Chapter DHS 106
PROVIDER RIGHTS AND RESPONSIBILITIES
DHS 106.02 General requirements for provision of services. DHS 106.03 Manner of preparing and submitting claims for reimbursement. DHS 106.04 Payment of claims for reimbursement. DHS 106.05 Voluntary termination of program participation. DHS 106.06 Involuntary termination or suspension from program participation. DHS 106.065 Involuntary termination and alternative sanctions for home care providers. DHS 106.07 Effects of suspension or involuntary termination. DHS 106.08 Intermediate sanctions. DHS 106.09 Departmental discretion to pursue monetary recovery. DHS 106.10 Withholding payment of claims. DHS 106.11 Pre-payment review of claims. DHS 106.12 Procedure, pleadings and practice. DHS 106.13 Discretionary waivers and variances. Ch. DHS 106 NoteNote: Chapter HSS 106 was renumbered Chapter HFS 106 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, January, 1997, No. 493. Chapter HFS 106 was renumbered to chapter DHS 106 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636. DHS 106.01DHS 106.01 Introduction. In addition to provisions of chs. DHS 105 and 107 relating to individual provider types and the manner by which specified services are to be provided and paid for under medical assistance (MA), the participation of all providers certified under ch. DHS 105 to provide or claim reimbursement for services under the program shall be subject to the conditions set forth in this chapter. DHS 106.01 HistoryHistory: Cr. Register, December, 1979, No. 288, eff. 2-1-80; am. Register, February, 1986, No. 362, eff. 3-1-86; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636. DHS 106.02DHS 106.02 General requirements for provision of services. Providers shall comply with the following general conditions for participation as providers in the MA program: DHS 106.02(2)(2) Covered services. A provider shall be reimbursed only for covered services specified in ch. DHS 107. DHS 106.02(3)(3) Recipient eligible on date of service. A provider shall be reimbursed for a service only if the recipient of the service was eligible to receive MA benefits on the date the service was provided. DHS 106.02(4)(4) Compliance with state and federal requirements. A provider shall be reimbursed only if the provider complies with applicable state and federal procedural requirements relating to the delivery of the service. DHS 106.02(5)(5) Appropriate and medically necessary services. A provider shall be reimbursed only for services that are appropriate and medically necessary for the condition of the recipient.