(b) A fracture; or
(c) A pronounced decline in communication or cognitive abilities.
(26) “Significant change in a participant’s physical or mental condition” means one or more of the following:
(a) Decline in a participant’s medical condition that results in further impairment.
(b) Decline in 2 or more ADLs.
(c) A pronounced decline in communication or cognitive abilities.
(d) Decline in behavior or mood which requires either a temporary or permanent increase in the level of ADL assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, mobility and transferring.
(27) “Standard precautions”are a set of infection control practices used to prevent transmission of diseases that can be acquired by contact with blood, body fluids, non-intact skin (including rashes), and mucous membranes. These measures are used when providing care to all individuals, whether or not they appear infectious or symptomatic.
(28) “Supervision” means oversight of a participant’s daily functioning, keeping track of a participant’s whereabouts and providing guidance and intervention when needed by a participant.
(29) “Transferor” means the current operator in a change of ownership process who will voluntarily relinquish the current certification.
(30) “Transferee” means the recipient of a property or business in a change ownership process who will submit application for a new certification.
(31) “Utensils” means dishes, silverware and pots and pans used for storing, preparing, serving or consuming food.
(32) “Volunteer” means any person who provides services for participants without compensation.
DHS 105.14.03 Variance and waiver. (1) In this section:
(a) “Variance” means the granting of an alternate means of meeting a requirement in this chapter.
(b) “Waiver” means the granting of an exemption from a requirement of this chapter.
(2) Exception to a Requirement. (a) The department may grant a waiver or variance if the department determines that the proposed waiver or variance will not jeopardize the health, safety, welfare or rights of any participant.
(b) A written request for a waiver or variance shall be sent to the department and include justification that the waiver or variance will not adversely affect the health, safety or welfare of any participant for the requested action.
(c) A written request for a variance shall include a description of an alternative means planned to meet the intent of the requirement.
(3) The department may rescind a waiver or variance if any of the following occurs:
(a) The department determines the waiver or variance has adversely affected the health, safety, well-being or welfare of the participants.
(b) The ADCC fails to comply with any of the conditions of the waiver or variance as granted.
Subchapter II – Certification
DHS 105.14.04 Application requirements. (1) No person may receive reimbursement under s. 46.27 (11) Wis. Stat. for the provision of services to participants in an adult day care center unless the adult day care center is certified by the department. A person who assumes ownership interest in a certified ADCC, regardless of whether the transfer includes title to the real estate, or changes the location of the ADCC shall complete an application as required under sub. (2). (2) An application for certification shall be on a form provided by the department and shall be accompanied by all of the following:
(a) A program description as specified under s. DHS 105.14.05. (b) A floor plan specifying dimensions of the ADCC, exits and planned room usage.
(c) A fire inspection report.
(d) All required fees.
(e) A balance sheet.
(f) Evidence that the applicant has 60 days of projected operating funds in reserve.
(g) Proof of transportation liability insurance (if applicable).
(h) Well water test results (if applicable).
(i) Program evaluation plan.
(j) Any additional information requested by the department.
(3) An ADCC may not be located on a parcel of land zoned for industrial or manufacturing use.
DHS 105.14.05 Program description. (1) CONTENT. The program description shall accurately include all of the following:
(a) The name of the operator, the program director and the caregiver position in charge when the operator or program director is away from the ADCC.
(b) The participant capacity of the ADCC.
(c) A definition of the program goals; the days and hours of operation; a description of the services provided or made available to participants.
(d) A description of any limits the program establishes for providing service to participants with specific care needs.
(e) A fee schedule that pertains to the perspective participant which includes: The daily charge; additional fees for specific services, goods, or supplies that are not included in the daily charge, i.e., transportation, baths, personal cares, and the method for notifying participants or legal representatives of fee changes.
(f) A procedure for informing the participant’s legal representative, family, or caregiver of any major change in the participant’s general functioning or medical condition.
(g) A procedure for documenting any incident occurring at the site which would affect the health, safety or welfare of a participant.
(i) The participant group to be served. If serving more than one participant group, the program description shall include an explanation acceptable to the department of how the participant groups are compatible with one another.
(j) A grievance procedure for investigating and resolving complaints made by a participant, legal representative, family member, caregiver, or other interested persons about the services provided by the ADCC which includes informing such persons of appropriate local, county and/or state agency contacts.
(k) The criteria for voluntary and involuntary discharge of a participant from the program as defined in s. DHS 105.14.25 Discharge. (2) AVAILABILITY. (a) Before finalizing an agreement to provide care, the ADCC shall provide its program description to each person seeking services or to the person’s legal representative.
(b) The program description shall be provided to caregivers and any other person upon request.
DHS 105.14.06 Fit and qualified. (1) ELIGIBILITY. An applicant may not be certified unless the department determines the applicant is fit and qualified to operate an ADCC.
(2) STANDARDS. In determining whether a person is fit and qualified, the department shall consider all of the following:
(a) Compliance history. Compliance history with Wisconsin or any other state’s licensing or certification requirements and with any federal certification requirements, including any license revocation or denial.
(b) Criminal history. Arrest and criminal records, including any of the following:
1. Crimes or acts involving abuse, neglect or mistreatment of a person or misappropriation of property of a person.
2. Crimes or acts subject to elder abuse reporting under s. 46.90, Wis. Stat. 3. Crimes or acts related to the manufacture, distribution, use, or dispensing of a controlled substance.
4. Fraud or substantial or repeated violations of applicable laws and rules in the operation of any health care center or in the care of dependent persons.
5. A conviction or pending criminal charge which substantially relates to the care of adults or minors, to the funds or property of adults or minors, or to the operation of a residential or health care center.
(c) Financial history. Financial stability, including:
1. Financial history and financial viability of the owner or related organization.
2. Outstanding debts or amounts due to the department or other government agencies, including unpaid fees and fines.
DHS 105.14.07 Department action. (1) INITIAL CERTIFICATION. (a) Within 70 days after receipt of a complete application, the department shall either approve or deny the certification.
(b) A certification issued by the department shall be only for the premises and persons named in the application. A certification may not be transferred or assigned without following the change of ownership provisions in s. DHS 105.14.09. (c) A certification is valid until suspended or revoked by the department.
(2) Certification Denial. The department shall deny a certification to any applicant who does not substantially comply with any provision of this chapter or ch. 49, Wis. Stat., or who is not fit and qualified as specified in s. DHS 105.14.06 or who has failed to pay any fee or any outstanding amounts due to the department. The department shall provide the reasons for denial and the process for appeal of the denial in a written notice to the applicant. (3) MONITORING. The department shall conduct periodic inspections of the ADCC during the period of certification and may, without notice to the operator, visit an ADCC at any time to determine if the ADCC continues to comply with this chapter. The operator shall be able to verify compliance with this chapter and shall provide the department access to the ADCC, its staff, participants and records.
(4) SANCTIONS. (a) Notice of violation. The department shall issue a written notice of violation when it finds that an ADCC is in violation of this chapter or with any federal, state, and local laws and codes that govern the operation of the ADCC, including, but not limited to, space, heating, plumbing, ventilation and lighting systems, fire safety and sanitation requirements. The notice shall explain the grounds for the notice of violation, the sanction to be imposed, if any, and the process for appeal, if any.
(b) Plan of correction. An ADCC may submit a written plan of correction to the department within 10 days after the date of receipt of the notice of violation.
(c) Suspension. The department may summarily suspend the ADCC’s certification following procedures in ch. 227, Wis. Stats., when the department finds that participant health, safety or welfare requires emergency action. (d) Revocation. The department may revoke the ADCC’s certification whenever the department finds that the ADCC has failed to maintain substantial compliance with one or more of the requirements set forth in this chapter. Revocation of certification will result in the ADCC being ineligible for Medicaid waiver funds.
(5) APPEALS. (a) Any person whose application for certification is denied under sub. (2) or suspended under sub. (4) (c) or revoked under sub. (4) (d) may request a hearing on that decision under s. 227.42, Wis. Stat. (b) A request for hearing shall be in writing, shall be filed with the department of administration’s division of hearings and appeals and shall be sent to that office so that it is received there within 10 days after the date of the notice under sub. (4) (a).
DHS 105.14.08 Biennial report and fees. Every 24 months, on a date determined by the department, the operator shall submit a biennial report containing all of the information required by the department on the form provided by the department, and shall submit payment of the certification continuation fees.
DHS 105.14.09 Change of ownership. (1) Duties of the Transferee. (a) When an ADDC seeks a change of ownership, the transferee shall submit a complete application for certification as required under s. DHS 105.14.04 at least 30 days prior to the change of ownership. (b) If there is less than 30 days’ notice given to participants of the change of ownership, neither the transferor nor the transferee may enforce any advanced notice requirements for discharge as specified in any participant’s enrollment agreement.
(2) DUTIES OF THE TRANSFEROR. (a) The transferor shall notify the department within 30 days before a change of ownership of an ADCC and shall include the name and contact information of the transferee.
(b) The transferor remains responsible for the operation of the ADCC until the department issues a certification to the transferee.
(c) The transferor shall disclose to the transferee any existing department waiver, variance or outstanding deficiencies. Violations reported in department inspection reports prior to the change of ownership shall be corrected, with corrections verified by the department, prior to the issuance of the certification to the transferee. The transferee shall apply for continuation of any existing waivers or variances, if necessary.
(3) TRANSFERABILITY. (a) The department shall issue a certification only for the premises and persons named in the certification application. A certification may not be transferred or reassigned without following the change of ownership provisions in DHS 105.14.09.
DHS 105.14.10 Center closing. (1) Any ADCC that intends to close shall notify the department, participants or legal representative, and case manager, if any, in writing at least 30 days before closing and comply with the requirements under s. DHS 105.14.25.
