Wisconsin Legislature: DHS 133.02(5m)(c)

DHS 133.10 Services provided.

DHS 133.11 Referrals.

DHS 133.12 Coordination with other providers.

DHS 133.13 Emergency notification.

DHS 133.14 Skilled nursing services.

DHS 133.15 Therapy services.

DHS 133.16 Medical social services.

DHS 133.17 Home health aide services.

DHS 133.18 Supervisory visits.

DHS 133.19 Services under contract.

DHS 133.20 Plan of care.

DHS 133.21 Medical records.

Note: Chapter H 33 as it existed on May 31, 1984 was repealed and a new chapter HSS 133 was created effective June 1, 1984. Chapter HSS 133 was renumbered chapter HFS 133 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, September, 1999, No. 525. Chapter HFS 133 was renumbered chapter DHS 133 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 133.01 Authority and purpose. This chapter is promulgated under the authority of s. 50.49 (2), Stats. The chapter establishes minimum standards for the care, treatment, health, safety, welfare, and comfort of patients by home health agencies and for the maintenance and operation of home health agencies which, in the light of advancing knowledge, will promote safe and adequate care and treatment of such patients by home health agencies.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; correction made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; CR 16-077: am. Register September 2017 No. 741 eff. 10-1-17.

DHS 133.02 Definitions. In this chapter:

(1) “Advanced practice nurse” has the meaning given in s. N 8.02 (1).

(1e) “Advanced practice nurse prescriber” has the meaning given in s. N 8.02 (2).

(1m) “Branch office” means a location or site from which a home health agency provides services within a portion of the total geographic area served by the home health agency.

(1s) “Caregiver” has the meaning given in s. 50.065 (1) (ag), Stats.

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

(3) “Home health agency” has the meaning given in s. 50.49 (1) (a), Stats.

(4) “Home health aide” means an individual whose name is on the registry and who is eligible for employment in a home health agency, and who is employed by or under contract to a home health agency to provide home health aide services under supervision of a registered nurse.

(5) “Home health aide services” means personal care services which will facilitate the patient’s self-care at home and are necessary to prevent or postpone institutionalization, but do not require performance by a registered nurse or licensed practical nurse.

(5g) “Home health services” has the meaning given in s. 50.49 (1) (b), Stats.

(5m) “Legal representative” means a person who is any of the following:

(a) A guardian as defined under s. 54.01 (10), Stats.

(b) A person appointed as a health care agent under an activated power of attorney for health care under ch. 155, Stats.

(c) A person appointed as an agent to make health care decisions under a durable power of attorney under s. 243.07, 1989 Stats., executed on or before April 28, 1990.

(d) A parent of a minor.

(6) “Licensed practical nurse” means a person licensed as a trained practical nurse under ch. 441, Stats.

(6g) “Medical assistance” has the meaning given in s. DHS 101.03 (95).

(6m) “Medicare” has the meaning given is s. DHS 101.03 (98).

(7) “Occupational therapist” means someone who meets the requirements of s. DHS 105.28.

(8) “Parent agency” means a home health agency with one or more branch offices.

(8m) “Patient fee revenue” means gross patient revenue less the following deductions:

(a) Contractual adjustments from medical assistance, medicare, other federal payment sources, and third party payers.

(b) Bad debts that cannot be collected from private pay clients.

Note: Examples of other federal payment sources are the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as authorized under 32 CFR 199, and benefits provided through the Veteran’s Administration. An example of a third party payer is a commercial insurer, including a health maintenance organization.

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

(9m) “Physician assistant” has the meaning given in s. 448.01 (6), Stats.

(10) “Registered nurse” means a nurse registered under s. 441.06, Stats.

(10m) “Registry” has the meaning specified in s. DHS 129.03 (18).

(11) “Social worker” means an individual who holds a social worker certificate or a clinical social worker license under s. 457.08, Stats., and has had one year of social work experience in a health care setting.

(12) “Speech pathologist” means a person who possesses a certificate of clinical competence from the American speech and hearing association, or has completed the equivalent educational requirements and work experience necessary for such a certificate, or who will have completed the academic program and be in the process of accumulating the supervised work experience required to qualify for such a certificate before employment by the home health agency.

(12m) “Statement of deficiency” means a notice of a violation of a requirement of s. 50.49, Stats., or this chapter.

(13) “Therapeutic service” means physical, occupational, speech or other therapy, medical social services, home health aide service, or any other medically oriented service except skilled nursing care.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; reprinted to correct printing error in (8), Register, September, 1984, No. 345; cr. (6g), Register, October, 1995, No. 478, eff. 11-1-95; correction in (6g) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; cr. (5m), r. and recr. (6g), cr. (6m), (8m) and (12m); Register, April, 2001, No. 544, eff. 5-1-01; corrections in (8m) were made under s. 13.93 (2m) (b) 1., Stats., Register August 2001 No. 548; CR 07-060: renum. (1) to be (1m), cr. (1), (1e), (1s) and (10m), am. (4) and (11) Register November 2007 No. 623, eff. 12-1-07; correction in (5m) (a) made under s. 13.93 (2m) (b) 7., Stats., Register November 2007 No. 623; corrections in (2), (6g), (6m), (7) and (10m) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 636; CR 09-107: am. (5m) (c), cr. (5m) (d) Register August 2010 No. 656, eff. 9-1-10; correction in (5m) (c) made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; CR 16-077: am. (3), cr. (5g), (9m) Register September 2017 No. 741 eff. 10-1-17; correction in (3), (5g) made under s. 35.17, Stats., Register September 2017 No. 741.

DHS 133.03 Licensure.

(1) License requirement. No person, firm, partnership, association, corporation, receiver, political subdivision of the state or other governmental agency may establish, operate, or maintain a home health agency, or represent and advertise by any means that it operates a home health agency providing services within the state without first obtaining a license from the department.

(2) Multiple units. Multiple units of a licensed agency shall be separately licensed if the department determines that the units, because of the volume of services provided or the distance between them and the central office, cannot adequately share supervision and administration of services with the central office. If a branch agency is not separately licensed from a parent agency, the parent agency shall be deemed to be in violation of this chapter if the branch is in violation.

(3) Application. Application for a license to operate a home health agency shall be made on a form provided by the department, shall be accompanied by a nonrefundable fee of $300, and shall include at least the following information:

(a) Name and address of applicant;

(b) For all incorporated applicants, the date and the state of incorporation, a copy of the articles of incorporation, tax status and, if a foreign corporation, evidence of authority to do business in Wisconsin;

(d) The name, principal business address and the percentage of ownership interest of all officers, directors, stockholders owning 10% or more of stock, members, partners, and all other persons having authority or responsibility for the operation of the agency;

(e) Proof of sufficient financial responsibility as may be necessary to operate the agency for at least 90 days;

(f) A description of the nature, type and scope of service to be provided, including geographic area to be served;

(g) Name, identification and qualifications of the administrator; and

(h) Name, identification, and qualifications of the substitute administrator required by s. DHS 133.05 (1) (e).

(i) The department may use any of the following information to determine that a home health agency applicant or owner is fit and qualified:

1. Any adverse action against a home health agency applicant or owner by a licensing agency of any state that resulted in denial, suspension, injunction, or revocation of a health care agency or health care facility license.

2. Any adverse action initiated by a state or federal agency based on non-compliance that resulted in civil money penalties, termination of a provider agreement, suspension of payments, or the appointment of temporary management of the facility.

3. 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, or any act of abuse under ss. 940.285 or 940.295, Stats.

4. Any conviction of a home health agency applicant or owner for a crime related to the delivery of health care services or items, or for providing health care without a license.

5. Any conviction of a home health agency applicant or owner for a crime involving a controlled substance under ch. 961, Stats.

6. Any conviction of a home health agency applicant or owner for a crime involving a sexual offense.

7. Any prior financial failure of a home health agency applicant or owner that resulted in bankruptcy or in the closing of a health care agency or health care facility or the relocation or discharge of a health care agency’s or health care facility’s patients.

8. Any unsatisfied judgment against a home health agency applicant or owner or any debts that are at least 90 days past due.

Note: To obtain a copy of the license application form, send your request to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969. The street address is 1 W. Wilson Street in Madison. Additional contact information is available under the “contact us” section at https://www.dhs.wisconsin.gov/regulations/hha/application.htm. The completed application form should be sent to the same office.

(4) Issuance of license.

(a) Following receipt of a complete application for a new license or for a license change when there has been a change in the ownership of a home health agency, the department shall investigate the application to determine the applicant’s ability to comply with this chapter.

(b)

1. Within 90 days after receiving a complete application, the department shall either approve the application and issue a license or deny the application, unless either of the following applies:

a. The department has not yet completed its investigation; or

b. The applicant or agency is temporarily unable to conform to all the rules in this chapter.

2. If subd. 1. a. or b. applies, the department may, within the 90-day period in subd. 1., issue a provisional license for a term of 90 days. The department may, upon the agency’s request, renew that license for additional 90-day terms not to exceed one year from the original issuance date of the provisional license.

3. During the provisional period specified in subd. 2., the home health agency shall actively serve at least 10 patients requiring skilled nursing care or other therapeutic services in Wisconsin. At least seven of the 10 patients shall be actively receiving skilled nursing services when the home health agency submits a written request for an on-site licensure survey. At least 3 patients shall be receiving skilled nursing services at the time of the on-site licensure survey.

(c) The department may not charge an additional fee for the original regular license issued to a home health agency that has not had a provisional license.

(d) After the department issues an initial regular license, the department may not charge the home health agency an additional licensing fee until the annual, continuing license fee is due. The fee shall be 0.25% of patient fee revenue of the home health agency based on the agency’s financial information submitted to the department in the form prescribed by the department, with a maximum fee of $2,500 and a minimum fee of $500.

(5) Licensure term. A home health agency regular license is valid indefinitely unless suspended, revoked or voluntarily surrendered.

(6) Report of changes.

(a) Changes requiring notice. The licensee shall, within 10 days, notify the department in writing of any changes in the services provided and any appointment or change of the administrator.

(b) Changes requiring new application. A new application under sub. (3) shall be submitted to the department within 10 working days when any of the following changes has occurred:

1. The corporate licensee has transferred 50% or more of the issued stock to another party or other parties;

2. The licensee has transferred ownership of 50% or more of the assets to another party or other parties;

3. There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits; or