In Wisconsin

Facilities are permitted to work with external providers to ensure a patient has access to their infusion/injection medication. If a client is unable to or is not permitted to self-administer and the facility does not have appropriately licensed or credentialed staff that are comfortable administering the medication, the facility is required to coordinate services with appropriate medical providers to ensure access to required medical services. Facilities must have written policies and procedures for referring patients to other providers.

Sources:

• DHS 75.24 Service operations (12)(a) and (19) (a) and (c).

• (12) REFERRAL. (a) A service shall have written policies and procedures for referring patients to other service providers and for coordinating care with other providers.

• (19) MEDICAL SERVICES.(a) DHS 75.24 Service operations (19)(a).

  (19) MEDICAL SERVICES: (a) All medical services provided under this chapter shall be provided by appropriately credentialed staff operating within their scope of practice,

• (c) For medical needs of a patient that exceed the scope of the service under this chapter, the service shall coordinate with appropriate medical providers.

Talking Points for Facilities When a Patient Requires Infusion or Injection Support

“Under WI state regulations,  facilities are permitted to work with external providers and refer a patient to other service providers to coordinate care for services outside the scope of the facility. This includes access to the administration of prescribed injection and infusion medications. If [insert patient’s name] is unable or not permitted to self-administer [his/her/their] prescribed [IV/injection] medication and your facility does not have appropriately licensed staff that can administer [insert patient’s name] medication, under state regulations, your facility is required to coordinate services with appropriate medical providers.”

"[Insert patient name] will require someone to administer [his/her/their] bleeding disorder medication during [his/her/their] stay at your facility. Maintaining the patient’s established treatment protocol is essential to ensuring bleeding disorder stability and significantly reduces the risk that mental health or substance use disorder treatment will be interrupted by a bleeding episode."

Step 1: Assess internal capacity
"Do you have someone on staff who is qualified to administer an [infusion/injection]?"

Step 2: Explore in-system options
"If not, is there a provider from a medical unit within your healthcare system who might be able to administer the medication?"

Step 3: Explore external provider options
"If no one within your facility or health system is available, would your facility permit an external provider to administer the medication onsite?"

"Do you currently have any contracts with:

• A home infusion or visiting nurse agency?

• A specialty pharmacy with staff trained to administer infusions or injections?"

Step 4: One-time/one-off administration option
"If you do not have an existing contract, would you permit one of the following to administer the medication at your facility on a one-time basis? We would be happy to help develop a single-use case agreement, if needed:

• A staff member from our Hemophilia Treatment Center (HTC)

• A home infusion nurse

• A visiting nurse

• A trained professional from a specialty pharmacy"

Step 5: Consider family/caregiver support
"Would your facility permit a trained family member or legal guardian—approved by the bleeding disorder treatment team—to administer the infusion or injection onsite?"

Final note on standard of care
"Asking a person to discontinue their bleeding disorder treatment in order to receive mental health or substance use disorder care would represent a violation of the standard of care. We are committed to working with you to find a safe and appropriate solution."

Send the following to the facility:

• Facilitating Coordination with Medical Providers on Behalf of [Patient name]: Personalize this template to facilitate access to care in a substance use disorder facility.