reglab/statecodes huggingface dataset:
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.03 - Participation by non-certified persons

Current through June 24, 2024
(1) REIMBURSEMENT
				FOR EMERGENCY SERVICES. If a resident of Wisconsin or of another state who is
				not certified by MA in this state provides emergency services to a Wisconsin
				recipient, that person shall not be reimbursed for those services by MA unless
				the services are covered services under ch. DHS 107 and:
(a) The person submits to the fiscal agent a
				provider data form and a claim for reimbursement of emergency services on forms
				prescribed by the department;
(b)
				The person submits to the department a statement in writing on a form
				prescribed by the department explaining the nature of the emergency, including
				a description of the recipient's condition, cause of emergency, if known,
				diagnosis and extent of injuries, the services which were provided and when,
				and the reason that the recipient could not receive services from a certified
				provider; and
(c) The person
				possesses all licenses and other entitlements required under state and federal
				statutes, rules and regulations, and is qualified to provide all services for
				which a claim is submitted.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.04 - Supervision of provider assistants

Current through June 24, 2024
Provider assistants shall be supervised. Unless otherwise
				  specified under ss.
				  DHS
				  105.05 to
				  105.49, supervision shall consist of
				  at least intermittent face-to-face contact between the supervisor and the
				  assistant and a regular review of the assistant's work by the
				  supervisor.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.05 - Physicians and assistants

Current through June 24, 2024
(1) PHYSICIANS. For
				MA certification, physicians shall be licensed to practice medicine and surgery
				pursuant to ss.
				448.05
				and
				448.07,
				Stats., and chs.
				Med 1,
				2, 3, 4,
				5 and 14.
(2) PHYSICIAN ASSISTANTS. For MA
				certification, physician assistants shall be certified and registered pursuant
				to ss.
				448.05
				and
				448.07,
				Stats., and chs.
				Med 8 and 14.
For covered physician services, see s.
					 DHS
					 107.06.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.055 - Nurse anesthetists and anesthesiologist assistants

Current through June 24, 2024
(1) CERTIFIED
				REGISTERED NURSE ANESTHETIST. For MA certification, a nurse anesthetist shall
				be licensed as a registered nurse pursuant to s.
				441.06,
				Stats., and shall meet one of the following additional requirements:
(a) Be certified by either the council on
				certification of nurse anesthetists or the council on recertification of nurse
				anesthetists; or
(b) Have graduated
				within the past 18 months from a nurse anesthesia program that meets the
				standards of the council on accreditation of nurse anesthesia educational
				programs and be awaiting initial certification.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.06 - Dentists and dental hygienists

Current through June 24, 2024
(1) DENTISTS. For
				MA certification, dentists shall be licensed pursuant to ss.
				447.03 and
				447.04,
				Stats.
(2) DENTAL HYGIENISTS. For
				MA certification, dental hygienists shall be licensed pursuant to s.
				447.04(2),
				Stats.; have 2 years or 3,200 hours of active practice experience as a licensed
				dental hygienist; and operate within the scope of dental hygiene as defined
				under ss.
				447.01(3)
				and
				447.06,
				Stats. Written documentation showing the required experience shall be provided
				to the department upon application for MA certification.
For covered dental services, see s.
					 DHS
					 107.07.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.07 - General hospitals

Current through June 24, 2024
For MA certification a hospital shall be approved as a
				  general hospital under s.
				  50.35,
				  Stats., and ch. DHS 124, shall meet conditions of participation for medicare
				  and shall have a utilization review plan that meets the requirements of
				  42 CFR
				  456.101. No facility determined by the
				  department or the federal health care financing administration to be an
				  institution for mental disease (IMD) may be certified as a general hospital
				  under this section. In addition:
(1) A
				hospital providing outpatient psychotherapy shall meet the requirements
				specified in s.
				DHS 105.22(1) and
				(2);
(2) A hospital providing outpatient alcohol
				and other drug abuse (AODA) services shall meet the requirements specified in
				s.
				DHS
				105.23;
(3) A hospital providing mental health day
				treatment services shall be certified under s.
				DHS
				105.24;
(4) A hospital participating in a PRO review
				program shall meet the requirements of
				42 CFR
				456.101 and any additional requirements
				established under state contract with the PRO; and
(5) A hospital providing AODA day treatment
				services shall be certified under s.
				DHS
				105.25.
For certification of a hospital that is an institution for
					 mental disease, see s.
					 DHS
					 105.21. For covered hospital services, see s.
					 DHS
					 107.08.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.075 - Rehabilitation hospitals

