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.
DHS 105.21(1)(1)Requirements. For MA certification, a hospital which is an institution for mental disease (IMD) shall:
DHS 105.21(1)(a) (a) Meet the requirements of s. DHS 105.07, and;
DHS 105.21(1)(a)1. 1. Maintain clinical records on all patients, including records sufficient to permit determination of the degree and intensity of treatment furnished to MA recipients, as specified in 42 CFR 482.61; and
DHS 105.21(1)(a)2. 2. Maintain adequate numbers of qualified professional and supportive staff to evaluate patients, formulate written, individualized comprehensive treatment plans, provide active treatment measures and engage in discharge planning, as specified in 42 CFR 482.62;
DHS 105.21(1)(b) (b) Have a utilization review plan that meets the requirements of 42 CFR 405.1035, 405.1037 and 405.1038;
DHS 105.21(1)(c) (c) If participating in the PRO review program, meet the requirements of that program and any other requirements established under the state contract with the PROs;
DHS 105.21(1)(d) (d) If providing outpatient psychotherapy, comply with s. DHS 105.22;
DHS 105.21(1)(e) (e) If providing outpatient alcohol and other drug abuse services, comply with s. DHS 105.23; and
DHS 105.21(1)(f) (f) If providing day treatment services, comply with s. DHS 105.24.
DHS 105.21(2) (2) Waivers and variances. The department shall consider applications for waivers or variances of the requirements in sub. (1) if the requirements and procedures stated in s. DHS 106.11 are followed.
DHS 105.21 Note Note: For covered mental health services, see s. DHS 107.13.
DHS 105.21 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) (a) made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1990, No. 414; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.22 DHS 105.22Psychotherapy providers.
DHS 105.22(1)(1)Types of psychotherapy providers. For MA certification, a psychotherapy provider shall be one of the following:
DHS 105.22(1)(a) (a) A physician meeting the requirements of s. DHS 105.05 (1) who has completed a residency in psychiatry. Proof of residency shall be provided to the department. Proof of residency shall either be board-certification from the American board of psychiatry and neurology or a letter from the hospital in which the residency was completed;
DHS 105.22(1)(b) (b) A psychologist licensed under ch. 455, Stats., who is listed or eligible to be listed in the national register of health service providers in psychology;
DHS 105.22(1)(bm) (bm) An advanced practice nurse prescriber who is certified under s. 441.16 (2), Stats., and holds current certification in a psychiatric specialty from the American Nurses Credentialing Center.
DHS 105.22(1)(c) (c) An outpatient clinic certified under ch. DHS 35; or
DHS 105.22(1)(d) (d) A hospital outpatient mental health clinic located on the hospital's physical premises.
DHS 105.22(2) (2) Staffing of outpatient facilities. To provide psychotherapy reimbursable by MA, personnel employed by an outpatient clinic under sub. (1) (c) shall meet applicable requirements under ch. DHS 35. Persons employed by a hospital outpatient mental health clinic under sub. (1) (d) need not be individually certified as providers but may provide psychotherapy services upon the department's issuance of certification to the mental health clinic by which they are employed. A hospital outpatient mental health clinic shall maintain a list of the names of persons employed by the clinic who are performing psychotherapy services for which reimbursement may be claimed under MA. This listing shall document the credentials possessed by the named persons which would qualify them for certification under the standards specified in this subsection and shall include the dates that the named persons began employment.
DHS 105.22(3) (3) Reimbursement for outpatient psychotherapy services. Reimbursement shall be made to any certified outpatient mental health clinic meeting the requirement under sub. (1) (c) for services rendered by any provider who meets the applicable requirements under ch. DHS 35 and working for that clinic, except that a provider certified under sub. (1) (a), (b), or (bm) may be reimbursed directly.
DHS 105.22 Note Note: For covered mental health services, see s. DHS 107.13.
DHS 105.22 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (c), (d) and (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 06-080: cr. (1) (bm), am. (1) (c), (2) (a) and (3), r. and recr. (1) (d), r. (2) (b) Register May 2009 No. 641, eff. 6-1-09; correction in (2) made under s. 13.92 (4) (b) 1., Stats., Register May 2009 No. 641.
DHS 105.23 DHS 105.23Alcohol and other drug abuse (AODA) treatment providers.
DHS 105.23(1)(1)Types of providers. For MA certification, an outpatient alcohol and other drug abuse (AODA) treatment provider shall be:
DHS 105.23(1)(a) (a) An outpatient facility operated by a board and certified under s. DHS 75.13;
DHS 105.23(1)(b) (b) An outpatient facility or hospital outpatient AODA facility certified under s. DHS 75.13; or
DHS 105.23(1)(c) (c) A provider certified under s. DHS 105.05 (1) or 105.22 (1) (b).
DHS 105.23(2) (2) Staffing requirements.
DHS 105.23(2)(a)(a) To provide AODA services reimbursable under MA, personnel employed by an outpatient facility under sub. (1) (a) or (b) shall:
DHS 105.23(2)(a)1. 1. Meet the requirements in s. DHS 105.22 (1) (b) or 105.05 (1); or
DHS 105.23(2)(a)2. 2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse counselor certification board and work under the supervision of a provider who is a licensed physician or licensed psychologist and employed by the same facility.
DHS 105.23 Note Note: Certification standards of the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board may be obtained by writing the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board, Inc., 416 East Main Street, Waukesha, WI 53186.
DHS 105.23(2)(b) (b) The facility shall provide the department with a list of persons employed by the facility who perform AODA services for which reimbursement may be claimed under MA. The listing shall identify the credentials possessed by the named persons which would qualify them for certification under the standards specified in par. (a). A facility, once certified, shall promptly advise the department in writing of the employment or termination of employees who will be or have been providing AODA services under MA.
DHS 105.23(3) (3) Reimbursement for AODA services. Reimbursement for outpatient AODA treatment services shall be as follows:
DHS 105.23(3)(a) (a) For the services of any provider employed by or under contract to a certified AODA facility, reimbursement shall be made to the facility; and
DHS 105.23(3)(b) (b) For the services of any provider who is a physician or licensed psychologist defined under sub. (1) (c) in private practice, reimbursement shall be to the physician or psychologist.
DHS 105.23 Note Note: For covered alcohol and other drug abuse treatment services, see s. DHS 107.13 (3).
DHS 105.23 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (b) and(c) and (2) (a) 1., Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections in (1) (a) and (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.24 DHS 105.24Mental health day treatment or day hospital service providers.
DHS 105.24(1)(1)Requirements. For MA certification, a day treatment or day hospital service provider shall:
DHS 105.24(1)(a) (a) Be a medical program certified under s. DHS 61.75; and
DHS 105.24(1)(b) (b) Meet the following personnel and staffing requirements:
DHS 105.24(1)(b)1. 1. A registered nurse and a registered occupational therapist shall be on duty to participate in program planning, program implementation and daily program coordination;
DHS 105.24(1)(b)2. 2. The day treatment program shall be planned for and directed by designated members of an interdisciplinary team that includes a social worker, a psychologist, an occupational therapist and a registered nurse or a physician, physician's assistant or another appropriate health care professional;
DHS 105.24(1)(b)3. 3. A written patient evaluation involving an assessment of the patient's progress by each member of the multidisciplinary team shall be made at least every 60 days; and
DHS 105.24(1)(b)4. 4. For the purposes of daily program performance, coordination guidance and evaluation:
DHS 105.24(1)(b)4.a. a. One qualified professional staff member such as an OTR, masters degree social worker, registered nurse, licensed psychologist or masters degree psychologist for each group, or one certified occupational therapy assistant and one other paraprofessional staff person for each group; and
DHS 105.24(1)(b)4.b. b. Other appropriate staff, including volunteer staff.
DHS 105.24(2) (2) Billing and reimbursement.
DHS 105.24(2)(a) (a) Reimbursement for medical day treatment or day hospital services shall be at a rate established and approved by the department.
DHS 105.24(2)(b) (b) Reimbursement payable under par. (a) shall be subject to reductions for third party recoupments.
DHS 105.24 Note Note: For covered day treatment and day hospital services, see s. DHS 107.13 (4).
DHS 105.24 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (1) (a), am. (2) (b), r. (2) (c), Register, September, 1991, No. 429, eff. 10-1-91; correction in (1) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.25 DHS 105.25Alcohol and other drug abuse (AODA) day treatment providers.
DHS 105.25(1)(1)Types of providers. For MA certification, an alcohol and other drug abuse (AODA) day treatment provider shall be certified under ss. DHS 75.12 and 105.23.
DHS 105.25(2) (2) Staffing requirements.
DHS 105.25(2)(a)(a) An alcohol and drug counselor certified as provided in ss. DHS 75.02 (84) and 75.03 (4) (d) shall be on duty during all hours in which services are provided to participate in treatment planning and implementation and daily program coordination.
DHS 105.25(2)(b) (b) A treatment plan for each participating recipient shall be developed, directed and monitored by designated members of an interdisciplinary treatment team which includes an alcohol and drug counselor II or III, certified as provided in ss. DHS 75.02 (84) and 75.03 (4) (d), a physician or licensed psychologist, and other health care professionals. The treatment team shall maintain a written record of each recipient's treatment and progress toward meeting the goals described in the recipient's plan of care.
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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.