The WIsconsin Department of Health Services (DHS) held the last of six listening sessions in Madison on July 16 seeking input and experiences with Wisconsin’s Community Substance Abuse Standards—DHS 75—as DHS begins an effort to rewrite those rules. Matthew Stanford, WHA General Counsel, attended the listening sessions and is a member of a DHS advisory committee that will be convened this fall to work on a final proposed rewrite of DHS 75.
The rulemaking is an outgrowth of a recommendation from the Governor’s Task Force on Opioids. During that Task Force, WHA noted concerns from substance abuse providers that Wisconsin’s special substance abuse treatment rules can create costly and unnecessary burdens that are not keeping up with care delivery changes and create barriers to expanding substance abuse treatment services.
About 40 behavioral health providers attended the listening session, and examples of common key themes of the comments included:
- The DHS 75 clinical supervision requirements are outdated and often inconsistent with a modern licensed and professionalized substance abuse treatment delivery model.
- The DHS 75 rules frequently require multiple signatures, documentation and reviews that create paperwork burden, but no meaningful benefit for patient care.
- Separate treatment service-type silos are creating unnecessary barriers to person-centered health care and service model flexibility and integration.
- Current rules are inconsistent with modern electronic health records technology.
Consistent with prior listening sessions, providers also repeatedly cautioned DHS to not be too prescriptive in the new rule.
“Be cautious about making DHS 75 too prescriptive,” said Michael Wapoose, Director of Behavioral Health, Quartz Health Plan. “Treatment should be designed to community needs. The prescriptiveness of the current role is a real problem and burden during surveys.” Wapoose is also a member of the DHS 75 Advisory Committee.
Others said that current prescriptiveness and documentation requirements negatively impacts access and treatment.
“There is lots of time spent on lots of paperwork,” said one provider. “We need more time with patients. Instead, we are seeing more challenging patients, requiring more needs and more steps, many of which are not reimbursed.” “Sign, sign, sign,” was the way another provider described the current paperwork burden.
Others cautioned against enshrining a particular evidence-based practice in rule and one provider asked DHS to consider the purpose of having a rule. “The purpose of having a rule should be to ensure someone is not endangered by solely receiving a service. We need to ensure the rule allows individuals to get the number and type of services they need.”
Throughout the process, DHS staff has recognized many of the concerns, including a recognition that the current rule is “pretty prescriptive right now” and the need for the rule to better “align with integrated care, other DHS regulations, and Medicaid payment.”
Next, DHS will convene the DHS 75 Advisory Group sometime this fall to review and provide input on a draft proposed DHS 75 rewrite.
If you have questions, additional input, or would like more information about the DHS 75 rewrite process, contact WHA General Counsel Matthew Stanford at 608-274-1820.