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;
Principal diagnosis, surgical procedures and other pertinent diagnosis;
Necessary durable medical equipment and disposable medical supplies;
Identification of back-ups in the event scheduled personnel are unable to attend the case;
The name of the registered nurse designated as the recipient's case coordinator;
Provision for reliable, 24-hour a day, 7 days a week emergency service for repair and delivery of equipment; and
A plan to move the recipient to safety in the event of fire, flood, tornado warning or other severe weather, or any other condition which threatens the recipient's immediate environment.
All services covered under sub. (1)
and all home health services under s. DHS 107.11
provided to a recipient receiving respiratory care shall be authorized prior to the time the services are rendered. Prior authorization shall be renewed every 12 calendar months if the respiratory care under this section is still needed. The prior authorization request shall include the name of the registered nurse who is responsible for coordination of all care provided under the MA program for the recipient in his or her home. Independent MA-certified respiratory therapists or nurses in private practice who are not employees of or contracted to a home health agency but are certified under s. DHS 105.19 (1) (b)
to provide respiratory care shall include in the prior authorization request the name and license number of a registered nurse who will participate, on 24-hour call, in emergency assessment and management and who will be available to the respiratory therapist for consultation and assistance.
Services under this section shall not be reimbursed if the recipient is receiving respiratory care from an RN, licensed practical nurse or respiratory therapist who is providing these services as part of the rental agreement for a ventilator or other respiratory equipment.
Respiratory care provided to a recipient residing in a community-based residential facility (CBRF) as defined in s. 50.01 (1g)
, Stats., shall be in accordance with the requirements of ch. DHS 83
Durable medical equipment and disposable medical supplies shall be provided in accordance with conditions set out in s. DHS 107.24
Respiratory care services provided by a licensed practical nurse shall be provided under the supervision of a registered nurse and in accordance with standards of practice set out in s. N 6.04
Case coordination services provided by the designated case coordinator shall be documented in the clinical record, including the extent and scope of specific care coordination provided.
In the event that a recipient receiving services at home who is discharged from the care of one respiratory care provider and admitted to the care of another respiratory care provider continues to receive services at home under this section, the admitting provider shall coordinate services with the discharging provider to ensure continuity of care. The admitting provider shall establish the recipient's plan of care as provided under sub. (2)
and request prior authorization under sub. (3)