Chapter DHS 61

DHS 61.40(2)(d) (d) The agency offering sheltered employment or work activity shall provide the client with effective grievance procedures.

DHS 61.40(2)(e) (e) The agency offering sheltered employment or work activity shall provide the clients with paid vacation, holidays and a minimum of 5 sick days per year.

DHS 61.40(2)(f) (f) Sheltered employment or work activity shall be provided as recommended in the service plan.

DHS 61.40(2)(g) (g) Appointed staff supervising the sheltered employment or work activity shall send a written report to the case manager at least every 6 months. The report shall contain a statement on progress toward the objectives of the service plan and the recommendations for changes.

DHS 61.40(2)(h) (h) Commission on accreditation of rehabilitation facilities (CARF) accreditation for sheltered employment or work activities may substitute for all except pars. (f) and (g).

DHS 61.40 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80; CR 20-068: am. (intro.) Register December 2021 No. 792, eff. 1-1-22.

DHS 61.41 DHS 61.41 Day care. Day care is clustered and coordinated sets of services provided to an individual with a developmental disability on a scheduled portion of a 24 hour day. Day care shall include at least 2 of the following: counseling, education, recreation, or training. It may also include any one or combination of the following: evaluation, transportation, treatment and personal care.

DHS 61.41(1) (1) Personnel.

DHS 61.41(1)(a) (a) There shall be a director who shall have the skills and knowledges typically acquired through a course of study leading to a bachelor’s degree in a human services field, with a minimum of 2 years’ supervisory or administrative experience in programming for the developmentally disabled.

DHS 61.41(1)(b) (b) There shall be additional personnel as required under appropriate sections of the service standards.

DHS 61.41(2) (2) Program. Program requirements shall be as specified in appropriate sections of the service standards. Day care should be provided in generic day care programs whenever possible.

DHS 61.41 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80.

DHS 61.42 DHS 61.42 Personal care services. Personal care services include the provision of meals, clothing and bodily care. They are designed to maintain health and well-being, to improve development and to prevent regression. Personal care services can be delivered at home or in sheltered apartments.

DHS 61.42(1) (1) Personnel.

DHS 61.42(1)(a) (a) The case manager shall be responsible for coordinating the delivery of personal care services.

DHS 61.42(1)(b) (b) There shall be additional staff as needed and staff shall have training or experience in that area in which care or services are provided.

DHS 61.42(2) (2) Program.

DHS 61.42(2)(a) (a) Personal care services shall be provided in the least restrictive setting.

DHS 61.42(2)(b) (b) Personal care services shall be provided on a long-term basis as well as a short-term care basis.

DHS 61.42(2)(c) (c) Personal care services shall be provided as recommended in the service plan.

DHS 61.42(2)(d) (d) The case manager shall review the personal care service plan with the person receiving the services at least every 6 months.

DHS 61.42 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80.

DHS 61.43 DHS 61.43 Domiciliary care service. Domiciliary care services are provided by the state developmental disabilities centers.

DHS 61.43(1) (1) Personnel. There shall be an administrator and staff as required under ch. DHS 134, and federal standards regulating intermediate care facilities for individuals with intellectual disabilities.

DHS 61.43(2) (2) Program.

DHS 61.43(2)(a) (a) Program requirements shall comply with appropriate sections of ch. DHS 134, and federal standards regulating intermediate care facilities for individuals with intellectual disabilities.

DHS 61.43(2)(b) (b) The centers shall provide the responsible board with a copy of the annual review of the service plan.

DHS 61.43 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80; corrections made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1995, No. 474; corrections in (1) and (2) made under s. 13.93 (2m) (b) 7., Stats., Register, October, 1999, No. 526; corrections in (1) and (2) (a) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635; 2019 Wis. Act 1: am. (1), (2) (a) Register May 2019 No. 761, eff. 6-1-19.

DHS 61.44 DHS 61.44 Special living arrangements services. Special living arrangements may provide living quarters, meals and supportive services up to 24 hour per day for people in need of assistance in the areas of community and daily living but who require less care and supervision than is characteristic of individuals needing domiciliary or nursing home care. Special living arrangement services may be provided in foster homes, group foster homes, halfway houses, community based residential facilities, child welfare institutions, homes and apartments.

DHS 61.44(1) (1) Personnel. Staff shall possess the personal qualities, skills and education necessary to meet the needs of the residents and comply with the appropriate sections of Wisconsin statutes, administrative codes and licensing rules.

DHS 61.44(2) (2) Program.

DHS 61.44(2)(a) (a) Program requirements shall comply with appropriate sections of Wisconsin statutes, administrative codes and licensing rules.

DHS 61.44(2)(b) (b) The individual receiving special living arrangement services shall be employed or otherwise engaged away from the residential setting in accordance with the individual’s service plan except in child welfare institutions.

DHS 61.44(2)(c) (c) When special living arrangements are provided on a respite basis they shall meet the requirements of this section.

DHS 61.44(2)(d) (d) Special living arrangement services shall be provided as recommended in the service plan.

DHS 61.44(2)(e) (e) Appointed staff supervising the special living arrangement shall send a written report to the case manager or his or her designee at least every 6 months. The report shall contain a statement on progress toward the goals of the service plan and the recommendations for change in the service plan.

DHS 61.44 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80.

DHS 61.45 DHS 61.45 Transportation services. Transportation services provide for the necessary travel of a developmentally disabled individual and if necessary, escorts to and from places in which the individual is receiving services recommended in the individual’s service plan. Transportation may include taking services to the homebound, and includes but is not limited to delivery of raw materials and pick up of the finished product from homebound industries.

DHS 61.45(1) (1) Personnel.

DHS 61.45(1)(a) (a) Any person operating a motor vehicle which transports either people with developmental disabilities or the products of their homebound industry, shall hold an appropriate operator’s license from the department of transportation.

DHS 61.45(1)(b) (b) All motor vehicle operators shall be covered by liability insurance.

DHS 61.45(1)(c) (c) Motor vehicles shall be inspected by, and meet the requirements of the department of transportation.

DHS 61.45(2) (2) Program.

DHS 61.45(2)(a) (a) When possible, regularly scheduled public transportation shall be used.

DHS 61.45(2)(b) (b) When possible, transportation services shall be coordinated with the efforts of voluntary agencies and other agencies serving community groups.

DHS 61.45 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80.

DHS 61.46 DHS 61.46 Protective services.

DHS 61.46(1) (1) Protective services are a system of continuing socio-legal services designed to assist individuals who are unable to manage their own resources or to protect themselves from neglect, abuse, exploitation or degrading treatment and to help them exercise their rights as citizens. This system ensures that no right of a person with a developmental disability shall be modified without due process. It must be emphasized that insofar as protective services are concerned, it is not the services that are distinctive but rather the individual for whom the services are intended, along with reasons why the services are being provided.

DHS 61.46(2) (2) Protective services shall be provided under applicable sections of chs. 48, 54 and 55, Stats., and applicable sections of the department’s administrative code.

DHS 61.46(3) (3) If any developmental disabilities services are provided as part of protective services, they shall comply with the appropriate standard.

DHS 61.46 History History: Cr. Register, January, 1980, No. 289, eff. 2-1-80; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635.

DHS 61.69 DHS 61.69 Duration of certification for community mental health programs.

DHS 61.69(1) (1) A certification under this subchapter remains valid until it is suspended or terminated by the department in accordance with s. DHS 61.20 (5).

DHS 61.69(2) (2) Certification becomes invalid due to non-submission of the biennial report or non-payment of biennial fees in accordance with s. DHS 61.695.

DHS 61.69 History History: CR 22-078: cr. Register July 2023 No. 811, eff. 8-1-23.

DHS 61.695 DHS 61.695 Biennial report and fees for community mental health programs.

DHS 61.695(1) (1) 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.

DHS 61.695(2) (2) The department shall send the certification continuation materials to the provider, which the provider is expected to complete and submit to the department according to instructions provided under s. 51.04, Stats.

DHS 61.695(3) (3) A certification will be suspended or terminated if biennial reports and fees are not submitted prior to the end of the biennial cycle.

DHS 61.695 History History: CR 22-078: cr. Register July 2023 No. 811, eff. 8-1-23.

subch. IV of ch. DHS 61 Subchapter IV — Community Mental Health Programs

DHS 61.70 DHS 61.70 Inpatient program - introduction and definitions.

DHS 61.70(1) (1) Introduction. The following standards have been developed for community inpatient mental health services receiving state aids, whether directly operated by counties or contracted with private providers. The standards are intended to be consistent with those stated in Standards for Psychiatric Facilities, published by the American Psychiatric Association, 1969; with the psychiatric footnotes to the Accreditation Manual for Hospitals, published by the Joint Commission on Accreditation of Hospitals, December, 1970; and with recent federal court decisions in Wisconsin and other states. They are intended to insure that each mental health inpatient service will provide appropriate treatment to restore mentally disordered persons to an optimal level of functioning and return them to the community at the earliest possible date. In order to do this the service must:

DHS 61.70(1)(a) (a) Have an ethical, competent staff responsible for carrying out a comprehensive treatment program;

DHS 61.70(1)(b) (b) Integrate its services with those provided by other facilities in the county which serve the mentally ill, individuals with intellectual disabilities, and alcoholics and drug abusers;

DHS 61.70(1)(c) (c) Preserve the dignity and rights of all its patients; and

DHS 61.70(1)(d) (d) Be responsive to the needs of its community.

DHS 61.70(2) (2) Definitions. As used in this subchapter:

DHS 61.70(2)(a) (a) “Community mental health inpatient services”, hereafter called “services”, means a county-operated unit, general hospital psychiatric unit, or private psychiatric hospital whose primary objective is to provide care and intensive treatment for the mentally ill, alcoholics and drug abusers.

DHS 61.70(2)(b) (b) “Patient” means anyone receiving care in a community mental health inpatient service.

DHS 61.70 History History: Cr. Register, December, 1973, No. 216, eff. 1-1-74; renum. from PW-MH 60.61, and am. (2), Register, September, 1982, No. 321, eff. 10-1-82; 2019 Wis. Act 1: am. (1) (b) Register May 2019 No. 761, eff. 6-1-19.

DHS 61.71 DHS 61.71 Inpatient program standards.

DHS 61.71(1) (1) Required personnel.

DHS 61.71(1)(a) (a) Psychiatry. Each mental health inpatient service shall have a psychiatrist who has competed an approved residency training program in psychiatry as its director of mental health services. This director shall be responsible for organization and maintenance of an active mental health treatment program and shall assume responsibility for the admission, treatment, discharge planning, and release of patients from the inpatient service. The director of mental health services and additional psychiatrists, as needed, shall be available for daily inpatient visits, in order to carry out an adequate treatment program. Additional provision shall be made for emergency contact between such visits. Each service shall provide for a minimum of .8 hour a week psychiatric treatment time per patient under care. The psychiatric staff will assume responsibility for patient care, utilizing the services of the medical staff for necessary general medical care.

DHS 61.71(1)(b) (b) Nursing service.

DHS 61.71(1)(b)1. 1. ‘Registered nurses and licensed practical nurses.’ Each service shall employ sufficient registered nurses and licensed practical nurses to provide full-time nursing service for each shift 7 days a week. All registered nurses and licensed practical nurses employed to provide nursing service must have a current Wisconsin certificate to practice as a RN or LPN, and appropriate experience and/or further education for the responsibility of the position. The following schedule of licensed nursing coverage is minimal, with the added provisions that at least one staff member on the day and evening shift be a registered nurse. In computing the number of licensed personnel needed on each shift, the totals should be rounded up if .5 or more, down if less than .5. There must always be at least one licensed person on duty on each shift, even if the number required is less than .5.

DHS 61.71(1)(b)2. 2. ‘Aides and other paraprofessionals.’ Each service shall employ a sufficient number of aides or other paraprofessionals to provide a ratio of 1.25 hours of such time per patient per day. In computing this ratio, dietary, maintenance and housekeeping staff, volunteers or building security shall not be included as aides. There shall be at least one aide or other treatment staff person on duty in each ward when patients are present to insure adequate patient supervision. In determining adequate care the department has the authority to determine what constitutes units of coverage. Paraprofessionals entitled mental health technicians or mental health workers may be employed. They shall be selected on the basis of their personal qualities and aptitude. They must have a period of orientation and inservice training, and work under the supervision designated treatment staff.

DHS 61.71(1)(c) (c) Activity therapy. Each service shall employ at least one full-time registered occupational therapist and one certified occupational therapy assistant or a graduate of the division of mental hygiene’s Activity Therapy Assistant Course. Where other health care services are located in the same or continuous property, one full-time occupational therapist may serve the other health care service as well as the inpatient mental health services. The mental health inpatient service shall maintain a ratio of 1.6 hours of activity therapy staff time per patient per week. A registered music therapist or art therapist may fill the requirement for activity therapy positions after one registered occupational therapist has been employed. Where work therapy is utilized, each service shall designate the registered occupational therapist, unless the service has employed a vocational rehabilitation counselor. In this circumstance the vocational rehabilitation counselor shall be in charge of industrial therapy.

