DHS 105.17(4)(a)1.1. The department's division of quality assurance may make any inspections and investigations, including complaint investigations, it considers necessary and may review clinical and administrative records, policies and other documents required under this section or s. DHS 107.112.
DHS 105.17(4)(a)2. 2. Any interference with or refusal to allow or cooperate with any inspection or investigation under this subsection may be grounds for termination of MA certification.
DHS 105.17(4)(b) (b) The department may contact clients of personal care providers as part of an inspection or investigation. The provider shall provide the department a list of names, addresses and other identifying information of current and past clients as may be requested. The department may select the names of the clients to be contacted and may contact these clients upon the client's approval.
DHS 105.17(4)(c) (c) Upon determining that a personal care provider is not compliant with one or more certification requirements under this section or s. DHS 107.112, the department shall promptly notify the provider of the specific rule violated, state the facts that constitute the deficiency and specify the date by which the provider is required to correct the deficiency.
DHS 105.17(5) (5)MA application requirements; freestanding personal care agencies.
DHS 105.17(5)(a)(a) Definitions. In the section, “branch office" means a location or site from which a personal care agency provides services within a portion of the total geographic area served by the personal care agency. “Parent agency" means a personal care agency with one or more branch offices.
DHS 105.17(5)(ag) (ag) Application for MA certification. For MA certification, a freestanding personal care agency shall submit an application on forms provided by the department, and provide all information requested on the forms. The application shall be fully completed and submitted with the applicable nonrefundable fee in an amount established by the department.
DHS 105.17(5)(ar) (ar) Multiple locations. A branch office shall separately apply and be separately certified if the department determines that the branch office, because of the volume of services provided or the distance between the branch office and the parent agency, cannot adequately share supervision and administration of services with the parent agency. Each office the department finds to be necessary shall submit a separate application under this subsection and shall independently satisfy all requirements for certification set forth in this section, except that the requirements under s. DHS 105.17 (1e) (b), (1g) (a) and (b), (1n), and (1w) (h) may be satisfied by policies and practices that are adopted by the entity that owns or controls the agency, and that are applicable to all required offices of the agency. If a branch agency is not separately approved from a parent agency, the parent agency shall be deemed to be in violation of this chapter or s. DHS 107.112 if the branch is in violation.
DHS 105.17 Note Note: To obtain a copy of the application forms, send your request to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969. The street address is 1 W. Wilson Street in Madison. The e-mail address is : Dhswebmaildqa@wisconsin.gov. The completed application forms should be sent to the same office.
DHS 105.17 Note Note: Fees are permitted under s. 49.45 (42) (c), Stats., and set and periodically revised by the Department's Division of Quality Assurance. Fees may vary based on a number of factors including revenues from operations.
DHS 105.17(5)(b) (b) Issuance of certification. Following receipt of a complete application for MA certification or for a change in certification when there has been a change in the ownership of a freestanding personal care agency, the department shall review the application and investigate the applicant and principals to determine the applicant's ability to comply with this section and s. DHS 107.112. Except as provided in par. (c), within 90 days after receiving a complete application, the department shall either approve the application and issue the certification or deny the application. Except as provided in par. (c), a certification issued under this section is valid indefinitely unless sooner terminated or suspended under s. DHS 106.05, 106.06 or 106.065.
DHS 105.17(5)(c) (c) Provisional certification.
DHS 105.17(5)(c)1.1. The department may, within the 90-day period in par. (b), issue a provisional certification for a term of up to one year under any of the following circumstances:
DHS 105.17(5)(c)1.a. a. The department has not completed its investigation of the applicant within 90 days after receiving a completed application.
DHS 105.17(5)(c)1.b. b. The applicant attests that at the time of or within 6 months prior to the application, the applicant had been under contract with a Medicaid certified personal care provider that is a county agency, independent living center, federally-recognized American Indian tribe or band in Wisconsin or home health agency to provide Medicaid personal care services, and that the applicant is in compliance with this section and s. DHS 107.112.
