DHS 105.07(5) (5)A hospital providing AODA day treatment services shall be certified under s. DHS 105.25.
DHS 105.07 Note Note: For certification of a hospital that is an institution for mental disease, see s. DHS 105.21. For covered hospital services, see s. DHS 107.08.
DHS 105.07 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (intro.), am. (1) to (4), cr. (5), Register, September, 1991, No. 429, eff. 10-1-91; correction in (intro.) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.075 DHS 105.075Rehabilitation hospitals. For MA certification, a rehabilitation hospital shall be approved as a general hospital under s. 50.35, Stats., and ch. DHS 124, including the requirements for rehabilitation services under s. DHS 124.21, shall meet conditions of participation for medicare and shall have a utilization review plan that meets the requirements of 42 CFR 456.101. No facility determined by the department or the federal health care financing administration to be an institution for mental disease (IMD) may be certified as a rehabilitation hospital under this section.
DHS 105.075 Note Note: For covered hospital services, see s. DHS 107.08.
DHS 105.075 History History: Cr. Register, September, 1991, No. 429, eff. 10-1-91; corrections made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.08 DHS 105.08Skilled nursing facilities. For MA certification, skilled nursing facilities shall be licensed pursuant to s. 50.03, Stats., and ch. DHS 132.
DHS 105.08 Note Note: For covered nursing home services, see s. DHS 107.09.
DHS 105.08 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.09 DHS 105.09Medicare bed requirement.
DHS 105.09(1)(1)Definition. In this section, “sufficient number of medicare-certified beds" means a supply of beds that accommodates the demand for medicare beds from both the home county and contiguous counties so that no dual eligible recipient is denied access to medicare SNF benefits because of a lack of available beds. In this subsection, “dual eligible recipient" means a person who qualifies for both medical assistance and medicare.
DHS 105.09(2) (2) Medicare bed obligation. Each county shall have a sufficient number of skilled nursing beds certified by the medicare program pursuant to ss. 49.45 (6m) (g) and 50.02 (2), Stats. The number of medicare-certified beds required in each county shall be at least 3 beds per 1000 persons 65 years of age and older in the county.
DHS 105.09(3) (3) Penalty.
DHS 105.09(3)(a)(a) If a county does not have sufficient medicare-certified beds as determined under sub. (1), each SNF within that county which does not have one or more medicare-certified beds shall be subject to a fine to be determined by the department of not less than $10 nor more than $100 for each day that the county continues to have an inadequate number of medicare-certified beds.
DHS 105.09(3)(b) (b) The department may not enforce penalty in par. (a) if the department has not given the SNF prior notification of criteria specific to its county which shall be used to determine whether or not the county has a sufficient number of medicare-certified beds.
DHS 105.09(3)(c) (c) If the number of medicare-certified beds in a county is reduced so that the county no longer has a sufficient number of medicare-certified beds under sub. (1), the department shall notify each SNF in the county of the number of additional medicare-certified beds needed in the county. The department may not enforce the penalty in par. (a) until 90 days after this notification has been provided.
DHS 105.09(4) (4) Exemptions.
DHS 105.09(4)(a)(a) In this subsection, a “swing-bed hospital" means a hospital approved by the federal health care financing administration to furnish skilled nursing facility services in the medicare program.
DHS 105.09(4)(b) (b) A home or portion of a home certified as an ICF-IID is exempt from this section.
DHS 105.09(4)(c) (c) The department may grant an exemption based on but not limited to:
DHS 105.09(4)(c)1. 1. Availability of a swing-bed hospital operating within a 30 mile radius of the nursing home; or
DHS 105.09(4)(c)2. 2. Availability of an adequate number of medicare-certified beds in a facility within a 30 mile radius of the nursing home.
DHS 105.09(4)(d) (d) A skilled nursing facility located within a county determined to have an inadequate number of medicare-certified beds and which has less than 100 beds may apply to the department for partial exemption from the requirements of this section. An SNF which applies for partial exemption shall recommend to the department the number of medicare-certified beds that the SNF should have to meet the requirements of this section based on the facility's analysis of the demand for medicare-certified beds in the community. The department shall review all recommendations and issue a determination to each SNF requesting a partial exemption.
DHS 105.09 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; renum. (1), (2), (3) (a) and (b) to be (2), (3), (4) (a) and (b) and am. (2) and (4) (b), cr. (1), (4) (c) and (d), Register, February, 1988, No. 386, eff. 7-1-88; 2019 Wis. Act 1: am. (4) (b) Register May 2019 No. 761, eff. 6-1-19.
DHS 105.10 DHS 105.10SNFs and ICFs with deficiencies. If the department finds a facility deficient in meeting the standards specified in s. DHS 105.08, 105.09, 105.11 or 105.12, the department may nonetheless certify the facility for MA under the conditions specified in s. DHS 132.21 and 42 CFR 442, Subpart C.
DHS 105.10 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.11 DHS 105.11Intermediate care facilities. For MA certification, intermediate care facilities shall be licensed pursuant to s. 50.03, Stats., and ch. DHS 132.
DHS 105.11 Note Note: For covered nursing home services, see s. DHS 107.09.
DHS 105.11 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.12 DHS 105.12ICFs for individuals with intellectual disabilities or individuals with related conditions. For MA certification, institutions for individuals with intellectual disabilities or individuals with related conditions shall be licensed pursuant to s. 50.03, Stats., and ch. DHS 134.
DHS 105.12 Note Note: For covered ICF/IID services, see s. DHS 107.09.
DHS 105.12 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1991, No. 432; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; 2019 Wis. Act 1: am. Register May 2019 No. 761, eff. 6-1-19.
DHS 105.15 DHS 105.15Pharmacies. For MA certification, pharmacies shall meet the requirements for registration and practice under ch. 450, Stats., and chs. Phar 1 to 17.
DHS 105.15 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. Register, December, 1991, No. 432, eff. 1-1-92; correction made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667.
DHS 105.16 DHS 105.16Home health agencies. For MA certification, a home health agency shall be certified to participate in medicare as a home health agency, be licensed pursuant to ch. DHS 133 and meet the requirements of this section as follows:
DHS 105.16(1) (1) Home health agency services. For MA certification, a home health agency shall provide part-time, intermittent skilled nursing services performed by a registered nurse or licensed practical nurse and home health aide services and may provide physical therapy, occupational therapy, speech and language pathology services and medical supplies and equipment. Services may be provided only on visits to a recipient's home and that home may not be a hospital or nursing home. Home health services shall be provided in accordance with a written plan of care, which the physician shall review at least every 62 days or when the recipient's medical condition changes, whichever occurs first.
DHS 105.16(2) (2) Home health aides.
DHS 105.16(2)(a)(a) Assignment and duties. Home health aides shall be assigned to specific recipients by a registered nurse. Written instructions for patient care shall be prepared by a registered nurse, a physical or occupational therapist or a speech and language pathologist, as appropriate. Duties shall include medically oriented tasks, assistance with the recipient's activities of daily living and household tasks as specified in s. DHS 107.11 (2) (b) and further described in the Wisconsin medical assistance home health agency provider handbook.
DHS 105.16(2)(b) (b) Supervision. A registered nurse shall make supervisory visits to the recipient's home as often as necessary, but at least every 60 days, to review, monitor and evaluate the recipient's medical condition and medical needs according to the written plan of care during the period in which agency care is being provided. The RN shall evaluate the appropriateness of the relationship between the direct care giver and the recipient, assess the extent to which goals are being met, and determine if the current level of home health services provided to the recipient continues to be appropriate to treat the recipient's medical condition and if the services are medically necessary. The supervising RN shall discuss and review with the recipient the services received by the recipient and discuss the results of the supervisory visit with the LPN, home health aide or personal care worker. The results of each supervisory visit shall be documented in the recipient's medical record.
DHS 105.16(2)(c) (c) Training. Home health aides shall be trained and tested in accordance with the requirements of s. 146.40, Stats., and ch. DHS 129. Aides shall not be assigned any tasks for which they are not trained, and training and competency in all assigned tasks shall be documented and made part of the provider's records.
DHS 105.16(3) (3) Physical therapists. Physical therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under the contract to the home health agency.
DHS 105.16(4) (4) Occupational therapists. Occupational therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.
DHS 105.16(5) (5) Speech and language pathologists. Speech and language pathologists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.
DHS 105.16(6) (6) Respiratory care services.
DHS 105.16(6)(a)(a) A certified home health agency may be certified to provide respiratory care services under s. DHS 107.113 if registered nurses, licensed practical nurses and respiratory therapists employed by or under contract to the agency and providing these services are certified under ch. Med 20 and:
DHS 105.16(6)(a)1. 1. Are credentialed by the national board on respiratory care; or
DHS 105.16(6)(a)2. 2. Know how to perform services under s. DHS 107.113 (1) and have the skills necessary to perform those services. Skills required to perform services listed in s. DHS 107.113 (1) (e) to (f) are required on a case-by-case basis, as appropriate. In no case may a person provide respiratory care before that person has demonstrated competence in all areas under s. DHS 107.113 (1) (a) to (d).
DHS 105.16(6)(b) (b) A registered nurse who fulfills the requirements of this subsection shall coordinate the recipient's care.
DHS 105.16(6)(c) (c) The department shall review an agency's continued compliance with this subsection.
DHS 105.16(7) (7) Private duty nursing. A home health agency may provide private duty nursing services under s. DHS 107.12 performed by a registered nurse or licensed practical nurse.
DHS 105.16(8) (8) Cost reports. The department may, when necessary, require home health agencies to report information which is supplementary to information required on medicare cost reports.
DHS 105.16(9) (9) Department review.
DHS 105.16(9)(a)(a) Record review. The department may periodically review the records described in this section and s. DHS 106.02 (9), subject only to restrictions of law. All records shall be made immediately available upon the request of an authorized department representative.
DHS 105.16(9)(b) (b) In-home visits. As part of the review under par. (a), the department may contact recipients who have received or are receiving MA services from a home health care provider. The provider shall provide any identifying information requested by the department. The department may select the recipients for visits and may visit a recipient with the approval of the recipient or recipient's guardian. The recipient to be visited has the opportunity to have any person present whom he or she chooses, during the visit by personnel of the department or other governmental investigating agency.
