Chapter DHS 132

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).

DHS 132.16(2)(b) (b)

DHS 132.16(2)(b)1. 1. Committee members shall be appointed by the secretary for a term of up to 12 months and include, at the secretary’s discretion, one or more representatives from the department, the board on aging and long term care, disability, aging and long term care advocates, facilities, and other persons with an interest or expertise in quality improvement or delivery of long term care services. Facility members shall comprise at least half of the committee membership.

DHS 132.16(2)(b)2. 2. A representative’s term may be extended at the secretary’s discretion.

DHS 132.16(3) (3) Committee responsibilities. The quality assurance and improvement committee shall do all of the following:

DHS 132.16(3)(a) (a) Meet at least annually.

DHS 132.16(3)(b) (b) Develop and propose for the secretary’s approval criteria for review and approval of projects proposed under this section.

DHS 132.16(3)(c) (c) Considering the criteria approved by the secretary under par. (b), review proposals submitted by facilities under this section and approve submitted proposals, defer a determination pending additional information, or deny approval of proposals submitted.

DHS 132.16(3)(d) (d) Identify areas of need within a facility or corporation, the state or regions as projects to be addressed.

DHS 132.16(3)(e) (e) Develop opportunities and strategies for general improvement concerning licensed facilities.

DHS 132.16(3)(f) (f) Encourage proposals that develop innovative cost-effective methods for improving the operation and maintenance of facilities and that protect residents’ rights, health, safety and welfare and improve residents’ quality of life.

DHS 132.16(3)(g) (g) Disseminate within the department and to facilities and other interested individuals and organizations the information learned from approved projects.

DHS 132.16(3)(h) (h) Prepare an annual report to the secretary.

DHS 132.16(4) (4) A decision under sub. (3) (c) to defer or deny approval of or award funds for a proposal may not be appealed.

DHS 132.16 History History: CR 06-053: cr. Register August 2007 No. 620, eff. 9-1-07; CR 13-028: am. (1) Register December 2013 No. 696, eff. 1-1-14.

subch. II of ch. DHS 132 Subchapter II — Enforcement

DHS 132.21 DHS 132.21 Waivers and variances.

DHS 132.21(1) (1) Definitions. As used in this section:

DHS 132.21(1)(a) (a) “Waiver” means the grant of an exemption from a requirement of this chapter.

DHS 132.21(1)(b) (b) “Variance” means the granting of an alternate requirement in place of a requirement of this chapter.

DHS 132.21(2) (2) Requirements for waivers or 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 resident and that:

DHS 132.21(2)(a) (a) Strict enforcement of a requirement would result in unreasonable hardship on the facility or on a resident; or

DHS 132.21(2)(b) (b) An alternative to a rule, including new concepts, methods, procedures, techniques, equipment, personnel qualifications, or the conducting of pilot projects, is in the interests of better care or management.

DHS 132.21(3) (3) Procedures.

DHS 132.21(3)(a) (a) Applications.

DHS 132.21(3)(a)1. 1. All applications for waiver or variance from the requirements of this chapter shall be made in writing to the department, specifying the following:

DHS 132.21(3)(a)1.a. a. The rule from which the waiver or variance is requested;

DHS 132.21(3)(a)1.b. b. The time period for which the waiver or variance is requested;

DHS 132.21(3)(a)1.c. c. If the request is for a variance, the specific alternative action which the facility proposes;

DHS 132.21(3)(a)1.d. d. The reasons for the request; and

DHS 132.21(3)(a)1.e. e. Justification that sub. (2) would be satisfied.

DHS 132.21(3)(a)2. 2. Requests for a waiver or variance may be made at any time.

DHS 132.21(3)(a)3. 3. The department may require additional information from the facility prior to acting on the request.

DHS 132.21(3)(b) (b) Grants and denials.

DHS 132.21(3)(b)1. 1. The department shall grant or deny each request for waiver or variance in writing. Notice of denials 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 132.21(3)(b)2. 2. The terms of a requested variance may be modified upon agreement between the department and a facility.

DHS 132.21(3)(b)3. 3. The department may impose such conditions on the granting of a waiver or variance which it deems necessary.

DHS 132.21(3)(b)4. 4. The department may limit the duration of any waiver or variance.

DHS 132.21(3)(c) (c) Hearings.