DHS 105.17(5)(c)2. 2. Within 90 days before its provisional certification expires, a provisionally certified personal care provider shall submit a written request to the department for an on-site survey. The provider shall show that the provider has served at least 5 clients requiring personal care services during the period of provisional certification. At the time of the on-site survey the provider shall be providing personal care services to at least 2 clients.
DHS 105.17(5)(d) (d) Annual reporting and fee.
DHS 105.17(5)(d)1.1. Every 12 months, on a schedule determined by the department, a certified freestanding personal care agency shall submit an annual report to the department in the form and containing the information that the department requires. The freestanding personal care agency shall submit with the report a fee in an amount determined by the department. If a complete annual report and fee are not timely submitted to the department, the department shall issue a warning to the freestanding personal care agency.
DHS 105.17(5)(d)2. 2. The department may terminate certification of a freestanding personal care agency that does not submit a completed report and fee to the department within 60 days after the date established by the department in subd. 1.
DHS 105.17 Note Note: Fees are permitted under s. 49.45 (42) (c), Stats., and set and periodically revised by the Department's Division of Quality Assurance. Fees may vary based on a number of factors including revenues from operations.
DHS 105.17 History History: Cr. Register, April, 1988, No. 388, eff. 7-1-88; emerg. am. (1) (intro.), eff. 7-1-88; am. (1) (intro.), Register, December, 1988, No. 396, eff. 1-1-89; am. (3) (a) 1., Register, February, 1993, No. 446, eff. 3-1-93; correction in (1) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528; correction in (1) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 08-108: am. (1) (intro.) Register June 2009 No. 642, eff. 7-1-09; CR 09-107: renum. (1) to be (1c), (1e), (1g), (1n), (1r) and (1w) and am., renum. (4) (intro.) to be (4) (a) 1. and am., renum. (4) (a) to (f), (h) and (i) to be (1g) (c) 1. to 8. and am., r. (1) (L), (3) (a) 4. and (4) (g), cr. (1), (1e) (intro.), (e), (1f), (1g) (intro.), (1n) (a) 2., 3., (1r) (title), (a) to (c), (1w) (intro.) to (c), (f), (2) (b) 3m., (3) (b) 5., (4) (a) 2., (b), (c) and (5), am. (2) (a) (intro.) to 2., (b), (3) (a) 1., 3., (b), and (4) (title), r. and recr. (2) (a) 3. Register August 2010 No. 656, eff. 9-1-10; correction in (1) (b) 3. made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667.
DHS 105.19 DHS 105.19Nurses in independent practice.
DHS 105.19(1)(1)Qualifications..
DHS 105.19(1)(a)(a) For MA certification to perform skilled nursing services as a nurse in independent practice providing home health services under s. DHS 107.11 (6) or private duty nursing services under s. DHS 107.12, the nurse shall be:
DHS 105.19(1)(a)1. 1. Licensed as a registered nurse pursuant to s. 441.06, Stats.;
DHS 105.19(1)(a)2. 2. Licensed as a practical nurse pursuant to s. 441.10, Stats.; or
DHS 105.19(1)(a)3. 3. A registered nurse providing supervision of a licensed practical nurse certified under this section.
DHS 105.19(1)(b) (b) For MA certification to perform respiratory care services as a provider in independent practice, the provider shall be certified pursuant to ch. Med 20 and shall be a nurse described in par. (a) or a respiratory therapist. Any person providing or supervising respiratory care who is not credentialed by the national board on respiratory care shall know how to perform the services under s. DHS 107.113 (1) and shall 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). A registered nurse who fulfills these requirements shall coordinate the recipient's care.
DHS 105.19(2) (2)Plan of care. Nursing services and respiratory care shall be provided in accordance with a written plan of care which the physician reviews and signs at least every 62 days or when the recipient's condition changes, whichever occurs first.
DHS 105.19(3) (3)Supervision of a licensed practical nurse. A registered nurse or physician designated by the LPN providing nursing or respiratory care services shall supervise the LPN as often as necessary under the requirements of ss. N 6.03 and 6.04 (2) and shall document the results of supervisory activities. An LPN may provide nursing or respiratory care services delegated by an RN as delegated nursing acts under ss. N 6.03 and 6.04 and guidelines established by the board of nursing.
DHS 105.19(4) (4)Duties of the nurse.
DHS 105.19(4)(a)(a) The following nursing services may be performed only by a registered nurse:
DHS 105.19(4)(a)1. 1. Making the initial evaluation visit;
DHS 105.19(4)(a)2. 2. Initiating the physician's plan of care and necessary revisions;
DHS 105.19(4)(a)3. 3. Providing those services that require care of a registered nurse as defined in ch. N 6;
DHS 105.19(4)(a)4. 4. Initiating appropriate preventive and rehabilitative procedures;
DHS 105.19(4)(a)5. 5. 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 105.19(4)(a)6. 6. Regularly reevaluating the patient's needs.
DHS 105.19(4)(b) (b) 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 105.19(4)(b)1. 1. Performing nursing care delegated by an RN under s. N 6.03;
DHS 105.19(4)(b)2. 2. Assisting the patient in learning appropriate self-care techniques; and
DHS 105.19(4)(b)3. 3. Meeting the nursing needs of the recipient according to the written plan of care.
DHS 105.19(4)(c) (c) Both RNs and LPNs shall:
DHS 105.19(4)(c)1. 1. 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 105.19(4)(c)2. 2. Provide coordination of care for the recipient, including ensuring that provision is made for all required hours of care for the recipient;
DHS 105.19(4)(c)3. 3. 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 105.19(4)(c)4. 4. 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 105.19(4)(c)5. 5. Promptly inform the physician and other personnel participating in the patient's care of changes in the patient's condition and needs.
DHS 105.19(5) (5)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 recipient 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 105.19(5)(a) (a) To be fully informed of all rules and regulations affecting the recipient;
DHS 105.19(5)(b) (b) To be fully informed of all services to be provided by the nurse and of related charges, including any charges for services for which the recipient may be responsible;
DHS 105.19(5)(c) (c) 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 105.19(5)(d) (d) To refuse treatment to the extent permitted by law and to be informed of the medical consequences of that refusal;
DHS 105.19(5)(e) (e) 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 105.19(5)(f) (f) 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 105.19(5)(g) (g) To have one's property treated with respect; and
DHS 105.19(5)(h) (h) To complain about care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.
DHS 105.19(6) (6)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 105.19 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 105.19(7) (7)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 105.19(7)(a) (a) Recipient identification information;
DHS 105.19(7)(b) (b) Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care;
DHS 105.19(7)(c) (c) Recipient admission evaluation and assessment;
DHS 105.19(7)(d) (d) All medical orders, including the written plan of care and all interim physician's orders;
DHS 105.19(7)(e) (e) A consolidated list of medications, including start and stop dates, dosage, route of administration and frequency. This list shall be reviewed and updated for each nursing visit, if necessary;
DHS 105.19(7)(f) (f) Progress notes posted as frequently as necessary to clearly and accurately document the recipient's status and services provided. In this paragraph, “progress note" means a written notation, dated and signed by a member of the health team providing covered services, that summarizes facts about care furnished and the recipient's response during a given period of time;
DHS 105.19(7)(g) (g) Clinical notes written the day service is provided and incorporated into the clinical record within 7 days after the visit or recipient contact. In this paragraph, “clinical note" means a notation of a contact with a recipient that is written and dated by a member of the home health team providing covered services, and that describes signs and symptoms, treatment and drugs administered and the patient's reaction, and any changes in physical or emotional condition;
DHS 105.19(7)(h) (h) Written summaries of the recipient's care provided by the nurse to the physician at least every 62 days; and
DHS 105.19(7)(i) (i) Written authorizations from the recipient or the recipient's guardian when it is necessary for the nurse to procure medical supplies or equipment needed by the recipient.
DHS 105.19(8) (8)Back-up and emergency procedures.
