DHS 101.03(92)(b) (b) “Hospital laboratory” means a laboratory operated under the supervision of a hospital or its organized medical staff that serves hospital patients.

DHS 101.03(92)(c) (c) “Physician’s office laboratory” means a laboratory maintained by a physician for performing diagnostic tests for his or her own patients.

DHS 101.03 Note Note: A physician’s office laboratory which accepts at least 100 specimens in any category during any calendar year on referral from other physicians is considered an independent laboratory.

DHS 101.03(93) (93) “Legally responsible” means a spouse’s liability for the support of a spouse or a parent’s liability for the support of a child as specified in s. 49.90, Stats.

DHS 101.03(94) (94) “Legend drug” means, for the purposes of MA, any drug requiring a prescription under 21 USC 353 (b).

DHS 101.03(94m) (94m) “Medicaid purchase plan” means the medical assistance program allowed under 42 USC 1396a (a) (10) (A) (ii) and s. 49.472, Stats.

DHS 101.03(94p) (94p) “Medicaid review period” is the calendar month of a medical assistance recipient’s application plus 11 calendar months or the medicaid eligibility review calendar month plus 11 calendar months.

DHS 101.03(94r) (94r) “Medical expense” means a cost paid by a medicaid purchase plan recipient, an institutionalized person, or someone receiving home and community-based services for goods or services that have been prescribed or provided by a medical practitioner licensed in Wisconsin or another state. The cost is not reimbursable by another source such as medicare, medical assistance, private insurance or an employer. Medical expenses may be used to expend excess income during a spend-down period.

DHS 101.03(95) (95) “Medical assistance” or “MA” means the assistance program operated by the department under ss. 49.43 to 49.497, Stats., any services or items under ss. 49.45 to 49.497, Stats., and this chapter and chs. DHS 102 to 108, or any payment or reimbursement made for these services or items.

DHS 101.03(96) (96) “Medical assistance group” or “MA group” means all persons listed on an application for MA who meet nonfinancial eligibility requirements, except that each SSI recipient comprises a separate MA group.

DHS 101.03(96m) (96m) “Medically necessary” means a medical assistance service under ch. DHS 107 that is:

DHS 101.03(96m)(a) (a) Required to prevent, identify or treat a recipient’s illness, injury or disability; and

DHS 101.03(96m)(b) (b) Meets the following standards:

DHS 101.03(96m)(b)1. 1. Is consistent with the recipient’s symptoms or with prevention, diagnosis or treatment of the recipient’s illness, injury or disability;

DHS 101.03(96m)(b)2. 2. Is provided consistent with standards of acceptable quality of care applicable to the type of service, the type of provider and the setting in which the service is provided;

DHS 101.03(96m)(b)3. 3. Is appropriate with regard to generally accepted standards of medical practice;

DHS 101.03(96m)(b)4. 4. Is not medically contraindicated with regard to the recipient’s diagnoses, the recipient’s symptoms or other medically necessary services being provided to the recipient;

DHS 101.03(96m)(b)5. 5. Is of proven medical value or usefulness and, consistent with s. DHS 107.035, is not experimental in nature;

DHS 101.03(96m)(b)6. 6. Is not duplicative with respect to other services being provided to the recipient;

DHS 101.03(96m)(b)7. 7. Is not solely for the convenience of the recipient, the recipient’s family or a provider;

DHS 101.03(96m)(b)8. 8. With respect to prior authorization of a service and to other prospective coverage determinations made by the department, is cost-effective compared to an alternative medically necessary service which is reasonably accessible to the recipient; and

DHS 101.03(96m)(b)9. 9. Is the most appropriate supply or level of service that can safely and effectively be provided to the recipient.

DHS 101.03(97) (97) “Medically needy” means the group of persons who meet the non-financial eligibility conditions for MA, but whose income exceeds the financial eligibility limits for categorically needy MA groups. Medically needy eligibility exists if applicant’s income does not exceed, for the applicant’s family size, the income limits under. s. 49.47 (4) (c) 1. or 49.471 (7), Stats.

DHS 101.03(98) (98) “Medicare” means the health insurance program operated by the U.S. department of health and human services under 42 USC 1395 and 42 CFR subchapter B.

DHS 101.03(99) (99) “Modality” means a treatment involving physical therapy equipment that does not require the physical therapist’s personal continuous attendance during the periods of use but that does require setting up, frequent observation, and evaluation of the treated body part by the physical therapist prior to and after treatment.

DHS 101.03(100) (100) “Net income” means the amount of the applicant’s income that is left after deductions are made for allowable expenses and income disregards.

DHS 101.03(101) (101) “Net market value” means for the purposes of divestment the fair market value of the resource on the date it was disposed of less the reasonable costs of the transaction on the open market.

DHS 101.03(101m) (101m) “Networking of existing resources” means the identification of and referral to an agency in the person’s community for any services necessary to overcome the person’s barriers to employment.

DHS 101.03(102) (102) “Non-billing performing provider number” means the provider number assigned to an individual who is under professional supervision in order to be an eligible provider. A non-billing provider is not directly reimbursed for services rendered to an MA recipient.