Chapter DHS 105

DHS 105.17(2)(b) (b) Duties. The RN supervisor shall perform all of the following duties:

DHS 105.17(2)(b)1. 1. Assess and evaluate the need for services according to the standards of practice contained in s. N 6.03 (1) (a) and (d), and make referrals to other services as appropriate. Documentation shall be signed and dated by the RN supervisor who conducted the assessment and evaluation, attesting to its accuracy and truthfulness.

DHS 105.17(2)(b)2. 2. Secure written orders from the client’s physician. These orders are to be renewed once every 3 months unless the physician specifies that orders covering a period of time up to one year are appropriate, or when the client’s needs change, whichever occurs first. Physician orders for personal care services are not required for clients who are not Medicaid recipients unless the personal care service is a delegated act. This provision does not mitigate the RN supervisor’s responsibility to follow the standards contained in ch. N 6.

DHS 105.17(2)(b)3. 3. Develop a plan of care for the client, giving full consideration to the client’s preferences for service arrangements and choice of personal care workers, interpret the plan to the personal care worker, include a copy of the plan in the client’s health record, and review the plan at least every 60 days and update it as necessary.

DHS 105.17(2)(b)3m. 3m. Promptly notify a client’s physician or other appropriate medical personnel and legal representative, if any, of any significant changes observed or reported in the client’s condition.

DHS 105.17(2)(b)4. 4. Develop appropriate time and service reporting mechanisms for personal care workers and instruct the workers on their use.

DHS 105.17(2)(b)5. 5. Give the personal care worker written instructions about the services to be performed and arrange for an appropriate person to demonstrate to the personal care worker how to perform the services.

DHS 105.17(2)(b)6. 6. Evaluate the competency of the personal care worker to perform the services.

DHS 105.17(3) (3) Qualifications and duties of personal care workers.

DHS 105.17(3)(a) (a) Qualifications. Personal care workers shall have the following qualifications:

DHS 105.17(3)(a)1. 1. Be trained under s. DHS 105.17 (1n) (a) 2. and (b) in the provision of personal care services, and in each skill that the personal care worker is assigned.

DHS 105.17(3)(a)2. 2. Provide documentation of required training to the personal care provider for the provider’s records;

DHS 105.17(3)(a)3. 3. Be a person who is not a legally responsible relative of the client under s. 49.90 (1), Stats.

DHS 105.17(3)(a)4. 4. Have the skills, education, experience and ability to fulfill the employee’s job requirements.

DHS 105.17(3)(a)5. 5. Be at least 16 years old.

DHS 105.17(3)(b) (b) Duties. Personal care workers shall do all of the following:

DHS 105.17(3)(b)1. 1. Perform tasks assigned by the RN supervisor.

DHS 105.17(3)(b)2. 2. Report in writing to the RN supervisor on each assignment.

DHS 105.17(3)(b)3. 3. Promptly report any significant changes observed or reported in the client’s condition to the RN supervisor.

DHS 105.17(3)(b)4. 4. Confer as required with the RN supervisor regarding the client’s progress.

DHS 105.17(3)(b)5. 5. Upon coming in contact with blood or other potentially infectious materials including those that are air-borne, non-intact skin, or mucus membranes in caring for clients, practice infection control measures as recommended by the U.S. centers for disease control and prevention.

DHS 105.17(4) (4) Inspections and investigations.

DHS 105.17(4)(a) (a)

DHS 105.17(4)(a)1. 1. The department’s division of quality assurance may make any inspections and investigations, including complaint investigations, it considers necessary and may review clinical and administrative records, policies and other documents required under this section or s. DHS 107.112.

DHS 105.17(4)(a)2. 2. Any interference with or refusal to allow or cooperate with any inspection or investigation under this subsection may be grounds for termination of MA certification.

DHS 105.17(4)(b) (b) The department may contact clients of personal care providers as part of an inspection or investigation. The provider shall provide the department a list of names, addresses and other identifying information of current and past clients as may be requested. The department may select the names of the clients to be contacted and may contact these clients upon the client’s approval.

DHS 105.17(4)(c) (c) Upon determining that a personal care provider is not compliant with one or more certification requirements under this section or s. DHS 107.112, the department shall promptly notify the provider of the specific rule violated, state the facts that constitute the deficiency and specify the date by which the provider is required to correct the deficiency.

DHS 105.17(5) (5) MA application requirements; freestanding personal care agencies.

DHS 105.17(5)(a) (a) Definitions. In the section, “branch office” means a location or site from which a personal care agency provides services within a portion of the total geographic area served by the personal care agency. “Parent agency” means a personal care agency with one or more branch offices.

DHS 105.17(5)(ag) (ag) Application for MA certification. For MA certification, a freestanding personal care agency shall submit an application on forms provided by the department, and provide all information requested on the forms. The application shall be fully completed and submitted with the applicable nonrefundable fee in an amount established by the department.

DHS 105.17(5)(ar) (ar) Multiple locations. A branch office shall separately apply and be separately certified if the department determines that the branch office, because of the volume of services provided or the distance between the branch office and the parent agency, cannot adequately share supervision and administration of services with the parent agency. Each office the department finds to be necessary shall submit a separate application under this subsection and shall independently satisfy all requirements for certification set forth in this section, except that the requirements under s. DHS 105.17 (1e) (b), (1g) (a) and (b), (1n), and (1w) (h) may be satisfied by policies and practices that are adopted by the entity that owns or controls the agency, and that are applicable to all required offices of the agency. If a branch agency is not separately approved from a parent agency, the parent agency shall be deemed to be in violation of this chapter or s. DHS 107.112 if the branch is in violation.

DHS 105.17 Note Note: To obtain a copy of the application forms, send your request to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969. The street address is 1 W. Wilson Street in Madison. The e-mail address is: [e-mail]. The completed application forms should be sent to the same office.

DHS 105.17 Note Note: Fees are permitted under s. 49.45 (42) (c), Stats., and set and periodically revised by the Department’s Division of Quality Assurance. Fees may vary based on a number of factors including revenues from operations.

DHS 105.17(5)(b) (b) Recommendation for certification.

DHS 105.17(5)(b)1. 1. Following receipt of a complete application for MA certification or for a change in certification when there has been a change in the ownership of a personal care agency, the department shall review the application, and investigate the applicant and principals to determine the applicant’s ability to comply with this section and s. DHS 107.112.

DHS 105.17(5)(b)2. 2. Within 90 days after receiving a complete application, the department shall either approve or deny the application. Approval will be effective for a 1-year period from the date a complete application was submitted to the department.

DHS 105.17(5)(b)3. 3. The applicant shall submit a written request to the department for an on-site survey within 9 months of the date the application was approved.

DHS 105.17(5)(b)4. 4. The applicant shall show that the agency has served at least 5 clients requiring personal care services during the period of the approved application. At the time of the on-site survey, the applicant or its personnel shall demonstrate provision of personal care services to at least 2 clients.

DHS 105.17(5)(b)5. 5. If the applicant does not submit a written request for an on-site survey within 9 months of the date the application was approved, the application will no longer be valid.

DHS 105.17(5)(b)6. 6. Within 90 days following completion of an on-site survey, the department shall either recommend certification or not recommend certification of the applicant to the department’s division of medicaid services.

DHS 105.17(5)(c) (c) Non approval. The department may not approve certification for an applicant who does not comply with any provision of this chapter, s. DHS 107.112, or ch. 50, Stats., or who is not fit and qualified as specified in DHS 105.17 (1e) (e), or who has failed to pay any fee or any outstanding amounts due to the department.

DHS 105.17(5)(d) (d) Annual reporting and fee.

DHS 105.17(5)(d)1. 1. Every 12 months, on a schedule determined by the department, a certified freestanding personal care agency shall submit an annual report to the department in the form and containing the information that the department requires. The freestanding personal care agency shall submit with the report a fee in an amount determined by the department. If a complete annual report and fee are not timely submitted to the department, the department shall issue a warning to the freestanding personal care agency.

DHS 105.17(5)(d)2. 2. The department may terminate certification of a freestanding personal care agency that does not submit a completed report and fee to the department within 60 days after the date established by the department in subd. 1.

DHS 105.17 Note Note: Fees are permitted under s. 49.45 (42) (c), Stats., and set and periodically revised by the Department’s Division of Quality Assurance. Fees may vary based on a number of factors including revenues from operations.

DHS 105.17(6) (6) Quality assessment and assurance committee.

DHS 105.17(6)(a) (a) A personal care agency shall establish a quality assessment and assurance committee for the purpose of identifying and addressing quality of care issues. The committee shall include all of the following members:

DHS 105.17(6)(a)1. 1. The administrator.

DHS 105.17(6)(a)2. 2. The substitute administrator.

DHS 105.17(6)(a)3. 3. The registered nurse supervisor.

DHS 105.17(6)(a)4. 4. At least 1 other member of the agency’s staff.

DHS 105.17(6)(b) (b) The quality assessment and assurance committee shall do all of the following:

DHS 105.17(6)(b)1. 1. Meet at least quarterly to identify quality of care issues that require quality assessment and assurance activities.

DHS 105.17(6)(b)2. 2. Develop and implement appropriate plans of action to correct identified quality of care issues.

DHS 105.17(6)(c) (c) The department may not require disclosure of the records of the quality assessment and assurance committee except to determine compliance with the requirements of this section.

DHS 105.17(7) (7) Agency closure.

DHS 105.17(7)(a) (a) Any personal care agency that intends to close shall provide written notice to each client, the client’s legal representative, if any, the client’s attending physician and the department at least 30 days before closing.

DHS 105.17(7)(b) (b) The personal care agency shall provide assistance to clients in arranging for continuity of necessary services.

DHS 105.17 History History: Cr. Register, April, 1988, No. 388, eff. 7-1-88; emerg. am. (1) (intro.), eff. 7-1-88; am. (1) (intro.), Register, December, 1988, No. 396, eff. 1-1-89; am. (3) (a) 1., Register, February, 1993, No. 446, eff. 3-1-93; correction in (1) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1999, No. 528; correction in (1) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 08-108: am. (1) (intro.) Register June 2009 No. 642, eff. 7-1-09; CR 09-107: renum. (1) to be (1c), (1e), (1g), (1n), (1r) and (1w) and am., renum. (4) (intro.) to be (4) (a) 1. and am., renum. (4) (a) to (f), (h) and (i) to be (1g) (c) 1. to 8. and am., r. (1) (L), (3) (a) 4. and (4) (g), cr. (1), (1e) (intro.), (e), (1f), (1g) (intro.), (1n) (a) 2., 3., (1r) (title), (a) to (c), (1w) (intro.) to (c), (f), (2) (b) 3m., (3) (b) 5., (4) (a) 2., (b), (c) and (5), am. (2) (a) (intro.) to 2., (b), (3) (a) 1., 3., (b), and (4) (title), r. and recr. (2) (a) 3. Register August 2010 No. 656, eff. 9-1-10; correction in (1) (b) 3. made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; CR 19-087: cr. (1) (ag), (1e) (f) to (L), (1k), am. (1n) (a) 2. b., (d) 1., r. and recr. (2) (b) 1., am. (2) (b) 2., cr. (3) (a) 4., 5., r. and recr. (5) (b), (c), cr. (6), (7) Register August 2020 No. 776, eff. 9-1-20; correction in (1n) (a) 2. b., (5) (c) made under s. 35.17, Stats., Register August 2020 No. 776; republished to correct an error in transcription in (5) (c) Register December 2020 No. 779; CR 22-026: r. (1c) (c) Register May 2023 No. 809, eff. 6-1-23; EmR2306: emerg. cr. (1g), (cm), eff. 5-1-23; CR 23-045: cr. (1g) (cm) Register January 2024 No. 817, eff. 2-1-24.

DHS 105.19 DHS 105.19 Nurses in independent practice.

DHS 105.19(1) (1) Qualifications.

DHS 105.19(1)(a) (a) For MA certification to perform skilled nursing services as a nurse in independent practice providing home health services under s. DHS 107.11 (6) or private duty nursing services under s. DHS 107.12, the nurse shall be:

DHS 105.19(1)(a)1. 1. Licensed as a registered nurse pursuant to s. 441.06, Stats.;

DHS 105.19(1)(a)2. 2. Licensed as a practical nurse pursuant to s. 441.10, Stats.; or

DHS 105.19(1)(a)3. 3. A registered nurse providing supervision of a licensed practical nurse certified under this section.

DHS 105.19(1)(b) (b) For MA certification to perform respiratory care services as a provider in independent practice, the provider shall be a nurse described in par. (a) or a respiratory therapist. Any person providing or supervising respiratory care who is not credentialed by the national board on respiratory care shall know how to perform the services under s. DHS 107.113 (1) and shall have the skills necessary to perform those services. Skills required to perform services listed in s. DHS 107.113 (1) (e) to (f) are required on a case-by-case basis, as appropriate. In no case may a person provide respiratory care before that person has demonstrated competence in all areas under s. DHS 107.113 (1) (a) to (d). A registered nurse who fulfills these requirements shall coordinate the recipient’s care.

DHS 105.19(2) (2) Plan of care. Nursing services and respiratory care shall be provided in accordance with a written plan of care which the physician reviews and signs at least every 62 days or when the recipient’s condition changes, whichever occurs first.

DHS 105.19(3) (3) Supervision of a licensed practical nurse. A registered nurse or physician designated by the LPN providing nursing or respiratory care services shall supervise the LPN as often as necessary under the requirements of ss. N 6.03 and 6.04 (2) and shall document the results of supervisory activities. An LPN may provide nursing or respiratory care services delegated by an RN as delegated nursing acts under ss. N 6.03 and 6.04 and guidelines established by the board of nursing.

DHS 105.19(4) (4) Duties of the nurse.

DHS 105.19(4)(a) (a) The following nursing services may be performed only by a registered nurse:

DHS 105.19(4)(a)1. 1. Making the initial evaluation visit;

DHS 105.19(4)(a)2. 2. Initiating the physician’s plan of care and necessary revisions;

DHS 105.19(4)(a)3. 3. Providing those services that require care of a registered nurse as defined in ch. N 6;

DHS 105.19(4)(a)4. 4. Initiating appropriate preventive and rehabilitative procedures;

DHS 105.19(4)(a)5. 5. Accepting only those delegated medical acts which the RN is competent to perform based on his or her nursing education, training or experience; and

DHS 105.19(4)(a)6. 6. Regularly reevaluating the patient’s needs.

DHS 105.19(4)(b) (b) Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse. Licensed practical nurse duties include:

DHS 105.19(4)(b)1. 1. Performing nursing care delegated by an RN under s. N 6.03;

DHS 105.19(4)(b)2. 2. Assisting the patient in learning appropriate self-care techniques; and

DHS 105.19(4)(b)3. 3. Meeting the nursing needs of the recipient according to the written plan of care.

DHS 105.19(4)(c) (c) Both RNs and LPNs shall:

DHS 105.19(4)(c)1. 1. Arrange for or provide health care counseling within the scope of nursing practice to the recipient and recipient’s family in meeting needs related to the recipient’s condition;

DHS 105.19(4)(c)2. 2. Provide coordination of care for the recipient, including ensuring that provision is made for all required hours of care for the recipient;

DHS 105.19(4)(c)3. 3. Accept only those delegated medical acts for which there are written or verbal orders and for which the nurse has appropriate training or experience;

DHS 105.19(4)(c)4. 4. Prepare written clinical notes that document the care provided within 24 hours of providing service and incorporate them into the recipient’s clinical record within 7 days; and

DHS 105.19(4)(c)5. 5. Promptly inform the physician and other personnel participating in the patient’s care of changes in the patient’s condition and needs.

DHS 105.19(5) (5) Patient rights. A nurse shall provide a written statement of the rights of the recipient for whom services are provided to the recipient or guardian or any interested party prior to the provision of services. The recipient or guardian shall acknowledge recipient of the statement in writing. The nurse shall promote and protect the exercise of these rights and keep written documentation of compliance with this subsection. Each recipient receiving care shall have the following rights:

DHS 105.19(5)(a) (a) To be fully informed of all rules and regulations affecting the recipient;

DHS 105.19(5)(b) (b) To be fully informed of all services to be provided by the nurse and of related charges, including any charges for services for which the recipient may be responsible;