DHS 107.113
DHS 107.113
Respiratory care for ventilator-assisted recipients. 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)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)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)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.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)5.b.
b. Continuous positive airway pressure (CPAP) by means of a tracheostomy tube or mask.
DHS 107.113(1)(d)9.
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.
DHS 107.113(2)
(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:
DHS 107.113(2)(a)
(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;
DHS 107.113(2)(c)
(c) Principal diagnosis, surgical procedures and other pertinent diagnosis;
DHS 107.113(2)(e)
(e) Necessary durable medical equipment and disposable medical supplies;
DHS 107.113(2)(h)
(h) Identification of back-ups in the event scheduled personnel are unable to attend the case;
DHS 107.113(2)(i)
(i) The name of the registered nurse designated as the recipient's case coordinator;
DHS 107.113(2)(j)2.
2. Provision for reliable, 24-hour a day, 7 days a week emergency service for repair and delivery of equipment; and
DHS 107.113(2)(k)
(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.
DHS 107.113(3)
(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.
DHS 107.113(4)(a)
(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.
DHS 107.113(4)(b)
(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.
DHS 107.113(4)(c)
(c) Durable medical equipment and disposable medical supplies shall be provided in accordance with conditions set out in s.
DHS 107.24.
DHS 107.113(4)(d)
(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.
DHS 107.113(4)(e)
(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.
DHS 107.113(4)(f)
(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).
DHS 107.113(4)(g)
(g) Travel, recordkeeping and RN supervision of a licensed practical nurse are not separately reimbursable services.
DHS 107.113(5)
(5) Non-covered services. The following services are not covered services:
DHS 107.113(5)(b)
(b) Supervision of the recipient when supervision is the only service provided;
DHS 107.113(5)(d)1.1. 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:
DHS 107.113(5)(d)2.
2. Services may exceed the limitations in subd.
1. when both of the following conditions are met:
DHS 107.113(5)(d)2.a.
a. The services are approved by the department on a case-by-case basis for circumstances that could not reasonably have been predicted.
DHS 107.113(5)(d)2.b.
b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient's health.
DHS 107.113(5)(e)
(e) Services provided in a setting other than the recipient's place of residence; and
DHS 107.113(5)(g)1.1. Except as provided in subd.
2., services provided during any 24-hour period during which the nurse who performs the services has less than 8 continuous and uninterrupted hours off duty.
DHS 107.113(5)(g)2.
2. Services may exceed the limitations in subd.
1. when both of the following conditions are met:
DHS 107.113(5)(g)2.a.
a. The services are approved by the department on a case-by-case basis for circumstances that could not reasonably have been predicted.
DHS 107.113(5)(g)2.b.
b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient's health.
DHS 107.113 History
History: Cr.
Register, February, 1993, No. 446, eff. 3-1-93; correction in (4) (c) made under s. 13.93 (2m) (b) 7., Stats.,
Register, April, 1999, No. 520;
CR 05-052: r. and recr. (5) (d), cr. (5) (g)
Register June 2007 No. 618, eff. 7-1-07; corrections in (1) (intro.), (3) and (4) (b) made under s. 13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636;
CR 23-046: r. and recr. (1), am. (2) (intro.), (a), (3) (a), (4) (f) Register April 2024 No. 820, eff. 5-1-24; correction in (1) (b) 2. made under s. 35.17, Stats., correction in numbering of (1) (d) 4. a. to c. made under s. 13.92 (4) (b) 7., Stats., and (3) (a) renumbered (3) under s. 13.92 (4) (b) 1., Stats., Register April 2024 No. 820. DHS 107.12
DHS 107.12
Private duty nursing services. DHS 107.12(1)(a)(a) Private duty nursing is skilled nursing care available for recipients with medical conditions requiring more continuous skilled care than can be provided on a part-time, intermittent basis. Only a recipient who requires 8 or more hours of skilled nursing care and is authorized to receive these services in the home setting may make use of the approved hours outside of that setting during those hours when normal life activities take him or her outside of that setting. Private duty nursing may be provided according to the requirements under ss.
DHS 105.16 and
105.19 when the written plan of care specifies the medical necessity for this type of service.
DHS 107.12(1)(b)
(b) Private duty nursing services provided by a certified registered nurse in independent practice are those services prescribed by a provider acting within the scope of the provider's practice which comprise the practice of professional nursing as described under s.
441.001 (4), Stats., and s.
N 6.03. Private duty nursing services provided by a certified licensed practical nurse are those services which comprise the practice of practical nursing under s.
441.001 (3), Stats., and s.
N 6.04. An LPN may provide private duty nursing services delegated by a registered nurse as delegated nursing acts under the requirements of ch.
N 6 and guidelines established by the state board of nursing.
DHS 107.12(1)(c)
(c) Services may be provided only when prescribed by a provider acting within the scope of the provider's practice and the prescription calls for a level of care which the nurse is licensed and competent to provide.
DHS 107.12(1)(d)1.1. A written plan of care, including a functional assessment, medication and treatment orders, shall be established for every recipient admitted for care and shall be incorporated in the recipient's medical record within 72 hours after acceptance in consultation with the recipient and the recipient's provider acting within the scope of the provider's practice and shall be signed by the provider within 20 working days following the recipient's admission for care. The provider's plan of care shall include, in addition to the medication and treatment orders:
DHS 107.12(1)(d)1.b.
b. Methods for delivering needed care, and an indication of which other professional disciplines, if any, are responsible for delivering the care;
DHS 107.12(1)(d)1.c.
c. Provision for care coordination by an RN when more than one nurse is necessary to staff the recipient's case; and
