Appeals
Currently, in order to appeal a DHFS finding that the nursing home violated
a state requirement, a nursing home must request a hearing on the finding within
ten days of receiving notice of the violation. If DHFS assesses a forfeiture for the
violation and the nursing home wishes to appeal the forfeiture, the nursing home
must request a separate hearing on the forfeiture within ten days of receiving notice
of a contested action. Upon request of the nursing home, the hearing on the finding
of violation may be stayed until DHFS assesses a forfeiture so that the hearing on
the finding of violation and the hearing on the forfeiture may be consolidated.
The bill extends the deadline for a nursing home to request a hearing on a
finding that the nursing home violated a state requirement to 60 days after receipt
of the notice of violation. The bill also extends the deadline for requesting a hearing
on a forfeiture to 60 days after receipt of notice of the forfeiture. The bill further
provides that, if a nursing home timely appeals both a finding of violation and a
forfeiture, the hearings on the violation and the forfeiture will be consolidated.
Monetary penalties
Under current law, DHFS may assess a forfeiture against a nursing home for
a violation of a state requirement. The maximum amount of the forfeiture varies
according to the classification of the violation and ranges from $500 to $10,000.
There is no time limit for DHFS to assess a forfeiture for a violation. Nursing homes
must pay forfeitures to DHFS within ten days after receipt of notice of imposition of
the forfeiture or after receipt of the final decision after exhaustion of administrative
review. If a nursing home does not contest a notice of violation and a forfeiture and
pays the forfeiture within ten days after receipt of the notice, DHFS must reduce the
forfeiture amount by 35 percent. Forfeitures collected for violations of state
requirements are deposited in the school fund.
The bill reduces the maximum forfeiture amounts permitted for violations of
state requirements and requires that DHFS impose a penalty assessment on a
nursing home whenever DHFS assesses a forfeiture for a violation of a state
requirement. The bill further requires DHFS to impose a forfeiture and penalty
assessment within 120 days of notifying a nursing home of a violation or lose the
authority to impose a forfeiture and penalty assessment. The bill changes to 60 days
the time period by which nursing home must pay forfeitures and penalty
assessments to DHFS after receipt of the notice of imposition or the final decision
after exhaustion of administrative review, and also changes to 60 days the time
period within which a nursing home may pay a forfeiture and penalty assessment
and have the forfeiture and penalty assessment amounts reduced by 35 percent. The
bill allocates moneys collected from the penalty assessments for nursing home
quality-of-care improvement grants.

Conditional licenses
Currently, in addition to the right to impose a forfeiture on a nursing home for
violations, DHFS may issue a conditional license to a nursing home in which DHFS
finds that a class "A" or a class "B" violation continues to exist. (A class "A" violation
creates a condition or occurrence relating to the operation and maintenance of a
nursing home that presents a substantial probability that death or serious mental
or physical harm to a nursing home resident will result. A class "B" violation creates
a condition or occurrence relating to the operation and maintenance of a nursing
home that directly threatens the health, safety, or welfare of a nursing home
resident.) Issuing a conditional license revokes any outstanding license held by the
nursing home.
This bill expands the standard for issuance by DHFS of a conditional license for
a nursing home to also include a continuing violation of federal law that constitutes
immediate jeopardy, high risk of death, substantial harm, or actual harm not
involving immediate jeopardy to a nursing home resident or that directly threatens,
as defined in the bill, such a resident.
Suspension of admissions
Under current law, DHFS must suspend new admissions to a nursing home if
the nursing home received notices of a class "A" violation or three or more class "B"
violations in the previous 12 months; and if the nursing home received notices of a
class "A" violation or three or more class "B" violations in any 12-month period
during the three years immediately preceding the previous 12 months. Suspension
of admissions begins 90 days after a nursing home receives its last notice of a class
"A" or class "B" violation if DHFS determines that the violation is uncorrected or on
the day that DHFS makes a return visit to the nursing home and determines that
the violation has not been corrected. A suspension must remain in effect until DHFS
determines that the nursing home has corrected all class "A" and class "B" violations.
This bill expands the standard for suspension of new admissions to a nursing
home to include circumstances under which a nursing home received written notice
of a violation that involved immediate jeopardy or high risk of death or substantial
harm to a resident; a class "A" violation; or three or more class "B" violations or
situations that either constituted actual harm not involving immediate jeopardy to
a resident or directly threatened, as defined in the bill, a resident. These
circumstances must have occurred both in the previous 15 months and in any
15-month period during the 36 months immediately preceding the previous 15
months. Under the bill, suspension of admissions must remain in effect until DHFS
determines that the nursing home has corrected the violation in question.
Suspension or revocation of licensure
Currently, DHFS may, after providing notice to a nursing home applicant or
licensee, suspend or revoke the license if DHFS finds that the nursing home
substantially failed to comply with applicable state statutes or rules. No state or
federal funds passing through the state treasury may be paid to a nursing home that
does not have a valid license. This bill also permits DHFS to suspend or revoke a
nursing home license if the nursing home has substantially failed to comply with

specified state law or with federal requirements related to the operation of a nursing
home.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB842, s. 1 1Section 1. 20.435 (6) (ge) of the statutes is created to read:
AB842,4,42 20.435 (6) (ge) Nursing home improvement grants. All moneys received from
3penalty assessments imposed by the department under s. 50.04 (5), for nursing home
4improvement grants under s. 50.15.
AB842, s. 2 5Section 2. 50.01 (1k) of the statutes is created to read:
AB842,4,96 50.01 (1k) "Directly threatened" means created a condition or occurrence
7relating to nursing home operation and maintenance that could reasonably be
8expected to lead to injury or impairment of a resident or to harm to the health, safety,
9or welfare of a resident.
AB842, s. 3 10Section 3. 50.01 (1nd) of the statutes is created to read:
AB842,4,1411 50.01 (1nd) "High risk of death or substantial harm" means a condition or
12occurrence relating to nursing home operation and maintenance that presents a
13substantial probability of the death or serious mental or physical injury, harm, or
14impairment of a resident.
AB842, s. 4 15Section 4. 50.01 (1ng) of the statutes is created to read:
AB842,4,1916 50.01 (1ng) "Immediate jeopardy" means a situation in which a nursing home's
17noncompliance with one or more federal requirements related to the operation of a
18nursing home has caused, or is likely to cause, death or serious injury, harm, or
19impairment to a resident.
AB842, s. 5 20Section 5. 50.03 (5) (a) of the statutes is amended to read:
AB842,5,7
150.03 (5) (a) Power of department. The department, after notice to a nursing
2home applicant or licensee, may suspend or revoke a license in any case in which the
3department finds that the nursing home has substantially failed to comply with the
4applicable requirements of this subchapter and the rules promulgated under this
5subchapter, with s. 49.498, or with federal requirements related to the operation of
6a nursing home
. No state or federal funds passing through the state treasury may
7be paid to a nursing home that does not have a valid license issued under this section.
AB842, s. 6 8Section 6. 50.04 (4) (am) of the statutes is created to read:
AB842,5,159 50.04 (4) (am) Dual federal and state violations. If an act or omission
10constitutes a violation of this subchapter or the rules promulgated under this
11subchapter, s. 49.498, or federal requirements related to the operation of a nursing
12home, the department may not issue under s. 50.04 (4) (a) a notice of violation of this
13subchapter, the rules promulgated under this subchapter, or s. 49.498 if the
14department has, in a statement of deficiency, cited the nursing home for the violation
15under federal requirements related to the operation of a nursing home.
AB842, s. 7 16Section 7. 50.04 (4) (b) 4. of the statutes is amended to read:
AB842,5,2217 50.04 (4) (b) 4. Each day of violation constitutes a separate violation. Except
18as provided in sub. (5) (a) 4., the department shall have the burden of showing that
19a violation existed on each day for which a forfeiture and penalty assessment is
20assessed imposed. No forfeiture or penalty assessment may be assessed imposed for
21a condition for which the nursing home has received a variance or waiver of a
22standard.
AB842, s. 8 23Section 8. 50.04 (4) (d) 1. a. of the statutes is repealed and recreated to read:
AB842,6,424 50.04 (4) (d) 1. a. In the previous 15 months, the nursing home received written
25notice of a violation of a state statute or rule or a federal statute or regulation that

1involved either immediate jeopardy or a high risk of death or substantial harm to a
2resident; a class "A" violation; or 3 or more class "B" violations or situations that
3either constituted actual harm not involving immediate jeopardy to a resident or
4directly threatened a resident.
AB842, s. 9 5Section 9. 50.04 (4) (d) 1. b. of the statutes is repealed and recreated to read:
AB842,6,126 50.04 (4) (d) 1. b. In any 15-month period during the 36 months immediately
7preceding the period specified in subd. 1. a., the nursing home received written notice
8of a violation of a state statute or rule or a federal statute or regulation that involved
9either immediate jeopardy or a high risk of death or substantial harm to a resident;
10a class "A" violation; or 3 or more class "B" violations or situations that either
11constituted actual harm not involving immediate jeopardy to a resident or directly
12threatened a resident.
AB842, s. 10 13Section 10. 50.04 (4) (d) 2. of the statutes is amended to read:
AB842,7,214 50.04 (4) (d) 2. A suspension of admissions under subd. 1. shall begin 90 days
15after a nursing home received its last notice of violation for a class "A" or class "B"
16violation or situation specified in subd. 1. a. if the department determines that the
17violation or situation remains uncorrected 90 days after the nursing home received
18the last notice of the violation or situation. If the nursing home earlier indicates to
19the department that the violation or situation has been corrected, but the
20department is unable to verify that the violation has been corrected,
a suspension of
21admissions under subd. 1. shall begin on the day that the department makes a return
22visit to the nursing home and determines that the violation or situation has not been
23corrected. A suspension of admissions under subd. 1. shall remain in effect until the
24department determines that all class "A" and class " B" violations by the nursing
25home have been has corrected the violation or situation. Admission of a new resident

1during the period for which admissions have been suspended constitutes a class "B"
2violation.
AB842, s. 11 3Section 11. 50.04 (4) (e) 1. of the statutes is amended to read:
AB842,7,244 50.04 (4) (e) 1. If a nursing home desires to contest any department action
5under this subsection, it shall send a written request for a hearing under s. 227.44
6to the division of hearings and appeals created under s. 15.103 (1) within 10 60 days
7of receipt of notice of the contested action. Department action that is subject to a
8hearing under this subsection includes service of a notice of a violation of this
9subchapter or rules promulgated under this subchapter, a notation in the report
10under sub. (3) (b), imposition of a plan of correction, and rejection of a nursing home's
11plan of correction, but does not include a correction order. Upon the request of the
12nursing home, the division shall grant a stay of the hearing under this paragraph
13until the department assesses a forfeiture and penalty assessment, so that its
14hearing under this paragraph is consolidated with the forfeiture and penalty
15assessment
appeal hearing held under sub. (5) (e). All agency action under this
16subsection arising out of a violation, deficiency, or rejection and imposition of a plan
17of correction shall be the subject of a single hearing. Unless a stay is granted under
18this paragraph, the division shall commence the hearing within 30 days of the
19request for hearing, within 30 days of the department's acceptance of a nursing
20home's plan of correction, or within 30 days of the department's imposition of a plan
21of correction, whichever is later. The division shall send notice to the nursing home
22in conformance with s. 227.44. Issues litigated at the hearing may not be relitigated
23at subsequent hearings under this paragraph arising out of the same violation or
24deficiency.
AB842, s. 12 25Section 12. 50.04 (5) (title) of the statutes is amended to read:
AB842,8,1
150.04 (5) (title) Forfeitures and penalty assessments.
AB842, s. 13 2Section 13. 50.04 (5) (a) (intro.) of the statutes is amended to read:
AB842,8,73 50.04 (5) (a) Amounts. (intro.) Any operator or owner of a nursing home which
4that is in violation of this subchapter or any rule promulgated thereunder under this
5subchapter
may be subject to the forfeitures specified in this section. If the
6department imposes a forfeiture under this subsection, the department shall also
7impose a penalty assessment under this subsection
.
