Chapter DHS 127

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.

DHS 127.03(4)(d)6.c. c. Any conviction of the applicant for a crime related to the delivery of health care services or items, providing health care services without a license, controlled substances violations, neglect or abuse of patients or residents or assaultive behavior or wanton disregard for the health or safety of others. If the applicant is a corporation, the background check consideration applies to the chief executive officer, each officer or director of the corporation and each owner, directly or indirectly, of any equity security or other ownership interest in the corporation. This restriction does not apply if the corporation has terminated its relationship with the convicted administrator, officer, director or owner.

DHS 127.03(4)(d)6.d. d. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information.

DHS 127.03(4)(d)6.e. e. Any prior financial failures of the applicant, including but not limited to those related to bankruptcy or to the closing of a health care services entity or the moving of its patients or residents.

DHS 127.03(5) (5) License issuance.

DHS 127.03(5)(a) (a) General provisions.

DHS 127.03(5)(a)1. 1. If the department approves an application following its review under sub. (4), the department shall issue either a provisional license under par. (c) or a regular license within the time period for the applicable type of review under sub. (4) (b), provided that the applicant pays the license fee under sub. (3).

DHS 127.03(5)(a)2. 2. The license shall bear the name and address of the rural medical center and the name and address of the applicant and identify the types of health care services that the center is licensed to provide.

DHS 127.03(5)(a)3. 3. The license shall state any applicable conditions and restrictions, including maximum bed capacity and the level of care that may be provided, and any other limitations that the department finds necessary and appropriate.

DHS 127.03(5)(a)4. 4. A license shall be issued exclusively for the rural medical center applicant named in the application and may not be transferred or assigned. A licensee shall fully comply with all requirements and restrictions of the license. When there is a change in the ownership of the rural medical center, the new operator shall submit a new application to the department.

DHS 127.03(5)(a)5. 5. Rural medical center licensees shall surrender to the department all single-service licenses or other approvals held for the types of health care services identified in the rural medical center license.

DHS 127.03(5)(b) (b) Regular license. A regular license is valid until it is suspended or revoked.

DHS 127.03(5)(c) (c) Provisional license.

DHS 127.03(5)(c)1. 1. If an approved applicant is not currently licensed by the department or certified by the federal government to provide one or more of the health care services that the applicant seeks to provide as a rural medical center, the department shall issue the applicant a provisional license.

DHS 127.03(5)(c)2. 2. A provisional license is valid for 6 months from the date of issuance per s. 50.52 (4), Stats.

DHS 127.03(5)(c)3. 3. A rural medical center with a provisional license shall submit an application for a regular license to the department so that it is received by the department at least 45 calendar days before expiration of the provisional license. If an application for a regular license is not received by that date, the provisional license shall lapse as of the date of its expiration. If the department does not make a favorable determination under sub. (4) on the application for a regular license, the department may not issue a regular license. Expiration of a rural medical center’s provisional license does not affect other licenses, approvals or certifications maintained by the entity.

DHS 127.03(6) (6) Reporting of changes.

DHS 127.03(6)(a) (a) Changes requiring notice.

DHS 127.03(6)(a)1. 1. The licensee shall notify the department in writing of any changes that affect the continuing accuracy and completeness of the information required under sub. (2) (a). If the rural medical center provides nursing home services, any change in ownership shall be reported to the department in writing at least 30 calendar days prior to the change.

DHS 127.03(6)(a)2. 2. The licensee shall notify the department in writing of any changes in the administrator of the nursing home service within 2 business days of the change.

DHS 127.03(6)(a)3. 3. The licensee shall notify the department in writing of any changes in the director of nursing of the nursing home service within 2 business days of the change.

DHS 127.03(6)(b) (b) Changes requiring new application. An application for a new license shall be submitted to the department within 30 calendar days after any of the following:

DHS 127.03(6)(b)1. 1. The licensee transfers title of the rural medical center, regardless of whether the transfer includes title to the real estate.

DHS 127.03(6)(b)2. 2. In a partnership, the removal, addition or substitution of an individual as a partner or the dissolving of an existing partnership and the creation of a new partnership.