(d) A staff member was included on the Caregiver Misconduct Registry under ch. DHS 13 and did not receive a rehabilitation determination from the department for all instances of substantiated misconduct. (e) The program or a staff member submitted or caused to be submitted a false statement for purposes of obtaining certification under this chapter.
(f) A license, certification, or required approval of the program expired, was revoked, or was suspended by any local, state, or federal authority, or the program’s Medicaid or Medicare provider certification was suspended or terminated for any basis under s. DHS 106.06 or federal law, or by any local, state, or federal authority. (25) “Measurable objective” means a clear statement of the behavioral changes that are to be made, the conditions under which the behaviors are to occur, and a criterion for success.
(26) “Mechanical restraint” means any physical device, used for the purpose of limiting or controlling a youth’s movement.
(27) “Mental health day treatment service” means non-residential care, prescribed by a physician, and provided in a clinically supervised therapeutic milieu that provides an integrated system of individual, family, and group psychotherapy, care coordination, and support services pursuant to a treatment plan.
(28) “Mental health professional” means a licensed treatment professional, a qualified treatment trainee, or a recognized psychotherapy practitioner that practices within the scope of their practice.
(29) “Mental health support worker” means an individual who has a bachelor’s or master’s degree and provides services to implement the treatment plan.
(30) “Mental health technician” means an individual who assists mental health support workers and mental health professionals with implementation of support services.
(31) “Mental illness” means a mental health disorder that a mental health professional determines substantially diminishes a youth’s ability to carry out age-appropriate activities of daily living, except mental illness does not include dementia or a developmental disability.
(32) “Occupational therapist” has the meaning given in s. 448.96 (4), Stats. (33) “Occupational therapy assistant” has the meaning given in s. 448.96 (6), Stats. (34) “Parent peer specialist” means a person with knowledge gained from parenting youth with social, emotional, behavioral, mental health or substance use challenges and who has training to increase their skills to guide and support other parents or those in a parenting role.
(35) “Physical restraint” means use of physical force for the purpose of interfering with the movement of a youth, which includes forcibly moving or transporting a youth from one location to a seclusion room or area. Physical restraint does not include briefly holding a youth, without force, to calm or comfort her or him, or holding a youth’s hand to safely escort him or her from one area to another and similar physical guidance and prompting techniques of brief duration.
(36) “Positive behavior support” means specific proactive strategies, documented in the treatment plan, intended to replace challenging behaviors with positive and functional alternatives.
(37) “Physician” has the meaning given in s. 448.01 (5), Stats. (38) “Physician assistant” has the meaning given in s. 448.01 (6), Stats. (39) “Prescriber” means a physician, a physician assistant acting within the conditions and limitations set forth in s. 7, or an advanced practice nurse prescriber acting within the conditions and limitations set forth in s. N 8.06. (40) “Program” means a community-based program or a hospital-based program.
(41) “Psychotherapy” has the meaning given in s. 457.01 (8m) for marriage and family therapy, professional counseling, and social workers or 455.01 (6), Stats for psychologists (42) “Psychotropic medication” means a prescription drug as defined in s. 450.01 (20), Stats., that is prescribed by a prescriber to treat or manage mental illness. (43) “Qualified treatment trainee” means either of the following:
(a) A graduate student who is enrolled in an accredited institution in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field and is doing a supervised practicum for their graduate degree program.
(b) A person who has been awarded a graduate degree by an accredited institution and has completed coursework in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field who has not yet completed the applicable supervised practice requirements described under s. MPSW 4.01, 12.01, or 16.04, or Psy 2.10. (44) “Recognized psychotherapy practitioner” means an individual who may lawfully practice psychotherapy within the scope of a license, permit, registration or certificate granted by this state, other than under ch. 455 or 457, Stats. (45) “Registered nurse” means a person licensed under s. 441.06, Stats. as a registered nurse. (46) “Seclusion” means the involuntary confinement and isolation in a room or area from which the youth is prevented from leaving.
(47) “Sensory interventions” means a treatment or therapy that makes use of, or aims to improve, sensitivity to one or more of the senses.
(48) “Service” means a crisis response service, a mental health day treatment service, a support service, transition service, trauma-informed service, or minimum required service under s. DHS 40.07 (4). (49) “Severe emotional disturbance” means an emotional or behavioral problem for a youth that currently meets, or at any time during the past year, met criteria for a mental disorder specified within a recognized diagnostic classification, and that produces a functional impairment which substantially interferes with or limits functioning in family, school, employment, relationships, or community activities.
(50) “Staff member” means a person employed or contracted through the program who provides treatment services to a youth or legal representative.
(51) “Support service” means individualized advice, guidance, or assistance with planning, designed to facilitate positive alternatives to challenging behaviors, and to assist a youth with developing adaptive and functional restoration. Support services do not include psychotherapy or time spent in educational services, meals, or recreation.
(52) “Therapeutic milieu” means the combination of physical and interpersonal environments established and maintained in the mental health day treatment program to provide safety, trust, and consistency of care, and to model, teach, and reinforce positive and supportive behaviors and interactions among youth and staff.
(53) “Therapeutic specialists” means experiential therapists, art therapists, and music therapists who have complied with the appropriate certification procedures for their profession as required by state statute or administrative rule or the governing body regulating their profession.
(54) “Transition services” means services provided to a youth to ensure continuity of care and management of the youth’s needs to ensure gradual reintegration back into school and the community as appropriate.
(55) “Treatment plan” means the document required under s. DHS 40.14. (56) “Trauma” means significant distress or impairment in a person’s social, coping, or other important areas of functioning, resulting from experiences or events.
(57) “Trauma-informed service” means a service that is attentive to the role that trauma plays in the lives of youth and family members, including recognition of the traumatic effect of misdiagnosis, coercive treatment, and inadvertent re-traumatization.
(58) “Variance” means a modification to a requirement of this chapter.
(59) “Voluntary time out” means an intervention intended to accomplish any of the following:
(a) Encourage youth to voluntarily use a calming or safe place that does not physically confine the youth, and that permits program staff members to visually monitor the youth when they are experiencing agitation or anxiety.
(b) Protect a client from another client who is posing a risk of harm or serious disruption.
(60) “Waiver” means an exemption from a specific requirement of this chapter.
(61) “Youth” means a person under 21 years of age.
DHS 40.04 Certification.
(1)
Initial Certification Requirements(a) GENERAL. A program that provides mental health day treatment services may not be established without certification from the department.
(b) APPLICATION.
1. Certification may be granted to establish any of the following:
a. A community-based program.
b. An intensive hospital- based program.
(Note) Application materials may be obtained from the Behavioral Health Certification Section, Division of Quality Assurance, PO Box 2969, Madison, WI 53701−2969 or online at DHSDQAMentalHealthAODA@wisconsin.gov. Completed application materials may be submitted by mail to the Behavioral Health Certification Section, Division of Quality Assurance, PO Box 2969, Madison, WI 53701−2969. 2. A program may apply for certification by submitting the following application materials to the department:
a. A completed application form.
b. Payment for the certification fee required under s. 51.04, Stats.
c. A program description, containing all of the following information:
1. The age range and characteristics of youth the program proposes to admit and if the program proposes to offer services based on age, the age range and client characteristics for each service.
2. The maximum number of youth that the program proposes to serve at any given time.
3. The hours and days of the year when the program will operate, and the proposed times during the day and week when youth will receive services from the program.
4. The treatment, services and supports, including parent peer specialists when appropriate, that will be offered by the program, and a rationale for how they will help the youth population achieve and sustain positive outcomes. If the program proposes to incorporate specific evidence-based practices in its array of services, a description of those services, the training and certification that its staff members have received or will receive that qualifies them to offer those services, and how those services will be provided. A description of the therapeutic milieu the program proposes to create with the proposed treatment, services and supports, how it will be maintained, its intended therapeutic benefits, and the rationale supporting its use for the youth served by the program. If the program proposes to offer other services within the same facility or program, it shall indicate the process that the program will use in deciding when and how to offer these services, how it will obtain any necessary authorization for these services, and how these services will be funded and regulated.
5. The program’s proposal for meeting staffing level requirements in s. DHS 40.10 (2), the qualifications and roles for each position, and an analysis showing that staffing is adequate to meet the needs of the youth that the program proposes to serve. A description is also required of any specialized training and certification that program staff members have received or will be receiving that will help them better identify and address the specific needs of the youth served by the program. 6. A description of the physical settings indicating where services will be provided and whether these settings will be used for other purposes. Documentation of inspection or permit indicating the state building code requirements have been met, including chs. SPS 361 to 366, American with Disabilities Act, any applicable local ordinance or municipal building codes, and any additional information requested by the department. 7. If a program is proposing to operate a community-based program in a school, an agreement that describes the school in which the program will be located, the area or areas in the school where program operations will occur, the interactions that the program will have with other school activities and classes, the relationship that the program staff will have with school staff, how program staff and school staff will maintain separate duties, and the activities that youth will be participating in while also receiving services through the program.
8. How the program will participate in care coordination for youth within the community.
9. Where client records will be maintained and how confidentiality requirements of those records will be safeguarded, as required under s. DHS 40.15. 10. How the program will arrange for food service to any youth who is in the program for four or more hours during a day.
c. INITIAL ON-SITE INSPECTION. Upon receipt of all application materials described in (2), the applicant shall do all of the following:
1. Permit the department to conduct an on-site inspection of the program’s physical settings to determine compliance with this chapter.
2. Make available for review by the department any documentation necessary to determine compliance with the standards in this chapter.
d. CERTIFICATION DETERMINATION.
1. The department shall make a certification determination within 60 days of receiving all completed application materials.
2. The department may grant certification if all the requirements of this chapter are met.
3. If the department determines that a program applying for certification does not comply with the requirements of this chapter, has a major deficiency, or the program description is not approved, the department may deny certification. A denial of certification shall be in writing and shall contain the reason for the denial and notice of appeal rights.
e. SCOPE OF CERTIFICATION. Certification granted by the department shall only be valid for the program described in the application materials.
(2) Ongoing Oversight Provisions
(a) NOTIFICATION OF CHANGES. A program that has received certification from the department shall notify the department of any change of administration, ownership, program name, required staff, or any other program 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 the program.
(Note) Program notifications should be made to: Behavioral Health Certification Section, Division of Quality Assurance, PO Box 2969, Madison, WI 53701−2969 or by emailing DHSDQAMentalHealthAODA@wisconsin.gov. (b) DURATION OF CERTIFICATION. Certification is valid until suspended or terminated by the department under sub. (11).
1 Certification may be suspended or terminated under s. DHS 40.04(11). 2 Any program that intends to close shall notify the department in writing at least 30 days before closing and comply with s. 40.15(9). (c) BIENNIAL REPORT AND FEES. Every 24 months, by the date of renewal, the program shall submit a biennial report on the form provided by the department, and shall submit payment of certification continuation fees for the purpose of renewing certification of the program for two years.
(d) ON-GOING ON-SITE INSPECTIONS. The program shall permit unannounced, on-site inspections of the program by the department to conduct program reviews, complaint or death investigations involving any aspect of the program, or to determine a program’s progress in correcting a deficiency or major deficiency cited by the department. All of the following conditions apply to an on-site inspection:
