CurrentUtah MedicaidPolicy UT-26-0004

Rehabilitative Services Practitioner Qualifications, Supervision, and Payment

Customize your policy alerts

Sign up for Utah Medicaid Policy UT-26-0004 alerts

Get alerted when Policy UT-26-0004 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Identifies practitioner qualifications, supervision rules, authorized rehabilitative services, and direct medical payment methodology for participating school-based local education agencies.

Policy Summary

PayerUtah Medicaid

PolicyRehabilitative Services Practitioner Qualifications, Supervision, and Payment

Policy CodePolicy UT-26-0004

Change TypeClarification

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionEnsure peer support specialists meet state statute requirements and receive provider supervision.

SourceLink

POLICY UPDATE CHANGES

The chart clarifies that providers may supervise peer support specialists.

The chart updates the stated authority for certified behavioral health technicians and the description of registered nursing student or substance use disorder education program personnel.

The direct medical payment methodology permits an LEA to select a monthly interim payment level of 70%, 80%, or 90% of the calculated amount.

6Practitioner or personnel categories

Peer support specialistsPersonnel category eligible for provider supervision

70%, 80%, or 90%LEA interim payment options

Policy Summary

PayerUtah Medicaid

PolicyRehabilitative Services Practitioner Qualifications, Supervision, and Payment

Policy CodePolicy UT-26-0004

Change TypeClarification

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionEnsure peer support specialists meet state statute requirements and receive provider supervision.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

CurrentUtah MedicaidPolicy UT-26-0004

Rehabilitative Services Practitioner Qualifications, Supervision, and Payment

Customize your policy alerts

Sign up for Utah Medicaid Policy UT-26-0004 alerts

Get alerted when Policy UT-26-0004 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Identifies practitioner qualifications, supervision rules, authorized rehabilitative services, and direct medical payment methodology for participating school-based local education agencies.

Policy Summary

PayerUtah Medicaid

PolicyRehabilitative Services Practitioner Qualifications, Supervision, and Payment

Policy CodePolicy UT-26-0004

Change TypeClarification

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionEnsure peer support specialists meet state statute requirements and receive provider supervision.

SourceLink

POLICY UPDATE CHANGES

The chart clarifies that providers may supervise peer support specialists.

The chart updates the stated authority for certified behavioral health technicians and the description of registered nursing student or substance use disorder education program personnel.

The direct medical payment methodology permits an LEA to select a monthly interim payment level of 70%, 80%, or 90% of the calculated amount.

6Practitioner or personnel categories

Peer support specialistsPersonnel category eligible for provider supervision

70%, 80%, or 90%LEA interim payment options

Policy Summary

PayerUtah Medicaid

PolicyRehabilitative Services Practitioner Qualifications, Supervision, and Payment

Policy CodePolicy UT-26-0004

Change TypeClarification

Effective DateMarch 1, 2026

Next Review DateN/A

Key ActionEnsure peer support specialists meet state statute requirements and receive provider supervision.

SourceLink

On This Page

12SDS payment installments

AnnualLEA cost reconciliation

Practitioner Eligibility and Direct Medical Payment

Practitioner Supervision and Service Eligibility

Practitioner eligibility, supervision requirements, and eligible rehabilitative services are determined as follows.

Registered Nurse

Utah Nurse Practice Act applies.
Provider requires supervision and may supervise LPNs, medical assistants, and individuals trained to provide psychosocial rehabilitative services.
Eligible services: therapeutic behavioral services, supportive living services, and psychosocial rehabilitative services.

Licensed Practical Nurse

Utah Nurse Practice Act applies.
Provider requires supervision; provider may not supervise.
Eligible service: therapeutic behavioral services.

Peer Support Specialist

State statute applies.
Provider requires supervision and may supervise peer support specialists.
Eligible service: peer support services.

Individual Trained to Provide Psychosocial Rehabilitative Services

No separate eligibility authority is specified in the chart.
Provider requires supervision; provider may not supervise peer support specialists.
Eligible services: supportive living services and psychosocial rehabilitative services.

Certified Behavioral Health Technician

Utah Mental Health Professional Act applies.
Provider requires supervision; provider may not supervise.
Eligible services: psychosocial rehabilitative services and supportive living services.

Registered Nursing Student or Individual Enrolled in a Qualified Substance Use Disorder Education Program

State statute applies.
Supervision is pursuant to state statute by qualified faculty, staff, or designee; provider may not supervise.
Eligible services: therapeutic behavioral services, supportive living services, and psychosocial rehabilitative services.

Direct Medical Payment Methodology

Participating school-based direct medical services (SDS) local education agencies (LEAs) are reimbursed on a cost basis through monthly interim payments followed by annual reconciliation and settlement.

ALL of the following

LEAs are paid on a cost basis for rendering SDS direct medical services.
Monthly Interim Payment Methodology
- Participating SDS LEAs receive interim payments based on a monthly calculated rate established before the school year begins and divided into 12 equal monthly installments payable from July 1 through June 30.
- Interim payments are tied to claim submissions by the LEA.
- For the 2021-22 school year, interim rates were based on the LEA's reported costs from the 2019-20 school year.

Payment Percentages and Installment Schedule

LEA monthly interim payment percentage

Available payment levels70%, 80%, or 90% of the total calculated amount

SelectionThe LEA may request the monthly amount at one of the available payment levels

PurposeThe selected percentage is applied to minimize LEA overpayments

SDS interim payment installment schedule

Installment count12 equal monthly installments

Payment periodJuly 1 through June 30

Rate calculation

Supervision, Claims, and Reconciliation Requirements

Note

Registered Nurse Supervision

Registered nurses must meet Utah Nurse Practice Act practice requirements and follow provider-required supervision. An RN may supervise licensed practical nurses, medical assistants, and individuals trained to provide psychosocial rehabilitative services.

Permitted services include therapeutic behavioral services, supportive living services, and psychosocial rehabilitative services.

Note

Licensed Practical Nurse Supervision

Licensed practical nurses must meet Utah Nurse Practice Act practice requirements and follow provider-required supervision. The provider may not supervise licensed practical nurses.

Permitted services include therapeutic behavioral services and supportive living services.

Note

Peer Support Specialist Supervision

Peer support specialists are subject to state statute requirements and provider-required supervision. The provider may supervise peer support specialists.

Program and Eligibility Terms

SDS

TermSDS

MeaningSchool-based direct medical services program

Payment contextParticipating SDS LEAs receive interim payments based on a monthly calculated rate

LEA

TermLEA

MeaningLocal education agency participating in the school-based direct medical services payment program

Payment responsibilityLEAs submit claims tied to monthly interim payments and participate in annual cost reconciliation and settlement

For the 2022-23 school year, interim rates were based on direct service cost-pool data from the October-December 2021 quarterly financial submissions for the administrative claims.

For the 2023-24 school year and subsequent years, interim rates are based on the LEA's actual, certified costs identified in its most recently filed annual cost report from the prior fiscal year.

For a new participating LEA, the interim rate is calculated using statewide historical data.

After the LEA's Total Medicaid Allowable Cost is calculated under the applicable cost-allocation processes, the amount is divided by 12 to establish the monthly rate for interim payments in the following fiscal year. Each LEA has its own monthly rate, inclusive of Medicaid Allowable Costs for both direct service cost pools.

The LEA may request that the monthly payment amount be set at 70%, 80%, or 90% of the total calculated amount to minimize overpayments.

Annual Reconciliation and Cost Settlement

A LEA-specific cost reconciliation and cost settlement for overpayments and underpayments is processed annually.
If the LEA's total monthly interim payments for the year exceed its costs to render services, the LEA is invoiced for the difference and the state recoups the amount.
If the LEA's total monthly interim payments for the year are less than its costs to render services, the LEA is reimbursed for the difference.

The calculated amount is divided by 12 to determine the monthly rate

Claim requirementInterim payments are tied to claim submissions by the LEA

Permitted service: peer support services.

Note

Psychosocial Rehabilitative Personnel Supervision

Individuals trained to provide psychosocial rehabilitative services require provider supervision. The provider may not supervise peer support specialists.

Permitted services include supportive living services and psychosocial rehabilitative services.

Note

Certified Behavioral Health Technician Supervision

Certified behavioral health technicians are governed by the Utah Mental Health Professional Act and require provider supervision. The provider may not supervise certified behavioral health technicians.

Permitted services include psychosocial rehabilitative services and supportive living services.

Note

Student and Substance Use Disorder Education Personnel Supervision

Registered nursing students and individuals enrolled in a qualified substance use disorder education program must be supervised pursuant to state statute by qualified faculty, staff, or a designee. The provider may not supervise these personnel.

Permitted services include therapeutic behavioral services, supportive living services, and psychosocial rehabilitative services.

Billing Rule

SDS LEA Interim Payment Claims

Participating SDS local education agencies (LEAs) receive interim payments based on a monthly calculated rate, with twelve equal installments paid from July 1 through June 30. Interim payments are tied to the LEA's claim submissions.

For 2021–22, rates were based on reported 2019–20 costs.
For 2022–23, rates used direct-service cost-pool data from October–December 2021 quarterly financial submissions for administrative claims.
For 2023–24 and later years, rates are based on the LEA's actual certified costs in its most recently filed annual cost report from the prior fiscal year.
For a new participating LEA, the interim rate is based on statewide historical data.
After the LEA's total Medicaid allowable cost is calculated, it is divided by 12 to establish the monthly rate for the following fiscal year, including both direct-service cost pools.
The LEA may request payment at 80% or 90% of the calculated monthly amount to help minimize overpayments.

Billing Rule

LEA Cost Reconciliation and Settlement

LEAs are paid on a cost basis and must undergo an annual, LEA-specific cost reconciliation and settlement for all overpayments and underpayments. The reconciliation compares total monthly interim payments with the LEA's allowable costs for rendering SDS direct medical services.

If annual interim payments exceed the LEA's service costs, the LEA will be invoiced for the difference and the state will recoup the overpayment.
If annual interim payments are less than the LEA's service costs, the LEA will be reimbursed the difference.
Complete the annual reconciliation and settlement in accordance with the procedures in Sections G and H.

EPSDT/CHEC

TermEPSDT/CHEC

MeaningMedically necessary services not otherwise provided under the state plan

Eligibility contextThese services are available to individuals eligible through EPSDT