Select the form in the table below for application information for each service identified in Wis. Admin. Code ch. DHS 75 – Community Substance Use Service Standards.
Certification may be required prior to an entity receiving reimbursement under Wis. Stat. ch. 51, third party reimbursement, and/or reimbursement for participants in the Medicaid program.
For mental health information, go to Mental Health Treatment Programs: Certification Information.
|75.15||Intervention Service and Intoxicated Driver Service||F-03082|
|75.49||Outpatient Substance Use Treatment Service||F-03082A|
|75.50||Outpatient Integrated Behavioral Health Treatment Service||F-03082A|
|75.51||Intensive Outpatient Treatment Service||F-03082A|
|75.52||Day Treatment or Partial Hospitalization Treatment Service||F-03082A|
|75.53||Transitional Residential Treatment Service||F-03082E (Word)|
|75.54||Medically Monitored Residential Treatment Service||F-03082E (Word)|
|75.55||Medically Managed Inpatient Treatment Service||F-03082E (Word)|
|75.56||Adult Residential Integrated Behavioral Health Stabilization Service||F-03082E (Word)|
|75.57||Residential Withdrawal Management Service||F-03082E (Word)|
|75.58||Residential Intoxication Monitoring Service||F-03082E (Word)|
|75.59||Opioid Treatment Program||F-03082B|
|75.59||Opioid Treatment Program - Mobile Unit Application||F-03082F (Word)|
|75.60||Office-based Opioid Treatment Service||F-03082D|
|All Services||Branch Office or School Branch Application||F-03082C|