Variance for Recognizing the Practice and Role of the
Advanced Practice Nurse Prescriber in Certified Programs
PDF Version of BQA 04-024 (PDF
Date: September 17, 2004 -- DDES-BQA 04-024
FROM: Joyce Allen, Director, Bureau of Mental Health and Substance Abuse
Services; Cris Ros-Dukler, Director, Bureau of Quality Assurance
The purpose of this memorandum is to address the roles served by
advanced practice nurse prescribers (APNP) in certified community support
programs (CSPs) and in outpatient mental health clinics. This
clarification and variance do not limit the scope and practice of the
APNPs. Their practice continues to be governed by their credentialing
requirements found in Wisconsin Administrative Code Chapter N8 and is
under the jurisdiction of the Department of Regulation and Licensing. The
variance provides the flexibility for CSPs and outpatient mental health
clinics to utilize APNPs to serve their clients.
APNPs not Recognized by HFS 61 and HFS 63
HFS 63 and s. HFS 61.91 of the Wisconsin Administrative Code,
relating to CSPs and mental health outpatient clinics, respectively, do
not list APNPs as program personnel. HFS 61 and HFS 63 were promulgated
before 1996, the year the Wisconsin Board of Nursing adopted Chapter
N 8 of the Wisconsin Administrative Code, relating to certification of
APNPs. Chapter N 8 outlines the education, training and experience
requirements that a registered nurse must meet to be an APNP.
The Department initiated a review of the requirements established in
Chapter N 8 and their relationship to the provision of services in CSPs.
After collaborating with stakeholders and nursing professionals, the
Department approved "pilot" variances to s. HFS 63.06(2) and s.
HFS 63.06(4) in 2002 and 2003. To recognize the value of APNPs in
improving access to mental health treatment and services, the Department
has decided to issue a statewide variance.
Statewide Variance to CSP and Outpatient Mental Health Clinic
The Department hereby grants a statewide variance to the following
requirements subject to the conditions outlined below:
- Section HFS 61.96(1)(a) of the mental health outpatient clinic
- Sections HFS 63.06(2) and HFS 63.06(4) for community support
Although some certified clinics have utilized APNPs since 1996,
effective immediately, this variance will be the sole method for the
utilization of APNPs for prescribing purposes.
This variance recognizes that APNPs can serve to supplement existing
physician/psychiatric time required in CSPs and the need for APNPs to
serve as program personnel in outpatient mental health clinics. This
variance also recognizes the provisions of ss. N8.06 and N8.07.
Providers electing to utilize the APNP in these certified programs must
demonstrate to the Bureau of Quality Assurance (BQA) licensing specialist
during the site review that they have developed and implemented a written
policy for utilizing the APNP in delivering CSP and outpatient mental
health services. Certified programs that intend to utilize the services of
an APNP must notify their program certification specialist in writing to
document the timetable for implementing APNP services.
Conditions of Variance
- APNPs are included as Program Personnel in Outpatient Mental Health
Clinics, and will practice as allowed in N 8.
- APNPs will supplement existing psychiatry time available, not
replace the psychiatrist in the provision of services. In CSPs, the
psychiatrist will be responsible for the initial in-depth psychiatric
assessment of all CSP clients, including the development of a working
diagnosis and assuring the need for CSP services. The CSP psychiatrist
will also be responsible for assessing the need for further medical
evaluation and for making the initial determination for
medical/pharmacological treatment. The APNP may conduct the
aforementioned activities in collaboration with a psychiatrist.
- APNPs in Certified Outpatient Mental Health Clinics and CSPs shall
have Board Certification as an Advanced Practice Psychiatric-Mental
Health Nurse. [Note: This provision will require Board Certification
for any APNP working in this setting.]
- Collaboration must be documented, in keeping with the provisions of
s. N8.10, and available for review, when requested, by BQA staff.
- All remaining requirements in HFS 61 and HFS 63 remain unchanged
unless the Department has previously issued a variance or waiver.
APNPs Serving as a Psychotherapist in Mental Health Outpatient Clinics
APNPs who wish to provide psychotherapy services in mental health
outpatient clinics must continue to meet the mental health professional
requirements found in s. HFS 61.96(1)(b) and s. HFS 61.96(3). The
statewide variance granted to s HFS 61.96(1)(a) does not affect those
Exception: APNPs who have been issued a license by the Wisconsin
Department of Regulation and Licensing under Chapter MPSW 3, Chapter MPSW
11, and Chapter MPSW 16 for social workers, professional counselors, and
marriage and family therapists need only send a copy of the license to BQA
for approval as a mental health professional.
Rescinding the Variance
The Department may revoke any variance if, for example, it determines
that patient needs are not being met with continued approval of this
variance; or, if the health, safety, or welfare of any patient is
Note: Granting this variance does not constitute granting a variance of
a Medicaid (Title XIX or Medical Assistance) requirement. The Bureau of
Quality Assurance does not have authority to grant waivers or variances
for Medicaid rules. Please contact Christine Wolf at (608) 266-9195 for
further information about requirements for Medicaid.
If you have questions about this variance, please contact Mark Hale in
the Program Certification Unit at (608) 243-2087.
cc: Jeff Hinz, Section Chief, Bureau of Mental Health and Substance
Abuse Services; Mark Hale, Supervisor, Program Certification Unit, Bureau of Quality
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