Chapter DHS 124

DHS 124.07 DHS 124.07 Maternity and neonatal care.

DHS 124.07(1) (1) Definitions. In this section:

DHS 124.07(1)(a) (a) “Neonatal” means pertaining to the first 28 days following birth.

DHS 124.07(1)(c) (c) “Nurse-midwife” means an individual licensed under s. 441.15, Stats., and ch. N 4.

DHS 124.07(1)(d) (d) “Perinatal” means pertaining to the mother, fetus or infant, in anticipation of and during pregnancy and through the first 28 days following birth.

DHS 124.07(2) (2) Personnel.

DHS 124.07(2)(a) (a) A registered nurse shall be responsible for the admission assessment of the maternity patient in labor and continuing assessment and support of the mother and fetus during labor, delivery and the early postpartum period.

DHS 124.07(2)(b) (b) A registered nurse shall be responsible for the admission assessment of the newborn infant and continuing assessment until the newborn infant is stabilized as defined by current, accepted standards of practice.

DHS 124.07(2)(c) (c) Hospitals with maternity units shall have a qualified anesthesia provider available at all times to provide emergency care to maternity patients.

DHS 124.07(3) (3) Admission and patient placement. Hospitals with maternity units shall do all of the following:

DHS 124.07(3)(a) (a) The hospital shall establish and implement written policies for maternity and non-maternity patients who may be admitted to the maternity unit, including a policy that delineates medical staff responsibility for the admission of maternity patients in non-emergency situations.

DHS 124.07(3)(b) (b) The hospital’s infection prevention policies shall address patient placement and visitation in the maternity unit.

DHS 124.07(3)(c) (c) The hospital shall establish and implement written policies for admission of newborn infants, including newborn infants born outside the hospital, and criteria for identifying conditions for directly admitting or readmitting newborn infants to the newborn nursery or neonatal intensive care unit for further treatment and follow-up care. For an infant delivered outside the hospital, admission may be made directly to the newborn nursery or neonatal intensive care unit if the admission complies with infection control policies adopted by the hospital to protect patients from communicable disease or infection.

DHS 124.07(4) (4) Transfer. A maternity unit shall do all of the following:

DHS 124.07(4)(a) (a) Provide adequate facilities, personnel, and equipment and support services for the care of high-risk infants, including premature infants, or a plan for transfer of these infants to a neonatal or pediatric intensive care unit.

DHS 124.07(4)(b) (b) Establish and implement written policies and procedures for inter-hospital transfer of perinatal and neonatal patients.

DHS 124.07(4)(c) (c) Establish and implement written policies for the transfer of infants from one hospital to another hospital.

DHS 124.07(4)(d) (d) Have available personnel and equipment to transfer infants to another hospital. The execution of transfer is a joint responsibility of the sending and receiving hospitals.

DHS 124.07(5) (5) Delivery. Hospitals with maternity units shall do all of the following:

DHS 124.07(5)(a) (a) If cesarean deliveries are not performed in the maternity unit, equipment for neonatal stabilization and resuscitation shall be available during delivery.

DHS 124.07(5)(b) (b) Delivery rooms shall be used only for delivery and operating procedures related to deliveries unless permitted by a written safety risk assessment that facilitates safe delivery of care.

DHS 124.07(6) (6) Tests for congenital disorders. The hospital shall establish and implement written policies that address the screening and testing of newborns for congenital and metabolic disorders consistent with s. 253.13, Stats., and ch. DHS 115.

DHS 124.07(7) (7) Security.

DHS 124.07(7)(a) (a) The hospital shall establish and implement written policies that address infant identification and security.

DHS 124.07(7)(b) (b) An infant may be discharged only to a parent who has lawful custody of the infant or to an individual who is legally authorized to receive the infant. If the infant is discharged to a legally authorized individual, that individual shall provide identification and, if applicable, the identification of the agency the individual represents. The hospital shall record the identity of the legally authorized individual to whom the infant is discharged.

DHS 124.07(8) (8) Labor-inducing medications.

DHS 124.07(8)(a) (a) Only a physician or a nurse-midwife may order the administration of a labor-inducing medication.

DHS 124.07(8)(b) (b) Only a physician or a nurse-midwife or a registered nurse who has adequate training and experience may administer a labor-inducing medication.

DHS 124.07(8)(c) (c) A registered nurse shall be present when administration of a labor-inducing medication is initiated and shall remain immediately available to monitor maternal and fetal well-being. Hospitals shall develop and implement policies allowing the registered nurse to discontinue the labor-inducing medication if circumstances warrant discontinuation and no standing orders by a physician or a nurse-midwife are in place authorizing their discontinuation.

DHS 124.07(8)(d) (d) A registered nurse shall closely monitor and document the administration of a labor-inducing medication. Monitoring shall include monitoring of the fetus and monitoring of uterine contraction during administration of a labor-inducing medication.

DHS 124.07(8)(e) (e) The physician or nurse-midwife, who prescribed the labor-inducing medication, or another physician or nurse-midwife, shall be readily available during its administration so that, if needed, he or she will arrive at the patient’s bedside within 30 minutes after being notified.

DHS 124.07(9) (9) Religious circumcisions. A separate room apart from the newborn nursery shall be provided when circumcisions are performed according to religious rites. A physician, physician’s assistant or registered nurse shall be present during the performance of the religious rite. Aseptic techniques shall be used when an infant is circumcised.

DHS 124.07 History History: Cr. Register, January, 1988, No. 385, eff. 2-1-88; CR 19-135: r. and recr. Register June 2020 No. 774, eff. 7-1-20; renum. (1) (b) to (d) under s. 13.92 (4) (b) 1., Stats., Register June 2020.

DHS 124.08 DHS 124.08 Forfeiture assessment.

DHS 124.08(1) (1) In this section, “victim” means a female who alleges or for whom it is alleged that she suffered sexual assault and who, as a result of the sexual assault, presents as a patient at a hospital that provides emergency services.

DHS 124.08(2) (2) The department may directly assess a forfeiture for each violation of a requirement under s. 50.375 (2) or (3), Stats., for care of a victim by a hospital that provides emergency services. The department may assess the forfeitures as follows:

DHS 124.08(2)(a) (a) $2,500 for a first violation of a requirement under s. 50.375 (2) or (3), Stats.

DHS 124.08(2)(b) (b) $5,000 for a subsequent violation of a requirement under s. 50.375 (2) or (3), Stats.

DHS 124.08 Note Note: Section 50.375 (2), Stats., requires a hospital that provides emergency services to a victim to 1) provide to the victim medically and factually accurate and unbiased written and oral information about emergency contraception and its use and efficacy; 2) orally inform the victim of her option to receive emergency contraception at the hospital, her option to report the sexual assault to a law enforcement agency, and any available options for her to receive an examination to gather evidence regarding the sexual assault; and 3) except as specified in s. 50.375 (4), Stats., immediately provide to the victim upon her request emergency contraception, in accordance with instructions approved by the federal food and drug administration. If the medication is taken in more than one dosage, the hospital shall provide all subsequent dosages to the victim for later self administration.

DHS 124.08 Note Note: Section 50.375 (3), Stats., requires a hospital that provides emergency care to ensure that each hospital employee who provides care to a victim has available medically and factually accurate and unbiased information about emergency contraception.

DHS 124.08(3) (3) If the department determines that a forfeiture should be assessed for a particular violation, the department shall send a notice of assessment to the hospital. The notice shall specify the amount of the forfeiture assessed, the violation and the statute or rule alleged to have been violated, and shall inform the hospital of the right to a hearing under sub. (4) pursuant to s. 50.377 (3), Stats.

DHS 124.08(4) (4) Pursuant to s. 50.377 (4), Stats., all forfeitures shall be paid to the department within 10 days after receipt of a notice of assessment or, if the forfeiture is contested under sub. (5), within 10 days after receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order.

DHS 124.08(5) (5) Pursuant to s. 50.377 (3), Stats., a hospital may contest an assessment of a forfeiture by the department under sub. (2) by sending, within 10 days after receipt of notice under sub. (3), a written request for a hearing under s. 227.44, Stats., to the division of hearings and appeals. The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under s. 227.46, Stats. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days after receipt of the request for a hearing and shall issue a final decision within 15 days after the close of the hearing.

DHS 124.08 History History: CR 19-135: renum. from DHS 124.24 (3) Register June 2020 No. 774, eff. 7-1-20; correction in (1), (3) to (5) made under s. 13.92 (4) (b) 7., Stats., Register June 2020 No. 774.

DHS 124.09 DHS 124.09 Freestanding emergency departments.

DHS 124.09(1) (1) Definition. In this subchapter, “freestanding emergency department” means a dedicated location that is physically separate from a hospital campus that offers inpatient overnight care, with services and staff organized primarily for the purpose of delivering emergency medical services without requiring a previously scheduled appointment.

DHS 124.09(2) (2) Freestanding emergency departments.

DHS 124.09(2)(a) (a) A freestanding emergency department must comply with subs. (3), (4), and (5) and have provider-based status under 42 CFR 413.65 as a department of a hospital that offers inpatient overnight care.

DHS 124.09(2)(b) (b) A freestanding emergency department shall be under the direction of the emergency services department of a Wisconsin licensed hospital.

DHS 124.09(2)(c) (c) A freestanding emergency department shall provide emergency services 24 hours a day, 7 days a week, 365 days a year, on an outpatient basis.

DHS 124.09(3) (3) Physical environment.

DHS 124.09(3)(a) (a) A freestanding emergency department shall be identifiable to a patient.

DHS 124.09(3)(b) (b) The exterior entrance of a freestanding emergency department shall be at grade level, well-marked, and illuminated, with a covered ambulance bay.

DHS 124.09(3)(c) (c) The freestanding emergency department equipment shall be readily available, serviced, maintained and adequate to provide comprehensive emergency care.

DHS 124.09(4) (4) Personnel.

DHS 124.09(4)(a) (a) There shall be sufficient qualified medical, nursing, and ancillary personnel available to the freestanding emergency departments at all times to manage the number and severity of emergency department cases anticipated by the location. At all times, freestanding emergency departments shall have on-site the following minimum staffing, equipment and services necessary to evaluate and treat patients:

DHS 124.09(4)(a)1. 1. One physician, who through education, training, and experience specializes in emergency medicine.

DHS 124.09(4)(a)2. 2. One registered nurse, who through education, training, and experience specializes in emergency nursing.

DHS 124.09(4)(a)3. 3. A laboratory technician to provide laboratory services.

DHS 124.09(4)(b) (b) A person authorized to perform radiological services pursuant to ch. 462, Stats., shall be available at the freestanding emergency department, as follows:

DHS 124.09(4)(b)1. 1. At all times for plain films.

DHS 124.09(4)(b)2. 2. On-call to perform CT scanning within 30 minutes.

DHS 124.09(4)(b)3. 3. On-call to perform ultrasound within 1 hour.

DHS 124.09(5) (5) Ancillary services.

DHS 124.09(5)(a) (a) Radiology.

DHS 124.09(5)(a)1. 1. Plain film, CT scanner and ultrasound equipment shall be available.

DHS 124.09(5)(a)2. 2. Radiologist interpretation of CT scans and ultrasounds shall be available within one hour.

DHS 124.09(5)(a)3. 3. The freestanding emergency department shall develop and implement a written policy for timely interpretation of plain film studies.

DHS 124.09(5)(b) (b) Laboratory.

DHS 124.09(5)(b)1. 1. Blood or blood replacement shall be available within thirty minutes.

DHS 124.09(5)(b)2. 2. Services available within the freestanding emergency department shall be appropriate for the care of emergency medical cases anticipated by the location.

DHS 124.09(5)(c) (c) Pharmacy, respiratory and social services.

DHS 124.09(5)(c)1. 1. The freestanding emergency department shall provide pharmacy and respiratory services appropriate for the care of emergency medical cases anticipated by the location.

DHS 124.09(5)(c)2. 2. Services and supplies available within the freestanding emergency department shall be appropriate for the care of emergency medical cases anticipated by the freestanding emergency department.

DHS 124.09(5)(c)3. 3. Written policies regarding the availability and utilization of social services shall be established.

DHS 124.09(6) (6) Ambulance delivery. A freestanding emergency department shall:

DHS 124.09(6)(a) (a) Establish written policies and procedures governing ambulance delivery of patients that are consistent with the local emergency medical service system.

DHS 124.09(6)(b) (b) Communicate these policies to the local emergency medical services system to ensure appropriate routing of emergency cases by emergency medical services practitioners.

DHS 124.09(6)(c) (c) Establish written policies regarding patient transfers to other medical facilities. The policies shall address transfers by ambulance and, if the freestanding emergency department determines it is appropriate for that location, by helicopter.

DHS 124.09 History History: Cr. Register, January, 1988, No. 385, eff. 2-1-88; CR 19-135: r. and recr. Register June 2020 No. 774, eff. 7-1-20; correction in (1), (2) (c), (3) (a), (4) (b) (intro.), 2., 3. made under s. 35.17, Stats., Register June 2020 No. 774; CR 23-046: am. (6) (b) Register April 2024 No. 820, eff. 5-1-24.

subch. V of ch. DHS 124 Subchapter V — Physical Environment

DHS 124.275 DHS 124.275 Definitions. In this subchapter:

DHS 124.275(1) (1) “Alteration” has the meaning provided in the International Building Code Sec. 202 as adopted in s. SPS 361.05.

DHS 124.275(2) (2) “Existing construction” means a building which is in place or is being constructed with plans approved by the department prior to the effective date of this chapter.

DHS 124.275(3) (3) “Life Safety Code” means the National Fire Protection Association’s (NFPA) Standard 101.

DHS 124.275(4) (4) “New construction” means construction for the first time of any building or addition to an existing building, the plans for which are approved on or after July 1, 2020.

DHS 124.275(5) (5) “Owner” has the meaning provided in s. 101.01 (10), Stats.

DHS 124.275 Note Note: The International Building Code is located at www.iccsafe.org.

DHS 124.275 Note Note: Copies of the Life Safety Code and related codes can be obtained from the National Fire Protection Association, 1 Batterymarch Park, Quincy, Massachusetts, USA 02169-7471.