Chapter DHS 134

DHS 134.47(5)(c)4. 4. Any records that document compliance with applicable sanitation, health and environmental safety rules and local ordinances, and written reports of inspections and actions taken to enforce these rules and local ordinances;

DHS 134.47(5)(c)5. 5. Records of inspections by local fire inspectors or departments, records of fire and disaster evacuation drills and records of tests of fire detection, alarm and extinguishing equipment;

DHS 134.47(5)(c)6. 6. Documentation of professional consultation by registered dietitians, registered nurses, social workers and special professional services providers, and other persons used by the facility as consultants;

DHS 134.47(5)(c)7. 7. Medical transfer service agreements and agreements with outside agency service providers; and

DHS 134.47(5)(c)8. 8. A description of subject matter, a summary of contents and a list of instructors and attendance records for all employee orientation and inservice programs.

DHS 134.47 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; correction in (3) (d) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 2000, No. 532; CR 04-053: am. (3) (h) 1. Register October 2004 No. 586, eff. 11-1-04; correction in (3) (d) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; 2019 Wis. Act 1: am. (4) (d) 3. Register May 2019 No. 761, eff. 6-1-19.

subch. IV of ch. DHS 134 Subchapter IV — Admission, Retention and Removal

DHS 134.51 DHS 134.51 Limitations on admissions and retentions.

DHS 134.51(1) (1) Limitations on admission.

DHS 134.51(1)(a) (a) Bed capacity. No facility may admit or retain more persons than the maximum bed capacity for which it is licensed.

DHS 134.51(1)(b) (b) Persons requiring unavailable services.

DHS 134.51(1)(b)1. 1. Persons who require services that the facility does not provide or make available may not be admitted or retained.

DHS 134.51(1)(b)2. 2. Persons who do not have a diagnosis of developmental disability may not be admitted.

DHS 134.51(1)(c) (c) Communicable disease management.

DHS 134.51(1)(c)1. 1. ‘Communicable diseases.’ The facility shall have the ability to manage persons with communicable disease that the facility admits or retains, based on currently recognized standards of practice.

DHS 134.51(1)(c)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 134.51(1)(d) (d) Destructive residents.

DHS 134.51(1)(d)1. 1. Notwithstanding s. DHS 134.13 (1), in this paragraph, “abuse” means 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 134.51(1)(d)2. 2. A person who the facility administrator has reason to believe is destructive of property or self-destructive, would disturb or abuse other residents or is suicidal, shall not be admitted or retained unless the facility has and uses sufficient resources to appropriately manage and care for the person.

DHS 134.51(1)(e) (e) Minors. Except for a facility that was permitted to admit minors prior to the effective date of this chapter, no facility may admit a person under the age of 18 unless the admission is approved by the department after the department receives the following documents:

DHS 134.51(1)(e)1. 1. A statement from the referring physician stating the medical, nursing, rehabilitation and special services required by the minor;

DHS 134.51(1)(e)2. 2. A statement from the administrator certifying that the required services can be provided;

DHS 134.51(1)(e)3. 3. A statement from the attending physician certifying that the physician will be providing medical care; and

DHS 134.51(1)(e)4. 4. A statement from the person or agency assuming financial responsibility for the minor.

DHS 134.51(1)(f) (f) Admissions 7 days a week. No facility may refuse to admit a person to be a new resident solely because of the day of the week.

DHS 134.51(2) (2) Living unit limitations.

DHS 134.51(2)(a) (a) A facility may not house residents of very different ages or developmental levels or with very different social needs in close physical or social proximity to one another unless the housing is planned to promote the growth and development of all the residents who are housed together.

DHS 134.51(2)(b) (b) A facility may not segregate residents on the basis of their physical disabilities. The facility shall integrate residents who have different physical disabilities with other residents who have attained comparable levels of social and intellectual development.

DHS 134.51 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; correction in (1) (c) 3. made under s. 13.93 (2m) (b) 7., Stats., Register, April, 2000, No. 532; correction in (1) (c) 3. made under s. 13.93 (2m) (b) 6., Stats., Register December 2003 No. 576; CR 04-053: r. and recr. (1) (c) and am. (1) (d) Register October 2004 No. 586, eff. 11-1-04; correction in (1) (c) 2. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 134.52 DHS 134.52 Admission-related requirements.

DHS 134.52(1) (1) Exception. The procedures in this section apply to all persons admitted to facilities except persons admitted for short-term care. Section DHS 134.70 (2) applies to persons admitted for short-term care.

DHS 134.52(2) (2) Conditions for admission. A facility may not admit an individual unless each of the following conditions has been met:

DHS 134.52(2)(a) (a) An interdisciplinary team has conducted or updated a comprehensive preadmission evaluation of the individual as specified in sub. (3) and has determined that residential care is the best available plan for the individual;

DHS 134.52(2)(b) (b) Except in an emergency, for an individual who is under age 65, there is a written recommendation of the county department established under s. 46.23, 51.42 or 51.437, Stats., in the individual’s county of residence, that residential care in the facility is the best available placement for the individual;

DHS 134.52(2)(c) (c) If the individual’s medical condition and diagnosis require on-going monitoring and physician supervision, the facility has obtained the concurrence of a physician in the admission decision and information about the person’s current medical condition and diagnosis, and any orders from a physician for immediate care have been received by the facility before or on the day of admission;

DHS 134.52(2)(d) (d) The facility has received written certification from a physician, physician assistant or advanced practice nurse prescriber that the individual has been screened for communicable diseases detrimental to other residents or a physician, physician assistant or advanced practice nurse prescriber has ordered procedures to treat and limit the spread of any communicable diseases the person may be found to have; and

DHS 134.52(2)(e) (e) Court-ordered protective placement has been obtained in accordance with s. 55.06, Stats., for a person who has been found by a court to be incompetent.

DHS 134.52(3) (3) Preadmission evaluation.

DHS 134.52(3)(a) (a) Within 90 days before the date of admission, an interdisciplinary team shall conduct or update a comprehensive evaluation of the individual. The evaluation shall include consideration of the individual’s:

DHS 134.52(3)(a)1. 1. Physical development and health;

DHS 134.52(3)(a)2. 2. Sensorimotor development;

DHS 134.52(3)(a)3. 3. Affective development;

DHS 134.52(3)(a)4. 4. Speech and language development and auditory functioning;

DHS 134.52(3)(a)5. 5. Cognitive development;

DHS 134.52(3)(a)6. 6. Vocational skills; and

DHS 134.52(3)(a)7. 7. Adaptive behaviors or independent living skills necessary for the individual to be able to function in the community.

DHS 134.52(3)(b) (b) The interdisciplinary team shall:

DHS 134.52(3)(b)1. 1. Identify the presenting problems and disabilities and, where possible, their causes;

DHS 134.52(3)(b)2. 2. Identify the individual’s developmental strengths;

DHS 134.52(3)(b)3. 3. Identify the individual’s developmental and behavioral modification needs;

DHS 134.52(3)(b)4. 4. Define the individual’s need for services without regard to availability of those services;

DHS 134.52(3)(b)5. 5. Review all available and applicable programs of care, treatment and training for the individual; and

DHS 134.52(3)(b)6. 6. Record the evaluation findings.

DHS 134.52(4) (4) Physical examination by physician.

DHS 134.52(4)(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 134.52(4)(b) (b) Evaluation. Within 48 hours after admission the physician or physician extender shall complete the resident’s medical and physical examination record.

DHS 134.52(5) (5) 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 134.52 History History: Cr. Register, June, 1988, No. 390, eff. 7-1-88; cr. (5), Register, October, 2000, No. 538, eff. 11-1-00; CR 04-053: r. and recr. (2) (d) Register October 2004 No. 586, eff. 11-1-04; corrections in (5) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; CR 23-046: am. (2) (c) Register April 2024 No. 820, eff. 5-1-24.

DHS 134.53 DHS 134.53 Removal from the facility.

DHS 134.53(1) (1) Scope. The provisions of this section shall apply to all transfers, discharges and leaves of residents from facilities except that the removal of residents when a facility closes is governed by s. 50.03 (14), Stats.

DHS 134.53(2) (2) Reasons for removal. No resident may be temporarily or permanently transferred or discharged from a facility, except:

DHS 134.53(2)(a) (a) Voluntary removal. Upon the request or with the informed consent of the resident or guardian;

DHS 134.53(2)(b) (b) Involuntary removal.

DHS 134.53(2)(b)1. 1. For nonpayment of charges, following reasonable opportunity to pay any deficiency;

DHS 134.53(2)(b)2. 2. If the resident requires care that the facility is not licensed to provide;

DHS 134.53(2)(b)3. 3. If the resident requires care that the facility does not provide and is not required to provide under this chapter;

DHS 134.53(2)(b)4. 4. For medical reasons as ordered by a physician;

DHS 134.53(2)(b)5. 5. In case of a medical emergency or disaster;

DHS 134.53(2)(b)6. 6. For the resident’s welfare or the welfare of other residents;

DHS 134.53(2)(b)7. 7. If the resident does not need FDD care;

DHS 134.53(2)(b)8. 8. If the short-term care period for which the resident was admitted has expired; or

DHS 134.53(2)(b)9. 9. As otherwise permitted by law.

DHS 134.53(3) (3) Alternate placement. Except for removals under sub. (2) (b) 5., no resident may be involuntarily removed unless an alternative placement is arranged for the admission of the resident pursuant to sub. (4) (c).

DHS 134.53(4) (4) Permanent involuntary removal.

DHS 134.53(4)(a) (a) Consultation. Before a decision is made to transfer or discharge a resident under sub. (2) (b), facility staff shall meet with the resident’s parent or guardian, if any, and any other person the resident decides should be present, to discuss the need for and alternatives to the transfer or discharge.

DHS 134.53(4)(b) (b) Notice. The facility shall provide the resident, the resident’s family or guardian or other responsible person, the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats., and, if appropriate, the resident’s physician, with at least 30 days notice before making a permanent removal under sub. (2) (b), except under sub. (2) (b) 5. or if the continued presence of the resident endangers his or her health, safety or welfare or that of other residents.

DHS 134.53(4)(c) (c) Removal procedures.

DHS 134.53(4)(c)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, the appropriate county department designated under s. 46.23, 51.42 or 51.437, Stats., and any person 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 about the prospective removal.

DHS 134.53(4)(c)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 permanent involuntary removal under sub. (2) (b), a planning conference shall be held at least 14 days before removal with the resident, the resident’s guardian, if any, any appropriate county agency and any persons designated by the resident, including the resident’s physician or the facility QDIP, 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 134.53 Note Note: The discharge planning conference requirement for a resident receiving recuperative care is found in s. DHS 134.70 (6).

DHS 134.53(4)(c)3. 3. Removal activities shall include:

DHS 134.53(4)(c)3.a. a. Counseling the resident about the impending removal;

DHS 134.53(4)(c)3.b. b. Making arrangements for the resident to make at least one visit to the potential alternative placement facility and to meet with that facility’s admissions staff, unless this is medically contraindicated or the resident chooses not to make the visit;

DHS 134.53(4)(c)3.c. c. Providing assistance in moving the resident and the resident’s belongings and funds to the new facility or quarters; and

DHS 134.53(4)(c)3.d. d. Making sure that the resident receives needed medications and treatments during relocation.

DHS 134.53(4)(d) (d) Transfer and discharge records. Upon removal of a resident, the documents required by s. DHS 134.47 (4) (k) shall be prepared and provided to the facility admitting the resident, along with any other information about the resident needed by the admitting facility. When a resident is permanently released, the facility shall prepare and place in the resident’s record a summary of habilitative, rehabilitative, medical, emotional, social and cognitive findings and progress and plans for care.

DHS 134.53(5) (5) Voluntary discharge. When a discharge is voluntary and expected to be permanent, the facility shall, prior to the removal:

DHS 134.53(5)(a) (a) Counsel the resident, the parent of a minor resident or the guardian who requests the discharge concerning the advantages and disadvantages of the discharge;

DHS 134.53(5)(b) (b) Under the guidance and recommendations of the facility’s interdisciplinary team, make necessary arrangements for appropriate services, including post-discharge planning, protective supervision and follow-up services, during relocation and in the new environment;