Register

• Certification of a service (program);

• Actions the Department may take against a certified service for violating the rules;

• Waivers of particular requirements;

• Qualifications of staff;

• Required staff;

• Staff training;

• Minimum hours of staff services per patient;

• The intake process after a person is admitted to the service;

• Treatment plans;

• Review of the ongoing treatment plan;

• Medications administration;

• Termination of treatment and preparation of the discharge summary;

• Patient records;

• Patient rights; and

• Limitations on the use of seclusion, isolation and restraints.

By comparison with the current rules, the revised rules:

• Are more specific about the qualifications of clinical staff, and more detailed about the use of restraints and seclusion or other isolation and actions that may be taken against a certified service for violating the rules;

• Include new sections on the process for certifying a service and on patient rights; and

• Include new requirements concerning clinical supervision, orientation and inservice training for staff, uniform background checks on prospective new staff members, screening at admission, when treatment is provided to children, treatment plan review and reporting of certain deaths of patients.

Analysis -- Chapter HFS 33, Community Mental Health Adult Day Treatment Programs

This is a general revision, renumbering and considerable expansion of the Department's rules for certification of community mental health day treatment programs for adults. The current rules, s. HFS 61.75, date from 1977.

A mental health day treatment program is a nonresidential, medically supervised program that offers a schedule of active treatment services provided in a therapeutic milieu and aimed at averting or shortening an individual's need for inpatient mental health services and improving the individual's ability to function as independently as possible. In July 1999 there were 52 certified programs operating in the state. Certification by the Department is a condition for county purchase of services from a program with community aids funds.

The current rules for certification of these programs identify required personnel, state that a program is to provide services that meet the needs of clients, specify some possible treatment goals and require for each client a written plan of treatment to be reviewed at least monthly and an up-to-date treatment record that includes individual goals and the treatment modalities to achieve them.

The revised rules add:

• Qualifications of professional staff;

• A detailed certification process similar in both organization and content to the certification process set out in the other new community mental health rule chapters;

• Special staffing requirements for programs serving clients who also have substance abuse treatment needs or are developmentally disabled;

• A requirement to follow uniform procedures under ch. HFS 12 for checking the backgrounds of prospective new employes;

• Staff training requirements;

• Minimum hours of operation;

• Staffing levels by purpose of admission (for stabilization services, restorative services or maintenance services);

• Criteria for admission;

• Requirements relating to consent for treatment, suicide prevention, administration of psychotropic medications, early termination of services and preparation of a discharge summary; and

• Sections on client rights and obtaining indications of client satisfaction with the quality and outcomes of services.

Analysis - Chapter HFS 35, Community Mental Health Clinic Programs

This is a general revision and renumbering of the Department's standards for certification of outpatient mental health clinics, also called outpatient psychotherapy clinics. In October 1999 there were 781 outpatient mental health clinic programs certified by the Department. The significance of Department program certification is that it is a condition for the purchase of services by counties with state community services funds, for reimbursement by the Medical Assistance (Medicaid) program for the costs of providing outpatient mental health services to Medical Assistance recipients and for mandatory coverage of outpatient mental health services by group insurance policies that provide coverage for any outpatient treatment. The standards now make up subch. V of ch. HFS 61, Wis. Adm. Code. The revised standards for mental health outpatient clinics will be in ch. HFS 35, Wis. Adm. Code.

The current rules for outpatient mental health clinic programs cover:

• Procedures for certification;

• Required personnel;

• Service requirements; and

• Denial, involuntary termination or suspension of certification.

The revised rules:

• Permit a clinic to meet, alternatively, the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) or the Council on Accreditation of Services for Families and Children (CASFC);

• Establish a detailed certification process similar in both organization and content to the certification process set out in new chapters of rules for other community mental health certified programs, which includes actions taken against certified programs and permits issuance of provisional certification pending correction of minor deficiencies;

• Add a requirement to follow uniform procedures under ch. HFS 12 for checking the backgrounds of prospective new employes;

• Modify minimum professional staffing of a clinic to consist of a clinic administrator, a clinical coordinator qualified under s. HFS 35.07 (3) (b) 1. to 8., a psychiatrist and a mental health professional qualified under s. HFS 35.07 (3) (b) 2. to 8.;

• Add training requirements for clinic staff;

• Permit Master's-level clinicians to offer one of four national professional registry listings in place of the requirement for 3000 hours of supervised clinical experience;

• Add or expand rule language on admission, assessment, consent for treatment, treatment planning and medications administration; and

• Add sections on client rights and obtaining information about client satisfaction with treatment.

Contact Information

To find out more about the hearings or to request copies of the proposed rules, write or phone:

Dennis Bobo

Bureau of Community Mental Health

P.O. Box 7851

Madison, WI 53707-7851

Telephone [phone] or,

if you are hearing-impaired, [phone] (TDD)

If you are hearing- or visually-impaired, do not speak English, or have circumstances which might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number shown above. Persons requesting a non-English or sign language interpreter should contact the person at the address or phone number given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.

Written comments on the proposed rules received at the above address no later than December 23, 1999 will be given the same consideration as testimony presented at the hearing.

Fiscal Estimate

Chapter HFS 32, Community Mental Health Inpatient Programs

This order renumbers, updates and expands the Department's rules for certification of community mental health inpatient treatment programs.

There are currently 49 certified community mental health inpatient programs. Four of these are in other states. Of the 45 in Wisconsin, 38 are hospitals that are certified by the Department on the basis of compliance with standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The remaining seven programs are approved under ch. HFS 124, the Department's rules for hospitals, but are not JCAHO-accredited. Acceptance of alternative JCAHO accreditation will continue under the renumbered and updated rules. The revised rules, therefore, will affect mainly the seven hospital programs that are not JCAHO-accredited. These include the Brown, Fond du Lac, Marathon, Rock and Waukesha county mental health centers. The other two programs are under contract to counties to operate inpatient programs.

The (mainly) updating revisions made by this order in the Department's standards for certification of community mental health inpatient treatment programs are not expected to affect the expenditures or revenues of state government, including expenditures of the Medical Assistance Program, or county governments. The updating changes mainly bring the rules into compliance with current drafting standards; incorporate and add more detail to recent new statutory requirements, such as for reporting certain deaths of patients to the Department and conducting caregiver background checks on prospective and current employes; and identify recognized good management and treatment practices.

Chapter HFS 33, Community Mental Health Adult Day Treatment Programs

This is a renumbering and complete revision of what is now s. HFS 61.75. The program and personnel requirements under the new rules are stricter than under the current rules.

At the local level, the rule revisions may result in higher program costs for some of the 52 currently certified mental health day treatment programs for adults that choose to maintain their certification under the new rules. However, other programs certified under these rules may not experience any increase in costs. Additionally, there are adult mental health day treatment programs that are not presently certified, and any that choose to remain uncertified would not be affected by the new rules. The revised rules could result in higher costs to the state through the Medical Assistance (MA) program to the extent that the programs with higher costs bill the state for care provided to MA-eligible individuals. Also, some county departments of community programs or human service departments that provide or contract out for adult mental health day treatment programs may experience cost increases while other local agencies may not experience any cost changes. Overall, the revised rules should not result in a significant increase in state or local costs.

Chapter HFS 35, Community Mental Health Clinic Programs

These are rules for the 781 outpatient mental health clinics in the state that are certified by the Department under s. 51.42 (7) (b), Stats. The order renumbers and updates current rules found in ss. HFS 61.91 to 61.98 that were last revised in 1984.

Department certification of a clinic is a condition for the purchase of clinic services by counties with state community services funds, for reimbursement of the clinic by the Medical Assistance program for the costs of providing outpatient mental health services to Medical Assistance recipients, and for reimbursement of the clinic by private insurers required under s. 632.89, Stats., to cover outpatient mental health services under group insurance policies that provide coverage for any outpatient treatment.

The revised rules give more flexibility to clinics by permitting a clinic to meet standards of one of 2 specified national accrediting organizations in lieu of the standards in the rules and permitting Masters-level clinicians on a clinic's staff to offer one of 4 national professional listings in place of the requirement for 3000 hours of supervised clinical experience. The revised rules also add orientation and inservice training requirements, but without specification of the number of hours; require compliance with new statutes and rules on performing uniform background checks on applicants for employment and reporting instances of staff abuse or neglect of a patient or misappropriation of a patient's property; require assignment of responsibility for clinic operations and the treatment program, without thereby affecting the minimum required professional staffing of a clinic; and make the certification process and enforcement provisions similar to those in new rules for other community mental health programs.

The revised rules will not affect the expenditures or revenues of state government or local governments. About 28 of the clinics are directly operated by county governments. The costs of purchased and reimbursed services should not be affected by the rule changes. Some of the changed requirements either represent economies and efficiencies for state government or are largely already in effect as good management practices in the clinics. Others are statute-made changes or are clarifications.

Initial Regulatory Flexibility Analysis

These orders update, renumber and expand rules on the basis of which the Department certifies community mental health inpatient treatment programs, adult day treatment programs and outpatient clinic programs under s. 51.42 (7), Stats. The proposed new rules replace current rules in subch. IV of ch. HFS 61, Wis. Adm. Code.

Department certification of a program is a condition for public funding of services, including for reimbursement by Medicaid, and, since November 1992, for mandated coverage by private group health insurance policies.

There are currently 49 certified inpatient programs, all of which are operated by hospitals. None of the 45 Wisconsin hospitals with a certified mental health inpatient treatment program is a small business as “small business" is defined in s. 227.114 (1) (a), Stats.

There are currently 52 certified adult day treatment programs. Not more than one or 2 are operated by or as a small business as “small business" is defined in s. 227.114 (1) (a), Stats.

There are currently 781 certified clinic programs. About half of them are small businesses as “small business" is defined in s. 227.114 (1) (a), Stats.

Adult Day Treatment Programs

The revised rules for adult day treatment programs add:

• Professional staff qualifications;

• A detailed certification process;

• Special staffing requirements for programs serving clients who also have substance abuse treatment needs or are developmentally disabled;

• Staff training requirements;

• Minimum hours of operation;