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Wisconsin Assembly Bill AB111

Wisconsin 2025-2026 Regular Session

Wisconsin Assembly Bill AB111 Compare Versions

Only one version of the bill is available at this time.
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11 2025 - 2026 LEGISLATURE
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44 2025 ASSEMBLY BILL 111
55 March 11, 2025 - Introduced by JOINT LEGISLATIVE COUNCIL. Referred to
66 Committee on Mental Health and Substance Abuse Prevention.
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88 ***AUTHORS SUBJECT TO CHANGE***
99 AN ACT to create 20.435 (5) (bt), 49.46 (2) (b) 14c., 49.46 (2) (bv) and 51.044 of
1010 the statutes; relating to: psychiatric residential treatment facilities,
1111 providing an exemption from emergency rule procedures, and granting rule-
1212 making authority.
1313 Analysis by the Legislative Reference Bureau
1414 This bill is explained in the NOTES provided by the Joint Legislative Council in
1515 the bill.
1616 The people of the state of Wisconsin, represented in senate and assembly, do
1717 enact as follows:
1818 JOINT LEGISLATIVE COUNCIL PREFATORY NOTE: This bill was prepared for the
1919 Joint Legislative Council Study Committee on Emergency Detention and Civil
2020 Commitment of Minors.
2121 The bill specifies that the Department of Health Services (DHS) may establish a
2222 certification process for and certify psychiatric residential treatment facilities (PRTFs)
2323 to provide inpatient psychiatric services for individuals under age 21, under the
2424 direction of a physician, with services provided by a facility that meets PRTF standards
2525 under federal regulations. The bill also specifies that PRTF services are a reimbursable
2626 Medical Assistance (MA) benefit, subject to any necessary federal approval.
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3434 Certification
3535 The bill specifies certain aspects of PRTF certification. In particular, DHS may
3636 make announced and unannounced inspections and complaint investigations of PRTFs
3737 as it deems necessary. DHS may limit the number of certifications it grants to operate
3838 PRTFs. DHS must, using the DHS[s division of the state into regions by county, include
3939 statewide geographic consideration in its evaluation of applications for certification to
4040 ensure geographic diversity among the regions in the location of PRTFs.
4141 The bill also grants rule-making authority to DHS to promulgate administrative
4242 rules, including emergency rules, to implement the bill. Specifically, DHS may
4343 promulgate rules to establish any of the following: (1) minimum security requirements
4444 for PRTFs; (2) a target range for the number of beds in a PRTF; (3) policies for
4545 coordination between PRTFs and certain other facilities; (4) appropriate staffing level
4646 requirements, including policies to ensure the availability of adequate in-person and
4747 on-site care; (5) requirements to define the population to be served at a given PRTF,
4848 including establishment of any minimum age requirements; and (6) rules and
4949 standards for PRTF operations as the department determines are necessary to provide
5050 safe and adequate care and treatment of patients and to protect the health and safety of
5151 patients and employees of a PRTF.
5252 Federal Regulations
5353 The bill applies the federal regulatory framework for PRTFs to the state[s
5454 regulation of PRTFs, including standards for admission and other conditions for MA
5555 participation.
5656 The bill defines a PRTF with the meaning given in the federal regulations. Under
5757 those regulations, a PRTF means a facility other than a hospital, that provides
5858 psychiatric services to individuals under age 21, in an inpatient setting. The
5959 Xpsychiatric servicesY are described in federal MA requirements and limits that are
6060 applicable to inpatient psychiatric services for individuals under age 21. The bill
6161 incorporates those requirements and limits, including requirements to provide active
6262 treatment and individual plans of care.
6363 As provided under the federal regulations, the bill specifies that in order to admit
6464 an individual for services, a treatment team must certify all of the following: (1)
6565 ambulatory care resources available in the community do not meet the treatment needs
6666 of the individual; (2) proper treatment of the individual[s psychiatric condition requires
6767 services on an inpatient basis under the direction of a physician; and (3) the services
6868 can reasonably be expected to improve the individual[s condition or prevent further
6969 regression, so that the services will no longer be needed. Under the federal regulations
7070 incorporated in the bill, if an individual is an MA participant when admitted to a PRTF,
7171 the treatment team must include a physician who has competence in diagnosis and
7272 treatment of mental illness, preferably in child psychiatry, and who has knowledge of
7373 the individual[s situation.
7474 The bill specifies that a PRTF must comply with all federal conditions of
7575 participation, including provisions for the protection of residents, orders for the use of
7676 restraint or seclusion, and all other federal conditions of participation that apply to a
7777 PRTF.
7878 Additional State Regulations
7979 The bill addresses three aspects of PRTF operation that are not addressed in the
8080 federal regulations.
8181 First, the bill specifies that a PRTF may use video surveillance and recordings in
8282 common areas, entrances, and exits, without a patient[s consent, but must inform the
8383 patient and the patient[s parent, guardian, legal custodian, or Indian custodian of the
8484 surveillance and recording. The bill specifies that video surveillance and recording may
8585 not be used as a substitute for one-on-one monitoring of a patient who is at high risk for
8686 self-harm. It also specifies that any video recording is confidential, except as provided
8787 by the department by rule. The department may review any recording made by a PRTF. 2025 - 2026 Legislature
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9191 SECTION 1
9292 The bill specifies that DHS may promulgate rules requiring a PRTF to adopt a policy for
9393 monitoring safety, which may include the use of video surveillance and recording in
9494 common areas, entrances, and exits.
9595 Second, the bill specifies that a PRTF may implement the use of locked units for
9696 safety, and specifies that DHS may promulgate rules requiring a PRTF to adopt a policy
9797 for the use of locked units for safety.
9898 Third, the bill clarifies that admission to a PRTF is subject to the requirements of
9999 Chapter 51, Stats.
100100 Administration
101101 Lastly, the bill addresses certain state administrative and operational aspects.
102102 This includes: (1) allowing DHS to provide grants to entities to establish a PRTF, with
103103 preference toward having at least one PRTF in the northern or north-central region of
104104 the state and at least one in the southern region of the state; (2) specifying that a PRTF
105105 may seek reimbursement for its services from a private health benefit plan or a self-
106106 insured governmental health plan; and (3) providing DHS with position authority for
107107 four full-time equivalent positions for the purpose of implementing the certification
108108 process and requirements for PRTFs. The bill includes a placeholder to add funding for
109109 PRTFs in DHS[s schedule under the biennial state budget.
110110 SECTION 1. 20.005 (3) (schedule) of the statutes: at the appropriate place,
111111 insert the following amounts for the purposes indicated:
112112 2025-26 2026-27
113113 20.435 Health services, department of
114114 (5) CARE AND TREATMENT SERVICES
115115 (bt) Psychiatric residential treatment
116116 facilities GPR B -0- -0-
117117 SECTION 2. 20.435 (5) (bt) of the statutes is created to read:
118118 20.435 (5) (bt) Psychiatric residential treatment facilities. Biennially, the
119119 amounts in the schedule for the administration and funding of psychiatric
120120 residential treatment facilities under s. 51.044.
121121 SECTION 3. 49.46 (2) (b) 14c. of the statutes is created to read:
122122 49.46 (2) (b) 14c. Subject to par. (bv), services by a psychiatric residential
123123 treatment facility.
124124 SECTION 4. 49.46 (2) (bv) of the statutes is created to read:
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143143 SECTION 4
144144 49.46 (2) (bv) The department shall submit to the federal department of
145145 health and human services any request for a state plan amendment, waiver, or
146146 other federal approval necessary to provide reimbursement for services by a
147147 psychiatric residential treatment facility. If the federal department of health and
148148 human services approves the request or if no federal approval is necessary, the
149149 department shall provide reimbursement under par. (b) 14c. If the federal
150150 department of health and human services disapproves the request, the department
151151 may not provide reimbursement for services under par. (b) 14c.
152152 SECTION 5. 51.044 of the statutes is created to read:
153153 51.044 Psychiatric residential treatment facilities. (1) DEFINITION. In
154154 this section, Xpsychiatric residential treatment facilityY has the meaning given in
155155 42 CFR 483.352.
156156 (2) CERTIFICATION AND REQUIREMENTS . (a) The department may establish a
157157 certification process for and certify psychiatric residential treatment facilities to
158158 provide inpatient psychiatric services for individuals under the age of 21, under the
159159 direction of a physician, with services provided by a psychiatric facility that meets
160160 the requirements of 42 CFR 441.151 (a) (2) (ii). No person may operate a psychiatric
161161 residential treatment facility without a certification from the department. The
162162 department may make announced and unannounced inspections and complaint
163163 investigations of psychiatric residential treatment facilities as it deems necessary,
164164 at reasonable times and in a reasonable manner. The department may limit the
165165 number of certifications it grants to operate psychiatric residential treatment
166166 facilities. The department shall, using the department[s division of the state into
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193193 SECTION 5
194194 regions by county, include statewide geographic consideration in its evaluation of
195195 applications for certification under this section to ensure geographic diversity
196196 among the regions in the location of psychiatric residential treatment facilities
197197 certified under this section.
198198 (b) A psychiatric residential treatment facility that has a certification from
199199 the department under this section is not subject to facility regulation under ch. 48.
200200 (c) In order to admit an individual for services at a psychiatric residential
201201 treatment facility, a treatment team shall, as required under 42 CFR 441.152,
202202 certify that all of the following are true:
203203 1. Ambulatory care resources available in the community do not meet the
204204 treatment needs of the individual. For purposes of this subdivision, Xambulatory
205205 care resourcesY means any service except hospital inpatient care or inpatient care
206206 in an institution for mental diseases, as defined in s. 49.43 (6m).
207207 2. Proper treatment of the individual[s psychiatric condition requires services
208208 on an inpatient basis under the direction of a physician.
209209 3. The services at a psychiatric residential treatment facility can reasonably
210210 be expected to improve the individual[s condition or prevent further regression so
211211 that the services will no longer be needed.
212212 (d) The treatment team certifying the need for services under par. (c) shall
213213 meet the requirements of 42 CFR 441.153.
214214 (e) A psychiatric residential treatment facility shall comply with all federal
215215 requirements for active treatment and individual plans of care under 42 CFR
216216 441.154 to 441.156, as well as emergency preparedness requirements under 42 CFR
217217 441.184.
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245245 SECTION 5
246246 (f) A psychiatric residential treatment facility shall comply with all of the
247247 following federal conditions of participation:
248248 1. Protection of residents as set forth under 42 CFR 483.356.
249249 2. Orders for the use of restraint or seclusion as set forth under 42 CFR
250250 483.358.
251251 3. All other requirements set forth under 42 CFR 483.350 to 483.376.
252252 (g) Admission to a psychiatric residential treatment facility is subject to the
253253 procedures of this chapter.
254254 (3) VIDEO MONITORING. (a) Notwithstanding s. 51.61 (1) (o), a psychiatric
255255 residential treatment facility may use video surveillance and recordings in common
256256 areas, entrances, and exits without the consent of the patient being surveilled or
257257 recorded. The psychiatric residential treatment facility shall inform the patient
258258 and the patient's parent, guardian, legal custodian, or Indian custodian about the
259259 video surveillance and recording.
260260 (b) Any video recording made under this subsection is confidential and not
261261 open to public inspection, except as provided by the department by rule. The
262262 department may review any recording made under this subsection.
263263 (c) Video surveillance and recording may not be used as a substitute for one-
264264 on-one monitoring of a patient who is at high risk for self-harm.
265265 (d) The department shall promulgate rules requiring that all psychiatric
266266 residential treatment facilities adopt a policy for monitoring safety, which may
267267 include the use of video surveillance and recording in common areas, entrances,
268268 and exits.
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295295 SECTION 5
296296 (4) LOCKED UNITS FOR SAFETY. (a) A psychiatric residential treatment facility
297297 may implement the use of locked units for safety.
298298 (b) The department may promulgate rules requiring that all psychiatric
299299 residential treatment facilities adopt a policy for the use of locked units for safety.
300300 (5) GRANTS. The department may distribute grants to entities to establish a
301301 psychiatric residential treatment facility. In distributing grants under this
302302 subsection, the department shall give preference toward having at least one
303303 psychiatric residential treatment facility in the northern or north-central region of
304304 the state and at least one in the southern region of the state.
305305 (6) INSURANCE. This section may not be construed to limit a psychiatric
306306 residential treatment facility from seeking reimbursement for its services from a
307307 health benefit plan, as defined in s. 632.745 (11), or self-insured health plan, as
308308 defined s. in s. 632.85 (1) (c).
309309 (7) RULES. The department may promulgate rules to implement this section,
310310 including any of the following:
311311 (a) Minimum security requirements for psychiatric residential treatment
312312 facilities certified under this section.
313313 (b) Establishment of a target range for the number of beds in a psychiatric
314314 residential treatment facility certified under this section.
315315 (c) Establishment of policies for coordination between psychiatric residential
316316 treatment facilities certified under this section and any facility established or
317317 operated with funding received under s. 165.12 from settlement proceeds from the
318318 opiate litigation, as defined in s. 165.12 (1), as well as policies to encourage
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345345 SECTION 5
346346 awareness of and communication and coordination with other facilities that provide
347347 services similar to those provided by psychiatric residential treatment facilities.
348348 (d) Establishment of appropriate staffing level requirements, including
349349 policies to ensure the availability of adequate in-person and on-site care.
350350 (e) Establishment of requirements to define the population to be served at a
351351 given psychiatric residential treatment facility, including establishment of any
352352 minimum age requirements.
353353 (f) Rules and standards for psychiatric residential treatment facility
354354 operations as the department determines are necessary to provide safe and
355355 adequate care and treatment of patients and to protect the health and safety of
356356 patients and employees of a psychiatric residential treatment facility.
357357 SECTION 6. Nonstatutory provisions.
358358 (1) EMERGENCY RULES ON PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES.
359359 The department of health services may promulgate emergency rules under s.
360360 227.24 implementing certification of psychiatric residential treatment facilities
361361 under s. 51.044, including development of a new provider type and a
362362 reimbursement model for psychiatric residential treatment facilities under the
363363 Medical Assistance program under subch. IV of ch. 49. Notwithstanding s. 227.24
364364 (1) (a) and (3), the department of health services is not required to provide evidence
365365 that promulgating a rule under this subsection as an emergency rule is necessary
366366 for the preservation of the public peace, health, safety, or welfare and is not required
367367 to provide a finding of emergency for a rule promulgated under this subsection.
368368 Notwithstanding s. 227.24 (1) (c) and (2), emergency rules promulgated under this
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395395 SECTION 6
396396 subsection remain in effect until July 1, 2027, or the date on which permanent rules
397397 take effect, whichever is sooner.
398398 (2) POSITION AUTHORIZATIONS FOR THE DEPARTMENT OF HEALTH SERVICES.
399399 The authorized FTE positions for the department of health services are increased
400400 by 4.0 GPR positions, to be funded from the appropriation under s. 20.435 (5) (bt),
401401 for the purpose of implementing the certification process and requirements for
402402 psychiatric residential treatment facilities under s. 51.044.
403403 SECTION 7. Effective date.
404404 (1) This act takes effect on the day after publication, or on the 2nd day after
405405 publication of the 2025 biennial budget act, whichever is later.
406406 (END)
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