Document Citation: Wis. Adm. Code DHS 75.11

Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 75 COMMUNITY SUBSTANCE ABUSE SERVICE STANDARDS

Date:
08/31/2009

Document:

DHS 75.11 Medically monitored treatment service.

(1) SERVICE DESCRIPTION. A medically monitored treatment service operates as a 24-hour, community-based service providing observation, monitoring and treatment by a multidisciplinary team under supervision of a physician, with a minimum of 12 hours of counseling provided per week for each patient.

(2) REQUIREMENTS. To receive certification from the department under this chapter, a medically monitored treatment service shall comply with all requirements included in s. DHS 75.03 that apply to a medically monitored treatment service as shown in Table 75.03 and, in addition, shall comply with the requirements of this section. If a requirement in this section conflicts with an applicable requirement in s. DHS 75.03, the requirement in this section shall be followed.

(3) ORGANIZATIONAL REQUIREMENTS. Before operating or expanding a medically monitored treatment service, a facility shall be approved under ch. DHS 124 as a hospital or shall be licensed under ch. DHS 83 as a community-based residential facility.

(4) REQUIRED PERSONNEL. (a) A medically monitored treatment service shall have the following personnel:

1. A director responsible for the overall operation of the service, including the therapeutic design and delivery of services.

2. At least one full-time substance abuse counselor for every 15 patients or fraction thereof enrolled in the service.

3. A physician available to provide medical supervision and clinical consultation as either an employee of the service or through a written agreement.

4. At least one clinical supervisor on staff to provide ongoing clinical supervision of the counseling staff or a person outside the agency who is a clinical supervisor and who by written agreement will provide ongoing clinical supervision of the counseling staff.

5. A mental health professional available either as an employee of the service or through written agreement to provide joint and concurrent services for the treatment of dually diagnosed patients.

(b) A clinical supervisor who meets the requirements of a substance abuse counselor may provide direct counseling services in addition to his or her supervisory responsibilities.

(c) A trained staff member designated by the director to be responsible for the operation of the service shall be on the premises at all times the service is in operation. That person may provide direct counseling or other duties in addition to being in charge of the service.

(5) CLINICAL SUPERVISION. (a) A medically monitored treatment service shall provide for ongoing clinical supervision of the counseling staff. Ongoing clinical supervision shall be provided as required in s. RL 162.01.

Note: Section RL 162.01 (1) states that a clinical supervisor shall provide a minimum of:

1. Two hours of clinical supervision for every 40 hours of work performed by a substance abuse counselor-in-training.
2. Two hours of clinical supervision for every 40 hours of counseling provided by a substance abuse counselor.
3. One hour of clinical supervision for every 40 hours of counseling provided by a clinical substance abuse counselor.
4. 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 above.

(b) The clinical supervisor shall provide supervision and performance evaluation of substance abuse counselors in the areas identified in s. RL 162.01 (5).

Note: Section RL 162.01 (5) states that the goals of clinical supervision are to provide the opportunity to develop competency in the transdisciplinary foundations, practice dimensions and care functions, provide a context for professional growth and development and ensure a continuance of quality patient care.

(6) SERVICE OPERATIONS. (a) 1. A physician, registered nurse or physician assistant shall conduct a medical screening of a patient no later than 7 working days after the person's admission to a service to identify health problems and screen for communicable diseases unless there is documentation that screening was completed within 90 days prior to admission.

2. A service shall arrange for services for a patient with medical needs unless otherwise arranged by the patient.

(b) A service shall complete intake within 24 hours of a person's admission to the service except that the assessment and treatment plan shall be completed within 4 days of admission.

(c) A service shall arrange for additional psychological tests for a patient as needed.

(d) A service shall operate 24 hours per day, 7 days per week.

(e) Each service shall have a written statement describing its treatment philosophy and objectives in providing care and treatment for substance abuse problems.

(f) A service shall provide a minimum of 12 hours per week of treatment for each patient, including individual and group counseling. Family and couples counseling shall be provided or made available, when appropriate. The service shall ensure that:

1. Each patient receives at least one hour of individual counseling per week.

2. The service's treatment schedule is communicated to patients in writing and by any other means necessary for patients with communication difficulties.

(g) A service shall ensure that 3 meals per day are provided to each patient.

(h) A service shall ensure that services required by a patient that are not provided by the service are provided to the patient by referral to an appropriate agency.

(i) A service shall have a written agreement with a hospital for provision of emergency and inpatient medical services, when needed.

(j) A service staff member shall be trained in life-sustaining techniques and emergency first aid.

(k) A service shall have a written policy on urinalysis that includes all of the following:

1. Procedures for collection and analysis of samples.

2. A description of how urinalysis reports are used in the treatment of the patient.

(7) ADMISSION. Admission to a medically monitored treatment service is appropriate only if one of the following conditions is met:

(a) The person to be admitted is determined appropriate for placement in this level of care by the application of approved placement criteria.

(b) The person to be admitted is determined appropriate for this level of care through the alternative placement recommendations of WI-UPC or other approved placement criteria.