DHS 105.50DHS 105.50 Hospices. For MA certification, a hospice shall be certified to participate in medicare as a hospice under 42 CFR 418.50 to 418.100. DHS 105.50 HistoryHistory: Cr. Register, February, 1988, No. 386, eff. 3-1-88. DHS 105.51DHS 105.51 Case management agency providers. DHS 105.51(1)(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. DHS 105.51(2)(a)(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: DHS 105.51(2)(a)1.1. 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 DHS 105.51(2)(a)2.2. Possess 2 years of supervised experience or an equivalent combination of training and experience. DHS 105.51 NoteNote: The knowledge required in subd. 1. is typically gained through supervised experience working with persons in the target population.
DHS 105.51(2)(b)(b) To provide ongoing monitoring and service coordination reimbursable under MA, personnel employed by a case management agency under sub. (1) shall 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. DHS 105.51(3)(3) Sufficiency of agency certification for employed personnel. Individuals employed by or under contract to an agency certified to provide case management services under this section may provide case management services upon the department’s issuance of certification to the agency. The agency shall maintain a list of the names of individuals employed by or under contract to the agency who are performing case management services for which reimbursement may be claimed under MA. This list shall certify the credentials possessed by the named individuals which qualify them under the standards specified in sub. (2). Upon request, an agency shall promptly advise the department in writing of the employment of persons who will be providing case management services under MA and the termination of employees who have been providing case management services under MA. DHS 105.51(4)(4) Contracted personnel. Persons under contract with a certified case management agency to provide assessments or case plans shall meet the requirements of sub. (2) (a), and to provide ongoing monitoring and service coordination, shall meet the requirements of sub. (2) (b). DHS 105.51(5)(5) Recordkeeping. The case manager under s. DHS 107.32 (1) (d) shall maintain a file for each recipient receiving case management services which includes the following: DHS 105.51(5)(g)(g) A written record of all monitoring and quality assurance activities; and DHS 105.51(5)(h)(h) All pertinent correspondence relating to the recipient’s case management. DHS 105.51(6)(a)(a) Case management services shall be reimbursed when the services are provided by certified providers or their subcontractors to recipients eligible for case management. DHS 105.51(6)(b)(b) Payment shall be made to certified providers of case management services according to terms of reimbursement established by the department. DHS 105.51(7)(a)(a) The department may not certify a case management agency for a target population unless the county board or tribal government of the area in which the agency will operate has elected to participate in providing benefits under s. DHS 107.32 through providers operating in the county or tribal area. The county board or tribal government may terminate or modify its participation by giving a 30 day written notice to the department. This election is binding on any case management agencies providing services within the affected county or tribal area. DHS 105.51(7)(b)(b) Any case management agency provider requesting certification under this section shall provide written proof of the election of the county or tribal government to participate under this subsection. DHS 105.51 HistoryHistory: Cr. Register, February, 1988, No. 386, eff. 3-1-88; corrections in (1) (a), (5) (intro.) and (7) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636. DHS 105.52DHS 105.52 Prenatal care coordination providers. DHS 105.52(1)(1) Agency. For MA certification, an agency that provides prenatal care coordination services under s. DHS 107.34 (1) may be any of the following: DHS 105.52(1)(c)(c) A county, city, or combined city and county public health agency. DHS 105.52(2)(a)(a) Definition. In this subsection, “qualified professional” means any of the following: DHS 105.52(2)(a)1.1. A nurse practitioner licensed as a registered nurse pursuant to s. 441.06, Stats., and currently certified by the American nurses’ association, the national board of pediatric nurse practitioners and associates, or the nurses’ association of the American college of obstetricians and gynecologists’ certification corporation. DHS 105.52(2)(a)6.6. A dietitian certified or eligible for registration by the commission on dietetic registration of the academy of nutrition and dietetics with at least 2 years of community health experience. DHS 105.52(2)(a)7.7. A registered nurse with at least 2 years of experience in maternity nursing or community health services or a combination of maternity nursing and community