This statement of scope was approved by the governor on April 27, 2018
Statement of Scope
DEPARTMENT OF HEALTH SERVICES
Rule No.: | Section DHS 75.15 (9) (a) |
Relating to: | Community Substance Abuse Service Standards |
Rule Type: | Permanent and Emergency |
Type of Statement of Scope: Original
1. Finding/nature of emergency (Emergency Rule only):
Wisconsin is in the midst of a growing crisis related to misuse of opioids. There is an urgent need to address this crisis by repealing s. DHS 75.15 (9) (a), a rule provision that limits the type of entities that may be certified to provide substance abuse prevention, intervention or treatment services in the state. Preservation of the public peace, health, safety, and welfare necessitates repealing this restriction prior to the time it would take to promulgate a permanent rule. 2. Detailed description of the objective of the proposed rule:
The objective is to create both an emergency and permanent rule to repeal s. DHS 75.15 (9) (a). This provision currently prohibits entities that provide substance abuse prevention, intervention or treatment services1—referred to as Opiate Treatment Providers (OTPs) under federal law— from also providing medical services not directly related to narcotic treatment. Repealing s. DHS 75.15 (9) (a) will permit a wider array of medical providers to become certified as OTPs. 1These entities are currently referred to as systems in ch. DHS 75, and have also been referred to as narcotic treatment service agencies, or programs. 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
Wisconsin data from the National Survey on Drug Use and Health shows that 4.3% of Wisconsin adults (or 163,000 adults) report using heroin or another opioid (for nonmedical purposes) in 2016. Among young Wisconsin adults age 18-25, the rate of past year use of opioids is 11% (or 68,600 persons).2 Between the years 2000-2012, Wisconsin experienced a 333% increase in deaths involving prescription opioids. According to the Wisconsin Interactive Statistics on Health (WISH) data query system, in 2016 there were 827 opioid overdose deaths in Wisconsin, a 34.7% increase over the prior year with a total of 614 deaths.3 In 2004, 36 Wisconsin counties reported no opioid-related deaths, while by 2015 that number dropped more than 60% to only 14 Wisconsin counties. These statistics show that Wisconsin is in the midst of a growing crisis related to opioids misuse.
The prevalence of prescription drug misuse has also contributed to a rise in substance use disorder treatment admissions for prescription drug dependence and addiction. Between the years 2008-2011, the number of treatment admissions for opioids other than heroin grew 43.9%. Moreover, the number of persons receiving county-authorized services for any opiate drug abuse increased 132%, from 2,096 persons in 2005 to 4,861 in 2015. These various rate increases demonstrate the growing need for treatment resources to treat opioid use disorders (OUDs).
There are currently a total of 18 OTPs that are certified under s. DHS 75.15; all of them are located in the southern half of the state. This leaves large parts of the state without adequate access to these critical treatment services. In 2016, those 18 clinics served 8,160 patients who received medication-assisted treatment. However, recent data also shows that the need for medication-assisted treatment far exceeds the current capacity of these 18 providers. Thus, there is an urgent need to address this crisis, by expanding the number and geographic distribution of OTPs that provide evidence-based treatment options to individuals with significant OUDs New Policy
The Department proposes to repeal s. DHS 75.15 (9) (a). This will permit a wider array of medical providers to become certified under ch. DHS 75 as OTPs. Policy Alternatives
1. The Department could repeal s. DHS 75.15 (9) (a) during a more comprehensive revision of ch. DHS 75. However, the complexity and the scope of this comprehensive revision will require greater time and resources to complete, leaving the current opioid crisis unaddressed. 2. The Department could continue to promote awareness of the need for additional providers to offer substance abuse prevention, intervention or treatment services within the existing ch. DHS 75 framework. However, s. DHS 75.15 (9) (a) would continue to present a barrier for many providers that seek certification, again leaving the current opioid crisis unaddressed. 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 the following statutory provisions.
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.
2. Establish uniform cost record-keeping requirements.
3. Prescribe standards for qualifications and salaries of personnel.
4. Prescribe standards for quality of professional services.
5. Prescribe requirements for in-service and educational leave programs for personnel.
6. Prescribe standards for establishing patient fee schedules.
