Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 107 - Covered Services › Section DHS 107.113 - Respiratory care for ventilator-assisted recipients

Current through June 24, 2024
(1) COVERED
				SERVICES.
(a) Services, medical supplies and
				equipment necessary to provide life support for a recipient who has been
				hospitalized for at least 30 consecutive days for his or her respiratory
				condition and who is dependent on a ventilator for at least 6 hours per day
				shall be covered services when these services are provided to the recipient in
				the recipient's home.
(b) A
				recipient receiving these services is one for whom respiratory care can safely
				be provided in any setting in which normal life activities take place,
				excluding all of the following settings:
1. A
				hospital.
2. A nursing
				facility.
3. An intermediate care
				facility for individuals with intellectual disabilities.
4. Any setting in which payment is or could
				be made under medical assistance for inpatient services that include room and
				board.
(c) Respiratory
				care shall be provided as required under ss.
				DHS
				105.16 and
				105.19
				and according to a written plan of care under sub. (2) signed by the
				recipient's provider acting within the scope of the provider's practice for a
				recipient who lives in a residence that is not a hospital or a skilled nursing
				facility.
(d) Respiratory care
				includes any of the following:
1. Airway
				management, consisting of:
a. Tracheostomy
				care: all available types of tracheostomy tubes, stoma care, changing a
				tracheostomy tube, and emergency procedures for tracheostomy care including
				accidental extubation;
b. Tracheal
				suctioning technique; and
c. Airway
				humidification;
2. Oxygen
				therapy and operation of oxygen systems and auxiliary oxygen delivery
				devices.
3. Respiratory assessment,
				including but monitoring of breath sounds, patient color, chest excursion,
				secretions and vital signs.
4.
				Ventilator management, including any of the following:
a. Operation of positive pressure ventilator
				by means of tracheostomy to include, but not limited to, different modes of
				ventilation, types of alarms and responding to alarms, troubleshooting
				ventilator dysfunction, operation and assembly of ventilator circuit, that is,
				the delivery system, and proper cleaning and disinfection of
				equipment.
b. Operation of a manual
				resuscitator.
c. Emergency
				assessment and management including cardiopulmonary resuscitation.
5. Any of the following modes of
				ventilatory support:
a. Positive pressure
				ventilation by means of a nasal mask or mouthpiece.
b. Continuous positive airway pressure (CPAP)
				by means of a tracheostomy tube or mask.
c. Negative pressure ventilation - iron lung,
				chest shell or pulmowrap.
d.
				Rocking beds.
e.
				Pneumobelts.
f. Diaphragm
				pacing.
6. Operation and
				interpretation of the following monitoring devices:
a. Cardio-respiratory monitoring.
b. Pulse oximetry.
c. Capnography.
7. Knowledge of and skills in weaning from
				the ventilator.
8. Adjunctive
				techniques, including any of the following:
a.
				Chest physiotherapy.
b. Aerosolized
				medications.
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.