DHS 107.13(1)(f)4.4. Conditional leave, convalescent leave or transfer days from psychiatric hospitals for recipients under the age of 21; DHS 107.13(1)(f)5.5. Psychotherapy or AODA treatment services when separately billed and performed by masters level therapists or AODA counsellors certified under s. DHS 105.22 or 105.23; DHS 107.13(1)(f)6.6. Group therapy services or medication management for hospital inpatients whether separately billed by an IMD hospital or by any other provider as an outpatient claim for professional services; DHS 107.13(1)(f)7.7. Court appearances, except when necessary to defend against commitment; and DHS 107.13(1)(f)8.8. Inpatient services for recipients between the ages of 21 and 64 when provided by a hospital IMD, except that services may be provided to a 21 year old resident of a hospital IMD if the person was a resident of that institution immediately prior to turning 21 and continues to be a resident after turning 21. A hospital IMD patient who is 21 to 64 years of age may be eligible for MA benefits while on convalescent leave from a hospital IMD. DHS 107.13 NoteNote: Subdivision 8 applies only to services for recipients 21 to 64 years of age who are actually residing in an IMD. Services provided to a recipient who is a patient in one of these facilities but temporarily hospitalized elsewhere for medical treatment or temporarily residing at a rehabilitation facility or another type of medical facility are covered services.
DHS 107.13 NoteNote: For more information on non-covered services, see ss. DHS 107.03 and 107.08 (4). DHS 107.13(2)(a)(a) Covered services. Except as provided in par. (b), outpatient psychotherapy services shall be covered services when provided by a provider certified under s. DHS 105.22, and when the following conditions are met: DHS 107.13(2)(a)1.1. A strength-based assessment, including differential diagnostic examination, is performed by a certified psychotherapy provider. A physician’s prescription is not necessary to perform the assessment. The assessment shall include: DHS 107.13(2)(a)1.b.b. Diagnosis established from the current Diagnostic and Statistical Manual of Mental Disorders including all 5 axes or, for children up to age four, the current Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood. DHS 107.13(2)(a)1.d.d. The recipient’s strengths, and current and past psychological, social, and physiological data; information related to school or vocational, medical, and cognitive function; past and present trauma; and substance abuse. DHS 107.13(2)(a)1.e.e. The recipient’s unique perspective and own words about how he or she views his or her recovery, experience, challenges, strengths, needs, recovery goals, priorities, preferences, values and lifestyle, areas of functional impairment, and family and community support. DHS 107.13(2)(a)1.f.f. Barriers and strengths to the recipient’s progress and independent functioning. DHS 107.13(2)(a)3.a.a. A provider who is a licensed physician, licensed psychologist, or a licensed and certified advanced practice nurse prescriber who is individually certified under s. DHS 105.22 (1) (a), (b), or (bm) and who is working in an outpatient mental health clinic certified under s. DHS 105.22 or in private practice. DHS 107.13(2)(a)4.b.b. A hospital outpatient mental health clinic on the hospital’s physical premises.