DAR File No. 44005
This rule was published in the September 15, 2019, issue (Vol. 2019, No. 18) of the Utah State Bulletin.
Human Services, Substance Abuse and Mental Health
Certification Requirements for Screening, Assessment, Prevention, Treatment and Recovery Support Programs for Adults
Notice of Proposed Rule
DAR File No.: 44005
Filed: 08/20/2019 10:51:07 AM
Purpose of the rule or reason for the change:
This rule prescribes the minimum standards required for justice certification of mental health and substance use disorder (SUD) providers serving adults participating in mandatory education and treatment programs designed to reduce criminogenic risk. These changes are being proposed based on the agency's self-review of the statutory requirements placed on the Division of Substance Abuse and Mental Health (Division), and analysis of how to best meet the intent of Justice Reinvestment Initiative (JRI) certification.
Summary of the rule or change:
These amendments include: 1) formatting of sections has been changed; 2) an emphasis has been placed on the intent for certification to be extended to programs serving adults with criminogenic risk factors; 3) mandatory services has been defined; 4) a section for justice certification eligibility has been added to this rule; 5) requirements for criminogenic risk assessments has been removed; 6) criminogenic screening requirements have been updated; 7) standards for substance use and mental health screening and assessments have been combined and updated; 8) standards for providers of educational series have been updated; 9) the "Standards for Community-based Treatment" section has been updated and combined with the "Program Standards" section, and provisions for sole proprietorships and health clinics have been added; 10) the "Standards for Jail or Prison Treatment Programs" and "Documentation Standards for Community and Jail/Prison Based Treatment Services" sections have been eliminated; 11) justice certification requirements have been updated to reflect current agency expectations and actions; and 12) key search phrases have been updated to reflect the current justice certification nomenclature.
Statutory or constitutional authorization for this rule:
- Subsection 62A-15-103(j)
- 42 CFR Part 2
Anticipated cost or savings to:
the state budget:
The proposed changes in this rule amendment update procedures and expectation to meet current Division expectations and procedures, and do not require additional cost to the state budget beyond that which already exist with this rule as it is currently written.
The proposed changes in this rule amendment update procedures and expectation to meet current Division expectations and procedures, and do not require additional cost to local governments service provider systems beyond that which already exist with this rule as it is currently written.
The proposed changes in this rule amendment update procedures and expectation to meet current Division expectations and procedures, and do not require additional cost to small businesses holding current justice certifications or small businesses that will potentially apply to be justice certified in the future beyond that which already exist with this rule as it is currently written.
persons other than small businesses, businesses, or local governmental entities:
There are no costs or benefits in this rule change associated with other persons.
Compliance costs for affected persons:
There are no compliance cost in this rule amendment.
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 amendments will not result in a fiscal impact to 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 email@example.com
- Jonah Shaw at the above address, by phone at 801-538-4219, by FAX at 801-538-3942, or by Internet E-mail at firstname.lastname@example.org
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:
This rule may become effective on:
Doug Thomas, Director
Appendix 1: Regulatory Impact Summary Table*
Total Fiscal Costs:
Total Fiscal Benefits:
Net Fiscal Benefits:
*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 any fiscal impact on non-small businesses' revenues or expenditures, because there are not any non-small businesses that are currently providing substance use and/or mental health services to individuals who are required to participate in treatment; and it is unlikely a non-small business will ever participate in the activities describe in these rule changes.
The director of the Department of Human Services, Ann Williamson, has reviewed and approved this fiscal analysis.
R523. Human Services, Substance Abuse and Mental Health.
R523-4. Certification Requirements for Screening, Assessment, Prevention, Treatment and Recovery Support Programs for Adults.
This rule is authorized by Section
(h)] and 62A-15-103(2)(a)(v) requiring the Division of
Substance Abuse and Mental Health (Division) to establish by rule,
in accordance with Title 63G, Chapter 3, Utah Administrative
Rulemaking Act, minimum standards and requirements for the
provision of substance use disorder and mental health treatment
[ to individuals who are] required to participate in
treatment by the court or the Board of Pardons and Parole[ , or who are incarcerated and to develop, in collaboration
with public and private programs, minimum standards for public and
private providers of substance abuse and mental health programs
licensed by the Department of Human Services under Title 62A,
Chapter 2, Licensure of Programs and Facilities].
This rule prescribes the minimum standards
required for [
programs that provide mental health and substance use
disorder screening, assessment, prevention, treatment, education
and recovery supports services for adults, and requirements to
obtain a quality certification].
(1) "Screening" means a
preliminary appraisal of an [
individual] to determine if further assessment of mental health,
and/or substance use risk and needs is warranted.
(2) "Assessment" means an in-depth clinical interview with a licensed mental health therapist, used to:
(a) Determine if an [
individual] is in need of:
(i) Mental health or substance use
Educational or Prevention] series;
(iii) Recovery support services;
(b) Recommend a needed level of care or array of services.
(3) "Criminogenic Risk" means individual characteristics that are directly related to researched causations of crime.
(4) "Level of Care" means the intensity of either substance use disorder services needed as defined by the American Society of Addiction Medicine (ASAM) or the array of services needed to address an individual's mental health issues.
(5) "Treatment" means the array
of therapeutic services, including individual, family, group
services, medications and interventions designed to improve and
enhance social or psychological functioning and reduce criminogenic
risk for individuals identified as having either mental health or
substance use disorders.[
The ultimate goal of treatment services is to engage the
individual in a process of recovery.]
or Prevention] Series" means an
evidence-based instructional series[ for individuals with low criminogenic risk] obtained at a substance use disorder program that is approved by
the Division of Substance Abuse and Mental Health in accordance
with Section 62A-15-105 designed to prevent the onset of substance
use and/or mental health disorders.
(7) "Recovery" means a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
(8) "Recovery Support" means social support services or activities provided before, during or after completion of acute treatment services to enhance an individual's ability to either attain or retain their recovery from either mental health or substance use disorders.
4]. Standards for Criminogenic Risk Screening[ and Assessment for Agencies Treating Justice Involved
(1) Prior to participating in
educational, preventative] or treatment [ services ]adults shall [ be given] a brief, validated
[ ,] risk[ and needs] screen[ to determine whether the adult is of low, moderate, or high
risk to re-offend].
(a) Be conducted by an individual that has completed
training recommended by the developer of the specific instrument
being used and/or approved by the Division; (b) Collect information about behaviors and
characteristics known to predict re-offending including
delinquency history, social history, and
attitudes/behaviors. (3) If the screen indicates a high or moderate likelihood
of re-offending the adult shall be given an in-depth assessment
of criminogenic risk and need with an instrument that has been
evaluated and found reliable and valid by the scientific
community for the purpose of identifying specific criminogenic
risks and needs. (4) The criminogenic assessment shall examine a wide
variety of factors related to the adult's strengths and
challenges including: criminal history, school, employment,
relationships, environment, current living arrangements, alcohol
and drugs, mental health, attitudes, behaviors, and
skills. (5) The criminogenic assessment shall also identify
protective factors that are related to the reduced likelihood of
re-offending and risk factors that are related to the increased
likelihood of re-offending.]
5]. Standards for Substance Use and Mental Health Disorder
Adults shall be screened] using an instrument(s) that has been evaluated and found
reliable and valid by the scientific community[ to determine whether the adult is in need of a
Screenings shall be: (a) Conducted by an individual that has completed
training recommended by the developer of the specific instrument
being used and/or approved by the Division; (b) Trauma-sensitive, developmentally appropriate, and
The individual shall be referred for an] assessment
if the screening [ identifies] potential
substance use and/or mental health disorders.
Screenings shall not be used to determine diagnosis but may
assist in determining the need for further assessment.
R523-4-6. Standards for Substance Use and Mental Health
(1) Assessments shall be conducted by a licensed mental
health therapist using a standardized process/instrument(s) that
has been evaluated by the scientific community and determined to
be reliable and valid for the purpose of assessing
individuals. (2) Assessments shall identify the individual's level
of motivation for treatment and implement strategies to increase
engagement and need for clinically appropriate Mental Health
Disorder services and/or Substance Use Disorder services in the
following modified ASAM Patient Placement Criteria
(a) Risk of acute psychosis, intoxication/withdrawal;
(b) Biomedical conditions or complications;
(c) Emotional, behavioral, or cognitive conditions;
(d) Readiness to change;
(e) Relapse, continued use or continued problem potential; and
(f) Recovery environment.
(3) The assessment shall include relevant information
on: (a) The individual's psychosocial function, substance
use including tobacco/nicotine, mental and physical health, and
other factors, such as educational experiences, trauma history,
cultural issues, legal involvement, and family relationships that
are relevant to the purpose of the assessment; (b) Strengths, resiliencies, natural supports, interests
of the individual, and an evaluation of the individual's
unique abilities; (c) Developmental and functional levels, social,
emotional, communication abilities and strengths, and independent
living skills; (d) Cognitive, social, and affective development; family,
peer, and intimate relationships; trauma; current or past
emotional, physical or sexual abuse; suicidality; and
safety; (e) Collateral information from other sources that are
relevant to the individual's situation and provides insight
into the issues in Subsection R523-4-6(2)(a) through
(2)(d). (4) The assessment shall include a diagnosis when
clinically indicated. (5) Based on the screening and the assessment, the
assessor shall make recommendations regarding the needed level of
care and services to address the identified clinical
needs. (6) The levels of care and array of services shall be based
on the ASAM or equivalent Mental Health criteria.]
R523-4-7. Standards for Providers of
Entities wishing to provide an intervention, program,
activity or curriculum to individuals with a substance use disorder
shall: (a) Obtain and maintain an outpatient or residential
facility license from the Department of Human Services, Office of
(b) Use only educational and prevention material that
requirements for listing on Utah's registry of evidence-based
practices identified in Section R523-9[ that:]
(i) Address the substance use, and mental health needs of
the targeted population; (ii)] Provide[ s] accurate information [ that is ]designed to promote compliance with Utah
(iii)] Meet the requirements set forth in Subsection
62A-15-103(h) and Subsection R523-4-7(1)(b) through 1(f)[ .]
(c) Not implement any educational programs until approved
by the Division. (d)] Maintain records documenting the individual's
attendance and course completion or failure to attend and/or
(e) Not include minors in adult groups. (f) Serve low criminogenic risk individuals and high
criminogenic risk individuals separately. (g) Provide accurate information and be designed to promote
compliance with Utah laws.]
]Standards for Community-Based Treatment[
shall maintain the appropriate license from] the Department of Human Services Office of
Licensing [ for the type(s) of services being provided].
Treatment programs shall: (a) Ensure that public funds are the payor of last resort
and: (i) Coordinate or refer individuals to the Department of
Workforce Services or healthcare navigators for assistance with
eligibility for public or private insurance plans. (ii) May negotiate and assess usual and customary fees to
adults. (b) All substance use providers complete and submit the
National Survey on Substance Abuse Treatment Services (N-SSATS),
and all mental health providers complete the National Mental
Health Services Survey (N-MHSS). (4) All public substance use providers, including the
Local Substance Abuse Authorities and their contracted providers,
shall submit Treatment Episode Data (TEDs) admission and
discharge data as outlined in the Division's most current
Division Directives. (5) Programs seeking a quality certification that
provides services to justice involved individuals shall: (a) Evaluate all participants for criminogenic risk and
need, and deliver services that target the specific risk and
needs identified; (b) Ensure individuals with high risk and individuals
with low risk to re-offend are treated separately; (c) Provide multi-dimensional treatment that targets the
validated criminogenic risk factors; and (d) Coordinate and communicate with Adult Probation and
Parole, county sheriff's offices, or other necessary criminal
justice agencies on a regular and consistent basis as
R523-4-9. Treatment Standards for Community-Based Treatment
(1) Treatment intensity, duration and modality
for: (a) Substance use disorders shall be based on the current
ASAM criteria; and (b) Mental health disorders shall be determined by the
clinical assessment process and medical necessity. (2) Treatment programs shall: (a) Have qualified staff licensed and capable of
assessing individuals for both mental health and substance use
disorders; (b) Develop strategies to screen for, prevent, and refer
to treatment adults with serious chronic conditions such as, but
not limited to, HIV/AIDS, Hepatitis B and C, and
tuberculosis; (c) Ensure that assessment is an ongoing component of
treatment; (d) Diagnose, treat or ensure treatment for co-occurring
conditions; (e) Ensure treatment participation and length shall be of
sufficient dosage/duration to affect stable behavioral change and
long term recovery supports; (f) Develop an individualized treatment plan that
identifies a comprehensive set of tools and strategies that
address the client's identifiable strengths as well as their
problems and deficits; (g) Provide comprehensive treatment services that
includes but is not limited to: (i) Developmentally appropriate and informed
treatments; (ii) Recognition of gender, cultural, linguistic, and
other individual differences in the treatment approach; (iii) Ensuring all individuals with alcohol and/or opioid
disorders are educated and screened for the potential use of
medication-assisted treatment; (iv) Monitoring drug use through drug testing and other
means; (v) Individuals testing positive for drugs or alcohol
shall not be denied entry or removed from treatment from a
program solely for positive drug tests; (vi) All public substance use providers, including the
Local Substance Abuse Authorities and their contracted providers
shall comply with all Division Directives for Drug testing as
published in the annual DSAMH Division Directives and/or
preferred practice guidelines; (vii) As appropriate and with consent, involve families
and support persons in the treatment and recovery process;
and (viii) Provide Naloxone education, training and
assistance to individuals with opiate use disorders and when
possible to their families, friends, and significant
others. (2) Treatment programs shall work with individuals to
identify needed and desired recovery supports and ensure
that: (a) Participation in recovery support shall be voluntary;
and (b) Whenever possible, individuals are encouraged and
given a choice of potential recovery support services and a
choice of programs. (3) Services such as case management, housing, employment
training, transportation, childcare, healthcare, peer support and
other social supports shall be strongly considered and implemented
if appropriate before, during and after the completion of acute
R523-4-10. Standards for Jail or Prison Treatment
(1) All individuals shall be screened for criminogenic
risk, mental health, substance use disorders and substance
withdrawal syndromes as part of the intake process. (2) Individuals with signs and symptoms of withdrawal
shall receive timely medical care or a transfer to a more
appropriate facility that can provide standard detoxification
services. (3) Jail or prison-based treatment service providers
shall coordinate care with community-based treatment providers so
that individuals may transition to treatment services in the
community. (4) Treatment programs shall: (a) First assess level of motivation for treatment and
implement strategies to increase engagement; (b) Assess individuals for mental health, substance use
disorders and criminogenic risk using scientifically validated
instruments and protocols; (c) Diagnose and treat or ensure treatment for
co-occurring conditions; (d) Provide comprehensive treatment services; (e) As appropriate and with consent, involve families and
support persons in the treatment process; (f) Use developmentally appropriate and informed
treatments; (g) Monitor drug use through drug testing and other
means; (i) Programs shall comply with all Division Directives
for drug testing as published in the annual DSAMH Division
Directives; (h) Have qualified staff licensed and capable of
assessing individuals for both mental health and substance use
disorders; (i) Recognize gender, cultural, linguistic, and other
individual differences in their treatment approach; (j) Provide ongoing chronic disease management, recovery
support, monitoring and link to needed community
supports; (k) All individuals with alcohol and/or opioid disorders
shall be educated and screened for the potential use of
medication-assisted treatment; (l) Treatment providers shall develop strategies to
screen for, prevent, and refer to treatment adults with serious
chronic conditions such as HIV/AIDS, Hepatitis B and C, and
tuberculosis; (m) Work with individuals to identify needed and desired
recovery supports; (i) Recovery supports may include preparation/planning
for housing, employment, health care, peer support or other
services upon release; (ii) Recovery supports may be provided before, during or
after the completion of acute treatment services.
R523-4-11. Documentation Standards for Community and
Jail/Prison Based Treatment Services.
(1) A complete and accurate record of all clinical
services shall be kept for each individual served that contains
the following information: (a) Any and all screenings and assessments
completed; (b) Any and all consent forms or required
disclosures; (c) A comprehensive treatment plan; (d) Progress notes; (e) Continuing recovery recommendations upon discharge;
and (f) Record reflects cultural and gender specificity in
treatment. (2) The individual record is maintained in a manner so as
to protect confidentiality and comply with 42 CFR Part 2 and the
Health Insurance Portability and Accountability Act of 1996
(HIPAA) documentation/privacy standards. The record is organized,
clear, complete, current and legible. (a) Consent forms for any release of information shall be
found in the file. (b) Consent forms shall be complete, and contain a
statement that consent is subject to revocation, and shall be
signed and dated by the patient. (c) Each file shall contain a signed and witnessed
Acknowledgement of Receipt of Privacy Statement. (3) The individual record shall contain documentation of
the initial assessment/engagement session. (a) The assessment/engagement session identifies
presenting problems and individual goals. (b) The assessment/engagement session includes a
statement of the individual's presenting problem(s)
and: (i) Identification and documentation of acute psychosis,
intoxication/withdrawal relevant to the presenting
problem. (ii) Identification and documentation of biomedical
conditions and complications relevant to the presenting
problem. (iii) Identification and documentation of emotional,
behavioral, cognitive conditions, and/or complications relevant
to the individual's current situation and presenting
problem. (iv) Identification, evaluation and documentation of
readiness to change relevant to presenting problem. (v) Identification and documentation of relapse, or
continued problem potential relevant to presenting
problem. (vi) Identification and documentation of the
individual's recovery environment relative to presenting
problem. (vii) Identification of recovery support services needed
relevant to presenting problem. (viii) An assessment/engagement session summary includes
recommendations for level of care and intensity of services
needed. (ix) Documentation of an assignment for the individual to
complete for their next session. (4) Assessment process is ongoing and changes to
assessment information are reflected throughout the
record. (5) Level of care and intensity of services are supported
by ongoing assessment information, or differences are clinically
justified. (6) Assessment shall be signed and include the title of a
person licensed in the State of Utah to diagnose, assess and
treat people with mental health and substance use
disorders. (7) A treatment plan that contains the
following: (a) Specific, individualized, long-range goals; (b) Behaviorally measurable, short-term objectives that
support long-range goals; (c) Evidence of the individual's participation in
development of the plan; (d) Evidence that the plan is based on the
individual's goals and other needs identified in the
screening and assessments; (e) Objectives that are measurable, achievable within a
specified time frame and reflect developmentally appropriate
activities that support progress towards achievement of
individual goals; (f) Substance use disorder treatment plans should be
based on the six ASAM Patient Placement Dimensions and shall
address critical areas identified in each dimension. Mental
Health Recovery Plans shall be organized in a similar
manner; (g) Interventions designed to help the patient complete
the objectives; and (h) Signature and title of a person licensed in the State
of Utah to diagnose, assess and treat people with mental health
and substance use disorders. (6) The individual file shall include documentation of
the individual's status throughout the individual record
including: (a) Changes in types, schedule, duration and frequency of
therapeutic interventions to facilitate individual progress as
well as changes in individual objectives and goals; (b) Each contact shall be documented in a timely
manner; (c) Progress notes shall be kept that identify the date,
duration and type of intervention; (d) Progress notes shall document progress or lack of
progress on the individual's goals as well as the
clinician's assessment of the individual's changes in
behaviors, attitudes and beliefs; (e) Progress notes shall reflect clinician's
assessment of the effectiveness of the therapeutic interventions
and plans for future interventions, which is ideally accomplished
through the use of standardized evidence based tools; (f) Notes shall be legible and signed by a qualified
staff indicating appropriate credentials; (g) No-shows, cancellations or gaps in service such as
vacation, incarceration or home visits shall be
documented; (h) Notes shall reflect behavioral changes as well as
changes in attitudes and beliefs; (i) Other group activities such as psychosocial
rehabilitation, psychoeducation, life skills, case management,
recreational therapy and recovery support services are documented
to the extent required for clinical continuity and in order to
meet financial requirements; and (k) Upon discharge, recommendations for ongoing services
include the extent to which established goals and objectives were
achieved, what ongoing services are recommended, and a description
of the individual's recovery support plan.]
