Register December 2013 No. 696
Chapter DHS 152
REIMBURSEMENT FOR TREATMENT OF CHRONIC RENAL DISEASE
DHS 152.01   Authority and purpose.
DHS 152.02   Definitions.
DHS 152.03   Eligibility and certification.
DHS 152.035   Events which affect eligibility.
DHS 152.04   Patient rights and responsibilities.
DHS 152.05   Certification of renal transplantation centers, dialysis centers and dialysis facilities.
DHS 152.06   Provider reimbursement.
DHS 152.065   Patient liability.
DHS 152.07   Standards for renal transplantation centers.
DHS 152.08   Standards for renal dialysis centers and facilities.
DHS 152.09   CRD program advisory committee.
Ch. DHS 152 Note Note: Chapter H 52 as it existed on June 30, 1988, was repealed and a new chapter HSS 152 was created effective July 1, 1988. Chapter HSS 152 as it existed on September 30, 1999, was renumbered to chapter HFS 152, Register, September, 1999, No. 525, eff. 10-1-99 and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, September, 1999, No. 525. Chapter HFS 152 was renumbered chapter DHS 152 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.
DHS 152.01 DHS 152.01Authority and purpose. This chapter is promulgated under the authority of ss. 49.68 (2), 49.687 (1) and 227.11 (2) (a), Stats., to implement a treatment cost reimbursement program for residents of Wisconsin who have chronic renal disease.
DHS 152.01 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; am. Register, December, 1994, No. 468, eff. 1-1-95.
DHS 152.02 DHS 152.02Definitions. In this chapter:
DHS 152.02(1) (1) “Agreement" means a written document executed between an ESRD unit and another unit, in which the other unit agrees to assume responsibility for furnishing specified services to patients and for obtaining reimbursement for those services.
DHS 152.02(2) (2) “Arrangement" means a written document executed between an ESRD unit and another unit, in which the other unit agrees to furnish specified services to patients but the ESRD unit retains responsibility for the services and for obtaining reimbursement.
DHS 152.02(2m) (2m) “BadgerCare" means the medical assistance-related program established under s. 49.665, Stats., and chs. DHS 101 to 108.
DHS 152.02(3) (3) “Chronic renal disease" or “CRD" means that stage of renal impairment which is virtually irreversible and requires a regular course of dialysis or kidney transplantation to maintain life.
DHS 152.02(4) (4) “CRD program advisory committee" means the committee appointed by the department under s. DHS 152.09.
DHS 152.02(4m) (4m) “Current year" means the 12-month period beginning with the month of a patient's first application to the CRD program, or beginning with the month of a certified patient's subsequent annual recertification for the CRD program.
DHS 152.02(5) (5) “Department" means the department of health services.
DHS 152.02(6) (6) “Dialysis" means a process by which dissolved substances are removed from a patient's body by diffusion and osmosis from one fluid compartment to another across a semipermeable membrane.
DHS 152.02(7) (7) “Dietitian" means a person who is eligible for registration by the American dietetic association and has at least 1 year of experience in clinical nutrition, or a person who has a baccalaureate or advanced degree with major studies in food and nutrition or dietetics and at least 1 year of experience in clinical nutrition.
DHS 152.02(8) (8) “End-stage renal disease" or “ESRD" has the meaning prescribed for chronic renal disease or CRD in sub. (3).
DHS 152.02(9) (9) “ESRD unit" or “unit" means a free-standing or hospital-based renal dialysis facility, a renal dialysis center or a renal transplantation center.
DHS 152.02(9m) (9m) “Family" means a patient and that patient's spouse, if any, and any other person who is claimed as a dependent of that patient or that patient's spouse or who claims that patient as a dependent under the U.S. internal revenue code for the purpose of filing a federal income tax return.
DHS 152.02(9t) (9t) “Federal poverty guidelines" means the annually updated poverty income thresholds by family size published each year by the U.S. department of health and human services in the federal register.
DHS 152.02 Note Note: The federal poverty guidelines for 1999 were published in the Federal Register, March 18, 1999, 13428.
DHS 152.02(9u) (9u) “Fiscal agent" means the organization under contract to the department to process claims and determine eligibility for services provided under the CRD program.
DHS 152.02(10) (10) “Free-standing renal dialysis facility" means a non-hospital unit which is approved by the department under this chapter to furnish chronic maintenance dialysis with or without self-care dialysis training.
DHS 152.02(11) (11) “Furnishes directly" means that the ESRD unit provides the service through its own staff and employees, or through individuals who are under personal contract to furnish services for the facility.
DHS 152.02(12) (12) “Home dialysis" means dialysis performed by a trained ESRD patient or helper, or both, at home.
DHS 152.02(13) (13) “Hospital-based renal dialysis facility" means a hospital unit approved by the department to furnish one or more of the following dialysis services to ESRD patients:
DHS 152.02(13)(a) (a) Outpatient dialysis;
DHS 152.02(13)(b) (b) Inpatient dialysis;
DHS 152.02(13)(c) (c) Home dialysis;
DHS 152.02(13)(d) (d) Self-dialysis training.
DHS 152.02(14)(a)(a) “Income," for the period January 1, 1994 to June 30, 1994, has the meaning prescribed in s. 49.485 (1) (dm), 1991 Stats., except that a certified patient may for that period elect to use the definition under par. (b).
DHS 152.02(14)(b) (b) “Income," beginning July 1, 1994, means a family's total earnings, including wages and salary and net income from self-employment, as well as unearned income including social security and supplemental security income, dividends and interest income, income from estates or trusts, net rental income, public assistance, pensions or annuities, unemployment compensation, maintenance or alimony, child support or family support, nontaxable deferred compensation, and nontaxable interest such as interest on federal, state or municipal bonds, but not capital gains income.
DHS 152.02(15) (15) “Inpatient dialysis" means dialysis which, because of medical necessity, is furnished to an ESRD patient on a temporary basis in a hospital.
DHS 152.02(15m) (15m) “Medical assistance" has the meaning specified in s. 49.43 (8), Stats.
DHS 152.02(16) (16) “Medicare" means the health insurance program operated by the U.S. department of health and human services under 42 USC 1395 to 1395zz and 42 CFR Pts. 405 to 421.
DHS 152.02(17) (17) “Nephrologist" means a physician licensed in Wisconsin or, if employed by an ESRD unit approved under this chapter in a border state, in that state, who is board-eligible or board-certified by the American board of internal medicine, or by an equivalent certifying body as determined by the department on recommendation of the CRD program advisory committee, and who has a minimum of 12 months of fellowship training in nephrology or 2 years of experience in delivering care to ESRD patients. Pediatric training may be substituted for internal medicine board eligibility or board certification if the ESRD unit's services are associated with pediatric ESRD care.
DHS 152.02(18) (18) “Nurse" means a full-time supervisory nurse registered in Wisconsin or, if employed by an ESRD unit approved under this chapter in a border state, in that state, with at least 12 months of experience in clinical nursing and an additional 6 months of experience in nursing care of an outpatient dialysis or kidney transplantation patient, including training in and experience with the dialysis process, or 18 months of experience in nursing care of an outpatient dialysis or kidney transplantation patient, including training in and experience with the dialysis process. If the nurse is in charge of home dialysis or self-dialysis training, at least 3 months of the total required ESRD experience shall be in home dialysis or self-dialysis patient training.
DHS 152.02(19) (19) “Outpatient dialysis" means dialysis which is regularly furnished on an outpatient basis to an ESRD patient in a renal dialysis center, hospital-based renal dialysis facility or a free-standing renal dialysis facility.
DHS 152.02(20) (20) “Patient" means a person who has been diagnosed as having ESRD and who receives treatment for ESRD. “Patient" does not include a kidney donor.
DHS 152.02(21) (21) “Patient registry program" means a computerized list of all certified patients on dialysis which includes verification that each case has been reviewed by a transplant surgeon and that cases meeting criteria for a transplant are placed on the transplant list.
DHS 152.02(22) (22) “Provider" means a renal dialysis facility or center, a renal transplantation center, or another source of dialysis or transplantation services approved by the department.
DHS 152.02(23) (23) “Renal dialysis center" means a hospital unit approved by the department to furnish the full spectrum of diagnostic services, therapeutic services including inpatient dialysis furnished directly or under arrangement, and rehabilitative services, except renal transplantation, required for the care of ESRD patients.
DHS 152.02(24) (24) “Renal transplantation center" means a hospital unit approved by the department to furnish transplantation and other medical and surgical specialty services required for the care of ESRD transplant patients, including inpatient dialysis furnished directly or under arrangement or agreement.
DHS 152.02(25) (25) “Resident" means any person who is living in Wisconsin with the intention of remaining permanently in the state. A person under the age of 18 is a resident if he or she is determined to be a resident in accordance with s. DWD 11.15.
DHS 152.02 Note Note: DWD 11.15 was repealed eff. 4-1-02.
DHS 152.02(26) (26) “Self-dialysis" means dialysis which is regularly furnished on an outpatient basis to an ESRD patient in a renal dialysis center, hospital-based renal dialysis facility or a free-standing renal dialysis facility, in which the ESRD patient is responsible for the dialysis treatment but is supervised by a dialysis nurse.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.