DHS 83.27 Limitations on admissions and retentions.
(1) LICENSE CAPACITY. (a) No CBRF may have more residents, including respite care residents, than the maximum bed capacity on its license.
(b) The CBRF may not have more than 4 residents or 10% of the licensed capacity, whichever is greater, who need more than
3 hours of nursing care per week or care above intermediate level nursing care for not more than 30 days unless the facility has
obtained a waiver from the department or the department has received a request for a waiver from the CBRF and the department’s decision is pending.
(2) ADMISSION AND RETENTION LIMITATIONS. A CBRF may not admit or retain any of the following persons:
(a) A person who has an ambulatory or cognitive status that is not compatible with the license classification under s. DHS 83.04
(2). (b) A person who is destructive of property or self, or who is
physically or mentally abusive to others, unless the CBRF has sufficient resources to care for such an individual and is able to protect the resident and others.
(c) A person who has physical, mental, psychiatric, or social needs that are not compatible with the client group as described in the CBRF’s program statement.
(d) A person who needs more than 3 hours of nursing care per week except for a temporary condition needing more than 3 hours
of nursing care per week for no more than 30 days. If the CBRF requests a waiver or variance, the department may grant a waiver
or variance to this requirement, as described under s. DHS 83.03, if the following conditions are met:
1. The resident’s clinical condition is stable and predictable, does not change rapidly, and medical orders are unlikely to
involve frequent changes or complex modifications and the resident’s clinical condition is one that may be treatable, or the resident has a long−term condition needing more than 3 hours of nursing care per week for more than 30 days.
2. The resident is otherwise appropriate for the level of care provided in the CBRF.
3. The services needed to treat the resident’s condition are available in the CBRF.
(e) A person whose condition requires 24−hour supervision by a registered nurse or licensed practical nurse.
(f) A person whose condition requires care above intermediate level nursing care.
(g) A person who requires a chemical or physical restraint
except as authorized under s. 50.09 (1) (k), Stats.
(h) A person who is incapacitated, as defined under s. 50.06
(1), Stats., unless the person has a health care agent under a valid
and properly activated power of attorney for health care under ch.
155, Stats., or a court-appointed guardian under ch. 54, Stats.,
except for the admission of an incapacitated individual who does
not have such a legal representative, and who is admitted directly
from the hospital according to the provision of s. 50.06, Stats.
(i) A person who resides in a CBRF licensed for 16 or more
residents and has been found incompetent under ch. 54, Stats.,
and does not have a court−ordered protective placement under s.
(3) ADMISSION OF MINORS. The CBRF may not admit a person
under 18 years of age without the written approval of the department
and only if any of the following apply:
(a) The CBRF is also licensed under ch. DCF 57 as a group foster care home or under ch. DCF 52 as a residential care center for children and youth.
(b) The minor has been waived to an adult court under s. 938.18, Stats.
(c) The minor is the child of an adult resident. When the minor
child of an adult resident resides in a CBRF, all of the following shall apply:
1. The adult resident retains custody and control of the child.
2. The CBRF shall have written policies related to the presence of minors in the CBRF, including policies on parental
responsibility, school attendance and any care, treatment or services provided to the minors by the CBRF.
DHS 83.28 Admission procedures.
(1) ASSESSMENT. The CBRF shall assess each resident before admission as required under s. DHS 83.35 (1).
(2) SERVICES AND CHARGES. Before or at the time of admission, the CBRF shall provide written information regarding services available and charges for those services as required in s.
DHS 83.29 (1).
(3) ADMISSION AGREEMENT. Before or at the time of admission, the CBRF shall provide the admission agreement as required under s. DHS 83.29 (2).
(4) HEALTH SCREENING. (a) Resident health screening. 1.
Within 90 days before or 7 days after admission, a physician, physician assistant, clinical nurse practitioner or a licensed registered
the nurse shall screen each person admitted to the CBRF for clinically apparent communicable disease, including tuberculosis, and document the results of the screening.
2. Screening for tuberculosis and all immunizations shall be conducted using centers for disease control and prevention standards.
3. The CBRF shall maintain the screening documentation in each resident’s record.
(b) Respite care health screening. 1. Within 90 days before
or 7 days after admission for persons in respite care who will reside in the CBRF for more than 7 days, a physician, physician
assistant, clinical nurse practitioner or a licensed registered nurse shall screen each respite care person for clinically apparent communicable disease, including tuberculosis, and document the
results of the screening.
2. If the person did not provide evidence of health screening required under sub. 1., prior to the second admission in a calendar year of a person in respite care, a physician, physician assistAgenda Item X.A – WI Chapter DHS 83 Regulations
3. Screening for tuberculosis and all immunizations shall be
conducted using centers for disease control and prevention standards.
4. The CBRF shall maintain the screening documentation for each respite care person.
(5) TEMPORARY SERVICE PLAN. Upon admission, the CBRF shall develop a temporary service plan as required under s. DHS 83.35 (2).
