Chapter DHS 133

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.

DHS 133.07(1) (1) Requirement. An evaluation of the home health agency’s total program shall be conducted at least once a year by the advisory group required by s. DHS 133.05 (2), home health agency staff and consumers.

DHS 133.07(2) (2) Method of evaluation. The agency shall establish methods to determine whether the established programs and service policies are effective and whether service policies and procedures are substantially followed by agency staff. These methods shall include a review of a sample of patient records to determine whether services are being provided appropriately and the extent to which the needs of patients are met.

DHS 133.07(3) (3) Reports. Results of the evaluations shall be recorded in writing and reported to those responsible for the operation of the agency.

DHS 133.07(4) (4) Management review. The agency shall periodically review its policies and administrative practices to determine the extent to which they promote appropriate, adequate, effective and efficient patient care.

DHS 133.07 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.08 DHS 133.08 Patient rights.

DHS 133.08(1) (1) Service applicant. The home health agency shall promptly determine the applicant’s suitability for services and, if the applicant is accepted, shall promptly provide services to the individual. If the applicant is found unsuitable for acceptance, the agency shall inform the applicant of other service providers in the area.

DHS 133.08(2) (2) Policies. The home health agency shall provide the patient with a written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation visit before the initiation of treatment. Each patient receiving care from the agency shall have all of the following rights:

DHS 133.08(2)(a) (a) To be fully informed, as evidenced by home health agency documentation, of all rules and regulations governing patient responsibilities;

DHS 133.08(2)(b) (b) To be fully informed, prior to or at the time of admission, of services available from the agency and of related charges, including any charges for services for which the patient or a private insurer may be responsible;

DHS 133.08(2)(c) (c) To be informed of all changes in services and charges as they occur;

DHS 133.08(2)(d) (d) To be fully informed of one’s own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of the home health services, including referral to health care institutions or other agencies, and to refuse to participate in experimental research;

DHS 133.08(2)(e) (e) To refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal;

DHS 133.08(2)(f) (f) To confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the agency, except in the case of transfer to another health facility, or as required by law or third-party payment contract;

DHS 133.08(2)(g) (g) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs; and

DHS 133.08(2)(h) (h) To be taught, and have the family taught, the treatment required, so that the patient can, to the extent possible, help himself or herself, and the family or other party designated by the patient can understand and help the patient.

DHS 133.08(2)(i) (i) To exercise his or her rights as a patient of the home health agency;

DHS 133.08(2)(j) (j) To have the patient’s family or legal representative exercise the patient’s rights when the patient has been judged incompetent by a court of law.

DHS 133.08(3) (3) Complaints. At the same time that the statement of patient rights is distributed under sub. (2), the home health agency shall provide the patient or guardian with a statement, provided by the department, setting forth the right to and procedure for registering complaints with the department.

DHS 133.08 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; reprinted to correct printing error in (2) (g), Register, September, 1984, No. 345; CR 07-060: r. and recr. (2) (intro.) and (a), cr. (2) (i) and (j) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.09 DHS 133.09 Acceptance and discharge of patients.