DHS 107.02(2)(b)(b) Services which the department, the PRO review process or the department fiscal agent’s professional consultants determine to be medically unnecessary, inappropriate, in excess of accepted standards of reasonableness or less costly alternative services, or of excessive frequency or duration;
DHS 107.02(2)(c)(c) Non-emergency services provided by a person who is not a certified provider;
DHS 107.02(2)(d)(d) Services provided to recipients who were not eligible on the date of the service, except as provided under a prepaid health plan or HMO;
DHS 107.02(2)(e)(e) Services for which records or other documentation were not prepared or maintained, as required under s. DHS 106.02 (9);
DHS 107.02(2)(f)(f) Services provided by a provider who fails or refuses to prepare or maintain records or other documentation as required under s. DHS 106.02 (9);
DHS 107.02(2)(g)(g) Services provided by a provider who fails or refuses to provide access to records as required under s. DHS 106.02 (9) (e) 4.;
DHS 107.02(2)(h)(h) Services for which the provider failed to meet any or all of the requirements of s. DHS 106.03, including but not limited to the requirements regarding timely submission of claims;
DHS 107.02(2)(i)(i) Services provided inconsistent with an intermediate sanction or sanctions imposed by the department under s. DHS 106.08; and
DHS 107.02(2)(j)(j) Services provided by a provider who fails or refuses to meet and maintain any of the certification requirements under ch. DHS 105 applicable to that provider.
DHS 107.02(2m)(2m)Services requiring a physician’s order or prescription.
DHS 107.02(2m)(a)(a) The following services require a physician’s order or prescription to be covered under MA:
DHS 107.02(2m)(a)1.1. Skilled nursing services provided in a nursing home;
DHS 107.02(2m)(a)2.2. Intermediate care services provided in a nursing home;
DHS 107.02(2m)(a)3.3. Home health care services;
DHS 107.02(2m)(a)4.4. Independent nursing services;
DHS 107.02(2m)(a)5.5. Respiratory care services for ventilator-dependent recipients;
DHS 107.02(2m)(a)6.6. Physical and occupational therapy services;
DHS 107.02(2m)(a)8.8. Speech pathology and audiology services;
DHS 107.02(2m)(a)9.9. Medical supplies and equipment, including rental of durable equipment, but not hearing aid batteries, hearing aid accessories or repairs;
DHS 107.02(2m)(a)10.10. Drugs, except when prescribed by a nurse practitioner under s. DHS 107.122, a podiatrist under s. DHS 107.14 or an advanced practice nurse prescriber under s. DHS 107.10;
DHS 107.02(2m)(a)11.11. Prosthetic devices;
DHS 107.02(2m)(a)12.12. Laboratory, diagnostic, radiology and imaging test services;
DHS 107.02(2m)(a)13.13. Inpatient hospital services;
DHS 107.02(2m)(a)14.14. Outpatient hospital services;
DHS 107.02(2m)(a)15.15. Inpatient hospital IMD services;
DHS 107.02(2m)(a)16.16. Hearing aids;
DHS 107.02(2m)(a)18.18. Hospital private room accommodations;
DHS 107.02(2m)(a)19.19. Personal care services; and
DHS 107.02(2m)(a)20.20. Hospice services.