1. (1) Each residential treatment provider shall document local government approval, as described in Section 26B-2-117, for new program services or increased consumer capacity.

2. (2) Any qualifying residential treatment provider:

   1. (a) may not deny any client services solely based on a client receiving medication assisted treatment; and
   2. (b) shall ensure any client continues the medication assisted treatment while receiving services from the provider.
3. (3) Each residential treatment provider shall ensure policies include client privacy accommodation in each bedroom space while ensuring client health and safety.

4. (4) Each residential treatment provider serving a child shall:

   1. (a) provide direct supervision that meets supervision and ratio requirements described in this section;
   2. (b) ensure two direct care staff are always on duty;

   3. (c) maintain a staff-to-client ratio of one staff to every four clients except:

      1. (i) as otherwise required by a Department of Health and Human Services (department) contract; or
      2. (ii) to reduce ratios to one staff to every 16 clients during client sleeping hours;

   4. (d) only decrease the number of staff as described in this section if:

      1. (i) each client is appropriately supervised to ensure health and safety at the ratio; and
      2. (ii) each direct care staff remains awake while on duty;
   5. (e) increase the staff-to-client ratio as necessary to ensure the health and safety of the current client population;
   6. (f) only allow direct care staff to perform direct supervision with line of sight check-ins every 15 minutes;
   7. (g) ensure that any direct care staff member assigned to a client's one-on-one supervision is not counted at the same time in the staffing ratio for any other client, except in an emergency situation;

   8. (h) only utilize on-site video surveillance to directly supervise a client in time out or seclusion or as an enhancement to minimum supervision ratio requirements;

      1. (i) conduct and document physical check-ins every 15-minutes when a client is being monitored by video; and

   9. (j) only use video surveillance in a bedroom:

      1. (i) with client, parent, or guardian permission;
      2. (ii) when there is a documented need;
      3. (iii) when the provider monitors any camera or physically checks in at intervals of 15 minutes or less; and
      4. (iv) when video surveillance complies with Rule R539-3 for serving an individual with disabilities.

5. (5) Each residential treatment provider serving a child may provide step-down privileges, including authorized departures from the program and unsupervised time, if the provider:

   1. (a) maintains a staff-to-client ratio of one direct care staff to every four clients;

   2. (b) documents in the client record and communicates to each of the client's direct care staff:

      1. (i) the individualized justification for the step-down privileges; and
      2. (ii) which privileges are authorized by a clinical professional;
   3. (c) obtains written parental or guardian consent before allowing step-down privileges; and

   4. (d) provides a policy to each client and parent or guardian that includes:

      1. (i) a description of what constitutes authorized departure and unsupervised time;
      2. (ii) a description of how each step-down privilege, including authorized departure or unsupervised time, is achieved or rescinded;
      3. (iii) a statement that the provider will immediately communicate to each client parent or guardian and direct care staff when any step-down privilege has been rescinded; and
      4. (iv) a statement that no step-down client is allowed to perform any direct care staff duty.
6. (6) Each residential treatment provider shall make any necessary accommodation to allow a child to continue that child's education with a curriculum approved by the State Board of Education.
7. (7) Each residential treatment provider that offers education shall use a curriculum that is recognized by an educational accreditation organization, including the State Board of Education or the National School Accreditation Board.

8. (8)(a) In addition to the behavior management policy and training requirements listed in Rule R501-1, each residential treatment provider serving youth shall ensure each direct care staff member is trained through a nationally or regionally recognized curriculum and can recognize the difference between a restraint and an emergency safety intervention.

   1. (b) An emergency safety intervention may not be used as a behavioral compliance method.
   2. (c) The provider shall only use an emergency safety intervention to ensure immediate safety of a client or staff member.
   3. (d) An emergency safety intervention is subject to each requirement of a restraint for reporting, debriefing, clinical reviews, and training.
   4. (e) An emergency safety intervention may exceed the limitations of any restraint listed in Rule R501-1 with documented justification explaining why a regular restraint or another less intrusive intervention was not used.

9. (9) Each residential treatment provider serving adults may admit a 17-year-old individual if the provider:

   1. (a) obtains written permission from the individual's parent or legal guardian;
   2. (b) provides clinical justification;

   3. (c) ensures that the individual sleeps in a room:

      1. (i) separate from any adult; or
      2. (ii) that the individual shares with one or more adults no more than two years older than the individual;
   4. (d) ensures that any adult with direct access to the individual is directly supervised by a direct care staff; and
   5. (e) ensures enhanced safety and supervision measures for treating a minor in an adult setting.

10. (10) Each residential treatment provider providing services to a substance use disorder client shall:

    1. (a) only admit a substance use disorder client with a level of care that falls within American Society of Addiction Medicine levels 3.1 through 3.5; and
    2. (b) obtain any required license before providing any service to a substance use disorder client outside of the residential setting with a level of care described in Subsection (10)(a), unless otherwise outlined in categorical rule.
11. (11) Each residential treatment provider that allows a client to participate in food preparation shall ensure the client is trained in safe food handling practices and the provider justifies the client's participation in writing.
12. (12) Each residential treatment provider shall provide individual, group, and family counseling or other treatment, including skills development, at least weekly or as outlined in the individual's treatment plan.

13. (13) A clinical professional shall oversee any therapeutic services conducted in the therapeutic environment including:

    1. (a) life skill development;
    2. (b) psychoeducation; and
    3. (c) social coaching.
14. (14) Each residential treatment provider shall document the time and date of each service provided to each client and include the signature of the individual providing the service.
15. (15) Each residential treatment provider shall provide indoor space for free time and informal client activities.

KEY: human services, licensing, residential treatment, congregate care

Date of Last Change: January 26, 2026

Notice of Continuation: February 28, 2025

Authorizing, and Implemented or Interpreted Law: 26B-2-104; 26B-2-117