Wisconsin Legislature: DHS 75.56(3)(c)

(a) An intensive outpatient treatment service may provide case management and outreach services in the community or other locations, provided all requirements of this chapter are able to be met in that setting.

(b) A service that provides intensive outpatient case management and outreach services in the community shall have written policies and procedures for community-based service delivery.

(c) A service that provides intensive outpatient case management and outreach services in the community shall provide annual training for all staff that deliver services in the community regarding in-home and community safety and avoiding sexual or other exploitative relationships with patients. A record of each training shall be available to the department upon request.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.52 Day treatment or partial hospitalization treatment service. In this section, “day treatment service” or “partial hospitalization service” means a medically-monitored and non-residential substance use treatment service totaling 15 or more hours of treatment services per patient per week for adults and 12 or more hours of treatment services per patient per week for minors, in which substance use and mental health treatment personnel provide assessment and treatment for substance use and co-occurring mental health disorders under the oversight of a medical director. Day treatment or partial hospitalization services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.53 Transitional residential treatment service. In this section, “transitional residential treatment service” means a residential substance use treatment service totaling 6 or more hours of treatment services per patient per week, in which substance use treatment personnel provide assessment and treatment for substance use disorders in a structured and recovery-supportive 24-hour residential setting, under the oversight of a physician or a prescriber knowledgeable in addiction, providing medical supervision and clinical consultation. Transitional residential treatment services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.54 Medically monitored residential treatment service. In this section, “medically monitored residential treatment service” means a residential substance use treatment service totaling 20 or more hours of treatment services per patient per week, in which substance use and mental health treatment personnel provide assessment and treatment for substance use disorders and co-occurring mental health disorders, under the oversight of a medical director. Medically monitored residential treatment services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning. Medically monitored residential treatment services are delivered in a 24-hour clinical residential setting. This level of care is appropriate for patients who require a 24-hour supportive treatment environment to develop sufficient recovery skills and address functional limitations to prevent imminent relapse or dangerous substance use.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.55 Medically managed inpatient treatment. In this section, “medically managed inpatient treatment service” means an inpatient substance use treatment service delivered under the oversight of a medical director in a hospital setting, and includes 24-hour nursing care, physician management, and the availability of sufficient resources to respond to an acute medical or behavioral health emergency. A medically managed inpatient treatment service is appropriate for patients whose acute biomedical, emotional, behavioral, and cognitive problems are so severe that they require primary medical and nursing care. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate acute behavioral health symptoms and stabilize functioning. Medically managed inpatient treatment services address patient needs for mental health, psychiatric, or medical services through integrated co-occurring treatment.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.56 Adult residential integrated behavioral health stabilization service.

(1) Service description. In this section, “adult residential integrated behavioral health stabilization service” means a residential behavioral health treatment service, delivered under the oversight of a medical director, that provides withdrawal management and intoxication monitoring, as well as integrated behavioral health stabilization services, and includes nursing care on-site for medical monitoring available on a 24-hour basis. Patients in this setting may receive treatment services for a substance use disorder, a mental health disorder, or both. Adult residential integrated behavioral health stabilization services are appropriate for adult patients whose acute withdrawal signs and symptoms or behavioral health needs are sufficiently severe to require 24-hour care; however, the full resources of a hospital are not required. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, determination of medical stability, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, recovery support services, and crisis intervention services, to ameliorate acute behavioral health symptoms and stabilize functioning.

(2) Staff orientation and training.

(a) An adult residential integrated behavioral health stabilization service shall develop and implement an orientation program for all staff and volunteers. The orientation shall be designed to ensure that staff and volunteers know and understand all of the following:

1. The program’s general policies and procedures.

2. Applicable parts of chs. 48, 51 and 55, Stats., and any administrative rules related to behavioral health emergency services.

3. Applicable parts of chapter DHS 34 rules concerning emergency mental health service programs.

4. Behavioral health and psychopharmacology concepts applicable to crisis situations.

5. Techniques and procedures for providing non-violent crisis management for patients, including verbal de-escalation, methods for obtaining backup, and acceptable methods for self-protection and protection of the patient and others in emergency situations.

(b) Unlicensed staff working in the clinical setting shall complete a minimum of 40 hours of documented orientation training within 3 months after beginning work with the program.

(c) Staff of an adult residential integrated behavioral health stabilization service shall receive at least 8 hours per year of training on emergency behavioral health services, rules and procedures relevant to the operation of the program, compliance with state and federal regulations, cultural competency in behavioral health services, and current issues in client’s rights and services.

(3) Additional intake and admission requirements.

(a) An adult residential integrated behavioral health stabilization service shall have written policies and procedures for the assessment of safety and consideration of safety risks to the patient and others prior to admitting a patient.

(b) An individual with any of the following symptoms, behaviors, or concerns shall be excluded from admission to an adult residential integrated behavioral health stabilization service:

1. Assaultive ideation or assaultive behaviors combined with likelihood to act on those behaviors.

2. Exhibiting active self-injurious behavior.

3. A recent suicide attempt or ongoing suicidal ideation combined with a continued threat or plan to act on suicidal ideation.

(c) The intake screening shall include documentation of the determination and plan for the level of observation needed to address the patient’s needs and any safety concerns.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.57 Residential withdrawal management service.

(1) Service description for residential withdrawal management service. In this section, “residential withdrawal management service” means a residential substance use treatment service that provides withdrawal management and intoxication monitoring, and includes medically managed 24-hour on-site nursing care, under the supervision of a physician. Residential withdrawal management is appropriate for patients whose acute withdrawal signs and symptoms are sufficiently severe to require 24-hour care; however, the full resources of a hospital are not required. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate symptoms of acute intoxication and withdrawal and to stabilize functioning. Services provided in this setting may include community-based withdrawal management and intoxication monitoring services, subject to the requirements listed in this section.

(2) Service description for community-based withdrawal management. Community-based withdrawal management is a medically-managed withdrawal management service delivered on an outpatient basis by a physician, or other service personnel acting under the supervision of a physician.

(3) Additional requirements for community-based withdrawal management.

(a) A service that provides community-based withdrawal management shall meet the requirements in this section, however, services may be provided on an outpatient basis, in the community, or in the patient’s home.

(b) Community-based withdrawal management services are delivered by medical and nursing professionals under the supervision of physician.

(c) A service that provides community-based withdrawal management services shall have written policies and procedures for the delivery of community-based withdrawal management services.

(d) Residential living areas under this section shall be physically separated from service areas for community-based withdrawal management patients.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (2) made under s. 35.17, Stats., Register October 2021 No. 790.

DHS 75.58 Residential intoxication monitoring service.

(1) Service description. In this section, “residential intoxication monitoring service” means a residential service that provides 24-hour observation to monitor the safe resolution of alcohol or sedative intoxication and to monitor for the development of alcohol withdrawal for intoxicated patients who are not in need of emergency medical or behavioral healthcare. Residential intoxication monitoring services may include screening, assessment, intake, evaluation and diagnosis, observation and monitoring, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services.

(2) Observation and medication requirements.

(a) Observation. Trained staff shall observe a patient and record the patient’s condition at intervals no greater than every 30 minutes during the first 12 hours following admission.

(b) Medications.

1. A residential intoxication monitoring service shall not administer or dispense medications.

2. When a patient has been admitted with prescribed medication, staff shall consult with the patient’s physician or other person licensed to prescribe and administer medications to determine the appropriateness of the patient’s continued use of the medication while under the influence of alcohol or sedatives.

3. If approval for continued use of prescribed medication is received from a prescriber, the patient may self-administer the medication under the observation of service staff.

(3) Prohibited admissions. No person may be admitted if any of the following apply:

(a) The person’s behavior is determined by the service to be dangerous to self or others.

(b) The person requires professional nursing or medical care.

(c) The person is incapacitated by alcohol and is placed in or is determined to be in need of protective custody by a law enforcement officer as required under s. 51.45 (11) (b), Stats.

(d) The person is under the influence of any substance other than alcohol or a sedative.

(e) The person requires restraints.

(f) The person requires medication normally used for the detoxification process.

History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; (2) (a) (title) created under s. 13.92 (4) (b) 2., Stats., and correction in (2) (b) 3. made under s. 35.17, Stats., Register October 2021 No. 790.

Subchapter VII — Opioid Treatment Programs and Office-Based Opioid Treatment

DHS 75.59 Opioid treatment program.

(1) Service description. In this section, “opioid treatment program,” or “OTP,” means a service that provides for the management and rehabilitation of persons with an opioid use disorder through the use of methadone and other FDA-approved medications for the treatment of persons with an opioid use disorder, and also provides a broad range of medical and psychological services, substance use counseling and social services. OTPs shall provide adequate medical, counseling, vocational, educational, and other assessment and treatment services. These services must be available at the primary facility, except where the program sponsor has entered into a formal, documented agreement with a private or public agency, organization, practitioner, or institution to provide these services to patients enrolled in the OTP. The program sponsor, in any event, must be able to document that these services are fully and reasonably available to patients. An OTP is subject to the oversight of the SOTA.

(2) Requirements. To receive certification from the department under this chapter, an OTP shall comply with all requirements included in subch. IV, as applicable, be certified under and follow all requirements included in s. DHS 75.50, and the requirements of this section. If a requirement in this section conflicts with an applicable requirement in subch. IV or s. DHS 75.50, the requirement in this section shall be followed.

(3) Definitions. In this section:

(a) “Biochemical monitoring” means the collection and analysis of specimens of body fluids such as blood or urine to determine use of licit or illicit drugs.

(b) “Central registry” means an organization that obtains patient identifying information from 2 or more OTPs about individuals applying for maintenance treatment or detoxification treatment for the purpose of preventing an individual’s concurrent enrollment in more than one program.

(c) “Clinical probation” means the period of time determined by the treatment team that a patient is required to increase frequency of service attendance due to rule violations.

(d) “Guest dose” means administration of a medication used for the treatment of opioid addiction to a person who is not a client of the program that is administering or dispensing the medication.

(e) “Initial dosing” means the first administration of methadone or other FDA-approved medication for the treatment of opioid use disorder to relieve a degree of withdrawal and drug craving of the patient.

(f) “Maintenance treatment” means the dispensing of a narcotic drug in the treatment of an individual for opioid dependence.

(g) “Mandatory schedule” means the required dosing schedule for a patient and the established frequency that the patient must attend the service.

(h) “Medically-supervised withdrawal” means dispensing, administering, or prescribing of an FDA-approved medication for the treatment of opioid use disorder in gradually decreasing doses to alleviate adverse physical or psychological effects incident to withdrawal from the continuous or sustained use of opioid drugs. The purpose of medically supervised withdrawal is to bring a patient maintained on maintenance medication to a medication-free state within a target period.

(i) “Medication unit” means a facility established as part of a service but geographically separate from the service, from which licensed private practitioners and community pharmacists are:

1. Permitted to administer and dispense a narcotic drug.

2. Authorized to conduct biochemical monitoring for narcotic drugs.

(j) “Objectively intoxicated person” means a person who is determined through a breathalyzer test to be under the influence of alcohol.

(k) “Opioid addiction” means psychological and physiological dependence on an opiate substance, either natural or synthetic, that is beyond voluntary control.

(L) “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.

(m) “Phase” means a patient’s level of dosing frequency.

(n) “Potentiation” means the increasing of potency and, in particular, the synergistic action of two or more drugs which produces an effect that is greater than the effect of each drug used alone.

(o) “SAMHSA” means the Substance Abuse and Mental Health Services Administration.

(p) “Service physician” means a physician licensed to practice medicine in the jurisdiction in which the service is located, and knowledgeable in addiction treatment, who assumes responsibility for the administration of all medical services performed by the OTP including ensuring that the service is in compliance with all federal, state and local laws relating to medical treatment of an opioid use disorder with an FDA approved medication for the treatment of an opioid use disorder.

(q) “Program sponsor” means the person named in the application for certification described in 42 CFR 8.11 (b) who is responsible for the operation of the OTP and who assumes responsibility for all its employees, including any practitioners, agents, or other persons providing medical, rehabilitative, or counseling services at the program or any of its medication units. The program sponsor need not be a licensed physician but shall employ a licensed physician for the position of medical director. The program sponsor is responsible for ensuring the service is in continuous compliance with all federal, state, and local laws and regulations.

(r) “State opioid treatment authority” (SOTA) 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.

(s) “Take-homes” means medications such as methadone that reduce the frequency of a patient’s service visits and with the approval of the service physician, are dispensed in an oral form and are in a container that at a minimum discloses the treatment service name, address and telephone number and the patient’s name, the dosage amount and the date on which the medication is to be ingested.

(t) “Treatment contracting” means an agreement developed between the primary counselor or the clinic director and the patient in an effort to allow the patient to remain in treatment on condition that the patient adheres to service rules.

(u) “Treatment team” means a team established to evaluate the progress of a patient and consisting of at least the primary counselor, the service staff nurse who administers doses and the clinic director.

(4) State Opioid Treatment Authority. The powers and duties of the SOTA include:

(a) Facilitating the development and implementation of rules, regulations, standards, and evidence-based practices, emerging best practices, or promising practices, to ensure the quality of services delivered by OTPs.

(b) Monitoring and evaluation of program outcomes for service recipients and the community. The SOTA may establish or follow already established performance indicators by accrediting bodies or SAMHSA including improvement in medical condition, recidivism rates, and such other measures as appropriate.

(d) Reviewing opioid treatment guidelines and regulations developed by the federal government.