DHS 133.12 Coordination with other providers. DHS 133.13 Emergency notification. DHS 133.14 Skilled nursing services. DHS 133.15 Therapy services. DHS 133.16 Medical social services. DHS 133.17 Home health aide services. DHS 133.18 Supervisory visits. DHS 133.19 Services under contract. DHS 133.21 Medical records. Ch. DHS 133 NoteNote: Chapter H 33 as it existed on May 31, 1984 was repealed and a new chapter HSS 133 was created effective June 1, 1984.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. DHS 133.01DHS 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 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. DHS 133.01 HistoryHistory: 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; CR 16-077: am. Register September 2017 No. 741 eff. 10-1-17. DHS 133.02DHS 133.02 Definitions. In this chapter: DHS 133.02(1m)(1m) “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. DHS 133.02(2)(2) “Department” means the Wisconsin department of health services. DHS 133.02(4)(4) “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. DHS 133.02(5)(5) “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. DHS 133.02(5m)(5m) “Legal representative” means a person who is any of the following: DHS 133.02(5m)(b)(b) A person appointed as a health care agent under an activated power of attorney for health care under ch. 155, Stats. DHS 133.02(5m)(c)(c) 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. DHS 133.02(6)(6) “Licensed practical nurse” means a person licensed as a trained practical nurse under ch. 441, Stats. DHS 133.02(8)(8) “Parent agency” means a home health agency with one or more branch offices. DHS 133.02(8m)(8m) “Patient fee revenue” means gross patient revenue less the following deductions: DHS 133.02(8m)(a)(a) Contractual adjustments from medical assistance, medicare, other federal payment sources, and third party payers. DHS 133.02 NoteNote: 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. DHS 133.02(9)(9) “Physical therapist” means a person licensed to practice physical therapy under ch. 448, Stats. DHS 133.02(11)(11) “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. DHS 133.02(12)(12) “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. DHS 133.02(12m)(12m) “Statement of deficiency” means a notice of a violation of a requirement of s. 50.49, Stats., or this chapter. DHS 133.02(13)(13) “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 HistoryHistory: 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; CR 16-077: am. (3), cr. (5g), (9m) Register September 2017 No. 741 eff. 10-1-17; correction in (3), (5g) made under s. 35.17, Stats., Register September 2017 No. 741. DHS 133.03(1)(1) License requirement. 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. DHS 133.03(2)(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. DHS 133.03(3)(3) Application. 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: DHS 133.03(3)(b)(b) 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; DHS 133.03(3)(d)(d) 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; DHS 133.03(3)(e)(e) Proof of sufficient financial responsibility as may be necessary to operate the agency for at least 90 days; DHS 133.03(3)(f)(f) A description of the nature, type and scope of service to be provided, including geographic area to be served; DHS 133.03(3)(g)(g) Name, identification and qualifications of the administrator; and DHS 133.03(3)(i)(i) The department may use any of the following information to determine that a home health agency applicant or owner is fit and qualified: DHS 133.03(3)(i)1.1. 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. DHS 133.03(3)(i)2.2. 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. DHS 133.03(3)(i)3.3. 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 or 940.295, Stats. DHS 133.03(3)(i)4.4. 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. DHS 133.03(3)(i)5.5. Any conviction of a home health agency applicant or owner for a crime involving a controlled substance under ch. 961, Stats. DHS 133.03(3)(i)6.6. Any conviction of a home health agency applicant or owner for a crime involving a sexual offense. DHS 133.03(3)(i)7.7. 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. DHS 133.03(3)(i)8.8. 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 NoteNote: 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. Additional contact information is available under the “contact us” section at https://www.dhs.wisconsin.gov/regulations/hha/application.htm. The completed application form should be sent to the same office. DHS 133.03(4)(a)(a) 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. DHS 133.03(4)(b)1.1. 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: DHS 133.03(4)(b)1.b.b. The applicant or agency is temporarily unable to conform to all the rules in this chapter. DHS 133.03(4)(b)2.2. If subd. 1. a. or b. 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. DHS 133.03(4)(b)3.3. 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. DHS 133.03(4)(c)(c) 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. DHS 133.03(4)(d)(d) 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. DHS 133.03(5)(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. DHS 133.03(6)(b)(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: DHS 133.03(6)(b)1.1. The corporate licensee has transferred 50% or more of the issued stock to another party or other parties; DHS 133.03(6)(b)2.2. The licensee has transferred ownership of 50% or more of the assets to another party or other parties; DHS 133.03(6)(b)3.3. There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits; or
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