ut-20261015-R156-4a: R156-4a. Utah Professionals Health Program Rule

1. Agency Information

Title catchline: Commerce, Professional Licensing Building: Heber M Wells Building Street address: 160 E 300 S City, state: Salt Lake City, UT 84111 Mailing address: PO Box 146741 City, state and zip: Salt Lake City, UT 84114-6741

2. Contact Persons

Name: Phone: Email: Kelli Jacobsen 801-530-6291 kellijacobsen@utah.gov Please address questions regarding information on this notice to the persons listed above.

A. Rule or section catchline:

R156-4a. Utah Professionals Health Program Rule

B. Purpose of the new rule or reason for the change:

SB 26 passed by the Legislature in the 2024 General Session and SB 117 passed by the Legislature in the 2026 General Session updated Title 58, Chapter 4a, Utah Professionals Health Program (UPHP), to allow a broader range of licensed professionals to participate in UPHP and allow the Division to promulgate rules regarding informal adjudicative proceedings for terminating a program contract and placing a licensee on probation. The proposed rule amendments establish those standards in accordance with the advice and recommendations of UPHP's executive advisory committee. Additionally, the proposed amendments streamline and update this rule throughout by refining and adding definitions, adding language to clarify and provide for UPHP practices and procedures, and making nonsubstantive formatting changes for clarity and to conform this rule to standard drafting conventions.

C. Summary of the new rule or change:

Section R156-4a-101a is renumbered to R156-4a-101 and amended to conform with the Division of Professional Licensing (Division) standard drafting conventions and to update citations. Section R156-4a-101b is removed as the language was moved to Section R156-4a-101. Section R156-4a-102 is amended to conform with standard Division introductory language and to meet drafting requirements. This section also adds a definition for "approved return to work plan," "collateral source," "diagnostic monitoring," and "required party." This section also refines the definitions of "continuing care," "evaluator," "private agreement to not practice," "program contract," "record," and "worksite practice liaison." Finally, this section removes the definitions for misconduct, diversion agreement, qualifying condition, relapse, screening, and substance abuse. Section R156-4a-103a is amended to conform with Division standards and drafting guidelines. This section also further explains practice accommodations and limitations, adds language to differentiate between UPHP and the UPHP program, and adds an additional consideration to the UPHP program intake session to determine if the licensee should withdraw or refrain from practice and execute a private agreement to not practice. 8 UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 NOTICES OF PROPOSED RULES Section R156-4a-103b is amended to conform with Division standards and drafting guidelines, clarify language by being more specific, and add language about a leave of absence and steps for returning to work. Section R156-4a-105 is amended to add the requirement that a program contract includes language about costs associated with participation in the UPHP program. This section is amended to conform to Division standards and drafting guidelines. Section R156-4a-107 is amended to clarify and add more detail including the terms of public probation that may be included in an order. Section R156-4a-110 is amended to place the information into a table format. Section R156-4a-111 is amended to more clearly state the requirements for UPHP agreements with third parties. Additionally, this section is amended to detail the requirements of a comprehensive clinical evaluation and the evaluators who do the evaluations. This section is also amended to conform to Division standards and drafting guidelines. 4. Legislative Action Information

B. If yes, any bill number and SB 26 (2024 General Session), SB 117 (2026 General Session)

session: 5. Fiscal Information Provide an estimate and written explanation of the aggregate anticipated cost or savings to:

A. State budget:

The Division does not anticipate any fiscal impact to the state budget beyond that determined by the fiscal notes for SB 26 (2024) at: https://le.utah.gov/Session/2024/bills/static/SB0026.html, and SB 117 (2026), and at: https://le.utah.gov/~2026/bills/static/SB0117.html because the proposed amendments clarify and update this rule to be compatible with the statutory changes and accurate for licensees.

B. Local governments:

The Division does not anticipate any cost or savings to local governments from the proposed amendments because the proposed amendments do not apply to local governments.

C. Small businesses ("small business" means a business employing 1-49 persons):

There are no aggregate anticipated cost or savings to small businesses because these proposed amendments do not create new obligations for small businesses, nor do they increase the costs associated with any existing obligation. Individual participation in the UPHP program is voluntary and optional.

D. Non-small businesses ("non-small business" means a business employing 50 or more persons):

There are no aggregate anticipated cost or savings to non-small businesses because these proposed amendments do not create new obligations for non-small businesses, nor do they increase the costs associated with any existing obligation. Individual participation in the UPHP program is voluntary and optional. E. Persons other than small businesses, non-small businesses, state, or local government entities ("person" means any individual, partnership, corporation, association, governmental entity, or public or private organization of any character other than an agency): There are no aggregate anticipated cost or savings to other persons because these proposed amendments do not create new obligations for other persons, nor do they increase the costs associated with any existing obligation. Individual participation in the UPHP program is voluntary and optional. UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 9 NOTICES OF PROPOSED RULES

F. Compliance costs for affected persons:

As described in Box 5E for other persons, no compliance costs are expected for affected persons. 6. Regulatory Impact Summary Table Enter the cost or savings in the relevant cell. If there is no cost or savings, enter, "$0." If a cost or savings is inestimable, enter, "inestimable." Fiscal Cost FY2027 FY2028 FY2029 FY2030 FY2031 State Budget $0 $0 $0 $0 $0 Local Governments $0 $0 $0 $0 $0 Small Businesses $0 $0 $0 $0 $0 Non-Small Businesses $0 $0 $0 $0 $0 Other Persons $0 $0 $0 $0 $0 Total Fiscal Cost $0 $0 $0 $0 $0 Fiscal Benefits FY2027 FY2028 FY2029 FY2030 FY2031 State Budget $0 $0 $0 $0 $0 Local Governments $0 $0 $0 $0 $0 Small Businesses $0 $0 $0 $0 $0 Non-Small Businesses $0 $0 $0 $0 $0 Other Persons $0 $0 $0 $0 $0 Total Fiscal Benefits $0 $0 $0 $0 $0 Net Fiscal Benefits $0 $0 $0 $0 $0 7. Regulatory Impact Analysis Approval The Commissioner of the Department of Commerce, Margaret W. Busse, has reviewed and approved this regulatory impact analysis. 8. Family Impact Information

A. The agency has considered this rule's impact on family health, stability, and fo☒mation:

9. Citation Information Provide citations to the statutory authority for the rule. If there is also a federal requirement for the rule, provide a citation to that requirement: Subsection 58-1-106(1) Subsection 58-4a-103(2) Subsection 58-4a-107(4) Subsection 58-4a-110(2) 11. Public Notice Information The public may submit written or oral comments to the agency identified in box 1.

