DepartmenT of Health Services Office of Legal Counsel F-02318 (12/2018) | STATE OF WISCONSIN |
WISCONSIN DEPARTMENT OF HEALTH SERVICES PROPOSED ORDER TO ADOPT PERMANENT RULES |
The Wisconsin Department of Health Services (“the Department”) proposes an order to create s. DHS 105.14, relating to adult day care centers. RULE SUMMARY
Statute interpreted
Statutory authority
Explanation of agency authority
Section 49.45 (2) (a) 11., Stats., authorizes the Department to establish criteria for certification of providers of Medical Assistance (MA), certify providers who meet certification criteria and promulgate rules to implement the statute.
Section 49.45 (10), Stats., authorizes the Department to promulgate rules consistent with its duties in administering MA, including its duties relating to reimbursement for personal care services by certified providers.
Related statute or rule
There are no related statutes or rules.
Plain language analysis
Adult day care providers offer services for part of a day, in a group setting, to adults who need an enriched health, supportive, or social experience, and who may need assistance with activities of daily living, supervision, or protection. These may include personal care and supervision, meals, medical care, transportation, and activities designed to meet physical, social, and leisure time needs. Adult day care providers do not need to be licensed or certified to operate in Wisconsin. However, certification as an MA provider is required, under both state and federal law, s. 49.45 (47) (b), Stats., and 42 C.F.R. 441.352 (a) (1) and (2), for providers that wish to receive reimbursement by MA for adult day care services provided to MA recipients. Adult day care centers (ADCCs) are either free-standing, or housed in nursing homes or multi-use facilities such as churches, schools, or senior centers. ADCCs provide a necessary link and resource for older adults who either reside in their own homes or come to the center for part of the day from assisted living facilities or other settings. There are currently 124 ADCCs in Wisconsin. In 1990, the Department articulated interim requirements for ADCCs seeking MA reimbursement. Pursuant to the directive given by the Legislature in s. 49.45 (2) (a) 11. b., Stats., the Department proposes to establish these requirements by rule, in DHS 105.14. There are no reasonable policy alternatives to implementing this statutory requirement. Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulation that addresses the criteria for certification of ADCCs to be established by the proposed rule.
Comparison with rules in adjacent states
Illinois:
Illinois Administrative Code at Title 89 Social Services, Chapter 11 Department on Aging, Part 240 Community Care Program, Section 240.230, adult day services requires programs to provide an assessment of the participant’s strengths and needs and development of an individual written person-centered plan of care that establishes participant goals for all services to be provided or arranged for by the service provider. Programs are to provide purposeful activities to meet the participant’s needs and interests designed to improve or maintain the optimal functioning of the participant. Programs must also provide assistance or supervision of activities of daily living, health-related services including monitoring, nursing intervention, and medication administration if needed. A copy of participant rights and responsibilities are to be provided to participants at the time of admission. There shall be 40 square feet of activity area per participant. The facility shall meet the Illinois Plumbing Code, Accessibility Code, Fire Prevention and Food Services Sanitation Code, the National Fire Protections Association standards and the Americans with Disabilities Act. Room temperature in the facility shall be not less than 70 degrees and not more than 85 degrees by using a heating system, air conditioning or circulating fans. Hot water shall be controlled to not exceed 119 degrees but not less than 100 degrees. Exit areas shall be clear of equipment and debris and equipped with monitoring or signaling devices to alert staff of participants leaving the facility unattended. Service providers shall provide 1 meal at mid-day that meets the dietary guidelines for Americans established by the Secretary of Health and Human Services. Minimum ratios of full-time staff are established by code. Staff is required to have 24 hours of training within the first week of employment and include purpose of adult day services, assistance with activities of daily living, dealing with adverse behaviors, recognizing abuse, confidentiality of participant information, universal precautions, fire safety, cardiopulmonary resuscitation and understanding Alzheimer’s disease and dementia. Staff who hold a valid, active certified nursing assistant, registered nursing, or licensed practical nursing degree are exempt from training. A minimum of 12 hours of in-services training for continuing education is mandatory annually.
Iowa:
Iowa Administrative Code 481, Chapter 70, adult day services requires programs to evaluate each prospective participant prior to the participant signing the contractual agreement to determine the participant’s eligibility for the program including whether the services needed are available. A service plan shall be developed for each participant based on the evaluation conducted and shall be designed to meet the specific service needs of the participant. The program shall provide a hot or other appropriate meal at least once a day or shall make arrangements for the availability of meals in accordance with the Food and Nutrition Board of the National Research Council. Dementia specific programs shall provide staff with a minimum of eight hours of dementia specific education within 30 days of employment. Programs must have a managed risk policy and provide the participant with a copy at the time of admission. The program shall submit to the department and follow written emergency policies and procedures related to fire safety procedures, regular staff training, fire drills, monitoring and testing smoke control system, participant evacuation procedures, reporting and documentation. The program shall meet building and public safety codes including accessibility regulations related to people with disabilities. Michigan:
Michigan Master Standards C-1 adult day services must complete a uniform preliminary screening and maintain consistent records for all individuals. Screening may be conducted over the telephone. If the screenings indicates that the individual is eligible for adult day services, a comprehensive individual assessment of needs shall be performed before admission to the program. All assessments shall be conducted face to face. The assessment must identify the individual’s functional status, supporting resources, and needs. The adult day care shall provide directly or make arrangement for transportation, personal care, nutrition, rehabilitation, and medical support. The center shall provide one hot meal per 8 hour day.
The program shall establish written policies and procedures to govern the assistance given to a participant in taking medication. Each program shall employ a full-time program director with a minimum of a bachelor’s degree in health or human services field or be a qualified health professional. The program shall provide support staff at a ratio of no less than one staff person for each 10 participants. Program staff shall receive orientation training that includes topics specified in the general requirement of all service programs including assessment and observation skills and basic first-aid. In-service training shall be provided twice a year which is designed to increase staff knowledge and understanding of the program, aging process issues, including cultural diversity, dementia, cognitive impairment, mental illness, abuse and exploitation.
Each program shall have first-aid supplies, and a staff person knowledgeable in first-aid procedures, including cardiopulmonary resuscitation, shall be present at all time at the center. Procedures to be followed in an emergency situation shall be posted in each room of the center. Programs shall conduct practice drills or emergency procedure every six months and maintain a record of all practice drills. Each center shall have at least one straight back chair for each participant, lounge chairs or day beds as needed for rest periods, storage space for participant’s personal belongings, tables, a telephone that is accessible to all participants and special equipment as needed to assist person with disabilities. Each program shall be in compliance with fire safety standards and the Michigan Food Code.
Minnesota:
Minnesota Administrative Rules 9555.9600 require the program to conduct an intake screening to determine whether the center can serve the person‘s needs and condition. After conducting the screening the center shall conduct a needs assessment and develop a service plan. The assessment shall include the participant’s functional status, psychosocial needs, physical status, nutritional needs and services needed. Each center shall adopt and hold employees accountable for complying with the participant’s bill of rights. The center shall provide a meal which meets the requirements of the Food and Nutrition Board of the National Research Council. The center shall offer health services developed in consultation with a registered nurse. The center shall offer a daily structured exercise program for participants and a daily activity program that includes socialization, activities, group projects, arts, craft, and music. Required safety components include a first aid kit, telephone and posted emergency numbers, and emergency phone numbers for participants.
Furniture and equipment shall be in good repair and without sharp points, splinter and paint that contains lead. Areas used by participants must be free from debris, loose plaster, peeling paint, and litter. Rugs must have a nonskid backing. The center shall have written procedures governing medical emergencies and emergencies caused by fire or weather. The center shall provide 40 square feet for each participant. A minimum of 70 degrees must be maintained in indoor areas. Outside doors and windows used for ventilation must be screened in summer months.
Summary of factual data and analytical methodologies
The Department formed an advisory committee with 7 members composed of the President of the Wisconsin Adult Day Services Association, adult day care providers for elders and for persons with disabilities, and a representative from the Disability Provider Network, an advocacy organization. Committee members were provided a copy of an initial draft of the rule for review and asked for comments. Recommendations from the advisory committee were incorporated into the proposed rule.
Analysis and supporting documents used to determine effect on small business
The Department solicited information and advice from individuals, businesses, associations representing businesses, and local governmental units who may be affected by the proposed rule for use in analyzing and determining the economic impact that the rules would have on businesses, individuals, public utility rate payers, local governmental units, and the state’s economy as a whole from 3/24/2020 through 4/14/20. No public comments were received. In 1990, the Department articulated interim requirements for ADCCs seeking MA reimbursement. Pursuant to the directive given by the Legislature in s. 49.45 (2) (a) 11. b., Stats. the Department established these requirements by rule, in DHS 105.14. MA certified adult day care centers have been required to meet these interim requirement since 1990. There is no fiscal impact on ADCCs. Effect on small business
Based on the foregoing analysis, the rules are anticipated to have little to no economic impact on small businesses.
Agency contact person
Statement on quality of agency data
The data used by the Department to prepare this proposed rule and analysis comply with s. 227.14 (2m), Stats. Place where comments are to be submitted and deadline for submission
Comments may be submitted to the agency contact person that is listed above until the deadline given in the upcoming notice of public hearing. The notice of public hearing and deadline for submitting comments will be published in the Wisconsin Administrative Register and to the department’s website, at https://www.dhs.wisconsin.gov/rules/permanent.htm. Comments may also be submitted through the Wisconsin Administrative Rules Website, at: https://docs.legis.wisconsin.gov/code/chr/active. RULE TEXT
SECTION 1. DHS 105.14 is created to read:
DHS 105.14 Adult day care centers.
(1) General provisions.
(a) Introduction. In accordance with s. 49.45 (2) (a) 11. and (47) (a) and (b) Stats., this section is promulgated to establish regulations and standards for the care, treatment or services, and health, safety, rights, well-being and welfare of participants in certified adult day care centers (ADCCs). This section is promulgated to ensure that each ADCC provides a supportive environment in a community-based group setting that is the least restrictive of each participant’s freedom, and that care and services are provided in a manner that protects the rights and dignity of each participant. (b) Definitions.
2. “Accessible” means barriers are not present that prevent a person from entering, leaving, or functioning within an ADCC without physical help.
3. “Activities of daily living” or “ADL” means bathing, eating, oral hygiene, dressing, toileting, incontinence care, mobility and transferring from one surface to another such as from a bed to a chair.
4. “Adult” means an individual who is at least 18 years of age.
5. “Adult day care center” or “ADCC” means an entity that provides services for part of a day in a group setting to adults who need an enriched health, supportive or social experience, and who may need assistance with activities of daily living, supervision, or protection.
6. “Applicant” means the person seeking certification of an ADCC.
7. “Assessment” means gathering and analyzing information about a prospective or existing participant’s needs and abilities as provided in sub. (7) (a).
9. “Chemical restraint” means a psychotropic medication used for discipline or convenience, and not required to treat medical symptoms.
