Substance Use: Provider Information

Meetings will be scheduled when there is information to share. Providers certified under Wis. Admin. ch. DHS 35 are invited to these meetings. 

2025

April 8: April 8, 2025, video

• Client Rights Limitations and Denials (PDF) 
• Medicaid Coverage of Intensive Outpatient Program Services (PDF)
• ForwardHealth Update 2024-38: New Intensive Outpatient Program Benefit (PDF)
• FAQs About Integrated Intensive Outpatient Program Benefit (PDF)

2024

November 12: No slides were shared at this meeting. | November, 12, 2024, video

August 13: Qualified Treatment Trainees Policy Clarification (PDF) | August 13, 2024, video

May 14: No slides were shared at this meeting. | May 14, 2024, video

Are there changes to the fee schedule for certification?

Except for opioid treatment programs, DHS 75.06(1) requires treatment programs to submit certification continuation fees every 24 months, instead of annually as required in the past. There has been no increase in fees.

Do branch offices need certification?

With the exception of schools, locations where treatment is being provided on a consistent basis need to be listed as a branch office location on the provider’s main certificate. Branch offices are authorized to provide the same services as the main certificate. Residential and inpatient treatment services may not have branch offices due to the additional requirements specific to the location.

A DHS 75.50 certified service main office may have branch offices that can provide mental health, substance use services, or both. This is based on the language in DHS 75.50(3)(a) that states that an outpatient substance use treatment service may provide services at one or more offices.

Can an agency be certified as a DHS 75.49 operation and a DHS 75.50 operation?

Providers should choose one or the other. Providers who are certified under DHS 75.50 (outpatient integrated behavioral health treatment services) should not be located with a DHS 75.49 outpatient substance use treatment service or with a Wis. Admin. Code ch. DHS 35 community mental health treatment service at the same service location.

Are mental health intensive outpatient services covered under DHS 75 or should agencies continue to provide mental health intensive outpatient services under DHS 35?

Unlike intensive outpatient services for substance use disorder (DHS 75.51), intensive outpatient services for mental health does not have its own certification through the Division of Quality Assurance and Wisconsin Medicaid does not have a specific mental health intensive outpatient benefit. DHS 75.50 includes limits of less than nine hours of treatment services per patient per week for adults, and less than six hours of treatment services per patient per week for minors. Providers wishing to be reimbursed for services that exceed these limits should consider retaining their DHS 35 certification or be certified for day treatment.

Is a community-based residential facility license still required for residential care providers?

Facilities are no longer required to be licensed as a community-based residential facility (CBRF) in addition to their DHS 75 residential certification. Facilities that choose to surrender their CBRF license and operate solely under DHS 75 should notify the appropriate Division of Quality Assurance Bureau of Assisted Living Regional Office as soon as possible regarding their intent to surrender their CBRF license. Facilities must follow any other applicable requirements if they are certified to provide services in addition to DHS 75 covered services.

Facilities that surrender their CBRF license must limit the type of residents to people who are receiving care and treatment for mental health or substance use needs. Based on the number of CBRF residents who are no longer eligible for care, the CBRF may need to submit a Resident Relocation Plan and retain their CBRF license until all residents whose needs are not served under DHS 75 are relocated.

Licensing fees are not refundable.

Is a DHS 75 certification needed for an agency certified as a DHS 124 hospital facility?

This answer depends on the services being provided.

A DHS 75 certification is not required for an agency licensed as a DHS 124 hospital facility if any of the following apply:

• Per DHS 75.02(3), this chapter shall not apply to a general medical service that delivers substance use treatment services as an adjunct to general medical care, unless that service meets the definition of a “program” under 42 CFR 2.11.
• Per DHS 75.60(1), office-based opioid treatment certification is not required in a hospital as defined under Wis. Stat. § 50.33 (2) and their affiliates.
• DHS 75 certification is not required for a DHS 124 hospital providing withdrawal or detoxification services in a hospital setting.

This is based on a DHS 75 perspective. Providers need to check with their payor sources to determine if there are additional reimbursement requirements including the possible need for DHS 75 certification.

A hospital that is providing substance use treatment programs such as an outpatient, residential, or inpatient program are required to have the applicable DHS 75 certification. Review DHS 75 for additional applicability and requirements for the services being provided.

What certification is needed for a private practice professional to provide substance use services?

All outpatient clinics that provide substance use treatment services are required to be certified under DHS 75 as a substance use provider [Wis. Stat. § 51.45(8)(c)]. Therapists working at an outpatient clinic should follow DHS 75 requirements related to the level of care being provided and also reference Department of Safety and Professional Services requirements for their specific licensure.

Do physicians (non-psychiatry) who provide addiction medicine services (example: SUBOXONE®) in a medical office need to obtain certification under DHS 75.60?

A certification is not required under DHS 75.60 if you are certified as a hospital, primary care service, or state or local correctional facility. If you are providing medications to patients who are are all enrolled in a service under DHS 75 or you are providing medication to less than 30 patients, you do not need to be certified under DHS 75.60.

Do Intoxicated Driver Program agencies that provide culturally specific alternative education services need to be certified under DHS 75?

DHS 75.15(2) requires the Intoxicated Driver Program service to be certified.

DHS 75.15(2) applies to intervention services, as required by contract with DHS; intoxicated driver services, and an intervention service that requests certification.

A certified Intoxicated Driver Program Alternative Education Service may contract with individuals or another agency to provide culturally specific alternative education on their behalf. If this occurs, the certified provider maintains the records of the individual served and completes the required Intoxicated Driver Program reporting. The certified provider needs to ensure the contracted instructor/agency are meeting the administrative rule requirements (for example, background checks, experience, documentation, course requirements, etc.) associated with any staff providing services. If the Division of Quality Assurance uncovers noncompliance when looking at participant or staff records, the certified entity is held responsible.

Are intoxicated driver intervention service providers required to provide both alternative education and intoxicated driver assessments?

No. The revised DHS 75 does not require an intoxicated driver intervention service provider to provide both alternative education and intoxicated driver assessments. The revised rule allows a provider to choose to provide alternative education and/or intoxicated driver assessments. Only the single identified county assessment agency may provide intoxicated driver assessments.

Do policies of Intoxicated Driver Programs need to comply with DHS 62 and DHS 75.15?

Administrative rules frequently refer to other administrative rules or statutes. If a rule refers to another rule or statue, it is indicating that a provider also needs to be aware of and compliant with the corresponding rule or statute.

Do substance use counselors need to have a minimum of a bachelor’s degree?

Providers should follow the Department of Safety and Professional Services requirements for their specific certification or licensure.

In DHS 75, “substance abuse counselor,” or “counselor,” means any of the following:

• A clinical substance abuse counselor as defined in Wis. Admin. Code SPS § 160.02(5).
• A substance abuse counselor as defined in Wis. Admin. Code SPS § 160.02 (26).
• A substance abuse counselor-in-training as defined in Wis. Admin. Code SPS § 160.02(27).

People holding an LCSW, LPC, or LMFT credential do not need to have a substance use credential to be considered a substance abuse counselor. 2017 Wisconsin Act 262 revised DHS 75 to allow LMFT, LPC, and LCSW to provide clinical supervision. In addition, Wis. Admin. Code ch. SPS 160 does not apply to physicians, psychologists, LMFT, LPC and LCSW.

Individuals with APSW and ISW certifications are authorized to provide substance use disorder treatment with the enactment of 2021 Wisconsin Act 222.

Is it within my scope as a substance abuse counselor-in-training with appropriate clinical supervision to complete the ASAM Criteria with clients?

Per DHS 75.03(17), a substance abuse counselor-in-training as defined in Wis. Admin. Code SPS § 160.02(27) is considered clinical staff who can deliver screening, assessment, or treatment services under DHS 75. Per DHS 75.03(14), clinical assessment means the procedure by which a clinical staff of a service operates within the scope of their practice. Also, it is important to note that DHS 75.24(11)(k) states for assessments completed by a substance abuse counselor-in-training or a graduate student qualified treatment trainee, the assessment and recommendations should be reviewed and signed by the clinical supervisor within 7 days of the assessment date. Review the service requirements by level of care tables (DHS 75.48). These tables establish additional requirements for outpatient levels of care, residential levels of care, and withdrawal management levels of care.

