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Policies & Procedures Needed to Meet DHS 133 Requirements for HHA Licensure

Return to Home Health Agency Application Process

Completion of these materials are critical to issuance of a license.
You must submit copies of policies and procedures and/or other documents that define how your agency will comply with each of these  requirements, found in DHS 133 and DHS 13.

1. DHS 133.05: (1) (a) (b) (d) (e) Governance: (Provide Copies)

  • Governing body policies: as they relate to agency's management

2. DHS 133.05(2): Professional Advisory Board Policies (Provide Copies)

  • Method of Program Evaluation (DHS 133.07)(2)
  • Emergency Care (DHS 133.13)
  • Supervisory Visits (DHS 133.18)
  • Plan of Treatment (DHS 133.20 (1)
  • Contents of plan; include a copy of a plan of care (DHS 133.20(2)

3. DHS 133.06(3)(a): Administration Policy Statements: (Provide Copies)

  • Recruitment (DHS 133.06(3)(a)
  • Orientation of Personnel including DHS 133.06(4)(a)
  • Staff Evaluation (DHS 133.06(4)(c))
  • Communicable Disease Control (DHS 133.06(4)(d) 3.
  • Continued Training of Staff (DHS 133.06(4)(e))
  • Employee Background Checks and Reporting (DHS133.06(4)(g))
  • Infection Control and Prevention (DHS133.06(5)(a)-(c))

4. DHS 133.08(1) and DHS 133.08(2)(a) - (j): Patient Rights Policies and Statements: (Provide Copies)

  • Patient Rights Statement
  • Advance Directives
  • Complaint Process (DHS 133.08(3))

5. DHS 133.09 Acceptance and Discharge of Patients: (Provide Copies)

  • Services under contract (DHS 133.19(1(a - f) and (2)
  • Service Agreement (DHS 133.09(2)
  • Discharge Statement (DHS 133.09(3)(a)1; 2 a.b; .3, a.b.c; 4, and 5 a.b.
  • Aide Assignment Sheet (submit copy)

6. DHS 133.21(1 - 7): Medical Records Policies: (Provide Copies)

  • Security Against Loss, Destruction or Unauthorized Use.
  • Retention of Records
  • Transfer of Records to Another Agency
  • Form of Entries
  • Abbreviations (DHS 133.21(7))

7. Submit copies of job descriptions for each of the following:

  1. Administrator
  2. Director of Nursing/Supervising Nurse
  3. Registered Nurse/LPN
  4. Home Health Aides
  5. Personal Care Workers
  6. Therapists (PT,OT,ST)
  7. Medical Social Worker

8.  DHS 13.05(3) Misconduct Reporting & Investigation (Provide Copies)

  • Policy on conducting and documenting investigations

Last Revised:  August 26, 2013