AB842, s. 14 8Section 14. 50.04 (5) (a) 1., 2. and 3. (intro.) of the statutes are amended to
9read:
AB842,8,1110 50.04 (5) (a) 1. A class "A" violation may be subject to a forfeiture of not more
11than
$250 and a penalty assessment of not more than $10,000 for each violation.
AB842,8,1312 2. A class "B" violation may be subject to a forfeiture of not more than $125 and
13a penalty assessment of not more than
$5,000 for each violation.
AB842,8,1714 3. (intro.) A class "C" violation may be subject to a forfeiture of not more than
15$60 and a penalty assessment of not more than $500. No forfeiture or penalty
16assessment
may be assessed imposed for a class "C" violation unless at least one of
17the following applies:
AB842, s. 15 18Section 15. 50.04 (5) (a) 4. of the statutes is amended to read:
AB842,9,219 50.04 (5) (a) 4. Notwithstanding subds. 1., 2. and 3., if the violation or group
20of violations results from inadequate staffing, the combined amount of the forfeiture
21and penalty assessment that the department may assess impose shall be no less than
22the difference between the cost of the staff actually employed and the estimated cost
23of the staff required. The number of staff required shall be determined by the
24provider contract, the court order, or the department, by rule, whichever is greatest.

1The inadequate staff shall be presumed to exist from the date of the notice of
2violation.
AB842, s. 16 3Section 16. 50.04 (5) (a) 5. a., b. and d. of the statutes are amended to read:
AB842,9,94 50.04 (5) (a) 5. a. A nursing home that violates a statute or rule resulting in a
5class "A" violation and that has received a notice of violation for a class "A" "A"
6violation within the previous 3-year period involving the same situation shall be
7subject to a forfeiture 3 times the forfeiture amount authorized for a class "A"
8violation and a penalty assessment 3 times the penalty assessment amount
9authorized for a class "A" violation
.
AB842,9,1510 b. Except as provided in subd. 5. a., a nursing home that violates a statute or
11rule resulting in a class "A" or class "B" violation and that has received a notice of a
12class "A" or class "B" violation of the same statute or rule within the previous 3-year
13period may be subject to a forfeiture 3 times the forfeiture amount authorized for the
14most recent class of violation involved and a penalty assessment 3 times the penalty
15assessment amount authorized for the most recent class of violation involved
.
AB842,9,2216 d. The forfeiture amount and penalty assessment amounts that is are tripled
17under this subdivision shall be the amount assessed forfeiture and penalty
18assessment amounts imposed
after all appeals have been exhausted. If an
19assessment imposition of a forfeiture and penalty assessment is not contested and
20the forfeiture is and penalty assessment are paid as provided in par. (fm), the
21forfeiture amount and penalty assessment amounts that is are tripled is are the
22amount assessed amounts imposed after the reduction specified in par. (fm).
AB842, s. 17 23Section 17. 50.04 (5) (a) 5m. of the statutes is repealed
AB842, s. 18 24Section 18. 50.04 (5) (a) 6. of the statutes is renumbered 50.04 (5) (a) 6. (intro.)
25and amended to read:
AB842,10,5
150.04 (5) (a) 6. (intro.) If a licensee fails to correct a violation within the time
2specified in the notice of violation or approved plan of correction, or within the
3extended correction time granted under sub. (4) (c) 4., or if a violation continues after
4a report of correction, the department may assess upon the licensee a for each day
5of the continuing violation whichever of the following is applicable:
AB842,10,8 6a. A separate forfeiture of not more than $10,000 $250 and a separate penalty
7assessment of not more than $10,000
for a class "A" violations, and may assess a
8violation.
AB842,10,11 9b. A separate forfeiture of not more than $5,000 $125 and a separate penalty
10assessment of not more than $5,000
for a class "B" violations, for each day of
11continuing
violation.
AB842, s. 19 12Section 19. 50.04 (5) (b) (intro.) of the statutes is amended to read:
AB842,10,1713 50.04 (5) (b) Factors in assessment imposition of forfeitures and penalty
14assessments
. (intro.) In determining whether to impose a forfeiture is to be imposed
15and penalty assessment for a violation and in fixing the amount of the forfeiture to
16be imposed
penalty assessment, if any, for a violation, the following factors shall be
17considered:
AB842, s. 20 18Section 20. 50.04 (5) (c) of the statutes is amended to read:
AB842,11,519 50.04 (5) (c) Assessment Imposition of forfeitures and penalty assessments;
20powers and duties of department.
The department may directly assess impose
21forfeitures and penalty assessments provided for under par. (a). If the department
22determines that a forfeiture and penalty assessment should be assessed imposed for
23a particular violation or for failure to correct it, it the department shall send a notice
24of assessment imposition of forfeiture and penalty assessment to the nursing home.
25The notice shall specify the amount amounts of the forfeiture assessed and penalty

1assessment imposed
, the violation, and the statute or rule alleged to have been
2violated, and shall inform the licensee of the right to hearing under par. (e). If the
3department does not issue a notice of forfeiture and penalty assessment within 120
4days after the date on which a nursing home receives the notice of a violation, the
5department may not impose a forfeiture or penalty assessment for the violation.
AB842, s. 21 6Section 21. 50.04 (5) (d) (title) of the statutes is amended to read:
AB842,11,77 50.04 (5) (d) (title) Forfeiture and penalty assessment period.
AB842, s. 22 8Section 22. 50.04 (5) (d) 1. of the statutes is amended to read:
AB842,11,189 50.04 (5) (d) 1. In the case of a class "B" violation, no forfeiture or penalty
10assessment
may be assessed imposed for the violation from the day following the
11date of discovery until the date of notification. If the department fails to approve or
12reject a plan of correction within 15 days after its receipt of a complete plan, no
13forfeiture or penalty assessment may be imposed for the period beginning with the
1415th day after receipt and ending when notice of approval or rejection is received by
15the home. If a plan of correction is approved and carried out, no forfeiture or penalty
16assessment
may be assessed imposed during the time period specified in the
17approved plan of correction, commencing on the day the plan of correction is received
18by the department.
AB842, s. 23 19Section 23. 50.04 (5) (d) 2. (intro.) of the statutes is amended to read:
AB842,11,2220 50.04 (5) (d) 2. (intro.) In the case of a class "C" violation for which a notice of
21violation has been served, a forfeiture and penalty assessment may be assessed
22imposed for whichever of the following periods is applicable:
AB842, s. 24 23Section 24. 50.04 (5) (dm) (intro.) of the statutes is amended to read:
AB842,12,3
150.04 (5) (dm) (intro.) Forfeiture and penalty assessment imposition date. In
2the case of a class "B" violation, the department may not assess impose a forfeiture
3or a penalty assessment upon a nursing home until:
AB842, s. 25 4Section 25. 50.04 (5) (e) of the statutes is amended to read:
AB842,12,245 50.04 (5) (e) Forfeiture and penalty assessment appeal hearing. A nursing
6home may contest an assessment imposition of a forfeiture and penalty assessment
7by sending, within 10 60 days after receipt of notice of a contested action the
8imposition of the forfeiture and penalty assessment
, a written request for hearing
9under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1).
10The administrator of the division may designate a hearing examiner to preside over
11the case and recommend a decision to the administrator under s. 227.46. The
12decision of the administrator of the division shall be the final administrative
13decision. The division shall commence the hearing within 30 days of receipt of the
14request for hearing and shall issue a final decision within 15 days after the close of
15the hearing. Proceedings before the division are governed by ch. 227. In any petition
16for judicial review of a decision by the division, the party, other than the petitioner,
17who was in the proceeding before the division shall be the named respondent. If,
18after receipt of notice of imposition of a forfeiture and penalty assessment, a nursing
19home that has timely requested a hearing under sub. (4) (e) on the notice of violation
20under sub. (4) for which the forfeiture and penalty assessment were imposed
21requests a hearing under this paragraph on the imposition of the forfeiture and
22penalty assessment, the hearing on the notice of violation under sub. (4) and the
23hearing on the imposition of the forfeiture and penalty assessment shall be
24consolidated.
