2025 - 2026 LEGISLATURE
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2025 SENATE BILL 106
March 7, 2025 - Introduced by JOINT LEGISLATIVE COUNCIL. Referred to Committee
on Mental Health, Substance Abuse Prevention, Children and Families.
AN ACT to create 20.435 (5) (bt), 49.46 (2) (b) 14c., 49.46 (2) (bv) and 51.044 of
the statutes; relating to: psychiatric residential treatment facilities,
providing an exemption from emergency rule procedures, and granting rule-
making authority.
Analysis by the Legislative Reference Bureau
This bill is explained in the NOTES provided by the Joint Legislative Council in
the bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
JOINT LEGISLATIVE COUNCIL PREFATORY NOTE: This bill was prepared for the
Joint Legislative Council Study Committee on Emergency Detention and Civil
Commitment of Minors.
The bill specifies that the Department of Health Services (DHS) may establish a
certification process for and certify psychiatric residential treatment facilities (PRTFs)
to provide inpatient psychiatric services for individuals under age 21, under the
direction of a physician, with services provided by a facility that meets PRTF standards
under federal regulations. The bill also specifies that PRTF services are a reimbursable
Medical Assistance (MA) benefit, subject to any necessary federal approval.
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Certification
The bill specifies certain aspects of PRTF certification. In particular, DHS may
make announced and unannounced inspections and complaint investigations of PRTFs
as it deems necessary. DHS may limit the number of certifications it grants to operate
PRTFs. DHS must, using the DHS[s division of the state into regions by county, include
statewide geographic consideration in its evaluation of applications for certification to
ensure geographic diversity among the regions in the location of PRTFs.
The bill also grants rule-making authority to DHS to promulgate administrative
rules, including emergency rules, to implement the bill. Specifically, DHS may
promulgate rules to establish any of the following: (1) minimum security requirements
for PRTFs; (2) a target range for the number of beds in a PRTF; (3) policies for
coordination between PRTFs and certain other facilities; (4) appropriate staffing level
requirements, including policies to ensure the availability of adequate in-person and
on-site care; (5) requirements to define the population to be served at a given PRTF,
including establishment of any minimum age requirements; and (6) rules and
standards for PRTF operations as the department determines are necessary to provide
safe and adequate care and treatment of patients and to protect the health and safety of
patients and employees of a PRTF.
Federal Regulations
The bill applies the federal regulatory framework for PRTFs to the state[s
regulation of PRTFs, including standards for admission and other conditions for MA
participation.
The bill defines a PRTF with the meaning given in the federal regulations. Under
those regulations, a PRTF means a facility other than a hospital, that provides
psychiatric services to individuals under age 21, in an inpatient setting. The
Xpsychiatric servicesY are described in federal MA requirements and limits that are
applicable to inpatient psychiatric services for individuals under age 21. The bill
incorporates those requirements and limits, including requirements to provide active
treatment and individual plans of care.
As provided under the federal regulations, the bill specifies that in order to admit
an individual for services, a treatment team must certify all of the following: (1)
ambulatory care resources available in the community do not meet the treatment needs
of the individual; (2) proper treatment of the individual[s psychiatric condition requires
services on an inpatient basis under the direction of a physician; and (3) the services
can reasonably be expected to improve the individual[s condition or prevent further
regression, so that the services will no longer be needed. Under the federal regulations
incorporated in the bill, if an individual is an MA participant when admitted to a PRTF,
the treatment team must include a physician who has competence in diagnosis and
treatment of mental illness, preferably in child psychiatry, and who has knowledge of
the individual[s situation.
The bill specifies that a PRTF must comply with all federal conditions of
participation, including provisions for the protection of residents, orders for the use of
restraint or seclusion, and all other federal conditions of participation that apply to a
PRTF.
Additional State Regulations
The bill addresses three aspects of PRTF operation that are not addressed in the
federal regulations.
First, the bill specifies that a PRTF may use video surveillance and recordings in
common areas, entrances, and exits, without a patient[s consent, but must inform the
patient and the patient[s parent, guardian, legal custodian, or Indian custodian of the
surveillance and recording. The bill specifies that video surveillance and recording may
not be used as a substitute for one-on-one monitoring of a patient who is at high risk for
self-harm. It also specifies that any video recording is confidential, except as provided
by the department by rule. The department may review any recording made by a PRTF. 2025 - 2026 Legislature
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The bill specifies that DHS may promulgate rules requiring a PRTF to adopt a policy for
monitoring safety, which may include the use of video surveillance and recording in
common areas, entrances, and exits.
Second, the bill specifies that a PRTF may implement the use of locked units for
safety, and specifies that DHS may promulgate rules requiring a PRTF to adopt a policy
for the use of locked units for safety.
Third, the bill clarifies that admission to a PRTF is subject to the requirements of
Chapter 51, Stats.
Administration
Lastly, the bill addresses certain state administrative and operational aspects.
This includes: (1) allowing DHS to provide grants to entities to establish a PRTF, with
preference toward having at least one PRTF in the northern or north-central region of
the state and at least one in the southern region of the state; (2) specifying that a PRTF
may seek reimbursement for its services from a private health benefit plan or a self-
insured governmental health plan; and (3) providing DHS with position authority for
four full-time equivalent positions for the purpose of implementing the certification
process and requirements for PRTFs. The bill includes a placeholder to add funding for
PRTFs in DHS[s schedule under the biennial state budget.
SECTION 1. 20.005 (3) (schedule) of the statutes: at the appropriate place,
insert the following amounts for the purposes indicated:
2025-26 2026-27
20.435 Health services, department of
(5) CARE AND TREATMENT SERVICES
(bt) Psychiatric residential treatment
facilities GPR B -0- -0-
SECTION 2. 20.435 (5) (bt) of the statutes is created to read:
20.435 (5) (bt) Psychiatric residential treatment facilities. Biennially, the
amounts in the schedule for the administration and funding of psychiatric
residential treatment facilities under s. 51.044.
SECTION 3. 49.46 (2) (b) 14c. of the statutes is created to read:
49.46 (2) (b) 14c. Subject to par. (bv), services by a psychiatric residential
treatment facility.
SECTION 4. 49.46 (2) (bv) of the statutes is created to read:
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49.46 (2) (bv) The department shall submit to the federal department of
health and human services any request for a state plan amendment, waiver, or
other federal approval necessary to provide reimbursement for services by a
psychiatric residential treatment facility. If the federal department of health and
human services approves the request or if no federal approval is necessary, the
department shall provide reimbursement under par. (b) 14c. If the federal
department of health and human services disapproves the request, the department
may not provide reimbursement for services under par. (b) 14c.
SECTION 5. 51.044 of the statutes is created to read:
51.044 Psychiatric residential treatment facilities. (1) DEFINITION. In
this section, Xpsychiatric residential treatment facilityY has the meaning given in
42 CFR 483.352.
(2) CERTIFICATION AND REQUIREMENTS . (a) The department may establish a
certification process for and certify psychiatric residential treatment facilities to
provide inpatient psychiatric services for individuals under the age of 21, under the
direction of a physician, with services provided by a psychiatric facility that meets
the requirements of 42 CFR 441.151 (a) (2) (ii). No person may operate a psychiatric
residential treatment facility without a certification from the department. The
department may make announced and unannounced inspections and complaint
investigations of psychiatric residential treatment 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 psychiatric residential treatment
facilities. The department shall, using the department[s division of the state into
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regions by county, include statewide geographic consideration in its evaluation of
applications for certification under this section to ensure geographic diversity
among the regions in the location of psychiatric residential treatment facilities
certified under this section.
(b) A psychiatric residential treatment facility that has a certification from
the department under this section is not subject to facility regulation under ch. 48.
(c) In order to admit an individual for services at a psychiatric residential
treatment facility, a treatment team shall, as required under 42 CFR 441.152,
certify that all of the following are true:
1. Ambulatory care resources available in the community do not meet the
treatment needs of the individual. For purposes of this subdivision, Xambulatory
care resourcesY means any service except hospital inpatient care or inpatient care
in an institution for mental diseases, as defined in s. 49.43 (6m).
2. Proper treatment of the individual[s psychiatric condition requires services
on an inpatient basis under the direction of a physician.
3. The services at a psychiatric residential treatment facility can reasonably
be expected to improve the individual[s condition or prevent further regression so
that the services will no longer be needed.
(d) The treatment team certifying the need for services under par. (c) shall
meet the requirements of 42 CFR 441.153.
(e) A psychiatric residential treatment facility shall comply with all federal
requirements for active treatment and individual plans of care under 42 CFR
441.154 to 441.156, as well as emergency preparedness requirements under 42 CFR
441.184.
