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Substance Use Treatment Programs: Certification

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.

Community Substance Use Services defined in Wis. Admin. Code ch. DHS 75
Section Service Application Form
75.14 Prevention Service F-03082
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
Last revised October 2, 2023