Home Health Update
Chapter HFS 133, Wisconsin Administrative Code Effective December 1,
2007
PDF Version of DQA 07-022
(PDF, 42 KB)
Date: December 3, 2007 -- DQA Memo 07-022
Supersedes DSL-BQA - 01-017
To: Home
Health Agencies HHA 10
From: Cremear Mims, Director
Bureau of Health Services
Via: Otis Woods,
Administrator
Division of Quality Assurance
Home Health Update Chapter HFS 133, Wisconsin
Administrative Code, Effective December 1, 2007
In the past, the Division of Quality Assurance (DQA) has received
numerous questions related to patient discharge regulations. This memorandum
replaces DSL-BQA 01-017 and updates the information to reflect the
promulgation of revisions to ch. HFS 133, Wisconsin Administrative Code
effective December 1, 2007.
Section HFS 133.09 (3) Notice of Discharge
Question: What information must be included in the notice of discharge
provided to the patient at the time of discharge?
Response: Section HFS 133.09 (3)(a) 5. requires that the home health
agency include all of the following in every written discharge notice to a
patient or the patient's legal representative:
- The reason for discharge;
- A notice of the patient's right to file a complaint with the
department;
- The department's toll-free home health hotline telephone number; and
- The address and telephone number of the department's Division of
Quality Assurance.
Question: Home health agencies are required to provide information
about the right to file a complaint and the process for filing a complaint
with the Department upon admission. Are they required to provide this
information again in writing upon discharge?
Response: Yes, s. HFS 133.09(3)(a)5.b. requires a home health agency to
provide this information at the time of discharge.
Question: Do home health agencies have to give a written notice if the
patient is being discharged with goals met and care is discontinued?
Response: If the patient is being discharged because goals have been met
and the physician or the advance practice nurse prescriber has discontinued
the plan of care, the agency should provide the patient with a written
notice at the time of discharge.
The agency must discuss the discharge with the patient or the patient's
legal representative and the attending physician or advance practice nurse
prescriber prior to the discharge (s. HFS 133.09(3)(a)1.). The clinical
record documentation must reflect these contacts and discussions (s. HFS
133.21(5)(i)).
Question: Is a notice of discharge necessary if the patient is going
from Medicare/Medicaid covered services to private pay?
Response: If the payment source changes and the patient is not being
discharged from the agency, there is no need to provide a written notice of
discharge.
Question: Do home health agencies have to give the patient a 10-day
notice if the patient is being discharged due to the patient's non-payment
of fees or the agency's inability to provide services?
Response: If the reason for discharge is non-payment of fees or the
agency's inability to provide the care due to a change in patient
condition that is not an emergency, the patient must be given the
written notice at least 10 working days in advance of the discharge (s. HFS
133.09(3)(a)2.).
In addition, if the patient has needs which the home health agency cannot
meet, s. HFS 133.11 requires the agency to refer the patient to other
resources that may be appropriate to meet those needs.
Question: Are home health agencies required to provide a notice of
discharge to patients who refuse the continuation of services and discharge
themselves?
Response: A home health agency cannot prohibit the patient from
discontinuing services and discharging himself or herself. The agency must
inform the attending physician or the advance practice nurse prescriber of
the patient's decision to discontinue services.
If the physician or advance practice nurse prescriber concurs with the
patient's request to discontinue service, the agency would process and
document the physician's or advance practice nurse prescriber's discharge of
the patient. The agency would then provide the patient with a notice of
discharge pursuant to s. HFS 133.09 (3)(a)3.c.
If the physician or the advance practice nurse prescriber disagrees with
the patient's decision to discontinue services, and the agency and the
physician or the advance practice nurse prescriber are unsuccessful in
persuading the patient to continue services, the clinical record
documentation should reflect the patient's decision to discontinue
services.
Section HFS 133.08(2)(e) allows a patient to refuse treatment to the
extent permitted by law and to be informed of the medical consequences of
such refusal.
The agency would inform the physician or the advance practice nurse
prescriber of the last date of service. The clinical record documentation
must reflect patient notification, physician or advance practice nurse
prescriber contacts, coordination efforts and the actions of the patient,
attending physician or advance practice nurse prescriber and the agency (s.
HFS 133.21(5)).
Although s. HFS 133.09 does not require the agency to provide a patient
who discontinues services with a notice of discharge, s. HFS 133.08(2)(c)
requires the agency to inform the patient of all changes in services and
charges as they occur.
Accordingly, the agency would need to provide a notice to the patient
regarding the cessation of services without physician or advance practice
nurse prescriber authorization and the medical consequences of this service
refusal.
In the past, DQA issued a statewide variance of s. HFS 133.21(5)(i) to
permit home health agencies to complete the discharge summary within 30 days
because the standard was inconsistent with the timeframe contained in s. HFS
133.09(3)(b). This variance is no longer necessary because HFS 133.21(5)(i)
has been amended to allow for 30 days following discharge to complete the
discharge summary.
If you have questions about this information, please contact the Section
Chief assigned to your agency. The names and telephone numbers of the
Section Chiefs are listed below:
Jan Heimbruch
Section Chief
Acute Care Compliance Section
Northern Team
(608) 266-0371
Mark Andrews
Section Chief
Acute Care Compliance Section
Southern Team
(608) 266-0269
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