DHS 107.09(4)(k)3.3. The recipient or legal representative is personally liable for no more than the difference between the nursing home’s private pay rate for a semi-private room and the private room rate; and DHS 107.09(4)(k)4.4. Pursuant to s. DHS 132.31 (1) (d), if at any time the differential rate determined under subd. 3. changes, the recipient or legal representative shall be notified by the nursing home administrator within 15 days and a new consent agreement shall be reached. DHS 107.09(4)(m)(m) Physician certification of need for SNF or ICF inpatient care. DHS 107.09(4)(m)1.1. A physician shall certify at the time that an applicant or recipient is admitted to a nursing home or, for an individual who applies for MA while in a nursing home before the MA agency authorizes payment, that SNF or ICF nursing home services are or were needed. DHS 107.09(4)(m)2.2. Recertification shall be performed by a physician, a physician’s assistant, or a nurse practitioner under the supervision of a physician as follows: DHS 107.09(4)(m)2.a.a. Recertification of need for inpatient care in an SNF shall take place 30, 60 and 90 days after the date of initial certification and every 60 days after that; DHS 107.09(4)(m)2.b.b. Recertification of need for inpatient care in an ICF shall take place no earlier than 60 days and 180 days after initial certification, at 12, 18 and 24 months after initial certification, and every 12 months after that; and DHS 107.09(4)(m)2.c.c. Recertification shall be considered to have been done on a timely basis if it was performed no later than 10 days after the date required under subd. 2. a. or b., as appropriate, and the department determines that the person making the certification had a good reason for not meeting the schedule. DHS 107.09(4)(n)(n) Medical evaluation and psychiatric and social evaluation — SNF. DHS 107.09(4)(n)1.1. Before a recipient is admitted to an SNF or before payment is authorized for a resident who applies for MA, the attending physician shall: DHS 107.09(4)(n)1.a.a. Undertake a medical evaluation of each applicant’s or recipient’s need for care in the SNF; and DHS 107.09(4)(n)2.2. A psychiatric and a social evaluation of an applicant’s or recipient’s need for care shall be performed by a provider certified under s. DHS 105.22. DHS 107.09(4)(n)3.3. Each medical evaluation shall include: diagnosis, summary of present medical findings, medical history, documentation of mental and physical status and functional capacity, prognosis, and a recommendation by the physician concerning admission to the SNF or continued care in the SNF. DHS 107.09(4)(o)(o) Medical evaluation and psychological and social evaluation — ICF. DHS 107.09(4)(o)1.1. Before a recipient is admitted to an ICF or before authorization for payment in the case of a resident who applies for MA, an interdisciplinary team of health professionals shall make a comprehensive medical and social evaluation and, where appropriate, a psychological evaluation of the applicant’s or recipient’s need for care in the ICF within 48 hours following admission unless the evaluation was performed not more than 15 days before admission. DHS 107.09(4)(o)2.2. In an institution for individuals with intellectual disabilities or persons with related conditions, the team shall also make a psychological evaluation of need for care. The psychological evaluation shall be made before admission or authorization of payment, but may not be made more than 3 months before admission. DHS 107.09(4)(o)3.3. Each evaluation shall include: diagnosis; summary of present medical, social and, where appropriate, developmental findings; medical and social family history; documentation of mental and physical status and functional capacity; prognosis; kinds of services needed; evaluation by an agency worker of the resources available in the home, family and community; and a recommendation concerning admission to the ICF or continued care in the ICF. DHS 107.09(4)(o)4.4. If the comprehensive evaluation recommends ICF services for an applicant or recipient whose needs could be met by alternate services that are not then available, the facility shall enter this fact in the recipient’s record and shall begin to look for alternative services. DHS 107.09(4)(p)(p) MA agency review of need for admission to an SNF or ICF. Medical and other professional personnel of the agency or its designees shall evaluate each applicant’s or recipient’s need for admission to an SNF or ICF by reviewing and assessing the evaluations required under pars. (n) and (o). DHS 107.09(4)(q)1.1. The level of care and services to be received by a recipient from the SNF or ICF shall be documented in the physician’s plan of care by the attending physician and approved by the department. The physician’s plan of care shall be submitted to the department whenever the recipient’s condition changes. DHS 107.09(4)(q)2.2. A physician’s plan of care shall be required at the time of application by a nursing home resident for MA benefits. If a physician’s plan of care is not submitted to the department by the nursing home at the time that a resident applies for MA benefits, the department shall not certify the level of care of the recipient until the physician’s plan of care has been received. Authorization shall be covered only for the period of 2 weeks prior to the date of submission of the physician’s plan of care. DHS 107.09(4)(q)3.3. The physician’s plan of care shall include diagnosis, symptoms, complaints and complications indicating the need for admission; a description of the functional level of the individual; objectives; any orders for medications, treatments, restorative and rehabilitative services, activities, therapies, social services or diet, or special procedures recommended for the health and safety of the patient; plans for continuing care, including review and modification to the plan of care; and plans for discharge. DHS 107.09(4)(q)4.4. The attending or staff physician and a physician assistant and other personnel involved in the recipient’s care shall review the physician’s plan of care at least every 60 days for SNF recipients and at least every 90 days for ICF recipients. DHS 107.09(4)(r)(r) Reports of evaluations and plans of care - ICF and SNF. A written report of each evaluation and the physician’s plan of care shall be made part of the applicant’s or recipient’s record: DHS 107.09(4)(r)2.2. If the individual is already in the facility, immediately upon completion of the evaluation or plan.