Chapter DHS 75

subch. VI of ch. DHS 75 Subchapter VI — Additional Requirements for Treatment Service Levels of Care

DHS 75.47 DHS 75.47 Applicability of other requirements.

DHS 75.47(1) (1) Relationship to treatment service general requirements. The requirements for a treatment service provided in subch. IV apply to this subchapter as the minimum standards for any service in this subchapter. If a requirement in any section of this subchapter is inconsistent with, or poses a more restrictive standard than a similar provision in subch. IV, the requirement is this subchapter shall control.

DHS 75.47(2) (2) Relationship to residential service facility requirements. The requirements for a residential treatment service provided in subch. V apply to this subchapter as the minimum standards for residential services under this subchapter. If a requirement regarding any residential services in this subchapter is inconsistent with, or poses a more restrictive standard than a similar provision in subch. V, the requirement is this subchapter shall control.

DHS 75.47 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.48 DHS 75.48 Service requirements by level of care tables.

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

- See PDF for table

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

- See PDF for table

DHS 75.48(3) (3) Table 75.48 (3) establishes additional requirements for residential withdrawal management levels of care.

- See PDF for table

DHS 75.48 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (2) (d) made under s. 35.17, Stats., Register October No 790.

DHS 75.49 DHS 75.49 Outpatient substance use treatment service.

DHS 75.49(1) (1) Service description. In this section, “outpatient substance use treatment service” means a non-residential treatment service totaling less than 9 hours of treatment services per patient per week for adults and less than 6 hours of treatment services per patient per week for minors, in which substance use treatment personnel provide screening, assessment, and treatment for substance use disorders. Outpatient substance use treatment services may include intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services to ameliorate symptoms and restore effective functioning.

DHS 75.49(2) (2) Location of service delivery.

DHS 75.49(2)(a) (a) An outpatient substance use treatment service may provide services at one or more offices. If a service provides outpatient substance use treatment services at more than one office, all of the following shall apply:

DHS 75.49(2)(a)1. 1. The service shall designate one office as its main office.

DHS 75.49(2)(a)2. 2. All notices under this chapter will be sent to the main office.

DHS 75.49(2)(a)3. 3. Each office providing the service shall comply with the applicable requirements of this chapter.

DHS 75.49(2)(a)4. 4. The service shall adopt written policies and procedures to ensure that the service director is able to carry out the oversight and other responsibilities specified under s. DHS 75.18 (1) with respect to all other offices.

DHS 75.49(2)(b) (b) A service may provide outpatient substance use treatment services in the community or other locations, provided all requirements of this chapter are able to be met in the setting.

DHS 75.49(2)(c) (c) A service that provides outpatient substance use treatment services in the community shall have written policies and procedures for community-based service delivery.

DHS 75.49(2)(d) (d) A service that provides outpatient substance use treatment services in the community shall provide annual training for all staff that deliver services in the community regarding in-home and community safety, and avoiding sexual or other exploitative relationships with patients. A record of each training shall be available to the department upon request.

DHS 75.49 History History: 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.

DHS 75.50 DHS 75.50 Outpatient integrated behavioral health treatment service.

DHS 75.50(1) (1) Service description. In this section, “outpatient integrated behavioral health treatment service” means a non-residential treatment service totaling less than 9 hours of treatment services per patient per week for adults, and less than 6 hours of treatment services per patient per week for minors, in which substance use and mental health treatment personnel provide screening, assessment and treatment for substance use and mental health disorders. Patients in this setting may receive treatment services for a substance use disorder, a mental health disorder, or both. Outpatient integrated behavioral health treatment services may include intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services to ameliorate symptoms and restore effective functioning.

DHS 75.50(2) (2) Combined certification. Certification for this level of care shall not be located with s. DHS 75.49 outpatient substance use treatment service or with a ch. DHS 35 community mental health treatment service at the same service location.

DHS 75.50(3) (3) Location of service delivery.

DHS 75.50(3)(a) (a) An outpatient integrated behavioral health treatment service may provide services at one or more offices. If a service provides outpatient substance use treatment services at more than one office, all of the following shall apply:

DHS 75.50(3)(a)1. 1. The service shall designate one office as its main office.

DHS 75.50(3)(a)2. 2. All notices under this chapter will be sent to the main office.

DHS 75.50(3)(a)3. 3. Each office providing the service shall comply with the applicable requirements of this chapter.

DHS 75.50(3)(a)4. 4. The service shall adopt written policies and procedures to ensure that the service director is able to carry out the oversight and other responsibilities specified under s. DHS 75.18 (1) with respect to all other offices.

DHS 75.50(3)(b) (b) A service may provide outpatient integrated behavioral health treatment services in the community or other locations, provided all requirements of this chapter are able to be met in the setting.

DHS 75.50(3)(c) (c) A service that provides outpatient integrated behavioral health treatment services in the community shall have written policies and procedures for community-based service delivery.

DHS 75.50(3)(d) (d) A service that provides outpatient integrated behavioral health treatment services in the community shall provide annual training for all staff that deliver services in the community regarding in-home and community safety, and avoiding sexual or other exploitative relationships with patients. A record of each training shall be available to the department upon request.

DHS 75.50 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.51 DHS 75.51 Intensive outpatient treatment service.

DHS 75.51(1) (1) Service description. In this section, “intensive outpatient treatment service” means a non-residential treatment service totaling at least 9 hours of treatment services per patient per week for adults and at least 6 hours of treatment services per patient per week for minors, in which substance use treatment personnel provide assessment and treatment for substance use disorders under the oversight of a medical director. Intensive outpatient treatment services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services to ameliorate symptoms and restore effective functioning. Intensive outpatient treatment services address patient needs for mental health, psychiatric, or medical services through integrated co-occurring treatment or through coordinated services, consultation, and referrals.

DHS 75.51(2) (2) Location of service delivery.

DHS 75.51(2)(a) (a) An intensive outpatient treatment service may provide case management and outreach services in the community or other locations, provided all requirements of this chapter are able to be met in that setting.

DHS 75.51(2)(b) (b) A service that provides intensive outpatient case management and outreach services in the community shall have written policies and procedures for community-based service delivery.

DHS 75.51(2)(c) (c) A service that provides intensive outpatient case management and outreach services in the community shall provide annual training for all staff that deliver services in the community regarding in-home and community safety and avoiding sexual or other exploitative relationships with patients. A record of each training shall be available to the department upon request.

DHS 75.51 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.52 DHS 75.52 Day treatment or partial hospitalization treatment service. In this section, “day treatment service” or “partial hospitalization service” means a medically-monitored and non-residential substance use treatment service totaling 15 or more hours of treatment services per patient per week for adults and 12 or more hours of treatment services per patient per week for minors, in which substance use and mental health treatment personnel provide assessment and treatment for substance use and co-occurring mental health disorders under the oversight of a medical director. Day treatment or partial hospitalization services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning.

DHS 75.52 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.53 DHS 75.53 Transitional residential treatment service. In this section, “transitional residential treatment service” means a residential substance use treatment service totaling 6 or more hours of treatment services per patient per week, in which substance use treatment personnel provide assessment and treatment for substance use disorders in a structured and recovery-supportive 24-hour residential setting, under the oversight of a physician or a prescriber knowledgeable in addiction, providing medical supervision and clinical consultation. Transitional residential treatment services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning.

DHS 75.53 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.54 DHS 75.54 Medically monitored residential treatment service. In this section, “medically monitored residential treatment service” means a residential substance use treatment service totaling 20 or more hours of treatment services per patient per week, in which substance use and mental health treatment personnel provide assessment and treatment for substance use disorders and co-occurring mental health disorders, under the oversight of a medical director. Medically monitored residential treatment services may include screening, intake, evaluation and diagnosis, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, vocational services, peer support services, recovery coaching, outreach activities, and recovery support services, to ameliorate symptoms and restore effective functioning. Medically monitored residential treatment services are delivered in a 24-hour clinical residential setting. This level of care is appropriate for patients who require a 24-hour supportive treatment environment to develop sufficient recovery skills and address functional limitations to prevent imminent relapse or dangerous substance use.

DHS 75.54 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.55 DHS 75.55 Medically managed inpatient treatment. In this section, “medically managed inpatient treatment service” means an inpatient substance use treatment service delivered under the oversight of a medical director in a hospital setting, and includes 24-hour nursing care, physician management, and the availability of sufficient resources to respond to an acute medical or behavioral health emergency. A medically managed inpatient treatment service is appropriate for patients whose acute biomedical, emotional, behavioral, and cognitive problems are so severe that they require primary medical and nursing care. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate acute behavioral health symptoms and stabilize functioning. Medically managed inpatient treatment services address patient needs for mental health, psychiatric, or medical services through integrated co-occurring treatment.

DHS 75.55 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.56 DHS 75.56 Adult residential integrated behavioral health stabilization service.

DHS 75.56(1) (1) Service description. In this section, “adult residential integrated behavioral health stabilization service” means a residential behavioral health treatment service, delivered under the oversight of a medical director, that provides withdrawal management and intoxication monitoring, as well as integrated behavioral health stabilization services, and includes nursing care on-site for medical monitoring available on a 24-hour basis. Patients in this setting may receive treatment services for a substance use disorder, a mental health disorder, or both. Adult residential integrated behavioral health stabilization services are appropriate for adult patients whose acute withdrawal signs and symptoms or behavioral health needs are sufficiently severe to require 24-hour care; however, the full resources of a hospital are not required. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, determination of medical stability, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, recovery support services, and crisis intervention services, to ameliorate acute behavioral health symptoms and stabilize functioning.

DHS 75.56(2) (2) Staff orientation and training.

DHS 75.56(2)(a) (a) An adult residential integrated behavioral health stabilization service shall develop and implement an orientation program for all staff and volunteers. The orientation shall be designed to ensure that staff and volunteers know and understand all of the following:

DHS 75.56(2)(a)1. 1. The program’s general policies and procedures.

DHS 75.56(2)(a)2. 2. Applicable parts of chs. 48, 51 and 55, Stats., and any administrative rules related to behavioral health emergency services.

DHS 75.56(2)(a)3. 3. Applicable parts of chapter DHS 34 rules concerning emergency mental health service programs.

DHS 75.56(2)(a)4. 4. Behavioral health and psychopharmacology concepts applicable to crisis situations.

DHS 75.56(2)(a)5. 5. Techniques and procedures for providing non-violent crisis management for patients, including verbal de-escalation, methods for obtaining backup, and acceptable methods for self-protection and protection of the patient and others in emergency situations.

DHS 75.56(2)(b) (b) Unlicensed staff working in the clinical setting shall complete a minimum of 40 hours of documented orientation training within 3 months after beginning work with the program.

DHS 75.56(2)(c) (c) Staff of an adult residential integrated behavioral health stabilization service shall receive at least 8 hours per year of training on emergency behavioral health services, rules and procedures relevant to the operation of the program, compliance with state and federal regulations, cultural competency in behavioral health services, and current issues in client’s rights and services.

DHS 75.56(3) (3) Additional intake and admission requirements.

DHS 75.56(3)(a) (a) An adult residential integrated behavioral health stabilization service shall have written policies and procedures for the assessment of safety and consideration of safety risks to the patient and others prior to admitting a patient.

DHS 75.56(3)(b) (b) An individual with any of the following symptoms, behaviors, or concerns shall be excluded from admission to an adult residential integrated behavioral health stabilization service:

DHS 75.56(3)(b)1. 1. Assaultive ideation or assaultive behaviors combined with likelihood to act on those behaviors.

DHS 75.56(3)(b)2. 2. Exhibiting active self-injurious behavior.

DHS 75.56(3)(b)3. 3. A recent suicide attempt or ongoing suicidal ideation combined with a continued threat or plan to act on suicidal ideation.

DHS 75.56(3)(c) (c) The intake screening shall include documentation of the determination and plan for the level of observation needed to address the patient’s needs and any safety concerns.

DHS 75.56 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22.

DHS 75.57 DHS 75.57 Residential withdrawal management service.

DHS 75.57(1) (1) Service description for residential withdrawal management service. In this section, “residential withdrawal management service” means a residential substance use treatment service that provides withdrawal management and intoxication monitoring, and includes medically managed 24-hour on-site nursing care, under the supervision of a physician. Residential withdrawal management is appropriate for patients whose acute withdrawal signs and symptoms are sufficiently severe to require 24-hour care; however, the full resources of a hospital are not required. Services delivered in this setting may include screening, assessment, intake, evaluation and diagnosis, medical care, observation and monitoring, physical examination, medication management, nursing services, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services, to ameliorate symptoms of acute intoxication and withdrawal and to stabilize functioning. Services provided in this setting may include community-based withdrawal management and intoxication monitoring services, subject to the requirements listed in this section.

DHS 75.57(2) (2) Service description for community-based withdrawal management. Community-based withdrawal management is a medically-managed withdrawal management service delivered on an outpatient basis by a physician, or other service personnel acting under the supervision of a physician.

DHS 75.57(3) (3) Additional requirements for community-based withdrawal management.

DHS 75.57(3)(a) (a) A service that provides community-based withdrawal management shall meet the requirements in this section, however, services may be provided on an outpatient basis, in the community, or in the patient’s home.

DHS 75.57(3)(b) (b) Community-based withdrawal management services are delivered by medical and nursing professionals under the supervision of physician.

DHS 75.57(3)(c) (c) A service that provides community-based withdrawal management services shall have written policies and procedures for the delivery of community-based withdrawal management services.

DHS 75.57(3)(d) (d) Residential living areas under this section shall be physically separated from service areas for community-based withdrawal management patients.

DHS 75.57 History History: CR 20-047: cr. Register October 2021 No. 790, eff. 10-1-22; correction in (2) made under s. 35.17, Stats., Register October 2021 No. 790.

DHS 75.58 DHS 75.58 Residential intoxication monitoring service.

DHS 75.58(1) (1) Service description. In this section, “residential intoxication monitoring service” means a residential service that provides 24-hour observation to monitor the safe resolution of alcohol or sedative intoxication and to monitor for the development of alcohol withdrawal for intoxicated patients who are not in need of emergency medical or behavioral healthcare. Residential intoxication monitoring services may include screening, assessment, intake, evaluation and diagnosis, observation and monitoring, case management, drug testing, counseling, individual therapy, group therapy, family therapy, psychoeducation, peer support services, recovery coaching, and recovery support services.

DHS 75.58(2) (2) Observation and medication requirements.

DHS 75.58(2)(a) (a) Observation. Trained staff shall observe a patient and record the patient’s condition at intervals no greater than every 30 minutes during the first 12 hours following admission.

DHS 75.58(2)(b) (b) Medications.

DHS 75.58(2)(b)1. 1. A residential intoxication monitoring service shall not administer or dispense medications.

DHS 75.58(2)(b)2. 2. When a patient has been admitted with prescribed medication, staff shall consult with the patient’s physician or other person licensed to prescribe and administer medications to determine the appropriateness of the patient’s continued use of the medication while under the influence of alcohol or sedatives.

DHS 75.58(2)(b)3. 3. If approval for continued use of prescribed medication is received from a prescriber, the patient may self-administer the medication under the observation of service staff.