Chapter DHS 105

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

DHS 105.36(7)(b)6. 6. Referral to inpatient service when necessary to treat complications of contraceptive services provided by the clinic.

DHS 105.36(7)(c) (c) Equipment and supplies in the clinic shall be commensurate with the services offered. Sufficient first aid equipment shall be available for use when needed.

DHS 105.36(7)(d) (d) Treatment for minor vaginal infections and venereal disease may be made available either by the clinic or through referral.

DHS 105.36(8) (8) Facilities. The family planning clinic shall be designed to provide comfort and dignity for the patients and to facilitate the work of the staff. A clinic facility shall be adequate for the quantity of services provided, and shall include:

DHS 105.36(8)(a) (a) A comfortable waiting room with an area for patient reception, record processing and children’s play;

DHS 105.36(8)(b) (b) Private interviewing and counseling areas;

DHS 105.36(8)(c) (c) A group conference room for staff meetings and patient education;

DHS 105.36(8)(d) (d) A work room or laboratory area with sufficient equipment and nearby storage space, none of which is accessible to the patient;

DHS 105.36(8)(e) (e) A sufficient number of private and well-equipped examining rooms with proximal dressing areas which ensure the dignity of the patient;

DHS 105.36(8)(f) (f) Adequate toilet facilities, preferably near the dressing room; and

DHS 105.36(8)(g) (g) Arrangements for routine and restorative facility maintenance.

DHS 105.36 Note Note: For covered family planning services, see s. DHS 107.21.

DHS 105.36 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. (2) (e), (7) (b) 6., renum. (2) (f) and (g) to be (2) (e) and (f), (7) (b) 7. to be (7) (b) 6., Register, January, 1997, No. 493, eff. 2-1-97; correction in (1) (b) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528; CR 20-068: am. (2) (a) (intro.), 1. to 3. Register December 2021 No. 792, eff. 1-1-22.

DHS 105.37 DHS 105.37 Early and periodic screening, diagnosis and treatment (EPSDT) providers.

DHS 105.37(1) (1) EPSDT health assessment and evaluation services.

DHS 105.37(1)(a) (a) Eligible providers. The following providers are eligible for certification as providers of EPSDT health assessment and evaluation services:

DHS 105.37(1)(a)1. 1. Physicians;

DHS 105.37(1)(a)2. 2. Outpatient hospital facilities;

DHS 105.37(1)(a)3. 3. Health maintenance organizations;

DHS 105.37(1)(a)4. 4. Visiting nurse associations;

DHS 105.37(1)(a)5. 5. Clinics operated under a physician’s supervision;

DHS 105.37(1)(a)6. 6. Local public health agencies;

DHS 105.37(1)(a)7. 7. Home health agencies;

DHS 105.37(1)(a)8. 8. Rural health clinics;

DHS 105.37(1)(a)9. 9. Indian health agencies; and

DHS 105.37(1)(a)10. 10. Neighborhood health centers.

DHS 105.37(1)(b) (b) Procedures and personnel requirements.

DHS 105.37(1)(b)1. 1. EPSDT providers shall provide periodic comprehensive child health assessments and evaluations of the general health, growth, development and nutritional status of infants, children and youth. Immunizations shall be administered at the time of the screening if determined medically necessary and appropriate. The results of a health assessment and evaluation shall be explained to the recipient’s parent or guardian and to the recipient if appropriate.

DHS 105.37(1)(b)2. 2. EPSDT health assessment and evaluation services shall be delivered under the supervision of skilled medical personnel. In this section “skilled medical personnel” means physicians, physician assistants, nurse practitioners, public health nurses or registered nurses. Skilled medical personnel who perform physical assessment screening procedures shall have successfully completed either a formal pediatric assessment or an inservice training course on physical assessments approved by the department. Individual procedures may be completed by paraprofessional staff who are supervised by skilled medical personnel. Registered nurses who perform EPSDT physical assessments shall have satisfactorily completed a curriculum for pediatric physical assessments approved by the department.

DHS 105.37(1)(b)3. 3. All conditions uncovered which warrant further care shall be diagnosed or treated or both by the provider, if appropriate, or referred to other appropriate providers. A referral may either be a direct referral to the appropriate health care provider or a referral recommendation submitted through the agency responsible for the patient’s case management and advocacy.

DHS 105.37(1)(b)4. 4. Health maintenance organizations and prepaid health plans providing EPSDT services shall meet all requirements of 42 CFR 441.60 in addition to the requirements under subds. 1. to 3.

DHS 105.37(1)(c) (c) Records and documentation.

DHS 105.37(1)(c)1. 1. Certified providers of EPSDT screening services shall:

DHS 105.37(1)(c)1.a. a. Complete the department’s EPSDT claim form and an individual health and developmental history for each client; and

DHS 105.37(1)(c)1.b. b. Maintain a file on each client receiving EPSDT services which includes a copy of the EPSDT claim form, individual health and developmental history and follow-up for necessary diagnosis and treatment services.

DHS 105.37(1)(c)2. 2. The EPSDT provider shall release information on the results of the health assessment to appropriate health care providers and health authorities when authorized by the patient or the patient’s parent or guardian to do so.

DHS 105.37(2) (2) EPSDT case management activities.

DHS 105.37(2)(a) (a) Case management reimbursement. Providers certified under sub. (1) as providers of EPSDT health assessment and evaluation services shall be eligible to receive reimbursement for EPSDT case management in accordance with the limitations contained in the case management agreement between the provider and the department.

DHS 105.37(2)(b) (b) Case management plan.

DHS 105.37(2)(b)1. 1. All EPSDT providers who apply to receive reimbursement for EPSDT case management services shall submit to the department a case management plan. The case management plan shall describe the geographic service area, target population, coordination with support activities conducted by the department and other health-related services, case management activities and the method of documenting the activities.

DHS 105.37(2)(b)2. 2. The department shall evaluate the adequacy of each provider’s case management plan according to the case management requirements of the proposed service area and target population, the extent to which the plan would ensure that children receive the necessary diagnosis and treatment services for conditions detected during EPSDT health examinations, the proposed coordination with the EPSDT central notification system and other health related services, and proposed methods for documenting case management services. Based on the evaluation, the department shall either approve or deny the provider’s request for reimbursement of case management activities and shall impose on providers as conditions for reimbursement any personnel, staffing or procedural requirements that it determines are necessary pursuant to 42 CFR 441 Part B.

DHS 105.37(2)(c) (c) Records and documentations. Providers shall maintain records and documentation required by the department in order to verify appropriate use of funds provided by the department for EPSDT case management activities.

DHS 105.37(3) (3) Diagnosis and treatment services. Providers of diagnosis and treatment services for EPSDT recipients shall be certified according to the appropriate provisions of this chapter.

DHS 105.37 Note Note: For covered EPSDT services, see s. DHS 107.22.