DHS 107.13(2)(a)4.b.b. A hospital outpatient mental health clinic on the hospital’s physical premises.
DHS 107.13(2)(a)4.c.c. An outpatient mental health clinic.
DHS 107.13(2)(a)4.d.d. A nursing home.
DHS 107.13(2)(a)4.e.e. A school.
DHS 107.13(2)(a)4.f.f. A hospital.
DHS 107.13(2)(a)4.g.g. The home.
DHS 107.13(2)(a)4.h.h. Via telehealth when the provider is in a location that ensures privacy and confidentiality of recipient information and communications.
DHS 107.13(2)(a)5.5. The provider who performs psychotherapy shall engage in contact with the recipient in person, via real-time interactive audio-visual telehealth, or real-time interactive audio-only telehealth for at least 5/6 of the time for which reimbursement is claimed under MA.
DHS 107.13(2)(c)(c) Other limitations.
DHS 107.13(2)(c)1.1. Collateral interviews shall be limited to members of the recipient’s immediate family. These are parents, spouse and children or, for children in foster care, foster parents.
DHS 107.13(2)(c)2.2. No more than one provider may be reimbursed for the same psychotherapy session, unless the session involves a couple, family group or is a group therapy session. In this subdivision, “group therapy session” means a session not conducted in a hospital for an inpatient recipient at which there are more than one but not more than 10 individuals receiving psychotherapy services together from one or 2 providers. Under no circumstances may more than 2 providers be reimbursed for the same session.
DHS 107.13(2)(c)3.3. Emergency psychotherapy may be performed by a provider for a recipient without a prescription for treatment or prior authorization when the provider has reason to believe that the recipient may immediately injure himself or herself or any other person. A prescription for the emergency treatment shall be obtained within 48 hours of the time the emergency treatment was provided, excluding weekends and holidays. Services shall be incorporated within the limits described in par. (b) and this paragraph, and subsequent treatment may be provided if par. (b) is followed.
DHS 107.13(2)(c)4.4. Strength-based assessment, including a differential diagnostic evaluation for mental health, day treatment and substance abuse services shall be limited to 8 hours every calendar year per recipient as a unique procedure before prior authorization is required.
DHS 107.13(2)(c)5.5. Services under this subsection are not reimbursable if the recipient is receiving community support program services under sub. (6) or psychosocial services provided through a community-based psychosocial service program under sub. (7).
DHS 107.13(2)(c)6.6. Professional psychotherapy services provided to hospital inpatients in general hospitals, other than group therapy and medication management, are not considered inpatient services. Reimbursement shall be made to the psychiatrist, psychologist, or advanced practice nurse prescriber billing providers certified under s. DHS 105.22 (1) (a), (b), or (bm) who provide mental health professional services to hospital inpatients in accordance with requirements of this subsection.
DHS 107.13(2)(d)(d) Non-covered services. All of the following services are not covered services:
DHS 107.13(2)(d)1.1. Collateral interviews with persons not stipulated in par. (c) 1., and consultations, except as provided in s. 49.45 (29y), Stats., and s. DHS 107.06 (4) (d).
DHS 107.13(2)(d)2.2. Psychotherapy for individuals with the primary diagnosis of developmental disabilities, including intellectual disabilities, except when they experience psychological problems that necessitate psychotherapeutic intervention.
DHS 107.13(2)(d)3.3. For individuals age 21 and over, psychotherapy provided in a person’s home.
DHS 107.13 NoteNote: Section 49.45 (45), Stats., provides for in-home community mental health and alcohol and other drug abuse (AODA) services for individuals age 21 and over. However, these services are available to an individual only if the county, city, town or village in which the individual resides elects to make the services available and agrees to pay the non-federal share of the cost of those services.
DHS 107.13(2)(d)4.4. Self-referrals. For purposes of this paragraph, “self-referral” means that a provider refers a recipient to an agency in which the provider has a direct financial interest, or to himself or herself acting as a practitioner in private practice.
DHS 107.13(2)(d)5.5. Court appearances except when necessary to defend against commitment.
DHS 107.13 NoteNote: For more information on non-covered services, see s. DHS 107.03.
DHS 107.13(2m)(2m)The goals of psychotherapy and specific objectives to meet those goals shall be documented in the recipient’s recovery and treatment plan that is based on the strength-based assessment. In the recovery and treatment plan, the signs of improved functioning that will be used to measure progress towards specific objectives at identified intervals, agreed upon by the provider and recipient shall be documented. A mental health diagnosis and medications for mental health issues used by the recipient shall be documented in the recovery and treatment plan.
DHS 107.13(3)(3)Alcohol and other drug abuse outpatient treatment services.
DHS 107.13(3)(a)(a) Covered services. Outpatient alcohol and drug abuse treatment services shall be covered when prescribed by a physician, provided by a provider who meets the requirements of s. DHS 105.23, and when the following conditions are met:
DHS 107.13(3)(a)1.1. The treatment services furnished are AODA treatment services;
DHS 107.13(3)(a)2.2. Before being enrolled in an alcohol or drug abuse treatment program, the recipient receives a complete medical evaluation, including diagnosis, summary of present medical findings, medical history and explicit recommendations by the physician for participation in the alcohol or other drug abuse treatment program. A medical evaluation performed for this purpose within 60 days prior to enrollment shall be valid for reenrollment;
DHS 107.13(3)(a)3.3. The supervising physician or psychologist develops a treatment plan which relates to behavior and personality changes being sought and to the expected outcome of treatment;