A. Comments will be accepted until: 11/16/2026

B. A public hearing (optional) will be held (The public may request a hearing by submitting a written request to the agency, as outlined in Section 63G-3-302 and Rule R15-1.): Date: Time: Place (physical address or URL): Anchor Meeting Location: Heber M Wells Building Room 402 160 E 300 S Salt Lake City, UT 10 UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 NOTICES OF PROPOSED RULES Google Meet joining info: Video call link: https://meet.google.com/qyr-rvcq-edn Or dial: (US) +1 260-215-6455 PIN: 217 815 599# More phone numbers: https://tel.meet/qyr-rvcq-edn? pin=2112834373143 12. Effective Date Information This rule change MAY become effective on: 11/23/2026 (NOTE: This is the date the agency anticipates making the filing effective. It is NOT the effective date) 13. Agency Authorization Information Agency head or Deborah Blackburn, Assistant Director Date: 10/01/2026 designee and title: R156. Commerce[. Occupational and], Professional Licensing. R156-4a. Utah Professionals Health Program Rule. R156-4a-101[a]. Title -Authority - Relationship to Rule R156-1. (1) This rule is known as the "Utah Professionals Health Program Rule." (2) This rule is adopted by the Division under the authority of Section 58-4a-103 to enable the Division to administer Title 58, Chapter 4a, Utah Professionals Health Program. (3) The organization of this rule and its relationship to Rule R156-1 is as described in Section R156-1-101. [R156-4a-101b. Authority - Purpose - Organization. (1) This rule is adopted by the Division under the authority of Section 58-4a-103 to enable the Division to administer Title 58, Chapter 4a, Utah Professionals Health Program. (2) The organization of this rule and its relationship to Rule R156-1, General Rule of the Division of Occupational and Professional Licensing, is as described in Section R156-1-107.] R156-4a-102. Definitions. [In addition to the definitions]Terms used in this rule are defined in Title 58, Chapter 1, Division of Professional Licensing Act and Title 58, Chapter 4a, Utah Professionals Health Program.[, Occupations and Professions, as used in Title 58, Occupations and Professions, or in Title R156, Commerce, Occupational and Professional Licensing, the following rule definitions supplement the statutory definitions] In addition: (1) "Abstinence" or "abstain" is [means the same as ]defined in the FSPHP Guidelines[:] [T]and means the absence of substances that are UPHP nonapproved mind- or mood-[ ]altering, including alcohol and other substance use disorder potentiating substances. (2) "Abstinence-based [self-]mutual help group" means a [self-]mutual help group [having]with a foundation in abstinence that is approved by [the Division]UPHP for a participant to attend. [ (3) "Aftercare" means the same as Continuing Care.] ([4]3) "Acknowledgment of Participation" means a document signed by a UPHP participant and a required party [required by the participant's program contract ]in which: (a) the participant certifies that the participant has informed the required party of the participant's participation in UPHP; and (b) the required party certifies that they have reviewed the program contract. ([5]4) "[Compliance]Adherence [M]monitoring" means the coordination of services on behalf of the participant to ensure the integrity of monitoring and continuing care accountability. (5) "Approved Return to Work Plan" as used in Subsection R156-4a-103b(3)(e) means UPHP approval of a participant's return to practice after a period of leave during which a participant was determined fit to practice and includes identification of the steps that shall be taken to ensure safe and supported return to practice. (6) "Comprehensive [C]clinical [E]evaluation" means the evaluation described in Subsection R156-4a-111(2).[a Division-approved independent evaluation of a participant that: (a) is diagnostically rigorous; (b) is tailored to the specific needs of the participant; (c) includes collateral information; and (d) assesses the presence of a substance use disorder and of any other conditions that may affect the participant's physical or psychological fitness for practice.] UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 11 NOTICES OF PROPOSED RULES (7)(a) "Collateral source" means an individual or entity, other than the participant, who has been authorized by the participant or is otherwise permitted by law to provide information to UPHP regarding the participant's adherence with UPHP agreements including a program contract. (b) "Collateral source" may include: (i) a treatment provider; (ii) an employer or supervisor; (iii) a family member; (iv) an educational institution; (v) a friend or acquaintance; (vi) a community organization; (vii) a law enforcement or investigative body; or (viii) another person with relevant knowledge. [ (7) "Continuing Care" means the same as defined in the FSPHP Guidelines: Care that follows the acute phase of intervention and initial treatment, sometimes referred to as aftercare. Professional health programs oversee and monitor the continuity of care to ensure progress and continued compliance. Continuing Care includes PHP guidance, support, toxicology collection, and accountability through a formal monitoring contract concurrent with or following an evaluation or treatment process.] (8) "Continuing care" as used in Subsections R156-4a-103b(1)(c) and (3)(j) is defined in the FSPHPGuidelines and means care that: (a) follows the acute phase of intervention and initial treatment and is sometimes referred to as aftercare; (b) is overseen and monitored by UPHP to ensure progress and continued adherence; (c) includes UPHP guidance, support, toxicology, collection, and accountability through a formal monitoring contract concurrent with or following an evaluation or treatment process. (9) "Diagnostic monitoring" as used in Section 58-4a-105 means UPHP monitoring under a program contract that occurs when an evaluator cannot establish a definitive substance use disorder