Behavioral/Mental Health Services

Mission Statement
The mission of Behavioral Health Services is to serve the citizens of Rusk County suffering from mental illness or substance abuse and dependence.
To provide emergency and short-term services focused on the primary treatment need of the client that will assist in their stabilization within the community.

Definitions:

  • Stabilize - To stabilize means the emotional and psychological health of the individual is restored to a point, where the individual is able to function within the community with existing support services.
  • Support Services - Support services are identified as a continuum of community resources, which include but not limited to; faith based providers, historical community groups i.e. Alcoholics Anonymous, Short-term contracted Behavioral Health/AODA services, and agencies located within the community that provide a host of behavioral health/AODA services.

Exceptions
In using the information contained on this web site, there are a few prefacing remarks that should be kept in mind:

  • This information is not all-inclusive reflection of statutes related to issues with individuals suffering from AODA or Mental Health Illness. Most policies and procedures related to jurisdiction over individuals suffering from AODA or Mental Health Illness are contained in the statutes and HFS Administrative Codes.
  • Policies may not be adopted that are in contradiction to statute. Therefore, in cases in which either through error or oversight, policies not consistent with statute/administrative code, the statutory or administrative code language is governing.
  • Within statute and policy, in those cases in which the Court feels that an exception to the general policy is necessary, the Court may make exceptions consistent with the best interest of the individual, and the goals and principles of the Rusk County Circuit Court. By their nature, the lives and situations of individuals presented to the Court are unique and require the thoughtful consideration of individual factors.

 

Definitions:
Behavioral Health – Emergency Services
As put forth in Wisconsin State Statutes, the Rusk County Department of Health and Human Services is responsible to provide for emergency services for the citizens of the County.

Emergency services are identified as follows;

  • Emergency Detention: action taken through local law enforcement agencies, which ensures the safety of the individual and the community. Rusk County Health and Human Services will maintain a contractual relationship with the provider for the services articulated under Wisconsin chapter 51.15.
  • Drug\Alcohol Detox: action taken through local law enforcement agencies, which addresses the physical safety of the individual impaired by the consumption of alcohol and or other mind-altering substances.Rusk County Health and Human Services will maintain a contractual relationship with the provider for the services articulated under Wisconsin chapter 51.45(11)(d)

Behavioral Health – Inpatient / Residential

  • Inpatient:
    • Those who are a danger to themselves or others (involuntary),
    • Those who are experiencing extreme symptoms and are in need of psychiatric stabilization to avoid potential risk. (County funded, approval for placement shall be authorized through the Rusk County Behavioral Health Coordinator or their designee.)
    • Those who are in need of further in-depth evaluation, outpatient means have been exhausted, and behavior/symptoms are escalating and interfering significantly in a multiple of life areas. (County funded approval for placement shall be authorized through the Rusk County Behavioral Health Coordinator or their designee.)
  • Residential
    Those for whom this level of care is viewed by the Rusk County Behavioral Health Coordinator (through consultation) as being the least restrictive setting recommended to ensuring that basic needs of the individual are met. There may be a need for a Chapter 55 involvement with guardianship/protective placement.

Behavioral Health – Community Base Services (Note: This section does not apply to the Intoxicated Driver Program.)

  • Community Based Services: Although not mandated by statutory language, the Rusk County Department of Health and Human Services can provide community-based services to the citizens of Rusk County upon the determination of need and financial eligibility.
  • Procedure:
    The agency contracted to provide behavioral health/AODA services for the County of Rusk is permitted to see a client once, prior to receiving authorization from the Behavioral Health Coordinator for the County of Rusk.
    • Request\authorization for an assessment
    • Development of the treatment plan
    • The treatment plan shall clearly articulate the primary diagnosis, and addresses services that will lead to the stabilization of the client in the community.
    • Coordination with providers to fulfill the goals of the treatment plan.
    • A client can receive up to a maximum of 10 sessions (This could be individual or group participation, including AODA & Behavioral Health. The twelve sessions reflects the sum total of all sessions) in a twelve-month period of time. This does not include time spent with a psychiatrist for the purpose the monitoring the mental health and or the medication the client is taking.
    • The client shall participate in a financial assessment to determine cost share for services if they are a County funded client.
    • If it is determined that the client has needs that exceed the services allowable under this level of services the client can be referred to the Intensive Services Assessment (hereafter ISA)

Behavioral Health – Intensive Services Assessment
Although not mandated by State Statute, and available based on financial resources the Intensive Services Program allows for the utilization of concentrated/long term services developed through a treatment plan that focuses on the stabilization of the client.

These criteria are meant to be a guideline for making a decision to serve a client under the ISA Program. Most of the following should be present to warrant a referral and further screening for appropriateness.

  1. Diagnosis of a Behavioral Health/AODA illness that severely impacts the daily life of the individual.
  2. Client must demonstrate an inability to function without significant support; i.e., history or risk of multiple hospitalizations, history or risk of committing criminal acts/serving jail time as a result of mental/AODA illness.
  3. Low functioning with regard to managing finances, decision making, living independently.
  4. Limited or no support systems to accommodate immediate emotional, physical and psychological needs.
  5. Failure to function well, even with lower intensity mental health/AODA case management, psychiatry and/or outpatient therapy.

Procedure:

  • A referral would be submitted in writing to the Behavioral Health Coordinator by a local service provider on be half of the client. (An exception to the rule would be a self referral on the part of a client to Rusk County Health & Human Services)
  • The Rusk County Health and Human Services will contract with independent consultant(s) for the purpose of conducting the assessment. Included in the assessment will be but not limited to:
    • Hospitalization(s) (History of the client, recommendations, response to past hospitalizations)
    • Treatment Plans/Provider(s) (History of the client, recommendations, response to past treatment plans)
    • Diagnosis
    • Medical Complications(Associated with the diagnosis)
    • Daily Living Situation

Based on the independent assessment a treatment plan will be developed that will identify services/providers that will assist the client in their stabilization in the least restrictive living environment. 

Behavioral Health – Mental Health AODA Clinical Records

  • Policy: All mental health and AODA clinical records of clients serviced by the county or county designated provider will be assigned to a “Keeper of the Record.” Formal releases of information will be required for any unauthorized individual to access the information in the record. Records kept by the county will be stored for 10 years from the date of case closure, unless otherwise specified by WI administrative codes and statutes.
  • Purpose: Ownership, storage, handling, disposal and release of information from the behavioral health record shall be in accordance with WI Stat. 51.30, HFS 92, and HFS 61.97
Procedure: All mental health and AODA open clinical records are records of individuals who are actively being treated for their diagnosable illness. The agency that is providing the primary care for the individual shall be designated the keeper of the clinical record, whether that agency is Rusk County Health and Human Services or a contracted agency of the department.

Clients who choose to access services with a county contracted agency or agency of their choosing will be asked to sign an informed consent releasing information to that agency, entitling that agency to be keeper of their clinical record. (See attached form) If an agency becomes the keeper of the record, Rusk County Health and Human Services will issue a statement to be signed by a designee of the agency, indicating this agency’s new responsibility, at the request of the client, to be keeper of the record. (See attached form)

Clients may choose to transfer their clinical records to another provider who will be providing care for them if their relationship with the agency that is keeping their record is terminated. In this case, the agency keeping the record will maintain custody of the original record, now closed, and the new provider may receive photocopies of the necessary clinical information at the written request of the client. The procedure will be in accordance with the agency’s policy and procedure manual with regard to clinical records.

Closed records maintained by Rusk County Health and Human Services will be stored in a locked, metal file cabinet within a locked room and will be kept for a minimum of 10 years from the date of closure. Records for minors will be kept for 10 years or until the person turns 19 years of age, whichever is longer. Records relating to legal actions shall be maintained until completion of the legal action.

Behavioral Health – Psychotropic Medication funding for indigent consumers

  • Objective: The objective of the psychotropic medication funding policy is to establish a consistent and objective set of criteria to determine eligibility for financial assistance for medications that are recommended by a psychiatrist.
  • Policy: It is the policy of Rusk County Health and Human Services that mentally ill consumers of behavioral health services be offered limited and temporary financial assistance with medications that are prescribed by a psychiatrist if they meet both financial and clinical criteria. Assistance will be in the form of pre-payment and consumers will be responsible for repayment of total cost to the County.

Criteria for determining eligibility:

  • Consumer must be a resident of Rusk County
  • Consumer must be an open case of Rusk County Health and Human Services through our contracted outpatient provider
  • Consumer must have no medication coverage, and no eligibility to be covered by insurance, WI MA, Family Health Center or any other 3rd party pay source.
  • Consumer must demonstrate there are no other financial resources available to pay for the medication
  • Consumer will stop taking the medication if not provided by the program and this will have a severe negative clinical impact on the consumer (as established by a written statement from the psychiatrist’s office and the MD’s signature)
  • Medications covered will only include medications designed to treat psychiatric disorders and related side effects, and the treatment of acute withdrawal and will not include medications that are either designed to address other physical symptoms/illness.

Procedure:

  • Individuals who receive the financial assistance benefit for psychotropic medications will be responsible for repayment of the total cost of the medication to Rusk County Health & Human Services. Reference should be made to the Behavioral Health Uniform Fee Policy and Procedures in terms of financial application/eligibility, billing, collections, hardship determination and administrative review.
  • A new referral will be considered for authorization when the outpatient provider submits a request for authorization form, and an accurately completed HSRS form, and the consumer completes appropriate financial eligibility forms. Health and Human Services will review these items and determine authorization for services. Cases that are authorized will be opened.
  • Once a case is opened, a referral for psychiatry must be requested by a counselor, therapist or Behavioral Health case manager. This request must be documented in the outpatient treatment plan or in the Behavioral Health care plan.
  • At the psychiatric appointment, the psychiatrist will document a decision regarding the negative clinical impact on the consumer if the consumer did not take the recommended psychotropic medication. See attached authorization form.
  • Wherever possible, RCHHS will look to our contracted provider to provide samples of medications to consumers, particularly for an emergency or trial basis, or while awaiting approval from an indigent medication program. The provider will also be responsible for assisting consumers in applying for pharmaceutical patient assistant programs. Any financial eligibility information that the County possesses will be available to the provider in this process. These expectations will be referenced in our provider contract for services.
  • RCHHS will receive a request from our outpatient provider for medication advance payment assistance when the above steps have been taken and County financial assistance is still necessary. Included in the request will be the authorization form including documentation from the psychiatrist of negative clinical impact, and a copy of a completed indigent medication program application, where available.
  • If RCHHS approves the request for advance payment assistance for medications, a Behavioral Health Services representative will phone or fax in the authorization to one of the pre-selected pharmacies.
  • When the bill is received for the medications, it will be paid and copied to the consumers billing file for reimbursement by the consumer. See Behavioral Health Uniform Fee Policy for details.
  • The time frame for County advance payment assistance with medications will be limited to 30 days, with exceptions possible at the discretion of RCHHS.

Behavioral Health – Rusk County Jail MH/AODA Services (Mental Health/AODA Services in the Rusk County Jail)
This policy is developed under compliance with Wisconsin statute 302.365 jail and house of correction program standards. Subsection; policies and procedures for screening prisoners for medical illness or disabilities, mental illnesses, developmental disabilities and alcohol or other drug abuse problems

Wisconsin statute 302.365 section 1, a, 3,b

“Crisis intervention services; that the share for other keeper of the jail warehouse of corrections insure that the jail or the house of correction has available emergency services for crisis intervention for business of medical illness or disabilities, mental illness, developmental disabilities, or alcohol or other drug abuse problems.”

In that the responsibility of the jail is to provide “Crisis Intervention Services”, the Rusk County Health and Human Services will only provide behavioral health services to inmates when a crisis situation arises or when a client is under the care of a psychiatrist and routine care in compliance with the established treatment plan will prevent crisis situations.

The Rusk County Department of Health and Human Services in compliance with the policies developed by the Rusk County Sheriff Department, sets forth the following procedure/policy for crisis intervention services in the Rusk County jail.

Crisis Intervention Services
All inmates of the Rusk County jail are entitled to crisis intervention services. The following procedure has been developed to insure that timely and adequate services are provided.

  1. The staff of the Rusk County jail will follow the written policy developed by the Rusk County Sheriff Department for the referral of inmates to the Rusk County Department of Health and Human Services for behavioral health services.
  2. If it is determined that an inmate is in need of emergency detention, based on an immediate threat of physical harm to themselves or others, the Rusk County sheriff department will be the agency responsible for taking the inmate into protective custody under Wisconsin statute 51.15. In this situation notification of the emergency detention will be given to the Rusk County behavioral health coordinator as soon as allowable under the given situation. Once notified of the emergency detention the Rusk County behavioral health coordinator, will be responsible for the monitoring of the emergency detention, assisting in the coordination of court hearings, and establishing a follow-up treatment plan for the inmate in cooperation with the Rusk County jail.
  3. The Rusk County sheriff department, under the procedures established by their department can access the emergency crisis line and or the Rusk County behavioral health coordinator for assistance in the determination of the need for emergency detention.  In the event there is a request for a consult, the mental health provider shall coordinate with the Rusk County jail supervisor or their designee the time and location for meeting with the inmate. After the initial interview with the client, the mental health provider shall speak to the Rusk County jail supervisor or their designee as to the immediate concerns regarding the mental health needs of the inmate interviewed. Within 24 hours of seeing an inmate the mental health provider shall submit a written summary identifying the content of interview, summary of concerns/impression and recommendations to the Jail Supervisor.

Behavioral Health – Financial Determination/Cost Share
Under Wisconsin Statues any client, the spouse of a married client, or the parents of a minor client are responsible to pay the full cost of counseling (if a minor seeks services under the Wisconsin Statues Chapter 51.47 for alcohol or drug treatment without parental authority, the minor will be assessed for payment).

  • A person in need of counseling who has insurance benefits, Medicare, or medical assistance should inform the service provider of those benefits and permit the provider to bill to this source. If the person does not have any benefits, but has income to cover the cost of services, that person will be billed directly by the service provider.
  • If a person does not have the ability to pay for counseling expenses, and is a Rusk County resident, he/she may apply for financial assistance from Rusk County Department of Health and Human Services. This financial program is a privilege offered by Rusk County and the customer is expected by Wisconsin Law to make payments based on ability.
  • The Clerk in Behavioral Health Services at Rusk County Health and Human Services will review proof of residence, health insurance, income and assets to determine ability to pay for counseling services. The customer will sign a financial agreement authorizing release of information and understanding of the agreement.
  • Rusk County Human Services will pay the counseling expense and will bill the customer for the determined part of the cost.
Type of Service
 Client Pays Rusk County Pays
AODA Inpatient Entire amount reimbursed by Rusk County at contracted rate Initial balance due at contracted rate-then collects amount paid from client.
MH Inpatient Entire amount reimbursed by Rusk County at contracted rate Initial balance due at contracted rate-then collects amount paid from client
AODA Outpatient **Co-pay as financially determined Contracted amount
MH Outpatient **Co-pay as financially determined Contracted amount
AODA Residential Cost share determined Difference between contracted rate and client cost share
MH Residential Cost share determined Difference between contracted rate and client cost share
Medications Entire amount reimbursed by Rusk County Initial balance due then collect amount paid from the client.
Inpatient
Physician charges-psych		 Entire amount reimbursed by Rusk County. Initial balance due then collect amount paid from the client.
Physician charges-ER Entire amount due None
Transportation **Co-pay as financially determined Total balance due
Psychological testing **Co-pay as financially determined Total balance due
OWI Assessment Entire amount due None
Court ordered assessments Entire amount due None

** Co-pay the lowest amount on the co-pay scale is $5 per unit of service with a maximum of $25 per month. If the determined co-pay is more than $5, the client pays the co-pay amount for the first unit of service per month and Rusk County pays the remaining monthly balance.

Behavioral Health – Intoxicated Driver Program
Assessment of Drivers with Alcohol or Controlled Substance Problems

The Department of Health & Family Services developed the guidelines for IDP. (HFS 62)

Policy (This policy is written in compliance with HFS 62)
Rusk County Department of Health & Human Services will provide a “treatment program” as identified under HFS 75, within limits of available funding (HFS 62.02)

Process

  • Rusk County Health and Human services through the authority of the Rusk County 51.42 Board will contract with an Assessment Facility or an Independent Assessor for the purpose of conducting an assessment and establishing a driver safety plan.
  • In interest of avoiding a conflict of interest, Rusk County Health & Human Services will contract with an Assessment Facility or an Independent Assessor that does not provide the program/programs called for in the clients driver safety plan.
  • Assessments shall be completed in compliance with HFS 62.03 (Assessment Standards) & (Conflict of Interests Guidelines.)
  • The client is responsible for the full cost of the assessment, and traffic safety schools.
  • Upon completion of the assessment/driver safety plan, the client shall be shown/given all county-approved public and private program providers, by the assessor. The client shall be informed of the rates charged by the program provider’s services. That they may be eligible as a board client for reduced costs according to his or her ability to pay. (Financial Determination/Cost Share Policy)
  • The client shall also be informed that they elect to receive services from other than the client’s board contracted program provider, the client is responsible for the full cost of services.
  • Clients seeking financial assistance in fulfilling their Driver Safety Plan shall follow the steps articulated in the Financial Determination/Cost Share Policy.
  • Clients, who are eligible for reduced costs, will be provided assistance in the cost of the services to fulfill their driver safety plan, until which point allocations received from the Driver Improvement Surcharge (DRVIM) have been exhausted.
  • In the event that allocations have been depleted, the client will be informed through the Rusk County Behavioral Health Coordinator, that there are no funds currently available, and that their name will be place on a wait list in the order in which it is received. When funds become available clients will be notified of their ability to receive assistance, and an authorization will be given to the county contracted provider.
  • The client will be notified that although DRVIM funds are not available, they are still responsible for the fulfillment of their driver safety plan in the timeline established through their individualized treatment plan.