Chapter DHS 105

DHS 105.21(1)(a) (a) Meet the requirements of s. DHS 105.07, and;

DHS 105.21(1)(a)1. 1. Maintain clinical records on all patients, including records sufficient to permit determination of the degree and intensity of treatment furnished to MA recipients, as specified in 42 CFR 482.61; and

DHS 105.21(1)(a)2. 2. Maintain adequate numbers of qualified professional and supportive staff to evaluate patients, formulate written, individualized comprehensive treatment plans, provide active treatment measures and engage in discharge planning, as specified in 42 CFR 482.62;

DHS 105.21(1)(b) (b) Have a utilization review plan that meets the requirements of 42 CFR 405.1035, 405.1037 and 405.1038;

DHS 105.21(1)(c) (c) If participating in the PRO review program, meet the requirements of that program and any other requirements established under the state contract with the PROs;

DHS 105.21(1)(d) (d) If providing outpatient psychotherapy, comply with s. DHS 105.22;

DHS 105.21(1)(e) (e) If providing outpatient alcohol and other drug abuse services, comply with s. DHS 105.23; and

DHS 105.21(1)(f) (f) If providing day treatment services, comply with s. DHS 105.24.

DHS 105.21(2) (2) Waivers and variances. The department shall consider applications for waivers or variances of the requirements in sub. (1) if the requirements and procedures stated in s. DHS 106.11 are followed.

DHS 105.21 Note Note: For covered mental health services, see s. DHS 107.13.

DHS 105.21 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) (a) made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1990, No. 414; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.22 DHS 105.22 Psychotherapy providers.

DHS 105.22(1) (1) Types of psychotherapy providers. For MA certification, a psychotherapy provider shall be one of the following:

DHS 105.22(1)(a) (a) A physician meeting the requirements of s. DHS 105.05 (1) who has completed a residency in psychiatry. Proof of residency shall be provided to the department. Proof of residency shall either be board-certification from the American board of psychiatry and neurology or a letter from the hospital in which the residency was completed;

DHS 105.22(1)(b) (b) A psychologist licensed under ch. 455, Stats.;

DHS 105.22(1)(bm) (bm) An advanced practice nurse prescriber who is certified under s. 441.16 (2), Stats., and holds current certification in a psychiatric specialty from the American Nurses Credentialing Center.

DHS 105.22(1)(bn) (bn) A marriage and family therapist licensed under ss. 457.10, 457.11, and 457.14, Stats., including holding a valid training or temporary license;

DHS 105.22(1)(bo) (bo) A professional counselor licensed under ss. 457.12 to 457.14, Stats., including holding a valid training or temporary license;

DHS 105.22(1)(bp) (bp) An advanced practice social worker certified under s. 457.08 (2), Stats.;

DHS 105.22(1)(bq) (bq) An independent social worker certified under s. 457.08 (3), Stats.;

DHS 105.22(1)(br) (br) A clinical social worker licensed under s. 457.08 (4), Stats.;

DHS 105.22(1)(c) (c) An outpatient clinic certified under ch. DHS 35; or

DHS 105.22(1)(d) (d) A hospital outpatient mental health clinic located on the hospital’s physical premises.

DHS 105.22(2) (2) Staffing of outpatient facilities. To provide psychotherapy reimbursable by MA, personnel employed by an outpatient clinic under sub. (1) (c) shall meet applicable requirements under ch. DHS 35. Persons employed by a hospital outpatient mental health clinic under sub. (1) (d) need not be individually certified as providers but may provide psychotherapy services upon the department’s issuance of certification to the mental health clinic by which they are employed. A hospital outpatient mental health clinic shall maintain a list of the names of persons employed by the clinic who are performing psychotherapy services for which reimbursement may be claimed under MA. This listing shall document the credentials possessed by the named persons which would qualify them for certification under the standards specified in this subsection and shall include the dates that the named persons began employment.