(6) RESIDENT RIGHTS, GRIEVANCE PROCEDURE, AND HOUSE
RULES. Before or at the time of admission, the CBRF shall provide and explain resident rights, the house rules of the CBRF as
required under s. DHS 83.32 (2), and the grievance procedure,
including written information regarding the names, addresses and
telephone numbers of all resident advocacy groups serving the client groups in the facility, including the long term care ombudsman
program and the protection and advocacy services of Disability
Rights Wisconsin, Inc.
(7) ADVANCED DIRECTIVES. At the time of admission, the CBRF shall determine if the resident has executed an advanced
directive. An advanced directive describes, in writing, the choices about treatments the resident may or may not want and about how
health care decisions should be made for the resident if the resident becomes incapacitated and cannot express their wishes. A copy of the document shall be maintained in the resident record
as required under s. DHS 83.42 (1) (s). A CBRF may not require an advanced directive as a condition of admission or as a condition
of receiving any health care service. An advanced directive may be a living will, power of attorney for health care, or a do−not−resuscitate order under ch. 154 or 155, Stats., or other authority as
recognized by the courts of this state.
DHS 83.29 Admission agreement.
(1) SERVICES AND CHARGES. (a) Definition. In this section, “entrance fee” means a
payment required for admission to the CBRF that is in addition to the fees for services and security deposit.
(b) Written information regarding services and charges. Before or at the time of admission, the CBRF shall provide written
information regarding services available and the charges for those services to each resident, including persons admitted for respite
care, or the resident’s legal representative. This information shall include any charges for services not covered by the daily or
monthly rate, any entrance fees, assessment fees, and security deposits.
(c) Written notice of any change in services or in charges. The CBRF shall give the resident or the resident’s legal representative
a 30−day written notice of any change in services available or in charges for services that will be in effect for more than 30 days.
(2) ADMISSION AGREEMENT REQUIREMENTS. The admission
agreement shall be given in writing and explained orally in the language of the prospective resident or legal representative. Admission is contingent on a person or that person’s legal representative
signing and dating an admission agreement. The admission agreement shall include all of the following:
(a) An accurate description of the basic services provided, the rate charged for those services and the method of payment.
(b) Information about all additional services offered, but not included in the basic services. The CBRF shall provide a written
statement of the fees charged for each of these services.
(c) The method for notifying residents of a change in charges for services.
(d) Terms for resident notification to the CBRF of voluntary discharge. This paragraph does not apply to a resident in the custody of a government correctional agency.
(e) Terms for refunding charges for services paid in advance, entrance fees, or security deposits in the case of transfer, death or
voluntary or involuntary discharge.
(f) A statement that the amount of the security deposit may not exceed one month’s fees for services, if a security deposit is collected.
(g) Terms for holding and charging for a resident’s room during a resident’s temporary absence. This paragraph does not apply
to a resident in the custody of a government correctional agency.
(h) Reasons and notice requirements for involuntary discharge or transfer, including transfers within the CBRF. This paragraph
does not apply to a resident in the custody of a government correctional agency.
(3) REFUNDS. (a) The CBRF shall return all refunds due a resident under the terms of the admission agreement within 30 days after the date of discharge.
(b) During the first 6 months following the date of initial admission, the CBRF shall refund the entire entrance fee when the
resident is discharged or when the resident meets the terms for notification to the CBRF of voluntary discharge as contained in
the CBRF’s admission agreement.
(4) CONFLICT WITH THIS CHAPTER. No statement of the admission agreement may be in conflict with any part of this chapter,
unless the department has granted a waiver or variance of a provision of this chapter.
DHS 83.30 Family care information and referral. If the secretary of the department has certified that a resource center,
as defined under s. DHS 10.13 (42), is available for the facility under s. DHS 10.71, the CBRF shall provide information to prospective residents and refer residents and prospective residents to
an aging and disability resource center as required under s. 50.035 (4m) to (4p), Stats., and s. DHS 10.73.
DHS 83.31 Discharge or transfer. (1) APPLICABILITY.
This section applies to all resident discharges except for persons in respite care.
(2) EMERGENCY OR TEMPORARY TRANSFERS. If a condition or action of a resident requires the emergency transfer of the resident
to a hospital, nursing home or other facility for treatment not available from the CBRF, the CBRF may not involuntarily discharge
the resident unless the requirements under sub. (4) are met.
(3) DISCHARGE OR TRANSFER INITIATED BY RESIDENT. (a) Any
competent resident may initiate transfer or discharge at any time
in accordance with the terms of the admission agreement if the resident is not in the custody of a government correctional agency,
committed under s. 51.20, Stats., or under a court−ordered protective placement under s. 55.12, Stats.
(b) If a resident found incompetent under ch. 54, Stats., protests the resident’s admission or continued stay, the licensee or
designee shall immediately notify the legal representative and the county protective services agency to obtain a determination about
whether to discharge the resident under s. 55.055 (3), Stats.
(4) DISCHARGE OR TRANSFER INITIATED BY CBRF. (a) Notice
and discharge requirements. 1. Before a CBRF involuntarily discharges a resident, the licensee shall give the resident or legal representative a 30 day written advance notice. The notice shall
explain to the resident or legal representative the need for and possible alternatives to the discharge. Termination of placement initiated by a government correctional agency does not constitute a
discharge under this section.
2. The CBRF shall provide assistance in relocating the resident and shall ensure that a living arrangement suitable to meet the
needs of the resident is available before discharging the resident.
(b) Reasons for involuntary discharge. The CBRF may not
involuntarily discharge a resident except for any of the following reasons:
1. Nonpayment of charges, following reasonable opportunity to pay.
2. Care is required that is beyond the CBRF’s license classification.
3. Care is required that is inconsistent with the CBRF’s program statement and beyond that which the CBRF is required to
provide under the terms of the admission agreement and this chapter.
4. Medical care is required that the CBRF cannot provide.
5. There is an imminent risk of serious harm to the health or safety of the resident, other residents or employees, as documented in the resident’s record.
6. As provided under s. 50.03 (5m), Stats.
7. As otherwise permitted by law.
(c) Notice requirements. Every notice of involuntary discharge shall be in writing to the resident or resident’s legal representative and shall include all of the following:
1. A statement setting forth the reason and justification for discharge listed under par. (b).
2. A statement that the resident or the resident’s legal representative may ask the department to review the involuntary discharge by sending a written request within 10 days of receipt of
the discharge statement to the department’s regional office with a
copy to the CBRF. The notice shall state that the request must provide an explanation of why the discharge should not take place.
3. The name, address, and telephone number of the department’s regional office director.
4. The name, address, and telephone number of the regional
office of the board on aging and long-term care’s ombudsman program. For residents with a developmental disability or mental illness, the notice shall include the name, address and telephone
number of the protection and advocacy agency designated under s. 51.62 (2) (a), Stats.
(d) Department review of discharge. 1. A resident may request department review of an involuntary discharge within 10 days of
receipt of such notice. If a timely request is sent to the department, the CBRF may not proceed with an involuntary discharge until the
department has completed its review and notified the resident or the resident’s legal representative and the CBRF of the department’s decision.
2. Within 7 days after receiving the copy of the letter requesting the review, the CBRF may provide to the department’s regional office, additional information justifying the discharge.
3. The department shall complete its review within 10 days after the CBRF submits additional information under subd. 2., if
any, and will notify in writing the resident or the resident’s legal representative and the CBRF of the department’s decision.
Note: See Appendix A for the addresses and phone numbers of the Department’s
Division of Quality Assurance, Bureau of Assisted Living regional offices.
(e) Coercion and retaliation prohibited. Any form of coercion to discourage or prevent a resident or legal representative from requesting a department review of any notice of involuntary discharge is prohibited. Any form of retaliation against a resident or legal representative for requesting a department review, or against
an employee who assists in submitting a request for department review or otherwise provides assistance with a request for review,
(5) REMOVAL OR DISPOSAL OF RESIDENT’S BELONGINGS. If a resident or the resident’s representative does not remove the resident’s belongings within 30 days after discharge, the CBRF may
dispose of the belongings. This subsection does not apply to a resident who absconds from the CBRF and who is under the custody
of a government correctional agency or under the legal jurisdiction of a criminal court and for whom there is an apprehension order.
(6) DISBURSEMENT OF FUNDS. (a) The CBRF shall return all refunds due a resident within 30 days of the date of discharge as
required under s. DHS 83.29 (3).
(b) The CBRF shall return all resident funds held by the CBRF to the resident or the resident’s legal representative within 14 days
after discharge as required under s. DHS 83.34 (4).
(7) INFORMATION PROVIDED AT THE TIME OF TRANSFER OR DISCHARGE. At the time of a resident’s transfer or discharge, the
CBRF shall inform the resident or the resident’s legal representative and the resident’s new place of residence that all of the following information is available in writing upon request:
(a) Facility information. The name and address of the CBRF, the dates of admission, and discharge or transfer, and the name and
address of a person to contact for additional information.
(b) Medical providers. Names and addresses of the resident’s physician, dentist, and other medical care providers.
(c) Emergency contacts. Names and addresses of the resident’s relatives or legal representative to contact in case of emergency.
(d) Other contacts. Names and addresses of the resident’s significant social or community contacts.
(e) Assessment and individual service plan. The resident’s assessment and individual service plan, or a summary of each.
(f) Medical needs. The resident’s current medications and
dietary, nursing, physical, and mental health needs, if not included in the assessment or individual service plan.
(g) Reason for discharge or transfer. The reason for the resident’s discharge or transfer