Chapter DHS 127

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.

DHS 127.07(3)(e) (e) Prevent or attempt to prevent any duly authorized representative of the department from examining any relevant accounts, books or records of the center in the conduct of official duties under this chapter.

DHS 127.07(3)(f) (f) Prevent or attempt to prevent any duly authorized representative of the department from preserving evidence of any violation of any provision of this chapter.

DHS 127.07(4) (4) Penalties. As provided by s. 50.55 (2), Stats., whoever violates sub. (3) (a), (b), or (c) may be imprisoned for up to 6 months or fined not more than $1,000, or both, for each violation.

DHS 127.07(5) (5) Forfeitures. The department may assess forfeitures in the manner prescribed by s. 50.55, Stats., against any person who violates any provision of this chapter except sub. (3) (a), (b), or (c).

DHS 127.07(6) (6) Appeal. Except as provided by s. 50.55 (1), Stats., a rural medical center that chooses to contest any department assessment under sub. (5) may request a hearing by sending, within 10 calendar days after receipt of a notice of assessment, a written request for hearing under ch. 227, Stats., to the department of administration’s division of hearings and appeals.

DHS 127.07 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 127.07 History History: Cr., Register, February, 1999, No. 518, eff. 3-1-99; correction in (1) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 127.08 DHS 127.08 Waivers and variances.

DHS 127.08(1) (1) Definitions. In this section:

DHS 127.08(1)(a) (a) “Variance” means the granting by the department of an alternative requirement in place of a nonstatutory requirement of this chapter.

DHS 127.08(1)(b) (b) “Waiver” means the granting by the department of an exception from a nonstatutory requirement of this chapter.

DHS 127.08(2) (2) Requirements for waivers and variances. The department may grant a waiver or variance if the department finds that:

DHS 127.08(2)(a) (a) The waiver or variance will not adversely affect the health, safety or welfare of any rural medical center patient or resident.

DHS 127.08(2)(b) (b) The requirement from which the rural medical center seeks relief would result in unreasonable hardship or is infeasible as applied to the rural medical center or a patient or resident of the rural medical center.

DHS 127.08(2)(c) (c) If the request is for a variance, the proposed condition, method, procedure, practice, technique, equipment, personnel qualification, pilot project or other alternative is in the interests of the management of patient or resident care.

DHS 127.08(3) (3) Procedures.

DHS 127.08(3)(a) (a) Requests.

DHS 127.08(3)(a)1. 1. A request for a waiver or variance shall be made in writing to the department and shall include all of the following:

DHS 127.08(3)(a)1.a. a. The requirement from which the waiver or variance is requested.

DHS 127.08(3)(a)1.b. b. The time period for which the waiver or variance is requested.

DHS 127.08(3)(a)1.c. c. The reason or reasons for the request. The center shall provide an explanation of why the requirement from which the center seeks relief results in unreasonable hardship or is infeasible as applied to the rural medical center or a patient or resident of the rural medical center.

DHS 127.08(3)(a)1.d. d. If the request is for a variance, the rural medical center’s proposal of the alternative condition, method, procedure, practice, technique, equipment, personnel qualification, pilot project or other alternative is in the interests of the management of patient or resident care and is as protective as the requirement from which the waiver or variance is being sought.

DHS 127.08(3)(a)2. 2. A request for a waiver or variance may be made at any time.

DHS 127.08(3)(a)3. 3. The department may require additional information from the rural medical center before acting on the request.

DHS 127.08 Note Note: A request for a waiver or variance should be addressed to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.

DHS 127.08(3)(b) (b) Grants and denials.

DHS 127.08(3)(b)1. 1. The department shall grant or deny in writing each request for a waiver or variance. A notice of denial shall state the department’s findings and reasons for denial and shall indicate that the rural medical center may request a hearing under par. (c). Except when additional information is requested under par. (a) 3., if a notice of denial is not issued within 60 calendar days after the receipt of a complete request, the waiver or variance shall be automatically approved.

DHS 127.08(3)(b)2. 2. The department may limit the duration of any waiver or variance.

