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. 7. A clinical social worker licensed under s. 457.08 (4), Stats. 8. A clinical substance abuse counselor or independent clinical supervisor certified under s. 440.88, Stats. 9. Any of the individuals under subds. 1. to 8. who are practicing under a currently valid training or temporary license or certificate granted under applicable provisions of ch. 457, Stats. (b) “Competent mental health professional" does not include 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. “
_Hlk150507525(5) “Continuum of behavioral health and peer recovery support services” means an integrated system of care that includes a comprehensive array of behavioral health services spanning all levels of intensity of care including prevention, early intervention, harm reduction, treatment, psychosocial rehabilitation services, continuing care, and recovery services. (6) “County department” means a county department of human services under s. 46.23, Stats., or a county department of community programs established under s. 51.42, Stats., to administer community mental health and alcohol and drug abuse programs on a single-county or multi-county basis. (7) “Department” means the Wisconsin department of health services.
(8) “DSM” means the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013), published by the American psychiatric association.
(10) “Mental illness" means a diagnosis meeting the criteria in the DSM.
(11) “Overdose” means the ingestion or application of a drug or other substance in a quantity greater than is recommended that results in serious negative health effects or death.
