This Statement of Scope was approved by Governor Scott Walker on March 29, 2018.
Statement of Scope
DEPARTMENT OF HEALTH SERVICES
Relating to: | Youth Crisis Stabilization Facility |
Rule Type: | Permanent and Emergency |
Type of Statement of Scope: Original
1. Finding/nature of emergency:
Pursuant to 2017 Wis. Act 59, Section 9120, the department is not required to provide a finding of emergency to create rules implementing certification of Youth Crisis Stabilization Facilities, under s. 51.042, Stats. 2. Detailed description of the objective of the proposed rule:
The objective is to create an emergency and permanent rule for the certification and operation of youth crisis stabilization facilities.
3. Description of the existing policies relevant to the rule, new policies proposed to be included in the rule, and an analysis of policy alternatives:
Policy Problem
All Wisconsin counties are required to have an emergency mental health services program, which must be available for least 8 hours a day, 7 days a week during those periods of time identified in the emergency mental health services plan when mobile services would be most needed. Counties may, at their option, establish a crisis stabilization component to their emergency mental health program. Stabilization services are defined under s. DHS 34.22(4) to include optional emergency mental health services which provide short-term, intensive, community-based services to avoid the need for inpatient hospitalization. Such services can occur in a variety of settings. For youth, Medicaid-reimbursable residential stabilization sites include group homes, foster homes, and treatment foster homes, which are licensed and regulated by the Department of Children and Families (DCF). However, due to a variety of factors, including the need for DCF resources to serve child welfare consumers, these sites are increasingly unavailable statewide. This has led to greater numbers of youth being detained and committed to more restrictive, inappropriate levels of care in institutes and hospitals through Emergency Detentions, creating a strain on resources at Winnebago Mental Health Institute and a financial strain on counties. New Policy
To address this shortage of youth crisis stabilization sites, 2017 Wisconsin Act 59 contains a provision to create Youth Crisis Stabilization Facilities. These are defined as treatment facilities with a maximum of eight beds that admit a minor to prevent or de-escalate the minor’s mental health crisis and avoid admission of the minor to a more restrictive setting, such as mental health institutes or hospitals. The facilities are intended for short term stabilization. Admission is voluntary or by court order, under s. 51.20(13)(a) or 51.13, Stats. The facilities are not to be used for Emergency Detentions. A crisis is defined as a situation caused by an individual’s apparent mental disorder that results in a high level of stress or anxiety for the individual, persons providing care for the individuals, or the public, and that is not resolved by the available coping methods of the individual or by the efforts of those providing ordinary care or support for the individual. Youth Crisis Stabilization Facilities are not subject to facility regulation by the Department of Children and Families under the state children’s code. The rule will include provisions on program certification, which will address operations, requirements for admission, assessment, treatment planning, and treatment, as well as staffing, training, and education for consumers. The department may also include provisions regulating the number of facilities, as authorized in s. 51.042(2)(a), Stats. Entities Affected
County emergency mental health services programs will be affected by providing them with an additional resource to serve minors experiencing a mental health crisis which does not rise to the level of needing inpatient care or require an Emergency Detention, but necessitates a therapeutic, short term community-based treatment setting.
Minors experiencing a mental health crisis, and their families, will be affected based on the availability and outcomes of this treatment setting.
Public and private mental health providers will be affected by having greater opportunities to administer, staff, or work with consumers at a youth crisis stabilization facility.
Fiscal entities such as Medicaid and private insurance will also be impacted, by reducing potential inpatient services expenditures, where the youth would probably be served if not in this facility.
Existing Policies and Policy Alternatives
Youth crisis stabilization facilities are a new type of entity and there are no administrative rules regulating their certification. There are no reasonable alternatives to the proposed rulemaking, because s. 51.042(2)(a), Stats., requires that Youth Crisis Stabilization Facilities be certified by the department to operate in the state. A pathway to certification is therefore necessary to address the shortage of youth crisis stabilization sites. 4. Detailed explanation of statutory authority for the rule (including the statutory citation and language):
The proposed rulemaking is explicitly authorized by the Legislature in various statutory and non-statutory provisions.
Rules. The department may promulgate rules to implement this section
Nonstatutory provisions; Health Services.
(1) EMERGENCY RULES ON YOUTH CRISIS STABILIZATION FACILITIES. The department of health services may promulgate emergency rules under section 227.24 of the statutes implementing certification of youth crisis stabilization facilities under section 51.042 of the statutes. Notwithstanding section 227.24 (1) (a) and (3) of the statutes, the department of health services is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection. Notwithstanding section 227.24 (1) (c) and (2) of the statutes, emergency rules promulgated under this subsection remain in effect until July 1, 2019, or the date on which permanent rules take effect, whichever is sooner. Duties of the department of health services.
(b) The department shall promulgate rules which do all of the following:
1. Govern the administrative structure deemed necessary to administer community mental health, developmental disabilities, alcoholism and drug abuse services.
