Under the bill, DHFS must, by January 1, 2009, submit a report to the governor
and to the legislature with recommendations as to methods by which nursing homes
would be able more effectively to recruit and retain caregivers; proposed revised
minimum nursing home staffing ratios that minimize additional state costs,
maximize access to care, facilitate care of the highest quality, and take into account
the levels of care for physical or mental conditions that nursing home residents
require; and a proposed revised nursing home Medical Assistance (MA) Program
reimbursement methodology. DHFS must develop the report after first referring to
the most recent national research on nursing home staffing and consulting with
specified persons and entities.
Also, under the bill, by July 1, 2008, and by July 1 every 48 months thereafter,
the Legislative Audit Bureau must conduct a performance evaluation audit of the
nursing home staffing requirements, investigate whether the staffing requirements
should be based in part on the level of care for physical or mental conditions that a
nursing home resident requires, and file a report of the audit with the governor and
the legislature.
Under the bill, DHFS must submit to the legislature by each January 1 from
2006 to 2009 a report that includes information from the preceding year for each
nursing home on average wage and fringe benefit costs, costs of nonemployee
purchased nursing services, staff turnover, total revenue and expenses, staff
training and continuing education costs, and law violations and related information.

Each report must also include recommendations by DHFS for ways by which nursing
homes may reduce their reliance on nonemployee purchased nursing services.
Criminal background checks
Under current law relating to criminal histories and child abuse record
searches, DHFS, a county department, a child welfare agency, or a school board must
conduct background checks by obtaining certain information with respect to persons
who have or are seeking licenses, certifications, or contracts to operate entities, and
an entity must obtain the same information with respect to a caregiver of the entity.
("Entity" is defined as a child welfare agency, a licensed foster home or treatment
foster home, a group home, a shelter care facility, a day care center, a day care
provider, or a temporary employment agency that provides caregivers to another
entity.) The information that must be obtained is a criminal history search from
records maintained by the Department of Justice; any information in a registry kept
by DHFS of persons against whom DHFS has made findings of misappropriation of
property, neglect, or abuse; any applicable information maintained by the
Department of Regulation and Licensing about the status of the person's credentials;
information maintained by DHFS about substantiated reports of the person's child
abuse or neglect; and information maintained by DHFS about denial to the person
of a license, certification, or certain contracts, employment, or permission to reside
at an entity, for specific reasons including conviction for a serious crime. Very similar
laws relating to criminal histories and patient abuse record searches apply to
persons who have or are seeking a license, certificate, registration, or certificate of
approval issued by DHFS to operate a facility, organization, or service (such as a
hospital or a personal care worker agency) that is licensed, certified, or registered
with DHFS to provide direct care or services to patients.
This bill creates two additional sources of information that must be checked
with respect to persons who have or are seeking licenses, certifications, or contracts
to operate entities, facilities, organizations, or services: (1) information maintained
by the Department of Corrections in the registry of sex offenders; and (2) information
on persons convicted of crimes as specified under the circuit court automation
information system maintained by the Wisconsin court system on its Internet site.
Quality of nursing home care
This bill requires DHFS to submit to the legislature a proposal for legislation
to create a program to provide grants to nursing homes for quality-of-care
improvement projects.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB1146, s. 1 1Section 1. 13.94 (12) of the statutes is created to read:
AB1146,5,13
113.94 (12) Nursing home staffing. By July 1, 2008, and by July 1 every 48
2months thereafter, the legislative audit bureau shall conduct a performance
3evaluation audit of the nursing home staffing requirements under s. 50.04 (2) and
4investigate whether the staffing requirements should be based in part on the level
5of care for physical or mental conditions that a nursing home resident requires. The
6legislative audit bureau shall consult advocates for nursing home residents,
7physicians, nurses, nursing home employees or their representatives, nursing home
8administrators, and other experts in the field of long-term care and shall consider
9current research and case data, as well as any other relevant resources, in assessing
10whether the staffing ratios are sufficient to meet the needs of nursing home
11residents. The legislative audit bureau shall file a report of each audit with the
12legislature under s. 13.172 (3) and with the governor no later than 30 days after
13completion of the audit.
AB1146, s. 2 14Section 2. 16.009 (1) (em) 7. of the statutes is created to read:
AB1146,5,1615 16.009 (1) (em) 7. A residential care apartment complex, as defined in s. 50.01
16(1d).
AB1146, s. 3 17Section 3. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
18the following amounts for the purposes indicated: - See PDF for table PDF
AB1146, s. 4
1Section 4. 20.432 (1) (gt) of the statutes is created to read:
AB1146,6,52 20.432 (1) (gt) Activities in residential care apartment complexes. The amounts
3in the schedule for Long-Term Care Ombudsman Program activities in residential
4care apartment complexes. All moneys received under s. 50.034 (9) shall be credited
5to this appropriation account.
AB1146, s. 5 6Section 5. 48.685 (2) (am) 2g. of the statutes is created to read:
AB1146,6,87 48.685 (2) (am) 2g. Information maintained by the department of corrections
8in the registry of sex offenders under s. 301.45 (2).
AB1146, s. 6 9Section 6. 48.685 (2) (am) 2r. of the statutes is created to read:
AB1146,6,1210 48.685 (2) (am) 2r. Information on persons convicted of crimes as specified
11under the circuit court automation information system maintained by the Wisconsin
12court system on its Internet site.
AB1146, s. 7 13Section 7. 48.685 (2) (b) 1. bg. of the statutes is created to read:
AB1146,6,1514 48.685 (2) (b) 1. bg. Information maintained by the department of corrections
15in the registry of sex offenders under s. 301.45 (2).
AB1146, s. 8 16Section 8. 48.685 (2) (b) 1. br. of the statutes is created to read:
AB1146,6,1917 48.685 (2) (b) 1. br. Information on persons convicted of crimes as specified
18under the circuit court automation information system maintained by the Wisconsin
19court system on its Internet site.
AB1146, s. 9 20Section 9. 49.45 (6m) (a) 3m. of the statutes is created to read:
AB1146,6,2221 49.45 (6m) (a) 3m. "Licensed practical nurse" means a nurse who is licensed
22or has a temporary permit under s. 441.10.
AB1146, s. 10 23Section 10. 49.45 (6m) (a) 4m. of the statutes is created to read:
AB1146,6,2524 49.45 (6m) (a) 4m. "Nurse's assistant" has the meaning given in s. 146.40 (1)
25(d).
AB1146, s. 11
1Section 11. 49.45 (6m) (a) 5m. of the statutes is created to read:
AB1146,7,32 49.45 (6m) (a) 5m. "Registered nurse" means a nurse who has a certificate of
3registration under s. 441.06 or a temporary permit order under s. 441.08.
AB1146, s. 12 4Section 12. 49.45 (6m) (m) of the statutes is created to read:
AB1146,7,75 49.45 (6m) (m) By January 1, 2006, 2007, 2008, and 2009, the department shall
6submit a report to the chief clerk of each house of the legislature, for distribution to
7the legislature under s. 13.172 (2), that shall include all of the following:
AB1146,7,88 1. For the preceding calendar year for each facility:
AB1146,7,109 a. The staff turnover rate for registered nurses, licensed practical nurses, and
10nurse's assistants employed by the facility.
AB1146,7,1611 b. The average hourly wage and fringe benefit costs, including specific
12unemployment compensation and worker's compensation costs, for registered
13nurses, licensed practical nurses, nurse's assistants, dietary staff, housekeeping
14staff, and laundry staff employed by the facility and the average hourly cost for
15nonemployee purchased services, if any, of registered nurses, licensed practical
16nurses, and nurse's assistants.
AB1146,7,2017 c. Total revenues and expenses, total net income after taxes, expenses for each
18of the facility's cost centers under par. (am), the medical assistance reimbursement
19rate and method of calculation, the number of patient beds, and the number of
20patient days.
AB1146,7,2221 d. Total cost of recruiting, screening, educating, and training the nursing staff
22of the facility.
AB1146,8,223 e. Any correlation that may be shown between the number of notices of
24violations for class "A," "B," or "C" violations a facility received under s. 50.04, if any,

1and the frequency with which the facility used nonemployee purchased services of
2registered nurses, licensed practical nurses, or nurse's assistants.
AB1146,8,53 2. Recommendations of the department for incentives for facilities to reduce
4reliance on nonemployee purchased services of registered nurses, licensed practical
5nurses, or nurse's assistants.
AB1146, s. 13 6Section 13. 50.02 (2) (bn) of the statutes is amended to read:
AB1146,8,97 50.02 (2) (bn) The department may, by rule, increase the minimum hours of
8nursing home care per day
staffing standards that are specified in s. 50.04 (2) (d) 1.
9to 3.
(e).
AB1146, s. 14 10Section 14. 50.034 (3) (e) of the statutes is created to read:
AB1146,8,1411 50.034 (3) (e) Post in a conspicuous location in the residential care apartment
12complex a notice, provided by the board on aging and long-term care, of the name,
13address, and telephone number of the Long-Term Care Ombudsman Program under
14s. 16.009 (2) (b).
AB1146, s. 15 15Section 15. 50.034 (9) of the statutes is created to read:
AB1146,8,1716 50.034 (9) Assessment on occupied apartments. (a) In this subsection,
17"complex" means a certified or registered residential care apartment complex.
AB1146,8,2018 (b) For the privilege of doing business in this state, there is imposed on all
19occupied apartments of a complex an annual assessment that shall be credited to the
20appropriation account under s. 20.432 (1) (gt) and that is $12 per apartment.
AB1146,9,221 (c) By July 1 annually, a complex shall submit to the department the amount
22due under par. (b) for each occupied apartment of the complex for the preceding June.
23The department shall verify the number of apartments of a complex and, if necessary,
24make adjustments to the payment, notify the complex of changes in the payment

1owing, and send the complex an invoice for the additional amount due or send the
2complex a refund.
AB1146,9,53 (d) Sections 77.59 (1) to (5), (6) (intro.), (a), and (c), and (7) to (10), 77.60 (1) to
4(7), (9), and (10), 77.61 (9) and (12) to (14), and 77.62, as they apply to the taxes under
5subch. III of ch. 77, apply to the assessment under this subsection.
AB1146,9,86 (e) 1. The department shall enforce and collect the assessment under this
7subsection and shall develop and distribute forms necessary for levying and
8collection.
AB1146,9,109 2. The department shall promulgate rules that establish procedures and
10requirements for levying the assessment under this subsection.
AB1146,9,1311 (f) 1. An affected complex may contest an action by the department under this
12subsection by submitting a written request for a hearing to the department within
1330 days after the date of the department's action.
AB1146,9,1514 2. An order or determination made by the department under a hearing as
15specified in subd. 1. is subject to judicial review as prescribed under ch. 227.
AB1146, s. 16 16Section 16. 50.04 (2) (d) of the statutes is repealed.
AB1146, s. 17 17Section 17. 50.04 (2) (e) of the statutes is created to read:
AB1146,9,1818 50.04 (2) (e) 1. In this paragraph:
AB1146,9,2019 a. "Afternoon work shift" means the 8-hour work shift that begins immediately
20after the morning shift.
AB1146,9,2221 b. "Certified nurse's assistant" means a nurse's assistant who meets the
22requirements specified under 42 USC 1296r (b) (5) (A) to (E).
AB1146,9,2423 c. "Evening work shift" means the 8-hour work shift that begins immediately
24after the afternoon work shift.
AB1146,10,2
1d. "Morning work shift" means the first 8-hour work shift that begins after
2midnight.
AB1146,10,113 2. The department shall promulgate rules that specify minimum staffing
4standards that are based on ratios between the number of registered nurses on duty
5in a nursing home per morning work shift, afternoon work shift, or evening work
6shift and the number of residents of the nursing home, between the number of
7licensed practical nurses on duty in a nursing home per morning work shift,
8afternoon work shift, or evening work shift and the number of residents of the
9nursing home, and between the number of certified nurse's assistants on duty in a
10nursing home per morning work shift, afternoon work shift, or evening work shift
11and the number of residents of the nursing home.
AB1146,10,1512 3. By July 1, 2007, the department shall convert the minimum staffing
13requirements specified in s. 50.04 (2) (d), 2005 stats., to the minimum staffing
14standards specified in subd. 2., shall provide training to staff on enforcement of the
15standards, and shall assist nursing homes in implementing the standards.
AB1146,10,1916 4. By July 1, 2007, a nursing home, other than a nursing home that primarily
17serves the developmentally disabled, shall have on duty the number of registered
18nurses, licensed practical nurses, and certified nurse's assistants necessary to satisfy
19the minimum staffing standards developed by the department under subd. 2.
AB1146,11,220 5. A registered nurse, licensed practical nurse, or certified nurse's assistant
21who while on duty provides primarily support services, including food preparation,
22housekeeping, laundry, or maintenance services, may not be counted for purposes of
23calculating the minimum staffing ratios under subd. 2. A registered nurse who is
24employed as a director of nursing, as an assistant director of nursing, or as the charge
25nurse required under par. (b), may not be counted for purposes of calculating the

1minimum staffing requirements under subd. 2. while he or she is performing the
2duties of a director of nursing, assistant director of nursing, or charge nurse.
AB1146,11,113 6. By January 1, 2009, after first referring to the most recent national research
4on nursing home staffing and consulting with representatives of the nursing home
5industry, labor unions that represent nursing home employees, advocates for elderly
6and disabled persons, recognized experts with experience in long-term care
7reimbursement, economists, the attorney general, the federal centers for medicare
8and medicaid services, and other interested parties, the department shall submit a
9report to the governor, and to the chief clerk of each house of the legislature for
10distribution to the legislature under s. 13.172 (2). The report shall contain all of the
11following recommendations:
AB1146,11,1312 a. Proposed methods by which nursing homes are able more effectively to
13recruit and retain caregivers.
AB1146,11,1714 b. Proposed revised minimum nursing home staffing ratios that minimize
15additional state costs, maximize access to care, facilitate care of the highest quality,
16and take into account the levels of care for physical or mental conditions that nursing
17home residents require.
AB1146,11,2218 c. A proposed revised nursing home medical assistance reimbursement
19methodology that more effectively promotes resident care of high quality, advances
20wages and benefits for nursing home workers, supports nursing home provider
21compliance with applicable state statutes and rules and federal statutes and
22regulations, and encourages administrative efficiency.
AB1146, s. 18 23Section 18. 50.065 (2) (am) 2g. of the statutes is created to read:
AB1146,11,2524 50.065 (2) (am) 2g. Information maintained by the department of corrections
25in the registry of sex offenders under s. 301.45 (2).
AB1146, s. 19
1Section 19. 50.065 (2) (am) 2r. of the statutes is created to read:
AB1146,12,42 50.065 (2) (am) 2r. Information on persons convicted of crimes as specified
3under the circuit court automation information system maintained by the Wisconsin
4court system on its Internet site.
AB1146, s. 20 5Section 20. 50.065 (2) (b) 1g. of the statutes is created to read:
AB1146,12,76 50.065 (2) (b) 1g. Information maintained by the department of corrections in
7the registry of sex offenders under s. 301.45 (2).
AB1146, s. 21 8Section 21. 50.065 (2) (b) 2r. of the statutes is created to read:
AB1146,12,119 50.065 (2) (b) 2r. Information on persons convicted of crimes as specified under
10the circuit court automation information system maintained by the Wisconsin court
11system on its Internet site.
AB1146, s. 22 12Section 22. 50.09 (title) of the statutes is amended to read:
AB1146,12,13 1350.09 (title) Rights of residents in certain facilities and complexes.
AB1146, s. 23 14Section 23. 50.09 (1) of the statutes is renumbered 50.09 (1m), and 50.09 (1m)
15(intro.), (b), (c), (e), (f) 1. and 3., (g), (j) (intro.) and 2. (intro.) and a. and (L), as
16renumbered, are amended to read:
AB1146,12,1917 50.09 (1m) Residents' rights. (intro.) Every resident in a nursing home or
18community-based residential
facility or a complex shall, except as provided in sub.
19(5), have the right to:
AB1146,12,2420 (b) Present grievances on the resident's own behalf or others to the facility's
21staff or administrator of the facility or complex, to public officials or to any other
22person without justifiable fear of reprisal, and to join with other residents or
23individuals within or outside of the facility or complex to work for improvements in
24resident care.
AB1146,13,8
1(c) Manage the resident's own financial affairs, including any personal
2allowances under federal or state programs, unless the resident delegates, in
3writing, such this responsibility to the facility or complex and the facility or complex
4accepts the responsibility, or unless the resident delegates to someone else of the
5resident's choosing and that person accepts the responsibility. The resident shall
6receive, upon written request by the resident or guardian, a written monthly account
7of any financial transactions made by the facility or complex under such a delegation
8of responsibility.
AB1146,13,129 (e) Be treated with courtesy, respect and full recognition of the resident's
10dignity and individuality, by all employees of the facility or complex and licensed,
11certified, or registered providers of health care and pharmacists with whom the
12resident comes in contact.
AB1146,13,1613 (f) 1. Privacy for visits by spouse. If both spouses are residents of the same
14facility or complex, they shall be permitted to share a room or apartment unless
15medically contraindicated as documented by the resident's physician in the
16resident's medical record.
AB1146,13,2017 3. Confidentiality of health and personal records, and the right to approve or
18refuse their release to any individual outside the facility or complex, except in the
19case of the resident's transfer to another facility or complex or as required by law or
203rd-party payment contracts and except as provided in s. 146.82 (2) and (3).
AB1146,13,2221 (g) Not to be required to perform services for the facility or complex that are not
22included for therapeutic purposes in the resident's plan of care.
AB1146,14,523 (j) (intro.) Be transferred or discharged, and be given reasonable advance notice
24of any planned transfer or discharge, and an explanation of the need for and
25alternatives to the transfer or discharge. The facility or complex to which the

1resident is to be transferred must have accepted the resident for transfer, except in
2a medical emergency or if the transfer or discharge is for nonpayment of charges
3following a reasonable opportunity to pay a deficiency. No person may be
4involuntarily discharged for nonpayment under this paragraph if the person meets
5all of the following conditions:
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