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LRB-3943/1
TJD:klm
2017 - 2018 LEGISLATURE
October 18, 2017 - Introduced by Committee on Health. Referred to Committee on
Health.
AB542,1,2 1An Act relating to: changes to administrative rules for mental health services
2providers and mental health services provided in schools.
Analysis by the Legislative Reference Bureau
This bill makes various changes to the administrative rules for mental health
services providers and mental health services provided in schools in order to conform
those rules to the statutory requirements for the Medical Assistance program.
Among other things, the bill changes the administrative rules to allow licensed
clinical social workers, licensed marriage and family therapists, and licensed
professional counselors to be certified as mental health service providers and
requires coverage of mental health services by these providers, as well as mental
health services by licensed physicians and psychologists, under the Medical
Assistance program to the extent that the services are provided at a school. The bill
also changes administrative rule provisions regarding reimbursement for outpatient
psychotherapy services and alcohol and other drug abuse services under the Medical
Assistance program to conform to statutory requirements, including allowing
reimbursement for certain services by certified providers regardless of whether the
school site is designated as a clinic office and regardless of whether the provider is
employed by, a contractor of, or affiliated with a clinic.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB542,1
1Section 1. DHS 105.22 (1) (ad), (ae) and (af) of the administrative code are
2created to read:
AB542,2,33 DHS 105.22 (1) (ad) A clinical social worker licensed under ch. 457, Stats.;
AB542,2,44 (ae) A marriage and family therapist licensed under s. 457.10, Stats.;
AB542,2,55 (af) A professional counselor licensed under s. 457.12, Stats.;
AB542,2 6Section 2. DHS 105.22 (1) (ak) of the administrative code is created to read:
AB542,2,97 DHS 105.22 (1) (ak) For outpatient mental health services provided in a school,
8a licensed treatment professional, as defined in s. DHS 35.03 (9g), who is not
9described in par. (a), (ad), (ae), (af), or (b).
AB542,3 10Section 3. DHS 105.22 (1) (b) of the administrative code is amended to read:
AB542,2,1311 DHS 105.22 (1) (b) A psychologist licensed under ch. 455, Stats., who is listed
12or eligible to be listed in the national register of health service providers in
13psychology
;
AB542,4 14Section 4. DHS 105.22 (3) of the administrative code is amended to read:
AB542,3,415 DHS 105.22 (3) Reimbursement for outpatient psychotherapy services.
16Reimbursement shall be made to any certified outpatient mental health clinic
17meeting the requirement under sub. (1) (c) for services rendered by any provider who
18meets the applicable requirements under ch. DHS 35 and working for that clinic,
19except that a provider certified under sub. (1) (a), (ad), (ae), (af), (b), or (bm) may be
20reimbursed directly. Except for services described in s. 49.45 (30e), Stats.,
21psychotherapy services provided by providers certified under sub. (1) (ad), (ae), and
22(af) shall be reimbursed regardless of whether the services are provided under a
23certified program. Providers certified under sub. (1) (ad), (ae), and (af) may provide
24psychotherapy services that are not described in s. 49.45 (30e), Stats., without
25supervision by another health care provider. Reimbursement shall be made for

1mental health services provided by providers certified under sub. (1) (a), (ad), (ae),
2(af), (ak), (b), or (bm) in a school regardless of whether the school site is designated
3as a clinic office and regardless of whether the provider is employed by, a contractor
4of, or affiliated with a clinic.
AB542,5 5Section 5. DHS 105.23 (1) (c) of the administrative code is amended to read:
AB542,3,76 DHS 105.23 (1) (c) A provider certified under s. DHS 105.05 (1) or 105.22 (1)
7(ad), (ae), (af), or (b).
AB542,6 8Section 6. DHS 105.23 (1) (d) of the administrative code is created to read:
AB542,3,119 DHS 105.23 (1) (d) For AODA services provided at a school, a mental health
10clinic or a provider certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (ak), (b), or
11(bm).
AB542,7 12Section 7. DHS 105.23 (2) (a) 1. and 2. of the administrative code are amended
13to read:
AB542,3,1514 DHS 105.23 (2) (a) 1. Meet the requirements in s. DHS 105.22 (1) (ad), (ae), (af)
15or
(b) or 105.05 (1); or
AB542,3,2016 2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse
17counselor certification board and work under the supervision of a provider who is a
18licensed physician or licensed psychologist and employed by the same facility, except
19that a provider who meets the requirements in s. DHS 105.22 (1) (ad), (ae), or (af) may
20provide services that are not described in s. 49.45 (30e), Stats., without supervision
.
AB542,8 21Section 8. DHS 105.23 (2) (c) of the administrative code is created to read:
AB542,3,2422 DHS 105.23 (2) (c) A provider who meets the requirements in s. DHS 105.22
23(1) (ad), (ae), (af), or (b) may provide AODA services that are not described under s.
2449.45 (30e), Stats., without supervision by another health care provider.
AB542,9 25Section 9. DHS 105.23 (3) (a) of the administrative code is amended to read:
AB542,4,2
1DHS 105.23 (3) (a) For the services of any provider employed by or under
2contract to a certified AODA facility, reimbursement shall be made to the facility; and
AB542,10 3Section 10. DHS 105.23 (3) (b) of the administrative code is amended to read:
AB542,4,104 DHS 105.23 (3) (b) For the services of any provider who is a physician or
5licensed psychologist defined
under sub. (1) (c) in private practice, reimbursement
6shall be to the physician or psychologist individual provider. A provider who meets
7the requirements under s. DHS 105.22 (1) (ad), (ae), (af), or (b) shall be reimbursed
8for AODA services, except those services described in s. 49.45 (30e), Stats.,
9regardless of whether the AODA services are provided through a certified program;
10and
AB542,11 11Section 11. DHS 105.23 (3) (c) of the administrative code is created to read:
AB542,4,1312 DHS 105.23 (3) (c) For AODA services provided at a school by a provider under
13sub. (1) (d), reimbursement shall be made to the individual provider.
AB542,12 14Section 12. DHS 107.13 (2) (a) 3. a. of the administrative code is amended to
15read:
AB542,4,2116 DHS 107.13 (2) (a) 3. a. A provider who is a licensed physician, licensed
17psychologist, or a licensed and certified advanced practice nurse prescriber, clinical
18social worker, marriage and family therapist, or professional counselor;
who is
19individually certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (b), or (bm); and who
20is working in an outpatient mental health clinic certified under s. DHS 105.22 or in
21private practice.
AB542,13 22Section 13. DHS 107.13 (2) (a) 3. c. of the administrative code is created to
23read:
AB542,5,3
1DHS 107.13 (2) (a) 3. c. For mental health services provided at a school, a
2mental health clinic or a provider certified under s. DHS 105.22 (1) (a), (ad), (ae), (af),
3(ak), (b), or (bm).
AB542,14 4Section 14. DHS 107.13 (2) (a) 4. e. of the administrative code is amended to
5read:
AB542,5,86 DHS 107.13 (2) (a) 4. e. A school. A mental health clinic or licensed treatment
7professional, as defined in s. DHS 35.03 (9g), is not required to designate the school
8site as a clinic office for mental health services provided at a school to be covered.
AB542,15 9Section 15. DHS 107.13 (2) (a) 5. of the administrative code is amended to
10read:
AB542,5,1411 DHS 107.13 (2) (a) 5. The Except for mental health services provided in a
12school, the
provider who performs psychotherapy shall engage in face-to-face
13contact with the recipient for at least 5/6 of the time for which reimbursement is
14claimed under MA;
AB542,16 15Section 16. DHS 107.13 (2) (b) 4m. of the administrative code is created to
16read:
AB542,5,1817 DHS 107.13 (2) (b) 4m. Prior authorization is not required for mental health
18services provided in a school by a provider specified under s. DHS 105.23 (1) (d).
AB542,17 19Section 17. DHS 107.13 (2) (c) 6. of the administrative code is amended to read:
AB542,6,220 DHS 107.13 (2) (c) 6. Professional psychotherapy services provided to hospital
21inpatients in general hospitals, other than group therapy and medication
22management, are not considered inpatient services. Reimbursement shall be made
23to the psychiatrist, clinical social worker, marriage and family therapist,
24professional counselor,
psychologist, or advanced practice nurse prescriber billing
25providers certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (b), or (bm) who provide

1mental health professional services to hospital inpatients in accordance with
2requirements of this subsection.
AB542,18 3Section 18. DHS 107.13 (2) (c) 7. of the administrative code is created to read:
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