1. (1) Prerequisites. For MA certification, an agency that provides child care coordination services under s. DHS 107.345 (1) shall:

   1. (a) Be an agency under s. DHS 105.52 (1) (a) to (d) or (f) to (o) that is certified to provide prenatal care coordination services. An agency providing services to residents of the city of Racine shall also participate in a program to reduce fetal and infant mortality and morbidity under s. 253.16, Stats.

   2. (b) Render services to one of the following groups:

      1. 1. Members who are residents of Milwaukee County.
      2. 2. Members who are residents of the city of Racine.

2. (2) Qualified professionals.

   1. (a) Definitions. In this section, “qualified professional” means any of the following:

      1. 1. A professional listed in s. DHS 105.52 (2) (a) 1., 3., 4., 5., 8., 9., or 12.
      2. 2. A registered nurse with at least 2 years of experience in pediatric nursing or community health services or a combination of pediatric nursing and community health services.

      3. 3. An employee with an Infant Mental Health Endorsement from the Alliance for the Advancement of Infant Mental Health or an affiliated state association.

         Note: All states affiliated with the Alliance for the Advancement of Infant Mental Health are listed at https://www.allianceaimh.org/members-of-the-alliance.

   2. (b) Required qualified professionals. To be certified to provide child care coordination services that are reimbursable under MA, the child care coordination provider shall have on staff, either employed, under contract, or in a volunteer capacity, at least one qualified professional with all of the following:

      1. 1. At least 2 years of experience in coordinating services for at-risk or low income children and families.
      2. 2. The necessary skills and relevant education to supervise assessment and ongoing care coordination and monitoring performed by care coordinators.
   3. (c) Duties. A qualified professional shall perform all of the duties listed in s. DHS 105.52 (2) (c) 1. to 4.

3. (3) Qualifications and duties of care coordinators.

   1. (a) Qualifications. In addition to the qualifications required under s. DHS 105.52 (2m) (a) 3. and 4., a care coordinator shall have a minimum of a high school diploma or GED.
   2. (b) Duties. A care coordinator shall perform all of the duties listed in s. DHS 105.52 (2m) (b) 1. to 3.

4. (4) Sufficiency of agency certification. Individuals employed by or under contract with a child care coordination agency may provide child care coordination services upon the department’s issuance of certification to the child care coordination agency under this section. In order to obtain and maintain certification, the child care coordination agency shall do all of the following:

   1. (a) Comply with the background check provisions in s. DHS 105.52 (3)(a).
   2. (b) Maintain a list of all persons who provide or supervise the provision of child care coordination services. The list shall include the credentials of each named individual who is qualified to supervise assessment and ongoing care coordination under sub. (2) (b) and (c).
   3. (c) Report in writing to the department the name of any qualified professional hired to provide child care coordination services within 10 business days of the hiring.
   4. (d) Report in writing to the department the termination of any qualified professional who provided child care coordination services within 10 business days of the termination.

5. (5) Fit and qualified determination.

   1. (a) In this subsection:

      1. 1. “Applicant” has the meaning provided in s. DHS 105.52 (3m) (a) 1.
      2. 2. “Principal” has the meaning provided in s. DHS 105.52 (3m) (a) 2.
   2. (b) An applicant may not be certified under this section unless the department determines that the applicant and any principal with the agency are fit and qualified to provide child care coordination services, considering all of the factors listed in s. DHS 105.52 (3m) (b) 1. to 4.

6. (6) Administrative records and required documentation. To be certified to provide child care coordination services under this section, the child care coordination agency shall comply with provider conditions of participation in s. DHS 106.02 (9) and shall submit plan of operation to the department and implement the plan, once certified. The plan of operation shall demonstrate all of the following:

   1. (a) That the agency is located in the area it will serve.
   2. (b) That the agency has a variety of techniques to identify low-income children and families that are appropriate for services under this section.

   3. (c) That the agency will provide the name, location, and telephone number of all of the following resources to individuals in the area to be served:

      1. 1. All of the resources identified in s. DHS 105.52 (4) (c) 1. to 10r.
      2. 2. MA-certified primary care and pediatric providers, including health maintenance organizations participating in the medical assistance program’s HMO program.
   4. (d) That the agency has the ability and willingness to deliver services and maintain documentation as provided in s. DHS 105.52 (4) (f), and to arrange for supportive services as provided in s. DHS 105.52 (4) (g).

