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 History
History: 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 105.52
DHS 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:
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 American dietetic association 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 a health care or family services program; or
DHS 105.52(2)(a)9.
9. A health educator with a master's degree in health education and at least 2 years of experience in community health services.
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:
DHS 105.52(2)(b)1.
1. Employ at least one qualified professional with at least 2 years of experience in coordinating services for at-risk or low income women;
DHS 105.52(2)(b)2.
2. Have on staff, under contract or available in a volunteer capacity a qualified professional to supervise risk assessment and ongoing care coordination and monitoring; and
DHS 105.52(2)(b)3.
3. Have on staff, under contract or available in a volunteer capacity one or more qualified professionals with the necessary expertise, based on education or at least one year of work experience, to provide health education and nutrition counseling.
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 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 risk assessment and ongoing care coordination under sub.
(2) (b) 2. and to provide health education or nutrition counseling under sub.
(2) (b) 3. Upon the department's request, an agency shall promptly report to the department in writing the names of persons hired to provide prenatal care coordination services under MA and the termination of employees who have been providing prenatal care coordination services under MA.
DHS 105.52(4)
(4)
Administrative records and required documentation. To be certified to provide prenatal care coordination services reimbursable under MA, the prenatal care coordination agency under sub.
(1) shall comply with s.
DHS 106.02 (9) and shall submit a plan to the department documenting:
DHS 105.52(4)(b)
(b) That the agency has a variety of techniques to identify low-income pregnant women;
DHS 105.52(4)(c)
(c) That, at a minimum, the agency has the name, location and telephone number of the following resources in the area to be served:
DHS 105.52(4)(c)5.
5. Mental health and alcohol or other drug abuse prevention and treatment agencies;
DHS 105.52(4)(c)8.
8. Translator and interpreter services including services for the hearing-impaired;
DHS 105.52(4)(c)11.
11. MA-certified primary care and obstetric providers, including health maintenance organizations participating in the medical assistance program's HMO program.
DHS 105.52(4)(d)
(d) That the agency, if located in a county with health maintenance organizations (HMO) participating in the medical assistance HMO program, has on file a signed copy of a memorandum of understanding with each HMO participating in the medical assistance HMO program in the county;
DHS 105.52(4)(e)
(e) That the agency has contacted in writing MA-certified primary and obstetric care providers in its area and has identified the types of services the prenatal care coordination agency provides. These contacts and this information shall be documented and the documentation retained in the agency's administrative records;
DHS 105.52(4)(f)
(f) That the agency has the ability and willingness to deliver services in a manner that is sensitive to the particular characteristics of the racial or ethnic group or groups with which it intends to work. Documentation of that ability shall be maintained and kept up-to-date. Documentation shall consist of one or more of the following at all times:
DHS 105.52(4)(f)1.
1. Records showing the racial and ethnic composition of the population served in the past;
DHS 105.52(4)(f)2.
2. Records showing that the agency has developed, implemented and evaluated programs specifically targeted toward the racial or ethnic group or groups;
DHS 105.52(4)(f)3.
3. Records showing that the agency has provided health care services in a geographic area where a significant percentage of the population was the same as the agency's targeted racial or ethnic group or groups;
DHS 105.52(4)(f)4.
4. Evidence that the agency's board or administration has a significant amount of representation from the targeted group or groups;
DHS 105.52(4)(f)5.
5. Letters of support from minority health service organizations which represent the targeted group or groups; or
DHS 105.52(4)(f)6.
6. Evidence of the agency's ability to address pertinent cultural issues such as cultural norms and beliefs, language, outreach networking and extended family relationships;
DHS 105.52(4)(g)
(g) That the agency has the ability to arrange for supportive services provided by other funding sources such as county transportation, county protective services, interpreter services, child care services and housing. This description shall include the methods, techniques and contacts which will be used to offer and provide assistance in accessing those services;
DHS 105.52(4)(h)
(h) That the agency has the capability to provide ongoing prenatal care coordination monitoring of high-risk pregnant women and to ensure that all necessary services are obtained; and
DHS 105.52(4)(i)
(i) That the agency has on staff, under contract or available in a volunteer capacity, individuals who are qualified professionals under sub.
(2) (a) with the expertise required under sub.
(2) (b).
DHS 105.52(5)
(5)
Recipient record. The prenatal care coordination agency shall maintain a confidential prenatal care coordination file for each recipient receiving prenatal care coordination services, which includes the following items required or produced in connection with provision of covered services under s.
DHS 107.34 (1):
DHS 105.52(5)(e)
(e) A written record of all recipient-specific prenatal care coordination monitoring which includes, but is not limited to: the dates of service, description of service provided, the staff person doing the monitoring, the contacts made and the results;
DHS 105.52(5)(g)
(g) All pertinent correspondence relating to coordination of the recipient's prenatal care.
DHS 105.52 History
History: Cr.
Register, June, 1994, No. 462, eff. 7-1-94;
CR 03-033: am. (1) (L), (2) (a) (intro.), 1., 6. to 8.
Register December 2003 No. 576, eff. 1-1-04; corrections in (1) (intro.), (2) (a) 3., (4) (intro.) and (5) made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
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(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)(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)3.
3. Documentation used to develop the recipient's IEP and to annually revise the IEP; and
DHS 105.53(3)(a)4.
4. Annual documentation of the individual's progress toward treatment goals identified in the IEP, changes in the individual's physical or mental status and changes in the treatment plan identified in the IEP.
DHS 105.53(3)(b)
(b) For each date of service, the provider shall keep a service record within the recipient's record containing all of the following:
