DQA
Quarterly Information Update
August 2006
[PDF
Version of this month's Quarterly Update (PDF,
120 KB) - blue text indicates links
to other sections or to Internet pages]
Electronic Subscription Service
We are pleased to announce a new electronic subscription listserv for
BQA numbered memos, quarterly updates, and Pharmacy Newscapsules. This
service will allow Internet users to receive E-mails announcing new items.
Viewers will no longer need to review the BQA memos website on a regular
basis to check on recent postings.
This listserv was announced via a Division of Disability and Elder
Services (DDES) Information Memo, 2006-11, available via http://dhfs.wisconsin.gov/dsl_info/InfoMemos/InfoMemos_2006.htm.
The site to sign up to receive BQA and DDES memos is at
http://dhfs.wisconsin.gov/dsl_info/signup.htm. If you have signed up for BQA memos, and have not received any
notifications within a month or so, you may want to try signing up again.
Remember that you will need to unsubscribe yourself should your E-mail
address change.
FOCUS 2006 Conference - Still
Time to Register
There is still time to register
for the 6th Annual Conference for health care providers on August 29th and
30th, 2006, at the Radisson Paper Valley Hotel in Appleton, Wisconsin.
Please visit http://dhfs.wisconsin.gov/rl_DSL/Training/index.htm
for
registration information before August 16, 2006. You may also call Leann
Graffin at (608) 267-1438.
Survey Guides Now Available on the Internet!
Effective immediately, survey guides for the following provider types
are available on the Internet. As a result, surveyors will no longer be
routinely providing a paper copy of the entire document at survey
entrance, unless the provider does not have Internet access and requests a
copy. Surveyors will provide the cover page and a contact page, which
includes the website address, the (lead) surveyor's name, the surveyor's
supervisor, and contact information for both.
The following survey guides are available on the Internet at:
BQA Numbered Memos May-July 2006
| Memo |
Title |
Providers Affected |
| 06-004 |
Medicare Part D Issues: Timely Services and
Medication Coverage Issues |
Adult Day Care Programs, Adult Family Homes,
Community Based Residential Facilities, Nursing Homes, Residential
Care Apartment Complexes |
| 06-005 |
Informal Dispute Resolution (IDR) Update |
Facilities Serving People with
Developmental Disabilities, Nursing Homes |
| 06-006 |
Variance of Chapter HFS 124,
WI Administrative Code: Authentication of Physician Orders |
Hospitals |
| 06-007 |
Health Facility Construction Plan Reviews and
Onsite Inspections |
Ambulatory Surgery Centers, Community Based
Residential Facilities, End Stage Renal Dialysis Units, Hospitals,
Nursing Homes |
| 06-008 |
DHFS 24-Hour Emergency Telephone Hotline for
Reporting Public Health & Human Services Emergencies |
All Provider types |
| 06-009 |
Statewide Variance of HFS 124 & HFS 83,
Mantoux Tuberculin Skin Test |
Hospitals, Community Based Residential Facilities |
| 06-010 |
Assisted Living Industry - "State of the
State" |
Adult Day Care Programs, Adult Family Homes,
Community Based Residential Facilities, Residential Care Apartment
Complexes |
| 06-011 |
Sharing of Toilet Facilities - Obsoleted by 07-016 |
Nursing Homes |
| 06-012 |
Immediate Jeopardy Citations |
Nursing Homes |
| 06-013 |
Modular Education Program for
Activity Professionals - Obsoleted by 07-017 |
Nursing Homes |
| 06-014 |
Medicaid Eligibility for Nursing Home
Care Determination |
Nursing Homes |
| 06-015 |
Federal Caregiver Background Check Pilot
Quarterly Data Collection Tool |
Caregiver Background Check Pilot Entities |
| 06-016 |
Insulin and Assisted Living |
Adult Day Care Programs, Adult Family Homes,
Community Based Residential Facilities, Residential Care Apartment
Complexes |
| 06-017 |
Standard Precautions
Training in Adult Family Homes (AFHs) |
Adult Family Homes |
| Upcoming Memos: |
| "Patient Privacy During Inpatient Psychiatric
Treatment" (hospitals, mental health treatment programs) |
| "Medication Return, Disposal & Donation"
(nursing homes) |
| "Resident Medication Regimen & Administrative
Review" (CBRFs) |
| "Hospice Aides & Topical Medication
Administration" (Hospices) |
Access these memos via http://dhfs.wisconsin.gov/rl_DSL/Publications/BQAnodMems.htm,
or from individual providers' publications pages via http://dhfs.wisconsin.gov/rl_DSL/.
The following BQA memos have been made obsolete:
- 06-002, "Variance of Chapter HFS 124, Wisconsin Administrative
Code: Authentication of Physician Orders - Effective Date -
Immediate," replaced by 06-006.
- 90-024, "Statewide Waiver of HSS 132.84(2)(e)1., Amended to
Include HSS 132.84(2)(f)2" (Sharing of Toilet Facilities),
replaced by 07-016.
- RAI and MDS Automation memos 98-009, 98-018, 98-037, 98-042, 99-050,
and 00-037 have been retired as they contained out-of-date
information.
-
OASIS memos 98-047, 98-058, 99-005, 99-006, 99-018, 99-027, 99-055,
99-067 and 01-029 have been retired as they contained out-of-date
information.
DDES Info Memo 2006-15: Statutory Changes Affecting Counties and DHFS
Licensed or Certified Providers
On July 26, 2006, the Division of Disability and Elder Services issued
DDES Info Memo 2006-15 to counties and DHFS-licensed and certified
providers, identifying nine recently-passed Wisconsin Acts. Changes have
been made to several laws regarding adult protective services, including
administration of psychotropic medication, court-ordered protective
placements and guardianship, and confidentiality requirements for
treatment records.
The memo provides a brief overview of the statutory changes, effective
dates and includes links to access each Act. Facilities will find that
many of the new laws may have considerable impact on how they provide
services and operate programs. DDES Info Memo 2006-15 can be found at http://dhfs.wisconsin.gov/dsl_info/InfoMemos/InfoMemos_2006.htm.
Caregiver Project Abuse and Neglect Prevention Training
This spring, 500 caregivers participated in the first phase of an
innovative abuse and neglect prevention training program. This training
program, known as the Caregiver Project, is made possible through the
Caregiver Background Check Pilot grant funds. As a result, the same
long-term care providers that are required to fingerprint newly hired
caregivers are also eligible to send caregivers to free abuse and neglect
prevention training through the Caregiver Project.
The purpose of the Caregiver Project is to increase awareness about
abuse, neglect, and misappropriation of property in long-term care
settings; and to encourage a team approach to reducing its occurrence. To
reach this goal, the Office of Caregiver Quality, which is administering
the project, contracted with the University of Wisconsin-Oshkosh to
develop two phases of training.
The first phase is experiential training. The interactive, four-hour,
experiential training is specifically designed for direct-patient-access
employees and their managers who work in long term care settings. During
the training session, caregivers interact in reality-based scenarios. This
experiential training gives caregivers a unique opportunity to walk in the
shoes of other caregivers, managers, residents/consumers, and family
members. By actively participating in the scenario, caregivers learn:
- The red flags of abuse and neglect and how to identify them;
- Appropriate responses when abuse or neglect is suspected or
observed, including reporting protocols;
- Strategies and techniques to protect residents and prevent abuse;
and
- Promising practices to promote resident and staff safety, dignity,
respect and health
Scenarios cover both facility-based and home-based settings and address
the following issues:
- Emotional abuse
- Mental abuse
- Physical abuse
- Sexual abuse
- Verbal abuse
- Neglect and
- Misappropriation
Caregivers who attended the experiential training this spring,
responded positively. Eighty-nine percent said they would recommend the
training to a coworker. Individual comments included:
- "Really made one stop and think about "being there"
puts a different light on the situation - VERY WELL DONE!!"
- "Wasn't just a boring lecture. Interactive learning was fun and
more effective."
- "Facilitators were excellent! Interactive in the best ways -
"safe" (mostly scripted) role playing, lively sharing of
information. Real-life scenarios with good amount of detail."
- "Hands-on, relevant, motivational - very well done."
The Caregiver Project will continue to provide the experiential
training for the duration of the project. In fact, twelve additional
training sessions are already scheduled for this fall, many of which will
take place at long-term care facilities.