DHS 132.21(3)(c)1. 1. Denials of waivers or variances may be contested by requesting a hearing as provided by ch. 227, Stats.

DHS 132.21(3)(c)2. 2. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable.

DHS 132.21(3)(d) (d) Revocation. The department may revoke a waiver or variance if:

DHS 132.21(3)(d)1. 1. It is determined that the waiver or variance is adversely affecting the health, safety or welfare of the residents; or

DHS 132.21(3)(d)2. 2. The facility has failed to comply with the variance as granted; or

DHS 132.21(3)(d)3. 3. The licensee notifies the department in writing that it wishes to relinquish the waiver or variance and be subject to the rule previously waived or varied; or

DHS 132.21(3)(d)4. 4. Required by a change in law.

DHS 132.21 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; am. (3) (a) 1. d., Register, January, 1987, No. 373, eff. 2-1-87.

subch. III of ch. DHS 132 Subchapter III — Residents’ Rights and Protections

DHS 132.31 DHS 132.31 Rights of residents.

DHS 132.31(1) (1) Residents’ rights. Every resident shall have the right to all of the following:

DHS 132.31(1)(d) (d) Admission information. Be fully informed in writing, prior to or at the time of admission, of all services and the charges for these services, and be informed in writing, during the resident’s stay, of any changes in services available or in charges for services, as follows:

DHS 132.31(1)(d)1. 1. No person may be admitted to a facility without that person or that person’s guardian or any other responsible person designated in writing by the resident signing an acknowledgement of having received a statement of information before or on the day of admission which contains at least the following information or, in the case of a person to be admitted for short-term care, the information required under s. DHS 132.70 (3):

DHS 132.31(1)(d)1.a. a. An accurate description of the basic services provided by the facility, the rate charged for those services, and the method of payment for them;

DHS 132.31(1)(d)1.b. b. Information about all additional services regularly offered but not included in the basic services. The facility shall provide information on where a statement of the fees charged for each of these services can be obtained. These additional services include pharmacy, x-ray, beautician and all other additional services regularly offered to residents or arranged for residents by the facility;

DHS 132.31(1)(d)1.c. c. The method for notifying residents of a change in rates or fees;

DHS 132.31(1)(d)1.d. d. Terms for refunding advance payments in case of transfer, death or voluntary or involuntary discharge;

DHS 132.31(1)(d)1.e. e. Terms of holding and charging for a bed during a resident’s temporary absence;

DHS 132.31(1)(d)1.f. f. Conditions for involuntary discharge or transfer, including transfers within the facility;

DHS 132.31(1)(d)1.g. g. Information about the availability of storage space for personal effects; and

DHS 132.31(1)(d)1.h. h. A summary of residents’ rights recognized and protected by this section and all facility policies and regulations governing resident conduct and responsibilities.

DHS 132.31(1)(d)2. 2. No statement of admission information may be in conflict with any part of this chapter.

DHS 132.31(1)(p) (p) Nondiscriminatory treatment. Be free from discrimination based on the source from which the facility’s charges for the resident’s care are paid, as follows:

DHS 132.31(1)(p)1. 1. No facility may assign a resident to a particular wing or other distinct area of the facility, whether for sleeping, dining or any other purpose, on the basis of the source or amount of payment, except that a facility only part of which is certified for Medicare reimbursement under 42 USC 1395 is not prohibited from assigning a resident to the certified part of the facility because the source of payment for the resident’s care is Medicare.

DHS 132.31(1)(p)2. 2. Facilities shall offer and provide an identical package of basic services meeting the requirements of this chapter to all individuals regardless of the sources of a resident’s payment or amount of payment. Facilities may offer enhancements of basic services, or enhancements of individual components of basic services, provided that these enhanced services are made available at an identical cost to all residents regardless of the source of a resident’s payment. A facility which elects to offer enhancements to basic services to its residents must provide all residents with a detailed explanation of enhanced services and the additional charges for these services pursuant to par. (d) 1. b.

DHS 132.31(1)(p)3. 3. If a facility offers at extra charge additional services which are not covered by the medical assistance program under ss. 49.43 to 49.497, Stats., and chs. DHS 101 to 108, it shall provide them to any resident willing and able to pay for them, regardless of the source from which the resident pays the facility’s charges.