A request for prior authorization of part-time, intermittent care performed by an LPN shall include the name and license number of the registered nurse supervising the LPN.
Each independent RN or LPN shall document the care and services provided. Documentation required under par. (b)
of the unavailability of a home health agency shall include names of agencies contacted, dates of contact and any other pertinent information.
Registered nurse supervision of an LPN is not separately reimbursable.
(e) Non-covered services.
The following services are not covered services under this subsection:
Any service that fails to meet the recipient's medical needs or places the recipient at risk for a negative treatment outcome.
DHS 107.11 History
Cr. Register, February, 1986, No. 362
, eff. 3-1-86; r. and recr. Register, April, 1988, No. 388
, eff. 7-1-88; am. (3) (d) and (e), cr. (3) (f), Register, December, 1988, No. 396
, eff. 1-1-89; emerg. r. and recr. eff. 7-1-92; r. and recr. Register, February, 1993, No. 446
, eff. 3-1-93; emerg. cr. (3) (ag), eff. 1-1-94; correction in (6) (b) 1. made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520
; corrections in (1) (c), (2) (b) 1. and (5) (i) and (j) made under s. 13.93 (2m) (b) 7., Stats., Register, October, 2000, No. 538
; correction in (4) (k) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554
; CR 03-033
: am. (6) (b) 5. Register December 2003 No. 576
, eff. 1-1-04; corrections in (6) (b) 2. made under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576
; corrections in (1) (c), (2) (intro.), (b) 1., (4) (c), (k), (5) (i), (j) and (6) (d) 2. made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636
Personal care services are medically oriented activities related to assisting a recipient with activities of daily living necessary to maintain the recipient in his or her place of residence in the community. These services shall be provided upon written orders of a physician by a provider certified under s. DHS 105.17
and by a personal care worker employed by the provider or under contract to the provider who is supervised by a registered nurse according to a written plan of care. The personal care worker shall be assigned by the supervising registered nurse to specific recipients to do specific tasks for those recipients for which the personal care worker has been trained. The personal care worker's training for these specific tasks shall be assured by the supervising registered nurse. The personal care worker is limited to performing only those tasks and services as assigned for each recipient and for which he or she has been specifically trained.
Assistance with mobility and ambulation including use of walker, cane or crutches;
Changing the recipient's bed and laundering the bed linens and the recipient's personal clothing;
Light cleaning in essential areas of the home used during personal care service activities;
Prior authorization is required for personal care services in excess of 250 hours per calendar year.
The personal care worker is trained and supervised by the provider to provide the tasks; and
The recipient, parent or responsible person is permitted to participate in the training and supervision of the personal care worker.
Personal care services shall be performed under the supervision of a registered nurse by a personal care worker who meets the requirements of s. DHS 105.17 (3)
and who is employed by or is under contract to a provider certified under s. DHS 105.17
Services shall be performed according to a written plan of care for the recipient developed by a registered nurse for purposes of providing necessary and appropriate services, allowing appropriate assignment of a personal care worker and setting standards for personal care activities, giving full consideration to the recipient's preferences for service arrangements and choice of personal care workers. The plan shall be based on the registered nurse's visit to the recipient's home and shall include:
Assessment of the recipient's social and physical environment, including family involvement, living conditions, the recipient's level of functioning and any pertinent cultural factors such as language.
Review of the plan of care, evaluation of the recipient's condition and supervisory review of the personal care worker shall be made by a registered nurse at least every 60 days. The review shall include a visit to the recipient's home, review of the personal care worker's daily written record and discussion with the physician of any necessary changes in the plan of care.
Reimbursement for registered nurse supervisory visits is limited to one visit per month.
No more than one-third of the time spent by a personal care worker may be in performing housekeeping activities.
(4) Non-covered services.
The following services are not covered services:
Personal care services provided in a hospital or a nursing home or in a community-based residential facility, as defined in s. 50.01 (1)
, Stats., with more than 20 beds;
Homemaking services and cleaning of areas not used during personal care service activities, unless directly related to the care of the person and essential to the recipient's health;
Personal care services provided in excess of 250 hours per calendar year without prior authorization;
Application of dressings involving prescription medication and use of aseptic techniques; and
DHS 107.112 History
Cr. Register, April, 1988, No. 388
, eff. 7-1-88; renum. (2) to be (2) (a), cr. (2) (b), am. (3) (e), Register, December, 1988, No. 396
, eff. 1-1-89; r. and recr. (2) (b), r. (3) (f), am. (4) (f), Register, February, 1993, No. 446
, eff. 3-1-93; emerg. am. (2) (a), (4) (e), eff. 1-1-94; correction in (3) (a) made under s. 13.92 (4) (b) 7.
, Stats., Register December 2008 No. 636
Respiratory care for ventilator-assisted recipients. DHS 107.113(1)
Services, medical supplies and equipment necessary to provide life support for a recipient who has been hospitalized for at least 30 consecutive days for his or her respiratory condition and who is dependent on a ventilator for at least 6 hours per day shall be covered services when these services are provided to the recipient in the recipient's home. A recipient receiving these services is one who, if the services were not available in the home, would require them as an inpatient in a hospital or a skilled nursing facility, has adequate social support to be treated at home and desires to be cared for at home, and is one for whom respiratory care can safely be provided in the home. Respiratory care shall be provided as required under ss. DHS 105.16
and according to a written plan of care under sub. (2)
signed by the recipient's physician for a recipient who lives in a residence that is not a hospital or a skilled nursing facility. Respiratory care includes:
Tracheostomy care: all available types of tracheostomy tubes, stoma care, changing a tracheostomy tube, and emergency procedures for tracheostomy care including accidental extubation;
Oxygen therapy: operation of oxygen systems and auxiliary oxygen delivery devices;
Respiratory assessment, including but not limited to monitoring of breath sounds, patient color, chest excursion, secretions and vital signs;
Operation of positive pressure ventilator by means of tracheostomy to include, but not limited to, different modes of ventilation, types of alarms and responding to alarms, troubleshooting ventilator dysfunction, operation and assembly of ventilator circuit, that is, the delivery system, and proper cleaning and disinfection of equipment;
Emergency assessment and management including cardiopulmonary resuscitation (CPR);
Continuous positive airway pressure (CPAP) by means of a tracheostomy tube or mask;
Case coordination activities performed by the registered nurse designated in the plan of care as case coordinator. These activities include coordination of health care services provided to the recipient at home and coordination of these services with any other health or social service providers serving the recipient.
(2) Plan of care.
A recipient's written plan of care shall be based on the orders of a physician, a visit to the recipient's home by the registered nurse and consultation with the family and other household members. The plan of care established by a home health agency or independent provider for a recipient to be discharged from a hospital shall consider the hospital's discharge plan for the recipient. The written plan of care shall be reviewed, signed and dated by the recipient's physician and renewed at least every 62 days and whenever the recipient's condition changes. Telephone orders shall be documented in writing and signed by the physician within 10 working days. The written physician's plan of care shall include:
Physician orders for treatments provided by the necessary disciplines specifying the amount and frequency of treatment;