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AB1081: Bill Text
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2025 - 2026 LEGISLATURE
LRB-5946/1
SWB:wlj
2025 ASSEMBLY BILL 1081
February 26, 2026 - Introduced by Representatives
Kurtz
,
Dittrich
,
Duchow
,
Knodl
,
Maxey
,
Moses
,
Mursau
,
Nedweski
,
Novak
,
O'Connor
,
Rodriguez
,
Snodgrass
and
Steffen
, cosponsored by Senators
Testin
,
James
and
Wanggaard
. Referred to Committee on Mental Health and Substance Abuse Prevention.
AB1081,1,4
1
An Act
to create
51.422 (4) of the statutes;
relating to:
modifying
2
administrative rules relating to regulation of opioid treatment programs and
3
requiring adjustments to the rates for substance use disorder treatment
4
services with medications for opioid use disorder.
Analysis by the Legislative Reference Bureau
This bill makes various changes to administrative rules promulgated by the Department of Health Services relating to the regulation of opioid treatment programs (OTPs). Among other things, the bill eliminates a requirement in current administrative rules that persons under the age of 18 have a one-year opioid addiction history and two documented instances of unsuccessful treatment in order to be admitted to an OTP.
Mirroring federal regulations, the bill creates an administrative rule defining “practitioner” as a health care professional who is appropriately licensed by a state to prescribe or dispense medications for opioid use disorders and, as a result, is authorized to practice within an OTP. The bill then also expands certain administrative rules that reference physicians to instead refer to practitioners.
The bill modifies current administrative rules to provide that screening examinations for admission to an OTP may be completed by a non-OTP practitioner up to seven days prior to admission and that a full examination must be completed within 14 days and may be completed by a non-OTP practitioner with review by an OTP provider.
Under current administrative rules, an OTP must have a registered nurse on staff to supervise the dosing process, and a registered nurse must be physically on the premises any time dosing is occurring. The bill modifies this rule, eliminating the requirement for a registered nurse to be on site any time dosing is occurring and allowing either a registered nurse or licensed practical nurse to administer medication.
The bill repeals administrative rules relating to take-home medications and replaces those rules with new rules relating to the criteria for unsupervised use of medication for the treatment of opioid use disorders, restrictions for unsupervised use of methadone hydrochloride, and certain exceptions to those restrictions. Under the administrative rules created by the bill, a patient in an OTP may receive their individual take-home doses as ordered for days that the clinic is closed for business, on one weekend day, and on state and federal holidays, no matter their length of time in treatment, as permitted by federal regulations. For take-home doses beyond that, a practitioner must review and document the criteria set forth under federal regulations when determining whether dispensing medication for a patient’s unsupervised use is safe and it is appropriate to set, increase, or extend the amount of time between visits to the OTP. That determination, including the basis for the determination, must be documented by a practitioner in the patient’s medical record. Under the rules established by the bill, if a practitioner assesses, determines, and documents that a patient meets the federal criteria and can safely manage unsupervised doses of methadone, the number of take-home doses is limited by federal regulations. When a practitioner has reason to accelerate the number of unsupervised doses of methadone hydrochloride, they must comply with the requirements under applicable federal regulations and the criteria for unsupervised use and must use the exception process provided by the federal Center for Substance Abuse Treatment Division of Pharmacologic Therapies. The bill establishes a rule that DHS has the authority to monitor a program for compliance with federal regulations and may take licensing actions on the basis of a DHS determination of noncompliance.
Current administrative rules generally require patients receiving guest dosing (administration of a medication used for the treatment of opioid addiction to a person who is not a client of the program that is administering or dispensing the medication) to have been enrolled at their home clinic for a minimum of 30 days before being eligible for a guest dose. The bill eliminates that requirement.
With certain limited exceptions, current administrative rules provide that the maximum initial dose of methadone may not exceed 30 milligrams. The bill increases the maximum initial dose to 50 milligrams, unless the practitioner finds sufficient medical rationale, including if the patient is transferring from another OTP on a higher dose that has been verified, and documents in the patient’s record that a higher dose was clinically indicated. The bill also changes the current rule regarding the maximum number of days during any 12-month period that an individual may be provided interim maintenance treatment from 120 days to 180 days.
