DHS 122.06(10)(a)1. 1. The project does not increase the bed capacity of or totally replace an existing nursing home and the project was developed pursuant to a department-approved plan of correction to remedy code-related physical plant deficiencies. Applications submitted to correct code violations shall provide evidence of the violations and approved plan of correction and shall not go beyond what is necessary to correct those deficiencies; or
DHS 122.06(10)(a)2. 2. The application concerns a cost overrun on a previously approved project.
DHS 122.06(10)(b) (b) Timing of application. An application under par. (a) may be submitted at any time on forms prescribed by the department provided that at least 30 days notice has been given to the department of a person's intent to submit the application and the applicant has received written authorization from the department to submit the application.
DHS 122.06(10)(c) (c) Review period. Applications which are subject to this subsection shall be reviewed by the department within 60 days of receipt of a complete application.
DHS 122.06(10)(d) (d) Completeness.
DHS 122.06(10)(d)1.1. The department shall have 5 working days to determine if the application is complete and, if incomplete, to issue a request for additional information to the applicant. An incomplete application is one in which:
DHS 122.06(10)(d)1.a. a. The applicant has failed to provide requested information;
DHS 122.06(10)(d)1.b. b. The information is illegible or unreadable in the form submitted; or
DHS 122.06(10)(d)1.c. c. The application contains information contradicted or unjustified by other materials in the application.
DHS 122.06(10)(d)2. 2. Applications that were originally declared incomplete shall be declared complete on the date of receipt of all additional information requested by the department.
DHS 122.06(10)(e) (e) Meeting: No public meeting is required on any project submitted under this subsection.
DHS 122.06(10)(f) (f) Department's initial finding. The department shall issue its initial finding to approve or reject the application within 60 days following receipt of a complete application. The initial finding shall be based on the criteria specified in s. DHS 122.07.
DHS 122.06(10)(g) (g) Hearing. An adversely affected applicant shall have 10 days after the date of the initial finding to file a written request for a public hearing to challenge the initial finding on an application. Public hearings shall be held in the manner specified in s. DHS 122.08. If no requests for a hearing are made or if they are received after the 10-day limit, the initial finding becomes the department's final action.
DHS 122.06 History History: Cr. Register, March, 1985, No. 351, eff. 4-1-85; emerg. cr. (1) (c), eff. 1-1-87; emerg. cr. (1) (c), am. (9), eff. 5-31-87; cr. (1) (c), (7) (c) and (9) (b), am. (7) (a), renum. (9) to be (9) (a) and am., Register, October, 1987, No. 382, eff. 11-1-87; emerg. cr. (1) (d), eff. 10-1-88; emerg. cr. (1m) eff. 7-1-89; emerg. cr. (1r), eff. 9-21-90; am. (1) (a) 1. a. to d., (3), (4) (a), (b), (c) (intro.), (d) 1. intro., 2. and 5., (7) (a), (8), (9) (a), (10) (a) (intro.), (b) (d) 1. intro. and (10) (g), r. and recr. (2) and (10) (e), r. (6) (a) and (c), renum. (5) and (6) (b) to be (5) (a) and (6) and am., cr. (1) (c) 3. to 6., (4m), (5) (b) and (c), Register, January, 1991, No. 421, eff. 2-1-91; emerg. cr. (1) (d), eff. 5-11-93; cr. (1) (d), Register, January, 1994, No. 457, eff. 2-1-94; emerg. am. (2), (4) (a), (d) 1. (intro.) and 5., (5) (a), (6), cr. (3m), eff. 11-29-95; am. (2), (4) (a), (d) 1. (intro.), 5., (5) (a) and (6), cr. (3m), Register, May, 1996, No. 485, eff. 6-1-96; corrections in (1) (d) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.
DHS 122.07 DHS 122.07Review criteria and selection process.
DHS 122.07(1)(1)Review criteria. The department shall use the criteria set out in this subsection in its review of all applications for project approval. Cost containment shall be the first priority in applying these criteria. The department may not approve a project unless the applicant has demonstrated that:
DHS 122.07(1)(a) (a) The project is consistent with the state health plan and other long-term care support plans developed by the department.
DHS 122.07(1)(b) (b) Medical assistance funds appropriated are sufficient to reimburse the applicant for providing nursing home or FDD care.
DHS 122.07(1)(c) (c) The cost of renovating or replacing the facility or adding new beds is consistent with the cost of similar nursing home or FDD projects recently approved by the department and is reasonable based on independent analyses using industry-recognized cost-estimating techniques, and:
DHS 122.07(1)(c)1. 1. The proposed cost per bed for total facility replacement or for new facilities and beds does not exceed the following per bed cost expressed in the formula for nursing homes and FDDs, that C is less than or equal to 1.4 (S) (F).
DHS 122.07(1)(c)1.a. a. “C" in this formula means maximum cost per bed using the capitalized project costs, including site improvements, buildings, fixed equipment, interest during construction and professional and financing fees, calculated to the midpoint of construction.
DHS 122.07(1)(c)1.b. b. “S" equals $31,000.
DHS 122.07 Note Note: $31,000 is the statewide cost per bed for the base year 1983.
DHS 122.07(1)(c)1.c. c. “F" in this formula means inflation factor.
DHS 122.07 Note Note: The department uses the inflation estimates published in Engineering News Record's Building Cost Index.
DHS 122.07(1)(c)2. 2. The proposed equivalent cost per bed for renovation and partial replacement projects does not exceed the per bed cost as expressed in the formulae for nursing homes and FDDs, that Ce is less than - See PDF for diagram PDF
DHS 122.07(1)(c)2.a. a. “C e" in this formula means the maximum equivalent per bed cost, calculated as follows: - See PDF for diagram PDF
DHS 122.07(1)(c)2.b. b. “S" and “F" in this formula are as defined in subd. 1.
DHS 122.07 Note Note: The maximum capital allowances calculated pursuant to par. (c) are not to be used by applicants as the expected cost of projects. Applicants are encouraged to seek less costly alternatives to the state maximums and all applications will have to meet all review criteria before undergoing the selection process in sub. (2).
DHS 122.07(1)(d) (d) The project represents the most cost-effective, reasonable and feasible alternative for renovation or replacement of a facility, for the addition of beds to a facility or for the construction of a new facility.
DHS 122.07(1)(d)1. 1. The applicant shall provide an analysis which clearly defines all other reasonable alternatives such as:
DHS 122.07(1)(d)1.a. a. Variations in functional program;
DHS 122.07(1)(d)1.b. b. Renovation instead of replacement;
DHS 122.07(1)(d)1.c. c. Reductions in bed capacity;
DHS 122.07(1)(d)1.d. d. Variations in facility design; and
DHS 122.07(1)(d)1.e. e. Variations in methods or materials of construction.
DHS 122.07(1)(d)2. 2. The analysis shall include an evaluation of the existing physical plant.
DHS 122.07(1)(d)3. 3. The analysis shall include a life-cycle cost analysis for each alternative studied, using forms provided by the department. In this subsection “life cycle" means the number of years for which alternatives are compared, and “life-cycle cost" means all relevant costs associated with a project during the project's defined life cycle.
DHS 122.07 Note Note: Copies of the life-cycle cost analysis form are included in the application materials. They may be obtained from the Resource Allocation Program, Division of Health Care Access and Accountability, P.O. Box 309, Madison, Wisconsin 53701.
DHS 122.07(1)(d)4. 4. The department may independently develop its own alternatives to compare with those developed by the applicant.
DHS 122.07(1)(e) (e) A need for additional beds exists in the planning area in which the project would be located. No new beds may be approved in any planning area if their addition would exceed the planning area's adjusted allocation, calculated pursuant to s. DHS 122.05.
DHS 122.07(1)(f) (f) The project is consistent with local plans for developing community-based long-term care services. These plans shall include those developed by local units of government.
DHS 122.07(1)(g) (g) Necessary health care personnel, and capital and operating funds for provision of the proposed nursing home services are available, as follows:
DHS 122.07(1)(g)1. 1. The project will meet minimum staffing and financial requirements developed by the department pursuant to ch. DHS 132 or 134;
DHS 122.07(1)(g)2. 2. The facility will be located to assure reasonable access to nursing staff, emergency medical care, physician coverage, acute care services and ancillary services; and
DHS 122.07(1)(g)3. 3. Sufficient cash resources and cash flow exist to pay operating and initial start-up costs.
DHS 122.07(1)(h) (h) The project is financially feasible, capable of being undertaken within one year of approval and completed within a reasonable period of time beyond the one-year approval period, as evidenced by:
DHS 122.07(1)(h)1. 1. The applicant's demonstration of ability to secure adequate funds to finance the project. The applicant shall have adequate capacity to incur the debt associated with the project. Applicants shall have the ability to pay long-term debt through their present and future cash flow and profitability positions;
DHS 122.07(1)(h)2. 2. The availability of financing at average or below market rates for the class of home during the period of validity of the approval. Classes of homes are governmental, proprietary and nonprofit. Projects relying on sources of financing which historically take longer to process than the period of validity of an approval shall be rejected unless there is clear and definite proof supplied by the applicant that the funding source will be able to make adequate funds available within the period of validity of the approval; and
DHS 122.07(1)(h)3. 3. The reasonableness and attainability of the applicant's construction schedule.
DHS 122.07(1)(i) (i) Appropriate alternative methods for providing nursing home or FDD care are unavailable in the planning area. Alternative methods shall be deemed unavailable if the project is consistent with long-term care initiatives developed by the department.
DHS 122.07(1)(j) (j) The existing and proposed quality of care is satisfactory, as determined by:
DHS 122.07(1)(j)1. 1. The department's investigations. No approvals may be granted to any person who owns or operates a facility with one or more uncorrected class A or class B violations unless the project is specifically designed to remedy those violations, or to any person who owns or operates a facility against which a medical assistance or medicare decertification action is pending;
DHS 122.07(1)(j)2. 2. The department's review of materials submitted by the applicant, which may include an independent performance evaluation of an existing facility, an evaluation of other homes owned and operated by an applicant seeking approval for a new facility, and patient satisfaction surveys, where available;
DHS 122.07(1)(j)3. 3. Recommendations or comments from affected parties regarding the quality of care in facilities owned and operated by the applicant; and
DHS 122.07(1)(j)4. 4. For applications proposing replacement or relocation of beds, approval by the department of a plan for the placement or relocation of persons residing in those beds, based on the census of the FDD or other nursing home at the time of submission of the application.
DHS 122.07(1)(k) (k) The project is consistent with all applicable federal, state and local licensing, physical plant, zoning and environmental laws.
DHS 122.07(1)(L) (L) Applications for renovation proposals, replacement facilities and capital expenditures over $600,000 which do not affect bed capacity and which meet all criteria in sub. (1) shall be approved unless the per diem rates proposed as a result of the project are inconsistent with those of similar FDD or other nursing home projects recently approved by the department.
DHS 122.07(1m) (1m) Review criteria for conversion of a nursing home to an FDD. The department shall use the criteria in sub. (1) and the additional criteria in this subsection in its review of all applications for conversion of a nursing home to an FDD under s. DHS 122.02 (2) (a) and (c). The department shall solicit the comments of county departments organized under s. 46.23, 51.42, or 51.437, Stats., on all of these applications. The department shall not approve an application subject to this subsection unless the applicant has demonstrated that:
DHS 122.07(1m)(a) (a) The proposed per diem rates for the FDD are consistent with those of similar facilities for developmentally disabled persons;
DHS 122.07(1m)(b) (b) The applicant has experience in providing active treatment as defined in 42 CFR 435.1099 and the department has approved the applicant's program statement under s. DHS 132.51 (3);
DHS 122.07(1m)(c) (c) Conversion of some beds within a non-FDD nursing home to FDD beds will result in a physically separate unit of the facility, which may be a ward, contiguous wards, a wing, a floor or a building, and which is separately staffed;
DHS 122.07(1m)(d) (d) Staff will be efficiently deployed in the FDD part of the facility and in the nursing home part of the facility, as well as in the facility as a whole;
DHS 122.07(1m)(e) (e) The FDD will have a minimum of 16 beds for developmentally disabled persons; and
DHS 122.07(1m)(f)1.1. A number of developmentally disabled residents sufficient to fill the requested beds currently reside in the facility and require active treatment; and
DHS 122.07(1m)(f)2. 2. If the applicant proposes more beds than it has residents under par. (f), that county departments organized under s. 46.23, 51.42 or 51.437, Stats., identify persons who need placement in an FDD and give assurances that these persons will be placed in that facility.
