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

R523-18. Mobile Crisis Outreach Team Certification and Standards of Care.

R523-18-1. Authority and Purpose.

(1) Subsections 26B-5-112(5), 26B-5-112.5(5), 26B-5-609(2), and 26B-5-609(3) authorize this rule.

(2) This rule increases the availability of comprehensive mental health crisis services throughout the state, by:

(a) establishing standards of certification, care, and practice for mobile crisis outreach teams (MCOTs) and MCOT personnel, including MCOT involvement with civil commitment procedures; and

(b) establishing a process for the Office of Substance Use and Mental Health to award grants as directed by Section 26B-5-112 and Subsection 26B-5-112.5(5), through application by qualified local mental health authorities.

R523-18-2. Definitions.

Terms used in this rule are defined in Sections 26B-5-101 and 26B-5-609. Additionally:

(1) "Assessment" means a formal and continuous process of collection and evaluating information about an individual to ascertain whether a patient is functioning at a healthy psychological, social, or developmental level and aids in service planning, treatment, and referral.

(2) "Crisis response system" means the array of community services organizations that provide direct care to an individual in crisis and includes:

(a) first responders;

(b) the statewide crisis line;

(d) private and public mental health and substance use service providers; and

(e) for-profit and nonprofit hospitals.

(3) "Crisis stabilization" means direct mental health care to a non-hospitalized individual experiencing a mental health crisis by:

(a) providing emotional support and safety; and

(b) mobilizing the following for ongoing maintenance and rehabilitation:

(i) community resources;

(ii) the individual's support system;

(iii) the individual's family members; and

(iv) other informal supports for ongoing maintenance and rehabilitation.

(4) "Crisis worker" means the same as defined in Section 26B-5-610.

(5) "Designated examiner" means the same as that term is defined in Section 26B-5-301.

(6) "Family peer support specialist" means an individual who meets the requirements outlined in Rule R523-6.

(7) "Major non-compliance issue" means an MCOT has violated this rule and improperly created a condition that negatively affects the imminent health, safety, or wellbeing of an individual.

(8) "Minor non-compliance issue" means a relatively small in scope infraction of this rule by an MCOT that does not impact client wellbeing.

(9) "Mental health officer" means an individual who is designated by a local mental health authority as qualified by training and experience in the recognition and identification of mental illness.

(10) "Peer support specialist" means an individual who meets the requirements outlined in Rule R523-5.

(11) "Risk corridor funding structure" means a methodology used by the Office of Substance Use and Mental Health to ensure the risk of funding coverage for operating a MCOT created by a grant award intended to fund the entire operating cost of a MCOT is shared by the grantee and the state.

(12) "Significant non-compliance issue" means a violation of this rule by an MCOT that is so severe or pervasive that it jeopardizes the effectiveness of services.

(13) "Warm hand off" means to personally connect a patient with a new provider before their first appointment.

R523-18-3. General Provisions.

(1) MCOT services shall be based on the following principles:

(a) cultural competence;

(b) strong community relationships;

(d) the use of evidence-based practices;

(e) building on existing foundations with an eye toward innovation;

(f) utilization of an integrated system of care;

(g) outreach to students through school-based clinics;

(h) trauma informed care;

(i) de-escalation;

(j) timely access to supports and services;

(k) providing services in the least restrictive manner possible;

(l) strength-based treatment plans;

(m) prioritizing helping individuals and families regain a sense of control and safety after being involved in a mental health crisis; and

(n) embedding the following elements of the zero suicide framework for suicide care:

(i) lead the crisis response system in creating a wide culture change committed to reducing suicides;

(ii) train a competent, confident, and caring workforce;

(iii) identify individuals with suicide risk through comprehensive screening and assessment;

(iv) engage an individual who is at-risk of suicide using a suicide care management plan;

(v) treat suicidal thoughts and behaviors directly using evidence-based treatment;

(vi) transition an individual through care with a warm hand off and supportive contact; and

(vii) improve policy and procedure through continuous quality improvement.

(2) An MCOT shall be capable of serving the following individuals in the context of a crisis:

(a) children, adolescents, adults, and older adults;

(b) individuals with co-occurring conditions including:

(i) mental health conditions;

(ii) substance use disorders;

(iii) medical needs;

(iv) intellectual and developmental disabilities;

(v) physical disabilities;

(vi) traumatic brain injuries; and

(vii) dementia and related neurological conditions;

(d) individuals who are uninsured or unable to pay for services; and

(e) individuals who may lack Utah residency or legal immigration status.

(3) An MCOT shall encourage each modality of service within the crisis response system to incorporate peer support into the services they provide, when clinically appropriate.

R523-18-4. Minimum Guidelines and Standards of Care.

(1) Each MCOT shall have at least one member of the team that provides services at the site of the crisis.

(2) Each MCOT shall collaborate with local and statewide crisis line services, and additional available crisis response services including stabilization and mobile response services.

