DHS 122.03(25)(25) “Statewide bed limit” means the maximum number of nursing home beds or FDD beds allowed to be licensed under ch. 50, Stats., as set out in s. 150.31 (1), Stats., with any adjustments made by the department under s. 150.31 (2) to (6), Stats. DHS 122.03(26)(26) “Total replacement” or “totally replace” means the closing of a facility and the construction or licensure of an equal or lesser number of beds and ancillary space designed to replace that facility within the planning area. DHS 122.03 HistoryHistory: Cr. Register, March, 1985, No. 351, eff. 4-1-85; cr. (17m), Register, January, 1987, No. 373, eff. 2-1-87; am. (1) (d), (11) and (15), r. (16) and (23), renum. (17), (17m), (24) and (25) to be (16), (17), (23) and (24), cr. (25), Register, January, 1991, No. 421, eff. 2-1-91; corrections in (13), (14) and (24) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637. DHS 122.04(1)(a)(a) Nursing homes exclusive of FDDs. The department shall biennially update and submit to the legislature statewide recommended bed limits for nursing homes exclusive of FDDs, taking into account programs the purpose of which is to reduce institutionalization of persons in long-term care facility settings. In developing the recommendation for a new statewide bed limit, the department shall add the following numbers for nursing homes exclusive of FDDs: DHS 122.04(1)(a)3.3. An allotment for new beds which shall be derived by dividing medical assistance reimbursement funds available for new beds as proposed in the following biennial budget by an estimated medical assistance allowable skilled care per diem rate. The resulting patient days shall be divided by the most recent available 3-year average percentage ratio of medical assistance residents to total residents. The patient days shall then be divided by the number of days in the year. This figure is the new allotment. Separate allotments shall be developed for nursing homes exclusive of FDDs. The new bed allotment shall be the maximum number of new nursing home beds exclusive of FDDs which may be approved during the biennium for which the new bed limit is approved by the legislature. DHS 122.04(1)(b)1.1. The department shall biennially update and submit to the legislature statewide recommended bed limits for FDD beds, taking into account programs whose purpose is to reduce institutionalization of developmentally disabled persons. The new statewide bed limit for FDDs shall be established in the same manner as for nursing homes under par. (a) except that the new bed allotment for FDDs may not exceed the number of beds determined to be needed under s. DHS 122.05 (2) (a) and (b). DHS 122.04(1)(b)2.a.a. Except as provided in subd. 2. b., the department shall limit approvals for conversions to FDDs under s. DHS 122.02 (2) (a) and (c) to a total of 1,600 beds statewide by December 31, 1989, no more than 1,000 of which may be approved by December 31, 1987. DHS 122.04(1)(b)2.b.b. Notwithstanding the bed limit under subd. 2. a., the department may in addition approve the total conversion of a facility to an FDD if the conversion would be the result of relocating developmentally disabled residents from 2 or more facilities operated by one county, the new FDD will serve only residents who are developmentally disabled and the department determines that there is a compelling need for the conversion. DHS 122.04(2)(2) Interim adjustments by the department. Interim adjustments to the statewide bed limit may be made by the department for: DHS 122.04(2)(a)(a) Conversion of community-based residential facilities. The department shall adjust the total statewide bed limit, on a bed-for-bed basis, for each community-based residential facility currently certified as a medical assistance provider which obtains nursing home or FDD licensure in order to retain medical assistance certification. The effect of the adjustment may be to increase the statewide bed limit. If the number of licensed and approved nursing home beds is less than the statewide bed limit, the department shall count the CBRF beds under this paragraph toward the originally established statewide bed limit; DHS 122.04(2)(b)(b) Code violations. The department may decrease the statewide bed limit, on a bed-for-bed basis, to account for nursing home or FDD beds which are licensed but which are not set up or staffed due to life-safety or physical plant code violations. The department shall determine whether the situation is likely to be corrected within the forthcoming biennium. If the beds are not likely to be reopened within the forthcoming biennium, the department shall reduce the statewide bed limit by the number of beds currently out of circulation due to code violations; DHS 122.04(2)(c)(c) Medical assistance waivers. The department shall decrease the statewide bed limit, on a bed-for-bed basis, to account for nursing home or FDD beds closed under the medical assistance waiver specified in 42 USC 1396n (c) or under other medical assistance waivers specified in 42 USC 1396 to 1396n; and DHS 122.04(2)(d)(d) Wisconsin center reductions. The department shall decrease, on a bed-for-bed basis, the statewide bed limit for FDDs by each bed removed at the Wisconsin centers for the developmentally disabled as a result of the department’s community integration program under s. 46.275, Stats. DHS 122.04(2)(e)1.1. The department may decrease the statewide bed limit, on a bed-for-bed basis, to account for beds made available by the reduction of licensed beds not included in pars. (b) to (d). The department may decrease the statewide bed limit under this paragraph only if: DHS 122.04(2)(e)1.a.a. The county in which the beds were located had more than 125% of the statewide average number of nursing home beds per 1,000 persons 65 years of age or older, as determined under subd. 2., prior to the reduction in that county; and DHS 122.04(2)(e)1.b.b. No decrease under this paragraph may result in the county in which the bed reduction occurred having fewer than the statewide average number of nursing home beds per 1,000 persons 65 years of age or older. DHS 122.04(2)(e)2.2. The statewide average number of nursing home beds per 1,000 persons 65 years of age or older in subd. 1. is calculated by dividing the total current number of licensed nursing home beds exclusive of FDD beds in the state, as reported by the department’s bureau of quality compliance, by the total current estimated population of persons 65 years of age or older, as determined by the Wisconsin department of administration, and multiplying that result by 1,000. DHS 122.04(2)(f)(f) Conversion of nursing homes and FDDs. The department shall adjust the statewide bed limits to account for the partial or total conversion of nursing homes to facilities primarily serving the developmentally disabled or of facilities primarily serving the developmentally disabled to nursing homes that have received approval under this chapter. DHS 122.04(3)(3) Publication of adjustments. The department shall publish any adjustments to the statewide bed limit in the ch. 150 newsletter of the department’s office of management and policy and in a newspaper of general circulation. This publication shall occur by the 20th day of the month following the adjustment date. DHS 122.04 HistoryHistory: Cr. Register, March, 1985, No. 351, eff. 4-1-85; emerg. cr. (1) (b) 2., eff. 1-1-87; cr. (2) (e), Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (1) (b) 2., eff. 5-31-87; cr. (1) (b) 2., Register, October, 1987, No. 382, eff. 11-1-87; r. (1) (a) 2., renum. (1) (a) 3. and 4. to be 2. and 3. and am. 3., cr. (2) (f), am. (3), Register, January, 1991, No. 421, eff. 2-1-91; emerg. renum. (2) (d) to be (2) (d) 1. and am., cr. (2) (d) 2., eff. 9-27-91. DHS 122.05(1)(a)(a) Distribution of the statewide allotment of new beds. In distributing among planning areas new nursing home beds exclusive of FDD beds from the allotment under s. DHS 122.04 (1) (a) 3., the department shall proceed as follows: DHS 122.05(1)(a)1.1. Calculate for each planning area the population growth for the age cohorts under 65, 65 to 74, 75 to 84 and over 84 years of age for a 3-year period beginning in the calendar year for which the most current data on utilization of nursing homes are available; DHS 122.05(1)(a)2.2. Divide each planning area’s population growth for each age cohort by the state growth in population for each cohort for those years to obtain the percentage that a planning area’s growth represents of the total state growth by cohort; DHS 122.05(1)(a)3.3. Ascertain the statewide nursing home utilization percentage for each of the age cohorts in subd. 1. and multiply these by the new bed allotment for nursing homes exclusive of FDDs calculated pursuant to s. DHS 122.04 (1) (a) 3. to get the statewide allotment for each age cohort; DHS 122.05(1)(a)4.4. Multiply the statewide allotment for each age cohort by each planning area’s percentage of state growth for its respective cohort calculated under subd. 2.; DHS 122.05(1)(a)5.5. Add the 4 age cohort allotments for each planning area to determine the unadjusted new bed allotment for each planning area for nursing homes exclusive of FDDs; DHS 122.05(1)(a)6.6. Adjust downward the allotment for each planning area that has more beds per 1,000 residents age 65 and over than there are beds per 1,000 residents age 65 and over statewide by multiplying the unadjusted allotment for the planning area by the ratio of the number of existing and approved beds per 1,000 residents age 65 and over statewide to the number of existing and approved beds per 1,000 residents age 65 and over in the planning area as calculated from county level data, and subtracting the result from the unadjusted allotment. The result shall be the maximum new bed allotment for that planning area; and DHS 122.05(1)(a)7.7. Increase the unadjusted allotment for the remaining planning areas proportionately so that the total new bed allotments for all planning areas equal the total statewide new bed allotment calculated pursuant to s. DHS 122.04 (1) (a) 3. The result shall be the maximum new bed allotments for these planning areas. DHS 122.05(1)(b)1.1. The department shall distribute new nursing home beds exclusive of FDD beds within a planning area by: DHS 122.05(1)(b)1.a.a. Calculating the age-specific statewide use rates for long-term care services by adding the total statewide number of persons being served under a medical assistance waiver, exclusive of persons relocated from a state center for the developmentally disabled under s. 46.275, Stats., and the total statewide number of persons utilizing nursing homes, exclusive of FDDs, for each of the age groups under 21, 21 to 54, 55 to 64, 65 to 74, 75 to 84 and 85+, and dividing the resulting sum for each age group by the current total statewide population for that age group. Utilization data shall be for December 31 of the most recent year for which data is available; DHS 122.05(1)(b)1.b.b. Determining the age-specific expected county use of long-term care services by multiplying each age-specific statewide use rate by the actual current population for each age group in each county as estimated by the Wisconsin department of administration; DHS 122.05(1)(b)1.c.c. Determining each county’s total expected use of long-term care services by summing the age-specific calculations in subd. 1. b. for each county; DHS 122.05(1)(b)1.d.d. Determining the actual countywide use of long-term care services by adding the total number of residents of the county reported in the department’s annual survey of nursing homes as residing in nursing homes, exclusive of FDD’s, on December 31 of the recent survey year, and the number of persons being served under a medical assistance waiver, exclusive of persons relocated from a state center for the developmentally disabled under s. 46.275, Stats., in the same year in that county; and DHS 122.05(1)(b)1.e.e. Determining the ratio of actual use to expected use by dividing the result of the calculation in subd. 1. d. by the result of the calculation in subd. 1. c. DHS 122.05(1)(b)2.2. Only applicants whose projects would be located in counties which meet both of the following conditions are eligible to compete for new beds: DHS 122.05(1)(b)2.b.b. The countywide occupancy rate as reported in the most recently available annual survey of nursing homes is greater than 94%. The countywide occupancy rate is calculated by dividing the sum of all patient days for all nursing homes exclusive of FDDs in a county, as reported in the annual survey of nursing homes, by the number of days in the calendar year and then dividing that result by the total current number of licensed nursing home beds in that county, exclusive of FDDs, as reported by the department’s bureau of quality compliance. DHS 122.05(1)(b)3.a.a. The department shall review the methodology under subds. 1. and 2. every 3 years in consultation with the area agencies on aging, the county social service or human service departments and representatives of the nursing home industry. DHS 122.05(1)(b)3.b.b. The department shall annually update data necessary to establish a priority list of counties for the purpose of allocating beds. The department may revise the priority list between annual updates to reflect changes in bed capacity resulting from approvals under this chapter, reductions in the capacity of existing nursing homes, facility closures, or relocations of beds or facilities within a planning area. DHS 122.05(1)(c)1.1. The department may distribute nursing home beds, exclusive of FDD beds, made available in the state as a result of facility closure or bed capacity reductions which were not closed under a medical assistance waiver, as specified in 42 CFR 1396n, and which were not replaced by CBRF beds converting to nursing home licensure. Except as provided in s. 150.40, Stats., applications to replace or redistribute closed beds may be submitted only from counties which are eligible to compete for new beds under par. (b). DHS 122.05(1)(c)2.2. Except as provided in s. 150.40, Stats., the department shall redistribute beds under this paragraph to the planning area in which they were originally located. DHS 122.05(1)(c)3.3. The statewide average of nursing home beds for each 1,000 persons 65 years of age or over referred to in s. 150.40, Stats., is calculated by dividing the total current number of licensed nursing home beds, exclusive of FDD beds, in the state, as reported by the department’s bureau of quality compliance, by the total current estimated population of persons 65 years of age and older, as determined by the Wisconsin department of administration, and multiplying that result by 1,000. DHS 122.05(1)(c)4.4. The department may not approve more beds for redistribution within a planning area, or within a county if s. 150.40, Stats., is applicable, than were made available as a result of facility closure or bed reduction in that planning area or county. DHS 122.05(2)(a)(a) The department shall not approve the addition of new beds to a state center for the developmentally disabled or other FDD licensed under subch. I of ch. 50, Stats., unless the beds are needed to serve persons who cannot adequately be served in an existing FDD, another nursing home or in a less costly or less restrictive setting. Need for the beds shall be determined by the department through an objective analysis of the developmentally disabled population in the planning area. DHS 122.05(2)(b)(b) The number of new beds allocated to the centers and other FDDs in an FDD planning area shall not exceed the number of persons requiring FDD care as determined under par. (a) for that planning area. DHS 122.05 HistoryHistory: Cr. Register, March, 1985, No. 351, eff. 4-1-85; emerg. cr. (2) (c), eff. 1-1-87; r. and recr. (1) (b) and (c), Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (2) (c), eff. 5-31-87; cr. (2) (c), Register, October, 1987, No. 382, eff. 11-1-87; am. (1) (a) (intro.), 3. and 7., (b) 2. intro. and (2) (a), r. (1) (b) 3., renum. (1) (b) 4. to be 3. and am., Register, January, 1991, No. 421, eff. 2-1-91. DHS 122.06(1)(a)1.1. After amendment of the statewide bed limit by the legislature, the department shall accept applications to fill the allotments for new beds, if any, for each planning area. Allotments shall be determined in the manner described in s. DHS 122.05. Application shall be made according to the following schedule: DHS 122.06(1)(a)2.2. The department shall request applications for new beds once from each planning area during the first half of each biennium. If the number of new beds approved for an area is less than the planning area’s adjusted allotment, a second request for applications may be made during the second half of the biennium according to the schedule in par. (a). DHS 122.06(1)(b)(b) Replacement beds. The department shall annually accept applications to replace beds in a planning area which have been de-licensed but which were not closed under a medical assistance waiver or which were not replaced by CBRF beds which converted to nursing home licensure in order to retain medical assistance certification. Application shall be made according to the schedule in par. (a). DHS 122.06(1)(c)1.1. Applications that meet all applicable review criteria but do not receive approval due to bed limits imposed under s. DHS 122.04 (1) (b) 2. a. shall be automatically accepted for review under any subsequent request for applications without additional application fee unless the application has been substantially modified. DHS 122.06(1)(c)2.2. The department shall request applications at least once between January 1, 1988 and December 31, 1989. DHS 122.06(1)(c)3.3. Upon application to the department, the department may approve the operation of a distinct part of a nursing home as an FDD for a period of time not to exceed 4 years. Renewal of an approval initially granted under this subsection may be granted for a period of time not to exceed 4 years and only if all of the following conditions are met by the applicant: DHS 122.06(1)(c)3.b.b. There is continued need, as determined by the department, for the FDD in the health planning area in which the facility is located; and DHS 122.06(1)(c)3.c.c. Community-based services, including services developed under s. 46.278, Stats., are inappropriate for the individuals served in the FDD. DHS 122.06(1)(c)4.4. The department may require that a nursing home seeking approval or an FDD seeking renewal under subd. 3. agree to reduce the size of the FDD under a plan submitted by the facility and approved by the department, during the approval or renewal period, in order to reflect reduced service need or increased availability of community-based long-term care services. DHS 122.06(1)(c)6.6. Notwithstanding s. 150.29, Stats., if initial approval of an FDD is not renewed under subd. 3. or if approval or renewal is conditioned upon the requirement of subd. 4., reconversion of these beds to nursing home beds does not require approval under s. DHS 122.04. DHS 122.06(1)(d)1.1. An application may be submitted only in response to a request by the department for applications. DHS 122.06(1)(d)2.2. The department may accept an application only if the proposed converted facility is presently located or will be located in a county designated in accordance with s. DHS 122.05 (1) (b) 2. or s. 150.40, Stats., and that county is located within the same health planning area in which the facility is presently located. DHS 122.06(2)(2) Other applications. Any person intending to engage in activities subject to this subchapter that are not specified under sub. (1), (3) or (3m) shall notify the department in writing of this intent at least 30 days prior to submitting an application for review. An application expires unless the department declares the application complete within 365 days after the date the department receives notice of the applicant’s intent to engage in the activity. DHS 122.06(3)(3) Centers. After a change in the statewide bed limit, the department shall solicit applications from the state centers for the developmentally disabled to increase bed capacity. The schedule for submitting applications shall be determined by the department. DHS 122.06(3m)(3m) Pilot projects. The department may at any time solicit applications from nursing homes which seek to demonstrate new nursing home designs. The schedule for submitting applications shall be determined by the department. DHS 122.06(4)(4) Process for applications for beds, applications from centers and applications for pilot projects. DHS 122.06(4)(a)(a) Notice requesting applications. A notice requesting applications for beds under sub. (1), applications from centers under sub. (3) and applications for pilot projects under sub. (3m) shall be published in a major daily newspaper in each affected planning area on the first and second working days of the month during which requests are to be made. The notice shall state the deadline by which all applications are to be received. DHS 122.06(4)(b)(b) Application forms. All applications shall be submitted on forms prescribed by the department. A prospective applicant may obtain the forms from the department.
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Chs. DHS 110-199; Health
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