Wisconsin Legislature: DHS 105.39(4)(b)1.

Alert! This chapter may be affected by an emergency rule:

EmR2421

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.38 Ambulance providers.

(1) 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.

(2) 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.

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.

Note: For covered transportation services, see s. DHS 107.23.

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.

(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.

(2) Vehicles.

(a) 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.

(b) Each vehicle shall be inspected and the inspection documented at least every 7 days by an assigned driver or mechanic, to ensure:

1. 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;

2. That all brakes, front suspension and steering mechanisms and shock absorbers are functioning correctly;

3. 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

4. That windshields and mirrors are free from cracks or breaks.

(d) 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.

(e) Windows, windshield and mirrors shall be maintained in a clean condition with no obstruction to vision.

(f) Smoking is not permitted in the vehicle.

(g) 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.

(h) 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.

(3) Vehicle equipment.

(a) 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.

(b) 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.

(c) 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.

(4) Drivers.

(a) 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.

(b)

1. Each driver before driving a vehicle or serving as an attendant shall have received all of the following:

a. Basic Red Cross or equivalent training in first aid and cardiopulmonary resuscitation (CPR);

b. Specific instructions on care of passengers in seizure; and

c. Specific instructions in the use of all ramps, lift equipment and restraint devices used by the provider.

2. Each driver shall receive refresher training in first aid at least every 3 years and shall maintain CPR certification. A driver who is an emergency medical services practitioner licensed under ch. DHS 110, a licensed practical nurse, a registered nurse or a physician assistant shall be considered to have met these requirements by completion of continuing education which includes first aid and CPR.

(c) The provider shall maintain a current list of all drivers showing the name, license number and any driving violations or license restrictions of each and shall keep that list current.

(5) Company policy. Company policies and procedures shall include:

(a) Compliance with state and local laws governing the conduct of businesses, including ch. Trans 301.

(b) Establishment and implementation of scheduling policies that assure timely pick-up and delivery of passengers going to and returning from medical appointments;

1. For medical purposes only;

2. Ordered by the attending provider of medical service; and

3. Provided only to persons who require this transportation because they lack other means of transport, and who are also physically or mentally incapable of using public transportation;

(d) Maintenance of records of services for 5 years, unless otherwise authorized in writing by the department; and

(e) On request of the department, making available for inspection records that document both medical service providers’ orders for services and the actual provision of services.

(6) Affidavit. The provider shall submit to the department a notarized affidavit attesting that the provider meets the requirements listed in this section. The affidavit shall be on a form developed by and available from the department, and shall contain the following:

(a) A statement of the requirements listed in this section;

(b) The date the form is completed by the provider;

(d) The name and signature of the provider or a person authorized to act on behalf of the provider; and

(e) A notarization.

Note: For covered transportation services, see s. DHS 107.23.

(7) Denial of recertification. If a provider violates provisions of this chapter, s. DHS 106.06, 107.23 or any other instruction in MA program manuals, handbooks, bulletins or letters on provision of SMV services 3 times in a 36-month period, the department may deny that provider’s request for re-certification.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1), (2) (a), (b) (intro.), 1., (3) (a), (b), (4) (a), (5) (a), renum. (2) (b) 2. and 3. to be 3. and 4., cr. (2) (b) 2., (h), (7), r. and recr. (4) (b), (c), Register, November, 1994, No. 467, eff. 12-1-94; reprinted to restore dropped copy in (3), Register, January, 1997, No. 493; emerg. am. (4) (b) 3., eff. 7-3-99; am. (4) (b) 3., Register, December, 1999, No. 528, eff. 1-1-00; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 03-033: r. (4) (b) 2., renum. (4) (b) 3. to be (4) (b) 2. Register December 2003 No. 576, eff. 1-1-04; corrections in (3) (b), (4) (b) 2. and (7) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (4) (b) 2. made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; CR 20-039: am. (4) (b) 2. Register October 2021 No. 790, eff. 11-1-21.

