Chapter DHS 127

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.

DHS 127.03(6)(b)3. 3. The operator has relinquished management of the rural medical center.

DHS 127.03(7) (7) Denial, suspension or revocation.

DHS 127.03(7)(a) (a) Action.

DHS 127.03(7)(a)1. 1. ‘Denial.’ The department shall deny an application for an initial rural medical center license or for modification of a license to provide an additional health care service to any applicant not receiving a favorable license application determination under sub. (4) or failing to pay the license fee under sub. (3). The department shall provide written notice to the applicant within 45 calendar days after receipt of the complete application. If the department denies an application for a license or for authorization to provide a specific type of health care service for the sole reason that the applicant has an outstanding adverse action and the cause of the adverse action is subsequently corrected, the department shall issue the license within 30 calendar days after receiving notice from the applicant that the cause of the adverse action has been corrected, provided that the application is otherwise complete and the applicant pays the license fee under sub. (3).

DHS 127.03(7)(a)2. 2. ‘Suspension or revocation.’

DHS 127.03(7)(a)2.a. a. Non-emergency. The department, after providing written notice to the licensee, may suspend or revoke a rural medical center license or authorization to provide a specific type of health care service if the department determines that the rural medical center has substantially failed to comply with the requirements of ss. 50.50 to 50.56, Stats., or this chapter. Except as provided in subd. 2. b., the department shall provide written notice to the licensee of the suspension or revocation at least 30 days before the suspension or revocation is to take effect.

DHS 127.03(7)(a)2.b. b. Emergency. The department may, in the event of an emergency condition that imminently threatens the health, safety or welfare of rural medical center patients or residents, order summary suspension of new admissions to all or part of the rural medical center or order summary suspension of the rural medical center’s authorization to provide a specific type of health care service until such time as the department decides that the rural medical center has removed or corrected the causes or violations creating the emergency.

DHS 127.03(7)(b) (b) Contents of notice. In a notice of denial, suspension or revocation under par. (a), the department shall state the reasons for its action and specify the statute or rule and facts that constitute any violation or noncompliance. The notice shall identify the process under par. (g) for an appeal of the denial, suspension or revocation.

DHS 127.03(7)(c) (c) Return receipt. If the department receives a return receipt for the notice sent under par. (a), the return receipt is conclusive evidence that the addressee received the notice. If the department does not receive a return receipt for the notice sent under par. (a), the addressee shall be presumed to have received the notice on the fifth calendar day after the date the notice was mailed.

DHS 127.03(7)(d) (d) Effective date.

DHS 127.03(7)(d)1. 1. Subject to s. 227.51, Stats., a denial, suspension or revocation is effective on the date set by the department in the notice of denial, suspension or revocation, on the date of expiration of an existing license, except that:

DHS 127.03(7)(d)1.a. a. In the event of a contested case hearing pursuant to s. 227.42, Stats., the effective date is the date of final action.

DHS 127.03(7)(d)1.b. b. In the event of judicial review pursuant to s. 227.52, Stats., or a stay granted under s. 227.54, Stats., the effective date is the date of final action.

DHS 127.03(7)(d)2. 2. The department may delay the effective date of license revocation in order to permit orderly removal and relocation of patients or residents served by the rural medical center.

DHS 127.03(7)(f) (f) Effect on other licenses, approvals, certifications or health care services. The department’s denial, suspension or revocation of an application, license or authorization to provide a specific type of health care service shall have no bearing on any other license, approval or certification of health care services maintained in good standing as specified under sub. (4) (d) 6., unless the applicant ceases to qualify as a rural medical center.

DHS 127.03(7)(g) (g) Appeal of denial, suspension or revocation. An applicant or licensee may request a hearing under ch. 227, Stats., to appeal the department’s decision to deny, suspend or revoke the application or license. The request for hearing shall be in writing and filed in the department of administration’s division of hearings and appeals within 10 working days after receipt of the notice of denial under par. (a) 1. or of suspension or revocation under par. (a) 2. A request for a hearing is considered filed on the date of its receipt by the division of hearings and appeals. Review of the department’s decision by that office is not available if the request for a hearing is received more than 10 working days after the date that the applicant or licensee receives the notice of denial, suspension or revocation of the license.

DHS 127.03 Note Note: A hearing request should be sent or may be delivered to the Department of Administration’s Division of Hearings and Appeals, 5005 University Avenue, Suite 201, Madison, Wisconsin, 53705-5400.

DHS 127.03 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections in (2) (a), (3) (a), (4) (d) 5. and 6. made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; correction in (3) (a) 4. made under s. 13.92 (4) (b) 7., Stats., Register December 2010 No. 660; correction in (3) (a) 4. made under s. 13.92 (4) (b) 7., Stats., Register January 2011 No. 661.

DHS 127.04 DHS 127.04 Compliance with laws. All rural medical centers shall operate and provide health care services in compliance with all applicable federal, state and local government statutes, regulations, rules and ordinances and accepted standards and principles that apply to professionals providing health care services for the center.

DHS 127.04 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.05 DHS 127.05 Inspections and investigations.

DHS 127.05(1) (1) The department may conduct an unannounced inspection of a rural medical center facility as often as required by the federal government or as the department deems necessary. The department may investigate complaints it receives concerning the operation of a rural medical center.

DHS 127.05(2) (2) 

DHS 127.05(2)(a) (a) A rural medical center surveyed or investigated under this section shall provide the department with access to patient or resident health care records, regardless of the source of patient or resident health care payment, as well as clinical, financial and administrative records, throughout the duration of any survey, inspection or investigation that the department conducts.

DHS 127.05(2)(b) (b) A rural medical center shall release patient or resident health care records without the informed consent of the patient or resident in response to a request by any federal or state governmental agency to perform a legally authorized function, including but not limited to management audits, financial audits, program monitoring and evaluation or facility licensure or certification.

DHS 127.05(3) (3) A survey or investigation by the department may include visits with patients or residents with the prior consent of the patients or residents. Upon the department’s request, a rural medical center shall provide the department a list of names, addresses and other identifying information of current and past patients or residents. The department may select the names of the patients or residents to be visited and may visit those patients or residents with their prior consent.

DHS 127.05(4) (4) If a rural medical center interferes with or refuses to allow any survey, inspection or investigation under this section or s. DHS 127.06, the department may suspend or revoke the rural medical center’s license.

DHS 127.05 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.06 DHS 127.06 Consolidated survey requirement.

DHS 127.06(1) (1) Any survey by the department of a rural medical center shall be comprehensive and consolidated with all health care services listed on the license. In conducting a survey, the department shall select a sample of patients or residents served by the center to facilitate an outcome-based, program-wide consolidated survey.

DHS 127.06(2) (2) The department shall afford opportunities for representatives of the rural medical center to consult with department staff concerning compliance, noncompliance and findings throughout the duration of a survey.

DHS 127.06 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.07 DHS 127.07 Violations and penalties.

DHS 127.07(1) (1) Notice of violation. Upon determining that a rural medical center is in violation of a requirement of this chapter, including any requirement under ss. DHS 127.16 to 127.24, the department shall promptly send a notice of violation to the chief executive officer, director, administrator or other designated agent of the rural medical center. The notice shall specify the rule violated and state the facts that constitute the violation. If the department receives a return receipt for the notice, the return receipt is conclusive evidence that the addressee received the notice. If the department does not receive a return receipt for the notice, the addressee shall be presumed to have received the notice on the fifth calendar day after the date the notice was mailed.

DHS 127.07(2) (2) Plan of correction. Within 10 calendar days of receipt of a notice of violation under sub. (1), the rural medical center shall submit a plan of correction to the department, detailing how the center plans to correct the violation or how the center has already corrected the violation. If the rural medical center fails to submit an acceptable plan of correction, the department may impose a plan with which the center shall comply. The department shall verify that the rural medical center has completed or complied with the plan of correction.

DHS 127.07(3) (3) Prohibitions. No person may do any of the following:

DHS 127.07(3)(a) (a) Intentionally prevent, interfere with or impede in any way the work of any duly authorized representative of the department in making investigations under this chapter or in enforcing this chapter.

DHS 127.07(3)(b) (b) Intentionally retaliate or discriminate against any patient, resident or employee of a rural medical center for contacting or providing information to any state agency, as defined by s. 16.004 (12) (a), Stats., or for initiating, participating in or testifying in an action to enforce any provision of this chapter.

DHS 127.07(3)(c) (c) Intentionally destroy, change or modify the original report of an inspection that the department conducts under this chapter.

DHS 127.07(3)(d) (d) Fail to correct, or attempt to interfere with the correction of, a violation within the maximum time for correction specified in a notice of violation or plan of correction, unless the department grants an extension and the rural medical center corrects the violation before expiration of the extension.