The Department of Health Services (DHS) offers technical assistance and support to county agencies participating in the Community Recovery Services (CRS) program.
Spotlight: DCTS Action Memo 2019-15
The Division of Care and Treatment Services (DCTS) issued DCTS Action Memo 2019-15 in December 2019 outlining operational changes to the CRS program, effective January 1, 2020. The changes are summarized below. View DCTS Action Memo 2019-15 for more information (PDF).
Documentation oversight requirements
DCTS will request a random sample of CRS consumer documentation from counties on an annual or biannual basis, depending on program size as listed in the table below.
|Program Size||Random Sample Requirement|
|1-9 consumers||30% of consumer materials and CRS consumer list annually (example: 1x/year)|
|10+ consumers||15% of consumer materials and CRS consumer list biannually (example: 2x/year)|
Counties have 15 business days to electronically send the most recently completed materials to DCTS.
A list of consumers in the CRS program should be sent to DCTS at the same time the requested random sample of consumer documentation is sent, either annually or biannually. This list should provide information on all consumers enrolled at that time. There is no required format for this list. DCTS has created an optional template (EXCEL) for this list.
Program Participation System
As of January 1, 2020, CRS programs must enroll and discharge consumers in the Program Participation System. Programs should also continue entering consumer status data fields every six months in the Program Participation System for all CRS consumers. For additional information on entering consumer information in the Program Participation System, visit the Program Participation System: MH/AODA webpage.
Frequently asked questions
Who is responsible for enrolling and discharging consumers in the Program Participation System?
Under the changes announced in DCTS Action Memo 2019-15, the county is now responsible for enrolling and discharging consumers in the Program Participation System.
Does the consumer's initial CRS application have to be approved by DCTS prior to billing for services?
No. The county needs to complete all CRS enrollment paperwork, including functional screen, assessment, and service plan, and ensure Medicaid enrollment prior to billing.
Can a county receive back pay for services?
Medicaid claims can be filed for services during a time when an individual is enrolled in Medicaid, their paperwork is completed and up-to-date, and there is documentation or a progress note for the corresponding service(s) that is being billed.
Will DCTS still send confirmation letters and discharge letters?
Will six-month reviews and annual recertifications still happen?
Yes. Counties and consumer team members will continue completing six-month reviews, annual recertifications, and any updates in between those two events. With the changes announced in DCTS Action Memo 2019-15, there is no longer a need to submit information about these events to DCTS upon completion.
How many CRS consumers will DCTS request documentation from if my county serves six CRS consumers? How often will this request be made?
See the table above. DCTS will request documentation from 30% of consumers once per year for programs with nine or fewer consumers.
How many CRS consumers will DCTS request documentation from if my county serves 12 CRS consumers? How often will this request be made?
See the table above. DCTS will request documentation from 15% of consumers twice per year for programs with ten or more consumers.
Why is a CRS roster needed?
Your CRS roster must be submitted to allow DCTS staff to use a random sampling system when requesting consumer documentation.
What consumer documentation will DCTS request?
See DCTS Action Memo 2019-15 for the full list. The request will always be for the most recent documentation completed. For some consumers, it may be their initial enrollment. For others, it may be their six-month review. For consumers who have discharged from CRS, it will be their discharge paperwork.
How long do I have to gather the consumer documentation and send it to DCTS after it is requested?
You have 15 business days to submit the information to DCTS.
How often will DCTS ask for billing and provider progress notes?
Requests for this documentation will made at least once every two years.
How often will DCTS conduct in-person monitoring visits?
In-person monitoring visits will happen at least once every two years. Counties and providers can request trainings, meetings, and other forms of technical assistance from DCTS whenever needed.
Is the monitoring process new?
No. DCTS has been monitoring CRS county agencies and contracted providers since 2011.
Has the incident report process changed?
No. All incident reports should be sent to DCTS within 30 business days of the occurrence or within 72 hours if the incident is critical.
All CRS program staff must be qualified to provide CRS and meet training curriculum standards developed by DCTS. The training standards are listed in DCTS Action Memo 2018-10. (PDF)
- Person-centered planning training
- Trauma-informed care
- Wisconsin Public Psychiatry Network Teleconference
Medicaid information and forms
Memos and handbooks
Provider registration forms
DCTS reviews consumer's service type, rates, and units of service. The type and quantity of services must be consistent with the consumer's assessed needs. The requested rate for services must be reasonable per the definitions in the state's Allowable Cost Policy Manual (ACPM).
Actual county and tribal costs which exceed 100% of the Medicaid Fee Schedule (MFS) for services may be captured during the cost reconciliation process provided they meet the reasonableness tests specified in the ACPM.
Registering for access to state's eligibility systems
CRS service providers should obtain access to two state information systems: Functional Screen Information Access (FSIA) and the Program Participation System.
Access to these systems is obtained through the Web Access Management System (WAMS). Obtain a WAMS ID.
Functional Screen Information Access (FSIA)
Wisconsin's automated functional screen is used to document functional eligibility for several state benefits, including CRS.
Steps to obtain access:
- Obtain a WAMS ID
- Visit the Human Services System Gateway
- Select FSIA-Access Request.
- Complete the fillable form
- Submit the fillable form to your agency's information security officer for processing
Program Participation System (PPS)
After completing the consumer's individual service plan packet, the final step for the care manager is to register the consumer into PPS. PPS provides the linkage to the state's Medicaid system. Through PPS, the care manager requests enrollment into CRS. The process is a simple, but requires access to PPS.
Steps to obtain access:
- Obtain a WAMS ID
- Visit the Human Services System Gateway
- Select PPS-Access Request
- Follow steps to complete and submit paper request form to your agency's information security officer
Use these definitions when preparing the outcomes form to indicate the services for the CRS consumer and who will be providing these services.
Community living supportive services
This service covers activities necessary to allow individuals to live with maximum independence in community integrated housing. Activities are intended to assure successful community living through utilization of skills training, cueing and/or supervision as identified by the person-centered assessment.
Community Living Supportive Services consist of meal planning/preparation; household cleaning; personal hygiene; reminders for medications and monitoring symptoms and side effects; teaching parenting skills; community resource access and utilization' emotional regulation skills; crisis coping skills; shopping; transportation; recovery management skills and education; financial management; social and recreational activities; and developing and enhancing interpersonal skills. Tasks such as meal planning, cleaning, etc., are not done for the individual, but rather they are delivered through training, cueing, and supervision to help the participant become more independent in doing these tasks.
These services are available in a variety of community locations that encompass residential, business, social, and recreational settings. Residential settings are limited to an individual’s own apartment or house, supported apartment programs, adult family homes (AFH), residential care apartment complexes (RCACs), and community-based residential facilities (CBRFs) of from 5 to 16 beds (inclusive). The type of residential setting needed is agreed upon in the person-centered assessment. Individuals needing services in a CBRF setting are those whose health and safety are at risk without 24-hour supervision. Payment is not made for room and board including the cost of building maintenance.
The services provided will not be duplicative of other State Plan services, including but not limited to personal care and transportation.
Peer support services
Individuals trained and certified as peer specialists serve as advocates, provide information, and peer support for consumers in outpatient and other community settings. All consumers receiving peer support services will reside in home and community settings.
Certified peer specialists perform a wide range of tasks to assist consumers in regaining control over their own lives and over their own recovery process. Peer specialists function as role models demonstrating techniques in recovery and in ongoing coping skills through:
- Offering effective recovery-based services
- Assisting consumers in finding self-help groups
- Assisting consumers in obtaining services that suit that individual’s recovery needs
- Teaching problem solving techniques
- Teaching consumers how to identify and combat negative self-talk and how to identify and overcome fears
- Assisting consumers in building social skills in the community that will enhance integration opportunities
- Lending their unique insight into mental illness and what makes recovery possible
- Attending treatment team and crisis plan development meetings to promote consumer's use of self-directed recovery tools
- Informing consumers about community and natural supports and how to utilize these in the recovery process
- Assisting consumers in developing empowerment skills through self-advocacy and stigma-busting activities
Supported employment services
This service covers activities necessary to assist individuals to obtain and maintain competitive employment. This service may be provided by a supported employment program agency or individual employment specialist. This service follows the Individual Placement and Support (IPS) model recognized by the Substance Abuse and Mental Health Services Administration to be an evidence-based practice. This model has been shown to be effective in helping individuals obtain and maintain competitive employment.
The core principles of this supported employment approach are:
- Participation is based on consumer choice. No one is excluded because of prior work history, hospitalization history, substance use, symptoms, or other characteristics. No one is excluded who wants to participate.
- Supported employment is closely integrated with mental health treatment. Employment specialists meet frequently with the mental health treatment team to coordinate plans.
- Competitive employment is the goal. The focus is community jobs anyone can apply for that pay at least minimum wage, including part-time and full-time jobs.
- Job search starts soon after a consumer expresses an interest in working. There are no requirements for completing extensive pre-employment assessment and training or intermediate work experiences (like pre-vocational work units, transitional employment, or sheltered workshops).
- Follow-along supports are continuous. Individualized supports to maintain employment continue as long as the consumer wants assistance.
- Consumer preferences are important. Choices and decisions about work and support are individualized based on the person’s preferences, strengths, and experiences.
The service covers supported employment intake, assessment, job development, job placement, work related symptom management, employment crisis support, and follow-along supports by an employment specialist. It also covers employment specialist time spent with the individual’s mental health treatment team and vocational rehabilitation (VR) counselor.
This service does not include services available as defined in S4 (a) (4) of the 1975 Amendments to the Education of the Handicapped Act (20 U.S.C. 1401(16), (17)) which otherwise are available to the individual through a state or local educational agency and vocational rehabilitation services which are otherwise available to the individual through a program funded under S110 of the Rehabilitation Act of 1973 (29 U.S.C. 730).
Individual Service Plan: Quality review process
Counties are encouraged to use the following ISP template but are not required to do so. If counties choose to use their own template, the domains listed in F-00202 should be included in the county document.
DHS is required by the Centers for Medicare and Medicaid Services (CMS) to ensure the health, safety, and welfare of CRS participants. This is done in partnership with local Medicaid agencies, service providers, guardians, and family members. The state uses incident reports to identify statewide or regional patterns and trends, which allow the development of interventions to decrease the likelihood of re-occurrence of such incidents. Thank you for your cooperation with the incident reporting process.
Incident reporting is always a person-specific process. If an incident involves or affects multiple CRS participants, a separate report must be submitted for each participant affected by the incident.
The process begins when the Medicaid agency, service provider, guardian, or family member observe, learn, or discover an event or situation that conforms to the definition of an incident. Providers, guardians, or family members must inform Medicaid agencies of such incidents and Medicaid agencies must both notify and report the event and the response to the assigned state contact as specified in the instructions.
Discharging a CRS consumer is an active process.
Discharge from CRS shall be based on the discharge criteria in the service plan of the consumer unless any one of the following applies:
- The consumer no longer wants psychosocial rehabilitation services.
- The whereabouts of the consumer are unknown for at least 90 calendar days despite diligent efforts to locate the consumer.
- The consumer refuses services from the CRS for at least 90 calendar days despite diligent outreach efforts to engage the consumer.
- The consumer enters a long-term care facility for medical reasons and is unlikely to return to community living.
- The consumer is deceased.
- Psychosocial rehabilitation services are no longer needed.
When a consumer is discharged from the CRS program, the consumer shall be given written notice of the discharge. The notice shall include all of the following:
- A copy of the discharge summary (as developed under "Discharge summary" below).
- Written procedures on how to reapply for CRS services.
- If a consumer is involuntarily discharged from the CRS benefit and the consumer receives Medical Assistance, the fair hearing procedures prescribed in Wis. Admin. Code § DHS 104.01(5).
For all other consumers, a written request for review of the determination of need for psychosocial rehabilitation services should be addressed to:
Wisconsin Department of Health Services
Bureau of Prevention Treatment and Recovery
1 W. Wilson Street, Room 851
PO Box 7851
Madison, WI 53707-7851
The county/tribal Medicaid agency shall develop a written discharge summary for each consumer discharged from psychosocial rehabilitation services.
- The reasons for discharge.
- The consumer's status and condition at discharge, including the consumer's progress toward the outcomes specified in the service plan.
- Documentation of the circumstances, as determined by the consumer and recovery team, that would suggest a renewed need for psychosocial rehabilitation services.
- For a planned discharge, the signature of the consumer, the service facilitator, and mental health professional or substance abuse professional.
DCTS staff make in-person visits to ensure CRS programs are complying with program policies and procedures.
Each CRS program, both county agencies and contracted CRS providers, will be visited at minimum once every two years. Prior to these program monitoring visits, DCTS staff will request documentation be sent electronically for one consumer per provider. If the provider has more than one location, documentation for one consumer per location should be sent. DCTS conducts in-person interviews with consumers and providers to gather information on progress toward recovery goals and barriers to providing services. Programs may request training and technical assistance from DCTS staff during the program monitoring process or whenever needed.
The following documentation should be shared with DHS for the monitoring process:
- Provider progress notes and the corresponding Medicaid invoices for the dates specified by DCTS.
- Community Recovery Services staff orientation and training documentation.
- Community Recovery Services Provider Agreements (F-00312 (WORD), F-00312A (WORD)).
- Provider’s current license or certification that meets provider requirements in ForwardHealth Update 2010-94 (PDF) .
- Community Recovery Services Staff Background Check Confirmation, F-02565 (WORD) .
Provide these brochures to all CRS consumers.
- Client Rights and the Grievance Procedure for Inpatient and Residential Services (PDF)
- Client Rights and the Grievance Procedure for Community Services (PDF)
Contact the DHS Client Rights Office with questions about client rights and the grievance procedure.
If you have a question about the CRS program, email DHS CRS staff.