WISCONSIN DEPARTMENT OF HEALTH SERVICES
PROPOSED ORDER TO ADOPT PERMANENT RULES
The Wisconsin Department of Health Services proposes an order to repeal and recreate ch. DHS 75 of the Wisconsin Administrative Code, relating to community substance abuse services. RULE SUMMARY
Statute interpreted
Not applicable.
Statutory authority
Explanation of agency authority
In s. 51.42 (7) (b), Stats., the legislature authorized the department to promulgate rules governing the provision of community substance abuse services. The department determines and monitors standards and requirements to administer services for community mental health, developmental disabilities, and substance use. Related statute or rule
Plain language analysis
In response to recommendations from the Governor’s Task Force on Opioid Abuse, 2017, Executive Order 228 directed the department to revise ch. DHS 75 to better align with evidence-based practice standards in the industry and address gaps in service delivery related to the opioid epidemic in Wisconsin. Chapter DHS 75 establishes minimum standards for substance use prevention and treatment services delivered across a variety of settings and levels of care in Wisconsin. Chapter DHS 75 has not been revised since 2010, and much of the terminology and structure no longer reflects the rapidly evolving field of behavioral healthcare and the needs of Wisconsin consumers. Following extensive consultation with stakeholders in the substance abuse service community, the department proposes to update the rule chapter as follows:
Revise the rule’s terminology and structure to better align with the American Society of Addiction Medicine’s (ASAM) standards and more clearly define and expand available levels of care for substance use disorder treatment.
Incorporate recommendations from the Substance Abuse and Mental Health Services Association (SAMHSA) to better address integrated treatment for co-occurring substance use and mental health disorders.
Incorporate standards that increase the adoption of best practices for the treatment of opioid use disorders and other substance use disorders, along with increasing overall flexibility for providers and reducing unnecessary barriers to the delivery of substance use prevention and treatment services.
Align with more recent Medicaid requirements for substance use disorder services, and with revised professional licensing and credentialing standards from the Department of Safety and Professional Services. Given the need for substantive changes related to practice standards of the profession, alternatives to rule revision would fail to address the ordered changes to ensure the adequate protection of Wisconsin consumers and availability of a full continuum of substance use services for Wisconsin citizens.
Summary of, and comparison with, existing or proposed federal regulations
Federal regulations outline expectations with regard to substance use patient confidentiality protections in 42 CFR Part 2, the administration of opioid treatment programs by the state opioid treatment authority in 42 CFR Part 8, federal Medicaid coverage policies for behavioral health services in 42 CFR Part 440, and requirements for recipients of substance abuse prevention and treatment block grant funds in 45 CFR Part 96. The federal regulations and requirements are incorporated into the proposed rule, and updated for any recent changes in federally-required standards of practice. Comparison with rules in adjacent states
Illinois:
Substance use intervention and treatment services in Illinois are governed by Title 77, Chapter X, subchapter d, Part 2060: Alcoholism and Substance Abuse Treatment and Intervention Licenses, within the Public Health code. The Illinois rules also incorporate alignment with ASAM levels of care, although they do not appear to include specific requirements related to overdose prevention or the provision of integrated co-occurring treatment services for individuals with mental health and substance use disorders.
Iowa:
Licensure standards for substance use disorder and problem gambling treatment programs for the state of Iowa can be found in Chapter 155 of the Public Health code. Iowa also aligns with ASAM levels of care, although the rule does not address the provision of integrated co-occurring treatment services for individuals with mental health and substance use disorders. Michigan:
The Michigan Department of Licensing and Regulatory Affairs outlines requirements for Substance Use Disorder Services Programs in Mich. Adm. Code R. 325.1301 to 325.1399. The Michigan rules contain broader applicability related to office-based opioid treatment programs, and also outline more specific requirements related to medical director role and medical staffing, as well as using updated language in reference to medication-assisted treatment services for opioid use disorders. The Michigan rules were recently revised and are in the process of being revised again, according to the Prevention and Treatment Section Manager at the Michigan Department of Health and Human Services.
Minnesota:
Substance use treatment services in Minnesota are governed by Chapter 245G. Specific other services, including services for youth and integrated co-occurring treatment services are governed under Minn. R. Part 2960 and Minn. Stat. s. 245.4863, respectively. Minnesota has developed a statewide placement tool that is consistent with ASAM. Minnesota has provisions for integrated care of co-occurring treatment services for individuals with mental health and substance use disorders. Minnesota’s rules and statutes also incorporate medical services, including availability of Naloxone for overdose prevention, and address services delivered by recovery peers, which is an emerging service-delivery area within the substance use treatment profession. Summary of factual data and analytical methodologies
The minimum standards in the proposed rule were developed based on industry standards from ASAM, publications and recommendations from SAMHSA, and best-practice standards endorsed by the National Institute on Drug Abuse. Other sources were considered were comparable rules from other states and requirements from healthcare accrediting bodies, such as the Joint Commission on Accreditation of Healthcare Organizations and the Commission on Accreditation of Rehabilitation Facilities.
The department held seven listening sessions across the state that were broadly advertised and included input from over 150 stakeholders in the substance use prevention and treatment field. Feedback from the listening sessions was compiled and reviewed by the draft workgroup and the advisory committee for consideration and integration into the rule revision.
The department’s internal ch. DHS 75 workgroup consists of subject-matter experts from the Division of Care and Treatment Services, as well as collaborative partners from the Division of Quality Assurance, and consultation with the Division of Medicaid Services for alignment with rule provisions. The rule was also developed and reviewed with the ch. DHS 75 Advisory Committee, which consists of 16 members approved by the Governor to provide diverse stakeholder input regarding the different levels of care and settings applicable to the proposed rule. Rule development also included other specific and targeted stakeholder input and consultation meetings, including feedback received from opioid treatment program providers, the Wisconsin Society of Addiction Medicine, and the State Council on Alcohol and Other Drug Abuse, office-based opioid treatment providers, and the PEW Charitable Trust.
Lastly, throughout the rule-making process, an email account was established and publicized for individuals to provide written comments for consideration regarding the rule. The workgroup prioritized transparency by responding to and incorporating stakeholder input throughout the rule drafting process.
Analysis and supporting documents used to determine effect on small business
The Department of Health Services solicited public comments regarding the proposed rule from public and private treatment providers, health systems, Wisconsin counties, tribes, and behavioral health providers and consumers, from July 27, 2020 to August 26, 2020. The department received 18 responses to the solicitation. The public comments received, as well as an analysis of certification-related fiscal impacts, and other estimated costs, were compiled for the Fiscal Estimate and Economic Impact Analysis of the proposed rule.
Effect on small business
Based on the foregoing analysis, the proposed rule is anticipated to have a moderate economic impact on small businesses.
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