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.