DHS 61.71(1)(d) (d) Social services. Each service shall employ one full-time social worker and provide for a minimum of .8 hour a week social work time per patient under care. Social workers must have a master’s degree from an accredited school of social work or a bachelor’s degree in social work, or social science. The first social worker hired must have a master’s degree in social work.

DHS 61.71(1)(e) (e) Psychological services. Each service shall employ or contract for the services of a clinical psychologist licensed in the state of Wisconsin to provide psychological testing, counseling and other psychological services. A minimum ratio of .8 hour per week psychology time per patient under care shall be provided.

DHS 61.71(1)(f) (f) Exceptions. A special exception to any of the foregoing personnel requirements may be granted in unusual circumstances, if a service develops an alternative proposal, satisfactory to the department, to provide an innovative approach to patient care, which provides levels of services equivalent to those required in these standards. An exception may also be granted to a proposal which substitutes personnel with qualifications equal to those listed above.

DHS 61.71(2) (2) Program content.

DHS 61.71(2)(a) (a) Therapeutic milieu.

DHS 61.71(2)(a)1. 1. ‘General consideration.’ An important factor in a mental health treatment program in an inpatient service is a therapeutic atmosphere. Although intangible, the presence or lack of this atmosphere is pervasive and immediately apparent. It is important that all staff members treat each patient with respect, providing all freedoms his or her condition permits and allowing the patient to retain a sense of individuality, freedom of choice and independence. Patients shall be encouraged to behave appropriately and in a socially acceptable way. Patients shall be permitted to dress in individually selected street clothing and retain sentimentally important personal possessions as clinically indicated. They shall be permitted to write letters, subject to restrictions only as clinically indicated. Home-like living quarters with drapes, pictures and furnishings shall be provided, and normal needs for privacy and feelings of modesty respected. Conversely, severe restriction of freedom of movement by prison-like practices; implicit or explicit expectations of dangerous, unpredictable behavior; use of punishment, especially seclusion and restraint, in the guise of therapy; exploitation of patient labor; use of spoons only as eating utensils and the like, shall not be permitted.

DHS 61.71(2)(a)2. 2. ‘Staff functions.’ To maximize the therapeutic effect of hospitalization, all aspects of mental health inpatient care must be integrated into a continuous treatment program. The activities of all staff — psychiatrists, physicians, psychologists, social workers, activity therapists, nurses, aids, chaplains and others — must be coordinated in a concerted treatment effort, utilizing the special skills and roles of each in a complementary manner to effect a total therapeutic purpose. The services of volunteers must be used in the same way. The specific treatment responsibilities of psychiatrists, psychologists, social workers and activity therapists are generally well understood, but the contributions of volunteers and other staff, such as chaplains and food service workers, also have important implications for patients’ welfare. Their work must be carried out in a manner which furthers the total treatment program. Nursing staff shall be full partners in therapeutic team and, as a significant portion of their nursing responsibilities, shall participate in activities such as group therapy, supportive counseling, and socializing experience for patients. Mental health aides are valuable contributors to the therapeutic milieu. As staff members who are constantly in close contact with patients, their activities are to be geared carefully to provide patients with emotional support and respite from inquiry into their difficulties, promote their independence, and provide them with companionship and assistance in personal care and grooming, recreational activities, social behavior, care of property and day to day living.

DHS 61.71(2)(b) (b) Evaluation. Every newly received patient shall be evaluated by the professional staff within 48 hours after admission. This evaluation shall include psychiatric examination, the initiation of family contact and social history taking, and psychological examination when indicated. A plan of treatment and/or disposition shall be formulated and periodically reviewed. Progress notes on all cases shall be written frequently and regularly as the patient’s condition requires, but in no instance less than once a week.

DHS 61.71(2)(c) (c) Clinical records. The mental health inpatient service shall maintain a current treatment plan and clinical record on each patient admitted to the service.

DHS 61.71(2)(d) (d) Drug and somatic therapy. Every patient deemed an appropriate candidate shall receive treatment with modern drugs and somatic measures in accordance with existent laws, established medical practice, and therapeutic indications as determined by current knowledge.

DHS 61.71(2)(e) (e) Group therapy. Each mental health inpatient service is encouraged to develop group therapy programs, including remotivation groups where appropriate. Nursing and aid staff should be trained in these therapy techniques.