DAR File No. 29382

Human Services, Substance Abuse and Mental Health

R523-1-11

Policies and Procedures Relating to Referrals, Admissions, and Transfers of Mental Health Consumers to the Utah State Hospital and Between Mental Health Center Catchment Areas

NOTICE OF PROPOSED RULE

DAR File No.: 29382
Filed: 01/02/2007, 02:02
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Division of Substance Abuse and Mental Health has determined that the procedures and conflict resolution process described in this rule were in need of streamlining to more accurately reflect current practices. It was also determined that these practices should be moved into a section that set forth procedures relating to the relationships between the Division and the local mental health authorities, so they have been moved to Section R523-1-2. (DAR NOTE: The proposed amendment to Section R523-1-2 is under DAR No. 29381 in this issue, January 15, 2007, of the Bulletin.)

Summary of the rule or change:

All practices described in this rule have been moved to Subsection R523-1-2(4) and replaced with a simple statement that the Division shall oversee the continuity of care for services provided to consumers and resolve conflicts between the State Hospital and local mental health authorities. Conflict resolutions will follow a four-step process: 1) a committee will review the issues and make recommendations; 2) if no resolution, discussions between the center's clinical or medical director and the State Hospital's clinical director; 3) if no resolution, then discussions between the center's director and the superintendent of the State Hospital; and finally 4) if no resolution, the Division director or designee makes a final determination. If the local mental health authorities have conflicts between each other, the Division director or designee shall make a final determination.

State statutory or constitutional authorization for this rule:

Subsection 62A-15-105(5) and Section 62A-15-603

Anticipated cost or savings to:

the state budget:

The practices described in this amendment are already in place so there will be no increase or decrease in the state budget to implement or administer these changes.

local governments:

The practices described in this amendment are already in place so there will be no increase or decrease in local government budgets to implement or administer these changes.

other persons:

This rule pertains only to the Division and its relationships with the local mental health authorities. There should be no impact on the business dealings of the local mental health authorities and their private contractors; and there should be no impact on others within the state.

Compliance costs for affected persons:

This rule pertains only to the Division and its relationships with the local mental health authorities. There should be no impact on the business dealings of the local mental health authorities and their private contractors; and there should be no impact on others within the state.

Comments by the department head on the fiscal impact the rule may have on businesses:

After careful review, the Department of Human Services has determined that this rule will have no financial impact on businesses in the State of Utah. Lisa-Michele Church, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Human Services
Substance Abuse and Mental Health
120 N 200 W
SALT LAKE CITY UT 84103-1500

Direct questions regarding this rule to:

Thom Dunford at the above address, by phone at 801-538-4519, by FAX at 801-538-9892, or by Internet E-mail at TDUNFORD@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

02/14/2007

This rule may become effective on:

02/22/2007

Authorized by:

Mark I Payne, Director

R523. Human Services, Substance Abuse and Mental Health.

R523-1. Procedures.

[R523-1-11. Policies and Procedures Relating to Referrals, Admissions, and Transfers of Mental Health Consumers to the Utah State Hospital and Between Mental Health Center Catchment Areas.

(1) All consumers shall be referred into the public mental health system through admission to the local comprehensive community mental health center. For purposes of this document, whenever center is used, it means a local comprehensive community mental health center or agency that provides treatment and services to residents of a designated geographic area, operated by or under contract with a local mental health authority, in compliance with state standards for local comprehensive community mental health centers.

(2) In providing services to consumers from other catchment areas, including interstate transient consumers, the Center staff shall have the responsibility to assess the consumer's needs and to provide necessary emergency services consistent with the Center's current emergency procedures. Following such interventions, the Center staff shall assist the consumer in arranging for services from resources near the individual's place of residence.

(3) A Center shall utilize the services of the Utah State Hospital (hereinafter referred to as Hospital) when evaluation by the Center staff and the Hospital staff determine such services to be the treatment of choice. In every instance, continuity of consumer care will be a joint responsibility between the Center staff and the Hospital. The Center shall (1) provide information upon transfer to the Hospital; (2) participate in planning for transfer out of the Hospital; and (3) provide appropriate supportive services to the consumer upon their return to the community.

(4) The Hospital and the Centers are expected to provide services only within the state substance abuse and mental health systems' limited fiscal capacity.

(5) All consumers referred to the Utah State Hospital will have been seen, evaluated, and admitted to the local public mental health center. Prior to the consumer admission to the hospital, the center must follow the procedures specified via the Bed Allocation Policy. If the Hospital has reached maximum bed capacity, referred consumer's shall be placed on the Hospital waiting list.

(6) The Hospital, in consultation with the Centers, has the responsibility of prioritizing consumers ready for discharge. In the event of a consumer who is ready for discharge from the Hospital, but is from a different catchment area other than the referring center, the two centers will negotiate and coordinate services. Nevertheless, final discharge coordination remains the responsibility of the referring center. If a suitable placement cannot be achieved, the referring Center may appeal to the Chair of the Continuity of Care Committee for arbitration and resolution.

(7) If a consumer arrives at the Hospital without having been referred by a Center, the Hospital shall contact the appropriate Center to insure appropriate disposition. Should an emergency admission occur to the Hospital, the Center shall visit the consumer within three working days to coordinate services.

(8) Appropriate information pertaining to the consumer's evaluation, care, and treatment will follow the consumer to and from the Hospital.

(9) Each Center will designate a Hospital liaison(s). The Hospital will designate a Center liaison(s) for each of its programs. All consumer transfers between a Center and the Hospital will be managed through the identified Center liaisons.

(10) The emergency needs of transient consumers will be met by the Centers and will be consistent with the Centers' current emergency procedures. The Center providing emergency services will follow the appropriate procedures in coordinating the transfer of the consumer to his place of residence. Centers transferring transient consumers to the Hospital will comply with the consumer Continuity of Care procedures defined in this Policy.

(11) The Center liaison shall meet at least monthly with Hospital staff to discuss the treatment progress of the consumer and jointly plan with Hospital staff around discharge procedures.

(12) When it is agreed by the Hospital and the Center liaison that a consumer has received maximum hospital benefit, it will be the responsibility of the Center to find a satisfactory placement for the consumer within a 15-day period. Written documentation must be submitted to the Hospital when a satisfactory placement cannot be accomplished within 15 days.

(13) When resources are available only outside the consumer's catchment area, it will be the responsibility of the original referring Center to negotiate arrangements for an appropriate placement. Within seven days, the receiving center will provide verbal or written acceptance or denial of the consumer transfer. The receiving Center shall accept the consumer on a 30-day trial basis. If during the 30-day trial period, the placement is determined unsuccessful, the initiating Center will assume responsibility for the consumer's care. However, after 30 days, if the consumer's placement is successful, the receiving Center will assume responsibility for the consumer's care; and the consumer becomes a resident of that Center.

(14) When referrals involve the placement of consumers outside of a comprehensive community mental health center for time-limited treatment, the Center of origin remains responsible for the consumer's ongoing continuity of care. However, if the consumer wishes to reside in a new catchment area, the receiving center assumes responsibility for the consumer's ongoing continuity of care needs.

(15) In the event that either the referring or receiving Center perceive that procedures have not been adhered to, the Center liaisons from the two catchment areas will discuss the continuity of care concerns in an effort to bring about an acceptable resolution to both parties. If the liaisons cannot resolve their concerns, a written compliant may be submitted to the Chair of the Continuity of Care Committee for final arbitration.

(16) For the purposes of admitting and discharging children and youth to and from the State Hospital, all continuity of care procedures defined in this Rule will be adhered to.

(17) In addition, the following procedures shall apply for children and youth:

(a) The Center will document that less restrictive placement alternatives have been considered and are inadequate to meet the consumer's treatment needs.

(b) The Center and the Hospital both agree that restrictive intermediate care at the Hospital is in the best interest in meeting the treatment needs of the consumer.

(c) If an agency other than a local comprehensive community mental health center is seeking to admit a consumer to the hospital, both the referring agency and Center must agree at the time of referral to participate in the child's service plan. Within seven working days, the Center will notify the referring agency regard the status of the referral.

(d) If there is a custodial agency other than the Division of Substance Abuse and Mental Health, the agency agrees at admission to the hospital to retain custody of the consumer.]

 

KEY: bed allocations, due process, prohibited items and devices, fees

Date of Enactment or Last Substantive Amendment: [March 7, 2005]2007

Notice of Continuation: December 11, 2002

Authorizing, and Implemented or Interpreted Law: 62A-12-102; 62A-12-104; 62A-12-209.6(2); 62A-12-283.1(3)(a)(i); 62A-12-283.1(3)(a)(ii); 62A-15-612(2)