Wisconsin Legislature: DHS 34.03

(5) “Crisis” means a situation caused by an individual’s apparent mental disorder which results in a high level of stress or anxiety for the individual, persons providing care for the individual or the public which cannot be resolved by the available coping methods of the individual or by the efforts of those providing ordinary care or support for the individual.

(6) “Crisis plan” means a plan prepared under s. DHS 34.23 (7) for an individual at high risk of experiencing a mental health crisis so that, if a crisis occurs, staff responding to the situation will have the information and resources they need to meet the person’s individual service needs.

(7) “Department” means the Wisconsin department of health services.

(8) “Emergency mental health services” means a coordinated system of mental health services which provides an immediate response to assist a person experiencing a mental health crisis.

(8m) “Functionally equivalent” means a service provided via telehealth where the transmission of information is of sufficient quality as to be the same level of service as an in-person visit. Transmission of voices, images, data, or video must be clear and understandable.

(9) “Guardian” means the person or agency appointed by a court under ch. 54, Stats., to act as the guardian of a person.

(10) “Medical assistance” means the assistance program under 42 USC 1396 and ss. 49.43 to 49.475 and 49.49 to 49.497, Stats.

(11) “Medication administration” means the physical act of giving medication to a client by the prescribed route.

(12) “Medication monitoring” means observation to determine and identify any beneficial or undesirable effects which could be related to taking psychotropic medications.

(13) “Medically necessary” has the meaning prescribed under s. DHS 101.03 (96m).

(14) “Mental disorder” means a condition listed in the Diagnostic and Statistical Manual of Mental Disorders IV (4th edition), published by the American psychiatric association, or in the International Classification of Diseases, 9th edition, Clinical Modification, ICD-9-CM, Chapter 5, “Mental Disorders,” published by the U.S. department of health and human services.

(15) “Minor deficiency” means a determination by a representative of the department that while an aspect of the operation of the program or the conduct of the program’s personnel deviates from the requirements of this chapter, the deviation does not substantially interfere with the delivery of effective treatment to clients, create a risk of harm to clients, violate the rights of clients created by this chapter or by other state or federal law, misrepresent the nature, amount or expense of services delivered or offered, or the qualifications of the personnel offering those services, or impede effective monitoring of the program by the department.

(16) “Mobile crisis service” means a mental health service which provides immediate, on-site mental health service for individuals experiencing a mental health crisis.

(16m) “Onsite” or “onsite response” means crisis service providers are deployed in real time to the location and in the physical presence of the person in crisis.

(17) “Parent” means a biological parent, a husband who has consented to the artificial insemination of his wife under s. 891.40, Stats., a male who is presumed to be the father under s. 891.41, Stats., or has been adjudicated the child’s father by final order or judgment of a court of competent jurisdiction in this state or another state, or an adoptive parent, but does not include a person whose parental rights have been terminated.

(18) “Program” means an emergency mental health services program certified under this chapter.

(19) “Psychotropic medication” means an antipsychotic, an antidepressant, lithium carbonate or a tranquilizer or any other drug used to treat, manage or control psychiatric symptoms or disordered behavior.

Note: Examples of drugs other than an antipsychotic or antidepressant, lithium carbonate or tranquilizer used to treat, manage or control psychiatric symptoms or disordered behavior include, but are not limited to, carbamazepine (Tegretol), which is typically used for control of seizures but may be used to treat a bi-polar disorder, and propanolol (Inderal), which is typically used to control high blood pressure but may be used to treat explosive behavior or anxiety state.

(20) “Response plan” means the plan of action developed by program staff under s. DHS 34.23 (5) (a) to assist a person experiencing a mental health crisis.

(20m) “Signature” or “signed” means a signature that meets the requirements in s. 990.01 (38), Stats.

(21) “Stabilization services” means optional emergency mental health services under s. DHS 34.22 (4) which provide short-term, intensive, community-based services to avoid the need for inpatient hospitalization.

