DHS 105.51(6)(a) (a) Case management services shall be reimbursed when the services are provided by certified providers or their subcontractors to recipients eligible for case management.

DHS 105.51(6)(b) (b) Payment shall be made to certified providers of case management services according to terms of reimbursement established by the department.

DHS 105.51(7) (7) County election to participate.

DHS 105.51(7)(a) (a) The department may not certify a case management agency for a target population unless the county board or tribal government of the area in which the agency will operate has elected to participate in providing benefits under s. DHS 107.32 through providers operating in the county or tribal area. The county board or tribal government may terminate or modify its participation by giving a 30 day written notice to the department. This election is binding on any case management agencies providing services within the affected county or tribal area.

DHS 105.51(7)(b) (b) Any case management agency provider requesting certification under this section shall provide written proof of the election of the county or tribal government to participate under this subsection.

DHS 105.51 History History: Cr. Register, February, 1988, No. 386, eff. 3-1-88; corrections in (1) (a), (5) (intro.) and (7) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 105.52 DHS 105.52 Prenatal care coordination providers.

DHS 105.52(1) (1) Agency. For MA certification, an agency that provides prenatal care coordination services under s. DHS 107.34 (1) may be:

DHS 105.52(1)(a) (a) A community-based health organization;

DHS 105.52(1)(b) (b) A community-based social services agency or organization;

DHS 105.52(1)(c) (c) A county, city, or combined city and county public health agency;

DHS 105.52(1)(d) (d) A county department of human services under s. 46.23, Stats., or social services under s. 46.215 or 46.22, Stats.;

DHS 105.52(1)(e) (e) A family planning agency certified under s. DHS 105.36;

DHS 105.52(1)(f) (f) A federally qualified health center (FQHC) as defined in 42 CFR 405.2401 (b);

DHS 105.52(1)(g) (g) A health maintenance organization (HMO);

DHS 105.52(1)(h) (h) An independent physician association (IPA);

DHS 105.52(1)(i) (i) A hospital;

DHS 105.52(1)(j) (j) A physician’s office or clinic;

DHS 105.52(1)(k) (k) A private case management agency;

DHS 105.52(1)(L) (L) A registered nurse or nurse practitioner;

DHS 105.52(1)(m) (m) A rural health clinic certified under s. DHS 105.35;

DHS 105.52(1)(n) (n) A tribal agency health center; or

DHS 105.52(1)(o) (o) A women, infants, and children (WIC) program under 42 USC 1786.

DHS 105.52(2) (2) Qualified professionals.

DHS 105.52(2)(a) (a) Definition. In this subsection, “qualified professional” means any of the following:

DHS 105.52(2)(a)1. 1. A nurse practitioner licensed as a registered nurse pursuant to s. 441.06, Stats., and currently certified by the American nurses’ association, the national board of pediatric nurse practitioners and associates or the nurses’ association of the American college of obstetricians and gynecologists’ certification corporation;

DHS 105.52(2)(a)2. 2. A nurse midwife certified under s. DHS 105.201;

DHS 105.52(2)(a)3. 3. A public health nurse meeting the qualifications of s. DHS 139.08;

DHS 105.52(2)(a)4. 4. A physician licensed under ch. 448, Stats., to practice medicine or osteopathy;