FY 2016 Appropriation

The Division of Substance Abuse and Mental Health (DSAMH) is the state's public mental health and substance abuse authority. It has the duty to consult and coordinate with local substance abuse and mental health authorities regarding programs and services. The DSAMH sets policy for programs funded with state and federal money by establishing rules and minimum standards for local substance abuse and mental health authorities. The DSAMH also oversees the Utah State Hospital in Provo.

Additional information regarding the Division of Substance Abuse and Mental Health can be found on its official website found at: Utah Division of Substance Abuse and Mental Health

The Division of Substance Abuse and Mental Health's most recent annual report can be found at:2014 DSAMH Annual Report

Funding History

Funding Issues

Children's Mental Health Early Intervention for Children and Youth

Children's mental health promotion/mental illness prevention that was funded $1,500,000 one time during the 2014 General Session. This request is to make that funding ongoing. Counties are also asking that this funding be increased by an additional $1.5 million in order to serve more schools. Children, Youth and their Families who have Serious Emotional Disturbance (SED) or who are at Risk of developing SEDs are the population being served. In the past two years these community based efforts to intervene early, helped 9,744 children, youth, and their families; 3,983 in the first year of funding and 5,761 in the second year of funding. The subcommittee took action to reduce the request to $1.2 million and fund $300,000 one-time with TANF funds.

Local Mental Health Medicaid Match

Local Mental Health Medicaid caseload growth has exceeded the growth in available Medicaid match funding sources. During the 2014 General Session the Legislature provided an additional $6.4 million one-time to counties to assist them in paying for Medicaid match. Counties are now looking to the state to: 1) make the $6.4 million ongoing. The Medicaid program requires that state partners (including counties) pay for a portion of Medicaid expenditures called Medicaid match. The total FY 2013 Utah Medicaid match requirement was approximately 30%. Local authority information indicates the increased pressure to fund the Medicaid match affects all counties. Growth in Medicaid enrollment has outpaced funding for Medicaid match. In FY 2013 73% of the match was paid for with State General Fund received by the counties as pass through while 27% was paid using county General Fund sources.

Replace Lost Medicaid Funding

This request results from Medicaid auditors disallowing previous cost allocation methods which lowered the annual Medicaid payments to the State Hospital. Medicaid auditors recommended various changes to the Utah State Hospital (USH) cost allocation methods previously agreed upon by both parties which have now lowered the annual Medicaid payments to the State Hospital. Lowering the Medicaid payments has the effect of increasing the state funding requirement.
Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $153,392,000 from all sources for Substance Abuse and Mental Health. This is a 1.9 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $105,535,600 from the General/Education Funds, an increase of 5.7 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time ACA Savings - Local Mental Health/Sub Abuse ($100,000)$0
OngoingOne-TimeFinancing Source
($100,000)$0General Fund
Savings to local mental health and substance abuse systems for both children and adults that have already occurred resulting from passage of federal health care reform (ACA). The amount represents less than four tenths of 1% of state General Fund pass through provided. Savings would involve newly covered groups either on Medicaid or ACA subsidy where local agencies had paying the full amount before (e.g. - children 6-18 below 100% of poverty, etc.).
Background Checks/HB 145 Vulnerable Adult Workers$29,800$0
OngoingOne-TimeFinancing Source
$29,800$0General Fund
Human Services - Background Checks & HB 145 - Vulnerable Adult Worker Amendments - "to enable background checks of employees working with vulnerable adults."
Children's Mental Health Early Intervention for Children and Youth$1,500,000$0
OngoingOne-TimeFinancing Source
$1,200,000$0General Fund
$300,000$0Federal Funds
Children's mental health promotion/mental illness prevention that was funded $1,500,000 one time during the 2014 General Session. This request is to make that funding ongoing. Counties are also asking that this funding be increased by an additional $1.5 million in order to serve more schools. Children, Youth and their Families who have Serious Emotional Disturbance (SED) or who are at Risk of developing SEDs are the population being served. In the past two years these community based efforts to intervene early, helped 9,744 children, youth, and their families; 3,983 in the first year of funding and 5,761 in the second year of funding. The subcommittee took action to reduce the request to $1.2 million and fund $300,000 one-time with TANF funds.
Employment Program for the Mentally Ill$0$120,000
OngoingOne-TimeFinancing Source
$0$120,000Federal Funds
Funding is to assist individuals with a serious and persistent mental illness the opportunity to build self-confidence and self-esteem through reintregartion into their community through meaningful work, education, safe and affordable housing, and respectful relationships.
Expand Autism Classrooms$0$500,000
OngoingOne-TimeFinancing Source
$0$500,000General Fund, One-time
Funding is meant to expand autism classrooms available throughout the state.
Forensic Competency Restoration$300,000$0
OngoingOne-TimeFinancing Source
$300,000$0General Fund
County needs for competency evaluations are exceeding the availability of State Hospital forensic beds. The forensic program has 100 beds. Forensic adults are "adults who have been adjudicated and found not competent to stand trial. These patients are held in a secure facility (regardless of the severity of the crime they are accused of committing) until competency can be restored. . . The forensic unit also holds and treats patients who have been adjudicated and been found guilty or not guilty and mentally ill [20%]. . . Forensic patients cost more than civilly committed adult patients. Over the past four fiscal years, the average cost for forensic patients was $475 per patient day. The average cost for a civilly committed adult was $434 per patient day." A review by the Department of Human Services has determined that a less expensive option than adding more State Hospital forensic beds is to hire State Hospital level staff to go directly to county jails and restore competency there. This option allows the use of existing jails to provide the room and board.
Justice Reinvestment Initiative$3,355,000$1,620,000
OngoingOne-TimeFinancing Source
$3,355,000$0General Fund
$0$1,620,000General Fund, One-time
Over the past 18 months, leaders in state government collaborated with the Pew Charitable Trusts Public Safety Performance Project and the U.S. Department of Justice to examine and find solutions to Utah's recidivism rate and growing prison population. The Justice Reinvestment Initiative is the broad project to begin implementation of key recommendations from the study. Funding is provided for the Department of Corrections, Board of Pardons and Parole, Governor's Office (Commission on Criminal and Juvenile Justice); additional funding is provided for the Division of Substance Abuse and Mental Health.
Local Mental Health Medicaid Match$0$6,400,000
OngoingOne-TimeFinancing Source
$0$6,400,000General Fund, One-time
Local Mental Health Medicaid caseload growth has exceeded the growth in available Medicaid match funding sources. During the 2014 General Session the Legislature provided an additional $6.4 million one-time to counties to assist them in paying for Medicaid match. Counties are now looking to the state to: 1) make the $6.4 million ongoing. The Medicaid program requires that state partners (including counties) pay for a portion of Medicaid expenditures called Medicaid match. The total FY 2013 Utah Medicaid match requirement was approximately 30%. Local authority information indicates the increased pressure to fund the Medicaid match affects all counties. Growth in Medicaid enrollment has outpaced funding for Medicaid match. In FY 2013 73% of the match was paid for with State General Fund received by the counties as pass through while 27% was paid using county General Fund sources.
Medication Assisted Addiction Treatment$0$500,000
OngoingOne-TimeFinancing Source
$0$500,000General Fund, One-time
Funding provides assistance for medication assisted addiction treatment.
Replace Lost Medicaid Funding$1,100,000$0
OngoingOne-TimeFinancing Source
$1,100,000$0General Fund
This request results from Medicaid auditors disallowing previous cost allocation methods which lowered the annual Medicaid payments to the State Hospital. Medicaid auditors recommended various changes to the Utah State Hospital (USH) cost allocation methods previously agreed upon by both parties which have now lowered the annual Medicaid payments to the State Hospital. Lowering the Medicaid payments has the effect of increasing the state funding requirement.
State Hospital Savings regarding HB 14 (2012 GS) ($32,500) ($32,500)
OngoingOne-TimeFinancing Source
($32,500)$0General Fund
$0 ($32,500)General Fund, One-time
DHS - State Hospital Savings re H.B. 14 (2012) GS - The original fiscal note anticipated 4 individuals civilly committed to the State Hospital as a result of this bill. There has only been one civil commitment to the State Hospital since enactment of the bill. The State Hospital did hire staff to prepare for the effects of H.B. 14 at an ongoing cost of $167,500 leaving an ongoing surplus of $32,500.
Suicide Prevention Amendments$191,000$210,000
OngoingOne-TimeFinancing Source
$191,000$0General Fund
$0$210,000General Fund, One-time
No Description
Supplemental Federal Funds Adjustment - Human Services$0$3,002,700
OngoingOne-TimeFinancing Source
$0$3,002,700Federal Funds
No Description
Staff Analysis

Separate tables are shown under the tab labeled "Financials" in each COBI section. These tables provide information regarding: 1) funding sources (where the money comes from), 2) standardized state expenditure categories (where the money goes), and 3) agency sub-programs (when viewed at the line item level). For the most recent completed fiscal year, the following information represents the purposes for which the money was used:

Substance Abuse and Mental Health Administration Detailed Purposes

Community Mental Health Services Detailed Purposes

Mental Health Centers Detailed Purposes

Residential Mental Health Services Detailed Purposes

Utah State Hospital Detailed Purposes

State Substance Abuse Services Detailed Purposes

Local Substance Abuse Detailed Purposes

Driving Under the Influence Program Detailed Purposes

Drug Courts Detailed Purposes

Drug Offender Reform Act Detailed Purposes

Mental Health Medicaid Match Intent Language Report

Local Mental Health Authority Medicaid Match Report

Local Mental Health Authority and Division of Substance Abuse and Mental Health Medicaid Match Presentation

USAAV DORA Report 2014

-Issue Brief - 2014 Interim - DORA Program Report

DORA Quick Facts 2014

Performance measures can be found at the individual program level.

The Division of Substance Abuse and Mental Health includes information on its website showing performance of local mental health and substance abuse authorities. Additional outcome data can be found at:DSAMH Outcome data and local mental health and substance abuse authority reviews at:Local Authority / County Monitoring Reports

Statute

Utah Code Title 62A Chapter 15 describes the functions and responsibilities of Utah's public mental health and substance abuse treatment and prevention systems. Included in this chapter are the following:

  • Section 103: Creation and responsibilities of the Division of Substance Abuse and Mental Health including oversight of the Utah State Hospital
  • Section 105: Authority and responsibilities of the DSAMH
  • Section 107: Authority to assess fees
  • Section 108: Formula for the allocation of funds to local substance abuse and mental health authorities
  • Section 110: Contracts for substance abuse and mental health services (provisions and responsibilities)
  • Section 201: Teen Substance Abuse Intervention and Prevention Act
  • Section 301: Commitment of minors to drug or alcohol programs or facilities
  • Section 401: Alcohol training and education including programs for DUI drivers

Utah Code Title 17, Chapter 43 describes the functions and responsibilities of the counties related to the public mental health and substance abuse treatment and prevention systems. Included in this chapter are the following:

  • Section 201: Responsibilities of the local substance abuse authorities
  • Section 202: Requirements prior to distributing public funds
  • Section 204: Requirement to charge fees for substance abuse services
  • Section 301: Responsibilities of the local mental health authorities including the physical custody of minors committed by a judicial court
  • Section 303: Responsibility for the oversight of public funds
  • Section 304: Contracting for mental health services
  • Section 306: Fees for services including authority to receive funds from other sources
  • Section 308: Specific treatments prohibited
  • Section 309: Powers and responsibilities of local mental health advisory councils

In addition to state law, many functions provided by DSAMH have provisions detailed in federal law. Those federal law references, where available, follow:

SUMMARY:

  • Public Law 102-321 (US Code Part B, Subpart II and Subpart III): Block Grants for Prevention and Treatment of Substance Abuse
  • 45 CFR 96.45, 96.51, and 96.120-131: Substance Abuse Prevention and Treatment Block Grant (Interim Final Rule)
  • Title XXXI of the Public Health Service Act as amended by Public Law (P.L.) 102-321 and P.L. 106-321 (Children's Health Act of 2000)
  • Definition of Adults with SMI and Children with SED, as published in the Federal Register May 20, 1993 (Volume 58, No.1 96)

DETAIL

Public Law 102-321 enacted by the 102nd Congress on July 10, 1992, was intended to amend the Public Health Service Act in order to restructure the Alcohol, Drug Abuse, and Mental Health Administration and the authorities of such Administration.

The table of contents for the Federal Public Health Service Act is as follows:

  • Title I - Reorganization of Administration and Institutes
  • Title II - Block Grants to States Regarding Mental Health and Substance Abuse
  • Title III - Model Comprehensive Program for Treatment of Substance Abuse
  • Title IV - Children of Substance Abusers
  • Title V - Home-visiting Services for At-risk Families
  • Title VI - Trauma Centers and Drug Related Violence
  • Title VII - Studies
  • Title VIII - General Provisions

The Children's Health Act of 2000

Title XXXI Provisions Relating to Services for Children and Adolescents

  • Section 3101: Children and Violence
  • Section 3102: Emergency Response
  • Section 3103: High Risk Youth Reauthorizations
  • Section 3104: Substance Abuse Treatment Services for Children and Adolescents
  • Section 3105: Comprehensive Community Services for Children with Serious Emotional Disturbance
  • Section 3106: Services for Children of Substance Abusers
  • Section 3107: Services for Youth Offenders
  • Section 3108: Underage Drinking
  • Section 3109: Services for Individuals with Fetal Alcohol Syndrome
  • Section 3111: Suicide Prevention
  • Section 3112: General Provisions

State statute assigns the responsibility to provide substance abuse and mental health services to the local authorities (counties). The local authorities provide services directly or contract with private providers (such as Davis Behavioral Health in Davis County). Counties may elect to perform their local authority responsibilities singularly or through an interlocal agreement between multiple counties. In Utah, counties are currently organized as thirteen (13) local mental health authorities and thirteen (13) local substance abuse authorities. Counties are required to provide at a minimum the services mandated by state statute and must provide matching funds equal to at least twenty percent (20%) of most state General Fund passed through to local authorities.

The Public Local Mental Health Authority System

The state public mental health system serves adults with serious mental illness and children with serious emotional disturbances. Many of the recipients do not have private insurance and have limited financial resources. Local authorities, through consultation with the DSAMH, have established schedules that base fees on income levels and family size.

Mental health services are funded by a variety of revenue streams including state General Fund revenue, county funds, Medicaid and Medicare, other third party payers, and client fees. Medicaid is the primary funding stream for mental health services provided by local authorities. In addition, the state applies for and receives a federal Mental Health Services Block Grant (MHBG). Funding from the MHBG supplements other sources of revenue for mental health services in the state.

Local mental health authorities review and evaluate the mental health needs and services of their local populations including those of incarcerated individuals. They prepare annual plans for mental health funding and service delivery for adults, youth, and children. These plans are submitted to and approved by the DSAMH and include the following services mandated by Utah Code:

  • Inpatient care and services;
  • Residential care and services;
  • Outpatient care and services;
  • 24-hour crisis care and services;
  • Psychotropic medication management;
  • Psychosocial rehabilitation, including vocational training and skills development;
  • Case Management;
  • Community supports, including in-home services, housing, family support services, and respite services;
  • Consultation and education services, including case consultation, collaboration with other county service agencies, public education, and public information; and
  • Services to incarcerated persons (UCA 17-43-301).

Local mental health centers also provide additional services including peer support, school-based services, mobile crisis outreach teams, crisis lines, housing, clubhouses, consumer drop-in centers, employment and rehabilitation, services to the homeless, family respite, nursing home and hospital alternatives, and consumer education.

The Public Local Substance Abuse Authority System

The state public substance abuse system serves any person in need of substance abuse services. Local authorities are required to charge a fee for substance abuse services rendered. However, no individual may be refused service because of an inability to pay. Local authorities through consultation with the DSAMH have established schedules that base fees on income levels and family size. Because of funding limitations, individuals may experience delays in the availability of services. Priorities for services include the following:

  • Pregnant women;
  • Intravenous (IV) Drug Users;
  • Women with dependent children; and
  • All others.

In addition to the priority populations listed above, significant public resources are focused on individuals in the criminal justice system (see also the separate section of this report on drug courts). Annually, the state applies for and receives a federal Substance Abuse Prevention and Treatment Block Grant. Funding from this grant supplements the General Fund appropriations for substance abuse services in the state. This federal grant requires that the state, through the local substance abuse authorities, provide a continuum of the following services:

  • Detoxification;
  • Prevention services;
  • Outpatient services;
  • Intensive outpatient services; and
  • Residential treatment programs.

