Frequently Asked Questions (FAQs) Regarding BQA Memo
04-005 Clinical Collaboration instead of Supervision
1. Q. What type of format do you need from us
when we request this variance for our clinic?
2. Q. Where do I send my clinic proposal?
- A. The Department issued a statewide variance to allow collaboration
in BQA memo 04-005. Certified
psychotherapy clinics do not need to request a variance to permit
Certified outpatient mental health clinics that intend to implement
clinical collaboration must notify their program certification
specialist in writing.
The narrative should include the timeline for transition from the
requirements established in HFS 61.97 (3) and detail the policy and
procedure for implementation of a collaborative practice protocol
within the certified clinic.
- A. The proposal to switch to a
collaborative protocol should be provided to the Division of Quality
Assurance behavioral health certification specialist.
A list of surveyors and contact information was
attached to the statewide variance notice. There are several reasons why
the surveyor needs to be notified, including, but not limited, to:
determine the degree of consistency of proposals within each region and
for Department review of statewide implementation;
- For confirmation of
timelines for clinic transition;
- To have Department staff available for
consultation during the transition period.
3. Q. Does someone who only sees four patient hours per week still need
one hour per month collaboration time?
- A. Yes, either one-hour per month or one hour for every 120 clock hours
of face-to-face mental health services is required.
4. Q. Will I get a written notice of
- A. This
statewide variance does not require correspondence back to the clinic as
would be customary with other waiver or variance requests.
You will be
notified if the Department does not approve your proposal or if the Department
requires additional qualifying information in order to consider your
5. Q. Am I correct in assuming that each staff person with a Masterís degree is required to attend?
6. Q. Do psychologists and psychiatrists who
provide psychotherapy have to engage in collaboration? If so, why?
- A. Certified Clinic professional staff as
outlined in section 3 of DDES-BQA-04-005 must participate in the process
of collaboration unless the certified clinic continues to meet the
supervision requirements established in DHS 61.97
(3) (exit DHS).
includes all licensed staff providing psychotherapy.
- A. Yes. A Department goal with this
variance is to ensure the certified clinic has established a good/quality
Quality Improvement system.
All staff who provide psychotherapy should participate in a
collaborative process to ensure the quality of the system and support
colleagueís efforts at the provision of quality care.
7. Q. Does this mean we no longer need to
have a psychiatrist or psychologist on staff?
- A. The psychiatrist and/or psychologist are required staff identified
61.96 (exit DHS). The psychiatrist or psychologist is also required to provide
2 hours of psychotherapy for each 40 hours of therapy provided within the
clinic as required in DHS
61.97(2) (exit DHS).
This variance was specific to the role
of collaboration and did not change any staff requirements in outpatient
8. Q. If a Masterís level clinician misses a meeting because of
sickness or vacation, is that okay?
- A. The Department recognizes there may be short-notice circumstances
that impact scheduling of collaboration meetings. Clinic policy may
provide the guidelines necessary for reestablishing collaboration
9. Q. If I have a relevant Masterís degree, previous clinical
experience, but no license because Iím not currently practicing (e.g. an
administrator in the clinic), can I become a collaborator?
- A. If you have a Masterís degree in the behavioral sciences, previous
clinical experience and are part of the staff of the entity you may
participate in the review.
However, only staff identified as
"qualified staff" in BQA memo
04-005 may be recorded as
evidence of clinical collaboration.
10. Q. Do we need to involve a staff member with a Masters in Social
Work (MSW) in reviews/collaboration?
- A. An MSW is not required to participate in all reviews/
collaboration. A qualified MSW that is identified as clinical
staff participates in the collaboration if the certified clinic has
approval for a collaborative practice by the Department.
11. Q. Now that I can collaborate with other Masterís level therapists, do I
still need an MSW coming to my clinic?
- A. The requirement to have an MSW in a certified clinic has not changed.
The Department is currently reviewing this requirement to determine if
it will be maintained.
12. Q. Are professionals who practice in more than one location able to
combine the clinical collaboration received in each practice setting?
- A. Each certified clinic is required to have evidence of compliance with
supervision or collaborative practice specific to clients receiving
services in that clinic. Qualified staff may collaborate about care
provided at a branch of a certified clinic as well.
Staff who may provide
services in more than one certified clinic must meet the requirements for
collaboration in each certified entity.
13. Q. Can I participate in collaboration to earn my 3,000 hours of
post-masterís clinical experience?
- A. Yes, as long as those who participate in the collaboration are
qualified clinical staff.
14. Q. Do the new clinical collaboration regulations replace the requirement
for social workers to obtain physician (MD) case supervision on intake and every 90
- A. The requirement of review at intake and at least once every 90 days for
patients receiving one or less therapy sessions per week has not changed
and was not included in the statewide variance.
The Department will
monitor the QI systems established and will provide feedback for future
rule language development. This variance does not limit the review to the
psychiatrist or psychologist.
A clinic could continue to follow that
practice outlined in DHS 61
(exit DHS) or establish guidelines in the collaborative
practice protocol that includes the necessary review.
15. Q. Treatment plans---Will we need to formally review the plans every 3
months or can they be developed with the patient (obtaining their informed
consent) and be in effect for 15 months without quarterly review?
- A. This variance does not change the requirement for review of client
care. The variance allows the opportunity for a collaborative review as an
option for clinics to consider.
Note: The Departmentís intent for DHS
94.03 (exit DHS) that permits an informed consent document to be valid for 15 months
- to have the informed consent renewed annually,
- and/or to provide
additional time for providers to obtain the consent via mail from a
guardian or other legal representative who lives out-of-town.
16. Q. Does this requirement also apply to an Alcohol and Other Drug
Abuse (AODA) / Community Substance Abuse Services (CSAS) outpatient
program? If not, why not?
- A. This variance is specific to requirements identified in DHS 61.97
(3) (exit DHS) that are established for outpatient psychotherapy clinics. AODA/CSAS
protocols are not currently being reviewed.
17. Q. In designing a treatment plan for dually diagnosed clients, do I still
need supervision from a Certified Clinical Supervisor (CCS) who does not have a Masterís degree?
- A. The requirements for the provision of services under DHS 75
(exit DHS) are not
impacted by this variance. If the clinic is certified under HFS 75 and
providing services to dual diagnosed clients mental health and AODA
professionals may need to be involved in the review.
18. Q. Can we stop listing the supervising physician on insurance claims?
- A. The variance does not address or change billing protocol or
19. Q. Can clinical collaboration be obtained from qualified licensed
professionals practicing at other locations?
- A. Yes. This practice is encouraged for small, certified clinics in order
to bring other professional perspectives into the collaborative process.
Each clinic should establish business associates agreements (45 CFR
164.502 and 164.504 (exit DHS) with qualified professionals from other
ensures patient rights and confidentiality are maintained and compliance
with HIPAA requirements.
20. Q. Are the new variance regulations concerned about which party in the clinical
collaboration activity poses the questions or receives the feedback?
Does an equal exchange of clinical information between two or more
professionals count as clinical coordination?)
- A. Staff shall document the collaboration by signature and date in
regularly maintained clinical records. The names of the persons who
participate in the collaboration and the time they spend on collaboration
The patient clinical record should reflect case
collaboration has occurred. One goal of the collaborative process is to
have a reasonably equitable distribution of case review among clinicians
21. Q. Is it allowable for clinical collaboration to be general clinical
treatment information, and not specific to the treatment of a particular
- A. Certified clinics must distinguish between general staff meetings that
may discuss clinical practice from individual case collaboration. Client
focused collaboration meets the requirements of the variance.
22. Q. We assume that clinical collaboration that takes place over the
telephone is allowed by the regulation. Is this correct?
- A. There may be circumstances that necessitate collaboration regarding a
specific case and these episodes are permitted. Utilization of telephone
collaboration should not be the routine or customary practice for the
staff in the certified clinic.
23. Q. What do we need to do to document the collaboration process? Do
collaboration reviews need to be documented in the clinical record? May we
maintain a separate log or record?
- A. Staff shall document the collaboration by signature and date in
regularly maintained clinical records for each client. The documentation
regarding collaboration may include a progress note regarding:
of the client to outside resources;
- Descriptions of significant events
that are related to the clientís service plan and contribute to an
overall understanding of the consumerís ongoing level and quality of
- Evidence of the clientís progress, including response to
services, changes in condition and changes in services provided;
- Observation of changes inactivity level or in physical, cognitive or
emotional status and details of any related referrals;
- Reports of
treatment or other activities from outside resources that may be
influential in the clinicís service planning.
24. Q. When the collaboration is anonymous, is it essential to note that fact
in the record?
- A. Collaboration involves representatives of a treatment team and
should not be anonymous. Those participating in the collaboration and
their recommendations should be recorded.
25. Q. If this variance does not constitute granting a variance of the
Medicaid requirement, what are the Medicaid requirements? Where could I find information
on the Medicaid requirements?
26. Q. If our clinic changes to a collaboration process, do we still need to
look at the medical necessity issue for discharge? If so, how can we
process the discharge decision without a physician present?
- A. If the entity that provides reimbursement for services requires
physician participation in the discharge, the certified clinic should adhere to
27. Q. Do we still need a prescription for treatment/referral for
psychotherapy per WI Admin Code HFS 61.97 (5)?
- A. The requirement for an order for treatment has not changed. The
Department is exploring options for addressing concerns about this
There are HFS code requirements for a physicianís
prescription for outpatient mental health therapy for which the Department
may consider a waiver/variance.
However, there is a State statutory
requirement for a physicianís prescription for Medicaid recipients to
receive outpatient mental health therapy, which the Department cannot
At minimum this issue will be addressed to the extent that the
Department is able to in the re-write of HFS 35.
28. Q. Will we need any signatures from supervisors or clinical collaborators
on our Intake Notes, Treatment Plan, and Discharge Summaries? We now have
our Ph.D. psychologist or physician sign all of these documents.
- A. The Outpatient Psychotherapy Clinic Administrative Code outlines
minimum standards for the provision of services. Each entity will develop
policy and procedure for their collaborative practice.
If the entity
determines certain signatures add value to the process of collaboration
those signatures should be part of the clinic protocol.
If a clinic does
participate in the variance, the clinic policy/ procedure should detail how
these signatures will be secured as evidence of review. The surveyor will
review the policy and monitor compliance through the record review
29. Q. How can I secure a copy of this BQA memo?
Last Updated: March 18, 2011