Chapter DHS 132

DHS 132.46(1)(b) (b) The medical director or a physician designated by the facility.

DHS 132.46(1)(c) (c) At least 3 other members of the facility’s staff.

DHS 132.46(2) (2) Committee responsibilities. The quality assessment and assurance committee shall do all of the following:

DHS 132.46(2)(a) (a) Meet at least quarterly to identify quality of care issues with respect to which quality assessment and assurance activities are necessary.

DHS 132.46(2)(b) (b) Identify, develop and implement appropriate plans of action to correct identified quality deficiencies.

DHS 132.46(3) (3) Confidentiality. The department may not require disclosure of the records of the quality assessment and assurance committee except to determine compliance with the requirements of this section. This paragraph does not apply to any record otherwise specified in this chapter or s. 50.04 (3), 50.07 (1) (c) or 146.82 (2) (a) 5., Stats.

DHS 132.46 History History: CR 04-053: cr. Register October 2004 No. 586, eff. 11-1-04.

subch. V of ch. DHS 132 Subchapter V — Admissions, Retentions and Removals

DHS 132.51 DHS 132.51 Limitations on admissions and programs.

DHS 132.51(1) (1) License limitations.

DHS 132.51(1)(a) (a) Bed capacity. No facility may house more residents than the maximum bed capacity for which it is licensed. Persons participating in a day care program are not residents for purposes of this chapter.

DHS 132.51(1)(b) (b) Care levels.

DHS 132.51(1)(b)1. 1. No person who requires care greater than that which the facility is licensed to provide may be admitted to or retained in the facility.

DHS 132.51(1)(b)2. 2. No resident whose condition changes to require care greater than that which the facility is licensed to provide shall be retained.

DHS 132.51(1)(c) (c) Other conditions. The facility shall comply with all other conditions of the license.

DHS 132.51(2) (2) Other limitations on admissions.

DHS 132.51(2)(a) (a) Persons requiring unavailable services. Persons who require services which the facility does not provide or make available shall not be admitted or retained.

DHS 132.51(2)(b) (b) Communicable diseases.

DHS 132.51(2)(b)1. 1. ‘Communicable disease management.’ The nursing home shall have the ability to appropriately manage persons with communicable disease the nursing home admits or retains based on currently recognized standards of practice.

DHS 132.51(2)(b)2. 2. ‘Reportable diseases.’ Facilities shall report suspected communicable diseases that are reportable under ch. DHS 145 to the local public health officer or to the department’s bureau of communicable disease.

DHS 132.51 Note Note: For a copy of ch. DHS 145 which includes a list of the communicable diseases which must be reported, write the Bureau of Public Health, P.O. Box 309, Madison, WI 53701 (phone [phone]). There is no charge for a copy of ch. DHS 145. The referenced publications,“Guideline for Isolation Precautions in Hospitals and Guideline for Infection Control in Hospital Personnel” (HHS Publication No. (CSC) 83-8314) and “Universal Precautions for Prevention of . . . Bloodborne Pathogens in Health Care Settings”, may be purchased from the Superintendent of Documents, Washington D.C. 20402, and is available for review in the office of the Department’s Division of Quality Assurance and the Legislative Reference Bureau.

DHS 132.51(2)(c) (c) Abusive or destructive residents.

DHS 132.51(2)(c)1. 1. Notwithstanding s. DHS 132.13 (1), in this paragraph, “abusive” describes a resident whose behavior involves any single or repeated act of force, violence, harassment, deprivation or mental pressure which does or reasonably could cause physical pain or injury to another resident, or mental anguish or fear in another resident.

DHS 132.51(2)(c)2. 2. Residents who are known to be destructive of property, self-destructive, disturbing or abusive to other residents, or suicidal, shall not be admitted or retained, unless the facility has and uses sufficient resources to appropriately manage and care for them.

DHS 132.51(2)(d) (d) Developmental disabilities.

DHS 132.51(2)(d)1. 1. No person who has a developmental disability may be admitted to a facility unless the facility is certified as an intermediate care facility for individuals with intellectual disabilities, except that a person who has a developmental disability and who requires skilled nursing care services may be admitted to a skilled nursing facility.

DHS 132.51(2)(d)2. 2. Except in an emergency, no person who has a developmental disability may be admitted to a facility unless the county department under s. 46.23, 51.42, or 51.437, Stats., of the individual’s county of residence has recommended the admission.

DHS 132.51(2)(e) (e) Mental illness. Except in an emergency, no person who is under age 65 and has a mental illness as defined in s. 51.01 (13), Stats., may be admitted to a facility unless the county department under s. 46.23, 51.42 or 51.437, Stats., of the individual’s county of residence has recommended the admission.

DHS 132.51(2)(f) (f) Minors.

DHS 132.51(2)(f)1. 1. No person under the age of 18 years may be admitted, unless approved for admission by the department.

DHS 132.51(2)(f)2. 2. Requests for approval to admit a person under the age of 18 years shall be made in writing and shall include:

DHS 132.51(2)(f)2.a. a. A statement from the referring physician stating the medical, nursing, rehabilitation, and special services required by the minor;

DHS 132.51(2)(f)2.b. b. A statement from the administrator certifying that the required services can be provided;

DHS 132.51(2)(f)2.c. c. A statement from the attending physician certifying that the physician will be providing medical care; and

DHS 132.51(2)(f)2.d. d. A statement from the persons or agencies assuming financial responsibility.

DHS 132.51(2)(g) (g) Admissions 7 days a week. No facility may refuse to admit new residents solely because of the day of the week.

DHS 132.51(3) (3) Day care services. A facility may provide day care services to persons not housed by the facility, provided that:

DHS 132.51(3)(a) (a) Day care services do not interfere with the services for residents;

DHS 132.51(3)(b) (b) Each day care client is served upon the certification by a physician or physician’s assistant that the client is free from tuberculosis infection; and

DHS 132.51(3)(c) (c) Provision is made to enable day care clients to rest. Beds need not be provided for this purpose, and beds assigned to residents may not be provided for this purpose.

DHS 132.51 Note Note: For administration of medications to day care clients, see s. DHS 132.60 (5) (d) 6.; for required records, see s. DHS 132.45 (4) (c).

DHS 132.51 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; emerg. r. and recr. (2) (d) and (3), eff. 9-15-86; r. and recr. (2) (d) am. (1) (b) 1., (2) (e) 1. and 2. intro., (3) (a) and (b), (4) (c), Register, January, 1987, No. 373, eff. 2-1-87; am. (2) (b) 2. and 3. (d) 2., r. (2) (d) 3. and (3), renum. (2) (e), (f) and (4) to be (2) (f), (g) and (3), cr. (2) (e), Register, February, 1989, No. 398, eff. 3-1-89; correction in (2) (b) 3. made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536; CR 03-033: r. and recr. (2) (b) 1. Register December 2003 No. 576, eff. 1-1-04: CR 04-053: r. and recr. (2) (b) and am. (2) (c) Register October 2004 No. 586, eff. 11-1-04; correction in (2) (b) 2. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (2) (d) 1. Register May 2019 No. 761, eff. 6-1-19.

DHS 132.52 DHS 132.52 Procedures for admission.

DHS 132.52(2) (2) Physician’s orders. No person may be admitted as a resident except upon:

DHS 132.52(2)(a) (a) Order of a physician;

DHS 132.52(2)(b) (b) Receipt of information from a physician, before or on the day of admission, about the person’s current medical condition and diagnosis, and receipt of a physician’s initial plan of care and orders from a physician for immediate care of the resident; and

DHS 132.52(2)(c) (c) Receipt of certification in writing from a physician, physician assistant or advanced practice nurse prescriber that the individual has been screened for the presence of clinically apparent communicable disease that could be transmitted to other residents or employees, including screening for tuberculosis within 90 days prior to admission, or a physician, physician assistant or advanced practice nurse prescriber has ordered procedures to treat and limit the spread of any communicable diseases the individual may be found to have.

DHS 132.52(3) (3) Medical examination and evaluation.

DHS 132.52(3)(a) (a) Examination. Each resident shall have a physical examination by a physician or physician extender within 48 hours following admission unless an examination was performed within 15 days before admission.

DHS 132.52(3)(b) (b) Evaluation. Within 48 hours after admission the physician or physician extender shall complete the resident’s medical history and physical examination record.

DHS 132.52 Note Note: For admission of residents with communicable disease, see s. DHS 132.51 (2) (b).

DHS 132.52(4) (4) Initial care plan. Upon admission, a plan of care for nursing services based on an initial assessment shall be prepared and implemented, pending development of the plan of care required by s. DHS 132.60 (8).

DHS 132.52 Note Note: For care planning requirements, see s. DHS 132.60 (8).

DHS 132.52(7) (7) Family care information and referral. If the secretary of the department has certified that a resource center, as defined in s. DHS 10.13 (42), is available for the facility under s. DHS 10.71, the facility shall provide information to prospective residents and refer residents and prospective residents to the aging and disability resource center as required under s. 50.04 (2g) to (2i), Stats., and s. DHS 10.73.

DHS 132.52 History History: Cr. Register, July, 1982, No. 319, eff. 8-1-82; renum. (1) to (5) to be (2) to (6) and am. (2) and (3), cr. (1), Register, January, 1987, No. 373, eff. 2-1-87; cr. (7), Register, October, 2000, No. 538, eff. 11-1-00; CR 03-033: am. (2) (c) Register December 2003 No. 576, eff. 1-1-04; CR 04-053: am. (2) (c) and (4) and r. (5) and (6) Register October 2004 No. 586, eff. 11-1-04; CR 06-053: r. (1), Register August 2007 No. 620, eff. 9-1-07; corrections in (7) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 132.53 DHS 132.53 Transfers and discharges.

DHS 132.53(1) (1) Scope. This section shall apply to all resident transfers and discharges, except that in the event of conflict with s. 49.45 (6c) (c) and (d), 49.498 (4) or 50.03 (5m) or (14), Stats., the relevant statutory requirement shall apply.

DHS 132.53(2) (2) Conditions.

DHS 132.53(2)(a) (a) Prohibition and exceptions. No resident may be discharged or transferred from a facility, except:

DHS 132.53(2)(a)1. 1. Upon the request or with the informed consent of the resident or guardian;

DHS 132.53(2)(a)2. 2. For nonpayment of charges, following reasonable opportunity to pay any deficiency;

DHS 132.53(2)(a)3. 3. If the resident requires care other than that which the facility is licensed to provide;

DHS 132.53(2)(a)4. 4. If the resident requires care which the facility does not provide and is not required to provide under this chapter;

DHS 132.53(2)(a)5. 5. For medical reasons as ordered by a physician;

DHS 132.53(2)(a)6. 6. In case of a medical emergency or disaster;

DHS 132.53(2)(a)7. 7. If the health, safety or welfare of the resident or other residents is endangered, as documented in the resident’s clinical record;

DHS 132.53(2)(a)8. 8. If the resident does not need nursing home care;

DHS 132.53(2)(a)9. 9. If the short-term care period for which the resident was admitted has expired; or

DHS 132.53(2)(a)10. 10. As otherwise permitted by law.

DHS 132.53(2)(b) (b) Alternate placement.

DHS 132.53(2)(b)1. 1. Except for transfers or discharges under par. (a) 2. and 6., for nonpayment or in a medical emergency, no resident may be involuntarily transferred or discharged unless an alternative placement is arranged for the resident. The resident shall be given reasonable advance notice of any planned transfer or discharge and an explanation of the need for and alternatives to the transfer or discharge except when there is a medical emergency. The facility, agency, program or person to which the resident is transferred shall have accepted the resident for transfer in advance of the transfer, except in a medical emergency.

DHS 132.53(2)(b)2. 2. No resident may be involuntarily transferred or discharged under par. (a) 2. for nonpayment of charges if the resident meets both of the following conditions:

DHS 132.53(2)(b)2.a. a. He or she is in need of ongoing care and treatment and has not been accepted for ongoing care and treatment by another facility or through community support services; and

DHS 132.53(2)(b)2.b. b. The funding of the resident’s care in the nursing home under s. 49.45 (6m), Stats., is reduced or terminated because either the resident requires a level or type of care which is not provided by the nursing home or the nursing home is found to be an institution for mental diseases as defined under 42 CFR 435.1009.

DHS 132.53(3) (3) Procedures.

DHS 132.53(3)(a) (a) Notice. The facility shall provide a resident, the resident’s physician and, if known, an immediate family member or legal counsel, guardian, relative or other responsible person at least 30 days notice of transfer or discharge under sub. (2) (a) 2. to 10., and the reasons for the transfer or discharge, unless the continued presence of the resident endangers the health, safety or welfare of the resident or other residents. The notice shall also contain the name, address and telephone number of the board on aging and long-term care. For a resident with developmental disability or mental illness, the notice shall contain the mailing address and telephone number of the protection and advocacy agency designated under s. 51.62 (2) (a), Stats.

DHS 132.53(3)(b) (b) Planning conference.

DHS 132.53(3)(b)1. 1. Unless circumstances posing a danger to the health, safety or welfare of a resident require otherwise, at least 7 days before the planning conference required by subd. 2., the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident’s physician, shall be given a notice containing the time and place of the conference, a statement informing the resident that any persons of the resident’s choice may attend the conference, and the procedure for submitting a complaint to the department.

DHS 132.53(3)(b)2. 2. Unless the resident is receiving respite care or unless precluded by circumstances posing a danger to the health, safety, or welfare of a resident, prior to any involuntary transfer or discharge under sub. (2) (a) 2. to 10., a planning conference shall be held at least 14 days before transfer or discharge with the resident, guardian, if any, any appropriate county agency, and others designated by the resident, including the resident’s physician, to review the need for relocation, assess the effect of relocation on the resident, discuss alternative placements and develop a relocation plan which includes at least those activities listed in subd. 3.

DHS 132.53(3)(b)3. 3. Transfer and discharge activities shall include:

DHS 132.53(3)(b)3.a. a. Counseling regarding the impending transfer or discharge;

DHS 132.53(3)(b)3.b. b. The opportunity for the resident to make at least one visit to the potential alternative placement, if any, including a meeting with that facility’s admissions staff, unless medically contraindicated or waived by the resident;

DHS 132.53(3)(b)3.c. c. Assistance in moving the resident and the resident’s belongings and funds to the new facility or quarters; and

DHS 132.53(3)(b)3.d. d. Provisions for needed medications and treatments during relocation.

DHS 132.53(3)(b)4. 4. A resident who is transferred or discharged at the resident’s request shall be advised of the assistance required by subd. 3. and shall be provided with that assistance upon request.

DHS 132.53(3)(c) (c) Records. Upon transfer or discharge of a resident, the documents required by s. DHS 132.45 (5) (L) and (6) (h) shall be prepared and provided to the facility admitting the resident, along with any other information about the resident needed by the admitting facility.

DHS 132.53(4) (4) Transfer agreements.

DHS 132.53(4)(a) (a) Requirement. Each facility shall have in effect a transfer agreement with one or more hospitals under which inpatient hospital care or other hospital services are available promptly to the facility’s residents when needed. Each intermediate care facility shall also have in effect a transfer agreement with one or more skilled care facilities.

DHS 132.53(4)(b) (b) Transfer of residents. A hospital and a facility shall be considered to have a transfer agreement in effect if there is a written agreement between them or, when the 2 institutions are under common control, if there is a written statement by the person or body which controls them, which gives reasonable assurance that: