DHS 89.24 NoteNote: Some individuals may initially need little or no service but, over time, may need more services up to the full 28 hours per week.
DHS 89.24(2)(2) Amount of service provided to individual tenants. DHS 89.24(2)(a)(a) Services provided by the residential care apartment complex. The amount of supportive, personal and nursing service which a facility provides to a tenant, either directly or under contract, shall be determined by the tenant’s needs and preferences, as documented in the service agreement. A residential care apartment complex shall not limit the hours of service it makes available for an individual tenant to less than 28 hours per week if needed by the tenant. DHS 89.24(2)(b)(b) Services from providers other than the residential care apartment complex. DHS 89.24(2)(b)1.1. A tenant may contract for additional services not included in the service agreement from providers of the tenant’s choice, so long as the tenant informs the facility, complies with applicable facility policies and procedures and agrees to have the arrangements reflected in the risk agreement. Except as limited by a facility under subd. 3., there is no restriction on the amount or type of service which a tenant may receive from providers other than the facility. DHS 89.24(2)(b)2.2. A residential care apartment complex may approve the provider of supportive, personal or nursing services for any particular tenant and require that providers of these services comply with established facility standards and policies. DHS 89.24(2)(b)3.3. A residential care apartment complex may only limit the amount of supportive, personal and nursing service a tenant purchases from outside providers when the total amount of supportive, personal and nursing services that the tenant receives from all paid providers exceeds 28 hours per week. A facility may not limit the amount of hospice care a tenant receives or the amount of unpaid services provided by the tenants family or friends. A facility may not limit the amount of recuperative care which a tenant receives, provided the recuperative care will not raise the total service level above 28 hours per week for more than 90 days. DHS 89.24(3)(a)(a) Purpose. A residential care apartment complex shall compute hours of service provided to an individual tenant when necessary for the purpose of determining whether the 28 hour per week limit on services under sub. (1) has been reached and making related decisions about the appropriateness of continued residency in the facility. The computation may be initiated by the facility or at the request of the tenant, the tenant’s family or other representative, or the department. Facilities are not required to continually document the amount of time spent in providing services to each tenant. DHS 89.24 NoteNote: This requirement is intended solely for the purpose of determining whether a person can appropriately reside in a residential care apartment complex. It is not intended for the purposes of documenting or billing for services provided or for determining facility staffing levels.
DHS 89.24(3)(b)1.1. Only staff time that is directly attributable to providing or arranging supportive, personal and nursing services to a tenant shall count toward the 28-hour per week limit on services. Hours of service include time devoted to nursing assessment, documentation and consultation, stand-by assistance for activities of daily living and any other services directly attributable to an individual tenant. DHS 89.24(3)(b)2.2. Congregate services such as meals served in a common dining room, housekeeping in common areas of the facility, laundry and social and recreational activities which would be typically available in a hotel or in unlicensed housing for the elderly shall not be counted toward the 28-hour per week limit on services. DHS 89.24(3)(b)3.3. Time spent in meeting a tenant’s unscheduled care needs shall be included in the 28 hours. DHS 89.24(3)(b)4.4. Services arranged directly by an individual tenant from a provider other than the residential care apartment complex shall not count toward the limit on the amount of services provided by a facility under sub. (1). DHS 89.25DHS 89.25 Schedule of fees for services. DHS 89.25(1)(1) Residential care apartment complexes shall have a written schedule of fees for services which includes all of the following: DHS 89.25(1)(a)(a) Separately identified charges for rent, meals and services. The schedule of fees for services shall clearly identify those services which are included in any base service rate or rates and those for which there will be separate charges. DHS 89.25(1)(b)(b) The amount of any application fee, entrance fee or security deposit. DHS 89.25(1)(c)(c) The facility’s refund policy regarding application and entrance fees, security deposits and monthly rent, meal and service charges in the event of death or termination of the contract between the tenant and the facility. DHS 89.25(2)(2) The schedule of fees for services shall be presented in language and a format that make it possible for tenants to readily identify the cost of the components of the service agreement and to be able to make informed choices about the services they receive. DHS 89.25(3)(3) A copy of the schedule of fees for services shall be given to each prospective tenant and to the prospective tenant’s family or designated representative, where appropriate, along with public information materials on assisted living if provided by the department. Copies of revised fee schedules shall be provided to current tenants and their families or representatives, where appropriate, at least 30 days in advance of an increase in fees. DHS 89.26(1)(1) Requirement. A comprehensive assessment shall be performed prior to admission for each person seeking admission as a basis for developing the service agreement under s. DHS 89.27 and the risk agreement under s. DHS 89.28. DHS 89.26(2)(2) Contents. The comprehensive assessment shall identify and evaluate the following factors relating to the person’s need and preference for services: DHS 89.26(2)(i)(i) Situations or conditions which could put the tenant at risk of harm or injury. DHS 89.26(2)(j)(j) Type, amount and timing of services desired by the tenant. DHS 89.26(2)(k)(k) Frequency of monitoring which the resident’s condition requires. DHS 89.26(3)(a)(a) A comprehensive assessment shall be performed with the active participation of the prospective tenant. That person’s family or designated representative shall also participate in the assessment, if desired by the person. DHS 89.26(3)(b)(b) Persons performing the comprehensive assessment shall have expertise in areas related to the tenant’s health and service needs. Portions of the comprehensive assessment relating to physical health, medications and ability to self-administer medications shall be performed by a physician or a registered nurse. DHS 89.26(3)(c)(c) A comprehensive assessment shall be performed or arranged for by: DHS 89.26(3)(c)1.1. The residential care apartment complex for tenants whose bills are paid for from private resources or by third party payers. DHS 89.26(3)(c)2.2. The county department or aging unit designated to administer the medicaid waiver for those tenants whose services are paid for under s. 46.277, Stats. DHS 89.26(4)(4) Annual review. A tenant’s capabilities, needs and preferences identified in the comprehensive assessment shall be reviewed at least annually to determine whether there have been changes that would necessitate a change in the service or risk agreement. The review may be initiated by the facility, the county department designated under sub. (3) (c) 2., or at the request of or on the behalf of the tenant. DHS 89.27(1)(1) Requirement. A residential care apartment complex shall enter into a mutually agreed-upon written service agreement with each of its tenants consistent with the comprehensive assessment under s. DHS 89.26. DHS 89.27(2)(2) Contents. A service agreement shall identify all of the following: DHS 89.27(2)(a)1.1. The type, amount and frequency of the services to be provided to the tenant, including services which will be available to meet unscheduled care needs. DHS 89.27(2)(a)2.2. Any additional services which are available for purchase by the tenant. DHS 89.27(2)(a)3.3. The activities and social connections the tenant will be assisted in maintaining. DHS 89.27(2)(b)1.1. The charge for the services covered by the service agreement, both individually and in total, and the time and amount of any fee increase that will occur during the period covered by the service agreement. Facilities shall remind tenants of any fee increase by written notice 30 days in advance of the effective date. DHS 89.27(2)(b)2.2. Any supplemental fees for services not covered in the service agreement or other agreement between the facility and the tenant. DHS 89.27(2)(c)1.a.a. Types of additional services which the facility would make available or which the facility would assist in arranging for a tenant during acute episodes, following release from the hospital or during other periods when the tenant may experience temporary needs. DHS 89.27(2)(c)1.b.b. Policies and procedures regarding services which the tenant arranges to receive from providers other than the residential care apartment complex. DHS 89.27(2)(c)2.2. ‘Termination or transfer.’ Grounds for termination of the contract between the tenant and the facility or relocation of the tenant to another residence and the procedure for tenant participation in decisions regarding termination and relocation. Conditions for termination contained in the service agreement shall not be contrary to the requirements relating to contract termination contained in s. DHS 89.29 (3). DHS 89.27(2)(c)3.3. ‘Tenant’s rights.’ The residential care apartment complex’s policies relating to tenant rights, including at a minimum, the rights identified in subch. III. DHS 89.27(2)(c)4.4. ‘Dispute resolution.’ The facility’s internal grievance procedure for resolving tenant complaints. DHS 89.27(3)(a)(a) Only services selected and agreed to by the tenant may be included in the service agreement. DHS 89.27(3)(b)(b) A service agreement may not waive any of the provisions of this chapter or other rights of the tenant. DHS 89.27(3)(c)(c) The service agreement shall be presented in language and a format that make it possible for tenants to readily identify the type, amount, frequency and cost of services they receive, the qualifications of the staff providing those services and whether the services are provided directly by the facility or by subcontract. DHS 89.27(3)(d)(d) The initial service agreement and any renewals of the service agreement shall be dated and signed by a representative of the facility; by the tenant or by the tenant’s guardian, if any, and all other persons with legal authority to make health care or financial decisions for the tenant; and by the county for a tenant whose services are funded under s. 46.277, Stats. The facility shall provide a copy of the service agreement to all parties who signed the agreement. DHS 89.27 NoteNote: Persons with legal authority to make health care or financial decisions for the tenant include agents designated under an activated power of attorney for health care under ch. 155, Stats., and durable power of attorney under ch. 244, Stats. DHS 89.27(3)(e)(e) The service agreement shall be completed by the date of admission. DHS 89.27(4)(4) Review and update. The service agreement shall be reviewed when there is a change in the comprehensive assessment or at the request of the facility or at the request or on behalf of the tenant and shall be updated as mutually agreed to by all parties to the agreement. DHS 89.28(1)(1) Requirement. As a protection for both the individual tenant and the residential care apartment complex, a residential care apartment complex shall enter into a signed, jointly negotiated risk agreement with each tenant by the date of occupancy. DHS 89.28(2)(2) Content. A risk agreement shall identify and state all of the following: DHS 89.28(2)(a)1.1. Any situation or condition which is or should be known to the facility which involves a course of action taken or desired to be taken by the tenant contrary to the practice or advice of the facility and which could put the tenant at risk of harm or injury. DHS 89.28(2)(a)2.2. The tenant’s preference concerning how the situation is to be handled and the possible consequences of acting on that preference. DHS 89.28(2)(a)3.3. What the facility will and will not do to meet the tenant’s needs and comply with the tenant’s preference relative to the identified course of action. DHS 89.28(2)(a)4.4. Alternatives offered to reduce the risk or mitigate the consequences relating to the situation or condition. DHS 89.28(2)(a)5.5. The agreed-upon course of action, including responsibilities of both the tenant and the facility. DHS 89.28(2)(a)6.6. The tenant’s understanding and acceptance of responsibility for the outcome from the agreed-upon course of action. DHS 89.28(2)(b)(b) Unmet needs. Any needs identified in the comprehensive assessment which will not be provided for by the facility, either directly or under contract. DHS 89.28(2)(c)(c) Notice regarding enforcement in registered facilities. For registered facilities only, notice that the department does not routinely inspect registered facilities or verify their compliance with this chapter and does not enforce contractual obligations under the service or risk agreements. DHS 89.28(3)(3) No waiver of rules or rights. A risk agreement may not waive any provision of this chapter or any other right of the tenant. DHS 89.28(4)(4) Obligation to negotiate in good faith. Neither the tenant nor the facility shall refuse to accept reasonable risk or insist that the other party accept unreasonable risk. DHS 89.28(5)(5) Signed and dated. The risk agreement shall be signed and dated by both an authorized representative of the residential care apartment complex and by the tenant or the tenant’s guardian and agents designated under an activated power of attorney for health care under ch. 155, Stats., and durable power of attorney under ch. 244, Stats., if any. DHS 89.28(6)(6) Updating. The risk agreement shall be updated when the tenant’s condition or service needs change in a way that may affect risk, as indicated by a review and update of the comprehensive assessment, by a change in the service agreement or at the request of the tenant or facility. DHS 89.28 HistoryHistory: Cr. Register, February, 1997, No. 494, eff. 3-1-97; am. Register, November, 1998, No. 515, eff. 12-1-98; correction in (5) made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667.
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