Statewide Individual Provider Status Variance for
Certified Outpatient Mental Health Clinics
PDF Version of BQA 04-027 (PDF
Date: August 31, 2004 -- DDES-BQA 04-027
FROM: Joyce Allen, Director, Bureau of Mental Health and Substance Abuse
Services; Cris Ros-Dukler, Director, Bureau of Quality Assurance
The mental health clinic standards found in §§ HFS 61.91-61.98
itemize the requirements for the certification of outpatient psychotherapy
clinics. Within the code, §§ HFS 61.96(1)(b), 61.96(2) and 61.96(3)
contain the requirements for mental health professionals who may be
employed in the clinic. This variance clarifies which prospective
individuals considered for employment by certified mental health clinics
need to submit the educational and experience requirements found in s. HFS
61.96(3) when they are concurrently approved by the Department of
Regulation and Licensing (DRL) under 2001 WI Act 80.
Passage of 2001 WI Act 80
Wisconsin Act 80 was enacted April 17, 2002 and published on May 1,
2002. Wisconsin Act 80 granted licensure status to Marriage and Family
Therapists, Professional Counselors and Social Workers through the DRL.
These professionals were previously "certified" by DRL.
Wisconsin Act 80 licensure standards promulgated through the
administrative code for social workers, professional counselors, and
marriage and family therapists (Chapter MPSW 3, Chapter MPSW 11, and
Chapter MPSW 16) closely match requirements previously established in s.
HFS 61.96 and monitored by DHFS through the "Individual Provider
Status" application process. Currently, licensed psychotherapists
must complete duplicative credential review steps in order to qualify for
Medicaid reimbursement for services they deliver in certified outpatient
mental health clinics. The Department of Health and Family Services will,
effectively immediately, extend a variance to all clinics whose current
and prospective staff possess the DRL license issued under WI Act 80 and
as outlined below.
The Variance and To Whom It Applies
Individuals licensed by DRL in the following categories meet the
individual provider status requirements. As such they no longer need to
complete the individual provider status credential review process.
- Chapter MPSW 3;
- Chapter MPSW 11;
- Chapter MPSW 16; or
Exception: Social workers, professional counselors, and marriage
and family therapists who possess a temporary license granted by DRL in
the same category, but who have not taken and passed the exam, are also
exempted from the provider status credential review process.
To Whom the Variance Does Not Apply
While the variance applies to certain individuals approved under WI Act
80, it does not apply to all. These include:
- Licensed professional counselors who do not meet the HFS
61.96 (3) requirement for 3,000 hours of supervised experience in
clinical practice. As such, they are not eligible for Medicaid
- Individuals who remain certified by DRL as a Social Worker, Advanced
Practice Social Worker or Independent Social Worker.
- Individuals who are not eligible for DRL psychotherapist licensure,
but comply with HFS 61.96(1)(b) and 61.96(2).
The individual provider status credential review process will continue
for masters prepared psychiatric nurses, persons with course work in
clinical psychology, psychology, school psychology, counseling and
guidance, or counseling psychology, and other mental health professionals
that meet the requirement under HFS 61.96(2).
Required Clinic Follow Up
Each State certified clinic shall maintain a current list of all
qualified licensed personnel identified under HFS 61.96 and have that list
readily available for Department staff during unannounced inspections or
annual clinic review. All other prospective therapists must continue to
follow the existing individual provider status application process.
For questions regarding this variance, contact Mark Hale at 608-264-9894, email
cc: Sinikka Santala, Administrator, Division of Disability and Elder
Services; Chris Wolf, Division of Healthcare Financing; Kimberly Nania,
Department of Regulation and Licensing; Jeff Hinz, Section Chief, Bureau of Mental
Health and Substance Abuse Services; Mark Hale, Supervisor, Program Certification Unit, Bureau of
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