Date of enactment: March 29, 2024
2023 Senate Bill 462 Date of publication*: March 30, 2024
2023 WISCONSIN ACT 249
AN ACT to renumber and amend 49.45 (41) (a); to amend 49.45 (41) (b), 49.45 (41) (c) (intro.) and 51.15 (2) (d);
and to create 49.45 (41) (a) 1., 49.45 (41) (d), 51.036 and 51.043 of the statutes; relating to: crisis urgent care and
observation facilities, crisis hostels, and granting rule−making authority.
The people of the state of Wisconsin, represented in
senate and assembly, do enact as follows:
SECTION 1. 49.45 (41) (a) of the statutes is renum-
bered 49.45 (41) (a) (intro.) and amended to read:
49.45 (41) (a) (intro.) In this subsection, “crisis inter-
vention services” means crisis intervention services for
the treatment of mental illness, intellectual disability,
substance abuse, and dementia that are provided by a any
of the following:
2. A crisis intervention program operated by, or
under contract with, a county, if the county is certified as
a medical assistance provider.
SECTION 2. 49.45 (41) (a) 1. of the statutes is created
to read:
49.45 (41) (a) 1. A crisis urgent care and observation
facility certified under s. 51.036.
SECTION 3. 49.45 (41) (b) of the statutes is amended
to read:
49.45 (41) (b) If a county elects to become certified
as a provider of crisis intervention services under par. (a)
2., the county may provide crisis intervention services
under this subsection in the county to medical assistance
recipients through the medical assistance program. A
county that elects to provide the services shall pay the
amount of the allowable charges for the services under
the medical assistance program that is not provided by
the federal government. The department shall reimburse
the county under this subsection only for the amount of
the allowable charges for those services under the medi-
cal assistance program that is provided by the federal
government.
SECTION 4. 49.45 (41) (c) (intro.) of the statutes is
amended to read:
49.45 (41) (c) (intro.) Notwithstanding par. (b), if a
county elects, pursuant to par. (a) 2., to deliver crisis
intervention services under the Medical Assistance pro-
gram on a regional basis according to criteria established
by the department, all of the following apply:
SECTION 5. 49.45 (41) (d) of the statutes is created to
read:
49.45 (41) (d) The department shall, in accordance
with all procedures set forth under s. 20.940, request a
waiver under 42 USC 1315 or submit a Medical Assist-
ance state plan amendment to the federal department of
health and human services to obtain any necessary fed-
eral approval required to provide reimbursement to crisis
urgent care and observation facilities certified under s.
51.036 for crisis intervention services under this subsec-
tion. If the department determines submission of a state
plan amendment is appropriate, the department shall,
notwithstanding whether the expected fiscal effect of the
amendment is $7,500,000 or more, submit the amend-
* Section 991.11, WISCONSIN STATUTES: Effective date of acts. “Every act and every portion of an act enacted by the legislature over the governor’s
partial veto which does not expressly prescribe the time when it takes effect shall take effect on the day after its date of publication.” − 2 −2023 Wisconsin Act 249 2023 Senate Bill 462
ment to the joint committee on finance for review in
accordance with the procedures under sub. (2t). If federal
approval is granted or no federal approval is required, the
department shall provide reimbursement under s. 49.46
(2) (b) 15. If federal approval is necessary but is not
granted, the department may not provide reimbursement
for crisis intervention services provided by crisis urgent
care and observation facilities.
SECTION 6. 51.036 of the statutes is created to read:
51.036 Crisis urgent care and observation facili-
ties. (1) DEFINITIONS. In this section:
(a) “Crisis” means a situation caused by an individu-
al’s apparent mental or substance use disorder that results
in a high level of stress or anxiety for the individual, per-
sons providing care for the individual, or the public and
that is not resolved by the available coping methods of the
individual or by the efforts of those providing ordinary
care or support for the individual.