DHS 105.22(3) (3) Reimbursement for outpatient psychotherapy services. Reimbursement shall be made to any certified psychotherapy provider whose practice, as described by individual licensure or clinic certification regulations, allows for the delivery of psychotherapy without clinical supervision. For outpatient psychotherapy services delivered by certified providers who are required, under individual licensure or clinic certification regulations, to practice under a clinical supervisor, reimbursement shall be made to the supervising provider. The supervising provider must be MA certified.

DHS 105.22 Note Note: For covered mental health services, see s. DHS 107.13.

DHS 105.22 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (c), (d) and (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 06-080: cr. (1) (bm), am. (1) (c), (2) (a) and (3), r. and recr. (1) (d), r. (2) (b) Register May 2009 No. 641, eff. 6-1-09; correction in (2) made under s. 13.92 (4) (b) 1., Stats., Register May 2009 No. 641; CR 20-039: am. (1) (b), cr. (1) (bn) to (br), am. (3) Register October 2021 No. 790, eff. 11-1-21.

DHS 105.23 DHS 105.23 Alcohol and other drug abuse (AODA) treatment providers.

DHS 105.23(1) (1) Types of providers. For MA certification, an outpatient alcohol and other drug abuse (AODA) treatment provider shall be:

DHS 105.23(1)(a) (a) An outpatient facility operated by a board and certified under ss. DHS 75.49, 75.50, and 75.51;

DHS 105.23(1)(b) (b) An outpatient facility or hospital outpatient AODA facility certified under ss. DHS 75.49, 75.50, and 75.51; or

DHS 105.23(1)(c) (c) A provider certified under s. DHS 105.05 (1), 105.22 (1) (b), 105.22 (1) (bn), 105.22 (1) (bo), or 105.22 (1) (br). Providers that hold a training or temporary license under s. DHS 105.22 (1) (bn) or (bo) are excluded.

DHS 105.23(2) (2) Staffing requirements.

DHS 105.23(2)(a) (a) To provide AODA services reimbursable under MA, personnel employed by an outpatient facility under sub. (1) (a) or (b) shall:

DHS 105.23(2)(a)1. 1. Meet the requirements in s. DHS 105.22 (1) (b) or 105.05 (1); or

DHS 105.23(2)(a)2. 2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse counselor certification board and work under the supervision of a provider who is a licensed physician or licensed psychologist and employed by the same facility.

DHS 105.23 Note Note: Certification standards of the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board may be obtained by writing the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board, Inc., 416 East Main Street, Waukesha, WI 53186.

DHS 105.23(2)(b) (b) The facility shall provide the department with a list of persons employed by the facility who perform AODA services for which reimbursement may be claimed under MA. The listing shall identify the credentials possessed by the named persons which would qualify them for certification under the standards specified in par. (a). A facility, once certified, shall promptly advise the department in writing of the employment or termination of employees who will be or have been providing AODA services under MA.

DHS 105.23(3) (3) Reimbursement for AODA services. Reimbursement for outpatient AODA treatment services shall be as follows:

DHS 105.23(3)(a) (a) For the services of any provider employed by or under contract to a certified AODA facility, reimbursement shall be made to the facility; and

DHS 105.23(3)(b) (b) For the services of any provider who is a physician or licensed psychologist defined under sub. (1) (c) in private practice, reimbursement shall be to the physician or psychologist.

DHS 105.23 Note Note: For covered alcohol and other drug abuse treatment services, see s. DHS 107.13 (3).

DHS 105.23 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (b) and(c) and (2) (a) 1., Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections in (1) (a) and (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: am. (1) (c) Register October 2021 No. 790, eff. 11-1-21; correction in (1) (c) made under s. 35.17, Stats., Register October 2021 No. 790; correction in (1) (a), (b) made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801.

DHS 105.24 DHS 105.24 Mental health day treatment or day hospital service providers.

DHS 105.24(1) (1) Requirements. For MA certification, a day treatment or day hospital service provider shall:

DHS 105.24(1)(a) (a) Be a medical program certified under s. DHS 61.75; and

DHS 105.24(1)(b) (b) Meet the following personnel and staffing requirements:

DHS 105.24(1)(b)1. 1. A registered nurse and a registered occupational therapist shall be available to participate in program planning, program implementation and daily program coordination;

DHS 105.24(1)(b)2. 2. The day treatment program shall be planned for and directed by designated members of an interdisciplinary team that includes a social worker, a psychologist, an occupational therapist and a registered nurse or a physician, physician’s assistant or another appropriate health care professional;

DHS 105.24(1)(b)3. 3. A written patient evaluation involving an assessment of the patient’s progress by each member of the multidisciplinary team shall be made at least every 60 days; and

DHS 105.24(1)(b)4. 4. For the purposes of daily program performance, coordination guidance and evaluation:

DHS 105.24(1)(b)4.a. a. One qualified professional staff member such as an OTR, masters degree social worker, registered nurse, licensed psychologist or masters degree psychologist for each group, or one certified occupational therapy assistant and one other paraprofessional staff person for each group; and

DHS 105.24(1)(b)4.b. b. Other appropriate staff, including volunteer staff.

DHS 105.24(2) (2) Billing and reimbursement.

DHS 105.24(2)(a) (a) Reimbursement for medical day treatment or day hospital services shall be at a rate established and approved by the department.

DHS 105.24(2)(b) (b) Reimbursement payable under par. (a) shall be subject to reductions for third party recoupments.

DHS 105.24 Note Note: For covered day treatment and day hospital services, see s. DHS 107.13 (4).

DHS 105.24 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (1) (a), am. (2) (b), r. (2) (c), Register, September, 1991, No. 429, eff. 10-1-91; correction in (1) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 22-043: am. (1) (b) 1. Register May 2023 No. 809, eff. 6-1-23.

DHS 105.25 DHS 105.25 Alcohol and other drug abuse (AODA) day treatment providers.

DHS 105.25(1) (1) Types of providers. For MA certification, an alcohol and other drug abuse (AODA) day treatment provider shall be certified under ss. DHS 75.52 and 105.23.

DHS 105.25(2) (2) Staffing requirements.

DHS 105.25(2)(a) (a) An alcohol and drug counselor certified as provided in ss. DHS 75.02 (84) and 75.03 (4) (d) shall be available during all hours in which services are provided to participate in treatment planning and implementation and daily program coordination.

DHS 105.25(2)(b) (b) A treatment plan for each participating recipient shall be developed, directed and monitored by designated members of an interdisciplinary treatment team which includes an alcohol and drug counselor II or III, certified as provided in ss. DHS 75.03 (85) and 75.18 (2) (c) and (6) (b), a physician or licensed psychologist, and other health care professionals. The treatment team shall maintain a written record of each recipient’s treatment and progress toward meeting the goals described in the recipient’s plan of care.

DHS 105.25(2)(c) (c) All treatment shall be coordinated and provided by at least one qualified professional staff member who has demonstrated experience in delivering direct treatment to persons with alcohol and other drug abuse problems. Other staff members, such as an AODA counselor I who has filed for certification with the Wisconsin alcoholism and drug counselor certification board, inc., may assist in treatment under the supervision of a qualified professional staff member.

DHS 105.25 History History: Emerg. cr. eff. 3-9-89; cr. Register, December, 1989, No. 408, eff. 1-1-90; corrections in (1), (2) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (1), (2) (a), (b) made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801; CR 22-043: am. (2) (a) Register May 2023 No. 809, eff. 6-1-23.

DHS 105.255 DHS 105.255 Community support programs.

DHS 105.255(1) (1) General requirements. For MA certification, a community support program (CSP) service provider shall meet the requirements under ss. DHS 63.06 to 63.17 and this section. The department may waive a requirement in ss. DHS 63.06 to 63.17 under the conditions specified in s. DHS 63.05 if requested by a provider. Certified providers under this section may provide services directly or may contract with other qualified providers to provide all or some of the services described in s. DHS 107.13 (6).

DHS 105.255(2) (2) Mental health technician.

DHS 105.255(2)(a) (a) In this subsection, “mental health technician” means a paraprofessional employee of the CSP who is limited to performing the services set out in s. DHS 63.11 (3) (c) and (4).

DHS 105.255(2)(b) (b) Except as provided in par. (c), a mental health technician shall have at least 1,000 hours of supervised work experience with long-term mentally ill persons and meet at least one of the following conditions:

DHS 105.255(2)(b)1. 1. Has satisfactorily completed the educational curriculum developed by the department;

DHS 105.255(2)(b)2. 2. Is certified by the American occupational therapy association as an occupational therapy assistant;

DHS 105.255(2)(b)3. 3. Is a practical nurse (LPN) licensed under s. 441.10, Stats.;

DHS 105.255(2)(b)4. 4. Has satisfied the training requirements under s. DHS 133.17 (4) for a home health aide;

DHS 105.255(2)(b)5. 5. Is included in the registry of persons under ch. DHS 129 who have completed a nurse’s assistant training and testing program or only a testing program; or

DHS 105.255(2)(b)6. 6. Has satisfied the requirements under s. DHS 105.17 (3) (a) 1. to provide personal care services and has completed an additional 1000 hours of supervised work experience with long-term mentally ill persons.

DHS 105.255(2)(c) (c) A mental health technician providing CSP services who does not meet the requirements of par. (b) shall meet the requirements of s. DHS 63.06 (4) (a) 9. and shall in addition meet the requirements of par. (b) within one year following the effective date of the provider’s MA certification or the technician’s date of employment by the CSP, whichever is later.

DHS 105.255(3) (3) Documentation of employee qualifications. Providers shall maintain current written documentation of employee qualifications required under s. DHS 63.06 (4) and this section.

DHS 105.255 History History: Cr. Register, September, 1990, No. 417, eff. 10-1-90; corrections in (1), (2) (c) and (3) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; correction in (2) (b) 5. made under s. 13.93 (2m) (b) 7., Stats., October, 2000, No. 538; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.257 DHS 105.257 Community-based psychosocial service programs. For MA certification as a community-based psychosocial service program under s. 49.45 (30e), Stats., a provider shall be certified as a comprehensive community services program under ch. DHS 36. The department may waive a requirement in ss. DHS 36.04 to 36.12 under the conditions specified in s. DHS 36.065 if requested by a provider. Certified providers under this section may provide services directly or may contract with other qualified providers to provide all or some of the services described in s. DHS 107.13 (7).

DHS 105.257 History History: Emerg. cr. eff. 7-1-04; CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.26 DHS 105.26 Chiropractors. For MA certification, chiropractors shall be licensed pursuant to s. 446.02, Stats.

DHS 105.26 Note Note: For covered chiropractic services, see s. DHS 107.15.

DHS 105.26 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.265 DHS 105.265 Podiatrists. For MA certification, podiatrists shall be licensed under s. 448.63, Stats., and ch. Pod 1 and registered under s. 448.07, Stats., and ch. Pod 4.

DHS 105.265 History History: Cr. Register, January, 1991, No. 421, eff. 2-1-91; corrections made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.27 DHS 105.27 Physical therapists and assistants.

DHS 105.27(1) (1) Physical therapists. For MA certification, physical therapists shall be licensed pursuant to ss. 448.05 and 448.07, Stats., and ch. PT 1.

DHS 105.27(2) (2) Physical therapist assistants. For MA certification, physical therapist assistants shall have graduated from a 2-year college-level program approved by the American physical therapy association, and shall provide their services under the supervision of a physical therapist certified pursuant to sub. (1) and. ss. 448.53, 448.56, and 448.985, Stats. Documentation of supervision shall be maintained and provided to the department upon request. Physical therapist assistants may not bill or be reimbursed directly for their services. When performing services, physical therapist assistants are to be submitted as renderer on billing claims.