ORDER OF THE
DEPARTMENT OF HEALTH SERVICES
TO ADOPT RULES
The Wisconsin Department of Health Services proposes an order to renumber DHS 124.24 (3) to DHS 124.08; to repeal DHS 124.02 (1), (4), (7), (8), (15) to (18), (20) and (21), DHS 124 Subchapter III, DHS 124.13 to 124.24 (2), and DHS 124.25 to DHS 124.28, DHS 124.32 (1), (3) (c) and (5), DHS 124.33, and DHS 124.34 (1),(2), and (4) to (7), DHS 124.35 (1) and (3) to (7), and DHS 124.36 (1) to (10), and DHS 124.40 and to repeal and recreate DHS 124.02 (10) and (14), DHS 124.04 (2), DHS 124 Subchapter II and (title), DHS 124.29 and (title), DHS 124.30 and (title), DHS 124.31, and DHS 124.38 (2) are repealed and recreated; and to create DHS 124.34 (3) (c) and DHS 124.36 (11) (Note), relating to Hospitals.
Explanation of agency authority
“Pursuant to s. 50.36 (1), Stats., the Department may promulgate additional rules if they are necessary to provide safe and adequate care and treatment of hospital patients and to protect the health and safety of the patients and employees. The proposed rules are necessary to effectuate the purposes of the statutes listed in the “statute interpreted” section, and also necessary to comply with s. 227.11 (2) (a), Stats.”
Related statute or rule
See the “statutes interpreted” and “statutory authority” sections.
Plain language analysis
Beginning July 1, 2016, pursuant to s. 50.36 (1m) (a), (b), and (c), Stats., the department may not, except for s. DHS 124.24 (3), enforce any of the rules contained in s. DHS 124.40 or subch. II, III, or IV of ch. DHS 124. Also effective July 1, 2016, s. 50.36 (1), Stats., requires the department to use and enforce Medicare conditions of participation for hospitals as the minimum standards that apply to hospitals and interpret the conditions for Medicare participation for hospitals using guidelines adopted by the federal Centers for Medicare and Medicaid Services unless the department determines that a different interpretation is reasonably necessary to protect public health and safety. The department may promulgate additional rules if they are necessary to provide safe and adequate care and treatment of hospital patients and to protect the health and safety of the patients and employees, per s. 50.36 (1), Stats.
The department has determined that the following rule changes are necessary to ensure a safe and adequate environment for hospital patients and employees and to protect the health and welfare of the patients and employees. The rule would affect hospitals licensed by the State of Wisconsin.
The proposed rule also incorporates the NFPA Life Safety Code 101 - 2012 edition. Consent to incorporate the standards was given in writing by the Attorney General, pursuant to s. 227.21 (2) (a), Stats., on December 5, 2019.
Plans of correction
Section 50.36 (4), Stats., states that if the department takes enforcement action against a hospital for a violation of the requirements for hospitals, and the department subsequently conducts an on-site inspection of the hospital to review the hospital’s action to correct the violation, the department may, unless the hospital is operated by the state, impose a $200 inspection fee on the hospital. The proposed rules establish the manner in which violations of requirements stated in ch. DHS 124 and ss. 50.32 to 50.39, Stats., must be communicated to hospitals and the manner in which the hospital communicates its plan to correct the violation to the department.
Waivers and variances
Section 50.36 (6m), Stats., authorizes the department to grant a variance or a waiver of a requirement for hospitals. The proposed rule interprets the circumstances under which a waiver or variance would be seen to support the efficient and economic operation of the hospital.
Maternity and neonatal care
Section 50.36 (1), Stats., provides that the department must use and enforce the conditions for Medicare participation for hospitals as quality control measures, but may promulgate such additional rules as it deems necessary for safe and adequate care of hospital patients and to protect the health and safety of the patients and employees. The department has determined that additional rules are necessary to address the care and treatment of maternity patients and newborns regarding personnel, admission, patient placement and transfer, delivery, security, labor inducing medication and nursery.
Patient rights and responsibilities in critical access hospitals
Section 50.36 (1), Stats., provides that the department must use and enforce the conditions for Medicare participation for hospitals as quality control measures, but may promulgate such additional rules as it deems necessary for safe and adequate care of hospital patients and to protect the health and safety of the patients and employees. The conditions of participation for Medicare do not address patient rights in the critical access hospital setting. Proposed rules establish patient rights similar to the rights in the previous provisions contained in s. DHS 124.05 (3) (a).
Freestanding emergency departments
Section 50.36(1), Stats., provides that the department must use and enforce the conditions for Medicare participation for hospitals as quality control measures, but may promulgate such additional rules as it deems necessary for safe and adequate care of hospital patients and to protect the health and safety of the patients and employees. It was determined that additional rules were necessary to address physical environment, personnel, laboratory, and pharmacy and ambulance delivery in these settings. The requirements for freestanding emergency departments under DHS 124.09 would apply to most facilities with services and staff organized primarily for the purpose of offering emergency medical services without requiring a previously scheduled appointment and that is physically separate from a hospital campus that offers inpatient overnight care.
Existing rules under ch. DHS 124, subch. V, relating to the hospital’s physical environment, require hospitals to design, construct, and operate their facilities in accordance with the Life Safety Code, Wisconsin Commercial Building Code, and national standards on construction and fire safety. The rules also require that patient rooms be of sufficient size, supported by sanitary support spaces and afford the patient privacy and the means to contact staff, fire safe finishes, emergency procedures, and fire incident reporting to the department. Proposed rules require hospitals to meet the provisions of the Life Safety Code (LSC) adopted into the federal Conditions of Participation.
Fee schedule for plan review
Section 50.36 (2) (a), Stats., requires the department to conduct plan reviews of all capital construction and remodeling projects of hospitals to ensure that the plans comply with applicable building code requirements under ch. 101, Stats., and with the physical plant requirements under ch. 50, Stats., or department rules. Section 50.36 (2) (b), Stats., requires the department to promulgate rules that establish a fee schedule for its services in conducting plan reviews. Proposed rules establish standards for plan reviews and prescribe a fee schedule for providing plan review services.
Summary of, and comparison with, existing or proposed federal regulations
There appears to be no existing or proposed federal regulations that address the activities regulated by the proposed rule.
Comparison with rules in adjacent states
Plans of correction/waivers/variances: Illinois has no administrative code regarding plans of correction, waivers and variances.
Maternity and neonatal care: Illinois has extensive regulations regarding obstetric departments including standards related to accommodations and facilities for obstetric patients, personnel requirements medical personnel, procedures for care of mother and infants, identification of infants, pharmacy services, caesarean birth, labor, delivery, recovery and postpartum care, records and infant feeding.
Patient rights in critical access hospitals: Illinois has no administrative code regarding patient rights in critical access hospitals.