DHS 105.16(9)(c) (c) Investigation of complaints. The department may investigate any complaint received by it concerning the provision of MA services by a home health care provider. Following the investigation, the department may issue a preliminary final report to the home health care provider in question, except when doing so would jeopardize any other investigation by the department or other state or federal agency.
DHS 105.16(10) (10) Requirements for providing private duty nursing or respiratory care services. For certified agencies providing private duty nursing or respiratory care services or both under this section, the following requirements apply:
DHS 105.16(10)(a) (a) Duties of the nurse.
DHS 105.16(10)(a)1.1. The following nursing services may be performed only by a registered nurse:
DHS 105.16(10)(a)1.a. a. Making the initial evaluation visit;
DHS 105.16(10)(a)1.b. b. Initiating the physician's plan of care and necessary revisions;
DHS 105.16(10)(a)1.c. c. Providing those services that require care of a registered nurse as defined in ch. N 6;
DHS 105.16(10)(a)1.d. d. Initiating appropriate preventive and rehabilitative procedures;
DHS 105.16(10)(a)1.e. e. Accepting only those delegated medical acts which the RN is competent to perform based on his or her nursing education, training or experience; and
DHS 105.16(10)(a)1.f. f. Regularly reevaluating the patient's needs.
DHS 105.16(10)(a)2. 2. Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse. Licensed practical nurse duties include:
DHS 105.16(10)(a)2.a. a. Performing nursing care delegated by an RN under s. N 6.03;
DHS 105.16(10)(a)2.b. b. Assisting the patient in learning appropriate self-care techniques; and
DHS 105.16(10)(a)2.c. c. Meeting the nursing needs of the recipient according to the written plan of care.
DHS 105.16(10)(a)3. 3. Both RNs and LPNs shall:
DHS 105.16(10)(a)3.a. a. Arrange for or provide health care counseling within the scope of nursing practice to the recipient and recipient's family in meeting needs related to the recipient's condition;
DHS 105.16(10)(a)3.b. b. Provide coordination of care for the recipient;
DHS 105.16(10)(a)3.c. c. Accept only those delegated medical acts for which there are written or verbal orders and for which the nurse has appropriate training or experience;
DHS 105.16(10)(a)3.d. d. Prepare written clinical notes that document the care provided within 24 hours of providing service and incorporate them into the recipient's clinical record within 7 days; and
DHS 105.16(10)(a)3.e. e. Promptly inform the physician and other personnel participating in the patient's care of changes in the patient's condition and needs.
DHS 105.16(10)(b) (b) Patient rights. A nurse shall provide a written statement of the rights of the recipient for whom services are provided to the recipient or guardian or any interested party prior to the provision of services. The recipient or guardian shall acknowledge receipt of the statement in writing. The nurse shall promote and protect the exercise of these rights and keep written documentation of compliance with this subsection. Each recipient receiving care shall have the following rights:
DHS 105.16(10)(b)1. 1. To be fully informed of all rules and regulations affecting the recipient;
DHS 105.16(10)(b)2. 2. To be fully informed of services to be provided by the nurse and of related charges, including any charges for services for which the recipient may be responsible;
DHS 105.16(10)(b)3. 3. To be fully informed of one's own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of services, including referral to a health care institution or other agency;
DHS 105.16(10)(b)4. 4. To refuse treatment to the extent permitted by law and to be informed of the medical consequences of that refusal;
DHS 105.16(10)(b)5. 5. To confidential treatment of personal and medical records and to approve or refuse their release to any individual, except in the case of transfer to a health care facility;
DHS 105.16(10)(b)6. 6. To be taught, and have the family or other persons living with the recipient taught, the treatment required, so that the recipient can, to the extent possible, help himself or herself, and the family or other party designated by the recipient can understand and help the recipient;
DHS 105.16(10)(b)7. 7. To have one's property treated with respect; and
DHS 105.16(10)(b)8. 8. To complain about care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.
DHS 105.16(10)(c) (c) Universal precautions. A nurse shall have the necessary orientation, education and training in epidemiology, modes of transmission and prevention of HIV and other blood-borne or body fluid-borne infections and shall follow universal blood and body-fluid precautions for each recipient for whom services are provided. The nurse shall employ protective measures recommended by the federal centers for disease control (CDC), including those pertaining to medical equipment and supplies, to minimize the risk of infection from HIV and other blood-borne pathogens.
DHS 105.16 Note Note: A copy of the CDC recommended universal precautions may be obtained from the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701.
DHS 105.16(10)(d) (d) Medical record. The nurse shall maintain a medical record for each recipient. The record shall document the nature and scope of all services provided and shall be systematically organized and readily accessible to authorized department personnel. The medical record shall document the recipient's condition, problems, progress and all services rendered, and shall include:
DHS 105.16(10)(d)1. 1. Recipient identification information;
DHS 105.16(10)(d)2. 2. Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care;
DHS 105.16(10)(d)3. 3. Recipient admission evaluation and assessment;
Loading...
Loading...
Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.