DHS 63.17 Program evaluation.
Ch. DHS 63 Note
Note: Chapter HSS 63 was renumbered chapter HFS 63 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats.,
Register, July, 1997, No. 499. Chapter HFS 63 was renumbered to chapter DHS 63 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635.
DHS 63.01(1)(1)
Authority and purpose. This chapter is promulgated under authority set out in ss.
51.42 (7) (b),
51.421 (3) (a) and
(c), and
227.11 (2) (a), Stats., to establish standards for community support programs under s.
51.421, Stats. These programs are for chronically mentally ill persons living in the community. The purpose of a community support program is to provide effective and easily accessible treatment, rehabilitation and support services in the community where persons with chronic mental illness live and work.
DHS 63.01(2)
(2) To whom this chapter applies. This chapter applies to any county establishing a community support program under s.
51.421, Stats., which wishes to receive reimbursement under the Wisconsin medical assistance program for community support program services, if medical assistance reimbursement is available for those services.
DHS 63.01 History
History: Cr.
Register, April, 1989, No. 400, eff. 5-1-89.
DHS 63.02
DHS 63.02
Definitions. In this chapter:
DHS 63.02(1)
(1) “Alcoholic" has the meaning prescribed in s.
51.01 (1), Stats., namely, a person who is suffering from alcoholism.
DHS 63.02(2)
(2) “Alcoholism" has the meaning prescribed in s.
51.01 (1m), Stats., namely, a disease which is characterized by the dependency of a person on the drug alcohol, to the extent that the person's health is substantially impaired or endangered or his or her social or economic functioning is substantially disrupted.
DHS 63.02(3)
(3) “Applicant" means a person who has begun, but not completed, the admissions process under s.
DHS 63.09.
DHS 63.02(4)
(4) “Assessment" means the process used to evaluate a client's presenting problems with an accompanying description of the reported or observed conditions which led to the classification or diagnosis of the client's chronic mental illness.
DHS 63.02(5)
(5) “Case management" means an organized process for providing a full range of appropriate treatment, rehabilitation and support services to a client in a planned, coordinated, efficient and effective manner.
DHS 63.02(6)
(6) “Certification" means the approval of a community support program by the department.
DHS 63.02(7)
(7) “Chronic mental illness" means a mental illness which is severe in degree and persistent in duration, which causes a substantially diminished level of functioning in the primary aspects of daily living and an inability to cope with the ordinary demands of life, which may lead to an inability to maintain stable adjustment and independent functioning without long-term treatment and support and which may be of lifelong duration. “Chronic mental illness" includes schizophrenia as well as a wide spectrum of psychotic and other severely disabling psychiatric diagnostic categories, but does not include organic mental disorders or a primary diagnosis of intellectual disability or of alcohol or drug dependence.
DHS 63.02(8)
(8) “Client" means an individual who has completed the admissions process under s.
DHS 63.09 and is receiving treatment or services for mental illness.
DHS 63.02(9)
(9) “Community support program" or “CSP" means a coordinated care and treatment program which provides a range of treatment, rehabilitation and support services through an identified treatment program and staff to ensure ongoing therapeutic involvement, individualized treatment, rehabilitation and support services in the community for persons with chronic mental illness.
DHS 63.02(10)
(10) “County department" means a county department of community programs established under s.
51.42, Stats.
DHS 63.02(11)
(11) “Department" means the Wisconsin department of health services.
DHS 63.02(13)
(13) “Drug dependence" has the meaning prescribed in s.
46.973 (1) (c), Stats., namely, a condition arising from the periodic or continuous use of a drug which may result in psychic or physical dependence which would affect or potentially affect the public health, safety or welfare.
DHS 63.02(13m)
(13m) “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 63.02(14)
(14) “Mental illness" means mental disorder to such an extent that an afflicted person requires care and treatment for his or her own welfare or the welfare of others or of the community. For purposes of involuntary commitment, “mental illness" means a substantial disorder of thought, mood, perception, orientation or memory which grossly impairs judgment, behavior, capacity to recognize reality or ability to meet the ordinary demands of life, but does not include organic mental disorder or a primary diagnosis of intellectual disability, or of alcohol or drug dependence.
