Wisconsin Administrative Code

DHS 105.23 Alcohol and other drug abuse (AODA) treatment providers. (1) TYPES OF PROVIDERS. For MA certification, an outpatient alcohol and other drug abuse (AODA) treatment provider shall be: (a) An outpatient facility operated by a board and certified under ss. DHS 75.49, 75.50…

DHS 105.24 Mental health day treatment or day hospital service providers. (1) REQUIREMENTS. For MA certification, a day treatment or day hospital service provider shall: (a) Be a medical program certified under s. DHS 61.75; and (b) Meet the following personnel and staffing requi…

DHS 105.25 Alcohol and other drug abuse (AODA) day treatment providers. (1) TYPES OF PROVIDERS. For MA certification, an alcohol and other drug abuse (AODA) day treatment provider shall be certified under ss. DHS 75.52 and 105.23. (2) STAFFING REQUIREMENTS. (a) An alcohol and dru…

DHS 105.255 Community support programs. (1) GENERAL REQUIREMENTS. For MA certification, a community support program (CSP) service provider shall meet the requirements under ss. DHS 63.06 to 63.17 and this section. The department may waive a requirement in ss. DHS 63.06 to 63.17 u…

DHS 105.257 Community-based psychosocial service programs. For MA certification as a community-based psychosocial service program under s. 49.45 (30e), Stats., a provider shall be certified as a comprehensive community services program under ch. DHS 36. The department may waive a…

DHS 105.259 Peer recovery support services. For MA certification under s. 49.45 (30j), Stats., a provider agency shall be certified to operate as one of the following: (1) A substance use overdose treatment program under subch. III of ch. DHS 72. (2) A service under ch. DHS 34, 3…

DHS 105.26 Chiropractors. For MA certification, chiropractors shall be licensed pursuant to s. 446.02, Stats. Note: For covered chiropractic services, see s. DHS 107.15. History: Cr. Register, February, 1986, No. 362, eff. 3-1-86. the chapter was last published. DHS 105.265 WISCO…

DHS 105.265 Podiatrists. For MA certification, podiatrists shall be licensed under s. 448.63, Stats., and ch. Pod 1 and registered under s. 448.07, Stats., and ch. Pod 4. History: Cr. Register, January, 1991, No. 421, eff. 2-1-91; corrections made under s. 13.93 (2m) (b) 7., Stat…

DHS 105.27 Physical therapists and assistants. (1) PHYSICAL THERAPISTS. For MA certification, physical therapists shall be licensed pursuant to ss. 448.05 and 448.07, Stats., and ch. PT 1. (2) PHYSICAL THERAPIST ASSISTANTS. For MA certification, physical therapist assistants shal…

DHS 105.28 Occupational therapists and assistants. (1) OCCUPATIONAL THERAPISTS. For MA certification, an occupational therapist shall: (a) Be certified by the American occupational therapy association as an occupational therapist, registered; or (b) Have graduated from a program …

DHS 105.29 Speech and hearing clinics. For MA certification, speech and hearing clinics shall be currently accredited by the American speech and hearing association (ASHA) pursuant to the guidelines for “accreditation of professional ser- 26 vices programs in speech pathology and…

DHS 105.30 Speech pathologists. For MA certification, speech pathologists shall: (1) Possess a current certification of clinical competence from the American speech and hearing association; (2) Have completed the educational requirements and work experience necessary for such a c…

DHS 105.31 Audiologists. For MA certification, audiologists shall: (1) Possess a certificate of clinical competence from the American speech and hearing association (ASHA); (2) Have completed the educational requirements and work experience necessary for the certificate; or (3) H…

DHS 105.32 Optometrists. For MA certification, optometrists shall be licensed and registered pursuant to ss. 449.04 and 449.06, Stats. Note: For covered vision care services, see s. DHS 107.20. History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.33 Opticians. For MA certification, opticians shall practice as described in s. 449.01 (2), Stats. Note: For covered vision care services, see s. DHS 107.20. History: Cr. Register, February, 1986, No. 362, eff. 3-1-86.

DHS 105.34 Rehabilitation agencies. For MA certification on or after January 1, 1988, a rehabilitation agency providing outpatient physical therapy, or speech and language pathology form, or occupational therapy shall be certified to participate in medicare as an outpatient rehab…

DHS 105.35 Rural health clinics. For MA certification, a rural health clinic shall be: (1) Certified to participate in medicare; (2) Licensed as required under all other local and state laws; and (3) Staffed with persons who are licensed, certified form or registered in accordanc…

DHS 105.36 Family planning clinics or agencies. For MA certification, family planning clinics or agencies shall meet the following conditions: (1) GENERAL. In order to qualify for MA reimbursement, family planning clinics shall certify to the department that: (a) An MA card has b…

DHS 105.37 Early and periodic screening, diagnosis and treatment (EPSDT) providers. (1) EPSDT HEALTH ASSESSMENT AND EVALUATION SERVICES. (a) Eligible providers. The following providers are eligible for certification as providers of EPSDT health assessment and evaluation services:…

DHS 105.38 Ambulance providers. (1) For MA certification, ambulance service providers shall be licensed pursuant to s. 256.15, Stats., and ch. DHS 110, and shall meet ambulance inspection standards of the Wisconsin department of transportation under s. 341.085, Stats., and ch. Tr…

DHS 105.39 Specialized medical vehicle providers. (1) For MA certification, a specialized medical vehicle provider shall meet the requirements of this section and shall sign the affidavit required under sub. (6) stipulating that the provider is in compliance with the requirements…

DHS 105.40 Durable medical equipment and medical supply vendors. (1) Except as provided in sub. (2), vendors of durable medical equipment and medical supplies shall be eligible to participate in the MA program. (2) Orthotists and prosthetists who develop and fit appliances for re…

DHS 105.41 Certification of hearing instrument specialists. For MA certification, hearing instrument specialists shall be licensed pursuant to ss. 459.01 to 459.14, Stats. Note: For covered hearing aids and supplies, see s. DHS 107.24.

DHS 105.42 Physician office laboratories. (1) REFor MA certification, physician office laboratories, except as noted in sub. (2), shall be licensed pursuant to 42 CFR 493 (CLIA). QUIREMENTS. (2) EXCEPTION. Physician office laboratories servicing no more than 2 physicians, chiropr…

DHS 105.43 Hospital and independent clinical laboratories. For MA certification, a clinical laboratory that is a hospital laboratory or an independent laboratory shall be licensed pursuant to 42 CFR 493 (CLIA). In addition, the laboratory shall be certified to participate in medi…

DHS 105.44 Portable x-ray providers. For MA certification, a portable x-ray provider shall be directed by a physician or group of physicians, registered pursuant to s. 254.35, Stats., and ch. DHS 157, certified to participate in medicare, and shall meet the requirements of 42 CFR…

DHS 105.45 Dialysis facilities. For MA certification, dialysis facilities shall meet the requirements enumerated in ss. DHS 152.05 and 152.08, and shall be certified to participate in medicare. Note: For covered dialysis services, see s. DHS 107.26. History: Cr. Register, Februar…

DHS 105.46 Blood banks. For MA certification, blood banks shall be licensed or registered with the U.S. food and drug administration and shall be approved pursuant to 42 CFR 493 (CLIA). Note: For covered blood services, see s. DHS 107.27. History: Cr. Register, February, 1986, No…

DHS 105.47 Health maintenance organizations and prepaid health plans. (1) CONTRACTS AND LICENSING. Except as provided in sub. (3), for MA certification, a health maintenance organization or prepaid health plan shall enter into a written contract with the department to provide ser…

DHS 105.48 Out-of-state providers. (1) When a provider in a state that borders on Wisconsin documents to the department’s satisfaction that it is common practice for recipients in a particular area of Wisconsin to go for medical services to the provider’s locality in the neighbor…

