DHS 122.07(1r)
(1r) Additional review criteria for conversion of an FDD to a nursing home. The department shall use the applicable criteria in sub.
(1) and the additional criteria in this subsection in its review of an application under s.
DHS 122.02 (2) (b) and s.
150.21 (5), Stats., for the total conversion of an FDD under ch.
DHS 134 to be a nursing home under ch.
DHS 132. The department shall not approve an application subject to this subsection unless the applicant demonstrates that:
DHS 122.07(1r)(a)
(a) The proposed per diem rates for the nursing home are consistent with those of similar facilities;
DHS 122.07(1r)(b)
(b) There will remain in the health planning area in which the applicant FDD is located sufficient FDD beds to serve the population of persons with developmental disabilities, including any residents of the converting facility who need to remain in an FDD;
DHS 122.07(1r)(c)
(c) There are other adequate and appropriate resources available in the county or counties served by the facility being converted for relocating its residents as determined by the applicable county department or departments organized under s.
46.23,
51.42 or
51.437, Stats.; and
DHS 122.07(1r)(d)
(d) The facility, in conjunction with the applicable county department or departments organized under s.
46.23,
51.42, or
51.437, Stats., has developed a preliminary relocation plan under s.
50.03 (14) (c) 8., Stats., for each resident which is acceptable to the county department or departments and addresses the needs and concerns of the resident or the resident's guardian.
DHS 122.07(1t)
(1t) Review criteria for nursing home design pilot projects. The department, in its review of all applications under s.
DHS 122.06 (3m) for nursing home design pilot projects, shall use the criteria in sub.
(1), with the exception of sub.
(1) (c) and
(d), and the additional criteria in this subsection. The department may approve no more than 3 projects subject to this subsection. An applicant shall do each of the following:
DHS 122.07(1t)(a)
(a) Document a significant departure from traditional nursing home design;
DHS 122.07(1t)(b)1.
1. The new nursing home design improves the quality of life and care of nursing home residents;
DHS 122.07(1t)(b)2.
2. The new nursing home design improves productivity of nursing home staff; and
DHS 122.07(1t)(c)
(c) Utilize a minimum of 30 existing nursing facility beds for the research and a comparable control group of nursing facility beds in the traditional nursing home setting within the same licensed facility;
DHS 122.07(1t)(d)
(d) Submit a copy of the written research proposal which documents that the proposal:
DHS 122.07(1t)(d)1.
1. Has been prepared in conjunction with an established independent research organization; and
DHS 122.07(1t)(d)2.
2. Will be conducted in conjunction with an established independent researcher;
DHS 122.07(1t)(g)
(g) Document that the cost per bed will not exceed an amount 45% over the maximum cost per bed as determined in sub.
(1) (c);
DHS 122.07(1t)(h)
(h) Agree to obtain the written consent to participate in the research from all residents participating in the research or from their guardians; and
DHS 122.07(1t)(i)
(i) Document a 92% occupancy rate by reference to the most recent annual survey of nursing homes issued by the department.
DHS 122.07(2)(a)(a) Applications for new or redistributed beds which meet all of the criteria in sub.
(1) shall be subject to the following final selection process:
DHS 122.07(2)(a)1.
1. Applications shall be ranked in the order of their proposed composite per diem rates, beginning with the lowest and ending with the highest. Rates within one percent of each other shall be considered equal for purposes of ranking. The composite per diem rate shall be calculated as follows:
DHS 122.07(2)(a)1.a.
a. Multiply the proposed skilled nursing facility per diem rates, exclusive of supplements, for each payment source by the percentage of projected skilled nursing facility patient days by payment source; and
DHS 122.07(2)(a)1.b.
b. Add all the products of the multiplication in subpar. a to obtain the composite per diem rate;
DHS 122.07(2)(a)2.
2. The department shall review the applicant's methodology for calculation of the proposed rates for consistency with current reimbursement practices and reasonableness. An applicant whose rates are found to be inconsistent or unreasonable will be removed from the selection process;
DHS 122.07(2)(a)3.
3. The department shall approve projects in the order of their ranking until all beds allotted to a planning area are distributed;
DHS 122.07(2)(a)4.
4. The department may approve an application proposing a higher per diem rate than others undergoing concurrent review if the applicant can demonstrate that the application would substantially resolve a significant problem identified in the state health plan with respect to:
DHS 122.07(2)(a)4.a.
a. The existing distribution of beds in the county in which the project would be located, or in contiguous counties;
DHS 122.07(2)(a)4.b.
b. The need to serve a special diagnostic group of inpatients in the planning area or county in which the project would be located; or
DHS 122.07(2)(a)4.c.
c. The existing distribution of population within the planning area or county in which the project would be located; and
DHS 122.07(2)(a)5.
5. If the composite per diem rate for 2 or more of the applicants undergoing concurrent review is equal, the department shall approve or deny those projects as follows:
DHS 122.07(2)(a)5.a.
a. If the total number of beds proposed by all applicants undergoing concurrent review is less than the total number of beds available, each of the projects shall be approved; and
DHS 122.07(2)(a)5.b.
b. If the total number of beds proposed by all applicants undergoing concurrent review is greater than the number of beds available, applications shall be ranked on the basis of per bed cost as calculated in sub.
(1) (c), beginning with the lowest and ending with the highest. The department shall then approve projects in order of this ranking until all beds available are distributed.
DHS 122.07(2)(am)1.
1. If after removing from consideration all applications which fail to meet one or more review criteria, there remain more applications than can be approved for the beds available under s.
DHS 122.04 (1) (b) 2. a., the department shall rank the remaining applications according to how each meets each applicable review criterion under subs.
(1) and
(1m), assigning the lowest number to the application which best meets each criterion.
DHS 122.07(2)(am)2.
2. The department shall approve applications in order beginning with the lowest score, until all available beds are allocated. If there is a tie between applications for the last available approval, the department shall rank the applications according to their scores on review criteria under sub.
(1m) (b).
DHS 122.07(2)(at)1.
1. If after removing from consideration all applications which fail to meet one or more review criteria, there remain more applications than can be approved for the number of projects allowed under sub.
(1t), the department shall rank the remaining applications according to how each meets each applicable review criterion under subs.
(1),
(1m) and
(1t), assigning the lowest number to the application which best meets each criterion.
DHS 122.07(2)(at)2.
2. The department shall approve projects in order beginning with the lowest score, until all approvable projects are allocated. If there is a tie between applications, the department shall rank those applications based on the best research design.
DHS 122.07(2)(b)
(b) Applications for renovation proposals, replacement facilities and capital expenditures over $600,000 which do not affect bed capacity and which meet all criteria in sub.
(1) shall be approved unless the per diem rates proposed as a result of the project are inconsistent with those of similar FDD or other nursing home projects recently approved by the department.
DHS 122.07(2)(c)
(c) In applying pars.
(a) and
(b), the department shall consider the comments of affected parties.
DHS 122.07(2)(d)
(d) The department may not approve new beds if this would cause the statewide bed limit to be exceeded.
DHS 122.07 History
History: Cr.
Register, March, 1985, No. 351, eff. 4-1-85; emerg. cr. (1m) and (2) (am), eff. 1-1-87; am. (2) (a) (intro.) and 1., cr. (2) (a) 5.,
Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (1m) and (2) (am), eff. 5-31-87; cr. (1m) and (2) (am),
Register, October, 1987, No. 382, eff. 11-1-87; emerg. cr. (1r), eff. 10-1-88; emerg. am. (1) (c) 1. and 2. eff. 3-16-90; am. (1) (c) 1. and 2.,
Register, September, 1990, No. 417, eff. 10-1-90; correction in (1) (g) 1. made under s. 13.93 (2m) (b) 7., Stats.,
Register, September, 1990, No. 417; am. (1) (f), (2) (a) 4. intro. and (c), cr. (1) (L),
Register, January, 1991, No. 421, eff. 2-1-91; emerg. cr. (lr), eff. 5-11-93; emerg. r. and recr. (lr) (d), eff. 9-30-93; cr. (lr),
Register, January, 1994, No. 457, eff. 2-1-94; emerg. cr. (1t) and (2) (at), eff. 11-29-95; cr. (1t) and (2) (at),
Register, May, 1996, No. 485, eff. 6-1-96; correction in (1m) (f) 2., made under 13.93 (2m) (b) 7., Stats.,
Register, September, 1999, No. 525; corrections in (1) (g) 1., (1m) (b) and (1r) (intro.) made under s. 13.92 (4) (b) 7., Stats.,
Register January 2009 No. 637.
