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(1)Definition. In this section, “sufficient number of medicare-certified beds” means a supply of beds that accommodates the demand for medicare beds from both the home county and contiguous counties so that no dual eligible recipient is denied access to medicare SNF benefits because of a lack of available beds. In this subsection, “dual eligible recipient” means a person who qualifies for both medical assistance and medicare.
(2)Medicare bed obligation. Each county shall have a sufficient number of skilled nursing beds certified by the medicare program pursuant to ss. 49.45 (6m) (g) and 50.02 (2), Stats. The number of medicare-certified beds required in each county shall be at least 3 beds per 1000 persons 65 years of age and older in the county.
(3)Penalty.
(a) If a county does not have sufficient medicare-certified beds as determined under sub. (1), each SNF within that county which does not have one or more medicare-certified beds shall be subject to a fine to be determined by the department of not less than $10 nor more than $100 for each day that the county continues to have an inadequate number of medicare-certified beds.
(b) The department may not enforce penalty in par. (a) if the department has not given the SNF prior notification of criteria specific to its county which shall be used to determine whether or not the county has a sufficient number of medicare-certified beds.
(c) If the number of medicare-certified beds in a county is reduced so that the county no longer has a sufficient number of medicare-certified beds under sub. (1), the department shall notify each SNF in the county of the number of additional medicare-certified beds needed in the county. The department may not enforce the penalty in par. (a) until 90 days after this notification has been provided.
(4)Exemptions.
(a) In this subsection, a “swing-bed hospital” means a hospital approved by the federal health care financing administration to furnish skilled nursing facility services in the medicare program.
(b) A home or portion of a home certified as an ICF-IID is exempt from this section.
(c) The department may grant an exemption based on but not limited to:
1. Availability of a swing-bed hospital operating within a 30 mile radius of the nursing home; or
2. Availability of an adequate number of medicare-certified beds in a facility within a 30 mile radius of the nursing home.
(d) A skilled nursing facility located within a county determined to have an inadequate number of medicare-certified beds and which has less than 100 beds may apply to the department for partial exemption from the requirements of this section. An SNF which applies for partial exemption shall recommend to the department the number of medicare-certified beds that the SNF should have to meet the requirements of this section based on the facility’s analysis of the demand for medicare-certified beds in the community. The department shall review all recommendations and issue a determination to each SNF requesting a partial exemption.
History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; renum. (1), (2), (3) (a) and (b) to be (2), (3), (4) (a) and (b) and am. (2) and (4) (b), cr. (1), (4) (c) and (d), Register, February, 1988, No. 386, eff. 7-1-88; 2019 Wis. Act 1: am. (4) (b) Register May 2019 No. 761, eff. 6-1-19.
DHS 105.10SNFs and ICFs with deficiencies. If the department finds a facility deficient in meeting the standards specified in s. DHS 105.08, 105.09, 105.11 or 105.12, the department may nonetheless certify the facility for MA under the conditions specified in s. DHS 132.21 and 42 CFR 442, Subpart C.
History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.11Intermediate care facilities. For MA certification, intermediate care facilities shall be licensed pursuant to s. 50.03, Stats., and ch. DHS 132.
Note: For covered nursing home services, see s. DHS 107.09.
History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.
DHS 105.12ICFs for individuals with intellectual disabilities or individuals with related conditions. For MA certification, institutions for individuals with intellectual disabilities or individuals with related conditions shall be licensed pursuant to s. 50.03, Stats., and ch. DHS 134.
Note: For covered ICF/IID services, see s. DHS 107.09.
History: Cr. Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats., Register, December, 1991, No. 432; correction made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636; 2019 Wis. Act 1: am. Register May 2019 No. 761, eff. 6-1-19.
DHS 105.14Adult day care centers.
(1)General provisions.
(a) Introduction. In accordance with s. 49.45 (2) (a) 11. and (47) (a) and (b), Stats., this section is promulgated to establish regulations and standards for the care, treatment or services, and health, safety, rights, well-being and welfare of participants in certified adult day care centers (ADCCs). This section is promulgated to ensure that each ADCC provides a supportive environment in a community-based group setting that is the least restrictive of each participant’s freedom, and that care and services are provided in a manner that protects the rights and dignity of each participant.
(b) Definitions.
1. “Abuse” has the meaning given in s. DHS 13.03 (1) (a).
2. “Accessible” means barriers are not present that prevent a person from entering, leaving, or functioning within an ADCC without physical help.
3. “Activities of daily living” or “ADL” means bathing, eating, oral hygiene, dressing, toileting, incontinence care, mobility and transferring from one surface to another such as from a bed to a chair.
4. “Adult” means an individual who is at least 18 years of age.
5. “Adult day care center” or “ADCC” means an entity that provides services for part of a day in a group setting to adults who need an enriched health, supportive or social experience, and who may need assistance with activities of daily living, supervision, or protection.
6. “Applicant” means the person seeking certification of an ADCC.
7. “Assessment” means gathering and analyzing information about a prospective or existing participant’s needs and abilities as provided in sub. (7) (a).
8. “Caregiver” has the meaning given in s. 50.065 (1) (ag), Stats.
9. “Chemical restraint” means a psychotropic medication used for discipline or convenience, and not required to treat medical symptoms.
10. “Department” means the Wisconsin department of health services.
11. “Legal representative” means any of the following:
a. The health care agent under an activated power of attorney for health care under ch. 155, Stats.
b. A person appointed as a durable power of attorney under ch. 244, Stats.
c. A guardian, guardian of the estate, or guardian of the person, as defined in s. 54.01 (10), (11), or (12), Stats.
12. “Medication administration” means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to a participant, but does not include reminders to take the medication. Medication administration can be performed by any of the following:
a. A practitioner.
b. The practitioner’s authorized agent.
c. An ADCC caregiver, or the participant, at the direction of the practitioner.
13. “Misappropriation of property” has the meaning given in s. DHS 13.03 (12).
14. “Neglect” has the meaning given in s. DHS 13.03 (14).
15. “Nursing care” means nursing procedures, other than personal or supportive care, that a registered nurse or a licensed practical nurse performs directly on or to a participant.
16. “Occupant” means any of the following:
a. A person who lives and sleeps in the ADCC, but who is not a participant.
b. A non-client resident, as defined in s. 50.065 (1) (cn), Stats.
17. “Operator” means an individual or business entity to whom a certification is granted and is legally responsible for the operation of the ADCC.
18. “Participant” means an adult who attends the ADCC during listed hours of operation and receives care, treatment, or services.
19. “Participant group” means a group of participants who need similar services because of a common disability, condition, or status. “Participant group” includes a group of individuals who have any of the following:
a. Functional impairments commonly associated with advanced age.
b. Irreversible dementia, such as Alzheimer’s disease.
c. A developmental disability, as defined in s. 51.01 (5), Stats.
d. An emotional disturbance or a mental illness, as defined in s. 51.01 (13) (a), Stats.
e. A physical disability.
f. A traumatic brain injury.
20. “Physical restraint” means any manual method, article, device, or garment interfering with the free movement of the participant or the normal functioning of a portion of the participant’s body or normal access to a portion of the participant’s body, and which the participant is unable to remove easily, or confinement of a participant in a locked room.
21. “Program director” means an employee who is responsible for the management and day-to-day operation of the ADCC. A program director includes any of the following:
a. The operator.
b. An employee designated by the operator.
22. “Psychotropic medication” means a prescription drug, defined in s. 450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior.
23. “Qualified Caregiver” means an employee who is at least 18 years of age and has successfully completed all of the applicable orientation and training under sub. (4) (a) and (b).
a. “Seclusion” means physical or social separation of a participant from others by actions of caregivers.
b. “Seclusion” does not include separation to prevent the spread of communicable disease or voluntary cool-down periods in an unlocked room.
25. “Serious injury” means an injury from any incident or accident which results in any of the following:
a. A temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
b. A fracture.
c. A pronounced decline in communication or cognitive abilities.
26. “Significant change” in a participant’s physical or mental condition means any of the following:
a. A decline in a participant’s medical condition that results in further impairment.
b. A decline in 2 or more ADLs.
c. A pronounced decline in communication or cognitive abilities.
d. A decline in behavior or mood which requires either a temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or 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.
a. “Supervision” means oversight of a participant’s functioning.
b. “Supervision” includes keeping track of a participant’s whereabouts and providing guidance and intervention when needed by a participant.
28m. “Transferee” means the recipient of a property or business in a change of ownership process who will submit application for a new certification.
29. “Transferor” means the current operator in a change of ownership process who will voluntarily relinquish the current certification.
31. “Utensils” means dishes, silverware and pots and pans used for storing, preparing, serving, or consuming food.
32. “Variance” means an alternate means of meeting a requirement in this section, as approved by the department under par. (c).
33. “Volunteer” means any person who provides services for participants without compensation.
34. “Waiver” means an exemption from a requirement in this section, as approved by the department under par. (c).
(c) Variances and waivers.
1. The department may grant approval of 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.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.