Chapter DHS 131

Subchapter V — Physical Environment

DHS 131.35   Definitions.

DHS 131.36   Scope.

DHS 131.37   Physical plant.

DHS 131.38   Fire protection.

DHS 131.39   Fire safety.

DHS 131.40   Plans for new construction and alterations.

DHS 131.41   Plan review.

DHS 131.42   Fees for plan reviews.

Ch. DHS 131 Note Note: Chapter HSS 131 was renumbered Chapter HFS 131 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, July, 1999, No. 523. Chapter HFS 131 was renumbered chapter DHS 131 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b 7., Stats., Register January 2009 No. 637. Chapter DHS 131 as it existed on September 30, 2010 was repealed and a new chapter DHS 131 was created, effective October 1, 2010.

subch. I of ch. DHS 131 Subchapter I — General Provisions

DHS 131.11 DHS 131.11 Authority and purpose. This chapter is promulgated under the authority of s. 50.95, Stats., to establish minimum standards for the operation of hospice programs in Wisconsin. The purpose of the chapter is to ensure that hospice patients receive safe and adequate care and support and that the health and safety of hospice patients, employees and volunteers are protected.

DHS 131.11 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.12 DHS 131.12 Applicability. This chapter applies to all organizations, programs and places operating as hospices in Wisconsin.

DHS 131.12 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.

DHS 131.13 DHS 131.13 Definitions. In this chapter:

DHS 131.13(1) (1) “Advance directive” means a written instruction, such as a living will under ch. 154, Stats., or a power of attorney for health care under ch. 155, Stats., or as otherwise recognized by the courts of the state, relating to the provision or nonprovision of health care when the individual is incapacitated.

DHS 131.13(2) (2) “Advanced practice nurse” means a person who is certified as an advanced practice nurse as provided in ch. N 8.

DHS 131.13(3) (3) “Attending physician” means a person who is either a doctor of medicine or osteopathy legally authorized to practice medicine and surgery under ch. 448, Stats., physician assistant or a nurse practitioner who meets the training, education, and experience requirements specified in s. DHS 105.20 (1) and the who identified by the patient, at the time he or she elects to receive hospice care, as having the greatest overall role in the determination and delivery of the individual’s medical care.

DHS 131.13(4) (4) “Bereavement services” means emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment.

DHS 131.13(5) (5) “Core team” means a defined group within the hospice’s interdisciplinary group that has represented on it physician, nurse, social worker and bereavement or other counseling services and that is responsible for all aspects of care and services to a patient and the patient’s family.

DHS 131.13(6) (6) “Department” means the Wisconsin department of health services.

DHS 131.13(7) (7) “Employee” means a person who:

DHS 131.13(7)(a) (a) Works for the hospice and for whom the hospice is required to issue a W–2 form on his or her behalf.

DHS 131.13(7)(b) (b) If the hospice is a subdivision of an agency or organization, an employee of the agency or organization who is appropriately trained and assigned to the hospice.

DHS 131.13(7)(c) (c) Is a volunteer under the jurisdiction of the hospice.

DHS 131.13(8) (8) “Family member” means an individual with significant personal ties to the hospice patient who is designated a family member by mutual agreement between the individual and the patient.

DHS 131.13(9) (9) “Hospice” means any of the following:

DHS 131.13(9)(a) (a) An organization that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays and, if necessary to meet the needs of an individual with terminal illness, arranges for or provides short-term inpatient care and treatment or provides respite care.

DHS 131.13(9)(b) (b) A program within an organization that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays, that uses designated staff time and facility services, that is distinct from other programs of care provided by the organization and, if necessary to meet the needs of an individual with terminal illness, that arranges for or provides short-term inpatient care and treatment or respite care.

DHS 131.13(9)(c) (c) A place, including a freestanding structure or a separate part of a structure in which other services are provided, that primarily provides palliative and supportive care and a place of residence to individuals with terminal illness and provides or arranges for short-term inpatient care as needed.

DHS 131.13(10) (10) “Hospice patient” or “patient” means an individual in the terminal stage of illness who has an anticipated life expectancy of 12 months or less and who has been admitted to the hospice.

DHS 131.13(11) (11) “Interdisciplinary group” or “IDG” means the group of hospice employees which has represented on it the core team services and may, in addition, have physical therapy, occupational therapy, speech pathology and nurse aide services.

DHS 131.13(11m) (11m) “Nonambulatory” means unable to walk.

DHS 131.13(12) (12) “Nurse aide” means an individual employed by or under contract to a hospice to provide nurse aide services as specified in s. DHS 131.26 (2) (b) under the supervision of a registered nurse.

DHS 131.13(12m) (12m) “Semiambulatory” means able to walk with difficulty or able to walk only with the assistance of an aid, such as crutches, a cane, or a walker.

DHS 131.13(13) (13) “Palliative care” means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy and access to information.

DHS 131.13(14) (14) “Physician” means a person licensed to practice medicine or osteopathy under ch. 448, Stats.

DHS 131.13(15) (15) “Plan of care” means the written information that describes a patient’s needs and related needs of the patient’s family, goals and interventions by specified hospice employees or volunteers as well as a means for evaluating the effectiveness of the interventions.

DHS 131.13(16) (16) “Registered nurse” means a person licensed as a registered nurse under ch. 441, Stats.

DHS 131.13(17) (17) “Representative” means an individual who has the authority under s. 50.94, Stats., to authorize or terminate medical care or to elect or revoke the election of hospice care on behalf of a terminally ill patient who is mentally or physically incapacitated. This may include a legal guardian.

DHS 131.13(18) (18) “Respite care” means care provided to a terminally ill individual in order to provide temporary relief to the primary caregiver.

DHS 131.13(19) (19) “Restraint” means any of the following:

DHS 131.13(19)(a) (a) Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely, not including devices, such as orthopedically prescribed devices, surgical dressings or bandages, protective helmets, or other methods that involve the physical holding of a patient for the purpose of conducting routine physical examinations or tests, or to protect the patient from falling out of bed, or to permit the patient to participate in activities without the risk of physical harm that does not include a physical escort.

DHS 131.13(19)(b) (b) A drug or medication when it is used as a restriction to manage the patient’s behavior or restrict the patient’s freedom of movement and is not a standard treatment or dosage for the patient’s condition.

DHS 131.13(20) (20) “Seclusion” means the involuntary confinement of a patient alone in a room or an area from which the patient is physically prevented from leaving.

DHS 131.13(20m) (20m) “Semiambulatory” means able to walk with difficulty or able to walk only with the assistance of an aid, such as crutches, a cane, or a walker.

DHS 131.13(21) (21) “Short-term inpatient care” means care provided to a terminally ill individual in an inpatient setting for brief periods of time for the purpose of pain control or acute or chronic symptom management.

DHS 131.13(22) (22) “Social worker” means an individual who holds a social worker certificate or a clinical social worker license under s. 457.08, Stats.

DHS 131.13(23) (23) “Supportive care” means services provided during the final stages of an individual’s terminal illness and dying and after the individual’s death to meet the psychosocial, social and spiritual needs of family members of the terminally ill individual and other individuals caring for the terminally ill individual.

DHS 131.13(24) (24) “Terminal illness” means a medical prognosis by a doctor of medicine or osteopathy that an individual’s life expectancy is less than 12 months.

DHS 131.13(25) (25) “Volunteer” means an uncompensated staff person.

DHS 131.13 History History: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10; CR 19-092: r. and recr. (3), cr. (11m), (20m) Register July 2020 No. 775, eff. 8-1-20; correction in (3) made under s. 35.17, Stats., Register July 2020 No. 775.

DHS 131.14 DHS 131.14 License.

DHS 131.14(1) (1) License requirement.

DHS 131.14(1)(a) (a) No person may conduct, maintain, operate or otherwise participate in conducting, maintaining or operating a hospice unless the hospice is licensed by the department.

DHS 131.14(1)(b) (b) A hospice program may have more than one office or facility. Multiple units do not need to be separately licensed if the hospice is able to demonstrate supervision and administration from the central office.

DHS 131.14(2) (2) Application.

DHS 131.14(2)(a) (a) Application for a license to operate a hospice shall be made in writing on a form provided by the department.

DHS 131.14(2)(b) (b) The completed application shall contain all of the following information:

DHS 131.14(2)(b)1. 1. The name and address of the applicant.

DHS 131.14(2)(b)2. 2. The location of the hospice.

DHS 131.14(2)(b)3. 3. Identification of the person or persons administratively responsible for the program, and the affiliation, if any, of the person or persons with a licensed home health agency, hospital, nursing home or other health care facility.

DHS 131.14(2)(b)4. 4. The proposed geographic area the hospice will serve.

DHS 131.14(2)(b)5. 5. A listing of those hospice services provided directly by the hospice, and those hospice services provided through a contractual agreement.

DHS 131.14(2)(b)6. 6. A list of those providers under contract with the hospice to provide hospice services.

DHS 131.14(2)(b)7. 7. Evidence to establish that the applicant has sufficient resources to permit operation of the hospice for a period of at least 90 days.

DHS 131.14(2)(b)8. 8. Any additional information specified by the department as necessary to determine that the entity detailed in the application is a hospice and that the applicant is and is fit and qualified to operate it.

DHS 131.14(2)(c) (c) The applicant shall submit the application form to the department accompanied by the applicable fee established under s. 50.93 (1) (c), Stats.

DHS 131.14 Note Note: To obtain an application form for a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, Department of Health Services, P.O. Box 2969, Madison, WI 53701-2969 or telephone [phone]. The completed application form should be sent to the same office.

DHS 131.14(3) (3) Review of the application.

DHS 131.14(3)(a) (a) Investigation. After receiving a complete application, the department shall investigate and inspect the applicant to determine if the applicant is fit and qualified to be a licensee and to determine if the applicant is able to comply with this chapter. An applicant that is currently certified as meeting conditions for medicare participation under 42 USC 1395 to 1395ccc, need not be investigated or inspected as a condition for issuance of a license.

DHS 131.14(3)(b) (b) Fit and qualified. In making its determination of the applicant’s fitness, the department shall review the information contained in the application and shall review any other documents that appear to be relevant in making that determination, including survey and complaint investigation findings for each health care provider with which the applicant is affiliated or was affiliated during the past 5 years. The department shall consider at least all of the following:

DHS 131.14(3)(b)1. 1. Any adverse action against the applicant by the licensing agency of this state or any other state relating to the applicant’s operation of a hospice, home health agency, residential facility or health care facility. In this subdivision, “adverse action” means an action initiated by a state licensing agency which resulted in the denial, suspension or revocation of the license of a hospice, home health agency, residential facility or health care facility operated by the applicant.

DHS 131.14(3)(b)2. 2. Any adverse action against the applicant based upon noncompliance with federal statutes or regulations in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state. In this subdivision, “adverse action” means an action by a state or federal agency which resulted in civil money penalties, termination of a provider agreement, and suspension of payments or the appointment of temporary management of a hospice, home health agency, residential facility or health care facility operated by the applicant.

DHS 131.14(3)(b)3. 3. The frequency of noncompliance with state licensure and federal certification laws in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state.

DHS 131.14(3)(b)4. 4. Any denial, suspension, enjoining or revocation of a license that the applicant had as a health care provider as defined in s. 146.81 (1), Stats., or any conviction of the applicant for providing health care without a license.

DHS 131.14(3)(b)5. 5. Any conviction of the applicant for a crime involving neglect or abuse of patients, or involving assaultive behavior, wanton disregard for the health or safety of others or any act of elder abuse under s. 46.90, Stats.

DHS 131.14(3)(b)6. 6. Any conviction of the applicant for a crime related to delivery of health care services or items.

DHS 131.14(3)(b)7. 7. Any conviction of the applicant for a crime involving controlled substances under ch. 961, Stats.

DHS 131.14(3)(b)8. 8. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information.

DHS 131.14(3)(b)9. 9. Any prior financial failure of the applicant that resulted in bankruptcy or in the closing of a hospice, home health agency or an inpatient health care facility or the relocation of its patients.

DHS 131.14(4) (4) Provisional license. After receiving a complete application for a new license, the department shall investigate the applicant to determine the applicant’s ability to comply with this chapter. Prior to completing its investigation or if the hospice is not in operation at the time that application is made, the department may issue a provisional license. Unless sooner revoked or suspended, a provisional license shall be valid for no more than 24 months from the date of issuance.

DHS 131.14(5) (5) Regular license.

DHS 131.14(5)(a) (a) The department shall inspect a hospice prior to issuing a regular license unless sub. (3) (a) applies and the hospice need not be inspected.

DHS 131.14(5)(b) (b) During the provisional period specified in sub. (4), the hospice shall actively serve at least 5 patients in Wisconsin. At the time of this inspection the hospice shall be actively providing services to at least 3 patients and be able to demonstrate the operational capability of all the facets of the program in order to be issued a regular license.

DHS 131.14(5)(c) (c) A regular license is valid indefinitely unless revoked or suspended.

DHS 131.14(7) (7) Ongoing licensure.