Chapter DHS 36

Ch. DHS 36 Note Note: Chapter HFS 36 was created as an emergency rule effective July 1, 2004. Chapter HFS 36 was renumbered to chapter DHS 36 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 36 was reprinted Register December 2010 No. 660 to reflect Note revisions.

subch. I of ch. DHS 36 Subchapter I — General Provisions

DHS 36.01 DHS 36.01 Authority and purpose. This chapter is promulgated under the authority of ss. 49.45 (30e) (b) and 51.42 (7) (b), Stats., to establish the scope of psychosocial service programs, standards for certification and criteria for determining the need for psychosocial rehabilitation services, and other conditions of coverage of community based psychosocial services under the medical assistance program pursuant to ss. 49.45 (30e) and 49.46 (2) (b) 6. Lm., Stats.

DHS 36.01 History History: CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04.

DHS 36.02 DHS 36.02 Applicability.

DHS 36.02(1) (1) This chapter applies to the department and to county departments and tribes that apply for certification or are certified to provide comprehensive community services under ss. 49.45 (30e) and 51.42 (7) (b), Stats.

DHS 36.02(2) (2) Programs operating under this chapter shall do business as comprehensive community services programs.

DHS 36.02(3) (3) This chapter regulates only comprehensive community services programs. This chapter is not intended to regulate other mental health or substance-use disorder programs.

DHS 36.02(4) (4) Persons covered under the comprehensive-community services programs include children and adults, including elders, with mental disorders or substance-use disorders.

DHS 36.02 History History: CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04.

DHS 36.03 DHS 36.03 Definitions. In this chapter:

DHS 36.03(1) (1) “Adult” means an individual 18 years of age or older.

DHS 36.03(2) (2) “Assessment” means the process used to identify the strengths, needs and desired outcomes of a consumer and to evaluate progress toward desired outcomes.

DHS 36.03(3) (3) “Certification” means the approval by the department of a comprehensive community services program.

DHS 36.03(4) (4) “Comprehensive community services program” or “CCS” has the same meaning as “community-based psychosocial service program” under s. 49.45 (30e), Stats., namely a county-wide or tribal community-based psychosocial rehabilitation program that is operated by a county department or tribe to provide or arrange for the provision of psychosocial rehabilitation services.

DHS 36.03(5) (5) “Coordination committee” means a group of individuals appointed by the county department or tribal government to advise and assist the county department or tribal government in the development and quality improvement of psychosocial rehabilitation services.

DHS 36.03(6) (6) “Comprehensive community services plan” means the plan developed under s. DHS 36.07.

DHS 36.03(7) (7) “Consumer” means an individual who has been determined to need psychosocial rehabilitation services.

DHS 36.03 Note Note: Family members of the consumer or the consumer’s primary caregivers also are considered to be consumers, and therefore, may receive services related to the consumer’s disorder.

DHS 36.03(8) (8) “Co-occurring disorder” means any combination of a substance-use disorder and a mental disorder identified in the Diagnostic and Statistical Manual of Mental Disorder — Fourth Edition — Text Revision (DSM-IV-TR) published by the American Psychiatric Association.

DHS 36.03(9) (9) “County department” means a county department of human services under s. 46.23, Stats., or a county department of community programs established under s. 51.42, Stats., to administer community mental health and alcohol and drug abuse programs on a single-county or multi-county basis.

DHS 36.03(10) (10) “Department” means the Wisconsin department of health services.

DHS 36.03(10m) (10m) “Elder” means a person who is age 60 or older.

DHS 36.03(10r) (10r) “Face to face” means engaging in contact with the recipient via in person, real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth.

DHS 36.03(11) (11) “Family member,” means a parent, legal custodian, sibling, spouse, child, or primary caregiver of a consumer.

DHS 36.03(11m) (11m) “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 36.03(12) (12) “Legal custodian” means an individual to whom legal custody of a minor has been granted by a court in an action under ch. 48 or 767, Stats.

DHS 36.03(13) (13) “Legal representative” means any of the following:

DHS 36.03(13)(a) (a) A guardian as defined under s. 54.01 (10), Stats.

DHS 36.03(13)(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.

DHS 36.03(14) (14) “Medical assistance” means the assistance program under 42 USC 1396 and ss. 49.43 to 49.475 and 49.49 to 49.497, Stats.

DHS 36.03(15) (15) “Mental disorder” means a diagnosis meeting the criteria in the Diagnostic and Statistical Manual of Mental Disorders — Fourth Edition — Text Revision (DSM-IV-TR) excluding the categories of dementia, substance-related disorders, and developmental disability as defined in 42 CFR 435.1009.

DHS 36.03 Note Note: DSM-IV-TR is published by the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000. DSM-IV-TR may be ordered through http://www.amazon.com/Diagnostic-Statistical-Disorders-Revision-DSM-IV-TR/dp/0890420254 or other sources. The current version of the Diagnostic and Statistical Manual of Mental Disorders, DSM 5 is published by the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Washington, DC, American Psychiatric Association, 2013. The DSM 5 may be ordered through http://www.appi.org/Pages/DSM.aspx or other sources.

DHS 36.03(16) (16) “Mental health professional” means a staff member who is qualified under s. DHS 36.10 (2) (g) 1. to 8.

DHS 36.03(17) (17) “Minor” means an individual under the age of 18 years.

DHS 36.03(18) (18) “Natural supports” means a friend, or other person available in the community who may assist consumers seeking stability and independence.

DHS 36.03(19) (19) “Outreach” means identifying and contacting individuals with mental disorders or substance-use disorders to directly engage and link with individuals who need psychosocial rehabilitation services or other mental health or substance-use disorder services, and making referral agreements with psychiatric inpatient units, residential treatment facilities, outpatient treatment clinics and other community treatment and service providers as appropriate.

DHS 36.03(20) (20) “Parent” means a biological parent; an adoptive 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 a male who has been adjudicated the child’s father either under s. 767.89, Stats., or by final order or judgment of a court of competent jurisdiction in another state. “Parent” does not include individuals whose parental rights have been terminated.

DHS 36.03(21) (21) “Primary care giver” means an individual who provides a majority of a consumer’s day-to-day support, shelter, sustenance or nurturing.

DHS 36.03(22) (22) “Psychosocial rehabilitation services” has the same meaning as “psychosocial services” under s. 49.45 (30e), Stats., namely the medical and remedial services and supportive activities provided to or arranged for a consumer by a comprehensive community services program authorized by a mental health professional to assist individuals with mental disorders or substance-use disorders to achieve the individual’s highest possible level of independent functioning, stability and independence and to facilitate recovery.

DHS 36.03(23) (23) “Recovery” means the process of a person’s growth and improvement, despite a history of mental or substance use disorder in attitudes, values, feelings, goals, skills and behavior and is 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 36.03(24) (24) “Recovery team” means the group of individuals who are identified to participate in an assessment of the needs of the consumer, service planning and delivery, and evaluation of desired outcomes.

DHS 36.03(25) (25) “Service facilitation” means any activity that ensures the consumer receives assessment services, service planning, service delivery and supportive activities in an appropriate and timely manner.

DHS 36.03(26) (26) “Service facilitator” means a staff member who is qualified under s. DHS 36.10 (2) (g) 1. to 21. and who has the overall responsibility for service facilitation.

DHS 36.03(27) (27) “Service plan” means a written plan of psychosocial services to be provided or arranged for a consumer that is based on an individualized assessment of the consumer.

DHS 36.03(28) (28) “Service provider” means an agency or individual that provides one or more mental health or substance-use treatment or services.

DHS 36.03(28m) (28m) “Signature” or “signed” means a signature that meets the requirements in s. 990.01 (38), Stats.

DHS 36.03(29) (29) “Staff member” means a person employed by a county department, tribe, or contracted agency.

DHS 36.03(30) (30) “Substance abuse professional” means a person who meets the requirements of s. DHS 75.02 (84), a physician knowledgeable in addiction treatment, or a psychologist knowledgeable in psychopharmacology and addiction treatment.

DHS 36.03(31) (31) “Substance-use disorder” means a condition related to the use of alcohol or a drug of abuse listed in the DSM IV-TR.

DHS 36.03(32) (32) “Supportive activities” means actions and events that help address the needs and recovery goals of a consumer.

DHS 36.03(32m) (32m) 

DHS 36.03(32m)(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 36.03(32m)(b) (b) “Telehealth” may include real-time interactive audio-only communication.

DHS 36.03(32m)(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 36.03(33) (33) “Tribe” means a federally recognized American Indian tribe or band.

DHS 36.03 History History: CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04; corrections in (10), (13) (a), (20) and (30) made under s. 13.92 (4) (b) 6. and 7., Stats., Register November 2008 No. 635; CR 20-067: am. (10m), r. (11m) Register December 2021 No. 792, eff. 1-1-22; CR 23-053: cr. (10r), (11m), (28m), (32m) Register September 2023 No. 813, eff. 10-1-23.

subch. II of ch. DHS 36 Subchapter II — Certification

DHS 36.04 DHS 36.04 Certification requirements.

DHS 36.04(1) (1) Application.

DHS 36.04(1)(a) (a) A county department or tribe seeking to operate a certified comprehensive community services program shall apply to the department for certification on an application form provided by the department.

DHS 36.04 Note Note: An application for certification may be obtained by writing to the Behavioral Health Certification Section, Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969.

DHS 36.04(2) (2) Application materials. The application shall be accompanied by all of the following:

DHS 36.04(2)(a) (a) Required fees.

DHS 36.04(2)(b) (b) A copy of the comprehensive community services plan developed under s. DHS 36.07.

DHS 36.04(2)(c) (c) A copy of the personnel policies and procedures developed under s. DHS 36.10 and operational policies developed.

DHS 36.04(2)(d) (d) A copy of any previously approved waiver or variance and information on the current status.

DHS 36.04(2)(e) (e) Any other information required by the department.

DHS 36.04 History History: CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04.

DHS 36.05 DHS 36.05 Certification process.

DHS 36.05(1) (1) In this section:

DHS 36.05(1)(a) (a) “Deficiency” means the failure to meet a requirement of this chapter.

DHS 36.05(1)(b) (b) “Major deficiency” means a determination by the department that an aspect of the CCS program or the conduct of its personnel does any of the following:

DHS 36.05(1)(b)1. 1. The psychosocial rehabilitation services substantially fail to meet the requirements of this chapter.

DHS 36.05(1)(b)2. 2. 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, which may include any one of the following of the following:

DHS 36.05(1)(b)2.a. a. A staff member has had sexual contact or intercourse, as defined in s. 940.225 (5) (b) or (c), Stats., with a consumer.

DHS 36.05(1)(b)2.b. b. A staff member of the CCS has been convicted of consumer abuse under s. 940.285, 940.29 or 940.295, Stats.

DHS 36.05(1)(b)2.c. c. The health or safety of a consumer is in imminent danger because of a failure of the CCS or a CCS staff member to comply with requirements of this chapter or any other applicable local, state or federal statute or regulation.

DHS 36.05(1)(b)3. 3. The CCS has submitted, or caused to be submitted, one or more statements for purposes of obtaining certification under this chapter which the CCS knew or should have known to be false.

DHS 36.05(1)(b)4. 4. A license, certification or required local, state or federal approval of the CCS has been revoked or suspended or has expired.

DHS 36.05(1)(b)5. 5. A staff member has signed a billing statement or other document that represents the CCS staff member as the provider of service when the staff member did not provide the service.

DHS 36.05(1)(b)6. 6. A staff member impedes or has impeded monitoring of the program by the department.

DHS 36.05(1)(b)7. 7. An action or inaction by a staff member constitutes grounds for involuntary termination or suspension from program participation under s. DHS 106.06.

DHS 36.05(2) (2) Initial application. Upon receipt of a complete application for initial certification, the department shall review the application and accompanying materials required under s. DHS 36.04 (2). The department’s designated representative responding to a request for an initial certification shall review CCS personnel policies and procedures and operational policies, and the community services plan developed under s. DHS 36.07.

DHS 36.05(4) (4) Transferability of certification. Certification may only be issued to the CCS specified in the application. A CCS may not transfer or assign its certification to another entity. An applicant or certified CCS shall notify the department of any change in administration, location, name, offered services or any other change that may affect compliance with this chapter no later than the effective date of the change.

DHS 36.05(5) (5) Effective date of certification.

DHS 36.05(5)(a) (a) The date of certification shall be the date that the department determines that an applicant is in compliance with this chapter.

DHS 36.05(5)(b) (b) The department may change the date of certification if the department has made an error in the certification process. A date of certification that is adjusted under this paragraph may not be earlier than the date the department receives a written application under sub. (2) or (3).