Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 107 - Covered Services › Section DHS 107.12 - Private duty nursing services

Current through June 24, 2024
(1) COVERED
				SERVICES.
(a) Private duty nursing is skilled
				nursing care available for recipients with medical conditions requiring more
				continuous skilled care than can be provided on a part-time, intermittent
				basis. Only a recipient who requires 8 or more hours of skilled nursing care
				and is authorized to receive these services in the home setting may make use of
				the approved hours outside of that setting during those hours when normal life
				activities take him or her outside of that setting. Private duty nursing may be
				provided according to the requirements under ss.
				DHS
				105.16 and
				105.19
				when the written plan of care specifies the medical necessity for this type of
				service.
(b) Private duty nursing
				services provided by a certified registered nurse in independent practice are
				those services prescribed by a provider acting within the scope of the
				provider's practice which comprise the practice of professional nursing as
				described under s. 441.001 (4),
				Stats., and s. N 6.03. Private duty nursing services provided by a certified
				licensed practical nurse are those services which comprise the practice of
				practical nursing under s.
				441.001 (3),
				Stats., and s. N 6.04. An LPN may provide private duty nursing services
				delegated by a registered nurse as delegated nursing acts under the
				requirements of ch. N 6 and guidelines established by the state board of
				nursing.
(c) Services may be
				provided only when prescribed by a provider acting within the scope of the
				provider's practice and the prescription calls for a level of care which the
				nurse is licensed and competent to provide.
(d)
1. A
				written plan of care, including a functional assessment, medication and
				treatment orders, shall be established for every recipient admitted for care
				and shall be incorporated in the recipient's medical record within 72 hours
				after acceptance in consultation with the recipient and the recipient's
				provider acting within the scope of the provider's practice and shall be signed
				by the provider within 20 working days following the recipient's admission for
				care. The provider's plan of care shall include, in addition to the medication
				and treatment orders:
a. Measurable
				time-specific goals;
b. Methods for
				delivering needed care, and an indication of which other professional
				disciplines, if any, are responsible for delivering the care;
c. Provision for care coordination by an RN
				when more than one nurse is necessary to staff the recipient's case;
				and
d. A description of functional
				capability, mental status, dietary needs and allergies.
2. The written plan of care shall be reviewed
				and signed by the recipient's provider acting within the scope of the
				provider's practice as often as required by the recipient's condition, but not
				less often than every 62 days. The RN shall promptly notify the provider of any
				change in the recipient's condition that suggests a need to modify the plan of
				care.
(e)
1. Except as provided in subd. 2., drugs and
				treatment shall be administered by the RN or LPN only as ordered by the
				recipient's provider acting within the scope of the provider's practice or his
				or her designee. The nurse shall immediately record and sign oral orders and
				shall obtain the provider's countersignature within 10 working days.
2. Drugs may be administered by an advanced
				practice nurse prescriber as authorized under ss. N 8.06 and 8.10.
(f) Medically necessary actual
				time spent in direct care that requires the skills of a licensed nurse is a
				covered service.