Wisconsin Legislature: DHS 101.03(169)

(b) Levin tube and gastrostomy feedings;

(d) Insertion and sterile irrigation and replacement of catheters;

(e) Application of dressings involving prescription medications and aseptic techniques;

(f) Treatment of extensive decubitus ulcers or other widespread skin disorder;

(g) Heat treatments which have been specifically ordered by a physician as part of active treatment and which require observation by nurses to adequately evaluate the patient’s progress;

(h) Initial phases of a regimen involving administration of medical gases; and

(i) Rehabilitation nursing procedures, including the related teachings and adaptive aspects of nursing that are part of active treatment, e.g., the institution and supervision of bowel and bladder training programs.

(164) “Skilled nursing services for individuals age 21 or older”means skilled nursing services that are:

(a) Needed on a daily basis and required to be provided on an inpatient basis;

(b) Provided by a facility or distinct part of a facility that is certified under s. DHS 105.08; and

(164m) “Skilled nursing services provided primarily in the home” means nursing services requiring the skills of a licensed professional nurse or a licensed practical nurse supervised by a registered nurse according to the requirements of ch. N 6 and directly provided as specified by a written plan of care.

(165) “Skilled rehabilitation services” means those services furnished pursuant to a physician’s orders which require the skills of a physical therapist, occupational therapist, speech pathologist or audiologist and which are provided either directly by or under the supervision of the professional personnel.

Note: Skilled rehabilitation services include:

(a) Ongoing assessment of rehabilitation needs and potential, including tests and measurements of range of motion, strength, balance, coordination, endurance, functional ability, activities of daily living, perceptual deficits, speech and language or hearing disorders and sensory integrative abilities;

(b) Therapeutic exercises or activities which, because of the type of exercises employed or the condition of the patient, must be performed by or under the supervision of a qualified physical therapist or occupational therapist to ensure the safety of the patient and the effectiveness of the treatment;

(c) Gait evaluation and training furnished to restore function in a patient whose ability to walk has been impaired by neurological, muscular, or skeletal abnormality;

(d) Range of motion exercises which are part of the active treatment of a specific disease state which has resulted in loss or restriction of mobility as evidenced by a therapist’s notes showing the degree of motion lost and the degree to be restored;

(e) Sensory integrative evaluation and training which, because of the type of training or the condition of the patient, must be performed by or under the supervision of a qualified occupational therapist or physical therapist or other appropriate licensed health care provider to ensure the safety of the patient and the effectiveness of the treatment;

(f) Preventive therapy utilizing the principles or techniques of minimizing further debilitation in the areas of energy preservation, joint protection, edema control, positioning, etc., which requires the specialized knowledge and judgment of a qualified occupational or physical therapist;

(g) Maintenance therapy, when the specialized knowledge and judgment of a qualified therapist is required to design and establish a maintenance program based on an initial evaluation and periodic reassessment of the patient’s needs, and consistent with the patient’s capacity and tolerance;

(h) Ultrasound, shortwave, and microwave therapy treatments by a qualified physical therapist;

(i) Hot pack, hydrocollator, infra-red treatments, paraffin baths, and whirlpool in particular cases where the patient’s condition is complicated by circulatory deficiency, areas of desensitization, open wounds, fractures, or other complications, and where the skills, knowledge, and judgment of a qualified physical therapist are required;

(j) Therapeutic adaptations, including orthotics, splinting, prosthetics and assistive or adaptive equipment prescribed by a physician and provided by a qualified occupational or physical therapist are required; and

(k) Services of a speech pathologist or audiologist when necessary for the restoration of function in speech or hearing.

(166) “Specialized medical vehicle” or “SMV” means a non-emergency vehicle used to transport a recipient who is confined to a wheelchair or whose condition contraindicates transportation by common carrier, and whose physician has prescribed specialized medical vehicle transportation to a facility at which the recipient primarily receives medical services.

(167) “Spell of illness” means, in relationship to physical therapy, occupational therapy, and speech pathology services, 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.

(168) “Spend-down period” means the period during which excess income may be expended or obligations to expend excess income may be incurred for the purpose of obtaining MA eligibility, as described under s. DHS 103.08 (2) (a).

(169) “SSI” means supplemental security income, the assistance program under Title XVI of the Social Security Act of 1935, as amended, and s. 49.77, Stats.

(170) “SSI-related person” means a person who meets the requirements of s. DHS 103.03 (1) (c).

(170m) “State employees health plan” means family or individual coverage under a group health insurance plan offered by a unit of state government to its employees.

(171) “Stepparent case” means an MA case consisting of a family in which a legal parent, a stepparent and a child under age 18 reside in the home.

(172) “Sterilization” means any medical procedure, treatment, or operation for the purpose of rendering an individual permanently incapable of reproducing.

(172m) “Subscriber” means the person through whom health insurance benefits are made available, who either owns a health insurance policy or is the policyholder of a health insurance policy provided by his or her employer.

(173) “Supervision,” unless otherwise indicated in chs. DHS 101 to 108, means at least intermittent face-to-face contact between supervisor and assistant and a regular review of the assistant’s work by the supervisor.

(174) “Tape billing service” means a provider or an entity under contract to a provider which provides magnetic tape billing for one or more providers.

(174m)

(a) “Telehealth” means the use of telecommunications technology by a certified provider to deliver services allowable under s. DHS 107.02 (5) and ss. 49.45 (61) and 49.46 (2) (b) 21. to 23., Stats., including assessment, diagnosis, consultation, treatment, or transfer of medically relevant data in a functionally equivalent manner as that of an in-person contact.

(b) “Telehealth” may include real-time interactive audio-only communication.

(c) “Telehealth” does not include communication between a certified provider and a recipient that consists solely of an electronic mail message, text, or facsimile transmission.

(175) “Therapeutic/rehabilitative program” means a formal or structured medical or health care activity which is designed to contribute to the mental, physical or social development of its participants, and is certified or approved, or its sponsoring group is certified or approved, by a national standard-setting or certifying organization when such an organization exists.

(176) “Therapeutic visit” means a visit by a resident recipient to the home of relatives or friends for at least an overnight stay.

(177) “Three-generation case” means an MA case in which there are 3 generations living in the home and the second generation is a never-married minor parent.

(178) “Time out” means time away from positive reinforcement. It is a behavior modification technique in which, in response to undesired behavior, the resident is removed from the situation in which positive reinforcement is available.

(179) “Treatment unit” means, for purposes of reimbursement for therapy services, the time spent in direct treatment services to the individual patient. Time spent in activities not associated with the treatment of the individual patient such as preparation of the patient for treatment, preparation of the treatment area and preparation of the patient for return from the treatment area, otherwise known as “preparation time”, shall also be reimbursable for up to 15 minutes per patient per treatment day. Time spent in other activities which are not associated with the treatment of the individual patient, including end of the day clean-up of the treatment area, paperwork, consultations, transportation time and training, is not reimbursable.

(180) “Unearned income” means income which is not the direct result of labor or services performed by the individual as an employee or as a self-employed person.

(180m) “Income disregard” means earned or unearned income that is not considered when calculating an applicant’s or recipient’s monthly premium amount.

(181) “Usual and customary charge” means the provider’s charge for providing the same service to persons not entitled to MA benefits.

(182) “Ventilator-dependent person” means a person who requires mechanically assisted respiration.

