Chapter DHS 152

DHS 152.065(5)(a) (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:

DHS 152.065(5)(a)1. 1. For an income of up to $10,000, 3%;

DHS 152.065(5)(a)2. 2. For an income of $10,001, to $20,000, 4%;

DHS 152.065(5)(a)3. 3. For an income of $20,001 to $40,000, 5%;

DHS 152.065(5)(a)4. 4. For an income of $40,001 to $60,000, 6%;

DHS 152.065(5)(a)5. 5. For an income of $60,001 to $80,001, 7%;

DHS 152.065(5)(a)6. 6. For an income of $80,001 to $100,000, 9%; and

DHS 152.065(5)(a)7. 7. For an income of $100,001 and over, 10%.

DHS 152.065(5)(b) (b) The limit on liability under par. (a) does not include the income deductible under sub. (2).

DHS 152.065(6) (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.

DHS 152.065(7) (7) Estate recovery.

DHS 152.065(7)(a) (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.

DHS 152.065(7)(b) (b) For purposes of applying s. DHS 108.02 (12) (b) to (e) to this subsection the following definitions apply:

DHS 152.065(7)(b)1. 1. “Beneficiary” means any person nominated in a will to receive an interest in property other than in a fiduciary capacity;

DHS 152.065(7)(b)2. 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.;

DHS 152.065(7)(b)3. 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;

DHS 152.065(7)(b)4. 4. “Recipient” means a patient who received reimbursement under s. 49.48, Stats.; and

DHS 152.065(7)(b)5. 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.

DHS 152.065(7)(c) (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

DHS 152.065 Note 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.

DHS 152.065 History 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 DHS 152.07 Standards for renal transplantation centers.

DHS 152.07(1) (1) General. To be reimbursed by the CRD program, renal transplantation centers shall comply with the standards in this section.

DHS 152.07(2) (2) Staffing. A renal transplantation center shall have the following staff:

DHS 152.07(2)(a) (a) A transplant surgeon;

DHS 152.07(2)(b) (b) A nephrologist;

DHS 152.07(2)(c) (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;

DHS 152.07(2)(d) (d) A nurse;

DHS 152.07(2)(e) (e) A dietitian; and

DHS 152.07(2)(f) (f) A social worker.

DHS 152.07(3) (3) Services. The hospital housing the renal transplantation center shall:

DHS 152.07(3)(a) (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;

DHS 152.07(3)(b) (b) Be approved under 42 USC 1395rr (b);

DHS 152.07(3)(c) (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:

DHS 152.07(3)(c)1. 1. Suitable maintenance of recipient sera and typing reagents;

DHS 152.07(3)(c)2. 2. Phenotyping for donors and recipients;

DHS 152.07(3)(c)3. 3. Updating and retyping for human lymphocyte antigens (HLA);

DHS 152.07(3)(c)4. 4. Screening of recipient sera for preformed antibodies with a suitable lymphocyte panel;

DHS 152.07(3)(c)5. 5. Testing the mixed lymphocyte cultures to determine cellularly defined antigens;

DHS 152.07(3)(c)6. 6. ABO blood grouping and typing;

DHS 152.07(3)(c)7. 7. Unusual pathogen culturing, fungal cultures, tissue cultures and tuberculosis cultures;

DHS 152.07(3)(c)8. 8. Immunofluorescence and electron microscopy;

DHS 152.07(3)(c)9. 9. Urine glucose, protein, and microscopy;

DHS 152.07(3)(c)10. 10. Complete blood count (CBC) and platelet count;

DHS 152.07(3)(c)11. 11. Blood gases and blood pH;

DHS 152.07(3)(c)12. 12. Serum calcium, potassium, phosphorous, and glucose;

DHS 152.07(3)(c)13. 13. Blood urea nitrogen (BUN), creatinine, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), lactic dehydrogenase (LDH) and prothrombin time; and

DHS 152.07(3)(c)14. 14. Spinal fluid and bone marrow exams;

DHS 152.07(3)(d) (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;

DHS 152.07(3)(e) (e) Participate in a patient registry program; and

DHS 152.07(3)(f) (f) Provide outpatient services for the evaluation, care and follow-up of renal transplantation patients.

DHS 152.07(4) (4) Physical design. In regard to physical design, the renal transplantation center shall:

DHS 152.07(4)(a) (a) Provide a minimum of 10 beds to accommodate patients before and after transplantation; and

DHS 152.07(4)(b) (b) Have rooms on the unit designed to provide isolation or segregation from patients with an infection or a communicable disease.

DHS 152.07(5) (5) Equipment and supplies. In regard to equipment and supplies, the renal transplantation center shall have:

DHS 152.07(5)(a) (a) Donor kidney preservation equipment on the premises or available under arrangement or agreement, with donor kidneys preserved by currently acceptable medical methods; and

DHS 152.07(5)(b) (b) Emergency resuscitation equipment available on the premises.

DHS 152.07(6) (6) Policies and procedures. In regard to policies and procedures, the renal transplantation center shall have:

DHS 152.07(6)(a) (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

DHS 152.07(6)(b) (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.

DHS 152.07 History 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 DHS 152.08 Standards for renal dialysis centers and facilities.

DHS 152.08(1) (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.

DHS 152.08(2) (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:

DHS 152.08(2)(a) (a) A nephrologist;

DHS 152.08(2)(b) (b) A vascular surgeon;

DHS 152.08(2)(c) (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, psychiatry, urology, orthopedics, pathology, pediatrics if children are under care, and radiology;

DHS 152.08(2)(d) (d) A nurse;

DHS 152.08(2)(e) (e) A dietitian; and

DHS 152.08(2)(f) (f) A social worker.

DHS 152.08(3) (3) Services. A renal dialysis center or facility shall:

DHS 152.08(3)(a) (a) Be approved under 42 USC 1395rr (b);

DHS 152.08(3)(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;

DHS 152.08(3)(c) (c) Provide self-care dialysis training and kidney transplantation to all suitable patients either directly or under arrangement or agreement;

DHS 152.08(3)(d) (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:

DHS 152.08(3)(d)1. 1. Urine glucose and microscopy;

DHS 152.08(3)(d)2. 2. Complete blood count (CBC) and platelet count;

DHS 152.08(3)(d)3. 3. Prothrombin time;

DHS 152.08(3)(d)4. 4. ABO blood grouping, Rh typing and cross-matching;

DHS 152.08(3)(d)5. 5. Serum glucose, calcium, potassium, phosphorous and magnesium;

DHS 152.08(3)(d)6. 6. Blood urea nitrogen (BUN), creatinine, uric acid, serum glutamic-oxaloacetic transaminase (SGOT), lactic dehydrogenase (LDH) and alkaline phosphatase;

DHS 152.08(3)(d)7. 7. Blood pH and gases;

DHS 152.08(3)(d)8. 8. Pathogen cultures;

DHS 152.08(3)(d)9. 9. Tissue typing and spinal fluid analysis; and

DHS 152.08(3)(d)10. 10. Serum hepatitis screening;

DHS 152.08(3)(e) (e) Maintain clinical records for each patient in accordance with professional principles; and

DHS 152.08(3)(f) (f) Have available other support services, including physical therapy, pharmacy, inhalation therapy, blood banking, medical records and nuclear medicine.