DHS 127.08(3)(b)3. 3. The department may impose conditions on a waiver or variance if the department finds that the conditions are necessary to protect the health, safety or welfare of rural medical center patients or residents.

DHS 127.08(3)(b)4. 4. The terms of a waiver or variance may be modified only upon written agreement between the department and the rural medical center.

DHS 127.08(3)(c) (c) Appeal.

DHS 127.08(3)(c)1. 1. A rural medical center may contest the denial of a waiver or variance by requesting a hearing pursuant to ch. 227, Stats. The request for hearing shall be in writing and filed with the department of administration’s division of hearings and appeals within 10 working days after receipt of the notice under par. (b). A request for a hearing is considered filed on the date of its receipt by that office.

DHS 127.08(3)(c)2. 2. The rural medical center shall bear the burden of proving by a preponderance of the evidence that a denial of a waiver or variance was unreasonable.

DHS 127.08 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 127.08(3)(d) (d) Revocation. The department may revoke a waiver or variance, subject to appeal rights under par. (c), for any of the following reasons:

DHS 127.08(3)(d)1. 1. The department determines that the waiver or variance adversely affects the health, safety or welfare of the rural medical center’s patients or residents.

DHS 127.08(3)(d)2. 2. The rural medical center failed to comply with the waiver or variance as granted or with a condition of the waiver or variance.

DHS 127.08(3)(d)3. 3. The person representing the rural medical center who received the waiver or variance notifies the department in writing that the center wishes to relinquish the waiver or variance and be subject to the requirement previously waived or varied.

DHS 127.08(3)(d)4. 4. Revocation is required by a change in state law.

DHS 127.08 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

subch. II of ch. DHS 127 Subchapter II — Program and Operational Standards

DHS 127.16 DHS 127.16 Nursing home services. A rural medical center offering or proposing to offer nursing home services shall comply with ch. DHS 132 or 134, as appropriate, and 42 CFR 483, Subpart B. If ch. DHS 132 or 134 conflicts with this chapter, this chapter shall take precedence.

DHS 127.16 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 127.17 DHS 127.17 Hospital services. A rural medical center offering or proposing to offer hospital services shall comply with ch. DHS 124 and 42 CFR 482. If ch. DHS 124 conflicts with this chapter, this chapter shall take precedence.

DHS 127.17 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 127.18 DHS 127.18 Home health services. A rural medical center offering or proposing to offer home health services shall comply with ch. DHS 133 and 42 CFR 484. If ch. DHS 133 conflicts with this chapter, this chapter shall take precedence.

DHS 127.18 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 127.19 DHS 127.19 Hospice services. A rural medical center offering or proposing to offer hospice services shall comply with ch. DHS 131 and 42 CFR 418. If ch. DHS 131 conflicts with this chapter, this chapter shall take precedence.

DHS 127.19 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99; correction made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.

DHS 127.20 DHS 127.20 Critical access hospital services. A rural medical center offering or proposing to offer critical access hospital services shall comply with applicable sections of 42 CFR 400, 409, 410, 411, 412, 413, 424, 440, 485, 488, 489 and 498.

DHS 127.20 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.21 DHS 127.21 Rural health clinic services. A rural medical center offering or proposing to offer rural health clinic services shall comply with applicable sections of 42 CFR 405, Subpart X and 42 CFR 491, Subpart A.

DHS 127.21 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.22 DHS 127.22 Rehabilitation, outpatient physical therapy and outpatient occupational therapy services. A rural medical center offering or proposing to offer rehabilitation, outpatient physical therapy or outpatient occupational therapy services shall comply with applicable sections of 42 CFR 405 or 485.

DHS 127.22 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.23 DHS 127.23 Ambulatory surgery center services. A rural medical center offering or proposing to offer ambulatory surgery center services shall comply with applicable sections of 42 CFR 416.

DHS 127.23 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.

DHS 127.24 DHS 127.24 End-stage renal disease services. A rural medical center offering or proposing to offer end-stage renal disease services shall comply with applicable sections of 42 CFR 405, Subpart U.

DHS 127.24 History History: Cr. Register, February, 1999, No. 518, eff. 3-1-99.