• Preface
• Covered Services
• Wisconsin Medicaid Covers Personal Care Services
• Medical Necessity
• Covered Personal Care Services
  • Assistance with Activities of Dailing Living
  • Assistance with Housekeeping Activities
  • Accompanying the Recipient to Medical Appointments
  • Assistance with Medically Oriented Tasks
  • Travel Time
  • Registered Nurse Supervisory Visits
  • Disposable Medical Supplies
• Limitations to Covered Services
  • General
  • Prior Authorization
  • Medically Oriented Tasks
  • Place of Service
  • Housekeeping Activities
  • Supervision
  • Plan of Care
• Noncovered Services
• Duplicative Services
• Informal Support Systems
• Care in Group Settings
• Two Caregivers Providing Care for a Recipient at the Same Time
• Personal Care to Multiple Recipients at a Single Location
• Appendices
• Appendix 1 — Delegation of Medically Oriented Tasks
• Appendix 2 — Examples of Medically Oriented Tasks That May be Delegated to PCWs

Selection Menu :   Personal Care » General Information » Covered Services » Prior Authorization » Billing

 

Covered Services

Preface

The Wisconsin Medicaid Personal Care Handbook is issued to personal care providers who participate in Wisconsin Medicaid. It contains information that applies to fee-for-service Medicaid providers. The information in this handbook applies to services provided to both Medicaid and BadgerCare recipients.

Wisconsin Medicaid and BadgerCare are administered by the Department of Health and Family Services (DHFS). Within the DHFS, the Division of Health Care Financing (DHCF) is directly responsible for managing Wisconsin Medicaid and BadgerCare. BadgerCare extends Medicaid coverage to uninsured children and parents with incomes below 185% of the federal poverty level and who meet other program requirements. BadgerCare recipients receive the same health benefits as Wisconsin Medicaid recipients and their health care is administered through the same delivery system.

Medicaid and BadgerCare recipients enrolled in Medicaid HMOs are entitled to at least the same benefits as Medicaid fee-for-service recipients; however, HMOs may establish their own requirements regarding coverage limitations, prior authorization, billing, etc. If you are a Medicaid HMO network provider, contact your managed care organization regarding its requirements. Information contained in this and other Medicaid publications is used to resolve disputes regarding covered benefits under managed care arrangements.

The Personal Care Handbook consists of the following sections:

• General Information.
• Covered Services.
• Prior Authorization.
• Billing.

In addition to the Personal Care Handbook, each Medicaid-certified provider is issued a copy of the All-Provider Handbook. The All-Provider Handbook includes the following subjects:

• Claims Submission.
• Coordination of Benefits.
• Covered and Noncovered Services.
• Prior Authorization.
• Provider Certification.
• Provider Resources.
• Provider Rights and Responsibilities.
• Recipient Rights and Responsibilities.
• Response to Claims Submission.

The Provider Rights and Responsibilities section of the All-Provider Handbook identifies specific responsibilities of a Wisconsin Medicaid provider. Refer to this section for detailed information regarding fair treatment of the recipient, maintenance of records, recipient requests for noncovered services, services rendered to a recipient during periods of retroactive eligibility, grounds for provider sanctions, and additional state and federal requirements.

Important:

The following laws and regulations provide the legal framework for Wisconsin Medicaid and BadgerCare:

Wisconsin regulation and law

• Regulation: Wisconsin Administrative Code, Rules of Health and Family Services, Chapters HFS 101 - 108.
• Law: Wisconsin Statutes: Sections 49.43 - 49.497 and 49.665.

Federal regulation and law

• Regulation: Title 42 CFR Parts 430 - 456 — Public Health.
• Law: United States Social Security Act; Title XIX (42 US Code ss. 1396 and following) and Title XXI.

Wisconsin Medicaid handbooks and Updates further interpret and implement these laws and regulations.

Wisconsin Medicaid handbooks and Updates, maximum allowable fee schedules, helpful telephone numbers and addresses, and much more information are available at Wisconsin Medicaid’s web site at: dhs.wisconsin.gov/medicaid.

The DHFS contracts with a fiscal agent to provide health claims processing, communications, and other related services.

Next — Covered Services, Wisconsin Medicaid Covers Personal Care Services

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Personal Care Services Handbook
PHC 1369-B, January 2000