Wisconsin Legislature: DHS 133.06(4)(a)2.

(5) Interference with inspections. Any interference with or refusal to allow any inspection or investigation under this chapter shall be grounds for denial or revocation of the license.

(6) Waivers or variances. Upon application of a home health agency, the department may waive or vary any provision of this chapter if it finds that the waiver or variance will not adversely affect the health, safety or welfare of any patient.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; r. and recr. (4), Register, April, 2001, No. 544, eff. 5-1-01.

DHS 133.05 Governance.

(1) Governing body. Each home health agency shall have a governing body which shall:

(a) Adopt governing policies in the form of by-laws, charter, written policies or other official means;

(b) Adopt a statement detailing the services to be provided;

(d) Appoint an administrator; and

(e) Provide for a qualified substitute administrator to act in absence of the administrator.

(2) Professional advisory body.

(a) The home health agency shall establish an advisory group of at least one practicing physician and one registered nurse and appropriate representation from other professional disciplines. A majority of the members shall be persons who are neither owners nor employees of the agency.

(b) The advisory group shall:

1. Review annually and make recommendations to the governing body concerning the agency’s scope of services offered, admission and discharge policies, medical supervision and plans of care, emergency care, clinical records, personnel qualifications, and program evaluation;

2. Meet at least annually to advise the agency on professional issues, participate in the evaluation of the agency’s program and assist the agency in maintaining liaison with other health care providers in a community information program; and

3. Document all meetings by dated minutes.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (2) (b) 1., Register November 2007 No. 623, eff. 12-1-07.

DHS 133.06 Administration.

(1) Administrator. The home health agency shall be administered by an administrator who shall be a licensed physician, a registered nurse, or a person who has had training and experience in health care administration and at least one year of supervisory or administrative experience in home health care or related health programs.

(2) Duties of the administrator. The administrator shall:

(a) Be knowledgeable about this chapter, and shall take all reasonable steps to ensure compliance of the agency with the requirements of this chapter;

(b) Administer the entire home health services of the agency; and

(3) Personnel policies. The agency shall prepare in writing and review annually the following policies:

(a) A system for recruitment, orientation and continuing training of staff; and

(b) A plan for the evaluation of staff in the performance of duties.

(4) Employees.

(a) Orientation. Prior to beginning patient care, every employee shall be oriented to the agency and the job for which he or she is hired, with the orientation program to include:

1. Policies and objectives of the agency;

2. Information concerning specific job duties;

3. The functions of health personnel employed by the home health agency and how they relate to each other in providing services;

4. Information about other community agencies, including emergency medical services; and

5. Ethics, confidentiality of patient information, and patients’ rights.

(b) Scope of duties. No employees may be assigned any duties for which they are not capable, as evidenced by training or possession of a license.

(c) Evaluation. Every employee shall be evaluated periodically for quality of performance and adherence to the agency’s policies and this chapter, in accordance with the written plan of evaluation under sub. (3) (b). Evaluations shall be followed up with appropriate action.

(d) Health.

1. ‘Physical health of new employees.’ Each new employee, prior to having direct patient contact, shall be certified in writing by a physician, physician assistant or registered nurse as having been screened for tuberculosis, and clinically apparent communicable disease that may be transmitted to a patient during the normal performance of the employee’s duties. The screening shall occur within 90 days prior to the employee having direct patient contact.

2. ‘Continuing employees.’ Each employee having direct patient contact shall be screened for clinically apparent communicable disease by a physician, physician assistant, or registered nurse based on the likelihood of their exposure to a communicable disease, including tuberculosis. The exposure to a communicable disease may have occurred in the community or in another location.

3. ‘Disease surveillance.’ Agencies shall develop and implement written policies for control of communicable diseases which take into consideration control procedures incorporated by reference in ch. DHS 145 and which ensure that employees with symptoms or signs of communicable disease or infected skin lesions are not permitted to work unless authorized to do so by a physician or physician assistant or advanced practice nurse.

Note: The Americans with Disabilities Act and the Rehabilitation Act of 1973 prohibit the termination or non-hiring of an employee based solely on an employee having an infectious disease, illness or condition.

(e) Continuing training. A program of continuing training shall be provided to all employees as appropriate for the client population and the employee’s duties.

(f) Personnel records. A separate up-to-date personnel record shall be maintained on each employee. The record shall include evidence of suitability for employment in the position to which the employee is assigned.

(g) Background checks and misconduct reporting and investigation. Each home health agency shall comply with the caregiver background check and misconduct reporting requirements in s. 50.065, Stats., and ch. DHS 12, and the caregiver misconduct reporting and investigation requirements in ch. DHS 13.

(5) Infection control and prevention. Each home health agency shall do all of the following:

(a) Develop and implement initial orientation and ongoing education and training for all staff having direct patient contact, including students, trainees and volunteers, in the epidemiology, modes of transmission and prevention of infections and the need for routine use of current infection control measures as recommended by the U.S. centers for disease control and prevention.

(b) Provide equipment and supplies necessary for all staff having direct patient care contact to minimize the risk of infection while providing patient care.

(c) Monitor adherence to evidence-based standards of practice related to protective measures. When monitoring reveals a failure to follow evidence-based standards of practice, the home health agency shall provide counseling, education, or retraining to ensure staff is adequately trained to complete their job responsibilities.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (4) (d) 1., Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (4) (d) 1. and 3., r. and recr. (4) (d) 2., cr. (4) (g) and (5) Register November 2007 No. 623, eff. 12-1-07; corrections in (4) (d) 3. and (g) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 133.07 Evaluation.

