DHS 107.13(7)
(7) Psychosocial services provided through a community-based psychosocial service program. DHS 107.13(7)(a)
(a)
Covered services. Psychosocial services provided through a community-based psychosocial service program shall be covered services when authorized by a mental health professional under s.
DHS 36.15 for recipients determined to have a need for the services under s.
DHS 36.14. These non-institutional services must fall within the definition of “rehabilitative services" under
42 CFR 440.130 (d) and must be described in a service plan under s.
DHS 36.17. Covered services include assessment under s.
DHS 36.16 and service planning and review under s.
DHS 36.17.
DHS 107.13(7)(b)2.
2. Group psychotherapy is limited to no more than 10 persons in a group. No more than 2 professionals shall be reimbursed for a single session of group psychotherapy. Mental health technicians shall not be reimbursed for group psychotherapy.
DHS 107.13(7)(b)3.
3. Reimbursement is not available for a person participating in the program under this subsection if the person is also participating in the program under sub.
(6).
DHS 107.13(7)(c)
(c)
Non-covered services. The following are not covered services under this subsection:
DHS 107.13(7)(c)2.
2. Services provided to a resident of an intermediate care facility, skilled nursing facility or an institution for mental diseases, or to a hospital patient unless the services are performed to prepare the recipient for discharge from the facility to reside in the community.
DHS 107.13(7)(c)3.
3. Services performed by volunteers, except that out-of-pocket expenses incurred by volunteers in performing services may be covered.
DHS 107.13(7)(c)4.
4. Services that are not rehabilitative, including services that are primarily recreation-oriented.
DHS 107.13 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (f) 8.,
Register, February, 1988, No. 386, eff. 3-1-88; emerg. cr. (3m), eff. 3-9-89; cr. (3m),
Register, December, 1989, No. 408, eff. 1-1-90; emerg. cr. (2) (c) 5., (3) (c) 2., (4) (c) 4. and (6), eff. 1-1-90; cr. (2) (c) 5., (3) (c) 2., (4) (c) 4. and (6),
Register, September, 1990, No. 417, eff. 10-1-90; emerg. r. and recr. (1) (b) 3., am. (1) (f) 6., eff. 1-1-91; am. (1) (a), (b) 1. and 2., (c), (f) 5., 6. and 8., (2) (a) 1., 3. a. and b., 4. f., 6., 7., (b) 1. and 2., (c) 2., (3) (a) (intro.), 4., 5., 7., (b) 1. and 2., (c) 1. (3) (d) 1. and 2., (4) (a) 3. and 6. and (d) 6., r. and recr. (1) (b) 3. and (e), r. (4) (b) 1. d., renum. (4) (b) 1. c. to be d., cr. (2) (c) 6., (3) (c) 3. and 4., (3) (d) 3.,
Register, September, 1991, No. 429, eff. 10-1-91; am. (4) (a) 2., cr. (4) (a) 8.,
Register, February, 1993, No. 446, eff. 3-1-93; corrections in (3) (d) 3. and (3m) (a) 1. made under s. 13.93 (2m) (b) 7., Stats.,
Register February 2002 No. 554; emerg. am. (2) (c) 5. and (4) (c) 4., cr. (6) (b) 4. and (7), eff. 7-1-04;
CR 04-025: am (2) (c) 5. and (4) (c) 4., cr. (6) (b) 4. and (7)
Register October 2004 No. 586, eff. 11-1-04; corrections in (1) (a), (f) 5., (2) (a) (intro.), 3., (c) 6., (3) (a) (intro.), (c) 3., (d) 3., (3m) (a) (intro.), 1., (b) 3., (4) (a) (intro.), 8., (6) (a) (intro.), (c) 1., (7) (a) and (c) 1. made under s. 13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636;
CR 06-080: am. (2) (a) (intro.), 1. (intro.), 3. a., b., 4. a. to f., 6., 7., (b) 1., 4. a. to d., (c) 4., 6. and (d) 2., cr. (2) (a) 1. a. to g. and (2m)
Register May 2009 No. 641, eff. 6-1-09;
CR 14-066: am. (2) (a) (intro.), r. (2) (a) 2., am. (2) (a) 4. (intro.), cr. (2) (a) 4. g., r. (2) (b) 4. b., am. (2) (d) (intro.), 1. to. 4.
Register August 2015 No. 716, eff. 9-1-15;
2019 Wis. Act 1: am. (2) (d) 2.
Register May 2019 No. 761; eff. 6-1-19;
CR 20-039: am. (2) (d) 1.
Register October 2021 No. 790, eff. 11-1-21; correction in (6) (c) 2. made under s. 35.17, Stats.,
Register July 2022 No. 799; correction in (3) (d) 3., (3m) (a) 1. made under s. 13.92 (4) (b) 7., Stats., made under s. 13.92 (4) (b) 7., Stats.,
Register September 2022 No. 801;
CR 22-043: cr. (2) (a) 4. h., am. (2) (a) 5., (b) 4. e., (3) (a) 5., 6., (b) 4. d., (3m) (d) 6., (4) (a) 8., (d) 7.
Register May 2023 No. 809, eff. 6-1-23; correction in (2) (a) 5., (3) (a) 6. made under s. 35.17, Stats.,
Register May 2023 No. 809;
CR 23-046: r. (2) (a) 6., 7., (b), (3) (a) 4., 7., (b) Register April 2024 No. 820, eff. 5-1-24; correction in (2) (a) 5., (3) (a) 6. made under s. 35.17, Stats., Register April 2024 No. 820. DHS 107.14(1)(a)(a) Podiatry services covered by medical assistance are those medically necessary services for the diagnosis and treatment of the feet and ankles, within the limitations described in this section, when provided by a certified podiatrist.
DHS 107.14(1)(b)
(b) The following categories of services are covered services when performed by a podiatrist:
DHS 107.14(1)(b)9.
9. Plaster or other cast material used in cast procedures and strapping or tape casting for treating fractures, dislocations, sprains and open wounds of the ankle, foot and toes;
DHS 107.14(2)(a)
(a) Podiatric services pertaining to the cleaning, trimming and cutting of toenails, often referred to as palliative or maintenance care, shall be reimbursed once per 61 day period only if the recipient is under the active care of a physician and the recipient's condition is one of the following:
DHS 107.14(2)(a)3.
3. Peripheral neuropathies involving the feet, which are associated with:
DHS 107.14(2)(b)
(b) The cutting, cleaning and trimming of toenails, corns, callouses and bunions on multiple digits shall be reimbursed at one fee for each service which includes either one or both feet.
DHS 107.14(2)(c)
(c) Initial diagnostic services are covered when performed in connection with a specific symptom or complaint if it seems likely that treatment would be covered even though the resulting diagnosis may be one requiring non-covered care.
DHS 107.14(2)(d)
(d) Physical medicine modalities may include, but are not limited to, hydrotherapy, ultrasound, iontophoresis, transcutaneous neurostimulator (TENS) prescription, and electronic bone stimulation. Physical medicine is limited to 10 modality services per calendar year for the following diagnoses only:
DHS 107.14(2)(e)
(e) Services provided during a nursing home visit to cut, clean or trim toenails, corns, callouses or bunions of more than one resident shall be reimbursed at the nursing home single visit rate for only one of the residents seen on that day of service. All other claims for residents seen at the nursing home on the same day of service shall be reimbursed up to the multiple nursing home visit rate. The podiatrist shall identify on the claim form the single resident for whom the nursing home single visit rate is applicable, and the residents for whom the multiple nursing home visit rate is applicable.
DHS 107.14(2)(f)
(f) Debridement of mycotic conditions and mycotic nails is a covered service provided that utilization guidelines established by the department are followed.
DHS 107.14(3)
(3) Non-covered services. The following are not covered services:
DHS 107.14(3)(a)
(a) Procedures which do not relate to the diagnosis or treatment of the ankle or foot;
DHS 107.14(3)(c)
(c) All orthopedic and orthotic services except plaster and other material cast procedures and strapping or tape casting for treating fractures, dislocations, sprains or open wounds of the ankle, foot or toes;
DHS 107.14(3)(d)
(d) Orthopedic shoes and supportive devices such as arch supports, shoe inlays and pads;
DHS 107.14(3)(h)
(h) Services directed toward the care and correction of “flat feet;"
DHS 107.14(3)(j)
(j) All other services not specifically identified as covered in this section.
DHS 107.14 History
History: Emerg. cr. eff. 7-1-90; cr.
Register, January, 1991, No. 421, eff. 2-1-91.
DHS 107.15(1)(1)
Definition. In this section, “spell of illness" means a condition characterized by the onset of a spinal subluxation.“Subluxation" means the alteration of the normal dynamics, anatomical or physiological relationships of contiguous articular structures. A subluxation may have biomechanical, pathophysiological, clinical, radiologic and other manifestations.
DHS 107.15(2)
(2) Covered services. Chiropractic services covered by MA are manual manipulations of the spine used to treat a subluxation. These services shall be performed by a chiropractor certified pursuant to s.
DHS 105.26.
DHS 107.15(3)(a)1.1. Prior authorization is required for services beyond the initial visit and 20 spinal manipulations per spell of illness. The prior authorization request shall include a justification of why the condition is chronic and why it warrants the scope of service being requested.
DHS 107.15(3)(a)2.
2. Prior authorization is required for spinal supports which have been prescribed by a physician or chiropractor if the purchase or rental price of a support is over $75. Rental costs under $75 shall be paid for one month without prior approval.
DHS 107.15(3)(b)
(b) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness if treatment for the condition is medically necessary:
DHS 107.15(3)(b)2.
2. An acute onset of an aggravation of pre-existing spinal subluxation by injury; or
DHS 107.15(3)(b)3.
3. An acute onset of a change in pre-existing spinal subluxation based on objective findings.
DHS 107.15(3)(c)
(c) Onset and termination of spell of illness. The spell of illness begins with the first day of treatment or evaluation following the onset of a condition under par.
(b) and ends when the recipient improves so that treatment by a chiropractor for the condition causing the spell of illness is no longer medically necessary, or after 20 spinal manipulations, whichever comes first.
DHS 107.15(3)(d)
(d) Documentation. The chiropractor shall document the spell of illness in the patient plan of care.
DHS 107.15(3)(e)
(e) Non-transferability of treatment days. Unused treatment days from one spell of illness shall not be carried over into a new spell of illness.
DHS 107.15(3)(f)
(f) Other coverage. Treatment days covered by medicare or other third-party insurance shall be included in computing the 20 spinal manipulation per spell of illness total.
DHS 107.15(3)(g)
(g) Department expertise. The department may have on its staff qualified chiropractors to develop prior authorization criteria and perform other consultative activities.
