Chapter DHS 105

DHS 105.255(3) (3) Documentation of employee qualifications. Providers shall maintain current written documentation of employee qualifications required under s. DHS 63.06 (4) and this section.

DHS 105.255 History History: Cr. Register, September, 1990, No. 417, eff. 10-1-90; corrections in (1), (2) (c) and (3) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; correction in (2) (b) 5. made under s. 13.93 (2m) (b) 7., Stats., October, 2000, No. 538; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.257 DHS 105.257 Community-based psychosocial service programs. For MA certification as a community-based psychosocial service program under s. 49.45 (30e), Stats., a provider shall be certified as a comprehensive community services program under ch. DHS 36. The department may waive a requirement in ss. DHS 36.04 to 36.12 under the conditions specified in s. DHS 36.065 if requested by a provider. Certified providers under this section may provide services directly or may contract with other qualified providers to provide all or some of the services described in s. DHS 107.13 (7).

DHS 105.257 History History: Emerg. cr. eff. 7-1-04; CR 04-025: cr. Register October 2004 No. 586, eff. 11-1-04; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.26 DHS 105.26 Chiropractors. For MA certification, chiropractors shall be licensed pursuant to s. 446.02, Stats.

DHS 105.26 Note Note: For covered chiropractic services, see s. DHS 107.15.

DHS 105.26 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.265 DHS 105.265 Podiatrists. For MA certification, podiatrists shall be licensed under s. 448.63, Stats., and ch. Pod 1 and registered under s. 448.07, Stats., and ch. Pod 4.

DHS 105.265 History History: Cr. Register, January, 1991, No. 421, eff. 2-1-91; corrections made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.27 DHS 105.27 Physical therapists and assistants.

DHS 105.27(1) (1) Physical therapists. For MA certification, physical therapists shall be licensed pursuant to ss. 448.05 and 448.07, Stats., and ch. PT 1.

DHS 105.27(2) (2) Physical therapist assistants. For MA certification, physical therapist assistants shall have graduated from a 2-year college-level program approved by the American physical therapy association, and shall provide their services under the supervision of a physical therapist certified pursuant to sub. (1) and. ss. 448.53, 448.56, and 448.985, Stats. Documentation of supervision shall be maintained and provided to the department upon request. Physical therapist assistants may not bill or be reimbursed directly for their services. When performing services, physical therapist assistants are to be submitted as renderer on billing claims.

DHS 105.27 Note Note: For covered physical therapy services, see s. DHS 107.16.

DHS 105.27 Note Note: The declaration of supervision for non-billing providers’ form is available by accessing: https://www.dhs.wisconsin.gov/library/f-01182.htm.

DHS 105.27 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 22-043: am. (2) Register May 2023 No. 809, eff. 6-1-23.

DHS 105.28 DHS 105.28 Occupational therapists and assistants.

DHS 105.28(1) (1) Occupational therapists. For MA certification, an occupational therapist shall:

DHS 105.28(1)(a) (a) Be certified by the American occupational therapy association as an occupational therapist, registered; or

DHS 105.28(1)(b) (b) Have graduated from a program in occupational therapy accredited by the council on medical education of the American medical association and the American occupational therapy association, have completed the required field work experience, and have made application to the American occupational therapy association for the certification examination for occupational therapist, registered. Certification under this paragraph shall be valid until 8 weeks after the examination is taken. On passing the examination, the therapist shall obtain certification by the American occupational therapy association in the calendar year in which the examination is taken. An individual certified under this paragraph for medical assistance who fails the examination may be recertified for medical assistance only under the conditions of par. (a).

DHS 105.28(2) (2) Occupational therapy assistants. For MA certification, occupational therapy assistants shall be certified by the American occupational therapy association. Occupational therapy assistants may not bill or be reimbursed directly for their services. When performing services, occupational therapy assistants are to be submitted as renderer on billing claims. Occupational therapy assistants shall provide services under the supervision of an occupational therapist certified under sub. (1) and ss. 448.961, 448.963, and 448.966, Stats. Documentation of supervision shall be maintained and provided to the department upon request.

