Chapter DHS 131

DHS 131.14(5)(b) (b) During the provisional period specified in sub. (4), the hospice shall actively serve at least 5 patients in Wisconsin. At the time of this inspection the hospice shall be actively providing services to at least 3 patients and be able to demonstrate the operational capability of all the facets of the program in order to be issued a regular license.

DHS 131.14(5)(c) (c) A regular license is valid indefinitely unless revoked or suspended.

DHS 131.14(7) (7) Ongoing licensure.

DHS 131.14(7)(a) (a) A regular license shall be valid indefinitely if the following condition is satisfied:

DHS 131.14(7)(b) (b) Every 12 months, on a schedule determined by the department, the hospice submits an annual report to the department in the form and containing the information that the department requires, including payment of the applicable fee specified in s. 50.93 (1) (c), Stats. If a complete annual report is not timely filed, the department shall issue a warning to the licensee. If a hospice that 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 131.14 Note Note: To obtain an application form for renewal of a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or telephone [phone].

DHS 131.14(8) (8) 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. (3) (b) 1. to 3., of substantial noncompliance with federal or this state’s or any state’s requirements, who fails under sub. (3) (b) 4. to 9. to qualify for a license, or who is found not in substantial compliance with this chapter. 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 under sub. (11) for appealing the denial.

DHS 131.14(9) (9) Scope of license. A license is issued only for the premises identified in the license application, if the hospice is a residential facility, and only for the persons named in the license application, and may not be transferred or assigned by the licensee.

DHS 131.14(10) (10) Report of changes.

DHS 131.14(10)(a) (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.

DHS 131.14(10)(b) (b) Changes requiring new application. A new application under sub. (2) shall be submitted to the department within 10 working days when any of the following changes has occurred:

DHS 131.14(10)(b)1. 1. The corporate licensee has transferred 50% or more of the issued stock to another party or other parties.

DHS 131.14(10)(b)2. 2. The licensee has transferred ownership of 50% or more of the assets to another party or other parties.

DHS 131.14(10)(b)3. 3. There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits.

DHS 131.14(10)(b)4. 4. The licensee has relinquished management of the agency.

DHS 131.14(11) (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.

DHS 131.14(12) (12) Appeal of decision to deny, suspend or revoke a license.

DHS 131.14(12)(a) (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).

DHS 131.14(12)(b) (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).

DHS 131.14 Note Note: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, Wisconsin 53707.

DHS 131.14 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.15 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.

DHS 131.15 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.16 DHS 131.16 Waivers and variances.

DHS 131.16(1) (1) Definitions. In this section:

DHS 131.16(1)(a) (a) “Variance” means the granting of an alternate requirement in place of a requirement of this chapter.

DHS 131.16(1)(b) (b) “Waiver” means the granting of an exemption from a requirement of this chapter.

DHS 131.16(2) (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:

DHS 131.16(2)(a) (a) Strict enforcement of a requirement would result in unreasonable hardship on the hospice or on a patient.

DHS 131.16(2)(b) (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.

DHS 131.16(3) (3) Procedures.

DHS 131.16(3)(a) (a) Application.

DHS 131.16(3)(a)1. 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:

DHS 131.16(3)(a)1.a. a. The rule from which the waiver or variance is requested.

DHS 131.16(3)(a)1.b. b. The time period for which the waiver or variance is requested.

DHS 131.16(3)(a)1.c. c. If the request is for a variance, the specific alternative action which the facility proposes.

DHS 131.16(3)(a)1.d. d. The reasons for the request.

DHS 131.16(3)(a)1.e. e. Justification that a requirement under sub. (2) would be satisfied.

DHS 131.16(3)(a)2. 2. A request for a waiver or variance may be made at any time.

DHS 131.16(3)(a)3. 3. The department may require additional information from the hospice prior to acting on the request.

DHS 131.16(3)(b) (b) Grants and denials.

DHS 131.16(3)(b)1. 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.

DHS 131.16(3)(b)2. 2. The terms of a requested variance may be modified upon agreement between the department and the hospice.

DHS 131.16(3)(b)3. 3. The department may impose conditions on the granting of a waiver or variance which it deems necessary.

DHS 131.16(3)(b)4. 4. The department may limit the duration of a waiver or variance.

DHS 131.16(3)(c) (c) Hearings.

DHS 131.16(3)(c)1. 1. Denial of a requested waiver or variance may be contested by requesting a hearing as provided by ch. 227, Stats.

DHS 131.16(3)(c)2. 2. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable.

DHS 131.16(3)(d) (d) Revocation. The department may revoke a waiver or variance for any of the following reasons:

DHS 131.16(3)(d)1. 1. The department determines that the waiver or variance is adversely affecting the health, safety or welfare of the patients.

DHS 131.16(3)(d)2. 2. The hospice has failed to comply with the waiver or variance as granted.

DHS 131.16(3)(d)3. 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.

DHS 131.16(3)(d)4. 4. Revocation is required by a change in law.

DHS 131.16 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

subch. II of ch. DHS 131 Subchapter II — Patient Rights

DHS 131.17 DHS 131.17 Admission.

DHS 131.17(1) (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:

DHS 131.17(1)(a) (a) Clearly define the philosophy of the program.

DHS 131.17(1)(b) (b) Limit admission to individuals with terminal illness as defined under s. DHS 131.13 (24).

DHS 131.17(1)(c) (c) Clearly define the hospice’s limits in providing services and the settings for service provision.

DHS 131.17(1)(d) (d) Ensure protection of patient rights.

DHS 131.17(1)(e) (e) Provide clear information about services available for the prospective patient and his or her representative, if any.

DHS 131.17(1)(f) (f) Allow an individual to receive hospice services whether or not the individual has executed an advance directive.

DHS 131.17(2) (2) Program explanation.

DHS 131.17(2)(a) (a) A hospice employee shall inform the person and his or her representative, if any, of admission policies under sub. (1).

DHS 131.17(3) (3) Initial determination.

DHS 131.17(3)(a) (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.

DHS 131.17(3)(b) (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.

DHS 131.17(4) (4) Patient acknowledgement and hospice acceptance. The person seeking admission to the hospice shall be recognized as being admitted after:

DHS 131.17(4)(a) (a) Completion of the assessment under sub. (3).

DHS 131.17(4)(b) (b) Completion of a service agreement in which:

DHS 131.17(4)(b)1. 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.

DHS 131.17(4)(b)2. 2. The hospice agrees to provide care for the person.

DHS 131.17(4)(b)3. 3. The person or the person’s representative, if any, authorizes services in writing.

DHS 131.17(5) (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.

DHS 131.17 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.18 DHS 131.18 Discharge.

DHS 131.18(1) (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.

DHS 131.18(2) (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:

DHS 131.18(2)(a) (a) The hospice may discharge a patient:

DHS 131.18(2)(a)1. 1. Upon the request or with the informed consent of the patient or the patient’s representative.

DHS 131.18(2)(a)2. 2. If the patient elects care other than hospice care at any time.

DHS 131.18(2)(a)3. 3. If the patient elects active treatment, inconsistent with the role of palliative hospice care.

DHS 131.18(2)(a)4. 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.

DHS 131.18(2)(a)5. 5. If the patient requests services in a setting that exceeds the limitations of the hospice’s authority.

DHS 131.18(2)(a)6. 6. For nonpayment of charges, following reasonable opportunity to pay any deficiency.

DHS 131.18(2)(a)7. 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.

DHS 131.18(2)(a)8. 8. If the hospice determines that the patient is no longer terminally ill.

DHS 131.18(2)(b) (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: