R523-2. Local Mental Health Authorities and Local Substance Abuse Authorities, R523. Human Services, Substance Abuse and Mental Health, Utah Administrative Code

Utah Administrative Code (Current through November 1, 2019)

R523. Human Services, Substance Abuse and Mental Health

R523-2. Local Mental Health Authorities and Local Substance Abuse Authorities

R523-2-1. Authority

Latest version.

This rule is promulgated under authority granted to the Division of Substance Abuse and Mental Health (Division) by Subsections 62A-15-105, 62A-15-108(1), 62A-15-611(2)(a), 62A-15-612(2) and 62A-15-902(2)(c).

R523-2-2. Purpose

Latest version.

(1) The purpose of this rule is to provide:

(a) Guidance on the priorities for treatment services

(b) Guidance on the rights of individuals participating in services.

(c) A process for Local Mental Health Authorities (LMHAs) and Local Substance Abuse Authorities (LSAAs) to set policies on fees for service.

(d) Guidance on LMHA/LSAA program standards.

(e) Guidance on the formula for allocation of funding.

(f) Guidance on allocation of Utah State Hospital (Hospital) beds to LMHAs.

(g) Guidance on admission to the Hospital and coordination of care.

(h) Guidance on determining the proper LMHA under special situations.

(i) Guidance on transfer planning between LMHAs from the Hospital.

(j) Guidance on conflict resolution.

(k) Guidance on prohibited items and devices on the grounds of public mental health facilities.

R523-2-3. Priorities for Treatment Services

Latest version.

(1) Programs providing substance use disorder and mental health treatment services with public funds (federal, state, and local match) shall comply with the priorities listed below. The Division shall regularly seek and receive input from the Utah Behavioral Health Planning and Advisory Council on priorities for services.

(2) Mental Health services provided with public funds (federal, state, and local match) shall provide services based on immediacy of need and severity of the mental illness. Priority may also be given to under-served age groups as appropriately demonstrated through needs studies.

(a) Effective and responsive crisis intervention, suicide prevention, assessment, direct care, and referral program available to all citizens.

(b) Provision of the least restrictive and most appropriate treatment and settings for:

(i) Children, youth, and adults with severe mental illness;

(ii) Children, youth, and adults with acute mental illness; and

(iii) Children, youth and adults who are receiving services from other divisions within the Department of Human Services.

(c) Provisions of services to children with emotional disabilities, youth and aged citizens who are neither acutely nor severely mentally ill, but whose adjustment is critical for their future as well as for society in general.

(d) Provision of services to emotionally disabled adults who are neither acutely nor severely mentally ill, but whose adjustment is critical to their personal quality of life as well as for society in general.

(e) Provision of consultation, education and preventive mental health services targeted at high risk groups in particular.

(3) Substance use disorder treatment services provided with public funds (federal, state, and local match) shall provide priority admission to the following populations (in order of priority):

(a) Pregnant females who use drugs by injection;

(b) Pregnant females who use substances;

(d) Substance using females with dependent children and their families, including women who are attempting to regain custody of their children; and

(e) All other clients with a substance use disorder, regardless of gender or route of use.

R523-2-4. Rights of Individuals Participating in Services

Latest version.

(1) All service providers contracted with the Division and County Local Authority programs shall disclose the following information in writing to all individuals participating in treatment services:

(a) Rights and responsibilities to participate in the development of the treatment or other type of service plan.

(b) Right to be involved in selection of their primary therapist.

(d) Right to informed consent regarding medications.

(e) Rights regarding medication-assisted treatment.

(f) Disclosure of all program fees and personal financial responsibility.

(g) Information on grievance procedures that includes all necessary information to file a formal grievance.

(h) Service provider's commitment to treat individuals with substance use disorders and mental health consumers with dignity and individuality in a positive, supportive and empowering manner.

(2) This information shall be shared with the individual participating in treatment services at the time of intake and a signed copy made part of their individual file. The Division shall periodically review this process to assure appropriate content within the rights statement and proper application of the intent of this policy.

(3) If an individual is impaired or temporarily incapable of understanding the initial information, it shall be shared again when the individual is able to understand the information and give informed consent. This shall also be made part of their individual file.

R523-2-5. LMHA/LSAA Fee Policy

Latest version.

(1) Each LMHA/LSAA shall require all programs that receive federal and state funds from the Division and provide services to clients to establish a policy to set and collect fees.

(a) Each fee policy shall include:

(i) A fee reduction plan based on the client's ability to pay for services; and

(ii) A provision that clients who have received an assessment and require mental health or substance use disorder services shall not be denied services based on the lack of ability to pay.

(b) Any adjustments to the assessed fee shall follow the procedures approved by the LMHA/LSAA.

(2) The governing body of each LMHA/LSAA shall approve the fee policy and shall set a usual and customary rate for services rendered.

(3) All LMHA/LSAA programs shall provide a written explanation of the fee policy to all clients at the time of intake except in the case of emergency services.

(4) All clients shall be assessed fees based on:

(a) The usual and customary rate established by the LMHA/LSAA, or

(b) A negotiated contracted cost of services rendered to clients.

(5) Fees assessed to clients shall not exceed the average cost of delivering the service.

(6) All fees assessed to clients, including upfront administrative fees, shall be reasonable as determined by the LMHA/LSAA.

(7) All programs shall make reasonable effort to collect outstanding fee charges and may use an outside collection agency.

(8) All programs may reduce the assessed fee for services if the fee is determined to be a financial hardship for the client.

(9) The Division shall annually review each program's policy and fee schedule to ensure that the elements set in this rule are incorporated.

R523-2-6. LMHA/LSAA Program Standards

Latest version.

(1) The Division establishes minimum standards for LMHA/LSAA programs.

(a) Each LMHA/LSAA program shall have the appropriate current license issued by the Office of Licensing, Department of Human Services and any other required licenses.

(b) Each LMHA/LSAA shall have a comprehensive plan of service which shall be reviewed and updated at least annually to reflect changing needs. The plan shall:

(i) Be consistent with the Division Directives for the Division of Substance Abuse and Mental Health;

(ii) Designate the projected use of state and federal contracted dollars and the 20% county match dollars; and

(iii) Define the LMHA/LSAA's priorities for service and the population to be served.

(i) Inpatient care and services (hospitalization);

(ii) Residential care and services;

(iii) Day treatment and psycho-social rehabilitation;

(iv) Outpatient care and services;

(v) Twenty-four hour crisis care and services;

(vi) Psychotropic medication management;

(vii) Case management services;

(viii) Community supports including in-home services, housing, family support services and respite services;

(ix) Consultation, education and preventative services, including case consultation, collaboration with other county service agencies, public education and public information; and

(x) Services to persons incarcerated in a county jail or other county correctional facility.

(d) Each LSAA shall provide or arrange for the provision of services within the following continuum of care:

(i) Universal prevention;

(ii) Selective prevention;

(iii) Indicated prevention including the educational series approved by the Division in R523-11 for individuals convicted of driving under the influence; and

(iv) Treatment services prescribed by Division contract and Directives; and

(v) Recovery Support Services.

(e) Each LMHA/LSAA shall participate in a yearly on-site evaluation conducted by the Division.

(f) The LMHA/LSAA shall be responsible for monitoring and evaluating all subcontracts to ensure:

(i) Services delivered to consumers commensurate with funds provided; and

(ii) Progress is made toward accomplishing contract goals and objectives.

(g) The LMHA/LSAA shall conduct a minimum of one site visit per year with each subcontractor. There shall be a written report to document the review activities and findings, a copy of which will be made available to the Division.

R523-2-7. Formula for Allocation of Funding

Latest version.

(1) The Division establishes by rule, a formula for the annual allocation of funds to LSAAs and a formula for the annual allocation of funds to the LMHAs.

(a) The formulas do not apply to funds used by the Division for administration, statewide services consistent with the requirements of Section 62A-15-201 et seq. for discretionary grants awarded to the Division, funds appropriated for drug court, the Drug Offender Reform Act and the Medicaid Match funds.

(b) Funds used by the Division for administration shall not exceed 5% of the total annual legislative appropriation to the Division excluding the appropriation for the Utah State Hospital.

(c) The funding formulas shall be applied annually to state and federal block grant funds appropriated by the legislature to the Division and are intended for the annual equitable distribution of these funds to the state's LMHAs and LSAAs.

