No. 43605 (Amendment): Rule R523-7. Certification of Designated Examiners and Case Managers

(Amendment)

DAR File No.: 43605
Filed: 03/27/2019 10:15:24 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

These amendments are being proposed to increase the quality of case management for homeless individuals, and to strengthen and clarify the case management certification process and requirements.

Summary of the rule or change:

The amendments include: 1) "case managers" has been added to the purpose; 2) homeless services and service providers have been added as a sector that now requires certification for case managers; 3) certification itself has been clarified as being required for non-licensed professionals; 4) experience has been clarified to be specifically 400 hours in human services or related fields prior to application; and 5) a bachelor's degree has been added as a qualifying scholastic credential. Other changes involve experience: 1) the required case management practicum has been clarified to be 40 hours and Division approved; 2) applications and requests to waive requirements can only be approved by the Division of Substance Abuse and Mental Health (Division)director or designee; 3) certification follows the case manager between jobs if the provider is a qualifying employer; 4) a more defined corrective action process has been described; 5) continuing education has been clarified to required four hours ethics and three hours suicide prevention; 6) request for information about conduct must be provided within 30 days or certification is automatically revoked; 7) failure of the Division administered exam has been clarified to twice within 30 days; and 8) agencies are no longer required to notify the Division when a certified case manager separates from employment.

Statutory or constitutional authorization for this rule:

• Subsection 62A-15-602(3)
• Section 62A-15-105

Anticipated cost or savings to:

the state budget:

There are potential costs to the Division in printing and mailing certificates, and time in reviewing applications and providing certificates. The Division does not have clear understanding of how many potential new applications will be received due to the expansion of certification for homeless services agencies, but the cost to create a certificate is about $0.90 per certificate which includes bonded paper, gold seal, printing, signature and mail costs. Per-event time costs can be set at around 17 minutes per application. This calculation includes review of the application, receipt of information that a passing score was achieved, recording of the certification in the Division database, production of the certificate, signing the certificate and mailing the certificate. Based on these calculations, it will cost the Division an additional $0.90 and 17 minutes to process all new case management certifications that are generated by the changes in this rule. These rule changes have the potential of benefiting Division of Child and Family Services (DCFS) and the Division of Juvenile Justice Services (DJJS). Both agencies receive a portion of the child Medicaid carve out funding that was instituted by the Department of Human Services (DHS), to provide behavioral health services to children and youths through the Local Mental Health and Substance Abuse Authorities. Neither agency is currently able to bill Medicaid for Targeted Case Management in behavioral health, because certification for case managers has been limited to the local authorities, and Case Management Certification is required to bill behavioral health Targeted Case Management. The changes being proposed at this time, open Case Management Certification to any agency providing Targeted Case Management services. Gaining access to this money would be a slight challenge, because it would require both divisions to enter into some type of billing agreement with the local authorities in their areas, allowing them to bill the local authority directly if they offer behavioral health case management. The reason for this process is that the local authorities are the agencies that currently hold and control the Capitated Medicaid Behavioral Health contracts and the only ones to receive Medicaid reimbursements from the federal government. The billing rate would be $13.64 per quarter hour of service. The Division has contacted both sister agencies and has been informed that neither one is interested in negotiating Targeted Case Management payments from the local authorities at this time.

local governments:

These amendments are mostly clarifying in nature and do not require any additional actions from local governments than already exist.

small businesses:

There are both a potential cost and benefit to agencies (624221 Temporary Shelters) receiving funds for homeless services. Anticipated costs are time, financial, and unmeasurable. Anticipated time costs include the amount of time it will take an employee to study and take the Division approved test, the amount of time that each employee will need to complete and document the 30 hours of CEUs to maintain their certification, and the time needed for the employee's supervisor to review, grade, and report on the Division approved test that will be administered. Anticipated financial costs include and reimbursement for CEU classes that might be offered to an employer. The anticipated unmeasurable cost is the agency productivity loss, in any one employee, because of reallocated time to certify and maintain certification. The Division has been unable to estimate these costs because there are too many variables. The benefit to these agencies is $13.64 per quarter hour that can be billed to Medicaid for Targeted Case Management, and the number of agencies that qualify for this benefit is 20, based on the 20 agencies receiving homeless services funds.

persons other than small businesses, businesses, or local governmental entities:

There are both a potential cost and benefit to individuals who receive a Case Management Certification, and work for a homeless shelter that received homeless services funds. Costs are both time and financial. Anticipated time costs include the amount of time it will take an individual to study, and take the Division approved test, and the amount of time needed to complete, document and report the 30 hours of CEUs to maintain certification. The anticipated financial costs include the cost of CEU courses if reimbursement from the employer is not available. The Division has been unable to estimate these costs because there are too many variables. The financial benefit to these individuals include possible increases in pay by obtaining certification, and the opportunity to move into a better paying job across agencies because the individual holds a Case Management Certification. The Division has been unable to estimate these benefits because there are too many variables.

