Utah Office of Administrative Rules

NOTICE OF SUBSTANTIVE CHANGE

TYPE OF FILING: Repeal and Reenact

Rule or section number:

R523-2

Filing ID: 57587

Agency Information

1. Title catchline:

Health and Human Services, Substance Use and Mental Health

Building:

Cannon Health Building

Street address:

288 N 1460 W, Floor 3

City, state:

Salt Lake City, UT

Mailing address:

288 N 1460 W, Floor 3

City, state and zip:

Salt Lake City, UT 84116

Contact persons:

Name:

Phone:

Email:

Thomas Dunford

801-538-4181

tdunford@utah.gov

Mariah Noble

385-214-1150

mariahnoble@utah.gov

Please address questions regarding information on this notice to the persons listed above.

General Information

2. Rule or section catchline:

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

3. Are any changes in this filing because of state legislative action?

Changes are because of legislative action.

If yes, any bill number and session:

SB 45 (2022 General Session), SB 41 (2023 General Session)

4. Purpose of the new rule or reason for the change:

This filing is necessary to update this rule following the reorganization of the Department of Health and Human Services (DHHS) and recodification of applicable statute.

It updates statutory citations and complies with the Governor's Executive Order No. 2021-12 by aligning rule language with the Rulewriting Manual for Utah.

Further, it removes sections of this rule that are not in compliance with the agency's rulewriting authority.

5. Summary of the new rule or change:

This filing updates statutory citations, aligns the rule with the standards of the Rulewriting Manual for Utah, and complies with the Governor's Executive Order No. 2021-12.

It includes corrections for grammar and punctuation, clarifies or removes superfluous requirements, and simplifies language.

This filing removes rule text that previously detailed practices incorporated into the daily administration of the publicly funded substance use and mental health treatment network or enforced through contracts, including an individual's right to participate in treatment, local authority fee policies, determining the proper local authority under special situations, coordination of care committees for the state hospital, and conflict resolution.

This filing also removes language that is being moved into a new rule or exists in different rule, causing any such language in this rule to be redundant.

The allocation formula for state hospital beds is moving to Rule R523-24. Language that was previously in Section R523-2-15 is removed because statute does not authorize the Office of Substance Use and Mental Health (OSUMH) to prohibit certain items within mental health facilities, which are owned and operated by the counties. Therefore, the counties have the responsibility to determine the need to make a prohibited items policy or rule.

Due to the extensive amount of changes to the rule text, this filing is being submitted as a repeal and reenact.

(EDITOR'S NOTE: The proposed new Rule R523-24, ID 57856, is in this issue, April 1, 2026, of the Bulletin.)

Fiscal Information

6. Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

There is no anticipated fiscal impact to the state budget as a result of this filing.

Changes to this rule do not increase or decrease costs that already exist in state budgets.

Sections removed as a result of this filing are being moved to a different rule that will be made effective before this repeal and reenact, so there is no lapse in oversight that would lead to a fiscal impact.

Contained practices that are incorporated into the publicly funded treatment network are enforced through annual contracts with the local authorities. No administrative duties for state agencies are being removed as a result of this filing, and no savings are anticipated to result from this repeal and reenact.

B. Local governments:

There is no anticipated fiscal impact to local governments as a result of this filing.

Changes to this rule do not increase or decrease costs that already exist in local government budgets.

Contained practices that are incorporated into the publicly funded treatment network are enforced through annual contracts with the local authorities. No administrative duties for local governments are being removed as a result of this filing, and no savings are anticipated to result from this repeal and reenact.

C. Small businesses ("small business" means a business employing 1-49 persons):

The statutory authority used to create this rule applies to local substance use and mental health authorities. Local substance abuse authorities and local mental health authorities are county governments and defined in Subsection 17-43-201(1) and Subsection 17-43-301(2).

The Office of Substance Use and Mental health is authorized to contract with a county to provide the substance use and mental health services described in this rule, therefore, this rule applies to local governments and not small businesses.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency):

F. Compliance costs for affected persons:

There are no anticipated compliance costs for affected persons, identified as local authorities, as a result of this filing.

