Register May 2009 No. 641
Chapter DHS 107
General statement of coverage.
Services not covered.
Definition and identification of experimental services.
Coverage of out-of-state services.
Coverage of emergency services provided by a person not a certified provider.
Nursing home services.
Home health services.
Personal care services.
Respiratory care for ventilator-assisted recipients.
Private duty nursing services.
Independent nurse practitioner services.
Mental health services.
Speech and language pathology services.
Vision care services.
Family planning services.
Early and periodic screening, diagnosis and treatment (EPSDT) services.
Durable medical equipment and medical supplies.
Diagnostic testing services.
Health maintenance organization and prepaid health plan services.
Rural health clinic services.
Ambulatory surgical center services.
Hospice care services.
Case management services.
Ambulatory prenatal services for recipients with presumptive eligibility.
Prenatal care coordination services.
Ch. DHS 107 Note
Chapter HSS 107 as it existed on February 28, 1986 was repealed and a new chapter HSS 107 was created effective March 1, 1986. Chapter HSS 107 was renumbered Chapter HFS 107 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, January, 1997, No. 493
. Chapter HFS 107 was renumbered to chapter DHS 107 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636
General statement of coverage. DHS 107.01(1)
The department shall reimburse providers for medically necessary and appropriate health care services listed in ss. 49.46 (2)
and 49.47 (6) (a)
, Stats., when provided to currently eligible medical assistance recipients, including emergency services provided by persons or institutions not currently certified. The department shall also reimburse providers certified to provide case management services as defined in s. DHS 107.32
to eligible recipients.
Services provided by a student during a practicum are reimbursable under the following conditions:
Reimbursement for the services is not reflected in prospective payments to the hospital, skilled nursing facility or intermediate care facility at which the student is providing the services;
The student does not bill and is not reimbursed directly for his or her services;
The student provides services under the direct, immediate on-premises supervision of a certified provider; and
The supervisor documents in writing all services provided by the student.
DHS 107.01 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86; am. (1), Register, February, 1988, No. 386
, eff. 3-1-88.
The department shall reject payment for claims which fail to meet program requirements. However, claims rejected for this reason may be eligible for reimbursement if, upon resubmission, all program requirements are met.
Medical assistance shall pay the deductible and coinsurance amounts for services provided under this chapter which are not paid by medicare under 42 USC 1395
, and shall pay the monthly premiums under 42 USC 1395v
. Payment of the coinsurance amount for a service under medicare part B, 42 USC 1395j
, may not exceed the allowable charge for this service under MA minus the medicare payment, effective for dates of service on or after July 1, 1988.