DHS 105.49 Ambulatory surgical centers. For MA certification, an ambulatory surgical center shall be certified to participate in medicare as an ambulatory surgical center under 42 CFR 416.39. Note: For covered ambulatory surgical center services, see s. DHS 107.30. History: Cr. R…

DHS 105.50 Hospices. For MA certification, a hospice shall be certified to participate in medicare as a hospice under 42 CFR 418.50 to 418.100. History: Cr. Register, February, 1988, No. 386, eff. 3-1-88.

DHS 105.51 Case management agency providers. (1) AGENCY. For MA certification, a provider of case management services shall be an agency with state statutory authority to operate one or more community human service programs. A case management agency may be a county or Indian trib…

DHS 105.52 Prenatal care coordination providers. (1) AGENCY. For MA certification, an agency that provides prenatal care coordination services under s. DHS 107.34 (1) may be any of the following: (a) A community-based health organization. (b) A community-based social services age…

DHS 105.525 Child care coordination providers. (1) PREREQUISITES. For MA certification, an agency that provides child care coordination services under s. DHS 107.345 (1) shall: (a) Be an agency under s. DHS 105.52 (1) (a) to (d) or (f) to (o) that is certified to provide prenatal…

DHS 105.529 Crisis urgent care and observation facilities. For MA certification as a crisis urgent care and observation facility under s. 49.45 (41a), Stats., a provider agency shall be certified to operate under ch. DHS 31. History: EmR2507: emerg. cr., eff. 6-16-25; CR 25-051: …

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. (1m) DEFINITION. In this sect…

DHS 105.54 Qualified complex rehabilitation technology suppliers. (1) CERTIFICATION. For MA certification, the chapter was last published. DHS 105.54 WISCONSIN ADMINISTRATIVE CODE complex rehabilitation technology suppliers shall do all of the following: (a) Be accredited by a de…

DHS 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 10…

DHS 106.02 General requirements for provision of services. Providers shall comply with the following general conditions for participation as providers in the MA program: (1) CERTIFICATION. A provider shall be certified under ch. DHS 105. (2) COVERED SERVICES. A provider shall be …

DHS 106.03 Manner of preparing and submitting claims for reimbursement. (1) FORMAT. (a) In this subsection, Xbilling serviceY means a provider or an entity under contract to a provider which provides electronic media billing or electronic billing transmission for one or more prov…

DHS 106.04 Payment of claims for reimbursement. (1) TIMELINESS. (a) Timeliness of payment. The department shall reimburse a provider for a properly provided covered service according to the provider payment schedule entitled Xterms of provider reimbursement,Y found in the appropr…

DHS 106.05 Voluntary termination of program participation. (1) PROVIDERS OTHER THAN NURSING HOMES. (a) Termination notice. Any provider other than a skilled nursing facility or intermediate care facility may at any time terminate participation in the program. A provider electing …

DHS 106.06 Involuntary termination or suspension from program participation. The department may suspend or terminate the certification of any person, partnership, corporation, association, agency, institution or other entity participating as a health care provider under the progr…

DHS 106.065 Involuntary termination and alternative sanctions for home care providers. (1) TERMINATION. (a) The department may terminate a home care provider[s certification to participate in the MA program for failure to comply with the requirements of s. DHS 105.19, 107.11, 107…

DHS 106.07 Effects of suspension or involuntary termination. (1) LENGTH OF SUSPENSION OR INVOLUNTARY TERMINATION. In determining the period for which a party identified in this chapter is to be disqualified from participation in the program, the department shall consider the foll…

DHS 106.08 Intermediate sanctions. (1) To enforce compliance with MA program requirements, the department may impose on a provider for a violation listed under sub. (2) one or more of the sanctions under sub. (3) unless the requirements of s. DHS 106.065 apply. Any sanction impos…