DHS 107.11(1)(c)(c) “Home health visit” or “visit” means a period of time of any duration during which home health services are provided through personal contact by agency personnel of less than 8 hours a day in the recipient’s place of residence for the purpose of providing a covered home health service. The services are provided by a home health provider employed by a home health agency, by a home health provider under contract to a home health agency according to the requirements of s. DHS 133.19 or by arrangement with a home health agency. A visit begins when the home health provider starts to provide a covered service and ends when the service is complete.

DHS 107.11(1)(d)(d) “Home health provider” means a person who is an RN, LPN, home health aide, physical or occupational therapist, speech pathologist, certified physical therapy assistant or certified occupational therapy assistant.

DHS 107.11(1)(e)(e) “Initial visit” means the first home health visit of any duration in a calendar day provided by a registered nurse, licensed practical nurse, home health aide, physical or occupational therapist or speech and language pathologist for the purpose of delivering a covered home health service to a recipient.

DHS 107.11(1)(f)(f) “Subsequent visit” means each additional visit of any duration following the initial visit in a calendar day provided by an RN, LPN or home health aide for the purpose of delivering a covered home health service to a recipient.

DHS 107.11(2)(2) Covered home health services. Services provided by an agency certified under s. DHS 105.16 which are covered by MA are those reasonable and medically necessary services required to treat the recipient’s condition. Covered services must meet all of the following criteria:

DHS 107.11(2)(c)1.1. Skilled nursing services provided under a plan of care which requires less than 8 hours of skilled nursing care per day and specifies which level of care the nurse is qualified to provide. Skilled nursing services are any of the following:

DHS 107.11(2)(c)1.a.a. Nursing services performed by a registered nurse, or by a licensed practical nurse under the supervision of a registered nurse, according to the written plan of care and accepted standards of medical and nursing practice, in accordance with ch. N 6.

DHS 107.11(2)(c)1.b.b. Services which, due to the recipient’s medical condition, may be only safely and effectively provided by an RN or LPN.

DHS 107.11(2)(c)1.c.c. Assessments performed only by a registered nurse.

DHS 107.11(2)(c)1.d.d. Teaching and training of the recipient, the recipient’s family or other caregivers requiring the skills on an RN or LPN.

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)2.c.c. Household tasks incidental to direct care activities described in subd. 2. a. and b.

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)(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;