DHS 105.40 Durable medical equipment and medical supply vendors.

(1) Except as provided in sub. (2), vendors of durable medical equipment and medical supplies shall be eligible to participate in the MA program.

(2) Orthotists and prosthetists who develop and fit appliances for recipients shall be certified by the American board for certification in orthotics and prosthetics (A.B.C.). Certification shall be a result of successful participation in an A.B.C. examination in prosthetics, orthotics, or both, and shall be for:

(a) Certified prosthetist (C.P.);

(b) Certified orthotist (C.O.); or

Note: For covered durable medical equipment and medical supply services, see s. DHS 107.24.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.41 Certification of hearing instrument specialists. For MA certification, hearing instrument specialists shall be licensed pursuant to ss. 459.01 to 459.14, Stats.

Note: For covered hearing aids and supplies, see s. DHS 107.24.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; CR 03-033: am. Register December 2003 No. 576, eff. 1-1-04.

DHS 105.42 Physician office laboratories.

(1) Requirements. For MA certification, physician office laboratories, except as noted in sub. (2), shall be licensed pursuant to 42 CFR 493 (CLIA).

(2) Exception. Physician office laboratories servicing no more than 2 physicians, chiropractors or dentists, and not accepting specimens on referral from outside providers, are not required to be licensed under 42 CFR 493 (CLIA). These laboratories, however, shall submit an affidavit to the department declaring that they do not accept outside specimens.

(3) Medicare certification requirement. Physician office laboratories which accept referrals of 100 or more specimens a year in a specialty shall be certified to participate in medicare in addition to meeting the requirements under sub. (1).

Note: For covered diagnostic testing services, see s. DHS 107.25.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) and (2) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.43 Hospital and independent clinical laboratories. For MA certification, a clinical laboratory that is a hospital laboratory or an independent laboratory shall be licensed pursuant to 42 CFR 493 (CLIA). In addition, the laboratory shall be certified to participate in medicare and meet the requirements of 42 CFR 405.1310 to 405.1317.

Note: For covered diagnostic testing services, see s. DHS 107.25.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.44 Portable x-ray providers. For MA certification, a portable x-ray provider shall be directed by a physician or group of physicians, registered pursuant to s. 254.35, Stats., and ch. DHS 157, certified to participate in medicare, and shall meet the requirements of 42 CFR 405.1411 to 405.1416.

Note: For covered diagnostic testing services, see s. DHS 107.25.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528; correction made under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.45 Dialysis facilities. For MA certification, dialysis facilities shall meet the requirements enumerated in ss. DHS 152.05 and 152.08, and shall be certified to participate in medicare.

Note: For covered dialysis services, see s. DHS 107.26.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, November, 1994, No. 467; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.46 Blood banks. For MA certification, blood banks shall be licensed or registered with the U.S. food and drug administration and shall be approved pursuant to 42 CFR 493 (CLIA).

Note: For covered blood services, see s. DHS 107.27.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.47 Health maintenance organizations and prepaid health plans.

(1) Contracts and licensing. Except as provided in sub. (3), for MA certification, a health maintenance organization or prepaid health plan shall enter into a written contract with the department to provide services to enrolled recipients and shall be licensed by the Wisconsin commissioner of insurance.

(2) Requirements for health maintenance organizations. For MA certification, an HMO shall:

(a) Meet the requirements of 42 CFR 434.20 (c);

(b) Make services it provides to individuals eligible under MA accessible to these individuals, within the area served by the organization, to the same extent that the services are made accessible under the MA state plan to individuals eligible for MA who are not enrolled with the organization; and

(c) Make adequate provision against the risk of insolvency, which is satisfactory to the department and which ensures that individuals eligible for benefits under MA are not held liable for debts of the organization in case of the organization’s insolvency.

Note: For covered health maintenance organization and prepaid health plan services, see s. DHS 107.28.