The corporation counsel should provide legal advice and representation to ss. 51.42 and 51.437 boards as well as to the county board. 63 Atty. Gen. 468.
Liability, reimbursement, and collection for services provided under ss. 51.42 and 51.437 programs are discussed. 63 Atty. Gen. 560, 65 Atty. Gen. 49.
The county board of supervisors may require its approval of contracts for purchase of services by a community services board if it so specified in its coordinated plan and budget. Otherwise it may not. 69 Atty. Gen. 128.
Menominee Tribe members are eligible to participate in voluntary programs but the state cannot accept tribe members into involuntary programs on the basis of tribal court orders alone. 70 Atty. Gen. 219.
A multicounty 51.42/51.437 board may retain private legal counsel only when the corporation counsel of each county, or the district attorney of each county not having a corporation counsel, notifies the board that he or she is unable to provide specific services in a timely manner. 73 Atty. Gen. 8
The appointing authority has broad discretion to determine the interests and abilities of persons appointed to a “51.42 board." 78 Atty. Gen. 56
Counties may enter into joint agreements to collectively furnish and fund nursing home services if the agreements do not violate federal and state Medicaid statutes and regulations prohibiting supplementation. Assessments resulting from such agreements that are computed without reference to and are not attributable to purchase of services contracts involving particular Medicaid patients would not be considered supplementation. Assessments that are computed with reference to or are attributable to purchase of services contracts involving particular Medicaid patients are not permissible. The validity of hybrid assessments that do not fit solely within either one of those two categories must be determined on a case-by-case basis. OAG 4-09
Community support programs. 51.421(1)(1)
In order to provide the least restrictive and most appropriate care and treatment for persons with serious and persistent mental illness, community support programs should be available in all parts of the state. In order to integrate community support programs with other long-term care programs, community support programs shall be coordinated, to the greatest extent possible, with the protective services system in a county, with the medical assistance program under subch. IV of ch. 49
and with other care and treatment programs for persons with serious and persistent mental illness.
If funds are provided, and within the limits of the availability of funds provided under s. 51.423 (2)
, each county department under s. 51.42
shall establish a community support program. Each community support program shall use a coordinated case management system and shall provide or assure access to services for persons with serious and persistent mental illness who reside within the community. Services provided or coordinated through a community support program shall include assessment, diagnosis, identification of persons in need of services, case management, crisis intervention, psychiatric treatment including medication supervision, counseling and psychotherapy, activities of daily living, psychosocial rehabilitation which may include services provided by day treatment programs, client advocacy including assistance in applying for any financial support for which the client may be eligible, residential services and recreational activities. Services shall be provided to an individual based upon his or her treatment and psychosocial rehabilitation needs.
The department shall:
Promulgate rules establishing standards for the certified provision of community support programs by county departments under s. 51.42
, except as provided in s. 51.032
. The department shall establish standards that ensure that providers of services meet federal standards for certification of providers of community support program services under the medical assistance program, 42 USC 1396
. The department shall develop the standards in consultation with representatives of county departments under s. 51.42
, elected county officials and consumer advocates.
Ensure the development of a community support program in each county through the provision of technical assistance, consultation and funding.
Monitor the establishment and the continuing operation of community support programs and ensure that community support programs comply with the standards promulgated by rule. The department shall ensure that the persons monitoring community support programs to determine compliance with the standards are persons who are knowledgeable about treatment programs for persons with serious and persistent mental illness.
Develop and conduct training programs for community support program staff.
See also chs. DHS 63
, Wis. adm. code.
Opioid and methamphetamine treatment programs. 51.422(1)(1)
The department shall create 2 or 3 new, regional comprehensive opioid treatment programs, and in the 2017-19 fiscal biennium, shall create 2 or 3 additional regional comprehensive opioid and methamphetamine treatment programs, to provide treatment for opioid and opiate addiction and methamphetamine addiction in underserved, high-need areas. The department shall obtain and review proposals for opioid and methamphetamine treatment programs in accordance with its request-for-proposal procedures.
An opioid or methamphetamine treatment program created under this section shall offer an assessment to individuals in need of service to determine what type of treatment is needed. The program shall transition individuals to a certified residential program, if that level of treatment is necessary. The program shall provide counseling, medication-assisted treatment, including medications that have been approved by the federal food and drug administration for treating opioid addiction, and abstinence-based treatment. The program shall transition individuals who have completed treatment to county-based or private post-treatment care.
By April 1, 2016, and annually thereafter, the department shall submit to the joint committee on finance and to the appropriate standing committees under s. 13.172 (3)
a progress report on the outcomes of the program under this section.
Reporting by methadone treatment programs. 51.4223(1)(1)
Annually, a treatment program that treats addiction using methadone shall report to the department all of the following:
The ratio of treatment program staff to the number of individuals receiving methadone treatment.
The number of individuals receiving methadone treatment who are receiving behavioral health services.
The relapse rate or the average time an individual is receiving methadone treatment.
The treatment program's plan for tapering individuals off of methadone.
The average mileage that individuals receiving treatment in the methadone treatment program are traveling to receive treatment at the facility.
The number of doses of methadone that individuals carry out of the facility to take outside of treatment program staff supervision.
The number of individuals in the treatment program on each of the 3 forms of medication-assisted treatment, specifically methadone, buprenorphine-containing products, and oral or extended-release injectable naltrexone, that are approved by the federal food and drug administration.
The number of individuals who engage in a program of aftercare and the number of individuals who are treated with antagonist medication, such as oral or extended-release injectable naltrexone, as part of relapse prevention.
Any other information specified by the department.
The treatment program shall ensure that the information under sub. (1)
is provided in a manner that does not permit the identification of an individual who is receiving methadone treatment from the program.
History: 2015 a. 262
; 2017 a. 365
“Narcotic treatment service for opiate addiction" is an opioid treatment system that includes a physician who administers or dispenses a narcotic drug to a narcotic addict for treatment or detoxification treatment with a comprehensive range of medical and rehabilitation services; that is approved by the state methadone authority and the designated federal government's regulatory authority; and that is registered with the U.S. drug enforcement administration to use a narcotic drug for treatment of a narcotic addiction.
“Opioid treatment system" means a structured delivery system for providing substance abuse prevention, intervention, or treatment services and meets all of the following criteria:
The system receives funds through the state under this chapter.
The system is approved by the state methadone authority.
“State methadone authority" means the subunit of the department designated by the governor to exercise the responsibility and authority in this state for governing the treatment of a narcotic addiction with a narcotic drug.
Duration of certification.
The department shall issue a certification for an eligible opioid treatment system, as determined by the department, that remains in effect for 3 years unless suspended or revoked and coincides with the federal government certification period.
The department shall allow a narcotic treatment service for opiate addiction to contract for substance abuse counselors and clinical substance abuse counselors in lieu of employing substance abuse counselors or clinical substance abuse counselors. The narcotic treatment service for opiate addiction may enter into a contract agreement with an agency to provide counseling services. A narcotic treatment service for opiate addiction that enters into a contract agreement for counseling service shall submit to the department a copy of the agreement with each application and reapplication.
Length of treatment.
The department may not limit the length of treatment an individual receives from a narcotic treatment service for opiate addiction. Nothing in this subsection affects whether treatment is reimbursable under the Medical Assistance program under subch. IV of ch. 49
The department may not require an individual who seeks admission to a narcotic treatment service for opiate addiction to reside within a certain radius of the narcotic treatment service for opiate addiction. The department may not require an individual who resides outside of a certain radius of a narcotic treatment service for opiate addiction to request an exception to receive treatment from the narcotic treatment service for opiate addiction. Nothing in this subsection affects whether treatment is reimbursable under the Medical Assistance program under subch. IV of ch. 49
History: 2015 a. 263
; 2017 a. 365
The department shall fund, within the limits of the department's allocation for mental health services under s. 20.435 (7) (b)
and subject to this section, services for mental illness, developmental disability, alcoholism, and drug abuse to meet standards of service quality and accessibility. The department's primary responsibility is to guarantee that county departments established under either s. 51.42
receive a reasonably uniform minimum level of funding and its secondary responsibility is to fund programs which meet exceptional community needs or provide specialized or innovative services. Moneys appropriated under s. 20.435 (7) (b)
and earmarked by the department for mental health services under s. 20.435 (7) (o)
shall be allocated by the department to county departments under s. 51.42
in the manner set forth in this section.
From the appropriations under s. 20.435 (7) (b)
, the department shall distribute the funding for services provided or purchased by county departments under s. 46.23
, or 51.437
to such county departments as provided under s. 46.40
. County matching funds are required for the distributions under s. 46.40 (2)
and (9) (b)
. Each county's required match for the distributions under s. 46.40 (2)
for a year equals 9.89 percent of the total of the county's distributions under s. 46.40 (2)
for that year for which matching funds are required plus the amount the county was required by s. 46.26 (2) (c)
, 1985 stats., to spend for juvenile delinquency-related services from its distribution for 1987. Each county's required match for the distribution under s. 46.40 (9) (b)
for a year equals 9.89 percent of that county's amounts described in s. 46.40 (9) (ar) (intro.)
for that year. Matching funds may be from county tax levies, federal and state revenue sharing funds, or private donations to the counties that meet the requirements specified in sub. (5)
. Private donations may not exceed 25 percent of the total county match. If the county match is less than the amount required to generate the full amount of state and federal funds distributed for this period, the decrease in the amount of state and federal funds equals the difference between the required and the actual amount of county matching funds.
The department shall prorate the amount allocated to any county department under sub. (2)
to reflect actual federal funds available.
A private donation to a county may be used to match the state grant-in-aid under s. 46.495 (1) (d)
or under sub. (2)
only if the donation is both of the following:
Donated without restrictions as to use, unless the restrictions specify that the donation be used for a particular service and the donor neither sponsors nor operates the service.
Voluntary federated fund-raising organizations are not sponsors or operators of services within the meaning of par. (a) 2.
Any member agency of such an organization that sponsors or operates services is deemed an autonomous entity separate from the organization unless the board membership of the organization and the agency interlock.
The county allocation to match aid increases shall be included in the contract under s. 46.031 (2g)
and approved by January 1 of the year for which the funds are allocated, in order to generate state aid matching funds. All funds allocated under sub. (2)
shall be included in the contract under s. 46.031 (2g)
Each county department under either s. 51.42
, but not both, shall be treated, for the purpose of this section only, as unified with any other county department established in its jurisdiction under either s. 51.42
and shall receive an amount determined under sub. (2)
If the funds appropriated under s. 20.435 (7) (b)
for any fiscal year are insufficient to provide county departments with the sums calculated under subs. (1)
, the appropriation shall be allocated among county departments in proportion to the sums they would receive under subs. (1)
Each county department which is eligible under the state plan for medical assistance shall obtain a medical assistance provider number and shall bill for all eligible clients. A county department operating an inpatient facility shall apply for a special hospital license under s. 50.33 (2) (c)
. Under powers delegated under s. 46.10 (16)
, each county department shall retain 100 percent of all collections it makes and its providers make for care other than that provided or purchased by the state.
Each county department under s. 51.42
, or both, shall apply all funds it receives under subs. (1)
to provide the services required under ss. 51.42
and 51.45 (2) (g)
to meet the needs for service quality and accessibility of the persons in its jurisdiction, except that the county department may pay for inpatient treatment only with funds designated by the department for inpatient treatment. The county department may expand programs and services with county funds not used to match state funds under this section subject to the approval of the county board of supervisors in a county with a single-county department, except in Milwaukee County, the Milwaukee County mental health board in Milwaukee County, or the county boards of supervisors in counties with multicounty departments and with other local or private funds subject to the approval of the department and the county board of supervisors in a county with a single-county department under s. 51.42
, the Milwaukee County mental health board with a department under s. 51.42
, or the county boards of supervisors in counties with a multicounty department under s. 51.42
. The county board of supervisors in a county with a single-county department under s. 51.42
, the Milwaukee County mental health board with a department under s. 51.42
, or the county boards of supervisors in counties with a multicounty department under s. 51.42
may delegate the authority to expand programs and services to the county department under s. 51.42
. The county department under s. 51.42
shall report to the department all county funds allocated to the county department under s. 51.42
and the use of such funds. Moneys collected under s. 46.10
shall be applied to cover the costs of primary services, exceptional and specialized services or to reimburse supplemental appropriations funded by counties. County departments under ss. 51.42
shall include collections made on and after October 1, 1978, by the department that are subject to s. 46.10 (8m) (a) 3.
and are distributed to county departments under ss. 51.42
from the appropriation account under s. 20.435 (5) (gg)
, as revenues on their grant-in-aid expenditure reports to the department.
The department may not provide state aid to any county department under s. 51.42
for excessive inpatient treatment. For each county department under ss. 51.42
in each calendar year, sums expended for the 22nd and all subsequent average days of care shall be deemed excessive inpatient treatment. No inpatient treatment provided to children, adolescents, chronically mentally ill patients, patients requiring specialized care at a mental health institute, or patients at the centers for the developmentally disabled may be deemed excessive. If a patient is discharged or released and then readmitted within 60 days after such discharge or release from an inpatient facility, the number of days of care following readmission shall be added to the number of days of care before discharge or release for the purpose of calculating the total length of such patient's stay in the inpatient facility.
Funds allocated under this section and recovered from audit adjustments from a prior fiscal year may be included in subsequent certifications only to pay counties owed funds as a result of any audit adjustment. By June 30 of each year the department shall submit to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3)
, a report on funds recovered and paid out during the previous calendar year as a result of audit adjustments.
Developmental disabilities services. 51.437(1)(1)
In this section, “services" means specialized services or special adaptations of generic services directed toward the prevention and alleviation of a developmental disability or toward the social, personal, physical or economic habilitation or rehabilitation of an individual with such a disability, and includes diagnosis, evaluation, treatment, personal care, day care, domiciliary care, special living arrangements, training, sheltered employment, protective and other social and socio-legal services, follow-along services and transportation services necessary to assure delivery of services to individuals with developmental disabilities.