AB842, s. 26
1Section 26. 50.04 (5) (f) of the statutes, as affected by 2003 Wisconsin Act 33,
2is amended to read:
AB842,13,123 50.04 (5) (f) Forfeitures and penalty assessments paid within 10 60 days. All
4forfeitures and penalty assessments shall be paid to the department within 10 60
5days of receipt of notice of assessment imposition of the forfeiture and penalty
6assessment
or, if the forfeiture or penalty assessment is contested under par. (e),
7within 10 60 days of receipt of the final decision after exhaustion of administrative
8review, unless the final decision is appealed and the order is stayed by court order
9under s. 50.03 (11). The department shall remit all forfeitures paid to the secretary
10of administration for deposit in the school fund. All moneys collected as penalty
11assessments under this subsection shall be credited to the appropriation account
12under s. 20.435 (6) (ge).
AB842, s. 27 13Section 27. 50.04 (5) (fm) of the statutes is amended to read:
AB842,13,2114 50.04 (5) (fm) Forfeiture and penalty assessment reduction for timely payment.
15If a nursing home does not contest a notice of violation under sub. (4) (e) and does not
16contest an assessment imposition of a forfeiture and penalty assessment under par.
17(e) for a class "A" or class "B" violation and pays the forfeiture and penalty
18assessment
to the department within 10 60 days after receipt of the notice of
19assessment imposition of the forfeiture and penalty assessment, the department
20shall reduce the amount of the assessment forfeiture and penalty assessment by 35%
2135 percent.
AB842, s. 28 22Section 28. 50.04 (5) (fr) of the statutes is amended to read:
AB842,14,523 50.04 (5) (fr) Report to the legislature. Annually, the department shall submit
24a report to the legislature under s. 13.172 (2) that specifies for the previous year the
25number of class "A" violations, the amount amounts of the forfeiture assessment and

1penalty assessment imposed
for each of those violations and, if known, the amount
2amounts of the forfeiture and penalty assessment actually paid and collected with
3respect to those violations. The report shall also include an explanation for any
4assessment that was imposition of a forfeiture and penalty assessment that totaled
5less than $2,500 for the violations specified in the report.
AB842, s. 29 6Section 29. 50.04 (5) (g) of the statutes is amended to read:
AB842,14,127 50.04 (5) (g) Enforcement by attorney general. The attorney general may bring
8an action in the name of the state to collect any forfeiture or penalty assessment
9imposed under this section if the forfeiture or penalty assessment has not been paid
10following the exhaustion of all administrative and judicial reviews. The only issue
11to be contested in any such action shall be whether the forfeiture or penalty
12assessment
has been paid.
AB842, s. 30 13Section 30. 50.04 (6) (a) of the statutes is repealed and recreated to read:
AB842,14,1714 50.04 (6) (a) Power of department. 1. In addition to the right to impose
15forfeitures and penalty assessments under sub. (5), the department may issue a
16conditional license to any nursing home if the department finds that any of the
17following is true:
AB842,14,1918 a. A class "A" or class "B" violation, as defined in sub. (4), continues to exist in
19the nursing home.
AB842,14,2220 b. A federal violation continues to exist that constitutes immediate jeopardy,
21high risk of death, substantial harm, or actual harm not involving immediate
22jeopardy to a resident, or that directly threatens a resident.
AB842,14,2423 2. The issuance of a conditional license shall revoke any outstanding license
24held by the nursing home.
AB842,15,2
13. The nursing home may seek review of a decision to issue a conditional license
2as provided in s. 50.03 (5).
AB842, s. 31 3Section 31. 50.15 of the statutes is created to read:
AB842,15,8 450.15 Nursing home improvement grants. From the appropriation
5account under s. 20.435 (6) (ge), the department shall make grants to nursing homes
6to fund quality-of-care improvement projects. The department shall promulgate
7rules that specify the eligibility criteria and application procedures for receipt of a
8grant under this section.
AB842, s. 32 9Section 32. Nonstatutory provisions.
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