DHS 105.52(5) (5) Recipient record. The prenatal care coordination agency shall maintain a confidential prenatal care coordination file for each recipient receiving prenatal care coordination services, which includes the following items required or produced in connection with provision of covered services under s. DHS 107.34 (1):

DHS 105.52(5)(a) (a) Verification of the pregnancy;

DHS 105.52(5)(b) (b) Completed risk assessment document;

DHS 105.52(5)(c) (c) Care plan;

DHS 105.52(5)(d) (d) Completed consent documents for release of information;

DHS 105.52(5)(e) (e) A written record of all recipient-specific prenatal care coordination monitoring which includes, but is not limited to: the dates of service, description of service provided, the staff person doing the monitoring, the contacts made and the results;

DHS 105.52(5)(f) (f) Referrals and follow-up; and

DHS 105.52(5)(g) (g) All pertinent correspondence relating to coordination of the recipient’s prenatal care.

DHS 105.52 History History: Cr. Register, June, 1994, No. 462, eff. 7-1-94; CR 03-033: am. (1) (L), (2) (a) (intro.), 1., 6. to 8. Register December 2003 No. 576, eff. 1-1-04; corrections in (1) (intro.), (2) (a) 3., (4) (intro.) and (5) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.53 DHS 105.53 School-based service providers.

DHS 105.53(1) (1) Eligible providers. For MA certification, a school-based service provider shall be either a school district under ch. 120, Stats., or a cooperative educational service agency (CESA) under ch. 116, Stats.

DHS 105.53(2) (2) Separate certification prohibited. No school district or CESA may be separately certified as a provider of nursing services under ss. DHS 105.19 and 105.20, physical therapy services under s. DHS 105.27, occupational therapy services under s. DHS 105.28, speech and language pathology services under ss. DHS 105.29 and 105.30, audiology services under s. DHS 105.31 or transportation services under s. DHS 105.39.

DHS 105.53(3) (3) Record-keeping requirements.

DHS 105.53(3)(a) (a) For each recipient of school-based services, the provider shall keep a record containing, at a minimum, all of the following:

DHS 105.53(3)(a)1. 1. The recipient’s first and last name and date of birth;

DHS 105.53(3)(a)2. 2. The prescription or, if referred, the referral for the service;

DHS 105.53(3)(a)3. 3. Documentation used to develop the recipient’s IEP and to annually revise the IEP; and

DHS 105.53(3)(a)4. 4. Annual documentation of the individual’s progress toward treatment goals identified in the IEP, changes in the individual’s physical or mental status and changes in the treatment plan identified in the IEP.

DHS 105.53(3)(b) (b) For each date of service, the provider shall keep a service record within the recipient’s record containing all of the following:

DHS 105.53(3)(b)1. 1. The date of service;

DHS 105.53(3)(b)2. 2. The general type of service provided;

DHS 105.53(3)(b)3. 3. A brief description of the specific service provided;

DHS 105.53(3)(b)4. 4. The unit of service delivered as defined through handbooks distributed by the department under s. DHS 108.02 (4);

DHS 105.53(3)(b)5. 5. A description and the cost of each durable medical equipment item with sufficient detail to allow the MA program to determine the reimbursement rate, when appropriate; and

DHS 105.53(3)(b)6. 6. Documentation of whether the procedure was provided in a group or individual setting, when appropriate.

DHS 105.53(3)(c) (c) Periodically, at least monthly, the provider shall include in the service record under par. (b) the following:

DHS 105.53(3)(c)1. 1. For each service provided, a brief description of the recipient’s response to the service and progress toward the treatment goals identified in the IEP; and

DHS 105.53(3)(c)2. 2. The service provider’s signature.

DHS 105.53(3)(d) (d) The provider shall include in the records other information identified by the department in publications in accordance with s. DHS 108.02 (4).