Wisconsin Legislature: DHS 131.16(3)(b)2.

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

4. The licensee has relinquished management of the agency.

(11) Suspension or revocation. The department by written notice to the applicant or recipient may suspend or revoke a license if the department finds that there has been a substantial failure to comply with the requirements of ss. 50.90 to 50.98, Stats., or this chapter. The notice shall identify the violation and the statute or rule violated, and shall describe the process under sub. (11) for appealing the decision.

(12) Appeal of decision to deny, suspend or revoke a license.

(a) Any person aggrieved by the department’s decision to deny a license or to suspend or revoke a license may request a hearing on that decision under s. 227.42, Stats., which shall be limited to the issues stated as the bases for denial, suspension or revocation in the written notice under sub. (10).

(b) The request for hearing shall be in writing, shall be filed with the department of administration’s division of hearings and appeals, and shall be sent to that office so that it is received there within 10 days after the date of the notice under sub. (10). A request for a hearing is considered filed upon its receipt by the division of hearings and appeals. Review is not available if the request is received more than 10 days after the date of the notice under sub. (10).

Note: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, Wisconsin 53707.

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

DHS 131.15 Inspections of licensed programs. The department shall conduct unannounced inspections of a hospice which may include home visits with prior patient consent or a review of the clinical records of any individual with terminal illness served by the hospice. The department may inspect or investigate a hospice as it deems necessary.

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

DHS 131.16 Waivers and variances.

(1) Definitions. In this section:

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

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

(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:

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

(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.

(3) Procedures.

(a) Application.

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:

a. The rule from which the waiver or variance is requested.

b. The time period for which the waiver or variance is requested.

c. If the request is for a variance, the specific alternative action which the facility proposes.

d. The reasons for the request.

e. Justification that a requirement under sub. (2) would be satisfied.

2. A request for a waiver or variance may be made at any time.

3. The department may require additional information from the hospice prior to acting on the request.

(b) Grants and denials.

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.

2. The terms of a requested variance may be modified upon agreement between the department and the hospice.

3. The department may impose conditions on the granting of a waiver or variance which it deems necessary.

4. The department may limit the duration of a waiver or variance.

1. Denial of a requested waiver or variance may be contested by requesting a hearing as provided by ch. 227, Stats.

2. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable.

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

1. The department determines that the waiver or variance is adversely affecting the health, safety or welfare of the patients.

2. The hospice has failed to comply with the waiver or variance as granted.

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.

4. Revocation is required by a change in law.

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

Subchapter II — Patient Rights

DHS 131.17 Admission.

(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:

(a) Clearly define the philosophy of the program.

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

(d) Ensure protection of patient rights.

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

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

(2) Program explanation.

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

(3) Initial determination.

(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.

(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.

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

(a) Completion of the assessment under sub. (3).

(b) Completion of a service agreement in which:

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.

2. The hospice agrees to provide care for the person.

3. The person or the person’s representative, if any, authorizes services in writing.

(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.

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

DHS 131.18 Discharge.

(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.

(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:

(a) The hospice may discharge a patient:

1. Upon the request or with the informed consent of the patient or the patient’s representative.

2. If the patient elects care other than hospice care at any time.

3. If the patient elects active treatment, inconsistent with the role of palliative hospice care.

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.

5. If the patient requests services in a setting that exceeds the limitations of the hospice’s authority.

6. For nonpayment of charges, following reasonable opportunity to pay any deficiency.

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.

8. If the hospice determines that the patient is no longer terminally ill.

(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:

1. Advise the patient that a discharge for cause is being considered.

2. Make a serious effort to resolve the problem or problems presented by the patient’s behavior or situation.

3. Ascertain that the patient’s proposed discharge is not due to the patient’s use of necessary hospice services.

4. Document the matter and enter this documentation into the patient’s clinical record.

(3) Notice.

(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.

(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.

(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.

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 Patient rights.

(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:

(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.

(b) The right to prepare an advance directive.