Chapter DHS 133

DHS 133.03(4)(b)1. 1. Within 90 days after receiving a complete application, the department shall either approve the application and issue a license or deny the application, unless either of the following applies:

DHS 133.03(4)(b)1.a. a. The department has not yet completed its investigation; or

DHS 133.03(4)(b)1.b. b. The applicant or agency is temporarily unable to conform to all the rules in this chapter.

DHS 133.03(4)(b)2. 2. If subd. 1. a. or b. applies, the department may, within the 90-day period in subd. 1., issue a provisional license for a term of 90 days. The department may, upon the agency’s request, renew that license for additional 90-day terms not to exceed one year from the original issuance date of the provisional license.

DHS 133.03(4)(b)3. 3. During the provisional period specified in subd. 2., the home health agency shall actively serve at least 10 patients requiring skilled nursing care or other therapeutic services in Wisconsin. At least seven of the 10 patients shall be actively receiving skilled nursing services when the home health agency submits a written request for an on-site licensure survey. At least 3 patients shall be receiving skilled nursing services at the time of the on-site licensure survey.

DHS 133.03(4)(c) (c) The department may not charge an additional fee for the original regular license issued to a home health agency that has not had a provisional license.

DHS 133.03(4)(d) (d) After the department issues an initial regular license, the department may not charge the home health agency an additional licensing fee until the annual, continuing license fee is due. The fee shall be 0.25% of patient fee revenue of the home health agency based on the agency’s financial information submitted to the department in the form prescribed by the department, with a maximum fee of $2,500 and a minimum fee of $500.

DHS 133.03(5) (5) Licensure term. A home health agency regular license is valid indefinitely unless suspended, revoked or voluntarily surrendered.

DHS 133.03(6) (6) Report of changes.

DHS 133.03(6)(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 133.03(6)(b) (b) Changes requiring new application. A new application under sub. (3) shall be submitted to the department within 10 working days when any of the following changes has occurred:

DHS 133.03(6)(b)1. 1. The corporate licensee has transferred 50% or more of the issued stock to another party or other parties;

DHS 133.03(6)(b)2. 2. The licensee has transferred ownership of 50% or more of the assets to another party or other parties;

DHS 133.03(6)(b)3. 3. There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits; or

DHS 133.03(6)(b)4. 4. The licensee has relinquished management of the agency.

DHS 133.03(7) (7) Denial or revocation. If at any time the department determines that there has been a substantial failure to comply with the requirements of this chapter, or that the license fee has not been paid, or that the information required by the department for licensure is not provided, it shall deny or revoke the license after providing notice to the licensee.

DHS 133.03(8) (8) Hearings.

DHS 133.03(8)(a) (a) An applicant or home health agency may appeal the following department actions:

DHS 133.03(8)(a)1. 1. Denial or revocation of a license.

DHS 133.03(8)(a)2. 2. Issuance of a statement of deficiency that results in the imposition of a plan of correction under s. DHS 133.04 (4) (b) 3. or the imposition of penalties under s. DHS 133.04 (4) (c).

DHS 133.03(8)(b) (b) If a home health agency wants to contest a department action specified in par. (a), it shall file a written request for a hearing under s. 227.44, Stats., with the department of administration’s division of hearings and appeals within 10 days of receipt of notice of the contested action.

DHS 133.03 Note Note: The mailing address of the Division of Hearing and Appeals is: P.O. Box 7875, Madison, WI 53707-7875. The facsimile transmission number is 608-267-2744. The hearing request may be delivered in person to the Division of Hearings and Appeals at: 5005 University Avenue, Suite 201, Madison, WI.

DHS 133.03(9) (9) Reporting. Every 12 months, on a schedule determined by the department, a licensed home health agency shall submit to the department an annual report in the form and containing the information that the department requires, including payment of the fee required under s. 50.49 (2) (b), Stats., and sub. (4) (d). If a complete annual report is not timely filed, the department shall issue a warning to the licensee. If a licensed home health agency 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 133.03 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; reprinted to correct printing error in (3) (e), Register, September, 1984, No. 345; r. and recr. (4) and (5), Register, November, 1985, No. 359, eff. 12-1-85; correction in (4) (b) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476; am. (6) (b), Register, October, 1995, No. 478, eff. 11-1-95; r. and recr. (5), r. (6), renum. (7) to (9) to be (6) to (8), cr. (9), Register, August, 2000, No. 536, eff. 9-1-00; r. and recr. (3) (h), (4) (b), (c), (8), cr. (4) (d), am. (9), Register, April, 2001, No. 544, eff. 5-1-01; correction in (8) (a) 2. was made under s. 13.93 (2m) (b) 7., Stats., Register August 2001 No. 548; CR 03-033: am. (8) (b) Register December 2003 No. 576, eff. 1-1-04; CR 07-060: am. (4) (b) 3. and (5), cr. (3) (i) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.04 DHS 133.04 Inspections.

DHS 133.04(1) (1) Regular surveys. The department may make any inspections and investigations it considers necessary, including review of clinical and administrative records, subject only to restrictions of law.

DHS 133.04(2) (2) Complaints. The department may investigate any complaints received by it concerning the operation or services of a home health agency.

DHS 133.04 Note 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.

DHS 133.04(3) (3) Patient visits. The department may contact patients of a home health agency as part of an inspection or investigation. A licensee shall provide the department a list of names, addresses and other identifying information of current and past patients as may be requested. The department may select the names of the patients to be visited and may visit these patients with their approval.

DHS 133.04(4) (4) Enforcement.

DHS 133.04(4)(a) (a) Statement of deficiency. Upon determining that a home health agency is in violation of any requirement of this chapter, the department shall promptly serve a statement of deficiency upon the administrator or other designated representative of the home health agency. The statement of deficiency shall specify the rule violated and state the facts that constitute the violation.

DHS 133.04(4)(b) (b) Plan of correction.

DHS 133.04(4)(b)1. 1. Within 10 working days of receipt of the statement of deficiency, the home health agency shall submit a plan of correction to the department for approval detailing how the agency will correct the violation or how the agency has corrected the violation. The department may require that a plan of correction be submitted for approval within a shorter specified time for violations the department determines may be harmful to the health, safety, welfare, or rights of patients.

DHS 133.04(4)(b)2. 2. The department may require the home health agency to modify the proposed plan of correction before the department approves the plan of correction.

DHS 133.04(4)(b)3. 3. The department may require a licensee to implement and comply with a plan of correction that is developed by the department.

DHS 133.04(4)(b)4. 4. The department shall verify that the home health agency has completed the plan of correction submitted or imposed in par. (b).

DHS 133.04(4)(c) (c) Penalties. The department may impose any of the following penalties for a violation of a requirement of this chapter:

DHS 133.04(4)(c)1. 1. Suspend admissions of new patients until the department has verified that the home health agency has completed the plan of correction under par. (b).

DHS 133.04(4)(c)2. 2. Place conditions on the license.

DHS 133.04(4)(c)3. 3. Revoke the license as specified in s. DHS 133.03 (7).

DHS 133.04(5) (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.

DHS 133.04(6) (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.

DHS 133.04 History 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 DHS 133.05 Governance.

DHS 133.05(1) (1) Governing body. Each home health agency shall have a governing body which shall:

DHS 133.05(1)(a) (a) Adopt governing policies in the form of by-laws, charter, written policies or other official means;

DHS 133.05(1)(b) (b) Adopt a statement detailing the services to be provided;

DHS 133.05(1)(c) (c) Oversee the management of the agency;

DHS 133.05(1)(d) (d) Appoint an administrator; and

DHS 133.05(1)(e) (e) Provide for a qualified substitute administrator to act in absence of the administrator.

DHS 133.05(2) (2) Professional advisory body.

DHS 133.05(2)(a) (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.

DHS 133.05(2)(b) (b) The advisory group shall:

DHS 133.05(2)(b)1. 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;

DHS 133.05(2)(b)2. 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

DHS 133.05(2)(b)3. 3. Document all meetings by dated minutes.

DHS 133.05 History 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 DHS 133.06 Administration.

DHS 133.06(1) (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.

DHS 133.06(2) (2) Duties of the administrator. The administrator shall:

DHS 133.06(2)(a) (a) Be knowledgeable about this chapter, and shall take all reasonable steps to ensure compliance of the agency with the requirements of this chapter;

DHS 133.06(2)(b) (b) Administer the entire home health services of the agency; and

DHS 133.06(2)(c) (c) Cooperate with the department in investigating compliance with this chapter.

DHS 133.06(3) (3) Personnel policies. The agency shall prepare in writing and review annually the following policies:

DHS 133.06(3)(a) (a) A system for recruitment, orientation and continuing training of staff; and

DHS 133.06(3)(b) (b) A plan for the evaluation of staff in the performance of duties.

DHS 133.06(4) (4) Employees.

DHS 133.06(4)(a) (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:

DHS 133.06(4)(a)1. 1. Policies and objectives of the agency;

DHS 133.06(4)(a)2. 2. Information concerning specific job duties;

DHS 133.06(4)(a)3. 3. The functions of health personnel employed by the home health agency and how they relate to each other in providing services;

DHS 133.06(4)(a)4. 4. Information about other community agencies, including emergency medical services; and

DHS 133.06(4)(a)5. 5. Ethics, confidentiality of patient information, and patients’ rights.

DHS 133.06(4)(b) (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.

DHS 133.06(4)(c) (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.

DHS 133.06(4)(d) (d) Health.

DHS 133.06(4)(d)1. 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.

DHS 133.06(4)(d)2. 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.

DHS 133.06(4)(d)3. 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.

DHS 133.06 Note 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.

DHS 133.06(4)(e) (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.

DHS 133.06(4)(f) (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.

DHS 133.06(4)(g) (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.

DHS 133.06(5) (5) Infection control and prevention. Each home health agency shall do all of the following:

DHS 133.06(5)(a) (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.

DHS 133.06(5)(b) (b) Provide equipment and supplies necessary for all staff having direct patient care contact to minimize the risk of infection while providing patient care.

DHS 133.06(5)(c) (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.

DHS 133.06 History 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 DHS 133.07 Evaluation.