EMERGENCY MENTAL HEALTH SERVICE PROGRAMS
Subchapter I — General Provisions
DHS 34.01 Authority, scope and purpose. Subchapter II — Standards for Basic Emergency Service Programs
Subchapter III — Standards for Emergency Service Programs Eligible for Medical Assistance Program or Other Third Party Reimbursement
DHS 34.23 Assessment and response. DHS 34.24 Client service records. DHS 34.26 Client satisfaction. Ch. DHS 34 NoteNote: Corrections in this chapter made under s. 13.93 (2m) (b) 1., 6., 7., Stats., Register, September, 1996, No. 489. Chapter HFS 34 was renumbered to chapter DHS 34 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635. Chapter DHS 34 was reprinted Register December 2010 No. 660 to revise a Note in s. DHS 34.03. DHS 34.01DHS 34.01 Authority, scope and purpose. DHS 34.01(1)(1) This chapter is promulgated under the authority of s. 51.42 (7) (b), Stats., to establish standards and procedures for certification of county and multi-county emergency mental health service programs. Section 51.42 (1) (b), Stats., requires every county to provide emergency mental health services to persons within the county in need of those services. The persons who need those services are persons who are experiencing a mental health crisis or are in a situation likely to turn into a mental health crisis if supportive services are not provided. A county may comply with s. 51.42 (1) (b), Stats., by operating or contracting for the operation of an emergency mental health program certified under this subchapter and either subch. II or III of ch. DHS 34. DHS 34.01(2)(2) This chapter applies to the department, to counties that request certification or are certified to provide emergency mental health services and to county-contracted agencies that request certification or are certified to provide emergency mental health services. DHS 34.01(3)(3) This chapter relates only to the certification of programs providing emergency mental health services. It is not intended to regulate other mental health service programs or other emergency service programs. DHS 34.01 HistoryHistory: Cr. Register, September, 1996, No. 489, eff. 10-1-96; correction in (1) made under s. 13.93 (2m) (b) 7., Stats, Register, April, 2000, No. 532. DHS 34.02DHS 34.02 Definitions. In this chapter: DHS 34.02(1)(1) “Certification” means the approval granted by the department that a county’s emergency mental health services program meets the requirements of this chapter. DHS 34.02(2)(2) “Client” means a person receiving emergency mental health services from a program. DHS 34.02(3)(3) “Coordinated emergency mental health services plan” means a plan prepared under s. DHS 34.22 (1) by an emergency mental health services program to ensure that emergency mental health services will be available that are appropriate to the specific conditions and needs of the people of the county in which the program operates. DHS 34.02(4)(4) “County department” means a county department of human services under s. 46.23, Stats., or a county department of community programs under s. 51.42 (1) (b), Stats. DHS 34.02(5)(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. DHS 34.02(6)(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. DHS 34.02(7)(7) “Department” means the Wisconsin department of health services. DHS 34.02(8)(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. DHS 34.02(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 34.02(9)(9) “Guardian” means the person or agency appointed by a court under ch. 54, Stats., to act as the guardian of a person. DHS 34.02(11)(11) “Medication administration” means the physical act of giving medication to a client by the prescribed route. DHS 34.02(12)(12) “Medication monitoring” means observation to determine and identify any beneficial or undesirable effects which could be related to taking psychotropic medications. DHS 34.02(14)(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. DHS 34.02(15)(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. DHS 34.02(16)(16) “Mobile crisis service” means a mental health service which provides immediate, on-site mental health service for individuals experiencing a mental health crisis. DHS 34.02(16m)(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. DHS 34.02(17)(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. DHS 34.02(18)(18) “Program” means an emergency mental health services program certified under this chapter. DHS 34.02(19)(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. DHS 34.02 NoteNote: 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.
DHS 34.02(20)(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. DHS 34.02(21)(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. DHS 34.02(21m)(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 to an in-person contact. DHS 34.02(21m)(b)(b) “Telehealth” may include real-time interactive audio-only communication. DHS 34.02(21m)(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 34.02(22)(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. DHS 34.02(23)(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. DHS 34.02 NoteNote: 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.
DHS 34.02 HistoryHistory: 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(1)(a)(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. DHS 34.03(1)(b)(b) The application shall contain information and supporting documents required by the department. DHS 34.03 NoteNote: 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.
DHS 34.03(2)(a)(a) On review of an application for initial certification, the department shall do all of the following: DHS 34.03(2)(a)2.2. Designate a representative to conduct an on-site survey of the program, including interviewing program staff. DHS 34.03(2)(b)(b) The department’s designated representative shall do all of the following: DHS 34.03(2)(b)1.1. Interview a representative sample of present or former participants in the program, if any, provided that the participants indicate a willingness to be contacted. DHS 34.03(2)(b)2.2. Review the results of any grievances filed against the program pursuant to s. DHS 94.27 during the preceding period of certification. DHS 34.03(2)(b)3.3. Review a randomly selected, representative sample of client service records. DHS 34.03(2)(b)4.4. 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. DHS 34.03(2)(c)(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: DHS 34.03(2)(c)1.1. Statements made by the applicant or the applicant’s designated agent, administrative personnel and staff members. DHS 34.03(2)(c)3.3. 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. DHS 34.03(2)(c)6.6. Information from grievances filed by persons served by the program. DHS 34.03(2)(d)(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. DHS 34.03(2)(e)(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. DHS 34.03(3)(a)(a) Within 60 days after receiving a completed application for initial certification, the department shall do one of the following: DHS 34.03(3)(a)1.1. Certify the program if all requirements for certification are met. DHS 34.03(3)(a)2.2. Provisionally certify the program under sub. (10) if only minor deficiencies are found. DHS 34.03(3)(b)1.1. 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.
