Chapter DHS 133

DHS 133.06(4)(d)2. 2. ‘Continuing employees.’ Each employee having direct patient contact shall be screened for clinically apparent communicable disease by a physician, physician assistant, or registered nurse based on the likelihood of their exposure to a communicable disease, including tuberculosis. The exposure to a communicable disease may have occurred in the community or in another location.

DHS 133.06(4)(d)3. 3. ‘Disease surveillance.’ Agencies shall develop and implement written policies for control of communicable diseases which take into consideration control procedures incorporated by reference in ch. DHS 145 and which ensure that employees with symptoms or signs of communicable disease or infected skin lesions are not permitted to work unless authorized to do so by a physician or physician assistant or advanced practice nurse.

DHS 133.06 Note Note: The Americans with Disabilities Act and the Rehabilitation Act of 1973 prohibit the termination or non-hiring of an employee based solely on an employee having an infectious disease, illness or condition.

DHS 133.06(4)(e) (e) Continuing training. A program of continuing training shall be provided to all employees as appropriate for the client population and the employee’s duties.

DHS 133.06(4)(f) (f) Personnel records. A separate up-to-date personnel record shall be maintained on each employee. The record shall include evidence of suitability for employment in the position to which the employee is assigned.

DHS 133.06(4)(g) (g) Background checks and misconduct reporting and investigation. Each home health agency shall comply with the caregiver background check and misconduct reporting requirements in s. 50.065, Stats., and ch. DHS 12, and the caregiver misconduct reporting and investigation requirements in ch. DHS 13.

DHS 133.06(5) (5) Infection control and prevention. Each home health agency shall do all of the following:

DHS 133.06(5)(a) (a) Develop and implement initial orientation and ongoing education and training for all staff having direct patient contact, including students, trainees and volunteers, in the epidemiology, modes of transmission and prevention of infections and the need for routine use of current infection control measures as recommended by the U.S. centers for disease control and prevention.

DHS 133.06(5)(b) (b) Provide equipment and supplies necessary for all staff having direct patient care contact to minimize the risk of infection while providing patient care.

DHS 133.06(5)(c) (c) Monitor adherence to evidence-based standards of practice related to protective measures. When monitoring reveals a failure to follow evidence-based standards of practice, the home health agency shall provide counseling, education, or retraining to ensure staff is adequately trained to complete their job responsibilities.

DHS 133.06 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (4) (d) 1., Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (4) (d) 1. and 3., r. and recr. (4) (d) 2., cr. (4) (g) and (5) Register November 2007 No. 623, eff. 12-1-07; corrections in (4) (d) 3. and (g) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 133.07 DHS 133.07 Evaluation.

DHS 133.07(1) (1) Requirement. An evaluation of the home health agency’s total program shall be conducted at least once a year by the advisory group required by s. DHS 133.05 (2), home health agency staff and consumers.

DHS 133.07(2) (2) Method of evaluation. The agency shall establish methods to determine whether the established programs and service policies are effective and whether service policies and procedures are substantially followed by agency staff. These methods shall include a review of a sample of patient records to determine whether services are being provided appropriately and the extent to which the needs of patients are met.

DHS 133.07(3) (3) Reports. Results of the evaluations shall be recorded in writing and reported to those responsible for the operation of the agency.

DHS 133.07(4) (4) Management review. The agency shall periodically review its policies and administrative practices to determine the extent to which they promote appropriate, adequate, effective and efficient patient care.

DHS 133.07 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.08 DHS 133.08 Patient rights.

DHS 133.08(1) (1) Service applicant. The home health agency shall promptly determine the applicant’s suitability for services and, if the applicant is accepted, shall promptly provide services to the individual. If the applicant is found unsuitable for acceptance, the agency shall inform the applicant of other service providers in the area.

DHS 133.08(2) (2) Policies. The home health agency shall provide the patient with a written notice of the patient’s rights in advance of furnishing care to the patient or during the initial evaluation visit before the initiation of treatment. Each patient receiving care from the agency shall have all of the following rights:

DHS 133.08(2)(a) (a) To be fully informed, as evidenced by home health agency documentation, of all rules and regulations governing patient responsibilities;

DHS 133.08(2)(b) (b) To be fully informed, prior to or at the time of admission, of services available from the agency and of related charges, including any charges for services for which the patient or a private insurer may be responsible;

DHS 133.08(2)(c) (c) To be informed of all changes in services and charges as they occur;

DHS 133.08(2)(d) (d) To be fully informed of one’s own health condition, unless medically contraindicated, and to be afforded the opportunity to participate in the planning of the home health services, including referral to health care institutions or other agencies, and to refuse to participate in experimental research;

DHS 133.08(2)(e) (e) To refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal;

DHS 133.08(2)(f) (f) To confidential treatment of personal and medical records and to approve or refuse their release to any individual outside the agency, except in the case of transfer to another health facility, or as required by law or third-party payment contract;

DHS 133.08(2)(g) (g) To be treated with consideration, respect and full recognition of dignity and individuality, including privacy in treatment and in care for personal needs; and

DHS 133.08(2)(h) (h) To be taught, and have the family taught, the treatment required, so that the patient can, to the extent possible, help himself or herself, and the family or other party designated by the patient can understand and help the patient.

DHS 133.08(2)(i) (i) To exercise his or her rights as a patient of the home health agency;

DHS 133.08(2)(j) (j) To have the patient’s family or legal representative exercise the patient’s rights when the patient has been judged incompetent by a court of law.

DHS 133.08(3) (3) Complaints. At the same time that the statement of patient rights is distributed under sub. (2), the home health agency shall provide the patient or guardian with a statement, provided by the department, setting forth the right to and procedure for registering complaints with the department.

DHS 133.08 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; reprinted to correct printing error in (2) (g), Register, September, 1984, No. 345; CR 07-060: r. and recr. (2) (intro.) and (a), cr. (2) (i) and (j) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.09 DHS 133.09 Acceptance and discharge of patients.

DHS 133.09(1) (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. No patient may be provided services except under a plan of care established by a physician, an advanced practice nurse prescriber, or a physician assistant.

DHS 133.09(2) (2) Service agreement. Before care is initiated, the home health agency shall inform the patient, orally and in writing, of the extent to which payment may be expected from other sources, the charges for services that will not be covered by other sources and charges that the individual may have to pay.

DHS 133.09(3) (3) Discharge of patients.

DHS 133.09(3)(a) (a) Notice of discharge.

DHS 133.09(3)(a)1. 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, 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)2. 2. The home health agency shall provide the written notice, except when a patient is discharged due to hospital admission that occurs near the end of a 60-day episode of treatment, required under subd. 1. to the patient or the patient’s legal representative at least 10 working days in advance of discharge if the reason for discharge is any of the following:

DHS 133.09(3)(a)2.a. a. Payment has not been made for the patient’s care, following reasonable opportunity to pay any unpaid billings.

DHS 133.09(3)(a)2.b. b. The home health agency is unable to provide the care required by the patient due to a change in the patient’s condition that is not an emergency.

DHS 133.09(3)(a)3. 3. The home health agency shall provide the written notice under subd. 1. to the patient or the patient’s legal representative at the time of discharge if the reason for discharge is any of the following:

DHS 133.09(3)(a)3.a. a. The safety of staff is compromised, as documented by the home health agency.

DHS 133.09(3)(a)3.b. b. The attending physician, advanced practice nurse prescriber, or physician assistant orders the discharge for emergency medical reasons.

DHS 133.09(3)(a)3.c. c. The patient no longer needs home health care as determined by the attending physician, advanced practice nurse prescriber, or physician assistant.

DHS 133.09(3)(a)4. 4. The home health agency shall insert a copy of the written discharge notice in the patient’s medical record.

DHS 133.09(3)(a)5. 5. The home health agency shall include in every written discharge notice to a patient or the patient’s legal representative all of the following:

DHS 133.09(3)(a)5.a. a. The reason for discharge.

DHS 133.09(3)(a)5.b. b. A notice of the patient’s right to file a complaint with the department and the department’s toll-free home health hotline telephone number and the address and telephone number of the department’s division of quality assurance.

DHS 133.09 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.

DHS 133.09(3)(b) (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, advanced practice nurse prescriber, or physician assistant.

DHS 133.09 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; r. and recr. (3), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (1), (3) (a) 1., 2. (intro.), 3. b., c. and (b), r. and recr. (2) Register November 2007 No. 623, eff. 12-1-07; correction in (3) (a) 5. b. made under s. 13.92 (4) (b) 6., Stats., Register February 2008 No. 626; CR 16-077: am. (1), (3) (a) 1., 3. b., c., (b) Register September 2017 No. 741 eff. 10-1-17.

DHS 133.10 DHS 133.10 Services provided.

DHS 133.10(1) (1) Required services. The home health agency shall directly provide or arrange for at least part-time or intermittent nursing services and provide or arrange for home health aide services.

DHS 133.10(2) (2) Optional services. In addition to the services required under sub. (1), the agency may provide therapeutic services including, but not limited to, physical therapy, speech therapy, occupational therapy and medical social services.

DHS 133.10 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; am. (1), Register, April, 2001, No. 544, eff. 5-1-01.

DHS 133.11 DHS 133.11 Referrals. When patients have needs which the home health agency cannot meet, the home health agency shall refer these patients to other agencies, social service organizations, or governmental units which are appropriate for unmet needs of the patients and which may be of assistance in meeting those needs. Referrals shall include referrals to meet the needs of patients for services at times before and after the normal business hours of the home health agency.

DHS 133.11 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.12 DHS 133.12 Coordination with other providers. The home health agency shall coordinate its services with any other health or social service providers serving the patient.

DHS 133.12 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84.

DHS 133.13 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.

DHS 133.13 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. Register September 2017 No. 741 eff. 10-1-17.

DHS 133.14 DHS 133.14 Skilled nursing services.

DHS 133.14(1) (1) Provision of services. Skilled nursing services shall be provided by or under the supervision of a registered nurse.

DHS 133.14(2) (2) Duties of the registered nurse. The registered nurse shall:

DHS 133.14(2)(a) (a) Make the initial evaluation visit to the patient.

DHS 133.14(2)(b) (b) Regularly reevaluate the patient’s needs.

DHS 133.14(2)(c) (c) Initiate the plan of care and necessary revisions.

DHS 133.14(2)(d) (d) Provide those services requiring substantial specialized care.

DHS 133.14(2)(e) (e) Initiate appropriate preventive and rehabilitative procedures.

DHS 133.14(2)(f) (f) Prepare clinical and progress notes.

DHS 133.14(2)(g) (g) Promptly inform either the physician, advanced practice nurse prescriber, or physician assistant, as well as other personnel participating in the patient’s care of changes in the patient’s condition and needs.

DHS 133.14(2)(h) (h) Arrange for counseling the patient and family in meeting related needs.

DHS 133.14(2)(i) (i) Participate in inservice programs for agency staff.

DHS 133.14(2)(j) (j) Supervise and teach other personnel.

DHS 133.14(3) (3) Scope of duties. Nurses shall perform only those duties within the scope of their licensure.

DHS 133.14(4) (4) Practical nursing. Nursing services not requiring a registered nurse may be provided by a licensed practical nurse under the supervision of a registered nurse.

DHS 133.14(5) (5) Coordination of services. A registered nurse shall maintain overall responsibility for coordinating services provided to the patient by the agency.

DHS 133.14(6) (6) Contracted registered nurse services. A home health agency may purchase registered nurse services on an hourly or per visit basis, in accordance with the requirements in s. DHS 133.19. Persons providing registered nurse services under contract shall meet the requirements in s. DHS 133.06 (4) (a) to (d), be assigned to duties for which they are licensed and trained and be utilized only in non-supervisory nursing assignments.

DHS 133.14 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; cr. (6), Register, April, 2001, No. 544, eff. 5-1-01; CR 07-060: am. (2) (c) and (g) Register November 2007 No. 623, eff. 12-1-07; CR 16-077: am. (2) (a) to (i) Register September 2017 No. 741 eff. 10-1-17; correction in (2) (b) made under s. 35.17, Stats., Register September 2017 No. 741.

DHS 133.15 DHS 133.15 Therapy services.

DHS 133.15(1) (1) Provision of services. Physical therapy, occupational therapy, speech therapy, and other therapy services provided directly by the home health agency or arranged for under s. DHS 133.19, shall be given in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (a), (c), (f), (h) and (i).

DHS 133.15(2) (2) Physical therapy. If offered, physical therapy shall be provided by a physical therapist or by a qualified therapy assistant under the supervision of a qualified physical therapist.

DHS 133.15(3) (3) Occupational therapy. If offered, occupational therapy shall be provided by an occupational therapist or by a qualified therapy assistant under the supervision of a qualified occupational therapist.

DHS 133.15(4) (4) Speech therapy. If offered, speech therapy shall be provided by a speech pathologist or audiologist.

DHS 133.15(5) (5) Other therapies. Therapies other than those under subs. (2), (3) and (4), shall be provided by persons qualified by training or by being licensed to perform the services.

DHS 133.15 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. (1) Register November 2007 No. 623, eff. 12-1-07.

DHS 133.16 DHS 133.16 Medical social services. If offered, medical social services shall be provided by a social worker in accordance with the plan of care developed under s. DHS 133.20. Individuals providing these services shall perform the duties under s. DHS 133.14 (2) (c), (f), (h) and (i).

DHS 133.16 History History: Cr. Register, May, 1984, No. 341, eff. 6-1-84; CR 07-060: am. Register November 2007 No. 623, eff. 12-1-07.