Intent Language

HB0003: Item 89

Under Section 63J-1-603 of the Utah Code, the Legislature intends that any remaining funds provided by Item 38, Chapter 13, Laws of Utah 2014 for the Drug Courts program within the Department of Human Services' Division of Substance Abuse and Mental Health line item not lapse at the close of Fiscal Year 2015. The use of any non-lapsing funds is limited to "other charges/pass through" expenditures consistent with the requirements found at UCA 63J-1-603(3)(b).

HB0003: Item 89

Under Section 63J-1-603 of the Utah Code, the Legislature intends that any remaining funds provided by Item 38, Chapter 13, Laws of Utah 2014 for State Substance Abuse Services and Local Substance Abuse Services within the Department of Human Services' Division of Substance Abuse and Mental Health line item not lapse at the close of Fiscal Year 2015. The use of any non-lapsing funds is limited to "other charges/pass through" expenditures consistent with the requirements found at UCA 63J-1-603(3)(b).

HB0003: Item 89

Under Section 63J-1-603 of the Utah Code, the Legislature intends that up to $50,000 of appropriations provided for the Department of Human Services' Division of Substance Abuse and Mental Health line item in Item 38, Chapter 13, Laws of Utah 2014 not lapse at the close of Fiscal Year 2015. These funds are to be used for the purchase of computer equipment and software, capital equipment or improvements, equipment, or supplies.

SB0002: Item 82

The Legislature intends the Department of Workforce Services and the Administrative Offices of the Courts provide a report to the Office of the Legislative Fiscal Analyst no later than September 1, 2015. The report shall include, at a minimum: 1) a summary of efforts to improve coordination between the Drug Court program and DWS' Workforce Development Division in order to improve Drug Court success, 2) data indicating the success of the efforts including the implementation and reporting on measures of post program recidivism, and 3) any identified savings or additional funding of drug court recipients as a result of improved coordination efforts.

SB0002: Item 82

The Legislature intends that the one-time General Fund appropriation of $6,400,000 to the Department of Human Services for Local Authority Mental Health Medicaid Match is provided to assist local mental health authorities for one year until they can find ways to provide their own matching funds in the future. The Legislature further intends the local mental health authorities report their plans to provide their own matching funds in the future to the Office of the Legislative Fiscal Analyst by September 1, 2015.

SB0002: Item 82

The Legislature intends that the $300,000 in federal funds appropriated for Children's Mental Health Early Intervention for Children and Youth in the Department of Human Services in the Division of Substance Abuse and Mental Health line item is dependent upon the availability of and qualification for the Children's Mental Health Early Intervention for Children and Youth for Temporary Assistance for Needy Families federal funds.

SB0007S01: Item 9

The Legislature intends that the Department of Human Services report on the following performance measures for the Substance Abuse and Mental Health line item: (1) Local Substance Abuse Services - Successful completion rate (Target = 40%), (2) Mental Health Services - Adult Outcomes Questionnaire - Percent of clients stable, improved, or in recovery while in current treatment (Target = 70%), and (3) Mental Health Centers - Youth Outcomes Questionnaire - Percent of clients stable, improved, or in recovery while in current treatment (Target = 70%) by January 1, 2016 to the Social Services Appropriations Subcommittee.

SB0007S01: Item 27

The Legislature intends that the Department of Human Services report on the following performance measures for the Substance Abuse and Mental Health line item: (1) Local Substance Abuse Services - Successful completion rate (Target = 40%), (2) Mental Health Services - Adult Outcomes Questionnaire - Percent of clients stable, improved, or in recovery while in current treatment (Target = 70%), and (3) Mental Health Centers - Youth Outcomes Questionnaire - Percent of clients stable, improved, or in recovery while in current treatment (Target = 70%) by January 1, 2016 to the Social Services Appropriations Subcommittee.

There are two restricted accounts that are used in connection with the Division of Substance Abuse and Mental Health: 1) Tobacco Settlement Restricted Account and 2) Intoxicated Driver Rehabilitation Account. A five year history of each account is shown here:

For analysis of current budget requests and discussion of issues related to this budget click here.

Special Funds

There are two restricted accounts that are used in connection with the Division of Substance Abuse and Mental Health: 1) Tobacco Settlement Restricted Account and 2) Intoxicated Driver Rehabilitation Account. A five year history of each account is shown here:

Tobacco Settlement Restricted Account

Intoxicated Driver Rehabilitation Account

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COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.