The bill creates a new administrative rule that an OTP may provide split dosing when, in the clinical judgment of the OTP practitioner, such dosing is medically appropriate. Under the bill, the practitioner’s determination and clinical rationale must be documented in the patient’s medical record. The new administrative rule created by the bill provides that no additional testing or documentation beyond routine clinical practice may be required, and any laboratory testing must be at the discretion of the practitioner.
Under current administrative rules, an OTP must employ at least one substance abuse counselor, substance abuse counselor-in training, licensed marriage and family therapist, licensed professional counselor, licensed clinical social worker, certified advanced practice social worker, certified independent social worker, or clinical substance abuse counselor who is under the supervision of a clinical supervisor. The rules also provide that an OTP must employ such a clinician for a minimum of one full-time equivalent of 40 hours per week for every 55 enrolled patients in the service. The bill eliminates that requirement.
The bill also requires DHS to update, each January 1, beginning January 1, 2027, the rates for substance use disorder treatment services with medications for opioid use disorder to be equivalent to the corresponding state-specific, locality-adjusted Medicare rates for the same or comparable services in the calendar year in which the services are provided. The bill provides that those rates do not apply to federally qualified health centers, rural health centers, Indian health services facilities, or certified community behavioral health centers.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
AB1081,1
1
Section
1
.
51.422 (4) of the statutes is created to read:
AB1081,2,8
2
51.422
(4)
Rate updates.
Each January 1, beginning January 1, 2027, the
3
department shall update the rates for substance use disorder treatment services
4
with medications for opioid use disorder to be equivalent to the corresponding state-
5
specific, locality-adjusted Medicare rates for the same or comparable services in the
6
calendar year in which the services are provided. The rates established under this
7
subsection do not apply to federally qualified health centers, rural health centers,
8
Indian health services facilities, or certified community behavioral health centers.
AB1081,2
1
Section
2
.
DHS 75.59 (3) (nm) of the administrative code is created to read:
AB1081,3,4
2
DHS 75.59
(3)
(nm) “Practitioner” means a health care professional who is
3
appropriately licensed by a state to prescribe or dispense medications for opioid use
4
disorders and, as a result, is authorized to practice within an OTP.
AB1081,3
5
Section
3
.
DHS 75.59 (5) (b) of the administrative code is amended to read:
AB1081,3,23
6
DHS 75.59
(5)
(b)
Medical director
. The service shall designate a physician
7
licensed under ch. 448, Stats., as its medical director. The medical director shall
8
have at least one year of experience in addiction medicine or addiction psychiatry,
9
be licensed to practice medicine or osteopathy, and meet all other requirements
10
listed in s. DHS 75.03 (52). If a service is not able to secure a medical director who
11
meets the one year of experience requirement, as documented through recruitment
12
efforts, there shall be a specific plan for the person to acquire equivalent training
13
and skills within 4 months after beginning employment. The medical director
,
14
service physician,
or
mid-level
practitioner
that has a federal exception approved by
15
SAMHSA and the SOTA to
42 CFR 8.12 (b)
, (e), (h), and (i)
shall be physically
16
present at the OTP at least 40 percent of the time that the program administers or
17
dispenses medication in order to comply with s. DHS 94.08, assure regulatory
18
compliance, and carry out duties specifically assigned by regulation as required by
19
SAMHSA under
42 CFR 8.12
. OTPs in the first 60 days of operation may reduce the
20
time requirement medical directors
or practitioners
must be present on site to at
21
least 20 percent of the time that the program administers or dispenses medication.
22
On the 61st day of operation the service shall be subject to the requirements of this
23
rule.
AB1081,4
24
Section
4
.
DHS 75.59 (5) (c) of the administrative code is amended to read:
AB1081,4,4
1
DHS 75.59
(5)
(c)
Nurses
. The service shall have a registered nurse
or
2
licensed practical nurse
on staff to supervise the dosing process and perform other
3
functions delegated by the physician.
A registered nurse shall be physically on the
4
premises any time dosing is occurring.
AB1081,5
5
Section
5
.
DHS 75.59 (5) (e) of the administrative code is amended to read:
AB1081,4,14
6
DHS 75.59
(5)
(e)
Licensed counselors
. The service shall employ at least one
7
of the following: substance abuse counselors, substance abuse counselors-in
8
training, licensed marriage and family therapists, licensed professional counselors,
9
licensed clinical social workers, certified advanced practice social workers, certified
10
independent social workers, or clinical substance abuse counselors who are under
11
the supervision of a clinical supervisor.
An OTP shall employ one of these
12
identified clinicians for a minimum of one full-time equivalent of 40 hours per week
13
for every 55 enrolled patients in the service. All counselors rostered to the service
14
are subject to this ratio.
AB1081,6
15
Section
6
.
DHS 75.59 (6) (a) 1. of the administrative code is amended to
16
read:
AB1081,5,2
17
DHS 75.59
(6)
(a) 1. ‘Maintenance treatment for an adult.’ The service shall
18
maintain current procedures determined by the service physician to ensure that
19
patients are admitted to maintenance treatment by qualified personnel who have
20
determined, using accepted medical criteria, such as those listed in the DSM, that
21
the person is currently addicted to an opioid drug
, and that the person became
22
addicted at least one year before admission for treatment
. In addition, a service
23
physician shall ensure that each patient voluntarily chooses maintenance
24
treatment and that all relevant facts concerning the use of the opioid drug are
1
clearly and adequately explained to the patient, and that each patient provides
2
informed written consent to treatment.
AB1081,7
3
Section
7
.
DHS 75.59 (6) (a) 2. of the administrative code is amended to
4
read:
AB1081,5,10
5
DHS 75.59
(6)
(a) 2. ‘Maintenance treatment for a minor.’
A minor shall be
6
eligible for maintenance treatment only if the minor has had at least 2 documented
7
unsuccessful attempts at short-term detoxification or drug-free treatment within a
8
12-month period.
No minor may be admitted to maintenance treatment unless a
9
parent, legal guardian, or responsible adult designated by the relevant state
10
authority consents in writing to such treatment.
AB1081,8
11
Section
8
.
DHS 75.59 (6) (a) 3. of the administrative code is repealed.
AB1081,9
12
Section
9
.
DHS 75.59 (6) (e) of the administrative code is amended to read:
AB1081,5,24
13
DHS 75.59
(6)
(e) 1. For each patient eligible for admission, the service shall
14
arrange for a comprehensive physical examination and clinically indicated
15
laboratory work-up. The comprehensive physical examination shall be ordered by
16
the
service physician
practitioner
on the day of admission and shall include a
17
complete blood count and liver function testing.
The service shall test for Hepatitis
18
A, B, C and HIV if the patient gives informed consent in writing.
If the patient
19
declines permission to test shall be documented in the patient’s record.
Screening
20
examinations may be completed by a non-OTP practitioner up to 7 days prior to
21
admission. Full examination must be completed within 14 days and may be
22
completed by a non-OTP practitioner with review by an OTP provider.
An updated
23
comprehensive physical examination including lab work shall be completed
24
annually.
AB1081,10
1
Section
10
.
DHS 75.59 (6) (f) of the administrative code is amended to read:
AB1081,6,11
2
DHS 75.59
(6)
(f)
Initial dose
. If a person meets the admission criteria under
3
par. (a), an initial dose of an FDA-approved medication may be administered to the
4
patient on the day of admission. For each new patient enrolled in a service, the
5
initial dose of methadone shall not exceed
30
50
milligrams and the total dose for
6
the first day shall not exceed 40 milligrams, unless the service physician documents
7
in the patient’s record that 40 milligrams did not suppress opioid abstinence
8
symptoms
milligrams, unless the practitioner finds sufficient medical rationale,
9
including if the patient is transferring from another OTP on a higher dose that has
10
been verified, and documents in the patient’s record that a higher dose was
11
clinically indicated
.
AB1081,11
12
Section
11
.
DHS 75.59 (6) (i) 3. of the administrative code is amended to
13
read:
AB1081,6,15
14
DHS 75.59
(6)
(i) 3. Determines and verifies the patient’s age.
If the patient
15
is a minor, the policy shall require documentation as provided in par. (a) 2.
AB1081,12
16
Section
12
.
DHS 75.59 (11) (a) of the administrative code is amended to
17
read:
AB1081,6,21
18
DHS 75.59
(11)
(a)
Dose determination
. The dose determination for a patient
,
19
including if split dosing is appropriate,
is a matter of clinical judgment by a
20
physician
practitioner
in consultation with the patient and appropriate clinical
21
staff.
AB1081,13
22
Section
13
.
DHS 75.59 (11) (f) of the administrative code is amended to read:
AB1081,7,5
23
DHS 75.59
(11)
(f)
Initial methadone dose
. A patient’s initial dose shall be
24
based on the
service physician’s
practitioner’s
evaluation of the history and present
1
condition of the patient. The initial dose of methadone may not exceed
30
50
2
milligrams except that the total dose for the first day may not exceed 40
milligrams
,
3
unless the practitioner finds sufficient medical rationale, including if the patient is
4
transferring from another OTP on a higher dose that has been verified, and
5
documents in the patient’s record that a higher dose was clinically indicated
.
AB1081,14
6
Section
14
.
DHS 75.59 (11) (h) of the administrative code is created to read:
AB1081,7,12
7
DHS 75.59
(11)
(h)
Split dosing.
An OTP may provide split dosing when, in
8
the clinical judgment of the OTP practitioner, such dosing is medically appropriate.
9
The practitioner’s determination and clinical rationale shall be documented in the
10
patient’s medical record. No additional testing or documentation beyond routine
11
clinical practice may be required, and any laboratory testing, including peak and
12
trough level, shall be at the discretion of the practitioner.
AB1081,15
13
Section
15
.
DHS 75.59 (13) of the administrative code is repealed and
14
recreated to read:
AB1081,7,21
15
DHS 75.59
(13)
Criteria for unsupervised use.
(a) To limit the potential
16
for diversion of medication used for the treatment of opioid use disorder to the illicit
17
market, medication dispensed to a patient for unsupervised use shall be subject to
18
the requirements under this subsection. Any patient in an OTP may receive their
19
individualized take-home doses as ordered for days that the clinic is closed for
20
business, on one weekend day, and on state and federal holidays, no matter their
21
length of time in treatment, as allowed under
42 CFR 8.12 (i) (1)
.
AB1081,8,2
22
(b) For take-home doses beyond those allowed under par. (a), a practitioner
23
shall review and document the criteria under
42 CFR 8.12 (i) (2)
when determining
24
whether dispensing medication for a patient’s unsupervised use is safe and it is
1
appropriate to set, increase, or extend the amount of time between visits to the
2
OTP.
AB1081,8,4
3
(c) A determination under par. (b), including the basis of the determination,
4
shall be documented by a practitioner in the patient’s medical record.
AB1081,16
5
Section
16
.
DHS 75.59 (14) of the administrative code is repealed and
6
recreated to read:
AB1081,8,11
7
DHS 75.59
(14)
Restrictions for unsupervised use of methadone
8
hydrochloride.
If a practitioner assesses, determines, and documents that a
9
patient meets the criteria under sub. (13) and that a patient can safely manage
10
unsupervised doses of methadone, the number of take-home doses the patient
11
receives shall be limited by the number allowed under
42 CFR 8.12 (i) (3)
.
AB1081,17
12
Section
17
.
DHS 75.59 (14m) of the administrative code is created to read:
AB1081,8,20
13
DHS 75.59
(14m)
Restriction exceptions.
When a practitioner has reason
14
to accelerate the number of unsupervised use doses of methadone hydrochloride,
15
the practitioner shall comply with the requirements under
42 CFR 8.12
and the
16
criteria for unsupervised use and shall use the exception process provided by the
17
federal center for substance abuse treatment division of pharmacologic therapies.
18
For the purposes of enforcement of this subsection, the department has authority to
19
monitor an OTP for compliance with federal regulations and may take licensing
20
actions on the basis of the department’s determination of noncompliance.
AB1081,18
21
Section
18
.
DHS 75.59 (16) (a) 8. of the administrative code is repealed.
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