DHS 109.51(3)(3) Provider responsibility. At the request of a person authorized by the department and on presentation of that person’s credentials, a SeniorCare provider shall permit access to any requested records, whether in written, electronic, or micrographic form. Access for purposes of this subsection shall include the opportunity to inspect, review, audit and reproduce the records. DHS 109.51(4)(4) Record retention. Termination of a SeniorCare provider’s program participation does not end the SeniorCare provider’s responsibility to retain and provide access to records unless an alternative arrangement for retention, maintenance and access has been established by the SeniorCare provider and approved in writing by the department. DHS 109.51(5)(5) Submission of claims. A SeniorCare provider shall submit all claims for prescription drugs purchased by a participant during spend-down and deductible periods. DHS 109.51(6)(6) Third party liability. A SeniorCare provider shall seek reimbursement from any third party insurer legally liable to contribute in whole or in part to the cost of prescription drugs prior to billing the SeniorCare program. DHS 109.51(7)(7) Refunds to participants. A SeniorCare provider shall fully refund participant payments for drugs subsequently covered by SeniorCare. If either the deductible or copayment retroactively applies, the provider shall fully refund the participant the excess amount that the participant paid. The excess is the difference between the actual amount the participant paid and the amount the participant is responsible for under SeniorCare. DHS 109.51(8)(a)(a) As a condition of participation by a SeniorCare provider in the program under s. 49.45, 49.46, or 49.47, Stats., the SeniorCare provider may not charge an eligible participant who presents a valid prescription order and a SeniorCare identification an amount for a prescription drug under the order that exceeds the following: DHS 109.51(8)(a)2.2. For a prescription benefit, the copayment amount, as applicable, that is specified in s. DHS 109.13 (2) (b). No dispensing fee may be charged to a person under this paragraph. DHS 109.51(8)(b)(b) The department shall calculate and transmit amounts that may be used in calculating charges under par. (a) to SeniorCare providers. DHS 109.51 HistoryHistory: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03; correction in (1) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 22-046: am. (5) Register June 2023 No. 810, eff. 7-1-23. DHS 109.52(1)(1) General. This section identifies the terms and conditions under which SeniorCare providers of drugs are certified for participation in the program. DHS 109.52(2)(a)(a) For SeniorCare certification, pharmacies located in Wisconsin shall meet the requirements for registration and practice under ch. 450, Stats., and chs. Phar 1 to 17. Pharmacies certified to serve patients under the medical assistance program under ch. DHS 105 are required to serve SeniorCare participants. DHS 109.52(2)(b)(b) Pharmacies located outside of Wisconsin are exempt from the requirement under par. (a), but shall be registered or licensed by the appropriate agency in the state in which they are located. DHS 109.52(3)(3) General conditions for participation. In order to be certified by the department to dispense drugs under this program, a SeniorCare provider shall do all of the following: DHS 109.52(3)(a)(a) Affirm in writing that the SeniorCare provider and each person employed by the SeniorCare provider for the purpose of providing the service holds all licenses or similar entitlements as specified in this chapter and as required by federal or state statute, regulation or rule for the provision of the service. DHS 109.52(3)(b)(b) Affirm in writing that neither the SeniorCare provider, nor any person in whom the SeniorCare provider has a controlling interest, nor any person having a controlling interest in the SeniorCare provider, has been convicted of a crime related to, or been terminated from, a federally-assisted or state-assisted medical program. DHS 109.52(3)(c)(c) Disclose in writing to the department all instances in which the SeniorCare provider, any person in whom the SeniorCare provider has a controlling interest, or any person having a controlling interest in the SeniorCare provider has been sanctioned by a federally-assisted or state-assisted medical program. DHS 109.52(3)(d)(d) Furnish the following information to the department in writing: DHS 109.52(3)(d)1.1. The names and addresses of all vendors of drugs, medical supplies or transportation, or other providers in which the SeniorCare provider has a controlling interest or ownership. DHS 109.52(3)(d)2.2. The names and addresses of all persons who have a controlling interest in the SeniorCare provider. DHS 109.52(3)(d)3.3. Whether any of the persons named in compliance with subd. 1. or 2., is related to another named in subd. 1. or 2. DHS 109.52(3)(e)(e) Execute a SeniorCare provider agreement with the department. DHS 109.52(4)(4) Notification of certification decision. Within 60 days after the department receives a complete application for certification, including evidence of licensure or Medicare certification, or both, if required, the department shall either approve the application and issue the certification, or deny the application. If the application for certification is denied, the department shall give the applicant reasons, in writing, for the denial. DHS 109.52(5)(a)(a) Compliance with requirements. A SeniorCare provider shall maintain compliance with the requirements in this subsection in order to maintain SeniorCare certification.