Rule-making notices
Notice of Hearing
Notice is hereby given that, pursuant to ss.
50.36 (1),
227.11 (2) (a) and
227.24 (4), Stats., the Department of Health and Family Services will hold a public hearing to consider both the emergency rules and proposed permanent rules amending ss.
HFS 124.38 (4),
124.39 (1) (intro),
(a),
(b) and
(e),
(2) (a) and
(3),
124.40 (2) (b) and
(3) and
124.41 and creating ss.
HFS 124.38 (5) and
124.40 (2) (c), relating to critical access hospitals.
Hearing Information
The public hearing will be held:
Friday, June 20, 2003, 9:00 a.m. to Noon
Superior Public Library
1530 Tower Ave.
Superior, WI
The hearing site is fully accessible to people with disabilities. Parking for people with disabilities is available on site.
Analysis Prepared by the Department of Health and Family Services
The federal Rural Hospital Flexibility Program promotes the continued viability of rural hospitals by allowing qualifying hospitals to receive cost-based reimbursement for their services if the hospital qualifies for and is approved to convert to what is known as a Critical Access Hospital (CAH). In Wisconsin, subchapter VI of ch.
HFS 124 governs the Department's designation and regulation of CAHs. Designation as a CAH and receipt of cost-based reimbursement promotes the hospital's continued viability. To date, 25 hospitals in Wisconsin have transitioned to CAH status, thereby ensuring continued acute care access for many rural residents.
The Department recently learned that the tenuous financial condition of St. Mary's Hospital in Superior jeopardizes its continued operation and places it in imminent danger of closing unless the hospital can be designated as a CAH and receive cost-based reimbursement. The closure of St. Mary's would reduce Douglas County residents' accessibility to acute care. Moreover, the loss of the facility would have a significant detrimental effect on the county because St. Mary's annual payroll is between $7-8 million and it employs the equivalent of about 160 persons full-time.
Federal regulations permit a hospital in an urban area such as Superior to be reclassified as a critical access hospital if the hospital is located in an area designated as rural under state law or regulation. The Department has determined that the current provisions in ch.
HFS 124 preclude St. Mary's from being reclassified as a rural hospital and designated as a necessary provider of health services to area residents. However, St. Mary's Hospital meets “necessary provider" status in the Wisconsin Rural Health Plan based on economic, demographic and health care delivery in its service area. Therefore, the Department is proposing to modify provisions in subchapter VI of ch.
HFS 124 to permit St. Mary's Hospital to be classified as a rural hospital and begin the approval process for designation as a Critical Access Hospital. To permit St. Mary's to initiate its transition to a critical access hospital, the Department issued a similar emergency order that became effective on March 21, 2003. Through this proposed permanent order, the Department is also modifying several other provisions in subch.
VI of ch. HFS 124 to more closely reflect current federal regulations, the October 2001 Wisconsin Rural Hospital Flexibility Program Implementation Plan and to change the name of the federal Health Care Financing Administration to the Centers for Medicare and Medicaid Services.
Contact Person
The initial proposed rules upon which the Department is soliciting comments and which will be the subject of this hearing are posted at the Department's administrative rules website at:
To find out more about the hearing, or to comment on the proposed rule, please write or phone:
Cheryl Bell-Marek
Division of Disability and Elder Services
P.O. Box 2969
Madison, WI 53701-2969
608-264-9896 or,
if you are hearing impaired,
(608) 266-1511 (TDD)
If you are hearing or visually impaired, do not speak English, or have other personal circumstances which might make communication at the hearing difficult and if you, therefore, require an interpreter, or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number above. A person requesting a non-English or sign language interpreter should make that request at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments on the proposed rule received at the above address no later than Wednesday, June 23, 2003, will be given the same consideration as testimony presented at the hearing.
Fiscal Estimate
A hospital may be designated as a critical access hospital if it satisfies federal and state requirements including requirements specified under ss.
HFS 124.37 through
124.41.
Section
HFS 124.39 (1) of the Wisconsin Administrative Code specifies state eligibility requirements for designation as a critical access hospital. A hospital must meet all of the following:
(a) A nonprofit or public hospital approved by the department to operate as a hospital.
(b) Located in an area outside of a metropolitan statistical area as defined in
42 USC 1395ww(d).
(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.
(d) A hospital that has a provider agreement to participate in Medicare in accordance with
42 CFR 485.612.
(e) A hospital that has not been designated by the federal health care financing administration as an urban hospital for the purposes of Medicare reimbursement.
The proposed rule change would expand the criteria for necessary providers under s.
HFS 124.39 (2) to rural hospitals, defined as hospitals located in a county that has at least a portion of a rural census tract of a metropolitan statistical are as determined under the most recent version of the Goldsmith Modification as provided in
42 CFR 412.103(a)(1), that meet the criteria under s.
HFS 123.39 (1) (a),
(d) and
(e).
Two counties in Wisconsin currently fall under Goldsmith Modification criteria: Douglas and Marathon. Three hospitals are located in these counties: St. Mary's in Superior, and NorthCentral Health Care Facility and Wausau Hospital in Wausau. None of these hospitals currently meet the requirements for a critical access hospital under s.
HFS 124.40. However, St. Mary's has expressed an interest in delicensing a number of its hospital beds. If St. Mary's were to delicense 137 beds, it would meet the requirements under 124.40 and could gain critical access hospital status under the proposed change.
If St. Mary's were to gain critical access hospital status, it would be eligible for inpatient and outpatient hospital cost-based reimbursement under fee-for-service Medicaid (MA), as well as increased federal Medicare payments. Under cost-based reimbursement, it is estimated St. Mary's would receive an MA increase of $285,200 AF ($118,400 GPR) annually. This increase includes the effect of eliminating Metropolitan Border Status Supplement payments. St. Mary's currently receives $152,500 AF in MA payments under the Metropolitan Border Status Supplement. Under cost-based reimbursement, St. Mary's would not be eligible for supplemental MA payments.
In addition, the Department would lose approximately $2,500 PR annually in bed licensing fees from St. Mary's due to the 137 delicensed beds.
Due to estimated increased MA payments and loss of bed licensing fees, this change has a state fiscal estimate of $287,700 AF ($118,400 GPR). This change has no fiscal effect for local governments.
Initial Regulatory Flexibility Analysis
The rule changes will not affect small businesses as “small business" is defined in s.
227.114 (1) (a), Stats.
Notice of Hearing
Notice is hereby given that pursuant to the authority granted under s.
601.41 (3), Stats., and the procedure set forth in under s.
227.18, Stats., OCI will hold a public hearing to consider the adoption of the attached proposed rulemaking order affecting s. Ins. 17.40 (1), (2), (3) and (4), Wis. Adm. Code requiring primary insurers and self-insurers to provide notice to the patients compensation fund of the filing of an out-of- state medical malpractice action against an insured Wisconsin health care provider.
Hearing Information
Date: May 14, 2003
Time: 10:00 a.m., or as soon thereafter as the matter may be reached
Place: Room 223, OCI, 125 S. Webster , Madison, WI
Written comments on the proposed rule will be accepted into the record and receive the same consideration as testimony presented at the hearing if they are received at OCI within 3 days following the date of the hearing. Written comments should be addressed to: Alice M. Shuman-Johnson, OCI, PO Box 7873, Madison WI 53707.
Initial Regulatory Flexibility Analysis
This rule does not impose any additional requirements on small businesses.
Copies of Rule and Contact Person
