Wisconsin Legislature: DHS 105.155(2)(a)1.

Alert! This chapter may be affected by an emergency rule:

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2. Install and maintain at least one 2A, 10-B-C fire extinguisher per 1,500 square feet of space. If only one extinguisher is necessary in the building, it is to be located near the cooking area.

3. Ensure fire extinguishers are operable at all times, inspected once a year by a qualified person, and shall bear a label indicating its condition and date of the last inspection.

4. Install and maintain smoke detectors in each activity room and hallways, unless the fire department indicates otherwise in writing. Each smoke detector shall be tested monthly.

5. Conduct and document quarterly fire drills.

(10) Requirements for multi-use facilities. An ADCC located in a multi-use facility shall ensure the setting, programs, and physical environment will enhance the dignity and individual respect of every participant.

(a) Nursing homes, community-based residential facilities, residential care apartment complexes and pre-vocational programs.

1. ‘Exterior.’

a. Access to the ADCC shall be distinct and have separate entrance and exit doors so each participant and staff are not walking through the living or program areas of others. A multi-use facility may have a shared lobby leading to a distinct entrance door for the ADCC.

b. The ADCC shall have a separate door to the outside so each participant and staff are not walking through the living or program areas of others.

2. ‘Interior.’

a. The ADCC shall be separate from living areas, shall be in addition to space required for other programs, and shall meet the requirements of sub. (8) (a) 2.

b. Spaces designated for program activities, dining, toileting, exercise and ambulation are distinctly part of the adult day care area and limited to use by an ADCC participant. An ADCC participant may be provided personal care or therapy in space also used by residents or attendees of a multi-use facility provided that the ADCC services are scheduled at different times from any other occupants.

3. ‘Staffing.’ The ADCC shall have distinct and separate caregivers. No caregiver may be concurrently assigned to the ADCC and another program. All staff assigned to the ADCC shall meet requirements for orientation and training under sub. (4).

4. ‘Activities.’ The ADCC activity program shall be programmatically distinct from the weekly or monthly calendar of activities planned for residents or attendees of a multi-use facility, but may include special events provided on a non-routine basis.

(b) Private family home. If ADCC participants and other occupants are intermixed in a private family home and the common dining and living space is available to ADCC participants and other occupants, the common dining and living space shall be determined by the total capacity of the building as described in sub. (8) (a) 2.

(11) Annual program review.

(a) An ADCC shall develop and implement an annual plan to evaluate and improve the effectiveness of the program’s operation and services to ensure continuous improvement in service delivery. The evaluation process shall include:

1. A review of the existing program to identify quality of care issues.

2. The opportunity for each participant or their legal representative to complete a satisfaction survey regarding the services provided at the ADCC.

3. The development and implementation of plans of action to correct identified quality of care deficiencies as identified in an ADCC’s internal review and the satisfaction survey.

4. A process for monitoring the effectiveness of the corrective actions taken by an ADCC.

(b) The department may not require disclosure of the records of the quality assessment process completed during the annual program review except to determine compliance with requirements of this subsection.

History: CR 20-006: cr. Register November 2021 No. 791, eff. 12-1-21; correction in (1) (b) 23., (2) (a) 2. a., (b) 1. (intro.), k., (d) 2., 4., (h), (i) 1., 5., 7., (j) 1., (k) 2., (m) 3. (intro.), c., 4., (o) (intro.), (3) (a) 2. d., (b) 3., (4) (e) 1., (5) (b) 1., (7) (b) 1., (8) (e) 6. b., (10) (a) 2. a., 3., (b) made under s. 13.92 (4) (b) 4., Stats., correction in (2) (a) 1. made under s. 13.92 (4) (b) 7., Stats., correction in (1) (a), (b) 12. (intro.), 16. b., 19. (intro.), c. to f., 28. b., (2) (m) 1. b., 2., (3) (d) 2. b., (e) 1. c., (6) (b) 9., 12., (7) (c) 4., 5., (f) 4. b. made under s. 35.17, Stats., and renumber (1) (b) 30. to (1) (b) 28m. and cons. and renum. (1) (b) 12. (intro.) and d. to 12. (intro.) under s. 13.92 (4) (b) 1., Stats., Register November 2021 No. 791.

DHS 105.15 Pharmacies. For MA certification, pharmacies shall meet the requirements for registration and practice under ch. 450, Stats., and chs. Phar 1 to 17.

History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. Register, December, 1991, No. 432, eff. 1-1-92; correction made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667.

DHS 105.155 Pharmacists.

(1) For MA certification, a pharmacist must be licensed under s. 450.03, Stats.

(2) When a pharmacist performs services under a delegation agreement in accordance with s. 450.033, they shall document and maintain the agreement in accordance with ch. Phar 7 and any guidelines set by the pharmacy examining board. Any pharmacist performing services under a delegation agreement shall make all of the following available for review by the department:

(a) Regarding the delegating authority of the physician, either of the following:

1. The name and license number of any delegating physicians.

2. The written protocol that identifies the organization’s medical committee delegating the authority and is approved by the organization’s physician staff.

(b) Regarding the delegated authority of the pharmacist, either of the following:

1. The name and license number of any pharmacist who may perform the delegated acts.

2. The written protocol from the delegating authority that identifies the authority delegated to the organization’s pharmacist or pharmacists.

(c) The patient or groups of patients eligible to receive delegated services under the agreement, including any patient inclusion or exclusion criteria.

(d) The delegated services that the pharmacist may perform.

(e) The process for the physician or designee of the physician to monitor compliance with the delegation agreement by the pharmacist.

(f) The process for how the delegated services provided by the pharmacist will be documented or included in the patient’s health record.

History: CR 24-047: cr. Register April 2025 No. 832, eff. 5-1-25.

DHS 105.16 Home health agencies. For MA certification, a home health agency shall be certified to participate in medicare as a home health agency, be licensed pursuant to ch. DHS 133 and meet the requirements of this section as follows:

(1) Home health agency services. For MA certification, a home health agency shall provide part-time, intermittent skilled nursing services performed by a registered nurse or licensed practical nurse and home health aide services and may provide physical therapy, occupational therapy, speech and language pathology services and medical supplies and equipment. Services may be provided only on visits to a recipient’s home and that home may not be a hospital or nursing home. Home health services shall be provided in accordance with a written plan of care, which the physician shall review at least every 62 days or when the recipient’s medical condition changes, whichever occurs first.

(1m) Electronic visit verification. The home health provider is required to capture and retain EVV records.

(2) Home health aides.

(a) Assignment and duties. Home health aides shall be assigned to specific recipients by a registered nurse. Written instructions for patient care shall be prepared by a registered nurse, a physical or occupational therapist or a speech and language pathologist, as appropriate. Duties shall include medically oriented tasks, assistance with the recipient’s activities of daily living and household tasks as specified in s. DHS 107.11 (2) (b) and further described in the Wisconsin medical assistance home health agency provider handbook.

(b) Supervision. A registered nurse shall make supervisory visits to the recipient’s home as often as necessary, but at least every 60 days, to review, monitor and evaluate the recipient’s medical condition and medical needs according to the written plan of care during the period in which agency care is being provided. The RN shall evaluate the appropriateness of the relationship between the direct care giver and the recipient, assess the extent to which goals are being met, and determine if the current level of home health services provided to the recipient continues to be appropriate to treat the recipient’s medical condition and if the services are medically necessary. The supervising RN shall discuss and review with the recipient the services received by the recipient and discuss the results of the supervisory visit with the LPN, home health aide or personal care worker. The results of each supervisory visit shall be documented in the recipient’s medical record.

(c) Training. Home health aides shall be trained and tested in accordance with the requirements of s. 146.40, Stats., and ch. DHS 129. Aides shall not be assigned any tasks for which they are not trained, and training and competency in all assigned tasks shall be documented and made part of the provider’s records.

(3) Physical therapists. Physical therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under the contract to the home health agency.

(4) Occupational therapists. Occupational therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.

(5) Speech and language pathologists. Speech and language pathologists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.

(6) Respiratory care services.

(a) A certified home health agency may be certified to provide respiratory care services under s. DHS 107.113 if registered nurses, licensed practical nurses and respiratory therapists employed by or under contract to the agency provide these services and:

1. Are credentialed by the national board on respiratory care; or

2. Know how to perform services under s. DHS 107.113 (1) and 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).

(b) A registered nurse who fulfills the requirements of this subsection shall coordinate the recipient’s care.

(7) Private duty nursing. A home health agency may provide private duty nursing services under s. DHS 107.12 performed by a registered nurse or licensed practical nurse.

(8) Cost reports. The department may, when necessary, require home health agencies to report information which is supplementary to information required on medicare cost reports.

(9) Department review.

(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.

(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 home health care provider. The 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 has 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.

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

(10) Requirements for providing private duty nursing or respiratory care services. For certified agencies providing private duty nursing or respiratory care services or both under this section, the following requirements apply:

(a) Duties of the nurse.

1. The following nursing services may be performed only by a registered nurse:

a. Making the initial evaluation visit;

b. Initiating the physician’s plan of care and necessary revisions;

c. Providing those services that require care of a registered nurse as defined in ch. N 6;

d. Initiating appropriate preventive and rehabilitative procedures;

e. Accepting only those delegated medical acts which the RN is competent to perform based on his or her nursing education, training or experience; and

f. Regularly reevaluating the patient’s needs.

2. 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:

a. Performing nursing care delegated by an RN under s. N 6.03;

b. Assisting the patient in learning appropriate self-care techniques; and

c. Meeting the nursing needs of the recipient according to the written plan of care.

3. Both RNs and LPNs shall:

a. 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;

b. Provide coordination of care for the recipient;

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

d. 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

e. Promptly inform the physician and other personnel participating in the patient’s care of changes in the patient’s condition and needs.

(b) 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 receipt 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:

1. To be fully informed of all rules and regulations affecting the recipient;

2. To be fully informed of services to be provided by the nurse and of related charges, including any charges for services for which the recipient may be responsible;

3. 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;

4. To refuse treatment to the extent permitted by law and to be informed of the medical consequences of that refusal;

5. 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;

6. 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;

7. To have one’s property treated with respect; and

8. To complain about care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.