DHS 107.31(3)(c)2.2. A hospice may contract for services required under sub. (2) (d). The contract shall include identification of services to be provided, the qualifications of the contractor’s personnel, the role and responsibility of each party and a stipulation that all services provided will be in accordance with applicable state and federal statutes, rules and regulations and will conform to accepted standards of professional practice.

DHS 107.31(3)(c)3.3. When a resident of a skilled nursing facility or an intermediate care facility elects to receive hospice care services, the hospice shall contract with that facility to provide the recipient’s room and board. Room and board includes assistance in activities of daily living and personal care, socializing activities, administration of medications, maintaining cleanliness of the recipient’s room and supervising and assisting in the use of durable medical equipment and prescribed therapies.

DHS 107.31(3)(d)(d) Reimbursement for services.

DHS 107.31(3)(d)2.2. A maximum amount, or hospice cap, shall be established by the department for aggregate payments made to the hospice during a hospice cap period. A hospice cap period begins November 1 of each year and ends October 31 of the following year. Payments made to the hospice provider by the department in excess of the cap shall be repaid to the department by the hospice provider.

DHS 107.31 HistoryHistory: Cr. Register, February, 1988, No. 386, eff. 3-1-88; emerg. am. (2) (a) and (3) (d) 1., r. and recr. (3) (a) 3., renum. (3) (d) 2. to 4. to be 3. to 5. and cr. (3) (d) 2., eff. 7-1-88; am. (2) (a), (3) (a) 1. and (d) 1., r. and recr. (3) (a) 3., renum. (3) (d) 2. to 4. to be 3. to 5. and cr. (3) (d) 2., Register, December, 1988, No. 396, eff. 1-1-89; corrections in (1) (a) and (2) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 107.32(1)(a)(a) General.

DHS 107.32(1)(a)1.1. Case management services covered by MA are services described in this section and provided by an agency certified under s. DHS 105.51 or by a qualified person under contract to an agency certified under s. DHS 105.51 to help a recipient, and, when appropriate, the recipient’s family gain access to, coordinate or monitor necessary medical, social, educational, vocational and other services.

DHS 107.32(1)(a)2.2. Case management services under pars. (b) and (c) are provided under s. 49.45 (25), Stats., as benefits to those recipients in a county in which case management services are provided who are over age 64, are diagnosed as having Alzheimer’s disease or other dementia, or are members of one or more of the following target populations: developmentally disabled, chronically mentally ill who are age 21 or older, alcoholic or drug dependent, physically or sensory disabled, or under the age of 21 and severely emotionally disturbed. In this subdivision, “severely emotionally disturbed”means having emotional and behavioral problems which:

DHS 107.32(1)(a)2.b.b. Have significantly impaired the person’s functioning for 6 months or more and, without treatment, are likely to continue for a year or more. Areas of functioning include: developmentally appropriate self-care; ability to build or maintain satisfactory relationships with peers and adults; self-direction, including behavioral controls, decisionmaking, judgment and value systems; capacity to live in a family or family equivalent; and learning ability, or meeting the definition of “child with exceptional educational needs” under ch. PI 1 and s. 115.76 (3), Stats.;

DHS 107.32(1)(a)2.d.d. Include mental or emotional disturbances diagnosable under DSM-III-R. Adult diagnostic categories appropriate for children and adolescents are organic mental disorders, psychoactive substance use disorders, schizophrenia, mood disorders, schizophreniform disorders, somatoform disorders, sexual disorders, adjustment disorder, personality disorders and psychological factors affecting physical condition. Disorders usually first evident in infancy, childhood and adolescence include pervasive developmental disorders (Axis II), conduct disorder, anxiety disorders of childhood or adolescence and tic disorders.

DHS 107.32(1)(b)(b) Case assessment. A comprehensive assessment of a recipient’s abilities, deficits and needs is a covered case management service. The assessment shall be made by a qualified employee of the certified case management agency or by a qualified employee of an agency under contract to the case management agency. The assessment shall be completed in writing and shall include face-to-face contact with the recipient. Persons performing assessments shall possess skills and knowledge of the needs and dysfunctions of the specific target population in which the recipient is included. Persons from other relevant disciplines shall be included when results of the assessment are interpreted. The assessment shall document gaps in service and the recipient’s unmet needs, to enable the case management provider to act as an advocate for the recipient and assist other human service providers in planning and program development on the recipient’s behalf. All services which are appropriate to the recipient’s needs shall be identified in the assessment, regardless of availability or accessibility of providers or their ability to provide the needed service. The written assessment of a recipient shall include: