DSL Memo Series 2002-19

Supercedes Numbered Memo DSL 98-04

November 14, 2002

STATE OF WISCONSIN
Department of Health and Family Services
Division of Supportive Living
Division of Care and Treatment Facilities

To:
Area Administrators/Assistant Area Administrators
Division Administrators
DSL Bureau / Office Directors
Certified Mental Health Inpatient Facilities
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Developmental Disability Services Coordinators
Mental Health Coordinators
Mental Health Institutes
Substance Abuse Coordinators
Tribal Chairperson/Human Services Facilitators

From: 
Sinikka McCabe, Administrator
Division of Supportive Living

Laura Flood, Administrator
Division of Care and Treatment Facilities

Re: EMERGENCY DETENTION SERVICES FOR NON-WISCONSIN RESIDENTS AND PROCEDURES FOR REIMBURSEMENT AUTHORIZATION

Document Summary

This Numbered Memo focuses on emergency detention services provided to non-Wisconsin residents under s. 51.15, Stats. by county agencies, and obtaining reimbursement authorization for those services from the Department of Health and Family Services under the appropriation in s. 20.435(7)(da), Stats. Please refer to the Table of Contents on page two for ease in locating specific topics in this document.

Attached to this memo are the "Statutory Basis for Emergency Detention" (see Attachment 1). Also attached are "Emergency Services Program Recommendations" that resulted from a program and financial review of four counties that have a high incidence of emergency detention of non-Wisconsin residents (see Attachment 2). These recommendations should be implemented by each county in relation to its current practices for emergency detention and other emergency services.

Also attached is the revised DSL-572 form "Request for State Public Funding for Non-Residents." Please use only this version of the form. Discard earlier versions of this form published on 3-98, 8-95, 5-94 and 2-94.

MEMO TEXT

I. Reimbursement to counties defined.
Reimbursement to counties as specified in this memo applies to non-Wisconsin residents who meet the "Basis for (Emergency) Detention" under s. 51.15 (1), Stats., and are emergency detained by law enforcement officials. This memo explains the responsibilities of the county agency where the person was detained, and the requirements for obtaining authorization for reimbursement from the Department of Health and Family Services (DHFS) under s. 51.22 (3), Stats.

A. Voluntary Admissions.

Reimbursement to counties may also apply to non-Wisconsin residents who voluntarily admit themselves to an inpatient psychiatric or substance abuse treatment facility in Wisconsin. However, this only applies when it can be demonstrated that he or she met the "Statutory Basis for Emergency Detention" criteria at the time of admission. (See Attachment 1, "Statutory Basis for Emergency Detention" under s. 51.15 (1), Stats.) See Section VII on page 10 of this memo for more details.

B. Wisconsin Residents.

Reimbursement to counties under s. 51.22 (3), Stats., does not apply to persons who have established Wisconsin residency consistent with the definition of legal residency in this memo, even if the person’s Wisconsin county of residence may be in dispute.

II. Definition of Legal Residency in Wisconsin.

The definition of legal residency is found in subsections 49.001 (6), 49.001 (8), 51.01 (14) and 51.42 (1) (b), Wis. Stats., as follows:

Legal residency is "the voluntary concurrence of physical presence with intent to remain in a place of fixed habitation. Physical presence shall be prima facie evidence of intent to remain."

"Voluntary means according to a person’s free choice, if competent, or by choice of a guardian if incompetent."

EXPLANATION.

There are four criteria (identified by superscript numbers) in the statutory definition of "legal residency":

• 1Physical presence within the state/county.
• Physical presence must be ²voluntary on the part of the individual, or by choice of the person’s legal guardian appointed by a court under ch. 880, Wis. Stats. (Note that guardianship court orders issued in other states are honored in Wisconsin.)
• The individual has the ³intent to remain* in ⁴a place of fixed habitation within the state/county.

All of these four criteria must occur simultaneously. If any one or more of the four criteria do not simultaneously apply to a person, legal residency is not established.

