Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since October 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


R523. Human Services, Substance Abuse and Mental Health.

Rule R523-4. Certification Requirements for Screening, Assessment, Prevention, Treatment and Recovery Support Programs for Adults.

As in effect on October 1, 2019

Table of Contents

R523-4-1. Authority.

This rule is authorized by Section 62A-15-103(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.

R523-4-2. Purpose.

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.

R523-4-3. Definitions.

(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 disorder treatment services;

(ii) 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.

(6) "Educational 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.

R523-4-4. Standards for Criminogenic Risk Screening and Assessment for Agencies Treating Justice Involved Individuals.

(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.

(2) Screenings shall:

(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.

R523-4-5. Standards for Substance Use and Mental Health Disorder Screenings.

(1) 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 comprehensive assessment.

(2) 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 culturally sensitive.

(3) The individual shall be referred for an assessment if the screening identifies potential substance use and/or mental health disorders.

(4) 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 Disorder Assessments.

(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 dimensions:

(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 Educational or Prevention Series.

(1) 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 Licensing.

(b) Use only educational and prevention material that meets the 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) Provides accurate information that is designed to promote compliance with Utah laws; and

(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 complete.

(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.

R523-4-8. Program Standards for Community-Based Treatment Programs.

(1) All programs shall maintain the appropriate license from the Department of Human Services Office of Licensing for the type(s) of services being provided.

(2) 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 agreed.

R523-4-9. Treatment Standards for Community-Based Treatment Programs.

(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 treatment services.

R523-4-10. Standards for Jail or Prison Treatment Programs.

(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.

R523-4-12. Quality Certification Procedures for Educational Series and Community-Based Treatment Provider Sites That Do Not Provide Opioid Replacement Treatment.

(1) Programs seeking first-time approval or re-approval shall make application to the Division at least 60 days prior to delivering services.

(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.

(5) 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 one year.

(6) The Division shall notify in writing all applicants within 30 days of submission of an application, whether the application is:

(a) Approved,

(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.

R523-4-13. 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.

R523-4-14. 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.

R523-4-15. 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.

R523-4-16. 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.

KEY

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, Implemented, or Interpreted Law

62A-15-103(h); 42 CFR Part 2


Additional Information

Contact

For questions regarding the content or application of rules under Title R523, please contact the promulgating agency (Human Services, Substance Abuse and Mental Health). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.