Additionally, the Department has determined that the policies and procedures regarding the provision of medications and referral to evidence-based treatment services for patients with substance use disorder authorized under s. 46.482 (3), Stats., should be established as rules to affirm compliance with s. 51.61 (5) (a), Stats., which requires that the department shall establish procedures to assure protection of patients’ rights guaranteed under Chapter 51 of the Wisconsin Statutes. Related statute or rule
The following statutes or rules relate to certification of peer recovery coaches and overdose treatment providers and reimbursement of peer recovery support services:
Section 1905 (a) (13) and 1915(b) and (c) of the Social Security Act (both of which are interpreted by SMDL #07-011)
Section 51.04, Stats. Plain language analysis
Section 49.45 (30j), Stats., which created in Act 122, directs the Department to certify PRCs for reimbursement under MA. There are no existing rules related to certification standards for peer recovery coaches, so the department intends to promulgate rules to effectuate Act 122 by creating a new administrative rule chapter numbered DHS 72. Subchapter I of the proposed ch. DHS 72 creates general applicability provisions and definitions. Subchapter II of the proposed ch. DHS 72 specifies training requirements related to the provision of services by a PRC, supervision by a competent mental health professional, training requirements, and documentation to be certified for reimbursement under MA. Notably, and based on extensive consultation with the advisory committee, the proposed rules would provide for all of the following:
1. Specifying which services (as indicated in an individual’s treatment goals and service plan) a PRC may provide and seek reimbursement for.
2. Requiring 40 hours of training under s. 49.45 (30j) (b) 4. a., Stats. 3. Requiring 24 hours of paid or volunteer experience under s. 49.45 (30j) (b) 4. b., Stats.
3. Co-supervision by a PRC supervisor (who is an experienced PRC with additional training specified in the rule) working under the direction of a competent mental health professional. Doing so will increase access to PRCs statewide by reducing the administrative strain on supervising competent mental health professionals while still providing the requisite oversight of the competent mental health professional to ensure PRC services are coordinated within the context of a comprehensive, individualized plan of care. The proposed rules prescribe the minimum amount of time that a competent mental health professional working with a co- supervisor must provide supervision to a PRC directly in order to meet the supervision requirements in the rule.
Subchapter III of the proposed ch. DHS 72 also establish requirements for Substance Use Overdose Program which are a new class of overdose treatment and peer recovery service provider in which PRC services may be provided. These providers are treatment facilities under s. 51.04, Stats., and must be certified for reimbursement under MA. The proposed rule seeks to establish all of the following:
1. Certification application requirements, including durational and biennial renewal requirements.
2. Program statement requirements.
3. Required policies and procedures.
4. General qualification requirements.
5. Orientation, training, and continuing education requirements.
6. Participant rights.
7. Service records and discharge summary requirements. 8. A process for any program certified as a Substance use overdose program to request a waiver or variance for any non-statutory requirements in subchapter III of proposed ch. DHS 72. Finally, the Department proposes to add provisions to chapter DHS 105 to include providers certified under ch. DHS 72 as appropriate for MA reimbursement, and to amend ch. DHS 107 to identify covered services provided under ch. DHS 72. Summary of, and comparison with, existing or proposed federal regulations
Section 1905(a)(13) of the Social Security Act provides for Medical Assistance program coverage of “other diagnostic, screening, preventive, and rehabilitative services,” such as overdose treatment services. Additionally, CMS has identified mental health and substance use peer support providers, such as peer recovery coach providers, as allowable providers in SMDL #07-011.
Comparison with rules in adjacent states
Illinois:
Illinois certifies peer recovery support specialists through the Illinois Certification Board, Inc., a professional organization that includes the Illinois Alcohol and Other Drug Abuse Professional Certification Association, Inc. While they have training and certification requirements, these are not based on statute or administrative rule. Instead, the certified peer recovery specialist competencies include the knowledge and skill base which is defined in the “Peer Recovery Credential, Role Delineation Study, and Final Report,” for IC&RC, dated January 2013 and completed by the Schroeder Measurement Technologies, Inc.
The International Certification and Reciprocity Consortium (“IC&RC”) is an international non-profit organization that promotes public protection by developing internationally recognized credentials and examinations for prevention, substance use disorder treatment, and recovery professionals, including peer recovery specialists.
Iowa:
Iowa certifies peer recovery specialists through the Iowa Board of Certification, which is very similar to the Illinois system. The Iowa Board of Certification (IBC) credentials prevention and treatment professionals in addictions and other behavioral health fields by promoting adherence to competency and ethical standards. These standards are based on professional standards based on IC&RC and not by any statute or administrative rule.
Michigan:
Michigan certifies recovery coaches through their Department of Health and Human Services, based on the IC&RC Peer Recovery Credentials and the MDHHS Peer Recovery Coach training requirements. Requirements are not based on statute or administrative rule.
Minnesota:
Like the above states, Minnesota certifies its peer recovery specialists through its MN state board responsible for alcohol and other drug certifications. Its policies and tests are based on IC&RC standards mentioned above, and they even have a state reciprocity certification. Requirements are not based in statute or administrative rule.
Summary of factual data and analytical methodologies
Information about other states was found in the State-by-State Directory of Peer Recovery Coaching Training and Certification Programs published by the Substance Abuse and Mental Health Services Administration (SAMHSA), along with each state’s certification board website.
Analysis and supporting documents used to determine effect on small business
According to the U.S. Small Business Administration, a small business is defined as a for-profit business of any legal structure. Section 227.114 (1) defines a small business as “a business entity, including its affiliates, which is independently owned and operated and not dominant in its field, and which employs 25 or fewer full-time employees or which has gross annual sales or less than $5,000,000.” Based on information gathered from peer providers during meetings of the advisory committee organizations conducting this work are not-for-profit or have more than 25 employees and would not meet the definition of a small business as defined by the U.S. Small Business Administration or in s.227.114 (1), Stats. It is therefore anticipated that the proposed rules will have minimal impact on small businesses. Effect on small business
Based on the foregoing analysis, the proposed rules are anticipated to have little to no economic impact on small businesses.
Agency contact person
Sarah Coyle, Dept. of Health Services, Division of Care and Treatment Services, 1 W. Wilson St., Room 850, Madison, WI 53716
Statement on quality of agency data
See summary of factual data and analytical methodologies.
Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active. RULE TEXT
SECTION 1. DHS 72 is created to read:
_Hlk152950781OVERDOSE TREATMENT PROVIDER CERTIFICATION AND COVERED SERVICES Subchapter I – General Provisions
DHS 72.01 Authority and purpose.
DHS 72.02 Applicability.
DHS 72.03 Definitions.
Subchapter II – Peer Recovery Support Services Standards
DHS 72.04 Peer recovery support services.
DHS 72.05 Training, orientation, and continuing education requirements.
DHS 72.06 Supervision of peer recovery coaches.
DHS 72.07 Documentation.
Subchapter III – Coordination of Care in Substance Use Overdose Program Requirements
DHS 72.08 Application requirements and policies.
DHS 72.09 Program statement.
DHS 72.10 Required policies and procedures.
DHS 72.11 General qualifications.
DHS 72.12 Orientation, training, and continuing education.
DHS 72.13 Participant rights.
DHS 72.14 Participant service records.
DHS 72. 15 Discharge summary.
(1) Peer recovery support services.
(2) Treatment programs for coordination and continuation of care following an overdose.
DHS 72.02 Applicability.
(1) This chapter shall apply to all of the following seeking reimbursement under the medical assistance program for recovery support services:
(a) A publicly or privately operated facility, clinic, or organization providing peer recovery support services, coordination and continuation of care for individuals at high risk for overdose, or both, in response to or following a substance use overdose.
(b) A county department or Tribal nation providing peer recovery support services, coordination of care in substance use overdose, mental health, or substance use treatment services.
(c) A publicly or privately operated service that requests certification by the department.
DHS 72.03 Definitions. In this chapter:
(1) “Behavioral health” means the spectrum encompassing mental health and substance use disorders occurring either independently or simultaneously.
(2) “Certification" means the approval of the service by the department’s division of quality assurance.
(3) “Co-supervision” means a shared model of supervision where a peer recovery coach is supervised by both a competent mental health professional and a peer recovery coach supervisor, either individually or in groups, to ensure that all aspects of peer recovery coaching can be modeled and supervised.
(4)
(a) “Competent mental health professional” means any of the following:
1. A physician who has completed a residence in psychiatry or is certified in addiction medicine.
2. A psychologist or a private practice school psychologist licensed under ch. 455, Stats. 3. A marriage and family therapist licensed under s. 457.10 or 457.11, Stats. 4. A professional counselor licensed under s. 457.12 or 457.13, Stats. 5. An advanced practice social worker granted a certificate under s. 457.08 (2), Stats. 6. An independent social worker granted a certificate under s. 457.08 (3), Stats.
