DHS 35: Resources for Wisconsin Outpatient Mental Health Clinics

 

DHS35 Main Page DHS 35 Text Policies Forms Client Rights DHS Resources DHS 35 FAQ Accreditation Other Resources Contacts WAFCA Membership

 

PLEASE NOTE:  This site is under development and new resources/links will be posted as they become available.  Last Updated 01-17-2012.

Note update to Consent Forms: language on discharge policy. 9.30.2010

On June 1, 2009, new administrative rules regulating licensed outpatient mental health clinics took effect.  In order to assist clinics with the transition to the new rule, the Department of Health Services is collaborating with the Wisconsin Association of Family & Children's Agencies (WAFCA), the Wisconsin Association of Behavioral Health Providers, Inc. and other stakeholders to develop model policies and procedures, model forms, and specific training curricula (e.g., trauma informed treatment services). (See Considerations below)

This website serves as an information "hub" for Licensed Outpatient Mental Health Clinics regarding the requirements under the new rule and the resources available to inform and assist clinics in their efforts to come into compliance.  The samples on this site are to help you think through what is necessary for your clinic and the population you serve.

Suggestions/Questions regarding this website and/or the materials provided here may be directed to one of the DHS 35 Contacts listed here.

Considerations regarding use of the documents on this website:

  1. Outpatient mental health clinics must comply with the requirements in DHS 35 and other applicable statutes and regulations. 

  2. The model policies/procedures and forms provided on this site were developed by the Wisconsin Association of Behavioral Health Providers, Inc. and the Wisconsin Association of Family and Children's Agencies (WAFCA) with input from Dan Zimmerman and Mark Hale (Department of Health Services).  The purpose of clinic policies is to provide direction to staff members regarding regulatory compliance and to effectively and efficiently meet the needs of the clinic’s consumers.  Of course, it is also important that well developed policies and procedures are implemented appropriately and that clinic staff's compliance is monitored.

  3. Outpatient mental health clinics may adopt or adapt the policies/procedures and forms as they wish.  However, it is important to note that the adoption of these documents does not guarantee compliance with DHS 35.  As you review these model documents , consider how they should be modified to:

    • meet the needs of your clinic and consumers; and

    • reflect changes over time due to changes in the needs of the clinic and its consumers.

  4. Assessment and treatment plan forms are merely tools designed to remind clinic staff members of common data elements that should be included in a consumer's assessment or treatment plan.  An assessment or treatment plan form that ensured every possible question/issue is addressed for all age groups, all cultural groups, all diagnoses and behavioral issues, etc. would be an unwieldy tool.  Therefore, clinic staff members need to understand that they may need to ask questions not included in the form, as part of their due diligence to identify a consumer's strengths, needs, and recovery goals.

(All documents are posted in Microsoft Word 2003 unless otherwise noted. If you receive a "login" prompt when you are trying to save one of these documents to your computer, hit "cancel" in the login box to proceed.)

Policies

Forms

Client Rights & Confidentiality

Department of Health Services Resources

  • DHS 35, the New Outpatient Mental Health Clinic Rule (DQA-DMHSAS Memo 09-008, March 2009)

  • DHS Frequently Asked Questions about DHS 35

  • DHS 35: Outpatient Mental Health Clinic Rules - The Complete Text of the Administrative Rule

  • Division of Quality Assurance

  • DHS Official Application Forms

  • DHS WEBSITE

    Under the Tab Reference Center you will find many useful resources at your fingertips.

    Forms Library and Webcast Library are the two most important resources. Several important forms are listed below for your convenience, but take a look at the entire list to find other forms that can assist your organization.

