Chapter DHS 132

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.

DHS 132.31(1)(p)4. 4. No facility may require, offer or provide an identification tag for a resident or any other item which discloses the source from which the facility’s charges for that resident’s care are paid.

DHS 132.31(4) (4) Notification.

DHS 132.31(4)(a) (a) Serving notice. Facility staff shall verbally explain to each new resident and to that person’s guardian, if any, prior to or at the time of the person’s admission to the facility, these rights and the facility’s policies and regulations governing resident conduct and responsibilities.

DHS 132.31(4)(b) (b) Amendments. All amendments to the rights provided under this section and all amendments to the facility regulations and policies governing resident conduct and responsibilities require notification of each resident or guardian, if any, or any other responsible person designated in writing by the resident, at the time the amendment is put into effect. The facility shall provide the resident or guardian, if any, or any other responsible person designated in writing by the resident and each member of the facility’s staff with a copy of all amendments.

DHS 132.31(6) (6) Complaints. Any person may file a complaint with a licensee or the department regarding the operation of a facility. Complaints may be made orally or in writing.

DHS 132.31 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. (1) (c), (d), (j), (m), (2) to (4), renum. (5) to (6), cr. (1) (p) and (5), Register, January, 1987, No. 373, eff. 2-1-87; am. (1) (d) 1. intro., (k) and (4) (b), Register, February, 1989, No. 398, eff. 3-1-89; am. (6) (e), Register, August, 2000, No. 536, eff. 9-1-00; CR 04-053: am. (1) (k) Register October 2004 No. 586, eff. 11-1-04; correction in (2) made under s. 13.93 (2m) (b) 7., Stats., Register August 2007, No. 620; CR 06-053: renum. (6) (a) to be (6), r. (1) (a) to (c), (e) to (o), (2), (3), (4) (c), (5) and (6) (b) to (e), am. (1) (intro.) and (4) (a), Register August 2007 No. 620, eff. 9-1-07; correction in (1) (p) 3. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 132.33 DHS 132.33 Housing residents in locked units.

DHS 132.33(1) (1) Definitions. As used in this section:

DHS 132.33(1)(a) (a) “Locked unit” means a ward, wing or room which is designated as a protective environment and is secured in a manner that prevents a resident from leaving the unit at will. A physical restraint applied to the body is not a locked unit. A facility locked for purposes of security is not a locked unit, provided that residents may exit at will.

DHS 132.33(1)(b) (b) “Consent” means a written, signed request given without duress by a resident capable of understanding the nature of the locked unit, the circumstances of one’s condition, and the meaning of the consent to be given.

DHS 132.33(2) (2) Restriction. Except as otherwise provided by this section, no resident may be housed in a locked unit. Physical or chemical restraints or repeated use of emergency restraint under sub. (5) may not be used to circumvent this restriction. Placement in a locked unit shall be based on the determination that this placement is the least restrictive environment consistent with the needs of the person.

DHS 132.33 Note Note: For requirements relating to the use of physical and chemical restraints, including locked rooms, see s. DHS 132.60 (6).

DHS 132.33(3) (3) Placement.

DHS 132.33(3)(a) (a) A resident may be housed in a locked unit under any one of the following conditions:

DHS 132.33(3)(a)1. 1. The resident consents under sub. (4) to being housed on a locked unit;

DHS 132.33(3)(a)2. 2. The court that protectively placed the resident under s. 55.15, Stats., made a specific finding of the need for a locked unit;

DHS 132.33(3)(a)3. 3. The resident has been transferred to a locked unit pursuant to s. 55.15, Stats., and the medical record contains documentation of the notice provided to the guardian, the court and the agency designated under s. 55.02, Stats.; or

DHS 132.33(3)(a)4. 4. In an emergency governed by sub. (5).

DHS 132.33(3)(b) (b) A facility may transfer a resident from a locked unit to an unlocked unit without court approval pursuant to s. 55.15, Stats., if it determines that the needs of the resident can be met on an unlocked unit. Notice of the transfer shall be provided as required under s. 55.15, Stats., and shall be documented in the resident’s medical record.