Phase two of the project consists of a series of four topical trainings
targeted at either direct caregivers or their managers. The topics include
"Keys to Professional Care Giving," "Supporting Your
Professional Caregiver, Internal Investigations," and "Dealing
with Difficult Clients." These training sessions are expected to last
between two to three hours each; and will be provided in all four of the
pilot counties, starting this fall and ending in the spring of 2007.
The Caregiver Background Check Pilot ends on September 30, 2007. The
Caregiver Project staff will spend the last few months of the pilot
developing ways to disseminate the training materials so that they can be
used by a wider audience.
To learn more about the Caregiver Project, visit the training website
at www.CaregiverProject.org (exit
DHFS).
To learn more about the Caregiver Background Check Pilot in general, visit
the pilot website at http://dhfs.wisconsin.gov/caregiver/fedBCpilot.htm.
RAI/MDS - No Changes in Medicaid Coding
The Department of Health & Family Services is moving from a level
of care-based Medicaid reimbursement method to an acuity-based method that
uses MDS assessments to calculate RUG levels. This change does not affect
how nursing homes code the MDS for their Medicaid residents. Nursing homes
should continue completing MDS assessments, following requirements
specified in the RAI manual. No additional MDS assessments are required,
and Wisconsin continues to require the standard 2-page MDS Quarterly
Assessment. Wisconsin does not require Medicaid resident MDS assessments
to be coded as AA8b = 06 (Other State Required Assessment).
The Division of Health Care Financing will provide additional
information on the changes to nursing home Medicaid reimbursement
procedures in a future Medicaid Update release.
New RAI/MDS Education Coordinator
The Bureau of Quality Assurance (BQA) is pleased to announce that
Margaret (Peg) Katz has been hired as the new RAI/MDS Education
Coordinator in the Provider Regulation and Quality Improvement Section.
Peg will be the Bureau's point of contact for nursing facilities with
questions or concerns regarding the Resident Assessment Instrument (RAI)
and Minimum Data Set (MDS). She will also conduct provider training
programs for facility nursing staff around the state; and will serve as
the Bureau's liaison to CMS and to Metastar, the Wisconsin Quality
Improvement Organization (QIO), on issues regarding the RAI and MDS.
Ms. Katz comes to her new position from Northern Wisconsin Center in
Chippewa Falls, where she was a nursing supervisor. She has also held
nursing positions with Northwest Pathways to Independence, the Trempealeau
County Health Care Center, St. Francis Hospital, and Lakeview Health Care
Center. She has also worked as a nurse consultant for Proctor and Gamble.
Peg attended the University of Minnesota with emphases on Psychology and
Anthropology. After graduation, she worked as a case manager for Hennepin
County's Department of Family Services in Minnesota. She completed her
nursing education in Rochester, Minnesota. Peg has certification as a
diabetic nurse educator, and has completed course work in "Train the
Trainer" programs.
Peg assumed her new duties in BQA on July 10, 2006. She will be based
in the Bureau's Western Regional Office, 610 Gibson St., Eau Claire, and
can be reached by telephone at 715-836-6748 or via email at KatzMA@dhfs.state.wi.us.
Please join us in welcoming Peg to her new position.
New OASIS Education Coordinator
The Bureau of Quality Assurance (BQA) is pleased to announce that Janie
Harris has joined us as the new OASIS Education Coordinator. Janie is
located in BQA's Provider Regulation and Quality Improvement Section, and
is the Bureau's central contact for home health agencies needing technical
assistance and consultation regarding the Outcome and Assessment
Information Set (OASIS). Janie will conduct provider training programs for
home health agency staff, work with BQA home health surveyors; and serve
as the Bureau's liaison to CMS and to Metastar, the Wisconsin Quality
Improvement Organization (QIO), on issues regarding OASIS.
Ms. Harris comes to her new position from the Mendota Mental Health
Institute in Madison, where she worked as a nurse clinician with emphases
on health assessment and health promotion and improvement programs. Prior
to coming to Wisconsin, she had lengthy experience as a nurse in the State
of Indiana. Janie is a Registered Nurse, with a nursing diploma from St.
Mary's School of Nursing in Madison. She has also pursued extensive
continuing education in nursing and psychology at Indiana University and
the University of Wisconsin.
