DHS 107.11(5)(u)
(u) Any service which is performed in a place other than the recipient's residence; and
DHS 107.11(6)(a)
(a)
Definition. In this subsection, “part-time, intermittent care" means skilled nursing services provided in a recipient's home under a plan of care which requires less than 8 hours of skilled care in a calendar day.
DHS 107.11(6)(b)1.1. Part-time, intermittent nursing care may be provided by an independent nurse certified under s.
DHS 105.19 when an existing home health agency cannot provide the services as appropriately documented by the nurse, and the physician's prescription specifies that the recipient requires less than 8 hours of skilled nursing care per calendar day and calls for a level of care which the nurse is licensed to provide as documented to the department.
DHS 107.11(6)(b)2.
2. Services provided by an MA-certified registered nurse are those services prescribed by a physician which comprise the practice of professional nursing as described under s.
441.001 (4), Stats., and s.
N 6.03. Services provided by an MA-certified licensed practical nurse are those services which comprise the practice of practical nursing under s.
441.001 (3), Stats., and s.
N 6.04. An LPN may provide nursing services delegated by an RN as delegated nursing acts under the requirements of ss.
N 6.03 and
6.04 and guidelines established by the state board of nursing.
DHS 107.11(6)(b)3.
3. A written plan of care shall be established for every recipient admitted for care and shall be signed by the physician and incorporated into the recipient's medical record. A written plan of care shall be developed by the registered nurse or therapist within 72 hours after acceptance. The written plan of care shall be developed by the registered nurse or therapist in consultation with the recipient and the recipient's physician and shall be signed by the physician within 20 working days following the recipient's admission for care. The written plan of care shall include, in addition to the medication and treatment orders:
DHS 107.11(6)(b)3.b.
b. Methods for delivering needed care, and an indication of which, if any, professional disciplines are responsible for delivering the care;
DHS 107.11(6)(b)3.c.
c. Provision for care coordination by an RN when more than one nurse is necessary to staff the recipient's case;
DHS 107.11(6)(b)3.d.
d. Identification of all other parties providing care to the recipient and the responsibilities of each party for that care; and
DHS 107.11(6)(b)3.e.
e. A description of functional capabilities, mental status, dietary needs and allergies.
DHS 107.11(6)(b)4.
4. The written plan of care shall be reviewed, signed and dated by the recipient's physician as often as required by the recipient's condition but at least every 62 days. The RN shall promptly notify the physician of any change in the recipient's condition that suggests a need to modify the plan of care.
DHS 107.11(6)(b)5.a.a. Except as provided in subd.
5. b., drugs and treatment shall be administered by the RN or LPN only as ordered by the recipient's physician or his or her designee. The nurse shall immediately record and sign oral orders and shall obtain the physician's countersignature within 10 working days.
DHS 107.11(6)(b)6.
6. Supervision of an LPN by an RN or physician shall be performed according to the requirements under ss.
N 6.03 and
6.04 and the results of supervisory activities shall be documented and communicated to the LPN.
DHS 107.11(6)(c)1.1. Prior authorization requirements under sub.
(3) apply to services provided by an independent nurse.
DHS 107.11(6)(c)2.
2. 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.
DHS 107.11(6)(d)1.1. 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.
DHS 107.11(6)(d)4.
4. Registered nurse supervision of an LPN is not separately reimbursable.
DHS 107.11(6)(e)
(e) Non-covered services. The following services are not covered services under this subsection:
DHS 107.11(6)(e)3.
3. 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
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;
CR 22-043: am. (1) (c)
Register May 2023 No. 809, eff. 6-1-23;
CR 23-046: r. and recr. (2), cr. (2m), r. (5) (t) Register April 2024 No. 820, eff. 5-1-24; correction in (2) (c) 2. a., c. made under s. 35.17, Stats., Register April 2024 No. 820. DHS 107.112(1)(a)(a) 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.
DHS 107.112(1)(b)4.
4. Assistance with mobility and ambulation including use of walker, cane or crutches;
DHS 107.112(1)(b)5.
5. Changing the recipient's bed and laundering the bed linens and the recipient's personal clothing;
DHS 107.112(1)(b)10.
10. Light cleaning in essential areas of the home used during personal care service activities;
DHS 107.112(2)(a)
(a) Prior authorization is required for personal care services in excess of 50 hours per calendar year.
DHS 107.112(2)(b)2.
2. The personal care worker is trained and supervised by the provider to provide the tasks; and
DHS 107.112(2)(b)3.
3. The recipient, parent or responsible person is permitted to participate in the training and supervision of the personal care worker.
DHS 107.112(3)(a)(a) 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.
DHS 107.112(3)(b)
(b) 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:
DHS 107.112(3)(b)4.
4. 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.
DHS 107.112(3)(c)
(c) 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.
DHS 107.112(3)(d)
(d) Reimbursement for registered nurse supervisory visits is limited to one visit per month.
DHS 107.112(3)(e)
(e) No more than one-third of the time spent by a personal care worker may be in performing housekeeping activities.
DHS 107.112(4)
(4)
Non-covered services. The following services are not covered services:
DHS 107.112(4)(a)
(a) 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;
DHS 107.112(4)(b)
(b) 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;
DHS 107.112(4)(e)
(e) Personal care services provided in excess of 50 hours per calendar year without prior authorization;
DHS 107.112(4)(g)3.
3. Application of dressings involving prescription medication and use of aseptic techniques; and
DHS 107.112 History
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;
CR 20-039: am. (2) (a), (4) (e)
Register October 2021 No. 790, eff. 11-1-21.
DHS 107.113
DHS 107.113 Respiratory care for ventilator-assisted recipients. DHS 107.113(1)(a)(a) 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.
DHS 107.113(1)(b)
(b) A recipient receiving these services is one for whom respiratory care can safely be provided in any setting in which normal life activities take place, excluding all of the following settings:
DHS 107.113(1)(b)3.
3. An intermediate care facility for individuals with intellectual disabilities.
DHS 107.113(1)(b)4.
4. Any setting in which payment is or could be made under medical assistance for inpatient services that include room and board.
DHS 107.113(1)(c)
(c) Respiratory care shall be provided as required under ss.
DHS 105.16 and
105.19 and according to a written plan of care under sub.
(2) signed by the recipient's provider acting within the scope of the provider's practice for a recipient who lives in a residence that is not a hospital or a skilled nursing facility.
