CCS: Providers

The following information is for providers of the Comprehensive Community Services (CCS) program.

Division/office updates

Three divisions and one office provide oversight of CCS. 

Division of Care and Treatment Services

The Division of Care and Treatment Services (DCTS) supports community mental health and substance use programs and operates seven facilities providing services for mental health and developmental disabilities.

Role of DCTS for CCS: The DCTS Bureau of Prevention Treatment and Recovery (BPTR) provides clarification and technical assistance regarding the structure and content of CCS. BPTR also gathers and analyzes program data and consumer outcomes. Counties and tribes interested in offering CCS should contact the Division of Care and Treatment Services. 

Contact the Division of Care and Treatment Services.

Memos

Division of Medicaid Services

The Division of Medicaid Services (DMS) administers the Medicaid and FoodShare programs and provides help to medically needy and low income individuals and families.

Role of DMS for CCS: DMS develops the ForwardHealth online handbook detailing coverage policy for CCS. Policy is written in accordance with federal and state regulations, which may describe requirements not found in Wis. Admin. Code ch. DHS 36. 

Contact the Division of Medicaid Services.

Memos
ForwardHealth Updates

Division of Quality Assurance

The Division of Quality Assurance (DQA) is responsible for regulating and licensing more than 40 different types of programs, facilities, and caregivers that provide health and residential care.

Role of DQA for CCS: The DQA Behavioral Health Certification Section (BHCS) participates in the review process of proposed regional CCS models, provides application materials for consideration for certification, monitors compliance with CCS and related rules via on-site inspections and desk reviews, and reviews and investigates complaints about CCS programs. BHCS provides limited guidance and technical assistance as the result of deficiencies identified during on-site visits and makes referral to DCTS or other experts within the DHS for detail or ongoing technical assistance. BHCS issues certificates that identify the period within which the CCS may operate.

Contact the Division of Quality Assurance.

Office of Inspector General

The Office of the Inspector General (OIG) prevents and detects fraud, waste, and abuse of public assistance programs administered by DHS.

Role of OIG for CCS: OIG audits providers who participate in Medicaid to ensure compliance with Medicaid rules and regulations. OIG reviews, monitors, and researches provider billing to detect and identify potential fraud, waste, and abuse.

Contact the Office of the Inspector General.

Administrative codes


Enrollment reports

2022

Quater 1 (PDF)

2021

2020

2019


Evidence-based practices

The Comprehensive Community Services Program Survey asks programs to report on which evidence-based practices the program offered and how many people received those evidence-based practices during the past year. Any evidence-based practice reported should match the description below and the description in the evidence-based practice toolkits listed below. Details about implementing an evidence-based practice also can be found in the evidence-based practice toolkits.

Programs should report whether an evidence-based practice was fully implemented, partially implemented, or not offered during the year of interest. Any evidence-based practice reported on the survey as being fully implemented should meet all the critical elements specified below. Any evidence-based practice reported as being partially implemented should meet some of the critical elements. Answer no for evidence-based practices not implemented during the year of interest. 

Some annual survey questions ask whether the program monitors the fidelity of each implemented evidence-based practice. Refer to the description of the tools and methods listed below and provided through the evidence-based practice toolkits referenced to determine if fidelity is monitored for an evidence-based practice.

For adult participants

Family Psychoeducation

Definition
Family psychoeducation is offered as part of an overall clinical treatment plan for individuals with mental illness to achieve the best possible outcome through the active involvement of family members in treatment and management and to alleviate the suffering of family members by supporting them in their efforts to aid the recovery of their loved ones. Family psychoeducation programs may be either multi-family or single-family focused. Core characteristics of family psychoeducation programs include the provision of emotional support, education, resources during periods of crisis, and problem-solving skills.

Toolkit and fidelity measure 
Family Psychoeducation Evidence-Based Practices (EBP) KIT

Critical elements of family psychoeducation

  • A structured curriculum is used.
  • Psychoeducation is a part of clinical treatment.

Family Psychoeducation is different from similar work that does not involve a clinician. The EBP of Family Psychoeducation must involve a clinician as part of clinical treatment.


