Wis. Admin. Code DHS § DHS 75.48

Current through December 30, 2024

Section DHS 75.48 - Service requirements by level of care tables

(1) Table 75.48 (1) establishes additional requirements for outpatient levels of care.

(2) Table 75.48 (2) establishes additional requirements for residential levels of care

(3) Table 75.48 (3) establishes additional requirements for residential with- drawal management levels of care.

DHS .48 (3) Service Requirements by Level of Care, Withdrawal Management
DHS .57 Residential Withdrawal Management Service	DHS .58 Residential Intoxication Monitoring Service
(a) Exemptions from general requirements	1. This service is exempt from the requirements of s. DHS 75.24(11) regarding assessment. 2. This service is exempt from the requirements of s. DHS 75.24(13) regarding treatment planning.	1. This service is exempt from ss. DHS 75.18(2) requiring a clinical supervisor. 2. This service is exempt from the requirements of s. DHS 75.24(11) regarding assessment. 3. This service is exempt from the requirements of s. DHS 75.24(13) regarding treatment planning.
(b) Medical director	Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service.
(c) Physician requirements	Available on a 24-hour basis.
(d) Nurse requirements	Registered nurse available on-site on a 24-hour basis.
(e) Additional personnel requirements	Requires a substance abuse counselor to provide consultation for each patient prior to discharge.	1. Requires at least one staff person trained in the recognition of withdrawal symptoms available on-site on a 24-hour basis. 2. Requires a substance abuse counselor to provide consultation for each patient prior to discharge.
(f) Additional assessment requirements	Each patient shall receive sufficient assessment of dimensional risk and severity of need to determine preliminary level of care and appropriate referral for continuing services.	Each patient shall receive sufficient assessment of dimensional risk and severity of need to determine preliminary level of care and appropriate referral for continuing services.
(g) Intake completion requirement	Within 24 hours of admission, or as soon as the patient is able to complete the intake.	Within 24 hours of admission, or as soon as the patient is able to complete the intake.
(h) Medical screening requirements	1. Required no later than 12 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record. 2. A physician shall review and document the medical status of a patient within 72 hours after admission.	Each patient shall be screened by medical personnel before admission to the service, unless the service has documentation of the patient's current physical condition.
(i) Additional treatment plan requirements	Each patient shall have a written plan, completed prior to discharge, for step down or transfer to ongoing treatment services and that addresses discharge needs and ongoing supports. The plan shall be reviewed and signed by the clinical supervisor.	Each patient shall have a written plan, completed prior to discharge, for linkage and referral to ongoing treatment services and that addresses discharge needs and ongoing supports.
(j) Clinical staffing frequency	Required daily for each patient.	Required daily for each patient.
(k) Additional requirements for discharge or transfer	1. Summary required within 48 hours after the discharge or transfer date. 2. The service shall facilitate linkage for follow-up and additional services that are consistent with the patient's assessment of dimensional risk and severity of need. 3. Documentation of linkage and follow-up shall be reviewed and signed by the clinical supervisor.	1. Summary required within 48 hours after the discharge or transfer date. 2. The service shall facilitate linkage and referral for follow-up and additional services that are consistent with the patient's assessment of dimensional risk and severity of need.
(l) Operational requirements	1. The service shall have written agreements with community behavioral health service providers or systems to provide care after the patient is discharged from the service. 2. The service shall maintain an automated external defibrillator device on-site and shall train staff in its use. Documentation of training shall be available to the department upon request.	1. The service shall have written agreements with community behavioral health service providers or systems for referral after the patient is discharged from the service. 2. The service shall maintain an automated external defibrillator device on-site and shall train staff in its use. Documentation of training shall be available to the department upon request.

Wis. Admin. Code Department of Health Services DHS 75.48

Adopted by, CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (2) (b) made under s. 35.17, Stats., Register October 2021 No. 790, eff. 10/1/2022

This section is created eff. 10-1-22 by CR 20-047.

