Wisconsin Legislature: DHS 36.03(28m)

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

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.

(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.

(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.

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

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

(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.

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

(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.

(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.

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

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

(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.

(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.

(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.

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.

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

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

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

(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.

(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.

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

(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.

(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.

(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.

(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.

(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.

(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.

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

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

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

(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.

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

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

(32m)

(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.

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

(c) “Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail, text, or facsimile transmission.

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

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.

Subchapter II — Certification

DHS 36.04 Certification requirements.

(1) Application.

(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.

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.

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

(a) Required fees.

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

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

(e) Any other information required by the department.

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

DHS 36.05 Certification process.

(1) In this section:

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

(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:

1. The psychosocial rehabilitation services substantially fail to meet the requirements of this chapter.

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:

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

b. A staff member of the CCS has been convicted of consumer abuse under s. 940.285, 940.29 or 940.295, Stats.

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.

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.

4. A license, certification or required local, state or federal approval of the CCS has been revoked or suspended or has expired.

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.

6. A staff member impedes or has impeded monitoring of the program by the department.

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

(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.

(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.

(5) Effective date of certification.

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

(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).

(6) Fees for certification. Fees for certification shall be established by the department.

(7) Issuance of certification.

(a) Action on application. Within 60 days after receiving a completed application for initial certification or for renewal of certification, the department shall do one of the following:

1. Approve the CCS if no deficiencies are found and all of the requirements for certification are met.

3. Deny certification under sub. (9), if the department finds one or more major deficiencies.

(9) Denial of certification. A denial of certification shall be in writing and shall contain the reason for the denial and notice of opportunity for a hearing under s. DHS 36.06 (3).

(10) Duration of certification. A certification remains valid until one of the following occur:

(a) The certification remains valid until it is revoked or suspended by the department in accordance with s. DHS 36.06 (1).

(b) The certification becomes invalid due to non-submission of the biennial report or non-payment of biennial fees in accordance with sub. (11).

(11) Biennial report and fees.

(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.

(b) The department will send the certification continuation materials to the provider, which the provider is expected to complete and submit to the department according to instructions provided.

(c) A certification will be suspended or terminated if biennial reports and fees are not submitted prior to the end of the biennial cycle.

History: CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04; corrections in (1) (b) 7. and (3) (f) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; CR 22-078: r. (3), (7) (a) 2., (b), (8), cr. (10), (11) Register July 2023 No. 811, eff. 8-1-23.

DHS 36.06 Enforcement actions.

(1) Revocation and suspension. The department may revoke or suspend certification at any time upon written notice to the CCS. The notice shall state the reason for the action and inform the CCS of the opportunity for a hearing under sub. (3).

(2) Inspections.

(a) The department may make announced and unannounced inspections of a certified CCS to verify compliance with this chapter, to investigate complaints received regarding the services provided by the CCS, or as part of an investigation into the cause of death of a consumer.