1. Finding/Nature of Emergency
Not applicable.
2. Detailed Description of the Objective of the Proposed Rule
The objective of the rulemaking is to update rules to reflect current policy and to conform rules to statute concerning MA reimbursement for outpatient mental health services.
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
Section
DHS 35.16 (4) (b) requires as a condition for MA reimbursement a physician's prescription for psychotherapy services. Similarly, ss.
DHS 107.02 (2m) (a) 7. and
107.13 (2) (a) (intro.) and
2. and
(b) 4. b., require a physician's prescription for mental health services, alcohol and other drug abuse services, and psychotherapy services as a condition for MA reimbursement. Pursuant to ss.
49.45 (30f) and
49.46 (2) (b) 6. f.,
fm.,
k., and
Lr., Stats., the department is prohibited from requiring a prescription from a physician or other health care provider for psychotherapy services, medical day treatment services, or mental health and alcohol and other drug abuse services as a condition for MA reimbursement. Thus, the department proposes to conform ss.
DHS 35.16 (4) (b),
107.02 (2m) (a) 7., and
107.13 (2) (a) (intro.) and
2. and
(b) 4. b. to existing state law.
2013 Wisconsin Act 20 included funding to expand MA outpatient mental health coverage to in-home psychotherapy services for children. See,
LFB Budget Summary. To effectuate this, the department proposes to revise s.
DHS 107.13 (2) (a) 4. and
(d) 3. to authorize in-home psychotherapy services as a covered service for children.
3.b. Alternatives
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
The department's authority to revise the referenced rules is as follows:
Section
49.45 (10), Stats., reads:
Rule-making powers and duties. The department is authorized to promulgate such rules as are consistent with its duties in administering medical assistance.
Section
227.11 (2) (a) 1. to
3., Stats. reads: Rule-making authority is expressly conferred as follows:
(a) Each agency may promulgate rules interpreting the provisions of any statute enforced or administered by the agency, if the agency considers it necessary to effectuate the purpose of the statute, but a rule is not valid if the rule exceeds the bounds of correct interpretation. All of the following apply to the promulgation of a rule interpreting the provisions of a statute enforced or administered by an agency:
1. A statutory or nonstatutory provision containing a statement or declaration of legislative intent, purpose, findings, or policy does not confer rule-making authority on the agency or augment the agency's rule-making authority beyond the rule-making authority that is explicitly conferred on the agency by the legislature.
2. A statutory provision describing the agency's general powers or duties does not confer rule-making authority on the agency or augment the agency's rule-making authority beyond the rule-making authority that is explicitly conferred on the agency by the legislature.
3. A statutory provision containing a specific standard, requirement, or threshold does not confer on the agency the authority to promulgate, enforce, or administer a rule that contains a standard, requirement, or threshold that is more restrictive than the standard, requirement, or threshold contained in the statutory provision.
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
The department estimates it will take 22 hours to develop the rule. No other resources will be necessary.
6. List with Description of all Entities that may be Affected by the Proposed Rule
7. Summary and Preliminary Comparison with any Existing or Proposed Federal Regulation that is Intended to Address the Activities to be Regulated by the Proposed Rule
There appears to be no existing or proposed federal regulations that address the activities to be regulated by the rules.
8. Anticipated Economic Impact of Implementing the Rule (Note if the Rule is Likely to Have a Significant Economic Impact on Small Businesses)
The department anticipates that the proposed rules would have little to no economic impact.
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