Chapter DHS 133

DHS 133.09(3)(a)3.a. a. The safety of staff is compromised, as documented by the home health agency.

DHS 133.09(3)(a)3.b. b. The attending physician, advanced practice nurse prescriber, or physician assistant orders the discharge for emergency medical reasons.

DHS 133.09(3)(a)3.c. c. The patient no longer needs home health care as determined by the attending physician, advanced practice nurse prescriber, or physician assistant.

DHS 133.09(3)(a)4. 4. The home health agency shall insert a copy of the written discharge notice in the patient’s medical record.

DHS 133.09(3)(a)5. 5. The home health agency shall include in every written discharge notice to a patient or the patient’s legal representative all of the following:

DHS 133.09(3)(a)5.a. a. The reason for discharge.

DHS 133.09(3)(a)5.b. b. A notice of the patient’s right to file a complaint with the department and the department’s toll-free home health hotline telephone number and the address and telephone number of the department’s division of quality assurance.

DHS 133.09 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 133.09(3)(b) (b) Discharge summary. The home health agency shall complete a written discharge summary within 30 calendar days following discharge of a patient. The discharge summary shall include a description of the care provided and the reason for discharge. The home health agency shall place a copy of the discharge summary in the former patient’s medical record. Upon request, the home health agency shall provide a copy of the discharge summary to the former patient, the patient’s legal representative, the attending physician, advanced practice nurse prescriber, or physician assistant.

DHS 133.09 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; r. and recr. (3), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (1), (3) (a) 1., 2. (intro.), 3. b., c. and (b), r. and recr. (2) Register November 2007 No. 623, eff. 12-1-07; correction in (3) (a) 5. b. made under s. 13.92 (4) (b) 6., Stats., Register February 2008 No. 626; CR 16-077: am. (1), (3) (a) 1., 3. b., c., (b) Register September 2017 No. 741 eff. 10-1-17.

DHS 133.10 DHS 133.10 Services provided.

DHS 133.10(1) (1) Required services. The home health agency shall directly provide or arrange for at least part-time or intermittent nursing services and provide or arrange for home health aide services.

DHS 133.10(2) (2) Optional services. In addition to the services required under sub. (1), the agency may provide therapeutic services including, but not limited to, physical therapy, speech therapy, occupational therapy and medical social services.

DHS 133.10 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (1), Register, April, 2001, No. 544, eff. 5-1-01.

DHS 133.11 DHS 133.11 Referrals. When patients have needs which the home health agency cannot meet, the home health agency shall refer these patients to other agencies, social service organizations, or governmental units which are appropriate for unmet needs of the patients and which may be of assistance in meeting those needs. Referrals shall include referrals to meet the needs of patients for services at times before and after the normal business hours of the home health agency.

DHS 133.11 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.12 DHS 133.12 Coordination with other providers. The home health agency shall coordinate its services with any other health or social service providers serving the patient.

DHS 133.12 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.13 DHS 133.13 Emergency notification. Home health agency personnel shall promptly notify a patient’s physician, advanced practice nurse prescriber, physician assistant, or other appropriate medical personnel and guardian, if any, of any significant changes observed or reported in the patient’s condition.

DHS 133.13 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. Register September 2017 No. 741 eff. 10-1-17.

DHS 133.14 DHS 133.14 Skilled nursing services.

DHS 133.14(1) (1) Provision of services. Skilled nursing services shall be provided by or under the supervision of a registered nurse.

DHS 133.14(2) (2) Duties of the registered nurse. The registered nurse shall:

DHS 133.14(2)(a) (a) Make the initial evaluation visit to the patient.

DHS 133.14(2)(b) (b) Regularly reevaluate the patient’s needs.

DHS 133.14(2)(c) (c) Initiate the plan of care and necessary revisions.

DHS 133.14(2)(d) (d) Provide those services requiring substantial specialized care.

DHS 133.14(2)(e) (e) Initiate appropriate preventive and rehabilitative procedures.

DHS 133.14(2)(f) (f) Prepare clinical and progress notes.

DHS 133.14(2)(g) (g) Promptly inform either the physician, advanced practice nurse prescriber, or physician assistant, as well as other personnel participating in the patient’s care of changes in the patient’s condition and needs.

DHS 133.14(2)(h) (h) Arrange for counseling the patient and family in meeting related needs.

DHS 133.14(2)(i) (i) Participate in inservice programs for agency staff.

DHS 133.14(2)(j) (j) Supervise and teach other personnel.

DHS 133.14(3) (3) Scope of duties. Nurses shall perform only those duties within the scope of their licensure.

DHS 133.14(4) (4) Practical nursing. Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse.

DHS 133.14(5) (5) Coordination of services. A registered nurse shall maintain overall responsibility for coordinating services provided to the patient by the agency.

DHS 133.14(6) (6) Contracted registered nurse services. A home health agency may purchase registered nurse services on an hourly or per visit basis, in accordance with the requirements in s. DHS 133.19. Persons providing registered nurse services under contract shall meet the requirements in s. DHS 133.06 (4) (a) to (d), be assigned to duties for which they are licensed and trained and be utilized only in non-supervisory nursing assignments.

DHS 133.14 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; cr. (6), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (2) (c) and (g) Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. (2) (a) to (i) Register September 2017 No. 741 eff. 10-1-17; correction in (2) (b) made under s. 35.17, Stats., Register September 2017 No. 741.

DHS 133.15 DHS 133.15 Therapy services.

DHS 133.15(1) (1) Provision of services. Physical therapy, occupational therapy, speech therapy, and other therapy services provided directly by the home health agency or arranged for under s. DHS 133.19, shall be given in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (a), (c), (f), (h) and (i).

DHS 133.15(2) (2) Physical therapy. If offered, physical therapy shall be provided by a physical therapist or by a qualified therapy assistant under the supervision of a qualified physical therapist.

DHS 133.15(3) (3) Occupational therapy. If offered, occupational therapy shall be provided by an occupational therapist or by a qualified therapy assistant under the supervision of a qualified occupational therapist.

DHS 133.15(4) (4) Speech therapy. If offered, speech therapy shall be provided by a speech pathologist or audiologist.

DHS 133.15(5) (5) Other therapies. Therapies other than those under subs. (2), (3) and (4), shall be provided by persons qualified by training or by being licensed to perform the services.

DHS 133.15 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (1) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.16 DHS 133.16 Medical social services. If offered, medical social services shall be provided by a social worker in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (c), (f), (h) and (i).

DHS 133.16 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. Register November 2007 No. 623, eff. 12-1-07.

DHS 133.17 DHS 133.17 Home health aide services.

DHS 133.17(1) (1) Provision of services. When a home health agency provides or arranges for home health aide services, the services shall be given in accordance with the plan of care provided for under s. DHS 133.20, and shall be supervised by a registered nurse or, when appropriate, by a therapist.

DHS 133.17(2) (2) Duties. Home health aide services may include, but are not limited to:

DHS 133.17(2)(a) (a) Assisting patients with care of mouth, skin and hair, and bathing;

DHS 133.17(2)(b) (b) Assisting patients into and out of bed and assisting with ambulation;

DHS 133.17(2)(c) (c) Assisting with prescribed exercises which patients and home health aides have been taught by appropriate health personnel;

DHS 133.17(2)(d) (d) Preparing meals and assisting patients with eating;

DHS 133.17(2)(e) (e) Household services essential to health care at home;

DHS 133.17(2)(f) (f) Assisting patients to bathroom or in using bedpan;

DHS 133.17(2)(g) (g) Assisting patients with self-administration of medications;

DHS 133.17(2)(h) (h) Reporting changes in the patient’s condition and needs; and

DHS 133.17(2)(i) (i) Completing appropriate records.

DHS 133.17(3) (3) Assignments. Home health aides shall be assigned to specific patients by a registered nurse. Written instructions for patient care shall be prepared and updated for the aides at least each 60 days by a registered nurse or appropriate therapist, consistent with the plan of care under s. DHS 133.20. These instructions shall be reviewed by the immediate supervisors with their aides.

DHS 133.17(4) (4) Training of aides.

DHS 133.17(4)(a) (a) Curriculum. In addition to the orientation required by s. DHS 133.06 (4) (a), the agency shall ensure that all home health aides providing service have successfully completed a course of training covering at least the following subjects:

DHS 133.17(4)(a)1. 1. The role of the home health aide as a member of the health services team;

DHS 133.17(4)(a)2. 2. Instruction and supervised practice in in-home personal care of the sick, including personal hygiene and activities of daily living;

DHS 133.17(4)(a)3. 3. Principles of good nutrition and nutritional problems of the sick and elderly;

DHS 133.17(4)(a)4. 4. Preparation of meals, including special diets;

DHS 133.17(4)(a)5. 5. The needs and characteristics of the populations served, including the aged and disabled;

DHS 133.17(4)(a)6. 6. The emotional problems accompanying illness;

DHS 133.17(4)(a)7. 7. Principles and practices of maintaining a clean, healthy, and safe environment;

DHS 133.17(4)(a)8. 8. What, when and how to report to the supervisor; and

DHS 133.17(4)(a)9. 9. Record-keeping.

DHS 133.17(4)(b) (b) Training. Training, if provided by the agency, shall be directed by a registered nurse. Physicians, nutritionists, physical therapists, medical social workers, and other health personnel shall provide relevant training when pertinent to the duties to be assigned.

DHS 133.17 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (1) and (3) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.18 DHS 133.18 Supervisory visits.

DHS 133.18(1) (1) If a patient receives skilled nursing care, a registered nurse shall make a supervisory visit to each patient’s residence at least every 2 weeks. The visit may be made when the home health aide is present or when the home health aide is absent. If the patient is not receiving skilled nursing care, but is receiving another skilled service, the supervisory visit may be provided by the appropriate therapist providing a skilled service.

DHS 133.18(2) (2) If home health aide services are provided to a patient who is not receiving skilled nursing care, or physical, occupational or speech-language therapy, the registered nurse shall make a supervisory visit to the patient’s residence, when the home health aide is present or when the home health aide is absent, at least every 60 days to observe or assist, to assess relationships, and to determine whether goals are being met and whether home health services continue to be required.

DHS 133.18 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: r. and recr. Register November 2007 No. 623, eff. 12-1-07.

DHS 133.19 DHS 133.19 Services under contract.

DHS 133.19(1) (1) Terms. A written contract shall be required for health care services purchased on an hourly or per visit basis or by arrangement with another provider. The contract shall contain:

DHS 133.19(1)(a) (a) A statement that patients are accepted for care only by the primary home health agency;

DHS 133.19(1)(b) (b) A list of services to be provided;

DHS 133.19(1)(c) (c) Agreement to conform to all applicable agency policies including personnel qualifications;

DHS 133.19(1)(d) (d) A statement about the contractor’s responsibility for participating in developing plans of treatment;

DHS 133.19(1)(e) (e) A statement concerning the manner in which services will be controlled, coordinated and evaluated by the primary agency; and

DHS 133.19(1)(f) (f) Procedures for submitting clinical and progress notes, scheduling visits, and undertaking periodic patient evaluation.

DHS 133.19(2) (2) Qualifications of contractors. All providers of services under contract shall meet the same qualifications required of practitioners of the same service under the terms of this chapter.

DHS 133.19 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.20 DHS 133.20 Plan of care.

DHS 133.20(1) (1) Requirement. A plan of care, including physician’s, advanced practice nurse prescriber’s, or physician assistant’s orders, shall be established for every patient accepted for care and shall be incorporated in the patient’s medical record. An initial plan shall be developed within 72 hours of acceptance. The total plan of care shall be developed in consultation with the patient, home health agency staff, contractual providers, and the patient’s physician, advanced practice nurse prescriber, or physician assistant and shall be signed and dated by the physician, advanced practice nurse prescriber, or physician assistant within 20 working days following the patient’s admission for care.