12]. [ Quality] Certification Procedures[ for Educational Series and Community-Based Treatment
Provider Sites That Do Not Provide Opioid Replacement
Programs] seeking first-time approval or re-approval shall
make application to the Division at least 60 days prior to
(2) Each [
treatment site ] seeking certification shall submit a completed and
signed application and assurances form to the Division.
(3) All application forms shall be reviewed by the Division.
(4) The Division shall determine if the application is complete and demonstrates compliance with this rule.
The] Division approves the application and determines the
program has met all other requirements, the Division shall
provisionally certify the program for a period of
(6) The Division shall notify [
in writing ]all applicants
[ within 30 days of submission of an application, whether the
(b) Denied, or
(c) Requires additional information.
(7) A final certification shall[
: (a) Be] completed within the one year provisional certification
period of time, according to the procedures established by the
Division[ ; and (b) The final certification may last up to two years from
the end date of the provisional certification].
(8) If an application for re-approval
requires additional information, a previously certified program may
continue to provide services for 30 days from the date of
notification unless notified by the [
Department of Human Services] to cease and desist.
13]. Corrective Action.
(1) When the Division becomes aware that a provider is in violation of this rule the Division shall:
(a) Identify in writing the specific areas in which the provider is not in compliance; and
(b) Send written notice to the provider within 30 days after becoming aware of the violation.
(2) The provider shall submit a written plan for achieving compliance within 30 days of notification of noncompliance.
14]. Suspension and Revocation.
(1) The Division may suspend the approval of a provider when a provider fails to:
(a) Respond in writing to areas of noncompliance identified in writing by the Division within the defined period;
(b) Comply with corrective action as agreed upon in its written response to the Division; or
(c) Allow the Division access to information or records necessary to determine the provider's compliance under this rule.
(2) The Division may revoke approval if a provider:
(a) Continues to provide the educational series after suspension;
(b) Fails to comply with corrective action while under a suspension; or
(c) Commits a second violation which constitutes grounds for suspension when a previous violation resulted in a suspension during the last 24 months.
(3) The Division shall notify the Administrative Office of the Courts, the Utah Department of Corrections, the Department of Human Services, Office of Licensing and county local authorities when a certification is suspended or revoked.
15]. Procedure for Denial, Suspension, or Revocation.
(1) If the Division has grounds for action under this rule and intends to deny, suspend or revoke approval of a provider, the Division shall notify the applicant or provider of the action to be taken.
(2) A notice to deny, suspend or revoke approval shall contain the reasons for the action, to include all statutory or rule violations, and a date when the action shall become effective.
(3) The provider may request a meeting with the Director or their designee within ten calendar days of receipt of notification.
(4) A request for a meeting for this purpose shall be in writing.
(5) Within ten days following the close of the meeting the Division shall inform the provider or applicant in writing of the decision of the Director or Designee of the Division.
16]. Posting of Certified Providers.
(1) The Division shall maintain and make public a list of all certified educational or prevention series and treatment programs.
(2) The list shall include agency contact information, service location address, and target population .
offender substance abuse screenings, offender substance
abuse assessments, offender substance abuse education series,
offender substance abuse treatments]
Date of Enactment or Last Substantive Amendment: [
January 17, 2017]
Authorizing, and Implemented or Interpreted Law: 62A-15-103[
42 CFR Part 2
More information about a Notice of Proposed Rule is available online.
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For questions regarding the content or application of this rule, please contact Thomas Dunford at the above address, by phone at 801-538-4181, by FAX at 801-538-4696, or by Internet E-mail at email@example.com; Jonah Shaw at the above address, by phone at 801-538-4219, by FAX at 801-538-3942, or by Internet E-mail at firstname.lastname@example.org. For questions about the rulemaking process, please contact the Office of Administrative Rules.