Utah Admin. Code 270-1-5

Current through Bulletin No. 2024-21, November 1, 2024

Section R270-1-5 - Mental Health Services

(1)

(a) Pursuant to Subsection 63M-7-511(4)(c), the office may pay for outpatient mental health counseling provided by a qualified mental health professional as follows:

(i) a primary victim of a crime is eligible for a total of 25 outpatient mental health counseling sessions, including either individual or group counseling session;

(ii) a parent, child, spouse, or sibling of a homicide victim is eligible for a total of 25 outpatient mental health counseling sessions, including either individual or group counseling sessions;

(iii) any other secondary victim of a crime is eligible for a total of 15 outpatient mental health counseling sessions, including either individual or group counseling sessions.

(b) Before the office may pay for any outpatient mental health counseling:

(i) a qualified mental health professional who intends to provide outpatient mental health counseling to a victim shall submit a Mental Health Treatment Plan to the office; and

(ii) the assigned reparations officer shall approve the Mental Health Treatment Plan.

(c) The amount paid for each outpatient mental health counseling session shall be the rate established by the PEHP fee schedule.

(d) Outpatient mental health counseling costs may not be paid in advance but will be paid on an ongoing basis as treatment is provided.

(e) The reparations officer may authorize additional outpatient mental health counseling beyond the limits described in Subsection R270-1-5(1)(a) if:

(i) a qualified mental health professional submits sufficient documentation to justify the need for additional outpatient mental health counseling; and

(ii) the assigned reparations officer determines that extenuating circumstances warrant additional outpatient mental health counseling.

(2)

(a) The office may pay for inpatient mental health treatment for:

(i) a primary victim; and

(ii) a parent, child, spouse, or a sibling of a homicide victim.

(b) The office may not pay for inpatient mental health treatment for a secondary victim.

(c) The office may only pay for inpatient mental health treatment when the treatment has been recommended by a qualified mental health professional as a result of a life-threatening situation.

(d) The office may pay an inpatient mental health treatment facility:

(i) up to $600 a day for facility fees, which includes any ancillary expense; and

(ii) the PEHP rate for one visit a day by a mental health professional.

(e) The office may pay the PEHP rate for diagnostic testing administered in an inpatient facility.

(3)

(a) The office may pay for mental health-related residential or day treatment for:

(i) a primary victim; and

(ii) a parent, child, spouse, or sibling of a homicide victim.

(b) The office may not pay for residential or day treatment for a secondary victim.

(c) The office may only pay for residential or day treatment when the treatment has been recommended by a qualified mental health professional to stabilize the victim's behavior and symptoms.

(d) Payment for residential treatment:

(i) may not exceed $300 a day; and

(ii) shall be limited to 30 days.

(e) Payment for day treatment:

(i) may not exceed $200 a day; and

(ii) shall be capped at $10,000.

(f) The office may not pay for residential or day treatment unless the facility has either 24-hour nursing care or 24-hour on-call nursing care.

(g) The office may pay the PEHP rate for one routine medication management assessment a week when conducted in an inpatient mental health facility by a qualified mental health professional.

(4) Reparations officers shall establish a reasonable percentage regarding victimization treatment for outpatient, inpatient, residential and day treatment on a case-by-case basis upon review of the Mental Health Treatment Plan and treatment records.

(5) The office may not pay for wilderness programs.

(6) The office may not pay for mental health services for an offender related to the perpetration of the criminally injurious conduct.

(7) The office may pay for hypnotherapy only when treatment is performed by a qualified mental health professional based upon an approved Mental Health Treatment Plan.

(8)

(a) The office may not pay for treatment for chemical dependency unless the reparations officer determines that it is directly related to the crime.

(b) The board may review requests for reimbursement for chemical dependency treatment where extenuating circumstances are present.

Utah Admin. Code R270-1-5

Amended by Utah State Bulletin Number 2016-22, effective 10/24/2016

Amended by Utah State Bulletin Number 2017-13, effective 6/7/2017

Amended by Utah State Bulletin Number 2022-01, effective 12/22/2021

Amended by Utah State Bulletin Number 2023-24, effective 12/8/2023