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Policies & Procedures Needed to Meet DHS 131 Requirements for Hospice Licensure

Return to Hospice Application Process

As an applicant, you must prepare and submit supporting documentation relating to your agency's operating policies and procedures.

This is a critical component of the application process and if not prepared thoroughly will delay or result in denial of your application.

READ CAREFULLY:  Once you are familiar with all of the Wisconsin Administrative Rule requirements within DHS 131, you must develop policies related to each of the following.  Each policy must clearly be outlined and labeled with it's corresponding rule requirement:  

A. Policies/Procedures and materials related to:

  1. Patient Rights - DHS 131.19
  2. Service Agreement - DHS 131.17(4)(b)
  3. Governing Body - DHS 131.28
  4. Administrator - DHS 131.29
  5. Orientation Program - DHS 131.31(3)
  6. Continuous Training - DHS 131.31(5)
  7. Infection Control - DHS 131.23
  8. Evaluation - DHS 131.31(6)
  9. Personnel Practices - DHS 131.31(7)
  10. Volunteers - DHS 131.27
  11. Health Care Records - DHS 131.33
    • Content
    • Protection of Records
    • Entries
    • Medical Symbols and Abbreviations
  12. Quality Assessment and Performance Improvement - DHS 131.22
  13. Admission - DHS 131.17
  14. Plan of Care - DHS 131.21
  15. Bereavement Program - DHS 131.25(6)(a)
  16. Discharge - DHS 131.18
  17. Reporting & Investigation of Caregiver Misconduct - DHS 13

B. Job Descriptions

  1. Administrator - DHS 131.29
  2. Volunteer - DHS 131.27
  3. Medical Director - DHS 131.32
  4. Nurses - DHS 131.25(4)
  5. Social Services - DHS 131.25(5)
  6. Bereavement - DHS 131.25(6)(a)
  7. Non-core Services - DHS 131.26

If these services will be provided, include documentation to support their credentials:

  • Spiritual Counsel
  • Other Counseling Services
  • Dietary
  • Therapy
  • Licensed Practical Nurse
  • Hospice Aide
  • Homemaker
  • Companion

C. Contracts - DHS 131.30(2)

  • Hospital
  • Nursing Home
  • CBRF/Assisted Living
  • Therapy
  • DME
  • Pharmaceutical
  • Inpatient
  • Respite

D. Sample of Forms: 

  • Patient Rights
  • Family Rights
  • Informed Consent
  • Service Agreement
  • Orientation Program
  • Assignment Sheets applicable to the hospice aide, volunteer, homemaker and companion

Last Revised: March 31, 2014