Wisconsin Legislature: DHS 152.07(2)(d)

(a) Each patient’s liability in a year for medicare-equivalent deductibles under sub. (3) and coinsurance under sub. (4) may not exceed the following applicable percentage of the family’s income, rounded to the nearest whole dollar, unless the annual deductibles under sub. (3) are greater:

1. For an income of up to $10,000, 3%;

2. For an income of $10,001, to $20,000, 4%;

3. For an income of $20,001 to $40,000, 5%;

4. For an income of $40,001 to $60,000, 6%;

5. For an income of $60,001 to $80,001, 7%;

6. For an income of $80,001 to $100,000, 9%; and

7. For an income of $100,001 and over, 10%.

(b) The limit on liability under par. (a) does not include the income deductible under sub. (2).

(6) Patient copayment. When a pharmacy directly bills the chronic renal disease program for a prescription received by an ESRD patient, the patient is responsible for a $7.50 copayment amount for each generic drug and a $15.00 copayment amount for each brand name drug.

(7) Estate recovery.

(a) An heir or beneficiary of the estate of a patient or a patient’s surviving spouse may apply to the department for a waiver of an estate claim filed by the department pursuant to s. 49.682 or 49.849, Stats. The criteria for granting waivers in s. DHS 108.02 (12) (b) shall apply to applications under this subsection. All of the procedures and rights in s. DHS 108.02 (12) (b) to (e) shall apply to this subsection.

(b) For purposes of applying s. DHS 108.02 (12) (b) to (e) to this subsection the following definitions apply:

1. “Beneficiary” means any person nominated in a will to receive an interest in property other than in a fiduciary capacity;

2. “Decedent” means a deceased patient or the deceased surviving spouse of a patient who received benefits that are subject to recovery under s. 49.682 or 49.849, Stats.;

3. “Heir” means any person who is entitled under the statutes of intestate succession, ch. 852, Stats., to an interest in property of a decedent;

4. “Recipient” means a patient who received reimbursement under s. 49.48, Stats.; and

5. “Waiver applicant” means a beneficiary or heir of a decedent who requests the department to waive an estate claim filed by the department pursuant to s. 49.682 or 49.849, Stats.

(c) The department may make adjustments to and settle estate claims filed under s. 49.682 or 49.849, Stats., to obtain the fullest amount practicable.

- See PDF for table

- See PDF for table

Note: To illustrate how a patient’s coinsurance liability is calculated, assume that the family has 2 members and an annual income of $38,000, and that a bill has been received for treatment in the amount of $600. The patient would be liable for 16% of that bill, or $96.

History: Cr. Register, December, 1994, No. 468, eff. 1-1-95; emerg. cr. (7), eff. 11-1-95; cr. (7), Register, April, 1996, No. 484, eff. 5-1-96; CR 02-070: am. (6) Register October 2002 No. 562, eff. 11-1-02; CR 04-051: am. (2) and (6), cr. (2) (f) to (h) Register November 2004 No. 587, eff. 12-1-04; corrections in (7) (a) and (b) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; corrections in (7) (a), (b) 2., 5., (c) made under s. 13.92 (4) (b) 7., Stats., Register December 2013 No. 696.

DHS 152.07 Standards for renal transplantation centers.

(1) General. To be reimbursed by the CRD program, renal transplantation centers shall comply with the standards in this section.

(2) Staffing. A renal transplantation center shall have the following staff:

(a) A transplant surgeon;

(b) A nephrologist;

(c) Other physicians licensed in Wisconsin or, if employed by an ESRD unit approved under this chapter in a border state, in that state, with experience in the following specialties: cardiology, endocrinology, hematology, neurology, infectious disease, orthopedics, pathology, psychiatry, nuclear medicine, radiology, urology, immunology, anesthesiology, gastroenterology, vascular surgery, pediatrics if pediatric patients are under care, neurosurgery and cardiovascular surgery;

(d) A nurse;

(e) A dietitian; and

(f) A social worker.

(3) Services. The hospital housing the renal transplantation center shall:

(a) Be approved under ss. 50.32 to 50.39, Stats., and ch. DHS 124, meet all the requirements of 42 USC 1395x (e) and be a certified medicare provider;

(b) Be approved under 42 USC 1395rr (b);

(c) Have laboratory services approved for participation in medicare and under 42 CFR 493 (CLIA) available for cross-matching of recipient serum and donor lymphocytes for preformed antibodies by an acceptable technique on a 24-hour emergency basis. Other available laboratory services shall include:

1. Suitable maintenance of recipient sera and typing reagents;

2. Phenotyping for donors and recipients;

3. Updating and retyping for human lymphocyte antigens (HLA);

4. Screening of recipient sera for preformed antibodies with a suitable lymphocyte panel;

5. Testing the mixed lymphocyte cultures to determine cellularly defined antigens;

6. ABO blood grouping and typing;

7. Unusual pathogen culturing, fungal cultures, tissue cultures and tuberculosis cultures;

8. Immunofluorescence and electron microscopy;

9. Urine glucose, protein, and microscopy;

10. Complete blood count (CBC) and platelet count;

11. Blood gases and blood pH;

12. Serum calcium, potassium, phosphorous, and glucose;

13. Blood urea nitrogen (BUN), creatinine, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), lactic dehydrogenase (LDH) and prothrombin time; and

14. Spinal fluid and bone marrow exams;

(d) Have available other support services, including physical therapy, pharmacy, inhalation therapy, blood banking, dialysis, nerve conduction, cardiac catheterization, electroencephalography, diagnostic ultrasound, angiography and diagnostic radioisotopic scanning;

(e) Participate in a patient registry program; and

(f) Provide outpatient services for the evaluation, care and follow-up of renal transplantation patients.

(4) Physical design. In regard to physical design, the renal transplantation center shall:

(a) Provide a minimum of 10 beds to accommodate patients before and after transplantation; and

(b) Have rooms on the unit designed to provide isolation or segregation from patients with an infection or a communicable disease.

(5) Equipment and supplies. In regard to equipment and supplies, the renal transplantation center shall have:

(a) Donor kidney preservation equipment on the premises or available under arrangement or agreement, with donor kidneys preserved by currently acceptable medical methods; and

(b) Emergency resuscitation equipment available on the premises.

(6) Policies and procedures. In regard to policies and procedures, the renal transplantation center shall have:

(a) Unit policies and procedures which shall be in writing and updated at least annually. These policies and procedures shall relate to the operation of the unit and shall include infection control and emergency evacuation policies and procedures; and

(b) Patient care policies and procedures which shall be in writing and updated at least annually. These policies and procedures shall include the development of an individualized care plan for every patient, a list of patient rights and responsibilities and a grievance mechanism which is made available to all patients.

History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; am. (3) (c) 13., Register, December, 1994, No. 468, eff. 1-1-95; correction in (3) (a) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 152.08 Standards for renal dialysis centers and facilities.

(1) General. To be reimbursed by the CRD program, renal dialysis centers and free-standing and hospital-based renal dialysis facilities shall comply with the standards in this section.

(2) Staffing. A renal dialysis center shall have the following staff and a hospital-based renal dialysis facility or a free-standing renal dialysis facility shall make available the following staff directly, under arrangement or under agreement:

(a) A nephrologist;

(b) A vascular surgeon;

(d) A nurse;

(e) A dietitian; and

(f) A social worker.

(3) Services. A renal dialysis center or facility shall:

(a) Be approved under 42 USC 1395rr (b);

(b) Comply with all local ordinances, state rules and federal regulations relating to ambulatory medical care facilities, including but not limited to those for building, zoning, fire and safety, health and civil rights;

(c) Provide self-care dialysis training and kidney transplantation to all suitable patients either directly or under arrangement or agreement;

(d) Have laboratory services approved for participation in medicare and under 42 CFR 493 (CLIA) and available on a 24-hour emergency basis for dialysis-related tests. Laboratory services shall include:

1. Urine glucose and microscopy;

2. Complete blood count (CBC) and platelet count;

3. Prothrombin time;

4. ABO blood grouping, Rh typing and cross-matching;

5. Serum glucose, calcium, potassium, phosphorous and magnesium;

6. Blood urea nitrogen (BUN), creatinine, uric acid, serum glutamic-oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH) and alkaline phosphatase;

7. Blood pH and gases;

8. Pathogen cultures;

9. Tissue typing and spinal fluid analysis; and

10. Serum hepatitis screening;

(e) Maintain clinical records for each patient in accordance with professional principles; and

(f) Have available other support services, including physical therapy, pharmacy, inhalation therapy, blood banking, medical records and nuclear medicine.