Revised DHS 75 Implementation

Improving substance use services

The revised Wis. Admin. Code ch. DHS 75 was published October 25, 2021. This administrative rule sets the minimum standards for substance use prevention, intervention, and treatment services delivered across a variety of settings and levels of care. With a goal of supporting access to services throughout the state, the new rule eases requirements for providers in many areas while maintaining safety and quality of care standards.

View the text of the revised Wis. Admin Code ch. DHS 75

Key revisions

The revised Wis. Admin. Code ch. DHS 75:

  • Revises outdated language to reflect industry standards, reduce stigma, and incorporate best practices for modern behavioral health care.
  • Increases flexibility for providers and reduces unnecessary barriers to the delivery of substance use prevention and treatment services.
  • Reduces duplicative certification requirements for integrated behavioral health care settings and residential services.
  • Incorporates standards of care for the treatment of opioid use disorders consistent with recommendations of the Governor’s Task Force on Opioid Abuse.
  • Establishes two new levels of care for integrated treatment of mental health and substance use disorders.
  • Aligns with the American Society of Addiction Medicine levels of care and more clearly defines and expands available levels of care for substance use disorder treatment services.
  • Aligns with revised Medicaid policies for behavioral health services.
  • Aligns with revised professional licensing and credentialing standards from the Wisconsin Department of Safety and Professional Services.

Revised rule effective October 1, 2022

While the revised rule was published October 25, 2021, it does not take effect until October 1, 2022. Until that date, the current version of Wis. Admin. Code ch. DHS 75 remains in effect.

 Keep in touch

Join our email list to receive information about implementation of the revised Wis. Admin. Code ch. DHS 75.

If you have questions, complete this online form.


 Attention DQA regulated entities

Providers certified under Wis. Admin. Code ch. DHS 75 are encouraged to sign up for email alerts from the Division of Quality Assurance to receive important updates regarding the transition to the regulatory standards under the revised rule.

 

Webinar series

All substance use providers are invited to attend webinars focused on the implementation of the revised Wis. Admin. Code ch. DHS 75. All of these webinars will be recorded. The videos will be posted here. 

Join our email list to receive updates on the dates and topics of future sessions in this webinar series


UWCRTI training opportunities

Integrating Tobacco Treatment into Substance Use Treatment Settings
August 19, 2022:
12 p.m. to 1 p.m. | Virtual

The revised DHS 75 requires all programs certified under DHS 75 have a written policy outlining the service’s approach to assessment and treatment of concurrent tobacco use disorders. Join the University of Wisconsin Center for Tobacco Research and Intervention for a discussion on integrating evidence-based tobacco treatments in substance use treatment settings. During the webinar, attendees will explore common myths on smoking and recovery, examine potential roadblocks of integrating tobacco treatment in substance use treatment settings, and discuss evidence-based treatments for tobacco use disorder. No registration is required. This webinar will be presented on Zoom.

Tobacco Treatment and Smoke-Free Environments Information

Bucket Approach Training

 

Frequently asked questions

Below are answers to the most commonly asked questions about the revised Wis. Admin. Code ch. DHS 75.

Background

Why was the rule revised?

The Governor's Task Force on Opioid Abuse and 2017 Executive Order #228 directed DHS to revise DHS 75 to better align with evidence-based practices standards in the industry and address gaps in service delivery related to the opioid epidemic. The last substantial revision of DHS 75 was published in 2010. Updates were needed to reflect the evolving field of substance use services and the needs of Wisconsin residents.

Who was consulted during the revision process?

The process to revise DHS 75 spanned several years. During this time, DHS:

  • Held seven listening sessions around the state in which information was collected from providers and consumers of services.
  • Convened an advisory committee with representatives from the diverse types of substance use services across the state.
  • Sought feedback from stakeholders, including the State Council on Alcohol and Other Drug Abuse, the Tribal State Collaborative for Positive Change, counties, and other provider groups.
  • Held a public comment period regarding the economic impact of the proposed revisions.
  • Hosted a public hearing on the proposed revisions.

Thank you to everyone who shared their professional and personal expertise during the rulemaking process. The input played a key role in establishing the final version of the revised DHS 75.

A team within DHS wrote and revised the text of the revised rule in a collaboration that included representatives from the Division of Care and Treatment Services, the Division of Quality Assurance, and the Division of Medicaid Services.

Why is the revised rule so different than the current rule?

Administrative rules may be revised in two ways: The first is to make changes that amend, create, or repeal specific portions of a rule text. The second type of revision is to repeal and recreate a rule. The repeal and recreate process is used when major changes are being made to a rule that differ substantially from the original text. In the case of DHS 75, there were major changes proposed to the organization of the rule, the structure for levels of care, and significant updates to outdated language and requirements. Based on discussions with DHS experts on administrative rules, it was determined that the multitude of proposed amendments would be best achieved by repealing and recreating the rule.

Is there a side-by-side comparison on exactly what has changed between the current rule and revised rule?

A side-by-side comparison of the changes made is not available since this was a complete rewrite. 

Are there resources to help me understand the changes made from the current rule to the revised rule?

Implementation

Can we transition to the new rule right away? Do we have to wait until October 2022?

Although the revised rule was published October 25, 2021, it does not take effect until October 1, 2022. All providers will transition to the revised rule on October 1, 2022. Until that date, the current version of the rule remains in effect. 

How can our agency prepare for the new rule? 

Provider agencies can take a number of steps to prepare for the October 1, 2022, implementation date.  These include but are not limited to:  
•    Reviewing the new rule.
•    Updating policies and procedures as needed Identifying any added training for staff in areas such as tobacco treatment, CLAS standards, etc.

Certification

Do agencies/providers need to apply for a new certification? 

Providers currently certified under DHS 75 will automatically be converted to the equivalent service in the revised DHS 75, effective October 1, 2022. These providers will not need to complete a new application. 

Providers currently certified under DHS 75 will automatically be converted to the equivalent service in the revised DHS 75, effective October 1, 2022. See the table below. Providers will not be required to complete a new or revised application. Each provider will receive confirmation from the Division of Quality Assurance of the conversion that will occur October 1, 2022, and any instructions related to the conversion.

A provider’s current certification will continue to the effective date of the conversion on October 1, 2022, unless revoked by DHS or surrendered by the provider. Providers will be sent revised certificates indicating the revised DHS 75 services. 

To ensure compliance with the revised requirements on October 1, 2022, providers are encouraged to review the revised DHS 75 and update their policies and procedures to be consistent with the revised rule.  

Current DHS 75 Revised DHS 75 Program
DHS 75.04 DHS 75.14 Prevention
DHS 75.07 DHS 75.57 Residential Withdrawal Management
DHS 75.09 DHS 75.58 Residential Intoxication Monitoring
DHS 75.10 DHS 75.55 Medically Managed Inpatient Treatment
DHS 75.11 DHS 75.54 Medically Monitored Residential Treatment
DHS 75.12 DHS 75.52 Day Treatment of Partial Hospitalization Treatment
DHS 75.13 DHS 75,49 Outpatient Substance Use Treatment 
(non-DHS 75.15 providers)
DHS 75.13 DHS 75.50 Outpatient Integrated Behavioral Health Treatment Service
(DHS 75.15 providers)  
DHS 75.14 DHS 75.53 Transitional Residential Treatment
DHS 75.15 DHS 75.59 Opioid Treatment Program
DHS 75.16 DHS 75.15  Intervention Service and Intoxicated Driver Service
(application need for Intoxicated Driver Service - see below)

 

What is the process to apply for a certification for one of the new services?

Providers who would like to be certified for any of the new services in DHS 75, effective October 1, 2022, will be asked to complete an application. Applications for the following new services are under development. Please watch this webpage for announcements regarding availability of applications and conversion updates for:

If we have an outpatient substance use certification (DHS 75.49), can we also be certified as DHS 75.50 (integrated outpatient)?

Providers should choose one or the other. Per DHS 75.50(2) providers who are certified under DHS 75.50 (outpatient integrated behavioral health treatment services) should not be located with DHS 75.49 (outpatient substance use treatment service) or with a DHS 35 (community mental health treatment service) at the same service location.

Is a community-based residential facility (CBRF) license still required for residential care providers?

Facilities are no longer required to be licensed as a community-based residential facility (CBRF) in addition to their DHS 75 residential certification. Facilities that choose to surrender their CBRF license and operate solely under DHS 75 should notify the appropriate DQA Bureau of Assisted Living Regional Office as soon as possible regarding their intent to surrender their CBRF license. Facilities must follow any other applicable requirements if they are certified to provide services in addition to DHS 75 covered services.
 
Facilities that surrender their CBRF license must limit the type of residents to people who are receiving care and treatment for mental health or substance use needs. Based on the number of CBRF residents who are no longer eligible for care, the CBRF may need to submit a Resident Relocation Plan and retain their CBRF license until all residents whose needs are not served under DHS 75 are relocated.

Licensing fees are not refundable. 

If our agency is certified as a DHS 124 facility, do we need a DHS 75 certification?

ForwardHealth 

Will ForwardHealth cover any new services under DHS 75 effective October 1, 2022?

ForwardHealth is exploring coverage options for new services available to DHS 75 certified providers. ForwardHealth currently is working on transitioning enrollment, no new service coverage is currently reimbursable under the rewritten code. When new service coverage becomes available, ForwardHealth will release a ForwardHealth Update explaining coverage policy for the new services.

Intoxicated Driver Program

What is the certification process to add an Intoxicated Driver Program to an agency's program certification? 

Certified programs listed in the Wisconsin Intoxicated Driver Program Directory will receive information regarding certification in their individualized conversion letter. Certified programs will be sent an application for the DHS 75.15 Intervention Service and Intoxicated Driver Service when available. The program will be asked to complete and return the application to DHS DQA Mental Health AODA. The Intoxicated Driver Program will receive their certificate from DHS showing certification effective October 1, 2022. You are not required to submit policies and procedures as specified in the application.  No certification fee is required.  Please send questions regarding the application or certification to DHS DQA Mental Health AODA.

Do agencies that provide culturally specific alternative education services need to be certified under the revised rule?

DHS 75.15(2) requires the Intoxicated Driver Program service to be certified.

DHS 75.15(2) applies to intervention services, as required by contract with DHS; intoxicated driver services, and an intervention service that requests certification.

A certified Intoxicated Driver Program Alternative Education Service may contract with individuals or another agency to provide culturally specific alternative education on their behalf.  If this occurs, the certified provider maintains the records of the individual served and completes the required Intoxicated Driver Program reporting. The certified provider would need to ensure the contracted instructor/agency are meeting the administrative rule requirements (for example, background checks, experience, documentation, course requirements, etc.) associated with any staff providing services. If DQA would uncover non-compliance when looking at participant or staff records, the certified entity would be held responsible.  

Does the revised rule require an intoxicated driver intervention service provider to provide both alternative education and intoxicated driver assessments?

No. The revised DHS 75 does not require an intoxicated driver intervention service provider to provide both alternative education and intoxicated driver assessments. The revised rule allows a provider to choose to provide alternative education and/or intoxicated driver assessments. Only the single identified county assessment agency may provide intoxicated driver assessments.

Policies

Can we use WI-UPC instead of ASAM?

Yes. The Wisconsin Uniform Placement Criteria (WI-UPC) is approved by DHS and permitted under DHS 75.03(4) as an “approved placement criteria” tool to determine levels of care.  However, it is recommended an agency consider other specific requirements by funding sources when selecting a placement tool. 

Are there requirements on where to store naloxone in a large medical facility?  

Per DHS 75.24(5), naloxone should be available within the physical structure of the certified program and readily available if needed in an emergency. Staff rostered to the DHS 75.49 through DHS 75.59 programs need to be trained on the use and administration of naloxone per DHS 75.24(5)(d). Providers also need to comply with other applicable medication-related storage regulations, including but not limited to those specific to residential programs, opioid treatment programs, and CBRF licensure.  Review general requirements and those specific to the levels of care being provided.  

Do we need a separate universal precautions policy?  

A provider needs to ensure that their universal precautions policy meets the requirements of DHS 75.19(5) personnel requirements. 

Tobacco treatment and policies

Do providers have to treat tobacco use disorders as of October, 1, 2022?

No. However, as of October 1, 2022, a service must have a written policy outlining the service’s approach to assessment and treatment for concurrent tobacco use disorders per DHS 75.24(7). Need help? View ressources from the University of Wisconsin Center for Tobacco Research and Intervention.

Do providers have to have a smoke-free facility as of October 1, 2022?

No. However, as of October 1, 2022, a service needs to have a written policy regarding whether their facility is a smoke-free environment. This is individualized to the specific service/facility’s decision on tobacco use at their site. Need help? View ressources from the University of Wisconsin Center for Tobacco Research and Intervention.


Do you have a question about the revised Wis. Admin. Code ch. DHS 75? Complete this online form.

Last Revised: August 12, 2022