Chapter DHS 105

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.

DHS 105.37 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.38 DHS 105.38 Ambulance providers.

DHS 105.38(1) (1) For MA certification, ambulance service providers shall be licensed pursuant to s. 256.15, Stats., and ch. DHS 110, and shall meet ambulance inspection standards of the Wisconsin department of transportation under s. 341.085, Stats., and ch. Trans 309.

DHS 105.38(2) (2) An ambulance service provider that also provides air ambulance services shall submit a separate application under s. DHS 105.01 for certification as an air ambulance provider.

DHS 105.38 Note Note: For a copy of the application form for an ambulance service provider license, write the EMS Section, Division of Public Health, P.O. Box 2659, Madison, Wisconsin, 53701.

DHS 105.38 Note Note: For covered transportation services, see s. DHS 107.23.

DHS 105.38 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; renum. 105.38 to 105.38 (1) and am., cr. (2), Register, November, 1994, No. 467, eff. 12-1-94; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.39 DHS 105.39 Specialized medical vehicle providers.

DHS 105.39(1) (1) For MA certification, a specialized medical vehicle provider shall meet the requirements of this section and shall sign the affidavit required under sub. (6) stipulating that the provider is in compliance with the requirements of this section as well as with the requirements of the department of transportation for human service vehicles under ss. 110.05 and 340.01 (23g), Stats., and ch. Trans 301, and shall provide proof of compliance when requested by the department.

DHS 105.39(2) (2) Vehicles.

DHS 105.39(2)(a) (a) Insurance of not less than $250,000 personal liability for each person, not less than $500,000 personal liability for each occurrence and not less than $10,000 property damage shall be carried on each specialized medical vehicle used to transport a recipient.

DHS 105.39(2)(b) (b) Each vehicle shall be inspected and the inspection documented at least every 7 days by an assigned driver or mechanic, to ensure:

DHS 105.39(2)(b)1. 1. The proper functioning of the vehicle systems including but not limited to all headlights, emergency flasher lights, turn signal lights, tail lights, brake lights, clearance lights, internal lights, windshield wipers, brakes, front suspension and steering mechanisms, shock absorbers, heater and defroster systems, structural integrity of passenger compartment, air conditioning system, wheelchair locking systems, doors, lifts and ramps, moveable windows and passenger and driver restraint systems;

DHS 105.39(2)(b)2. 2. That all brakes, front suspension and steering mechanisms and shock absorbers are functioning correctly;

DHS 105.39(2)(b)3. 3. That all tires are properly inflated according to vehicle or tire manufacturers’ recommendations and that all tires possess a minimum of 1/8-inch of tread at the point of greatest wear; and

DHS 105.39(2)(b)4. 4. That windshields and mirrors are free from cracks or breaks.

DHS 105.39(2)(c) (c) The driver inspecting the vehicle shall document all vehicle inspections in writing, noting any deficiencies.

DHS 105.39(2)(d) (d) All deficiencies shall be corrected before any recipient is transported in the vehicle. Corrections shall be documented by the driver. Documentation shall be retained for not less than 12 months, except as authorized in writing by the department.

DHS 105.39(2)(e) (e) Windows, windshield and mirrors shall be maintained in a clean condition with no obstruction to vision.

DHS 105.39(2)(f) (f) Smoking is not permitted in the vehicle.

DHS 105.39(2)(g) (g) Police, sheriff’s department and ambulance emergency telephone numbers shall be posted on the dash of the vehicle in an easily readable manner. If the vehicle is not equipped with a working two-way radio, sufficient money in suitable denominations shall be carried to enable not less than 3 local telephone calls to be made from a pay telephone.

DHS 105.39(2)(h) (h) A provider shall maintain a list showing for each vehicle its registration number, identification number, license number, manufacturer, model, year, passenger capacity, insurance policy number, insurer, types of restraint systems for wheelchairs and whether it is fitted with a wheelchair lift or with a ramp. Attached to the list shall be evidence of compliance with ch. Trans 301.

DHS 105.39(3) (3) Vehicle equipment.

DHS 105.39(3)(a) (a) The vehicle shall be equipped at all times with a flashlight in working condition, a first aid kit and a fire extinguisher. The fire extinguisher shall be periodically serviced as recommended by the local fire department.

DHS 105.39(3)(b) (b) The vehicle shall be equipped with a lift or ramp for loading wheelchairs. The vehicle shall also be equipped with passenger restraint devices for each passenger, including restraint devices for recipients in wheelchairs or on cots or stretchers as defined in s. DHS 107.23 (1) (c) 4. Both a recipient and the recipient’s wheelchair, cot or stretcher shall be secured.

DHS 105.39(3)(c) (c) Provision shall be made for secure storage of removable equipment and passenger property in order to prevent projectile injuries to passengers and the driver in the event of an accident.

DHS 105.39(4) (4) Drivers.

DHS 105.39(4)(a) (a) Each driver shall possess a valid regular or commercial operator’s license which shall be unrestricted, except that the vision restrictions may be waived if the driver’s vision is corrected to an acuity of 20/30 or better by the use of corrective lenses. In this event, the driver shall wear corrective lenses while transporting recipients.

DHS 105.39(4)(b) (b)

DHS 105.39(4)(b)1. 1. Each driver before driving a vehicle or serving as an attendant shall have received all of the following:

DHS 105.39(4)(b)1.a. a. Basic Red Cross or equivalent training in first aid and cardiopulmonary resuscitation (CPR);

DHS 105.39(4)(b)1.b. b. Specific instructions on care of passengers in seizure; and

DHS 105.39(4)(b)1.c. c. Specific instructions in the use of all ramps, lift equipment and restraint devices used by the provider.

DHS 105.39(4)(b)2. 2. Each driver shall receive refresher training in first aid at least every 3 years and shall maintain CPR certification. A driver who is an emergency medical services practitioner licensed under ch. DHS 110, a licensed practical nurse, a registered nurse or a physician assistant shall be considered to have met these requirements by completion of continuing education which includes first aid and CPR.

DHS 105.39(4)(c) (c) The provider shall maintain a current list of all drivers showing the name, license number and any driving violations or license restrictions of each and shall keep that list current.

DHS 105.39(5) (5) Company policy. Company policies and procedures shall include:

DHS 105.39(5)(a) (a) Compliance with state and local laws governing the conduct of businesses, including ch. Trans 301.

DHS 105.39(5)(b) (b) Establishment and implementation of scheduling policies that assure timely pick-up and delivery of passengers going to and returning from medical appointments;

DHS 105.39(5)(c) (c) Documentation that transportation services for which MA reimbursement is sought are:

DHS 105.39(5)(c)1. 1. For medical purposes only;

DHS 105.39(5)(c)2. 2. Ordered by the attending provider of medical service; and

DHS 105.39(5)(c)3. 3. Provided only to persons who require this transportation because they lack other means of transport, and who are also physically or mentally incapable of using public transportation;

DHS 105.39(5)(d) (d) Maintenance of records of services for 5 years, unless otherwise authorized in writing by the department; and

DHS 105.39(5)(e) (e) On request of the department, making available for inspection records that document both medical service providers’ orders for services and the actual provision of services.

DHS 105.39(6) (6) Affidavit. The provider shall submit to the department a notarized affidavit attesting that the provider meets the requirements listed in this section. The affidavit shall be on a form developed by and available from the department, and shall contain the following:

DHS 105.39(6)(a) (a) A statement of the requirements listed in this section;

DHS 105.39(6)(b) (b) The date the form is completed by the provider;

DHS 105.39(6)(c) (c) The provider’s business name, address, telephone number and type of ownership;

DHS 105.39(6)(d) (d) The name and signature of the provider or a person authorized to act on behalf of the provider; and

DHS 105.39(6)(e) (e) A notarization.