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(f) A psychiatric residential treatment facility shall comply with all of the
following federal conditions of participation:
1. Protection of residents as set forth under 42 CFR 483.356.
2. Orders for the use of restraint or seclusion as set forth under 42 CFR
483.358.
3. All other requirements set forth under 42 CFR 483.350 to 483.376.
(g) Admission to a psychiatric residential treatment facility is subject to the
procedures of this chapter.
(3) VIDEO MONITORING. (a) Notwithstanding s. 51.61 (1) (o), a psychiatric
residential treatment facility may use video surveillance and recordings in common
areas, entrances, and exits without the consent of the patient being surveilled or
recorded. The psychiatric residential treatment facility shall inform the patient
and the patient's parent, guardian, legal custodian, or Indian custodian about the
video surveillance and recording.
(b) Any video recording made under this subsection is confidential and not
open to public inspection, except as provided by the department by rule. The
department may review any recording made under this subsection.
(c) Video surveillance and recording may not be used as a substitute for one-
on-one monitoring of a patient who is at high risk for self-harm.
(d) The department shall promulgate rules requiring that all psychiatric
residential treatment facilities adopt a policy for monitoring safety, which may
include the use of video surveillance and recording in common areas, entrances,
and exits.
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(4) LOCKED UNITS FOR SAFETY. (a) A psychiatric residential treatment facility
may implement the use of locked units for safety.
(b) The department may promulgate rules requiring that all psychiatric
residential treatment facilities adopt a policy for the use of locked units for safety.
(5) GRANTS. The department may distribute grants to entities to establish a
psychiatric residential treatment facility. In distributing grants under this
subsection, the department shall give preference toward having at least one
psychiatric residential treatment facility in the northern or north-central region of
the state and at least one in the southern region of the state.
(6) INSURANCE. This section may not be construed to limit a psychiatric
residential treatment facility from seeking reimbursement for its services from a
health benefit plan, as defined in s. 632.745 (11), or self-insured health plan, as
defined s. in s. 632.85 (1) (c).
(7) RULES. The department may promulgate rules to implement this section,
including any of the following:
(a) Minimum security requirements for psychiatric residential treatment
facilities certified under this section.
(b) Establishment of a target range for the number of beds in a psychiatric
residential treatment facility certified under this section.
(c) Establishment of policies for coordination between psychiatric residential
treatment facilities certified under this section and 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 policies to encourage
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awareness of and communication and coordination with other facilities that provide
services similar to those provided by psychiatric residential treatment facilities.
(d) Establishment of appropriate staffing level requirements, including
policies to ensure the availability of adequate in-person and on-site care.
(e) Establishment of requirements to define the population to be served at a
given psychiatric residential treatment facility, including establishment of any
minimum age requirements.
(f) Rules and standards for psychiatric residential treatment facility
operations as the department determines are necessary to provide safe and
adequate care and treatment of patients and to protect the health and safety of
patients and employees of a psychiatric residential treatment facility.
SECTION 6. Nonstatutory provisions.
(1) EMERGENCY RULES ON PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES.
The department of health services may promulgate emergency rules under s.
227.24 implementing certification of psychiatric residential treatment facilities
under s. 51.044, including development of a new provider type and a
reimbursement model for psychiatric residential treatment facilities under the
Medical Assistance program under subch. IV of ch. 49. Notwithstanding s. 227.24
(1) (a) and (3), the department of health services is not required to provide evidence
that promulgating a rule under this subsection as an emergency rule is necessary
for the preservation of the public peace, health, safety, or welfare and is not required
to provide a finding of emergency for a rule promulgated under this subsection.
Notwithstanding s. 227.24 (1) (c) and (2), emergency rules promulgated under this
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subsection remain in effect until July 1, 2027, or the date on which permanent rules
take effect, whichever is sooner.
(2) POSITION AUTHORIZATIONS FOR THE DEPARTMENT OF HEALTH SERVICES.
The authorized FTE positions for the department of health services are increased
by 4.0 GPR positions, to be funded from the appropriation under s. 20.435 (5) (bt),
for the purpose of implementing the certification process and requirements for
psychiatric residential treatment facilities under s. 51.044.
SECTION 7. Effective date.
(1) This act takes effect on the day after publication, or on the 2nd day after
publication of the 2025 biennial budget act, whichever is later.
(END)
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