diagnosis under current DSM criteria but identifies safety-to-practice concerns. ([8]10) "Evaluator[s]" [means the same as]is defined in the FSPHP Guidelines[:] and means [Q]qualified clinical experts who are:[ consulted to investigate possible psychiatric or physical illness that potentially can cause impairment. Evaluators are used to formulate impressions, diagnoses, treatment plans, and suggestions for effective monitoring.] (a) consulted to investigate possible psychiatric or physical illnesses that may cause impairment; and (b) used to formulate impressions, diagnoses, treatment plans, and suggestions for effective monitoring. ([9]11) "FSPHP" means the Federation of State Physician Health Programs. ([10]12) "FSPHPGuidelines"meanstheFSPHP'sPhysicianHealth Program Guidelines,April16,2019, 1stEdition, whichis[hereby ]incorporated by reference. ([11]13) "Impairment" means the inability of a participant to safely engage in the participant's profession as a result of their substance use disorder. ([12]14) "Intake [S]session" means the procedure described in Subsection R156-4a-103a(3) to gather information from a licensee regarding entry into UPHP and to provide information about UPHP to the licensee. [ (13) " Misconduct" means a licensee's acts or omissions alleged to constitute either unprofessional or unlawful conduct, or both, that serve as the basis to consider the licensee for participation in UPHP.] ([14]15) "Participant" means a licensee participating in UPHP pursuant to an executed program contract[ or diversion agreement]. ([15]16) "PrivateAgreement to Not Practice" means a voluntary and private written agreement [between]signed by the licensee and [the ]UPHP to withdraw from practice and not return to practice until authorized by [the ]UPHP. ([16]17)(a) "Program contract[,]" as defined in Subsection 58-4a-102(4)[,] includes each written agreement entered into by a participant and the Division or UPHP[and may include multiple documents]. (b) "Program contract" may include multiple documents or agreements, entered into concurrently or successively, and which may vary in terms, components, and duration at the discretion of UPHPbased on the participant's comprehensive clinical evaluation and adherence. [ (17) "Qualifying condition" means a participant's substance use disorder that makes the participant eligible to participate in the UPHP.] (18) "Record" means [the stored documentation of a potential participant's or participant's contacts and interaction with and participation in the UPHP]information created, received, or maintained by UPHP, regardless of format, that pertains to a licensee's application for participation in UPHP and includes documents, electronic data, photographs, and any other forms of stored information. (19) "Relapse" means the same as [R]return to use behavior. (20) "Report" means a report from a collateral source addressing a participant's [compliance]adherence with UPHP agreements, including a program contract[ or diversion agreement]. (21) "Required party" as used in Subsection R156-4a-102(3) means a third party outside of UPHP who provides services to the participant as part of the participant's program contract and participation in UPHP, and may include the participant's employer, worksite liaison, therapist, or any individual prescribing medication to the participant. (2[1]2) "Return to use behavior" means a spectrum of thoughts and behaviors suggestive of increased risk for use or actual use of an unapproved substance[s] and is also known as relapse. [ (22) "Return to work plan" means the Division approval of a participant's return to practice after a period of leave during which a participant was determined fit to practice, and includes identification of the steps that shall be taken to ensure safe and supported return to practice. 12 UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 NOTICES OF PROPOSED RULES (23) "Screening" means the UPHP's initial meeting with a licensee to gather basic demographic information and information about the circumstances of the referral, and to schedule the intake session. A screening may also include discussion of UPHP confidentiality and its limits.] (2[4]3) "Substance" [means the same as]is defined in the FSPHP Guidelines[:] and means a [M]mind- or mood-[ ]altering substance[s] defined in law as a controlled substance[s; for example,] including alcohol or another legal or illegal substance[s] that [are]is mind- or mood-[ ]altering and can potentially impact the individual's ability to practice. [ (25) "Substanceabuse"meansthe sameasdefined intheFSPHPGuidelines:Theessential featureof substanceabuse isamaladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.] ([26]24) "Toxicology testing" means the collection of urine, blood, oral fluid, hair, nails, sweat, or breath used to deter and detect unauthorized drug or alcohol use by a participant. ([27]25) "Treatment" [means the same as]is defined in the FSPHP Guidelines[: T] and means the delivery of care and rehabilitation to a participant experiencing a potentially impairing illness, including a course of inpatient or outpatient care, treatment, or rehabilitation services provided or supervised by a [person]licensed health care professional authorized to provide such services [for the purpose of]to alleviate[ion of] impairment and improve[ment of] illness. ([28]26) "Treatment provider" [means the same as]is defined in the FSPHP Guidelines[: ] and means an [I]individual[s], organization[s], or another entity composed of licensed professionals who are providing care and treatment to a participant. ([29]27) "UPHP" means the Utah Professionals Health Program. ([30]28) "UPHP Medication Policy" means the policy identified in Subsection R156-4a-103b(3) regarding participant use of medication. ([31]29) "UPHP participation standards" means the criteria identified in Subsections R156-4a-103b(3) and R156-4a-105(5) for licensee participation in UPHP. ([32]30) "UPHP Return to Use Behavior Policy" means the policy identified in Subsection