DHS 105.19(8)(a)(a) A recipient's nurse shall designate an alternate nurse to provide services to the recipient in the event the nurse is temporarily unable to provide services. The recipient shall be informed of the identity of the alternate nurse before the alternate nurse provides services.
DHS 105.19(8)(b) (b) The nurse shall document a plan for recipient-specific emergency procedures in the event a life-threatening situation or fire occurs or there are severe weather warnings. This plan shall be made available to the recipient and all caregivers prior to initiation of these procedures.
DHS 105.19(8)(c) (c) The nurse shall take appropriate action and immediately notify the recipient's physician, guardian, if any, and any other responsible person designated in writing by the patient or guardian of any significant accident, injury or adverse change in the recipient's condition.
DHS 105.19(9) (9)Discharge of the recipient. A recipient shall be discharged from services provided by the nurse upon the recipient's request, upon the decision of the recipient's physician, or if the nurse documents that continuing to provide services to the recipient presents a direct threat to the nurse's health or safety and further documents the refusal of the attending physician to authorize discharge of the recipient with full knowledge and understanding of the threat to the nurse. The nurse shall recommend discharge to the physician and recipient if the recipient does not require services or requires services beyond the nurse's capability. The nurse provider shall issue a notification of discharge to the recipient or guardian, if possible at least 2 calendar weeks prior to cessation of skilled nursing services, and shall, in all circumstances, provide assistance in arranging for the continuity of all medically necessary care prior to discharge.
DHS 105.19(10) (10)Department review.
DHS 105.19(10)(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 105.19(10)(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 nurse provider. The nurse 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 shall be given 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 105.19(10)(c) (c) Investigation complaints. The department may investigate any complaint received by it concerning the provision of MA services by a nurse provider. Following the investigation, the department may issue a preliminary final report to the nurse provider in question, except when doing so would jeopardize any other investigation by the department or other state or federal agency.
DHS 105.19 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91; emerg. r. and recr., eff. 7-1-92; r. and recr. Register, February, 1993, No. 446, eff., 3-1-93; corrections in (1) (a) (intro.), (b) and (10) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.20 DHS 105.20Nurse practitioners.
DHS 105.20(1) (1)Qualifications. For MA certification, a nurse practitioner shall be licensed as a registered nurse pursuant to s. 441.06, Stats., and fulfill one of the following requirements:
DHS 105.20(1)(a) (a) If practicing as a pediatric nurse practitioner, be currently certified by the American nurses' association or by the national board of pediatric nurse practitioners and associates;
DHS 105.20(1)(b) (b) If practicing as any family nurse practitioner, be currently certified by the American nurses' association; or
DHS 105.20(1)(c) (c) If practicing as any other primary care nurse practitioner or as a clinical nurse specialist, be currently certified by the American nurses' association, the national certification board of pediatric nurse practitioners and associates, or the nurses' association of the American college of obstetricians and gynecologists' certification corporation, or have a master's degree in nursing from a school accredited by a program designed to prepare a registered nurse for advanced clinical nurse practice.
DHS 105.20(2) (2)Protocols. A written protocol covering a service or delegated medical act that may be provided and procedures that are to be followed for provision of services by nurse practitioners shall be developed and maintained by the nurse practitioner and the delegating licensed physician according to the requirements of s. N 6.03 (2) and the guidelines set forth by the board of nursing. This protocol shall include, but is not limited to, explicit agreements regarding those delegated medical acts which the nurse practitioner or clinical nurse specialist is delegated by the physician to provide. A protocol shall also include arrangements for communication of the physician's directions, consultation with the physician, assistance with medical emergencies, patient referrals and other provisions relating to medical procedures and treatment.
DHS 105.20 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91.
DHS 105.201 DHS 105.201Nurse-midwives. For MA certification, a nurse midwife shall be certified as a registered nurse under s. DHS 105.19 (1) and shall be certified as a nurse midwife under ch. N 4.
DHS 105.201 History History: Cr. Register, January, 1991, No. 421, eff. 2-1-91.
DHS 105.21 DHS 105.21Hospital IMDS.
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.