Wisconsin Legislature: DHS 105.17(1k)(a)6.

Alert! This chapter may be affected by an emergency rule:

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(f) Adopt written policies, procedures and documents that outline agency operations.

(g) Adopt a statement detailing the services to be provided.

(h) Oversee the management of the agency.

(i) Appoint an administrator.

(j) Provide for a substitute administrator to act in the absence of the administrator. If it is necessary to immediately terminate an administrator or if the agency loses an administrator for other reasons, employ or name a qualified replacement as soon as possible within 90 days of the vacancy.

(k) Notify the department in writing within 10 days of any appointment or change of the administrator or the substitute administrator.

(L) Notify the department in writing within 10 days of a change in the location of the agency or contact information for the personal care provider.

(1f) Provision of information. A county, independent living center or federally recognized American Indian tribe or band personal care provider shall provide, in a format approved by the department, identifying information about the county, independent living center or federally recognized American Indian tribe or band and those agencies and individuals that provide Medicaid personal care services through a contract with the county, independent living center or federally recognized American Indian tribe or band.

(1g) Finances; accounting; recordkeeping; billing. A personal care provider shall do all of the following:

(a) Cash flow. Document adequate resources to maintain a cash flow sufficient to cover operating expenses for 60 days.

(b) Accounting methods. Document a financial accounting system that complies with generally accepted accounting principles.

1. Written personnel policies.

2. Written job descriptions.

3. A written plan of operations indicating the entire process from making referrals through delivery of services and follow-up.

4. A written statement defining the scope of personal care services provided, including the population being served, service needs and service priorities.

5. A written record of personal care workers’ training.

6. Workers’ time sheets.

7. Contracts with workers and other agencies.

8. Records of supervisory visits.

(cm) Electronic visit verification. The provider is required to capture and retain EVV records.

(d) Billing. Bill the medical assistance program for services covered under s. DHS 107.112.

(1k) Administrator and administrator qualifications.

(a) The administrator of a personal care agency shall meet all of the following requirements:

1. Be at least 21 years of age.

2. Have the ability to fulfill the job requirements, respond to the needs of the clients, and manage the personal care agency.

3. Have an associate degree or higher in a health care-related field from an accredited college, or a bachelor’s degree in a field other than in health care from an accredited college and one year experience working in a health care-related field.

4. Have training and experience in health care administration and at least one year of supervisory or administrative experience in home health care or personal care, or a related health program.

5. Be knowledgeable about this chapter and s. DHS 107.112, and take all reasonable steps to ensure that the personal care agency complies with the requirements of this chapter.

6. Be responsible for the overall provision of training and competency of all employees.

(b) Persons who are the administrator of record with the department of a personal care agency on the effective date of this rule shall be exempt from the qualification requirements specified under par. (a).

(1n) Personnel management. The personal care provider shall document and implement a system of personnel management, if more than one personal care worker is employed or under contract, that includes all of the following:

(a)

1. Evaluate every personal care worker and RN supervisor employed by or under contract with the provider periodically according to the provider’s policy for quality of performance and adherence to the provider’s policies and this chapter and s. DHS 107.112. Evaluations shall be followed up with appropriate action.

2. Provide orientation and on-going instruction for RN supervisors and personal care workers. Personal care workers shall receive orientation before providing services to a client. The titles of the persons responsible for conducting orientation and training shall be specified in the plan. The plan shall include a system for providing instruction when an evaluation of the RN’s or personal care worker’s performance or competency indicates additional instruction may be needed. Orientation shall include training on all of the following:

a. Policies and objectives of the provider.

b. Information concerning specific job duties. Training shall be provided for each skill the personal care worker is assigned and shall include a successful demonstration of each skill by the personal care worker to the qualified trainer, under the supervision of the RN supervisor, prior to providing the service to a client independently. Only an RN may train others on a delegated act, as defined in s. N 6.02 (5), and s. N 6.03. The RN or qualified trainer shall document the personal care worker’s successful demonstration of each skill and maintain the information in their personnel file.

c. The functions of personnel employed by the provider and how they interrelate and communicate with each other in providing services.

d. Health and safety procedures for working in a home environment.

e. Epidemiology, modes of transmission and prevention of infections and the need for routine use of current infection control measures as recommended by the U.S. centers for disease control and prevention.

f. Responding to medical and non-medical emergencies.

g. Ethics, confidentiality of client information, and client rights.

3. Comply with the caregiver background check requirements under s. 50.065, Stats., and ch. DHS 12, including the disclosure requirements under s. 50.065 (2m), Stats., and s. DHS 12.115. The provider shall also comply with the caregiver misconduct reporting and investigation requirements under ch. DHS 13.

(b) Employ trained personal care workers as described under sub. (3), or train or arrange and pay for training of employed or subcontracted personal care workers as necessary. No employee or subcontractor may be assigned any duty for which he or she is not trained.

(d)

1. Supervise the provision of personal care services. Except as provided in subd. 2., services for all clients shall be supervised by an RN according to the requirements set forth in s. DHS 107.112 (3) (a) and (c). The visit to the client’s home by an RN shall be conducted at a time when the personal care worker will be directly observed providing personal care services to the client in the client’s home. The RN shall document the results of the visit including the observation of the personal care worker and maintain the information in their personnel file or other designated agency file. When observation of the personal care worker by the RN reveals a failure to follow the client’s care plan, the personal care provider shall provide counseling, education or retraining to ensure the personal care worker is adequately trained to complete their job responsibilities.

2. Clients who are not Medicaid recipients may choose to waive the requirements contained in s. DHS 107.112 (3) (c) for the supervisory review of the personal care worker, including a visit to the client’s home every 60 days, through a written agreement between the client or the client’s legal representative and the personal care agency. The agreement shall specify the requirements being waived by the client or the client’s legal representative and the benefits of the requirement and probable consequences of the requirement not applying to the client. The agreement shall be included in the service agreement required s. DHS 105.17 (1w) (c).

(e) Employ or contract with personal care workers to provide personal care services.

(f) In the case of personal care workers who are not employees of the personal care provider, specify all required training, qualifications and services to be performed in a written personal care provider contract between the personal care provider and personal care workers, and maintain a copy of that contract on file.

(fm) Document performance of personal care services by personal care workers by maintaining time sheets of personal care workers which document the types and duration of services provided, by funding source.

(1r) Infection control and prevention.

(a) The personal care provider shall develop and implement written policies for control of communicable diseases that take into consideration control procedures incorporated by reference in ch. DHS 145 and that ensure that employees with symptoms or signs of communicable disease or infected skin lesions are not permitted to work unless authorized to do so by a physician or physician assistant or advanced practice nurse.

(b)

1. The personal care provider shall ensure that each new employee, before having direct contact with clients, is certified in writing by a physician, physician assistant or registered nurse as having been screened for tuberculosis, and clinically apparent communicable disease that may be transmitted to a client during the normal performance of the employee’s duties. The screening shall occur within 90 days before the employee has direct client contact.

2. The personal care provider shall ensure that each continuing employee having direct contact with clients is periodically screened for clinically apparent communicable disease by a physician, physician assistant, or registered nurse based on the likelihood of their exposure to a communicable disease, including tuberculosis. The exposure to a communicable disease may have occurred in the community or in another location.

(c) The personal care provider shall monitor employees’ adherence to evidence-based standards of practice as recommended by the U.S. centers for disease control and prevention, or other evidence-based standards of practice, related to protective measures. When monitoring reveals a failure to follow evidence-based standards of practice, the provider shall provide counseling, education, or retraining to ensure staff is adequately trained to complete their job responsibilities.

(d) The personal care provider shall provide equipment and supplies necessary for all staff having direct care contact with the client to minimize the risk of infection.

(1w) Client services. The personal care provider shall do all of the following:

(a) Acceptance. Assess a prospective client’s appropriateness to be served by the provider without delay, unless the reason for the delay is justifiable and documented, and accept a client only if there is reasonable expectation that the client’s needs can be met by the provider. If the provider accepts the applicant as a client, the provider shall promptly provide services to the individual. If the provider does not accept an applicant as a client, the provider shall inform the applicant of other personal care providers in the area or how to obtain a list of those providers.

(b) Information to provide to the client. The provider shall provide, in writing, prior to or at the time of accepting an applicant as a client, each client or the client’s legal representative all of the following:

1. The provider’s rules and the client’s responsibilities under the provider’s rules.

2. The procedures indicating the complaint or grievance process which shall include a statement on how the client can make a complaint to the department.

3. A statement of client’s rights which shall include all of the following:

a. To be fully informed of these rights and of all of the provider’s rules governing client responsibilities.

b. To be fully informed of services available from the provider.

c. To be informed of all changes in services and charges as they occur.

Note: For clients who are Medicaid recipients, personal care services are not subject to recipient cost sharing, per s. 49.45 (18) (b) 11., Stats., and the provider is prohibited from charging the recipient for services in addition to or in lieu of obtaining Medicaid payment, per s. 946.91 (5), Stats.

d. To participate in the planning of services, including referral to a health care institution or other provider and to refuse to participate in experimental research.

dm. To have access to information about the client’s health condition to the extent required by law.

Note: Section 146.83, Stats., and federal HIPAA regulations [45 CFR s. 164.524] generally require health care providers to make health care records available for inspection by the patient.

e. To refuse service and to be informed of the consequences of that refusal.

f. To confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the provider, except in the case of transfer to another provider or to a health facility, or as otherwise permitted by law.

g. To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs.

h. To be taught the service required so that the client can, to the extent possible, help himself or herself.

i. To have a person designated by the client taught the service required, so that, to the extent possible, the person designated can understand and help the client.

j. To have one’s property treated with respect.

k. To complain about the care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.

L. To have the client’s legal representative exercise the client’s rights when the legal representative is legally authorized to do so.

(c) Service agreement. Before services are provided, the personal care provider shall inform the client, orally and in writing, of the extent to which payment may be expected from other sources, the charges for services that will not be covered by other sources and charges that the individual may have to pay.

(d) Client records. Maintain all of the following records, if required in this section or s. DHS 107.112, for each client:

1. The nursing assessment, physician prescription, plan of care, personal care worker’s assignment and record of all assignments, and record of registered nurse supervisory visits.

2. The record of all visits by the personal care worker, including observations and assigned activities completed and not completed.

3. Written acknowledgement of receipt by the client of the client’s rights and responsibilities, provider rules and policies, and the department statement on how to register a complaint.

4. A copy of the discharge summary.

5. All of the information required under s. DHS 106.02 (9) (e) 2. for each of its clients.

(e) Client’s preference for services. Give full consideration to a client’s preferences for service arrangements and choice of personal care workers.

(f) Discharge of a client.