DHS 105.17(1e)(1e) Contracting, planning and coordination; fit and qualified. A personal care provider shall do all of the following: DHS 105.17(1e)(b)(b) Present a proposal to the department to provide personal care services that does all of the following: DHS 105.17(1e)(b)2.2. Documents a quality assurance mechanism and quality assurance activities. DHS 105.17(1e)(b)3.3. Demonstrates that employees possess knowledge of and training and experience with special needs, including independent living needs, of the client group or groups receiving services. DHS 105.17(1e)(c)(c) Provide a written plan of operation describing the entire process from referral through delivery of services and follow-up. DHS 105.17(1e)(d)(d) Cooperate with other health and social service agencies in the area and with interested community referral groups to avoid duplication of services and to provide coordination of personal care services to clients. DHS 105.17(1e)(e)(e) Be fit and qualified. All of the following factors are relevant to a determination by the department whether the applicant is fit and qualified for purposes of this paragraph: DHS 105.17(1e)(e)1.1. Any adverse action against the applicant or any principal by a licensing agency of any state that resulted in denial, suspension, injunction, or revocation of a license to operate a human services or health care agency or facility. DHS 105.17(1e)(e)2.2. Any adverse action against the applicant or any principal initiated by a state or federal agency based on non-compliance that resulted in civil money penalties, termination of a provider agreement, suspension of payments, or the appointment of temporary management of a facility or agency. DHS 105.17(1e)(e)3.3. Any conviction of the applicant or any principal for a crime involving neglect or abuse of patients or of the elderly or involving assaultive behavior or wanton disregard for the health or safety of others, or any act of abuse under s. 940.285 or 940.295, Stats., or similar law in another jurisdiction. DHS 105.17(1e)(e)4.4. Any conviction of the applicant or any principal for a crime related to the delivery of personal care or other health care-related services or items, or for providing personal care or other health care-related services without a license or other form of permission required by law. DHS 105.17(1e)(e)5.5. Any conviction of the applicant or any principal for a crime involving a controlled substance under ch. 961, Stats., or similar law in another jurisdiction. DHS 105.17(1e)(e)6.6. Any conviction of the applicant or any principal for a crime involving a sexual offense. DHS 105.17(1e)(e)7.7. Any prior financial failure of the applicant or any principal that resulted in bankruptcy or in the closing of a human services or health care agency or facility or the relocation or discharge of such an agency’s or facility’s patients. DHS 105.17(1e)(e)8.8. Any unsatisfied judgment against the applicant or any principal or any debts that are at least 90 days past due. DHS 105.17(1e)(f)(f) Adopt written policies, procedures and documents that outline agency operations. DHS 105.17(1e)(j)(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. DHS 105.17(1e)(k)(k) Notify the department in writing within 10 days of any appointment or change of the administrator or the substitute administrator. DHS 105.17(1e)(L)(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. DHS 105.17(1f)(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. DHS 105.17(1g)(1g) Finances; accounting; recordkeeping; billing. A personal care provider shall do all of the following: DHS 105.17(1g)(a)(a) Cash flow. Document adequate resources to maintain a cash flow sufficient to cover operating expenses for 60 days. DHS 105.17(1g)(b)(b) Accounting methods. Document a financial accounting system that complies with generally accepted accounting principles. DHS 105.17(1g)(c)3.3. A written plan of operations indicating the entire process from making referrals through delivery of services and follow-up. DHS 105.17(1g)(c)4.4. A written statement defining the scope of personal care services provided, including the population being served, service needs and service priorities. DHS 105.17(1g)(cm)(cm) Electronic visit verification. The provider is required to capture and retain EVV records. DHS 105.17(1k)(a)(a) The administrator of a personal care agency shall meet all of the following requirements: DHS 105.17(1k)(a)2.2. Have the ability to fulfill the job requirements, respond to the needs of the clients, and manage the personal care agency. DHS 105.17(1k)(a)3.3. 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. DHS 105.17(1k)(a)4.4. 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. DHS 105.17(1k)(a)5.5. 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. DHS 105.17(1k)(a)6.6. Be responsible for the overall provision of training and competency of all employees. DHS 105.17(1k)(b)(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). DHS 105.17(1n)(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: DHS 105.17(1n)(a)1.1. 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. DHS 105.17(1n)(a)2.2. 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: DHS 105.17(1n)(a)2.b.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. DHS 105.17(1n)(a)2.c.c. The functions of personnel employed by the provider and how they interrelate and communicate with each other in providing services. DHS 105.17(1n)(a)2.e.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. DHS 105.17(1n)(a)3.3. 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. DHS 105.17(1n)(b)(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. DHS 105.17(1n)(d)1.1. 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. DHS 105.17(1n)(d)2.2. 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). DHS 105.17(1n)(e)(e) Employ or contract with personal care workers to provide personal care services. DHS 105.17(1n)(f)(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. DHS 105.17(1n)(fm)(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. DHS 105.17(1r)(a)(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. DHS 105.17(1r)(b)1.1. 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. DHS 105.17(1r)(b)2.2. 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. DHS 105.17(1r)(c)(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. DHS 105.17(1r)(d)(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. DHS 105.17(1w)(1w) Client services. The personal care provider shall do all of the following: DHS 105.17(1w)(a)(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. DHS 105.17(1w)(b)(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: DHS 105.17(1w)(b)1.1. The provider’s rules and the client’s responsibilities under the provider’s rules. DHS 105.17(1w)(b)2.2. The procedures indicating the complaint or grievance process which shall include a statement on how the client can make a complaint to the department. DHS 105.17(1w)(b)3.a.a. To be fully informed of these rights and of all of the provider’s rules governing client responsibilities. DHS 105.17 NoteNote: 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. DHS 105.17(1w)(b)3.d.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. DHS 105.17(1w)(b)3.dm.dm. To have access to information about the client’s health condition to the extent required by law. DHS 105.17 NoteNote: 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.
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Chs. DHS 101-109; Medical Assistance
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