AB542: Bill Text

AB542,3,7 DHS 105.23 (1) (c) A provider certified under s. DHS 105.05 (1) or 105.22 (1) (ad), (ae), (af), or (b).

AB542,6 Section 6 . DHS 105.23 (1) (d) of the administrative code is created to read:

AB542,3,11 DHS 105.23 (1) (d) For AODA services provided at a school, a mental health clinic or a provider certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (ak), (b), or (bm).

AB542,7 Section 7. DHS 105.23 (2) (a) 1. and 2. of the administrative code are amended to read:

AB542,3,15 DHS 105.23 (2) (a) 1. Meet the requirements in s. DHS 105.22 (1) (ad), (ae), (af) or (b) or 105.05 (1); or

AB542,3,20 2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse counselor certification board and work under the supervision of a provider who is a licensed physician or licensed psychologist and employed by the same facility, except that a provider who meets the requirements in s. DHS 105.22 (1) (ad), (ae), or (af) may provide services that are not described in s. 49.45 (30e), Stats., without supervision.

AB542,8 Section 8 . DHS 105.23 (2) (c) of the administrative code is created to read:

AB542,3,24 DHS 105.23 (2) (c) A provider who meets the requirements in s. DHS 105.22 (1) (ad), (ae), (af), or (b) may provide AODA services that are not described under s. 49.45 (30e), Stats., without supervision by another health care provider.

AB542,9 Section 9. DHS 105.23 (3) (a) of the administrative code is amended to read:

AB542,4,2 DHS 105.23 (3) (a) For the services of any provider employed by or under contract to a certified AODA facility, reimbursement shall be made to the facility; and

AB542,10 Section 10 . DHS 105.23 (3) (b) of the administrative code is amended to read:

AB542,4,10 DHS 105.23 (3) (b) For the services of any provider who is a physician or licensed psychologist defined under sub. (1) (c) in private practice, reimbursement shall be to the physician or psychologist individual provider. A provider who meets the requirements under s. DHS 105.22 (1) (ad), (ae), (af), or (b) shall be reimbursed for AODA services, except those services described in s. 49.45 (30e), Stats., regardless of whether the AODA services are provided through a certified program; and

AB542,11 Section 11 . DHS 105.23 (3) (c) of the administrative code is created to read:

AB542,4,13 DHS 105.23 (3) (c) For AODA services provided at a school by a provider under sub. (1) (d), reimbursement shall be made to the individual provider.

AB542,12 Section 12 . DHS 107.13 (2) (a) 3. a. of the administrative code is amended to read:

AB542,4,21 DHS 107.13 (2) (a) 3. a. A provider who is a licensed physician, licensed psychologist, or a licensed and certified advanced practice nurse prescriber, clinical social worker, marriage and family therapist, or professional counselor; who is individually certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (b), or (bm); and who is working in an outpatient mental health clinic certified under s. DHS 105.22 or in private practice.

AB542,13 Section 13 . DHS 107.13 (2) (a) 3. c. of the administrative code is created to read:

AB542,5,3 DHS 107.13 (2) (a) 3. c. For mental health services provided at a school, a mental health clinic or a provider certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (ak), (b), or (bm).

AB542,14 Section 14 . DHS 107.13 (2) (a) 4. e. of the administrative code is amended to read:

AB542,5,8 DHS 107.13 (2) (a) 4. e. A school. A mental health clinic or licensed treatment professional, as defined in s. DHS 35.03 (9g), is not required to designate the school site as a clinic office for mental health services provided at a school to be covered.

AB542,15 Section 15 . DHS 107.13 (2) (a) 5. of the administrative code is amended to read:

AB542,5,14 DHS 107.13 (2) (a) 5. The Except for mental health services provided in a school, the provider who performs psychotherapy shall engage in face-to-face contact with the recipient for at least 5/6 of the time for which reimbursement is claimed under MA;

AB542,16 Section 16 . DHS 107.13 (2) (b) 4m. of the administrative code is created to read:

AB542,5,18 DHS 107.13 (2) (b) 4m. Prior authorization is not required for mental health services provided in a school by a provider specified under s. DHS 105.23 (1) (d).

AB542,17 Section 17 . DHS 107.13 (2) (c) 6. of the administrative code is amended to read:

AB542,6,2 DHS 107.13 (2) (c) 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, clinical social worker, marriage and family therapist, professional counselor, psychologist, or advanced practice nurse prescriber billing providers certified under s. DHS 105.22 (1) (a), (ad), (ae), (af), (b), or (bm) who provide mental health professional services to hospital inpatients in accordance with requirements of this subsection.

AB542,18 Section 18 . DHS 107.13 (2) (c) 7. of the administrative code is created to read:

AB542,6,5 DHS 107.13 (2) (c) 7. This paragraph does not apply to mental health services provided in a school by a provider specified under s. DHS 105.23 (1) (d).

AB542,19 Section 19 . DHS 107.13 (2) (c) 8. of the administrative code is created to read:

AB542,6,10 DHS 107.13 (2) (c) 8. A prescription from a physician or other health care provider is not required for reimbursement for psychotherapy services provided by a clinical social worker, marriage and family therapist, professional counselor, or psychologist who is certified under s. DHS 105.22 (1) (ad), (ae), (af), or (b).

AB542,20 Section 20 . DHS 107.13 (3) (a) (intro.), 2. and 3. of the administrative code are amended to read:

AB542,6,16 DHS 107.13 (3) (a) (intro.) Outpatient Except as provided in par. (am), 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:

AB542,6,22 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, subject to par. (am), 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;

AB542,7,2 3. The supervising physician or a psychologist, clinical social worker, marriage and family therapist, or professional counselor develops a treatment plan which relates to behavior and personality changes being sought and to the expected outcome of treatment;

AB542,21 Section 21 . DHS 107.13 (3) (a) 5. of the administrative code is amended to read:

AB542,7,9 DHS 107.13 (3) (a) 5. AODA treatment services are performed only in the office of the provider, a hospital or hospital outpatient clinic, an outpatient facility, a nursing home, or a school. A mental health clinic or licensed treatment professional, as defined in s. DHS 35.03 (9g), is not required to designate the school site as a clinic office for mental health services provided at a school to be covered;

AB542,22 Section 22 . DHS 107.13 (3) (am) of the administrative code is created to read:

AB542,7,15 DHS 107.13 (3) (am) Outpatient alcohol and other drug abuse treatment services provided by a provider who meets the requirements of s. DHS 105.23 and who is a clinical social worker, marriage and family therapist, professional counselor, or psychologist shall be covered regardless of whether the services are prescribed by a physician or other health care provider.

AB542,7,16 (End)