DHS 35.24 Consumer rights.
DHS 35.25 Death reporting.
DHS 35.01
DHS 35.01
Authority and purpose. This chapter is promulgated under the authority of ss.
49.45 (2) (a) 11.,
51.04,
51.42 (7) (b) 11., and
227.11 (2) (a), Stats., to establish minimum standards for certification of outpatient mental health clinics that receive reimbursement for outpatient mental health services from the Wisconsin medical assistance and BadgerCare Plus programs or private insurance under s.
632.89 (2) (d), Stats., or that utilize federal community mental health services block grant funds under 42 USC section
300x, et.seq., or receive state community aids funds under s.
51.423 (2), Stats.
DHS 35.01 History
History: CR 06-080: cr.
Register May 2009 No. 641, eff. 6-1-09.
DHS 35.02(1)(1)
This chapter applies to public and private outpatient mental health clinics that request reimbursement for services from the Wisconsin medical assistance and BadgerCare Plus programs and from private insurance required under s.
632.89 (2), Stats., or who utilize federal community mental health services block grant funds under 42 USC section
300x, et.seq., or receive state community aids funds under s.
51.423 (2), Stats.
DHS 35.02(2)
(2) This chapter does not apply to outpatient programs governed under ch.
DHS 75 that provide services to persons who have alcohol or other drug abuse related treatment needs but do not provide mental health services.
DHS 35.02 History
History: CR 06-080: cr.
Register May 2009 No. 641, eff. 6-1-09.
DHS 35.03(1g)
(1g) “Advanced practice nurse prescriber" means an advanced practice nurse certified to issue prescription orders under s.
441.16 (2), Stats.
DHS 35.03(1m)
(1m) “Approved placement criteria" means a placement instrument that is used to develop a placement recommendation for an appropriate level of care for a consumer who has a substance use disorder such as the Wisconsin Uniform Placement Criteria (WI-UPC); the American Society of Addiction Medicine (ASAM); or similar placement instrument that is approved by the department.
DHS 35.03 Note
Note: A copy of the publications,
Wisconsin Uniform Placement Criteria and Patient Placement Criteria for the Treatment of Substance- Related Disorders, published by the American Society of Addiction Medicine (ASAM), may be obtained by writing the Bureau of Mental Health and Substance Abuse Services, 1 W. Wilson Street, Room 437, PO Box 7851, Madison, Wisconsin 53707-7851. Send inquires about the ASAM placement criteria to American Society of Addiction Medicine, 4601 N. Park Ave., Suite 101 Upper Arcade, Chevy Chase, MD 20815, or check ASAM's internet site at
www.asam.org.
DHS 35.03(2)
(2) “Available to provide outpatient mental health services" means physical presence at any of the clinic's offices or via telehealth.
DHS 35.03(4)
(4) “Clinical collaboration" means mental health professionals working together in a joint intellectual and clinical approach for the therapeutic benefit and favorable outcome of consumers.
DHS 35.03(5)
(5) “Clinical supervision" means any of the following:
DHS 35.03(5)(a)
(a) The supervised practice of psychotherapy as described under ch.
MPSW 4,
12, or
16, or
Psy 2, as applicable. For a recognized psychotherapy practitioner, “clinical supervision" means the supervised practice of psychotherapy by a licensed treatment professional of at least one hour per week.
DHS 35.03(5)(b)
(b) For any staff member, including a substance abuse counselor, who provides services to consumers who have a primary diagnosis of substance abuse, “clinical supervision" has the meaning given under s.
SPS 160.02 (6) by a clinical supervisor as defined under s.
SPS 160.02 (7).
DHS 35.03 Note
Note: Any staff member, including a substance abuse counselor-in training, substance abuse counselor, or clinical substance abuse counselor, providing services to consumers who have a primary diagnosis of substance abuse is required under s.
DHS 35.14 (4) (b) to receive clinical supervision from a clinical supervisor as defined under s.
SPS 160.02 (7).
DHS 35.03(6)
(6) “Consumer" means an individual who receives or requests outpatient mental health services from a clinic.
DHS 35.03(6m)
(6m) “Deficiency" means a failure to meet a requirement of this chapter.
DHS 35.03(7)
(7) “Department" means the Wisconsin department of health services.
DHS 35.03 Note
Note: Section
51.01 (7) Stats., defines “discharge" for a patient who is under involuntary commitment orders as meaning termination of custody and treatment obligations of the patient to the authority to which the patient was committed by court action. For voluntary admissions to a treatment program or facility, s.
51.01 (7), Stats., defines “discharge" as meaning termination of treatment obligations between the patient and the treatment program or facility.
DHS 35.03(8m)
(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.
DHS 35.03(9)
(9) “Legal representative" means any of the following:
DHS 35.03(9)(b)
(b) A health care agent as defined in s.
155.01 (4), Stats., if the principal has a finding of incapacity pursuant to s.
155.05 (2), Stats., and if the power to make decisions regarding outpatient mental health services is included in the scope of the agency.
DHS 35.03(9g)
(9g) “Licensed treatment professional" means an individual licensed as a physician under s.
448.03, Stats., who has completed a residency in psychiatry; a psychologist or a private practice school psychologist licensed under ch.
455, Stats., a marriage and family therapist licensed under s.
457.10 or
457.11, Stats., a professional counselor licensed under s.
457.12 or
457.13, Stats., an advanced practice social worker granted a certificate under s.
457.08 (2), Stats., an independent social worker licensed under s.
457.08 (3), Stats., or a clinical social worker licensed under s.
457.08 (4), Stats.; and includes any of these individuals practicing under a currently valid training or temporary license or certificate granted under applicable provisions of ch.
457, Stats. “Licensed treatment professional" does not include an individual whose license or certificate is suspended, revoked, or voluntarily surrendered, or whose license or certificate is limited or restricted, when practicing in areas prohibited by the limitation or restriction.
DHS 35.03(9m)
(9m) “Major deficiency" means the clinic has repeatedly or substantially failed to meet one or more requirements of this chapter or the department determines that an action, condition, policy or practice of the clinic or the conduct of its staff does any of the following:
DHS 35.03(9m)(a)
(a) Creates a risk of harm to a consumer or violates a consumer right created by this chapter or other state or federal statutes or rules, including any of the following:
DHS 35.03(9m)(a)3.
3. The health or safety of a consumer is in imminent danger because of any act or omission by the clinic or a staff member.
DHS 35.03(9m)(b)
(b) Submits or causes to be submitted one or more statements for purposes of obtaining certification under this chapter that were
false.
DHS 35.03(9m)(c)
(c) A license, certification or required local, state or federal approval of the clinic has been revoked or suspended or has expired, including termination of a provider's Medicaid or Medicare certification for any basis under s.
DHS 106.06 or federal law.
DHS 35.03 Note
Note: Under s.
DHS 108.02 (9) (d) 1., the department may withhold MA payments, in whole or in part, to a provider upon receipt of reliable evidence that the circumstances giving rise to the need for withholding of payments involve fraud or willful misrepresentation under the MA program. Reliable evidence of fraud or willful misrepresentation includes, but is not limited to, the filing of criminal charges for those activities against the provider or one of its agents or employees by a prosecuting attorney. The department may withhold payments without first notifying the provider of its intention to withhold the payments. A provider is entitled to a hearing under s.
DHS 106.12.
DHS 35.03 Note
Note: Willful misrepresentation under this paragraph does not include the signing of a claim for reimbursement by an authorized representative of a clinic who did not perform the service for which reimbursement is claimed, if the individual who performed the service was qualified to do so under this chapter and applicable professional licensure or certification law and was on the clinic's staff when the services were performed.
DHS 35.03(9m)(e)
(e) A staff member has a substantiated finding of caregiver misconduct as identified in chs.
DHS 12 and
13.
DHS 35.03(10)
(10) “Mental health practitioner" means a person who before January 1, 2012, holds a graduate degree from an accredited college or university in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field, and either has completed the applicable supervised practice requirements under ch.
MPSW 4,
12, or
16, or
Psy 2 or has 3,000 hours of supervised clinical post-graduate degree experience including at least 1,000 hours of face-to-face contact with consumers, and who commences work at a clinic required to be certified under this chapter no later than January 1, 2013. “Mental health practitioner" does not include an individual whose professional license is suspended, revoked, or voluntarily surrendered, or whose professional license or certificate is limited or restricted, when practicing in areas prohibited by the limitation or restriction, irrespective of whether that individual otherwise meets the terms of this definition. Whether a person's graduate degree is in a “closely related" field will be determined by the department on a case-by-case basis upon application by a clinic.
DHS 35.03(11)
(11) “Mental health professional" means a licensed treatment professional, a mental health practitioner, a qualified treatment trainee, or a recognized psychotherapy practitioner.
DHS 35.03(12)
(12) “Minor" means an individual who is 17 years old or younger.
DHS 35.03(13)
(13) “Outpatient mental health clinic" or “clinic" means an entity that is required to be certified under this chapter to receive reimbursement for outpatient mental health services to consumers.
DHS 35.03(14)
(14) “Outpatient mental health services" means the services offered or provided to a consumer, including intake, assessment, evaluation, diagnosis, treatment planning, psychotherapy and medication management.
DHS 35.03(15)
(15) “Physician" means an individual licensed under ch.
448, Stats., as a physician.
DHS 35.03(15m)
(15m) “Physician assistant" means an individual licensed under ch.
448, Stats., as a physician assistant.
DHS 35.03(16)
(16) “Prescriber" means a physician, a physician assistant acting within the conditions and limitations set forth in s.
Med 8.07, or an advanced practice nurse prescriber acting within the conditions and limitations set forth in s.
N 8.06.
DHS 35.03(17m)
(17m) “Qualified treatment trainee" means either of the following:
DHS 35.03(17m)(a)
(a) A graduate student who is enrolled in an accredited institution in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field.
DHS 35.03(17m)(b)
(b) A person with a graduate degree from an accredited institution and course work in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field who has not yet completed the applicable supervised practice requirements described under ch.
MPSW 4,
12, or
16, or
Psy 2 as applicable.
DHS 35.03(17r)
(17r) “Recognized psychotherapy practitioner" means an individual who may lawfully practice psychotherapy within the scope of a license, permit, registration or certificate granted by this state other than under ch.
455 or
457, Stats.
DHS 35.03 Note
Note: Section
457.02 (6) (a), Stats., provides that a license or certificate under ch.
457, Stats., is not required for a person to “lawfully practice within the scope of a license, permit, registration, or certificate granted by this state or the federal government." The department will recognize as a “recognized psychotherapy practitioner" for purposes of this chapter any person legally recognized as permitted to provide psychotherapy within the scope of his or her professional credential issued by a state agency.
DHS 35.03(18)
(18) “Recovery" means the process of a consumer's growth and improvement, despite a history of a mental or substance use disorder, in attitudes, values, feelings, goals, skills and behavior measured by a decrease in dysfunctional symptoms and an increase in maintaining the person's highest level of health, wellness, stability, self-determination and self-sufficiency.
DHS 35.03(19)
(19) “Staff" or “staff member" means an owner of a clinic or an individual employed by or under contract with an outpatient mental health clinic.
DHS 35.03(22hm)(a)(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 as that of an in-person contact.
DHS 35.03(22hm)(b)
(b) “Telehealth” may include real-time interactive audio-only communication.
DHS 35.03(22hm)(c)
(c) “Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail, text, or facsimile transmission.
DHS 35.03(22m)
(22m) “Treatment records" has the meaning given in s.
51.30 (1) (b), Stats., namely, all records created in the course of providing services to individuals for mental illness, which are maintained by the department, by boards and their staffs, and by treatment facilities. “Treatment records" do not include notes or records maintained for personal use by an individual providing treatment services for the department, a board, or a treatment facility if the notes or records are not available to others.
DHS 35.03(23)
(23) “Trauma" means a single experience, or an enduring or repeating event or events that results in significant distress or impairment in social, occupational, or other important areas of functioning for a person.
DHS 35.03(24)
(24) “Variance" means an alternate requirement in place of a non-statutory requirement of this chapter by the department.
DHS 35.03(25)
(25) “Waiver" means an exemption from a non-statutory requirement of this chapter by the department.
DHS 35.03 History
History: CR 06-080: cr.
Register May 2009 No. 641, eff. 6-1-09; correction in (5) (b), (20), (21), (22) made under s.
13.92 (4) (b) 7., Stats.,
Register November 2011 No. 671; correction in (16) made under s.
13.92 (4) (b) 7., Stats.,
Register February 2014 No. 698;
CR 23-053: am. (2), cr. (8m), (18m), (22hm) Register September 2023 No. 813, eff. 10-1-23. DHS 35.06(1)(1)
Public funding. Unless certified under this chapter, an outpatient mental health clinic is not eligible to receive funding from the Wisconsin medical assistance or BadgerCare Plus programs under ss.
49.45 and
49.471, Stats., federal community mental health services block grant funds under 42 USC section
300x, et. seq., or state community aids funds under s.
51.423 (2), Stats., in connection with the provision of outpatient mental health services.
DHS 35.06(2)
(2) Private insurance. An outpatient mental health clinic certified under this chapter is certified by the department within the meaning of s.
632.89 (1) (e) 1., Stats., for purposes of the provisions of s.
632.89 (2), Stats., relating to required coverage of treatment for certain conditions under certain policies issued by private insurers.
DHS 35.06 History
History: CR 06-080: cr.
Register May 2009 No. 641, eff. 6-1-09.
DHS 35.07
DHS 35.07
Location of service delivery. DHS 35.07(1)(1)
A clinic may provide outpatient mental health services at one or more offices. If a clinic provides outpatient mental health services at more than one office, all of the following apply:
DHS 35.07(1)(a)
(a) The clinic shall designate one office as its main office.
DHS 35.07(1)(b)
(b) All notices under this chapter will be sent to the main office.
DHS 35.07(1)(c)
(c) The clinic administrator shall be primarily located at the main office.
DHS 35.07(1)(e)
(e) The clinic shall adopt policies and procedures that are adequate to ensure that the clinic administrator is able to carry out the oversight and other responsibilities specified under ss.
DHS 35.123 (1),
35.14 (1), and
35.15 (1) and
(2) with respect to all other offices, given the location of the clinic's offices and their distance from the main office.
DHS 35.07(2)
(2) A clinic may provide outpatient mental health services at its offices, except in instances where therapeutic reasons are documented in the consumer file to show that it is appropriate to use an alternative location such as a nursing home, school, medical clinic, the consumer's home, or other location appropriate to support the consumer's recovery. The clinic may also deliver services via telehealth.
DHS 35.08(1)(1)
Initial application. Application to the department for initial outpatient mental health clinic certification shall be made to the department on a form provided by the department and shall include applicable fees, proof of malpractice and liability insurance for the clinic and each staff member who provides psychotherapy or who is a prescriber, and all of the information requested in the application. Additional offices do not require separate certification, but the clinic shall identify each office location and respond to any questions regarding each office in the application for initial certification.
DHS 35.08 Note
Note: Fees are set and periodically revised by the department's Division of Quality Assurance. Fees may vary based on a number of factors including the number of offices at which the clinic provides services.
