DHS 63.08(1)(a)2.2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and DHS 63.08(1)(b)1.1. A condition of chronic mental illness with another diagnosis listed in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), provided that documentation in the client record shows that: DHS 63.08(1)(b)1.a.a. There have been consistent and extensive efforts to treat the client, such as use of special structured housing, more frequent outpatient appointments combined with proactive efforts such as home visiting when the client does not come in for appointments, cooperative efforts by various outpatient, housing, vocational and crisis agencies to coordinate and plan treatment and face-to-face crisis intervention services on a regular basis, with or without crisis housing. The efforts have persisted for at least a year, except in unusual circumstances such as a serious and sudden onset of dysfunction, causing the client’s condition to move beyond basic outpatient clinical standards of practice; and DHS 63.08(1)(b)2.2. A significant risk of either continuing in a pattern of institutionalization or living in a severely dysfunctional way if CSP services are not provided; and DHS 63.08(2)(2) Areas of functional impairment. The functional areas in which individuals admitted to a CSP may show impairment are as follows: DHS 63.08(2)(a)1.1. Impairment in vocational functioning is manifested by an inability to be consistently employed at a self-sustaining level or an ability to be employed only with extensive supports, except that a person who is able to earn sustaining income but is recurrently unemployed because of acute episodes of mental illness shall be considered vocationally impaired; DHS 63.08 NoteNote: The following are examples of persons who function at a fairly high level in general terms but still manifest vocational impairment:
DHS 63.08 NoteA person who works 30 hours a week for years at a sheltered workshop at minimum wage, enough to sustain himself or herself, but who has shown repeated inability to work in competitive job sites because of loss of support and of the structure of sheltered work; and
DHS 63.08 NoteA person who works 40 hours a week at a wage that may be somewhat more than minimum without extensive supports but who is unemployed 2 to 4 months of most years because of acute psychosis and loses his or her job when psychotic.
DHS 63.08(2)(a)2.2. Impairment in educational functioning is manifested by an inability to establish and pursue educational goals within a normal time frame or without extensive supports; DHS 63.08 NoteNote: As an example, protracted part-time or intermittent full-time courses of study indicate impairment when goals are not being met or repeated class failure or frequent changes in major areas of study manifest an impairment in educational functioning.
DHS 63.08(2)(a)3.3. Impairment in homemaker functioning is manifested by an inability to consistently and independently carry out home management tasks, including household meal preparation, washing clothes, budgeting and child care tasks and responsibilities; and DHS 63.08(2)(a)4.4. When part-time homemaker and educational or vocational roles coexist, the functional level of the combined roles shall be assessed according to existing community norms; DHS 63.08(2)(b)1.1. Impairment in social or interpersonal functioning is manifested by a person’s inability to independently develop or maintain adult social relationships or to independently participate in adult social or recreational activities and is evidenced by: DHS 63.08(2)(b)1.a.a. Repeated inappropriate or inadequate social behavior or an ability to behave appropriately or adequately only with extensive or consistent support or coaching or only in special contexts or situations, such as social groups organized by treatment staff; or DHS 63.08(2)(b)1.b.b. Consistent participation in adult activities only with extensive support or coaching and when involvement is mostly limited to special activities established for the mentally ill or other persons with interpersonal impairments; DHS 63.08(2)(b)2.2. Impairment in community functioning is manifested by a pattern of significant community disruption, including family disruption or social unacceptability or inappropriateness, that may not recur often but is of such magnitude that it results in severe consequences, including exclusion from the person’s primary social group or incarceration, or in severe impediments to securing basic needs such as housing; and DHS 63.08 NoteNote: The following are examples of higher functioning persons who still manifest the impairments under par. (b):
DHS 63.08 NoteA person who socialized appropriately and effectively in one-to-one contacts with staff or in social groups organized by a CSP but is very isolative otherwise and does not socialize on his or her own;
DHS 63.08 NoteA person who anxiously participates in a community group or activity only with much weekly coaching by and frequent accompaniment of treatment staff, but who does not reach the point of going to this activity on his or her own or with only minimal coaching;
DHS 63.08 NoteA person who socializes on his or her own in relationships and groups, but who, after a period of time, drives away many friends because of inappropriate or ineffective behavior and therefore is recurrently lonely; and
DHS 63.08 NoteA divorced woman’s periodic threats to “steal” her children (who are in the custody of her ex-husband) from their day care center that lead to loss of visiting privileges with the children and therefore loss of the emotional sustenance the children bring.
DHS 63.08(2)(c)(c) Self-care or independent living. Impairment in self-care or independent living is manifested by: DHS 63.08(2)(c)1.1. A person’s inability to consistently perform the range of practical daily living tasks required for basic adult functioning in the community, including: DHS 63.08(2)(c)1.e.e. Recognition and avoidance of common dangers or hazards to self and possessions; or DHS 63.08(2)(c)2.2. A person’s persistent or recurrent failure to perform daily living tasks specified in subd. 1., except with significant support or assistance by others such as friends, family or relatives. DHS 63.08 HistoryHistory: Cr. Register, April, 1989, No. 400, eff. 5-1-89. DHS 63.09(1)(1) A CSP may not deny admission to an applicant solely on the basis of the number of previous admissions to any program or service provider. DHS 63.09(2)(2) A CSP shall have written policies and procedures governing the admissions process. The policies and procedures shall include: DHS 63.09(2)(b)(b) The types of information to be obtained on all applicants prior to admission; DHS 63.09(2)(c)(c) The procedures to be followed when accepting referrals from outside agencies; and DHS 63.09(2)(d)(d) The procedures to be followed in referring an applicant to other service providers when the applicant is found ineligible for admission. The reason for nonadmission shall be recorded in CSP records. DHS 63.09(3)(3) During the admissions process, unless an emergency situation is documented, each applicant and guardian, if any, shall be informed of the following: DHS 63.09(3)(b)(b) Program regulations governing client conduct, the types of infractions that may lead to corrective action or discharge from the program and the process for review and appeal; DHS 63.09(3)(d)(d) The service costs that may be billed to the client, if any; DHS 63.09(3)(e)(e) The program’s procedures for follow-up if a client is discharged; and DHS 63.09(4)(4) The CSP shall ensure that no client is denied any benefits or services or is subjected to discrimination on the basis of age, race, religion, color, sexual orientation, marital status, arrest and conviction record, ancestry, creed, national origin, disability, sex or physical condition. DHS 63.09(5)(5) A CSP shall have a telehealth policy, including when telehealth would be used and by whom, privacy and security considerations, and the right to decline services provided via telehealth. DHS 63.10DHS 63.10 Assessment and treatment planning. DHS 63.10(1)(a)(a) An initial assessment shall be done at the time of the client’s admission to the CSP, and an in-depth assessment shall be completed within one month after a client’s admission. The physician shall make a psychiatric assessment of the client’s need for CSP care and appropriate professional personal shall make a psychiatric and psychosocial assessment of the client’s need for CSP care. DHS 63.10(1)(b)1.1. Be clearly explained to the client or guardian, if any, and, when appropriate, to the client’s family; DHS 63.10(1)(b)2.2. Include available information on the client’s family and the client’s legal, social, vocational and educational history; and DHS 63.10(1)(b)3.3. Be incorporated into review and revisions of the client’s treatment plan under sub. (2). DHS 63.10(1)(c)(c) A clinical coordinator shall include a signed statement in the client’s treatment record that the assessments under par. (a) were performed by appropriate professional personnel specified under s. DHS 63.06 (4) (a) 1. to 8. DHS 63.10(1)(d)(d) The in-depth assessment shall include evaluation of the client’s: DHS 63.10(1)(d)1.1. Psychiatric symptomatology and mental status, by a psychiatrist and by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c). Utilizing information derived from the evaluation required under this subdivision, a psychiatrist or a clinical psychologist shall make a psychiatric diagnosis; DHS 63.10(1)(d)2.2. Use of drugs or alcohol, or both, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c); DHS 63.10(1)(d)3.3. Vocational and educational functioning, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c); DHS 63.10(1)(d)4.4. Social functioning, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c); DHS 63.10(1)(d)5.5. Self-care and independent living capacity, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c); DHS 63.10(1)(d)6.6. Relationship with his or her family, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c); DHS 63.10(1)(d)7.7. Medical health, by a psychiatrist or physician. A registered nurse may collect health-related information and history and perform partial examinations under supervision of a physician; DHS 63.10(1)(d)8.8. Dental health information and history may be collected by a psychiatrist, a physician or a CSP professional under the supervision of a physician; and DHS 63.10(1)(d)9.9. Other specified problems and needs, by a CSP professional supervised by the clinical coordinator or a designated staff member meeting qualifications under s. DHS 63.06 (2) (c). DHS 63.10(1)(e)(e) Evidence that a service is medically necessary shall be indicated through the signature of a psychiatrist on the client’s treatment record following the psychiatrist’s review and approval of the service. DHS 63.10(2)(a)(a) The case manager assigned to a client under s. DHS 63.12 (1) shall ensure that an initial written treatment plan is developed at the time of the client’s admission to the CSP and that a comprehensive treatment plan is developed and written within one month after admission and is reviewed and updated in writing at least once every 6 months. DHS 63.10(2)(b)2.2. Be developed in collaboration with other CSP professional and paraprofessional staff, service provider staff, the client or guardian, if any, and, when feasible, the client’s family. The client’s participation in the development of treatment or service goals shall be documented; DHS 63.10(2)(b)3.3. Specify treatment goals along with the treatment, rehabilitation and service actions necessary to accomplish the goals. The goals shall be developed with both short-range and long-range expectations and shall be written in measurable terms; DHS 63.10(2)(b)4.4. Identify the expected outcomes and the staff or agencies responsible for providing the client’s treatment, rehabilitation and support services; DHS 63.10(2)(b)5.5. Describe criteria for termination of treatment, rehabilitation and support services; and DHS 63.10(2)(b)6.6. Be reviewed, approved and signed by the CSP’s psychiatrist and clinical coordinator and be included in the client’s treatment record. DHS 63.10(2)(c)(c) Treatment or provision of services may begin before the treatment plans are completed. DHS 63.10(2)(d)(d) The client’s progress and current status in meeting the goals set forth in the plan shall be reviewed by the staff working with the client at regularly scheduled case conferences at least every 6 months and shall be recorded in the client’s treatment record as follows: DHS 63.10(2)(d)1.1. The date and results of the review and any changes in the plan shall be recorded; and DHS 63.10(2)(d)2.2. The names of participants in the case conference shall be recorded. DHS 63.10(2)(e)(e) The case manager shall discuss the results of the review required under par. (d) with the client or guardian, if any, and, if appropriate, the client’s parent and shall record the client’s or guardian’s acknowledgement of any changes in the plan. DHS 63.10(3)(3) Place of treatment. Each CSP shall set a goal of providing over 50% of service contacts in the community, in non-office based or non-facility based settings. For a period of 2 years following the effective date of this chapter, a CSP shall submit to the department records of the places where treatment and services are provided to each client. The records shall cover time periods specified by the department. DHS 63.10 HistoryHistory: Cr. Register, April, 1989, No. 400, eff. 5-1-89.
