SB309: Bill Text

LRB-3788/1

DAK:kmg:ks

1995 - 1996 LEGISLATURE

1995 Senate BILL 309

August 23, 1995 - Introduced by Senators Schultz, Rosenzweig, Jauch, Breske, Clausing, Rude, Panzer and Cowles, cosponsored by Representatives Freese, Musser, Hahn, Ourada, Gronemus, Baldus, Harsdorf, Zukowski, Handrick, Vrakas, Boyle, Seratti, Goetsch, Albers, Riley, Ainsworth, Urban, Grothman, Underheim, Brancel and Green, by request of Rural Wisconsin Health Cooperative.. Referred to Committee on Health, Human Services and Aging.

SB309,1,4 An Act to repeal 50.02 (6); to amend 20.435 (1) (gm); and to create subchapter III of chapter 50 [precedes 50.50], 146.81 (1) (p) and 146.82 (2) (a) 17. of the statutes; relating to: regulating rural medical centers, granting rule-making authority, making an appropriation and providing penalties.

Analysis by the Legislative Reference Bureau

Under current law, the department of health and social services (DHSS) must investigate the concept of regulating a new category of health care providers known as rural medical centers.

This bill eliminates that provision and establishes rural medical centers as a category of health care providers that, beginning on July 1, 1996, must be licensed, inspected and otherwise regulated by DHSS. Under the bill, a facility may be regulated as a rural medical center if it is organized under a single governing and corporate structure, is located in a county, city, town or village that has a population of less than 15,000 and in an area that the federal bureau of the census has not defined as an urbanized area and if it provides 2 or more health care services. The health care services are those provided by a hospital, a rural primary care hospital (as defined in (the bill), a nursing home, a hospice, a rural health clinic or an ambulatory surgery center; or they are home health services, outpatient physical therapy services, end-stage renal disease services or services that are specified by DHSS by rule.

The bill establishes licensing procedures and requires that DHSS promulgate rules that establish standards for operation of rural medical centers, minimum requirements for license issuance, licensure fee amounts, and procedures and criteria for waiver of or variance from standards and requirements. As part of license issuance, DHSS must inspect the health care services provided by an applying rural medical center, except that DHSS may, instead, accept evidence that an applicant has certain current state licensure or approval, has a current medicare provider agreement, has been designated as a rural primary care hospital or satisfies requirements in DHSS rules. The bill exempts a hospital, nursing home, hospice or home health agency that provides all of its services as part of a licensed rural medical center from obtaining licensure or approval and paying license or approval fees under other state laws. These facilities are not, however, exempted from standards and other regulations for operation under those licensing laws, unless the laws conflict with laws regulating rural medical centers. The bill authorizes DHSS to conduct unannounced inspections of rural medical centers and requires a rural medical center to provide access to any patient health care records necessary to fulfill the purpose of any DHSS inspections or investigations. The bill prohibits an unlicensed entity from using the phrase "rural medical center" to describe itself, prohibits intentional interference with any investigation by DHSS of alleged violations, prohibits certain intentional retaliation or discrimination against employes or patients and prohibits intentional destruction or modification of original inspection reports.

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:

SB309, s. 1 Section 1 . 20.435 (1) (gm) of the statutes is amended to read:

SB309,2,9 20.435 (1) (gm) Licensing, review and certifying activities. The amounts in the schedule for the purposes specified in ss. 50.135, 50.49 (2) (b), 50.52 (2) (a), 146.50 (8), 250.05 (6), 252.22 (7), 254.176, 254.178, 254.20 (5) and (8), 254.31 to 254.39, 254.47, 254.61 to 254.89 and 255.08 (2), subch. IV of ch. 50 and ch. 150. All moneys received under ss. 50.135, 50.49 (2) (b), 50.52 (2) (a), 50.93 (1) (c), 146.50 (8) (d), 150.13, 250.05 (6), 252.22 (7), 254.176, 254.178, 254.20 (5) and (8), 254.31 to 254.39, 254.47, 254.61 to 254.89 and 255.08 (2) (b), less the amounts appropriated under s. 20.488 (1) (g), shall be credited to this appropriation.

SB309, s. 2 Section 2. 50.02 (6) of the statutes is repealed.

SB309, s. 3 Section 3. Subchapter III of chapter 50 [precedes 50.50] of the statutes is created to read:

SB309,2,13 CHAPTER 50

SB309,3,2 Subchapter III rural medical centers

SB309,3,3 50.50 Definitions. In this subchapter:

SB309,3,4 (1) "Ambulatory surgery center" has the meaning given in s. 49.45 (6r) (a) 1.

SB309,3,6 (2) "End-stage renal disease services" has the meaning given under 42 CFR 405.2102.

SB309,3,7 (3) "Health care services" means any of the following:

SB309,3,8 (a) Care that is provided in or by any of the following:

SB309,3,9 1. A hospital.

SB309,3,10 2. A nursing home.

SB309,3,11 3. A hospice.

SB309,3,12 4. A rural health clinic.

SB309,3,13 5. An ambulatory surgery center.

SB309,3,14 6. A rural primary care hospital.

SB309,3,15 (b) Home health services.

SB309,3,16 (c) Outpatient physical therapy services.

SB309,3,17 (d) End-stage renal disease services.

SB309,3,18 (e) Services that are specified in rules that the department promulgates.

SB309,3,19 (4) "Home health services" has the meaning given in s. 50.49 (1) (b).

SB309,3,20 (5) "Hospice" has the meaning given in s. 50.90 (1).

SB309,3,22 (6) "Hospital" has the meaning given in s. 50.33 (2) (a) or (b), except that "hospital" does not include a rural primary care hospital.

SB309,3,23 (7) "Medicare" has the meaning given in s. 49.45 (3) (L) 1. b.

SB309,3,25 (8) "Outpatient physical therapy services" has the meaning given under 42 USC 1395x (p).

SB309,4,2 (9) "Patient" means an individual who receives services from a rural medical center.

SB309,4,3 (10) "Rural health clinic" has the meaning given under 42 USC 1395x (aa) (2).

SB309,4,5 (11) "Rural medical center" means an arrangement of facilities, equipment, services and personnel that is all of the following:

SB309,4,6 (a) Organized under a single governing and corporate structure.

SB309,4,10 (b) Capable of providing or assuring health care services, including appropriate referral, treatment and follow-up services, at one or more locations in a county, city, town or village that has a population of less than 15,000 and that is in an area that is not an urbanized area, as defined by the federal bureau of the census.

SB309,4,12 (c) A provider of at least 2 health care services under the arrangement or through a related corporate entity.

SB309,4,15 (12) "Rural primary care hospital" means a facility that is currently designated by the federal health care financing administration as meeting the applicable requirements of 42 USC 1395i-4 (i) (2) and of 42 CFR 485, Subpart F.

SB309,4,16 50.51 Departmental powers. The department shall do all of the following:

SB309,4,18 (1) Provide uniform, statewide licensing, inspection and regulation of rural medical centers as specified in this subchapter.

SB309,4,19 (2) Promulgate rules that establish all of the following:

SB309,4,22 (a) For the operation of licensed rural medical centers, standards that are designed to protect and promote the health, safety, rights and welfare of patients who receive health care services in rural medical centers.

SB309,4,24 (b) Minimum requirements for issuance of a provisional license, a regular initial license or a license renewal to rural medical centers.

SB309,5,3 (c) Fees for rural medical center provisional licensure and regular initial licensure and licensure renewal. The amounts of the fees shall be based on the health care services provided by the rural medical center.

SB309,5,5 (d) A procedure and criteria for waiver of or variance from standards under par. (a) or minimum requirements under par. (b).

SB309,5,10 50.52 Licensing procedure and requirements. (1) No person may be required to obtain licensure as a rural medical center, except that no person may conduct, maintain, operate or permit to be conducted, maintained or operated health care services as a rural medical center unless the rural medical center is licensed by the department.

SB309,5,13 (2) The department shall issue a provisional license, a regular initial license or a license renewal as a rural medical center to an applicant if all of the following are first done:

SB309,5,16 (a) The applicant pays the appropriate license fee, as established under s. 50.51 (2) (c). Fees collected under this paragraph shall be credited to the appropriation under s. 20.435 (1) (gm) for licensing and inspection activities.

SB309,5,20 (b) Except as provided in par. (c), the department inspects the health care services provided by the applying rural medical center and finds that the applicant is fit and qualified and meets the requirements and standards of this subchapter and the rules promulgated under this subchapter.

SB309,5,22 (c) In lieu of conducting the inspection under par. (b), the department accepts evidence that an applicant meets one of the following requirements:

SB309,5,24 1. Has applicable current, valid state licensure or approval as a hospital, a nursing home, a hospice or a home health agency.

SB309,6,2 2. Has an applicable, current agreement to participate as an eligible provider in medicare.

SB309,6,3 3. Is a rural primary care hospital.

SB309,6,4 4. Satisfies qualifications that are specified by the department by rule.

SB309,6,7 (3) Each license shall bear the name of the owner of the rural medical center, the name and address of the rural medical center and the health care services that the department authorizes the rural medical center to provide.

SB309,6,11 (4) Unless sooner revoked or suspended, a regular initial license or a license renewal issued to a rural medical center is valid for 24 months from the date of issuance and a provisional license issued to a rural medical center is valid for 6 months from the date of issuance.