Wisconsin Legislature: DHS 107.113(1)(d)

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2. Frequency and anticipated duration of service;

3. Evaluation of the recipient’s needs and preferences; and

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.

(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.

(d) Reimbursement for registered nurse supervisory visits is limited to one visit per month.

(e) 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:

(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;

(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;

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

(e) Personal care services provided in excess of 50 hours per calendar year without prior authorization;

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

(g) Skilled nursing services, including:

1. Insertion and sterile irrigation of catheters;

2. Giving of injections;

3. Application of dressings involving prescription medication and use of aseptic techniques; and

4. Administration of medicine that is not usually self-administered; and

(h) Therapy services.

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 Respiratory care for ventilator-assisted recipients.

(1) Covered services.

(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.

(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:

1. A hospital.

2. A nursing facility.

3. An intermediate care facility for individuals with intellectual disabilities.

4. Any setting in which payment is or could be made under medical assistance for inpatient services that include room and board.

(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.

(d) Respiratory care includes any of the following:

1. Airway management, consisting of:

a. Tracheostomy care: all available types of tracheostomy tubes, stoma care, changing a tracheostomy tube, and emergency procedures for tracheostomy care including accidental extubation;

b. Tracheal suctioning technique; and

c. Airway humidification;

2. Oxygen therapy and operation of oxygen systems and auxiliary oxygen delivery devices.

3. Respiratory assessment, including but monitoring of breath sounds, patient color, chest excursion, secretions and vital signs.

4. Ventilator management, including any of the following:

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.

b. Operation of a manual resuscitator.

c. Emergency assessment and management including cardiopulmonary resuscitation.

5. Any of the following modes of ventilatory support:

a. Positive pressure ventilation by means of a nasal mask or mouthpiece.

b. Continuous positive airway pressure (CPAP) by means of a tracheostomy tube or mask.

c. Negative pressure ventilation — iron lung, chest shell or pulmowrap.

d. Rocking beds.

e. Pneumobelts.

f. Diaphragm pacing.

6. Operation and interpretation of the following monitoring devices:

a. Cardio-respiratory monitoring.

b. Pulse oximetry.

c. Capnography.

7. Knowledge of and skills in weaning from the ventilator.

8. Adjunctive techniques, including any of the following:

a. Chest physiotherapy.

b. Aerosolized medications.

9. 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 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 provider acting within the scope of the provider’s practice, 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 provider 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 provider within 10 working days. The written provider’s plan of care shall include:

(a) Orders by a provider acting within the scope of the provider’s practice for treatments provided by the necessary disciplines specifying the amount and frequency of treatment;

(b) Medications, including route, dose and frequency;

(d) Nutritional requirements;

(e) Necessary durable medical equipment and disposable medical supplies;

(f) Ventilator settings and parameters;

(g) Procedures to follow in the event of accidental extubation;

(h) Identification of back-ups in the event scheduled personnel are unable to attend the case;

(i) The name of the registered nurse designated as the recipient’s case coordinator;

(j) A plan for medical emergency, to include:

1. Description of back-up personnel needed;

2. Provision for reliable, 24-hour a day, 7 days a week emergency service for repair and delivery of equipment; and

3. Specification of an emergency power source; and

(k) 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.

(3) Prior authorization. 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. 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.

(4) Other limitations.

(a) 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.

(b) 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.

(c) Durable medical equipment and disposable medical supplies shall be provided in accordance with conditions set out in s. DHS 107.24.

(d) 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.

(e) 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.

(f) In the event that a recipient receiving respiratory care services is discharged from the care of one respiratory care provider and admitted to the care of another respiratory care provider continues to receive services 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).

(g) Travel, recordkeeping and RN supervision of a licensed practical nurse are not separately reimbursable services.

(5) Non-covered services. The following services are not covered services:

(a) Parenting;

(b) Supervision of the recipient when supervision is the only service provided;

(d)

1. Except as provided in subd. 2., services provided by an individual nurse under this section that, when combined with services provided to all recipients and other patients under the nurse’s care, exceed either of the following limitations:

a. A total of 12 hours in a calendar day.

b. A total of 60 hours in a calendar week.

2. Services may exceed the limitations in subd. 1. when both of the following conditions are met: