WAFCA - DHS 35: DHS 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

DHS Official Application Forms

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 Complaince Check

F-62520 – Word – Caregiver Program Complaince 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 – Supevisor Affidavit

F-62570 – Word – Supervisor Affidavit

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

F-62589 – Word – Requet 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 (consent to treat)

F-82009 – Word – Confidential Information Release Authorization (consent to treat)

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.