Responsibility of county government. 51.437(4)(a)
The county board of supervisors has the primary governmental responsibility for the well-being of those developmentally disabled citizens residing within its county and the families of the developmentally disabled insofar as the usual resultant family stresses bear on the well-being of the developmentally disabled citizen. This primary governmental responsibility is limited to the programs, services and resources that the county board of supervisors is reasonably able to provide within the limits of available state and federal funds and of county funds required to be appropriated to match state funds.
County liability for care and services purchased through or provided by a county department of developmental disabilities services established under this section shall be based upon the client's county of residence except for emergency services for which liability shall be placed with the county in which the individual is found. For the purpose of establishing county liability, “emergency services" means those services provided under the authority of s. 55.05 (4)
, 2003 stats., or s. 55.06 (11) (a)
, 2003 stats., or s. 51.15
, or 55.135
. Nothing in this paragraph prevents recovery of liability under s. 46.10
or any other statute creating liability upon the individual receiving a service or any other designated responsible party.
County department of developmental disabilities services established; integration of services. 51.437(4g)(a)(a)
Except as provided under par. (b)
and ss. 46.21 (2m) (b)
and 46.23 (3) (b)
, every county board of supervisors shall establish a county department of developmental disabilities services on a single-county or multicounty basis to furnish services within its county. Counties lacking the financial resources and professional personnel needed to provide or secure such services on a single-county basis may combine their energies and financial resources to provide these joint services and facilities with the approval of the department of health services. The county department of developmental disabilities services shall consist of a county developmental disabilities services board, a county developmental disabilities services director and necessary personnel.
A county board of supervisors may transfer the powers and duties of a county department of developmental disabilities services under this section to a county department under s. 51.42
, which shall act under s. 51.42 (3) (ar) 3.
In a county with a population of 750,000 or more, the county board of supervisors shall integrate day care programs for persons with an intellectual disability and those programs for persons with other developmental disabilities into the county developmental disabilities program.
Duties of county department of developmental disabilities services.
A county department of developmental disabilities services shall do all of the following:
Within the limits of available state and federal funds and of county funds required to be appropriated to match state funds, establish a county developmental disabilities services program. Such services shall be provided either directly or by contract.
Develop, approve and modify on a continuing basis a single-county or multicounty plan for the delivery of services, including the construction of facilities, to those citizens affected by developmental disabilities. The purpose of the plan shall be to ensure the delivery of needed services and the prevention of unnecessary duplication, fragmentation of services and waste of resources. Plans shall include, to the fullest extent possible, participation by existing and planned agencies of the state, counties, municipalities, school districts and all other public and private agencies as are required to, or may agree to, participate in the delivery of services. The plan shall, to the fullest extent possible, be coordinated with and integrated into plans developed by regional comprehensive health planning agencies.
Provide continuing counsel to public and private agencies as well as other appointed and elected bodies within the county.
Establish a program of citizen information and education concerning the problems associated with developmental disabilities.
Establish a fixed point of information and referral within the community for developmentally disabled individuals and their families. The fixed point of information and referral shall consist of a specific agency designated to provide information on the availability of services and the process by which the services may be obtained.
Enter into contracts to provide or secure services from other agencies or resources including out-of-state agencies or resources. Notwithstanding ss. 59.42 (1)
and (2) (b)
, any multicounty department of developmental disabilities services may contract for professional legal services that are necessary to carry out the duties of the multicounty department of developmental disabilities services if the corporation counsel of each county of the multicounty department of developmental disabilities services has notified the multicounty department of developmental disabilities services that he or she is unable to provide those services in a timely manner.
Annually report to the department of health services regarding the use of any contract entered into under s. 51.87
By September 30, submit for inclusion as part of the proposed county budget to the county executive or county administrator or, in those counties without a county executive or county administrator, directly to the county board of supervisors in a county with a single-county department of developmental disabilities services or the county boards of supervisors in counties with a multicounty department of developmental disabilities services a proposed budget for the succeeding calendar year covering services, including active treatment community mental health center services, based on the plan required under s. 51.42 (3) (ar) 5.
The final budget shall be submitted to the department of health services.
Develop the cost of all services which it purchases based on the standards and requirements of s. 46.036
Except in an emergency, review and approve or disapprove all admissions to nursing homes of persons with a developmental disability who are residents of the county.
If the county board of supervisors establishes an initiative to provide coordinated services under s. 59.53 (7)
, participate in the initiative, including entering into any written interagency agreements or contracts.
If authorized under s. 46.283 (1) (a) 1.
, apply to the department of health services to operate a resource center under s. 46.283
and, if the department contracts with the county under s. 46.283 (2)
, operate the resource center.
If authorized under s. 46.284 (1) (a) 1.
, apply to the department of health services to operate a care management organization under s. 46.284
and, if the department contracts with the county under s. 46.284 (2)
, operate the care management organization and, if appropriate, place funds in a risk reserve.