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. DHS 107.09(4)(s)(s) Recovery of costs of services. All medicare-certified SNF facilities shall recover all medicare-allowable costs of services provided to recipients entitled to medicare benefits prior to billing MA. Refusal to recover these costs may result in a fine of not less than $10 nor more than $100 a day, as determined by the department. DHS 107.09(4)(t)(t) Prospective payment system. Provisions regarding services and reimbursement contained in this subsection are subject to s. 49.45 (6m), Stats. DHS 107.09(4)(u)(u) Active treatment. All developmentally disabled residents of SNF or ICF certified facilities who require active treatment shall receive active treatment subject to the requirements of s. DHS 132.695. DHS 107.09(5)(5) Non-covered services. The following services are not covered services: DHS 107.09(5)(a)(a) Services of private duty nurses when provided in a nursing home; DHS 107.09(5)(b)(b) For Christian Science sanatoria, custodial care and rest and study; DHS 107.09(5)(c)(c) Inpatient nursing care for ICF personal care and ICF residential care to residents who entered a nursing home after September 30, 1981; form DHS 107.09(5)(d)(d) ICF-level services provided to a developmentally disabled person admitted after September 15, 1986, to an ICF facility other than to a facility certified under s. DHS 105.12 as an intermediate care facility for individuals with intellectual disabilities unless the provisions of s. DHS 132.51 (2) (d) 1. have been waived for that person; and DHS 107.09(5)(e)(e) Inpatient services for residents between the ages of 21 and 64 when provided by an institution for mental disease, except that services may be provided to a 21 year old resident of an IMD if the person was a resident of the IMD immediately prior to turning 21 and continues to be a resident after turning 21. DHS 107.09 NoteNote: For more information about non-covered services, see s. DHS 107.03. DHS 107.09 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; renum. (1) to (4) to be (2) to (5) and am. (4) (g) 2. and (5) (6) and (c), cr. (1) (4) (u), (5) (d) and (e), Register, February, 1988, No. 386, eff. 3-1-88; emerg. cr. (4) (v), eff. 8-1-88; cr. (4) (v), Register, December, 1988, No. 396, eff. 1-1-89; correction in (4) (a) 1. intro. made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; corrections in (4) (v) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register, October, 2000, No. 538; corrections in (4) (g) 1., 2., (j) 1. g., (k), (n) 2., (u) and (5) (d) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; 2019 Wis. Act 1: am. (4) (o) 2., (5) (d) Register May 2019 No. 761, eff. 6-1-19; CR 20-039: r. (4) (v) Register October 2021 No. 790, eff. 11-1-21; CR 23-046: r. (4) (L) Register April 2024 No. 820, eff. 5-1-24. DHS 107.10(1)(1) Covered services. Drugs and drug products covered by MA include legend and non-legend drugs and supplies listed in the Wisconsin medicaid drug index which are prescribed by any of the following: