Chapter DHS 105

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;

DHS 105.36(4)(a)4. 4. The nurse or clinic aide shall assist the physician in providing medical services to the patient;

DHS 105.36(4)(a)5. 5. The physician shall be responsible for providing or exercising supervision over all medical and related services provided to patients; and

DHS 105.36(4)(a)6. 6. The clinic coordinator shall oversee the operation of the clinic.

DHS 105.36(4)(b) (b)

DHS 105.36(4)(b)1. 1. Training programs shall be developed for new staff, and time shall be made available periodically for their training.

DHS 105.36(4)(b)2. 2. For existing staff, time shall be made available for staff conferences and for inservice training in new techniques and procedures.

DHS 105.36(4)(b)3. 3. For volunteers, time shall be made available for staff to coordinate, train, and supervise them to be an effective, integral part of the clinic.

DHS 105.36(4)(c) (c) Paraprofessional personnel may be hired and trained.

DHS 105.36(5) (5) Patient and community outreach. Each clinic shall have an active outreach effort aimed at:

DHS 105.36(5)(a) (a) Recruiting and retaining patients in the family planning clinic, through:

DHS 105.36(5)(a)1. 1. A system of identifying the primary target populations;

DHS 105.36(5)(a)2. 2. A method of contacting the target population;

DHS 105.36(5)(a)3. 3. Procedures for family planning counseling and motivating appropriate persons to avail themselves of family planning medical services;

DHS 105.36(5)(a)4. 4. Assisting individuals in receiving family planning medical services;

DHS 105.36(5)(a)5. 5. Activities designed to follow-up potential and actual family planning patients as indicated; and

DHS 105.36(5)(a)6. 6. A record system sufficient to support the functions in subds. 1. to 5.;

DHS 105.36(5)(b) (b) Meeting all human needs through appropriate and effective referral to other community resources; and

DHS 105.36(5)(c) (c) Increasing community awareness and acceptance of the family planning clinic through:

DHS 105.36(5)(c)1. 1. The use of mass media;

DHS 105.36(5)(c)2. 2. Presentations to community organizations and agencies;

DHS 105.36(5)(c)3. 3. Public information campaigns utilizing all channels of communication;

DHS 105.36(5)(c)4. 4. Development of formal referral arrangements with community resources; and

DHS 105.36(5)(c)5. 5. Involvement of appropriate community residents in the operation of the family planning clinic.

DHS 105.36(6) (6) Patient education and counseling. At the time the patient is to receive family planning medical services, the following components of social services shall be provided:

DHS 105.36(6)(a) (a) An intake interview designed to obtain pertinent information regarding the patient, to explain the conditions under which services are provided and to create the opportunity for a discussion of the patient’s problems;

DHS 105.36(6)(b) (b) A group or individual information session which includes:

DHS 105.36(6)(b)1. 1. Reproductive anatomy and physiology;

DHS 105.36(6)(b)2. 2. Methods of contraception, including how they work, side effects and effectiveness;

DHS 105.36(6)(b)3. 3. An explanation of applicable medical procedures;

DHS 105.36(6)(b)4. 4. An opportunity for patients to ask questions and discuss their concerns; and

DHS 105.36(6)(b)5. 5. An optional discussion of such topics as breast and cervical cancer, venereal disease, human sexuality or vaginopathies; and

DHS 105.36(6)(c) (c) An exit interview which is designed to:

DHS 105.36(6)(c)1. 1. Clarify any areas of concern or questions regarding medical services;

DHS 105.36(6)(c)2. 2. Elicit from the patient evidence of a complete understanding of the use of family planning methods;

DHS 105.36(6)(c)3. 3. Effectively inform the patient what procedures are to be followed if problems are experienced;

DHS 105.36(6)(c)4. 4. Inform the patient about the clinic’s follow-up procedures and possible referral to other community resources; and

DHS 105.36(6)(c)5. 5. Arrange for the next visit to the clinic.

DHS 105.36(7) (7) Medical services.

DHS 105.36(7)(a) (a) All medical and related services shall be provided by or under the supervision and responsibility of a physician.

DHS 105.36(7)(b) (b) The following medical services shall be made available:

DHS 105.36(7)(b)1. 1. Complete medical and obstetrical history;

DHS 105.36(7)(b)2. 2. Physical examination;

DHS 105.36(7)(b)3. 3. Laboratory evaluation;

DHS 105.36(7)(b)4. 4. Prescription of the family planning method selected by the patient unless medically contraindicated;

DHS 105.36(7)(b)5. 5. Instructions on the use of the chosen method, provision of supplies and schedule for revisits; and