Changes do not increase or decrease costs that already exist.

Sections that were removed are already in rule, will be moved to a different rule that will be made effective before this repeal and reenact, or contained practices that are incorporated into the publicly funded treatment network and are enforced through annual contracts with the local authorities.

G. Regulatory Impact Summary Table (This table includes only fiscal impacts the agency was able to measure. If the agency could not estimate an impact, it is excluded from this table but described in boxes A through F.)

Regulatory Impact Summary Table

Fiscal Cost

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Cost

Fiscal Benefits

FY2026

FY2027

FY2028

FY2029

FY2030

State Budget

Local Governments

Small Businesses

Non-Small Businesses

Other Persons

Total Fiscal Benefits

Net Fiscal Benefits

H. Department head comments on fiscal impact and approval of regulatory impact analysis:

The Executive Director of the Department of Health and Human Services, Tracy S. Gruber, has reviewed and approved this regulatory impact analysis.

Citation Information

7. Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement:

Section 26B-5-104

Section 26B-5-107

Public Notice Information

9. The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until:

05/01/2026

10. This rule change MAY become effective on:

05/08/2026

NOTE: The date above is the date the agency anticipates making the rule or its changes effective. It is NOT the effective date.

Agency Authorization Information

Agency head or

designee and title:

Tracy S. Gruber, Executive Director

Date:

11/30/2025

[R523. Human Services, Substance Abuse and Mental Health.

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

R523-2-1. Authority.

This rule is promulgated under authority granted to the Division of Substance Abuse and Mental Health (Division) by Section 62A-15-105,

and Subsections 62A-15-108(1), 62A-15-611(2)(a), 62A-15-610(2)(a) and 62A-15-902(2)(c).

R523-2-2. Purpose.

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

(a) the priorities for treatment services;

(b) the rights of individuals participating in services;

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

service;

(d) LMHA and LSAA program standards;

(e) the formula for allocation of funding.

(f) allocation of Utah State Hospital (Hospital) beds to LMHAs;

(g) admission to the Hospital and coordination of care;

(h) determining the proper LMHA under special situations;

(i) transfer planning between LMHAs from the Hospital;

(j) conflict resolution; and

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

R523-2-3. Priorities for Treatment Services.

(1) The Division shall regularly seek, and receive input from the Utah Behavioral Health Planning and Advisory Council on priorities for

services.

(2) Programs providing substance use and mental health services with federal, state, and local matching funds shall provide:

(a) services based on immediacy of need, and severity of the mental illness, andpriority may also be given to under-served age groups as

appropriately demonstrated through needs studies;

(b) effective and responsive crisis intervention, suicide prevention, assessment, direct care, and referral program available to all citizens;

(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;

(d) 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;

(e) 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; and

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

(2) Programs providing substance use disorder treatment services with federal, state, and local matching funds shall provide priority

admission to the following populations in the following 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) any other client with a substance use disorder, regardless of gender or route of use.

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

(1) Any service provider contracted with the Division and the LMHAs and LSAAs shall disclose the following information in writing to

each individual participating in treatment services:

(a) their rights and responsibilities to participate in the development of the treatment or other type of service plan;

(b) their right to be involved in selection of their primary therapist;

(d) their right to informed consent regarding medications;

(e) their rights regarding medication-assisted treatment;

(f) disclosure of all program fees and personal financial responsibility;

(g) information on grievance procedures that include any necessary information to file a formal grievance; and

(h) the 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 that individual's file. The Division shall periodically review this process to assure appropriate content is present within the rights statement,

and that proper application of the intent of this policy is being carried out by the provider.

(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, and shall documented in the individual's file.

R523-2-5. LMHA and LSAA Fee Policy.

(1) Each LMHA, and LSAA shall require any program that receives federal, state and matching funds from the Division and provides

services to clients to establish a policy to set and collect fees. Each fee policy shall include:

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

(b) 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.

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

(3) The governing body of each LMHA and LSAA shall approve the fee policy, and shall set a usual and customary rate for services

rendered.

(4) Each LMHA and LSAA program shall provide a written explanation of the fee policy to clients at the time of intake except in the case

of emergency services.

(5) Each client shall be assessed fees based on:

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

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

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

(7) Any fee assessed to clients, including upfront administrative fees, shall be reasonable as determined by the LMHA or LSAA.

(8) Each LMHA and LSAA shall make reasonable effort to collect outstanding fee charges and may use an outside collection agency.

(9) Each LMHA and LSAA may reduce the assessed fee for services if the fee is determined to be a financial hardship for the client.

(10) The Division shall annually review each LMHA's and LSAA's policy and fee schedule to ensure that the elements set in this rule are

incorporated.

R523-2-6. LMHA and LSAA Minimum Program Standards.

(1) Each LMHA and LSAA program shall have the appropriate current license issued by the Office of Licensing, Department of Human

Services, and any other required licenses.

(2) Each LMHA and LSAA shall have a comprehensive plan of service which shall be reviewed and updated at least annually to reflect

changing needs. The plan shall:

(a) be consistent with the Division directives;

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

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

(a) inpatient care and services;

(b) residential care and services;

(d) outpatient care and services;

(e) twenty-four hour crisis care and services;

(f) psychotropic medication management;

(g) case management services;

(h) community supports including in-home services, housing, family support services and respite services;

(i) consultation, education and preventative services, including case consultation, collaboration with other county service agencies, public

education and public information; and

(j) services to persons incarcerated in a county jail or other county correctional facility.

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

(a) universal prevention;

(b) selective prevention;

(c) indicated prevention including the educational series approved by the Division in Rule R523-11 for individuals convicted of driving

under the influence,

(d) treatment services prescribed by Division contract and Directives; and

(e) recovery support services.

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

(6) Each LMHA and LSAA shall be responsible for monitoring and evaluating all subcontracts to ensure:

(a) services delivered to consumers commensurate with funds provided; and

(b) progress is made toward accomplishing contract goals and objectives.

(7) Each LMHA and 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 the Annual Allocation of Funding.

(1) The formulas for the annual allocation of funds to LMHAs and LSAAs do not apply to funds used by the Division for administration,

statewide services consistent with the requirements of Subsection 62A-15-108(2) for discretionary grants awarded to the Division, funds appropriated

for Drug Court, Medicaid matching funds, and any other funds where Utah code establishes the funding process.

(2) 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 Hospital.

(3) 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.

(4) Excluding discretionary grants, 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 Subsection 62A-15-108(2) shall not exceed 15% of the total

annual substance abuse legislative appropriation to the Division.

(5) 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).

(6) New funding and decreases in funding shall be processed, and distributed through the funding formulas.

(7) Each LMHA and 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's or LSAA's annual plan, and:

(a) the Division determines that the funds required by Subsection 17-43-301(6)(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;

(b) if a LMHA or LSAA is unable to provide the required matching funds, the LMHA or LSAA shall be allocated the amount the LMHA

or LSAA can match;

(d) if no LMHA or LSAA can provide the required match, the Division may use the funds to purchase statewide services.

(8) 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; and

(b) 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; and

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

(c) the Division shall allocate all remaining mental health funds to the LMHAs on a per capita basis, using the most current population

data available on the Utah Department of Health's IBIS website; and

(d) 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.

(9) 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.

(10) 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:

(a) 35% divided in equal amounts to the six smallest counties;

(b) 30% divided in equal amounts to the seventh through twelfth smallest counties;

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

(e) 60% 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;and

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

(f) 40% 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.

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

(a) the number of eligible Medicaid recipients in each county, for each month of the previous state fiscal year hereinafter called Medicaid

Member Months; and

(b) the actuarially established rates for each county;

(2) 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.

(3) The Division shall sum all county need to determine the state Medicaid match need.

(4) 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.

(5) LMHAs and LSAAs 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.

(6) 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, and:

(a) if a LMHA or LSAA is unable to provide the required matching funds, the LMHA or LSAA shall be allocated the amount the LMHA

or LSAA can match; and

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

R523-2-9. Allocation of Hospital Adult Bed Days to Local Mental Health Authorities.

(1) The allocation of adult beds shall be 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.

(2) The formula to determine adult bed allocation shall be based on:

(a) the most recent available population estimates obtained from the Utah Department of Health's IBIS website;

(b) the total adult population figures for the state; and

(3) Counties that are currently classified as urban by the lieutenant governor's office pursuant to Section 17-50-501 are given a differential

as follows:

(a) the total number of adult beds available at the Hospital shall be determined; and

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

(4) The total number of available adult beds minus the urban differential shall be multiplied by the county's percentage of the state's total

adult population to determine the number of allocated beds for each county.

(5) Each LMHA's service areas for individual county numbers shall be added to determine the total number of beds allocated to a LMHA.

This fractional number shall be rounded to the nearest whole bed.

(6) The urban differential shall be distributed to urban counties based on their respective percentage of urban counties as a whole.

(7) At least one adult bed shall be allocated to each LMHA.

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

(9) The Division is responsible to calculate the adult bed allocation,andto notify each LMHA of changes in adult bed allocations.

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

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

R523-2-10. Allocation of Hospital Pediatric Beds to Local Mental Health Authorities for Individuals Under the Age of 18.

(1) 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 service area.

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

(3) The formula to determine pediatric bed allocation shall be based on:

(a) the most recent available population estimates obtained from the Utah Department of Health's Indicator Based Information System

(IBIS) website;

(b) the total pediatric population figures for the state; and

(4) The total number of pediatric beds available shall be 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.

(5) Each LMHA's service area for individual county numbers shall be added to determine the total number of pediatric beds allocated to a

LMHA's service area. This fractional number shall be rounded to the nearest whole bed.

(6) Adjustments of pediatric beds shall be applied, and become effective at the beginning of the new fiscal year.

(7) Each LMHA shall be notified of changes in pediatric bed allocations.

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

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

R523-2-11. Admission to the Hospital and Coordination of Care.

(1) The Division has oversight of the Hospital as per Subsection 62A-15-103(2)(b)(ii) and shall oversee the Continuity of Care

Committees for adult and children, youths and their patients. When the patient is a child or youth, then patient also refers to the parent or legal

guardian as it pertains to admissions, coordination of care, discharges and transfers between LMHAs of patients to and from the Hospital.

(2) The Division and Hospital shall conduct Continuity of Care Committee meetings regularly according to need, unless the time for the

meetings is postponed or canceled for good cause.

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

(4) 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.

(5) LMHA liaisons are responsible to participate in the coordination of care at the Hospital. This includes participation in clinical staffing

in person when possible, when the LMHA has a patient in the Hospital, and when the Continuity of Care Committee is meeting. 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. On occasion in exceptional circumstances, liaisons may attend a Continuity of Care Committee

meeting, and to coordinate patient treatment via teleconference, preferably video conference, if circumstances make travel unreasonable. Liaisons

will inform the Division and Hospital staff in advance if this is the case.

(6) 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.

(7) Hospital staff and liaison shall coordinate discharge plans. As there are multiple factors inherent in determining "readiness for

discharge," this decision will be made:

(a) on an individual basis, with input from the patient, the Hospital, the LMHA and the Division as necessary; and

(b) with patient's preferences and feedback regarding discharge placements as a consideration.

(8) Outplacement funds shall be used to resolve financial barriers that delay or complicate patients discharge.

(9) 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 designated electronic discharge program.

(10) The Hospital and LMHAs are required to use the designated program consistently, and:

(a) LMHAs are required to have at least two designated individuals with access to the electronic program to ensure uninterrupted

coverage; and

(b) information from the designated program will be distributed monthly to the Hospital, and the LMHAs to track progress toward

discharge.

(11) 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 or the LMHA determine that the patient is clinically ready for discharge, and the

coordination of the placement is not occurring, the Hospital and liaison are required to notify the Division within five business days.

(12) If the LMHA does not agree the patient is clinically ready for discharge then the LMHA shall indicate disagreement, including a note

in the coordination software system, within 5 business days of the Hospital indicating readiness for discharge.

(13) The liaison shall follow the Hospital's policies on admission, treatment, discharge, and transfers of each Hospital patient.

R523-2-12. Determining the Proper LMHA Under Special Situations.

