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.
10. “Department” means the Wisconsin department of health services.
11. “Legal representative” means any of the following:
a. The health care agent under an activated power of attorney for health care under ch. 155, Stats. b. A person appointed as a durable power of attorney under ch. 244, Stats. c. A guardian, guardian of the estate, or guardian of the person, as defined in s. 54.01 (10), (11), or (12), Stats. 12. “Medication administration” means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to a participant by any of the following:
a. A practitioner.
b. The practitioner’s authorized agent.
c. An ADCC caregiver, or the participant, at the direction of the practitioner.
d. Medication administration does not include reminders to take medication.
13. “Misappropriation of property” has the meaning given in s. DHS 13.03 (12). 15. “Nursing care” means nursing procedures, other than personal or supportive care, that a registered nurse or a licensed practical nurse performs directly on or to a participant.
16. “Occupant” means any of the following:
a. A person who lives and sleeps in the ADCC, but who is not a participant.
b. A non-client resident, as defined in 50.065 (1) (cn), Stats.
17. “Operator” means an individual or business entity to whom a certification is granted and is legally responsible for the operation of the ADCC.
18. “Participant” means an adult who attends the ADCC during listed hours of operation and receives care, treatment, or services.
19. “Participant group” means a group of participants who need similar services because of a common disability, condition, or status. A participant group includes a group of individuals who have any of the following:
a. Functional impairments commonly associated with advanced age.
b. Irreversible dementia, such as Alzheimer's disease.
c. Developmental disability, as defined in s. 51.01 (5), Stats. d. An emotional disturbance or a mental illness as defined in s. 51.01 (13) (a), Stats. e. Physical disability.
f. Traumatic brain injury.
20. “Physical restraint” means any manual method, article, device, or garment interfering with the free movement of the participant or the normal functioning of a portion of the participant’s body or normal access to a portion of the participant’s body, and which the participant is unable to remove easily, or confinement of a participant in a locked room.
21. “Program Director” means an employee who is responsible for the management and day-to-day operation of the ADCC. A program director includes any of the following:
a. The operator.
b. An employee designated by the operator.
22. “Psychotropic medication” means a prescription drug, defined in s. 450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior. 23. “Qualified Caregiver” means an employee who is at least 18 years of age and has successfully completed all of the applicable orientation and training under sub. (4), pars. (a) and (b) of this section.
24. a. “Seclusion” means physical or social separation of a participant from others by actions of caregivers.
b. “Seclusion” does not include separation to prevent the spread of communicable disease or voluntary cool-down periods in an unlocked room.
25. “Serious injury” means an injury from any incident or accident which results in any of the following:
a. A temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
b. A fracture.
c. A pronounced decline in communication or cognitive abilities.
26. “Significant change” in a participant’s physical or mental condition means any of the following:
a. A decline in a participant’s medical condition that results in further impairment.
b. A decline in 2 or more ADLs.
c. A pronounced decline in communication or cognitive abilities.
d. A decline in behavior or mood which requires either a temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
27. “Standard precautions” are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are used when providing care to all individuals, whether or not they appear infectious or symptomatic.
28. a. “Supervision” means oversight of a participant’s functioning.
b. Supervision includes keeping track of a participant’s whereabouts and providing guidance and intervention when needed by a participant.
29. “Transferor” means the current operator in a change of ownership process who will voluntarily relinquish the current certification.
30. “Transferee” means the recipient of a property or business in a change of ownership process who will submit application for a new certification.
31. “Utensils” means dishes, silverware and pots and pans used for storing, preparing, serving, or consuming food.
32. “Variance” means an alternate means of meeting a requirement in this section, as approved by the department under par. (c).
33. “Volunteer” means any person who provides services for participants without compensation.
34. “Waiver” means an exemption from a requirement in this section, as approved by the department under par. (c).
(c) Variances and waivers.
1. The department may grant approval of a waiver or variance if the department determines that the proposed waiver or variance will not jeopardize the health, safety, welfare or rights of any participant.
2. A written request for a waiver or variance shall be sent to the department and include justification that the waiver or variance will not adversely affect the health, safety or welfare of any participant for the requested action.
3. A written request for a variance shall include a description of an alternative means planned to meet the intent of the requirement.
4. The department may terminate approval of a waiver or variance if any of the following occurs:
a. The department determines the waiver or variance has adversely affected the health, safety, well-being or welfare of a participant.
b. The ADCC fails to comply with any of the conditions of the waiver or variance as granted.
c. A change in circumstances from the time the waiver or variance approval was initially granted.
