R501. Health and Human Services, Human Services Program Licensing.

R501-20. Day Treatment Programs.

R501-20-1. Authority.

Section 26B-2-104 authorizes this rule.

R501-20-2. Purpose.

The purpose of this rule is to set foundational health and safety standards for licensed programs providing day treatment services.

R501-20-3. Definitions.

(1) "ABA" means Applied Behavioral Analysis as defined in Rule R539-4. The practice of Applied Behavior Analysis is regulated through Title 58, Chapter 61, Part 7, Behavior Analyst Licensing Act.

(2) "Activity Plan" means goal plan and encourages optimal mental or physical function that may consist of:

(a) behavioral training;

(b) community living skills;

(d) work adjustment;

(e) recreation;

(f) self-feeding;

(g) self-care;

(h) toilet training;

(i) social appropriateness;

(j) development of gross and fine motor skills;

(k) interpersonal adjustment;

(l) mobility training;

(m) self-sufficiency training;

(n) speech, audiology;

(o) physical therapy;

(p) psychological services;

(q) counseling;

(r) vocational training;

(s) education; and

(t) socialization.

(3) "Behavior Interventions" is defined in Rule R539-4.

(4) "Client" is defined in Section 26B-2-101 and includes members in a clubhouse setting or participants in a DSPD setting.

(5) "Clubhouse" means a program accredited by Clubhouse International that is organized to support people living with mental illness in community centers that offer supportive membership that provides:

(a) a work-ordered day in which the talents and abilities of clients are recognized and utilized within the clubhouse;

(b) participation in consensus-based decision-making regarding all important matters relating to the running of the clubhouse;

(c) opportunities to obtain paid employment in the local labor market through a clubhouse-created transitional employment program;

(d) opportunity to participate in clubhouse-supported and independent programs;

(e) assistance in accessing community-based educational resources;

(f) access to crisis intervention services when needed;

(g) evening and weekend social and recreational events; and

(h) assistance in securing and sustaining safe and affordable housing.

(6) "Day treatment" is defined in Section 26B-2-101. Day treatment may be considered "partial hospitalization" in the American Society of Addiction Medicine (ASAM) continuum of care.

(7) "DSPD" means the Division of Services for People with Disabilities within the Department of Health and Human Services.

(8) "DSPD Worksheet" means the mechanism used by DSPD to calculate hours and staffing ratios for programs serving DSPD clients.

(9) "Settings Rule" means the Home and Community Based Services (HCBS) Settings Final Rule as identified in 42 CFR 430 and 431.

R501-20-4. Administration and Direct Service.

(1) In addition to the following rules, each day treatment licensee shall comply with Rules R501-1 and R501-14..

(2) Non-residential licensees may meet less frequently than weekly only with individualized justification in the client record.

(3) A licensee shall:

(a) ensure that activity plans are prepared to meet individual client needs or link to applicable resources in the community;

(b) design and implement a daily activity or service schedule based on client needs and not staff convenience;

(d) ensure all clients are given the same quality of care.

(4) Except as outlined in Subsections R501-20-6(2) and R501-20-7(3), a licensee shall ensure that the minimum staffing ratio is one direct care staff to ten clients at all times.

(5) Day treatment or day support services may not be offered within a residential setting unless:

(a) each resident is a recipient of the day support services; or

(b) the residential setting has a current residential treatment license.

(6) A licensee who utilizes restraints shall report each incident of restraint resulting in injury beyond basic first aid to the office as a critical incident.

R501-20-5. Physical Facility.

(1) Except as outlined in Subsection R501-20-6(3), a licensee shall ensure that the facility has a minimum of 50 square feet of floor space per client designated specifically for day treatment services. Hallways, office, storage, kitchens, and bathrooms may not be included in computation.

(2) A licensee shall ensure that outdoor recreational space and compatible recreational equipment are available when necessary to meet treatment plans.

R501-20-6. Additional Considerations for Professional Licensees Providing ABA Day Treatment Services.

(1) An ABA licensee shall additionally adhere to Rule R539-4, if contracted for providing services to DSPD clients.

(2) A licensee shall ensure that behavior support plans outline individual behaviors and staff responses to them.

(3) The licensee shall submit a critical incident to the office for:

(a) any self-directed violence not identified in the behavior support plan; and

(b) any staff responses outside of the behavior support plan.

R501-20-7. Additional Considerations for Licensees Providing Clubhouse Day Treatment Services.

(1) This section of rule supersedes any conflicting requirements of Rules R501-1 and R501-20.

(2)(a) A clubhouse licensee accredited by Clubhouse International may apply a staff to client ratio of 1 staff to 15 clients in accordance with national standards.

(b) A clubhouse licensee may apply the higher ratio only for specialized activities involving transports or for clients and their guests when:

(i) staff and client safety has been assessed; and

(ii) there is identified back-up for the staff in case of emergency.

(3) Square footage calculations in a clubhouse may include hallways, office, storage, kitchens, and bathrooms.

(4) A clubhouse licensee may offer clients the option to bring their own food or purchase meals or snacks at a reduced rate.

(5) A clubhouse licensee may allow clients cleaning chemicals as part of their work-ordered day. Clubhouse staff shall follow suicide prevention policy and safety protocols when assessing and allowing client access to chemicals.

(6) Visitors to the clubhouse may only be exempt from background clearance in accordance with Subsection 26B-2-120(10).

R501-20-8. Additional Considerations for DSPD Home and Community Based Medicaid Waiver Licensees.

(1) This section of rule supersedes any conflicting requirements of Rules R501-1 and R501-20.

(2) A licensee serving clients of DSPD shall ensure staff to client ratios are determined by the DSPD worksheet and are individualized based on the person's need.

(3) A licensee shall ensure a ratio of one staff to six persons is maintained at all times.

(4) A licensee serving Home and Community Based Services (HCBS) Medicaid Waiver clients shall:

(a) identify themselves as a Waiver provider on their licensing application and follow all attestation and survey requirements therein;

(b) comply with the HCBS Settings rule and Rule R414-519 to include:

(i) providing non-segregated bathrooms;

(ii) providing individually stalled bathrooms with locking capability with only trained and authorized staff having access to keys for safety;

(iii) ensuring the setting is fully accessible and affords access to the community;

(iv) ensuring client information is not posted or stored in public spaces;

(v) not restricting client access to food unless documented in the person-centered service plan or behavior support plan;

(vi) allowing clients individual initiative, autonomy, independence and choices in regard to their daily activities, physical environment and with whom they interact as much as safely possible; and