*Note: Intent to remain. A person, or his or her guardian on behalf of their ward, must have the intent to remain, for the foreseeable future, in the county where he or she is physically present. Generally, intent to remain may be expressed verbally by the individual or his or her guardian, although a written expression of intent is preferable. No specific time period must have elapsed to establish the intent to remain for Wisconsin residency. Situations such as, but not limited to, seasonal employment in Wisconsin, an extended vacation, temporarily caring for a sick relative / friend, or for educational / training purposes do not alone qualify as having the intent to remain. Other facts that may be considered as indicators of intent include the location where the individual files tax returns or maintains financial accounts or a driver’s license, for example.

III. Emergency Detention Procedures.

A. Non-Wisconsin Residents.

The human service agency of the county in which a person is emergency detained is responsible, under s. 51.42 (1) (b), Wis. Stats., for providing emergency services needed by a non-Wisconsin resident that may include placement of the person into any of the following:

1. An inpatient psychiatric or substance abuse treatment facility as appropriate.
2. A crisis intervention program for persons with a mental illness and/or substance abuse issues as appropriate.
3. A community based program appropriate to meet the person’s crisis-related treatment needs.

B. General Emergency Detention Procedures for County Agencies.

The county agency crisis intervention worker should triage with the law enforcement officials to assure that the person is admitted to the appropriate and least restrictive setting needed to treat the person’s needs. Also, the county agency should monitor the person’s progress while in treatment to assure that the person is not retained in the facility longer than necessary to achieve clinical stability sufficient for discharge into the community. Upon discharge, the treating facility should assure that the person has a discharge plan for outpatient treatment in his or her home state. The county where the person was detained should assist the person to return to his or her home state.

C. Required Court Hearings.

Following the initial detention, the county where the person was detained must initiate a probable cause hearing in circuit court within 72 hours of the initial time of detention, not counting Saturdays, Sundays and legal holidays; and a commitment hearing within 14 days of the initial day of detention (including weekends and legal holidays), if the person is not able to be safely discharged anytime during the intervening time periods.

If, prior to the probable cause court hearing, the person voluntarily agrees to continued treatment and signs a voluntary admissions form, the county may choose not to continue the commitment process. However, the county may proceed with the hearing if it so desires. Without probable cause the person may decide to leave the treatment facility prior to his or her being clinically ready for discharge. Then, a director’s hold under s. 51.15(10), Stats., and the scheduling of a court hearing may be needed. The county agency may wish to seek the advice of the person’s treating psychiatrist before making the decision about whether to proceed with a probable cause hearing.

If probable cause has been found by the court and, prior to the commitment hearing the person voluntarily agrees to continued treatment and signs a voluntary admission form, the county should pursue a settlement agreement under s. 51.20(8)(bg), Stats., which would negate the need for a commitment hearing for a period not to exceed 90 days. The written settlement agreement must be approved by the court and must include a treatment plan that provides for treatment in the least restrictive manner consistent with the needs of the person.

If the need for a commitment hearing appears imminent, and the person appears to need the services of a State Mental Health Institute, the court should commit the person to the Department of Health and Family Services (DHFS) and order the person transferred to one of the State Mental Health Institutes (see Section IV on page 5). Please contact one of the institutes as early as possible prior to the commitment hearing to determine the availability of a bed and to arrange for the person’s potential admission. The admissions staff of the institute will assist in facilitating an admission to the institute that best fits the needs of the individual.

Exception to transferring a person to a state institute at the time of commitment.

When a detained non-Wisconsin resident is receiving inpatient treatment in a hospital or a treatment setting other than a state institute, the county agency where the person was detained is encouraged to retain the person in the hospital or other treatment setting if it appears that the person will stabilize sufficiently for safe discharge within seven* calendar days or less following the day of commitment. Retaining the person in the setting where he or she is currently a patient will assure a continuity of treatment, thereby hastening his or her potential for discharge and avoiding the added cost of transferring the person to a state mental health institute. In such instances the person should still be civilly committed to the DHFS under Chapter 51, Stats. In these instances, the county where the person was detained will be eligible for reimbursement from the DHFS from the appropriation under s. 20.435(7)(da), Stats., for the care and treatment provided prior to and following his or her commitment to the DHFS. However, if it appears that the person will continue to need inpatient treatment for stabilization for a period longer than seven* days following commitment, he or she should be transferred to a state institute at the time of his or her commitment to the DHFS. If it appears that a stay of more than seven* days following commitment will be needed in the setting where he or she is currently a patient, consultation with the DHFS Emergency Detention Coordinator should be initiated.

