Telephone (608) 266-0136
Notice of Hearings
Health and Family Services
(Community Services, Chs. HFS 30--)
Notice is hereby given that, pursuant to s. 51.42 (7) (b), Stats., the Department of Health and Family Services will hold public hearings to consider the repeal of ss. HFS 61.70 to 61.72 and 61.75, Wis. Adm. Code, and subch. V of ch. HFS 61, Wis. Adm. Code, and the creation of chs. HFS 32, 33 and 35, Wis. Adm. Code, relating to standards for community mental health inpatient treatment, adult day treatment and clinic programs.
Hearing Information
The public hearings will be held:
December 6, 1999 Room 120
Monday State Office Bldg.
From 1:00 p.m. 819 North 6th St.
to 5:00 p.m. MILWAUKEE, WI
December 10, 1999 Room 751
Friday State Office Bldg.
From 1:00 p.m. One Wilson St.
to 5:00 p.m. MADISON, WI
December 14, 1999 Room 123
Tuesday State Office Bldg.
From 12:30 p.m. 610 Gibson St.
to 4:30 p.m. EAU CLAIRE, WI
December 16, 1999 Room 152
Thursday State Office Bldg.
From 1:00 p.m. 200 North Jefferson St.
to 4:30 p.m. GREEN BAY, WI
The hearing sites are fully accessible to people with disabilities. Parking for people with disabilities attending the Madison hearing is available in the parking lot behind the building, in the Monona Terrace Convention Center Parking Ramp and in the Doty Street Parking Ramp. People with disabilities may enter the building directly from the parking lot at the west end of the building or from Wilson Street through the side entrance at the east end of the building.
Analyses Prepared by the Dept. of Health and Family Services
The Department under s. 51.42 (7), Stats., certifies community mental health treatment programs. All of the Department's standards for certification of community mental health treatment programs that have been included in subch. IV of ch. HFS 61, Wis. Adm. Code, are now being revised and at the same time renumbered into program-specific separate chapters of the Wisconsin Administrative Code. Separate chapters of the Wisconsin Administrative Code have recently been published for certification of emergency (crisis) service programs (ch. HFS 34) and day treatment programs for children (ch. HFS 40). At these hearings the Department is bringing before the public, for comment, proposed revised standards for inpatient, adult day treatment and mental health clinic programs.
Analysis -- Chapter HFS 32, Community Mental Health Inpatient Programs
This is a general revision, renumbering and considerable expansion of the Department's rules for certification of community mental health inpatient treatment programs. The current rules, ss. HFS 61.70 to 61.72, date from 1974 and have never been updated.
An inpatient mental health treatment program must be certified by the Department in order for the program to receive funds for services provided to a Medical Assistance recipient under s. 49.46 (2) (b) 6. f., Stats., community aids funding from counties under s. 51.423 (2), Stats., or payments provided as mandated insurance coverage under s. 632.89, Stats.
Inpatient mental health treatment programs are operated by hospitals, usually as a service or unit which is a part of a hospital. A hospital's inpatient mental health service is where patients receive inpatient mental health services. The term “service" is used throughout the rules in place of “program," but the meaning is the same.
The revised rules cover:
• 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.
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