Who can gather the information for the assessment requirements identified in DHS 75.24(11)?

DHS 75.03(17) identifies the clinical staff allowed to gather and complete the assessment under DHS 75.24(11).

What are the standards for clinical consultation and clinical staffing?

There is a difference between clinical staffing and clinical consultation.

Per DHS 75.03(15), clinical consultation means the review of a patient's plan of care or collaborative discussion of specific aspects of a patient's risks, needs, and functioning, between a clinical supervisor and other clinical staff of a service, another licensed professional, or both.

Per DHS 75.03(18), clinical staffing means the review of a patient's plan of care or collaborative discussion of specific aspects of a patient's risks, needs, and functioning, with other clinical staff of a service.

Per DHS 75.24(14) clinical consultation and DHS 75.24 (15) clinical staffing an agency should have written polices and procedures for both.

• Frequency of meeting for clinical consultation is determined by DHS 75.24(14)(e-g)
• Frequency of meeting for clinical staffing is determined by DHS 75.24(15)(c)(1-4)

Does a clinical supervisor need to be designated if all agency staff do not require clinical supervision based on their credentials?

DHS 75.18(2) requires a designated clinical supervisor either on staff or through contract to provide clinical supervisor or consultation.

Additionally, per DHS 75.18(2)(b), a clinical supervisor is responsible for professional development of clinical staff, and for ensuring delivery of appropriate clinical services to patients of a service.

There are levels of care that require a clinical supervisor to review and sign specific documents.

Clinical supervisors are not required to sign clinical documents in the outpatient level of care (DHS 75.49) unless they are supervising a substance abuse counselor-in-training or graduate student qualified treatment trainee.

Per DHS 75.18(2)(c), a clinical supervisor who is on staff of the service and meets the requirements of a substance abuse counselor or mental health professional may provide direct counseling services in addition to supervisory responsibilities.

Clinical staffing applies to all clinical staff of a service and includes the clinical supervisor and medical personnel. Clinical staffing is facilitated at intervals appropriate to the individual’s needs and as prescribed based on the level of care.

For clinical staffing required under DHS 75.49 to DHS 75.59:

• Clinical staffing should include the clinical supervisor of the service.
• Clinical staffing should include a patient’s prescriber or medical personnel, if applicable.
• Clinical staffing may be combined with treatment plan review and level of care review.
• Clinical staffing should be documented in the patient’s clinical record.

Can a fully licensed clinical supervisor-in-training provide clinical supervision?

Providers should follow the Department of Safety and Professional Services requirements for their specific certification or licensure.

Individuals with APSW and ISW certifications are authorized to provide substance use disorder treatment with the enactment of 2021 Wisconsin Act 222. Licensed physicians, psychologists, licensed professional counselors, licensed marriage and family therapists, and licensed clinical social workers are able to supervise SAC-IT, SAC and CSAC without obtaining an additional credential.

Clinical supervision provided by professional counselors, marriage and family therapists, or clinical social workers must be within the licensed practitioner’s education, training, and experience. Practice outside of one’s competency may be professional misconduct and can be grounds for disciplinary action against one’s license. Wis. Admin. Code. SPS § 162.01 references professionals without a mental health license, such as substance abuse counselors-in-training, substance abuse counselors, clinical substance abuse counselors, clinical supervisors-in-training, and intermediate clinical supervisors in regard to all activities including, but not limited to, counselor development, counselor skill assessment and performance evaluation, staff management and administration, and professional responsibility. A clinical supervisor should provide a minimum of:

• Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
• Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
• One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
• One in person meeting each calendar month with a substance abuse counselor-in-training, substance abuse counselor or clinical substance abuse counselor. This meeting may fulfill a part of the requirements of the first three bullets.  

This section does not apply to a physician, as defined in Wis. Stat. § 448.01(5), a clinical social worker, as defined in Wis. Stat. § 457.01(1r), an independent social worker, as defined in Wis. Stat. § 457.01(2g), an advanced practice social worker, as defined in Wis. Stat. § 457.01(1c), a psychologist licensed under Wis. Stat. § 455.04 (1) or (2), a marriage and family therapist, as defined in Wis. Stat. § 457.01(3), or a professional counselor, as defined in Wis. Stat. § 457.01(7), who practices as a substance abuse clinical supervisor or provides substance abuse counseling, treatment, or prevention services within the scope of their credential.

Can a clinical supervisor-in-training supervise a substance abuse counselor-in-training?

DHS 75.03(19) outlines the meaning of a clinical supervisor per Wis. Admin. Code SPS § 160.02(7) and 2017 Wisconsin Act 262. Individuals with APSW and ISW certifications are authorized to provide substance use disorder treatment with the enactment of 2021 Wisconsin Act 222. Licensed physicians, psychologists, professional counselors, marriage and family therapists, and clinical social workers are able to supervise substance abuse counselor-in-training, substance abuse counselor, and clinical substance abuse counselor without obtaining an additional credential from the Department of Safety and Professional Services as they are exempt from Wis. Admin. Code chs. SPS 160-168 by virtue of Wis. Stat. § 440.88(3m). Clinical supervision provided by professional counselors, marriage and family therapists, or clinical social workers must be within the licensed practitioner’s education, training, and experience. Practice outside of one’s competency may be professional misconduct and can be grounds for disciplinary action against one’s license. Providers should follow the the Department of Safety and Professional Services requirements for their specific certification or licensure.

EXCEPTION: This section does not apply to a physician, as defined in Wis. Stat. § 448.01(5), a clinical social worker, as defined in Wis. Stat. § 457.01(1r), an independent social worker, as defined in Wis. Stat. § 457.01(2g), an advanced practice social worker, as defined in Wis. Stat. § 457.01(1c), a psychologist licensed under Wis. Stat. § 455.04 (1) or (2), a marriage and family therapist, as defined in Wis. Stat. § 457.01(3), or a professional counselor, as defined in Wis. Stat. § 457.01(7), who practices as a substance abuse clinical supervisor or provides substance abuse counseling, treatment, or prevention services within the scope of their credential.

Has there been a change in the amount of supervision needed for individual therapy?

DHS 75 no longer indicates hours required for clinical supervision. The hours are based on the licensure and/or certification requirements of the designated provider. Under DHS 75.19, a service should have written policies and procedures for the provision of clinical supervision to unlicensed staff, qualified treatment trainees, and recovery support staff. Clinical supervision for substance abuse counselors, mental health professionals in-training, and qualified treatment trainees should be in accordance with requirements in Wis. Admin. Code ch. SPS 162, Wis. Admin. Code chs. MPSW 4, 12, and 16, and Wis. Admin. Code ch. Psy 2. A record of clinical supervision should be made available to DHS upon request. An LCSW, LPC or LMFT do not need to have a substance abuse credential to be considered a substance abuse counselor. 2017 Wisconsin Act 262 revised DHS 75 to allow MFT, LPC, and LCSW to provide clinical supervision. In addition, Wis. Admin. Code ch. SPS 160 does not apply to physicians, psychologists, MFT, LPC and LCSW. Individuals with APSW and ISW certifications are authorized to provide substance use disorder treatment with the enactment of 2021 Wisconsin Act 222. Please consider clinical consultation requirements per DHS 75.24(14).

Does a medical director have to do all the clinical supervision for a day treatment program?

Under DHS 75.48(1), a medical director is required either as an employee of the service or through a written agreement to provide medical oversight and consultation regarding clinical operations of the service.

The agency needs a clinical supervisor per DHS 75. The clinical supervisor can be the medical director but is not required to be the medical director. The clinical supervisor can be the medical director as long as the medical director meets the definition of clinical supervisor per DHS 75.03(19).

Clinical supervision requirements are outlined in DHS 75.19(3).

Is there a max group size per counselor per level of care?

Please see DHS 75.03(41).

Why are psychologists listed with psychiatrists as providing medical management?

Professionals should be providing services within their scope of practice under their license and clinical skills. A DHS 75.55 service must have a physician available to provide consultation, medication management, and medication-assisted treatment services. The physician would address the medical needs of patients. A consulting psychiatrist, or a consulting clinical psychologist also needs to be available as needed to provide consultation on a behavioral health emergency.

What are the medical director requirements for a a level 1 outpatient services provider (DHS 75.49)?

Please see the DHS 75.48 service requirements by level of care table.

What can peer specialists/recovery coaches do under DHS 75?

Clinical services such as counseling, assessment, group therapy, family therapy, medication management, or other services that require specialized knowledge and training as defined by DHS 75.03(48) in the assessment and treatment of mental health and substance use disorders need to be conducted by the clinical staff of a service, operating within the scope of their practice as defined by DHS 75.03(79).

A recovery coach and certified peer specialist are not considered clinical staff as defined in DHS 75.03(17) that can provide clinical services as defined in DHS 75.03(16). A certified peer specialist means a person who has lived experience of mental illnesses or substance use disorders, or both, and has completed formal training and holds a DHS certification in the peer specialist model of mental health or substance use disorders support, or both per DHS 75.03(13). A recovery coach means an individual that works with and supports individuals receiving substance use services and may be included in the treatment plan to assist with engagement in treatment services or recovery systems, or both per DHS 75.03(76).

Is a psychiatrist or advanced practice nurse prescriber needed on staff when a clinic is getting certified for integrated services under DHS 75.50.

Please see the DHS 75.48(1) table for outpatient services.

Is a separate universal precautions policy needed?

A provider needs to ensure that their universal precautions policy meets the requirements of DHS 75.19(5) personnel requirements.

Are providers required to treat tobacco use disorders?

No. However, as of October 1, 2022, a service must have a written policy outlining the service’s approach to assessment and treatment for concurrent tobacco use disorders per DHS 75.24(7). Need help? View resources from the University of Wisconsin Center for Tobacco Research and Intervention.

Are providers required to have a smoke-free facility?

No. However, as of October 1, 2022, a service needs to have a written policy regarding whether their facility is a smoke-free environment. This is individualized to the specific service/facility’s decision on tobacco use at their site. Need help? View resources from the University of Wisconsin Center for Tobacco Research and Intervention.

Is it acceptable to have youth and adults in the same lobby until staff get them for their appointments?

DHS 75.22(6) references separation of services in relation to treatment and does not include a lobby setting. Still, the provider needs to ensure the safety needs for minors [DHS 75.22(7)] and outline steps taken to do this in their policy and procedures. This typically includes monitoring the waiting room at all times if both youth and adults are present.

Can one site/facility be used for multiple residential/outpatient services?

A facility that has more than one residential program may have residents of each service co-mingled as long as the needs and treatment for each resident at their assessed level of care is provided. If a specific residential treatment service has residents that could interact with residents of a different level of care, a separation of some type is expected within the facility. Examples could be levels of service in different halls, wings, groupings, etc. If a facility provides residential treatment AND wants to add any type of outpatient, day treatment, or other business, within the same building, DHS approval under DHS 83.57 is needed. The residential treatment service is the home for the residents and direct public access to the residential section of the building is not allowed.

Are there requirements on where to store naloxone in a large medical facility?

Per DHS 75.24(5), naloxone should be available within the physical structure of the certified program and readily available if needed in an emergency. Staff rostered to the DHS 75.49 through DHS 75.59 programs need to be trained on the use and administration of naloxone per DHS 75.24(5)(d). Providers also need to comply with other applicable medication-related storage regulations, including but not limited to those specific to residential programs, opioid treatment programs, and CBRF licensure. Review general requirements and those specific to the levels of care being provided.

Can services be provided by telehealth?

Please see DHS 75.12.

Does an agency need to apply for DHS 75.14 if they have a prevention specialist?

The requirement to be certified under DHS 75.14 applies to a prevention service when the service receives funding from the Substance Use Prevention, Treatment, and Recovery Services Block Grant or other funding specifically designed for providing services under DHS 75.14 AND certification is required by contract with DHS OR a prevention service voluntarily requests certification. If you have a contract with DHS that specifies that the provider is required to be certified as a DHS 75.14, certification is required.

Can a DHS 75.50 provider offer only mental health services or psychiatric services?

An agency can provide mental health only, substance use disorder only or integrated mental health and substance use disorder services in a DHS 75.50 setting. Medicaid systems will allow for both mental health and substance use disorder services to be reimbursed in a DHS 75.50 setting. Policies and procedures are expected to include both services and meet requirements in DHS 75.50.

Will DHS be using the emergency rule change procedure to expand what can occur within a medication unit in line with the federal rules for medication units or will opioid treatment programs be required to submit waivers and variances for services provided by medication units?

Any opioid treatment program that selects to offer medication units should use waivers and variances as needed.

Can we only screen (not test) all patients for communicable diseases, including TB? Can we test only if it is recommended based on the screen?

The requirements may be different for specific certifications or levels of care.

Residential levels of care except for DHS 75.58 require screening for communicable illnesses per DHS 75.48(2)(L) which includes tuberculosis per DHS 75.24(9)(a)2. Please review these sections for information on the ability to use screenings completed in the past 30 or 90 days for specific certifications (DHS 75.53 and DHS 75.54). A positive screening would indicate the need for further TB or communicable disease testing.

Opioid treatment programs should screen patients for tuberculosis in a manner and frequency consistent with current CDC standard of practice under DHS 75.59(19)(a).

Is screening patients for communicable disease still required?

Under DHS 75.24(9)(a), a service should have written policies and procedures for intake, including information concerning communicable illnesses, such as sexually transmitted infections, hepatitis, tuberculosis, and HIV, and refer patients with communicable illness for treatment when appropriate

Are outpatient service providers required to provide drug testing?

DHS 75.24(20) does not require a DHS 75 provider to provide drug testing. Still, providers are required by DHS 75.24(20) to have a policy on drug testing, have a method for obtaining confirmation of drug testing results, inform patients of the costs of drug testing, if any, and obtain informed consent before releasing patient drug testing results, if any. For example, a provider could have a policy that states they do not use drug testing and/or that patients are referred to their primary care physician for drug testing.

Can the initial DHS 75.24 screening be done upon the first session/intake session with the therapist or does it need to be done when they first make contact with the clinic requesting services?

Certified programs need to develop their own policy specific to the screening process that meet DHS 75 requirements. This may include steps that happen prior to the first appointment with a provider.

It is important to ensure that the screening process includes identifying pregnant women and people who use substances by injection. This needs to happen as soon as possible to ensure that high priority populations are offered access to care or interim services.

The initial screening typically happens when the person first presents for services. The initial screening typically includes a determination of the preliminary level of care needed and if your program provides the appropriate level of care based on the ASAM Criteria or other DHS approved level of care placement criteria.

See DHS 75.24(1)(a) for general screening requirements.

Can WI-UPC be used instead of ASAM?

Yes. The Wisconsin Uniform Placement Criteria (WI-UPC) is approved by DHS and permitted under DHS 75.03(4) as an “approved placement criteria” tool to determine levels of care. However, it is recommended an agency consider other specific requirements by funding sources when selecting a placement tool.

If a consumer still in therapy discharges from CCS, can we use the CCS assessment as the initial assessment to continue care under DHS 75.50 and develop a new treatment plan?

If the assessment from CCS includes all the required components of DHS 75.24 (11)(a-L) and under DHS 75.48(i). For returning patients, an assessment update should be completed if 90 days have passed since the initial comprehensive assessment. If one year has passed, a new comprehensive assessment is required.

If using an assessment that has been conducted by a referring provider (from a different agency) within the last 30 days in lieu of conducting another one, does the assessment still need to be signed by physician, physician assistant, registered nurse, or clinical supervisor within 7 days of completion? If so, does it need to be signed by one of the above credentialed providers from the referring agency OR from the agency accepting the referral? Can a provider from the accepting agency sign the assessment as "reviewed" to meet this requirement?

