Alcohol and Other Drug Abuse (AODA) Medically Monitored Treatment Service - Initial Certification

Contact Email

Phone

608-261-0656

Fax

608-261-0655
DHS/Division of Quality Assurance
Behavior Health Certification Section
PO Box 2969
Madison, WI 53701-2969

Medically Monitored Treatment Service is certified by the Department of Health Services under Wisconsin Administrative Code Chapter DHS 75.11.

Type

Initial

Description

A medically monitored treatment service operates as a 24-hour, community-based service providing observation, monitoring and treatment by a multidisciplinary team under supervision of a physician, with a minimum of 12 hours of counseling provided per week for each patient.

Duration

One year (Provisional)

Fees

Annual Fee:

Services/Programs Amount
1 $550.00
2 $800.00
3 $1,000.00
4 $1,175.00
5 $1,350.00
Each additional $100.00

Prerequisites

See Wisconsin Administrative Code Chapter DHS 75.11 (2) and Chapter DHS 75.11 (3)

Application Process

According to Chapter DHS 75.03 (2)(c)Determination. Upon receipt of a completed application for certification the department shall review the application for compliance with this chapter, which may include an on-site survey. Within 45 days after receiving a completed application, the department shall either approve or deny the application. If the application for certification is denied, the department shall give the individual or organization applying for certification reasons, in writing, for the denial and shall inform the individual or organization of a right to appeal that decision under par. (i).

The following applications are required for Community Substance Abuse (CSAS) certification for a Medically Monitored Treatment Service:

  • F-00514 (Word, 84 KB) - CSAS Medically Monitored Treatment Service Initial Certification Application – Chapter DHS 75.11
  • F-00523 (Word, 374 KB) - CSAS General Requirements Initial Certification Application – Chapter DHS 75.03
  • F-00438 (Word, 117 KB) - CSAS Verification of Criteria (Clinical Supervisor, Medical Director, Physician, or Service Physician) – Chapter DHS 75.02 (11)
  • F-62504* - CSAS  or Mental Health Clinic Initial Certification Application (contact 608-261-0656 for this application)
  • F-00273* (Word, 425 KB) - Behavioral Health Services Initial Certification Application – Chapter DHS 94 – Patient Rights and Resolution of Patient Grievances

*These applications are not required if the service is being added to an existing certificate.

Caregiver Background Check

A caregiver background check (CBC) is required to be completed for all applicants/legal representatives prior to the approval of any new license, certification or registration of a DQA regulated entity.

  • Review information for Licensee Applicants/License Holder Background Checks found on the Caregiver Background Check Process web page for the completion of the Background Information Disclosure (BID) form and Appendix. Complete either the Online Caregiver Background Check (CBC) process or the manual application process.
  • Also review information on the requirement for Employee Background Checks found on the Caregiver Background Check Process webpage.

WI Statutes

Chapter 51, State Alcohol, Drug Abuse, Developmental Disabilities and Mental Health Act
Chapter 51.45, Prevention and Control of Alcoholism

WI Administrative Code

Chapter DHS 12, Caregiver Background Checks
Chapter DHS 13, Reporting and Investigation of Caregiver Misconduct
Chapter DHS 75 including Appendix A, Appendix B and Appendix C
Chapter DHS 75.02, Definitions
Chapter DHS 75.03, General Requirements
Chapter DHS 75.11, Medically Monitored Treatment Service
Chapter DHS 92, Confidentiality of Treatment of Records
Chapter DHS 94, Patient Rights and Resolution of Patient Grievances

Additional Information

Visit the Alcohol and Other Drug Abuse (AODA) Treatment Programs website for more information.

Last Revised: December 12, 2017