Wisconsin Legislature: 002 - CR 19-077 Rule Text

RULE TEXT

SECTION 1. Chapter DHS 50 is created to read:

DHS 50

Youth Crisis Stabilization Facilities

Subchapter I – General Provisions and Requirements

DHS 50.01 Authority and purpose.

This chapter is promulgated under the authority of ss. 51.042 (4), 51.42 (7) (b), and 227.11 (2) (a), Stats., for the purpose of creating certification to operate youth crisis stabilization facilities.

DHS 50.02 Definitions.

(1) “Chemical restraint” means any drug, drug dosage, or drug regimen that may decrease a youth’s independent functioning, that is administered to control a youth’s behavior, and that is not prescribed to the youth for the treatment of a medical or psychiatric condition.

(2) “Clinical staff” means any of the following:
(a) A psychiatrist with the qualifications stated in s. DHS 34.21 (3) (b) 1.
(b) A psychologist with the qualifications stated in s. DHS 34.21 (3) (b) 2.
(c) A psychology resident with the qualifications stated in s. DHS 34.21 (3) (b) 3.
(d) A psychiatric resident with the qualifications stated in s. DHS 34.21 (3) (b) 4.
(e) A certified independent clinical social worker with the qualifications stated in s. DHS 34.21 (3) (b) 5.
(f) A psychiatric nurse with the qualifications stated in s. DHS 34.21 (3) (b) (6).
(g) A professional counselor and marriage and family therapist with the qualifications stated in s. DHS 34.21 (3) (b)
(h). A Master's level clinician who has a master's degree and coursework in areas directly related to providing mental health services, including clinical psychology, psychology, school or educational psychology, rehabilitation psychology, counseling and guidance or counseling psychology.

(3) “Crisis” has the meaning given in s. 51.042 (1) (a), Stats.

(4) “Crisis stabilization” means a stabilization service that complies with the

requirements stated in s. DHS 34.22 (4) (a) to (c).

(5) “Culturally responsive” means a service, or the provision of a service, in a manner that demonstrates an understanding of, and is attentive to, a youth’s cultural history and background and how those impact the youth’s treatment needs.

(6) “Deficiency" means a failure to meet a requirement of this chapter.

(7) “Department” means the department of health services.

(8) “Division” means the division of care and treatment services.

(9) “Facility” means the physical site where the YCSF program is located. Facility is limited to the space used by the program.

(10) “Family” means a youth’s relatives and others who are considered family by the youth and the youth’s culture.

(11) “Group services” means services delivered in a group setting of two or more youth.

(12) “Individual services” are services delivered by staff to a youth or family.

(13) “Legal representative” means any of the following:
(a) A guardian of the person as defined under s. 54.01 (12), Stats.
(b) A health care agent as defined in s. 155.01 (4), Stats., if the youth has a finding of incapacity pursuant to s. 155.05 (2), Stats., and if the power to make decisions regarding outpatient mental health services is included in the scope of the agency.
(c) A parent of a minor as defined in s. 48.02 (13), Stats., a guardian of a minor as defined in s. 48.02 (8), Stats., or a legal custodian of a minor as defined in s. 48.02 (11), Stats.

(14) “Licensed treatment professional" means any of the following, who is practicing under a currently valid training or temporary license or certificate granted under applicable provisions of ch. 457, Stats., except an individual whose license or certificate is suspended, revoked, or voluntarily surrendered, or whose license or certificate is limited or restricted, when practicing in areas prohibited by the limitation or restriction:
(a) An individual licensed as a physician under s. 448.03, Stats., who has completed a residency in psychiatry.
(b) A psychologist or a private practice school psychologist licensed under ch. 455, Stats.
(c) A marriage and family therapist licensed under s. 457.10 or 457.11, Stats.
(d) A professional counselor licensed under s. 457.12 or 457.13, Stats.
(e) An advanced practice social worker granted a certificate under s. 457.08 (2), Stats.
(f) An independent social worker licensed under s. 457.08 (3), Stats.
(g) A clinical social worker licensed under s. 457.08 (4), Stats.