R156-4a-103b(3) regarding participant return to use behavior. ([33]31) "Worksite practice liaison" means [a participant's UPHP approved nonsubordinate support person who]an individual approved by UPHP to provide support to the participant who meets the following requirements: (a) is not the participant's subordinate; ([a]b) has regular contact with the participant in the participant's practice setting; ([b]c) understands the signs and symptoms of substance use disorder; ([c]d) can make independent objective judgments regarding the participant without risk of undue influence by the participant; ([d]e) is authorized by the participant to communicate with [the ]UPHP; and ([e]f) reports to [the ]UPHP on the participant's worksite practice behavior and performance. R156-4a-103a. UPHPEligibility and Entry. (1) Under Subsection 58-4a-103(2)(a) and Section 58-4a-105, each licensee applying to participate in [the ]UPHPshall complete the following steps [in accordance with UPHP eligibility process policies and procedures, including time deadlines]by the deadline provided by UPHP: (a) complete an intake session under Subsection R156-4a-103a(3); (b) complete a comprehensive clinical evaluation; (c) comply with toxicology testing as requested by [the ]UPHP; (d) submit documentation satisfactory to [the ]UPHP that the licensee meets UPHP eligibility criteria; (e) comply with additional eligibility process requirements as determined by [the ]UPHP[, including for example one or more of the following] which may include: (i) a practice accommodation[s] or limitation[s] including a Private Agreement to Not Practice as defined in Subsection R156-4a- 102(16); (ii) increased frequency of toxicology testing; or (iii) a restriction[s] on access to mind- or mood-[ ]altering substances and use of medication treatment; and (f) execute a program contract. (2) Alicensee may not participate in [the ]UPHP if: (a) the licensee has harmed a patient by providing care below the expected standard of care that resulted in an adverse consequence for the patient; (b) the licensee has engaged in unlawful conduct or unprofessional conduct as defined by statute or rule under Title 58, Occupations and Professions, with respect to: (i) a criminal sexual act; or (ii) [a boundary violation]sexual misconduct that the licensee's comprehensive clinical evaluation determines is unrelated to the licensee's substance use disorder; (c) the licensee has a currently active or pending criminal action, adjudicative proceeding, or charge alleging: (i) a criminal sexual act; or (ii) [a boundary violation]sexual misconduct that the licensee's comprehensive clinical evaluation determines is unrelated to the licensee's substance use disorder; (d) when a licensee is considered for UPHPeligibility, the licensee's license to practice in another jurisdiction was surrendered while under investigation, or is currently publicly conditioned, curtailed, limited, restricted, suspended, on probation, or otherwise subject to public discipline; or UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 13 NOTICES OF PROPOSED RULES (e) [the ]UPHP otherwise determines that the licensee is not a [ ]good candidate for participation in UPHP. (3) UPHP [I]intake session procedures shall include the following: (a) [the ]UPHP shall: (i) provide UPHP information to the licensee[, to] including[e] UPHP confidentiality and its limits and the types of information [the ]UPHP is mandated to [and will ]report to a regulatory authority including the Division; (ii) gather information about the circumstances that led the licensee to contact [the ]UPHP; (iii) gather clinical information regarding the licensee's potential substance use disorder, to include a preliminary diagnosis and need for immediate treatment; (iv) determine if the licensee may be eligible for participation in [the ]UPHP[,] and if [the ]UPHPmay be mandated to report licensee information to a regulatory authority, and discuss this information with the licensee;[ and] (v) determine if the licensee should withdraw or refrain from practice and execute a PrivateAgreement to Not Practice as defined in Subsection R156-4a-102(14); and (vi) if [the ]UPHPdetermines that the licensee may be eligible for participation in [the ]UPHP, [the ]UPHPshall provide the licensee with a list of [UPHP approved ]evaluators approved by UPHP. (b) the licensee shall [complete]submit to UPHPan initial [R]release of [I]information form that includes the names of the licensee's evaluators and additional sources as determined by [the ]UPHP. (4) The licensee's comprehensive clinical evaluation shall be completed by: (a) a multidisciplinary team at an evaluation center that has established expertise in the assessment of healthcare providers or other safety-sensitive professions with substance use disorders; or (b) a qualified specialist approved by UPHP. (5)(a) The licensee shall obtain the required comprehensive clinical evaluation within 30 days after the day of the licensee's intake session. (b) [The ]UPHP may grant an extension of time to a licensee to obtain the required comprehensive clinical evaluation if: (i) there is a lack of available evaluators or a waiting list to access an evaluation; (ii) the licensee needs further evaluation; or (iii) upon reasonable cause as determined by [the ]UPHP. (6)(a) An evaluator shall provide the licensee's comprehensive clinical evaluation report to [the ]UPHP. (b) An evaluator may not recommend a specific treatment provider for a licensee. (7) [The ]UPHP shall make the final determination of a licensee's eligibility to participate in [the ]UPHP based upon [the UPHP's ]review of: (a) the licensee's comprehensive clinical evaluation report, treatment records, and other applicable medical records; (b) the licensee's documentation that the licensee meets [the ]UPHP eligibility criteria; and (c) other information determined relevant by [the ]UPHP to the licensee's participation. (8)(a) After [the ]UPHP determines a licensee is eligible to participate in [the ]UPHP, [the ]UPHP shall develop the terms and conditions of the licensee's program contract and offer the program contract to the licensee. (b)(i) A licensee shall meet with [the ]UPHP to review and execute the program contract within 30 days after the day [the ]UPHP offers the program contract to the licensee. (ii) [The ]UPHP may grant an extension of time to a licensee to execute the program contract upon reasonable cause as determined by [the ]UPHP. (9)(a) The following do not constitute disciplinary action by the Division, and the Division may not report them to a disciplinary database: (i) a licensee's execution of a program contract; or (ii) a licensee's agreement with [the ]UPHPto comply with each practice accommodation[s] or limitation[s] under Subsection R156- 4a-103a(1)(e)(i). (b) Notwithstanding Subsection (9)(a), to the extent required by statute or rule pertaining to a compact in which Utah is a member, [the ]UPHP may report non-confidential data to a compact database. R156-4a-103b. Participation - UPHPComponents and UPHPParticipation Standards. (1) Under Section 58-4a-103, participation in [the ]UPHP shall include the following components, as determined by [the ]UPHP: (a) an executed program contract[ or diversion agreement]; (b) a comprehensive clinical evaluation; (c) participation and attendance in treatment and continuing care with the treatment providers approved by [the ]UPHP; (d) [compliance]adherence monitoring; (e) interstate monitoring; (f) participant contact, including at least quarterly reports by a worksite practice liaison; (g) monthly or quarterly reports, including at least quarterly reports by a therapist; (h) medication logs; (i) [support]abstinence-based mutual help group attendance; (j) toxicology testing; and (k) any other components as determined by [the ]UPHP. (2)(a) Monitoring of a participant pursuant to the terms and conditions of the program contract shall begin upon the participant's execution of the program contract. 14 UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 NOTICES OF PROPOSED RULES (b) If the program contract requires residential or inpatient treatment instead of outpatient treatment, monitoring under the program contract may commence after the participant completes the residential or inpatient treatment. (3) The following are established as the UPHP participation standards: (a) [A]a participant shall abstain from the use of mind- or mood-[ ]altering substances, including alcohol, medical cannabis, substances containing THC, inhalants, and illegal, non-prescribed, and certain identified psychotropic over-the-counter medications[.]; (b) [A]a participant shall abstain from the use of mind- or mood-[ ]altering, addictive, or potentially addictive prescription medications, including amphetamine preparations, opioids, sedatives, and benzodiazepines, except in an emergency[ ] such as hospitalization due to emergency surgery, illness, or accident[.]; (c) [A]a participant shall follow the UPHP Medication Policy, which [shall ]includes the following participant requirements: (i) provide UPHP with a cop[ies]y of each of the participant's prescriptions, including any prescriptions for controlled substances[,] that the participant received [by the participant ]during the term of the program contract; (ii) receive medications for a participant's own use only from treatment providers: (A) with whom the participant has a legitimate patient relationship; and (B) who have signed and submitted anAcknowledgment of Participation document from UPHPregarding the participant's terms and conditions for participating in UPHP; (iii) provide UPHP information, or request information for UPHP, regarding each medication[s] prescribed to the participant; (iv) if a participant has a medical condition requiring potentially addictive substance use, or is prescribed a controlled medication for any reason, the participant shall comply with each UPHP required practice accommodation[s] or limitation[s]; and (v) pursue effective alternatives or require a second opinion [prior to]before using any controlled or mind- or mood-[ ]altering substances in a non-emergency situation[.]; (d) [I]if a participant is at risk of impairment for any reason, the participant shall comply with each UPHP required practice accommodation[s] or limitation[s] and not return to work until approved by [the ]UPHP[.]; (e)(i) following any leave of absence during which the participant's fitness to practice was in question and before the participant my resume practice, the participant or their treatment provider shall submit a return to work plan to UPHP for approval and obtain an Approved Return to Work plan; and (ii) the return to work plan shall include each step the participant shall take to ensure the participant's safe and supported return to practice; ([e]f) [A]a participant may not prescribe scheduled drugs for family members or for others who are not the participant's legitimate patients within the scope of the participant's practice, in accordance with applicable law, rule, or regulation[.]; ([f]g) [A]a participant shall prescribe only within the scope of the participant's medical specialty, in accordance with applicable law, rule, or regulation[.]; ([g]h) [A]a participant shall provide current authorizations for [the ]UPHP as determined necessary by [the ]UPHP, including authorization to: (i) communicate with each of the participant's care providers and treatment providers as needed to verify medical issues; (ii) communicate with the participant's worksite practice liaison; (iii) communicate with third parties such as emergency contacts and treatment providers as determined necessary by [the ]UPHP; (iv) obtain information on medications prescribed to the participant; and (v) release information about the participant's participation to the Division if required by the program contract or Utah law[.]; ([h]i) [A]a participant shall identify a primary care provider to manage the participant's medical care and to comply with the participant's treatment plan, including complying with the treatment provider recommendations and not self-prescribing or independently discontinuing any medications[.]; ([i]j) [A]a participant shall follow the initial treatment, medication management, and continuing care recommendations with providers approved by [the ]UPHP until treatment objectives are met as determined by the treatment provider, and treatment is discontinued with [the ]UPHP's approval[.]; ([j]k) [A]a participant shall attend a minimum number of abstinence-based mutual help group meetings or an alternative approved by [the ]UPHP[,] that are documented in a manner acceptable to [the ]UPHP[.]; ([k]l) [A]aparticipantmaynotchangeordiscontinuetherapyortreatmentwithoutapprovaloftheparticipant'stherapistandUPHP[.]; ([l]m) [A]a participant shall identify and cooperate with a worksite practice liaison[.]; ([m]n) [A]a participant shall comply with each practice accommodation[s] or limitation[s] as required by: (i) the participant's program contract; (ii) UPHP policies and procedures; and (iii) statutes and rules pertaining to a compact in which Utah is a member[.]; ([n]o) [A]a participant shall submit to biological specimen testing if requested by [the ]UPHP[.]; ([o]p) [A]a participant shall participate in [the ]UPHP in good faith[,] and cooperate with UPHP staff[.]; ([p]q) [A]a participant shall comply with each UPHP policy, including: (i) the UPHP Return to Use Behavior Policy; and (ii) the UPHP Medication Policy[.]; ([q]r) [A]a participant shall notify [the ]UPHP within 24 hours if the participant: (i) has a medical or mental health hospitalization; (ii) has an arrest, investigation, charge, or complaint, including a Division or other regulatory agency complaint; (iii) receives a disciplinary notice from a regulatory agency, hospital, employer, or other third party; (iv) has any adverse events affecting patient care including malpractice claims; or UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 15 NOTICES OF PROPOSED RULES (v) [returns to ]uses [of ]any substance[s] not approved [by]under UPHPparticipation standards, including in a case[s] of emergency use due to illness or accident[.]; ([r]s) [A]a participant shall notify [the ]UPHP at least 24 hours before the participant's: (i) [prior to the participant's ]anticipated use of any controlled or mind- or mood- altering prescriptions or substances;[ and (ii) prior to the participant's:] ([A]ii) travel outside [UPHP's jurisdiction]of Utah or to an area where testing is unavailable; ([B]iii) change of address or phone number; ([C]iv) change of employment; ([D]v) engaging in practice in another jurisdiction, state, or territory; ([E]vi) applying for a license to practice in another jurisdiction, state, or territory; or ([F]vii) applying to participate in another alternative to public discipline program[.]; and ([s]t) [A]a participant shall maintain their Utah license in active status while participating in UPHP. R156-4a-104. Committees. Reserved. R156-4a-105. Program Contract - Successful Completion. (1) Under Subsection 58-4a-103(2) and Section 58-4a-105, each program contract shall comply with this section. (2)(a) A program contract shall identify the program contract period[,] and other time frames that may be required by the program contract[,] including tolling under Subsection 58-4a-106(4). (b) Aprogram contract shall provide that: (i) the program contract period may be extended at the discretion of [the ]UPHP in accordance with UPHP policy, if at the end of or during the program contract period, [the ]UPHP determines that there is reasonable cause to support the need for additional monitoring or extended treatment; and (ii) unless otherwise agreed in writing by [the ]UPHP, the program contract period is tolled during any period that the participant: (A) is not practicing; or (B) resides or practices outside Utah for 30 consecutive days or longer. (3) A program contract shall provide that the participant's monitoring may be transferred or shared with another appropriate health monitoring program if the participant moves or holds an active license in another jurisdiction, state, or territory. (4) Aprogram contract shall include a statement of UPHP confidentiality and its limitations, including conditions when [the ]UPHP may be required to report to the Division. (5) A program contract shall require the participant to adhere to the UPHP [P]participation [S]standards[,] as determined by [the ]UPHP. (6) A program contract shall require the participant to timely pay all costs associated with participation in UPHP, including costs to each individual or entity providing treatment or support. ([6]7)(a) A program contract [shall]may identify the potential consequences for a participant's violation, including when violation constitutes a violation of the program contract that [requires]may result in the Division issuing an order to show cause under Section 58-4a- 107. (b) Consequences for violation may include the following: (i) fine under Section R156-4a-110; (ii) referral to a higher level of care; (iii) increased frequency or intensification of treatment; (iv) increased frequency of toxicology testing or requiring additional testing methods; (v) additional biologic testing; (vi) independent evaluation; (vii) inpatient evaluation; (viii) refrain from or limit practice as determined appropriate by [the ]UPHP; (ix) revision of the program contract, such as extending the period of monitoring; or (x) a UPHP report to the Division for potential disciplinary action against the participant's license. ([7]8) A participant shall have successfully completed [the ]UPHP if [the ]UPHP has determined that the participant has fulfilled each term and condition of the participant's program contract[ or diversion agreement]. R156-4a-106. Effect on Other Disciplinary Proceedings. Reserved. R156-4a-107. Violation of a Program Contract. [ (1) Under Subsection 58-4a-107(4), the procedures for discovery in formal adjudicative proceedings are in Rule R151-4, Department of CommerceAdministrative ProceduresAct Rule. (2) Formal adjudicative proceedings to terminate a program contract under Section 58-4a-107 include a right to agency review and a right to reconsideration as described in Title 63G, Chapter 4, Administrative Procedures Act, and Rule R151-4, Department of Commerce Administrative ProceduresAct Rule.] 16 UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 NOTICES OF PROPOSED RULES (1) Under Section 58-4a-107, a notice of agency action in the form of an order to show cause may describe the public probation requirements that the Division may require the individual to complete if the presiding officer finds that the licensee has violated the program contract, made an intentional material misrepresentation of fact in the program contract, or violated a law or rule governing the licensee's profession. (2) The terms of public probation identified in the order to show cause may include: (a) revoking or suspending the individual's license to practice for a stated period of time or with a stated date before which the individual may not apply for licensure or return to full licensure; (b) suspending, limiting, or restricting the individual's license to practice for a stated period, including limiting the individual's practice to, or excluding from the individual's practice, one or more specific branches of medicine or types of practice, including any limitation on practice within the specified branch or type of practice; (c) requiring the individual to submit to care, counseling, or treatment by one or more physicians or mental health therapists approved by or designated by the board as a condition for licensure; (d) requiring the individual to participate in a program of education prescribed by the board; (e) requiring the individual to practice under the direction of a supervisor designated by the board for a specified period; or (f) other appropriate terms and conditions determined by the Division to be necessary to protect the public health, safety, or welfare. R156-4a-110. Fine Schedule. Under Subsection 58-4a-110(2), the following fine schedule shall apply for violation of these requirements in a program contract: [TABLE FINE SCHEDULE VIOLATION FIRST OFFENSE SUBSEQUENT OFFENSE R156-4a-103b(3)(g)(i$ 50 50 $250 - $1,000 R156-4a-103b(3)(k) $ 50 $250- $1,000 R156-4a-103b(3)(o) $ 50 $250 - $1,000 R156-4a-103b(3)(q) $ 50 $250 - $1,000 R156-4a-103b(3)(w)(ii) $ 50 $250 - $1,000] Table 1 Violation First Offense Subsequent Offense R156-4a-103b(3)(h) $50 $250 - $1,000 R156-4a-103b(3)(l) $50 $250 - $1,000 R156-4a-103b(3)(p) $50 $250 - $1,000 R156-4a-103b(3)(r) $50 $250 - $1,000 R156-4a-111. Reporting - UPHPAgreements andApproval for Evaluation, Treatment, or Other Services. (1) Under Section 58-4a-103, theDivision may enter into agreements with professional or occupational organizationsor associations, education institutions or organizations, testing agencies, health care facilities, health care practitioners, government agencies, or other persons to provide evaluations, treatments, monitoring, rehabilitation, education, or any other services necessary to facilitate a participant's successful completion of a program contract. [ (2) Each agreement shall be in writing and shall have the terms and conditions necessary to permit each party to fulfill its duties and obligations. (3) Each agreement shall addressthe circumstances and conditionsunder which information concerning the participant will be shared with the Division and other persons. (4)(a) The cost of administering an agreement and providing the services shall be borne by the participant benefiting from the services. (b) Costs paid by a participant shall be reasonable and in proportion to the value of the service provided. (c) Timely payment of costs shall be a condition of each program contract.] (2) UPHP may approve a comprehensive clinical evaluation if the evaluation is an independent evaluation of a licensee that meets the following criteria: (a) conducted by an approved evaluator as described in Subsection (3); (b) diagnostically rigorous and forensic in nature; (c) tailored to the specific occupational demands of the licensee's safety-sensitive profession; (d) includes collateral information; (e) conducted to determine the presence of any mental health, substance use, physical, or cognitive conditions that have the potential to impair, or have impaired, the licensee's ability to practice; (f) establishes clinical diagnoses and treatment recommendations; and (g) determines the licensee's fitness to practice their profession with reasonable skill and safety. (3) UPHP may approve an evaluator to provide a comprehensive clinical evaluation if the evaluator: (a) is a clinical expert, multidisciplinary team, or specialized evaluation center that: (i) is actively accredited under the Federation of State Physician Health Programs Evaluation and TreatmentAccreditation (FSPHP- ETA); or UTAH STATE BULLETIN, October 15, 2026, Vol. 2026, No. 20 17 NOTICES OF PROPOSED RULES (ii) has completed the UPHP application and approval process; (b) has documented clinical expertise and specialized training in the objective, forensic evaluation of safety-sensitive health care professionals; and (c) isnotthelicensee'sindividualpersonaltherapist,outpatientcounselor,orprimarycareprovider,unlesstheevaluationisconducted by an approved multidisciplinary treatment facility or specialized evaluation center actively accredited under the FSPHP-ETA system, regardless of whether the facility has provided or is currently providing clinical treatment to the licensee. (4) Costs for participatingin servicesassociated with or required by UPHPshall beborne by the licensee benefiting from the services. KEY: licensing, program contract, fines, professional health program Date of Last Change: [November 23, 2021]2026 Notice of Continuation: September 11, 2026 Authorizing, and Implemented or Interpreted Law: 58-1-106(1)(a); 58-4a-103(2); 58-4a-107(4); 58-4a-110(2) NOTICE OF SUBSTANTIVE CHANGE TYPE OF FILING: Filing ID: 58295