health services. DHS 105.52(2)(a)8.8. An employee with at least a bachelor’s degree and 2 years of experience in health promotion, health advocacy, health education, case management or care coordination, child or family social work, community outreach, or child welfare or related field; or DHS 105.52(2)(a)9.a.a. A certified health education specialist credential from the National Commission for Health Education Credentialing. DHS 105.52(2)(a)9.b.b. A master’s degree in health education and at least 2 years of experience in community health services. DHS 105.52(2)(a)10.10. A doula with at least 4 years of experience providing care coordination and any of the following: DHS 105.52(2)(a)10.b.b. Experience providing doula services that is functionally equivalent to the training required under a department approved doula certification program. DHS 105.52(2)(b)(b) Required qualified professionals. To be certified to provide prenatal care coordination services that are reimbursable under MA, the prenatal care coordination agency under sub. (1) shall have on staff, either employed, under contract, or in a volunteer capacity, at least one qualified professional with all of the following: DHS 105.52(2)(b)1.1. At least 2 years of experience in coordinating services for at-risk or low-income women. DHS 105.52(2)(b)2.2. The necessary skills to supervise assessment and ongoing care coordination and monitoring. DHS 105.52(2)(b)3.3. Education on providing health education and nutrition counseling or at least one year of work experience providing health education and nutrition counseling. DHS 105.52(2)(c)(c) Duties of a qualified professional. A qualified professional shall do all of the following: DHS 105.52(2)(c)2.2. Administer or review and sign each comprehensive assessment and assessment update performed. DHS 105.52(2)(c)3.3. Develop and sign the individualized plan of care based on the needs identified in the assessment. DHS 105.52(2)(c)4.4. Confer with the care coordinator regarding the member’s progress towards goals and outcomes identified in the member’s plan of care. DHS 105.52(2)(d)(d) Division of duties for multiple qualified professionals. If a prenatal care coordination agency has on staff or under contract more than one qualified professional meeting the requirements of par. (b) 1. to 3., then any duty listed in par. (c) may be assigned to a specific qualified professional. DHS 105.52(2m)(a)(a) Qualifications. A care coordinator shall have all of the following qualifications: DHS 105.52(2m)(a)1.1. Be trained under sub. (6) in the provision of prenatal care coordination services, and in each skill that the care coordinator is assigned under sub. (4) (k). DHS 105.52 NoteNote: The reference to skills assigned under sub. (4) (k) was inadvertently left in during rulemaking. The phrase after the comma should have been struck. Corrections will be made in future rulemaking.
DHS 105.52(2m)(a)2.2. Provide documentation of required training to the prenatal care agency for the provider’s records. DHS 105.52(2m)(a)3.3. Have the skills, education, experience and ability to fulfill the employee’s job duties listed in par. (b). DHS 105.52(2m)(b)2.2. Report in writing to the qualified professional supervisor on each comprehensive assessment and assessment update administered. DHS 105.52(2m)(b)3.3. Confer with the qualified professional supervisor regarding the member’s progress towards goals and outcomes identified in the member’s plan of care. DHS 105.52(3)(3) Sufficiency of agency certification. Individuals employed by or under contract with an agency that is certified to provide prenatal care coordination services under this section may provide prenatal care coordination services upon the department’s issuance of certification to the agency. The agency shall do all of the following: DHS 105.52(3)(a)(a) At the time of hire or contract, and at least every 3 years thereafter, conduct and document a background check for all care coordinators and qualified professionals following the procedures in s. 50.065, Stats., and ch. DHS 12. DHS 105.52(3)(b)(b) Maintain a list of all persons who provide or supervise the provision of prenatal care coordination services. The list shall include the credentials of each named individual who is qualified to supervise assessment and ongoing care coordination under sub. (2) (b) and (c). DHS 105.52(3)(c)(c) Report in writing to the department the name of any qualified professional hired to provide prenatal care coordination services within 10 business days of the hiring. DHS 105.52(3)(d)(d) Report in writing to the department the termination of any qualified professional who provided prenatal care coordination services within 10 business days of the termination.
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Department of Health Services (DHS)
Chs. DHS 101-109; Medical Assistance
administrativecode/DHS 105.52
administrativecode/DHS 105.52
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