Wisconsin Legislature: DHS 107.13(7)(c)3.

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EmR2421

d. Crisis intervention on a 24-hour basis, including short-term emergency care at home or elsewhere in the community; and

e. Psychiatric and psychological evaluations;

5. Psychological rehabilitation services as follows;

a. Employment-related services. These services consist of counseling the recipient to identify behaviors which interfere with seeking and maintaining employment; development of interventions to alleviate problem behaviors; and supportive services to assist the recipient with grooming, personal hygiene, acquiring appropriate work clothing, daily preparation for work, on-the-job support and crisis assistance;

b. Social and recreational skill training. This training consists of group or individual counseling and other activities to facilitate appropriate behaviors, and assistance given the recipient to modify behaviors which interfere with family relationships and making friends;

c. Assistance with and supervision of activities of daily living. These services consist of aiding the recipient in solving everyday problems; assisting the recipient in performing household tasks such as cleaning, cooking, grocery shopping and laundry; assisting the recipient to develop and improve money management skills; and assisting the recipient in using available transportation;

d. Other support services. These services consist of helping the recipient obtain necessary medical, dental, legal and financial services and living accommodations; providing direct assistance to ensure that the recipient obtains necessary government entitlements and services, and counseling the recipient in appropriately relating to neighbors, landlords, medical personnel and other personal contacts; and

6. Case management in the form of ongoing monitoring and service coordination activities described in s. DHS 107.32 (1) (d).

(b) Other limitations.

1. Mental health services under s. DHS 107.13 (2) and (4) are not reimbursable for recipients receiving CSP services.

2. An initial assessment shall be reimbursed only when the recipient is first admitted to the CSP and following discharge from a hospital after a short-term stay.

3. Group therapy is limited to no more than 10 persons in a group. No more than 2 professionals shall be reimbursed for a single session of group therapy. Mental health technicians shall not be reimbursed for group therapy.

4. Reimbursement is not available for a person participating in the program under this subsection if the person is also participating in the program under sub. (7).

1. Case management services provided under s. DHS 107.32 by a provider not certified under s. DHS 105.255 to provide CSP services;

2. Services provided to a resident of an intermediate care facility, skilled nursing facility or an institution for mental diseases, or to a hospital patient unless the services are performed to prepare the recipient for discharge from the facility to reside in the community;

3. Services related to specific job-seeking, job placement and work activities;

4. Services performed by volunteers;

5. Services which are primarily recreation-oriented; and

6. Legal advocacy performed by an attorney or paralegal.

(7) Psychosocial services provided through a community-based psychosocial service program.

(a) Covered services. Psychosocial services provided through a community-based psychosocial service program shall be covered services when authorized by a mental health professional under s. DHS 36.15 for recipients determined to have a need for the services under s. DHS 36.14. These non-institutional services must fall within the definition of “rehabilitative services” under 42 CFR 440.130 (d) and must be described in a service plan under s. DHS 36.17. Covered services include assessment under s. DHS 36.16 and service planning and review under s. DHS 36.17.

(b) Other limitations.

1. Mental health services under s. DHS 107.13 (2) and (4) are not reimbursable for recipients receiving services under this subsection.

2. Group psychotherapy is limited to no more than 10 persons in a group. No more than 2 professionals shall be reimbursed for a single session of group psychotherapy. Mental health technicians shall not be reimbursed for group psychotherapy.

3. Reimbursement is not available for a person participating in the program under this subsection if the person is also participating in the program under sub. (6).

1. Case management services provided under s. DHS 107.32 by a provider not certified under s. DHS 105.257 to provide services under this section.

3. Services performed by volunteers, except that out-of-pocket expenses incurred by volunteers in performing services may be covered.

4. Services that are not rehabilitative, including services that are primarily recreation-oriented.

5. Legal advocacy performed by an attorney or paralegal.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (f) 8., Register, February, 1988, No. 386, eff. 3-1-88; emerg. cr. (3m), eff. 3-9-89; cr. (3m), Register, December, 1989, No. 408, eff. 1-1-90; emerg. cr. (2) (c) 5., (3) (c) 2., (4) (c) 4. and (6), eff. 1-1-90; cr. (2) (c) 5., (3) (c) 2., (4) (c) 4. and (6), Register, September, 1990, No. 417, eff. 10-1-90; emerg. r. and recr. (1) (b) 3., am. (1) (f) 6., eff. 1-1-91; am. (1) (a), (b) 1. and 2., (c), (f) 5., 6. and 8., (2) (a) 1., 3. a. and b., 4. f., 6., 7., (b) 1. and 2., (c) 2., (3) (a) (intro.), 4., 5., 7., (b) 1. and 2., (c) 1. (3) (d) 1. and 2., (4) (a) 3. and 6. and (d) 6., r. and recr. (1) (b) 3. and (e), r. (4) (b) 1. d., renum. (4) (b) 1. c. to be d., cr. (2) (c) 6., (3) (c) 3. and 4., (3) (d) 3., Register, September, 1991, No. 429, eff. 10-1-91; am. (4) (a) 2., cr. (4) (a) 8., Register, February, 1993, No. 446, eff. 3-1-93; corrections in (3) (d) 3. and (3m) (a) 1. made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; emerg. am. (2) (c) 5. and (4) (c) 4., cr. (6) (b) 4. and (7), eff. 7-1-04; CR 04-025: am (2) (c) 5. and (4) (c) 4., cr. (6) (b) 4. and (7) Register October 2004 No. 586, eff. 11-1-04; corrections in (1) (a), (f) 5., (2) (a) (intro.), 3., (c) 6., (3) (a) (intro.), (c) 3., (d) 3., (3m) (a) (intro.), 1., (b) 3., (4) (a) (intro.), 8., (6) (a) (intro.), (c) 1., (7) (a) and (c) 1. made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 06-080: am. (2) (a) (intro.), 1. (intro.), 3. a., b., 4. a. to f., 6., 7., (b) 1., 4. a. to d., (c) 4., 6. and (d) 2., cr. (2) (a) 1. a. to g. and (2m) Register May 2009 No. 641, eff. 6-1-09; CR 14-066: am. (2) (a) (intro.), r. (2) (a) 2., am. (2) (a) 4. (intro.), cr. (2) (a) 4. g., r. (2) (b) 4. b., am. (2) (d) (intro.), 1. to. 4. Register August 2015 No. 716, eff. 9-1-15; 2019 Wis. Act 1: am. (2) (d) 2. Register May 2019 No. 761; eff. 6-1-19; CR 20-039: am. (2) (d) 1. Register October 2021 No. 790, eff. 11-1-21; correction in (6) (c) 2. made under s. 35.17, Stats., Register July 2022 No. 799; correction in (3) (d) 3., (3m) (a) 1. made under s. 13.92 (4) (b) 7., Stats., made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801; CR 22-043: cr. (2) (a) 4. h., am. (2) (a) 5., (b) 4. e., (3) (a) 5., 6., (b) 4. d., (3m) (d) 6., (4) (a) 8., (d) 7. Register May 2023 No. 809, eff. 6-1-23; correction in (2) (a) 5., (3) (a) 6. made under s. 35.17, Stats., Register May 2023 No. 809; CR 23-046: r. (2) (a) 6., 7., (b), (3) (a) 4., 7., (b) Register April 2024 No. 820, eff. 5-1-24; correction in (2) (a) 5., (3) (a) 6. made under s. 35.17, Stats., Register April 2024 No. 820.

DHS 107.14 Podiatry services.

(1) Covered services.

(a) Podiatry services covered by medical assistance are those medically necessary services for the diagnosis and treatment of the feet and ankles, within the limitations described in this section, when provided by a certified podiatrist.

(b) The following categories of services are covered services when performed by a podiatrist:

1. Office visits;

2. Home visits;

3. Nursing home visits;

4. Physical medicine;

5. Surgery;

6. Mycotic conditions and nails;

7. Laboratory;

8. Radiology;

9. Plaster or other cast material used in cast procedures and strapping or tape casting for treating fractures, dislocations, sprains and open wounds of the ankle, foot and toes;

10. Unna boots; and

11. Drugs and injections.

(2) Other limitations.

(a) Podiatric services pertaining to the cleaning, trimming and cutting of toenails, often referred to as palliative or maintenance care, shall be reimbursed once per 61 day period only if the recipient is under the active care of a physician and the recipient’s condition is one of the following:

1. Diabetes mellitus;

2. Arteriosclerosis obliterans evidenced by claudication;

3. Peripheral neuropathies involving the feet, which are associated with:

a. Malnutrition or vitamin deficiency;

b. Diabetes mellitus;

c. Drugs and toxins;

d. Multiple sclerosis; or

e. Uremia;

4. Cerebral palsy;

5. Multiple sclerosis;

6. Spinal cord injuries;

7. Blindness;

8. Parkinson’s disease;

9. Cerebrovascular accident; or

10. Scleroderma.

(b) The cutting, cleaning and trimming of toenails, corns, callouses and bunions on multiple digits shall be reimbursed at one fee for each service which includes either one or both feet.

(c) Initial diagnostic services are covered when performed in connection with a specific symptom or complaint if it seems likely that treatment would be covered even though the resulting diagnosis may be one requiring non-covered care.

(d) Physical medicine modalities may include, but are not limited to, hydrotherapy, ultrasound, iontophoresis, transcutaneous neurostimulator (TENS) prescription, and electronic bone stimulation. Physical medicine is limited to 10 modality services per calendar year for the following diagnoses only:

1. Osteoarthritis;

2. Tendinitis;

3. Enthesopathy;

4. Sympathetic reflex dystrophy;

5. Subclacaneal bursitis; and

6. Plantar fascitis, as follows:

a. Synovitis;

b. Capsulitis;

c. Bursitis; or

d. Edema.

(e) Services provided during a nursing home visit to cut, clean or trim toenails, corns, callouses or bunions of more than one resident shall be reimbursed at the nursing home single visit rate for only one of the residents seen on that day of service. All other claims for residents seen at the nursing home on the same day of service shall be reimbursed up to the multiple nursing home visit rate. The podiatrist shall identify on the claim form the single resident for whom the nursing home single visit rate is applicable, and the residents for whom the multiple nursing home visit rate is applicable.

(f) Debridement of mycotic conditions and mycotic nails is a covered service provided that utilization guidelines established by the department are followed.

(3) Non-covered services. The following are not covered services:

(a) Procedures which do not relate to the diagnosis or treatment of the ankle or foot;

(b) Palliative or maintenance care, except under sub. (2);

(c) All orthopedic and orthotic services except plaster and other material cast procedures and strapping or tape casting for treating fractures, dislocations, sprains or open wounds of the ankle, foot or toes;

(d) Orthopedic shoes and supportive devices such as arch supports, shoe inlays and pads;

(e) Physical medicine exceeding the limits specified under sub. (2) (d);

(f) Repairs made to orthopedic and orthotic appliances;

(g) Dispensing and repairing corrective shoes;

(h) Services directed toward the care and correction of “flat feet;”