Rule-Making Notices (Hearing Notices)
Jurisdiction
| Wisconsin |
Publication
| Issue | 778B |
|---|---|
| Published | October 26, 2020 |
Rule Type
| Proposed Rule |
Issuing Body
| Department of Health Services |
Notice Text
| Chapter DHS 75 |
| NOTICE IS HEREBY GIVEN that the Department of Health Services will hold a public hearing to consider amendments to DHS 75, relating to Community Substance Use Services. |
| Friday, November 13, 2020 | Meeting URL: https://dhswi.zoom.us/j/91039915067 |
| The Department of Health Services is an equal opportunity employer and service provider. If you need accommodations because of a disability or need an interpreter or translator, or if you need this material in another language or in an alternate format, you may request assistance to participate by contacting Amanda Lake at (608) 630-2703. You must make your request at least 7 days before the activity. |
| The Department of Health Services es una agencia que ofrece igualdad en las oportunidades de empleo y servicios. Si necesita algún tipo de acomodaciones debido a incapacidad o si necesita un interprete, traductor o esta información en su propio idioma o en un formato alterno, usted puede pedir asistencia para participar en los programas comunicándose con Amanda Lake al número (608) 630-2703. Debe someter su petición por lo menos 7 dÃas de antes de la actividad. |
| The Department of Health Services yog ib tus tswv hauj lwm thiab yog ib qhov chaw pab cuam uas muab vaj huam sib luag rau sawv daws. Yog koj xav tau kev pab vim muaj mob xiam oob qhab los yog xav tau ib tus neeg pab txhais lus los yog txhais ntaub ntawv, los yog koj xav tau cov ntaub ntawv no ua lwm hom lus los yog lwm hom ntawv, koj yuav tau thov kev pab uas yog hu rau Amanda Lake ntawm (608) 630-2703. Koj yuav tsum thov qhov kev pab yam tsawg kawg 7 hnub ua ntej qhov hauj lwm ntawd. |
| Analysis of the rule and the proposed rule text may be accessed at: https://docs.legis.wisconsin.gov/code/misc/chr/lc_ruletext/cr_20_047_rule_text_filed_with_lc_clearinghouse.pdf. |
| The fiscal estimate and economic impact analysis for the rule may be accessed at: https://docs.legis.wisconsin.gov/code/misc/chr/lc_ruletext/cr_20_047_fiscal_estimate_and_economic_impact_analysis.pdf. |
| Comments may be submitted to the Department until 11/13/2020 by: |
| Accessing: |
| Submitting a comment through the Wisconsin State Legislature's website: https://docs.legis.wisconsin.gov/code/chr/all/cr_20_047. |
| Mailing written comments to: |
| Amanda Lake Cismesia |
| The proposed rule affects public and private substance use service providers by reducing some staffing and certification requirements, aligning related administrative rule and Medicaid policy requirements, increasing requirements related to opioid treatment services, reducing some administrative requirements, and may also increase other administrative or training requirements for specific programs. For more information about the anticipated effect on small businesses, see the fiscal estimate and economic impact Attachment A, available at the link above. |
| Jackson Keuler |
| Amanda Lake Cismesia |
| Date | Register | File |
| 10/26/2020 | 778B, Rule-Making Notices (Hearing Notices) | CR 20-047 Hearing Information |
| 10/26/2020 | 778B, Rule-Making Notices (Hearing Notices) | CR 20-047 Rule Text |
| 10/26/2020 | 778B, Rule-Making Notices (Hearing Notices) | CR 20-047 Economic Impact Analysis |
| 10/19/2020 | 778A3, Notices of Submittal of Proposed Rules to Legislative Council Clearinghouse | CR 20-047 Submittal Notice |
| 10/19/2020 | 778A3, Notices of Submittal of Proposed Rules to Legislative Council Clearinghouse | CR 20-047 Rule Text |
| 10/19/2020 | 778A3, Notices of Submittal of Proposed Rules to Legislative Council Clearinghouse | CR 20-047 Economic Impact Analysis |
| Date | Action | Journal |
| 10/8/2020 | Received by Legislative Council |
| DHS 75.51(1) Service requirements by level of care, outpatient |
| (a) Adult services frequency |
Is less than 9 hours of treatment services per patient per week | Is less than 9 hours of treatment services per patient per week | At least 9 hours of treatment services per patient per week | 1. At least 20 hours of treatment services per patient per week |
| (b) Minor services frequency |
Is less than 6 hours of treatment services per patient per week | Is less than 6 hours of treatment services per patient per week | At least 6 hours of treatment services per patient per week | 1. At least 12 hours of treatment services per patient per week |
| (c) Medical director requirements | Required either as an employee of the service or through a written agreement to provide medical oversight and consultation regarding clinical operations of the service. | Required either as an employee of the service or through a written agreement to provide medical oversight and consultation regarding clinical operations of the service. |
| (d) Mental health professional requirements | Required to be available on-site during the hours of operation of clinical services. | Required either as an employee of the service or through a written agreement to provide collaborative and concurrent services for the treatment of patients with co-occurring mental health disorders. | Required to be available on-site during the hours of operation of clinical services. |
| (e) Additional personnel requirements | Requires at least one full-time counselor for every 15 patients enrolled in the service. |
| (f) Assessment completion | Required by the third appointment | Required by the third appointment | Required by the third appointment. | Required by the third appointment. |
| (g) Use of prior assessment | For returning patients, an assessment update shall be completed if 90 days have passed since the initial assessment. If one year has passed, a new comprehensive assessment is required. | For returning patients, an assessment update shall be completed if 90 days have passed since the initial comprehensive assessment. If one year has passed, a new comprehensive assessment is required. | For returning patients, an assessment update shall be completed if 90 days have passed since the initial comprehensive assessment. If six months have passed, a new comprehensive assessment is required. | 1. A new assessment, less than 30 days old, is required for each admission. |
| (h) Updated assessment, continuously enrolled patients | An assessment update shall be completed not less than once per year. | An assessment update shall be completed not less than once per year. | An assessment update shall be completed not less than once per year. |
| (i) Intake completion | Required by the end of the session following the assessment | Required by the end of the session following the assessment | Required by the end of the session following the assessment | Required by the end of the session following the assessment |
| (j) Treatment plan completion | Required before the second session following the assessment. | Required before the second session following the assessment. | Required before the second session following the assessment. | Required before the second session following the assessment. |
| (k) Treatment plan review frequency | Required every 90 days or 6 treatment sessions, whichever is longer, unless there is a clinical reason to review more frequently | Required every 90 days or 6 treatment sessions, whichever is longer, unless there is a clinical reason to review more frequently | Required every 14 days, unless there is a clinical reason to review more frequently | Required every 14 days, unless there is a clinical reason to review more frequently |
| (L) Clinical staffing | Required every 14 days for each patient | Required every 14 days for each patient |
| (m) Additional requirements for discharge or transfer | Summary required within 30 days after the discharge or transfer date | Summary required within 30 days after the discharge or transfer date | Summary required within 30 days after the discharge or transfer date | Summary required within 14 days after the discharge or transfer date |
| (n) Operational requirements | A service shall provide services at times that allow most patients to maintain employment or attend school. | 1. A service shall make efforts to provide services at times that allow patients to maintain employment or attend school. |
| DHS 75.51(2) Service requirements by level of care, residential |
| (a) Required treatment services | At least 6 hours of treatment services per patient per week | 1. At least 20 hours of treatment services per patient per week |
1. At least 12 hours of treatment services per patient per week |
| (b) Medical director | Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service | Required to provide medical oversight and consultation regarding the clinical operations of the service | Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service |
| (c) Physician requirements | Requires a physician available to provide medical and clinical consultation, either as an employee of the service or through a written agreement | 1. Requires a physician available to provide consultation, medication management, and medication-assisted treatment services |
1. Requires a psychiatrist either as an employee of the service or through a written agreement, to provide treatment services for patients with mental health disorders |
| (d) Mental health professional requirements | Required either as an employee of the service or through written agreement, to provide collaborative and concurrent services for the treatment of individuals with co-occurring mental health disorders | Required to be available during the hours of operation of clinical services | Required to be available during the hours of operation of clinical services | Required to be available during the hours of operation of clinical services |
| (e) Nurse requirements | Requires a registered nurse available on-site on a 24-hour basis |
| (f) Counselor- patient ratio requirements | At least one full-time substance abuse counselor for every 15 patients enrolled in the service | At least one full-time substance abuse counselor for every 10 patients enrolled in the service | At least one full-time counselor for every 10 patients enrolled in the service |
| (g) Assessment completion | 1. Required at the time of or prior to admission. |
1. Required at the time of or prior to admission. |
1. Required within 4 days of admission. |
1. Required within 4 days of admission. |
| (h) Additional assessment requirements | 1. For patients continuously enrolled in services, an assessment update shall be completed not less than every six months. |
A physician shall review and co-sign the assessment and level of care placement within 7 days of the assessment. | A physician shall review and co-sign the assessment and level of care placement within 2 working days following the assessment. | 1. The clinical assessment and level of care placement shall be reviewed at the next clinical consultation staffing following the assessment. |
| (i) Intake requirements | Intake shall be completed within 24 hours of admission. | Intake shall be completed within 24 hours of admission. | 1. Intake shall be completed within 24 hours of admission, or as soon as the patient is able to complete the intake. |
Intake shall be completed within 24 hours of admission, or as soon as the patient is able to complete the intake. |
| (j) Medical screening requirements | 1. Required no later than 7 days after the patient's admission to identify health problems and to screen for communicable illnesses, unless there is documentation that a screening was completed less than 90 days prior to admission. Medical screening shall be documented in the patient's case record. |
Required no later than 7 days after the patient's admission to identify health problems and screen for communicable illnesses, unless there is documentation that a screening was completed less than 30 days prior to admission. Medical screening shall be documented in the patient's case record. | Required no later than 24 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record. | 1. Required no later than 12 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record. |
| (k) Treatment plan completion | Required within one week of admission | Required within 5 days of admission | 1. A preliminary treatment plan is required within 48 hours of admission. |
1. A preliminary treatment plan is required within 48 hours of admission. |
| (L) Treatment plan review frequency | Required every 6 weeks, unless there is a clinical reason to review more frequently | Required weekly, unless there is a clinical reason to review more frequently | Required daily | Required daily |
| (m) Additional treatment plan requirements | The patient's treatment plan shall include a preliminary discharge plan outlining step down services and a plan for ongoing support. The discharge plan shall be reviewed and updated weekly, in conjunction with the treatment plan. | The preliminary and ongoing treatment plans shall include a preliminary discharge plan outlining step down services and a plan for ongoing support. The discharge plan shall be reviewed and updated in conjunction with the treatment plan. | 1. The preliminary and ongoing treatment plans shall include a determination and ongoing review of the level of observation needed to address the patient's needs and any safety concerns. |
| (n) Clinical staffing frequency | Required every 30 days for each patient | Required every 7 days for each patient | Required daily for each patient | Required daily for each patient |
| (o) Additional requirements for discharge or transfer | Summary required within 14 days after the discharge or transfer date | 1. Summary required within 14 days after the discharge or transfer date |
1. Summary required within 48 hours after the discharge or transfer date. |
1. Summary required within 48 hours after the discharge or transfer date. |
| (p) Operational requirements | Before operating or expanding a medically managed inpatient treatment service, the service shall be approved as a hospital under ch. DHS 124. | 1. The service shall have written agreements with community behavioral health service providers or systems to provide care after the patient is discharged from the service. |
| DHS 75.51(3) Service Requirements by Level of Care, Withdrawal Management |
| (a) Exemptions from general requirements | 1. This service is exempt from the requirements of s. DHS 75.25(11) regarding assessment. |
1. This service is exempt from ss. DHS 75.19(2) requiring a clinical supervisor. |
| (b) Medical director | Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service |
| (c) Physician requirements | Available on a 24-hour basis |
| (f) Nurse requirements | Registered nurse available on-site on a 24-hour basis |
| (g) Additional personnel requirements | Requires a substance abuse counselor to provide consultation for each patient prior to discharge | 1. Requires at least one staff person trained in the recognition of withdrawal symptoms available on-site on a 24-hour basis |
| (j) Additional assessment requirements | Each patient shall receive sufficient assessment of dimensional risk and severity of need to determine preliminary level of care and appropriate referral for continuing services. | Each patient shall receive sufficient assessment of dimensional risk and severity of need to determine preliminary level of care and appropriate referral for continuing services. |
| (k) Intake completion requirement | Within 24 hours of admission, or as soon as the patient is able to complete the intake | Within 24 hours of admission, or as soon as the patient is able to complete the intake |
| (L) Medical screening requirements | 1. Required no later than 12 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record. |
Each patient shall be screened by medical personnel before admission to the service, unless the service has documentation of the patient's current physical condition. |
| (o) Additional treatment plan requirements | Each patient shall have a written plan, completed prior to discharge, for step down or transfer to ongoing treatment services and that addresses discharge needs and ongoing supports. The plan shall be reviewed and signed by the clinical supervisor. | Each patient shall have a written plan, completed prior to discharge, for linkage and referral to ongoing treatment services and that addresses discharge needs and ongoing supports. |
| (p) Clinical staffing frequency | Required daily for each patient | Required daily for each patient |
| (q) Additional requirements for discharge or transfer | 1. Summary required within 48 hours after the discharge or transfer date. |
1. Summary required within 48 hours after the discharge or transfer date. |
| (r) Operational requirements | 1. The service shall have written agreements with community behavioral health service providers or systems to provide care after the patient is discharged from the service. |
1. The service shall have written agreements with community behavioral health service providers or systems for referral after the patient is discharged from the service. |