Utah Code § 26B-2-124 — Utah Code / Title 26B / Chapter 26B-2 / § 26B-2-124
§ 26B-2-124. Congregate care program requirements -- Admissions criteria -- Costs incurred at health care facilities.
Status: in_force

(1) As used in this section: (a) "Admissions criteria" means the risk factors that must be present in the life of a child in order for a congregate care program to admit the child to the program. (b) "Approved admissions criteria" means the admissions criteria that the division has approved in accordance with Section 26B-1-436. (c) "Critical incident" means an occurrence of any of the following: (i) a self-harm, or a suicide emergency, as defined in Section 78B-4-516; (ii) a practice that is prohibited under Section 26B-2-123; (iii) a restraint, seclusion, or emergency safety intervention under Section 26B-2-123 occurring at the program, whether it: (A) complies with Section 26B-2-123; or (B) fails to comply with Section 26B-2-123; (iv) a child's request for medical attention, except: (A) medical attention that is part of the child's treatment plan; or (B) when the medical attention requested does not require professional attention; (v) a denial or an unreasonable delay of required medical attention to a child in the program; (vi) an admittance or a transport of a child in the program to or from a medical facility; (vii) an incident or allegation of abuse or harm to a child while in the program; (viii) an unauthorized departure or attempted unauthorized departure of a child from the program; (ix) a use of force, coercion, or deception in transporting a child to or from the program, unless the program did not conduct or pay for the transport and: (A) the program does not know about the use of force, coercion, or deception; or (B) if the alleged use of force, coercion, or deception has been reported to the division or to the Division of Child and Family Services; (x) a child in the program who is in crisis; (xi) a police report or investigation involving: (A) a child; or (B) an individual who has had access to the program; (xii) a physical condition of the program's facility that jeopardizes the health, safety, or well-being of a child; and (xiii) any additional occurrence or condition that the division defines as a critical incident in rule. (d) "Disruption plan" means instructions and a predetermined protocol, specific to an individual child, that a congregate care program implements: (i) if the child: (A) is in crisis; or (B) stops receiving services at a congregate care program; or (ii) for transporting a child to: (A) a parent or guardian; (B) another congregate care program; or (C) a health care facility, as that term is defined in Section 78B-3-403, except for preventative or non-emergency health care. (e) "Qualified candidate" means, for an individual congregate care program's approved admissions criteria, a child who meets the program's approved admissions criteria. (f) (i) "Risk factors" means objectively identifiable characteristics, elements, or a combination of characteristics or elements of a child's life that, if present, evidence an ongoing criminogenic, emotional, or behavioral concern that a congregate care program can safely address. (ii) "Risk factors" include: (A) diagnoses defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association; and (B) any other characteristic, element, or combination of characteristics or elements of a child's life that the office, in consultation with the committee, establishes by rule. (2) For purposes of this section, congregate care program, as defined in Section 26B-2-101, does not include a youth shelter, youth receiving center, or any other short-term or temporary setting for children. (3) Notwithstanding any provision of this part, a congregate care program may not admit a child who the program knew or should have known the program is unqualified or unable to: (a) safely serve; and (b) protect from reasonably foreseeable harm. (4) A congregate care program shall: (a) for each child who is admitted to the program: (i) collect and maintain: (A) contact information for each individual who the child's parent, guardian, or sending government or private agency identifies as an authorized contact; and (B) accurate contact information for the child's parent or guardian; (ii) prepare a disruption plan tailored to the child; and (iii) prepare a suicide prevention plan, tailored to the child, and maintained and revised as necessary to maintain the child's safety; (b) develop proposed admissions criteria that, if approved by the office: (i) prescribe with specificity the criteria by which the program shall determine whether a child is a qualified candidate; (ii) are appropriate given the program's facilities, staffing, programming, policies, procedures, and any other elements of the program designed to safely and effectively serve the children who are admitted to the program; (iii) subject to Subsection (3), are the determining criteria against which the program shall consider and determine whether a child is a qualified candidate; and (iv) the program shall utilize to determine whether any child: (A) meets the admissions criteria, and therefore is a qualified candidate for the program; or (B) does not meet the admissions criteria, and therefore is not a qualified candidate for the program; (c) submit proposed admissions criteria in accordance with Subsection (4)(b) with each application for licensure or renewal of licensure; (d) subject to Subsection (5), decline to admit a child who does not meet the program's approved admissions criteria; (e) document and report each critical incident no later than one business day after the time at which the incident begins, to: (i) the parent or guardian of each child affected by the critical incident; and (ii) the office; (f) post a conspicuous notice: (i) in a common area that is frequently used and generally accessible to each child who is admitted to the program; (ii) in a bold font that is not less than one inch in height; and (iii) that includes the information and statement described in Subsection (7)(a)(i); (g) provide a telephone from which a child in the program, staff, or any other individual may place a direct call to the ombudsman under Section 26B-2-124.2: (i) at any time; (ii) without interference; (iii) with sufficient privacy to preclude another individual from hearing the conversation; and (iv) subject to the whistleblower protections under Section 26B-2-124.3; and (h) maintain a dedicated business telephone number that directly connects a caller to an individual who: (i) is physically present at the congregate care program; and (ii) who has been trained to and will comply with Subsection (6). (5) Notwithstanding the other provisions of this section, the department may grant an exception to the admittance requirements of this section for a child who is in the custody of the Division of Child and Family Services or the Division of Juvenile Justice and Youth Services, if the placement is with a program operated by the department or under contract with the department. (6) If a child is in crisis, a congregate care program shall: (a) notify the child's parent or guardian as soon as reasonably possible but not later than five hours after the time at which the child's state of crisis first begins; and (b) make every reasonable effort to connect a child by telephone to an authorized contact who: (i) attempts to contact the child by calling the program's telephone number described in Subsection (4)(h); and (ii) is an authorized contact under Subsection (4)(a)(i). (7) (a) A congregate care program shall provide the following information to the persons identified in Subsection (7)(b): (i) the name, telephone number, email, and address of the ombudsman established under Section 26B-2-124.2, immediately below a statement: (A) in bold font that is not less than one inch in height; and (B) stating "ANY PERSON WHO HAS A COMPLAINT OR A CONCERN REGARDING THIS CONGREGATE CARE PROGRAM MAY CONTACT THE CONGREGATE CARE OMBUDSMAN:"; (ii) a list of the child's authorized contacts, including name, contact information, and relationship to the child to: (A) the child's parent or guardian; (B) any other individual designated by the child's parent or guardian as an authorized contact; and (C) the ombudsman under Section 26B-2-124.2; and (iii) on the list described in Subsection (7)(a)(ii): (A) a copy of the division rule regarding a child who is in crisis, made in accordance with Subsection (12)(a)(iii); (B) a notice that the program will notify each authorized contact if the program determines that the child is in crisis; and (C) a notice that an authorized contact may contact the child by telephone if the child is in crisis. (b) A congregate care program shall provide the information described in Subsection (7)(a) to: (i) each child who is admitted to the program; (ii) the child's sending government or private agency; and (iii) the child's parent or guardian. (8) If a child whose parent or guardian resides outside the state leaves a congregate care program without following the child's disruption plan, the congregate care program shall: (a) notify the parent or guardian, office, and local law enforcement authorities; (b) assist the state in locating the child; and (c) after the child is located, transport the child: (i) to a parent or guardian; (ii) back to the program; or (iii) to another program. (9) A congregate care program may not solicit or accept payment from or on behalf of a child, unless: (a) the child meets the program's admissions criteria; and (b) the child's parent or guardian has executed a contract for the program's services. (10) (a) The payment provisions under this Subsection (10) apply if: (i) a child is transported to a health care facility; and (ii) the child's parent or guardian resides outside the state. (b) The payment provisions under this Subsection (10) do not apply to a child who is in state custody. (c) A health care facility that provides services to a child who was transported from a congregate care program to the facility is entitled to payment in accordance with this Subsection (10). (d) (i) The child's private or public health insurance policy or policies are responsible for and shall pay all amounts owed and for which there is coverage. (ii) The health care facility shall bill the private or public health insurance policy or policies, if any, for which there may be coverage, prior to seeking payment from any other person. (e) The program at which the child was admitted, if any, immediately prior to admittance at the health care facility is liable for and shall pay all amounts owed to the health care facility after any insurance payments are received under Subsection (10)(d). (f) (i) Subject to Subsections (10)(f)(ii) and (iii), if a child is admitted to a health care facility for inpatient behavioral health services, the program described in Subsection (10)(e) shall pay to the health care facility 70% of the health care facility's billed charges for services provided to the child. (ii) Notwithstanding Subsection (10)(f)(i), if a health care facility collects payment from a public or private insurer for any covered services provided under Subsection (10)(f)(i), the health care facility may not collect additional amounts for those covered services under Subsection (10)(f)(i). (iii) For purposes of the Health Information Portability and Accountability Act, disclosure of claim payment information by the health care facility meets the definition of payment in 45 C.F.R. Sec. 164.501 and is required under this section for the purpose of obtaining reimbursement for the provision of health care or engaging in collection activities in accordance with 45 C.F.R. Sec. 164.506(c). (g) The residential program at which the child was admitted at the time of admittance to a health care facility is liable for and shall pay all amounts owed under Subsection (10)(c), including the reasonable costs of transport from the health care facility to: (i) the child's home state residence; (ii) another residential or inpatient care facility or program; or (iii) any other lawful destination. (h) Nothing in this Subsection (10) may be construed to limit a health care facility's right to collect payment for health care services provided. (11) This section does not apply to a guardian that is a state or agency. (12) The office shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act: (a) describing: (i) additional mandatory provisions for a disruption plan; (ii) additional mandatory provisions for a discharge plan; (iii) objective criteria that a congregate care program shall apply in determining whether a child is in crisis; and (iv) how a congregate care program shall notify the office when a child begins receiving services; (b) defining key terms; and (c) establishing rules necessary to administer this section.