Wis. Admin. Code Department of Health Services DHS 105.53 - School-based service providers
(1) ELIGIBLE
PROVIDERS. For MA certification, a school-based service provider shall be
either a school district under ch. 120, Stats., or a cooperative educational
service agency (CESA) under ch. 116, Stats.
(2) SEPARATE CERTIFICATION PROHIBITED. No
school district or CESA may be separately certified as a provider of nursing
services under ss.
DHS
105.19 and
105.20, physical therapy services
under s.
DHS
105.27, occupational therapy services under s.
DHS
105.28, speech and language pathology services under
ss.
DHS
105.29 and
105.30, audiology services under s.
DHS
105.31 or transportation services under s.
DHS
105.39.
(3) RECORD-KEEPING REQUIREMENTS.
(a) For each recipient of school-based
services, the provider shall keep a record containing, at a minimum, all of the
following:
1. The recipient's first and last
name and date of birth;
2. The
prescription or, if referred, the referral for the service;
3. Documentation used to develop the
recipient's IEP and to annually revise the IEP; and
4. Annual documentation of the individual's
progress toward treatment goals identified in the IEP, changes in the
individual's physical or mental status and changes in the treatment plan
identified in the IEP.
(b) For each date of service, the provider
shall keep a service record within the recipient's record containing all of the
following:
1. The date of service;
2. The general type of service
provided;
3. A brief description of
the specific service provided;
4.
The unit of service delivered as defined through handbooks distributed by the
department under s.
DHS
108.02(4);
5. A description and the cost of each durable
medical equipment item with sufficient detail to allow the MA program to
determine the reimbursement rate, when appropriate; and
6. Documentation of whether the procedure was
provided in a group or individual setting, when appropriate.
(c) Periodically, at least
monthly, the provider shall include in the service record under par. (b) the
following:
1. For each service provided, a
brief description of the recipient's response to the service and progress
toward the treatment goals identified in the IEP; and
2. The service provider's
signature.
(d) The
provider shall include in the records other information identified by the
department in publications in accordance with s.
DHS
108.02(4).
(4) REPORTING REQUIREMENTS. The required
annual audit of school district accounts under s.
120.14, Stats., and the audit of
CESA receipts and expenditures under s.
115.28(3m),
Stats., shall include evidence, in accordance with instructions distributed by
the department under s.
DHS
108.02(4), that requirements for
billing and for paying expenses under s.
49.45(39) (b),
Stats., are being met. Sections of those annual audits shall be made available
to the department upon request.
(5)
REIMBURSEMENT.
(a) School-based services
shall be reimbursed when the services are provided by certified providers or
their contractors to recipients eligible for school-based services.
(b) Payment, based on the cost to provide the
service, shall be made to certified providers of school-based services
according to terms of reimbursement established by the department and stated in
the medicaid state plan under
42 CFR
430.10.
(c) Services provided between July 1, 1995
and June 30, 1996 may be billed through June 30, 1997, to the extent allowed by
federal law, notwithstanding s.
DHS 106.03(3) (b)
1.
(6) COORDINATION WITH OTHER MA-CERTIFIED
PROVIDERS.
(a)
Memorandum of
understanding with HMO. School-based services providers shall have on
file a signed copy of a memorandum of understanding with each HMO participating
in the medical assistance HMO program when the geographic service area of the
HMO coincides with part or all of the geographic service area of the
school-based services provider.
(b)
Coordination with fee-for-service providers. When a recipient
receives similar services from both an MA fee-for-service provider and a
school-based service provider, the school-based service provider shall
document, at least annually, regular contacts with the MA fee-for-service
provider, and provide the MA fee-for-service provider with copies of the
recipient's IEP and relevant components of the multidisciplinary team
evaluation under s. 115.80(3) and
(5), Stats., upon request.
Notes
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