DHS 105.01(5m) (5m) Optional Certification. A dental hygienist licensed under s. 447.04 (2), Stats., may opt to be individually certified by the department for MA reimbursement for dental hygiene services.

DHS 105.01(6) (6) Notification of certification decision. Except as provided in s. DHS 105.17 (5), within 60 days after receipt by the department or its fiscal agent of 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 105.01 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. (2) (b) and (c), (5) (a) 6., renum. (2) (d) and (5) (a) 7. to 12. to be (2) (b) and (5) (a) 6. to 11., Register, February, 1988, No. 386, eff. 3-1-88; am. (4) (c) and (d) and (5) (b), cr. (4) (e), Register, September, 1991, No. 429, eff. 10-1-91; emerg. am. (3) (d) 3. and (e), cr. (3) (f), eff. 7-1-92; am. (3) (d) 3. and (e), cr. (3) (f), Register, February, 1993, No. 446, eff. 3-1-93; CR 03-033: am. (3) (intro.) Register December 2003 No. 576, eff. 1-1-04; CR 05-033: am. (5) (a) 1., cr. (5m) Register August 2006 No. 608, eff. 9-1-06; corrections in (3) (a), (f) 4. and (4) (e) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 09-107: am. (6) Register August 2010 No. 656, eff. 9-1-10.

DHS 105.02 DHS 105.02 Requirements for maintaining certification. Providers shall comply with the requirements in this section in order to maintain MA certification.

DHS 105.02(1) (1) Change in provider status. Providers shall report to the department in writing any change in licensure, certification, group affiliation, corporate name or ownership by the time of the effective date of the change. The department may require the provider to complete a new provider application and a new provider agreement when a change in status occurs. A provider shall immediately notify the department of any change of address but the department may not require the completion of a new provider application or a new provider agreement for a change of address.

DHS 105.02(2) (2) Change in ownership.

DHS 105.02(2)(a) (a) Non-nursing home provider. In the event of a change in the ownership of a certified provider, except a nursing home, the provider agreement shall automatically terminate, except that the provider shall continue to maintain records required by subs. (4), (6) and (7) unless an alternative method of providing for maintenance of these records has been established in writing and approved by the department.

DHS 105.02(2)(b) (b) Nursing home provider. In the event of a change in the ownership of a nursing home, the provider agreement shall automatically be assigned to the new owner.

DHS 105.02(3) (3) Response to inquiries. A provider shall respond as directed to inquiries by the department regarding the validity of information in the provider file maintained by the department or its fiscal agent.

DHS 105.02(4) (4) Maintenance of records. Providers shall prepare and maintain whatever records are necessary to fully disclose the nature and extent of services provided by the provider under the program. Records to be maintained are those enumerated in subs. (6) and (7). All records shall be retained by providers for a period of not less than 5 years from the date of payment by the department for the services rendered, unless otherwise stated in chs. DHS 101 to 108. In the event a provider’s participation in the program is terminated for any reason, all MA-related records shall remain subject to the conditions enumerated in this subsection and sub. (2).

DHS 105.02(5) (5) Participation in surveys. Providers shall participate in surveys conducted for research and MA policy purposes by the department or its designated contractors. Participation involves accurate completion of the survey questionnaire and return of the completed survey form to the department or to the designated contractor within the specified time period.

DHS 105.02(6) (6) Records to be maintained by all providers. All providers shall maintain the following records:

DHS 105.02(6)(a) (a) Contracts or agreements with persons or organizations for the furnishing of items or services, payment for which may be made in whole or in part, directly or indirectly, by MA;

DHS 105.02(6)(b) (b) MA billings and records of services or supplies which are the subject of the billings, that are necessary to fully disclose the nature and extent of the services or supplies; and

DHS 105.02(6)(c) (c) Any and all prescriptions necessary to disclose the nature and extent of services provided and billed under the program.

DHS 105.02(7) (7) Records to be maintained by certain providers.

DHS 105.02(7)(a) (a) Specific types of providers. The following records shall be maintained by hospitals, skilled nursing facilities (SNFs), intermediate care facilities (ICFs) and home health agencies, except that home health agencies are not required to maintain records listed in subds. 5., 11. and 14., and SNFs, ICFs and home health agencies are not required to maintain records listed in subd. 4.:

DHS 105.02(7)(a)1. 1. Annual budgets;

DHS 105.02(7)(a)2. 2. Patient census information, separately:

DHS 105.02(7)(a)2.a. a. For all patients; and

DHS 105.02(7)(a)2.b. b. For MA recipients;

DHS 105.02(7)(a)3. 3. Annual cost settlement reports for medicare;

DHS 105.02(7)(a)4. 4. MA patient logs as required by the department for hospitals;

DHS 105.02(7)(a)5. 5. Annual MA cost reports for SNFs, ICFs and hospitals;

DHS 105.02(7)(a)6. 6. Independent accountants’ audit reports;

DHS 105.02(7)(a)7. 7. Records supporting historical costs of buildings and equipment;

DHS 105.02(7)(a)8. 8. Building and equipment depreciation records;

DHS 105.02(7)(a)9. 9. Cash receipt and receivable ledgers, and supporting receipts and billings;

DHS 105.02(7)(a)10. 10. Accounts payable, operating expense ledgers and cash disbursement ledgers, with supporting purchase orders, invoices, or checks;