(3) When an MCOT is dispatched from the statewide crisis line, the statewide crisis line staff shall provide, when possible, the following information for an individual in need of services:

(a) the name;

(b) the date of birth;

(d) the location;

(e) history of violence and substance use;

(f) the presence of weapons, dogs, or other dangerous conditions in the house; and

(g) the need for a coordination plan to include police assistance, and if available, the family's willingness to help coordinate services while accounting for relevant safety and security issues.

(4) Each MCOT shall respond to a crisis call as promptly as reasonably possible when law enforcement requests assistance and is staying on scene.

(5) Each MCOT shall have the capacity to:

(a) intervene wherever a crisis occurs;

(b) serve individuals unknown to the local mental health authority;

(d) work closely with:

(i) crisis hotlines;

(ii) dispatch;

(iii) EMS;

(iv) fire;

(v) hospital emergency departments;

(vi) police;

(vii) schools; and

(viii) other related agencies.

(6) Each MCOT shall operate 24 hours a day, and seven days per week in providing community-based crisis intervention, screening, assessment, and referrals to appropriate resources.

(7) The minimum information collected by a MCOT when screening an individual in crisis shall be:

(a) identifying information;

(b) the chief complaint or presenting problem;

(d) the names of current healthcare providers treating the individual.

(8) Each MCOT shall administer an ongoing assessment, if clinically indicated by the initial screening, that includes:

(a) any imminent danger to the individual in crisis through potentially lethal means of harm to self or others;

(b) risk for suicide using an empirically validated instrument that has been scientifically proven to detect risk for suicide;

(d) the names of individual strengths and available coping mechanisms;

(e) resources that can increase service participation and success;

(f) the most appropriate and least restrictive service alternative for the individual; and

(g) each referral mechanism and procedure the individual needs to access services.

(9) Following each assessment, if an individual has a risk for harm to self or others the MCOT shall engage the person to establish a crisis response plan using an evidenced based safety plan or crisis prevention practice.

(10) Each MCOT shall provide an individual with access to an emergency department or other crisis receiving facility to address an ongoing safety concern and to obtain further evaluations, when clinically indicated.

(11) Each MCOT shall be staffed by:

(a) at least one licensed mental health therapist who is capable of providing a clinical assessment, and is either:

(i) a designated examiner; or

(ii) a mental health officer; and

(b) a certified crisis worker.

(12) Each MCOT shall ensure its staff understand the emergency civil commitment process as described in Section 26B-5-331.

(13) Each MCOT shall ensure that one member of its staff is a designated examiner or a mental health officer to facilitate civil commitments.

(14) Each MCOT shall, when reasonably possible, utilize certified peer support specialists and certified family peer support specialists, in conjunction with a mental health therapist when deploying for mobile crisis outreach.

(15) Each MCOT that does not have a certified peer support specialist or family peer support specialist shall make reasonable efforts to add a certified peer support specialist and certified family peer support specialist to the team as soon as possible

(16) Each MCOT shall ensure that at least two certified crisis workers are available for mobile crisis outreach services.

(17) In cases where a mental health therapist is not a deploying member of the team, each MCOT shall ensure a mental health therapist is available through telehealth.

(18) Each MCOT shall ensure at least one member of the team is available on site if co-responding with law enforcement or another first responder, and that two individuals always respond in person.

(19) Each MCOT shall ensure each individual in crisis access to a designated examiner for consultation during each MCOT response.

(20) Each MCOT shall ensure that each response to an individual in crisis provides services in the least restrictive manner and setting, and that MCOT personnel attempt to:

(a) reduce inpatient treatment admissions and emergency department visits, where appropriate;

(b) increase jail diversions; and

(21) Each MCOT shall collaborate with stakeholders involved in the crisis service delivery system and partner to resolve service delivery concerns.

(22) Each MCOT shall have a written plan in place that outlines triage policies and coordination of crisis response services with community stakeholders.

(23) Each plan described in Subsection (22) shall address community collaboration with:

(a) local mental health and substance abuse authorities;

(b) stabilization and mobile response providers;

(d) fire departments;

(e) dispatch;

(f) hospital emergency departments;

(g) schools;

(h) emergency medical services;

(i) the Department of Health and Human Services;

(j) social service partners;

(k) health plans; and

(l) crisis services in the local community.

(24) Each MCOT shall enter into a memorandum of understanding with each local mental health and local substance abuse authority operating a crisis line in the MCOT's region, and the statewide crisis line. Each memorandum of understanding shall include:

(a) a data sharing process between the statewide crisis line, the local authority, and the MCOT including data on the number of callers from the region where the MCOT provides services;

(b) a plan for mobile deployments from the statewide crisis line that incorporates a clear procedure for coordination between the statewide crisis line and the MCOT provider for deploying MCOT services to individuals that have called the statewide crisis line to request assistance;

(c) a process for warm hand offs into ongoing services between the statewide crisis line, the MCOT, and the local authority;

(d) a description of data that must be collected; and

(e) procedures for:

(i) case consultation on services;

(ii) consultation on individuals who receive frequent services; and

(iii) collaboration.

R523-18-5. MCOT Certification.

(1) An MCOT must be certified by the Office of Substance Use and Mental Health before it may provide MCOT services.

(2) To be certified by the Office of Substance Use and Mental Health, an MCOT must apply for certification and demonstrate that it complies with the standards of this rule.

(3) MCOT personnel shall consist of at least two members:

(a) one mental health therapist who is a certified crisis worker, and is either a:

(i) designated examiner; or

(ii) mental health officer; and

(b) one certified crisis worker.

(4) The Office of Substance Use and Mental Health director or designee may grant an exception to this rule if the director or designee determines certification is necessary to promote the availability of comprehensive mental health services and the exception is not reasonably likely to negatively impact the wellbeing of an individual in crisis.

(5) The Office of Substance Use and Mental Health shall certify applicant entities that demonstrate compliance with the certification requirements of this rule.

R523-18-6. Office of Substance Use and Mental Health Oversight of Programs.

(1) The Office of Substance Use and Mental Health may enter and survey MCOT program operations, review MCOT curriculum, and interview MCOT agency staff to determine proper provision of mobile crisis outreach services.

(2) An MCOT shall allow representatives from the Office of Substance Use and Mental Health, and from other local authorities authorized by the Office of Substance Use and Mental Health, to make announced or unannounced visits to monitor services and complete fidelity reviews.

R523-18-7. Corrective Action of Certification.

(1) If the Office of Substance Use and Mental Health becomes aware that an MCOT that has violated the conditions of its certification, the Office of Substance Use and Mental Health shall:

(a) immediately review the allegation;

(b) take steps to ensure that each consumer involved with the allegation is protected; and

(2) If the Office of Substance Use and Mental Health determines a major non-compliance issue has occurred:

(a) the MCOT shall submit a written corrective action plan immediately after notification that ensures compliance will be achieved within 24 hours; and

(b) if compliance is not possible within 24 hours, the Office of Substance Use and Mental Health shall suspend the MCOT certification until the major non-compliant issue is resolved.

(3) If the Office of Substance Use and Mental Health determines a significant non-compliance issue has occurred:

(a) the MCOT shall submit a written corrective action plan within ten business days after notification that identifies the steps the MCOT will take to resolve the non-compliance issue within 30 days of notification; and

(b) if the compliance issue is not resolved within 30 days of notification, the Office of Substance Use and Mental Health shall suspend, revoke, or not renew the MCOT certification until the significant non-compliance issue is resolved.

(4) If the Office of Substance Use and Mental Health determines a minor non-compliance issue has occurred:

(a) the Office of Substance Use and Mental Health shall notify the MCOT;

(b) the MCOT shall submit a written corrective action plan within 15 business days after notification that identifies the steps the MCOT will take to resolve the issue within 60 days of notification; and

(c) if the compliance issue is not resolved within 60 days, the Office of Substance Use and Mental Health shall suspend, revoke, or not renew the MCOT certification until the minor non-compliance issue is resolved.

(5) If the Office of Substance Use and Mental Health determines an MCOT is not in full compliance with the conditions of certification, but the deficiency discovered is not severe enough to be categorized as a non-compliance issue, the Office of Substance Use and Mental Health shall:

(a) require the MCOT to submit a written corrective action plan; and

(b) if the compliance issue continues to be unresolved within a reasonable time, as determined by the Office of Substance Use and Mental Health, the Office of Substance Use and Mental Health shall classify the finding as a minor non-compliance issue, and corrective action shall follow the guidance outlined in Subsection (4)(b).

(6) Each MCOT's certification status shall be maintained by the Office of Substance Use and Mental Health and available upon written request.

R523-18-8. MCOT Grants.

(1) An entity wishing to establish an MCOT may respond to a request for proposal issued by the Office of Substance Use and Mental Health.

(2) A grant shall be awarded based on the applicant's ability to comply with:

(a) the conditions described in Section 26B-5-112.5; and

(b) this rule.

(3) MCOT grants shall be made available if funding is appropriated by the Legislature for establishing an MCOT.

R523-18-9. MCOT Funding Structure.

(1) Table 1 describes a county's portion of funding risk with the state based on a county's classification.

(2) Table 2 describes how a county's portion of funding risk with the state will increase over time.

(3) A county shall leverage Medicaid and private insurance reimbursements and other funding to cover its portion of the funding risk.

TABLE 1

Funding Coverage

County Classification

State Responsible Share of Total Operational Cost

Risk Corridor

1st

60%

40%

2nd a*

70%

30%

2nd b**

75%

25%

3rd-6th

80%

20%

A county's classification is determined in accordance with Section 17-50-501. Second class has been divided into two subcategories for this rule:

a* class counties are Utah County and Davis County

b ** class counties are Weber County and Washington County

TABLE 2

Risk Corridor Coverage

Year of Program Operation

State Responsible Share of Risk Corridor

County Responsible Share of Risk Corridor

75%

25%

50 %

50%

25%

75%

100%

KEY: mobile crisis outreach team, MCOT standards, statewide crisis response standards

Date of Last Change: October 9, 2025

Notice of Continuation: November 22, 2023

Authorizing, and Implemented or Interpreted Law: 26B-5-112(5); 26B-5-112.5(5); 26B-5-609(2); 26B-5-609(3)