Compliance costs for affected persons:

There are potential compliance costs associated with these amendments.

Comments by the department head on the fiscal impact the rule may have on businesses:

After conducting a thorough analysis, it was determined that these proposed rule changes will result in a fiscal impact to small businesses.

Ann Williamson, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
195 N 1950 W
SALT LAKE CITY, UT 84116

Direct questions regarding this rule to:

• Thomas Dunford at the above address, by phone at 801-538-4181, by FAX at 801-538-4696, or by Internet E-mail at [e-mail]
• Jonah Shaw at the above address, by phone at 801-538-4219, by FAX at 801-538-3942, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2019

This rule may become effective on:

05/22/2019

Authorized by:

Doug Thomas, Director

RULE TEXT

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs

FY 2019

FY 2020

FY 2021

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-Small Businesses

$0

$0

$0

Other Person

$0

$0

$0

Total Fiscal Costs:

$0

$0

$0

Fiscal Benefits

$0

$0

$0

State Government

$0

$0

$0

Local Government

$0

$0

$0

Small Businesses

$0

$0

$0

Non-SmallBusinesses

$0

$0

$0

Other Persons

$0

$0

$0

Total Fiscal Benefits:

$0

$0

$0

Net Fiscal Benefits:

$0

$0

$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described in the narrative. Inestimable impacts for Non - Small Businesses are described in Appendix 2.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

These rule changes are not expected to have fiscal impacts on non-small businesses' revenues or expenditures. No non-small businesses currently do, nor is it anticipated they will in the future, become contractors or subcontractors to the Department of Human Services to provide homeless services; therefore, case manager certification will not be a requirement for their employees through this rule.

 

 

R523. Human Services, Substance Abuse and Mental Health.

R523-7. Certification of Designated Examiners and Case Managers.

R523-7-1. Authority.

(1) This rule is promulgated under authority of Section 62A-15-105(2).

 

R523-7-2. Purpose.

(1) The purpose of this rule is to provide guidance on the process for designated examiners and case managers to attain certification from the Division of Substance Abuse and Mental Health (Division).

 

R523-7-3. Designated Examiners Certification.

(1) A "Designated Examiner" is a licensed physician or other licensed mental health professional designated by the Division as specially qualified by training or experience in the diagnosis of mental or related illness, as defined in Subsection 62A-15-602(3).

(a) The Division shall certify that a designated examiner is qualified by training and experience in the diagnosis of mental or related illness. Certification will require at least five years continual experience in the treatment of mental or related illness in addition to successful completion of training provided by the Division.

(b) Application for certification will be achieved by the applicant making a written request to the Division for their consideration. Upon receipt of a written application, the Director will initiate a review and examination of the applicant's qualifications.

(c) The applicant must meet the following minimum standards in order to be certified.

(i) The applicant must be a licensed mental health professional.

(ii) The applicant must be a resident of the State of Utah.

(iii) The applicant must demonstrate a complete and thorough understanding of abnormal psychology and abnormal behavior, to be determined by training, experience and written examination.

(iv) The applicant must demonstrate a fundamental and working knowledge of the mental health law. In particular, the applicant must demonstrate a thorough understanding of the conditions which must be met to warrant involuntary commitment, to be determined by training, experience and written examination.

(v) The applicant must be able to discriminate between abnormal behavior due to mental illness which poses a substantial likelihood of serious harm to self or others from those forms of abnormal behavior which do not represent such a threat. Such knowledge will be determined by experience, training and written examination.

(vi) The applicant must be able to demonstrate a general knowledge of the court process and the conduct of commitment hearings. The applicant must demonstrate an ability to provide the court with a thorough and complete oral and written evaluation that addresses the standards and questions set forth in the law, to be determined by experience, training and written and oral examination.

(vii) The applicant shall attend the training for the certification of designated examiners that is provided by the Division and pass the exam at the completion of the training with a minimum of 70% correct.

(d) The Division Director or designee will determine if experience and qualifications are satisfactory to meet the required standards. The Division Director or designee will also determine if there are any training requirements that may be waived due to prior experience and training to grant an exception of any of the above requirements.

(e) Upon satisfactory completion of the required experience and training, the Division Director or designee will certify the qualifications of the applicant, make record of such certification and issue a certificate to the applicant reflecting his status as a designated examiner and authorize the use of privileges and responsibilities as prescribed by law.

 

R523-7-4. Certified Case [ Management ] Manager Certification.

(1) Definitions.

(a) Certified Case [Management]Manager Certification means the process by which [an]a non-licensed individual obtains certification from the Division. [that allows them to provide case]Case [management]manager certification allows the Certified Case Manager to provide services for individuals with mental illness , [and / or ]substance use disorders, and/or individuals experiencing homelessness.

[(i)](2) Case Management services can be provided by:

[(A)](a) A qualified provider, as defined in the Utah Medicaid Provider Manual[, found at https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid%20Provider%20Manuals/Targeted%20Case%20Management/Serious%20Mental%20Illness/Archive/2014/SeriousMentalIllness1-14.pdf.]for Targeted Case Management for individuals with Serious Mental Illness or a Serious Emotional Disturbance; or

[(B)](b) An individual under the supervision of a qualified provider employed or [contracted by the local mental health or substance abuse authority. The qualified provider shall be responsible for coordinating, advocating, linking and monitoring the Case Manager]contracted by the Utah Department of Human Services, (DHS) a local mental health authority, a local substance abuse authority, a DHS licensed homeless shelter, or a targeted homeless service program defined as: public or private not-for-profit organizations, faith-based organizations, state departments and agencies, units of local governments and Indian tribal governments who provide services to children, individuals, and/or families who are experiencing homeless or at risk of experiencing homeless contracted by the Department of Workforce Services (DWS).

[(b)](3) Certified Case Manager [tasks]duties include activities that assist individuals with:

[(i)](a) Serious mental illness;

[(ii)](b) Serious emotional [disorder; and]disturbance;

[(iii)](c) [Individuals with substance]Substance use disorders[.]; and

(d) Services related to homelessness;

[(c) Case Managers tasks include:]

[(i)](e) Accessing medical and related therapeutic services; and

[(ii)](f) [To promote]Promoting the individual's general health and their ability to function independently and successfully in the community.

[(2) A certified case manager must meet the following minimum standards:

(a) Be at least 18 years of age;

(b) Have at least a high school degree or a GED;

(c) Have at least have at least two years experience in Human Services or related field (may include relevant education/volunteer activities).

(d) Be employed or subcontracted by a local mental health authority or a local substance abuse authority;](4) A Certified Case Manager must meet the following minimum standards:

(a) Be at least 18 years of age;

(b) Be employed or subcontracted by DHS, a local mental health authority or a local substance abuse authority, a DHS licensed homeless shelter, or a targeted homeless program as defined in R523-7-4(2)(b); and

(c) Meet one of the following:

(i) Have at least a high school degree or a General Education Diploma/GED, and prior to applying for the Case Management Certification, obtain 400 hours experience within the previous 10 years of application submission in human services or related fields, which may include relevant education/volunteer activities; or

(ii) Be a Certified Peer Support Specialist or Family Resource Facilitator and have been actively working in the humans services field for at least 400 hours within the previous 10 years of the application submission date; or

(iii) Have at least a bachelor's degree in Human Services or a related field of study;

[(e)](d) Pass a Division exam which tests basic knowledge, ethics, attitudes and case management skills with a score of 70 percent or above; and

[(f)](e) Have completed [an]a Division approved 40-hour supervised case management practicum.

[(3)](5) [An individual applying to become a certified case manager may request a waiver of the minimum standards in Subsection R523-7-4(2) based on their prior experience and training. The individual shall submit the request in writing to the Division. The Division shall review the documentation and issue a written decision regarding the request for waiver]The Division Director or designee shall determine if experience and qualifications are satisfactory to meet the required standards, and if there are any training requirements that may be waived due to prior experience and training to grant an exception of any of the above requirements.

[(4)](6) Applications and instructions to apply for certification to become a [case manager]Certified Case Manager can be obtained from the Division. Only complete applications supported by all necessary documents shall be considered.

(a) Applicants or the agency submitting the application shall respond to any Division requests for additional information regarding the application within 30 days or the Certified Case Managers certification may be denied.

[(a)](b) Individuals [will]shall be notified in writing of disposition and determination to grant or deny the application within 30 days of [completion of case management requirements]submission including response to Division requests for additional information of the Certified Case Manager's application. The Division shall issue a certificate for three years, and the certificate shall be transferable across qualified employers.

[(b)](c) If the application is denied the individual may file a written appeal within 30 days to the Division Director or designee.

[(5)](8) Each [certified case manager]Certified Case Manager is required to complete and document [eight]30 hours of continuing education (CEU) credits [each calendar year related to mental health, substance use disorder or related topics]related to mental health, substance use disorder homelessness, trauma informed care or related topics over the 3 year certification period. CEUs must include at least 4 hours of ethics and 3 hours of suicide prevention training.

