Chapter DHS 127

DHS 127.02 DHS 127.02 Definitions. In this chapter:

DHS 127.02(1) (1) “Adverse action” means an action initiated by a state or federal agency, based on the licensee’s noncompliance in the operation of health care services, that resulted in civil money penalties, suspension of payments, the appointment of temporary management, denial, suspension or revocation of licensure or termination or nonrenewal of provider participation under medicaid or medicare.

DHS 127.02(2) (2) “Ambulatory surgery center” has the meaning given in 42 CFR 416.2.

DHS 127.02(3) (3) “Applicant” means a person or persons who apply for a license to operate a rural medical center, who ultimately will be responsible for the operation of the rural medical center and legally responsible for decisions and liabilities related to the rural medical center. If a corporation, “applicant” means each person serving as director as indicated under ss. 180.0202 (2) (a) and 181.0202 (2) (a), Stats. If a partnership, “applicant” means persons identified in s. 178.0102 (11), Stats. If a limited partnership, “applicant” means persons identified in ch. 179, Stats. If a limited liability company, “applicant” means each person organizing the company as identified under s. 183.0202 (5), Stats.

DHS 127.02(4) (4) “Critical access hospital” has the meaning given in s. 50.33 (1g), Stats.

DHS 127.02(5) (5) “Department” means the Wisconsin department of health services.

DHS 127.02(6) (6) “End-stage renal disease service” has the meaning given in 42 CFR 405.2102.

DHS 127.02(7) (7) “Good standing” means that the applicant has a history of compliance with state and federal statutes, regulations and rules that promote the provision of quality care to patients and residents.

DHS 127.02(8) (8) “Health care services” or “services” means any of the following:

DHS 127.02(8)(a) (a) Care that is provided in or by any of the following:

DHS 127.02(8)(a)1. 1. A hospital.

DHS 127.02(8)(a)2. 2. A nursing home.

DHS 127.02(8)(a)3. 3. A hospice.

DHS 127.02(8)(a)4. 4. A rural health clinic.

DHS 127.02(8)(a)5. 5. An ambulatory surgery center.

DHS 127.02(8)(a)6. 6. A critical access hospital.

DHS 127.02(8)(b) (b) Home health services.

DHS 127.02(8)(c) (c) Outpatient physical therapy services.

DHS 127.02(8)(d) (d) End-stage renal disease services.

DHS 127.02(8)(e) (e) Services that are provided by a rehabilitation agency.

DHS 127.02(8)(f) (f) Outpatient occupational therapy services.

DHS 127.02(9) (9) “Home health services” has the meaning given in s. 50.49 (1) (b), Stats.

DHS 127.02(10) (10) “Hospice” has the meaning given in s. 50.90 (1), Stats.

DHS 127.02(11) (11) “Hospital” has the meaning given in s. 50.33 (2) (a) or (b), Stats.

DHS 127.02(12) (12) “Medicare” means Title XVIII of the federal Social Security Act of 1935, as amended, 42 USC 1395 to 1395ccc.

DHS 127.02(13) (13) “Nursing home” has the meaning given in s. 50.01 (3), Stats.

DHS 127.02(14) (14) “Outpatient occupational therapy services” has the meaning given in 42 USC 1395x(g).

DHS 127.02(15) (15) “Outpatient physical therapy services” has the meaning given in 42 USC 1395x(p).

DHS 127.02(16) (16) “Patient” means an individual who receives health care services, except nursing home services, from a rural medical center.

DHS 127.02(17) (17) “Provisional license” means department approval to operate a rural medical center for a temporary period of time, issued to a person who is either not currently licensed by the department or certified by the federal government to provide one or more of the health care services that the person seeks to provide as a rural medical center.

DHS 127.02(18) (18) “Rehabilitation agency” has the meaning given in 42 CFR 405.1702(i).

DHS 127.02(19) (19) “Resident” means a person who receives nursing home services from a rural medical center.

DHS 127.02(20) (20) “Rural health clinic” has the meaning given in 42 USC 1395x(aa)(2).

DHS 127.02(21) (21) “Rural medical center” or “center” means an arrangement of facilities, equipment, services and personnel that is all of the following:

DHS 127.02(21)(a) (a) Organized under a single governing and corporate structure.

DHS 127.02(21)(b) (b) Capable of providing or assuring health care services, including appropriate referral, treatment and follow-up services, at one or more locations in a county, city, town or village with a population of less than 15,000 and that is in an area that is not an urbanized area as defined by the federal bureau of the census.

DHS 127.02(21)(c) (c) A provider of at least 2 health care services under the arrangement or through a related corporate entity.

DHS 127.02 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections in (3) and (5) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637; CR 10-091: am. (2) Register December 2010 No. 660, eff. 1-1-11; correction in (3) made under s. 13.92 (4) (b) 7., Stats., Register February 2017 No. 734.

DHS 127.03 DHS 127.03 Licensure.

DHS 127.03(1) (1) License requirement. Only an entity that is licensed as a rural medical center by the department may establish, conduct, maintain, operate or permit to be maintained or operated, or represent and advertise by any means that it operates or provides rural medical center health care services.

DHS 127.03(2) (2) Application.

DHS 127.03(2)(a) (a) Initial license. An entity that meets the definition of rural medical center under s. DHS 127.02 (21) may apply to the department for a license to operate as a rural medical center. Application shall be made on a form prescribed by the department and shall include all of the following information:

DHS 127.03(2)(a)1. 1. The name or names and address or addresses of the applicant who shall be a natural person or persons.

DHS 127.03(2)(a)2. 2. For all incorporated applicants, the date and state of incorporation, a copy of the articles of incorporation, tax status and, if an out-of-state corporation, evidence of authority to do business in Wisconsin.

DHS 127.03(2)(a)3. 3. The location of the center’s central administrative offices, the location of the center’s services and the locations of any branches of those services.

DHS 127.03(2)(a)4. 4. The names, principal business addresses and percentage of ownership interest of all officers, directors and stockholders owning 10% or more of stock and of all board members, partners and all other persons having authority or responsibility, directly or indirectly, for the operation of the services provided by the center, including owners of any business entity that owns any part of the land or buildings, and whether the interest is in the profits, land or buildings.

DHS 127.03(2)(a)5. 5. The identities of all creditors and lessors holding a security interest in the premises, whether land or buildings.

DHS 127.03(2)(a)6. 6. The names and addresses of persons serving on the center’s board of directors.

DHS 127.03(2)(a)7. 7. In the case of a change in ownership, disclosure of any direct or indirect relationship or connection between the applicant and the prior manager, the prior owner and the manager of the rural medical center, and between the new owner and the manager of the rural medical center.

DHS 127.03(2)(a)8. 8. A detailed description of the geographic area to be served by the rural medical center.

DHS 127.03(2)(a)9. 9. Descriptions of the number and types of health care services to be provided by the rural medical center, and identification of all contracted health care services and the providers of those services, including the street address and distance of each provider from the rural medical center building.

DHS 127.03(2)(a)10. 10. Proof of sufficient financial resources to operate the center for at least 90 calendar days.

DHS 127.03(2)(a)11. 11. Any additional information requested by the department during the department’s review of the license application.

DHS 127.03 Note Note: For a copy of the rural medical center license application form, write to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.

DHS 127.03(2)(b) (b) License modification. A rural medical center proposing to add a new health care service shall apply to the department for a revised license. Application shall be on a form prescribed by the department and shall include all of the following information:

DHS 127.03(2)(b)1. 1. The name and address of the applicant.

DHS 127.03(2)(b)2. 2. Descriptions of the number and types of health care services to be provided by the rural medical center, and identification of all contracted health care services and the providers of those services, including the street address and distance of each provider from the rural medical center building.

DHS 127.03(2)(b)3. 3. Any additional information requested by the department during the department’s review of the license application.

DHS 127.03 Note Note: For a copy of the form for adding a new health care service, write to the Division of Quality Assurance, P. O. Box 2969, Madison, WI 53701-2969.

DHS 127.03(3) (3) License fees.

DHS 127.03(3)(a) (a) An application for a license or for addition of a new health care service shall be accompanied by a license fee. Pursuant to s. 50.51 (2) (c), Stats., the fee for a provisional license or for a regular license not preceded by a provisional license shall be the sum of fees for the specific types of health care services provided by the rural medical center as follows:

DHS 127.03(3)(a)1. 1. The fee for provision of hospital services shall be the same as the fee assessed under s. 50.135, Stats.

DHS 127.03(3)(a)2. 2. The fee for provision of nursing home services shall be the same as the fee assessed under s. 50.135, Stats.

DHS 127.03(3)(a)3. 3. The fee for provision of home health services shall be the same as the fee assessed under s. DHS 133.03 (3) to (6).

DHS 127.03(3)(a)4. 4. The fee for provision of hospice services shall be the same as the fee assessed under s. 50.93 (1) (c), Stats.

DHS 127.03(3)(b) (b) The department shall determine an applicant’s rural medical center license fee by adding the separate fees assessed for health care services under par. (a) 1. to 4. The rural medical center license fee shall be assessed biennially, except that for a rural medical center that does not provide any of the health care services for which fees are assessed under par. (a) 1. to 4., the rural medical center license fee shall be $300 and shall be assessed for a two-year period.

DHS 127.03(3)(c) (c) A rural medical center applying to initiate a new health care service shall pay a fee for the new service prorated for the period of time remaining until the next biennial license fee assessment, as determined by the department.

DHS 127.03(4) (4) Review of application.

DHS 127.03(4)(a) (a) General provisions. The department shall perform a full review, an expedited review or a combined review of an application for a rural medical center license, depending on whether the applicant holds current, valid state licenses or approvals or federal certifications for the types of health care services described in the application.

DHS 127.03(4)(b) (b) Review types.

DHS 127.03(4)(b)1. 1. ‘Full review.’

DHS 127.03(4)(b)1.a. a. If the applicant proposes to provide health care services for which the applicant does not hold current, valid state licenses or approvals or federal certifications on the date of application for a rural medical center license, the department shall conduct an inspection under par. (c) and a review under par. (d).

DHS 127.03(4)(b)1.b. b. If a rural medical center proposes to provide a health care service not currently listed on its license, the department shall conduct an inspection under par. (c) and a review under par. (d).

DHS 127.03(4)(b)1.c. c. The department shall make a determination on the application within 90 calendar days after receiving the complete application.

DHS 127.03(4)(b)2. 2. ‘Expedited review.’ If the applicant proposes to provide health care services for which the applicant holds current, valid state licenses or approvals or federal certifications on the date of application for a rural medical center license, the department shall conduct a review under par. (d) and make a determination on the application within 30 calendar days after receiving a complete application.

DHS 127.03(4)(b)3. 3. ‘Combined review.’ If the application requires both full review and expedited review under this subsection, the department shall make a determination on the application within 90 calendar days after receiving a complete application.

DHS 127.03(4)(c) (c) Inspection. Pursuant to s. 50.52 (2) (b) to (c), Stats., the department may conduct an inspection of each of the health care services that the applicant proposes to provide, except that the department in lieu of conducting an inspection may accept evidence that for a specific type of health care service the applicant meets one of the following requirements:

DHS 127.03(4)(c)1. 1. Has current, valid state licensure or approval and is in good standing as described in par. (d) 6. to operate as a hospital, a nursing home, a hospice or a home health agency applicable to the types of health care services that the applicant proposes to provide as a rural medical center.

DHS 127.03(4)(c)2. 2. Has a current, valid agreement and is in good standing as described in par. (d) 6. to participate as an eligible provider in medicare for the types of health care services that the applicant proposes to provide as a rural medical center.

DHS 127.03(4)(c)3. 3. Is a critical access hospital in good standing as described in par. (d) 6.

DHS 127.03(4)(d) (d) Review criteria. The department shall review an application and make a determination on whether to issue a license based on all of the following criteria:

DHS 127.03(4)(d)1. 1. Whether the applicant has supplied all information required or requested by the department under sub. (2).

DHS 127.03(4)(d)2. 2. Whether the applicant proposes to provide health care services.

DHS 127.03(4)(d)3. 3. Whether the applicant qualifies as a rural medical center.

DHS 127.03(4)(d)4. 4. Whether the applicant is operating in compliance with the provisions of this chapter or is able to comply with the provisions of this chapter, as determined by the inspection under par. (c) where applicable.

DHS 127.03(4)(d)5. 5. For the proposed provision of hospice or nursing home services, whether the applicant is fit and qualified under s. DHS 131.14 (3) (b) for hospice services or s. DHS 132.14 (4) (b) for nursing home services.

DHS 127.03(4)(d)6. 6. Whether the applicant is in good standing. In making its determination of good standing, the department may review the information contained in the application and any other relevant documents, including but not limited to survey and complaint investigation findings for each health care services provider with which the applicant is or was affiliated during the past 5 years. The department shall also conduct a background check of the applicant as required by ch. DHS 12. The department shall consider all of the following:

DHS 127.03(4)(d)6.a. a. Any outstanding adverse action or state class “A” or “B” violations as defined by s. 50.04 (4) (b) 1. and 2., Stats., against the applicant.

DHS 127.03(4)(d)6.b. b. The frequency of any noncompliance with state licensure or approval or federal certification laws in the applicant’s operation of health care services in this or any other state.