DHS 106.065(2)(b)2. 2. Suspension of payments for new admissions who require particular types of services;

DHS 106.065(2)(b)3. 3. Suspension of payments for any MA recipient requiring a particular type of service;

DHS 106.065(2)(b)4. 4. A plan of correction prescribed by the department;

DHS 106.065(2)(b)5. 5. Provider monitoring by the department;

DHS 106.065(2)(b)6. 6. Appointment of a temporary manager; or

DHS 106.065(2)(b)7. 7. Any of the sanctions described in s. DHS 106.07 (4).

DHS 106.065(2)(c) (c) In determining the most effective sanctions to be applied to a non-compliant provider, the department shall consider:

DHS 106.065(2)(c)1. 1. The severity and scope of noncompliance;

DHS 106.065(2)(c)2. 2. The relationship of several areas of the deficiencies or noncompliance;

DHS 106.065(2)(c)3. 3. The provider’s previous compliance history, particularly as it relates to the insufficiencies under consideration;

DHS 106.065(2)(c)4. 4. Immediate or potential jeopardy to patient health and safety;

DHS 106.065(2)(c)5. 5. The direct relationship to patient care; and

DHS 106.065(2)(c)6. 6. The provider’s financial condition.

DHS 106.065(2)(d) (d) The department may revisit the provider during the sanction period. Termination procedures may be initiated as a result of the review conducted during the revisit if substantial noncompliance is found to persist, or if recipient safety is potentially or actually compromised.

DHS 106.065 History History: Cr. Register, February, 1993, No. 446, eff. 3-1-93; corrections in (1) (a) made under s. 13.92 (4) (b) 7., Stats., Register December 2008 No. 636.

DHS 106.07 DHS 106.07 Effects of suspension or involuntary termination.

DHS 106.07(1) (1) Length of suspension or involuntary termination. In determining the period for which a party identified in this chapter is to be disqualified from participation in the program, the department shall consider the following factors:

DHS 106.07(1)(a) (a) The number and nature of the program violations and other related offenses;

DHS 106.07(1)(b) (b) The nature and extent of any adverse impact on recipients caused by the violations;

DHS 106.07(1)(c) (c) The amount of any damages;

DHS 106.07(1)(d) (d) Any mitigating circumstances; and

DHS 106.07(1)(e) (e) Any other pertinent facts which have direct bearing on the nature and seriousness of the program violations or related offenses.

DHS 106.07(2) (2) Federal exclusions. Notwithstanding any other provision in this chapter, a party who is excluded from participation in the MA program under s. DHS 106.06 (28) (e), (f) or (g) as the result of a directive from the secretary of the federal department of health and human services under the authority of section 1128 or 1128A of the social security act of 1935, as amended, shall be excluded from participation in the MA program for the period of time specified by the secretary of that federal agency.

DHS 106.07(3) (3) Referral to licensing agencies. The secretary shall notify the appropriate state licensing agency of the suspension or termination by MA of any provider licensed by the agency and of the act or acts which served as the basis for the provider’s suspension or termination.

DHS 106.07(4) (4) Other possible sanctions. In addition or as an alternative to the suspension or termination of a provider’s certification, the secretary may impose any or all of the following sanctions against a provider who has been found to have engaged in the conduct described in s. DHS 106.06:

DHS 106.07(4)(a) (a) Referral to the appropriate state regulatory agency;

DHS 106.07(4)(b) (b) Referral to the appropriate peer review mechanism;

DHS 106.07(4)(c) (c) Transfer to a provider agreement of limited duration not to exceed 12 months; or

DHS 106.07(4)(d) (d) Transfer to a provider agreement which stipulates specific conditions of participation.