DHS 63.02(15)
(15) “Organic mental disorder" means a disorder which has as its essential feature psychological or behavioral abnormalities, or both, associated with transient or permanent dysfunction of the brain that prevents a person from adequately providing for his or her own care.
DHS 63.02(16)
(16) “Outreach" means procedures for identifying and contacting chronically mentally ill persons who are in need of CSP treatment and services, including referral agreements with psychiatric inpatient units, outpatient treatment clinics, and other community treatment and service providers.
DHS 63.02(18)
(18) “Service provider" means a county department or a private agency that provides one or more services under this chapter.
DHS 63.02(19)
(19) “Supervision” means intermittent contact between a supervisor and a staff member to review the work of the staff member.
DHS 63.02(20)(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 of that of an in-person contact.
DHS 63.02(20)(b)
(b) “Telehealth” may include real-time interactive audio-only communication.
DHS 63.02(20)(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 63.02 History
History: Cr.
Register, April, 1989, No. 400, eff. 5-1-89; correction in (11) made under s.
13.92 (4) (b) 6., Stats.,
Register November 2008 No. 635;
2019 Wis. Act 1: am. (7), (12), (14)
Register May 2019 No. 761, eff. 6-1-19;
CR 20-068: r. and recr. (12)
Register December 2021 No. 792, eff. 1-1-22;
CR 23-053: cr. (13m), (18m), am. (19), cr. (20)
Register September 2023 No. 813, eff. 10-1-23.
DHS 63.03(1)(1)
Application. A county department shall submit written application to the department to initiate the CSP certification process.
DHS 63.03 Note
Note: The format for the written application can be obtained from the CSP Unit, Bureau of Community Mental Health, Division of Disability and Elder Services, P.O. Box 7851, Madison, WI 53707.
DHS 63.03(2)(a)
(a) The department shall review the application submitted under sub.
(1) to determine whether the requirements for certification set forth in this chapter have been met.
DHS 63.03(2)(b)
(b) A CSP shall make available for the department's review all documentation necessary to establish the CSP's compliance with this chapter.
DHS 63.03(3)(a)
(a) Within 60 days after receiving a complete application for certification under sub.
(1), the department shall either certify the CSP if all requirements for certification have been met or deny certification if requirements for certification have not been met. If the application for certification is denied, the department shall give the applicant reasons, in writing, for the denial. The denial notice shall specify the requirements under this chapter which the CSP has not met, shall specify the CSP's right to request a hearing in accordance with s.
DHS 63.04 (3), and shall require the CSP to submit a plan to correct program deficiencies in accordance with par.
(b).
DHS 63.03(3)(b)
(b) Within 10 days after receiving a notice of denial under par.
(a), a CSP shall inform the department of a plan to correct program deficiencies and the date by which the corrections will be made.
DHS 63.03(3)(c)
(c) Within 60 days after the planned date for correcting the deficiencies noted under par.
(a), the department shall conduct an on-site inspection of the CSP to determine whether the deficiencies have been corrected.
DHS 63.03(4)
(4) Content of certification. Certification shall be issued only for the location and program named and may not be transferred or assigned to another program. A CSP shall notify the department of a change of administration, ownership, location, program name or any other program change that may affect compliance with this chapter no later than the effective date of the change.
DHS 63.03(5)(a)
(a) The date of certification shall be the date that the department determines, by means of an on-site survey, that a CSP is in compliance with this chapter.
DHS 63.03(5)(b)
(b) The department may change the date of certification if the department 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.
DHS 63.03(6)(a)
(a) Certification remains valid until it is terminated or suspended by the department in accordance with s.
DHS 63.04.
DHS 63.03(6)(b)
(b) Certification becomes invalid due to non-submission of the biennial report or non-payment of biennial fees in accordance with sub.
(7) (c).
DHS 63.03(7)(a)
(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 certification continuation fees under s.
51.04, Stats.
DHS 63.03(7)(b)
(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 instructions provided.
DHS 63.03(7)(c)
(c) A certification will be suspended or terminated if biennial reports and fees are not submitted prior to the end of the biennial cycle.
DHS 63.03 History
History: Cr.
Register, April, 1989, No. 400, eff. 5-1-89;
CR 22-078: r. and recr. (6), cr. (7)
Register July 2023 No. 811, eff. 8-1-23.
DHS 63.04
DHS 63.04
Termination, suspension or denial of certification. DHS 63.04(1)(1)
Definition. In this section, “suspension" means a temporary withdrawal of certification.
DHS 63.04(2)
(2)
Termination, suspension, or denial of certification after prior notice and requested hearing. The department may terminate, suspend, or deny a CSP's certification after providing the CSP with prior written notice of the proposed action which includes the reason for the proposed action and a notice of opportunity for a hearing whenever the department finds that:
DHS 63.04(2)(b)
(b) A staff member requiring professional licensure claimed to be licensed when he or she was not licensed, has had his or her license suspended or revoked, or has allowed his or her license to expire;
DHS 63.04(2)(c)
(c) A CSP 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 USC 1395 and
42 CFR 400 to
421, or under this state's or any other state's medical assistance program. For purposes of 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;
DHS 63.04(2)(d)
(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;
DHS 63.04(2)(e)
(e) The program 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;
DHS 63.04(2)(f)
(f) The program failed to maintain compliance with one or more of the standards set forth in this chapter;
DHS 63.04(2)(g)
(g) Any of the program's practitioners signed billing or other documents as the provider of service when the service was not provided by the practitioner; or
DHS 63.04(2)(h)
(h) There is no documentary evidence in a client's treatment file that the client received services which were billed for.
DHS 63.04(3)
(3)
Right to a hearing. In the event that the department denies, terminates, or suspends a certification, a CSP may request a hearing under s.
227.42, Stats. The request for a hearing shall be submitted in writing to and received by the department of administration's division of hearings and appeals within 30 days after the date on the notice required under sub.
(2).
DHS 63.04 Note
Note: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, WI 53707.
DHS 63.04 History
History: Cr.
Register, April, 1989, No. 400, eff. 5-1-89;
CR 22-078: am. (2) (intro.), (3)
Register July 2023 No. 811, eff. 8-1-23.
DHS 63.05(1)(1)
Policy. The department may grant a waiver of any requirement of this chapter when the department determines that granting a waiver would not diminish the effectiveness of the CSP, violate the purposes of the program, or adversely affect clients' health and welfare. The department may not grant a waiver of clients' rights under ch.
DHS 94 or under other administrative rules, state statutes or federal regulations.
DHS 63.05(2)
(2) Waiver. A CSP may submit a request to the department for a waiver of any requirement in this chapter, except a requirement specified under s.
DHS 63.08 (1) (a).
DHS 63.05(3)
(3) Application. An application for a waiver under sub.
(2) shall be made in writing to the department and shall specify:
1. The rule from which the waiver is requested;
2. The time-period for which the waiver is requested;
3. Any alternative action which the CSP proposes;
4. The reason for the request; and
5. Assurances that sub. (1) would be satisfied.
DHS 63.05 Note
Note: A request for a waiver should be addressed to the Behavioral Health Certification Section, Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969.
DHS 63.05(4)(a)
(a) The department may require additional information from the CSP before acting on a request for a waiver.
DHS 63.05(4)(b)
(b) The department shall grant or deny each request for waiver in writing. Notice of denial shall contain the reasons for denial. If a notice of a denial is not issued within 60 days after the receipt of a complete request, the waiver shall be automatically approved.
DHS 63.05(4)(c)
(c) The department may impose any conditions on the granting of a waiver which it deems necessary.
DHS 63.05(4)(e)
(e) The department's decision to grant or deny a waiver shall be final.
DHS 63.05 History
History: Cr.
Register, April, 1989, No. 400, eff. 5-1-89; correction in (1) made under s.
13.92 (4) (b) 7., Stats.,
Register November 2008 No. 635.
