Chapter DHS 132

DHS 132.13(10m)(a) (a) Placing psychotropic medication in an individual’s food or drink with knowledge that the individual protests receipt of the psychotropic medication.

DHS 132.13(10m)(b) (b) Forcibly restraining an individual to enable administration of psychotropic medication.

DHS 132.13(10m)(c) (c) Requiring an individual to take psychotropic medication as a condition of receiving privileges or benefits.

DHS 132.13(11) (11) “Licensed practical nurse” means a person licensed as a licensed practical nurse under ch. 441, Stats.

DHS 132.13(12) (12) “Limited nursing care” means simple nursing care procedures required by residents with long-term illnesses or disabilities in order to maintain stability and which can be provided safely only by or under the supervision of a person no less skilled than a licensed practical nurse who works under the direction of a registered nurse. Supervision of the physical, emotional, social and rehabilitative needs of the resident is the responsibility of the appropriate health care provider serving under the direction of a physician.

DHS 132.13(13m) (13m) “Neglect” has the meaning specified under s. DHS 13.03 (14).

DHS 132.13(16) (16) “Nurse” means a registered nurse or licensed practical nurse.

DHS 132.13(17) (17) “Nurse practitioner” means a registered professional nurse who meets the requirements of s. DHS 105.20 (1).

DHS 132.13(18) (18) “Nursing assistant” means a person who is employed primarily to provide direct care services to residents but is not registered or licensed under ch. 441, Stats.

DHS 132.13(20) (20) “Pharmacist” means a person registered as a pharmacist under ch. 450, Stats.

DHS 132.13(21) (21) “Physical therapist” means a person licensed to practice physical therapy under ch. 448, Stats.

DHS 132.13(22) (22) “Physician” means a person licensed to practice medicine or osteopathy under ch. 448, Stats.

DHS 132.13(23) (23) “Physician extender” means a person who is a physician’s assistant or a nurse practitioner acting under the general supervision and direction of a physician.

DHS 132.13(24) (24) “Physician’s assistant” means a person certified under ch. 448, Stats., to perform as a physician’s assistant.

DHS 132.13(25) (25) “Practitioner” means a physician, dentist, podiatrist or other person permitted by Wisconsin law to distribute, dispense and administer a controlled substance in the course of professional practice.

DHS 132.13(25g) (25g) “Protest” means make more than one discernible negative response, other than mere silence, to the offer of, recommendation for, or other proffering of voluntary receipt of psychotropic medication. “Protest” does not mean a discernible negative response to a proposed method of administration of the psychotropic medication.

DHS 132.13(25r) (25r) “Psychotropic medication” means a prescription drug, as defined in s. 450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior.

DHS 132.13(26) (26) “Recuperative care” means care anticipated to be provided for a period of 90 days or less for a resident whose physician has certified that he or she is convalescing or recuperating from an illness or a medical treatment.

DHS 132.13(27) (27) “Registered nurse” means a person who holds a certificate of registration as a registered nurse under ch. 441, Stats.

DHS 132.13(28) (28) “Resident” means a person cared for or treated in any facility on a 24-hour basis irrespective of how the person has been admitted to the facility.

DHS 132.13(29) (29) “Respite care” means care anticipated to be provided for a period of 28 days or less for the purpose of temporarily relieving a family member or other caregiver from his or her daily caregiving duties.

DHS 132.13(30) (30) “Short-term care” means recuperative care or respite care.

DHS 132.13(31) (31) “Skilled nursing facility” means a nursing home which is licensed by the department to provide skilled nursing services.

DHS 132.13(32) (32) 

DHS 132.13(32)(a) (a) “Skilled nursing services” means those services furnished pursuant to a physician’s orders which:

DHS 132.13(32)(a)1. 1. Require the skills of professional personnel such as registered or licensed practical nurses; and

DHS 132.13(32)(a)2. 2. Are provided either directly by or under the supervision of these personnel.

DHS 132.13(32)(b) (b) In determining whether a service is skilled, the following criteria shall be used:

DHS 132.13(32)(b)1. 1. The service would constitute a skilled service where the inherent complexity of a service prescribed for a resident is such that it can be safely and effectively performed only by or under the supervision of professional personnel;

DHS 132.13(32)(b)2. 2. The restoration potential of a resident is not the deciding factor in determining whether a service is to be considered skilled or unskilled. Even where full recovery or medical improvement is not possible, skilled care may be needed to prevent, to the extent possible, deterioration of the condition or to sustain current capacities; and

DHS 132.13(32)(b)3. 3. A service that is generally unskilled would be considered skilled where, because of special medical complications, its performance or supervision or the observation of the resident necessitates the use of skilled nursing personnel.

DHS 132.13(34) (34) “Supervision” means at least intermittent face-to-face contact between supervisor and assistant, with the supervisor instructing and overseeing the assistant, but does not require the continuous presence of the supervisor in the same building as the assistant.

DHS 132.13(35) (35) “Tour of duty” means a portion of the day during which a shift of resident care personnel are on duty.

DHS 132.13(36) (36) “Unit dose drug delivery system” means a system for the distribution of medications in which single doses of medications are individually packaged and sealed for distribution to residents.

DHS 132.13 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; emerg. renum. (3) to (24) to be (4) to (25), cr. (3), eff. 9-15-86; r. and recr. Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (8m), eff. 7-1-88; am. (4), Register, February, 1989, No. 398, eff. 3-1-89; cr. (8m), Register, October, 1989, No. 406, eff. 11-1-89; correction made to (17) under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576; CR 04-053: r. and recr. (1), cr. (1m), (2m), (8r) and (13m), am. (2) and (5) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (2), (6), (13), (14), (15), (19) and (33), Register August 2007 No. 620, eff. 9-1-07; CR 07-042: cr. (10m), (25g) and (25r) Register October 2007 No. 622, eff. 11-1-07; corrections in (1), (3), (13m) and (17) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (4) (intro.) Register May 2019 No. 761, eff. 6-1-19; CR 23-046: am. (4) (intro.) Register April 2024 No. 820, eff. 5-1-24.

DHS 132.14 DHS 132.14 Licensure.

DHS 132.14(1) (1) Categories. Nursing homes shall elect one of the following categories of licensure:

DHS 132.14(1)(a) (a) Skilled nursing facility; or

DHS 132.14(1)(b) (b) Intermediate care facility.

DHS 132.14(1m) (1m) Licensure as an institution for mental diseases.

DHS 132.14(1m)(a) (a) Requirements. The department may grant a facility a license to operate as an institution for mental diseases if the following conditions are met:

DHS 132.14(1m)(a)1. 1. The conversion of all or some of the beds within the facility will result in a physically identifiable unit of the facility, which may be a ward, contiguous wards, a wing, a floor or a building, and which is separately staffed;

DHS 132.14(1m)(a)2. 2. The IMD shall have a minimum of 16 beds;

DHS 132.14(1m)(a)3. 3. The conversion of beds to or from an IMD shall not increase the total number of beds within the facility; and

DHS 132.14(1m)(a)4. 4. The facility has submitted an application under subs. (2) and (3) to convert all or a portion of its beds to an IMD and the department has determined that the facility is in substantial compliance with this chapter. A facility may not submit an application for conversion of beds to or from an IMD more than 2 times a year.

DHS 132.14(1m)(b) (b) Exclusion. An existing facility applying to be licensed in whole or part as an IMD is not subject to prior review under ch. 150, Stats.

DHS 132.14(2) (2) Application. Application for a license shall be made on a form provided by the department.

DHS 132.14 Note Note: To obtain a copy of the application form for a license to operate a nursing home, write: Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.

DHS 132.14(3) (3) Requirements for licensure.

DHS 132.14(3)(a) (a) In every application the license applicant shall provide the following information:

DHS 132.14(3)(a)1. 1. The identities of all persons or business entities having the authority, directly or indirectly, to direct or cause the direction of the management or policies of the facility;

DHS 132.14(3)(a)2. 2. The identities of all persons or business entities having any ownership interest whatsoever in the facility, whether direct or indirect, and whether the interest is in the profits, land or building, including owners of any business entity which owns any part of the land or building;

DHS 132.14(3)(a)3. 3. The identities of all creditors holding a security interest in the premises, whether land or building; and

DHS 132.14(3)(a)4. 4. In the case of a change of ownership, disclosure of any relationship or connection between the old licensee and the new licensee, and between any owner or operator of the old licensee and the owner or operator of the new licensee, whether direct or indirect.

DHS 132.14(3)(a)5. 5. Disclosure of any financial failures directly or indirectly involving any person or business entity identified in the application concerning the operation of a residential or health care facility that resulted in any debt consolidation or restructuring, insolvency proceeding or mortgage foreclosure, or in the closing of a residential or health care facility or the moving of its residents. In this subdivision “insolvency” means bankruptcies, receiverships, assignments for the benefit of creditors, and similar court-supervised proceedings.

DHS 132.14(3)(b) (b) The applicant shall provide any additional information requested by the department during its review of the license application.

DHS 132.14(3)(bm) (bm) The applicant shall provide information to demonstrate that any person having the authority to directly manage the operation of the facility has the education, training or experience to operate and manage a health care facility to provide for the health, safety, and welfare of its residents in substantial compliance with state and federal requirements.

DHS 132.14(3)(c) (c) The applicant shall submit evidence to establish that he or she has sufficient resources to permit operation of the facility for a period of 6 months.

DHS 132.14(3)(d) (d) No license may be issued unless and until the applicant has supplied all information requested by the department.

DHS 132.14(4) (4) Review of application.

DHS 132.14(4)(a) (a) Investigation. After receiving a complete application, the department shall investigate 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.

DHS 132.14(4)(b) (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 facility with which the applicant is affiliated or was affiliated during the past 5 years. The department shall consider at least the following:

DHS 132.14(4)(b)1. 1. Any class A or class B violation, as defined under s. 50.04, Stats., issued by the department relating to the applicant’s operation of a residential or health care facility in Wisconsin;

DHS 132.14(4)(b)2. 2. Any adverse action against the applicant or any person or business entity named in the application by the licensing agency of this state or any other state relating to the applicant’s or any person or business entity named in the application’s operation of a residential or health care facility. In this subdivision,“adverse action” means an action initiated by a state licensing agency which resulted in a conditional license, the placement of a monitor or the appointment of a receiver, or the denial, suspension or revocation of the license of a residential or health care facility operated by the applicant or any person or business entity named in the application;

DHS 132.14(4)(b)3. 3. Any adverse action against the applicant or any person or business entity named in the application based upon noncompliance with federal statutes or regulations in the applicant’s or any person or business entity named in the application’s operation of a residential or health care facility in this or any other state. In this subdivision, “adverse action” means an action by a state or federal agency which resulted in the imposition of Category 3 remedies pursuant to 42 CFR sec. 488.408 (e), placement of a state monitor or the appointment of a receiver, transfer of residents, or the denial, non-renewal, cancellation or termination of certification of a residential or health care facility operated by the applicant;

DHS 132.14(4)(b)4. 4. The frequency of noncompliance with state licensure and federal certification laws in the applicant’s operation of a residential or health care facility in this or any other state;

DHS 132.14(4)(b)5. 5. Any denial, suspension, enjoining or revocation of a license 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;

DHS 132.14(4)(b)6. 6. Any conviction of the applicant for a crime involving neglect or abuse of patients or of the elderly or involving assaultive behavior or wanton disregard for the health or safety of others;

DHS 132.14(4)(b)7. 7. Any conviction of the applicant for a crime related to the delivery of health care services or items;

DHS 132.14(4)(b)8. 8. Any conviction of the applicant for a crime involving controlled substances;

DHS 132.14(4)(b)9. 9. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information; and

DHS 132.14(4)(b)10. 10. Any prior financial failures of the applicant and any person and related business entity identified in the application concerning the operation of a residential or health care facility that resulted in any debt consolidation or restructuring, insolvency proceeding or mortgage foreclosure or in the closing of residential or health care facility or the moving of its residents. “Insolvency” has the meaning provided in s. DHS 132.14 (3) (a) 5.

DHS 132.14(5) (5) Action by the department. Within 60 days after receiving a complete application for a license, the department shall either approve the application and issue a license or deny the application. The department shall deny a license to any applicant who has a history, determined under sub. (4) (b) 1. to 4., of substantial noncompliance with federal or this state’s or any state’s nursing home requirements, or who fails under sub. (4) (b) 5. to 10., to qualify for a license. If the application for a license is denied, the department shall give the applicant reasons, in writing, for the denial and shall identify the process for appealing the denial.

DHS 132.14(6) (6) Types of license.

DHS 132.14(6)(a) (a) Probationary license. If the applicant has not been previously licensed under this chapter or if the facility is not in operation at the time application is made, the department shall issue a probationary license. A probationary license shall be valid for 12 months from the date of issuance unless sooner suspended or revoked under s. 50.03 (5), Stats. If the applicant is found to be fit and qualified under sub. (4) and in substantial compliance with this chapter, the department shall issue a regular license upon expiration of the probationary license. The regular license is valid indefinitely unless suspended or revoked.

DHS 132.14(6)(b) (b) Regular license. If the applicant has been previously licensed, the department shall issue a regular license if the applicant is found to be in substantial compliance with this chapter. A regular license is valid indefinitely unless suspended or revoked.

DHS 132.14(7) (7) Scope of license.

DHS 132.14(7)(a) (a) The license is issued only for the premises and the persons named in the license application, and may not be transferred or assigned by the licensee.

DHS 132.14(7)(b) (b) The license shall state any applicable restrictions, including maximum bed capacity and the level of care that may be provided, and any other limitations that the department considers appropriate and necessary taking all facts and circumstances into account.

DHS 132.14(7)(c) (c) A licensee shall fully comply with all requirements and restrictions of the license.

DHS 132.14(8) (8) Reporting. Every 12 months, on a schedule determined by the department, a nursing home licensee shall submit a report to the department in the form and containing the information that the department requires, including payment of the fee required under s. 50.135 (2) (a), Stats. If a complete report is not timely filed, the department shall issue a warning to the licensee. If a nursing home licensee who 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.

DHS 132.14(9) (9) Reporting involuntary administration of psychotropic medication. The licensee shall provide, in a format approved by the department, information required by the department to assess the facility’s compliance with s. 55.14, Stats., relating to involuntary administration of psychotropic medication to a resident.

DHS 132.14 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; cr. (5), Register, November, 1985, No. 359, eff. 12-1-85; r. and recr., Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (1m), eff. 7-1-88; am. (3) (c), renum. (4) to (6) to be (5) to (7) and am. (5) and (6) (a), cr. (4), Register, February, 1989, No. 398, eff. 3-1-89; cr. (1m), Register, October, 1989, No. 406, eff. 11-1-89; am. (6), cr. (8), Register, August, 2000, No. 536, eff. 9-1-00; CR 06-053: cr. (3) (a) 5. and (bm), am. (4) (b) 2., 3. and 10., Register August 2007 No. 620, eff. 9-1-07; CR 07-042: cr. (9) Register October 2007 No. 622, eff. 11-1-07.

DHS 132.15 DHS 132.15 Certification for medical assistance. For requirements for certification under the medical assistance program, see ch. DHS 105.

DHS 132.15 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; correction made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 132.16 DHS 132.16 Quality assurance and improvement projects.

DHS 132.16(1) (1) Funds. Pursuant to ss. 49.499 (2m) and 50.04 (8), Stats., the department may, from the appropriation under s. 20.435 (6) (g), Stats., distribute funds for innovative projects designed to protect the property and the health, safety, and welfare of residents in a facility and to improve the efficiency and cost effectiveness of the operation of a facility so as to improve the quality of life, care, and treatment of its residents.

DHS 132.16(2) (2) Quality assurance and improvement committee.

DHS 132.16(2)(a) (a) The department shall establish and maintain a quality assurance and improvement committee to review proposals and award funds to facilities for innovative projects approved by the committee under sub. (3).