomplish their purpose.

(2) The regional planning councils shall:

(a) Assess in the region the needs of individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses;

(b) 1. Study the regional mental health and substance abuse treatment delivery system and identify specific barriers in each region to accessing services;

2. Assess the capacity of and gaps in the existing system, including the adequacy of a safety net system and the adequacy and availability of the mental health and substance abuse professional work force in each region; and

3. Assess the coordination and collaboration of efforts between public and private facilities and entities;

(c) Develop a regional strategy to increase access to community-based services and supports for individuals with mental illness, alcohol and other drug abuse

disorders, and dual diagnoses. The strategies may include:

1. Exploration of the use of community-based treatment programs, including but not limited to community-based hospitalization;

2. Access to and funding for the most effective medications;

3. Promotion of family and consumer support groups statewide;

4. Reduction of instances of criminalization of individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses; and

5. Efforts to increase housing options for persons at risk of institutionalization;

(d) Identify funding needs and report to the commission established in KRS 210.502 about the use of any flexible safety net funding if appropriated by the General Assembly;

(e) Evaluate the access of children and youth to mental health and substance abuse services and preventive programs within the region, including but not limited to those provided by schools, family resource and youth services centers, public and private mental health and substance abuse providers and facilities, physical health care providers and facilities, the faith community, and community agencies;

(f) Collect and evaluate data regarding individuals with mental illness, alcohol and other drug abuse disorders, and dual diagnoses who experience

repeated hospital admissions, involvement with law enforcement, courts, and the judicial system, and repeated referrals from hospitals to community-based services; and

(g) Make recommendations on each subsection of this section to the commission established under KRS 210.502 by July 1 of each odd-numbered year. These recommendations may be incorporated into the regional annual plans required by KRS 210.400.

210.520 Enactment of compact

The interstate compact on mental health is hereby enacted into law and entered into by this state with all other states legally joining therein as follows:

The contracting states solemnly agree that:

Article I

The party states find that the proper and expeditious treatment of the mentally ill and mentally deficient can be facilitated by cooperative action, to the benefit of the patients, their families, and society as a whole. Further, the party states find that the necessity of and desirability for furnishing such care and treatment bears no primary relation to the residence or citizenship of the patient but that, on the contrary, the controlling factors of community

safety and humanitarianism require that facilities and services be made available for all who are in need of them. Consequently, it is the purpose of this compact and of the party states to provide the necessary legal basis for the institutionalization or other appropriate care and treatment of the mentally ill and mentally deficient under a system that recognizes the paramount importance of patient welfare and to establish the responsibilities of the party states in terms of such welfare.

Article II

As used in this compact:

(a) "Sending state" shall mean a party state from which a patient is transported pursuant to the provisions of the compact or from which it is contemplated that a patient may be so sent.

(b) "Receiving state" shall mean a party state to which a patient is transported pursuant to the provisions of the compact or to which it is contemplated that a patient may be so sent.

(c) "Institution" shall mean any hospital or other facility maintained by a party state or political subdivision thereof for the care and treatment of mental illness or mental deficiency.

(d) "Patient" shall mean any person subject to or eligible as determined by the laws of the sending state, for institutionalization or other care, treatment, or supervision pursuant to the provisions of this compact.

(e) "After-care" shall mean care, treatment and services provided a patient, as defined herein, on convalescent status or conditional release.

(f) "Mental illness" shall mean mental disease to such extent that a person so

afflicted requires care and treatment for his own welfare, or the welfare of others, or of the community.

(g) "Mental deficiency" shall mean mental deficiency as defined by appropriate clinical authorities to such extent that a person so afflicted is incapable of managing himself and his affairs, but shall not include mental illness as defined herein.

(h) "State" shall mean any state, territory or possession of the United States, the District of Columbia, and the Commonwealth of Puerto Rico.

Article III

(a) Whenever a person physically present in any party state shall be in need of institutionalization by reason of mental illness or mental deficiency, he shall be eligible for care and treatment in an institution in that state irrespective

of his residence, settlement or citizenship qualifications.

(b) The provisions of paragraph (a) of this article to the contrary notwithstanding, any patient may be transferred to an institution in another state whenever there are factors based upon clinical determinations indicating that the care and treatment of said patient would be facilitated or improved thereby. Any such institutionalization may be for the entire period of care and treatment or for any portion or portions thereof. The factors referred to in this paragraph shall include the patient's full record with due regard for the location of the patient's family, character of the illness and probable duration thereof, and such other factors as shall be considered appropriate.

(c) No state shall be obliged to receive any patient pursuant to the provisions of paragraph (b) of this article unless the sending state has given advance notice of its intention to send the patient; furnished all available medical and other pertinent records concerning the patient; given the qualified medical or other appropriate clinical authorities of the receiving state an opportunity to examine the patient if said authorities so wish; and unless the

receiving state shall agree to accept the patient.

(d) In the event that the laws of the receiving state establish a system of priorities for the admission of patients, an interstate patient under this compact shall receive the same priority as a local patient and shall be taken in the same order and at the same time that he would be taken if he were a local patient.

(e) Pursuant to this compact, the determination as to the suitable place of institutionalization for a patient may be reviewed at any time and such further transfer of the patient may be made as seems likely to be in the best interest of the patient.

Article IV

(a) Whenever, pursuant to the laws of the state in which a patient is

physically present, it shall be determined that the patient should receive after-care or supervision, such care or supervision may be provided in a receiving state. If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state shall have reason to believe that after-care in another state would be in the best interest of the patient and would not jeopardize the public safety, they shall request the appropriate authorities in the receiving state to investigate the desirability of affording the patient such after-care in said receiving state, and such investigation shall be made with all reasonable speed. The request for investigation shall be accompanied by complete information concerning the patient's intended place of residence and the identity of the person in whose charge it is proposed to place the patient, the complete medical history of the patient, and such other documents as may be pertinent.

(b) If the medical or other appropriate clinical authorities having responsibility for the care and treatment of the patient in the sending state and the appropriate authorities in the receiving state find that the best interest of the patient would be served thereby, and if the public safety would

not be jeopardized thereby, the patient may receive after-care or supervision in the receiving state.

(c) In supervising, treating, or caring for a patient on after-care pursuant to the terms of this article, a receiving state shall employ the same standards of visitation, examination, care, and treatment that it employs for similar local patients.

Article V

Whenever a dangerous or potentially dangerous patient escapes from an institution in any party state, that state shall promptly notify all appropriate authorities within and without the jurisdiction of the escape in a manner reasonably calculated to facilitate the speedy apprehension of the escapee. Immediately upon the apprehension and identification of any such dangerous or potentially dangerous patient, he shall be detained in the state where found pending disposition in accordance with law.

Article VI

The duly accredited officers of any state party to this compact, upon the establishment of their authority and the identity of the patient, shall be permitted to transport any patient being moved pursuant to this compact through any and all states party to this compact, without interference.

Article VII

(a) No person shall be deemed a patient of more than one institution at any given time. Completion of transfer of any patient to an institution in a receiving state shall have the effect of making the person a patient of the institution in the receiving state.

(b) The sending state shall pay all costs of and incidental to the transportation of any patient pursuant to this compact, but any two or more party states may, by making a specific agreement for that purpose, arrange for a different allocation of costs as among themselves.

(c) No provision of this compact shall be construed to alter or affect any internal relationships, among the departments, agencies and officers of and in the government of a party state, or between a party state and its subdivisions, as to the payment of costs, or responsibility therefor.

(d) Nothing in this compact shall be construed to prevent any party state or subdivision thereof from asserting any right against any person, agency or other entity in regard to costs for which such party state or subdivision thereof may be responsible pursuant to any provision of this compact.

(e) Nothing in this compact shall be construed to invalidate any reciprocal agreement between a party state and a non-party state relating to

institutionalization, care or treatment of the mentally ill or mentally deficient, or any statutory authority pursuant to which such agreements may be made.

Article VIII

(a) Nothing in this compact shall be construed to abridge, diminish, or in any way impair the rights, duties, and responsibilities of any patient's guardian on his own behalf or in respect of any patient for whom he may serve, except that where the transfer of any patient to another jurisdiction makes advisable the appointment of a supplemental or substitute guardian, any court of competent jurisdiction in the receiving state may make such supplemental or substitute appointment and the court which appointed the previous guardian shall upon being duly advised of the new appointment, and upon the satisfactory completion of such accounting and other acts as such court may by law require, relieve the previous guardian of power and responsibility to whatever extent shall be appropriate in the circumstances; provided, however, that in the case of any patient having settlement in the sending state, the court of competent

jurisdiction in the sending state, shall have the sole discretion to relieve a guardian appointed by it or continue his power and responsibility, whichever it shall deem advisable. The court in the receiving state may, in its discretion, confirm or reappoint the person or persons previously serving as guardian in the sending state in lieu of making a supplemental or substitute appointment.

(b) The term "guardian" as used in paragraph (a) of this article shall include any guardian, trustee, legal committee, conservator, or other person or agency however denominated who is charged by law with power to act for or responsibility for the person or property of a patient.

Article IX

(a) No provision of this compact except Article V shall apply to any person institutionalized while under sentence in a penal or correctional institution or while subject to trial on a criminal charge, or whose institutionalization is due to the commission of an offense for which, in the absence of mental

illness or mental deficiency, said person would be subject to incarceration in a penal or correctional institution.

(b) To every extent possible, it shall be the policy of states party to this compact that no patient shall be placed or detained in any prison, jail or lockup, but such person shall, with all expedition, be taken to a suitable institutional facility for mental illness or mental deficiency.

Article X

(a) Each party state shall appoint a "compact administrator" who, on behalf of his state, shall act as general coordinator of activities under the compact in his state and who shall receive copies of all reports, correspondence, and other documents relating to any patient processed under the compact by his state either in the capacity of sending or receiving state. The compact administrator or his duly designated representative shall be the official with whom other party states shall deal in any matter relating to the compact or any

patient processed thereunder.

(b) The compact administrators of the respective party states shall have power to promulgate reasonable rules and regulations to carry out more effectively the terms and provisions of this compact.

Article XI

The duly constituted administrative authorities of any two or more party states may enter into supplementary agreements for the provision of any service or facility or for the maintenance of any institution on a joint or cooperative basis whenever the states concerned shall find that such agreements will improve services, facilities, or institutional care and treatment in the fields of mental illness or mental deficiency. No such supplementary agreement shall be construed so as to relieve any party state of any obligation which it otherwise would have under other provisions of this compact.

Article XII

This compact shall enter into full force and effect as to any state when enacted by it into law and such state shall thereafter be a party thereto with any and all states legally joining therein.

Article XIII

(a) A state party to this compact may withdraw therefrom by enacting a statute repealing the same. Such withdrawal shall take effect one year after notice thereof has been communicated officially and in writing to the governors and administrators of all other party states. However, the withdrawal of any state shall not change the status of any patient who has been sent to said state or sent out of said state pursuant to the provisions of the compact.

(b) Withdrawal from any agreement permitted by Article VII (b) as to costs or from any supplementary agreement made pursuant to Article XI shall be in accordance with the terms of such agreement.

Article XIV

This compact shall be liberally construed so as to effectuate the purposes thereof. The provisions of this compact shall be severable and if any phrase, clause, sentence or provision of this compact is declared to be contrary to the constitution of any party state or of the United States or the applicability thereof to any government, agency, person or circumstance is held invalid, the validity of the remainder of this compact and the applicability thereof to any government, agency, person or circumstance shall not be affected thereby. If this compact shall be held contrary to the constitution of any state party thereto, the compact shall remain in full force and effect as to the remaining states and in full force and effect as to the state affected as to all severable matters.

