Authority, purpose and applicability. DHS 75.01(1)(a)(a)
This chapter is promulgated under the authority of ss. 46.973 (2) (c)
, 51.42 (7) (b)
and 51.45 (8)
, Stats., to establish standards for community substance abuse prevention and treatment services under ss. 51.42
, Stats. Sections 51.42 (1)
and 51.45 (1)
, Stats., provide that a full continuum of substance abuse services be available to Wisconsin citizens from county departments of community programs, either directly or through written agreements or contracts that document the availability of services. This chapter provides that service recommendations for initial placement, continued stay, level of care transfer and discharge of a patient be made through the use of Wisconsin uniform placement criteria (WI-UPC), American society of addiction medicine (ASAM) placement criteria or similar placement criteria that may be approved by the department.
Use of approved placement criteria serves as a contributor to the process of obtaining prior authorization from the treatment service funding source. It does not establish funding eligibility regardless of the funding source. The results yielded by application of these criteria serve as a starting point for further consultations among the provider, patient and payer as to an initial recommendation for the type and amount of services that may be medically necessary and appropriate in the particular case. Use of WI-UPC or any other department-approved placement criteria does not replace the need to do a complete assessment and diagnosis of a patient in accordance with DSM-IV.
DHS 75.01 Note
See s. DHS 75.03 (12)
on required assessment procedures.
This chapter applies to each substance abuse service that receives funds under ch. 51
, Stats., is approved by the state methadone authority, is funded through the department as the federally designated single state agency for substance abuse services, receives substance abuse prevention and treatment funding or other funding specifically designated for providing services under ss. DHS 75.04
or is a service operated by a private agency that requests certification.
DHS 75.01 Note
In this chapter, a certified service-providing entity is called a “service" rather than a “program," as in s. 51.42
, Stats., or a “facility," as in s. 51.45
DHS 75.01 History
Cr. Register, July, 2000, No. 535
, eff. 8-1-00; CR 06-035
: am. (2), Register November 2006 No. 611
, eff. 12-1-06.
In this chapter:
“Aftercare" has the meaning prescribed for “continuing care" in this chapter.
“Alternative education" means a course of traffic safety instruction that is designed to meet the goals of a group dynamic traffic safety program or a multiple offender traffic safety program for clients that cannot be accommodated by a group dynamic traffic safety program or a multiple offender traffic safety program.
“Ambulatory detoxification service" means a medically managed or monitored and structured detoxification service, delivered on an outpatient basis, provided by a physician or other service personnel acting under the supervision of a physician.
“Applicant" means, unless otherwise indicated, a person who has initiated but not completed the intake process.
“Approved placement criteria" means WI-UPC, ASAM or similar placement criteria that may be approved by the department.
“ASAM placement criteria" means a set of placement criteria for substance abuse patients published by the American Society of Addiction Medicine.
DHS 75.02 Note
The publication, Patient Placement Criteria for the Treatment of Substance-Related Disorders
, published by the American Society of Addiction Medicine (ASAM), may be consulted at the department's bureau of prevention, treatment and recovery or at the Secretary of State's office or the Legislative Reference Bureau. 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
“Case management" means an organized process for bringing services, agencies, resources and people together within a planned framework for linking, advocating for and monitoring the provision of appropriate educational, intervention, treatment, or support services to a client with alcohol or other drug abuse problems in a coordinated, efficient and effective manner.
“Certification" means approval of a service by the department.
“Certification specialist" means a department employee responsible for certifying a service under this chapter.
“Clinical supervisor" means any of the following:
A psychologist knowledgeable in psychopharmacology and addiction treatment.
“Clinical supervision" means intermittent face-to-face contact provided on or off the site of a service between a clinical supervisor and treatment staff to ensure that each patient has an individualized treatment plan and is receiving quality care. “Clinical supervision" includes auditing of patient files, review and discussion of active cases and direct observation of treatment, and means also exercising supervisory responsibility over substance abuse counselors in regard to at least the following: counselor development, counselor skill assessment and performance evaluation, staff management and administration, and professional responsibility.
“Consultation" means discussing the aspects of the individual patient's circumstance with other professionals to assure comprehensive and quality care for the patient, consistent with the objectives in the patient's treatment plan or for purposes of making adjustments to the patient's treatment plan.
“Continuing care" means the stage of treatment in which the patient no longer requires counseling at the intensity described in ss. DHS 75.10
. Continuing care is treatment that follows a treatment plan, is designed to support and sustain the process of recovery and is provided on an outpatient basis and at a frequency agreed upon between the patient and the provider.
“Counseling" means the application of recognized theories, principles, techniques and strategies to manage and facilitate the progress of diverse patients toward mutually determined treatment goals and objectives using culturally sensitive modalities as described in s. SPS 160.02 (10m)
or s. MPSW 2.01 (10)
“Crisis intervention" means services that respond to a substance abuser's needs during acute episodes that may involve physical distress.
“Day treatment service" means a medically monitored and structured non-residential treatment service consisting of regularly scheduled sessions of various modalities such as counseling, case management, group or individual therapy, medical services and mental health services, as indicated, by interdisciplinary providers for a scheduled number of sessions per day and week.
“Department" means the Wisconsin department of health services.
“Detoxification plan" means a planned procedure based on clinical findings for managing or monitoring withdrawal from alcohol or other drugs.
“Discharge planning" means planning and coordination of treatment and social services associated with the patient's discharge from treatment, including the preparation of a discharge summary as required under s. DHS 75.03 (17)
“DSPS" means the Wisconsin department of safety and professional services.
“DSM-IV" means the Diagnostic and Statistical Manual of Mental Disorders,
4th edition, published by the American Psychiatric Association.
“Drug detoxification treatment" means the dispensing of a narcotic drug in decreasing doses to a patient to alleviate adverse physiological or psychological effects incidental to the patient's withdrawal from continuous or sustained use of a narcotic drug and as a method of bringing the individual to a narcotic drug-free state.
“Dually diagnosed" means a patient diagnosed as having a substance use disorder listed in the DSM-IV that is accompanied by dependency, trauma or dementia and a diagnosed mental disorder.
“Early intervention" means activities that take place with high-risk individuals, families or populations with the goal of averting or interrupting the further progression of problems associated with substance use or abuse. These activities may include problem identification and resolution, referral for screening, specialized education, alternative activities development, social policy development, environmental change, training and development of risk reduction skills.
“Employee assistance program service" means an intervention service provided to employees by an employer for the purpose of identifying, motivating to seek help and referring for assistance those employees whose job performance is impaired or is at risk of impairment by personal problems, such as medical, family, marital, financial, legal, emotional and substance abuse or dependency problems.
“FDA" means the U.S. food and drug administration.
“First priority for services" means that an individual assessed as needing services will be referred immediately to available treatment resources and, in the event there is a waiting list for any treatment resource, the individual will be placed on the waiting list immediately before any person not entitled to first priority for services.
“Follow-up" means a process used by a treatment provider to periodically assess the referral process and rehabilitation progress of a patient who has completed treatment, has been discharged from treatment or has been referred for concurrent services.
“Group counseling" means the application of counseling techniques which involve interaction among members of a group consisting of at least 2 patients but not more than 16 patients with a minimum of one counselor for every 8 patients.
“Hospital services" means services typically provided only in a hospital as defined in s. 50.33 (2)
“Incapacitated person" means a person who, as a result of the use of or withdrawal from alcohol or other drugs, is unconscious or has his or her judgment otherwise so impaired that he or she is incapable of making a rational decision, as evidenced objectively by the service using
such indicators as extreme physical harm or threats of harm to himself or herself, to any other person or to property.
“Intake process" means the specific tasks necessary to admit a person to a substance abuse service, such as completion of admission forms, notification of patient rights, explanation of the general nature and goals of the service, review of policies and procedures of the service and orientation.
“Intensive supervision" means a program to promote public safety and reduce incarceration and recidivism related to substance abuse that includes all of the following:
Centralized screening, review, evaluation, and monitoring of offenders by caseworkers in coordination with law enforcement, the district attorney, the courts, or the department of corrections.
Community supervision of offenders from the time of arrest and formal charging through adjudication and compliance with court orders.
Coordination of an array of interventions for the offender while under community supervision. Interventions to be coordinated may include any of the following:
A corrective sanction program for juveniles under s. 938.533
, Stats., or an intensive supervision program for juveniles under s. 938.534
, Stats., a drug court, or other similar program.
“Intervention" means a process of interrupting an action or a behavior that is harmful to an individual. “Intervention" may be a formal substance abuse service under s. DHS 75.16
, or may be included in, but is not limited to, an educational program, an employee assistance program, an intoxicated driver assessment or driver safety plan program under ch. DHS 62
, screening procedures under s. DHS 75.03 (10)
, or consultation provided to non-substance abuse professionals.