(*NOTE: The seven days is meant to be a guide for retaining a person in an inpatient facility other than a state institute following his or her commitment to the DHFS. This time period may vary. However, if it appears that a person will need inpatient treatment for a longer period of time to stabilize sufficiently for discharge, he or she should be transferred to a state institute at the time of commitment to the DHFS, or as soon as this determination is made following commitment to DHFS.)

IV. Policy Items related to the use of the State Institutes.

1. County responsibility for commitment orders.

Except as indicated in paragraph B below, prior to transferring a non-Wisconsin resident who is receiving emergency detention services from an inpatient psychiatric facility to one of the State Mental Health Institutes, there must be a final commitment order by the circuit court of the county where the person was detained. The court should order the person committed to the DHFS. One of the institutes will accept the person for admission when the court enters a final commitment order, and a bed in the appropriate unit of one of the institutes is available.

2. Use of state Institutes prior to commitment.

There are certain circumstances where the institutes are used appropriately for an emergency detention prior to the issuance of a final commitment order. They are:

1. For an initial emergency detention because of the close proximity of the institute to the county where the person was found compared to other psychiatric inpatient facilities.
2. Transfer to an institute is warranted because the severity/complexity of an individual’s behavior exceeds the ability of the inpatient facility typically used by a county agency.
3. The inpatient facility typically used by a county agency does not have an available bed and an institute does.
4. A person’s non-Wisconsin residency is not known by a county agency prior to his/her initial detention in the inpatient facility typically used by the county agency, and it appears that the person will need long-term inpatient treatment.

In all of the above situations, a non-Wisconsin resident may be admitted to a State Mental Health Institute prior to the county agency obtaining a final commitment order. In all of the above situations, the county agency is responsible for initiating and completing the commitment process described above in Section III, Emergency Detention Procedures. The county agency should have the person committed to the Department of Health and Family Services. Also, in all of the above situations the county agency must notify the State Mental Health Institute, prior to or at the time of transfer, that the patient was emergency detained and that he or she is a non-Wisconsin resident (see Section VI on page 9 regarding "Billing and reimbursement to counties for use of the state institutes").

The following positions are the initial contacts at the institutes:

Mendota Mental Health Institute, Admission’s Office Coordinator, Phone (608) 301-1353; FAX (608) 301-1358.

Winnebago Mental Health Institute, Associate Director of Adult Services, Phone (920) 235-4910, Extension 2432; Fax (920) 237-0245.

V. Reimbursement to County Agencies.

A. Other third party payments must be sought first.

The providers of treatment and services must first attempt to recover the costs of emergency detention services from the person’s own resources under s. 46.10, Stats., when the person has the ability to pay for his or her care, and/or from the client’s insurance carriers, or from Medical Assistance when the person has such coverage. If it is known that the person has one or more of these resources, the providers of treatment and services should bill them and know the amount of payment they expect to receive from the applicable third-party payers prior to billing the county agency. The county agency should be billed only for the remaining balance. County agencies are responsible for monitoring these situations and assuring that the service providers and/or county will not receive double payments. When the remaining balance for a client is known, reimbursement authorization from the DHFS should be requested.

A county agency must notify the Division of Supportive Living Emergency Detention Coordinator of any double payments or over payments from the DHFS resulting from payments to the service provider and/or county from other third-party sources. An adjustment must be made by the county in one or more future reimbursements via the state’s Community Aids Reporting System (CARS Profile # 531, Non-Resident 997).

B. Statutory basis for reimbursement for non-Wisconsin resident emergency detention services.

Services Eligible for Reimbursement from DHFS.

The following types of services provided to non-Wisconsin residents who are emergency detained are eligible for reimbursement from DHFS from the appropriation under s. 20.435(7)(da), Stats.:

1. Medical clearance services from a medical hospital.
2. An inpatient psychiatric or substance abuse treatment facility as appropriate.
3. A crisis intervention program for persons with a mental illness and/or substance abuse issues (see list of recommended crisis intervention services in Attachment 2).
4. A community based treatment program appropriate to meet the person’s crisis-related treatment needs.
5. Transportation of the person to attend his or her applicable court hearings.
6. Transportation and related expenses to return a person to his or her home state.
7. Other needed services with approval from the Division of Supportive Living such as, but not limited to, ambulance services in special situations.

Reimbursement from the Department to a county agency for emergency detention services is allowable under s. 51.22 (3), from the appropriation under s. 20.435 (7) (da), Stats. To receive Department authorization for reimbursement of emergency detention services, the procedures under s. 51.20 (7), Stats., must be followed. Form DDE-572, "Request for State Public Funding for Non-Residents" (attached), has been revised and must be used to request approval for reimbursement. Please use only this version of Form DDE-572. Discard the earlier versions of this form that were published on 3-98,
8-95, 5-94 and 2-94.

The revised DDE-572 form is available in an electronic version that can be obtained on the Department’s web site at http://dhfs.wisconsin.gov/forms1/DDES/DDE0572.pdf. This electronic version may be easily completed on a computer by filling in the electronic field for each item on the form. The revised form may also be completed manually.

C. County contracted rate of reimbursement.

Counties are expected to request reimbursement from the Department for non-Wisconsin resident emergency detention services at the reduced or flat rate paid under contract by the county for other services. A typical example is where the basic daily inpatient hospital rate includes ancillary charges, plus added doctor’s fees. Billing statements submitted to the Department for reimbursement must reflect this reduced or flat rate.

D. One-year time limit to request authorization for reimbursement.

There is a one-year time limit for a county agency to request authorization for reimbursement following discharge of a non-Wisconsin resident who was emergency detained. A full year is provided to allow sufficient time for the providers to seek payment from other third-party payers, and because of the length of time needed for county agencies to receive billing statements from providers. Individual case exceptions to the one-year time limit may be made for situations beyond the county agency’s control.

It is preferable that requests for reimbursement be sent to the Division of Supportive Living (DSL) as soon as all the documentation for a case is assembled. (See section E 1 through 3 below for detailed descriptions of required documentation.) It is preferable that multiple requests not be bundled over a long period of time and sent to DSL at the same time. This may cause a delay in approving and returning them to the county agency.

In all of the instances described in Section E-1 "a" through "d" below, please send all of the required information (in Subsection 2 below) for each case to the Division of Supportive Living at the same time. Whenever possible, complete requests for reimbursement authorization will be processed and returned to the county agency within five working days of receipt.

County agencies are advised to keep a copy of all documentation on file to justify their request for reimbursement in the event of an audit.

E. Specific reimbursement procedures.

The following are reimbursement procedures for the various inpatient settings that are used for emergency detentions, and for voluntary admissions who meet one or more of the "Statutory Basis for Emergency Detention" under s. 51.15(1), Stats.

1. When a psychiatric inpatient facility other than a State Mental Health Institute is used for an initial emergency detention of a non-Wisconsin resident.

1. Emergency detention services for 72 hours or less. The request for reimbursement authorization for actual expenses for the first 72 hours of emergency detention services, plus intervening weekends and legal holidays, will be approved when the county has verification that the person is not a Wisconsin resident such as, but not limited to, evidence that the person resides in another state or country, a driver’s license from another state and/or statements by the person that they were just passing through the state, or visiting someone in the state, etc. The type of verification must be identified in the space provided on the DDE-572 form.
2. Probable cause hearing. If emergency detention services will extend beyond
   72 hours, plus intervening weekends and legal holidays, s. 51.20 (7) (a), Stats., requires a court determination of probable cause be made "within 72 hours after the individual arrives at the facility, plus intervening weekends and legal holidays. At the request of the subject individual or his or her counsel the hearing may be postponed, but in no case may the postponement exceed 7 days from the date of detention." An extension of a probable cause hearing beyond 72 hours, plus intervening weekends and legal holidays, must be documented in writing by the county agency and submitted to the Division of Supportive Living with the DDE-572 form.
3. Settlement agreement. Under s. 51.20(8)(bg), Stats., the subject individual, or the individual’s legal counsel with the individual’s consent, may waive the time periods under s. 51.10, Stats., for the probable cause hearing or the final commitment hearing, or both, for a period not to exceed 90 days from the date of the waiver if the individual and their counsel agree at any time after the commencement of the proceedings that the individual shall obtain treatment under a settlement agreement. Non-Wisconsin residents who are emergency detained may enter into a settlement agreement consistent with this statutory provision. In such cases, the county agency will be eligible for reimbursement from the DHFS for the person’s treatment and services pursuant to the procedures and conditions in this Memo Series.
4. Final commitment hearing. If emergency detention services will extend to 14 days or more beyond the day of initial detention, s. 51.20 (7) (c), Stats., requires that a final commitment hearing be held within 14 days of the day of initial detention, except as provided in sub. (8) (bg) or (bm), Stats. An extension of a final commitment hearing beyond 14 days must be documented in writing by the county agency and submitted to the Department with the other documentation.

2. Required documentation.

The documentation required for reimbursement authorization is as follows:

1. Completed "Request for State Public Funding for Non-Residents" form DDE-572.

2. The law enforcement report from the emergency detention.

3. Applicable court orders for probable cause and commitment to the DHFS, or a settlement agreement.

4. Any billing statements from the providers of treatment or    services.  These billing statements must reflect a reduced or flat rate negotiated by or under contract with the county agency, and any payments made or expected to be made to the providers by other third-party payers.

5. A statement from the county agency explaining any other third-party payments the county received or is expecting to receive; i.e., personal funds, insurance payments or Medical Assistance payments. (This statement is not needed if there are no third-party payments.)

3. When a State Mental Health Institute is used for an initial emergency detention of a non-Wisconsin resident.

When a State Mental Health Institute is used for an initial emergency detention of a non-Wisconsin resident, a timely probable cause hearing, commitment hearing, or a settlement agreement, as described above, must be initiated by the county where the person was detained if the person is not able to be safely discharged from the state institute during the intervening time period. A copy of the applicable court order(s) should be faxed as soon as possible to the state institute where the person is detained. For your convenience, please refer to the positions to contact at the state institutes, and the FAX numbers listed under "Policy Items," Section IV on pages 5 and 6 of this memo.

VI.  Billing and reimbursement to counties for use of the state institutes.

Whenever a state institute is used for a non-Wisconsin resident who was emergency detained (including initial detentions and transfers from other hospitals) the county agency must notify the State Mental Health Institute, prior to or at the time of admission/transfer, that the patient was emergency detained and that he or she is a non-Wisconsin resident.  This information will help assure that the county is billed appropriately, or not billed at all when applicable, for the patient’s care at one of the institutes.

A. Initial detention at an institute.

Section 51.42 (1) (b), Stats., entitled "County liability," specifies that the county is responsible for the first 72 hours of emergency services plus intervening weekends and legal holidays. Therefore, when a non-Wisconsin resident is initially emergency detained at one of the institutes, the county is billed by the Division of Care and Treatment Facilities (DCTF) only for the first 72 hours of care, plus intervening weekends and legal holidays. In these instances, the county agency should request authorization for reimbursement from the Division of Supportive Living only for the applicable period of time not to exceed the first 72 hours plus intervening weekends and legal holidays. DCTF pays for the emergency detention services provided by a state institute beyond the initial 72 hours of care plus intervening weekends and legal holidays. When the person is initially detained at one of the institutes, the documentation needed for reimbursement authorization is the same as the corresponding situation in the "Required documentation" section above.

B. Transfer to an institute prior to final commitment.

When an emergency detained non-Wisconsin resident is transferred to a State Mental Health Institute from another inpatient hospital setting where the person was initially detained, the county is not billed for the care and treatment the patient received from the institute. DCTF pays for the patient’s care in these transfer situations. See the Section IV-B, "Use of State Institutes prior to commitment" on page 5 that identifies the reasons a patient may be transferred to an institute prior to involuntary commitment.

C. Transfer to an institute following final commitment.

When an emergency detained non-Wisconsin resident is transferred to a State Mental Health Institute from another inpatient hospital setting following the patient’s final commitment hearing and commitment to the DHFS, DCTF pays for the cost of the patient’s care at the institute. The county will not be billed for the patient’s care at an institute in these situations.

When an emergency detained non-Wisconsin resident is discharged from a state institute, the institute will administratively discharge the person from his or her court commitment without conditions. This action is authorized under s. 51.35 (4) (b), Stats., and does not require a court order initiated by the county.

VII.  When a non-Wisconsin resident is voluntarily admitted to an inpatient psychiatric or substance abuse treatment facility.

When a non-Wisconsin resident is voluntarily admitted to an inpatient psychiatric or substance abuse treatment facility, and the reasons for the person’s admission meet one or more of the "Statutory Basis for Emergency Detention" under s. 51.15(1), Stats. (see Attachment 1), and the person was not detained by law enforcement officials, the county where the facility is located (or the county where the person is determined to be temporarily staying) should, if needed, assist with monitoring the person’s stay in the facility, discharge planning, and transportation of the person to his or her home state following discharge.

The county where the facility is located (or the county where the person is determined to be temporarily staying) is eligible for reimbursement authorization from the DHFS when the client’s voluntary admission meets one or more of the criteria for emergency detention listed in the "Statutory Basis for Emergency Detention" (see Attachment 1), even though the person was not detained by law enforcement officials. In these situations, it is important for representatives of the county agency to work closely with hospital/facility staff to match the clinical/behavioral reasons for the person’s voluntary admission with one or more criteria for emergency detention listed under the "Statutory Basis for Emergency Detention." This information must be provided in writing by the county agency to the Division of Supportive Living’s Emergency Detention Coordinator, along with other documentation typically required for reimbursement authorization, to justify authorization for reimbursement to the county for the cost of care, treatment and services. In these situations, the county is also eligible for reimbursement authorization for the cost of transportation and related expenses to return the person to his or her home state following discharge.

VIII.  Jailed non-Wisconsin residents who need emergency mental health or AODA services.

When a jailed non-Wisconsin resident requires emergency mental health and/or AODA services, the county where the jail is located is responsible for providing those services. These services may be provided to the person in the jail or in an inpatient treatment facility. The need for emergency services may occur on more than one occasion. The county where the jail is located is eligible for reimbursement from the DHFS at the county contracted rate (see Section V-C on page 7). As with other emergency detentions, the completed DDE-572 form and supporting documentation is required for all emergency mental health and/or AODA services to non-Wisconsin residents who are inmates of Wisconsin county jails.

If the non-Wisconsin resident who is an inmate of a Wisconsin county jail meets the criteria for commitment under ss. 51.20(1)(a) or (ar), Stats., then ss. 51.20(13)(a)4m and 5, Stats., authorizes commitment of the person to the DHFS. Upon commitment to the DHFS, the person will most likely be transferred to one of the state institutes and will be the responsibility of the DHFS.

Also, there are 2 statutory references regarding a criminal commitment (vs. a civil mental health commitment) that may apply to a jailed person. They are Section 971.14, Wis. Stats., "Competency to Stand Trial," and s. 971.17, "Commitment as Not Guilty by Reason of Mental Disease or Defect." The section most commonly used is s. 971.14. In both instances, the person is typically committed to the DHFS and admitted to one of the state institutes. The DHFS is then responsible and pays for the cost of care when in an Institute. Also, under s. 971.17, a person can be ordered by a court to a group home or other type of supervised setting. In these situations, the person is typically committed to the DHFS and the facilities used are under contract with the Division of Care and Treatment Facilities (DCTF).

For a Non-Wisconsin resident, a county is eligible for reimbursement for the cost of any intervening mental health and/or AODA services beginning with the provision of emergency mental health and/or AODA services and ending with the final civil mental health or criminal commitment to the DHFS.

IX. Reimbursement of transportation and related expenses.

Assisting a person who has received emergency detention (ED) services to return to his or her home state is considered a necessary component of providing effective ED services. Therefore, reimbursement to a county human services agency of transportation and related expenses (i.e., meals, lodging and transfer expenses) of the non-Wisconsin resident to his or her home state following completion of ED services is reimbursable under s. 51.42 (1) (b), Stats. This reimbursement applies to common carriers such as by bus, train or airplane, and/or by automobile, and to the cost of transportation and related expenses of having a qualified staff person or persons accompany the client to his or her home state. For the presenting purposes, a qualified staff person is one who is aware of, and is able to reasonably address the client’s needs and behaviors that may require the staff person’s attention or response during the trip.

A. When a client is accompanied by one or more qualified staff persons.

When a client is able to travel, but for his or her safety or the safety of other persons he or she needs to be accompanied by one or more qualified staff person(s), the cost of the staff person’s transportation and related travel expenses, and those of the client, are considered a necessary part of the emergency detention service and are reimbursable under s. 51.42 (1) (b), Stats. To be eligible for this reimbursement, the staff person(s) must be either a county employee or an employee of an inpatient facility under contract with the county agency. Not included in this reimbursement are the salary and fringe benefits earned by the employee(s) while accompanying the client.

The travel and related expenses of staff person(s), and those of the client, are reimbursable. The amount of reimbursement from the Department may not exceed the rate of reimbursement established by the county agency or the inpatient facility for their respective employees who are required to travel in their jobs. If an inpatient facility does not have travel reimbursement rates for its employees, the county agency rates should be used.

Volunteer drivers may also be used for this purpose and the cost of their mileage and related travel expenses, and those of the client, are eligible for reimbursement by the Department. The use of volunteer drivers is typically limited to cases involving clients from states bordering Wisconsin. Volunteer drivers should only be used when there is no need for the driver to be informed of confidential information regarding the client.

B. Payment to the client or to relatives or friends of the client.

Under certain circumstances, payments may be made to the client, or the relatives or friends of the client who provide transportation and accompany the client to his or her home state. This reimbursement does not apply to relatives or friends of the client who, at their expense, transport the client back to his or her home state, or to the client when he or she pays for any means of transportation back to his or her home state. Relatives and friends of the client, as well as the client, who are able to pay for their own transportation and related expenses must do so.

In situations where relatives or friends of the client, or the client, are not able to pay for transportation and related expenses to return the client to his or her home state, the county agency may pay for some or all of the transportation costs and related expenses and, by adhering to the following requirements, be reimbursed for these expenses by the DHFS.

1. The cost of transportation and related expenses cannot exceed the amount of reimbursement of a county agency to the agency’s employees for the same types of expenses; i.e., the amounts paid for mileage, meal and lodging expenses cannot exceed the amounts the county agency reimburses its employees whose job requires travel.
2. In applying these requirements to relatives or friends of the client, the maximum cost of travel should be pre-calculated by county agency staff before the trip by applying the maximum agency reimbursement rate to the estimated number of miles (or the cost of a common carrier), the number of people to make the trip, the number and types of meals, and any overnights (including the number of rooms) that may reasonably be needed for the trip. The total of all these anticipated costs may not be exceeded, and should be used as the basis of negotiating a lesser amount that may be acceptable to the relatives or friends of the client. With the exception of special accommodations for a person with physical disabilities or special medical needs, other expenses such as vehicle repairs, side trips, bringing more people on the trip than originally agreed to, and entertainment are not to be included in the calculation or the payment.
3. When these requirements are adhered to, the county agency may pay the agreed upon amount to the relatives or friends upon their arrival to pick up the client, or to the client when he or she is ready to travel home. When these requirements are adhered to, the county agency is not obligated to collect and/or retain any receipts for these travel or related expenses. However, the elements used in calculating the travel and related expenses (number of miles or common carrier cost, the number of people, the number and type of meals, and the number of rooms), and the total amount paid, should be documented in the agency’s appropriate accounting file.

Examples of situations where payment to relatives or friends of the client, or to the client, for transportation and related expenses is appropriate include, but are not limited to, the following:

1. Because of a client’s ongoing medical or physical needs, and/or ongoing psychiatric symptoms and behaviors, the client needs to be accompanied back to his or her home state. Relatives or friends are willing to accompany the client and provide the transportation, but are not able to afford the travel costs. The county agency, using the above requirements, negotiates a payment amount to the relatives or friends that covers reasonable travel costs (for a round trip if needed by relatives or friends).
2. A client has a vehicle, is able to travel unaccompanied back to his or her home state, but has insufficient funds for the trip. Relatives or friends have been contacted, but are not able to forward money for the cost of the trip home, and are not available to bring the client home. The county agency, using the above requirements, determines a reasonable payment amount sufficient for the client to return to his or her home state.

County agencies are expected to be reasonable about the number of family members or friends, and their travel and related expenses, for which the county agency is seeking reimbursement. The Department reserves the right to deny unreasonable travel and related expenses. If a county agency has a question about an unusual situation, contact the Emergency Detention Coordinator listed below before a commitment is made to pay relatives, friends or the client for travel and related expenses.

C. Transportation by Law Enforcement Officials.

Law enforcement officials frequently provide transportation of an emergency detained non-Wisconsin resident to and from his or her court hearings. This is a reimbursable service and does not require prior approval from the DHFS. Occasionally, law enforcement officials also transport a person to his or her home state, usually to the state line where the person’s physical custody is transferred to law enforcement officials from the receiving state. The use of law enforcement officials to transport a person to his or her home state is used primarily by border counties where transfer arrangements are more easily achieved, and for persons whose behavior warrants the use of law enforcement officials.

County agencies are urged to use other means of returning the person to his or her home state such as buying the person a ticket for a means of public transportation, or having county human services agency staff, treatment facility staff and/or volunteer drivers transport the person. By using staff and/or volunteers the person can more easily be delivered to the service agency in the receiving state or to housing / shelter that has been arranged for the person. The use of staff and/or volunteers also eliminates the stigma of being transported by law enforcement officials.

Because of the associated cost and other concerns identified above, the use of law enforcement officials to transport an emergency detained non-Wisconsin resident to his or her home state needs prior approval from the DHFS Emergency Detention Coordinator in order to receive reimbursement authorization for this expense.

D. Requesting authorization for reimbursement.

To request authorization for reimbursement of travel and related expenses for the client, any qualified staff person(s) who accompanied the client to his or her home state, to relatives or friends who accompanied and provided transportation to the client’s home state, or for law enforcement officials used to transport the person to his or her home state, please complete the necessary information on the "Request for State Public Funding for Non-Residents," form DDE-572, attached. As indicated earlier, send the completed DDE-572 form and other required information when it is all assembled.

Send all requests for authorization for reimbursement for non-Wisconsin resident emergency detentions to:

Michael A. Peters
Emergency Detention Coordinator
Division of Supportive Living
P.O. Box 7851, Room 558
Madison, WI 53707-7851
Phone (608) 266-6989; FAX (608) 264-9832
Peterma@dhfs.state.us

If you have any questions about the information in this memo, or if assistance is needed to return a person to his or her home state via the Interstate Compact on Mental Health, please contact Mike Peters.

Attachment 1: "Statutory Basis for Emergency Detention" 
Attachment 2: "Emergency Services Program Recommendations"
DDE-572 form: "Request for State Public Funding for Non-Residents"

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