DHS 75.24(11)(c) allows for a comprehensive clinical assessment that has been conducted by a referring agency within the past 90 days to serve as the assessment. However, as noted, specific levels of care may be more restrictive. This includes requiring the referring agency assessment to be completed within 30 days instead of the 90 days. [refer to DHS 75.48(2)] The co-signature needed for the assessment and level of care placement is required to be within 7 days of the assessment. If the assessment conducted by a referring substance use treatment provider is less than 30 days old with the appropriate co-signature, it does not have to be signed by the physician, physician assistant, registered nurse, or clinical supervisor. However, it is the responsibility of the agency providing services to that patient to assure that the assessment and level of care placement meet the requirements of DHS 75 and that the assessment provides all information necessary to make clinical decisions and treatment planning. Signing the assessment as “reviewed” or noting in the clinical record that the assessment or portions of the assessment were reviewed with no changes being indicated would meet this requirement as long as the reviewer is also the signer (meaning the qualified staff person needs to sign their own review, not another staff person signing on their behalf). DHS 75.24(15) regarding clinical staffing means the review of a patient’s plan of care or collaborative discussion of specific aspects of a patient’s risks, needs, and functioning, with other clinical staff of a service. This may include a review of the referring agencies’ assessment to gather aspects of a patient’s risks, needs, and functioning. Clinical staffing for DHS 75.54 is required every 7 days for each patient. The rules pertain to standards a provider must meet to become and stay certified. However, the administrative rule is not an insurance coverage policy. The individual payor source for the service may have additional limitations or requirements. While it is essential to meet the minimum requirements for certification, providers should always become familiar with payor requirements for reimbursement.

Can a patient of an opioid treatment program refuse to have the complete blood count completed and liver function testing?

DHS 75.59(6)(e)(1) states a comprehensive physical examination should be ordered by the service physician on the day of admission and should include a complete blood count and liver function testing. This is to ensure the patient is receiving a stable dose of medication to support their recovery. These tests are also to support medical decision-making regarding the need to a split dose throughout the individual’s treatment.

Can you provide an example of a preliminary discharge plan?

A preliminary discharge plan is initiated prior to the completion of treatment in the current level of care. Per DHS 75, this plan needs to outline step down services and ongoing support. This plan may:

• Identify what treatment needs a client may still have.
• Highlight additional community resources a client may still need.
• Identify needed referrals between providers for ongoing care.
• Address areas in a client’s life needing ongoing support such as transportation, employment, etc.
• Address personal goals such as recreational, leisure, self-fulfillment, and social supports.

The payor source for a service may have additional limitations or requirements that need to be taken into consideration when developing this plan.

Do treatment plans require an updated ASAM Criteria with all six dimensions listed/documented OR is documenting the appropriate level of care sufficient?

Under DHS 75.24(13)(h-j) an updated level of care assessment is required to validate your recommendations of continued stay, transfer, or discharge. An updated level of care assessment is re-assessing each of the six dimensions if using the ASAM Criteria or re-completing the Uniform Placement Criteria or other DHS approved level of care tool. It is an opportunity for the provider and the client to ensure that the treatment plan considers any updated needs or any new issues that may have arisen and may impact their recovery.

If using the ASAM Criteria, the treatment plan should tie back to the problems identified in the ASAM dimensions. Documentation can include notations in areas where no change has occurred.

Is there a recommended best practice for the annual report required under DHS 75.25?

An agency is required to have an outcome monitoring and quality improvement plan that includes the items listed in DHS 75.25. DHS does not have a best practice sample report. The specific format is up to each agency

What data needs to be collected as part of outcome monitoring?

Please see DHS 75.25(2).

What documents require signatures?

Signatures Required for DHS 75 Outpatient Services (PDF)
This job aid explains the signatures required on documentation for the key pieces of outpatient care.

Signatures Required for DHS 75 Residential/Withdrawal Management Services (PDF)
This job aid explains the signatures required on documentation for the key pieces of residential and withdrawal management services.

Is a DHS 75.50 outpatient integrated behavioral health treatment service able to bill Medicaid for mental health or substance use disorders or co-occurring treatment?

Medicaid does not technically have co-occurring treatment as a service but providers can bill mental health services under the outpatient mental health benefit and substance use disorder services under the outpatient sub stance use disorder benefit. Both benefit areas can be billed when treating for co-occurring needs.

Are qualified treatment trainees billable in DHS 75 certified services?

Medicaid allows for reimbursement of qualified treatment trainees in DHS 75 certified facilities. The effective date was December 1, 2022 (announced in ForwardHealth Update 2022-56 (PDF)). A policy update expected in 2024 will further clarify policy for qualified treatment trainees reimbursement.

Are prevention services reimbursable by Medicaid?

DHS 75.14 certified prevention services are not a Medicaid reimbursable service at this time.

How long would it take to reinstate my credentials to serve BadgerCare Plus members?

Contact your ForwardHealth field representative for more information. Find your FowardHealth field representative (PDF).