Clarify any areas of concern or questions regarding medical services;
Elicit from the patient evidence of a complete understanding of the use of family planning methods;
Effectively inform the patient what procedures are to be followed if problems are experienced;
Inform the patient about the clinic's follow-up procedures and possible referral to other community resources; and
All medical and related services shall be provided by or under the supervision and responsibility of a physician.
Prescription of the family planning method selected by the patient unless medically contraindicated;
Instructions on the use of the chosen method, provision of supplies and schedule for revisits; and
Referral to inpatient service when necessary to treat complications of contraceptive services provided by the clinic.
Equipment and supplies in the clinic shall be commensurate with the services offered. Sufficient first aid equipment shall be available for use when needed.
Treatment for minor vaginal infections and venereal disease may be made available either by the clinic or through referral.
The family planning clinic shall be designed to provide comfort and dignity for the patients and to facilitate the work of the staff. A clinic facility shall be adequate for the quantity of services provided, and shall include:
A comfortable waiting room with an area for patient reception, record processing and children's play;
A group conference room for staff meetings and patient education;
A work room or laboratory area with sufficient equipment and nearby storage space, none of which is accessible to the patient;
A sufficient number of private and well-equipped examining rooms with proximal dressing areas which ensure the dignity of the patient;
Adequate toilet facilities, preferably near the dressing room; and
Arrangements for routine and restorative facility maintenance.
DHS 105.36 Note
For covered family planning services, see s. DHS 107.21
DHS 105.36 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86; r. (2) (e), (7) (b) 6., renum. (2) (f) and (g) to be (2) (e) and (f), (7) (b) 7. to be (7) (b) 6., Register, January, 1997, No. 493
, eff. 2-1-97; correction in (1) (b) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528
DHS 105.37 Early and periodic screening, diagnosis and treatment (EPSDT) providers. DHS 105.37(1)(1)
EPSDT health assessment and evaluation services. DHS 105.37(1)(a)
(a) Eligible providers.
The following providers are eligible for certification as providers of EPSDT health assessment and evaluation services:
EPSDT providers shall provide periodic comprehensive child health assessments and evaluations of the general health, growth, development and nutritional status of infants, children and youth. Immunizations shall be administered at the time of the screening if determined medically necessary and appropriate. The results of a health assessment and evaluation shall be explained to the recipient's parent or guardian and to the recipient if appropriate.
EPSDT health assessment and evaluation services shall be delivered under the supervision of skilled medical personnel. In this section “skilled medical personnel" means physicians, physician assistants, nurse practitioners, public health nurses or registered nurses. Skilled medical personnel who perform physical assessment screening procedures shall have successfully completed either a formal pediatric assessment or an inservice training course on physical assessments approved by the department. Individual procedures may be completed by paraprofessional staff who are supervised by skilled medical personnel. Registered nurses who perform EPSDT physical assessments shall have satisfactorily completed a curriculum for pediatric physical assessments approved by the department.
All conditions uncovered which warrant further care shall be diagnosed or treated or both by the provider, if appropriate, or referred to other appropriate providers. A referral may either be a direct referral to the appropriate health care provider or a referral recommendation submitted through the agency responsible for the patient's case management and advocacy.
Health maintenance organizations and prepaid health plans providing EPSDT services shall meet all requirements of 42 CFR 441.60
in addition to the requirements under subds. 1.
Complete the department's EPSDT claim form and an individual health and developmental history for each client; and
Maintain a file on each client receiving EPSDT services which includes a copy of the EPSDT claim form, individual health and developmental history and follow-up for necessary diagnosis and treatment services.
The EPSDT provider shall release information on the results of the health assessment to appropriate health care providers and health authorities when authorized by the patient or the patient's parent or guardian to do so.
DHS 105.37(2)(a)(a) Case management reimbursement.
Providers certified under sub. (1)
as providers of EPSDT health assessment and evaluation services shall be eligible to receive reimbursement for EPSDT case management in accordance with the limitations contained in the case management agreement between the provider and the department.
All EPSDT providers who apply to receive reimbursement for EPSDT case management services shall submit to the department a case management plan. The case management plan shall describe the geographic service area, target population, coordination with support activities conducted by the department and other health-related services, case management activities and the method of documenting the activities.
The department shall evaluate the adequacy of each provider's case management plan according to the case management requirements of the proposed service area and target population, the extent to which the plan would ensure that children receive the necessary diagnosis and treatment services for conditions detected during EPSDT health examinations, the proposed coordination with the EPSDT central notification system and other health related services, and proposed methods for documenting case management services. Based on the evaluation, the department shall either approve or deny the provider's request for reimbursement of case management activities and shall impose on providers as conditions for reimbursement any personnel, staffing or procedural requirements that it determines are necessary pursuant to 42 CFR 441
(c) Records and documentations.
Providers shall maintain records and documentation required by the department in order to verify appropriate use of funds provided by the department for EPSDT case management activities.
(3) Diagnosis and treatment services.
Providers of diagnosis and treatment services for EPSDT recipients shall be certified according to the appropriate provisions of this chapter.
DHS 105.37 Note
For covered EPSDT services, see s. DHS 107.22
DHS 105.37 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86.
For MA certification, ambulance service providers shall be licensed pursuant to s. 256.15
, Stats., and ch. DHS 110
, and shall meet ambulance inspection standards of the Wisconsin department of transportation under s. 341.085
, Stats., and ch. Trans 309
An ambulance service provider that also provides air ambulance services shall submit a separate application under s. DHS 105.01
for certification as an air ambulance provider.
DHS 105.38 Note
Note: For a copy of the application form for an ambulance service provider license, write the EMS Section, Division of Public Health, P.O. Box 2659, Madison, Wisconsin, 53701.
DHS 105.38 Note
For covered transportation services, see s. DHS 107.23
DHS 105.38 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86; renum. 105.38 to 105.38 (1) and am., cr. (2), Register, November, 1994, No. 467
, eff. 12-1-94; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520
; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636
DHS 105.39 Specialized medical vehicle providers. DHS 105.39(1)(1)
For MA certification, a specialized medical vehicle provider shall meet the requirements of this section and shall sign the affidavit required under sub. (6)
stipulating that the provider is in compliance with the requirements of this section as well as with the requirements of the department of transportation for human service vehicles under ss. 110.05
and 340.01 (23g)
, Stats., and ch. Trans 301
, and shall provide proof of compliance when requested by the department.
Insurance of not less than $250,000 personal liability for each person, not less than $500,000 personal liability for each occurrence and not less than $10,000 property damage shall be carried on each specialized medical vehicle used to transport a recipient.
Each vehicle shall be inspected and the inspection documented at least every 7 days by an assigned driver or mechanic, to ensure:
The proper functioning of the vehicle systems including but not limited to all headlights, emergency flasher lights, turn signal lights, tail lights, brake lights, clearance lights, internal lights, windshield wipers, brakes, front suspension and steering mechanisms, shock absorbers, heater and defroster systems, structural integrity of passenger compartment, air conditioning system, wheelchair locking systems, doors, lifts and ramps, moveable windows and passenger and driver restraint systems;
That all brakes, front suspension and steering mechanisms and shock absorbers are functioning correctly;
That all tires are properly inflated according to vehicle or tire manufacturers' recommendations and that all tires possess a minimum of 1/8-inch of tread at the point of greatest wear; and
The driver inspecting the vehicle shall document all vehicle inspections in writing, noting any deficiencies.
All deficiencies shall be corrected before any recipient is transported in the vehicle. Corrections shall be documented by the driver. Documentation shall be retained for not less than 12 months, except as authorized in writing by the department.
Windows, windshield and mirrors shall be maintained in a clean condition with no obstruction to vision.
Police, sheriff's department and ambulance emergency telephone numbers shall be posted on the dash of the vehicle in an easily readable manner. If the vehicle is not equipped with a working two-way radio, sufficient money in suitable denominations shall be carried to enable not less than 3 local telephone calls to be made from a pay telephone.
A provider shall maintain a list showing for each vehicle its registration number, identification number, license number, manufacturer, model, year, passenger capacity, insurance policy number, insurer, types of restraint systems for wheelchairs and whether it is fitted with a wheelchair lift or with a ramp. Attached to the list shall be evidence of compliance with ch. Trans 301
The vehicle shall be equipped at all times with a flashlight in working condition, a first aid kit and a fire extinguisher. The fire extinguisher shall be periodically serviced as recommended by the local fire department.
The vehicle shall be equipped with a lift or ramp for loading wheelchairs. The vehicle shall also be equipped with passenger restraint devices for each passenger, including restraint devices for recipients in wheelchairs or on cots or stretchers as defined in s. DHS 107.23 (1) (c) 4.
Both a recipient and the recipient's wheelchair, cot or stretcher shall be secured.
Provision shall be made for secure storage of removable equipment and passenger property in order to prevent projectile injuries to passengers and the driver in the event of an accident.
Each driver shall possess a valid regular or commercial operator's license which shall be unrestricted, except that the vision restrictions may be waived if the driver's vision is corrected to an acuity of 20/30 or better by the use of corrective lenses. In this event, the driver shall wear corrective lenses while transporting recipients.
Each driver before driving a vehicle or serving as an attendant shall have received all of the following:
Basic Red Cross or equivalent training in first aid and cardiopulmonary resuscitation (CPR);