(183) “Wrap-around coverage” means the supplemental health care coverage necessary to provide any services which would be covered under medical assistance but which are not covered under the group health plan offered by the employer.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; cr. (9m), (22m), (75m), (85m), (114m), (122m), (129m) and (149m), am. (88), Register, February, 1988, No. 386, eff. 3-1-88; am. (73), (116) and (117), r. (74), Register April, 1988, No. 388, eff. 7-1-88; emerg. cr. (30m) and (33m) eff. 8-1-88; cr. (30m) and (33m), Register, December, 1988, No. 396, eff. 1-1-89; emerg. cr. (12m), eff. 3-9-89; emerg. am. (30m), eff. 6-1-89; cr. (12m), Register, December, 1989, No. 408, eff. 1-1-90; r. (33m), renum. (30m) to be (33m) and am. Register, February, 1990, No. 410, eff. 3-1-90; cr. (17m), Register, May, 1990, No. 413, eff. 6-1-90; cr. (27m), Register, September, 1990, No. 417, eff. 10-1-90; am. (108), Register, January, 1991, No. 421, eff. 2-1-91; cr. (136m), Register, September, 1991, No. 429, eff. 10-1-91; emerg. am. (31) (intro.) and (35), cr. (96m), (114r), (134m) and (164m), eff. 7-1-92; am. (8), (23), (31) (intro.), 93, 97 and (126), r. and recr. (35), cr. (70g), (96m), (114r), (124m), (155m), (155r), (164m) and (182), Register, February, 1993, No. 446, eff. 3-1-93; correction in (89) (c) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 1993, No. 446; correction in (62) made under s. 13.93 (2m) (b) 7., Stats., Register, May, 1995, No. 473; cr. (24m), (78m), (78r), Register, January, 1997, No. 493, eff. 2-1-97; emerg. cr. (24m), (78m) and (78r), eff. 6-15-96; correction in (21), (47) and (140) made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, April, 1999, No. 520; emerg. renum. (1) to be (1m), cr. (1), (17r), (17t), (17w), (22g), (52m), (67m), (69m), (114p), (125m), (170m) and (172m) and am. (95) and (132), eff. 7-1-99; renum. (1) to be (1m), cr. (1), (17r), (17t), (17w), (22g), (27g), (52m), (67m), (69m), (78s), (114p), (125m), (170m) and (172m) and am. (95) and (132), Register, March, 2000, No. 531, eff. 4-1-00; correction in (72) made under s. 13.93 (2m) (b) 7., Stats., Register, March, 2000, No. 531; cr. (17x), (34m), (36m), (42m), (51m), (52g), (52r), (52s), (69g), (78u), (80m), (94m), (94p), (94r), (101m), (114q), (115m), (152m), (160m), (160r), (170s), (172s), (180m) and (183), Register, November, 2000, No. 539, eff. 12-1-00; corrections in (6), (11), (128) and (169) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 02-154: am. (intro.) Register April 2003 No. 568, eff. 5-1-03; CR 02-154: am. (intro.) Register April 2003 No. 568, eff. 5-1-03; correction in (62) made under s. 13.93 (2m) (b) 7., Stats., Register April 2003 No. 568; CR 03-033: am. (49) Register December 2003 No. 576, eff. 1-1-04; corrections in (intro.), (7), (10), (11), (12m), (13), (16), (20), (22m), (24), (27m), (31), (38), (39), (54), (56), (57), (70) to (73), (75m), (88) (c), (89) (b), (c), (95), (96m) (intro.), 5., (103), (104), (108), (111), (114p) (d), (116), (117), (120) to (122), (124), (124m), (125), (128) to (129m), (134m), (136m), (140), (146), (162), (164) (c), (168) and (170) made under s. 13.92 (4) (b) 6. and 7., Stats., Register December 2008 No. 636; 2019 Wis. Act 1: am. (41) (intro.), (130) Register May 2019 No. 761, eff. 6-1-19; correction in (160) made under s. 35.17, Stats., Register January 2021 No. 781; CR 20-012: cr. (28g), (28m) Register October 2021 No. 790, eff. 11-1-21; CR 20-068: am. (152) Register December 2021 No. 792, eff. 1-1-22; CR 22-043: cr. (66m), (174m) Register May 2023 No. 809, eff. 6-1-23; EmR2306: emerg. cr. (51p), (51t), eff. 5-1-23; CR 23-045: cr. (51p), (51t) Register January 2024 No. 817, eff. 2-1-24; CR 23-046: am. (1), (6), r. (7), am. (8), (15), (17r) to (17w), (20), (23), r. (30), am. (38), cr. (38m), am. (41) (intro.), (a), (b), (c) 1. to 6., (52), (65), r. (78s), am. (94r), (95) to (97), renum. (129m) to (129m) (intro.) and am., cr. (129m) (a) to (c), am. (149m), (152m), r. (170s), (172s) Register April 2024 No. 820, eff. 5-1-24; correction in (8), (97) made under s. 35.17, Stats., Register April 2024 No. 820.