Chapter DHS 107

DHS 107.11(5)(j) (j) Skilled nursing services contracted for by a home health agency unless the requirements of s. DHS 133.19 are met and approved by the department;

DHS 107.11(5)(k) (k) Occupational therapy, physical therapy or speech pathology services requiring only the use of equipment without the skills of the therapist or speech pathologist;

DHS 107.11(5)(L) (L) Skilled nursing visits:

DHS 107.11(5)(L)1. 1. Solely for the purpose of ensuring that a recipient who has a demonstrated history of noncompliance over 30 days complies with the medications program;

DHS 107.11(5)(L)2. 2. To administer or assist with medication administration of an adult recipient who is capable of safely self-administering a medication as determined and documented by the RN;

DHS 107.11(5)(L)3. 3. To inject a recipient who is capable of safely self-injecting a medication, as described and documented by the RN;

DHS 107.11(5)(L)4. 4. To prefill syringes for self-injection when, as determined and documented by the RN, the recipient is capable of prefilling or a pharmacy is available to prefill; and

DHS 107.11(5)(L)5. 5. To set up medication for self-administration when, as determined and documented by the RN, the recipient is capable or a pharmacy is available to assist the recipient;

DHS 107.11(5)(m) (m) Home health services to a recipient who is eligible for covered services under the medicare program or any other insurance held by the recipient;

DHS 107.11(5)(n) (n) Services that are not medically appropriate. In this paragraph,“medically appropriate” means a service that is proven and effective treatment for the condition for which it is intended or used;

DHS 107.11(5)(o) (o) Parenting;

DHS 107.11(5)(p) (p) Services to other members of the recipient’s household;

DHS 107.11(5)(q) (q) A visit made by a skilled nurse, physical or occupational therapist or speech pathologist solely to train other home health workers;

DHS 107.11(5)(r) (r) Any home health service included in the daily rate of the community-based residential facility where the recipient is residing;

DHS 107.11(5)(s) (s) Services when provided to a recipient by the recipient’s spouse or parent if the recipient is under age 18;

DHS 107.11(5)(u) (u) Any service which is performed in a place other than the recipient’s residence; and

DHS 107.11(5)(v) (v) Independent nursing services under sub. (6).

DHS 107.11(6) (6) Unavailability of a home health agency.

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) (b) Covered services.

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.a. a. Measurable time-specific goals;

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. 5.

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)5.b. b. Drugs may be administered by an advanced practice nurse prescriber as authorized under ss. N 8.06 and 8.10.

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) (c) Prior authorization.

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) (d) Other limitations.

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)2. 2. Discharge of a recipient from nursing care under this subsection shall be made in accordance with s. DHS 105.19 (9).

DHS 107.11(6)(d)3. 3. The limitations under sub. (4) apply.

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)1. 1. Services listed in sub. (5);

DHS 107.11(6)(e)2. 2. Private duty nursing services under s. DHS 107.12; and

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 DHS 107.112 Personal care services.

DHS 107.112(1) (1) Covered services.

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) (b) Covered personal care services are:

DHS 107.112(1)(b)1. 1. Assistance with bathing;

DHS 107.112(1)(b)2. 2. Assistance with getting in and out of bed;

DHS 107.112(1)(b)3. 3. Teeth, mouth, denture and hair care;

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)6. 6. Skin care excluding wound care;

DHS 107.112(1)(b)7. 7. Care of eyeglasses and hearing aids;

DHS 107.112(1)(b)8. 8. Assistance with dressing and undressing;

DHS 107.112(1)(b)9. 9. Toileting, including use and care of bedpan, urinal, commode or toilet;

DHS 107.112(1)(b)10. 10. Light cleaning in essential areas of the home used during personal care service activities;

DHS 107.112(1)(b)11. 11. Meal preparation, food purchasing and meal serving;

DHS 107.112(1)(b)12. 12. Simple transfers including bed to chair or wheelchair and reverse; and

DHS 107.112(1)(b)13. 13. Accompanying the recipient to obtain medical diagnosis and treatment.

DHS 107.112(2) (2) Services requiring prior authorization.

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) (b) Prior authorization is required under par. (a) for specific services listed in s. DHS 107.11 (2). Services listed in s. DHS 107.11 (2) (b) are covered personal care services, regardless of the recipient’s age, only when:

DHS 107.112(2)(b)1. 1. Safely delegated to a personal care worker by a registered nurse;

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) (3) Other limitations.

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)1. 1. Review and interpretation of the physician’s orders;

DHS 107.112(3)(b)2. 2. Frequency and anticipated duration of service;

DHS 107.112(3)(b)3. 3. Evaluation of the recipient’s needs and preferences; and

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)(c) (c) Personal care services not documented in the plan of care;

DHS 107.112(4)(d) (d) Personal care services provided by a responsible relative under s. 49.90, Stats.;

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)(f) (f) Services other than those listed in subs. (1) (b) and (2) (b);

DHS 107.112(4)(g) (g) Skilled nursing services, including:

DHS 107.112(4)(g)1. 1. Insertion and sterile irrigation of catheters;

DHS 107.112(4)(g)2. 2. Giving of injections;