Header:
WISCONSIN ADMINISTRATIVE CODE
DEPARTMENT OF HEALTH SERVICES
CHAPTER DHS 105 PROVIDER CERTIFICATION
Date:
08/31/2009
Document:
DHS 105.16 Home health agencies.
For MA certification, a home health agency shall be certified to participate in medicare as a home health agency, be licensed pursuant to ch. DHS 133 and meet the requirements of this section as follows:
(1) HOME HEALTH AGENCY SERVICES. For MA certification, a home health agency shall provide part-time, intermittent skilled nursing services performed by a registered nurse or licensed practical nurse and home health aide services and may provide physical therapy, occupational therapy, speech and language pathology services and medical supplies and equipment. Services may be provided only on visits to a recipient's home and that home may not be a hospital or nursing home. Home health services shall be provided in accordance with a written plan of care, which the physician shall review at least every 62 days or when the recipient's medical condition changes, whichever occurs first.
(2) HOME HEALTH AIDES. (a) Assignment and duties. Home health aides shall be assigned to specific recipients by a registered nurse. Written instructions for patient care shall be prepared by a registered nurse, a physical or occupational therapist or a speech and language pathologist, as appropriate. Duties shall include medically oriented tasks, assistance with the recipient's activities of daily living and household tasks as specified in s. DHS 107.11 (2) (b) and further described in the Wisconsin medical assistance home health agency provider handbook.
(b) Supervision. A registered nurse shall make supervisory visits to the recipient's home as often as necessary, but at least every 60 days, to review, monitor and evaluate the recipient's medical condition and medical needs according to the written plan of care during the period in which agency care is being provided. The RN shall evaluate the appropriateness of the relationship between the direct care giver and the recipient, assess the extent to which goals are being met, and determine if the current level of home health services provided to the recipient continues to be appropriate to treat the recipient's medical condition and if the services are medically necessary. The supervising RN shall discuss and review with the recipient the services received by the recipient and discuss the results of the supervisory visit with the LPN, home health aide or personal care worker. The results of each supervisory visit shall be documented in the recipient's medical record.
(c) Training. Home health aides shall be trained and tested in accordance with the requirements of s. 146.40, Stats., and ch. DHS 129. Aides shall not be assigned any tasks for which they are not trained, and training and competency in all assigned tasks shall be documented and made part of the provider's records.
(3) PHYSICAL THERAPISTS. Physical therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under the contract to the home health agency.
(4) OCCUPATIONAL THERAPISTS. Occupational therapists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.
(5) SPEECH AND LANGUAGE PATHOLOGISTS. Speech and language pathologists may be employed by the home health agency or by an agency under contract to the home health agency, or may be independent providers under contract to the home health agency.
(6) RESPIRATORY CARE SERVICES. (a) A certified home health agency may be certified to provide respiratory care services under s. DHS 107.113 if registered nurses, licensed practical nurses and respiratory therapists employed by or under contract to the agency and providing these services are certified under ch. Med 20 and:
1. Are credentialed by the national board on respiratory care; or
2. Know how to perform services under s. DHS 107.113 (1) and have the skills necessary to perform those services. Skills required to perform services listed in s. DHS 107.113 (1) (e) to (f) are required on a case-by-case basis, as appropriate. In no case may a person provide respiratory care before that person has demonstrated competence in all areas under s. DHS 107.113 (1) (a) to (d).
(b) A registered nurse who fulfills the requirements of this subsection shall coordinate the recipient's care.
(c) The department shall review an agency's continued compliance with this subsection.
(7) PRIVATE DUTY NURSING. A home health agency may provide private duty nursing services under s. DHS 107.12 performed by a registered nurse or licensed practical nurse.
(8) COST REPORTS. The department may, when necessary, require home health agencies to report information which is supplementary to information required on medicare cost reports.
(9) DEPARTMENT REVIEW. (a) Record review. The department may periodically review the records described in this section and s. DHS 106.02 (9), subject only to restrictions of law. All records shall be made immediately available upon the request of an authorized department representative.
(b) In-home visits. As part of the review under par. (a), the department may contact recipients who have received or are receiving MA services from a home health care provider. The provider shall provide any identifying information requested by the department. The department may select the recipients for visits and may visit a recipient with the approval of the recipient or recipient's guardian. The recipient to be visited has the opportunity to have any person present whom he or she chooses, during the visit by personnel of the department or other governmental investigating agency.
(c) Investigation of complaints. The department may investigate any complaint received by it concerning the provision of MA services by a home health care provider. Following the investigation, the department may issue a preliminary final report to the home health care provider in question, except when doing so would jeopardize any other investigation by the department or other state or federal agency.
(10) REQUIREMENTS FOR PROVIDING PRIVATE DUTY NURSING OR RESPIRATORY CARE SERVICES. For certified agencies providing private duty nursing or respiratory care services or both under this section, the following requirements apply:
(a) Duties of the nurse. 1. The following nursing services may be performed only by a registered nurse:
a. Making the initial evaluation visit;
b. Initiating the physician's plan of care and necessary revisions;
c. Providing those services that require care of a registered nurse as defined in ch. N 6;
d. Initiating appropriate preventive and rehabilitative procedures;
e. Accepting only those delegated medical acts which the RN is competent to perform based on his or her nursing education, training or experience; and
f. Regularly reevaluating the patient's needs.
2. Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse. Licensed practical nurse duties include:
a. Performing nursing care delegated by an RN under s. N 6.03;
b. Assisting the patient in learning appropriate self-care techniques; and
c. Meeting the nursing needs of the recipient according to the written plan of care.
3. Both RNs and LPNs shall:
a. Arrange for or provide health care counseling within the scope of nursing practice to the recipient and recipient's family in meeting needs related to the recipient's condition;
b. Provide coordination of care for the recipient;
c. Accept only those delegated medical acts for which there are written or verbal orders and for which the nurse has appropriate training or experience;
d. Prepare written clinical notes that document the care provided within 24 hours of providing service and incorporate them into the recipient's clinical record within 7 days; and
e. Promptly inform the physician and other personnel participating in the patient's care of changes in the patient's condition and needs.
(b) Patient rights. A nurse shall provide a written statement of the rights of the recipient for whom services are provided to the recipient or guardian or any interested party prior to the provision of services. The recipient or guardian shall acknowledge receipt of the statement in writing. The nurse shall promote and protect the exercise of these rights and keep written documentation of compliance with this subsection. Each recipient receiving care shall have the following rights:
1. To be fully informed of all rules and regulations affecting the recipient;
2. To be fully informed of services to be provided by the nurse and of related charges, including any charges for services for which the recipient may be responsible;
3. To be fully informed of one's own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of services, including referral to a health care institution or other agency;
4. To refuse treatment to the extent permitted by law and to be informed of the medical consequences of that refusal;
5. To confidential treatment of personal and medical records and to approve or refuse their release to any individual, except in the case of transfer to a health care facility;
6. To be taught, and have the family or other persons living with the recipient taught, the treatment required, so that the recipient can, to the extent possible, help himself or herself, and the family or other party designated by the recipient can understand and help the recipient;
7. To have one's property treated with respect; and
8. To complain about care that was provided or not provided, and to seek resolution of the complaint without fear of recrimination.
(c) Universal precautions. A nurse shall have the necessary orientation, education and training in epidemiology, modes of transmission and prevention of HIV and other blood-borne or body fluid-borne infections and shall follow universal blood and body-fluid precautions for each recipient for whom services are provided. The nurse shall employ protective measures recommended by the federal centers for disease control (CDC), including those pertaining to medical equipment and supplies, to minimize the risk of infection from HIV and other blood-borne pathogens.
Note: A copy of the CDC recommended universal precautions may be obtained from the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701.
(d) Medical record. The nurse shall maintain a medical record for each recipient. The record shall document the nature and scope of all services provided and shall be systematically organized and readily accessible to authorized department personnel. The medical record shall document the recipient's condition, problems, progress and all services rendered, and shall include:
1. Recipient identification information;
2. Appropriate hospital information, including discharge information, diagnosis, current patient status and post-discharge plan of care;
3. Recipient admission evaluation and assessment;
4. All medical orders, including the physician's written plan of care and all interim physician's orders;
5. A consolidated list of medications, including start and stop dates, dosage, route of administration and frequency. This list shall be reviewed and updated for each nursing visit, if necessary;
6. Progress notes posted as frequently as necessary to clearly and accurately document the recipient's status and services provided. In this paragraph, "progress note" means a written notation, dated and signed by a member of the health team providing covered services, that summarizes facts about care furnished and the recipient's response during a given period of time;
7. Clinical notes written the day service is provided and incorporated into the clinical record within 7 days after the visit or recipient contact. In this paragraph, "clinical note" means a notation of a contact with a recipient that is written and dated by a member of the home health team providing covered services, and that describes signs and symptoms, treatment and drugs administered and the patient's reaction, and any changes in physical or emotional condition;
8. Written summaries of the recipient's care provided by the nurse to the physician at least every 62 days; and
9. Written authorizations from the recipient or the recipient's guardian when it is necessary for the nurse to procure medical supplies or equipment needed by the recipient, unless the recipient's care is being provided by an MA-certified home health agency.
(e) Back-up and emergency procedures. 1. The recipient shall be informed of the identity of the agency-assigned alternate nurse before the alternate nurse provides services.
2. The nurse shall document a plan for recipient-specific emergency procedures in the event a life-threatening situation or fire occurs or there are severe weather warnings. This plan shall be made available to the recipient and all caregivers prior to initiation of these procedures.
3. The nurse shall take appropriate action and immediately notify the recipient's physician, guardian, if any, and any other responsible person designated in writing by the patient or guardian of any significant accident, injury or adverse change in the recipient's condition.
(f) Discharge of the recipient. A recipient shall be discharged from services provided by the nurse upon the recipient's request, upon the decision of the recipient's physician, or if the nurse documents that continuing to provide services to the recipient presents a direct threat to the nurse's health or safety and further documents the refusal of the attending physician to authorized discharge of the recipient with full knowledge and understanding of the threat to the nurse. The nurse shall recommend discharge to the physician and recipient if the recipient does not require services or requires services beyond the nurse's capability. The nurse provider shall issue a notification of discharge to the recipient or guardian, if possible at least 2 calendar weeks prior to cessation of skilled nursing services, and shall, in all circumstances, provide assistance in arranging for the continuity of all medically necessary care prior to discharge.
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