Variance for Supervision
Requirements for Certified Outpatient Psychotherapy Clinics
PDF Version of BQA 04-005 (PDF,
NEW - Frequently
Asked Questions about Clinical Collaboration instead of Supervision
Date: February 4, 2004 -- DDES-BQA 04-005
To: Area Administrators/Assistant Area Administrators
County Department of Human Services Directors
County Mental Health Coordinators
Tribal Chairpersons/Human Services Facilitators
Certified Outpatient Psychotherapy
Community Substance Abuse Service
Hospitals HSP - 04
From: Dan Zimmerman, Contract Administrator, Bureau of Mental
Health and Substance Abuse Services
Mark Hale, Supervisor, Program Certification Unit, Bureau of Quality
Via: Joyce Allen, Director, Bureau of Mental Health and
Substance Abuse Services
Susan Schroeder, Director, Bureau of Quality Assurance
2001 Wisconsin Act 80 was published May 1, 2002 and enacted April 17,
2002. The Wisconsin Legislature passed WI Act 80, granting independent,
non-supervised license status to individuals practicing psychotherapy who
possessed the appropriate credentials. These included: Masterís level
Social Workers, Professional Counselors, Marriage and Family Therapists,
and select Music, Art and Dance Therapists.
Wisconsin Administrative Code HFS 61 governs Wisconsin certified
outpatient mental health clinics. Currently s.HFS 61.97 (3) requires
psychotherapist staff to be supervised either by a physician
(psychiatrist) or a licensed clinical psychologist. The intent of this
supervisory requirement is to utilize this form of quality assurance as a
means to ensure that clients receive appropriate mental health treatment.
Quality improvement systems are essential for achieving this outcome.
The Department hereby grants a statewide variance to s. HFS 61.97(3) in
recognition of Act 80 licensure for psychotherapists and to address
concerns related to the existing supervision requirements being costly and
burdensome for providers. This variance permits "clinical
collaboration" in certified outpatient mental health clinic settings.
Clinical collaboration is another means to provide a quality improvement
Providers electing clinical collaboration in lieu of or in addition to
M.D./Ph.D. supervision must demonstrate to the Bureau of Quality Assurance
(BQA) surveyor, during site review or other unannounced focused visits,
that they have developed and implemented a written policy for clinical
collaboration for their licensed psychotherapist staff. Certified
outpatient mental health clinics that intend to implement clinical
collaboration must notify their program certification specialist in
writing to document the timetable for transition. Providers may choose to
continue meeting the supervision requirement established in HFS 61.97(3)
by utilizing a psychiatrist or licensed clinical psychologist. Providers
may also choose to utilize both supervision options in order to meet the
unique needs of their various licensed psychotherapist staff members.
The Department has the authority to revoke any variance if, for
example, the Department determines that the needs of the patients of a
clinic are not being met with continued approval of this variance; or, if
the health, safety, or welfare of any patient is jeopardized.
Note: Granting this variance does not constitute granting a variance of
a Medical Assistance (Title XIX) requirement. The Bureau of Quality
Assurance does not have authority to grant waivers or variances for
Medical Assistance rules. Please contact Christine Wolf at (608) 266-9195
for further information about requirements for Medical Assistance.
If you have questions about this variance, please contact your Program
Certification Specialist. Contact
phone numbers are attached.
Conditions of Variance to s. HFS 61.97 (3)
"Clinical collaboration" means clinical staff working
together using consultation, supervision, mentoring or peer review by one
or more mental health professionals who meet the qualifications listed in
section 3. The certified clinic will demonstrate utilization of quality
improvement methods to improve the quality of care and treatment. Expected
client outcomes include a decrease of psychiatric symptoms and an increase
in the clientís level of independent functioning.
2. IMPLEMENTATION OF CLINICAL COLLABORATION (a) Written policy. Each
clinic shall develop and implement a written policy for clinical
(b) Clinical collaboration between individual clinic staff shall
include direct review, assessment and discussion with the staff person
about the staff personís delivery of outpatient mental health services.
(c) Clinical collaboration shall be accomplished by one or more of the
1. Individual, face-to-face meetings with staff to review cases, assess
performance and give advice;
2. Group staff meetings to review the services being provided to
clients, discuss alternative approaches or provide teaching opportunities;
3. Any other professionally recognized method of collaboration, such as
review using videotaped sessions or peer review, designed to provide
sufficient guidance to ensure that effective services are delivered to the
clinicís clients by that staff person.
(d) Minimum hours of clinical collaboration. (1). A staff member
providing mental health services who does not have 3,000 hours of
supervised clinical experience in the provision of mental health services
or who is not qualified under sub. 3.(b) 1. to 4. (see below), shall
receive a minimum of one hour of direct, individual clinical consultation
for every 30-clock hours of face-to-face mental health services provided.
(2) A staff member who has completed 3,000 hours of supervised clinical
experience in the provision of mental health services and who is qualified
under sub. 3.(b) 1. to 4. (see below), shall participate in ongoing
consultation and collaboration for a minimum of one hour of clinical
consultation per month or for every 120 clock hours of face-to-face mental
health services provided, whichever is greater.
(e) Additional required hours of clinical collaboration. The clinical
director may direct a staff person to participate in additional hours of
clinical collaboration beyond the minimum identified in par. (d) in order
to ensure that clients of the clinic receive appropriate mental health
services. (The clinical director may also direct a staff person be
supervised by an M.D. or Ph.D. in addition to their required hours of
(f) Providers of clinical collaboration. Clinical collaboration for
individual clinic staff shall be provided by Act 80 licensed
psychotherapists. Mental health professionals qualified under sub. 3 (b)
1. to 6 (see below) may also participate.
(g) Documentation. Staff shall document the collaboration by signature
and date in regularly maintained clinic records. The names of the persons
who participate in the collaboration and the time they spend on
collaboration are documented in one or more of the following: the master
log, supervisory records, personnel records of staff members who attend
the session or review, and patient records.
3. QUALIFICATIONS OF PROFESSIONAL STAFF. (a) 1. In this subsection,
"supervised clinical experience," means the professional (masterís
prepared) has received one hour of supervision or collaboration per thirty
(30) hours of clinical practice. Mental health professionals qualified
under par. (b) 1. to 6. that provide collaboration or supervision shall
have evidence of 3,000 hours of clinical experience under qualified
collaboration or supervision prior to the initiation of
collaboration/supervisory functions with other clinical staff.
2. Professional staff identified in par. (b) shall provide clinical
services within the limits of their disciplineís scope of practice as
defined through state licensure or certification.
(b) A person employed or retained by contract to fill any of the
following professional positions shall meet the minimum qualifications
listed for that position:
1. Psychiatrists shall be physicians licensed under ch. 448, Stats., to
practice medicine and surgery and shall have completed 3 years of
residency training in psychiatry in a program approved by the
accreditation council for graduate medical education and be either
certified or eligible for certification by the American board of
psychiatry and neurology.
2. Psychiatric residents shall hold a doctoral degree in medicine and
shall have successfully completed 1500 hours of supervised clinical
experience, the acceptable completion of which has been documented by the
program director of a psychiatric residency program accredited by the
accreditation council for graduate medical education.
3. Psychologists shall be licensed under ch. 455, Stats., and shall be
listed with the national register of health service providers in
psychology, meet the requirements for listing with the national register
of health services providers in psychology or have a minimum of one year
of supervised post-doctoral clinical experience related directly to the
assessment and treatment of clients with mental disorders.
4. Psychology residents shall hold a doctoral degree in psychology
meeting the requirements of s. 455.04 (1) (c), Stats., and shall have
successfully completed 1500 hours of supervised clinical experience as
documented by the Wisconsin psychology examining board.
5. Masterís level clinicians shall be persons with a master's
degree and course work in areas directly related to providing mental
health services, including clinical psychology, psychology, school or
educational psychology, rehabilitation psychology, counseling and
guidance, clinical social work, psychiatric nursing, professional
counselors, marriage and family therapy, or counseling psychology.
6. Registered nurses, including advanced practice nurse prescribers (APNPs),
shall be licensed under ch. 441, Stats., as a registered nurse and shall
have had training in psychiatric nursing and at least one year of
experience working in a clinical mental health facility.
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