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)(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 NoteNote: 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)(b)(b) Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care; 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)(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)(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 HistoryHistory: 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(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 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, January, 1991, No. 421, eff. 2-1-91. DHS 105.201DHS 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 HistoryHistory: Cr. Register, January, 1991, No. 421, eff. 2-1-91. 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)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)(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(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 NoteNote: For covered mental health services, see s. DHS 107.13. DHS 105.21 HistoryHistory: 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. DHS 105.22(1)(1) Types of psychotherapy providers. For MA certification, a psychotherapy provider shall be one of the following: DHS 105.22(1)(a)(a) A physician meeting the requirements of s. DHS 105.05 (1) who has completed a residency in psychiatry. Proof of residency shall be provided to the department. Proof of residency shall either be board-certification from the American board of psychiatry and neurology or a letter from the hospital in which the residency was completed; DHS 105.22(1)(bm)(bm) An advanced practice nurse prescriber who is certified under s. 441.16 (2), Stats., and holds current certification in a psychiatric specialty from the American Nurses Credentialing Center. DHS 105.22(1)(bo)(bo) A professional counselor licensed under ss. 457.12 to 457.14, Stats., including holding a valid training or temporary license; DHS 105.22(1)(d)(d) A hospital outpatient mental health clinic located on the hospital’s physical premises. DHS 105.22(2)(2) Staffing of outpatient facilities. To provide psychotherapy reimbursable by MA, personnel employed by an outpatient clinic under sub. (1) (c) shall meet applicable requirements under ch. DHS 35. Persons employed by a hospital outpatient mental health clinic under sub. (1) (d) need not be individually certified as providers but may provide psychotherapy services upon the department’s issuance of certification to the mental health clinic by which they are employed. A hospital outpatient mental health clinic shall maintain a list of the names of persons employed by the clinic who are performing psychotherapy services for which reimbursement may be claimed under MA. This listing shall document the credentials possessed by the named persons which would qualify them for certification under the standards specified in this subsection and shall include the dates that the named persons began employment. DHS 105.22(3)(3) Reimbursement for outpatient psychotherapy services. Reimbursement shall be made to any certified psychotherapy provider whose practice, as described by individual licensure or clinic certification regulations, allows for the delivery of psychotherapy without clinical supervision. For outpatient psychotherapy services delivered by certified providers who are required, under individual licensure or clinic certification regulations, to practice under a clinical supervisor, reimbursement shall be made to the supervising provider. The supervising provider must be MA certified. DHS 105.22 NoteNote: For covered mental health services, see s. DHS 107.13. DHS 105.22 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (c), (d) and (2) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 06-080: cr. (1) (bm), am. (1) (c), (2) (a) and (3), r. and recr. (1) (d), r. (2) (b) Register May 2009 No. 641, eff. 6-1-09; correction in (2) made under s. 13.92 (4) (b) 1., Stats., Register May 2009 No. 641; CR 20-039: am. (1) (b), cr. (1) (bn) to (br), am. (3) Register October 2021 No. 790, eff. 11-1-21. DHS 105.23DHS 105.23 Alcohol and other drug abuse (AODA) treatment providers. DHS 105.23(1)(1) Types of providers. For MA certification, an outpatient alcohol and other drug abuse (AODA) treatment provider shall be: DHS 105.23(2)(a)(a) To provide AODA services reimbursable under MA, personnel employed by an outpatient facility under sub. (1) (a) or (b) shall: DHS 105.23(2)(a)2.2. Be an AODA counselor certified by the Wisconsin alcoholism and drug abuse counselor certification board and work under the supervision of a provider who is a licensed physician or licensed psychologist and employed by the same facility. DHS 105.23 NoteNote: Certification standards of the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board may be obtained by writing the Wisconsin Alcoholism and Drug Abuse Counselor Certification Board, Inc., 416 East Main Street, Waukesha, WI 53186.
DHS 105.23(2)(b)(b) The facility shall provide the department with a list of persons employed by the facility who perform AODA services for which reimbursement may be claimed under MA. The listing shall identify the credentials possessed by the named persons which would qualify them for certification under the standards specified in par. (a). A facility, once certified, shall promptly advise the department in writing of the employment or termination of employees who will be or have been providing AODA services under MA. DHS 105.23(3)(3) Reimbursement for AODA services. Reimbursement for outpatient AODA treatment services shall be as follows: DHS 105.23(3)(a)(a) For the services of any provider employed by or under contract to a certified AODA facility, reimbursement shall be made to the facility; and DHS 105.23(3)(b)(b) For the services of any provider who is a physician or licensed psychologist defined under sub. (1) (c) in private practice, reimbursement shall be to the physician or psychologist. DHS 105.23 NoteNote: For covered alcohol and other drug abuse treatment services, see s. DHS 107.13 (3). DHS 105.23 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; am. (1) (b) and(c) and (2) (a) 1., Register, September, 1991, No. 429, eff. 10-1-91; corrections in (1) (a) and (b) made under s. 13.93 (2m) (b) 7., Stats., Register February 2002 No. 554; corrections in (1) (a) and (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 20-039: am. (1) (c) Register October 2021 No. 790, eff. 11-1-21; correction in (1) (c) made under s. 35.17, Stats., Register October 2021 No. 790; correction in (1) (a), (b) made under s. 13.92 (4) (b) 7., Stats., Register September 2022 No. 801.
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Chs. DHS 101-109; Medical Assistance
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