Current through June 24, 2024
For MA certification, a rehabilitation hospital shall be
				  approved as a general hospital under s.
				  50.35, Stats., and ch. DHS 124,
				  and shall meet the conditions of participation for medicare and shall have a
				  utilization review plan that meets the requirements of
				  42 CFR
				  456.101. No facility determined by the
				  department or the federal health care financing administration to be an
				  institution for mental disease (IMD) may be certified as a rehabilitation
				  hospital under this section.
For covered hospital services, see s.
					 DHS
					 107.08.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.08 - Skilled nursing facilities

Current through June 24, 2024
For MA certification, skilled nursing facilities shall be
				  licensed pursuant to s.
				  50.03,
				  Stats., and ch. DHS 132.
For covered nursing home services, see s.
					 DHS
					 107.09.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.09 - Medicare bed requirement

Current through June 24, 2024
(1) DEFINITION. In
				this section, "sufficient number of medicare-certified beds" means a supply of
				beds that accommodates the demand for medicare beds from both the home county
				and contiguous counties so that no dual eligible recipient is denied access to
				medicare SNF benefits because of a lack of available beds. In this subsection,
				"dual eligible recipient" means a person who qualifies for both medical
				assistance and medicare.
(2)
				MEDICARE BED OBLIGATION. Each county shall have a sufficient number of skilled
				nursing beds certified by the medicare program pursuant to ss.
				49.45(6m)
				(g) and
				50.02(2),
				Stats. The number of medicare-certified beds required in each county shall be
				at least 3 beds per 1000 persons 65 years of age and older in the
				county.
(3) PENALTY.
(a) If a county does not have sufficient
				medicare-certified beds as determined under sub. (1), each SNF within that
				county which does not have one or more medicare-certified beds shall be subject
				to a fine to be determined by the department of not less than $10 nor more than
				$100 for each day that the county continues to have an inadequate number of
				medicare-certified beds.
(b) The
				department may not enforce penalty in par. (a) if the department has not given
				the SNF prior notification of criteria specific to its county which shall be
				used to determine whether or not the county has a sufficient number of
				medicare-certified beds.
(c) If the
				number of medicare-certified beds in a county is reduced so that the county no
				longer has a sufficient number of medicare-certified beds under sub. (1), the
				department shall notify each SNF in the county of the number of additional
				medicare-certified beds needed in the county. The department may not enforce
				the penalty in par. (a) until 90 days after this notification has been
				provided.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.10 - SNFs and ICFs with deficiencies

Current through June 24, 2024
If the department finds a facility deficient in meeting the
				  standards specified in s.
				  DHS
				  105.08,
				  105.09,
				  105.11 or
				  105.12, the department may
				  nonetheless certify the facility for MA under the conditions specified in s.
				  DHS 132.21
				  and 42 CFR 442, Subpart C.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.11 - Intermediate care facilities

Current through June 24, 2024
For MA certification, intermediate care facilities shall be
				  licensed pursuant to s.
				  50.03,
				  Stats., and ch. DHS 132.
For covered nursing home services, see s.
					 DHS
					 107.09.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.12 - ICFs for mentally retarded persons or persons with related conditions

Current through June 24, 2024
For MA certification, institutions for individuals with
				  intellectual disabilities or individuals with related conditions shall be
				  licensed pursuant to s.
				  50.03,
				  Stats., and ch. DHS 134.
For covered ICF/IID services, see s.
					 DHS
					 107.09.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.17 - Personal care providers

Current through June 24, 2024
(1) DEFINITIONS. In
				this section:
(a) "Client" means an individual
				who receives personal care services from an entity certified or required to be
				certified under this section, irrespective of whether that individual is a
				medicaid recipient.
(ag) "Delegated
				act" means an act that is delegated to an RN or L.P.N. by a physician,
				podiatrist, dentist or optometrist.
(am) "Freestanding personal care agency"
				means an entity described in s.
				49.45 (42) (d)
				3 e., Stats.
(b) "Legal representative" means a person who
				is any of the following:
1. A guardian as
				defined under s. 54.01 (10),
				Stats.
2. A person appointed as a
				health care agent under an activated power of attorney for health care under
				ch. 155, Stats.
3. A person
				appointed as an agent under a durable power of attorney under s.
				243.07, 1989 Stats., executed on
				or before April 28, 1990.
4. A
				parent of a minor child.
(c) "Principal" means an administrator, a
				person with management responsibility for the applicant, an officer or person
				owning directly or indirectly 5% or more of the shares or other evidences of
				ownership of a corporate applicant, a partner in a partnership which is an
				applicant, or the owner of a sole proprietorship which is an
				applicant.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.19 - Nurses in independent practice

Current through June 24, 2024
(1) QUALIFICATIONS.
(a) For MA certification to perform skilled
				nursing services as a nurse in independent practice providing home health
				services under s.
				DHS 107.11
				(6) or private duty nursing services under s.
				DHS
				107.12, the nurse shall be:
1. Licensed as a registered nurse pursuant to
				s. 441.06, Stats.;
2. Licensed as a practical nurse pursuant to
				s. 441.10, Stats.; or
3. A registered nurse providing supervision
				of a licensed practical nurse certified under this section.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.20 - Nurse practitioners

Current through June 24, 2024
(1) QUALIFICATIONS. For MA certification, a
				nurse practitioner shall be licensed as a registered nurse pursuant to s.
				441.06,
				Stats., and fulfill one of the following requirements:
(a) If practicing as a pediatric nurse
				practitioner, be currently certified by the American nurses' association or by
				the national board of pediatric nurse practitioners and associates;
(b) If practicing as any family nurse
				practitioner, be currently certified by the American nurses' association;
				or
(c) If practicing as any other
				primary care nurse practitioner or as a clinical nurse specialist, be currently
				certified by the American nurses' association, the national certification board
				of pediatric nurse practitioners and associates, or the nurses' association of
				the American college of obstetricians and gynecologists' certification
				corporation, or have a master's degree in nursing from a school accredited by a
				program designed to prepare a registered nurse for advanced clinical nurse
				practice.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.201 - Nurse-midwives

Current through June 24, 2024
For MA certification, a nurse midwife shall be certified as a
				  registered nurse under s.
				  DHS
				  105.19(1) and shall be certified as a
				  nurse midwife under ch. N 4.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.21 - Hospital IMDS

Current through June 24, 2024
(1) REQUIREMENTS. For MA certification, a
				hospital which is an institution for mental disease (IMD) shall:
(a) Meet the requirements of s.
				DHS 105.07,
				and;
1. Maintain clinical records on all
				patients, including records sufficient to permit determination of the degree
				and intensity of treatment furnished to MA recipients, as specified in
				42
				CFR 482.61; and
2. Maintain adequate numbers of qualified
				professional and supportive staff to evaluate patients, formulate written,
				individualized comprehensive treatment plans, provide active treatment measures
				and engage in discharge planning, as specified in
				42
				CFR 482.62;
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.22 - Psychotherapy providers

Current through June 24, 2024
(1) TYPES OF
				PSYCHOTHERAPY PROVIDERS. For MA certification, a psychotherapy provider shall
				be one of the following:
(a) A physician
				meeting the requirements of s.
				DHS
				105.05(1) who has completed a
				residency in psychiatry. Proof of residency shall be provided to the
				department. Proof of residency shall either be board-certification from the
				American board of psychiatry and neurology or a letter from the hospital in
				which the residency was completed;
(b) A psychologist licensed under ch. 455,
				Stats.;
(bm) An advanced practice
				nurse prescriber who is certified under s.
				441.16(2),
				Stats., and holds current certification in a psychiatric specialty from the
				American Nurses Credentialing Center.
(bn) A marriage and family therapist licensed
				under ss.
				457.10,
				457.11,
				and
				457.14,
				Stats., including holding a valid training or temporary license;
(bo) A professional counselor licensed under
				ss.
				457.12
				to
				457.14,
				Stats., including holding a valid training or temporary license;
(bp) An advanced practice social worker
				certified under s.
				457.08(2),
				Stats.;
(bq) An independent social
				worker certified under s.
				457.08(3),
				Stats.;
(br) A clinical social
				worker licensed under s.
				457.08(4),
				Stats.;
(c) An outpatient clinic
				certified under ch. DHS 35; or
(d)
				A hospital outpatient mental health clinic located on the hospital's physical
				premises.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.23 - Alcohol and other drug abuse (AODA) treatment providers

Current through June 24, 2024
(1) TYPES OF
				PROVIDERS. For MA certification, an outpatient alcohol and other drug abuse
				(AODA) treatment provider shall be:
(a) An
				outpatient facility operated by a board and certified under ss. DHS 75.49,
				75.50, and 75.51;
(b) An outpatient
				facility or hospital outpatient AODA facility certified under ss. DHS 75.49,
				75.50, and 75.51; or
(c) A provider
				certified under s. DHS 105.05 (1), 105.22 (1) (b), 105.22 (1) (bn), 105.22 (1)
				(bo), or 105.22 (1) (br). Providers that hold a training or temporary license
				under s. DHS 105.22 (1) (bn) or (bo) are excluded.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.24 - Mental health day treatment or day hospital service providers

Current through June 24, 2024
(1) REQUIREMENTS.
				For MA certification, a day treatment or day hospital service provider shall:
(a) Be a medical program certified under s.
				DHS 61.75; and
(b) Meet the
				following personnel and staffing requirements:
1. A registered nurse and a registered
				occupational therapist shall be available to participate in program planning,
				program implementation and daily program coordination;
2. The day treatment program shall be planned
				for and directed by designated members of an interdisciplinary team that
				includes a social worker, a psychologist, an occupational therapist and a
				registered nurse or a physician, physician's assistant or another appropriate
				health care professional;
3. A
				written patient evaluation involving an assessment of the patient's progress by
				each member of the multidisciplinary team shall be made at least every 60 days;
				and
4. For the purposes of daily
				program performance, coordination guidance and evaluation:
a. One qualified professional staff member
				such as an OTR, masters degree social worker, registered nurse, licensed
				psychologist or masters degree psychologist for each group, or one certified
				occupational therapy assistant and one other paraprofessional staff person for
				each group; and
b. Other
				appropriate staff, including volunteer staff.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.25 - Alcohol and other drug abuse (AODA) day treatment providers

Current through June 24, 2024
(1) TYPES OF
				PROVIDERS. For MA certification, an alcohol and other drug abuse (AODA) day
				treatment provider shall be certified under ss. DHS 75.52 and 105.23.
(2) STAFFING REQUIREMENTS.
(a) An alcohol and drug counselor certified
				as provided in ss. DHS 75.02 (84) and 75.03 (4) (d) shall be available during
				all hours in which services are provided to participate in treatment planning
				and implementation and daily program coordination.
(b) A treatment plan for each participating
				recipient shall be developed, directed and monitored by designated members of
				an interdisciplinary treatment team which includes an alcohol and drug
				counselor II or III, certified as provided in ss. DHS 75.03 (85) and 75.18 (2)
				(c) and (6) (b), a physician or licensed psychologist, and other health care
				professionals. The treatment team shall maintain a written record of each
				recipient's treatment and progress toward meeting the goals described in the
				recipient's plan of care.
(c) All
				treatment shall be coordinated and provided by at least one qualified
				professional staff member who has demonstrated experience in delivering direct
				treatment to persons with alcohol and other drug abuse problems. Other staff
				members, such as an AODA counselor I who has filed for certification with the
				Wisconsin alcoholism and drug counselor certification board, inc., may assist
				in treatment under the supervision of a qualified professional staff
				member.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.255 - Community support programs

Current through June 24, 2024
(1) GENERAL
				REQUIREMENTS. For MA certification, a community support program (CSP) service
				provider shall meet the requirements under ss.
				DHS
				63.06 to
				63.17 and this section. The department
				may waive a requirement in ss.
				DHS
				63.06 to under the 63.17 conditions specified in s.
				DHS
				63.05 if requested by a provider. Certified providers
				under this section may provide services directly or may contract with other
				qualified providers to provide all or some of the services described in s.
				DHS
				107.13(6).
(2) MENTAL HEALTH TECHNICIAN.
(a) In this subsection, "mental health
				technician" means a paraprofessional employee of the CSP who is limited to
				performing the services set out in s.
				DHS 63.11(3) (c) and
				(4).
(b) Except as provided in par. (c), a mental
				health technician shall have at least 1,000 hours of supervised work experience
				with long-term mentally ill persons and meet at least one of the following
				conditions:
1. Has satisfactorily completed
				the educational curriculum developed by the department;
2. Is certified by the American occupational
				therapy association as an occupational therapy assistant;
3. Is a practical nurse (LPN) licensed under
				s.
				441.10,
				Stats.;
4. Has satisfied the
				training requirements under s.
				DHS
				133.17(4) for a home health
				aide;
5. Is included in the
				registry of persons under ch. DHS 129 who have completed a nurse's assistant
				training and testing program or only a testing program; or
6. Has satisfied the requirements under s.
				DHS 105.17(3) (a)
				1. to provide personal care services and has
				completed an additional 1000 hours of supervised work experience with long-term
				mentally ill persons.
(c) A mental health technician providing CSP
				services who does not meet the requirements of par. (b) shall meet the
				requirements of s.
				DHS
				63.06(4) (a) 9. and shall in addition
				meet the requirements of par. (b) within one year following the effective date
				of the provider's MA certification or the technician's date of employment by
				the CSP, whichever is later.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.257 - Community-based psychosocial service programs

Current through June 24, 2024
For MA certification as a community-based psychosocial
				  service program under s.
				  49.45(30e),
				  Stats., a provider shall be certified as a comprehensive community services
				  program under ch. DHS 36. The department may waive a requirement in ss.
				  DHS
				  36.04 to under the 36.12 conditions specified in s.
				  DHS 36.065
				  if requested by a provider. Certified providers under this section may provide
				  services directly or may contract with other qualified providers to provide all
				  or some of the services described in s.
				  DHS
				  107.13(7).
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.26 - Chiropractors

Current through June 24, 2024
For MA certification, chiropractors shall be licensed
				  pursuant to s.
				  446.02,
				  Stats.
For covered chiropractic services, see s.
					 DHS
					 107.15.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.265 - Podiatrists

Current through June 24, 2024
For MA certification, podiatrists shall be licensed under s.
				  448.63,
				  Stats., and ch. Pod 1 and registered under s.
				  448.07,
				  Stats., and ch. Pod 4.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.27 - Physical therapists and assistants

Current through June 24, 2024
(1) PHYSICAL
				THERAPISTS. For MA certification, physical therapists shall be licensed
				pursuant to ss. 448.05 and
				448.07, Stats., and ch. PT
				1.
(2) PHYSICAL THERAPIST
				ASSISTANTS. For MA certification, physical therapist assistants shall have
				graduated from a 2-year college-level program approved by the American physical
				therapy association, and shall provide their services under the supervision of
				a physical therapist certified pursuant to sub. (1) and. ss.
				448.53,
				448.56, and
				448.985, Stats. Documentation of
				supervision shall be maintained and provided to the department upon request.
				Physical therapist assistants may not bill or be reimbursed directly for their
				services. When performing services, physical therapist assistants are to be
				submitted as renderer on billing claims.
Note:
For covered physical therapy services, see
				  s. DHS 107.16.
The declaration of supervision for non-billing providers'
					 form is available by accessing:
https://www.dhs.wisconsin.gov/library/f-01182.htm
.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.28 - Occupational therapists and assistants

Current through June 24, 2024
(1) OCCUPATIONAL
				THERAPISTS. For MA certification, an occupational therapist shall:
(a) Be certified by the American occupational
				therapy association as an occupational therapist, registered; or
(b) Have graduated from a program in
				occupational therapy accredited by the council on medical education of the
				American medical association and the American occupational therapy association,
				have completed the required field work experience, and have made application to
				the American occupational therapy association for the certification examination
				for occupational therapist, registered. Certification under this paragraph
				shall be valid until 8 weeks after the examination is taken. On passing the
				examination, the therapist shall obtain certification by the American
				occupational therapy association in the calendar year in which the examination
				is taken. An individual certified under this paragraph for medical assistance
				who fails the examination may be recertified for medical assistance only under
				the conditions of par. (a).
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.29 - Speech and hearing clinics

Current through June 24, 2024
For MA certification, speech and hearing clinics shall be
				  currently accredited by the American speech and hearing association (ASHA)
				  pursuant to the guidelines for "accreditation of professional services programs
				  in speech pathology and audiology" published by ASHA.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.30 - Speech pathologists

Current through June 24, 2024
For MA certification, speech pathologists shall:
(1) Possess a current certification of
				clinical competence from the American speech and hearing association;
(2) Have completed the educational
				requirements and work experience necessary for such a certificate; or
(3) Have completed the educational
				requirements and be in the process of accumulating the work experience required
				to qualify for the certificate of clinical competence under sub. (1).
For covered speech pathology services, see. s.
					 DHS
					 107.18.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.31 - Audiologists

Current through June 24, 2024
For MA certification, audiologists shall:
(1) Possess a certificate of clinical
				competence from the American speech and hearing association (ASHA);
(2) Have completed the educational
				requirements and work experience necessary for the certificate; or
(3) Have completed the educational
				requirements and be in the process of accumulating the work experience required
				to qualify for the certificate under sub. (1).
For covered audiology services, see s.
					 DHS
					 107.19.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.32 - Optometrists

Current through June 24, 2024
For MA certification, optometrists shall be licensed and
				  registered pursuant to ss.
				  449.04
				  and
				  449.06,
				  Stats.
For covered vision care services, see s.
					 DHS
					 107.20.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.33 - Opticians

Current through June 24, 2024
For MA certification, opticians shall practice as described
				  in s.
				  449.01(2),
				  Stats.
For covered vision care services, see s.
					 DHS
					 107.20.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.34 - Rehabilitation agencies

Current through June 24, 2024
For MA certification on or after January 1, 1988, a
				  rehabilitation agency providing outpatient physical therapy, or speech and
				  language pathology form, or occupational therapy shall be certified to
				  participate in medicare as an outpatient rehabilitation facility under
				  42 CFR
				  485.50 to
				  485.74.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.35 - Rural health clinics

Current through June 24, 2024
For MA certification, a rural health clinic shall be:
(1) Certified to participate in
				medicare;
(2) Licensed as required
				under all other local and state laws; and
(3) Staffed with persons who are licensed,
				certified form or registered in accordance with appropriate state
				laws.
For covered rural health clinic services, see s.
					 DHS
					 107.29.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.36 - Family planning clinics or agencies

Current through June 24, 2024
For MA certification, family planning clinics or agencies
				  shall meet the following conditions:
(1) GENERAL. In order to qualify for MA
				reimbursement, family planning clinics shall certify to the department that:
(a) An MA card has been shown before services
				are provided;
(b) Services are
				prescribed by a physician or are provided by a nurse midwife as provided under
				s.
				441.15, Stats.;
				and
(c) No sterilization procedures
				are available to persons who are mentally incompetent, institutionalized or
				under the age of 21.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.37 - Early and periodic screening, diagnosis and treatment (EPSDT) providers

Current through June 24, 2024
(1) EPSDT HEALTH ASSESSMENT AND EVALUATION
				SERVICES.
(a)
Eligible
				providers.
The following providers are eligible for certification as
				providers of EPSDT health assessment and evaluation services:
1. Physicians;
2. Outpatient hospital facilities;
3. Health maintenance
				organizations;
4. Visiting nurse
				associations;
5. Clinics operated
				under a physician's supervision;
6.
				Local public health agencies;
7.
				Home health agencies;
8. Rural
				health clinics;
9. Indian health
				agencies; and
10. Neighborhood
				health centers.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.38 - Ambulance providers

Current through June 24, 2024
(1) For MA certification, ambulance service
				providers shall be licensed pursuant to s.
				256.15,
				Stats., and ch. DHS 110, and shall meet ambulance inspection standards of the
				Wisconsin department of transportation under s.
				341.085,
				Stats., and ch. Trans 309.
(2) An
				ambulance service provider that also provides air ambulance services shall
				submit a separate application under s.
				DHS
				105.01 for certification as an air ambulance
				provider.
For a copy of the
				  application form for an ambulance service provider license, write the EMS
				  Section, Division of Public Health, P.O. Box 2659, Madison, Wisconsin, 53701
Note: For covered transportation services, see s.
					 DHS
					 107.23.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.40 - Durable medical equipment and medical supply vendors

Current through June 24, 2024
(1) Except as
				provided in sub. (2), vendors of durable medical equipment and medical supplies
				shall be eligible to participate in the MA program.
(2) Orthotists and prosthetists who develop
				and fit appliances for recipients shall be certified by the American board for
				certification in orthotics and prosthetics (A.B.C.). Certification shall be a
				result of successful participation in an A.B.C. examination in prosthetics,
				orthotics, or both, and shall be for:
(a)
				Certified prosthetist (C.P.);
(b)
				Certified orthotist (C.O.); or
(c)
				Certified prosthetist and orthotist (C.P.O.)
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.41 - Certification of hearing instrument specialists

Current through June 24, 2024
For MA certification, hearing instrument specialists shall be
				  licensed pursuant to ss.
				  459.01 to
				  459.14,
				  Stats.
For covered hearing aids and supplies, see s.
					 DHS
					 107.24.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.42 - Physician office laboratories

Current through June 24, 2024
(1) REQUIREMENTS.
				For MA certification, physician office laboratories, except as noted in sub.
				(2), shall be licensed pursuant to 42 CFR 493 (CLIA).
(2) EXCEPTION. Physician office laboratories
				servicing no more than 2 physicians, chiropractors or dentists, and not
				accepting specimens on referral from outside providers, are not required to be
				licensed under 42 CFR 493 (CLIA). These laboratories, however, shall submit an
				affidavit to the department declaring that they do not accept outside
				specimens.
(3) MEDICARE
				CERTIFICATION REQUIREMENT. Physician office laboratories which accept referrals
				of 100 or more specimens a year in a specialty shall be certified to
				participate in medicare in addition to meeting the requirements under sub. (1).
For covered diagnostic testing services, see s.
					 DHS
					 107.25.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.43 - Hospital and independent clinical laboratories

Current through June 24, 2024
For MA certification, a clinical laboratory that is a
				  hospital laboratory or an independent laboratory shall be licensed pursuant to
				  42 CFR 493 (CLIA). In addition, the laboratory shall be certified to
				  participate in medicare and meet the requirements of 42 CFR 405.1310 to
				  405.1317.
For covered diagnostic testing services, see s.
					 DHS
					 107.25.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.44 - Portable x-ray providers

Current through June 24, 2024
For MA certification, a portable x-ray provider shall be
				  directed by a physician or group of physicians, registered pursuant to s.
				  254.35,
				  Stats., and ch. DHS 157, certified to participate in medicare, and shall meet
				  the requirements of 42 CFR 405.1411 to 405.1416.
For covered diagnostic testing services, see s.
					 DHS
					 107.25.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.45 - Dialysis facilities

Current through June 24, 2024
For MA certification, dialysis facilities shall meet the
				  requirements enumerated in ss.
				  DHS
				  152.05 and
				  152.08, and shall be certified to
				  participate in medicare.
For covered dialysis services, see s.
					 DHS
					 107.26.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.46 - Blood banks

Current through June 24, 2024
For MA certification, blood banks shall be licensed or
				  registered with the U.S. food and drug administration and shall be approved
				  pursuant to 42 CFR 493 (CLIA).
For covered blood services, see s.
					 DHS
					 107.27.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.47 - Health maintenance organizations and prepaid health plans

Current through June 24, 2024
(1) CONTRACTS AND
				LICENSING. Except as provided in sub. (3), for MA certification, a health
				maintenance organization or prepaid health plan shall enter into a written
				contract with the department to provide services to enrolled recipients and
				shall be licensed by the Wisconsin commissioner of insurance.
(2) REQUIREMENTS FOR HEALTH MAINTENANCE
				ORGANIZATIONS. For MA certification, an HMO shall:
(a) Meet the requirements of 42 CFR
				434.20(c);
(b) Make services it
				provides to individuals eligible under MA accessible to these individuals,
				within the area served by the organization, to the same extent that the
				services are made accessible under the MA state plan to individuals eligible
				for MA who are not enrolled with the organization; and
(c) Make adequate provision against the risk
				of insolvency, which is satisfactory to the department and which ensures that
				individuals eligible for benefits under MA are not held liable for debts of the
				organization in case of the organization's insolvency.
Note: For covered health maintenance organization and prepaid
				  health plan services, see s.
				  DHS
				  107.28.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.48 - Out-of-state providers

Current through June 24, 2024
(1) When a provider in a state that borders
				on Wisconsin documents to the department's satisfaction that it is common
				practice for recipients in a particular area of Wisconsin to go for medical
				services to the provider's locality in the neighboring state, the provider may
				be certified as a Wisconsin border status provider, subject to the
				certification requirements in this chapter and the same rules and contractual
				agreements that apply to Wisconsin providers, except that nursing homes are not
				eligible for border status.
(2)
				Out-of-state independent laboratories, regardless of location, may apply for
				certification as Wisconsin border status providers.
(2m) Out-of-state providers who meet the
				definition of a border-status provider as described in s. DHS 101.03 (19) and
				who provide services to Wisconsin members via telehealth, regardless of
				provider location, may apply for certification as Wisconsin border-status
				providers if they are licensed in Wisconsin under applicable Wisconsin statute
				and administrative code.
(3) Other
				out-of-state providers who do not meet the requirements of sub. (1) may be
				reimbursed for non-emergency services provided to a Wisconsin MA recipient upon
				approval by the department under s. DHS 107.04.
(4) The department may review border status
				certification of a provider annually. Border status certification may be
				canceled by the department if it is found to be no longer warranted by medical
				necessity, volume or other considerations.
(5)
(a) A
				provider certified in another state for services not covered in Wisconsin shall
				be denied border status certification for these services in the Wisconsin
				program.
Note:
Examples of providers whose services are
				  not covered in Wisconsin are music therapists and art
				  therapists.
(b) A provider
				denied certification in another state shall be denied certification in
				Wisconsin, except that a provider denied certification in another state because
				the provider's services are not MA-covered in that state may be eligible for
				Wisconsin border status certification if the provider's services are covered in
				Wisconsin.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.49 - Ambulatory surgical centers

Current through June 24, 2024
For MA certification, an ambulatory surgical center shall be
				  certified to participate in medicare as an ambulatory surgical center under 42
				  CFR 416.39.
For covered ambulatory surgical center services, see s.
					 DHS
					 107.30.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.51 - Case management agency providers

Current through June 24, 2024
(1) AGENCY. For MA
				certification, a provider of case management services shall be an agency with
				state statutory authority to operate one or more community human service
				programs. A case management agency may be a county or Indian tribal department
				of community programs, a department of social services, a department of human
				services, or a county or tribal aging unit. Each applicant agency shall specify
				each population eligible for case management under s.
				DHS 107.32(1) (a)
				2. for which it will provide case management
				services. Each certified agency shall offer all 3 case management components
				described under s.
				DHS
				107.32(1) so that a recipient can
				receive the component or components that meet his or her needs.
(2) EMPLOYED PERSONNEL.
(a) To provide case assessment or case
				planning services reimbursable under MA, persons employed by or under contract
				to the case management agency under sub. (1) shall:
1. Possess a degree in a human
				services-related field, possess knowledge regarding the service delivery
				system, the needs of the recipient group or groups served, the need for
				integrated services and the resources available or needing to be developed, and
				have acquired at least one year of supervised experience with the type of
				recipients with whom he or she will work; or
2. Possess 2 years of supervised experience
				or an equivalent combination of training and experience.
Note: The knowledge required in subd. 1. is typically gained
				  through supervised experience working with persons in the target
				  population.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.52 - Prenatal care coordination providers

Current through June 24, 2024
(1) AGENCY. For MA
				certification, an agency that provides prenatal care coordination services
				under s.
				DHS
				107.34(1) may be:
(a) A community-based health
				organization;
(b) A community-based
				social services agency or organization;
(c) A county, city, or combined city and
				county public health agency;
(d) A
				county department of human services under s.
				46.23,
				Stats., or social services under s.
				46.215
				or
				46.22,
				Stats.;
(e) A family planning
				agency certified under s.
				DHS
				105.36;
(f) A federally qualified health center
				(FQHC) as defined in
				42 CFR
				405.2401(b);
(g) A health maintenance organization
				(HMO);
(h) An independent physician
				association (IPA);
(i) A
				hospital;
(j) A physician's office
				or clinic;
(k) A private case
				management agency;
(L) A registered
				nurse or nurse practitioner;
(m) A
				rural health clinic certified under s.
				DHS
				105.35;
(n) A tribal agency health center;
				or
(o) A women, infants, and
				children (WIC) program under
				42
				USC 1786.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.53 - School-based service providers

Current through June 24, 2024
(1) ELIGIBLE
				PROVIDERS. For MA certification, a school-based service provider shall be
				either a school district under ch. 120, Stats., or a cooperative educational
				service agency (CESA) under ch. 116, Stats.
(2) SEPARATE CERTIFICATION PROHIBITED. No
				school district or CESA may be separately certified as a provider of nursing
				services under ss.
				DHS
				105.19 and
				105.20, physical therapy services
				under s.
				DHS
				105.27, occupational therapy services under s.
				DHS
				105.28, speech and language pathology services under
				ss.
				DHS
				105.29 and
				105.30, audiology services under s.
				DHS
				105.31 or transportation services under s.
				DHS
				105.39.
(3) RECORD-KEEPING REQUIREMENTS.
(a) For each recipient of school-based
				services, the provider shall keep a record containing, at a minimum, all of the
				following:
1. The recipient's first and last
				name and date of birth;
2. The
				prescription or, if referred, the referral for the service;
3. Documentation used to develop the
				recipient's IEP and to annually revise the IEP; and
4. Annual documentation of the individual's
				progress toward treatment goals identified in the IEP, changes in the
				individual's physical or mental status and changes in the treatment plan
				identified in the IEP.
Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 105 - Provider Certification › Section DHS 105.54 - Qualified complex rehabilitation technology suppliers

Current through June 24, 2024
(1) CERTIFICATION.
				For MA certification, complex rehabilitation technology suppliers shall do all
				of the following:
(a) Be accredited by a
				department recognized accrediting organization.
(b) Employ at least one complex
				rehabilitation technology professional.
(c) Have the capability to service and repair
				all complex rehabilitation technology provided.