Chapter DHS 105

DHS 105.525(7)(b) (b) A requirement that no employee or subcontractor may be assigned any duty for which they are not trained. The child care coordination agency shall provide or arrange for training of employed or subcontracted care coordinators as necessary.

DHS 105.525(7)(c) (c) Procedures for ensuring all qualified professionals and care coordinators receive orientation and on-going instruction. The procedures shall include:

DHS 105.525(7)(c)1. 1. All of the items required under s. DHS 105.52 (6) (d) 1., 2., 3., and 5.

DHS 105.525(7)(c)2. 2. Topics covered in orientation, which shall include training on all of the following, at minimum:

DHS 105.525(7)(c)2.a. a. All of the topics required under s. DHS 105.52 (6) (d) 4. a., d., e., and f.

DHS 105.525(7)(c)2.b. b. Specific job duties, specified in s. DHS 105.52 (2m) (b).

DHS 105.525(7)(c)2.c. c. The functions of the child care coordination provider staff and how they interrelate and communicate with each other in providing services.

DHS 105.525(7)(c)3. 3. A process for providing instruction when an evaluation of the qualified professional’s or care coordinator’s performance or competency indicates additional instruction may be needed.

DHS 105.525(7)(d) (d) Standards for qualified professional supervision of services rendered by a care coordinator, including the frequency and duration of supervision. When supervision reveals a failure to follow the member’s care plan, the child care coordination provider shall provide counseling, education or retraining to ensure the care coordinator is adequately trained to complete their job responsibilities. In the case of child care coordinators who are not employees of the child care coordination provider, the plan shall specify all required training, qualifications, and services to be performed in a written care coordinator provider contract between the child care coordination provider and care coordinators, and maintain a copy of that contract on file.

DHS 105.525(7)(e) (e) Requirements for ongoing training, including all of the following:

DHS 105.525(7)(e)1. 1. Training and documentation requirements listed in s. DHS 105.52 (6) (g) 1. and 2.

DHS 105.525(7)(e)2. 2. A minimum of 5 hours of annual training for child care coordination provider staff or contractors who have, or are expected to have, regular and direct contact with members. Annual training shall be related to early intervention, education, case management, or similar social service continuing education. Training may be in-service training, conferences, workshops, earning of continuing education credits or earning of higher education credits.

DHS 105.525(8) (8) Member record. The child care coordination agency shall maintain a confidential file for each member receiving child care coordination services, which includes all of the following items required or produced in connection with provision of covered services under s. DHS 107.345 (1):

DHS 105.525(8)(a) (a) All of the items required under s. DHS 105.52 (5) (b) to (d).

DHS 105.525 Note Note: The reference to s. DHS 105.52 (5) (b) to (d) inadvertently omitted a reference to par. (e). Paragraph (a) should read: “All of the items required under s. DHS 105.52 (5) (b) to (e).” This will be corrected in future rulemaking.

DHS 105.525(8)(b) (b) Documentation about any care coordination services provided immediately in urgent situations, including documentation regarding the circumstances and reasons for those services being rendered prior to the initial assessment and care plan.

DHS 105.525(8)(c) (c) Documentation regarding referrals from a child care coordination provider to service providers including all of the following:

DHS 105.525(8)(c)1. 1. The name of the referred provider.

DHS 105.525(8)(c)2. 2. The reason for referral.

DHS 105.525(8)(c)3. 3. The date the referral was made

DHS 105.525(8)(c)4. 4. Any authorizations from the member for release of information.

DHS 105.525(8)(c)5. 5. All communication and follow-up on the referral with both the member and the referred provider.

DHS 105.525(8)(d) (d) All pertinent correspondence relating to coordination of the member’s care.

DHS 105.525(9) (9) Agency closure or discharge of member. Any child care coordination agency that intends to close shall do all of the following:

DHS 105.525(9)(a) (a) Provide written notice to each member, the member’s legal representative, if any, the member’s attending physician and the department at least 30 days before closure.

DHS 105.525(9)(b) (b) Provide assistance to members in arranging for continuity of necessary services. This includes, but is not limited, to coordination with other child care coordination providers to ensure necessary services identified in the care plan are sustained or initiated.

DHS 105.525 History History: EmR2421: emerg. cr., eff. 1-6-25; CR 25-004: cr. Register September 2025 No. 837, eff. 10-1-25; correction in (4) (c), (d), (7) (d) made under s. 35.17, Stats., renumber (7) (c) 5., (i) to (7) (c) 3., (e) under s. 13.92 (4) (b) 1., Stats, and as renumbered, correction in (7) (e) 1. made under s. 12.92 (4) (b) 7., Stats., and renum. (9) (a) to (9) (a) (intro.) and (a) and, as renumbered, correction in (9) made under s. 35.17, Stats., Register September 2025 No. 837.

DHS 105.529 DHS 105.529 Crisis urgent care and observation facilities. For MA certification as a crisis urgent care and observation facility under s. 49.45 (41a), Stats., a provider agency shall be certified to operate under ch. DHS 31.

DHS 105.529 History History: EmR2507: emerg. cr., eff. 6-16-25; CR 25-051: cr. Register February 2026 No. 842, eff. 3-1-26; correction made under s. 35.17, Stats., Register February 2026 No. 842.

DHS 105.53 DHS 105.53 School-based service providers.

DHS 105.53(1) (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.

DHS 105.53(1m) (1m) Definition. In this section, “treatment plan” means any of the following:

DHS 105.53(1m)(a) (a) An MA member’s IEP.

DHS 105.53(1m)(b) (b) An IFSP.

DHS 105.53(1m)(c) (c) A section 504 accommodation plan under 34 CFR 104.36.

DHS 105.53(1m)(d) (d) Any other care plans documenting medical necessity for each service.

DHS 105.53(2) (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.

DHS 105.53(3) (3) Record-keeping requirements.

DHS 105.53(3)(a) (a) For each recipient of school-based services, the provider shall keep a record containing, at a minimum, all of the following:

DHS 105.53(3)(a)1. 1. The member’s first and last name and date of birth.

DHS 105.53(3)(a)2. 2. The prescription or, if referred, the referral for the service.

DHS 105.53(3)(a)3. 3. Documentation used to develop and annually revise the member’s treatment plan.

DHS 105.53(3)(a)4. 4. Annual documentation of the individual’s progress toward treatment goals, as identified in the member’s treatment plan, changes in the individual’s physical or mental status and changes in the treatment plan.

DHS 105.53(3)(b) (b) For each date of service, the provider shall keep a service record within the member’s record containing all of the following:

DHS 105.53(3)(b)1. 1. The date of service.

DHS 105.53(3)(b)2. 2. The general type of service provided.

DHS 105.53(3)(b)3. 3. A brief description of the specific service provided.

DHS 105.53(3)(b)4. 4. The unit of service delivered as defined through handbooks distributed by the department under s. DHS 108.02 (4).

DHS 105.53(3)(b)5. 5. A description and the cost of each durable medical equipment item with sufficient detail to allow the MA program to determine the reimbursement rate, when appropriate.

DHS 105.53(3)(b)6. 6. Documentation of whether the procedure was provided in a group or individual setting, when appropriate.

DHS 105.53(3)(c) (c) Periodically, at least monthly, the provider shall include in the service record under par. (b) the following:

DHS 105.53(3)(c)1. 1. For each service provided, a brief description of the member’s response to the service and progress toward the treatment goals identified in the treatment plan.

DHS 105.53(3)(c)2. 2. The service provider’s signature.

DHS 105.53(3)(d) (d) The provider shall include in the records other information identified by the department in publications in accordance with s. DHS 108.02 (4).

DHS 105.53(4) (4) Reporting requirements. The required annual audit of school district accounts under s. 120.14, Stats., and the audit of CESA receipts and expenditures under s. 115.28 (3m), Stats., shall include evidence, in accordance with instructions distributed by the department under s. DHS 108.02 (4), that requirements for billing and for paying expenses under s. 49.45 (39) (b), Stats., are being met. Sections of those annual audits shall be made available to the department upon request.

DHS 105.53(5) (5) Reimbursement.

DHS 105.53(5)(a) (a) School-based services shall be reimbursed when the services are provided by certified providers or their contractors to members eligible for school-based services.

DHS 105.53(5)(b) (b) Payment, based on the cost to provide the service, shall be made to certified providers of school-based services according to terms of reimbursement established by the department and stated in the medicaid state plan under 42 CFR 430.10.

DHS 105.53(5)(c) (c) Services provided between July 1, 1995 and June 30, 1996 may be billed through June 30, 1997, to the extent allowed by federal law, notwithstanding s. DHS 106.03 (3) (b) 1.

DHS 105.53(6) (6) Coordination with other MA-certified providers.

DHS 105.53(6)(a) (a) Memorandum of understanding with HMO. School-based services providers shall have on file a signed copy of a memorandum of understanding with each HMO participating in the medical assistance HMO program when the geographic service area of the HMO coincides with part or all of the geographic service area of the school-based services provider.

DHS 105.53(6)(b) (b) Coordination with fee-for-service providers. When a member receives similar services from both an MA fee-for-service provider and a school-based service provider, the school-based service provider shall document, at least annually, regular contacts with the MA fee-for-service provider, and provide the MA fee-for-service provider with copies of the member’s treatment plan and relevant components of the multidisciplinary team evaluation under s. 115.80 (3) and (5), Stats., upon request.

DHS 105.53 History History: Emerg. cr. eff. 6-15-96; cr. Register, January, 1997, No. 497, eff. 2-1-97; CR 03-033: am. (3) (a) 3., 4., (c) 1. and (6) (b) Register December 2003 No. 576, eff. 1-1-04; corrections in (3) (b) 4., (d), (4) and (5) (c) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; EmR2512: emerg. cr. (1m), am. (3) (a) 3., 4., (c) 1., (6) (b), eff. 8-11-25; CR 25-078: cr. (1m), am. (3) (a) 1. to 4., (b) (intro.), 1. to 5., (c) 1., (5) (a), (6) (b) Register April 2026 No. 844, eff. 5-1-26.

DHS 105.54 DHS 105.54 Qualified complex rehabilitation technology suppliers.

DHS 105.54(1) (1) Certification. For MA certification, complex rehabilitation technology suppliers shall do all of the following:

DHS 105.54(1)(a) (a) Be accredited by a department recognized accrediting organization.

DHS 105.54(1)(b) (b) Employ at least one complex rehabilitation technology professional.

DHS 105.54(1)(c) (c) Have the capability to service and repair all complex rehabilitation technology provided.

DHS 105.54(2) (2) Client services. Complex rehabilitation technology suppliers shall do all of the following:

DHS 105.54(2)(a) (a) Require a complex rehabilitation technology professional to be present for evaluation and determination of recipients’ complex rehabilitation technology needs.

DHS 105.54(2)(b) (b) Provide recipients with written information about how to receive service and repair for complex rehabilitation technology supplied at the time of delivery.

DHS 105.54(2)(c) (c) Maintain records of proof of delivery in recipients’ files.

DHS 105.54(3) (3) Requirements for managed care organizations. For MA certification, contracts between the department and managed care plans shall require managed care plans to comply with s. 49.45 (9r) (a) 2., Stats., this section, and s. DHS 107.24.

DHS 105.54 History History: CR 20-012: cr. Register October 2021 No. 790, eff. 11-1-21.