Wis. ForwardHealth Online Handbook, Hospice, Topic #206

In rare instances, a provider or member may apply for, and DMS (Division of Medicaid Services) will consider applications for, a

discretionary waiver or variance of certain rules in Wis. Admin. Code chs. DHS 102, 103, 104, 105, 107, and 108. Rules that

are not considered for a discretionary waiver or variance are included in Wis. Admin. Code § DHS 106.13.

Waivers and variances are not available to permit coverage of services that are either expressly identified as noncovered or are

not expressly mentioned in Wis. Admin. Code ch. DHS 107.

Requirements

A request for a waiver or variance may be made at any time; however, all applications must be made in writing to DMS. All

applications are required to specify the following:

• The rule from which the waiver or variance is requested.

• The time period for which the waiver or variance is requested.

• If the request is for a variance, the specific alternative action proposed by the provider.

• The reasons for the request.

• Justification that all requirements for a discretionary waiver or variance would be satisfied.

DMS may also require additional information from the provider or the member prior to acting on the request.

Application

DMS may grant a discretionary waiver or variance if it finds that all of the following requirements are met:

• The waiver or variance will not adversely affect the health, safety, or welfare of any member.

• Either the strict enforcement of a requirement would result in unreasonable hardship on the provider or on a member, or an

alternative to a rule is in the interests of better care or management. An alternative to a rule would include a new concept,

method, procedure or technique, new equipment, new personnel qualifications, or the implementation of a pilot project.

• The waiver or variance is consistent with all applicable state and federal statutes and federal regulations.

• Federal financial participation is available for all services under the waiver or variance, consistent with the Medicaid state

plan, federal CMS (Centers for Medicare and Medicaid Services), and other applicable federal program requirements.

• Services relating to the waiver or variance are medically necessary.

To apply for a discretionary waiver or variance, providers are required to send their application to the following address:

Division of Medicaid Services

Waivers and Variances

PO Box 309

Madison WI 53701-0309