Section 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.

History: Emerg. cr. eff. 6-15-96; cr. Register, January, 1997, No. 497 , eff. 2-1-97; CR 03-033 : am. (3) (a) 3., 4., (c) 1. and (6) (b) Register December 2003 No. 576 , eff. 1-1-04; corrections in (3) (b) 4., (d), (4) and (5) (c) made under s. 13.92 (4) (b) 7. , Stats., Register December 2008 No. 636 .