210.570 Legislative findings on review and evaluation of current system of services and supports for persons with mental retardation and other developmental disabilities; construction of KRS 210.570 to 210.577

The General Assembly of the Commonwealth of Kentucky hereby finds and declares that:

(1) Assistance and support to citizens of the Commonwealth with mental retardation and other developmental disabilities are necessary and appropriate roles of state government;

(2) The current system of services and supports to persons with mental retardation and other developmental disabilities suffers from a lack of program coordination, funding, controls on quality of care, and review and evaluation;

(3) As part of the review and evaluation, it is necessary to require:

(a) Identification, development, and provision of services and supports for

persons with mental retardation and other developmental disabilities using available institutional care as appropriate and integrated with community-based services designed to be inclusive, responsive to individual needs, and protective of the individual's legal rights to equal opportunity;

(b) Review of current funding mechanisms to determine the best method to establish an array of community-based comprehensive services using facility- based outpatient services and supports that are available through public and private sectors, including nonprofit and for-profit service providers, that will allow persons with mental retardation and other developmental disabilities the opportunity to participate in community life. The review shall include consideration of the availability of residential alternatives, employment opportunities, and opportunities for participation in community-based social and recreational activities; and

1. Flexibility for persons with mental retardation and other developmental disabilities;

2. Distribution of available funds among all interested service providers, including nonprofit and for-profit service providers, based on the needs of the person with mental retardation and other developmental disabilities; and

3. Efficiency and accountability to the general public;

(4) KRS 210.570 to 210.577 shall be construed to protect and to promote the continuing development and maintenance of the physical, mental, and social skills of persons with mental retardation and other developmental disabilities; and

(5) KRS 210.570 to 210.577 shall not be construed:

(a) To alter any requirements or responsibilities that are mandated by any state or federal law;

(b) To relieve any organizational unit or administrative body of its duties under state or federal law; or

(c) To transfer among state organizations or administrative bodies any responsibilities, powers, or duties that are mandated by state or federal law.

210.575 Kentucky Commission on Services and Supports for Individuals with Mental Retardation and Other Developmental Disabilities; membership; chair; compensation

(1) There is created the Kentucky Commission on Services and Supports for Individuals with Mental Retardation and Other Developmental Disabilities. The commission shall consist of:

(a) The secretary of the Cabinet for Health Services;

(b) The secretary of the Cabinet for Families and Children;

(d) The commissioner of the Department for Medicaid Services;

(e) The commissioner of the Department of Vocational Rehabilitation;

(f) The director of the University Affiliated Program at the Interdisciplinary Human Development Institute of the University of Kentucky;

(g) The director of the Kentucky Council on Developmental Disabilities;

(h) Two (2) members of the House of Representatives, appointed by the Speaker of the House;

(i) Two (2) members of the Senate, appointed by the Senate President; and

(j) Public members, appointed by the Governor as follows:

1. Five (5) family members, at least one (1) of whom shall be a member of a family with a child with mental retardation or other developmental disabilities, and one (1) of whom shall be a member of a family with an adult with mental retardation or other developmental disabilities. Of these five (5) family members, at least two (2) shall be members of a family with an individual with mental retardation or other developmental disabilities residing in the home of the family member or in a community-based setting, and at least two (2) shall be members of a family with an individual with mental retardation or other mental disabilities residing in an institutional residential facility that provides service to individuals with mental retardation or other developmental disabilities;

2. Three (3) persons with mental retardation or other developmental disabilities;

3. Two (2) business leaders;

4. Three (3) direct service providers representing the Kentucky Association of Regional Programs and the Kentucky Association of Residential Resources; and

5. One (1) representative of a statewide advocacy group.

The six (6) appointments made under subparagraphs 1. and 2. of this paragraph shall be chosen to reflect representation from each of Kentucky's six (6) congressional districts.

(2) The secretary of the Cabinet for Health Services shall serve as chair of the commission.

(3) Members defined in paragraphs (a) to (i) of subsection (1) of this section shall serve during their terms of office. All public members appointed by the Governor shall serve a four (4) year term and may be reappointed for one (1) additional four (4) year term.

(4) All public members of the commission shall receive twenty-five dollars ($25) per day for attending each meeting. All commission members shall be reimbursed for necessary travel and other expenses actually incurred in the discharge of duties of the commission.

210.577 Commission's meetings, purposes, and goals

(1) The commission created in KRS 210.575 shall meet at least quarterly or upon the call of the chair, the request of four (4) or more members, or the request of the Governor.

(2) The commission shall serve in an advisory capacity to accomplish the following:

(a) Advise the Governor and the General Assembly concerning the needs of persons with mental retardation and other developmental disabilities;

(b) Develop a statewide strategy to increase access to community-based services and supports for persons with mental retardation and other developmental disabilities. The strategy shall include:

1. Identification of funding needs and related fiscal impact; and

2. Criteria that establish priority for services that consider timeliness and service needs;

(c) Assess the need and potential utilization of specialized outpatient clinics for medical, dental, and special therapeutic services for persons with mental

retardation and other developmental disabilities;

(d) Evaluate the effectiveness of state agencies and public and private service providers, including nonprofit and for-profit service providers, in:

1. Dissemination of information and education;

2. Providing outcome-oriented services; and

3. Efficiently utilizing available resources, including blended funding streams;

(e) Develop a recommended comprehensive ten (10) year plan for placement of qualified persons in the most integrated setting appropriate to their needs;

(f) Recommend an effective quality assurance and consumer satisfaction monitoring program that includes recommendations as to the appropriate role of family members, persons with mental retardation and other developmental disabilities, and advocates in quality assurance efforts;

(g) Develop recommendations for the implementation of a self- determination model of funding services and supports as established under KRS 205.6317(1) for persons who are receiving services or supports under the Supports for Community Living Program as of June 24, 2003. The model shall include, but is not limited to, the following:

1. The ability to establish an individual rate or budget for each person;

2. Mechanisms to ensure that each participant has the support and assistance

necessary to design and implement a package of services and supports unique to the individual;

3. The ability to arrange services, supports, and resources unique to each person based upon the preferences of the recipient; and

4. The design of a system of accountability for the use of public funds.

The chairperson of the commission shall appoint an ad-hoc committee composed of commission members and other interested parties to develop the recommendations required by this paragraph; and

(h) Advise the Governor and the General Assembly on whether the recommendations should be implemented by administrative regulations or proposed legislation.

(3) The commission shall review the plan annually and shall submit annual updates no later than October 1 to the Governor and the Legislative Research Commission.

Legislative Research Commission Note (6-24-03): This section was amended by 2003 Ky. Acts chs. 108 and 161, which do not appear to be in conflict and have been codified together.

210.700 Short title

KRS 210.710 to 210.760 may be cited as the "Patient Liability Act of 1978."

210.710 Definitions

(1) "Cabinet" means the Cabinet for Health Services.

(2) "Facility" means a hospital or other institution operated or utilized by the cabinet for the mentally ill, mentally retarded or respiratory disease patients.

(3) "Homestead" means a place where a family makes its home including the land, house and furnishings, outbuildings, vehicles, and tools of the trade formerly occupied by the patient which is exempted by KRS 210.710 to 210.760 from liability to meet patient charges for services rendered in a facility.

(4) "Means test" means a uniform method adopted by the secretary for determining the ability to pay of the patient or person responsible for the patient for board, maintenance and treatment at a facility operated or utilized by the cabinet.

(5) "Person responsible for the patient" includes parents, spouses, guardians, and committees [FN1] within the scope of their fiduciary duties.

(6) "Secretary" means the secretary of the Cabinet for Health Services.

[FN1] So in original; should this read "guardian or conservator"?

