Analysis and supporting documents used to determine effect on small business
All home health agencies, both publicly and privately owned, are regulated by the department under ch. DHS 133 and ch. 50, Stats. These agencies are commonly referred to as state-only licensed home health agencies. If a home health agency participates as a provider in the Medicaid and Medicare programs, the home health agency is also regulated by the department under 42 CFR 484 and commonly referred to as a state licensed and federally certified home health agency. The department estimates that at least 50% of all licensed agencies may be considered small businesses, as defined in s. 227.114 (1), Stats., with estimated average gross annual revenues of $4.8 million and annual payroll of 2.5 million per agency. The proposed changes codify statute enacted in 2012 and clarify existing requirements. None of these proposed changes will have an economic impact on home health agencies. Pursuant to the foregoing analysis, the proposed rules will affect a substantial number of small businesses that are home health agencies, but the proposed rules will not have an economic impact on these businesses.
In addition, pursuant to s. 227.114 (2), Stats., the department considered the methods for reducing the impact of proposed rule revisions on small businesses. The department believes that proposed rule revisions will result in less stringent and simplified compliance requirements. Effect on small business
Based on the foregoing analysis, the rules are anticipated to have little to no economic impact on small businesses.
Statement on quality of agency data
The data sources used to draft the rules and analyses are accurate, reliable and objective and are listed in the Summary of Factual Data and Analytical Methodologies section of this rule order.
Agency contact person
Patricia Benesh
Phone: (608) 264-9896
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 deadline for submitting comments and the notice of public hearing will be posted on the Wisconsin State Legislature’s Administrative Rules website http://docs.legis.wisconsin.gov/code. RULE TEXT
SECTION 1. DHS 133.01 is amended to read:
DHS 133.01 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 home health 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 care, treatment, health, safety, welfare and comfort of patients by home health agencies and for the maintenance and operation of home health agencies which, in the light of advancing knowledge, will promote safe and adequate care and treatment of such patients by home health agencies. SECTION 2. DHS 133.02 (3) is amended to read:
DHS 133.02 (3) “Home health agency” means an organization that primarily provides both skilled nursing and other therapeutic services to patients in their homes has the meaning given in s. 50.49 (1) (a), Wis. Stats. SECTION 3. DHS 133.02 (5g) is created to read:
DHS 133.02 (5g) “home health services” has the meaning given in s. 50.49 (1) (b), Stats. SECTION 4. DHS 133.02 (9m) is created to read:
DHS 133.02 (9m) “Physician assistant” has the meaning given in s. 448.01 (6), Stats. SECTION 5. DHS 133.09 (1) is amended to read:
DHS 133.09 (1) Acceptance of patients. A patient shall be accepted for service on the basis of a reasonable expectation that the patient’s medical, nursing and social needs can be met adequately by the home health agency in the patient’s place of residence. No patient may be provided services except under a plan of care established by a physician or, an advanced practice nurse prescriber, or a physician assistant.
SECTION 6. DHS 133.09 (3) (a) 1., DHS 133.09(3) (a) 3. b. and c., and DHS 133.09 (3) (b) are amended to read:
DHS 133.09 (3) (a) 1. A home health agency may not discharge a patient for any reason until the agency has discussed the discharge with the patient or the patient’s legal representative and the patient’s attending physician or, advanced practice nurse prescriber, or physician assistant, and has provided written notice to the patient or the patient’s legal representative in the timelines specified in this paragraph.
DHS 133.09 (3) (a) 3. b. The attending physician, or advanced practice nurse prescriber, or physician assistant orders the discharge for emergency medical reasons.
c. The patient no longer needs home health care as determined by the attending physician, or advanced practice nurse prescriber, or physician assistant.
DHS 133.09 (3) (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, or advanced practice nurse prescriber, or physician assistant.
SECTION 7. DHS 133.13 is amended to read:
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.
SECTION 8. DHS 133.14 (2) (a) through (i) are amended to read:
DHS 133.14 (2) (a) Make the initial evaluation visit to the patient; patient.
(b) Regularly reevaluate the patient’s need; need.
(c) Initiate the plan of care and necessary revisions; revisions.
(d) Provide those services requiring substantial specialized care; care.
(e) Initiate appropriate preventive and rehabilitative procedures; procedures.
(f) Prepare clinical and progress notes; notes.
(g) Promptly inform either the physician or, advanced practice nurse prescriber and, or physician assistant, as well as other personnel participating in the patient’s care of changes in the patient’s condition and needs; needs.
(h) Arrange for counseling the patient and family in meeting related needs; needs.
(i) Participate in inservice programs for agency staff; and staff.
SECTION 9. DHS 133.20 (1) and (3) and (4) are amended to read:
DHS 133.20 (1) Requirement. A plan of care, including physician’s, or 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.
DHS 133.20 (3) Review of plan. The total plan of care shall be reviewed by the attending physician, or advanced practice nurse prescriber, or physician assistant, and appropriate agency personnel as often as required by the patient’s condition, but no less often than every 60 days. The agency shall promptly notify the physician or, the advanced practice nurse prescriber, or the physician assistant of any changes in the patient’s condition that suggest a need to modify the plan of care.
DHS 133.20 (4) Orders. Drugs and treatment shall be administered by the agency staff only as ordered by the attending physician, or advanced practice nurse prescriber. prescriber, or physician assistant. The nurse or therapist shall immediately record and sign and date oral orders and obtain the physician’s, the advanced practice nurse prescriber’s or physician assistant’s countersignature and date within 20 working days.
SECTION 10. DHS 133.21 (4) and (5) (a) through (h) are amended to read:
DHS 133.21 (4) Transfer. If a patient is transferred to another health facility or agency, a copy of the record or abstract shall accompany the patient. summary of the record shall be provided to the receiving agency or facility.
DHS 133.21 (5) (a) Patient identification information; information.
(b) Appropriate hospital information (discharge summary, diagnosis, current patient status, post-discharge plan of care); care.
(c) Patient evaluation and assessment; assessment.
(d) Plan of care; care.
(e) Physician’s or, advanced practice nurse prescriber’s orders;, or physician assistant’s orders.
