DHS 107.34(1)(g)(g) Nutrition counseling. Nutrition counseling is a covered prenatal care coordination service if provided either individually or in a group setting by an individual who is a qualified professional under s. DHS 105.52 (2) (a) with expertise in nutrition counseling based on education or at least one year of work experience. Nutrition counseling is a covered prenatal care coordination service if the medical need for it is identified in the risk assessment and the strategies and goals for it are part of the care plan to ameliorate a pregnant woman’s identified risk factors in areas including, but not limited to, the following:
DHS 107.34(1)(g)1.1. Weight and weight gain;
DHS 107.34(1)(g)2.2. A biochemical condition such as gestational diabetes;
DHS 107.34(1)(g)3.3. Previous nutrition-related obstetrical complications;
DHS 107.34(1)(g)4.4. Current nutrition-related obstetrical complications;
DHS 107.34(1)(g)5.5. Psychological problems affecting nutritional status;
DHS 107.34(1)(g)6.6. Dietary factors affecting nutritional status; and
DHS 107.34(1)(g)7.7. Reproductive history affecting nutritional status.
DHS 107.34(2)(2)Limitations.
DHS 107.34(2)(a)(a) Reimbursement for risk assessment and development of a care plan shall be limited to no more than one each for a recipient per pregnancy.
DHS 107.34(2)(b)(b) Reimbursement of a provider for on-going prenatal care coordination and health education and nutrition counseling provided to a recipient shall be limited to one claim for each recipient per month and only if the provider has had contact with the recipient during the month for which services are billed.
DHS 107.34(2)(c)(c) Prenatal care coordination is available to a recipient residing in an intermediate care facility or skilled nursing facility or as an inpatient in a hospital only to the extent that it is not included in the usual reimbursement to the facility.
DHS 107.34(2)(d)(d) Reimbursement of a provider for prenatal care coordination services provided to a recipient after delivery shall only be made if that provider provided prenatal care coordination services to that recipient before the delivery.
DHS 107.34(2)(e)(e) A prenatal care coordination service provider shall not terminate provision of services to a recipient it has agreed to provide services for during the recipient’s pregnancy unless the recipient initiates or agrees to the termination. If services are terminated prior to delivery of the child, the termination shall be documented in writing and the recipient shall sign the statement to indicate agreement. If the provider cannot contact a recipient in order to obtain a signature for the termination of services, the provider will document all attempts to contact the recipient through telephone logs and certified mail.
DHS 107.34(2)(f)(f) Reimbursement for prenatal care coordination services shall be limited to a maximum amount per pregnancy as established by the department.
DHS 107.34(3)(3)Non-covered services. Services not covered as prenatal care coordination services are the following:
DHS 107.34(3)(a)(a) Diagnosis and treatment, including:
DHS 107.34(3)(a)1.1. Diagnosis of a physical or mental illness;
DHS 107.34(3)(a)2.2. Follow-up of clinical symptoms;
DHS 107.34(3)(a)3.3. Administration of medications; and
DHS 107.34(3)(a)4.4. Any other professional service, except nutrition counseling or health education, which is a covered service by an MA certified or certifiable provider under this chapter;
DHS 107.34(3)(b)(b) Client vocational training;
DHS 107.34(3)(c)(c) Legal advocacy by an attorney or paralegal;
DHS 107.34(3)(d)(d) Care monitoring, nutrition counseling or health education not based on a plan of care;
DHS 107.34(3)(e)(e) Care monitoring, nutrition counseling or health education which is not reasonable and necessary to ameliorate identified prenatal risk factors; and
DHS 107.34(3)(f)(f) Transportation.
DHS 107.34 HistoryHistory: Cr. Register, June, 1994, No. 462, eff. 7-1-94; corrections in (1) (a) 1., (c), (d) (intro.), (e) 2. (intro.), (f) (intro.) and (g) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 107.36DHS 107.36School-based services.
DHS 107.36(1)(1)Covered services.