Ch. DHS 133 Note
Chapter H 33 as it existed on May 31, 1984 was repealed and a new chapter HSS 133 was created effective June 1, 1984. Chapter HSS 133 was renumbered chapter HFS 133 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, September, 1999, No. 525
. Chapter HFS 133 was renumbered chapter DHS 133 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637
Authority and purpose.
This chapter is promulgated under the authority of s. 50.49 (2)
, Stats. The chapter establishes minimum standards for the operation of agencies which primarily provide in-home part-time or intermittent nursing care and other therapeutic services. These minimum standards are intended to foster safe and adequate care and treatment of patients by home health agencies.
DHS 133.01 History
Cr. Register, May, 1984, No. 341
, eff. 6-1-84; correction made under s. 13.93 (2m) (b) 7., Stats., Register, August, 1995, No. 476
In this chapter:
"Branch office" means a location or site from which a home health agency provides services within a portion of the total geographic area served by the home health agency.
"Department" means the Wisconsin department of health services.
"Home health agency" means an organization that primarily provides both skilled nursing and other therapeutic services to patients in their homes.
"Home health aide" means an individual whose name is on the registry and who is eligible for employment in a home health agency, and who is employed by or under contract to a home health agency to provide home health aide services under supervision of a registered nurse.
"Home health aide services" means personal care services which will facilitate the patient's self-care at home and are necessary to prevent or postpone institutionalization, but do not require performance by a registered nurse or licensed practical nurse.
"Legal representative" means a person who is any of the following:
A person appointed as a health care agent under an activated power of attorney for health care under ch. 155, Stats.
A person appointed as an agent to make health care decisions under a durable power of attorney under s. 243.07
, 1989 Stats., executed on or before April 28, 1990.
"Licensed practical nurse" means a person licensed as a trained practical nurse under ch. 441, Stats.
"Parent agency" means a home health agency with one or more branch offices.
"Patient fee revenue" means gross patient revenue less the following deductions:
Contractual adjustments from medical assistance, medicare, other federal payment sources, and third party payers.
DHS 133.02 Note
Examples of other federal payment sources are the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as authorized under 32 CFR 199
, and benefits provided through the Veteran's Administration. An example of a third party payer is a commercial insurer, including a health maintenance organization.
"Physical therapist" means a person licensed to practice physical therapy under ch. 448, Stats.
"Social worker" means an individual who holds a social worker certificate or a clinical social worker license under s. 457.08
, Stats., and has had one year of social work experience in a health care setting.
"Speech pathologist" means a person who possesses a certificate of clinical competence from the American speech and hearing association, or has completed the equivalent educational requirements and work experience necessary for such a certificate, or who will have completed the academic program and be in the process of accumulating the supervised work experience required to qualify for such a certificate before employment by the home health agency.
"Statement of deficiency" means a notice of a violation of a requirement of s. 50.49
, Stats., or this chapter.
"Therapeutic service" means physical, occupational, speech or other therapy, medical social services, home health aide service, or any other medically oriented service except skilled nursing care.
DHS 133.02 History
Cr. Register, May, 1984, No. 341
, eff. 6-1-84; reprinted to correct printing error in (8), Register, September, 1984, No. 345
; cr. (6g), Register, October, 1995, No. 478
, eff. 11-1-95; correction in (6g) made under s. 13.93 (2m) (b) 7., Stats., Register, August, 2000, No. 536
; cr. (5m), r. and recr. (6g), cr. (6m), (8m) and (12m); Register, April, 2001, No. 544
, eff. 5-1-01; corrections in (8m) were made under s. 13.93 (2m) (b) 1., Stats., Register August 2001 No. 548
; CR 07-060
: renum. (1) to be (1m), cr. (1), (1e), (1s) and (10m), am. (4) and (11) Register November 2007 No. 623
, eff. 12-1-07; correction in (5m) (a) made under s. 13.93 (2m) (b) 7., Stats., Register November 2007 No. 623
; corrections in (2), (6g), (6m), (7) and (10m) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 636
; CR 09-107
: am. (5m) (c), cr. (5m) (d) Register August 2010 No. 656
, eff. 9-1-10; correction in (5m) (c) made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667
No person, firm, partnership, association, corporation, receiver, political subdivision of the state or other governmental agency may establish, operate, or maintain a home health agency, or represent and advertise by any means that it operates a home health agency providing services within the state without first obtaining a license from the department.
(2) Multiple units.
Multiple units of a licensed agency shall be separately licensed if the department determines that the units, because of the volume of services provided or the distance between them and the central office, cannot adequately share supervision and administration of services with the central office. If a branch agency is not separately licensed from a parent agency, the parent agency shall be deemed to be in violation of this chapter if the branch is in violation.
Application for a license to operate a home health agency shall be made on a form provided by the department, shall be accompanied by a nonrefundable fee of $300, and shall include at least the following information:
For all incorporated applicants, the date and the state of incorporation, a copy of the articles of incorporation, tax status and, if a foreign corporation, evidence of authority to do business in Wisconsin;
The name, principal business address and the percentage of ownership interest of all officers, directors, stockholders owning 10% or more of stock, members, partners, and all other persons having authority or responsibility for the operation of the agency;
Proof of sufficient financial responsibility as may be necessary to operate the agency for at least 90 days;
A description of the nature, type and scope of service to be provided, including geographic area to be served;
Name, identification and qualifications of the administrator; and
The department may use any of the following information to determine that a home health agency applicant or owner is fit and qualified:
Any adverse action against a home health agency applicant or owner by a licensing agency of any state that resulted in denial, suspension, injunction, or revocation of a health care agency or health care facility license.
Any adverse action initiated by a state or federal agency based on non-compliance that resulted in civil money penalties, termination of a provider agreement, suspension of payments, or the appointment of temporary management of the facility.
Any conviction of the applicant for a crime involving neglect or abuse of patients or of the elderly or involving assaultive behavior or wanton disregard for the health or safety of others, or any act of abuse under ss. 940.285
Any conviction of a home health agency applicant or owner for a crime related to the delivery of health care services or items, or for providing health care without a license.
Any conviction of a home health agency applicant or owner for a crime involving a controlled substance under ch. 961, Stats.
Any conviction of a home health agency applicant or owner for a crime involving a sexual offense.
Any prior financial failure of a home health agency applicant or owner that resulted in bankruptcy or in the closing of a health care agency or health care facility or the relocation or discharge of a health care agency's or health care facility's patients.
Any unsatisfied judgment against a home health agency applicant or owner or any debts that are at least 90 days past due.
DHS 133.03 Note
To obtain a copy of the license application form, send your request to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969. The street address is 1 W. Wilson Street in Madison. The e-mail address is:
. The completed application form should be sent to the same office.
Following receipt of a complete application for a new license or for a license change when there has been a change in the ownership of a home health agency, the department shall investigate the application to determine the applicant's ability to comply with this chapter.
Within 90 days after receiving a complete application, the department shall either approve the application and issue a license or deny the application, unless either of the following applies:
The applicant or agency is temporarily unable to conform to all the rules in this chapter.
If subd. 1. a.
applies, the department may, within the 90-day period in subd. 1.
, issue a provisional license for a term of 90 days. The department may, upon the agency's request, renew that license for additional 90-day terms not to exceed one year from the original issuance date of the provisional license.
During the provisional period specified in subd. 2.
, the home health agency shall actively serve at least 10 patients requiring skilled nursing care or other therapeutic services in Wisconsin. At least seven of the 10 patients shall be actively receiving skilled nursing services when the home health agency submits a written request for an on-site licensure survey. At least 3 patients shall be receiving skilled nursing services at the time of the on-site licensure survey.
The department may not charge an additional fee for the original regular license issued to a home health agency that has not had a provisional license.
After the department issues an initial regular license, the department may not charge the home health agency an additional licensing fee until the annual, continuing license fee is due. The fee shall be 0.25% of patient fee revenue of the home health agency based on the agency's financial information submitted to the department in the form prescribed by the department, with a maximum fee of $2,500 and a minimum fee of $500.
(5) Licensure term.
A home health agency regular license is valid indefinitely unless suspended, revoked or voluntarily surrendered.
DHS 133.03(6)(a)(a) Changes requiring notice.
The licensee shall, within 10 days, notify the department in writing of any changes in the services provided and any appointment or change of the administrator.
(b) Changes requiring new application.
A new application under sub. (3)
shall be submitted to the department within 10 working days when any of the following changes has occurred:
The corporate licensee has transferred 50% or more of the issued stock to another party or other parties;
The licensee has transferred ownership of 50% or more of the assets to another party or other parties;
There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits; or
(7) Denial or revocation.
If at any time the department determines that there has been a substantial failure to comply with the requirements of this chapter, or that the license fee has not been paid, or that the information required by the department for licensure is not provided, it shall deny or revoke the license after providing notice to the licensee.
An applicant or home health agency may appeal the following department actions:
If a home health agency wants to contest a department action specified in par. (a)
, it shall file a written request for a hearing under s. 227.44
, Stats., with the department of administration's division of hearings and appeals within 10 days of receipt of notice of the contested action.
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.
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
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.
The department may make any inspections and investigations it considers necessary, including review of clinical and administrative records, subject only to restrictions of law.
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.
(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.