Type
Description
An Outpatient Mental Health Clinic is a nonresidential program for persons with problems relating to mental illness to ameliorate or remove the disability and restore more effective functioning and to prevent regression from present level of functioning with services including, but not limited to, evaluation, diagnosis, medical services and psychotherapy.
Duration
One year (Provisional).
Fees
Annual Fees:
| Services/Programs | Amount | Branch Office |
Amount |
|---|---|---|---|
| 1 | $550.00 | Tier 1 | $200.00 |
| 2 | $800.00 | Tier 2 | $500.00 |
| 3 | $1,000.00 | ||
| 4 | $1,175.00 | ||
| 5 | $1,350.00 | ||
| Each additional | $100.00 |
Instructions
See Wis. Admin. Code § DHS 35.08 on receipt of an application for initial certification or renewal of certification, the department shall review the application and its supporting documents; designate a representative to conduct an on-site survey of the program. Within 60 days after receiving a completed application for initial certification or renewal of certification, the department shall either certify the program if all requirements for certification are met or deny certification if any requirement has not been met.
The following applications are required for certification of an Outpatient Mental Health Clinic:
- Outpatient Mental Health Clinic Application - DHS 35, F-00059
- Behavioral Health Certification Section: Initial Certification Application, F-62504* (Word)
- Behavioral Health Services Initial Certification Application - DHS 94 Patient Rights and Resolution of Patient Grievances, F-00273*
* These applications are not required if the program is being added to an existing certificate.
Caregiver Background Check – This process is not required if the program is being added to an existing certificate.
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.
Wisconsin statute
Wisconsin Stat. ch. 51, State Alcohol, Drug Abuse, Developmental Disabilities and Mental Health Act
Wisconsin administrative code
Wisconsin Admin. Code ch. DHS 12, Caregiver Background Checks
Wisconsin Admin. Code ch. DHS 13, Reporting and Investigation of Caregiver Misconduct
Wisconsin Admin. Code ch. DHS 35, Outpatient Mental Health Clinics
Wisconsin Admin. Code ch. DHS 92, Confidentiality of Treatment of Records
Wisconsin Admin. Code ch. DHS 94, Patient Rights and Resolution of Patient Grievances
Program information
Visit the Mental Health Treatment Programs webpage for more information.