(15) “Major deficiency” means a determination made by the department that any of the following have occurred:
(a) A YCSF has repeatedly or substantially failed to meet one or more requirements of this chapter.
(b) An action, condition, policy, or practice of the YCSF or the conduct of its staff created a risk of harm to a youth or violates a youth’s right created by this chapter or other state or federal statutes or rules, including any of the following:
1. A YCSF staff member had sexual contact as defined in s. 940.225 (5) (b) or sexual intercourse as defined in s. 940.225 (c), Stats., with a youth.
2. A YCSF staff member was convicted of abuse under s. 940.285, 940.29 or 940.295, Stats.
3. The health or safety of a youth is in imminent danger because of any act or omission by the YCSF or a staff member.
(c) A YCSF submits or causes to be submitted one or more false statements for purposes of obtaining certification under this chapter.
(d) Fraud or willful misrepresentation within the meaning of s. DHS 108.02 (9) (d). Willful misrepresentation under this paragraph does not include the signing of a claim for reimbursement by an authorized representative of a YCSF who did not perform the service for which reimbursement is claimed, if the individual who performed the service was qualified to do so under this chapter and was on the YCSF's staff when the services were performed.

(Note) The department may withhold Medical Assistance (MA) payments, in whole or in part, as provided in s. DHS 108.02 (9) (d) 1. A provider is entitled to a hearing under s. DHS 106.12.

(e) A YCSF staff member has a substantiated finding of caregiver misconduct as identified in ch. DHS 13.

(16) “Mechanical restraint” means any physical device, used for the purpose of limiting or controlling a youth’s movement, except that the procedures in s. DHS 50.12 (4) (e) 1. to 2. are not mechanical restraints.

(17) “Parent” means biological, foster, or adoptive parents legally recognized as a youth’s parent.

(18) “Physical restraint” means any manual method, such as a basket hold or prone or supine containment, or a mechanical device that the individual cannot remove easily and that is intended to restrict the freedom of movement or normal range of motion of one or more limbs or the entire body, but not including any of the following:
(a) Mechanical supports used to achieve proper body position, balance or alignment, such as arm splints to reduce contractures or leg braces to support the legs while standing or walking. Mechanical supports are used to enhance independent functioning whereas physical restraints are used to limit independent functioning.
(b) Physical guidance and prompting techniques of brief duration.

(19) “Program” means a YCSF’s treatment and services component.

(20) “Trauma-informed” are services which recognize the impact of trauma on a youth’s behavior. Trauma-informed care prioritizes addressing and minimizing the impact of trauma in a youth’s life. Trauma-informed means a service, or the provision of a service, in a manner that demonstrates an understanding of, and is attentive to, a youth’s trauma history and background and how those impact the youth’s treatment needs.

(21) “Youth” means an individual under the age of 18 who is being treated at, or seeking treatment from, a YCSF.

(22) “Youth crisis stabilization facility” or “YCSF” has the meaning given in s. 51.042 (2), Stats.

DHS 50.03 Certification.

(1) GENERAL. No person or entity may operate a YCSF without successfully completing a background check verified by the Office of Caregiver quality and obtaining a certification from the department. A YCSF that has a certification from the department under this section is not subject to facility regulation under ch. 48, Stats.
(Note) Information about obtaining a background check is available at: https://www.dhs.wisconsin.gov/caregiver/cbcprocess.htm

(2) APPLICATION. A YCSF may apply for a certification by submitting all of the following application materials to the department at the address given on the application:

(a) A completed application form.

(Note) Application forms are available at https://www.dhs.wisconsin.gov/regulations/mentalhealth/certification.htm

(b) Payment for the application fee required under s. 51.04, Stats.,

(Note) Fee information is available at https://www.dhs.wisconsin.gov/regulations/mentalhealth/certification.htm

(c)

A program statement as specified under s. DHS 50.05.

(e) A copy of the youth crisis stabilization facility’s policies and procedures, as specified under s. DHS 50.06.

(f) A floor plan of the YCSF, specifying dimensions, exits, and planned room usage.

(g) All inspection reports completed during the last 12 months as defined in ss. DHS 50.15. to DHS 50.18.

(h)

Proof of building insurance, risk, and liability insurance, and agency-owned vehicle insurance if transporting youth.

(i)

Payment of any forfeitures, fees, assessments related to any licenses or certifications issued by the department to the applicant, or a written statement signed by an authorized representative stating that no fees, forfeitures, assessments are owed.

(j)

Any other applicable fees.

(k)

Any additional information requested by the department.

(3) COMPLIANCE REVIEW. Upon receipt of all completed application materials described in (2), the applicant shall permit the department to conduct an on-site inspection of the facility and a review of any documentation necessary to determine compliance with this chapter.

(4) CERTIFICATION DETERMINATION.

(a) The department shall make a certification determination within 60 days of receiving all completed application materials.

(b) If the department does not approve the YCSF’s program statement or determines that an applicant does not comply with the requirements of this chapter, the department may deny the certification. A denial of certification shall be in writing and shall contain the reason for the denial and notice of opportunity for a hearing.

(5) NOTIFICATION OF CHANGES. A YCSF that has received certification from the department shall notify the department of any change of administration, ownership, program name, or any other change that may affect compliance with this chapter before the effective date of the change. A new application will be required if upon notification the department determines there is a substantial change in some aspect of the YCSF. A certification is non-transferable.

(6) DURATION OF CERTIFICATION.

(a) A certification is valid until suspended or revoked by the department.

(b) A certification becomes invalid upon non-payment of biennial fees.

(d) A certification may be suspended or terminated under s. DHS 50.03 (10).

(7) BIENNIAL REPORT AND FEES.

(a) Every 24 months, at least 60 days before the date of expiration, the YCSF shall submit a biennial report on the form provided by the department, and shall submit payment of certification continuation fees. This report shall include a program statement per s. DHS 50.05.

(b) The department will send the re-certification materials to the provider, which the provider is expected to fill out and submit to the department according to instructions provided.

(c) A certification will be suspended or terminated if biennial reports are not submitted prior to the end of the biennial cycle.

(8) YCSF INSPECTIONS. The YCSF shall permit unannounced, on-site inspections of the site by the department to conduct program reviews, complaint or death investigations involving any aspect of the YCSF, or to determine a YCSF’s progress in correcting a deficiency cited by the department. The department may use a random selection process for reviewing client records during program reviews. Complaint-driven program reviews shall include the records related to the complaint and may include additional records.

(9) NOTICE OF DEFICIENCIES.

(a) If the department determines that a YCSF has a deficiency, the department shall issue a notice of deficiency to the YCSF within 10 business days. The notice of deficiency may place restrictions on the YCSF or its activities, or suspend or terminate the YCSF’s certification, pursuant to s. DHS 50.03 (10).

(b) The YCSF shall submit a plan of correction to the department within 10 business days as indicated in the notice of deficiency. The plan of correction shall propose the specific steps the YCSF will take to correct the deficiency, the timelines within which the corrections will be made, and the licensed professional staff members who will implement the plan and monitor for future compliance.

(c) If the department determines that the plan of correction submitted by the YCSF does not adequately address deficiencies listed in the notice of deficiency, the department may request a new plan of correction from the YCSF or may impose a plan of correction.

(10) TERMINATION AND SUSPENSION OF CERTIFICATION.

(a) The department may terminate certification at any time for deficiency by issuing a notice of termination to the YCSF. The notice shall specify the reason for the department action and the appeal information under s. DHS 50.03(11).

(b) The department may suspend a YCSF’s certification if the department determines that immediate action is required to protect the health, safety, and welfare of youth. Written notice of suspension shall specify the reason for the department action and the date the action becomes effective. Within 10 business days after the order is issued, the department shall either lift or impose conditions on the suspension of the YCSF’s certification or proceed to terminate the YCSF’s certification.

(11) APPEALS. If the department denies, suspends, or terminates certification, or imposes conditions on a certification, the YCSF may request a hearing under ch. 227, Stats.

DHS 50.04 Variance and waiver.

(1) In this section:

(a) “Variance" means an alternate means of meeting a requirement in this chapter.

(b) “Waiver" means an exemption from a requirement of this chapter.

(2) The department may grant a waiver or variance if the department determines that the proposed waiver or variance will not diminish the effectiveness of the services provided and will not jeopardize the health, safety, welfare, or rights of any youth. The department may specify a timeframe for the waiver. A request for a variance or waiver must be submitted on a form provided by the department.

(Note) A variance and waiver request form is available by accessing.(link)

(3) The department may rescind or limit a waiver or variance at any time by notifying the YCSF, if any of the following occurs:

(a) The department determines the waiver or variance has adversely affected or likely may adversely affect the health, safety or welfare of the youths.

(b) The YCSF fails to comply with any of the conditions of the waiver or variance as granted.

(4) The department shall inform a YCSF in writing if it rescinds or limits a waiver or variance.

DHS 50.05 Program Statement. A program statement shall contain all of the following:

(1) A description of how the YCSF fits into a continuum of care for youth crisis stabilization and treatment services.

(2)

A description of services the program intends to provide, including all of the following:

(a) Referral and screening procedures.

(b) Intake procedures, including medication review.

(d) Treatment services, including crisis prevention and emotional regulation, including, if applicable, a description of any services that will be delivered in a group setting.

(e) Care coordination.

(f) Discharge planning, including any linkages and follow-up.

(3) A description of the therapeutic milieu the program proposes to create, its intended therapeutic benefits, and the rationale supporting its use for the youth served by the YCSF.

(a) Describe use of any evidence-based practices and non-traditional services. The description should include a rationale for how the services will help the youth population achieve and sustain positive outcomes.