DHS 107.11(2)(c)2.2. Home health aide services and medical supplies, equipment, and appliances. Home health services are any of the following: DHS 107.11(2)(c)2.a.a. Medically oriented tasks which cannot be safely delegated by an RN as determined and documented by the RN to a personal care worker who has not received special training in performing tasks for the specific individual, and which may include, but are not limited to, medically oriented activities directly supportive of skilled nursing services provided to the recipient. These may include assistance with and administration of oral, rectal and topical medications ordinarily self-administered and supervised by an RN according to 42 CFR 483.36 (d), ch. DHS 133, and ch. N 6, and assistance with activities directly supportive of current and active skilled therapy and speech pathology services and further described in the Wisconsin medical assistance home health agency provider handbook. DHS 107.11(2)(c)2.b.b. Assistance with the recipient’s activities of daily living only when provided on conjunction with a medically oriented task that cannot be safely delegated to a personal care worker as determined and documented by the delegating RN. Assistance with the recipient’s activities of daily living consists of medically oriented tasks when a reasonable probability exists that the recipient’s medical condition will worsen during the period when assistance is provided, as documented by the delegating RN. A recipient whose medical condition has exacerbated during care activities sometime in the past 6 months is considered to have a condition which may worsen when assistance is provided. Activities of daily living include, but are not limited to, bathing, dressing, grooming and personal hygiene activities, skin, foot and ear care, eating, elimination, ambulation, and changing bed positions. DHS 107.11(2)(c)3.3. Therapy and speech pathology services which the agency is certified to provide. DHS 107.11(2)(e)(e) The services are provided with supervision from, and coordination of all nursing care by, a registered nurse. DHS 107.11(2m)(2m) Additional requirements for covered home health services. DHS 107.11(2m)(a)(a) Covered services provided under sub. (2) must only be safely and effectively performed by a skilled therapist or speech pathologist or by a certified therapy assistant who receives supervision by the certified therapist according to 42 CFR 484.32. DHS 107.11(2m)(b)(b) Based on the assessment by the recipient’s physician of the recipient’s rehabilitation potential, services provided under sub. (2) are expected to materially improve the recipient’s condition within a reasonable, predictable time period, or are necessary to establish a safe and effective maintenance program for the recipient. DHS 107.11(2m)(c)(c) In conjunction with the written plan of care, a therapy evaluation shall be conducted prior to the provision of services under sub. (2) by the therapist or speech pathologist who will provide the services to the recipient. DHS 107.11(2m)(d)(d) The therapist or speech pathologist shall provide a summary of activities, including goals and outcomes, to the physician at least every 62 days, and upon conclusion of therapy services DHS 107.11(3)(3) Prior authorization. Prior authorization is required to review utilization of services and assess the medical necessity of continuing services for: DHS 107.11(3)(a)(a) All home health visits when the total of any combination of skilled nursing, home health aide, physical and occupational therapist and speech pathologist visits by all providers exceeds 30 visits in a calendar year, including situations when the recipient’s care is shared among several certified providers; DHS 107.11(3)(b)(b) All home health aide visits when the services are provided in conjunction with private duty nursing under s. DHS 107.12 or the provision of respiratory care services under s. DHS 107.113; DHS 107.11(3)(d)(d) All home health aide visits when 4 or more hours of continuous care is medically necessary; and DHS 107.11(4)(a)(a) The written plan of care shall be developed and reviewed concurrently with and in support of other health sustaining efforts for the recipient in the home. DHS 107.11(4)(c)(c) Services provided to a recipient who is a resident of a community-based residential facility shall be rendered according to the requirements of ch. DHS 83 and shall not duplicate services that the facility has agreed to provide. DHS 107.11(4)(d)1.1. Except as provided in subd. 2., home health skilled nursing services provided by one or more providers are limited to less than 8 hours per day per recipient as required by the recipient’s medical condition. DHS 107.11(4)(d)2.2. If the recipient’s medical condition worsens so that 8 or more hours of direct, skilled nursing services are required in a calendar day, a maximum of 30 calendar days of skilled nursing care may continue to be reimbursed as home health services, beginning on the day 8 hours or more of skilled nursing services became necessary. To continue medically necessary services after 30 days, prior authorization for private duty nursing is required under s. DHS 107.12 (2). DHS 107.11(4)(e)(e) An intake evaluation is a covered home health skilled nursing service only if, during the course of the initial visit to the recipient, the recipient is admitted into the agency’s care and covered skilled nursing services are performed according to the written physician’s orders during the visit. DHS 107.11(4)(f)(f) A skilled nursing ongoing assessment for a recipient is a covered service: DHS 107.11(4)(f)1.1. When the recipient’s medical condition is stable, the recipient has not received a covered skilled nursing service, covered personal care service, or covered home visit by a physician service within the past 62 days, and a skilled assessment is required to re-evaluate the continuing appropriateness of the plan of care. In this paragraph, “medically stable” means the recipient’s physical condition is non-acute, without substantial change or fluctuation at the current time. DHS 107.11(4)(f)2.2. When the recipient’s medical condition requires skilled nursing personnel to identify and evaluate the need for possible modification of treatment;