DHS 131.13(24)(24) “Terminal illness” means a medical prognosis by a doctor of medicine or osteopathy that an individual’s life expectancy is less than 12 months. DHS 131.13 HistoryHistory: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10; CR 19-092: r. and recr. (3), cr. (11m), (20m) Register July 2020 No. 775, eff. 8-1-20; correction in (3) made under s. 35.17, Stats., Register July 2020 No. 775. DHS 131.14(1)(a)(a) No person may conduct, maintain, operate or otherwise participate in conducting, maintaining or operating a hospice unless the hospice is licensed by the department. DHS 131.14(1)(b)(b) A hospice program may have more than one office or facility. Multiple units do not need to be separately licensed if the hospice is able to demonstrate supervision and administration from the central office. DHS 131.14(2)(a)(a) Application for a license to operate a hospice shall be made in writing on a form provided by the department. DHS 131.14(2)(b)(b) The completed application shall contain all of the following information: DHS 131.14(2)(b)3.3. Identification of the person or persons administratively responsible for the program, and the affiliation, if any, of the person or persons with a licensed home health agency, hospital, nursing home or other health care facility. DHS 131.14(2)(b)5.5. A listing of those hospice services provided directly by the hospice, and those hospice services provided through a contractual agreement. DHS 131.14(2)(b)6.6. A list of those providers under contract with the hospice to provide hospice services. DHS 131.14(2)(b)7.7. Evidence to establish that the applicant has sufficient resources to permit operation of the hospice for a period of at least 90 days. DHS 131.14(2)(b)8.8. Any additional information specified by the department as necessary to determine that the entity detailed in the application is a hospice and that the applicant is and is fit and qualified to operate it. DHS 131.14(2)(c)(c) The applicant shall submit the application form to the department accompanied by the applicable fee established under s. 50.93 (1) (c), Stats. DHS 131.14 NoteNote: To obtain an application form for a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, Department of Health Services, P.O. Box 2969, Madison, WI 53701-2969 or telephone (608) 266-2702. The completed application form should be sent to the same office.
DHS 131.14(3)(a)(a) Investigation. After receiving a complete application, the department shall investigate and inspect the applicant to determine if the applicant is fit and qualified to be a licensee and to determine if the applicant is able to comply with this chapter. An applicant that is currently certified as meeting conditions for medicare participation under 42 USC 1395 to 1395ccc, need not be investigated or inspected as a condition for issuance of a license. DHS 131.14(3)(b)(b) Fit and qualified. In making its determination of the applicant’s fitness, the department shall review the information contained in the application and shall review any other documents that appear to be relevant in making that determination, including survey and complaint investigation findings for each health care provider with which the applicant is affiliated or was affiliated during the past 5 years. The department shall consider at least all of the following: DHS 131.14(3)(b)1.1. Any adverse action against the applicant by the licensing agency of this state or any other state relating to the applicant’s operation of a hospice, home health agency, residential facility or health care facility. In this subdivision, “adverse action” means an action initiated by a state licensing agency which resulted in the denial, suspension or revocation of the license of a hospice, home health agency, residential facility or health care facility operated by the applicant. DHS 131.14(3)(b)2.2. Any adverse action against the applicant based upon noncompliance with federal statutes or regulations in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state. In this subdivision, “adverse action” means an action by a state or federal agency which resulted in civil money penalties, termination of a provider agreement, and suspension of payments or the appointment of temporary management of a hospice, home health agency, residential facility or health care facility operated by the applicant. DHS 131.14(3)(b)3.3. The frequency of noncompliance with state licensure and federal certification laws in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state. DHS 131.14(3)(b)4.4. Any denial, suspension, enjoining or revocation of a license that the applicant had as a health care provider as defined in s. 146.81 (1), Stats., or any conviction of the applicant for providing health care without a license. DHS 131.14(3)(b)5.5. Any conviction of the applicant for a crime involving neglect or abuse of patients, or involving assaultive behavior, wanton disregard for the health or safety of others or any act of elder abuse under s. 46.90, Stats. DHS 131.14(3)(b)6.6. Any conviction of the applicant for a crime related to delivery of health care services or items. DHS 131.14(3)(b)7.7. Any conviction of the applicant for a crime involving controlled substances under ch. 961, Stats. DHS 131.14(3)(b)8.8. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information. DHS 131.14(3)(b)9.9. Any prior financial failure of the applicant that resulted in bankruptcy or in the closing of a hospice, home health agency or an inpatient health care facility or the relocation of its patients. DHS 131.14(4)(4) Provisional license. After receiving a complete application for a new license, the department shall investigate the applicant to determine the applicant’s ability to comply with this chapter. Prior to completing its investigation or if the hospice is not in operation at the time that application is made, the department may issue a provisional license. Unless sooner revoked or suspended, a provisional license shall be valid for no more than 24 months from the date of issuance. DHS 131.14(5)(a)(a) The department shall inspect a hospice prior to issuing a regular license unless sub. (3) (a) applies and the hospice need not be inspected. DHS 131.14(5)(b)(b) During the provisional period specified in sub. (4), the hospice shall actively serve at least 5 patients in Wisconsin. At the time of this inspection the hospice shall be actively providing services to at least 3 patients and be able to demonstrate the operational capability of all the facets of the program in order to be issued a regular license. DHS 131.14(5)(c)(c) A regular license is valid indefinitely unless revoked or suspended. DHS 131.14(7)(a)(a) A regular license shall be valid indefinitely if the following condition is satisfied: DHS 131.14(7)(b)(b) Every 12 months, on a schedule determined by the department, the hospice submits an annual report to the department in the form and containing the information that the department requires, including payment of the applicable fee specified in s. 50.93 (1) (c), Stats. If a complete annual report is not timely filed, the department shall issue a warning to the licensee. If a hospice that has not filed a timely report fails to submit a complete report to the department within 60 days after the date established under the schedule determined by the department, the department may revoke the license. DHS 131.14 NoteNote: To obtain an application form for renewal of a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or telephone (608) 266-2702.
DHS 131.14(8)(8) Action by the department. Within 60 days after receiving a complete application for a license the department shall either approve the application and issue a license or deny the application. The department shall deny a license to any applicant who has a history, determined under sub. (3) (b) 1. to 3., of substantial noncompliance with federal or this state’s or any state’s requirements, who fails under sub. (3) (b) 4. to 9. to qualify for a license, or who is found not in substantial compliance with this chapter. If the application for a license is denied, the department shall give the applicant reasons, in writing, for the denial and shall identify the process under sub. (11) for appealing the denial. DHS 131.14(9)(9) Scope of license. A license is issued only for the premises identified in the license application, if the hospice is a residential facility, and only for the persons named in the license application, and may not be transferred or assigned by the licensee. DHS 131.14(10)(a)(a) Changes requiring notice. The licensee shall, within 10 days, notify the department in writing of any changes in the services provided and any appointment or change of the administrator. DHS 131.14(10)(b)(b) Changes requiring new application. A new application under sub. (2) shall be submitted to the department within 10 working days when any of the following changes has occurred: DHS 131.14(10)(b)1.1. The corporate licensee has transferred 50% or more of the issued stock to another party or other parties. DHS 131.14(10)(b)2.2. The licensee has transferred ownership of 50% or more of the assets to another party or other parties. DHS 131.14(10)(b)3.3. There has been change in partners or partnership interests of 50% or greater in terms of capital or share of profits. DHS 131.14(11)(11) Suspension or revocation. The department by written notice to the applicant or recipient may suspend or revoke a license if the department finds that there has been a substantial failure to comply with the requirements of ss. 50.90 to 50.98, Stats., or this chapter. The notice shall identify the violation and the statute or rule violated, and shall describe the process under sub. (11) for appealing the decision. DHS 131.14(12)(12) Appeal of decision to deny, suspend or revoke a license. DHS 131.14(12)(a)(a) Any person aggrieved by the department’s decision to deny a license or to suspend or revoke a license may request a hearing on that decision under s. 227.42, Stats., which shall be limited to the issues stated as the bases for denial, suspension or revocation in the written notice under sub. (10). DHS 131.14(12)(b)(b) The request for hearing shall be in writing, shall be filed with the department of administration’s division of hearings and appeals, and shall be sent to that office so that it is received there within 10 days after the date of the notice under sub. (10). A request for a hearing is considered filed upon its receipt by the division of hearings and appeals. Review is not available if the request is received more than 10 days after the date of the notice under sub. (10). DHS 131.14 NoteNote: The mailing address of the Division of Hearings and Appeals is P.O. Box 7875, Madison, Wisconsin 53707.
DHS 131.14 HistoryHistory: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10. DHS 131.15DHS 131.15 Inspections of licensed programs. The department shall conduct unannounced inspections of a hospice which may include home visits with prior patient consent or a review of the clinical records of any individual with terminal illness served by the hospice. The department may inspect or investigate a hospice as it deems necessary. DHS 131.15 HistoryHistory: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10. DHS 131.16(1)(a)(a) “Variance” means the granting of an alternate requirement in place of a requirement of this chapter. DHS 131.16(1)(b)(b) “Waiver” means the granting of an exemption from a requirement of this chapter. DHS 131.16(2)(2) Requirements for waivers and variances. A waiver or variance may be granted if the department finds that the waiver or variance will not adversely affect the health, safety, or welfare of any patient and that: DHS 131.16(2)(a)(a) Strict enforcement of a requirement would result in unreasonable hardship on the hospice or on a patient. DHS 131.16(2)(b)(b) An alternative to a requirement, including a new concept, method, procedure or technique, other equipment, other personnel qualifications, or the conducting of a pilot project, is in the interests of better care or management. DHS 131.16(3)(a)1.1. An application for a waiver of or variance from a requirement of this chapter shall be made in writing to the department, specifying all of the following: DHS 131.16(3)(a)1.c.c. If the request is for a variance, the specific alternative action which the facility proposes. DHS 131.16(3)(a)3.3. The department may require additional information from the hospice prior to acting on the request. DHS 131.16(3)(b)1.1. The department shall grant or deny each request for waiver or variance in writing. A notice of denial shall contain the reasons for denial. If a notice of denial is not issued within 60 days after the receipt of a complete request, the waiver or variance shall be automatically approved. DHS 131.16(3)(b)2.2. The terms of a requested variance may be modified upon agreement between the department and the hospice. DHS 131.16(3)(b)3.3. The department may impose conditions on the granting of a waiver or variance which it deems necessary. DHS 131.16(3)(c)1.1. Denial of a requested waiver or variance may be contested by requesting a hearing as provided by ch. 227, Stats. DHS 131.16(3)(c)2.2. The licensee shall sustain the burden of proving that the denial of a waiver or variance was unreasonable. DHS 131.16(3)(d)(d) Revocation. The department may revoke a waiver or variance for any of the following reasons: DHS 131.16(3)(d)1.1. The department determines that the waiver or variance is adversely affecting the health, safety or welfare of the patients. DHS 131.16(3)(d)2.2. The hospice has failed to comply with the waiver or variance as granted. DHS 131.16(3)(d)3.3. The licensee notifies the department in writing of the desire to relinquish the waiver or variance and be subject to the requirement for which the waiver or variance was previously granted. DHS 131.16 HistoryHistory: CR 10-034: cr. Register September 2010 No. 657, eff. 10-1-10.