Illness Self-Management and Recovery (IMR)

Definition
Illness Self-Management and Recovery (IMR) (also called illness management or wellness management) is a broad set of rehabilitation methods aimed at teaching people with mental illness strategies for collaborating actively in their treatment with professionals, reducing their risk of relapses and re-hospitalizations, reducing severity and distress related to symptoms, and improving their social support. Specific EBPs that are incorporated under the broad rubric of IMR are psychoeducation about the nature of mental illness and its treatment, "behavioral tailoring" to help individuals incorporate the taking of medication into their daily routines, relapse prevention planning, teaching coping strategies to managing distressing persistent symptoms, cognitive-behavior therapy for psychosis, and social skills training. The goal of IMR is to help people develop effective strategies for managing their illness in collaboration with professionals and significant others, thereby freeing up their time to pursue their personal recovery goals.

Toolkit and fidelity measure 
Illness Management and Recovery Evidence-Based Practices (EBP) KIT

Critical elements of IMR
IMR includes a specific curriculum that includes mental illness facts, recovery strategies, using medications, stress management, and coping skills. It is critical that a specific curriculum is being used for these components to be counted for reporting.

IMR is different from advice related to self-care. It is a comprehensive, systematic approach to developing an understanding and a set of skills that help a person be an agent for their own recovery.


Individual Placement and Support (IPS) Supported Employment

Definition
Individual Placement and Support (IPS) refers to the evidence-based practice of supported employment which helps people living with behavioral health conditions work at regular jobs of their choosing. IPS is based on the principle that work promotes recovery and wellness. Practitioners focus on each person’s strengths and services are individualized and last as long as the person needs and wants them. IPS uses a multidisciplinary team approach, including practitioners working in collaboration with state vocational rehabilitation counselors.

Toolkit and fidelity measure
IPS Fidelity Manual (PDF)

Critical elements of IPS

  • Competitive employment: The IPS model focuses on developing opportunities for job seekers that are inclusive. These are jobs that anyone can apply for, pay at least minimum wage or the same pay as coworkers with similar duties, and have no artificial times limits imposed by a social service agency.
  • Zero exclusion: The IPS model is open to all job seekers receiving services for mental health and substance use disorders. 
  • Integration services: The IPS model is part of mental health and substance use treatment programs. Employment specialists work with a job seeker's treatment team to support the job seeker's treatment goals.
  • Worker preferences: The IPS model focuses on each job seeker's desires and wishes.
  • Benefits planning: IPS employment specialists help people obtain personalized, understandable, and accurate information about their Social Security, Medicaid, and other government benefits. 
  • Rapid job search: In the IPS model, there are no requirements for assessments, training, or counseling before seeking employment. The first face-to-face contact between a job seeker and a business occurs within 30 days.
  • Systematic job development: Based on the job seeker's preferences, IPS employment specialists regularly visit businesses to learn about their needs and hiring preferences.
  • Time-unlimited supports: The services offered under the IPS model are continue as long as each person being served wants and needs support.

IPS is different from prevocational training, sheltered work, and employment in enclaves. 


Integrated Treatment for Co-Occurring Mental Health and Substance Use Disorders/Integrated Dual Disorders Treatment (IDDT)

Definition
Dual diagnosis treatments combine or integrate mental health and substance use interventions at the level of the clinical encounter. Hence, integrated treatment means that the same clinicians or teams of clinicians, working in one setting, provide appropriate mental health and substance use interventions in a coordinated fashion. In other words, the caregivers take responsibility for combining the interventions into one coherent package. For the individual with a dual diagnosis, the services appear seamless, with a consistent approach, philosophy, and set of recommendations. The need to negotiate with separate clinical teams, programs, or systems disappears. The goal of dual diagnosis interventions is recovery from two serious illnesses.

Toolkit and fidelity measure

Critical elements IDDT

  • Multidisciplinary team:  A team of clinical professionals working in one setting and providing mental health and substance use interventions in a coordinated fashion.
  • Stagewise interventions: That is, treatment is consistent with each client’s stage of recovery (engagement, motivation, action, relapse prevention).  

IDDT is different from coordination of clinical services across provider agencies.


Medication Management (MedTEAM)

Definition
There does not appear to be any explicit definition of medication management. However, the critical elements identified for evidence-based medication management approaches are:

  • Utilization of a systematic plan for medication management.
  • Objective measures of outcome are produced.
  • Documentation is thorough and clear.
  • Consumers and practitioners share in the decision-making.

Toolkit and fidelity measure 
MedTEAM (Medication Treatment, Evaluation, and Management) Evidence-Based Practices (EBP) KIT 
(MedTEAM is one example of an EBP for medication management.)

Critical elements of medication management

  • Treatment plan specifies outcome for each medication.
  • Desired outcomes are tracked systematically using standardized instruments in a way to inform treatment decisions.
  • Sequencing of antipsychotic medication and changes are based on clinical guidelines.

Medication management is different from medication prescription administration that occurs without the minimum requirements specified above.


Motivational Interviewing (MI)

Definition
Motivational Interviewing (MI) is a “collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion”. 

Fidelity
Fidelity is measured through the direct coding of practice samples. Fidelity is defined in terms of basic and advanced standards1 for skill measures which include percentage of open questions (of total questions), percentage of complex reflection (of total reflection), ratio of reflections to questions, and percentage of Motivational Interviewing-adherent behaviors (of total other behaviors). Additionally, there are global measures to assess overall Motivational Interviewing practice. 

Other resources

  • Miller, W. R., & Rollnick, S. (2013, p. 29, p. 400). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.
  • Miller, W. R., & Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioural and Cognitive Psychotherapy, 37(2), 129-140.

Critical elements of MI

  • A spirit or way of being with people which is collaborative, evocative, accepting and respectful of autonomy, and compassionate.  
  • Core skills which include asking open-ended questions, looking for strengths and affirming these strengths, careful listening and reflection, summarizing, and providing information using the “elicit-provide-elicit” procedure.
  • Core skills are applied specifically within four processes, including engaging the person and building the relational foundation; focusing on a collaboratively developed agenda for the conversation and a selected specific “target behavior;" evoking in which the person’s ideas and motivations for change are explored and the practitioner listens for change talk, proactively draws it out, and differentially responds to it in an effort to enhance motivation; and planning in which a goal and support plan is collaboratively developed.  

MI is different from stages of change; a manipulative way of tricking people into change; and client-centered therapy. 


Permanent Supportive Housing (PSH)

Definition
Permanent supportive housing (PSH) is defined as services to assist individuals in finding and maintaining appropriate housing arrangements. This activity is premised upon the idea that certain clients are able to live independently in the community only if they have support staff for monitoring and/or assisting with residential responsibilities. These staff assist clients in selecting, obtaining, and maintaining safe, decent, affordable housing while maintaining a link to other essential services provided within the community. The objective of permanent supportive housing is to help obtain and maintain an independent living situation.

PSH is a specific program model in which a consumer lives in a house, apartment, or similar setting, alone or with others, and has considerable responsibility for residential maintenance, but receives periodic visits from mental health staff or family for the purpose of monitoring and/or assisting with residential responsibilities. Criteria identified for permanent supportive housing programs include: housing choice, functional separation of housing from service provision, affordability, integration (with persons who do not have mental illness), and right to tenure, service choice, service individualization and service availability. 

Toolkit and fidelity measure  
Permanent Supportive Housing Evidence-Based Practices (EBP) KIT  

Critical elements of PSH

  • Target population: Targeted to people who would not have a viable housing arrangement without this service.
  • Staff assigned: Specific staff are assigned to provide supported housing services.
  • Housing is integrated: Supported housing is provided for living situations in settings that are also available to people who do not have mental illnesses.
  • Consumer has the right to tenure: The ownership or lease documents are in the name of the consumer.
  • Affordability: Supported housing assures that housing is affordable (consumers pay no more than 30-40% on rent and utilities) through adequate rent subsidies, etc. 

PSH is different from residential treatment services and a component of case management.


Supported Employment (SE) - SAMHSA

Definition
Mental health supported employment (SE) is an evidence-based service to promote rehabilitation and return to productive employment for persons with serious mental illnesses. SE programs use a team approach for treatment, with employment specialists responsible for carrying out all vocational services from intake through follow-along. Job placements are community-based (not sheltered workshops, not on-site at SE or other treatment agency offices), competitive (jobs are not exclusively reserved for SE clients, but open to public), in normalized settings, and utilize multiple employers. The SE team has a small client to staff ratio. SE contacts occur in the home, at the job site, or in the community. The SE team is assertive in engaging and retaining clients in treatment, especially utilizing face-to-face community visits, rather than phone or mail contacts. The SE team consults/works with family and significant others when appropriate. SE services are frequently coordinated with vocational rehabilitation benefits.

Toolkit and fidelity measure
Supported Employment Evidence-Based Practices (EBP) KIT

Critical elements of SE

  • Competitive employment: Employment specialists provide competitive job options that have permanent status rather than temporary or time-limited status. Employment is competitive so that potential applicants include people in the general population.
  • Integration with treatment: Employment specialists are part of the mental health treatment teams with shared decision-making. They attend regular treatment team meetings (not replaced by administrative meetings) and have frequent contact with treatment team members.
  • Rapid job search: The search for competitive jobs occurs rapidly after program entry.
  • Eligibility based on consumer choice (not client characteristics): No eligibility requirements such as job readiness, lack of substance use, no history of violent behavior, minimal intellectual functioning, and mild symptoms.
  • Follow–along support: Individualized follow-along supports are provided to employer and client on a time-unlimited basis. Employer supports may include education and guidance. Client supports may include crisis intervention, job coaching, job counseling, job support groups, transportation, treatment changes (medication), and networked supports (friends/family).  

SE is different from prevocational training, sheltered work, and employment in enclaves.


Tobacco Cessation Bucket Approach (TCBA) 

Definition
The Tobacco Cessation Bucket Approach (TCBA) was developed at UW Center for Tobacco Research and Intervention in collaboration with NAMI Wisconsin as a set of tobacco reduction interventions tailored to the user’s willingness to move toward quitting. An interventional approach founded upon the established stages of change model, it holds considerable promise in helping people with mental illness approach and achieve tobacco cessation. 

Assign each person in the program who currently use tobacco products (cigarettes, cigars, pipes, snuff, chew, snuz, and e-cigarettes) to only one bucket based upon their stage of change as determined at the end of the survey year. Categorize people who quit tobacco use during the survey year as quit. Assign people who discharged from the program during the survey year to the bucket that characterizes their stage of change at the date of discharge. 

  • Quit: Participant quit using tobacco and stayed quit during the survey year. (Do not assign this category if the individual states they’ve quit in the face of clear evidence to the contrary.)
  • Quit Now: Participant is actively trying to quit completely. 
  • Talk and Prepare: Participant is not trying to quit completely, but is making efforts toward that goal (reducing, practice quit attempts, pre-quit use of cessation medicines, recording smoking, etc.).
  • Just Talk: Participant is not willing to make any efforts toward quitting but is willing to talk about their tobacco use.
  • Not Right Now: Participant is not willing to talk about their tobacco use at this time.

Assign each person in the program who never used tobacco or quit previously to one of the following categories. Assign people to the other smoking category for any smoking activity (marijuana, crack, cocaine, heroin, methamphetamine, PCP, etc.) during the survey year involving chemicals that were not tobacco products. 

  • Never Used Tobacco: Participant never smoked nor used any tobacco products.
  • Ex-Users of Tobacco: Participant stopped use of tobacco prior to involvement in CSP or CCS or prior to the current survey year.
  • Other Smoking: Participant smoked other chemicals that are not tobacco products during the survey year. Include people who may be categorized into buckets above as well. (This is the only category that can be assigned along with another category.)

Other resources

Critical elements of TCBA

  • Utilization of a systematic plan for program-wide implementation of the Bucket Approach in accordance with the definition above.
  • Inquiry and assessment of each participant’s readiness for change according to the Bucket Approach.  
  • Treatment and recovery plans identify individualized assessed need for specific interventions to be provided and desired outcomes in accordance with the individual’s bucket assignment.
  • Proper application of interventions appropriate to each bucket in where participants are categorized. 
  • Outcomes are tracked systematically using standardized definitions to establish a metric of progress.

Other Adult EBPs

For youth participants

Functional Family Therapy (FFT)

Definition
Functional Family Therapy (FFT) is an outcome-driven prevention/intervention program for youth who have demonstrated the entire range of maladaptive, acting out behaviors and related syndromes. Treatment occurs in phases where each step builds on one another to enhance protective factors and reduce risk by working with both the youth and their family. The phases are engagement, motivation, assessment, behavior change, and generalization.

Toolkit
Interventions for Disruptive Behavior Disorders: Evidence-Based and Promising Practices (Pages 107-112)

Toolkit and fidelity measure
Functional Family Therapy 

Critical elements of FFT

  • Services are provided in phases related to engagement, motivation, assessment, behavior change, etc.
  • Services are short-term, ranging from 8-26 hours of direct service time.
  • Flexible delivery of service by one and two person teams to clients in the home, the clinic, juvenile court, and at time of re-entry from institutional placement.

Multisystemic Therapy (MST)

Definition
Multisystemic Therapy (MST) is an intensive family- and community-based treatment that addresses the multiple determinants of serious antisocial behavior. MST views individuals as being nested within a complex network of interconnected systems that encompass individual, family, and extra-familial (peer, school, neighborhood) factors. Intervention may be necessary in any one or a combination of these systems. The goal is to facilitate change in this natural environment to promote individual change. The caregiver is viewed as the key to long-term outcomes.

Toolkit
Interventions for Disruptive Behavior Disorders: Evidence-Based and Promising Practices (Pages 95-106)

Toolkit and fidelity measure
Multisystemic Therapy

Critical elements of MST

  • Services take into account the life situation and environment of the child/adolescent and involve peers, school staff, parents, etc.
  • Services are individualized.
  • Services are provided by MST therapists or master’s-level professionals.
  • Services are time limited.
  • Services are available 24/7.

Parent-Child Interaction Therapy (PCIT)

Definition
Parent-Child Interaction Therapy (PCIT) is a treatment program for young children with disruptive behavior disorders that places emphasis on improving the quality of the parent-child relationship and changing parent-child interaction patterns. PCIT was developed for children ages 2-7 years with externalizing behavior disorders. In PCIT, parents are taught specific skills to establish or strengthen a nurturing and secure relationship with their child while encouraging prosocial behavior and discouraging negative behavior. This treatment has two phases, each focusing on a different parent-child interaction: child-directed interaction (CDI) and parent-directed interaction (PDI).

Toolkit
Interventions for Disruptive Behavior Disorders: Evidence-Based and Promising Practices (Pages 61-65)

Other resource
Professionals: What is PCIT?

Critical elements of PCIT

  • Staff receive initial and ongoing training in PCIT to demonstrate adequate and sensitive coaching.
  • The application of PCIT meets the child's needs for nurturance and limits.

Therapeutic Foster Care (TFC) and Multidimensional Treatment Foster Care

Definition
Children are placed with foster parents who are trained to work with children with special needs. Usually, each foster home takes one child at a time and caseloads of supervisors in agencies overseeing the program remain small. In addition, therapeutic foster parents are given a higher stipend than traditional foster parents and they receive extensive pre-service training and in-service supervision and support. Frequent contact between case managers or care coordinators and the treatment family is expected, with additional resources and traditional mental health services provided as needed.

Toolkit
Interventions for Disruptive Behavior Disorders: Evidence-Based and Promising Practices (Pages 113-118)

Critical elements of TFC

  • There is an explicit focus on treatment.
  • There is an explicit program to train and supervise treatment foster parents.
  • Placement is in the individual family home.

TFC is different from an enhanced version of regular foster care.


Trauma-Focused Cognitive Behavior Therapy (TF-CBT)

Definition
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a psychosocial treatment model designed to treat posttraumatic stress and related emotional and behavioral problems in children and adolescents. Initially developed to address the psychological trauma associated with child sexual abuse, the model has been adapted for use with children who have a wide array of traumatic experiences, including domestic violence, traumatic loss, and the multiple psychological traumas often experienced by children prior to foster care placement. The treatment model is designed to be delivered by trained therapists who initially provide parallel individual sessions with children and their parents (or guardians), with conjoint parent-child sessions increasingly incorporated over the course of treatment. The components of the treatment model include: psychoeducation and parenting skills, relaxation skills, affect expression and regulation skills, cognitive coping skills and processing, trauma narrative, in vivo exposure (when needed), conjoint parent-child sessions, and enhancing safety and future development. Although TF-CBT is generally delivered in 12-16 sessions of individual and parent-child therapy, it also may be provided in the context of a longer-term treatment process or in a group therapy format.

Toolkit
TF-CBT Implementation Resources - Trauma Focus Cognitive Behavioral Therapy Certification Program

Fidelity measure
TF-CBT Brief Practice Fidelity Checklist - Trauma Focus Cognitive Behavioral Therapy Certification Program 

Other resources

Critical element of TF-CBT
Training delivered through a learning collaborative model (12 months) with consultation with national trainers on model to be followed.


Trauma-Informed Child-Parent Psychotherapy (TI-CPP)

Definition
Trauma-Informed Child-Parent Psychotherapy (TI-CPP) is s parent-child therapeutic treatment for children from birth to age 6 who have experienced trauma and, as a result, are experiencing emotional, behavior, attachment, and/or mental health problems. Child-Parent Psychotherapy (CPP) is an intervention for children from birth through age 5 who have experienced at least one traumatic event (maltreatment, the sudden or traumatic death of someone close, a serious accident, sexual abuse, exposure to domestic violence) and, as a result, are experiencing behavior, attachment, and/or mental health problems, including posttraumatic stress disorder. The primary goal of CPP is to support and strengthen the relationship between a child and their parent (or caregiver) as a vehicle for restoring the child's sense of safety, attachment, and appropriate affect and improving the child's cognitive, behavioral, and social functioning.

Toolkit
Child-Parent Psychotherapy

Fidelity measure
Child-Parent Psychotherapy Fidelity 

Other resources

Critical element of TI-CPP
Training is delivered through learning collaboratives (18 months) and consultation with national trainers on model to be followed.


Guidance

For the COVID-19 pandemic

This guidance was last updated in June 2020.

Below are answers to frequently asked questions from counties and tribes offering CCS related to providing services during the COVID-19 pandemic. This information is subject to change. 

Provision of services

How should services be provided during this time?
The Division of Care and Treatment Services recommends programs determine the safest way to meet the needs of consumers. This may include providing services face-to-face, through telehealth, or through a combination of these approaches (face-to-face and telehealth). Telehealth may be used to provide services that can be delivered with functional equivalency to face-to-face services.

What does synchronous communication mean in a telehealth setting?
Synchronous refers to the delivery of health information in real time. This allows for a live discussion with the patient or provider to deliver services. Telehealth services delivered through video or phone communication are considered synchronous communications.

Are texts and emails considered telehealth?
No. Texts and emails are not considered equivalent to face-to-face services.

What documentation is needed to use telehealth in CCS?
Providers must keep accurate and complete documentation according to existing telehealth benefit policy requirements. Providers must also document the type of technology utilized and the reason for remote provision of services for each telehealth encounter. Providers are expected to exercise professional judgment and use telehealth only for services that can be delivered appropriately and effectively via remote communication. Providers must let patients know that these third-party applications can introduce privacy risks. Providers should also enable all available encryption and privacy modes when using such applications.

Who is able to provide telehealth in CCS?
All CCS provider types may deliver allowable services using telehealth. All providers are required to act within their scope of practice.

Is group therapy allowable under telehealth?
Group therapy is allowable under the temporary telehealth policy. See ForwardHealth Update 2020-15: Additional services to be provided via telehealth(PDF)

Can supervision be provided through telehealth?
Supervision may be provided through telehealth, including phone communications. Providers must keep accurate and complete documentation according to existing telehealth benefit policy requirements. Agencies must adhere to Wis. Admin. Code ch. DHS 36 requirements.

Program admissions

Have deadlines been extended to support the completion of initial enrollment documentation?
CCS programs should complete the required enrollment documentation in a timely manner. Programs should clearly document reasons for any delays to obtain information in order to complete the required documentation. The CCS program should consider the use of the abbreviated assessment during the COVID-19 pandemic for the enrollment process. The assessment may be abbreviated if the consumer has signed an admission agreement and one of the following circumstances apply:

  1. The consumer’s health or symptoms are such that only limited information can be obtained immediately.
  2. The consumer chooses not to provide information necessary to complete a comprehensive assessment at the time of application.
  3. The consumer is immediately interested in receiving only specified services that require limited information.

The abbreviated assessment shall be valid for up to three months from the date of application and should include documentation identifying the reason for the abbreviated assessment.

Can the functional screen be conducted through synchronous technology?
Yes.

Signatures

What is the guidance related to obtaining signatures?
Certified CCS counties and tribes should develop policies and procedures to obtain signatures. CCS programs should consider the following when obtaining signatures.

  • Programs can utilize verbal consent for up to 10 days for treatment via telehealth, treatment plans, assessments, and informed consents. Documentation should include what the consent addressed and the associated risks discussed.
  • Programs must obtain a signature within 10 days after receiving verbal consent. An electronic signature is allowed and encouraged. If an individual is not able to complete an electronic signature, the program must obtain a written signature through mail or email. Text messaging does not satisfy this requirement.
  • Programs should document all attempts to obtain a written signature. If the signature is not received, document the follow-up to obtain the signature.

Agencies must adhere to Wis. Admin. Code ch. DHS 36 and Wis. Admin. Code ch. DHS 94 requirements.

Recovery team meetings

Can recovery team meetings be held through telehealth?
Yes.

Discharge

What should a program do if a consumer is found not functionally eligible or no longer needs psychosocial rehabilitation services?
If an adult is found not functionally eligible on an annual functional screen, CCS programs do not have to automatically discharge the individual during the COVID-19 pandemic. The CCS program should clearly document reasons why discharge has not occurred. Document if the functional screen indicates not functionally eligible or if psychosocial rehabilitation services are no longer needed. CCS services can continue, if needed, during the COVID-19 pandemic even with a not functionally eligible finding on the functional screen.

If a child/youth is found not functionally eligible, the CCS program should review the child/youth’s Medicaid source to determine if the child/youth is enrolled in CLTS, the Katie Beckett Program, or on the CLTS Wait List. It is important that eligibility be maintained. If the child is enrolled in a waiver program, the CCS program should work with the waiver staff to ensure waiver services are not impacted.

Medicaid requires a service be medically necessary for the individual. If the individual does not need a service, it is not medically necessary, which means it is a service Medicaid doesn’t cover. Agencies should adhere to the requirements list in Wis. Admin Code § DHS 101.03(96m).

For correcting files

This guidance was last updated in January 2017.

Note: These are only suggestions regarding how to correct documentation when a discrepancy has occurred or when a document has not been completed within the timeframes specified by CCS rules and regulations. The documentation of all factors affecting why a discrepancy has occurred or why a document was not completed within the timeframes required can be reviewed on a case-by-case basis, but are not a guarantee that the documentation provided will not be given a finding during an audit or survey.

Any past discrepancies cannot be fixed retroactively

Past discrepancies can only be considered correct from the date they are amended, moving forward. This leaves the counties and tribes at risk if another audit or survey, of any type, is performed on dates prior to the error(s) being corrected.

Amending files when a discrepancy has been identified

Suggested steps to amend files when a discrepancy has been identified:

  1. Add or adjust any missing or incomplete information on the document being corrected—making sure to note the date the changes are being made—in order to become fully compliant with all CCS rules and regulations.
  2. Create documentation explaining the circumstances of the corrections; again, noting the date the changes have been made.
  3. Once the corrections have been made, all necessary signatures must be re-obtained and dated for the new document to be considered correct.

Examples of unacceptable types of corrections:

  • Back dating any signatures or documents
  • Filling in missing information without indicating when and what additions were made
Amending documents beyond the required timeframe

Suggestions for addressing documents completed beyond the required timeframe as specified in code —for example, Wis. Admin. Code § DHS 36.16(2)(a), which requires that the assessment process and the assessment summary be completed within 30 days of the receipt of an application for services, and Wis. Admin. Code § DHS 36.17(2)(a), which states that a written service plan be completed within 30 days of the consumer’s application for services:

  • Complete the documents as soon as possible.
  • Document any and all reasons, at the time they occur, why the documents could not be completed timely.

As it relates to an audit or survey, this documentation can be reviewed on a case-by-case basis to determine its validity.

Progress notes/functional documents

It is understood that all counties and tribes will have their own internal policies that govern when items, such as progress notes, must be completed.

  • Progress notes will not be given a finding on an audit if they are completed within a reasonable timeframe from the date of service and are fully compliant with all CCS and Medicaid rules and regulations regarding documentation standards.
  • Functional documents, such as the assessment or written service plan, will not be given a finding as long as they are completed within any timeframes specified by CCS rules and regulations. Please review the above section, “Amending documents beyond the required timeframe” for additional information regarding these requirements.

For residential rate setting

The guidance was last updated in February 2015.

For guidance on transitioning CCS residential billing from a per diem rate to a per-unit rate, review this document (PDF).  The document includes information on the criteria for billing for CCS residential services costs, establishing an individual and group billing rate, and appropriately documenting individual and group residential services.

For substance use treatment

This guidance was last updated in March 2020.

The Division of Care and Treatment Services, Division of Medicaid Services, and Division of Quality Assurance collaborated on the following guidance regarding the provision of substance use treatment.

Comprehensive Community Services serves individuals with mental health, substance use disorders, or both and provides psychosocial rehabilitation and treatment services, including substance use treatment service category number 13 in the ForwardHealth Update 2014-42. Comprehensive Community Services programs can provide substance use treatment two ways:

The Comprehensive Community Services program can hire or contract a staff person that is on the roster to work directly in the Comprehensive Community Services program to provide substance use treatment to Comprehensive Community Services individuals with substance use disorder.  

  • The need for substance use treatment must be identified and services to be provided must be on the Comprehensive Community Services service plan.
  • The staff person must fit the qualifications of a substance abuse professional.
    • Wis. Admin. Code § DHS 36.10(2)(g)1, 2 (with knowledge of addiction treatment), 4 (with knowledge of psychopharmacology and addiction treatment), 16 (certified alcohol and drug abuse counselors or substance abuse professionals).
    • Wis. Admin. Code § DHS 75.02(84) Substance abuse professionals include: certified substance abuse counselor, substance abuse counselor, substance abuse counselor in training, marriage and family therapy, professional counseling, and Social Worker Examining Board (MPSW) 1.09 specialty.
    • All providers are required to be licensed/certified and acting within their scope of practice.

The Comprehensive Community Services program can contract with a certified Wis. Admin. Code § DHS 75.12 day treatment services and/or certified Wis. Admin. Code § DHS 75.13 outpatient treatment service to provide substance use treatment to Comprehensive Community Services individuals with substance use disorder.  

  • The need for substance use treatment must be identified and services to be provided must be on the Comprehensive Community Services service plan.
  • The Wis. Admin. Code § DHS 75.12 and Wis. Admin. Code § DHS 75.13 services must be provided by staff that fit the qualifications of a substance abuse professional listed above.
  • The Comprehensive Community Services consumer must be dually enrolled in both Comprehensive Community Services and the Wis. Admin. Code ch. DHS 75 services and both Wis. Admin. Code ch. DHS 36 and Wis. Admin. Code ch. DHS 75 rules are followed.
  • Pertinent Wis. Admin. Code ch. DHS 75 service documentation must be shared with the Comprehensive Community Services program and filed in the Comprehensive Community Services file and retained in the Wis. Admin. Code ch. DHS 75 file.
  • The individual should be enrolled in only one Wis. Admin. Code ch. DHS 75 service, unless dual enrollment is indicated by the individual’s assessed needs.

For tribes

This guidance was last updated in October 2016.

In the past, tribal providers who chose to participate in the CCS program have been required to submit an annual CCS cost report in order to receive their annual cost settlement payment. All tribes are also Federally Qualified Health Centers (FQHC) and are also required to submit annual cost reports as an FQHC. The annual cost reports for each program are used to ensure that 100 percent of the cost for providing services is reimbursed to the tribe.

In order to simplify the annual process, tribes may dispense with the annual CCS report and simply include CCS costs on their FQHC report. Interim claims for CCS should continue to be billed under procedure codes H2017 and 99199. These claims will be paid at the interim State rate as they are today. The program should continue to follow all requirements as specified in ForwardHealth Update No. 2014-42.


Satisfaction survey materials

The three-month period for the administration of consumer satisfaction surveys for calendar year 2022 will be August through October. The time period was moved to earlier in the year so as not to overlap with year-end holidays. Survey administration may begin August 1. The due date for surveys to be entered into eInsight is October 31.

The requirements and guidelines for survey administration in the user’s guide remain in effect. More information will be added to the user's guide in the coming weeks. If you have question about the consumer satisfaction survey process, contact Laura Gebhardt.

User's Guide for Participant Satisfaction Surveys, P-00887

Survey tools

Sample cover letters


Training opportunities

CCS/CST Statewide Meeting

August 16, 2022
9:00 a.m. to 4:00 p.m.
Zoom

Coordinating Committees: Engaging Parents and Youth
Hear from parents and youth on what they need in order to be fully engaged on coordinating committees. The results of a recent statewide study on coordinating committees will be presented. Learn how you can implement changes in your community to strengthen and improve your coordinating committee.

Register by August 12, 2022

Wraparound Conference

September 7, 2022
9:00 a.m. to 12:00 p.m.
Zoom

Engage, Equip, and Empower: The Ever-Evolving Children's System of Care
The focus is on the children's system of care and the intended audience is care coordinators/service facilitators, supervisors, and administrators of counties and tribes providing CCS and/or CST services to youth and their families. The focus will be on system of care and wraparound and how they work together to engage, equip, and empower children, youth, and families. Participants will hear from people with lived experience and national experts in wraparound and system of care development. Additionally, participants will have an opportunity to share thoughts about the children’s system of care in Wisconsin.

Register by September 5, 2022

Wraparound Seminar

September 20, 2022
9:00 a.m. to 4:00 p.m.
Zoom

A Team Approach to First Episode Psychosis 
Dr. Steven Dykstra will describe a model for the identification and treatment of first episode psychosis as well as syndromes which present an increased risk of the development of psychosis. He will describe how that model has been implemented in Milwaukee County, as well as how it might be implemented in areas with lower populations and less access to specialized services. 

A Developmental Framework for Understanding and Supporting Youth
Dr. Steven Dykstra will discuss what successful development looks like, the greatest threats to that development, and how to assist families whose youth face developmental challenges. He will describe how the essential factors of safety, language, and relationships affect development. Understanding how these factors impact development leads to a clearer understanding of current efforts to support children and families and suggests ways to be more effective.  

Register by September 16, 2022

Last Revised: July 28, 2022