Wisconsin Administrative Code › Department of Health Services › DHS 30-100 - Community Services › Chapter DHS 75 - Community Substance Use Service Standards › Subchapter VI - Additional Requirements for Treatment Service Levels of Care › Section DHS 75.48 - Service requirements by level of care tables

Current through June 24, 2024
(1) Table 75.48 (1)
				  establishes additional requirements for outpatient levels of care.
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.
(2)
				  Table 75.48 (2) establishes additional requirements for residential levels of
				  care
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.
(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.
This section is created eff. 10-1-22 by CR 20-047.