(d) Excluding discretionary grants, DORA, Drug Court, and other programs for which Utah Code establishes the funding process, funds used by the Division for statewide substance use disorder services consistent with requirements of Section 62A-15-201 et seq. shall not exceed 15% of the total annual substance abuse legislative appropriation to the Division.

(e) Population data used in the formulas shall be updated annually using the most current data available from the Utah Department of Health's website, Public Health Indicator Based Information System (IBIS).

(f) New funding and/or decreases in funding shall be processed and distributed through the funding formulas.

(g) Each LMHA/LSAA shall provide funding equal to at least 20% of the state general fund appropriation that it receives to fund services described in that LMHA/LSAA's annual plan.

(i) The Division determines that the funds required by Subsection 17-43-301(4)(a)(x) (normally called the 20% match requirement) shall be paid from tax revenues assessed by the county legislative body and collected by the County Clerk.

(ii) If a LMHA/LSAA is unable to provide the required matching funds, the LMHA/LSAA shall be allocated the amount the LMHA/LSAA can match.

(iii) Excess funds may be allocated on a one-time basis to LMHAs/LSAAs with the ability to provide matching funds.

(iv) If no LMHA/LSAA can provide the required match, the Division may use the funds to purchase statewide services.

(h) Changes in funding related to the adoption of new formulas in 2014 shall be phased in over a five year period beginning in State Fiscal year 2015.

(2) Funding for mental health shall be allocated as follows:

(a) The Division shall allocate 5% of mental health funds to the 24 smallest counties ranked by population as a rural differential. The rural differential shall be allocated using the following methodology:

(i) 35% divided in equal amounts to the six smallest counties.

(ii) 30% divided in equal amounts to the seventh through twelfth smallest counties.

(iii) 20% divided in equal amounts to the thirteenth through the eighteenth smallest counties.

(iv) 15% divided in equal amounts to the nineteenth through the twenty-fourth smallest counties.

(b) The Division shall allocate all remaining mental health funds to the LMHAs on a per capita basis, according to the most current population data available from IBIS.

(c) The funding formula may utilize a determination of need other than population if the Division establishes by valid and acceptable data, that other defined factors are relevant and reliable indicators of need.

(3) The funding formula for substance use disorder services shall be applied annually to state and federal funds appropriated by the legislature to the Division and is intended for the annual equitable distribution of these funds to the state's LSAAs.

(a) The Division shall allocate a total of $2,390,643 in funds used for prior cost of living increases and funds previously contracted with statewide residential providers to the LMHAs/LSAAs in an amount equal to the 2014 allocation.

(b) The Division shall allocate 5% of the remaining funds to the 24 smallest counties ranked by population. The rural differential shall be allocated using the following methodology:

(i) 35% divided in equal amounts to the six smallest counties.

(ii) 30% divided in equal amounts to the seventh through twelfth smallest counties.

(iii) 20% divided in equal amounts to the thirteenth through the eighteenth smallest counties.

(iv) 15% divided in equal amounts to the nineteenth through the twenty-fourth smallest counties.

(c) Sixty percent of the remaining funds shall be allocated to each county based on the incidence and prevalence of substance use disorders based on the following;

(i) The percent of adults estimated to be binge drinkers as reported by the Behavioral Risk Factor Surveillance System (BRFSS).

(ii) The percent of adults estimated to be chronic drinkers as reported by BRFSS.

(iii) The percent of youth reporting alcohol use within the past 30 days by the most current Student Health and Risk Protection Survey (SHARP).

(iv) The percent of youth estimated to be binge drinkers by the most current SHARP.

(v) The percent of youth needing drug treatment as reported by the most current SHARP.

(d) Forty percent of the remaining funds shall be allocated to LSAAs on a per capita basis, according to the most current population data available from the IBIS.

R523-2-8. Formula for Allocation of Medicaid Match Funds

Latest version.

(1) Medicaid match funds appropriated to the Division shall be allocated to the LMHAs/LSAAs using the methodology described below:

(a) The Division shall obtain the following data from the Utah Department of Health:

(i) The number of eligible Medicaid recipients in each county, for each month of the previous state fiscal year hereinafter called Medicaid Member Months; and;

(ii) The actuarially established rates for each county.

(b) The Division shall calculate County Need for Medicaid match funds by multiplying each County's Total Medicaid Member Months by their corresponding actuarial rates for the most current 12 month period.

(d) The percent of total Medicaid match funds for each local authority shall be determined by dividing the sum of County Need by the State Medicaid Match Need.

(e) Local authorities that do not participate in the Medicaid prospective payment-capitation plan shall receive the amount of funds they would have received if the funds had been distributed using state population.

(f) Each LMHA and LSAA shall provide funding from tax revenues assessed by the County legislative body equal to at least 20% of the Medicaid match funds.

(i) If a LMHA/LSAA is unable to provide the required matching funds, the LMHA/LSAA shall be allocated the amount the LMHA/LSAA can match.

(ii) Excess funds may be allocated on a one-time basis to local authorities with the ability to provide matching funds.

R523-2-9. Distribution of Fee-On-Fine (DUI) Funds

Latest version.

(1) The Fee-On-Fine funds collected by the court system under the criminal surcharge law and remitted to the State Treasurer will be allocated to the LSAAs based upon each county's percent of the total state population as determined at the time of the funding formula as described in Section R523-2-7. The Division shall authorize quarterly releases of these funds to the county commission of each county for which they are allocated unless notified in writing by the LSAA's governing board to send the funds to the local service provider.

(2) Utah Code 62A-15-503 states these funds "shall be used exclusively for the operation of licensed alcohol or drug rehabilitation programs and education, assessment, supervision, and other activities related to and supporting the rehabilitation of persons convicted of driving under the influence of intoxicating liquor or drugs. A requirement of the rehabilitation program shall be participation with a victim impact panel or program providing a forum for victims of alcohol or drug related offenses and defendants to shares experiences on the impact of alcohol or drug related incidents in their lives."

(3) Each counties proposed use of the funds shall be identified in the Local authority area plan submitted to the Division each year as described in Utah Code 62A-15-103(2)(c)(xi).

(4) Each counties actual expenditures shall be documented in an expenditure report submitted by the local authority within 60 days of the end of the State fiscal year that describes the actual use of the funds from this account.

(5) The Division shall review and monitor funds from this project during the annual site visit.

R523-2-10. Allocation of Utah State Hospital Adult Bed Days to Local Mental Health Authorities

Latest version.

(1) The Division herein establishes a formula to allocate to LMHAs the adult beds for persons who meet the requirements of Subsection 62A-15-610(2)(a).

(2) The formula established provides for allocation based on:

(a) The percentage of the state's adult population located within a LMHA catchment area; and

(b) A differential to compensate for the additional demand for hospital beds in LMHA catchment areas that are located within urban areas.

(3) The Division hereby establishes a formula to determine adult bed allocation:

(a) The most recent available population estimates are obtained from IBIS.

(b) The total adult population figures for the State are identified. Adult means age 18 and over.

(d) The urban counties are identified (county classifications are determined by the lieutenant governor's office pursuant to Subsections 17-50-501 and 17-50-502 and the most recent classifications are used to determine which counties are defined as urban) and given a differential as follows:

(i) The total number of adult beds available at the Utah State Hospital is determined.

(ii) 4.8% is subtracted from the total number of beds available for adults to be allocated as an urban differential.

(e) The total number of available adult beds minus the urban differential is multiplied by the county's percentage of the state's total adult population to determine the number of allocated beds for each county.

(f) Each catchment area's individual county numbers are added to determine the total number of beds allocated to a catchment area. This fractional number is rounded to the nearest whole bed.

(g) The urban differential beds are then distributed to urban counties based on their respective percentage of urban counties as a whole.

(h) At least one adult bed is allocated to each LMHA.

(4) In accordance with Subsection 62A-15-611(6), the Division shall periodically review and make changes in the formula as necessary to accurately reflect changes in population.

(5) Applying the formula:

(a) Adjustments of adult beds, as the formula is applied, shall become effective at the beginning of the next fiscal year.

(b) The Division is responsible to calculate the adult bed allocation.

(6) The number of allocated adult beds shall be reviewed and adjusted as necessary or at least every three years as required by statute.

(7) A LMHA may sell or loan its allocation of adult beds to another LMHA.

R523-2-11. Allocation of Utah State Hospital Pediatric Beds to Local Mental Health Authorities

Latest version.

(1) The Division establishes a formula to allocate to LMHAs the pediatric beds at the Utah State Hospital.

(2) The formula established provides for allocation based on the percentage of the state's population of persons under the age of 18 located within a LMHA catchment area.

(3) Each LMHA shall be allocated at least one pediatric bed.

(4) The formula to determine pediatric bed allocation:

(a) The most recent available population estimates are obtained from IBIS.

(b) The total pediatric population figures for the State are identified. Pediatric means under the age of 18.

(d) The total number of pediatric beds available is multiplied by the county's percentage of the state's total pediatric population. This will determine the number of allocated pediatric beds for each county.

(e) Each catchment area's individual county numbers are added to determine the total number of pediatric beds allocated to a catchment area. This fractional number is rounded to the nearest whole bed.

(5) The Division shall periodically review and make changes in the formula as necessary.

(6) Applying the formula:

(a) Adjustments of pediatric beds, as the formula is applied, shall become effective at the beginning of the new fiscal year.

(b) Each LMHA shall be notified of changes in pediatric bed allocation.

(7) The number of allocated pediatric beds shall be reviewed and adjusted as necessary or at least every three years as required by statute.

(8) A LMHA may sell or loan its allocation of pediatric beds to another LMHA.

R523-2-12. Admission to the Hospital and Coordination of Care

Latest version.

(1) The Division has oversight of the Utah State Hospital as per Subsection 62A-15-103(2)(b)(ii) and shall oversee the Continuity of Care Committees for adult and children/youth patients (when the patient is a child or youth, then patient also refers to the parent and/or legal guardian), as it pertains to Admissions, Coordination of Care, Discharges and Transfers between LMHAs of patients to and from the Utah State Hospital (Hospital). The Division shall conduct monthly Continuity of Care Committee meetings, unless the time for the meetings is postponed or canceled for good cause.

(2) Each LMHA shall assign a liaison to the Hospital as the identified representative of the LMHA.

(a) The Liaison shall coordinate patient needs for admission to the Hospital and shall complete the Hospital Pre-admission packet, which includes identifying community discharge and treatment options prior to admission. Any individual or family member independently requesting voluntary Hospital admission shall be referred to the appropriate LMHA geographical area in which the individual currently resides.

(b) LMHA liaisons are responsible to participate in the coordination of care at the Hospital. This includes participation in clinical staffing, at least monthly. The liaisons and Hospital staff are required to participate in order to coordinate patient treatment, discuss the progress of assigned patients and meet with patients and Hospital staff jointly to formulate patient care.

(c) Patients admitted to the Forensic units are under the jurisdiction of the criminal court system; if the need arises the LMHA liaison will participate in community discharge placements, and follow up care.

(d) Hospital staff and liaison shall coordinate discharge plans. As there are multiple factors inherent in determining "readiness for discharge," this decision will be made on an individual basis, with input from the patient, the Hospital, the LMHA and the Division as necessary. Outplacement funds shall be used to resolve financial barriers that delay or complicate patients discharge. Patient's preferences and feedback regarding discharge placements shall be considered. For adult patients the LMHA liaison is required to arrange discharge placement and follow up care once the patient is ready for discharge as indicated by the Division's REDI program (Readiness, Evaluation and Discharge Implementation). The Hospital and LMHAs are required to use the REDI program. REDI information will be distributed monthly to the Hospital, and the LMHAs to track progress toward discharge. The philosophy of the Hospital is to provide short-term inpatient care for the purpose of stabilization with the goal of transition to a less restrictive level of care as soon as possible. If the Hospital and/or the LMHA determine that the patient is ready for discharge and the coordination of the placement is not occurring, the Hospital and/or liaison is required to notify the Division within five business days.

(e) The Liaison shall follow the Hospital's policies on admission, treatment, discharge, and transfers of all Hospital patients.

R523-2-13. Determining the Proper LMHA Under Special Situations

Latest version.

(1) In the following special situations, the proper LMHA will be determined as follows:

(a) Homeless: Individuals who are homeless and in need of Hospital admission shall be the responsibility of the LMHA in which the individual came to the attention of local emergency services. If from out of state, the individual shall be referred to the LMHA where the individual was identified as mentally ill and in need of services.

(b) Children and Adolescent Patients: Children and Adolescents in state custody shall be referred to the LMHA in which they resided prior to their custody being changed to the Division of Child and Family Services or the Division of Juvenile Justice Services.

(c) Forensic Patients: When a forensic patient, placed at the Hospital pursuant to criminal adjudication as set forth in Utah Code Section 62A-15-902, and is determined to meet criteria for civil commitment, the patient shall be committed to the LMHA where the patient resided prior to his/her arrest.

(d) Prison Transfers: Utah State Prison inmates who are transferred to the Hospital Forensic Unit and subsequently civilly committed become the responsibility of the LMHA where the person resided prior to incarceration.

(e) Developmental Center Transfers: Individuals placed at the Utah State Developmental Center (USDC), who are transferred to the Hospital for treatment of a mental illness are the responsibility of the LMHA of their last community residence (excluding foster and group home placements less than one year in duration). If the individual was admitted to the USDC as a child, the residence of the custodial parent(s) at the time of admission to USDC shall be used to determine the responsible LMHA. The LMHA is responsible for treatment and discharge planning during the course of the individual's Hospital stay.

R523-2-14. Transfer Planning Between LMHAs From the Hospital

Latest version.

(1) When a Hospital patient or the patient's legal guardian desires to relocate to a new geographical area, the patient's LMHA liaison (the liaison responsible for the civil bed in which the patient currently resides), shall notify the receiving LMHA regarding the desire of the patient. It is the referring liaison's responsibility to discuss the matter with the patient and with the receiving LMHA and work toward discharge.

(2) The referring and receiving LMHA liaison shall discuss the transfer and shall provide information as needed.

(3) Once the receiving LMHA accepts the referral, the receiving LMHA shall proceed with Hospital patient discharge planning. During the time period between the referral to the receiving LMHA and Hospital discharge, the Hospital patient shall continue to be assessed against the bed allocation of the referring LMHA. The receiving LMHA is expected to work toward discharge.

(4) The LMHAs may negotiate an agreement (LMHA to LMHA) if the patient returns to the Hospital, the patient returns to the referring LMHA bed. The agreement is not to exceed one year, whereby the referring LMHA agrees the patient's bed shall be assessed against the bed allocation of the referring LMHA. The agreement specifies the role of each LMHA and who is responsible for providing needed services and payment for those services. Any such agreement shall be made in writing. If a LMHA to LMHA agreement cannot be reached, then the conflict resolution process as outlined in R523-2-15 below shall be followed.

(5) At the conclusion of the negotiated period, the receiving LMHA shall assume all responsibility for the full continuum of mental health services, including Hospital care.

R523-2-15. Conflict Resolution

Latest version.

(1) The Division will work to resolve conflicts between the Hospital and a LMHA, as well as conflicts between LMHAs.

(a) If negotiations between LMHAs and the USH regarding admissions, discharges or provisions of consumer services fail to be resolved at the local level, the following steps shall be taken:

(i) The director of the Division or designee shall appoint a committee to review the facts of the conflict and make recommendations;

(ii) If the recommendations of the committee do not adequately resolve the conflict, the clinical or medical director of the LMHA and USH clinical director shall meet and attempt to resolve the conflict;

(iii) If a resolution cannot be reached, the LMHA director and the superintendent of the USH shall meet and attempt to resolve the conflict;

(iv) If a resolution cannot be reached, the director of the Division or designee shall make the final decision.

(b) If conflicts arise between LMHAs regarding admissions, discharges, or provisions of consumer services, the final authority for resolution shall rest with the director of the Division or designee.

R523-2-16. Prohibited Items and Devices on the Grounds of Public Mental Health Facilities

Latest version.

(1) Pursuant to the requirements of Subsection 62A-15-602 (9), and Sections 76-10-523.5, 76-8-311.1, and 76-8-311.3, all facilities owned or operated by community mental health centers that have any contracts with a LMHA and/or the Division are designated as secure areas. Accordingly all weapons, contraband, controlled substances, implements of escape, ammunition, explosives, spirituous or fermented liquors, firearms, or any other devices that are normally considered to be weapons are prohibited from entry into community mental health centers. There shall be a prominent visual notice of secure area designation. Law enforcement personnel are authorized to carry firearms while completing official duties on the grounds of those facilities.