(1) An individual who is homeless and in need of Hospital admission shall be referred by the LMHA in which the individual comes to the

attention of local emergency services. If from out of state, the homeless individual shall be referred to the LMHA where the individual was identified

as mentally ill and in need of services.

(2) A child or adolescent 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.

(3) A forensic patient, placed at the Hospital pursuant to criminal adjudication as set forth in Section 62A-15-902, and determined to meet

civil commitment criteria shall be committed to the LMHA where the patient resided before being arrested.

(4) 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.

(5) An individual placed at the Utah State Developmental Center (USDC), who is transferred to the Hospital for treatment of a mental

illness is the responsibility of the LMHA of the individual's 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 custodial parent's residence 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.

R523-2-13. Transfer Planning Between LMHAs From the Hospital.

(1) When a Hospital patient or the patient's legal guardian desires to relocate to a new geographical area, the patient's LMHA liaison

responsible for the civil bed in which the patient currently resides shall notify the receiving LMHA regarding the desire of the patient. The referring

liaison has the 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 with one another, and if the patient returns to the Hospital, the patient returns to the referring

LMHA's 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 shall specify 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 Section R523-2-14 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.

R523-2-14. Conflict Resolution.

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

(2) If negotiations between a LMHA and the Hospital regarding admissions, discharges or provisions of patient services fails to be

resolved at the local level, the following steps shall be taken:

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

(b) if the recommendations of the committee do not adequately resolve the conflict, the clinical or medical director of the LMHA and the

Hospital clinical director shall meet, and attempt to resolve the conflict;

(c) if a resolution cannot be reached, the LMHA director and the superintendent of the Hospital shall meet, and attempt to resolve the

conflict; or

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

(3) 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.

R523-2-15. Prohibited Items and Devices on the Grounds of Public Mental Health Facilities.

(1) Pursuant to Sections 76-10-523.5, 76-8-311.1, and 76-8-311.3, any facility owned or operated by community mental health centers that

have any contracts with a LMHA or the Division are designated as secure areas.

(2) Any 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.

(3) There shall be a prominent visual notice of secure area designation.

(4) Law enforcement personnel are authorized to carry firearms while completing official duties on the grounds of those facilities.]

R523. Health and Human Services, Substance Use and Mental Health.

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

R523-2-1. Authority and Purpose.

(1) Sections 26B-5-104 and 26B-5-107 authorize this rule.

(2) This rule establishes:

(a) a procedure to seek local mental health authority (LMHA) and local substance abuse authority (LSAA) input;

(b) priority of services for a LMHA and LSAA; and

(c) formulas for allocating funds that are authorized by the Utah Legislature for the treatment of substance use and mental health disorders

to an LMHA and LSAA.

R523-2-2. LMHA and LSAA Input on Policies, Procedures, and Rules.

(1) The Division of Integrated Healthcare (division) shall regularly seek and receive input from the Utah Behavioral Health Committee on:

(a) priorities for services;

(b) changes to existing policy or implementation of new policy; and

(2) The division shall send notice of any change to a service priority, policy, procedure, or rule to the current chair of the Utah Behavioral

Health Committee.

R523-2-3. LMHA and LSAA Minimum Program Standards.

(1) Each LMHA and LSAA program shall have any legally mandated licenses, including the appropriate current license issued by the

Office of Licensing under the Department of Health and Human Services.

(2) Each LMHA and LSAA shall have a comprehensive plan of service that shall be reviewed and updated at least annually to reflect

changing needs of those served. This plan shall:

(a) be consistent with division directives;

(b) define the LMHA's or LSAA's priorities for service and the population to be served; and

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

(a) 24-hour crisis care and services;

(b) case management services;

(i) family support services;

(ii) in-home services;

(iii) housing; and

(iv) respite services;

(d) consultation, education, and preventative services, including;

(i) case consultation;

(ii) collaboration with other county service agencies; and

(iii) providing public education and public information;

(e) day treatment and psycho-social rehabilitation;

(f) inpatient care and services;

(g) outpatient care and services;

(h) psychotropic medication management;

(i) residential care and services; and

(j) services to persons incarcerated in a county jail or other county correctional facility.

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

(a) indicated prevention, including an educational series approved by the division in Rule R523-11, for individuals convicted of driving

under the influence;

(b) recovery support services;

(d) treatment services prescribed by division contract or directive; and

(e) universal prevention.

(5) Each LMHA and LSAA shall participate in a yearly on-site evaluation conducted by the division.

(6) Each LMHA and LSAA shall be responsible for monitoring and evaluating each subcontract to ensure:

(a) progress is made toward accomplishing contract goals and objectives; and

(b) services delivered to consumers are commensurate with funds provided.

(7)(a) Each LMHA and LSAA shall conduct a minimum of one site visit per year with each subcontractor and produce a written report to

document the reviewed activities and findings.

(b) A copy of the written site visit report shall be made available to the division upon request.

R523-2-4. Formula for the Annual Allocation of Funding to LMHAs and LSAAs.

(1) Funds authorized by the Legislature for mental health services shall be allocated to LMHAs and LSAAs as described in Section 26B-5-

107 and as follows:

(a)(i) 5% of the total mental health funds shall be divided between the 24 smallest county LMHAs ranked by population as a rural

differential; and

(ii) the rural differential shall be allocated using the following methodology:

(A) 35% shall be divided in equal amounts to the first through sixth smallest counties;

(B) 30% shall be divided in equal amounts to the seventh through twelfth smallest counties;

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

(b) The division shall allocate the remaining mental health funds to the LMHAs on a per capita basis, using the most current population

data available on the Utah Department of Health and Human Services Indicator-Based Information System for Public Health (IBIS-PH) website.

(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.

(2) Funds appropriated by the Legislature to the division for substance use disorder services shall be allocated using the following

formula:

(a)(i) 5% of the total substance use disorder services funds shall be divided between the 24 smallest county LMHAs ranked by population

as a rural differential; and

(ii) the rural differential shall be allocated using the following methodology:

(A) 35% shall be divided in equal amounts to the first through sixth smallest counties;

(B) 30% shall be divided in equal amounts to the seventh through twelfth smallest counties;

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

(b) 57% of the total substance use disorder services funds shall be allocated to each county based on the incidence and prevalence of

substance use disorders using the following data:

(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 (SHARP)

survey;

(iv) the percent of youth estimated to be binge drinkers by the most current SHARP survey; and

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

(c) 38% of the total substance use disorder services funds shall be allocated to LSAAs on a per capita basis, according to the most current

population data available from the IBIS-PH.

R523-2-5. Formula for Allocation of Medicaid Match Funds.

(1) For this section, "Medicaid member month" means the number of eligible Medicaid recipients in each county for each month of the

previous state fiscal year.

(2) The division shall obtain the following data from the division's Medicaid program:

(a) each Medicaid member month; and

(b) the actuarially established rates for a capitated Medicaid service system as determined by the Department of Health and Human

Services and approved by the federal government for each county.

(3) The division shall calculate county need for Medicaid match funds by multiplying each county's total Medicaid member months by that

county's corresponding actuarial rates for the most current 12-month period.

(4) The division shall sum county need to determine the state Medicaid match need.

(5) 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.

(6) LMHAs and LSAAs that do not participate in the Medicaid prospective payment-capitation plan shall receive the amount of funds the

LMHA or LSAA would have received if the funds had been distributed using state population as a determinate.

KEY: funding formula, bed allocations, Local Mental Health Authority, Local Substance Abuse Authority

Date of Last Change: [February 26, 2021]2026

Notice of Continuation: December 1, 2025

Authorizing, and Implemented or Interpreted Law: [17-43-301(6)(a)(x); 62A-10-103(2)(a); 62A-15-103(2)(b)(ii); 62A-15-103(2)(g); 62A-15-

105; 62A-15-108(1); 62A-15-108(2); 62A-15-610(2)(a); 62A-15-611(2)(a); 62A-15-902(2)(c); 76-8-311.1; 76-8-311.3; 76-10-523.5]26B-5-104;

26B-5-107

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Substance Use and Mental Health

Rule 2: Local Mental Health Authorities and Local Substance Abuse Authorities