Wisconsin Legislature: 237,225

237,215 Section 215 . 50.01 (1) (b) of the statutes is amended to read:

50.01 (1) (b) A place that meets the definition under sub. (1g), except sub. (1g) (e), and except that only where 3 or 4 unrelated adults reside there adults who are not related to the operator reside and receive care, treatment or services that are above the level of room and board and that may include up to 7 hours per week of nursing care per resident. “Adult family home" does not include a place that is specified in sub. (1g) (a) to (d), (f) or (g).

237,216 Section 216 . 50.01 (1e) of the statutes is created to read:

50.01 (1e) “Basic care" includes periodic skilled nursing services or physical, emotional, social or restorative care.

237,217 Section 217 . 50.01 (1g) (intro.) of the statutes is amended to read:

50.01 (1g) (intro.) “Community-based residential facility" means a place where 5 or more unrelated adults reside in which adults who are not related to the operator or administrator and who do not require care above intermediate level nursing care reside and receive care, treatment or services that are above the level of room and board but not including that include no more than 3 hours of nursing care are provided to persons residing in the facility as a primary function of the facility per week per resident. “Community-based residential facility" does not include any of the following:

237,217m Section 217m. 50.01 (1s) of the statutes is created to read:

50.01 (1s) “Intensive skilled nursing care" means care requiring specialized nursing assessment skills and the performance of specific services and procedures that are complex because of the resident's condition or the type or number of procedures that are necessary, including any of the following:

(a) Direct patient observation or monitoring or performance of complex nursing procedures by registered nurses or licensed practical nurses on a continuing basis.

(b) Repeated application of complex nursing procedures or services every 24 hours.

237,218 Section 218 . 50.01 (1t) of the statutes is created to read:

50.01 (1t) “Intermediate level nursing care" means basic care that is required by a person who has a long-term illness or disability that has reached a relatively stable plateau.

237,218m Section 218m. 50.01 (1w) of the statutes is created to read:

50.01 (1w) “Licensed practical nurse" means a nurse who is licensed or has a temporary permit under s. 441.10.

237,219 Section 219 . 50.01 (2m) of the statutes is created to read:

50.01 (2m) “Nursing care" means nursing procedures, other than personal care, that are permitted to be performed by a registered nurse under s. 441.01 (3) or by a licensed practical nurse under s. 441.11 (3), directly on or to a resident.

237,220 Section 220 . 50.01 (3) (intro.) of the statutes is amended to read:

50.01 (3) (intro.) “Nursing home" means a place which provides 24-hour services including board and room to 3 or more unrelated residents who where 5 or more persons who are not related to the operator or administrator reside, receive care or treatment and, because of their mental or physical condition require nursing care or personal care in excess of 7 hours a week, require access to 24-hour nursing services, including limited nursing care, intermediate level nursing care and skilled nursing services. “Nursing home" does not include any of the following:

237,221 Section 221 . 50.01 (4m) of the statutes is amended to read:

50.01 (4m) “Operator" means any person licensed or required to be licensed under s. 50.03 (1) or a person who operates an adult family home that is licensed under s. 50.033 (1m) (b).

237,222 Section 222 . 50.01 (4o) of the statutes is amended to read:

50.01 (4o) “Personal care" means assistance with the activities of daily living, such as eating, dressing, bathing and ambulation, but does not include nursing care.

237,223 Section 223 . 50.01 (5) of the statutes is repealed.

237,223m Section 223m. 50.01 (5r) of the statutes is created to read:

50.01 (5r) “Registered nurse" means a nurse who is licensed under s. 441.06 or permitted under s. 441.08.

237,224 Section 224 . 50.01 (6) of the statutes is amended to read:

50.01 (6) “Resident" means a person who is cared for or treated in any and is not discharged from a nursing home or ,community-based residential facility or adult family home, irrespective of how admitted.

237,225 Section 225 . 50.01 (6v) of the statutes is created to read:

50.01 (6v) “Skilled nursing services" means those services, to which all of the following apply, that are provided to a resident under a physician's orders:

(a) The services require the skills of and are provided directly by or under the supervision of a person whose licensed, registered, certified or permitted scope of practice is at least equivalent to that of a licensed practical nurse.

(b) Any of the following circumstances exist:

1. The inherent complexity of a service prescribed for a resident is such that it can be safely and effectively performed only by or under the supervision of registered nurses or licensed practical nurses.

2. The full recovery or medical improvement of the resident is not possible, but the services are needed to prevent, to the extent possible, deterioration of the resident's condition or to sustain current capacities of the resident.

3. Because of special medical complications, performing or supervising a service that is generally unskilled or observing the resident necessitates the use of a person whose licensed, registered, certified or permitted scope of practice is at least equivalent to that of a licensed practical nurse.

237,225g Section 225g. 50.02 (2) (bm) of the statutes is created to read:

50.02 (2) (bm) The department shall, by rule, define “intermediate nursing care", “limited nursing care" and “skilled nursing services" for use in regulating minimum hours of service provided to residents of nursing homes.

237,225h Section 225h. 50.02 (2) (bn) of the statutes is created to read:

50.02 (2) (bn) The department may, by rule, increase the minimum hours of nursing home care per day that are specified in s. 50.04 (2) (d) 1. to 3.

237,226 Section 226 . 50.035 (10) of the statutes is created to read:

50.035 (10) Exceptions to care limitations. (a) Notwithstanding the limitations on the type of care that may be required by and provided to residents under s. 50.01 (1g) (intro.), the following care may be provided in a community-based residential facility under the following circumstances:

1. Subject to par. (b), a community-based residential facility may provide more than 3 hours of nursing care per week or care above intermediate level nursing care for not more than 30 days to a resident who does not have a terminal illness but who has a temporary condition that requires the care, if all of the following conditions apply:

a. The resident is otherwise appropriate for the level of care that is limited in a community-based residential facility under s. 50.01 (1g) (intro.).

b. The services necessary to treat the resident's condition are available in the community-based residential facility.

2. Subject to par. (b) and if a community-based residential facility has obtained a waiver from the department or has requested such a waiver from the department and the decision is pending, the community-based residential facility may provide more than 3 hours of nursing care per week or care above intermediate level nursing care for more than 30 days to a resident who does not have a terminal illness but who has a stable or long-term condition that requires the care, if all of the following conditions apply:

a. The resident is otherwise appropriate for the level of care that is limited in a community-based residential facility under s. 50.01 (1g) (intro.).

b. The services necessary to treat the resident's condition are available in the community-based residential facility.

c. The community-based residential facility has obtained a waiver from the department under this subdivision or has requested such a waiver from the department and the decision is pending.

3. A community-based residential facility may provide more than 3 hours of nursing care per week or care above intermediate level nursing care to a resident who has a terminal illness and requires the care, under the following conditions:

a. If the resident's primary care provider is a licensed hospice or a licensed home health agency.

b. If the resident's primary care provider is not a licensed hospice or a licensed home health agency, but the community-based residential facility has obtained a waiver of the requirement under subd. 3. a. from the department or has requested such a waiver and the department's decision is pending.

(b) A community-based residential facility may not have a total of more than 4 residents or 10% of the facility's licensed capacity, whichever is greater, who qualify for care under par. (a) 1. or 2. unless the facility has obtained a waiver from the department of the limitation of this paragraph or has requested such a waiver and the department's decision is pending.

237,226bd Section 226bd. 50.04 (2) (d) of the statutes is created to read:

50.04 (2) (d) Each nursing home, other than nursing homes that primarily serve the developmentally disabled, shall provide at least the following hours of service by registered nurses, licensed practical nurses or nurse's assistants:

1. For each resident in need of intensive skilled nursing care, 3.25 hours per day, of which a minimum of 0.65 hour shall be provided by a registered nurse or licensed practical nurse.

2. For each resident in need of skilled nursing care, 2.5 hours per day, of which a minimum of 0.5 hour shall be provided by a registered nurse or licensed practical nurse.

3. For each resident in need of intermediate or limited nursing care, 2.0 hours per day, of which a minimum of 0.4 hour shall be provided by a registered nurse or licensed practical nurse.

237,226bm Section 226bm. 50.04 (2v) of the statutes, as affected by 1997 Wisconsin Act 114, is renumbered 50.04 (2v) (intro.) and amended to read:

50.04 (2v) Posting of notice required. (intro.) A nursing home shall post in a conspicuous location in the nursing home a all of the following:

(a) A notice, provided by the board on aging and long-term care, of the name, address and telephone number of the long-term care ombudsman program under s. 16.009 (2) (b).

237,226br Section 226br. 50.04 (2v) (b) of the statutes is created to read:

50.04 (2v) (b) The most recent copy of the report for the nursing home that is specified under s. 50.095 (3).

237,226c Section 226c. 50.04 (4) (d) of the statutes is created to read:

50.04 (4) (d) Suspension of admissions. 1. The department shall suspend new admissions to a nursing home if all of the following apply:

a. The nursing home received notices of violation for a class “A" violation or 3 or more class “B" violations in the previous 12 months.

b. The nursing home received notices of violation for a class “A" violation or 3 or more class “B" violations in any 12-month period during the 3 years immediately preceding the period specified in subd. 1. a.

2. A suspension of admissions under subd. 1. shall begin 90 days after a nursing home received its last notice of violation for a class “A" or class “B" violation if the department determines that the violation remains uncorrected 90 days after the nursing home received the last notice of the violation. If the nursing home indicates to the department that the violation has been corrected, but the department is unable to verify that the violation has been corrected, a suspension of admissions under subd. 1. shall begin on the day that the department makes a return visit to the nursing home and determines that the violation has not been corrected. A suspension of admissions under subd. 1. shall remain in effect until the department determines that all class “A" and class “B" violations by the nursing home have been corrected. Admission of a new resident during the period for which admissions have been suspended constitutes a class “B" violation.

3. In determining whether subd. 1. applies, the department may not consider a notice of violation found to be unjustified after hearing.

4. If the department suspends new admissions to a nursing home under this paragraph, the department shall publish a class 1 notice under ch. 985 in a newspaper likely to give notice in the area where the nursing home is located.

237,226d Section 226d. 50.04 (5) (a) 1., 2. and 3. (intro.) of the statutes are amended to read:

50.04 (5) (a) 1. A class “A" violation may be subject to a forfeiture of not more than $5,000 $10,000 for each violation.

2. A class “B" violation may be subject to a forfeiture of not more than $1,000 $5,000 for each violation.

3. (intro.) A class “C" violation may be subject to a forfeiture of not more than $100 $500. No forfeiture may be assessed for a class “C" violation unless at least one of the following applies:

237,226e Section 226e. 50.04 (5) (a) 5. of the statutes is repealed and recreated to read:

50.04 (5) (a) 5. a. A nursing home that violates a statute or rule resulting in a class “A" violation and that has received a notice of violation for a class “A" violation within the previous 3-year period shall be subject to a forfeiture 3 times the amount authorized for a class “A" violation.

b. Except as provided in subd. 5. a., a nursing home that violates a statute or rule resulting in a class “A" or class “B" violation and that has received a notice of violation of the same statute or rule within the previous 3-year period may be subject to a forfeiture 3 times the amount authorized for a class “B" violation.

c. A notice of violation found to be unjustified after hearing may not be considered in applying this subdivision.

d. The forfeiture amount that is tripled under this subdivision shall be the amount assessed after all appeals have been exhausted. If an assessment of forfeiture is not contested and the forfeiture is paid as provided in par. (fm), the forfeiture amount that is tripled is the amount assessed after the reduction specified in par. (fm).

237,226f Section 226f. 50.04 (5) (a) 6. of the statutes is amended to read:

50.04 (5) (a) 6. If a licensee fails to correct a violation within the time specified in the notice of violation or approved plan of correction, or within the extended correction time granted under sub. (4) (c) 4., or if a violation continues after a report of correction, a separate forfeiture may be assessed the department may assess upon the licensee in an amount not to exceed a separate forfeiture of not more than $10,000 for class “A" violations, and may assess a separate forfeiture of not more than $5,000 for class “B" violations, for each day of continuing violation, $5,000 for class “A" violations and $1,000 for class “B" violations.

237,226g Section 226g. 50.04 (5) (fm) of the statutes is created to read:

50.04 (5) (fm) Forfeiture reduction for timely payment. If a nursing home does not contest a notice of violation under sub. (4) (e) and does not contest an assessment of forfeiture under par. (e) for a class “A" or class “B" violation and pays the forfeiture to the department within 10 days after receipt of the notice of assessment, the department shall reduce the amount of the assessment by 35%.

237,226h Section 226h. 50.04 (5) (fr) of the statutes is created to read:

50.04 (5) (fr) Report to the legislature. Annually, the department shall submit a report to the legislature under s. 13.172 (2) that specifies for the previous year the number of class “A" violations, the amount of the forfeiture assessment for each of those violations and, if known, the amount of the forfeiture actually paid and collected with respect to those violations. The report shall also include an explanation for any assessment that was less than $2,500 for the violations specified in the report.

237,227 Section 227 . 50.065 (1) (am) of the statutes is created to read:

50.065 (1) (am) “Certificate of approval" means a certificate of approval issued under s. 50.35.

237,228 Section 228 . 50.065 (1) (b) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

50.065 (1) (b) “Client" means a person who receives direct care or treatment services from an entity.