DHS 122.08(1)(1)
Right to a hearing. An applicant whose application is rejected may request a public hearing to review the department's initial finding.
DHS 122.08(2)(a)
(a) An applicant desiring a public hearing shall file a written request for a public hearing, no later than 10 days after the issuance of the initial finding, to both the department's division of health care financing and the department of administration's division of hearings and appeals.
DHS 122.08 Note
Note: The Division of Health Care Financing has been renamed the Division of Health Care Access and Accountability. The mailing address of the Department's Division of Health Care Access and Accountability is P.O. Box 309, Madison, Wisconsin 53701 and the mailing address of the Division of Hearings and Appeals P.O. Box 7875, Madison, Wisconsin 53707.
DHS 122.08(2)(b)
(b) The applicant requesting the hearing shall identify the criteria at issue no later than 20 days after the issuance of the finding.
DHS 122.08(3)(a)
(a) Start of hearing process. The department shall commence the hearing process within 30 days after receiving a request under sub.
(2), or 30 days following the last request in the event of a concurrent review, unless all parties to the hearing consent to an extension of this period. The hearing process shall begin upon appearance of the parties before the hearing examiner as part of a prehearing conference.
DHS 122.08(3)(b)
(b) Applications undergoing concurrent review. All applications undergoing concurrent review shall be considered at one hearing.
DHS 122.08(3)(c)
(c) Location. All public hearings and prehearing conferences shall be held in the city of Madison unless any party demonstrates that this would impose an undue hardship on that party.
DHS 122.08(3)(d)
(d) Legal issues. A public hearing under this subsection shall consist of a review of the department's initial finding to approve or reject the project. The only issues in the hearing are whether the department's initial finding was:
DHS 122.08(3)(d)1.
1. Contrary to the weight of the evidence on the record when considered as a whole;
DHS 122.08(3)(e)1.1. At least 14 days prior to the public hearing, a prehearing conference shall be held. The purpose of the prehearing conference shall be to consider:
DHS 122.08(3)(e)1.a.
a. The possibility of obtaining admissions of fact and documents which will avoid unnecessary proof; and
DHS 122.08(3)(e)1.b.
b. The scheduling of the submission of names of witnesses to be called and the subject matter of testimony to be presented at the hearing.
DHS 122.08(3)(e)2.c.
c. Requiring that evidence be presented in written form and exchanged among parties prior to the hearing; and
DHS 122.08(3)(e)3.
3. The hearing examiner shall prepare a memorandum summarizing the actions taken at the conference.
DHS 122.08(3)(f)1.1. Issues raised at the hearing shall be limited to the review criteria cited as grounds for disapproval in the initial finding. Criteria not identified in the initial finding are deemed met or not applicable. Evidence may be received which relates to noncontested criteria only to the extent the evidence is relevant to contested criteria.
DHS 122.08(3)(f)2.
2. Except as provided in subd.
3., evidence admitted at the hearing shall be limited to:
DHS 122.08(3)(f)2.a.
a. The application, supporting documents which were submitted with the application, and additional information submitted in response to the department's requests;
DHS 122.08(3)(f)2.b.
b. The staff analysis, initial finding and supporting documents relied upon in making the initial finding;
DHS 122.08(3)(f)2.d.
d. Cross-examination of persons preparing or making statements contained in the documents under subpars. a to c.
DHS 122.08(3)(f)3.
3. Parties may be allowed to present additional evidence only to the extent the additional evidence is directly responsive to and made necessary by the evidence presented by any other party to the proceedings.
DHS 122.08(3)(f)4.
4. Persons preparing or making statements contained in the application, staff analysis, initial finding, recommendation or supporting documents shall be available for cross-examination, unless cross-examination is waived by opposing parties, and may give rebuttal testimony. Witnesses giving direct oral testimony shall be subject to cross-examination in the same manner as other witnesses.
DHS 122.08(3)(f)5.
5. Any party for the proceeding may be represented by counsel and present evidence and conduct cross-examinations subject to the provisions of subd.
2. DHS 122.08(3)(f)6.
6. The examiner conducting the hearing may question all witnesses and take administrative notice of all judicially cognizable facts.