“Intoxicated person" means a person whose mental or physical functioning, as determined and documented by the service, is substantially impaired as a result of the use of alcohol or other drugs.
“Level of care" means the intensity and frequency of services provided by a service under ss. DHS 75.06
. “Intensity of services" refers to both the degree of restrictiveness for a patient to participate and to the range of specific services expected, including the involvement of medical professionals in the delivery of care. “Frequency of service" refers to how often the service may be provided or is available to the patient.
“Licensed practical nurse" means a person who is licensed under s. 441.10
, Stats., as a licensed practical nurse.
“Maintenance treatment" means the dispensing of a narcotic drug in the treatment of an individual for dependence on heroin or another morphine-like drug.
“Medical director" means a physician knowledgeable in the practice of addiction medicine, certified in addiction medicine by the American society of addiction medicine or certified in addiction psychiatry by the American board of psychiatry and neurology, who is employed as the chief medical officer for a service.
DHS 75.02 Note
Note: A medical director of a certified service who is not certified in addiction medicine or in addiction psychiatry is encouraged to work toward and complete the requirements for certification in addiction medicine by the American society of addiction, or work toward and complete the requirements for certification by the American board of psychiatry and neurology in addiction psychiatry.
“Medical personnel" means a physician, a physician assistant, nurse practitioner or other health care personnel licensed to at least the level of a registered nurse or licensed practical nurse.
“Medical screening" means the examination conducted by medical personnel of a person to ascertain eligibility for admission to a substance abuse treatment service and to assess the person's medical needs.
“Medical services" means services designed to address the medical needs of a patient, including a physical examination, evaluating, managing and monitoring health-related risks of withdrawal from alcohol and other substances, administration of medications and emergency medical care.
“Medical supervision" means regular coordination, direction and inspection by a physician of an individual's exercise of delegation to deliver medical services when the individual is not licensed to administer medical services.
“Medically directed" means the carrying out of standing orders under the supervision of a physician for delivering the medical aspects of a service, including review and consultation provided to treatment staff in regard to the admission, treatment, transfer and discharge of patients.
“Medically managed inpatient detoxification service" means a 24-hour per day observation and monitoring service, with nursing care, physician management and all of the resources of a general or specialty inpatient hospital.
“Medically managed inpatient treatment service" means a service provided in a general or specialty hospital with 24-hour per day nursing care, physician management and all the resources of a hospital approved under ch. DHS 124
“Medically managed services" means services provided or directly managed by a physician.
“Medically monitored residential detoxification service" means a 24-hour per day service in a residential setting providing detoxification service and monitoring, with care provided by a multi-disciplinary team of service personnel including 24-hour nursing care under the supervision of a physician.
“Medically monitored services" means services provided under the direction and supervision of a physician. The physician may or may not directly administer care to the patient.
“Medically monitored treatment service" means a community or hospital based, 24-hour treatment service which provides a minimum of 12 hours of counseling per patient per week, including observation, and monitoring provided by a multi-disciplinary staff under the supervision of a physician.
“Mental health professional" means an individual with training and supervised clinical experience in the field of mental health who is qualified under appendix B.
“Mental disorder" means a condition listed in DSM-IV.
“Narcotic dependent" means an individual who is physiologically and psychologically dependent on heroin or another morphine-like drug to prevent the onset of withdrawal symptoms.
“Narcotic treatment service for opiate addiction" means an organization 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 and that is approved by the state methadone authority and the designated federal regulatory authority and registered with the U.S. drug enforcement administration to use a narcotic drug for treatment of narcotic addiction.
“Nurse practitioner" means a registered nurse licensed under ch. 441
, Stats., and certified by a national certifying body approved by the Wisconsin board of nursing to perform patient services under the supervision and direction of a physician.
“Outpatient treatment service" means a non-residential treatment service that provides a variety of evaluation, diagnostic, intervention, crisis and counseling services relating to substance abuse in order to ameliorate symptoms and restore effective functioning.
“Paraprofessional" means an individual hired on the basis of skills and knowledge to perform specific functions in connection with a substance abuse service, who is not licensed, credentialed or otherwise formally recognized as a medical services provider or a mental health professional.
“Patient" means an individual who has completed the screening, placement and intake process and is receiving substance abuse treatment services.
“Patient-identifying information" means the name, address, social security number, photograph or similar information by which the identity of a patient can be determined with reasonable accuracy and speed, either directly or by reference to other publicly available information.