Current through February 26, 2024
(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.