DHS 105.39 Note Note: For covered transportation services, see s. DHS 107.23.

DHS 105.39(7) (7) Denial of recertification. If a provider violates provisions of this chapter, s. DHS 106.06, 107.23 or any other instruction in MA program manuals, handbooks, bulletins or letters on provision of SMV services 3 times in a 36-month period, the department may deny that provider’s request for re-certification.

DHS 105.39 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1), (2) (a), (b) (intro.), 1., (3) (a), (b), (4) (a), (5) (a), renum. (2) (b) 2. and 3. to be 3. and 4., cr. (2) (b) 2., (h), (7), r. and recr. (4) (b), (c), Register, November, 1994, No. 467, eff. 12-1-94; reprinted to restore dropped copy in (3), Register, January, 1997, No. 493; emerg. am. (4) (b) 3., eff. 7-3-99; am. (4) (b) 3., Register, December, 1999, No. 528, eff. 1-1-00; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; CR 03-033: r. (4) (b) 2., renum. (4) (b) 3. to be (4) (b) 2. Register December 2003 No. 576, eff. 1-1-04; corrections in (3) (b), (4) (b) 2. and (7) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (4) (b) 2. made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; CR 20-039: am. (4) (b) 2. Register October 2021 No. 790, eff. 11-1-21.

DHS 105.40 DHS 105.40 Durable medical equipment and medical supply vendors.

DHS 105.40(1) (1) Except as provided in sub. (2), vendors of durable medical equipment and medical supplies shall be eligible to participate in the MA program.

DHS 105.40(2) (2) Orthotists and prosthetists who develop and fit appliances for recipients shall be certified by the American board for certification in orthotics and prosthetics (A.B.C.). Certification shall be a result of successful participation in an A.B.C. examination in prosthetics, orthotics, or both, and shall be for:

DHS 105.40(2)(a) (a) Certified prosthetist (C.P.);

DHS 105.40(2)(b) (b) Certified orthotist (C.O.); or

DHS 105.40(2)(c) (c) Certified prosthetist and orthotist (C.P.O.)

DHS 105.40 Note Note: For covered durable medical equipment and medical supply services, see s. DHS 107.24.

DHS 105.40 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.41 DHS 105.41 Certification of hearing instrument specialists. For MA certification, hearing instrument specialists shall be licensed pursuant to ss. 459.01 to 459.14, Stats.

DHS 105.41 Note Note: For covered hearing aids and supplies, see s. DHS 107.24.

DHS 105.41 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; CR 03-033: am. Register December 2003 No. 576, eff. 1-1-04.

DHS 105.42 DHS 105.42 Physician office laboratories.

DHS 105.42(1) (1) Requirements. For MA certification, physician office laboratories, except as noted in sub. (2), shall be licensed pursuant to 42 CFR 493 (CLIA).

DHS 105.42(2) (2) Exception. Physician office laboratories servicing no more than 2 physicians, chiropractors or dentists, and not accepting specimens on referral from outside providers, are not required to be licensed under 42 CFR 493 (CLIA). These laboratories, however, shall submit an affidavit to the department declaring that they do not accept outside specimens.

DHS 105.42(3) (3) Medicare certification requirement. Physician office laboratories which accept referrals of 100 or more specimens a year in a specialty shall be certified to participate in medicare in addition to meeting the requirements under sub. (1).

DHS 105.42 Note Note: For covered diagnostic testing services, see s. DHS 107.25.

DHS 105.42 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) and (2) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.

DHS 105.43 DHS 105.43 Hospital and independent clinical laboratories. For MA certification, a clinical laboratory that is a hospital laboratory or an independent laboratory shall be licensed pursuant to 42 CFR 493 (CLIA). In addition, the laboratory shall be certified to participate in medicare and meet the requirements of 42 CFR 405.1310 to 405.1317.

DHS 105.43 Note Note: For covered diagnostic testing services, see s. DHS 107.25.

DHS 105.43 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528.