Janie assumed her new duties in BQA on July 17, 2006, and is based in
the Bureau's Central Office in Madison. She can be reached by telephone at
608-267-3807, or via email at HarriJD@dhfs.state.wi.us.
Please join BQA in welcoming Janie to her new position.
Home Health Agency Information
Wisconsin Act 187
2005 Wisconsin Act 187, enacted on March 23, 2006, authorizes medically
related actions by advanced practice nurse prescribers (APNP). The Act
specifically amends Chapter 50.49(1)(b) (intro) to allow a home health
patient to be under the care of an APNP. It further allows the APNP to
establish, and periodically review, the plan for furnishing items and
services to a home health patient. Access the Act at www.legis.state.wi.us/2005/data/acts/05Act187.pdf (exit
DHFS; PDF, 46 KB).
The Bureau of Quality Assurance has determined that the authority given
to APNPs in Act 187 applies only to state licensed-only home health
agencies. Agencies that are federally certified for participation in the
Medicare program must abide by 42 CFR 484, which has no provisions for
physician extenders or APNPs.
Home Health Advanced Beneficiary Notification (HHABN)
The Centers for Medicare and Medicaid Services (CMS) issued the
following statement regarding the HHABN:
"This note is to follow up on an announcement from CMS's May 24
Home Health, Hospice and Durable Medical Equipment Open Door Forum. As
discussed, CMS received a significant number of comments on the revised
HHABN form and instructions. The comment period under the Paperwork
Reduction Act (PRA) ended on May 23, and we are now in the process of
reviewing these comments. In order to enable CMS to give due consideration
to these comments and make any appropriate changes, CMS is extending the
phase-in period for use of the new form through at least September 1,
2006. Thus, home health agencies may continue to use either the
traditional HHABN or the revised version of the form until further notice.
"We will issue further guidance as soon as possible with respect
to the deadline for final implementation of the new HHABN, and we
sincerely appreciate your cooperation in this process. In addition, please
note that we have now posted a new set of HHABN Questions and Answers on
the CMS website at www.cms.hhs.gov/BNI
(exit DHFS).
From the left menu, click on FFS HHABN, and scroll down the page to the
"Downloads" section. There you'll find a link titled: 'HHABN Qs
and As June 20, 2006.'"
Hospice Agency Information
Definition of Hospice
CMS has recently determined that hospices limiting their scope of
service to treating only patients in residential facilities do not meet
the definition of hospice as defined by Medicare. Section 1861(dd)(2)(A)(ii)
of the Social Security Act defines a hospice program as a public agency or
private organization that provides for such care and services in
individuals' homes, on a outpatient basis, and on a short-term inpatient
basis. Entities that only provide hospice services to their residents, and
exclude outpatients, do not meet this definition and may not participate
in the Medicare program as a hospice. This determination may also apply to
hospices serving patients only in residential facilities that are not
owned directly by the hospice.
Hospice care is an essential Medicare benefit that focuses on the
patient and family, and provides special support to the dying. Medicare is
committed to ensuring that all beneficiaries receive appropriate
end-of-life care, tailored to their needs, and that they understand their
rights and options. It was not intended to limit services to a select
group, or to place any barriers to the provision of care.
CMS intends to require any agency not meeting the Medicare definition
of hospice to develop a plan to meet the definition and come into
compliance with Section 1861(dd)(2)(A)(ii) of the Social Security Act. CMS
will then evaluate the plan to determine if it adequately addresses the
issue. If CMS accepts the plan for correcting the issue, it will authorize
BQA to conduct a visit to determine if the plan has been implemented and
the issue corrected.
Questions regarding this issue may be directed to Jacqueline Lewis,
Program Representative, at the Chicago CMS Office at (312) 353-8858.
Fires in Health Care Facilities
The National Fire Protection Association's (NFPA) March 2006 report,
"U.S Fires in Selected Occupancies," summarizes the current
trends of fires in health care facilities. The report provides detailed
information of structural fire trends, when fires occur, leading causes,
equipment involved in ignition, heat source, area of origin, item first
ignited, and extent of flame damage.
The leading area of origin in facilities is the kitchen, followed by
the laundry department.
Following is a summary of the data from 1999 to 2002:
- Hospitals had 3,150 fires each year, with an average of one death,
87 injuries and $21.3 million in direct property damage.