(a) A [certified case manager]Certified Case Manager shall retain CEU documentation. Documentation should not be sent to the Division unless requested for an audit.

(b) Documents to verify CEU credits include:

(i) A certificate of completion documenting continuing education validation furnished by the presenter[:];

(ii) A letter of certificate from the sponsoring agency verifying the name of the program, presenter, and number of hours attended and participants; or

(iii) An official grade transcript verifying completion of an undergraduate or graduate course(s) of study.

[(6) Certified case managers shall abide by the Provider Code of Conduct pursuant to Section R495-876, and as also found in the Department of Human Services Provider Code of Conduct Policy.

(a) Each employer shall notify the Division within 30 days, if a certified case manager engages in unprofessional or unlawful conduct.

(b) The Division shall revoke, refuse to certify or renew a certification to an individual who is substantiated to have engaged in unprofessional or unlawful conduct.

(c) An individual who has been served a Notice of Agency Action that the certification has been revoked or will not be renewed may request a Request for Review to the Division Director or designee within 30 days of receipt of notice.

(d) The Division Director or designee will review the findings of the Notice of Agency Action and shall determine to uphold, amend or revise the action of denial or revocation of the certification.](9) Certified Case Managers shall abide by the Provider Code of Conduct pursuant to Section R495-876, and as also found in the DHS Provider Code of Conduct Policy.

(a) Each employer that becomes aware of a Certified Case Manager engaging in unprofessional or unlawful conduct, or has violated the provider code of conduct shall:

(i) immediately take action to review the allegations,

(ii) take steps to ensure that all individuals involved with the allegation are protected, and

(iii) notify the Division within 30 days.

(b) Termination of certification shall be made effective immediately if the alleged violation(s) results in one or more of the following:

(i) personal financial gain through deception, or a business transaction with a client, by the Certified Case Manager,

(ii) physical or emotional harm to a person that is caused by the Certified Case Manager, or

(iii) a financial loss to a client, the State, or another employee that is caused by the Certified Case Manager.

(c) The Division shall take the following actions when it becomes aware of a Certified Case Manager in violation of the provider code of conduct that does not result in immediate termination:

(i) Within 30 days of becoming aware of the violation(s), the Division shall notify the Certified Case Manager, in writing, through a Notice of Agency Action specifying the area(s) of noncompliance.

(ii) Within 30 days of receiving a notice of Agency Action, the Certified Case Manager shall submit an acceptable written plan to the Division explaining how they will achieve compliance.

(iii) All plans shall demonstrate how the Certified Case Manager shall be in compliance within 30 days after receiving the Notice of Agency Action.

(iii) If an acceptable plan of action is not received by the Division within 30 days of sending the Notice of Agency Action, the Certified Case Manager shall be notified that their certification has been suspended until an acceptable plan is submitted to the Division.

(iv) A Certified Case Manager must cease providing any and all case management services until a suspension is lifted.

(d) The Division shall revoke the certification of any Certified Case Manager for the following reasons:

(i) The Certified Case Manager fails to provide the Division with written evidence of compliance to a plan of action within 30 days after the receiving a Notice of Agency Action that their certification has been suspended.

(ii) The Certified Case Manager continues to provide case management services during the period of a suspension; or

(iii) The Certified Case Manager receives more than two notices of noncompliance with the Provider Code of Conduct in a one-year period.

(e) Any Certified Case Manager whose certification has been revoked may request an informal hearing with the Division director or designee, in writing, within 10 business days of receiving notice of revocation.

(f) The Division director or designee shall review the request and determine to uphold, amend or reverse the action within 10 business days, and the Division shall inform the Certified Case Manager of the decision in writing.

(g) Any Certified Case Manager with a revoked certification may not reapply for recertification for a period of 12 months.

[(7)](10) If a [certified case manager]Certified Case Manager fails to complete the requirements for CEUs, their certificate will be revoked or allowed to expire and will not be renewed until the required CEUs have been completed and submitted to the Division for approval.

[(8)](11) If an individual fails the Division examination twice within a 30 day period of time, they must wait 30 days before taking the examination again.[ The individual may only attempt to pass the examination two times within a twelve-month period.

(9) The case manager's certification shall be posted and available upon request.

(10) The LMHA/LSAA shall notify the Division in writing when a Case Manager is no longer employed or subcontracted. The Case Manager certification shall be void upon separation of employment or termination of contract with the LMHA/LSAA.]

(12) The Certified Case Manager's certification shall be posted and available upon request.

 

KEY: designated examiners, involuntary commitment, case managers

Date of Enactment or Last Substantive Amendment: [December 22, 2015]2019

Authorizing, and Implemented or Interpreted Law: 62A-15-105 (2) ; 62A-15-602[(3)](5)

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