State Overview: Kentucky

Prior authorization requirements are up to the discretion of the state Medicaid program or insurance company.

Kentucky credentials two types of addiction counselor. A Licensed Alcohol and Drug Counselor must have a bachelor's degree in a relevant field and meet all education, work experience, and supervision requirements of the International Certification and Reciprocity Consortium for the Alcohol and Drug Counselor. A Licensed Clinical Alcohol and Drug Counselor must have a master's degree and meet all education and supervision requirements of the International Certification and Reciprocity Consortium for the Advanced Alcohol and Drug Counselor. Ky. Rev. Stat. §309.080 – .089 and Kentucky Board of Alcohol and Drug Counselors

A licensed professional clinical counselor may provide counseling services that involve the assessment, evaluation, treatment planning, amelioration, and remediation of adjustment problems and emotional disorders. Counselors also assist individuals or groups to achieve more effective personal, social, educational, or career development and adjustment. Diagnostic ability is not outlined in statute. Ky. Rev. Stat. §335.500

In Kentucky, the eligibility, training and supervision requirements for adult peer support specialists, family peer support specialists, and youth peer support specialists are established by the Cabinet for Health and Family Services. Training, supervision, and certification requirements for alcohol and drug peer support specialists are established by the Board of Alcohol and Drug Counselors. 908 Ky. Admin. Regs. 2:220, 908 Ky. Admin. Regs. 2:230,  908 Ky. Admin. Regs. 2:240, and 201 Ky. Admin. Regs, 35.010, et seq

Physician relationship required to prescribe.

Advanced practice registered nursing means the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program. Additional authorized acts include but are not limited to prescribing treatment, drugs, devices, and ordering diagnostic tests. Ky. Rev. Stat. §314.011

An APRN can prescribe Schedules II-V controlled substances (once they have practiced for at least one year) and legend drugs once entered into a written "collaborative agreement for the advanced practice registered nurse's prescriptive authority for controlled substances" and "collaborative agreement for the advanced practice registered nurse's prescriptive authority for nonscheduled legend drugs" (may prescribe without one after four years) with a physician licensed in Kentucky that defines the scope of prescriptive authority for controlled substances. Ky. Rev. Stat. §314.042

Physician relationship required to prescribe.

Advanced practice registered nursing means the performance of additional acts by registered nurses who have gained advanced clinical knowledge and skills through an accredited education program. Additional authorized acts include but are not limited to prescribing treatment, drugs, devices, and ordering diagnostic tests. Ky. Rev. Stat. §314.011

An advanced practice registered nurse can prescribe Schedules II-V controlled substances (once they have practiced for at least one year) and legend drugs once entered into a written "collaborative agreement for the advanced practice registered nurse's prescriptive authority for controlled substances" and "collaborative agreement for the advanced practice registered nurse's prescriptive authority for nonscheduled legend drugs" (may prescribe without one after four years) with a physician licensed in Kentucky that defines the scope of prescriptive authority for controlled substances.  Ky. Rev. Stat. §314.042

Only physicians are authorized to sign physician orders for scope of treatment. Ky. Rev. Stat. §311.6225

NPs are recognized in state policy as primary care providers. Ky. Rev. Stat. §314.198

Full independent practice authority; physician relationship required for prescriptive authority.

Kentucky opted out of the CRNA federal supervision requirement in 2012.

Advanced practice registered nursing means the performance of additional acts by registered nurses, including CRNAs, who have gained advanced clinical knowledge and skills through an accredited education program. Additional authorized acts include but are not limited to prescribing treatment, drugs, devices and ordering diagnostic tests. While an APRN, a CRNA is not required to enter into a collaborative agreement for prescriptive authority when delivering anesthesia care. Ky. Rev. Stat. §314.011(8)

Advanced practice registered nurses, including CRNAs, can prescribe Schedules II-V controlled substances when they have practiced for at least one year and once entered into a written “collaborative agreement for the advanced practice registered nurse’s prescriptive authority for controlled substances.” They can prescribe legend drugs once entered into a written “collaborative agreement for the advanced practice registered nurse’s prescriptive authority for nonscheduled legend drugs” (may prescribe without an agreement after four years) with a physician licensed in Kentucky that defines the scope of prescriptive authority for controlled substances. Ky. Rev. Stat. §314.042(12)

Optometrists may perform all procedures included in their full scope of practice, including surgical and laser procedures. 201 Ky. Admin. Reg. 5:110

Optometrists may administer all pharmaceutical agents for the diagnosis and treatment of eye diseases, including epinephrine auto-injections to counter anaphylaxis. Ky. Rev. Stat. §320.210(2)(a)

Optometrists may prescribe Schedule III-V controlled substances and also Schedule II hydrocodone or hydrocodone combination medications. 201 Ky. Admin. Reg. 5:130

A public health dental hygienist with at least two years of practice experience and who meets other qualifications may, for a limited number of days, provide dental hygiene services and screening services to patients without the physical presence of a dentist. 201 Ky. Admin. Regs. 8:563. A dental hygienist may provide certain services without the supervision of a dentist in volunteer community health settings. Ky. Rev. Stat. §313.040

Statute does not identify dental therapists as an oral health provider.

Kentucky allows for the practice of teledentistry and Medicaid reimburses for teledentistry services through live video and store-and-forward modalities. 907 Ky. Admin. Regs. 3:170 and Ky. Rev. Stat. §205.510

Kentucky has not enacted legislation allowing pharmacists to administer the COVID-19 vaccine. However, the federal PREP Act allowed pharmacists to administer the COVID-19 vaccine through the duration of the public health emergency.

Kentucky does not allow pharmacists to modify prescriptions.

Kentucky does not allow pharmacists to prescribe hormonal contraceptives.

Kentucky does not allow pharmacists to prescribe tobacco cessation aids.

Supervision by a physician required for practice and prescriptive authority.

A PA may perform medical services and procedures within the scope of medical services and procedures described in the initial or any supplemental application received by the board. A PA shall be considered an agent of the supervising physician in performing medical services and procedures.

A PA may prescribe and administer all nonscheduled legend drugs and medical devices to the extent delegated by the supervising physician. A PA who has been approved by the board may prescribe and administer Schedules III, IV, and V controlled substances to the extent delegated by the supervising physician. Ky. Rev. Stat. Ann. § 311.858

Statute limits the number of PAs a physician may supervise.

A physician may enter into supervision agreements with no more than four (4) PAs and shall not supervise more than four (4) PAs at any one (1) time. Ky. Rev. Stat. Ann. § 311.854(5)

Chart co-signatures may be determined at the practice level.

A supervising physician shall review and countersign a sufficient number of overall medical notes written by the PA to ensure quality of care provided by the PA and outline the specific parameters for review of countersignatures. Countersignature requirements shall be determined by the supervising physician, practice or institution. Ky. Rev. Stat. Ann. § 311.856(11)

Statute does not allow adaptable proximity.

A supervising physician shall maintain adequate, active, and continuous supervision of a PA's activities to assure that the PA is performing as directed and complying with the requirements. Ky. Rev. Stat. Ann. § 311.856(10)

A PA may perform medical services and procedures within the scope of practice described in the application to the board for supervisor approval. Ky. Rev. Stat. §311.858