DHS 107.12(1)(f)(f) Medically necessary actual time spent in direct care that requires the skills of a licensed nurse is a covered service. DHS 107.12(2)(a)(a) Prior authorization is required for all private duty nursing services. DHS 107.12(2)(c)(c) A request for prior authorization of private duty nursing services performed by an LPN shall include the name and license number of the registered nurse or physician supervising the LPN. DHS 107.12(2)(d)(d) A request for prior authorization for care for a recipient who requires more than one private duty nurse to provide medically necessary care shall include the name and license number of the RN performing care coordination responsibilities. DHS 107.12(3)(b)(b) An RN supervising an LPN performing services under this section shall supervise the LPN as often as necessary under the requirements of s. N 6.03 during the period the LPN is providing services, and shall communicate the results of supervisory activities to the LPN. These activities shall be documented by the RN. DHS 107.12(3)(c)(c) Each private duty nurse shall document the nature and scope of the care and services provided to the recipient in the recipient’s medical record. DHS 107.12(3)(e)(e) Travel time, recordkeeping and RN supervision of an LPN are not separately reimbursable services. DHS 107.12(4)(4) Non-covered services. The following services are not covered services: DHS 107.12(4)(c)(c) Skilled nursing services performed by a recipient’s spouse or parent if the recipient is under age 21; DHS 107.12(4)(e)(e) Any service that fails to meet the recipient’s medical needs or places the recipient at risk for a negative treatment outcome. DHS 107.12(4)(f)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 107.12(4)(f)2.2. Services may exceed the limitations in subd. 1. when both of the following conditions are met: DHS 107.12(4)(f)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 107.12(4)(f)2.b.b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient’s health. DHS 107.12(4)(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 107.12(4)(g)2.2. Services may exceed the limitations in subd. 1. when both of the following conditions are met: DHS 107.12(4)(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 107.12(4)(g)2.b.b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient’s health. DHS 107.12 HistoryHistory: Cr. Register, February, 1986, No. 362, eff. 3-1-86; emerg. r. and recr. eff. 7-1-90; 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; CR 03-033: am. (1) (e) Register December 2003 No. 576, eff. 1-1-04; corrections in (1) (b) made under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; CR 05-052: r. (2) (b) and (3) (d), cr. (4) (f) and (g) Register June 2007 No. 618, eff. 7-1-07; corrections in (1) (a) and (3) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 23-046: am. (1) (b), (c), (d) 1. (intro.), 2., (e) 1., (4) (a) Register April 2024 No. 820, eff. 5-1-24.