DHS .48 (1) Service requirements by level of care, outpatient
DHS .49 Outpatient Substance Use Treatment Service	DHS .50 Outpatient Integrated Behavioral Health Treatment Service	DHS .51 Intensive Outpatient Treatment Service	DHS .52 Day Treatment or Partial Hospitalization Treatment Service
(a) Adult services frequency requirements	Is less than 9 hours of treatment services per patient per week.	Is less than 9 hours of treatment services per patient per week.	At least 9 hours of treatment services per patient per week.	1. At least 15 hours of treatment services per patient per week. 2. At least one hour of individual counseling per week. 3. The maximum amount of time between clinical services shall not exceed 72 hours in any 7-day period.
(b) Minor services frequency requirements	Is less than 6 hours of treatment services per patient per week.	Is less than 6 hours of treatment services per patient per week.	At least 6 hours of treatment services per patient per week.	1. At least 12 hours of treatment services per patient per week. 2. At least one hour of individual counseling per week. 3. The maximum amount of time between clinical services shall not exceed 72 hours in any 7-day period.
(c) Service director requirements	Service director or an identified designee must be available on-site during the hours of operation of clinical services.
(d) Medical director requirements	Required either as an employee of the service or through a written agreement to provide medical oversight and consultation regarding clinical operations of the service.	Required either as an employee of the service or through a written agreement to provide medical oversight and consultation regarding clinical operations of the service.
(e) Substance abuse counselor requirements	Required to be available onsite during the hours of on-site operation of clinical services.	Required to be available onsite during the hours of onsite operation of clinical services.
(f) Mental health professional requirements	Required to be available during the hours of operation of clinical services.	Required either as an employee of the service or through a written agreement, to provide coordinated and concurrent services for the treatment of patients with cooccurring mental health disorders.	Required to be available during the hours of operation of clinical services.
(g) Additional personnel requirements	Requires at least one fulltime counselor for every 15 patients enrolled in the service.
(h) Assessment completion	Required by the third appointment.	Required by the third appointment.	Required by the third appointment.	Required by the third appointment.
(i) Use of prior assessment	For returning patients, an assessment update shall be completed if 90 days have passed since the initial assessment. If one year has passed, a new comprehensive assessment is required.	For returning patients, an assessment update shall be completed if 90 days have passed since the initial comprehensive assessment. If one year has passed, a new comprehensive assessment is required.	For returning patients, an assessment update shall be completed if 90 days have passed since the initial comprehensive assessment. If six months have passed, a new comprehensive assessment is required.	1. A new assessment, less than 30 days old, is required for each admission. 2. If a comprehensive assessment has been conducted by a referring substance use treatment provider and is less than 30 days old, the assessment may be utilized.
(j) Updated assessment, continuously enrolled patients	An assessment update shall be completed not less than once per year.	An assessment update shall be completed not less than once per year.	An assessment update shall be completed not less than once per year.
(k) Intake completion	Required by the end of the session following the assessment.	Required by the end of the session following the assessment.	Required by the end of the session following the assessment.	Required by the end of the session following the assessment.
(L) Treatment plan completion	Required before the second session following the assessment.	Required before the second session following the assessment.	Required before the second session following the assessment.	Required before the second session following the assessment.
(m) Treatment plan review frequency	Required every 90 days or 6 treatment sessions, whichever is longer, unless there is a clinical reason to review more frequently.	Required every 90 days or 6 treatment sessions, whichever is longer, unless there is a clinical reason to review more frequently.	Required every 14 days, unless there is a clinical reason to review more frequently.	Required every 14 days, unless there is a clinical reason to review more frequently.
(n) Clinical staffing	Required every 14 days for each patient.	Required every 14 days for each patient.
(o) Additional requirements for discharge or transfer	Summary required within 30 days after the discharge or transfer date.	Summary required within 30 days after the discharge or transfer date.	Summary required within 30 days after the discharge or transfer date.	Summary required within 14 days after the discharge or transfer date.
(p) Operational requirements	A service shall provide services at times that allow most patients to maintain employment or attend school.	1. A service shall make efforts to provide services at times that allow patients to maintain employment or attend school. 2. Service staff members shall be trained in life-sustaining techniques and emergency first aid. Documentation of training shall be available to the department upon request.

DHS .48 (2) Service requirements by level of care, residential
DHS .53 Transitional Residential Treatment Service	DHS .54 Medically Monitored Residential Treatment Service	DHS .55 Medically Managed Inpatient Treatment Service	DHS .56 Adult Residential Integrated Behavioral Health Stabilization Service
(a) Required treatment services	At least 6 hours of treatment services per patient per week.	1. At least 20 hours of treatment services per patient per week. 2. At least one hour of individual counseling per patient per week.	1. At least 12 hours of treatment services per patient per week. 2. At least one hour of individual counseling per patient per week.
(b) Service director requirements	Service director or an identified designee must be available on-site during hours of operation.	Service director or an identified designee must be available on-site during hours of operation.
(c) Medical director	Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service.	Required to provide medical oversight and consultation regarding the clinical operations of the service.	Required either as an employee of the service or through a written agreement, to provide medical oversight and consultation regarding the clinical operations of the service.
(d) Physician requirements	Requires a prescriber knowledgeable in addiction treatment available to provide medical and clinical consultation, either as an employee of the service or through a written agreement.	1. Requires a physician available to provide consultation, medication management, and medication-assisted treatment services. 2. Requires a consulting psychiatrist, or a consulting clinical psychologist licensed under ch. 455, Stats., who will be available as needed, with a written agreement to that effect.	1. Requires a psychiatrist either as an employee of the service or through a written agreement, to provide treatment services for patients with mental health disorders. 2. Requires a prescriber knowledgeable in addiction treatment available on a 24-hour basis.
(e) Substance abuse counselor requirements	Required to be available onsite during the hours of on-site operation of clinical services.
(f) Mental health professional requirements	Required either as an employee of the service or through written agreement, to provide coordinated and concurrent services for the treatment of individuals with co-occurring mental health disorders.	Required to be available during the hours of operation of clinical services.	Required to be available during the hours of operation of clinical services.	Required to be available during the hours of operation of clinical services.
(g) Nurse requirements	Requires a registered nurse or prescriber to be available on-site on a 24-hour basis.
(h) Counselorpatient ratio requirements	At least one full-time substance abuse counselor for every 15 patients enrolled in the service.	At least one full-time substance abuse counselor for every 10 patients enrolled in the service.	At least one full-time counselor for every 10 patients enrolled in the service.
(i) Assessment completion	1. Required at the time of or prior to admission. 2. If a comprehensive assessment has been conducted by a referring substance use treatment provider and is less than 30 days old, the assessment may be utilized in lieu of conducting another one.	1. Required at the time of or prior to admission. 2. If a comprehensive assessment has been conducted by a referring substance use treatment provider and is less than 30 days old, the assessment may be utilized in lieu of conducting another one.	1. Required within 4 days of admission. 2. Use of prior assessment under DHS 75.24(11) (c) shall not apply.	1. Required within 4 days of admission. 2. Use of prior assessment under DHS 75.24(11) (c) shall not apply.
(j) Additional assessment requirements	1. For patients continuously enrolled in services, an assessment update shall be completed not less than every six months. 2. The service shall have a written and documented procedure for reviewing assessments and level of care placement during clinical consultation or clinical supervision that occurs within 7 days of the assessment.	A physician, physician assistant, registered nurse, or clinical supervisor shall review and co-sign the assessment and level of care placement within 7 days of the assessment.	A prescriber shall review and co-sign the assessment and level of care placement within 2 working days following the assessment.	The clinical assessment and level of care placement shall be reviewed at the next clinical consultation staffing following the assessment.
(k) Intake requirements	Intake shall be completed within 24 hours of admission.	Intake shall be completed within 24 hours of admission.	1. Intake shall be completed within 24 hours of admission, or as soon as the patient is able to complete the intake. 2. Admission shall be by order of a physician. The physician's referral shall be in writing or indicated by the physician's signature on the placement criteria summary. 3. Admission is appropriate only if the person to be admitted is determined appropriate for placement in this level of care by the application of ASAM or other department-approved placement criteria.	Intake shall be completed within 24 hours of admission, or as soon as the patient is able to complete the intake.
(L) Medical screening requirements	1. Required no later than 7 days after the patient's admission to identify health problems and to screen for communicable illnesses, unless there is documentation that a screening was completed less than 90 days prior to admission. Medical screening shall be documented in the patient's case record. 2. A patient continuously enrolled in treatment shall receive an annual follow-up medical screening.	Required no later than 7 days after the patient's admission to identify health problems and screen for communicable illnesses, unless there is documentation that a screening was completed less than 30 days prior to admission. Medical screening shall be documented in the patient's case record.	Required no later than 24 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record.	1. Required no later than 12 hours after the patient's admission to identify health problems and to screen for communicable illnesses. Medical screening shall be documented in the patient case record. 2. A physician shall review and document the medical status of a patient within 72 hours after admission.
(m) Treatment plan completion	Required within one week of admission.	Required within 5 days of admission.	1. A preliminary treatment plan is required within 48 hours of admission. 2. A treatment plan consistent with ss. DHS 75.24(13) is required within 4 days of admission.	1. A preliminary treatment plan is required within 48 hours of admission. 2. A treatment plan consistent with ss. DHS 75.24(13) is required within 4 days of admission.
(n) Treatment plan review frequency	Required every 6 weeks, unless there is a clinical reason to review more frequently.	Required weekly, unless there is a clinical reason to review more frequently.	Required daily.	Required daily.
(o) Additional treatment plan requirements	The patient's treatment plan shall include a preliminary discharge plan outlining step down services and a plan for ongoing support. The discharge plan shall be reviewed and updated weekly, in conjunction with the treatment plan.	The preliminary and ongoing treatment plans shall include a preliminary discharge plan outlining step down services and a plan for ongoing support. The discharge plan shall be reviewed and updated in conjunction with the treatment plan.	1. The preliminary and ongoing treatment plans shall include a determination and ongoing review of the level of observation needed to address the patient's needs and any safety concerns. 2. The preliminary and ongoing treatment plans shall include a preliminary discharge plan outlining step down services and a plan for ongoing support. The discharge plan shall be reviewed and updated in conjunction with the treatment plan.
(p) Clinical staffing frequency	Required every 30 days for each patient.	Required every 7 days for each patient.	Required daily for each patient.	Required daily for each patient.
(q) Additional requirements for discharge or transfer	Summary required within 14 days after the discharge or transfer date.	1. Summary required within 14 days after the discharge or transfer date. 2. The service shall facilitate linkage and referral for follow-up and additional services that are consistent with the patient's ASAM placement criteria or other department-approved level of care placement criteria.	1. Summary required within 48 hours after the discharge or transfer date. 2. The service shall facilitate linkage and referral for follow-up and additional services that are consistent with the patient's ASAM placement criteria or other department-approved level of care placement criteria.	1. Summary required within 48 hours after the discharge or transfer date. 2. The service shall facilitate linkage and referral for follow-up and additional services that are consistent with the patient's ASAM placement criteria or other department-approved level of care placement criteria. 3. Documentation of linkage and follow-up shall be reviewed and signed by the clinical supervisor.
(r) Operational requirements	Before operating or expanding a medically managed inpatient treatment service, the service shall be approved as a hospital under ch. DHS 124.	1. The service shall have written agreements with community behavioral health service providers or systems to provide care after the patient is discharged from the service. 2. The service shall maintain an automated external defibrillator device on-site and shall train staff in its use. Documentation of training shall be available to the department upon request.