DHS 122.07(1r) (1r) Additional review criteria for conversion of an FDD to a nursing home. The department shall use the applicable criteria in sub. (1) and the additional criteria in this subsection in its review of an application under s. DHS 122.02 (2) (b) and s. 150.21 (5), Stats., for the total conversion of an FDD under ch. DHS 134 to be a nursing home under ch. DHS 132. The department shall not approve an application subject to this subsection unless the applicant demonstrates that:
DHS 122.07(1r)(a) (a) The proposed per diem rates for the nursing home are consistent with those of similar facilities;
DHS 122.07(1r)(b) (b) There will remain in the health planning area in which the applicant FDD is located sufficient FDD beds to serve the population of persons with developmental disabilities, including any residents of the converting facility who need to remain in an FDD;
DHS 122.07(1r)(c) (c) There are other adequate and appropriate resources available in the county or counties served by the facility being converted for relocating its residents as determined by the applicable county department or departments organized under s. 46.23, 51.42 or 51.437, Stats.; and
DHS 122.07(1r)(d) (d) The facility, in conjunction with the applicable county department or departments organized under s. 46.23, 51.42, or 51.437, Stats., has developed a preliminary relocation plan under s. 50.03 (14) (c) 8., Stats., for each resident which is acceptable to the county department or departments and addresses the needs and concerns of the resident or the resident's guardian.
DHS 122.07(1t) (1t) Review criteria for nursing home design pilot projects. The department, in its review of all applications under s. DHS 122.06 (3m) for nursing home design pilot projects, shall use the criteria in sub. (1), with the exception of sub. (1) (c) and (d), and the additional criteria in this subsection. The department may approve no more than 3 projects subject to this subsection. An applicant shall do each of the following:
DHS 122.07(1t)(a) (a) Document a significant departure from traditional nursing home design;
DHS 122.07(1t)(b) (b) Document through pilot research or sound academic theory that:
DHS 122.07(1t)(b)1. 1. The new nursing home design improves the quality of life and care of nursing home residents;
DHS 122.07(1t)(b)2. 2. The new nursing home design improves productivity of nursing home staff; and
DHS 122.07(1t)(b)3. 3. There is a need for additional research;
DHS 122.07(1t)(c) (c) Utilize a minimum of 30 existing nursing facility beds for the research and a comparable control group of nursing facility beds in the traditional nursing home setting within the same licensed facility;
DHS 122.07(1t)(d) (d) Submit a copy of the written research proposal which documents that the proposal:
DHS 122.07(1t)(d)1. 1. Has been prepared in conjunction with an established independent research organization; and
DHS 122.07(1t)(d)2. 2. Will be conducted in conjunction with an established independent researcher;
DHS 122.07(1t)(e) (e) Document that the study will measure:
DHS 122.07(1t)(e)1. 1. Outcome effectiveness of the design through:
DHS 122.07(1t)(e)1.a. a. Quality of resident care;
DHS 122.07(1t)(e)1.b. b. Quality of resident life; and
DHS 122.07(1t)(e)1.c. c. Staff productivity; and
DHS 122.07(1t)(e)2. 2. Impact of design on costs, including:
DHS 122.07(1t)(e)2.a. a. Operating costs; and
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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.