- Nursing Homes had 3,680 fires each year, with an average of 11
deaths, 172 injuries, and $12.6 million in direct property damage.
- January was the peak month for fires.
- Peak day for fires was Tuesday for hospitals, and Saturday for
nursing homes.
- Peak time for fires are from 8-10 a.m. and 4-7 p.m.
- The second leading item ignited was electrical wire or cable
insulation.
Sprinkler protection again demonstrated its benefits. A fully
sprinkler-protected building has a death rate six times lower and property
damage loss two times lower compared to a non-sprinkler protected
building. Of the reported fires, 74% took place in nursing homes with
sprinkler systems, while 61% of hospital fires involved facilities with
sprinkler systems.
The complete report is available at www.nfpa.org
(exit DHFS)
- search for the term "USS12."
Nursing Home Fires in the United States
According to the current issue of HCPro's monthly newsletter,
"Healthcare Life Safety Compliance," 4,130 fires were reported
to have occurred in the nation's nursing homes in 2002. This number almost
equaled the 4, 190 reported in 2001. Approximately 40% of the fires
reported in 2002 were cooking-related. Kitchens were the most likely point
of origin.
The National Fire Protection Association (NFPA) issued a report,
"U.S. Fires in Selected Occupancies," which identified the
leading causes of nursing home fires. These were:
- Cooking equipment (41%);
- Various sources (23%);
- Clothes dryer or washer (14%);
- Heating equipment (9%);
- Smoking materials (7%); and
- Electrical (6%).
CMS Webcasts May-August 2006
Listed below are the CMS webcasts that were produced between
May-August, 2006. They will be available for one (1) year after the date
of broadcast. You may access these webcasts at http://cms.internetstreaming.com/
(exit DHFS).
- 5-19-06 Adaptation: Dealing with Changing Needs and Capabilities
Part 3: Dealing With the Loss of a Body Part
- 6-23-06 SCG Semi-Annual News Magazine: Mind and Body Medicine
- 8-25-06 Primary Prevention: Preventative Measures Leading to Better
Health Outcomes
Latest CMS Survey & Certification Letters
Listed below are selected Survey and Certification (S&C) Letters
distributed by CMS during the last quarter. Titles pertaining only to
state agency operations are omitted. The CMS Internet site for all S&C
letters is www.cms.hhs.gov/SurveyCertificationGenInfo/PMSR/list.asp
(exit DHFS).
| Title |
Number |
Date |
| Issuance of Revised Appendix P, SOM, Survey Protocol for LTC
Facilities |
06-13 |
5/1/06 |
| Approval of Deeming Authority of the Accreditation Commission for
Healthcare (ACHC) for HHAs |
06-14 |
5/1/06 |
| Clarification of Physical Therapy Service Requirements for
Rehabilitation Agency Providers |
06-15 |
5/11/06 |
| Nursing Homes and Medicare Part D |
06-16 |
5/11/06 |
| Clarification of the Amount of Air Movement Allowed Between
Corridors and Resident Rooms |
06-18 |
5/26/06 |
| Nursing Homes - Issuance of New Tag F356 |
06-19 |
5/26/06 |
| Implementation of the New Psychosocial Outcome Severity Guide |
06-20 |
6/15/06 |
| EMTALA - "Parking" of Emergency Medical Service Patients
in Hospitals |
06-21 |
7/13/06 |
State Expert Panel on the Evacuation of Healthcare Facilities
On May 2, 2006, an expert panel met in Wisconsin Dells to discuss and
develop emergency evacuation and shelter-in-place policies that would be
consistent for all healthcare facilities. The panel consisted of
representatives from long term care and assisted living facilities, staff
from the Bureau of Mental Health & Substance Abuse Services and the
Bureau of Quality Assurance, a private consulting agency, and emergency
management services. Dennis Tomczyk, Director, Hospital Disaster
Preparedness, Wisconsin Division of Public Health, was the moderator for
the panel.
The mission of the panel was to:
1. Identify those protocols that need to be consistent for all
healthcare facilities, both in evacuation and shelter-in-place, so that
training for both healthcare personnel and training for those that assist
healthcare facilities can be better coordinated; and
2. Provide a template evacuation and shelter-in-place policy for
healthcare facilities (for those healthcare facilities that have requested
such a policy.
The panel reviewed the draft policy, developed by the State Expert
Panel on the Evacuation of Hospitals, to determine what protocols apply to
other healthcare facilities and to edit the draft to better meet the needs
of healthcare facilities. The resulting template for healthcare facilities
is at http://dhfs.wisconsin.gov/rl_DSL/Providers/dstrplng0506.htm.
When the various healthcare facilities met in May 2006 to help draft
the policy on the evacuation of healthcare facilities, there was general
consensus that nursing homes, assisted living facilities, and other such
organizations need to be better integrated into emergency preparedness
planning. The Hospital Disaster Preparedness Program of the Wisconsin
Division of Public Health has budgeted $200,000 for FY 2006 (September 1,
2006 through August 31, 2007) to help address this issue. The State Expert
Panel on Healthcare Facilities will be reconvened to develop a work plan
on how to better integrate nursing homes and other facilities into the
state emergency preparedness initiatives.
Administrative Rules Update
HFS 83 - "Community Based Residential Facilities"
The HFS 83 re-write workgroup has completed the draft of the proposed
rules for Chapter HFS 83. The goal of the workgroup was to eliminate
excessively prescriptive language and improve readability and
organization. The proposed rule clarifies medication administration
requirements and revises staff training standards, establishing a more
cost effective system for providers. The Rule Summary and draft rule are
currently under review by the DHFS Office of Legal Counsel. For more
information, you may view the Statement of Scope of proposed rules on the
Wisconsin Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
HFS 124 - "Hospitals"
On April 1, 2005, the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter 124. The Department
is planning to update Chapter HFS 124 to eliminate overly prescriptive
regulations, clarify the Department's enforcement authority, and make the
rule more consistent with the federal Medicare requirements. For more
information, you may view the Statement of Scope on the Wisconsin
Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
HFS 129 - "Certification Programs for Training and Testing Nurse
Assistants, Home Health Aides and Hospice Aides"
On March 31, 2006 the Wisconsin Administrative Register published a
Statement of Scope of proposed rules to amend Chapter HFS 129. Through
this initiative, the Department proposes to make the rule more consistent
with federal regulations, to include the feeding assistant and medication
aide training and testing program requirements, and to reflect the
Department's decision to standardize administration and operation of nurse
aide competency evaluation by contracting for this service. An advisory
committee was formed including advocates, educators, association
representatives, workforce development specialists, and representatives
from private industry. The committee is meeting regularly to review the
proposed revisions to the rule and make changes, as necessary. For more
information, you may view the Statement of Scope on the Wisconsin
Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
HFS 132 - "Nursing Homes"
BQA drafted proposed revisions to HFS 132 to eliminate duplicative
state regulations that are already contained in other State law or federal
nursing home regulations. The intent is to streamline the code by
eliminating regulations that provide unnecessary specificity, and to adopt
the applicable federal regulatory language. Public hearings were scheduled
for the last week of July in Milwaukee, Eau Claire, Rhinelander, Green Bay
and Madison. For more information, you may view the Statement of Scope on
the Wisconsin Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
HFS 133 - "Home Health Agencies"
The HFS 133 re-write workgroup, working with the advisory committee
(including providers, consumers and association representatives) has
completed the draft of the proposed rules for Chapter HFS 133. The goal of
the committee was to make the rule consistent with federal regulations and
to reflect current terminology and practice. The Rule Summary and draft
rule are currently under review by the DHFS Office of Legal Counsel. For
more information, you may view the Statement of Scope on the Wisconsin
Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
HFS 148 - "Cancer and Chronic Diseases Drug Repository
Program"
Chapter HFS 148 has been amended to include prescription drugs and
supplies for chronic disease, in addition to cancer drugs, in Wisconsin's
drug repository program. The revised rule was published in the Wisconsin
Administrative Register, and will be effective August 1, 2006. For
additional information, you may view the rule on the Wisconsin
Administrative Rules web-site at http://adminrules.wisconsin.gov
(exit DHFS).
For additional information about Wisconsin's Drug Repository Program,
you may view http://dhfs.wisconsin.gov/bqaconsumer/cancerdrugreposy.htm.
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