    Forms Library – forms can be located by using the lists located in the left column:

    alphabetic forms lists – form by name

    numeric lists – form by number

    division/office numeric lists – form by division/office

    Division/Office Links of greatest interest for clinics and residential treatment facilities:

    DMHSAS – Mental Health and Substance Abuse Services

    DQA – Quality Assurance

    HCAA – Health Care Access and Accountability (BadgerCare)

    HFS – Health Services

    NOTE: many forms are available as a PDF or a Word Doc that can be edited for your organization’s use; some forms are available in Spanish and Hmong

    DMHSAS 

    F-22538 – PDF – Consent to Film or Tape

    F-22538 – Word – Consent to Film or Tape

    F-22538S – PDF – Consent to Film or Tape - Spanish

    F-24277 BRD – PDF - Informed Consents for Medications: Brand Name Index

    F-24277 GEN – PDF - Informed Consents for Medications: Generic Name Index

    F-26003 – PDF – Notice of Privacy Practices - Treatment Facilities

    F-26030 – Word – Notice of Privacy Practices - Treatment Facilities

    F-26003H- PDF – Notice of Privacy Practices - Treatment Facilities - Hmong

    F-26003S – PDF – Notice of Privacy Practices - Treatment Facilities - Spanish

    F-26100 – PDF – Clients Rights Limitation or Denial Documentation

    DQA

    F-62504 (not available at this time/check later) - Community Based Substance Abuse Services Or Mental Health Clinic Certification Application

    F-62520 – PDF – Caregiver Program Compliance Check

    F-62520 – Word – Caregiver Program Compliance Check

    F-62569 – PDF – Application for Individual Provider Status Approval (unlicensed provider)

    F-62569 – Word – Application for Individual Provider Status Approval (unlicensed provider)

    F-62570 – PDF – Supervisor Affidavit

    F-62570 – Word – Supervisor Affidavit

    F-62589 – PDF – Request for Approval to Use TeleHealth (policy & procedure / Medicaid billing)

    F-62589 – Word – Request for Approval to Use TeleHealth (policy & procedure / Medicaid billing)

    HCAA

    F-00212 – Word - ForwardHealth Prior Authorization Intensive In-Home MHSA Services Assessment and Recovery / Treatment Plan (health check has to be done as a prior auth issue for in-home treatment of children)

    F-00212a – PDF - Completion Instructions

    HCF

    F-11018 – PDF - ForwardHealth Prior Authorization

    F-11018 – Word - ForwardHealth Prior Authorization

    F-11031 - PDF - Wisconsin Medicaid Prior Authorization / Psychotherapy Attachment (PA/PSYA)

    F-11031 - Word - Wisconsin Medicaid Prior Authorization / Psychotherapy Attachment (PA/PSYA)

    F-11031a – PDF - Completion Instructions

    F-11036 – Word - ForwardHealth Prior Authorization / In-Home Treatment Attachment (PA / ITA)

    F-11103 – PDF - Optional Outpatient Mental Health Assessment and Treatment / Recovery Plan

    F-11103 – Word - Optional Outpatient Mental Health Assessment and Treatment / Recovery Plan

    F-11103a – PDF - Completion Instructions (includes data elements required by Medicaid)

    HFS

    F-82009 – PDF – Confidential Information Release Authorization

    F-82009 – Word – Confidential Information Release Authorization

    Several Versions exist of this Form. Visit HFS forms page for more information.

    F-82064 – PDF – Background Information Disclosure and Instructions (caregiver background check)

    F-82064 – Word – Background Information Disclosure and Instructions (caregiver background check)

    Webcast Library – webcasts can be viewed online at your convenience and at no cost. The webcasts cover meetings, events and presentations by DHS staff and partners in the community.

    Click on the link: View our catalogue of all webcasts

    Upcoming events are listed at the top of the catalogue page. Events for 2010 are listed chronologically in reverse order. Division of Mental Health and Substance Abuse Services (left column list) provides a complete list of offerings for the division. You can also enter “DHS 35” in the SEARCH field to find more.

Accreditation Resources

DHS 35 allows for the waiver of recertification inspections and certain other requirements if a clinic is accredited by a recognized national accrediting body.  The Council on Accreditation (COA) and the Joint Commission (formerly JCAHO) are accrediting organizations recognized by the Department of Health Services.  Links to key documents related to the organizations and their standards are included in this section.

Council on Accreditation

Joint Commission

Other Resources

  • Webcasts on Treatment Approaches

  • HIPAA Collaborative of Wisconsin - Hipaacow.org - is an important resource for information on federal HIPAA laws. It is a non-profit organization providing up-to-date information and useful forms for entities covered by HIPAA regulations.

  • Electronic Health Records (information on planning & implementing)

  • EMDR (available soon)

  • Motivational Interviewing (available soon)

 

 
 
 

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