DHS 107.24(3)(3) Services requiring prior authorization. All of the following services require prior authorization: DHS 107.24(3)(a)(a) Purchase of all items indicated as requiring prior authorization in the Wisconsin DME and medical supplies indices, published periodically and distributed to appropriate providers by the department. DHS 107.24(3)(b)(b) Repair or modification of an item which exceeds the department-established maximum reimbursement without prior authorization. Reimbursement parameters are published periodically in the DME and medical supplies provider handbook. DHS 107.24(3)(c)(c) Purchase, rental, repair or modification of any item not contained in the current DME and medical supplies indices. DHS 107.24(3)(d)(d) Purchase of items in excess of department-established frequencies or dollar limits outlined in the current Wisconsin DME and medical supplies indices. DHS 107.24(3)(e)(e) The second and succeeding months of rental use, with the exception that all hearing aid or other assistive listening device rentals require prior authorization. DHS 107.24(3)(f)(f) Purchase of any item which is not covered by Medicare, part b, when prescribed for a recipient who is also eligible for Medicare. DHS 107.24(3)(g)(g) Any item required by a recipient in a nursing home which meets the requirements of sub. (4) (c). DHS 107.24(3)(h)(h) Purchase or rental of a hearing aid or other assistive listening device in any of the following circumstances: DHS 107.24(3)(h)1.1. A request for prior authorization of a hearing aid or other ALD shall be reviewed only if the request consists of an otological report from the recipient’s physician and an audiological report from an audiologist or hearing instrument specialist, is on forms designated by the department and contains all information requested by the department. A hearing instrument specialist may perform an audiological evaluation and a hearing aid evaluation to be included in the audiological report if these evaluations are prescribed by a physician who determines all of the following: DHS 107.24(3)(h)1.c.c. The recipient has no special need which would necessitate either the diagnostic tools of an audiologist or a comprehensive evaluation requiring the expertise of an audiologist. DHS 107.24(3)(h)2.2. After a new or replacement hearing aid or other ALD has been worn for a 30-day trial period, the recipient shall obtain a performance check from a certified audiologist, a certified hearing instrument specialist or at a certified speech and hearing center. The department shall provide reimbursement for the cost of the hearing aid or other ALD after the performance check has shown the hearing aid or ALD to be satisfactory, or 45 days has elapsed with no response from the recipient. DHS 107.24(3)(h)3.3. Special modifications other than those listed in the MA speech and hearing provider handbook shall require prior authorization. DHS 107.24(3)(h)4.4. Provision of services in excess of the life expectancies of equipment enumerated in the MA speech and hearing provider handbook require prior authorization, except for hearing aid or other ALD batteries and repair services. DHS 107.24(3)(i)(i) A request for prior authorization of complex rehabilitation manual wheelchairs, complex rehabilitation power wheelchairs, and other complex rehabilitation seating components shall be reviewed only if the request consists of all of the following: DHS 107.24(3)(i)1.1. Documentation of a complex rehabilitative technology clinical evaluation performed by a qualified health care professional that includes all of the following: DHS 107.24(3)(i)1.a.a. A detailed description of the qualified health care professional’s assessment as outlined in the provider handbook including identification of the specific complex rehabilitation technology items requested. DHS 107.24(3)(i)2.2. Documentation stating that a direct, on-premises complex rehabilitation technology evaluation was performed by a qualified complex rehabilitation technology professional that includes all of the following: DHS 107.24(3)(i)2.a.a. A detailed description of the recipient’s current durable medical equipment and requested complex rehabilitation technology items, the projected lifespan of both, the accessibility of the setting in which the requested items are to be used, the recipient’s applicable methods of transportation, and an analysis of at least one comparable alternative to each requested item including an explanation of why the alternative does not meet the recipient’s needs.