Wis. Admin. Code Department of Health Services § DHS 152.02 - Definitions
In this chapter:
(1)
"Agreement" means a written document executed between an ESRD unit and another
unit, in which the other unit agrees to assume responsibility for furnishing
specified services to patients and for obtaining reimbursement for those
services.
(2) "Arrangement" means a
written document executed between an ESRD unit and another unit, in which the
other unit agrees to furnish specified services to patients but the ESRD unit
retains responsibility for the services and for obtaining
reimbursement.
(2m) "BadgerCare"
means the medical assistance-related program established under s.
49.665, Stats., and
chs.
DHS
101 to 108.
(3) "Chronic renal disease" or "CRD" means
that stage of renal impairment which is virtually irreversible and requires a
regular course of dialysis or kidney transplantation to maintain
life.
(4) "CRD program advisory
committee" means the committee appointed by the department under s.
DHS
152.09.
(4m) "Current year" means the 12-month period
beginning with the month of a patient's first application to the CRD program,
or beginning with the month of a certified patient's subsequent annual
recertification for the CRD program.
(5) "Department" means the department of
health services.
(6) "Dialysis"
means a process by which dissolved substances are removed from a patient's body
by diffusion and osmosis from one fluid compartment to another across a
semipermeable membrane.
(7)
"Dietitian" means a person who is eligible for registration by the American
dietetic association and has at least 1 year of experience in clinical
nutrition, or a person who has a baccalaureate or advanced degree with major
studies in food and nutrition or dietetics and at least 1 year of experience in
clinical nutrition.
(8) "End-stage
renal disease" or "ESRD" has the meaning prescribed for chronic renal disease
or CRD in sub. (3).
(9) "ESRD unit"
or "unit" means a free-standing or hospital-based renal dialysis facility, a
renal dialysis center or a renal transplantation center.
(9m) "Family" means a patient and that
patient's spouse, if any, and any other person who is claimed as a dependent of
that patient or that patient's spouse or who claims that patient as a dependent
under the U.S. internal revenue code for the purpose of filing a federal income
tax return.
(9t) "Federal poverty
guidelines" means the annually updated poverty income thresholds by family size
published each year by the U.S. department of health and human services in the
federal register.
Note: The federal poverty guidelines for 1999 were published in the Federal Register, March 18, 1999, 13428.
(9u) "Fiscal agent" means
the organization under contract to the department to process claims and
determine eligibility for services provided under the CRD program.
(10) "Free-standing renal dialysis facility"
means a non-hospital unit which is approved by the department under this
chapter to furnish chronic maintenance dialysis with or without self-care
dialysis training.
(11) "Furnishes
directly" means that the ESRD unit provides the service through its own staff
and employees, or through individuals who are under personal contract to
furnish services for the facility.
(12) "Home dialysis" means dialysis performed
by a trained ESRD patient or helper, or both, at home.
(13) "Hospital-based renal dialysis facility"
means a hospital unit approved by the department to furnish one or more of the
following dialysis services to ESRD patients:
(a) Outpatient dialysis;
(b) Inpatient dialysis;
(c) Home dialysis;
(d) Self-dialysis training.
(14)
(a) "Income," for the period January 1, 1994
to June 30, 1994, has the meaning prescribed in s.
49.485(1)
(dm), 1991 Stats., except that a certified
patient may for that period elect to use the definition under par.
(b).
(b) "Income," beginning July
1, 1994, means a family's total earnings, including wages and salary and net
income from self-employment, as well as unearned income including social
security and supplemental security income, dividends and interest income,
income from estates or trusts, net rental income, public assistance, pensions
or annuities, unemployment compensation, maintenance or alimony, child support
or family support, nontaxable deferred compensation, and nontaxable interest
such as interest on federal, state or municipal bonds, but not capital gains
income.
(15) "Inpatient
dialysis" means dialysis which, because of medical necessity, is furnished to
an ESRD patient on a temporary basis in a hospital.
(15m) "Medical assistance" has the meaning
specified in s.
49.43(8),
Stats.
(16) "Medicare" means the
health insurance program operated by the U.S. department of health and human
services under
42 USC
1395 to
1395zz
and 42 CFR Pts. 405 to 421.
(17)
"Nephrologist" means a physician licensed in Wisconsin or, if employed by an
ESRD unit approved under this chapter in a border state, in that state, who is
board-eligible or board-certified by the American board of internal medicine,
or by an equivalent certifying body as determined by the department on
recommendation of the CRD program advisory committee, and who has a minimum of
12 months of fellowship training in nephrology or 2 years of experience in
delivering care to ESRD patients. Pediatric training may be substituted for
internal medicine board eligibility or board certification if the ESRD unit's
services are associated with pediatric ESRD care.
(18) "Nurse" means a full-time supervisory
nurse registered in Wisconsin or, if employed by an ESRD unit approved under
this chapter in a border state, in that state, with at least 12 months of
experience in clinical nursing and an additional 6 months of experience in
nursing care of an outpatient dialysis or kidney transplantation patient,
including training in and experience with the dialysis process, or 18 months of
experience in nursing care of an outpatient dialysis or kidney transplantation
patient, including training in and experience with the dialysis process. If the
nurse is in charge of home dialysis or self-dialysis training, at least 3
months of the total required ESRD experience shall be in home dialysis or
self-dialysis patient training.
(19) "Outpatient dialysis" means dialysis
which is regularly furnished on an outpatient basis to an ESRD patient in a
renal dialysis center, hospital-based renal dialysis facility or a
free-standing renal dialysis facility.
(20) "Patient" means a person who has been
diagnosed as having ESRD and who receives treatment for ESRD. "Patient" does
not include a kidney donor.
(21)
"Patient registry program" means a computerized list of all certified patients
on dialysis which includes verification that each case has been reviewed by a
transplant surgeon and that cases meeting criteria for a transplant are placed
on the transplant list.
(22)
"Provider" means a renal dialysis facility or center, a renal transplantation
center, or another source of dialysis or transplantation services approved by
the department.
(23) "Renal
dialysis center" means a hospital unit approved by the department to furnish
the full spectrum of diagnostic services, therapeutic services including
inpatient dialysis furnished directly or under arrangement, and rehabilitative
services, except renal transplantation, required for the care of ESRD
patients.
(24) "Renal
transplantation center" means a hospital unit approved by the department to
furnish transplantation and other medical and surgical specialty services
required for the care of ESRD transplant patients, including inpatient dialysis
furnished directly or under arrangement or agreement.
(26) "Self-dialysis" means dialysis which is
regularly furnished on an outpatient basis to an ESRD patient in a renal
dialysis center, hospital-based renal dialysis facility or a free-standing
renal dialysis facility, in which the ESRD patient is responsible for the
dialysis treatment but is supervised by a dialysis nurse.
(26m) "SeniorCare" means the program of
prescription drug assistance for eligible elderly persons under s.
49.688,
Stats., and ch. DHS 109.
(27)
"Social worker" means a person who provides counseling to an ESRD patient and
his or her family, and has either completed a course of study with
specialization in clinical practice at a graduate school of social work
accredited by the council on social work education and holds a masters degree
from that school, or has worked for at least 2 years as a social worker, 1 year
of which was in a dialysis or transplantation setting, and receives
consultation from a social worker who holds a masters degree from an accredited
school of social work.
(28)
"Transplant surgeon" means a physician licensed in Wisconsin or, if employed by
an ESRD unit approved under this chapter in a border state, in that state, who
is board-eligible or board-certified by the American board of surgery or by an
equivalent certifying body as determined by the department on recommendation of
the CRD program advisory committee, and who has a minimum of 12 months of
training or experience in the performance of renal transplantation and the care
of renal transplant patients in an accredited teaching institution.
(29) "Vascular surgeon" means a physician
licensed in Wisconsin or, if employed by an ESRD unit approved under this
chapter in a border state, in that state, who is board-eligible or
board-certified by the American board of surgery or by an equivalent certifying
body as determined by the department on recommendation of the CRD program
advisory committee under s.
DHS
152.09, and who has a minimum of 12 months of training
or experience in the performance of vascular access procedures.
Notes
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