(b) “Crisis urgent care and observation facility”
means a treatment facility that admits an individual to
prevent, de−escalate, or treat the individual’s mental
health or substance use disorder and includes the neces-
sary structure and staff to support the individual’s needs
relating to the mental health or substance use disorder.
(2) CERTIFICATION REQUIRED; EXEMPTION; GRANTS. (a)
The department shall establish a certification process for
crisis urgent care and observation facilities and a grant
program to award grants to develop and support crisis
urgent care and observation facilities. No person may
operate a crisis urgent care and observation facility with-
out a certification from the department. The department
may make announced and unannounced inspections and
complaint investigations of crisis urgent care and obser-
vation facilities as it deems necessary, at reasonable times
and in a reasonable manner. The department may limit
the number of certifications it grants to operate crisis
urgent care and observation facilities. The department
shall, using the department’s division of the state into
regions by county, include statewide geographic consid-
eration in its evaluation of applications for certification
under this section to ensure geographic diversity among
the regions in the location of crisis urgent care and obser-
vation facilities certified under this section.
(b) 1. A crisis urgent care and observation facility
certified under this section is not subject to facility regu-
lation under ch. 50, unless otherwise required due to the
facility’s licensure or certification for other services or
purposes. A crisis urgent care and observation facility is
not a hospital subject to approval under ss. 50.32 to 50.39
and nothing in this subsection limits services a hospital
may provide under ch. 50.
2. Notwithstanding par. (d), the department shall pro-
mote certification and encourage any facility that is
licensed as a hospital under ch. 50 and provides services
consistent with those described in par. (c) 1. to 9. to apply
for certification under this section. The requirements
under this section may not be construed to prohibit, limit,
or otherwise interfere with services provided by a county
or a hospital or other facility that are provided consistent
with the facility’s existing licensure or certification,
whether the facility is publicly or privately funded.
3. Notwithstanding s. 150.93, any hospital that
expands psychiatric bed capacity to accommodate
admissions under this section may increase its approved
bed capacity by the number of psychiatric beds added
under this subdivision.
4. The department shall take into account the geogra-
phy of hospital facilities granted certification under subd.
2. when considering certification applications for other
crisis urgent care and observation facilities.
(c) Subject to par. (d), the department may grant a
certification to a crisis urgent care and observation facil-
ity that specifies in an application the level of care the
facility can provide to patients and demonstrates in the
application its ability to do all of the following:
1. Accept referrals for crisis services for adults and,
if applicable, for youth, including any of the following:
a. Involuntary patients brought under s. 51.15.
b. Voluntary patients for services arriving as walk−
ins or brought by law enforcement, emergency medical
responders or emergency medical services practitioners,
or county crisis personnel.
2. Abstain from having a requirement for medical
clearance before admission assessment.
3. Provide assessments for physical health, substance
use disorder, and mental health.
4. Provide screening for suicide and violence risk.
5. Provide medication management and therapeutic
counseling.
6. Provide coordination of services for basic needs.
7. Provide for the safety and security of both the staff
and the patients.
8. Have adequate staffing 24 hours a day, 7 days a
week, including through use of telehealth, as described
under s. 49.45 (61), with a multidisciplinary team that
includes, as needed, psychiatrists or psychiatric nurse
practitioners, physician assistants, nurses, licensed clini-
cians capable of completing assessments, peers with
lived experience, and other appropriate staff.
9. Allow for voluntary and involuntary treatment of
individuals in crisis as a means to avoid unnecessary
placement of those individuals in hospital inpatient beds
and allow for an effective conversion to voluntary stabi-
lization when warranted in the same setting.
10. Contribute, from at least one nonstate, federal, or
3rd−party revenue source, an amount, as determined by
the department, in addition to any grant awarded by the
department under this section.
(d) Before the department may grant certification to
a facility under this section, the department shall submit
the proposal for certification to the joint committee on
finance for approval. If the cochairpersons of the joint − 3 − 2023 Wisconsin Act 249 2023 Senate Bill 462
committee on finance do not notify the department within
14 working days after the date of the submittal under this
paragraph that the committee has scheduled a meeting for
the purpose of reviewing the proposal, the department
may grant certification of that facility as described in the
proposal. If, within 14 working days after the date of the
submittal under this paragraph, the cochairpersons of the
committee notify the department that the committee has
scheduled a meeting for the purpose of reviewing the pro-
posal, the department may grant certification of that
facility only upon approval by the committee. When sub-
mitting a proposal regarding certification of a facility
under this paragraph, the department shall provide the
joint committee on finance with all of the following
information about the facility proposed for certification:
1. The department’s rationale for selecting the facil-
ity.
2. Where the facility is to be located.
3. A specific description of the entity that will be
awarded certification.
4. A description of how the funding for the facility
will work.
5. The timeline of the facility for accepting patients.
6. The distance from the facility to the nearest hospi-
tal.
7. A description of the facility’s plan for staffing,
including staff on call.
8. The number of beds in the facility.
9. A description of the facility’s admission, hold, and
discharge policies.
10. Security considerations for patients and staff at
the facility.
11. The estimated population to be served.
12. The estimated number of diversions from the
Winnebago Mental Health Institute had the facility been
operating the past 5 years.
13. Policies that ensure the facility has the capacity
to assess physical health needs and deliver care for most
minor physical health challenges, while also having an
identified process in order to transfer an individual to a
facility with more medically staffed services if needed.
(e) No later than June 30 of each year, beginning by
June 30, 2025, the department shall submit to the joint
committee on finance and to the chief clerk of each house
of the legislature, for distribution to the appropriate
standing committees under s. 13.172 (3), a report regard-
ing crisis urgent care and observation facilities under this
section, including information relating to all of the fol-
lowing:
1. Applications for certification received by the
department.
2. The number of admissions, including both volun-
tary and involuntary admissions.
3. Data regarding how patients are arriving for
admission, including through transport by law enforce-
ment, family, emergency medical responders or emer-
gency medical services practitioners, or county crisis
personnel.
4. Average wait times, including for admission, treat-
ment, discharge, and any other significant aspect of ser-
vices provided by a crisis urgent care and observation
facility.
5. The length of patient stays.
6. The time of day patients are admitted.
7. The source of payments for patient care, including
private payment sources or payment under the Medical
Assistance program under subch. IV of ch. 49.
8. Data regarding the county of residence for each
patient in counties for which the county’s data is equal to
or greater than 20 patients.
9. The estimated number of diversions from the Win-
nebago Mental Health Institute.
10. A description of the number and type of employ-
ees providing staffing during the various times of day,
including through the use of telehealth.
11. A description of rules and procedures for deter-
mining where to take an individual in need of crisis ser-
vices if a crisis urgent care and observation facility does
not have capacity or otherwise does not accept an indi-
vidual.
12. The number of repeat clients and readmissions.
13. Utilization of follow−up services, as applicable.
14. The number of transfers to other facilities, includ-
ing Winnebago Mental Health Institute, hospitals, or
other facilities.
15. A description of any injuries, assaults, or other
safety−related incidents.
16. A breakdown of funding, including the amounts
and sources of funding.
17. The number of clients served.
18. Facility capacity, specifically the number of
staffed beds.
(f) Notwithstanding the certification requirements
set forth under this subsection, any facility that before the
effective date of this paragraph .... [LRB inserts date], is
providing crisis intervention services that on or after the
effective date of this paragraph .... [LRB inserts date],
would otherwise require certification as a crisis urgent
care and observation facility may on and after the effec-
tive date of this paragraph .... [LRB inserts date], con-
tinue to provide these services without obtaining certifi-
cation from the department under this subsection.
(3) ADMISSIONS. (a) A crisis urgent care and observa-
tion facility certified under this section may accept indi-
viduals for any of the following services:
1. Voluntary stabilization.
2. Observation and treatment, including for assess-
ments for mental health or substance use disorder.
3. Screening for suicide and violence risk.
4. Medication management and therapeutic counsel-
ing. − 4 −2023 Wisconsin Act 249 2023 Senate Bill 462
(b) A crisis urgent care and observation facility certi-
fied under this section shall accept an adult individual for
emergency detention under s. 51.15 and may accept a
youth for emergency detention under s. 51.15. If the
facility does not have capacity to accept an adult individ-
ual for purposes of emergency detention or if the facility
does not accept a youth for purposes of emergency deten-
tion, that individual shall be transported to another appro-
priate facility in accordance with rules established by the
department under sub. (4). A county crisis assessment
under s. 51.15 (2) (c) is required prior to admission to a
crisis urgent care and observation facility for purposes of
emergency detention, but the medical clearance require-
ment under s. 51.15 (2) (b) does not apply to crisis urgent
care and observation facility admissions for purposes of
emergency detention.
(c) The department shall encourage each crisis urgent
care and observation facility certified under this section
to operate with the intent to admit individuals for no
longer than 5 days, except in exceptional circumstances.
(4) RULES. The department shall promulgate rules to
implement this section, including all of the following:
(a) Establishment of the grant program described
under sub. (2), including procedures for administration
and establishment of criteria for awarding grants.
(b) Establishment of requirements for crisis urgent
care and observation facilities to match a portion of any
grant awarded by the department under this section, as set
forth under sub. (2) (c) 10., and for determining what
types of contributions may count toward the matching
requirement. The matching requirement established by
the department under this paragraph may be fulfilled
through in−kind contributions.
(c) Requirements for admitting, holding, and dis-
charging individuals for purposes of emergency deten-
tion.
(d) Minimum security requirements for crisis urgent
care and observation facilities certified under this sec-
tion.
(e) Establishment of a target range for the number of
beds in a crisis urgent care and observation facility certi-
fied under this section.
(f) Establishment of policies and criteria to ensure
that law enforcement and other persons authorized to
transport or cause transportation of an individual for pur-
poses of emergency detention have clear standards and
procedures regarding all of the following:
1. The circumstances under which law enforcement
and other persons may bring an individual to a crisis
urgent care and observation facility certified under this
section.
2. The determination as to which facility law enforce-
ment and other persons authorized to transport or cause
transportation of an individual for purposes of emer-
gency detention may take an individual.
(g) Establishment of policies relating to interfacility
transfers initiated at a crisis urgent care and observation
facility, including how such transfers should occur and
who should be involved in such transfers. Barring exi-
gent circumstances that necessitate law enforcement
involvement, law enforcement may not transport an indi-
vidual for purposes of an interfacility transfer from a cri-
sis urgent care and observation facility.
(h) Establishment of procedures to coordinate com-
munication regarding bed availability in a crisis urgent
care and observation facility before the arrival of a
patient and establishment of a process for determining
where to take an individual in need of crisis services if a
crisis urgent care and observation facility does not have
capacity or otherwise does not accept an individual.
(i) Establishment of policies for coordination
between crisis urgent care and observation facilities cer-
tified under this section and any facility established or
operated with funding received under s. 165.12 from set-
tlement proceeds from the opiate litigation, as defined in
s. 165.12 (1), as well as policies to encourage awareness
of and communication and coordination with other facili-
ties that provide services similar to those provided by cri-
sis urgent care and observation facilities.
(j) Establishment of procedures to require a crisis
urgent care and observation facility to coordinate conti-
nuity of care with, when appropriate, a hub−and−spoke
health home pilot program for any patient treated at a cri-
sis urgent care and observation facility for a period of 5
or fewer days. The department shall establish procedures
for follow−up with other transition facilities in the event
that a hub−and−spoke health home pilot program is
appropriate but not available.
(k) Establishment of policies and procedures for cri-
sis urgent care and observation facilities that intend to
accept both youths and adults, including requirements
that youths be treated in a separate part of the facility
from adults, policies to address youth−related treatment
issues, including parental input, and staff training for
youth−specific issues.
(L) Establishment of appropriate staffing level
requirements, including policies to ensure the availabil-
ity of adequate in−person and on−site care.
(m) Establishment of requirements to define the pop-
ulation to be served at a given crisis urgent care and
observation facility, including establishment of any mini-
mum age requirements.
(5) COORDINATION. In accordance with rules estab-
lished by the department under sub. (4) (i), a crisis urgent
care and observation facility certified under this section
shall coordinate to the fullest extent possible with any
facility established or operated with funding received
under s. 165.12 from settlement proceeds from the opiate
litigation, as defined in s. 165.12 (1), as well as with other − 5 − 2023 Wisconsin Act 249 2023 Senate Bill 462
facilities that provide services similar to those provided
by crisis urgent care and observation facilities.
SECTION 6m. 51.043 of the statutes is created to read:
51.043 Crisis hostels. (1) DEFINITIONS. In this sec-
tion:
(a) “Crisis hostel” means a mental health stabiliza-
tion program with a maximum of 15 beds that provides
crisis stabilization services to an adult individual to pre-
vent or de−escalate the individual’s mental health crisis
and avoid admission of the individual to a more restric-
tive setting.
(b) “Crisis stabilization services” means optional
emergency mental health services that provide short−
term, intensive, community−based services to avoid the
need for inpatient hospitalization.
(2) CERTIFICATION REQUIRED; EXEMPTION. (a) Except
as provided in par. (b), no person may operate a crisis hos-
tel without a certification from the department.
(b) If a county has, by the effective date of this para-
graph .... [LRB inserts date], established a crisis hostel
and operates the crisis hostel pursuant only to certifica-
tion under ch. DHS 34, Wis. Adm. Code, where individu-
als whose anticipated length−of−stay is longer than 23
hours due to needs outside of crisis stabilization, and cri-
sis stabilization services are provided in a distinct and
separate area from where an individual may spend the
night, the county may continue to provide crisis stabiliza-
tion services without obtaining additional residential
licensure and is not required to receive a certification
under this section. Needs outside of crisis stabilization
may include housing insecurity or stability issues neces-
sitating coordination of transportation, advocacy, and
housing assistance.
(c) The department may not limit the number of certi-
fications it issues to operate a crisis hostel.
(d) The department shall establish application fees
and biennial certification fees.
(e) A crisis hostel operated under par. (a) or (b) is not
subject to facility regulation under ch. 50.
(3) ADMISSIONS. (a) An individual 18 years of age
or older may be admitted to a crisis hostel to receive crisis
stabilization services.
(b) Crisis stabilization services may only be provided
at a crisis hostel on a voluntary basis to individuals who
are 18 years of age or older. Crisis hostel staff may not
admit an individual who is transported to the hostel invol-
untarily for emergency detention under s. 51.15.
(4) RULES. The department shall promulgate rules to
implement this section.
SECTION 7. 51.15 (2) (d) of the statutes is amended
to read:
51.15 (2) (d) Detention under this section may only
be in a treatment facility approved by the department or
the county department, if the facility agrees to detain the
individual, or a state treatment facility. The department
shall approve for purposes of this subsection any facility
certified under s. 51.036.
SECTION 8.0Nonstatutory provisions.
(1) When considering the initial certifications of cri-
sis urgent care and observation facilities under s. 51.036,
the department of health services shall, to the fullest
extent possible, prioritize certification of a crisis urgent
care and observation facility to be located at least 100
miles from the Winnebago Mental Health Institute and in
the region of the state defined as the western region
according to the department’s division of the state into
five regions by county as of January 5, 2023, for purposes
of data analysis and communication.