210.720 Charge for board of patients; method of establishing

(1) Every patient admitted to a facility operated or utilized by the cabinet, except prisoners transferred pursuant to KRS 202A.201, shall be charged for their board, maintenance and treatment pursuant to this section and the cabinet may sue in the Franklin Circuit Court or Franklin District Court to recover from the patient or person responsible for the patient for liability as established by this section.

(2) The secretary shall fix the patient cost per day for board, maintenance and treatment for each facility operated by the cabinet at frequent intervals which shall be the uniform charge for all persons receiving such services.

(3) The liability of any patient, or person responsible for the patient, for payment of the charge for board, maintenance and treatment shall be based upon ability to pay by ascertaining the entire financial resources available to the patient, or to the person responsible for the patient, and shall include, but shall not be limited to: insurance, all third party coverage including

Medicare and Medicaid and other governmental programs, cash, stocks, bonds, and all other property owned by the patient or controlled by the person responsible for the patient. The secretary shall establish a reasonable means test for determining payment liability of patients and persons responsible for patients. In no event shall liability be in excess of the cost per patient per day established by the secretary.

(4) Nothing in KRS 210.710 to 210.760 shall be construed to limit any liability of insurance companies or other third party payors including Medicare and Medicaid and other governmental programs.

210.730 Exemption from liability

The following shall be exempt from liability for patient's board, maintenance and treatment charges:

(1) Any parents' liability for charges for board, maintenance and treatment at facilities operated or utilized by the cabinet that exceed the cost of caring for a normal child at home as determined from standard sources by the cabinet;

(2) Any parents' liability after the patient has attained the age of eighteen (18);

(3) A homestead.

210.770 Definitions for KRS 210.770 to 210.795

As used in KRS 210.770 to 210.795, unless the context otherwise requires:

(1) "Mental impairment" includes mental retardation, organic brain syndrome, emotional or mental illness, and specific learning disabilities;

(2) "Person with a disability" means someone with a physical or mental impairment and includes individuals who have a record or history of an impairment, or are regarded as having a physical or mental impairment that substantially limits one (1) or more major life activities;

(3) "Physical impairment" means any physiological disorder or corrective, cosmetic disfigurement, or an anatomical loss affecting one (1) or more of the following body systems: neurological, musculo-skeletal, special sense organs, respiratory including speech organs, cardiovascular, reproductive, digestive, genito-urinary, hemic and lymphatic, skin, and endocrine;

(4) "Substantial limitation of a major life activity" includes limiting such things as walking, talking, seeing, hearing, caring for oneself, or working;

(5) "Supported living" means a broad category of highly flexible, individualized services designed and coordinated in such a manner as to provide the necessary assistance to do the following:

(a) Provide the support necessary to enable a person who is disabled to live in a home of the person's choice which is typical of those living arrangements in which persons without disabilities reside;

(b) Encourage the individual's integrated participation in the community with persons who are members of the general citizenry;

(d) Enhance the individual's skills and competences in living in the community; and

(e) Enable the individual's acceptance in the community by promoting home ownership or leasing arrangements in the name of the individual or the individual's family or guardian;

(6) "Supported living" does not include the following housing arrangements:

(a) Segregated living models such as any housing situation which physically or socially isolates people with disabilities from general citizens of the community;

(b) Congregate living models such as any housing situation which groups individuals with disabilities as an enclave within an integrated setting;

(c) Any model where the individual, as an adult, does not have maximum control of the home environment commensurate with the individual's disabilities; and

(d) Any single living unit where more than three (3) people with disabilities live;

(7) "Supported living council" means a supported living council appointed by the Governor and recognized by the commissioner of the Department for Mental Health and Mental Retardation Services to approve individual supported living plans;

(8) "Supported living services" include, but are not limited to:

(a) Supported living community resource developers;

(b) Homemaker services;

(d) In-home training and home management assistance;

(e) Start-up grants;

(f) Monthly stipends;

(g) Transportation;

(h) Home modifications;

(i) Adaptive and therapeutic equipment; and

(j) An individual plan by an independent and trained facilitator; and

(9) "Regional Supported Living Council" means a regional supported living council created under KRS 210.785.

210.775 State Supported Living Council

(1) There is hereby created the State Supported Living Council for services to persons with a disability and their families.

(2) (a) The State Supported Living Council shall be composed of ten (10) members. The commissioner of the Department for Mental Health and Mental Retardation Services and the executive director of the Kentucky Housing Corporation or their designees shall be ex-officio members.

(b) Eight (8) of the members shall be volunteers and shall be appointed by the Governor from a list of nominees in the following manner:

1. Three (3) of the appointed members shall represent family members of persons with a disability. One (1) member shall be selected from each of three (3) lists containing two (2) nominees submitted by each of the following associations: the Kentucky Association for Retarded Citizens, the Association for Persons with Severe Handicaps, and the Mental Health Coalition;

2. One (1) of the appointed members shall represent family members of persons with a disability who reside in an intermediate care facility for mental

retardation or developmental disabilities. The nominee shall be selected from a list containing two (2) nominees submitted by each of the following associations: Concerned Parents of Hazelwood, Parents and Relatives of Oakwood Facility, and Concerned Parents of Outwood;

3. Two (2) of the appointed members shall be persons with a disability. They shall be selected from a list containing two (2) nominees submitted by each of the following associations: the Kentucky Campaign for Personal Attendant Care, the Kentucky Association for Retarded Citizens, the Mental Health Coalition, and the Kentucky Disabilities Coalition;

4. One (1) of the appointed members shall represent professionals and providers of services to persons with a disability. The nominee shall be selected from a list containing two (2) nominees submitted by each of the following associations: the Kentucky Association of Private Residential Resources and the Kentucky Association on Mental Retardation; and

5. One (1) of the appointed members shall represent advocates for persons with a disability. The nominee shall be selected from a list containing two (2) nominees submitted by each of the following entities: the Division of Protection and Advocacy and the Kentucky Council on Developmental Disabilities.

(3) The appointed members may serve on the council for three (3) years.

Members may be reappointed for a maximum of two (2) consecutive terms. The Governor shall fill any vacancy occurring in the council in the manner prescribed in subsection (2) of this section.

(4) The Department for Mental Health and Mental Retardation Services shall provide staff assistance to the State Supported Living Council.

(5) The chairman of the State Supported Living Council shall be elected from among the members. A majority of the members shall constitute a quorum.

(6) The State Supported Living Council shall meet as often as necessary but no less frequently than every other month.

210.780 Duties of state council

(1) Upon the appointment by the Governor of all members of the State Supported Living Council, the council shall recommend to the Department for Mental Health and Mental Retardation Services:

(a) A budget and priorities for fund allocations for supported living services for persons with disabilities within the Commonwealth;

(b) Standards for quality assurance for persons with a disability who receive supported living services in accordance with KRS 210.770 to 210.795.

(2) The provisions of paragraph (b) of subsection (3) of this section shall be effective upon the members' appointment, and for two (2) years after July 14, 1992, at which time the provisions of KRS 210.785(2) shall apply.

(3) The State Supported Living Council shall be responsible for:

(a) Disseminating information about supported living services available under KRS 210.770 to 210.795;

(b) Reviewing, approving, and recommending expenditures for individual plans

for supported living services submitted by the consumers and providers of supported living services to a regional community mental health-mental retardation board;

(d) Hearing grievances and providing due process for consumers and providers of supported living services.

(4) The State Supported Living Council shall not impose an individual service plan on any applicant who objects to the plan.

(5) The State Supported Living Council may recommend necessary administrative regulations under KRS Chapter 13A to carry out the purposes of KRS 210.770 to 210.795.

210.785 Regional supported living councils; duties

(1) There are hereby created fourteen (14) regional supported living councils which shall represent regions as established by KRS 210.370 to 210.460. Each regional supported living council shall be composed of eight (8) members who shall be volunteers and shall be appointed by the Governor. The method of submission of the list of nominees, composition, and the representation of the regional supported living council shall be the same as for the appointed members of the State Supported Living Council.

(2) At the beginning of the third year after July 14, 1992, and every year thereafter, each regional supported living council shall have the authority and duty to review, approve, and recommend expenditures for individual plans for supported living services submitted by any person with a disability and eligible providers of supported living services to a regional community mental health-mental retardation board.

(3) No individual service plan shall be imposed by a regional supported living

council on any person with a disability who objects to the plan.

210.790 Eligibility for services; design; payment

(1) Only a person with a disability who is a resident of Kentucky or whose family or guardian is a resident of Kentucky is eligible for supported living services. The person may be living with a family member, independently, or be in a congregate setting and be eligible for services.

(2) Any eligible person with a disability who wants to apply for supported living services may design and request a set of services in the amount, kind, frequency, and duration which is dependent upon the person's individual needs, and is consistent with the definition of supported living under KRS 210.770.

(3) Payments for supported living services may be made directly to the person with a disability to enable the person to purchase a service, or to the guardian of the person with a disability, or to the local service provider or to any combination of these parties.

(4) A license shall not be required for any supported living housing

arrangement provided on a contractual basis.

210.795 Standards for supported living arrangements; administrative regulations

(1) The Department for Mental Health and Mental Retardation Services in cooperation with the State Supported Living Services Council shall establish standards for quality assurance for eligible persons who live in the community in supported living arrangements as defined in KRS 210.770. The purpose of these standards is to ensure that a person with a disability receives supported living services in a manner that empowers the person to exercise choice and enhances the quality of that person's life. These standards shall promote the following:

(a) Control over where and with whom a person with a disability lives;

(b) Opportunities to meaningfully participate in activities in the community with members of the general citizenry;

(d) Flexible services that change as the person's needs change without the individual having to move elsewhere for services;

(e) Use of generic options such as home health aids, homemaker services, live-

in roommates or staff, community counselors, neighbors, family, and friends in the development of a supported living plan;

(f) Well planned and proactive opportunities to determine the kinds and amounts of support desired, with the meaningful participation of the individual, the individual's family or guardian where appropriate, friends, and professionals; and

(g) Home ownership or leasing with the home belonging to the person with a disability, that person's family, or to a landlord to whom rent is paid.

(2) The individual supported living plan shall be developed by the person with a disability and that person's family or guardian where appropriate, and, as appropriate, the proposed or current provider.

(3) The individual supported living plan shall document assistance and support required by the person with a disability in the following eight (8) areas:

(a) Choice and options;

(b) Personal income;

(d) Health;

(e) Safety;

(f) Appearance and hygiene;

(g) Relating to others; and

(h) Activities.

(4) The Department for Mental Health and Mental Retardation in concert with the State Supported Living Council shall promulgate administrative regulations under KRS Chapter 13A, if necessary, to establish the methods of monitoring the quality of service delivery and to provide for administrative appeal of decisions. Administrative hearings conducted on appeals shall be conducted in accordance with KRS Chapter 13B.

210.991 Penalties

Any person who willfully causes or conspires with or assists another in causing

(1) The unwarranted hospitalization of any individual under the provisions of KRS Chapter 210 or

(2) The denial to any individual of any of the rights accorded to him under the provisions of KRS Chapter 210 shall be punished by a fine not exceeding five thousand dollars ($5,000) or imprisoned for a term not to exceed five (5) years or both.

210.995 Penalty for taking patient from state hospital

(1) Any person who takes a lawfully involuntarily hospitalized patient or resident from any state hospital without the consent of authorized staff physician, or who entices, assists or encourages any such patient or resident to escape, shall be fined not more than five hundred dollars ($500). The District Court of the county in which the escape was effected shall have jurisdiction.

(2) Any person who entices, assists, or encourages any patient or resident in a state hospital to leave the hospital for any unlawful purposes shall be imprisoned for not more than six (6) months or fined not more than five hundred dollars ($500) or both. The District Court of the county in which the escape was effected shall have jurisdiction.