Wisconsin Administrative Code
Department of Health Services
DHS 30-100 - Community Services
Chapter DHS 73 - Selected Fiscal Management Procedures And Standards Under The Medical Assistance Home And Community-Based Services Waiver
Section DHS 73.09 - Documentation that services have been provided

Universal Citation: WI Admin Code ยง DHS 73.09

Current through February 26, 2024

(1) If a participant or the participant's representative employs a service provider, the county department shall verify the type and amount of service for which reimbursement is sought. A verification form developed and available from the county department shall either be submitted to the county department by the participant or participant's representative or be reviewed by the case manager at the participant's residence at least every 6 months.

(2) The completed verification form shall include the following information:

(a) The type or types of services provided;

(b) The number of hours of service provided in the past month or, if the service provider lives in the residence of the participant, the number of days of service provided in the past month;

(c) The total dollar amount paid for the services;

(d) The month in which the services were provided;

(e) The dated signature of the participant or participant's representative; and

(f) The dated signature of the service provider.

(3) The county department may provide in the form under sub. (2) that the information in sub. (2) (b) does not have to be maintained or reported if:

(a) The services provided are limited to household care;

(b) The services are for the purpose of providing respite care; or

(c) The services are provided by the spouse of the participant or by the parent of a minor participant.

(4) If a county department directly provides services or purchases services from a vendor agency, the county department and vendor agency, if any, shall establish procedures sufficient to document the amount of services provided to each participant each month.

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