Select Initial Certification or Recertification in the table below for application information for each service identified in Wis. Admin. Code ch. DHS 75 – Community Substance Use Service Standards.
Certification may be required prior to an entity receiving reimbursement under Wis. Stat. ch. 51, 3rd party reimbursement and/or reimbursement for participants in the Medicaid program.
For Mental Health information, visit Mental Health Treatment Programs: Certification Information.
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Community Substance Use Services defined in Wis. Admin. Code ch. DHS 75 |
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|---|---|---|---|
| Section | Service | Application Form | |
| 75.14 | Prevention Service | F-03082 | |
| 75.15 | Intervention Service and Intoxicated Driver Service | F-03082 | |
| 75.49 | Outpatient Substance Use Treatment Service | F-03082A | |
| 75.50 | Outpatient Integrated Behavioral Health Treatment Service | F-03082A | |
| 75.51 | Intensive Outpatient Treatment Service | F-03082A | |
| 75.52 | Day Treatment or Partial Hospitalization Treatment Service | F-03082A | |
| 75.53 | Transitional Residential Treatment Service | F-03082E (Word) | |
| 75.54 | Medically Monitored Residential Treatment Service | F-03082E (Word) | |
| 75.55 | Medically Managed Inpatient Treatment Service | F-03082E (Word) | |
| 75.56 | Adult Residential Integrated Behavioral Health Stabilization Service | F-03082E (Word) | |
| 75.57 | Residential Withdrawal Management Service | F-03082E (Word) | |
| 75.58 | Residential Intoxication Monitoring Service | F-03082E (Word) | |
| 75.59 | Opioid Treatment Program | F-03082B | |
| 75.59 | Opioid Treatment Program - Medication Unit, Mobile Medication Unit or Mobile Opioid Treatment Program Unit | F-03082F (Word) | |
| 75.60 | Office-based Opioid Treatment Service | F-03082D | |
| All Services | Branch Office or School Branch Application | F-03082C | |
Last Revised: November 8, 2022
