DHS 107.17(3)(e)6.
6. Other therapies are providing sufficient services to meet the recipient's functioning needs; or
DHS 107.17(3)(e)7.
7. The procedures requested are not medical in nature or are not covered services. Inappropriate diagnoses for therapy services and procedures of questionable medical necessity may not receive departmental authorization, depending upon the individual circumstances.
DHS 107.17(4)
(4)
Non-covered services. The following services are not covered services:
DHS 107.17(4)(a)
(a) Services related to activities for the general good and welfare of recipients, such as general exercises to promote overall fitness and flexibility and activities to provide diversion or general motivation;
DHS 107.17(4)(c)
(c) Crafts and other supplies used in occupational therapy services for inpatients in an institutional program. These are not billable by the therapist; and
DHS 107.17(4)(d)
(d) Activities such as end-of-the-day clean-up time, transportation time, consultations and required paper reports. These are considered components of the provider's overhead costs and are not covered as separately reimbursable items.
DHS 107.17 Note
Note: For more information on non-covered services, see s.
DHS 107.03.
DHS 107.17 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; emerg. am. (2) (b), (d), (g), (3) (c) and (e) (intro.), eff. 7-1-88; am. (2) (b) (d), (g) (3) (c) and (e) (intro.),
Register, December, 1988, No. 396, eff. 1-1-89; corrections in (1) (intro.) and (4) (b) made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
DHS 107.18
DHS 107.18 Speech and language pathology services. DHS 107.18(1)(a)(a) General. Covered speech and language pathology services are those medically necessary diagnostic, screening, preventive or corrective speech and language pathology services prescribed by a physician and provided by a certified speech and language pathologist or under the direct, immediate on-premises supervision of a certified speech and language pathologist.
DHS 107.18(1)(b)
(b) Evaluation procedures. Evaluation or re-evaluation procedures shall be performed by certified speech and language pathologists. Tests and measurements that speech and language pathologists may perform include the following:
DHS 107.18(1)(b)1.b.
b. Articulation evaluation (examples of tests are Arizona articulation, proficiency scale, Goldman-Fristoe test of articulation, Templin-Darley screening and diagnostic tests of articulation);
DHS 107.18(1)(b)1.c.
c. Cognitive assessment (examples are tests of classification, conservation, Piagetian concepts);
DHS 107.18(1)(b)1.d.
d. Language concept evaluation (examples are tests of temporal, spatial, and quantity concepts, environmental concepts, and the language of direction);
DHS 107.18(1)(b)1.e.
e. Morphological evaluation (examples are the Miller-Yoder test and the Michigan inventory);
DHS 107.18(1)(b)2.c.
c. Auditory discrimination evaluation (examples are the Goldman-Fristoe-Woodcock test of auditory discrimination and the Wepman test of auditory discrimination);
DHS 107.18(1)(b)2.f.
f. Cognitive assessment (examples are tests of one-to-one correspondence, and seriation classification conservation);
DHS 107.18(1)(b)2.g.
g. Language concept evaluation (an example is the Boehm test of basic concepts);
DHS 107.18(1)(b)2.h.
h. Morphological evaluation (examples are Bellugi-Klima grammatical comprehension tests, Michigan inventory, Miller-Yoder test);
DHS 107.18(1)(c)
(c) Speech procedure treatments. The following speech procedure treatments shall be performed by a certified speech and language pathologist or under the direct, immediate, on-premises supervision of a certified speech and language pathologist:
DHS 107.18(1)(c)1.e.
e. Language content, including range of abstraction in meanings and cognitive skills; and
DHS 107.18(1)(c)2.a.
a. Auditory processing — attention span, acuity or perception, recognition, discrimination, memory, sequencing and comprehension; and
DHS 107.18(1)(c)2.b.
b. Visual processing — attention span, acuity or perception, recognition, discrimination, memory, sequencing and comprehension;
DHS 107.18(2)(a)
(a) Definition. In this subsection, “spell of illness" means a condition characterized by a demonstrated loss of functional ability to perform daily living skills, caused by a new disease, injury or medical condition or by an increase in the severity of a pre-existing medical condition. For a condition to be classified as a new spell of illness, the recipient must display the potential to reachieve the skill level that he or she had previously.
DHS 107.18(2)(b)
(b) Requirement. Prior authorization is required under this subsection for speech and language pathology services provided to an MA recipient in excess of 35 treatment days per spell of illness, except that speech and language pathology services provided to an MA recipient who is a hospital inpatient or who is receiving speech therapy services provided by a home health agency are not subject to prior authorization under this subsection.
DHS 107.18 Note
Note: Speech and language pathology services provided by a home health agency are subject to prior authorization under s.
DHS 107.11 (3).
DHS 107.18(2)(c)
(c) Conditions justifying spell of illness designation. The following conditions may justify designation of a new spell of illness:
DHS 107.18(2)(c)1.a.
a. Neuromuscular dysfunction, including stroke-hemiparesis, multiple sclerosis, Parkinson's disease and diabetic neuropathy;
DHS 107.18(2)(c)1.b.
b. Musculoskeletal dysfunction, including fracture, amputation, strains and sprains, and complications associated with surgical procedures; or
DHS 107.18(2)(c)1.c.
c. Problems and complications associated with physiologic dysfunction, including severe pain, vascular conditions, and cardio-pulmonary conditions;
DHS 107.18(2)(c)2.
2. An exacerbation of a pre-existing condition including but not limited to the following, which requires speech therapy intervention on an intensive basis:
DHS 107.18(2)(c)3.
3. A regression in the recipient's condition due to lack of speech therapy, as indicated by a decrease of functional ability, strength, mobility or motion.
