Chapter DHS 124

DHS 124.36 History History: Emerg. renum. from DHS 124.27 (10), eff. 7-1-96; renum. from DHS 124.27 (10), Register, December, 1996, No. 492, eff. 1-1-97l; CR 19-135: r. (1) to (10) Register June 2020 No. 774, eff. 7-1-20; renum. (11) to DHS 124.36 under s. 13.92 (4) (b) 7., Stats., Register June 2020 No. 774.

subch. VI of ch. DHS 124 Subchapter VI — Critical Access Hospitals

DHS 124.37 DHS 124.37 Applicability. This subchapter applies to the department and to all hospitals designated by the department as critical access hospitals.

DHS 124.37 History History: Emerg. cr., eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99.

DHS 124.38 DHS 124.38 Definitions. In this subchapter:

DHS 124.38(1) (1) “Clinical nurse specialist” means a registered nurse who is currently certified as a clinical nurse specialist by a national certifying body that is recognized by the state board of nursing.

DHS 124.38(2) (2) “Network hospital” means a full-time hospital that has an agreement with a critical access hospital to provide ongoing acute care services for patients transferred or referred from the critical access hospital.

DHS 124.38(3) (3) “Nurse practitioner” means a registered nurse who is currently certified as a nurse practitioner by a national certifying body that is recognized by the state board of nursing.

DHS 124.38(4) (4) “Rural health plan” means a plan approved by the federal centers for medicare and medicaid services that describes how the department will implement and administer parts of the federal medicare rural hospital flexibility program — critical access hospitals — under 42 USC 1395i-4.

DHS 124.38(5) (5) “Rural hospital” means a hospital that was initially approved as a hospital prior to January 1, 2003 and is located in a county that has at least a portion of a rural census tract of a Metropolitan Statistical Area (MSA) as determined under the most recent version of the Goldsmith Modification as provided in 42 CFR 412.103(a)(1).

DHS 124.38 Note Note: The most recent version of the Goldsmith Modification as determined by the Office of Rural Health Policy (ORHP) of the Health Resources and Services Administration is available via the ORHP website at http://www.raconline.org/topics/what-is-rural/faqs/#goldsmith or from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy, 5600 Fishers Lane, Room 9A-55, Rockville, MD 20857. 42 CFR 412.103 of the federal regulations addresses hospitals located in urban areas that want to apply for reclassification as rural hospitals.

DHS 124.38 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; emerg. cr. (5), eff. 3-21-03; CR 03-042: am. (4), cr. (5) Register September 2003 No. 573, eff. 10-1-03; CR 19-135: r. and recr. (2) Register June 2020 No. 774, eff. 7-1-20.

DHS 124.39 DHS 124.39 Designation as a critical access hospital.

DHS 124.39(1) (1) Eligibility. Except as provided under sub. (2) (a), to be eligible for designation as a critical access hospital, a hospital shall be all of the following:

DHS 124.39(1)(a) (a) A hospital approved by the department under this chapter to operate as a hospital.

DHS 124.39(1)(b) (b) Located in an area outside of a metropolitan statistical area as defined in 42 USC 1395ww(d), or located in a rural area of an urban county.

DHS 124.39(1)(c) (c) Located more than a 35-mile drive from another hospital or certified by the department under sub. (2) as a necessary provider of health care services to residents in the area.

DHS 124.39(1)(d) (d) A hospital that has a provider agreement to participate in medicare in accordance with 42 CFR 485.612.

DHS 124.39(1)(e) (e) A hospital that has not been designated by the federal centers for medicare and medicaid services as an urban hospital for purposes of medicare reimbursement.

DHS 124.39(2) (2) Application for certification as a necessary provider for an area.

DHS 124.39(2)(a) (a)

DHS 124.39(2)(a)1. 1. A hospital meeting the criteria under sub. (1) (a), (b), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if it cannot meet the criterion under sub. (1) (c) that it be located more than a 35-mile drive from another hospital.

DHS 124.39(2)(a)2. 2. A rural hospital meeting the criteria under sub. (1) (a), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if the rural hospital cannot meet the criteria under sub. (1) (b) and (c).

DHS 124.39(2)(a)3. 3. Application under subd. 1. or 2. shall be made in accordance with a format provided by the department.

DHS 124.39 Note Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; [phone].

DHS 124.39(2)(b) (b) Upon receipt of a completed application from a hospital for certification as a necessary provider of health care services to residents in the area, the department shall review the application and shall approve or disapprove it within 60 days of receipt.

DHS 124.39(3) (3) Application for critical access hospital status.

DHS 124.39(3)(a) (a) A hospital eligible under sub. (1) or (2) (a) for designation as a critical access hospital may apply to the department for designation. Application shall be made in accordance with a format provided by the department.

DHS 124.39 Note Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; [phone].

DHS 124.39(3)(b) (b) Upon receipt of a completed application from a hospital for designation as a critical access hospital, the department shall review the application and shall determine if the applicant meets the federal conditions of participation in medicare for critical access hospitals under 42 CFR 485.601 to 485.645, and, if applicable, 42 CFR 412.103(a)(1). If the applicant hospital meets those federal regulations and all requirements under s. 124.41, the department shall, within 90 days after receipt of a completed application, recommend certification of the hospital as a critical access hospital to the federal centers for medicare and medicaid services.

DHS 124.39 Note Note: Section DHS 124.40 was repealed by CR 19-135, effective 7-1-20. This provision will be treated in future rulemaking.

DHS 124.39 Note Note: The federal Centers for Medicare and Medicaid Services will notify the Department and the applicant hospital of the certification decision.

DHS 124.39(3)(c) (c) Following notification by the federal centers for medicare and medicaid services that it has accepted the department’s certification recommendation, the department shall issue a certificate of approval that establishes the applicant’s critical access hospital status in the state.

DHS 124.39 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; emerg. am. (1) (intro.) and (e), (2) (a) and (3), eff. 3-21-03; CR 03-042: am. (1) (intro.), (a), (b), (e), (2) (a) and (3) Register September 2003 No. 573, eff. 10-1-03; CR 23-046: am. (3) (b) Register April 2024 No. 820, eff. 5-1-24.

DHS 124.41 DHS 124.41 Rural health plan. Before implementation of the state medicare rural hospital flexibility program pursuant to 42 USC 1395i-4 for the establishment of critical access hospitals, the department shall develop a rural health plan. The department shall submit the rural health plan to the federal centers for medicare and medicaid services for approval.

DHS 124.41 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; CR 03-042: am. Register September 2003 No. 573, eff. 10-1-03.