Wisconsin Legislature: DHS 131.13(9)(c)

DHS 131.37 Physical plant.

DHS 131.38 Fire protection.

DHS 131.39 Fire safety.

DHS 131.40 Plans for new construction and alterations.

DHS 131.41 Plan review.

DHS 131.42 Fees for plan reviews.

Note: Chapter HSS 131 was renumbered Chapter HFS 131 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, July, 1999, No. 523. Chapter HFS 131 was renumbered chapter DHS 131 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b 7., Stats., Register January 2009 No. 637. Chapter DHS 131 as it existed on September 30, 2010 was repealed and a new chapter DHS 131 was created, effective October 1, 2010.

Subchapter I — General Provisions

DHS 131.11 Authority and purpose. This chapter is promulgated under the authority of s. 50.95, Stats., to establish minimum standards for the operation of hospice programs in Wisconsin. The purpose of the chapter is to ensure that hospice patients receive safe and adequate care and support and that the health and safety of hospice patients, employees and volunteers are protected.

History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.12 Applicability. This chapter applies to all organizations, programs and places operating as hospices in Wisconsin.

History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.13 Definitions. In this chapter:

(1) “Advance directive” means a written instruction, such as a living will under ch. 154, Stats., or a power of attorney for health care under ch. 155, Stats., or as otherwise recognized by the courts of the state, relating to the provision or nonprovision of health care when the individual is incapacitated.

(2) “Advanced practice nurse” means a person who is certified as an advanced practice nurse as provided in ch. N 8.

(3) “Attending physician” means a person who is either a doctor of medicine or osteopathy legally authorized to practice medicine and surgery under ch. 448, Stats., physician assistant or a nurse practitioner who meets the training, education, and experience requirements specified in s. DHS 105.20 (1) and the who identified by the patient, at the time he or she elects to receive hospice care, as having the greatest overall role in the determination and delivery of the individual’s medical care.

(4) “Bereavement services” means emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment.

(5) “Core team” means a defined group within the hospice’s interdisciplinary group that has represented on it physician, nurse, social worker and bereavement or other counseling services and that is responsible for all aspects of care and services to a patient and the patient’s family.

(6) “Department” means the Wisconsin department of health services.

(7) “Employee” means a person who:

(a) Works for the hospice and for whom the hospice is required to issue a W–2 form on his or her behalf.

(b) If the hospice is a subdivision of an agency or organization, an employee of the agency or organization who is appropriately trained and assigned to the hospice.

(8) “Family member” means an individual with significant personal ties to the hospice patient who is designated a family member by mutual agreement between the individual and the patient.

(9) “Hospice” means any of the following:

(a) An organization that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays and, if necessary to meet the needs of an individual with terminal illness, arranges for or provides short-term inpatient care and treatment or provides respite care.

(b) A program within an organization that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays, that uses designated staff time and facility services, that is distinct from other programs of care provided by the organization and, if necessary to meet the needs of an individual with terminal illness, that arranges for or provides short-term inpatient care and treatment or respite care.

(c) A place, including a freestanding structure or a separate part of a structure in which other services are provided, that primarily provides palliative and supportive care and a place of residence to individuals with terminal illness and provides or arranges for short-term inpatient care as needed.

(10) “Hospice patient” or “patient” means an individual in the terminal stage of illness who has an anticipated life expectancy of 12 months or less and who has been admitted to the hospice.

(11) “Interdisciplinary group” or “IDG” means the group of hospice employees which has represented on it the core team services and may, in addition, have physical therapy, occupational therapy, speech pathology and nurse aide services.

(11m) “Nonambulatory” means unable to walk.

(12) “Nurse aide” means an individual employed by or under contract to a hospice to provide nurse aide services as specified in s. DHS 131.26 (2) (b) under the supervision of a registered nurse.

(12m) “Semiambulatory” means able to walk with difficulty or able to walk only with the assistance of an aid, such as crutches, a cane, or a walker.

(13) “Palliative care” means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy and access to information.

(14) “Physician” means a person licensed to practice medicine or osteopathy under ch. 448, Stats.

(15) “Plan of care” means the written information that describes a patient’s needs and related needs of the patient’s family, goals and interventions by specified hospice employees or volunteers as well as a means for evaluating the effectiveness of the interventions.

(16) “Registered nurse” means a person licensed as a registered nurse under ch. 441, Stats.

(17) “Representative” means an individual who has the authority under s. 50.94, Stats., to authorize or terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill patient who is mentally or physically incapacitated. This may include a legal guardian.

(18) “Respite care” means care provided to a terminally ill individual in order to provide temporary relief to the primary caregiver.

(19) “Restraint” means any of the following:

(a) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely, not including devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm that does not include a physical escort.

(b) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

(20) “Seclusion” means the involuntary confinement of a patient alone in a room or an area from which the patient is physically prevented from leaving.

(20m) “Semiambulatory” means able to walk with difficulty or able to walk only with the assistance of an aid, such as crutches, a cane, or a walker.

(21) “Short-term inpatient care” means care provided to a terminally ill individual in an inpatient setting for brief periods of time for the purpose of pain control or acute or chronic symptom management.

(22) “Social worker” means an individual who holds a social worker certificate or a clinical social worker license under s. 457.08, Stats.

(23) “Supportive care” means services provided during the final stages of an individual’s terminal illness and dying and after the individual’s death to meet the psychosocial, social and spiritual needs of family members of the terminally ill individual and other individuals caring for the terminally ill individual.

(24) “Terminal illness” means a medical prognosis by a doctor of medicine or osteopathy that an individual’s life expectancy is less than 12 months.

(25) “Volunteer” means an uncompensated staff person.

History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10; CR 19-092: r. and recr. (3), cr. (11m), (20m) Register July 2020 No. 775, eff. 8-1-20; correction in (3) made under s. 35.17, Stats., Register July 2020 No. 775.

DHS 131.14 License.

(1) License requirement.

(a) No person may conduct, maintain, operate or otherwise participate in conducting, maintaining or operating a hospice unless the hospice is licensed by the department.

(b) A hospice program may have more than one office or facility. Multiple units do not need to be separately licensed if the hospice is able to demonstrate supervision and administration from the central office.

(2) Application.

(a) Application for a license to operate a hospice shall be made in writing on a form provided by the department.

(b) The completed application shall contain all of the following information:

1. The name and address of the applicant.

2. The location of the hospice.

3. Identification of the person or persons administratively responsible for the program, and the affiliation, if any, of the person or persons with a licensed home health agency, hospital, nursing home or other health care facility.

4. The proposed geographic area the hospice will serve.

5. A listing of those hospice services provided directly by the hospice, and those hospice services provided through a contractual agreement.

6. A list of those providers under contract with the hospice to provide hospice services.

7. Evidence to establish that the applicant has sufficient resources to permit operation of the hospice for a period of at least 90 days.

8. Any additional information specified by the department as necessary to determine that the entity detailed in the application is a hospice and that the applicant is and is fit and qualified to operate it.

(c) The applicant shall submit the application form to the department accompanied by the applicable fee established under s. 50.93 (1) (c), Stats.

Note: To obtain an application form for a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, Department of Health Services, P.O. Box 2969, Madison, WI 53701-2969 or telephone (608) 266-2702. The completed application form should be sent to the same office.

(3) Review of the application.

(a) Investigation. After receiving a complete application, the department shall investigate and inspect the applicant to determine if the applicant is fit and qualified to be a licensee and to determine if the applicant is able to comply with this chapter. An applicant that is currently certified as meeting conditions for medicare participation under 42 USC 1395 to 1395ccc, need not be investigated or inspected as a condition for issuance of a license.

(b) Fit and qualified. In making its determination of the applicant’s fitness, the department shall review the information contained in the application and shall review any other documents that appear to be relevant in making that determination, including survey and complaint investigation findings for each health care provider with which the applicant is affiliated or was affiliated during the past 5 years. The department shall consider at least all of the following:

1. Any adverse action against the applicant by the licensing agency of this state or any other state relating to the applicant’s operation of a hospice, home health agency, residential facility or health care facility. In this subdivision, “adverse action” means an action initiated by a state licensing agency which resulted in the denial, suspension or revocation of the license of a hospice, home health agency, residential facility or health care facility operated by the applicant.

2. Any adverse action against the applicant based upon noncompliance with federal statutes or regulations in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state. In this subdivision, “adverse action” means an action by a state or federal agency which resulted in civil money penalties, termination of a provider agreement, and suspension of payments or the appointment of temporary management of a hospice, home health agency, residential facility or health care facility operated by the applicant.

3. The frequency of noncompliance with state licensure and federal certification laws in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state.

4. Any denial, suspension, enjoining or revocation of a license that the applicant had as a health care provider as defined in s. 146.81 (1), Stats., or any conviction of the applicant for providing health care without a license.

5. Any conviction of the applicant for a crime involving neglect or abuse of patients, or involving assaultive behavior, wanton disregard for the health or safety of others or any act of elder abuse under s. 46.90, Stats.

6. Any conviction of the applicant for a crime related to delivery of health care services or items.

7. Any conviction of the applicant for a crime involving controlled substances under ch. 961, Stats.

8. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information.

9. Any prior financial failure of the applicant that resulted in bankruptcy or in the closing of a hospice, home health agency or an inpatient health care facility or the relocation of its patients.

(4) Provisional license. After receiving a complete application for a new license, the department shall investigate the applicant to determine the applicant’s ability to comply with this chapter. Prior to completing its investigation or if the hospice is not in operation at the time that application is made, the department may issue a provisional license. Unless sooner revoked or suspended, a provisional license shall be valid for no more than 24 months from the date of issuance.

(5) Regular license.

(a) The department shall inspect a hospice prior to issuing a regular license unless sub. (3) (a) applies and the hospice need not be inspected.

(b) During the provisional period specified in sub. (4), the hospice shall actively serve at least 5 patients in Wisconsin. At the time of this inspection the hospice shall be actively providing services to at least 3 patients and be able to demonstrate the operational capability of all the facets of the program in order to be issued a regular license.

(7) Ongoing licensure.

(a) A regular license shall be valid indefinitely if the following condition is satisfied:

(b) Every 12 months, on a schedule determined by the department, the hospice submits an annual report to the department in the form and containing the information that the department requires, including payment of the applicable fee specified in s. 50.93 (1) (c), Stats. If a complete annual report is not timely filed, the department shall issue a warning to the licensee. If a hospice that has not filed a timely report fails to submit a complete report to the department within 60 days after the date established under the schedule determined by the department, the department may revoke the license.