DHS 109.31(6)(a)2. 2. Offer to discuss with each SeniorCare participant, the participant’s legal representative or the participant’s caregiver who presents the prescription, matters which, in the exercise of the SeniorCare provider’s professional judgment and consistent with state statutes and rules governing provisions of this information, the SeniorCare provider deems significant, including the following:

DHS 109.31(6)(a)2.a. a. The name and description of the medication.

DHS 109.31(6)(a)2.b. b. The route, dosage form, dosage, route of administration, and duration of drug therapy.

DHS 109.31(6)(a)2.c. c. Specific directions and precautions for preparation, administration and use by the patient.

DHS 109.31(6)(a)2.d. d. Common severe side effects or adverse effects or interactions and therapeutic contraindications that may be encountered, including how to avoid them, and the action required if they occur.

DHS 109.31(6)(a)2.e. e. Techniques for self-monitoring drug therapy.

DHS 109.31(6)(a)2.f. f. Proper storage.

DHS 109.31(6)(a)2.g. g. Prescription refill information.

DHS 109.31(6)(a)2.h. h. Action to be taken in the event of a missed dose.

DHS 109.31(6)(a)3. 3. Make a reasonable effort to obtain, record and maintain at least the following information regarding each SeniorCare participant for whom the SeniorCare provider dispenses drugs under the SeniorCare program:

DHS 109.31(6)(a)3.a. a. The participant’s name, address, telephone number, date of birth or age and gender.

DHS 109.31(6)(a)3.b. b. The participant’s medical history where significant, including any disease state or states, known allergies and drug reactions, and a comprehensive list of medications and relevant devices.

DHS 109.31(6)(a)3.c. c. The SeniorCare provider’s comments related to the participant’s drug therapy.

DHS 109.31(6)(b) (b) Nothing in this subsection shall be construed as requiring a SeniorCare provider to provide consultation when a SeniorCare participant, the participant’s legal representative or the participant’s caregiver refuses the consultation.

DHS 109.31 History History: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03; corrections in (2) (b), (3) (e) and (5) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register February 2014 No. 698; CR 22-046: cr. (3) (h) Register June 2023 No. 810, eff. 7-1-23.

DHS 109.32 DHS 109.32 Coverage while out-of-state. Drugs shall be covered for a SeniorCare participant only if the participant is within the United States, Canada or Mexico. Drugs provided by a person in another state who is not certified as a border status provider shall be covered only under either of the following circumstances:

DHS 109.32(1) (1) As a result of an accident or sudden illness, the individual needs the drug to prevent the individual’s death or the serious impairment of the individual’s health.

DHS 109.32(2) (2) When the department has granted prior authorization for provision of a non-emergency service, except that prior authorization is not required for non-emergency services provided to Wisconsin participants by border status providers certified by the Wisconsin medical assistance program.

DHS 109.32 History History: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03.

subch. IV of ch. DHS 109 Subchapter IV — Program Integrity

DHS 109.41 DHS 109.41 Annual report to legislature. The department shall monitor compliance with s. 49.688, Stats., and the provisions of this chapter by SeniorCare providers.

DHS 109.41 History History: CR 02-154: cr. Register April 2003 No. 568, eff. 5-1-03.

DHS 109.42 DHS 109.42 Prohibition on fraud.

DHS 109.42(1) (1) No person may do any of the following:

DHS 109.42(1)(a) (a) Knowingly and willfully make or cause to be made any false statement or representation of a material fact in any application for any SeniorCare benefit or payment.

DHS 109.42(1)(b) (b) Knowingly and willfully make or cause to be made any false statement or representation of a material fact for use in determining rights to any SeniorCare benefit or payment.

DHS 109.42(1)(c) (c) Have knowledge of the occurrence of any event affecting the initial or continued right to any SeniorCare benefit or payment, or the initial or continued right to any such benefit, or payment of any other individual in whose behalf he or she has applied for or is receiving such benefit or payment, or conceal or fail to disclose such event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized.

DHS 109.42(1)(d) (d) Having made application to receive any SeniorCare benefit or payment for the use and benefit of another and having received it, knowingly and willfully convert such benefit or payment or any part thereof to a use other than for the use and benefit of such other person.

DHS 109.42(2) (2) Violators of this section shall be subject to penalties under s. 49.688 (9), Stats.