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
DHS 122.07(1t)(e)2.b. b. Capital costs;
DHS 122.07(1t)(f) (f) Document:
DHS 122.07(1t)(f)1. 1. The availability and sources of funding for the research proposal; and
DHS 122.07(1t)(f)2. 2. The organizational resources committed to the proposed research;
DHS 122.07(1t)(g) (g) Document that the cost per bed will not exceed an amount 45% over the maximum cost per bed as determined in sub. (1) (c);
DHS 122.07(1t)(h) (h) Agree to obtain the written consent to participate in the research from all residents participating in the research or from their guardians; and
DHS 122.07(1t)(i) (i) Document a 92% occupancy rate by reference to the most recent annual survey of nursing homes issued by the department.
DHS 122.07(2) (2) Ranking and selection process.
DHS 122.07(2)(a) (a) Applications for new or redistributed beds which meet all of the criteria in sub. (1) shall be subject to the following final selection process:
DHS 122.07(2)(a)1. 1. Applications shall be ranked in the order of their proposed composite per diem rates, beginning with the lowest and ending with the highest. Rates within one percent of each other shall be considered equal for purposes of ranking. The composite per diem rate shall be calculated as follows:
DHS 122.07(2)(a)1.a. a. Multiply the proposed skilled nursing facility per diem rates, exclusive of supplements, for each payment source by the percentage of projected skilled nursing facility patient days by payment source; and
DHS 122.07(2)(a)1.b. b. Add all the products of the multiplication in subpar. a to obtain the composite per diem rate;
DHS 122.07(2)(a)2. 2. The department shall review the applicant's methodology for calculation of the proposed rates for consistency with current reimbursement practices and reasonableness. An applicant whose rates are found to be inconsistent or unreasonable will be removed from the selection process;
DHS 122.07(2)(a)3. 3. The department shall approve projects in the order of their ranking until all beds allotted to a planning area are distributed;
DHS 122.07(2)(a)4. 4. The department may approve an application proposing a higher per diem rate than others undergoing concurrent review if the applicant can demonstrate that the application would substantially resolve a significant problem identified in the state health plan with respect to:
DHS 122.07(2)(a)4.a. a. The existing distribution of beds in the county in which the project would be located, or in contiguous counties;
DHS 122.07(2)(a)4.b. b. The need to serve a special diagnostic group of inpatients in the planning area or county in which the project would be located; or
DHS 122.07(2)(a)4.c. c. The existing distribution of population within the planning area or county in which the project would be located; and
DHS 122.07(2)(a)5. 5. If the composite per diem rate for 2 or more of the applicants undergoing concurrent review is equal, the department shall approve or deny those projects as follows:
DHS 122.07(2)(a)5.a. a. If the total number of beds proposed by all applicants undergoing concurrent review is less than the total number of beds available, each of the projects shall be approved; and
DHS 122.07(2)(a)5.b. b. If the total number of beds proposed by all applicants undergoing concurrent review is greater than the number of beds available, applications shall be ranked on the basis of per bed cost as calculated in sub. (1) (c), beginning with the lowest and ending with the highest. The department shall then approve projects in order of this ranking until all beds available are distributed.
DHS 122.07(2)(am) (am) Applications under s. DHS 122.02 (2) (a) and (c) which meet all of the criteria in subs. (1) and (1m) shall be subject to the following selection process:
DHS 122.07(2)(am)1. 1. If after removing from consideration all applications which fail to meet one or more review criteria, there remain more applications than can be approved for the beds available under s. DHS 122.04 (1) (b) 2. a., the department shall rank the remaining applications according to how each meets each applicable review criterion under subs. (1) and (1m), assigning the lowest number to the application which best meets each criterion.
DHS 122.07(2)(am)2. 2. The department shall approve applications in order beginning with the lowest score, until all available beds are allocated. If there is a tie between applications for the last available approval, the department shall rank the applications according to their scores on review criteria under sub. (1m) (b).
DHS 122.07(2)(at) (at) Applications under s. DHS 122.06 (3m) which meet all of the applicable criteria in subs. (1), (1m) and (1t) shall be subject to the following selection process:
DHS 122.07(2)(at)1. 1. If after removing from consideration all applications which fail to meet one or more review criteria, there remain more applications than can be approved for the number of projects allowed under sub. (1t), the department shall rank the remaining applications according to how each meets each applicable review criterion under subs. (1), (1m) and (1t), assigning the lowest number to the application which best meets each criterion.
DHS 122.07(2)(at)2. 2. The department shall approve projects in order beginning with the lowest score, until all approvable projects are allocated. If there is a tie between applications, the department shall rank those applications based on the best research design.
DHS 122.07(2)(b) (b) 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(2)(c) (c) In applying pars. (a) and (b), the department shall consider the comments of affected parties.
DHS 122.07(2)(d) (d) The department may not approve new beds if this would cause the statewide bed limit to be exceeded.
DHS 122.07 History History: Cr. Register, March, 1985, No. 351, eff. 4-1-85; emerg. cr. (1m) and (2) (am), eff. 1-1-87; am. (2) (a) (intro.) and 1., cr. (2) (a) 5., Register, January, 1987, No. 373, eff. 2-1-87; emerg. cr. (1m) and (2) (am), eff. 5-31-87; cr. (1m) and (2) (am), Register, October, 1987, No. 382, eff. 11-1-87; emerg. cr. (1r), eff. 10-1-88; emerg. am. (1) (c) 1. and 2. eff. 3-16-90; am. (1) (c) 1. and 2., Register, September, 1990, No. 417, eff. 10-1-90; correction in (1) (g) 1. made under s. 13.93 (2m) (b) 7., Stats., Register, September, 1990, No. 417; am. (1) (f), (2) (a) 4. intro. and (c), cr. (1) (L), Register, January, 1991, No. 421, eff. 2-1-91; emerg. cr. (lr), eff. 5-11-93; emerg. r. and recr. (lr) (d), eff. 9-30-93; cr. (lr), Register, January, 1994, No. 457, eff. 2-1-94; emerg. cr. (1t) and (2) (at), eff. 11-29-95; cr. (1t) and (2) (at), Register, May, 1996, No. 485, eff. 6-1-96; correction in (1m) (f) 2., made under 13.93 (2m) (b) 7., Stats., Register, September, 1999, No. 525; corrections in (1) (g) 1., (1m) (b) and (1r) (intro.) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637.
DHS 122.08 DHS 122.08Hearing process.
DHS 122.08(1)(1)Right to a hearing. An applicant whose application is rejected may request a public hearing to review the department's initial finding.
DHS 122.08(2) (2) Request for a hearing.
DHS 122.08(2)(a)(a) An applicant desiring a public hearing shall file a written request for a public hearing, no later than 10 days after the issuance of the initial finding, to both the department's division of health care financing and the department of administration's division of hearings and appeals.
DHS 122.08 Note Note: The Division of Health Care Financing has been renamed the Division of Health Care Access and Accountability. The mailing address of the Department's Division of Health Care Access and Accountability is P.O. Box 309, Madison, Wisconsin 53701 and the mailing address of the Division of Hearings and Appeals P.O. Box 7875, Madison, Wisconsin 53707.
DHS 122.08(2)(b) (b) The applicant requesting the hearing shall identify the criteria at issue no later than 20 days after the issuance of the finding.
DHS 122.08(3) (3) Public hearing.
DHS 122.08(3)(a)(a) Start of hearing process. The department shall commence the hearing process within 30 days after receiving a request under sub. (2), or 30 days following the last request in the event of a concurrent review, unless all parties to the hearing consent to an extension of this period. The hearing process shall begin upon appearance of the parties before the hearing examiner as part of a prehearing conference.
DHS 122.08(3)(b) (b) Applications undergoing concurrent review. All applications undergoing concurrent review shall be considered at one hearing.
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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.