(21m)

(a) “Telehealth” means the use of telecommunications technology by a certified provider to deliver services allowable under this chapter, s. DHS 107.02 (5), and ss. 49.45 (61) and 49.46 (2) (b) 21. to 23., Stats., including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data in a functionally equivalent manner to an in-person contact.

(b) “Telehealth” may include real-time interactive audio-only communication.

(c) “Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail, text, or facsimile transmission.

(22) “Telephone services” means telephone response services to provide callers with immediate information, counseling, support and referral and to screen for situations which require in-person responses.

(23) “Walk-in services” means emergency mental health services provided at one or more locations in the county where a person can come and receive information and immediate counseling, support and referral.

Note: A potential walk-in service could be provided via telehealth if the patient walks into a facility, through which the client receives information, counseling, support, or referral through telehealth.

History: Cr. Register, September, 1996, No. 489, eff. 10-1-96; corrections in (7), (9) and (13) made under s. 13.92 (4) b) 6. and 7., Stats., Register November 2008 No. 635; CR 23-053: cr. (8m), am. (16), cr. (16m), (20m), (21m), am. (23) Register September 2023 No. 813, eff. 10-1-23; correction in (16) made under s. 35.17, Stats., Register September 2023 No. 813.

DHS 34.03 Certification.

(1) Application.

(a) A county department seeking to have its emergency mental health services program certified or recertified under this chapter, or a private agency contracting with a county department to operate an emergency mental health services program, shall submit a written application to the department.

(b) The application shall contain information and supporting documents required by the department.

Note: For a copy of the application form, write to the Behavioral Health Certification Section, Division of Quality Assurance, P.O. Box 2969, Madison, WI, 53701-2969.

(2) Initial certification process.

(a) On review of an application for initial certification, the department shall do all of the following:

1. Review the application and its supporting documents.

2. Designate a representative to conduct an on-site survey of the program, including interviewing program staff.

(b) The department’s designated representative shall do all of the following:

1. Interview a representative sample of present or former participants in the program, if any, provided that the participants indicate a willingness to be contacted.

2. Review the results of any grievances filed against the program pursuant to s. DHS 94.27 during the preceding period of certification.

3. Review a randomly selected, representative sample of client service records.

4. Review program policies and operational records, including the coordinated community services plan developed under s. DHS 34.22 (1) (a) or amended under s. DHS 34.22 (1) (c), and interview program staff to a degree sufficient to ensure that staff have knowledge of the statutes, administrative rules and standards of practice that may apply to the program and its participants.

(c) The certification survey under par. (b) shall be used to determine the extent of the program’s compliance with the standards specified in this chapter. Certification decisions shall be based on a reasonable assessment of the program. The indicators by which compliance with the standards is determined shall include all of the following:

1. Statements made by the applicant or the applicant’s designated agent, administrative personnel and staff members.

2. Documentary evidence provided by the applicant.

3. Answers to questions concerning the implementation of program policies and procedures, as well as examples of implementation provided to assist the department in making a judgment regarding the applicant’s compliance with the standards in this chapter.

4. On-site observations by surveyors from the department.

5. Reports by participants regarding the program’s operations.

6. Information from grievances filed by persons served by the program.

(d) The applicant shall make available for review by the designated representative of the department all documentation necessary to establish whether the program is in compliance with the standards in this chapter, including the written policies and procedures of the program, work schedules of staff, program appointment records, credentials of staff and treatment records.

(e) The designated representative of the department who reviews the documents under pars. (a) to (d) and interviews participants under par. (b) 1. shall preserve the confidentiality of all participant information contained in records reviewed during the certification process, in compliance with ch. DHS 92.

(3) Issuance of certification.

(a) Within 60 days after receiving a completed application for initial certification, the department shall do one of the following:

1. Certify the program if all requirements for certification are met.

2. Provisionally certify the program under sub. (10) if only minor deficiencies are found.

3. Deny certification if one or more major deficiencies are found.

(b)

1. If an application for certification is denied, the department shall provide the applicant reasons in writing for the denial and identify the requirements for certification which the program has not met.

2. A notice of denial shall state that the applicant has a right to request a hearing on that decision under sub. (12) and a right to submit a plan under par. (c) to correct program deficiencies in order to begin or continue operation of the program.

(c)

1. Within 10 days after receiving a notice of denial under par. (a), an applicant may submit to the department a plan to correct program deficiencies.

2. The plan of correction shall indicate the date on which the applicant will have remedied the deficiencies of the program. Within 60 days after that date, the department shall determine whether the corrections have been made. If the corrections have been made, the department shall certify the program.

(d) The department may limit the initial certification of a program to a period of one year.

(4) Content of certification. Certification shall be issued only for the specific program named in the application and may not be transferred to another entity. An applicant shall notify the department of all changes of administration, location, program name, services offered or any other change that may affect compliance with this section, no later than the effective date of the change.

(5) Date of certification.

(a) The date of certification shall be the date that the department determines, by means of an on-site survey, that an applicant is in compliance with this section.

(b) The department may change the date of certification if the department has made an error in the certification process. A date of certification which is adjusted under this paragraph may not be earlier than the date the written application under sub. (1) was submitted to the department.

(6) Duration of certification.

(a) Certification remains valid until it is suspended or terminated by the department in accordance with sub. (8), (9) (c), (10) (f), or (11).

(b) Certification becomes invalid due to non-submission of the biennial report or non-payment of biennial fees in accordance with sub. (7) (c).

(7) Biennial report and fees.

(a) Every 24 months, on a date determined by the department, the program shall submit a biennial report on the form provided by the department and shall submit payment of the certification continuation fees under s. 51.04, Stats.

(b) The department shall send the certification continuation materials to the provider, which the provider is expected to complete and submit to the department according to the instructions provided.

(c) A certification shall be suspended or terminated if biennial reports and fees are not submitted prior to the end of the biennial cycle.

(8) Actions against a certified program. The department may terminate or suspend a program’s certification after providing the program with prior written notice of the proposed action which shall include the reason for the proposed action and notice of opportunity for a hearing under sub. (12), whenever the department finds that any of the following has occurred:

(a) A program staff member has had sexual contact, as defined in s. 940.225 (5) (b), Stats., or sexual intercourse, as defined in s. 940.225 (5) (c), Stats., with a client.

(b) A staff member of the program requiring a professional license or certificate claimed to be licensed or certified when he or she was not, has had his or her license or certificate suspended or revoked, or has allowed his or her license or certificate to expire.

(c) A program staff member has been convicted of a criminal offense related to the provision of or claiming reimbursement for services under the medicare program under 42 CFR 430 to 456, or under this state’s or any other state’s medical assistance program or any other third party payer. In this paragraph, “convicted” means that a judgment of conviction has been entered by a federal, state or local court, regardless of whether an appeal from that judgment is pending.

(d) A staff member has been convicted of a criminal offense related to the provision of care, treatment or services to a person who is mentally ill, developmentally disabled, alcoholic or drug dependent; or has been convicted of a crime against a child under ch. 948, Stats.

(e) The program has submitted, or caused to be submitted, statements for purposes of obtaining certification under this chapter which it knew or should have known to be false.

(f) The program failed to maintain compliance with or is in substantial non-compliance with one or more of the requirements set forth in this section.

(g) A program staff member signed billing or other documents as the provider of service when the service was not provided by the program staff member.

(h) There is no documentary evidence in a client’s services file that the client received services for which bills had been submitted to a third party payer.

(9) Inspections.

(a) The department may make announced and unannounced inspections of the program to verify continuing compliance with this chapter or to investigate complaints received regarding the services provided by the program.

(b) Inspections shall minimize any disruption to the normal functioning of the program.

(c) If the department determines during an inspection that the program has one or more major deficiencies, or it finds that any of the conditions stated in sub. (8) or (11) exist, it may suspend or terminate the program’s certification.

(d) If the department determines during an inspection that the program has one or more minor deficiencies, it may issue a notice of deficiency to the program and offer the program provisional certification pursuant to sub. (10).