DHS 124.39(1)(1)Eligibility. Except as provided under sub. (2) (a), to be eligible for designation as a critical access hospital, a hospital shall be all of the following:
DHS 124.39(1)(a) (a) A hospital approved by the department under this chapter to operate as a hospital.
DHS 124.39(1)(b) (b) Located in an area outside of a metropolitan statistical area as defined in 42 USC 1395ww(d), or located in a rural area of an urban county.
DHS 124.39(1)(c) (c) Located more than a 35-mile drive from another hospital or certified by the department under sub. (2) as a necessary provider of health care services to residents in the area.
DHS 124.39(1)(d) (d) A hospital that has a provider agreement to participate in medicare in accordance with 42 CFR 485.612.
DHS 124.39(1)(e) (e) A hospital that has not been designated by the federal centers for medicare and medicaid services as an urban hospital for purposes of medicare reimbursement.
DHS 124.39(2) (2)Application for certification as a necessary provider for an area.
DHS 124.39(2)(a)1.1. A hospital meeting the criteria under sub. (1) (a), (b), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if it cannot meet the criterion under sub. (1) (c) that it be located more than a 35-mile drive from another hospital.
DHS 124.39(2)(a)2. 2. A rural hospital meeting the criteria under sub. (1) (a), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if the rural hospital cannot meet the criteria under sub. (1) (b) and (c).
DHS 124.39(2)(a)3. 3. Application under subd. 1. or 2. shall be made in accordance with a format provided by the department.
DHS 124.39 Note Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; (608) 266-7297.
DHS 124.39(2)(b) (b) Upon receipt of a completed application from a hospital for certification as a necessary provider of health care services to residents in the area, the department shall review the application and shall approve or disapprove it within 60 days of receipt.
DHS 124.39(3) (3)Application for critical access hospital status.
DHS 124.39(3)(a)(a) A hospital eligible under sub. (1) or (2) (a) for designation as a critical access hospital may apply to the department for designation. Application shall be made in accordance with a format provided by the department.
DHS 124.39 Note Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; (608) 266-7297.
DHS 124.39(3)(b) (b) Upon receipt of a completed application from a hospital for designation as a critical access hospital, the department shall review the application and shall determine if the applicant meets the federal conditions of participation in medicare for critical access hospitals under 42 CFR 485.601 to 485.645, and, if applicable, 42 CFR 412.103(a)(1). If the applicant hospital meets those federal regulations and all requirements under ss. DHS 124.40 and 124.41, the department shall, within 90 days after receipt of a completed application, recommend certification of the hospital as a critical access hospital to the federal centers for medicare and medicaid services.
DHS 124.39 Note Note: The federal Centers for Medicare and Medicaid Services will notify the Department and the applicant hospital of the certification decision.
DHS 124.39(3)(c) (c) Following notification by the federal centers for medicare and medicaid services that it has accepted the department's certification recommendation, the department shall issue a certificate of approval that establishes the applicant's critical access hospital status in the state.
DHS 124.39 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; emerg. am. (1) (intro.) and (e), (2) (a) and (3), eff. 3-21-03; CR 03-042: am. (1) (intro.), (a), (b), (e), (2) (a) and (3) Register September 2003 No. 573, eff. 10-1-03.
DHS 124.40 DHS 124.40Requirements for a critical access hospital.
DHS 124.40(1)(1)Operation as a hospital. A critical access hospital shall comply with all provisions of this chapter, except as provided in this section.
DHS 124.40(2) (2)Bed complement.
DHS 124.40(2)(a) (a) A critical access hospital shall maintain no more than a total of 25 beds to be used exclusively for acute inpatient care.
DHS 124.40(2)(b) (b) If the critical access hospital has an agreement established under 42 USC 1395tt governing the hospital's maintenance of swing beds, the critical access hospital may maintain not more than 25 inpatient beds to be used interchangeably for acute care or swing-bed services.
DHS 124.40(2)(c) (c) A critical access hospital may have up to 4 additional permanently-placed 24-hour observation beds.
DHS 124.40(3) (3)Limits on acute inpatient stays. A critical access hospital shall provide inpatient care for periods not to exceed an annual average of 96 hours per patient. The hospital shall record each patient's stay and any longer inpatient stay because transfer to a network or other hospital is precluded due to inclement weather or other emergency conditions.
DHS 124.40(4) (4)Emergency care services.
DHS 124.40(4)(a) (a) A critical access hospital shall make emergency services available on a 24-hour-a-day-basis and in accordance with the rural health plan.
DHS 124.40(4)(b) (b) Emergency services shall be provided by a practitioner with training or experience in emergency care who is on call and immediately available by telephone or radio contact, and available on-site within 30 minutes on a 24-hour-a-day basis. In this paragraph, “practitioner" means a physician, a nurse practitioner or a physician assistant.
DHS 124.40(5) (5)Staffing.
DHS 124.40(5)(a) (a) General. A critical access hospital shall comply with the provisions of subchs. III and IV only when the facility has one or more patients receiving care in the facility. When the facility does not have any inpatients, the facility need not comply with the federal conditions of participation of a hospital under medicare relating to the number of hours during a day, or days during a week, in which the facility must be open, and with the provisions of subchs. III and IV relating to staffing requirements, except that the facility is required to make available emergency care services pursuant to sub. (4) and shall have registered nurses available on a 24-hour basis as required by s. DHS 124.13 (1) (a).
DHS 124.40(5)(b) (b) Inpatient care services. Inpatient care under sub. (3) may be provided by a physician assistant, nurse practitioner or clinical nurse specialist subject to the oversight of a physician who need not be present in the facility.
DHS 124.40(5)(c) (c) Special services. A critical access hospital may make available any services provided by staff under ss. DHS 124.15, 124.16, 124.17, 124.18, 124.19, 124.20, 124.21, 124.22, 124.23 or 124.25 on a part-time, off-site basis under arrangements as specified in 42 USC 1395x(e).
DHS 124.40(6) (6)Referral agreement. A critical access hospital shall have a written agreement with one or more network hospitals which shall address all of the following:
DHS 124.40(6)(a) (a) Transfer and referral of patients from the critical access hospital.
DHS 124.40(6)(b) (b) Development and use of communication systems.
DHS 124.40(6)(c) (c) Provision of emergency and non-emergency transportation.
DHS 124.40(6)(d) (d) Credentialing of professional staff and quality assurance.
DHS 124.40 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; CR 03-042: am. (2) (b) and (3), cr. (2) (c) Register September 2003 No. 573, eff. 10-1-03; CR 04-040: am. (2) (a) and (b) Register November 2004 No. 587, eff. 12-1-04.
DHS 124.41 DHS 124.41Rural health plan. Before implementation of the state medicare rural hospital flexibility program pursuant to 42 USC 1395i-4 for the establishment of critical access hospitals, the department shall develop a rural health plan. The department shall submit the rural health plan to the federal centers for medicare and medicaid services for approval.
DHS 124.41 History History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; CR 03-042: am. Register September 2003 No. 573, eff. 10-1-03.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.