   5. (e) That the agency has the capability to provide ongoing child care coordination monitoring for children and families and to ensure that all necessary services are obtained. This includes all of the following:

      1. 1. Coordinating with other health and social service agencies in the service area, including managed care providers and community resource providers, to avoid duplication of services and to facilitate coordination of child care services to members.
      2. 2. Coordinating with MA-certified primary and pediatric care providers in the service area to communicate the services the child care coordination provider renders, and documenting and retaining these contacts in the provider’s administrative records.
   6. (f) That the agency hired or contracted at least one qualified professional meeting the criteria in sub. (2).
   7. (g) The agency’s process for referrals, service delivery, assessment, care planning, and follow-up activities.
   8. (h) The agency’s personnel management and training plan, as required under sub. (7).
   9. (i) The agency’s quality assurance procedures and documentation requirements.
   10. (j) That the agency has adequate resources to maintain a cash flow sufficient to cover operating expenses for 60 days.

7. (7) Personnel management. The child care coordination agency shall document and implement a personnel management system and training plan, which shall include all of the following:

   1. (a) All of the items required under s. DHS 105.52 (6) (a), (b), and (f).
   2. (b) A requirement that no employee or subcontractor may be assigned any duty for which they are not trained. The child care coordination agency shall provide or arrange for training of employed or subcontracted care coordinators as necessary.

   3. (c) Procedures for ensuring all qualified professionals and care coordinators receive orientation and on-going instruction. The procedures shall include:

      1. 1. All of the items required under s. DHS 105.52 (6) (d) 1., 2., 3., and 5.

      2. 2. Topics covered in orientation, which shall include training on all of the following, at minimum:

         1. a. All of the topics required under s. DHS 105.52 (6) (d) 4. a., d., e., and f.
         2. b. Specific job duties, specified in s. DHS 105.52 (2m) (b).
         3. c. The functions of the child care coordination provider staff and how they interrelate and communicate with each other in providing services.
      3. 3. A process for providing instruction when an evaluation of the qualified professional’s or care coordinator’s performance or competency indicates additional instruction may be needed.
   4. (d) Standards for qualified professional supervision of services rendered by a care coordinator, including the frequency and duration of supervision. When supervision reveals a failure to follow the member’s care plan, the child care coordination provider shall provide counseling, education or retraining to ensure the care coordinator is adequately trained to complete their job responsibilities. In the case of child care coordinators who are not employees of the child care coordination provider, the plan shall specify all required training, qualifications, and services to be performed in a written care coordinator provider contract between the child care coordination provider and care coordinators, and maintain a copy of that contract on file.

   5. (e) Requirements for ongoing training, including all of the following:

      1. 1. Training and documentation requirements listed in s. DHS 105.52 (6) (g) 1. and 2.
      2. 2. A minimum of 5 hours of annual training for child care coordination provider staff or contractors who have, or are expected to have, regular and direct contact with members. Annual training shall be related to early intervention, education, case management, or similar social service continuing education. Training may be in-service training, conferences, workshops, earning of continuing education credits or earning of higher education credits.

8. (8) Member record. The child care coordination agency shall maintain a confidential file for each member receiving child care coordination services, which includes all of the following items required or produced in connection with provision of covered services under s. DHS 107.345 (1):

   1. (a) All of the items required under s. DHS 105.52 (5) (b) to (d).

      Note: The reference to s. DHS 105.52 (5) (b) to (d) inadvertently omitted a reference to par. (e). Paragraph (a) should read: “All of the items required under s. DHS 105.52 (5) (b) to (e).” This will be corrected in future rulemaking.

   2. (b) Documentation about any care coordination services provided immediately in urgent situations, including documentation regarding the circumstances and reasons for those services being rendered prior to the initial assessment and care plan.

   3. (c) Documentation regarding referrals from a child care coordination provider to service providers including all of the following:

      1. 1. The name of the referred provider.
      2. 2. The reason for referral.
      3. 3. The date the referral was made
      4. 4. Any authorizations from the member for release of information.
      5. 5. All communication and follow-up on the referral with both the member and the referred provider.
   4. (d) All pertinent correspondence relating to coordination of the member’s care.

9. (9) Agency closure or discharge of member. Any child care coordination agency that intends to close shall do all of the following:

   1. (a) Provide written notice to each member, the member’s legal representative, if any, the member’s attending physician and the department at least 30 days before closure.
   2. (b) Provide assistance to members in arranging for continuity of necessary services. This includes, but is not limited, to coordination with other child care coordination providers to ensure necessary services identified in the care plan are sustained or initiated.

History

History: EmR2421: emerg. cr., eff. 1-6-25; CR 25-004: cr. Register September 2025 No. 837, eff. 10-1-25; correction in (4) (c), (d), (7) (d) made under s. 35.17, Stats., renumber (7) (c) 5., (i) to (7) (c) 3., (e) under s. 13.92 (4) (b) 1., Stats, and as renumbered, correction in (7) (e) 1. made under s. 12.92 (4) (b) 7., Stats., and renum. (9) (a) to (9) (a) (intro.) and (a) and, as renumbered, correction in (9) made under s. 35.17, Stats., Register September 2025 No. 837.