Chapter DHS 105

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;

DHS 105.19(5)(c) (c) To be fully informed of one’s own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of services, including referral to a health care institution or other agency;

DHS 105.19(5)(d) (d) To refuse treatment to the extent permitted by law and to be informed of the medical consequences of that refusal;

DHS 105.19(5)(e) (e) To confidential treatment of personal and medical records and to approve or refuse their release to any individual, except in the case of transfer to a health care facility;

DHS 105.19(5)(f) (f) To be taught, and have the family or other persons living with the recipient taught, the treatment required, so that the recipient can, to the extent possible, help himself or herself, and the family or other party designated by the recipient can understand and help the recipient;

DHS 105.19(5)(g) (g) To have one’s property treated with respect; and

DHS 105.19(5)(h) (h) To complain about care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.

DHS 105.19(6) (6) Universal precautions. A nurse shall have the necessary orientation, education and training in epidemiology, modes of transmission and prevention of HIV and other blood-borne or body fluid-borne infections and shall follow universal blood and body-fluid precautions for each recipient for whom services are provided. The nurse shall employ protective measures recommended by the federal centers for disease control (CDC), including those pertaining to medical equipment and supplies, to minimize the risk of infection from HIV and other blood-borne pathogens.

DHS 105.19 Note Note: A copy of the CDC recommended universal precautions may be obtained from the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701.

DHS 105.19(7) (7) Medical record. The nurse shall maintain a medical record for each recipient. The record shall document the nature and scope of all services provided and shall be systematically organized and readily accessible to authorized department personnel. The medical record shall document the recipient’s condition, problems, progress and all services rendered, and shall include:

DHS 105.19(7)(a) (a) Recipient identification information;

DHS 105.19(7)(b) (b) Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care;

DHS 105.19(7)(c) (c) Recipient admission evaluation and assessment;

DHS 105.19(7)(d) (d) All medical orders, including the written plan of care and all interim physician’s orders;

DHS 105.19(7)(e) (e) A consolidated list of medications, including start and stop dates, dosage, route of administration and frequency. This list shall be reviewed and updated for each nursing visit, if necessary;

DHS 105.19(7)(f) (f) Progress notes posted as frequently as necessary to clearly and accurately document the recipient’s status and services provided. In this paragraph, “progress note” means a written notation, dated and signed by a member of the health team providing covered services, that summarizes facts about care furnished and the recipient’s response during a given period of time;

DHS 105.19(7)(g) (g) Clinical notes written the day service is provided and incorporated into the clinical record within 7 days after the visit or recipient contact. In this paragraph, “clinical note” means a notation of a contact with a recipient that is written and dated by a member of the home health team providing covered services, and that describes signs and symptoms, treatment and drugs administered and the patient’s reaction, and any changes in physical or emotional condition;

DHS 105.19(7)(h) (h) Written summaries of the recipient’s care provided by the nurse to the physician at least every 62 days; and

DHS 105.19(7)(i) (i) Written authorizations from the recipient or the recipient’s guardian when it is necessary for the nurse to procure medical supplies or equipment needed by the recipient.

DHS 105.19(7m) (7m) Electronic visit verification. The nurse is required to capture and retain EVV records.

DHS 105.19(8) (8) Back-up and emergency procedures.

DHS 105.19(8)(a) (a) A recipient’s nurse shall designate an alternate nurse to provide services to the recipient in the event the nurse is temporarily unable to provide services. The recipient shall be informed of the identity of the alternate nurse before the alternate nurse provides services.

DHS 105.19(8)(b) (b) The nurse shall document a plan for recipient-specific emergency procedures in the event a life-threatening situation or fire occurs or there are severe weather warnings. This plan shall be made available to the recipient and all caregivers prior to initiation of these procedures.

DHS 105.19(8)(c) (c) The nurse shall take appropriate action and immediately notify the recipient’s physician, guardian, if any, and any other responsible person designated in writing by the patient or guardian of any significant accident, injury or adverse change in the recipient’s condition.

DHS 105.19(9) (9) Discharge of the recipient. A recipient shall be discharged from services provided by the nurse upon the recipient’s request, upon the decision of the recipient’s physician, or if the nurse documents that continuing to provide services to the recipient presents a direct threat to the nurse’s health or safety and further documents the refusal of the attending physician to authorize discharge of the recipient with full knowledge and understanding of the threat to the nurse. The nurse shall recommend discharge to the physician and recipient if the recipient does not require services or requires services beyond the nurse’s capability. The nurse provider shall issue a notification of discharge to the recipient or guardian, if possible at least 2 calendar weeks prior to cessation of skilled nursing services, and shall, in all circumstances, provide assistance in arranging for the continuity of all medically necessary care prior to discharge.

DHS 105.19(10) (10) Department review.

DHS 105.19(10)(a) (a) Record review. The department may periodically review the records described in this section and s. DHS 106.02 (9), subject only to restrictions of law. All records shall be made immediately available upon the request of an authorized department representative.

DHS 105.19(10)(b) (b) In-home visits. As part of the review under par. (a), the department may contact recipients who have received or are receiving MA services from a nurse provider. The nurse provider shall provide any identifying information requested by the department. The department may select the recipients for visits and may visit a recipient with the approval of the recipient or recipient’s guardian. The recipient to be visited shall be given the opportunity to have any person present whom he or she chooses during the visit by personnel of the department or other governmental investigating agency.

DHS 105.19(10)(c) (c) Investigation complaints. The department may investigate any complaint received by it concerning the provision of MA services by a nurse provider. Following the investigation, the department may issue a preliminary final report to the nurse provider in question, except when doing so would jeopardize any other investigation by the department or other state or federal agency.

DHS 105.19 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91; emerg. r. and recr., eff. 7-1-92; r. and recr. Register, February, 1993, No. 446, eff., 3-1-93; corrections in (1) (a) (intro.), (b) and (10) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: am. (1) (b) Register October 2021 No. 790, eff. 11-1-21; EmR2306: emerg. cr. (7m), eff. 5-1-23; CR 23-045: cr. (7m) Register January 2024 No. 817, eff. 2-1-24.

DHS 105.20 DHS 105.20 Nurse practitioners.

DHS 105.20(1) (1) Qualifications. For MA certification, a nurse practitioner shall be licensed as a registered nurse pursuant to s. 441.06, Stats., and fulfill one of the following requirements:

DHS 105.20(1)(a) (a) If practicing as a pediatric nurse practitioner, be currently certified by the American nurses’ association or by the national board of pediatric nurse practitioners and associates;

DHS 105.20(1)(b) (b) If practicing as any family nurse practitioner, be currently certified by the American nurses’ association; or

DHS 105.20(1)(c) (c) If practicing as any other primary care nurse practitioner or as a clinical nurse specialist, be currently certified by the American nurses’ association, the national certification board of pediatric nurse practitioners and associates, or the nurses’ association of the American college of obstetricians and gynecologists’ certification corporation, or have a master’s degree in nursing from a school accredited by a program designed to prepare a registered nurse for advanced clinical nurse practice.

DHS 105.20(2) (2) Protocols. A written protocol covering a service or delegated medical act that may be provided and procedures that are to be followed for provision of services by nurse practitioners shall be developed and maintained by the nurse practitioner and the delegating licensed physician according to the requirements of s. N 6.03 (2) and the guidelines set forth by the board of nursing. This protocol shall include, but is not limited to, explicit agreements regarding those delegated medical acts which the nurse practitioner or clinical nurse specialist is delegated by the physician to provide. A protocol shall also include arrangements for communication of the physician’s directions, consultation with the physician, assistance with medical emergencies, patient referrals and other provisions relating to medical procedures and treatment.

DHS 105.20 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91.

DHS 105.201 DHS 105.201 Nurse-midwives. For MA certification, a nurse midwife shall be certified as a registered nurse under s. DHS 105.19 (1) and shall be certified as a nurse midwife under ch. N 4.

DHS 105.201 History History: Cr. Register, January, 1991, No. 421, eff. 2-1-91.

DHS 105.21 DHS 105.21 Hospital IMDS.

DHS 105.21(1) (1) Requirements. For MA certification, a hospital which is an institution for mental disease (IMD) shall:

DHS 105.21(1)(a) (a) Meet the requirements of s. DHS 105.07, and;

DHS 105.21(1)(a)1. 1. Maintain clinical records on all patients, including records sufficient to permit determination of the degree and intensity of treatment furnished to MA recipients, as specified in 42 CFR 482.61; and

DHS 105.21(1)(a)2. 2. Maintain adequate numbers of qualified professional and supportive staff to evaluate patients, formulate written, individualized comprehensive treatment plans, provide active treatment measures and engage in discharge planning, as specified in 42 CFR 482.62;

DHS 105.21(1)(b) (b) Have a utilization review plan that meets the requirements of 42 CFR 405.1035, 405.1037 and 405.1038;

DHS 105.21(1)(c) (c) If participating in the PRO review program, meet the requirements of that program and any other requirements established under the state contract with the PROs;

DHS 105.21(1)(d) (d) If providing outpatient psychotherapy, comply with s. DHS 105.22;

DHS 105.21(1)(e) (e) If providing outpatient alcohol and other drug abuse services, comply with s. DHS 105.23; and

DHS 105.21(1)(f) (f) If providing day treatment services, comply with s. DHS 105.24.

DHS 105.21(2) (2) Waivers and variances. The department shall consider applications for waivers or variances of the requirements in sub. (1) if the requirements and procedures stated in s. DHS 106.11 are followed.

DHS 105.21 Note Note: For covered mental health services, see s. DHS 107.13.

DHS 105.21 History History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction in (1) (a) made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1990, No. 414; correction in (2) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.