Chapter DHS 134

DHS 134.14(7) (7) Condition for medical assistance provider certification. In order to claim reimbursement from the department’s medical assistance program for the cost of care provided to medical assistance recipients, an FDD is required to be a certified provider under that program. The sole condition for certification, stated in s. DHS 105.12, is that the FDD be licensed under this chapter. For services covered by the MA program and for prior authorization requirements, see chs. DHS 101 to 108.

DHS 134.14 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; corrections in (2) (a) 2. and (7) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 2000, No. 532; am. (5), cr. (5m), Register, August, 2000, No. 536, eff. 9-1-00; CR 03-033: am. (1), (2) (a) (intro.) and (5m) Register December 2003 No. 576, eff. 1-1-04; CR 04-053: am. (2) (a) 1. Register October 2004 No. 586, eff. 11-1-04; CR 07-042: cr. (5r) Register October 2007 No. 622, eff. 11-1-07; corrections in (2) and (7) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 134.15 DHS 134.15 Waivers and variances.

DHS 134.15(1) (1) Definitions. In this section:

DHS 134.15(1)(a) (a) “Variance” means the approval of an alternate requirement in place of a requirement of this chapter.

DHS 134.15(1)(b) (b) “Waiver” means the granting of an exemption from a requirement of this chapter.

DHS 134.15(2) (2) Requirements for waivers or variances. The department may grant a waiver or variance if the department finds that the waiver or variance will not adversely affect the health, safety or welfare of residents, taking into account the size of the facility and the condition of the residents, and that:

DHS 134.15(2)(a) (a) Strict enforcement of a requirement would result in unreasonable hardship on the facility or a resident; or

DHS 134.15(2)(b) (b) An alternative to a rule which may involve introducing a new concept, method, procedure or technique, using new equipment, modifying personnel qualifications or providing for the conduct of pilot projects, is in the interests of better care or management.

DHS 134.15(3) (3) Procedures.

DHS 134.15(3)(a) (a) Applications.

DHS 134.15(3)(a)1. 1. All applications for a waiver or variance shall be made in writing to the department, specifying the following:

DHS 134.15(3)(a)1.a. a. The rule from which the waiver or variance is requested;

DHS 134.15(3)(a)1.b. b. The time period for which the waiver or variance is requested;

DHS 134.15(3)(a)1.c. c. If the request is for a variance, the specific alternative action which the facility proposes;

DHS 134.15(3)(a)1.d. d. The reasons for the request; and

DHS 134.15(3)(a)1.e. e. Assurances that sub. (2) would be satisfied.

DHS 134.15(3)(a)2. 2. A request for a waiver or variance may be made at any time.

DHS 134.15(3)(a)3. 3. The department may require additional information from the facility before acting on the request.

DHS 134.15 Note Note: A request for a waiver or variance should be addressed to: Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.

DHS 134.15(3)(b) (b) Grants and denials.

DHS 134.15(3)(b)1. 1. The department shall grant or deny each request for waiver or variance in writing. Notice of denial shall contain the reasons for denial. If a notice of a denial is not issued within 60 days after the receipt of a complete request, the waiver or variance shall be automatically approved.

DHS 134.15(3)(b)2. 2. The department may impose whatever conditions on the granting of a waiver or variance that it deems necessary.

DHS 134.15(3)(b)3. 3. The department and a facility may agree to modify the terms of a requested variance.

DHS 134.15(3)(b)4. 4. The department may limit the duration of any waiver or variance.

DHS 134.15(3)(c) (c) Appeal.

DHS 134.15(3)(c)1. 1. A facility may ask the administrator of the department’s division of long term care to review the reasonableness of the denial of a request for a waiver or variance. The administrator shall make that review and notify the facility of his or her decision within 20 days following receipt of the appeal.

DHS 134.15 Note Note: To appeal the denial of a request for a waiver or variance, write: Administrator, Division of Long Term Care, P.O. Box 7851, Madison, Wisconsin 53707-7851.

DHS 134.15(3)(c)2. 2.

DHS 134.15(3)(c)2.a. a. A denial of a waiver or variance may be contested by requesting a hearing as provided by ch. 227, Stats.

DHS 134.15(3)(c)2.b. b. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable.

DHS 134.15(3)(d) (d) Revocation. The department may revoke a waiver or variance if:

DHS 134.15(3)(d)1. 1. The department determines that the waiver or variance is adversely affecting the health, safety or welfare of the residents;

DHS 134.15(3)(d)2. 2. The department determines that the facility has failed to comply with a variance as granted;

DHS 134.15(3)(d)3. 3. The licensee notifies the department in writing that he or she wishes to relinquish the waiver or variance and be subject to the rule previously waived or varied; or

DHS 134.15(3)(d)4. 4. Revocation is necessary because of a change in the law.

DHS 134.15 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; correction in (3) (c) 1. made under s. 13.93 (2m) (b) 6., Stats., Register December 2003 No. 576; correction in (3) (c) 1. made under s. 13.92 (4) (b) 6., Stats., Register January 2009 No. 637.

subch. II of ch. DHS 134 Subchapter II — Residents’ Rights and Protections

DHS 134.31 DHS 134.31 Rights of residents.

DHS 134.31(1) (1) Facility obligations. All facilities shall comply with the requirements governing residents’ rights enumerated in s. 50.09, Stats., and this chapter. Facilities shall have written policies and procedures to ensure that staff recognize that residents have these rights, and that staff respect and enforce these rights. The written policies and procedures shall encourage residents to exercise their rights on their own behalf whenever practicable.

DHS 134.31(2) (2) Delegation of rights and responsibilities. Each facility shall have written policies and procedures that provide that:

DHS 134.31(2)(a) (a) If a resident is adjudicated incompetent under ch. 54, Stats., all rights and responsibilities of the resident which the resident is not competent to exercise pass to the resident’s guardian pursuant to s. 50.09 (3), Stats., except as otherwise provided by law; and

DHS 134.31(2)(b) (b) If there has been no adjudication of incompetency but the resident requires assistance in understanding or exercising his or her rights, that assistance is provided to the resident to the extent necessary for the resident to receive the benefits of this section, including involvement of the next of kin or sponsoring agency and notification of the appropriate county agency if there is need for guardianship.

DHS 134.31(3) (3) Residents’ rights. Every resident, except as provided in sub. (4), has the right to:

DHS 134.31(3)(a) (a) Communications. Have private and unrestricted communications, unless medically contraindicated as documented by the resident’s physician in the resident’s medical record, except that receipt of mail from any source and communication with public officials or with the resident’s attorney may not be restricted in any event. The right to private and unrestricted communications includes the right to:

DHS 134.31(3)(a)1. 1. Receive, send and mail sealed, unopened correspondence. No resident’s incoming or outgoing correspondence may be opened, delayed, held or censored, except that a resident or guardian may direct in writing that specified incoming correspondence be opened, delayed or held;

DHS 134.31(3)(a)2. 2. Use a telephone for private communications, unless medically contraindicated in which case the resident shall be informed in writing of the grounds for withdrawal of the right and shall have the opportunity for a review of the withdrawal of the right;

DHS 134.31(3)(a)3. 3. Have private visits, pursuant to a reasonable written visitation policy, unless medically contraindicated in which case the resident shall be informed in writing of the grounds for withdrawal of the right and shall have the opportunity for a review of the withdrawal of the right. The facility shall ensure that individuals allowed to visit under this paragraph do not infringe on the privacy and rights of the other residents;

DHS 134.31(3)(a)4. 4. Communicate with staff in regard to all aspects of the treatment program. To facilitate this communication, the facility shall:

DHS 134.31(3)(a)4.a. a. Keep the resident’s legal guardian or, if there is no guardian, family or next of kin, informed of resident activities and significant changes in the resident’s condition;

DHS 134.31(3)(a)4.b. b. Answer communications from resident’s relatives or guardian promptly and appropriately;

DHS 134.31(3)(a)4.c. c. Allow close relatives and guardians to visit at any reasonable hour, without prior notice, unless an interdisciplinary team determines that this would not be appropriate; and

DHS 134.31(3)(a)4.d. d. Allow parents and guardians to visit any part of the facility that provides services to residents.

DHS 134.31(3)(b) (b) Grievances. Present grievances on the resident’s own behalf or through others to the facility’s staff or administrator, to public officials or to any other person without justifiable fear of reprisal and to join with other residents or individuals within or outside of the facility to work for improvements in resident care.

DHS 134.31(3)(c) (c) Finances. Manage one’s own financial affairs, including any personal allowances under federal or state programs. No resident funds may be held or spent except in accordance with the following requirements:

DHS 134.31(3)(c)1. 1. A facility may not hold or spend a resident’s funds unless the resident or another person legally responsible for the resident’s funds authorizes this action in writing. The facility shall obtain separate authorizations for holding a resident’s funds and for spending a resident’s funds. The authorization for spending a resident’s funds may include a spending limit. Expenditures that exceed a designated spending limit require a separate authorization for each individual occurrence;

DHS 134.31(3)(c)2. 2. Any resident funds held or controlled by the facility and any earnings from them shall be credited to the resident and may not be commingled with other funds or property except that of other residents;

DHS 134.31(3)(c)3. 3. The facility shall furnish a resident, the resident’s guardian or a representative designated by the resident with at least an annual statement of all funds and properties held by the facility for the resident and all expenditures made from the resident’s account, and a similar statement at the time of the resident’s permanent discharge. If the resident has authorized discretionary expenditures by the facility and the facility has accepted responsibility for these expenditures, upon written request of the resident, the resident’s guardian or a designated representative of the resident, the facility shall issue this statement monthly;

DHS 134.31(3)(c)4. 4. The facility shall maintain a record of all expenditures, disbursements and deposits made on behalf of the resident; and

DHS 134.31(3)(c)5. 5. The facility shall provide training and counseling to residents in the management and use of money as necessary to meet each resident’s needs.

DHS 134.31(3)(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 the services available or in charges for services, as follows:

DHS 134.31(3)(d)1. 1. No person may be admitted to a facility unless that person or that person’s guardian or designated representative has signed an acknowledgement of having received a statement of information before or on the day of admission which includes 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 134.70 (3):

DHS 134.31(3)(d)1.a. a. An accurate description of the basic services provided by the facility, the rates charged for those services and the method of payment for them;

DHS 134.31(3)(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 134.31(3)(d)1.c. c. The method for notifying residents of a change in rates or fees;

DHS 134.31(3)(d)1.d. d. Terms for refunding advance payments in the event of a resident’s transfer, death or voluntary or involuntary discharge;

DHS 134.31(3)(d)1.e. e. Terms for holding and charging for a bed during a resident’s temporary absence;

DHS 134.31(3)(d)1.f. f. Conditions for involuntary discharge or transfer, including transfer within the facility;

DHS 134.31(3)(d)1.g. g. Information about the availability of storage space for personal effects; and

DHS 134.31(3)(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 134.31(3)(d)2. 2. No statement of admission information may be in conflict with any part of this chapter.

DHS 134.31(3)(e) (e) Courteous treatment. Be treated with courtesy, respect and full recognition of one’s dignity and individuality by all employees of the facility and by all licensed, certified and registered providers of health care and pharmacists with whom the resident comes in contact.

DHS 134.31(3)(f) (f) Privacy. Have privacy in treatment, living arrangements and caring for personal needs, including:

DHS 134.31(3)(f)1. 1. If both spouses are residents of the same facility, they shall be permitted to share a room unless medically contraindicated as documented by either resident’s physician in the resident’s medical record;

DHS 134.31(3)(f)2. 2. Case discussion, consultation, examination and treatment shall be conducted discreetly. Persons not directly involved in the resident’s care shall require the resident’s permission to be present; and

DHS 134.31(3)(f)3. 3. Confidentiality of health and personal records, and the right to refuse their release to any individual outside the facility except in the case of the resident’s transfer to another facility or as required by ss. 146.81 to 146.83, Stats., s. 51.30, Stats., and ch. DHS 92 or other statutes or rules or third party payment contracts.

DHS 134.31(3)(g) (g) Work. Not be required to perform work for the facility unless the work is included for therapeutic purposes in the resident’s plan of care.

DHS 134.31 Note Note: Requirements governing wages for patient labor are found in s. 51.61 (1) (b) and ch. 104, Stats., and ch. DWD 272.

DHS 134.31(3)(h) (h) Outside activities. Meet with and participate in activities of social, religious and community groups at the resident’s discretion and with the permission of the resident’s parents, if the resident is under 18 years of age, or guardian, if any, unless contraindicated as documented by the QIDP in the resident’s record.

DHS 134.31(3)(i) (i) Leaves. Take frequent and informal leaves from the facility for visits, trips or vacations. The facility shall encourage residents to take these leaves and shall assist the resident in making arrangements for the leaves.

DHS 134.31(3)(j) (j) Personal possessions. Retain and use clothing and personal belongings and retain, as space permits, other personal possessions in a reasonably secure manner.

DHS 134.31(3)(k) (k) Transfer or discharge. Be transferred or discharged, and 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 where 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 134.31 Note Note: See s. DHS 134.53.

DHS 134.31(3)(L) (L) Abuse and restraints. Be free from mental and physical abuse, and be free from physical restraints except as authorized in writing by a physician for a specified and limited period of time and documented in the resident’s medical record.

DHS 134.31 Note Note: See s. DHS 134.33 on use of locked units, s. DHS 134.46 which prohibits abuse of residents, and s. DHS 134.60 (5) on use of physical restraints.

DHS 134.31(3)(m) (m) Care. Receive adequate and appropriate care and treatment that is within the capacity of the facility to provide as indicated under s. DHS 134.51.

DHS 134.31(3)(n) (n) Choice of provider. Use the licensed, certified or registered provider of health care and pharmacist of the resident’s choice.

DHS 134.31(3)(o) (o) Care planning. Be fully informed of one’s treatment and care and participate in the planning of that treatment and care, which includes the right to refuse medications, treatments and rehabilitative therapies.

DHS 134.31(3)(p) (p) Religious activity. Engage in religious worship within the facility if the resident desires such an opportunity and a member of the clergy of the resident’s religious denomination or society is available to the facility. Provisions for worship shall be available to all residents on a nondiscriminatory basis. No resident may be forced to take part in any religious activity.