Chapter DHS 107

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;

DHS 107.112(4)(g)3. 3. Application of dressings involving prescription medication and use of aseptic techniques; and

DHS 107.112(4)(g)4. 4. Administration of medicine that is not usually self-administered; and

DHS 107.112(4)(h) (h) Therapy services.

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) (1) Covered services.

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)1. 1. A hospital.

DHS 107.113(1)(b)2. 2. A nursing facility.

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.

DHS 107.113(1)(d) (d) Respiratory care includes any of the following:

DHS 107.113(1)(d)1. 1. Airway management, consisting of:

DHS 107.113(1)(d)1.a. a. Tracheostomy care: all available types of tracheostomy tubes, stoma care, changing a tracheostomy tube, and emergency procedures for tracheostomy care including accidental extubation;

DHS 107.113(1)(d)1.b. b. Tracheal suctioning technique; and

DHS 107.113(1)(d)1.c. c. Airway humidification;

DHS 107.113(1)(d)2. 2. Oxygen therapy and operation of oxygen systems and auxiliary oxygen delivery devices.

DHS 107.113(1)(d)3. 3. Respiratory assessment, including but monitoring of breath sounds, patient color, chest excursion, secretions and vital signs.

DHS 107.113(1)(d)4. 4. Ventilator management, including any of the following:

DHS 107.113(1)(d)4.a. a. 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.

DHS 107.113(1)(d)4.b. b. Operation of a manual resuscitator.

DHS 107.113(1)(d)4.c. c. Emergency assessment and management including cardiopulmonary resuscitation.

DHS 107.113(1)(d)5. 5. Any of the following modes of ventilatory support:

DHS 107.113(1)(d)5.a. a. Positive pressure ventilation by means of a nasal mask or mouthpiece.

DHS 107.113(1)(d)5.b. b. Continuous positive airway pressure (CPAP) by means of a tracheostomy tube or mask.

DHS 107.113(1)(d)5.c. c. Negative pressure ventilation — iron lung, chest shell or pulmowrap.

DHS 107.113(1)(d)5.d. d. Rocking beds.

DHS 107.113(1)(d)5.e. e. Pneumobelts.

DHS 107.113(1)(d)5.f. f. Diaphragm pacing.

DHS 107.113(1)(d)6. 6. Operation and interpretation of the following monitoring devices:

DHS 107.113(1)(d)6.a. a. Cardio-respiratory monitoring.