DHS 105.28 Note Note: For covered occupational therapy services, see s. DHS 107.17.

DHS 105.28 Note Note: The declaration of supervision for non-billing providers’ form is available by accessing: https://www.dhs.wisconsin.gov/library/f-01182.htm.

DHS 105.28 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; CR 22-043: renum. (2) (intro.) to (2) and am., r. (2) (a) to (c) Register May 2023 No. 809, eff. 6-1-23.

DHS 105.29 DHS 105.29 Speech and hearing clinics. For MA certification, speech and hearing clinics shall be currently accredited by the American speech and hearing association (ASHA) pursuant to the guidelines for “accreditation of professional services programs in speech pathology and audiology” published by ASHA.

DHS 105.29 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.30 DHS 105.30 Speech pathologists. For MA certification, speech pathologists shall:

DHS 105.30(1) (1) Possess a current certification of clinical competence from the American speech and hearing association;

DHS 105.30(2) (2) Have completed the educational requirements and work experience necessary for such a certificate; or

DHS 105.30(3) (3) Have completed the educational requirements and be in the process of accumulating the work experience required to qualify for the certificate of clinical competence under sub. (1).

DHS 105.30 Note Note: For covered speech pathology services, see. s. DHS 107.18.

DHS 105.30 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.31 DHS 105.31 Audiologists. For MA certification, audiologists shall:

DHS 105.31(1) (1) Possess a certificate of clinical competence from the American speech and hearing association (ASHA);

DHS 105.31(2) (2) Have completed the educational requirements and work experience necessary for the certificate; or

DHS 105.31(3) (3) Have completed the educational requirements and be in the process of accumulating the work experience required to qualify for the certificate under sub. (1).

DHS 105.31 Note Note: For covered audiology services, see s. DHS 107.19.

DHS 105.31 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) and (3), Register, May, 1990, No. 413, eff. 6-1-90.

DHS 105.32 DHS 105.32 Optometrists. For MA certification, optometrists shall be licensed and registered pursuant to ss. 449.04 and 449.06, Stats.

DHS 105.32 Note Note: For covered vision care services, see s. DHS 107.20.

DHS 105.32 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.33 DHS 105.33 Opticians. For MA certification, opticians shall practice as described in s. 449.01 (2), Stats.

DHS 105.33 Note Note: For covered vision care services, see s. DHS 107.20.

DHS 105.33 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.34 DHS 105.34 Rehabilitation agencies. For MA certification on or after January 1, 1988, a rehabilitation agency providing outpatient physical therapy, or speech and language pathology form, or occupational therapy shall be certified to participate in medicare as an outpatient rehabilitation facility under 42 CFR 485.50 to 485.74.

DHS 105.34 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. Register, February, 1988, No. 386, eff. 3-1-88; CR 23-046: am. Register April 2024 No. 820, eff. 5-1-24.

DHS 105.35 DHS 105.35 Rural health clinics. For MA certification, a rural health clinic shall be:

DHS 105.35(1) (1) Certified to participate in medicare;

DHS 105.35(2) (2) Licensed as required under all other local and state laws; and

DHS 105.35(3) (3) Staffed with persons who are licensed, certified form or registered in accordance with appropriate state laws.

DHS 105.35 Note Note: For covered rural health clinic services, see s. DHS 107.29.

DHS 105.35 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.36 DHS 105.36 Family planning clinics or agencies. For MA certification, family planning clinics or agencies shall meet the following conditions:

DHS 105.36(1) (1) General. In order to qualify for MA reimbursement, family planning clinics shall certify to the department that:

DHS 105.36(1)(a) (a) An MA card has been shown before services are provided;

DHS 105.36(1)(b) (b) Services are prescribed by a physician or are provided by a nurse midwife as provided under s. 441.15, Stats.; and

DHS 105.36(1)(c) (c) No sterilization procedures are available to persons who are mentally incompetent, institutionalized or under the age of 21.

DHS 105.36(2) (2) Principles of operation.

DHS 105.36(2)(a) (a) Family planning services shall be made available in all of the following conditions:

DHS 105.36(2)(a)1. 1. Upon referral from any source or upon the patient’s own application.

DHS 105.36(2)(a)2. 2. Without regard to race, nationality, religion, family size, marital status, maternity, paternity, disability or age, in conformity with the spirit and intent of the Civil Rights Act of 1964, as amended, and the Rehabilitation Act of 1973, as amended.

DHS 105.36(2)(a)3. 3. With respect for the dignity of the individual.

DHS 105.36(2)(a)4. 4. With efficient administrative procedures for registration and delivery of services, avoiding prolonged waiting and multiple visits for registration. Patients shall be seen on an appointment basis whenever possible.

DHS 105.36(2)(b) (b) Acceptance of family planning service shall be voluntary, and individuals shall not be subjected to coercion either to receive services or to employ or not to employ any particular method of family planning. Acceptance or nonacceptance of family planning services shall not be a prerequisite to eligibility for or receipt of any other service funded by local, state, or federal tax revenue.

DHS 105.36(2)(c) (c) A variety of medically approved methods of family planning, including the natural family planning method, shall be available to persons to whom family planning services are offered and provided.

DHS 105.36(2)(d) (d) The clinic shall not provide abortion as a method of family planning.

DHS 105.36(2)(e) (e) Efforts shall be made to obtain third party payments when available for services provided.

DHS 105.36(2)(f) (f) All personal information obtained shall be treated as privileged communication, shall be held confidential, and shall be divulged only upon the recipient’s written consent except when necessary to provide services to the individual or to seek reimbursement for the services. The agency director shall ensure that all participating agencies preserve the confidentiality of patient records. Information may be disclosed in summary, statistical or other form which does not identify specific recipients.

DHS 105.36(3) (3) Administration.

DHS 105.36(3)(a) (a) The family planning clinic shall have a governing body which is responsible for the conduct of the staff and the operation of the clinic.

DHS 105.36(3)(b) (b) A designated person shall be responsible for the day-to-day operation of the clinic.

DHS 105.36(3)(c) (c) Written policies and procedures shall be developed which govern the utilization of staff, services to patients and the general operation of the clinic.

DHS 105.36(3)(d) (d) Job descriptions for volunteer and paid staff shall be prepared to assist staff members in the performance of their duties.

DHS 105.36(3)(e) (e) Each clinic shall have a record system that includes the following components:

DHS 105.36(3)(e)1. 1. Patient records:

DHS 105.36(3)(e)1.a. a. With pertinent medical and social history;

DHS 105.36(3)(e)1.b. b. With all patient contacts and outcomes;

DHS 105.36(3)(e)1.c. c. With accumulated data on supplies, staffing, appointments and other administrative functions;

DHS 105.36(3)(e)1.d. d. For purposes of following up on patients for medical services or referrals to other community resources; and

DHS 105.36(3)(e)1.e. e. For purposes of program evaluation;

DHS 105.36(3)(e)2. 2. Fiscal records accounting for cash flow; and

DHS 105.36(3)(e)3. 3. Organizational records to document staff time, governing body meetings, administrative decisions and fund raising.

DHS 105.36(3)(f) (f) Each clinic shall engage in a continuing effort of evaluating, reporting, planning and implementing changes in program operation.

DHS 105.36(3)(g) (g) Each clinic shall develop a system of appointments and referrals which is flexible enough to meet community needs.

DHS 105.36(3)(h) (h) Each clinic shall make provision for a medical back-up for patients who experience family planning related problems at a time when the clinic staff is unavailable.

DHS 105.36(4) (4) Staffing.

DHS 105.36(4)(a) (a) Clinic staff, either paid or volunteer, shall perform the following functions:

DHS 105.36(4)(a)1. 1. Outreach workers or community health personnel shall have primary responsibility to contact individuals in need of family planning services, initiate family planning counseling, and assist in receiving, successfully using and continuing medical services;

DHS 105.36(4)(a)2. 2. The secretary or receptionist shall greet patients at the clinic, arrange for services and perform a variety of necessary clerical duties;

DHS 105.36(4)(a)3. 3. The interviewer or counselor shall take social histories, provide family planning information to patients and counsel patients regarding their family planning and related problems;