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Community Recovery Services: Provider Resources

The information on this page is for agencies providing and interested in providing Community Recovery Services (CRS).

CRS transitioned from the Medicaid 1915(i) State Plan Amendment to the 1905(a) State Plan Amendment in 2018. This began the identification of CRS as a psychosocial rehabilitation program.

Meetings

The Division of Care and Treatment Services hosts quarterly meetings for all CRS providers.

  • April 17, 2024: 10:00 a.m. to 12:00 p.m.
  • July 17, 2024: 10:00 a.m. to 12:00 p.m.
  • October 16, 2024: 10:00 a.m. to 12:00 p.m.

Join the Zoom meeting

Newsletters

The Division of Care and Treatment Services publishes a CRS newsletter twice per year, in the summer and winter.

Terms and definitions

There also are a few terms that are helpful for CRS providers to know. They define which services a CRS client will get and who will give them.

This service covers activities needed to allow a person to live with the most independence in community integrated housing. Others don’t do tasks for the client. Rather, clients get these services through training, cueing, and supervision. This helps the client be more independent in doing tasks.

The person-centered assessment defines what the client needs.

Examples of community living supporting services include:

  • Access to community resources
  • House cleaning
  • Meal planning and cooking
  • Medicine reminders
  • Help with watching medicine side effects
  • Money management
  • Personal hygiene
  • Shopping
  • Social and fun activities
  • Skill development
    • Crisis coping
    • Emotional regulation
    • Interpersonal
    • Parenting
    • Recovery management
  • Transportation

Services are available in different community locations: residential, business, social, and recreational settings. Residential settings include:

  • The client’s own apartment or house.
  • Supported apartment programs.
  • Adult family homes.
  • Residential care apartment complexes.
  • Community-based residential facilities with 5–16 beds—includes those whose health and safety are at risk without 24/7 supervision.

The type of residential setting the client needs is defined in the person-centered assessment. The cost of room and board and building maintenance is not included. Services also shouldn’t repeat other state plan services, including personal care and transportation.

Providers trained and certified as peer specialists serve as advocates. They also provide information and peer support for clients in outpatient and other community settings. All clients who get peer support services live at home or in a community setting.

Certified peer specialists do many tasks to help clients regain control over their lives and recovery process. They function as role models who show techniques for recovery and ongoing coping skills:

  • They offer effective recovery-based services.
  • They help clients find self-help groups.
  • They help clients get services that suit their recovery needs.
  • They teach problem solving techniques.
  • They teach clients how to find and combat negative self-talk. They also help them overcome fears.
  • They help clients build social skills in the community that will improve integration opportunities.
  • They lend unique insight into mental illness and what makes recovery possible.
  • They attend treatment team and crisis plan development meetings to promote the client using self-directed recovery tools.
  • They inform clients about community and natural supports and how to use these in the recovery process.
  • They help clients develop empowerment skills through activities that promote self-advocacy and removing stigmas.

This service covers activities needed to help clients get and keep a good job. A supported employment program agency or individual employment specialist may provide this service. Supported employment services follow the Individual Placement and Support model. The Substance Abuse and Mental Health Services Administration recognizes this model as an evidence-based practice. The model has shown to be effective at helping people get and keep a good job.

These are the core features of this service approach:

  • Participation is based on client choice. No one is removed because of prior work history, hospitalization history, substance use, symptoms, or other characteristics.
  • Supported employment is part of mental health treatment. Employment specialists meet with the client’s 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. This includes full-time and part-time jobs.
  • The job search starts soon after a client says they want to work. There are no required assessments, trainings, or intermediate work experiences (pre-vocational work units, transitional employment, or sheltered workshops).
  • Follow-along supports continue as long as the client wants and needs support.
  • Client preferences are important. Choices and decisions about work and support happen based on the client’s preferences, strengths, and experiences.

The service covers help from an employment specialist:

  • Employment intake
  • Assessment
  • Job development
  • Job placement
  • Work-related symptom management
  • Employment crisis support
  • Follow-along supports
  • Time spent with the client’s mental health treatment team and vocational rehabilitation counselor

Guiding documents

CRS providers must meet the standards identified in DHS publications and forms.

Getting started

Interested in providing CRS? New to CRS? The information below is for you.

Agency enrollment

Tribal nation and county agencies interested in providing CRS must complete the Community Recovery Services County/Tribal Agency Application, F-00203 (Word). Follow the instructions on the form to submit it to DHS.

Consumer enrollment

To be eligible for CRS, consumers must:

  • Be 14 or older.
  • Be eligible and enrolled in Medicaid or the BadgerCare Plus Standard Plan.
  • Meet functional eligibility criteria according to Mental Health/Substance Use Disorder Functional Screen or the Children’s Long Term Care Functional Screen.
  • Reside in the community.

Functional Screen Information Access (FSIA)

Wisconsin has an automated functional screen. It’s used to document functional eligibility for many state benefits, including CRS.

For access to FSIA, follow these steps:

  1. Get a Wisconsin Web Access Management System Identification (WAMS ID). If you already have a WAMS ID, skip this step.
  2. Go to the Human Services System Gateway.
  3. Select FSIA – Request Access.
  4. Complete the fillable form.
  5. Submit the form to your agency’s information security officer to process.

Program Participation System (PPS)

Effective January 1, 2020, CRS programs must enroll and discharge consumers in the PPS. CRS programs should also continue entering consumer status data fields every six months in the PPS for all CRS consumers.

For access to the PPS, follow these steps:

  1. Get a WAMS ID. If you already have a WAMS ID, skip this step.
  2. Go to the Human Services System Gateway.
  3. Select PPS – Request Access.
  4. Complete the paper request form.
  5. Submit the form to your agency’s information security officer to process

For additional information on entering consumer information in the PPS, visit the DHS PPS webpage.

The Division of Care and Treatment Services periodically may request a complete list of enrollments and discharges for auditing purposes.

Training

CRS providers must have a knowledge base and certain skills to work with CRS consumers.

CRS program staff and contracted providers must have 10 hours of orientation training within three months of beginning employment.

Orientation training must include:

  • A review of ForwardHealth updates 2010-94 (PDF) and 2018-17 (PDF).
  • A review of applicable parts of Wis. Stat. chs. 48, 51, and 55 and related administrative rules.
  • A review of the basic provisions of civil rights laws including the Americans with Disabilities Act of 1990 and the Civil Rights Act of 1964.
  • A review of current standards regarding documentation and the provisions of HIPAA.
  • Wis. Stat. § 51.30, Wis. Admin. Code ch. DHS 92, and, if applicable, 42 CFR Part 2 regarding confidentiality of treatment records.
  • A review of the provisions of Wis. Stat. § 51.61 and Wis. Admin. Code ch. DHS 94 regarding patient rights.
  • Current knowledge of mental health and substance use, such as:
    • Substance use and mental health recovery models.
    • Trauma-informed and/or recovery-oriented care.
    • Psychosocial rehabilitation.
    • Person-centered care and planning.
    • Motivational interviewing.
    • Culturally responsive care.
    • Strengths-based care and treatment.
    • Holistic wellness.
    • Peer supports.
    • De-escalation techniques.
    • Non-violent crisis interventions.
    • Psychopharmacology.

Training documentation

All CRS program staff and contracted providers must have orientation training documentation that includes the name of the employee, name of the employer, date of the training, method of training (for example, self-study, presentation, webinar, conference, etc.), a description of the course content, number of hours completed per training topic, and a signature from the tribal nation or county agency providing CRS.

Training exemptions

CRS program staff and contracted providers may be exempt from some or all the required orientation training. Exemptions are granted if duplicative training was completed through requirements of an administrative rule governing a program or facility within the last 12 months and there is documentation. To request an exemption, contact dhsdctscrs@dhs.wisconsin.gov.

Effective January 1, 2023, ongoing training is no longer required. It is recommended as a best practice that CRS program staff and contracted providers complete ongoing training relevant to providing care to CRS consumers and their needs. Ongoing training opportunities open to all CRS program staff and contracted providers will be offered annually by the Division of Care and Treatment Services. See information on ongoing training opportunities.

Consumer discharge documentation

The CRS provider must develop a written discharge summary for each consumer discharged from CRS. The written discharge summary should include:

  • The reason for discharge.
  • The consumer’s status and condition at discharge, including the consumer’s progress towards the outcomes specified in the service plan.
  • Identification of the circumstances, as determined by the consumer and providers that would suggest a need for CRS to resume.
  • Signatures. If the discharged was planned, the signature of the consumer and the tribal nation or county agency or contracted CRS service coordinator is required. If the discharged was unplanned, the signature of the tribal nation or county agency or the contracted CRS service coordinator is sufficient.

Incident reporting

CRS providers must report incidents pertaining to health and safety to the Division of Care and Treatment Services.

Submit completed incident report forms to the Division of Care and Treatment Services.

Watch the video below to learn more about the incident reporting process.

View CRS Incident Reporting Overview slides (PDF).

Annual documentation oversight

Effective June 1, 2023, documentation oversight is completed annually. This process includes a review of the documentation for 20% of the consumers served within the last year for each CRS program. Thirty days prior to the documentation oversight period for the CRS program, the Division of Care and Treatment Services will request a list of CRS consumer enrollments and discharges within the last year.

Upon receipt of this information, the Division of Care and Treatment Services will select a random sample of 20% of the CRS program’s consumers. CRS programs will have 15 business days to electronically send materials to dhsdctscrs@dhs.wisconsin.gov.

The materials submitted must include the following information for each consumer being reviewed:

  • Initial enrollment and annual recertification
    • Mental Health and Substance Use Disorder Functional Screen results
    • Assessment results
    • Service plan
  • Six-month update
    • Assessment results
    • Service plan
  • Discharge summary, if applicable

This information will be reviewed by the Division of Care and Treatment Services to ensure documentation requirements have been followed and that the materials meet the standards. This review may take up to 90 days.

When the review is complete, the CRS program will receive a “Documentation Oversight Debrief” report from the Division of Care and Treatment Services. The report will provide feedback on the program’s documentation efforts. If documentation requirements are not met, the Division of Care and Treatment Services will establish a plan of action or a corrective action plan for the CRS program.

Biennial monitoring process

CRS is not governed by a DHS administrative rule. There is no certification process for programs. As a result, Division of Care and Treatment Services staff make in-person visits to ensure CRS programs are complying with policies and procedures.

Each CRS program is visited at minimum once every two years. Prior to these monitoring visits, Division of Care and Treatment Services 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. During these monitoring visits, Division of Care and Treatment Services staff conduct in-person interviews with consumers and providers to gather information on progress toward recovery goals and barriers to providing services.

The following documentation should be shared with the Division of Care and Treatment Services for the monitoring process.

The biennial monitoring process concludes with a meeting that includes CRS program staff and Division of Care and Treatment Services staff. At this meeting, Division of Care and Treatment Services staff will review a report that provides details about the documentation reviewed, the strengths of the program, and opportunities for improvement that may require a plan of action or a corrective action plan.  

Plan of action

A plan of action is issued when the documentation oversight process and/or the biennial monitoring process shows that some or all the materials reviewed do not meet CRS program standards. A plan of action may require that a CRS program:

  • Submit additional information or documentation to the Division of Care and Treatment Services by a specified date. Failure to comply with this request may result in a corrective plan of action.
  • Make improvements to the materials as soon as possible, with the updated materials reviewed during the next review process for the CRS program.

Technical assistance and support can be requested from the Division of Care and Treatment Services to address any plan of action items identified.

Corrective action plan

A corrective action plan is issued when:

  • A plan of action was not completed by the specified date.
  • The documentation oversight and/or biennial monitoring process indicates the CRS program is out of compliance with the ForwardHealth Handbook, as well as other required policies and procedures.
  • There is indication of medical assistance fraud or overbilling.

When a corrective action plan is needed, the Division of Care and Treatment Services will coordinate a meeting with the CRS program to discuss the areas of concern. The areas in need of correction will be identified in writing and shared with the CRS program. The CRS program must draft a plan to respond to the concerns within 10 days of being notified of the concerns. This plan should be sent to DHSDCTSCRS@dhs.wisconsin.gov. The plan will be reviewed by Division of Care and Treatment Services staff. The CRS program is expected to implement the submitted plan after receiving a signed copy from the Division of Care and Treatment Services.

Technical assistance and support can be requested from the Division of Care and Treatment Services to address any corrective action plan items identified.

Contacts

For technical help and support, contact DHSDCTSCRS@dhs.wisconsin.gov.

Related topics

Last revised January 22, 2024