DHS 107.113(1)(d)9.9. Case coordination activities performed by the registered nurse designated in the plan of care as case coordinator. These activities include coordination of health care services provided to the recipient with any other health or social service providers serving the recipient. DHS 107.113(2)(2) Plan of care. A recipient’s written plan of care shall be based on the orders of a provider acting within the scope of the provider’s practice, a visit to the recipient’s home by the registered nurse and consultation with the family and other household members. The plan of care established by a home health agency or independent provider for a recipient to be discharged from a hospital shall consider the hospital’s discharge plan for the recipient. The written plan of care shall be reviewed, signed and dated by the recipient’s provider and renewed at least every 62 days and whenever the recipient’s condition changes. Telephone orders shall be documented in writing and signed by the provider within 10 working days. The written provider’s plan of care shall include: DHS 107.113(2)(a)(a) Orders by a provider acting within the scope of the provider’s practice for treatments provided by the necessary disciplines specifying the amount and frequency of treatment; DHS 107.113(2)(c)(c) Principal diagnosis, surgical procedures and other pertinent diagnosis; DHS 107.113(2)(e)(e) Necessary durable medical equipment and disposable medical supplies; DHS 107.113(2)(h)(h) Identification of back-ups in the event scheduled personnel are unable to attend the case; DHS 107.113(2)(i)(i) The name of the registered nurse designated as the recipient’s case coordinator; DHS 107.113(2)(j)2.2. Provision for reliable, 24-hour a day, 7 days a week emergency service for repair and delivery of equipment; and DHS 107.113(2)(k)(k) A plan to move the recipient to safety in the event of fire, flood, tornado warning or other severe weather, or any other condition which threatens the recipient’s immediate environment. DHS 107.113(3)(3) Prior authorization. All services covered under sub. (1) and all home health services under s. DHS 107.11 provided to a recipient receiving respiratory care shall be authorized prior to the time the services are rendered. Prior authorization shall be renewed every 12 calendar months if the respiratory care under this section is still needed. The prior authorization request shall include the name of the registered nurse who is responsible for coordination of all care provided under the MA program for the recipient. Independent MA-certified respiratory therapists or nurses in private practice who are not employees of or contracted to a home health agency but are certified under s. DHS 105.19 (1) (b) to provide respiratory care shall include in the prior authorization request the name and license number of a registered nurse who will participate, on 24-hour call, in emergency assessment and management and who will be available to the respiratory therapist for consultation and assistance. DHS 107.113(4)(a)(a) Services under this section shall not be reimbursed if the recipient is receiving respiratory care from an RN, licensed practical nurse or respiratory therapist who is providing these services as part of the rental agreement for a ventilator or other respiratory equipment. DHS 107.113(4)(b)(b) Respiratory care provided to a recipient residing in a community-based residential facility (CBRF) as defined in s. 50.01 (1g), Stats., shall be in accordance with the requirements of ch. DHS 83. DHS 107.113(4)(c)(c) Durable medical equipment and disposable medical supplies shall be provided in accordance with conditions set out in s. DHS 107.24. DHS 107.113(4)(d)(d) Respiratory care services provided by a licensed practical nurse shall be provided under the supervision of a registered nurse and in accordance with standards of practice set out in s. N 6.04. DHS 107.113(4)(e)(e) Case coordination services provided by the designated case coordinator shall be documented in the clinical record, including the extent and scope of specific care coordination provided. DHS 107.113(4)(f)(f) In the event that a recipient receiving respiratory care services is discharged from the care of one respiratory care provider and admitted to the care of another respiratory care provider continues to receive services under this section, the admitting provider shall coordinate services with the discharging provider to ensure continuity of care. The admitting provider shall establish the recipient’s plan of care as provided under sub. (2) and request prior authorization under sub. (3). DHS 107.113(4)(g)(g) Travel, recordkeeping and RN supervision of a licensed practical nurse are not separately reimbursable services. DHS 107.113(5)(5) Non-covered services. The following services are not covered services: