Section 35.03. Definitions.

 

(1)  "Advanced practice nurse" has the meaning given in s. N 8.02 (1) .

(1g)  "Advanced practice nurse prescriber" means an advanced practice nurse certified to issue prescription orders under s. 441.16 (2) , Stats.

(1m)  "Approved placement criteria" means a placement instrument that is used to develop a placement recommendation for an appropriate level of care for a consumer who has a substance use disorder such as the Wisconsin Uniform Placement Criteria (WI-UPC); the American Society of Addiction Medicine (ASAM); or similar placement instrument that is approved by the department.

(2)  "Available to provide outpatient mental health services" means physical presence at any of the clinic's offices.

(4)  "Clinical collaboration" means mental health professionals working together in a joint intellectual and clinical approach for the therapeutic benefit and favorable outcome of consumers.

(5)  "Clinical supervision" means any of the following:

(a) The supervised practice of psychotherapy as described under ch. MPSW 4 , 12 , or 16 , or Psy 2 , as applicable. For a recognized psychotherapy practitioner, "clinical supervision" means the supervised practice of psychotherapy by a licensed treatment professional of at least one hour per week.

(b) For any staff member, including a substance abuse counselor, who provides services to consumers who have a primary diagnosis of substance abuse, "clinical supervision" has the meaning given under s. SPS 160.02 (6) by a clinical supervisor as defined under s. SPS 160.02 (7) .

(6)  "Consumer" means an individual who receives or requests outpatient mental health services from a clinic.

(6m)  "Deficiency" means a failure to meet a requirement of this chapter.

(7)  "Department" means the Wisconsin department of health services.

(8)  "Discharge" has the meaning given in s. 51.01 (7) , Stats.

(9)  "Legal representative" means any of the following:

(a) A guardian of the person as defined under s. 54.01 (12) , Stats.

(b) A health care agent as defined in s. 155.01 (4) , Stats., if the principal has a finding of incapacity pursuant to s. 155.05 (2) , Stats., and if the power to make decisions regarding outpatient mental health services is included in the scope of the agency.

(c) A parent of a minor as defined in s. 48.02 (13) , Stats., a guardian of a minor as defined in s. 48.02 (8) , Stats., or a legal custodian of a minor as defined in s. 48.02 (11) , Stats.

(9g)  "Licensed treatment professional" means an individual licensed as a physician under s. 448.03 , Stats., who has completed a residency in psychiatry; a psychologist or a private practice school psychologist licensed under ch. 455 , Stats. , a marriage and family therapist licensed under s. 457.10 or 457.11 , Stats., a professional counselor licensed under s. 457.12 or 457.13 , Stats., an advanced practice social worker granted a certificate under s. 457.08 (2) , Stats., an independent social worker licensed under s. 457.08 (3) , Stats., or a clinical social worker licensed under s. 457.08 (4) , Stats.; and includes any of these individuals practicing under a currently valid training or temporary license or certificate granted under applicable provisions of ch. 457 , Stats. "Licensed treatment 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.

(9m)  "Major deficiency" means the clinic has repeatedly or substantially failed to meet one or more requirements of this chapter or the department determines that an action, condition, policy or practice of the clinic or the conduct of its staff does any of the following:

(a) Creates a risk of harm to a consumer or violates a consumer right created by this chapter or other state or federal statutes or rules, including any of the following:

1. A staff member has had sexual contact or intercourse, as defined in s. 940.225 (5) (b) or (c) , Stats., with a consumer.

2. A staff member has been convicted of abuse under s. 940.285 , 940.29 or 940.295 , Stats.

3. The health or safety of a consumer is in imminent danger because of any act or omission by the clinic or a staff member.

(b) Submits or causes to be submitted one or more statements for purposes of obtaining certification under this chapter that were false.

(c) A license, certification or required local, state or federal approval of the clinic has been revoked or suspended or has expired, including termination of a provider's Medicaid or Medicare certification for any basis under s. DHS 106.06 or federal law.

(d) Constitutes fraud or willful misrepresentation within the meaning of s. DHS 108.02 (9) (d) .

(e) A staff member has a substantiated finding of caregiver misconduct as identified in chs. DHS 12 and 13 .

(10)  "Mental health practitioner" means a person who before January 1, 2012, holds a graduate degree from an accredited college or university in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field, and either has completed the applicable supervised practice requirements under ch. MPSW 4 , 12 , or 16 , or Psy 2 or has 3,000 hours of supervised clinical post-graduate degree experience including at least 1,000 hours of face-to-face contact with consumers, and who commences work at a clinic required to be certified under this chapter no later than January 1, 2013. "Mental health practitioner" does not include an individual whose professional license is suspended, revoked, or voluntarily surrendered, or whose professional license or certificate is limited or restricted, when practicing in areas prohibited by the limitation or restriction, irrespective of whether that individual otherwise meets the terms of this definition. Whether a person's graduate degree is in a "closely related" field will be determined by the department on a case-by-case basis upon application by a clinic.

(11)  "Mental health professional" means a licensed treatment professional, a mental health practitioner, a qualified treatment trainee, or a recognized psychotherapy practitioner.

(12)  "Minor" means an individual who is 17 years old or younger.

(13)  "Outpatient mental health clinic" or "clinic" means an entity that is required to be certified under this chapter to receive reimbursement for outpatient mental health services to consumers.

(14)  "Outpatient mental health services" means the services offered or provided to a consumer, including intake, assessment, evaluation, diagnosis, treatment planning, psychotherapy and medication management.

(15)  "Physician" means an individual licensed under ch. 448 , Stats. , as a physician.

(15m)  "Physician assistant" means an individual licensed under ch. 448 , Stats. , as a physician assistant.

(16)  "Prescriber" means a physician, a physician assistant acting within the conditions and limitations set forth in s. Med 8.07 , or an advanced practice nurse prescriber acting within the conditions and limitations set forth in s. N 8.06 .

(17)  "Psychotherapy" means any activity that falls within the definitions set forth at s. 457.01 (8m) or 455.01 (6) , Stats.

(17m)  "Qualified treatment trainee" means either of the following:

(a) A graduate student who is enrolled in an accredited institution in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field.

(b) A person with a graduate degree from an accredited institution and course work in psychology, counseling, marriage and family therapy, social work, nursing or a closely related field who has not yet completed the applicable supervised practice requirements described under ch. MPSW 4 , 12 , or 16 , or Psy 2 as applicable.

(17r)  "Recognized psychotherapy practitioner" means an individual who may lawfully practice psychotherapy within the scope of a license, permit, registration or certificate granted by this state other than under ch. 455 or 457 , Stats.

(18)  "Recovery" means the process of a consumer's growth and improvement, despite a history of a mental or substance use disorder, in attitudes, values, feelings, goals, skills and behavior measured by a decrease in dysfunctional symptoms and an increase in maintaining the person's highest level of health, wellness, stability, self-determination and self-sufficiency.

(19)  "Staff" or "staff member" means an owner of a clinic or an individual employed by or under contract with an outpatient mental health clinic.

(20)  "Substance" has the meaning given under s. SPS 160.02 (25) .

(21)  "Substance abuse counselor" has the meaning given under s. SPS 160.02 (26) .

(22)  "Substance use disorder" has the meaning given under s. SPS 160.02 (28) .

(22m)  "Treatment records" has the meaning given in s. 51.30 (1) (b) , Stats., namely, all records created in the course of providing services to individuals for mental illness, which are maintained by the department, by boards and their staffs, and by treatment facilities. "Treatment records" do not include notes or records maintained for personal use by an individual providing treatment services for the department, a board, or a treatment facility if the notes or records are not available to others.

(23)  "Trauma" means a single experience, or an enduring or repeating event or events that results in significant distress or impairment in social, occupational, or other important areas of functioning for a person.

(24)  "Variance" means an alternate requirement in place of a non-statutory requirement of this chapter by the department.

(25)  "Waiver" means an exemption from a non-statutory requirement of this chapter by the department.

CR 06-080 : cr. Register May 2009 No. 641 , eff. 6-1-09; correction in (5) (b), (20), (21), (22) made under s. 13.92 (4) (b) 7. , Stats., Register November 2011 No. 671 ; correction in (16) made under s. 13.92 (4) (b) 7. , Stats., Register February 2014 No. 698 .

Note

A copy of the publications, Wisconsin Uniform Placement Criteria and Patient Placement Criteria for the Treatment of Substance- Related Disorders , published by the American Society of Addiction Medicine (ASAM), may be obtained by writing the Bureau of Mental Health and Substance Abuse Services, 1 W. Wilson Street, Room 437, PO Box 7851, Madison, Wisconsin 53707-7851. Send inquires about the ASAM placement criteria to American Society of Addiction Medicine, 4601 N. Park Ave., Suite 101 Upper Arcade, Chevy Chase, MD 20815, or check ASAM's internet site at www.asam.org . Microsoft Windows NT 6.1.7601 Service Pack 1 Any staff member, including a substance abuse counselor-in training, substance abuse counselor, or clinical substance abuse counselor, providing services to consumers who have a primary diagnosis of substance abuse is required under s. DHS 35.14 (4) (b) to receive clinical supervision from a clinical supervisor as defined under s. SPS 160.02 (7) . Microsoft Windows NT 6.1.7601 Service Pack 1 Section 51.01 (7) Stats., defines "discharge" for a patient who is under involuntary commitment orders as meaning termination of custody and treatment obligations of the patient to the authority to which the patient was committed by court action. For voluntary admissions to a treatment program or facility, s. 51.01 (7) , Stats., defines "discharge" as meaning termination of treatment obligations between the patient and the treatment program or facility. Microsoft Windows NT 6.1.7601 Service Pack 1 Under s. DHS 108.02 (9) (d) 1. , the department may withhold MA payments, in whole or in part, to a provider upon receipt of reliable evidence that the circumstances giving rise to the need for withholding of payments involve fraud or willful misrepresentation under the MA program. Reliable evidence of fraud or willful misrepresentation includes, but is not limited to, the filing of criminal charges for those activities against the provider or one of its agents or employees by a prosecuting attorney. The department may withhold payments without first notifying the provider of its intention to withhold the payments. A provider is entitled to a hearing under s. DHS 106.12 . Microsoft Windows NT 6.1.7601 Service Pack 1 Willful misrepresentation under this paragraph does not include the signing of a claim for reimbursement by an authorized representative of a clinic who did not perform the service for which reimbursement is claimed, if the individual who performed the service was qualified to do so under this chapter and applicable professional licensure or certification law and was on the clinic's staff when the services were performed. Microsoft Windows NT 6.1.7601 Service Pack 1 Section 457.02 (6) (a) , Stats., provides that a license or certificate under ch. 457 , Stats., is not required for a person to "lawfully practice within the scope of a license, permit, registration, or certificate granted by this state or the federal government." The department will recognize as a "recognized psychotherapy practitioner" for purposes of this chapter any person legally recognized as permitted to provide psychotherapy within the scope of his or her professional credential issued by a state agency. Microsoft Windows NT 6.1.7601 Service Pack 1