(1) Requirement. An evaluation of the home health agency’s total program shall be conducted at least once a year by the advisory group required by s. DHS 133.05 (2), home health agency staff and consumers.

(2) Method of evaluation. The agency shall establish methods to determine whether the established programs and service policies are effective and whether service policies and procedures are substantially followed by agency staff. These methods shall include a review of a sample of patient records to determine whether services are being provided appropriately and the extent to which the needs of patients are met.

(3) Reports. Results of the evaluations shall be recorded in writing and reported to those responsible for the operation of the agency.

(4) Management review. The agency shall periodically review its policies and administrative practices to determine the extent to which they promote appropriate, adequate, effective and efficient patient care.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.08 Patient rights.

(1) Service applicant. The home health agency shall promptly determine the applicant’s suitability for services and, if the applicant is accepted, shall promptly provide services to the individual. If the applicant is found unsuitable for acceptance, the agency shall inform the applicant of other service providers in the area.

(2) Policies. The home health agency shall provide the patient with a written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation visit before the initiation of treatment. Each patient receiving care from the agency shall have all of the following rights:

(a) To be fully informed, as evidenced by home health agency documentation, of all rules and regulations governing patient responsibilities;

(b) To be fully informed, prior to or at the time of admission, of services available from the agency and of related charges, including any charges for services for which the patient or a private insurer may be responsible;

(d) To be fully informed of one’s own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of the home health services, including referral to health care institutions or other agencies, and to refuse to participate in experimental research;

(e) To refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal;

(f) To confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the agency, except in the case of transfer to another health facility, or as required by law or third-party payment contract;

(g) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs; and

(h) To be taught, and have the family taught, the treatment required, so that the patient can, to the extent possible, help himself or herself, and the family or other party designated by the patient can understand and help the patient.

(i) To exercise his or her rights as a patient of the home health agency;

(j) To have the patient’s family or legal representative exercise the patient’s rights when the patient has been judged incompetent by a court of law.

(3) Complaints. At the same time that the statement of patient rights is distributed under sub. (2), the home health agency shall provide the patient or guardian with a statement, provided by the department, setting forth the right to and procedure for registering complaints with the department.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; reprinted to correct printing error in (2) (g), Register, September, 1984, No. 345; CR 07-060: r. and recr. (2) (intro.) and (a), cr. (2) (i) and (j) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.09 Acceptance and discharge of patients.

(1) Acceptance of patients. A patient shall be accepted for service on the basis of a reasonable expectation that the patient’s medical, nursing and social needs can be met adequately by the home health agency. No patient may be provided services except under a plan of care established by a physician, an advanced practice nurse prescriber, or a physician assistant.

(2) Service agreement. Before care is initiated, the home health agency shall inform the patient, orally and in writing, of the extent to which payment may be expected from other sources, the charges for services that will not be covered by other sources and charges that the individual may have to pay.

(3) Discharge of patients.

(a) Notice of discharge.

1. A home health agency may not discharge a patient for any reason until the agency has discussed the discharge with the patient or the patient’s legal representative and the patient’s attending physician, advanced practice nurse prescriber, or physician assistant, and has provided written notice to the patient or the patient’s legal representative in the timelines specified in this paragraph.

2. The home health agency shall provide the written notice, except when a patient is discharged due to hospital admission that occurs near the end of a 60-day episode of treatment, required under subd. 1. to the patient or the patient’s legal representative at least 10 working days in advance of discharge if the reason for discharge is any of the following:

a. Payment has not been made for the patient’s care, following reasonable opportunity to pay any unpaid billings.

b. The home health agency is unable to provide the care required by the patient due to a change in the patient’s condition that is not an emergency.

3. The home health agency shall provide the written notice under subd. 1. to the patient or the patient’s legal representative at the time of discharge if the reason for discharge is any of the following:

a. The safety of staff is compromised, as documented by the home health agency.

b. The attending physician, advanced practice nurse prescriber, or physician assistant orders the discharge for emergency medical reasons.

c. The patient no longer needs home health care as determined by the attending physician, advanced practice nurse prescriber, or physician assistant.

4. The home health agency shall insert a copy of the written discharge notice in the patient’s medical record.

5. The home health agency shall include in every written discharge notice to a patient or the patient’s legal representative all of the following:

a. The reason for discharge.

b. A notice of the patient’s right to file a complaint with the department and the department’s toll-free home health hotline telephone number and the address and telephone number of the department’s division of quality assurance.

Note: A complaint may be filed by writing the Bureau of Health Services, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or by calling the Wisconsin Home Health Hotline toll free at 1-800-642-6552.

(b) Discharge summary. The home health agency shall complete a written discharge summary within 30 calendar days following discharge of a patient. The discharge summary shall include a description of the care provided and the reason for discharge. The home health agency shall place a copy of the discharge summary in the former patient’s medical record. Upon request, the home health agency shall provide a copy of the discharge summary to the former patient, the patient’s legal representative, the attending physician, advanced practice nurse prescriber, or physician assistant.

History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; r. and recr. (3), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (1), (3) (a) 1., 2. (intro.), 3. b., c. and (b), r. and recr. (2) Register November 2007 No. 623, eff. 12-1-07; correction in (3) (a) 5. b. made under s. 13.92 (4) (b) 6., Stats., Register February 2008 No. 626; CR 16-077: am. (1), (3) (a) 1., 3. b., c., (b) Register September 2017 No. 741 eff. 10-1-17.