Chapter DHS 131

DHS 131.16(1)(a) (a) “Variance” means the granting of an alternate requirement in place of a requirement of this chapter.

DHS 131.16(1)(b) (b) “Waiver” means the granting of an exemption from a requirement of this chapter.

DHS 131.16(2) (2) Requirements for waivers and variances. A waiver or variance may be granted if the department finds that the waiver or variance will not adversely affect the health, safety, or welfare of any patient and that:

DHS 131.16(2)(a) (a) Strict enforcement of a requirement would result in unreasonable hardship on the hospice or on a patient.

DHS 131.16(2)(b) (b) An alternative to a requirement, including a new concept, method, procedure or technique, other equipment, other personnel qualifications, or the conducting of a pilot project, is in the interests of better care or management.

DHS 131.16(3) (3) Procedures.

DHS 131.16(3)(a) (a) Application.

DHS 131.16(3)(a)1. 1. An application for a waiver of or variance from a requirement of this chapter shall be made in writing to the department, specifying all of the following:

DHS 131.16(3)(a)1.a. a. The rule from which the waiver or variance is requested.

DHS 131.16(3)(a)1.b. b. The time period for which the waiver or variance is requested.

DHS 131.16(3)(a)1.c. c. If the request is for a variance, the specific alternative action which the facility proposes.

DHS 131.16(3)(a)1.d. d. The reasons for the request.

DHS 131.16(3)(a)1.e. e. Justification that a requirement under sub. (2) would be satisfied.

DHS 131.16(3)(a)2. 2. A request for a waiver or variance may be made at any time.

DHS 131.16(3)(a)3. 3. The department may require additional information from the hospice prior to acting on the request.

DHS 131.16(3)(b) (b) Grants and denials.

DHS 131.16(3)(b)1. 1. The department shall grant or deny each request for waiver or variance in writing. A notice of denial shall contain the reasons for denial. If a notice of denial is not issued within 60 days after the receipt of a complete request, the waiver or variance shall be automatically approved.

DHS 131.16(3)(b)2. 2. The terms of a requested variance may be modified upon agreement between the department and the hospice.

DHS 131.16(3)(b)3. 3. The department may impose conditions on the granting of a waiver or variance which it deems necessary.

DHS 131.16(3)(b)4. 4. The department may limit the duration of a waiver or variance.

DHS 131.16(3)(c) (c) Hearings.

DHS 131.16(3)(c)1. 1. Denial of a requested waiver or variance may be contested by requesting a hearing as provided by ch. 227, Stats.

DHS 131.16(3)(c)2. 2. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable.

DHS 131.16(3)(d) (d) Revocation. The department may revoke a waiver or variance for any of the following reasons:

DHS 131.16(3)(d)1. 1. The department determines that the waiver or variance is adversely affecting the health, safety or welfare of the patients.

DHS 131.16(3)(d)2. 2. The hospice has failed to comply with the waiver or variance as granted.

DHS 131.16(3)(d)3. 3. The licensee notifies the department in writing of the desire to relinquish the waiver or variance and be subject to the requirement for which the waiver or variance was previously granted.

DHS 131.16(3)(d)4. 4. Revocation is required by a change in law.

DHS 131.16 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

subch. II of ch. DHS 131 Subchapter II — Patient Rights

DHS 131.17 DHS 131.17 Admission.

DHS 131.17(1) (1) Program description. A hospice shall have a written description of its program that clearly describes the general patient and family needs that can be met by the hospice, and that includes written admission policies that includes all of the following:

DHS 131.17(1)(a) (a) Clearly define the philosophy of the program.

DHS 131.17(1)(b) (b) Limit admission to individuals with terminal illness as defined under s. DHS 131.13 (24).

DHS 131.17(1)(c) (c) Clearly define the hospice’s limits in providing services and the settings for service provision.

DHS 131.17(1)(d) (d) Ensure protection of patient rights.

DHS 131.17(1)(e) (e) Provide clear information about services available for the prospective patient and his or her representative, if any.

DHS 131.17(1)(f) (f) Allow an individual to receive hospice services whether or not the individual has executed an advance directive.

DHS 131.17(2) (2) Program explanation.

DHS 131.17(2)(a) (a) A hospice employee shall inform the person and his or her representative, if any, of admission policies under sub. (1).

DHS 131.17(3) (3) Initial determination.

DHS 131.17(3)(a) (a) The hospice employee shall, based on the needs described by the person seeking admission or that person’s representative, if any, or both, make an initial determination as to whether or not the hospice is generally able to meet those needs.

DHS 131.17(3)(b) (b) If the hospice employee determines that the hospice does not have the general capability to provide the needed services, the hospice may not admit the person but rather shall suggest to the referring source alternative programs that may meet the described needs.

DHS 131.17(4) (4) Patient acknowledgement and hospice acceptance. The person seeking admission to the hospice shall be recognized as being admitted after:

DHS 131.17(4)(a) (a) Completion of the assessment under sub. (3).

DHS 131.17(4)(b) (b) Completion of a service agreement in which:

DHS 131.17(4)(b)1. 1. The person or the person’s representative, if any, acknowledges, in writing, that he or she has been informed about admission policies and services.

DHS 131.17(4)(b)2. 2. The hospice agrees to provide care for the person.

DHS 131.17(4)(b)3. 3. The person or the person’s representative, if any, authorizes services in writing.

DHS 131.17(5) (5) Prohibition. Any person determined not to have a terminal illness as defined under s. DHS 131.13 (24) may not be admitted to the hospice.

DHS 131.17 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.18 DHS 131.18 Discharge.

DHS 131.18(1) (1) Obligation. Once a hospice has admitted a patient to the program, and the patient or the patient’s representative, if any, has signed the acknowledgement and authorization for services under s. DHS 131.17 (4) (b), the hospice is obligated to provide care to that patient.

DHS 131.18(2) (2) Written policy. The hospice shall have a written policy that details the manner in which the hospice is able to end its obligation to a patient. This policy shall be provided to the patient or patient’s representative, if any, as part of the acknowledgement and authorization process at the time of the patient’s admission. The policy shall include all of the following as a basis for discharging a patient:

DHS 131.18(2)(a) (a) The hospice may discharge a patient:

DHS 131.18(2)(a)1. 1. Upon the request or with the informed consent of the patient or the patient’s representative.

DHS 131.18(2)(a)2. 2. If the patient elects care other than hospice care at any time.

DHS 131.18(2)(a)3. 3. If the patient elects active treatment, inconsistent with the role of palliative hospice care.

DHS 131.18(2)(a)4. 4. If the patient moves out of the geographical area served by the hospice or into a facility that does not have a contract with the hospice.

DHS 131.18(2)(a)5. 5. If the patient requests services in a setting that exceeds the limitations of the hospice’s authority.

DHS 131.18(2)(a)6. 6. For nonpayment of charges, following reasonable opportunity to pay any deficiency.

DHS 131.18(2)(a)7. 7. For the patient’s safety and welfare or the safety and welfare of others, if the hospice determines that the behavior of the patient or other persons in the patient’s home is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired.

DHS 131.18(2)(a)8. 8. If the hospice determines that the patient is no longer terminally ill.

DHS 131.18(2)(b) (b) The hospice shall do all of the following before it seeks to discharge a patient whose behavior or the behavior of other persons in the patient’s home, is disruptive, abusive, or uncooperative to the extent that delivery of care to the patient or the ability of the hospice to operate effectively is seriously impaired:

DHS 131.18(2)(b)1. 1. Advise the patient that a discharge for cause is being considered.

DHS 131.18(2)(b)2. 2. Make a serious effort to resolve the problem or problems presented by the patient’s behavior or situation.

DHS 131.18(2)(b)3. 3. Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services.

DHS 131.18(2)(b)4. 4. Document the matter and enter this documentation into the patient’s clinical record.

DHS 131.18(3) (3) Notice.

DHS 131.18(3)(a) (a) When a patient is being discharged for a reason given in sub. (2) (a) 1.,2., 3., 4., 5., 7., or 8., the hospice shall give written notice of the discharge to the patient or patient’s representative, if any, a family representative and the attending physician.

DHS 131.18(3)(b) (b) When a patient is being discharged for the reason given in sub. (2) (a) 6., the hospice shall give written notice of the discharge at least 14 days prior to the date of discharge, and indicate a proposed date for pre-discharge planning. The written notice shall be given to the patient or patient’s representative, if any, a family representative and the attending physician.

DHS 131.18(4) (4) Planning. The hospice shall conduct the pre-discharge planning with the patient or the patient’s representative and review the need for discharge, assess the effect of discharge on the patient, discuss alternative placements and develop a comprehensive discharge plan.

DHS 131.18 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10; CR 19-092: am. (2) (a) 4., 7., r. and recr. (3), am. (4) Register July 2020 No. 775, eff. 8-1-20.

DHS 131.19 DHS 131.19 Patient rights.

DHS 131.19(1) (1) General information. A hospice shall provide each patient and patient’s representative, if any, with a written statement of the rights of patients before services are provided, and shall fully inform each patient and patient’s representative, if any, of all of the following:

DHS 131.19(1)(a) (a) Those patient rights and all hospice rules and regulations governing patient responsibilities, which shall be evidenced by written acknowledgement provided by the patient, if possible, or the patient’s representative, if any, prior to receipt of services.

DHS 131.19(1)(b) (b) The right to prepare an advance directive.

DHS 131.19(1)(c) (c) The right to be informed of any significant change in the patient’s needs or status.

DHS 131.19(1)(d) (d) The hospice’s criteria for discharging the individual from the program.

DHS 131.19(2) (2) rights of patients. In addition to rights to the information under sub. (1), each patient shall have all of the following rights:

DHS 131.19(2)(a) (a) To receive effective pain management and symptom control from the hospice for conditions related to the terminal illness.

DHS 131.19(2)(b) (b) To participate in planning care and in planning changes in care.

DHS 131.19(2)(c) (c) To select or refuse care or treatment.

DHS 131.19(2)(d) (d) To choose his or her attending physician.

DHS 131.19(2)(e) (e) To confidential treatment of personal and clinical record information and to approve or refuse release of information to any individual outside the hospice, except in the case of transfer to another health care facility, or as required by law or third party payment contract.

DHS 131.19(2)(f) (f) To request and receive an exact copy of one’s clinical record.

DHS 131.19(2)(g) (g) To be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, including injuries of unknown source, and misappropriation of patient property.

DHS 131.19(2)(h) (h) To be free from restraints and seclusion except as authorized in writing by the attending physician to provide palliative care for a specified and limited period of time and documented in the plan of care.

DHS 131.19(2)(i) (i) To be treated with courtesy, respect and full recognition of the patient’s dignity and individuality and to choose physical and emotional privacy in treatment, living arrangements and the care of personal needs.