DHS 105.06 Note
Note: For covered dental services, see s.
DHS 107.07.
DHS 105.06 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats.,
Register, June, 1994, No. 462;
CR 05-033: renum. to be (1), cr. (2)
Register August 2006 No. 608, eff. 9-1-06.
DHS 105.07
DHS 105.07 General hospitals. For MA certification a hospital shall be approved as a general hospital under s.
50.35, Stats., and ch.
DHS 124, shall meet conditions of participation for medicare and shall have a utilization review plan that meets the requirements of
42 CFR 456.101. No facility determined by the department or the federal health care financing administration to be an institution for mental disease (IMD) may be certified as a general hospital under this section. In addition:
DHS 105.07(2)
(2) A hospital providing outpatient alcohol and other drug abuse (AODA) services shall meet the requirements specified in s.
DHS 105.23;
DHS 105.07(3)
(3) A hospital providing mental health day treatment services shall be certified under s.
DHS 105.24;
DHS 105.07(4)
(4) A hospital participating in a PRO review program shall meet the requirements of
42 CFR 456.101 and any additional requirements established under state contract with the PRO; and
DHS 105.07 Note
Note: For certification of a hospital that is an institution for mental disease, see s.
DHS 105.21. For covered hospital services, see s.
DHS 107.08.
DHS 105.07 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; r. and recr. (intro.), am. (1) to (4), cr. (5),
Register, September, 1991, No. 429, eff. 10-1-91; correction in (intro.) made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
DHS 105.075
DHS 105.075 Rehabilitation hospitals. For MA certification, a rehabilitation hospital shall be approved as a general hospital under s.
50.35, Stats., and ch.
DHS 124, and shall meet the conditions of participation for medicare and shall have a utilization review plan that meets the requirements of
42 CFR 456.101. No facility determined by the department or the federal health care financing administration to be an institution for mental disease (IMD) may be certified as a rehabilitation hospital under this section.
DHS 105.075 Note
Note: For covered hospital services, see s.
DHS 107.08.
DHS 105.08
DHS 105.08 Skilled nursing facilities. For MA certification, skilled nursing facilities shall be licensed pursuant to s.
50.03, Stats., and ch.
DHS 132.
DHS 105.08 Note
Note: For covered nursing home services, see s.
DHS 107.09.
DHS 105.08 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; correction made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
DHS 105.09(1)(1)
Definition. In this section, “sufficient number of medicare-certified beds" means a supply of beds that accommodates the demand for medicare beds from both the home county and contiguous counties so that no dual eligible recipient is denied access to medicare SNF benefits because of a lack of available beds. In this subsection, “dual eligible recipient" means a person who qualifies for both medical assistance and medicare.
DHS 105.09(2)
(2)
Medicare bed obligation. Each county shall have a sufficient number of skilled nursing beds certified by the medicare program pursuant to ss.
49.45 (6m) (g) and
50.02 (2), Stats. The number of medicare-certified beds required in each county shall be at least 3 beds per 1000 persons 65 years of age and older in the county.
DHS 105.09(3)(a)(a) If a county does not have sufficient medicare-certified beds as determined under sub.
(1), each SNF within that county which does not have one or more medicare-certified beds shall be subject to a fine to be determined by the department of not less than $10 nor more than $100 for each day that the county continues to have an inadequate number of medicare-certified beds.
DHS 105.09(3)(b)
(b) The department may not enforce penalty in par.
(a) if the department has not given the SNF prior notification of criteria specific to its county which shall be used to determine whether or not the county has a sufficient number of medicare-certified beds.
DHS 105.09(3)(c)
(c) If the number of medicare-certified beds in a county is reduced so that the county no longer has a sufficient number of medicare-certified beds under sub.
(1), the department shall notify each SNF in the county of the number of additional medicare-certified beds needed in the county. The department may not enforce the penalty in par.
(a) until 90 days after this notification has been provided.
DHS 105.09(4)(a)(a) In this subsection, a “swing-bed hospital" means a hospital approved by the federal health care financing administration to furnish skilled nursing facility services in the medicare program.
DHS 105.09(4)(b)
(b) A home or portion of a home certified as an ICF-IID is exempt from this section.
DHS 105.09(4)(c)
(c) The department may grant an exemption based on but not limited to:
DHS 105.09(4)(c)1.
1. Availability of a swing-bed hospital operating within a 30 mile radius of the nursing home; or
DHS 105.09(4)(c)2.
2. Availability of an adequate number of medicare-certified beds in a facility within a 30 mile radius of the nursing home.
DHS 105.09(4)(d)
(d) A skilled nursing facility located within a county determined to have an inadequate number of medicare-certified beds and which has less than 100 beds may apply to the department for partial exemption from the requirements of this section. An SNF which applies for partial exemption shall recommend to the department the number of medicare-certified beds that the SNF should have to meet the requirements of this section based on the facility's analysis of the demand for medicare-certified beds in the community. The department shall review all recommendations and issue a determination to each SNF requesting a partial exemption.
DHS 105.09 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; renum. (1), (2), (3) (a) and (b) to be (2), (3), (4) (a) and (b) and am. (2) and (4) (b), cr. (1), (4) (c) and (d),
Register, February, 1988, No. 386, eff. 7-1-88;
2019 Wis. Act 1: am. (4) (b)
Register May 2019 No. 761, eff. 6-1-19.
DHS 105.10
DHS 105.10 SNFs and ICFs with deficiencies. If the department finds a facility deficient in meeting the standards specified in s.
DHS 105.08,
105.09,
105.11 or
105.12, the department may nonetheless certify the facility for MA under the conditions specified in s.
DHS 132.21 and
42 CFR 442, Subpart C.
DHS 105.10 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; correction made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
DHS 105.11
DHS 105.11 Intermediate care facilities. For MA certification, intermediate care facilities shall be licensed pursuant to s.
50.03, Stats., and ch.
DHS 132.
DHS 105.11 Note
Note: For covered nursing home services, see s.
DHS 107.09.
DHS 105.11 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; correction made under s.
13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636.
DHS 105.12
DHS 105.12 ICFs for individuals with intellectual disabilities or individuals with related conditions. For MA certification, institutions for individuals with intellectual disabilities or individuals with related conditions shall be licensed pursuant to s.
50.03, Stats., and ch.
DHS 134.
DHS 105.12 Note
Note: For covered ICF/IID services, see s.
DHS 107.09.
DHS 105.12 History
History: Cr.
Register, February, 1986, No. 362, eff. 3-1-86; correction made under s. 13.93 (2m) (b) 7., Stats.,
Register, December, 1991, No. 432; correction made under s. 13.92 (4) (b) 7., Stats.,
Register December 2008 No. 636;
2019 Wis. Act 1: am.
Register May 2019 No. 761, eff. 6-1-19.
DHS 105.14(1)(a)(a)
Introduction. In accordance with s.
49.45 (2) (a) 11. and
(47) (a) and
(b), Stats., this section is promulgated to establish regulations and standards for the care, treatment or services, and health, safety, rights, well-being and welfare of participants in certified adult day care centers (ADCCs). This section is promulgated to ensure that each ADCC provides a supportive environment in a community-based group setting that is the least restrictive of each participant's freedom, and that care and services are provided in a manner that protects the rights and dignity of each participant.
DHS 105.14(1)(b)2.
2. “Accessible” means barriers are not present that prevent a person from entering, leaving, or functioning within an ADCC without physical help.
DHS 105.14(1)(b)3.
3. “Activities of daily living” or “ADL” means bathing, eating, oral hygiene, dressing, toileting, incontinence care, mobility and transferring from one surface to another such as from a bed to a chair.
DHS 105.14(1)(b)5.
5. “Adult day care center” or “ADCC” means an entity that provides services for part of a day in a group setting to adults who need an enriched health, supportive or social experience, and who may need assistance with activities of daily living, supervision, or protection.
DHS 105.14(1)(b)7.
7. “Assessment” means gathering and analyzing information about a prospective or existing participant's needs and abilities as provided in sub.
(7) (a).
DHS 105.14(1)(b)9.
9. “Chemical restraint” means a psychotropic medication used for discipline or convenience, and not required to treat medical symptoms.
DHS 105.14(1)(b)11.a.
a. The health care agent under an activated power of attorney for health care under ch.
155, Stats.
DHS 105.14(1)(b)12.
12. “Medication administration” means the direct injection, ingestion or other application of a prescription or over-the-counter drug or device to a participant, but does not include reminders to take the medication. Medication administration can be performed by any of the following:
DHS 105.14(1)(b)15.
15. “Nursing care” means nursing procedures, other than personal or supportive care, that a registered nurse or a licensed practical nurse performs directly on or to a participant.
DHS 105.14(1)(b)17.
17. “Operator” means an individual or business entity to whom a certification is granted and is legally responsible for the operation of the ADCC.
DHS 105.14(1)(b)18.
18. “Participant” means an adult who attends the ADCC during listed hours of operation and receives care, treatment, or services.
DHS 105.14(1)(b)19.
19. “Participant group” means a group of participants who need similar services because of a common disability, condition, or status. “Participant group” includes a group of individuals who have any of the following:
DHS 105.14(1)(b)20.
20. “Physical restraint” means any manual method, article, device, or garment interfering with the free movement of the participant or the normal functioning of a portion of the participant's body or normal access to a portion of the participant's body, and which the participant is unable to remove easily, or confinement of a participant in a locked room.
DHS 105.14(1)(b)21.
21. “Program director” means an employee who is responsible for the management and day-to-day operation of the ADCC. A program director includes any of the following:
DHS 105.14(1)(b)22.
22. “Psychotropic medication” means a prescription drug, defined in s.
450.01 (20), Stats., that is used to treat or manage a psychiatric symptom or challenging behavior.
DHS 105.14(1)(b)23.
23. “Qualified Caregiver” means an employee who is at least 18 years of age and has successfully completed all of the applicable orientation and training under sub.
(4) (a) and
(b).
DHS 105.14(1)(b)24.a.a. “Seclusion” means physical or social separation of a participant from others by actions of caregivers.
DHS 105.14(1)(b)24.b.
b. “Seclusion” does not include separation to prevent the spread of communicable disease or voluntary cool-down periods in an unlocked room.
DHS 105.14(1)(b)25.
25. “Serious injury” means an injury from any incident or accident which results in any of the following:
DHS 105.14(1)(b)25.a.
a. A temporary or permanent increase in the level of assistance needed in one or more ADL categories, such as bathing, eating, oral hygiene, dressing, toileting, incontinence care, or mobility and transferring.
