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Revisions to HFS 132, Wisconsin Adm. Code, effective November 1, 2004

PDF Version of BQA 05-001 (PDF, 159 KB)

DATE: January 7, 2005 DSL-BQA-05-001

TO: Nursing Homes NH 01

FROM: Cris Ros-Dukler, Director, Bureau of Quality Assurance

On November 1, 2004, changes to HFS 132, Wisconsin Administrative Code, went into effect.

These changes, developed by members of the nursing home associations, nursing home administrators, and representatives from the Board of Aging and Long Term Care and the Bureau of Quality Assurance (BQA), represent the first substantial changes to chapter HFS 132 in more than ten years.

A current copy of chapter DHS 132 can be obtained on the Internet at:

This memo highlights the major changes that were made to chapter HFS 132.

  1. HFS 132.31(1)(k) was amended concerning the use of physical and chemical restraints. Instead of solely requiring the order of a physician, restraints may be used only when required to treat the resident’s medical symptoms. This mirrors the federal requirement found at 42 CFR 483.13(a) [F221].
  2. HFS 132.45(4)(g)2 was amended to allow the use of electronic signatures, provided the electronic representation is used only by the person who makes the entry, and provided the facility possesses a signed statement from that person certifying that s/he is the only person using that electronic signature.
  3. A new section, HFS 132.46 Quality assurance and assessment, was added to chapter HFS 132. These regulations require all nursing homes to have a Quality Assurance and Assessment Committee comprised of the Director of Nurses, the medical director or a designated physician, and at least three other members of facility staff. This committee must meet at least quarterly to identify, develop, and implement appropriate plans of action to correct any identified quality deficiencies within the facility. Facilities are not required to disclose the notes of this committee to BQA except to determine compliance with this section. These requirements mirror the federal nursing home regulations found at 42 CRF 483.75(o) [F520 – F522].
    The development of these regulations prompted the deletion of the regulations previously found at HFS 132.65(3)(a) concerning the Pharmaceutical Services Committee.
  4. HFS 132.42(3)(a), concerning physical health certifications for new employees, and HFS 132.52(2)(c), concerning physical health certifications of new residents, were amended to permit physician assistants and advanced practice nurse prescribers to screen the individuals for apparent clinical diseases. HFS 132.60(5)(a)1 and 2, concerning medication, treatment, and rehabilitative therapy orders, was amended to clarify the process for oral and written orders issued by authorized prescribers.
  5. A new subdivision, HFS 132.60(1)(c)5, was added concerning pain management. This codified the expectations for pain management based on accepted professional standards of practice. Nursing homes are required to:
  • assess and treat each resident suspected of or experiencing pain so that they may be as pain free as possible;
  • conduct an initial pain assessment and conduct regular and periodic reassessments of pain;
  • evaluate the effectiveness of the measures being taken to relieve pain; and
  • consider and implement, as appropriate, nonpharmacological interventions to control pain.
  1. HFS 132.83(4) was amended. Facilities whose medical records are solely electronically based must have emergency back-up power for the facility’s electronic record system.
  2. HFS 132.83(7)(a)2 was amended. Instead of 110o, hot water temperature at fixtures used by residents may be in the range of 110 – 115o.
  3. HFS 132.84(3) was amended. While each resident living area is required to have a staff work station, the requirement for a nurse station that is centrally located within the living area has been deleted.

We have attached a complete copy of the changes (PDF, 93 KB) that were made to HFS 132, Wisconsin Administrative Code.

If you have questions, please contact the Regional Field Operations Director whose region serves your nursing home.

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