Section 40.04. Certification.

 

(1)   Application.

(a) An organization wanting to be certified to operate a mental health day treatment services program for children shall apply to the department for certification on a form provided by the department and shall include with the application form all other supporting materials requested by the department.

(b) An organization may apply for certification to operate:

1. A community-based program;

2. A school-based program; or

3. A hospital-affiliated program.

(c) The organization shall indicate in its application the level or levels under s. DHS 40.07 (1) at which it intends to offer services.

(2)   Certification process.

(a) On receipt of an application for initial certification or renewal of certification, the department shall:

1. Review the application and its supporting documents; and

2. Designate a representative to conduct an on-site survey of the program, including interviewing program staff.

(b) The department's designated representative shall do all of the following:

1. Interview a randomly selected, representative sample of present or former clients of the program, if any, provided that the clients indicate a willingness to be contacted;

2. Review the results of any grievances filed against the program during any preceding period of certification, pursuant to s. DHS 94.27 ;

3. Review a randomly selected, representative sample of client records; and

4. Review program policies and records, and interview program staff to a degree sufficient to ensure that staff have knowledge of the statutes, rules and standards of practice that apply to the program and its clients.

(c) The certification survey under par. (b) shall be used to determine the extent of the program's compliance with the standards specified in this chapter. Certification decisions shall be based on a reasonable assessment of the program. The indicators by which compliance with the standards is determined shall include:

1. Statements made by the applicant or the applicant's designated agent, authorized administrative personnel and staff members;

2. Documentary evidence provided by the applicant;

3. Answers to questions concerning the implementation of program policies and procedures, as well as examples of implementation provided to assist the department in making a judgment regarding the applicant's compliance with the standards in this chapter;

4. On-site observations by surveyors from the department;

5. Reports by clients regarding the program's operations; and

6. Information from grievances filed by clients.

(d) The applicant shall make available for review by the designated representative of the department all documentation necessary to establish whether the program is in compliance with the standards in this chapter, including, but not limited to, the written policies and procedures of the program, work schedules of staff, program appointment records, credentials of staff and treatment records.

(e) The designated representative of the department who reviews the documents under pars. (a) to (d) and interviews clients under par. (b) 1. shall preserve the confidentiality of all client information obtained during the certification process, in compliance with ch. DHS 92 .

(3)   Issuance of certification.

(a) Within 60 days after receiving a completed application for initial certification or renewal of certification, the department shall:

1. Certify the program if all requirements for certification are met or deny certification if any requirement has not been met;

2. If the application for certification is denied, provide the applicant reasons in writing for the denial and identify the requirements for certification which the program has not met; and

3. State in a notice of denial that the applicant has a right to request a hearing on that decision under sub. (8) and a right to submit a plan under par. (b) to correct program deficiencies in order to begin operation of the program.

(b)

1. Within 10 days after receiving a notice of denial under par. (a) , an applicant may submit to the department a plan to correct program deficiencies.

2. The plan of correction shall indicate the date on which the applicant will have remedied the deficiencies of the program. Within 60 days after that date, the department shall determine whether the corrections have been made. If the corrections have been made, the department shall certify the program.

(c) The department may limit the initial certification of a program to a period of one year.

(4)   Content of certification. Certification shall be issued only for the location and program named and may not be transferred or assigned to another program. A program shall notify the department of a change of administration, ownership, program name or any other program change that may affect compliance with this chapter no later than the effective date of the change.

(5)   Effective date of certification.

(a) The date of certification shall be the date that the department determines, by means of an on-site survey, that an applicant is in compliance with this chapter.

(b) The department may change the date of certification if the department has made an error in the certification process. A date of certification which is adjusted under this paragraph may not be earlier than the date the written application under sub. (1) was submitted to the department.

(6)   Renewal.

(a) Certification is valid for a period of 3 years unless sooner suspended or revoked or unless a shorter period of time is specified under the sub. (3) (c) at the time of approval.

(b) The department shall send written notice of expiration and an application for renewal of certification to a certified program at least 30 days prior to expiration of the certification. If the department does not receive an application for renewal of certification before the expiration date, the program's certification shall be terminated.

(7)   Action against a certified program. The department may terminate, suspend or refuse to renew a program's certification after providing the program with prior written notice of the proposed action which shall include the reason for the proposed action and notice of opportunity for a hearing under sub. (8) whenever the department finds that:

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

(b) A program staff member who is required to have a professional license claimed to be licensed when he or she was not licensed, has had his or her license suspended or revoked or has allowed his or her license to expire;

(c) A program staff member has been convicted of a criminal offense related to the provision of or claiming reimbursement for services under the medicare program under 42 CFR 400 to 424 , or under this state's or any other state's medicaid program under 42 CFR 430 to 456 . In this paragraph, "convicted" means that a judgment of conviction has been entered by a federal, state or local court, regardless of whether an appeal from that judgment is pending;

(d) A program staff member has been convicted of a criminal offense related to the provision of care, treatment or services to a person who is mentally ill, developmentally disabled, alcoholic or drug dependent, or has been convicted of a crime against a child under ch. 948 , Stats. ;

(e) The program has submitted or caused to be submitted statements, for purposes of obtaining certification under this chapter, which it knew or should have known were false;

(f) The program fails to maintain compliance with or is in substantial noncompliance with one or more of the requirements set forth in this chapter;

(g) A program staff member signed billing or other documents as the provider of service when the service was not provided by the program; or

(h) There is no documentary evidence in a client's treatment file that the client received services for which bills had been submitted to a third-party payer.

(8)   Right to a hearing. If the department denies, terminates, suspends or refuses to renew a certification, an applicant or program may request a hearing under s. 227.42 , Stats. The request for a hearing shall be submitted in writing to and received by the department's office of administrative hearings within 30 days after the date on the notice required under sub. (2) or (6) .

(9)   Reapplication. If an application for certification is denied, the organization may not reapply for certification for 2 years following the date on which certification was denied.

(10)   Dissemination of results. Upon completing action on an application for certification, staff of the department responsible for certification shall provide a summary of the results of the process to the applicant program, to the subunit within the department responsible for monitoring community mental health programs and to the department under s. 51.42 , Stats., in the county in which the program is located.

History: Cr. Register, August, 1996, No. 488 , eff. 9-1-96; correction in (2) (e) made under s. 13.93 (2m) (b) 7., Stats., Register January 2004 No. 577 ; corrections in (2) (b) 2. and (e) made under s. 13.92 (4) (b) 7., Stats., Register November 2008 No. 635 .

Note

For a copy of the application form, write Program Certification Unit, Division of Disability and Elder Services, P.O. Box 309, Madison, Wisconsin 53707. Microsoft Windows NT 6.1.7601 Service Pack 1 The mailing address of the Office of Administrative Hearings is P.O. Box 7875, Madison, WI 53707. Microsoft Windows NT 6.1.7601 Service Pack 1