DHS 107.18(3)(e)5.5. The recipient shows no motivation, interest, or desire to participate in therapy, which may be for reasons of an overriding severe emotional disturbance;

DHS 107.18(3)(e)6.6. Other therapies are providing sufficient services to meet the recipient’s functioning needs; or

DHS 107.18(3)(e)7.7. The procedures requested are not medical in nature or are not covered services. Inappropriate diagnoses for therapy services and procedures of questionable medical necessity may not receive departmental authorization, depending upon the individual circumstances.

DHS 107.18(4)(4) Non-covered services. The following services are not covered services:

DHS 107.18(4)(a)(a) Services which are of questionable therapeutic value in a program of speech and language pathology. For example, charges by speech and language pathology providers for “language development — facial physical,” “voice therapy — facial physical” or “appropriate outlets for reducing stress”;

DHS 107.18(4)(b)(b) Those services that can be performed by restorative nursing, as under s. DHS 132.60 (1) (b) to (d); and

DHS 107.18(4)(c)(c) Activities such as end-of-the-day clean-up time, transportation time, consultations and required paper reports. These are considered components of the provider’s overhead costs and are not covered as separately reimbursable items.

DHS 107.18 HistoryHistory: Cr Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (a), (b) (intro.), (c) (intro.) (2) (b), (d), (e), (h) and (4) (a), Register, February 1988, No. 386, eff. 3-1-88; emerg. am. (2) (b), (d), (g) and (3) (c), eff. 7-1-88; am. (2) (b), (d), (g), and (3) (c), Register, December, 1988, No. 396, eff. 1-1-89; correction in (4) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 107.19(1)(1) Covered services. Covered audiology services are those medically necessary diagnostic, screening, preventive or corrective audiology services prescribed by a physician and provided by an audiologist certified pursuant to s. DHS 105.31. These services include:

DHS 107.19(1)(c)(c) Hearing aid or other assistive listening device performance check;

DHS 107.19(2)(a)(a) Services requiring prior authorization. The following covered services require prior authorization from the department:

DHS 107.19(2)(a)3.3. Dispensing of hearing aids and other assistive listening devices.

DHS 107.19(2)(b)(b) Conditions for review of requests for prior authorization. Requests for prior authorization of audiological services shall be reviewed only if these requests contain the following information: