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) (4) Other limitations.

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:

DHS 107.113(5)(a) (a) Parenting;

DHS 107.113(5)(b) (b) Supervision of the recipient when supervision is the only service provided;

DHS 107.113(5)(c) (c) Services provided without prior authorization;

DHS 107.113(5)(d) (d)

DHS 107.113(5)(d)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 107.113(5)(d)1.a. a. A total of 12 hours in a calendar day.

DHS 107.113(5)(d)1.b. b. A total of 60 hours in a calendar week.

DHS 107.113(5)(d)2. 2. Services may exceed the limitations in subd. 1. when both of the following conditions are met:

DHS 107.113(5)(d)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 107.113(5)(d)2.b. b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient’s health.

DHS 107.113(5)(e) (e) Services provided in a setting other than the recipient’s place of residence; and

DHS 107.113(5)(f) (f) Services that are not medically appropriate.

DHS 107.113(5)(g) (g)

DHS 107.113(5)(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 107.113(5)(g)2. 2. Services may exceed the limitations in subd. 1. when both of the following conditions are met:

DHS 107.113(5)(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 107.113(5)(g)2.b. b. Failure to provide skilled nursing services likely would result in serious impairment of the recipient’s health.

DHS 107.113 History History: Cr. Register, February, 1993, No. 446, eff. 3-1-93; correction in (4) (c) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1999, No. 520; CR 05-052: r. and recr. (5) (d), cr. (5) (g) Register June 2007 No. 618, eff. 7-1-07; corrections in (1) (intro.), (3) and (4) (b) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; CR 23-046: r. and recr. (1), am. (2) (intro.), (a), (3) (a), (4) (f) Register April 2024 No. 820, eff. 5-1-24; correction in (1) (b) 2. made under s. 35.17, Stats., correction in numbering of (1) (d) 4. a. to c. made under s. 13.92 (4) (b) 7., Stats., and (3) (a) renumbered (3) under s. 13.92 (4) (b) 1., Stats., Register April 2024 No. 820.

DHS 107.12 DHS 107.12 Private duty nursing services.