THIS SCOPE WAS APPROVED BY
GOVERNOR SCOTT WALKER ON JULY 27, 2018
Statement of Scope
DEPARTMENT OF HEALTH SERVICES
Rule No.: DHS 75
Relating to: Community Substance Abuse Service Standards
Rule Type: Permanent
Type of Statement of Scope:
1. Finding/nature of emergency (Emergency Rule only):
2. Detailed description of the objective of the proposed rule:
The department proposes to revise ch. DHS 75, which establishes standards for community substance use disorder prevention and treatment services. The general objectives of the rulemaking are drawn from 2017 Executive Order #228, and are as follows:
Require certified clinics to embrace evidence-based practices in treatment.
Require state-certified AODA clinics to keep Naloxone on-site in the event of opioid overdoses.
Streamline rules to improve quality of care and ease access to treatment services by:
Providing greater flexibility to providers.
Adopting best-practices in community substance use disorder treatment.
Adopting federal opioid drug program terminology.
In addition, the department proposes to revise rules language where needed to meet and align with federal Medicaid requirements and guidelines pertaining to substance use disorder 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:
The department proposes the following specific revisions to policies included in the rule:
Certified service providers are not currently required to embrace evidence-based practices in treatment. Revisions to the rule will include this requirement to ensure services are effective and supported by research.
Certified clinics are not currently required to keep Naloxone on-site to administer in the event of opioid overdoses. Revisions to the rule will include this requirement.
Chapter DHS 75 has not been substantially revised since 2010. Revisions to the rule will streamline various stages in the prevention, intervention and treatment process (including screening, intake, assessment, treatment planning, staffing and supervision), grant greater flexibility to counties, tribes and certified providers, in meeting emerging needs within their communities, and improve access to services. Specific revisions are intended to:
Reduce wait time for assessment by permitting treatment providers to accept a different assessment from an appropriately-credentialed provider that is less than 30 days old.
Limit the requirement for preliminary service plans only to high-risk situations.
Allow Advanced Practice Nurse Practitioners (APNPs) or Physician Assistants (PAs) with specialized addiction training to approve assessments (e.g., treatment plans, discharge summaries) under various circumstances.
Modify required signatures (e.g., counselor-to-supervisor; client-to-physician) for better flow of information (e.g., from counselor and client to supervisor and/or physician).
Increase group counseling staffing ratios to reflect standards adopted in evidence-based practice.
Align DHS 75 rules addressing supervision requirements of Clinical Substance Abuse Counselors (CSACs) and Substance Abuse Counselors (SACs) that have over 3,000 hours of experience with Department of Safety and Professional Services (DSPS) licensure rules.
Give providers more discretion in selecting performance criteria to include in outcome and performance reports.
Update references to include evidence-based criteria and guidelines adopted by the American Society of Addiction Medicine (ASAM) for services across all substance use disorder recovery stages.
Authorize the department to grant discretionary waivers and variances of regulatory requirements, under certain conditions, to all certified providers in the state. Permitting department authority to issue waivers and variances will create opportunities for counties, tribes and service providers to initiate new or alternative strategies for providing quality services and meeting consumer and community needs that change over time.
Allow clinics -- certified by a national accrediting body that has developed behavioral health standards for substance use disorders -- to submit their inspection materials for review, in lieu of an on-site visit.
Use ASAM or other nationally-recognized program standards for establishing minimum qualifications for residential treatment facilities to meet regarding specific types of services provided, hours of clinical care, and credentials for staff.
Replace outdated terminology, references, and provisions to promote consistency with current law and standards of practice within substance use disorders treatment.
Create a new, single certification category for integrated behavioral health outpatient services who seek to provide both substance use disorder and mental health counseling and services.
Incorporate input provided by stakeholders throughout the rulemaking process that is consistent with the authority granted to the department and the aforementioned objectives.
In place of the current 2 year certification period, certifications will be valid until suspended or revoked by the department for all programs except for opioid treatment systems, as defined and specified in 51.4224 (1) and (2), Stats. Every 24 months, on a date determined by the department, programs will be required to submit a biennial report on a form provided by the department and payment of certification continuation fees.
There are no reasonable alternatives to rulemaking. The objectives are drawn from the Governor’s executive order and are based on recommendations from the Governor’s Taskforce on Opioid Abuse. The proposed revisions are intended to improve quality and access to services, by offering greater flexibility to providers and updating rule provisions to reflect current best-practices in treatment.
4. Detailed explanation of statutory authority for the rule (including the statutory citation and language):
The department’s statutory authority for the rule is given in the following sections: