Revised DHS 75 Implementation

Unlike intensive outpatient services for substance use disorder (DHS 75.51), intensive outpatient services for mental health does not have its own certification through the Division of Quality Assurance and Wisconsin Medicaid does not have a specific mental health intensive outpatient benefit. DHS 75.50 includes limits of less than nine hours of treatment services per patient per week for adults, and less than six hours of treatment services per patient per week for minors. Providers wishing to be reimbursed for services that exceed these limits should consider retaining their DHS 35 certification or be certified for day treatment.

DHS 75.03(19) provides a definition of a clinical supervisor per SPS 160.02 (7) and 2017 Wisconsin Act 262.

• SPS 160.02 (7) “Clinical supervisor" means an individual who holds a clinical supervisor-in-training certificate, an intermediate clinical supervisor certificate, or an independent clinical supervisor certificate granted by the Department of Safety and Professional Services.
• 2017 Wisconsin Act 262 - Licensed physicians, psychologists, professional counselors, marriage and family therapists, and licensed clinical social workers are able to supervise SAC-IT, SAC, and CSAC without obtaining an additional credential from the Department of Safety and Professional Services as they are exempt from SPS 160-168 under Wis. Stat. § 440.88 (3m). Clinical supervision provided by professional counselors, marriage and family therapists, or clinical social workers must be within the licensed practitioner’s education, training, and experience. Practice outside of one’s competency may be professional misconduct and can be grounds for disciplinary action against one’s license under ch. MPSW 20.

With the exception of schools, locations where treatment is being provided on a consistent basis need to be listed as a branch office location on the provider’s main certificate. Branch offices are authorized to provide the same services as the main certificate. Residential and inpatient treatment services may not have branch offices due to the additional requirements specific to the location.

A DHS 75.50 certified service main office may have branch offices that can provide mental health, substance use services, or both. This is based on the language in DHS 75.50(3)(a) that states that an outpatient substance use treatment service may provide services at one or more offices.

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.

Programs converting to DHS 75.50 are expected to update policies to reflect the revised rule. The conversion process does not require submission of policies and procedures. The Division of Quality Assurance may review policies and procedures per their standard survey practice upon their next natural site visit (unless an adverse incident necessitates an earlier review). DHS understands that this is a significant transition for providers and may include updating electronic health records. If policies and procedures do not meet minimum requirements, The Division of Quality Assurance may issue a Notice of Finding for any new requirements specified in the revised code.

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 Division of Quality Assurance 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.

Except for opioid treatment programs, DHS 75.06(1) requires treatment programs to submit certification continuation fees every 24 months, instead of annually as required in the past. There has been no increase in fees.

This answer depends on the services being provided.

A DHS 75 certification is not required for an agency licensed as a DHS 124 hospital facility if any of the following apply:

• Per DHS 75.02(3), this chapter shall not apply to a general medical service that delivers substance use treatment services as an adjunct to general medical care, unless that service meets the definition of a “program” under 42 CFR 2.11.
• Per DHS 75.60 (1), office-based opioid treatment certification is not required in a hospital as defined under Wis. Stat. § 50.33 (2) and their affiliates.
• DHS 75 certification is not required for a DHS 124 hospital providing withdrawal or detoxification services in a hospital setting.

This is based on a DHS 75 perspective. Providers need to check with their payor sources to determine if there are additional reimbursement requirements including the possible need for DHS 75 certification.

A hospital that is providing substance use treatment programs such as an outpatient, residential, or inpatient program are required to have the applicable DHS 75 certification. Review DHS 75 for additional applicability and requirements for the services being provided.

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 Division of Quality Assurance would uncover non-compliance when looking at participant or staff records, the certified entity would be held responsible.

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.

Administrative rules frequently refer to other administrative rules or statutes. If a rule refers to another rule or statue, it is indicating that a provider also needs to be aware of and compliant with the corresponding rule or statute.

Yes. A 75.50 provider can be reimbursed for mental health, substance use disorders, or co-occurring treatment services.

Medicaid is working to create reimbursement for qualified treatment trainees in DHS 75 settings. Medicaid policy regarding qualified treatment trainees is expected to be published soon. It will clarify the effective date for coverage. Medicaid is currently working to secure the earliest possible effective date.

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.

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.

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

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 resources from the University of Wisconsin Center for Tobacco Research and Intervention.

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 resources from the University of Wisconsin Center for Tobacco Research and Intervention.