150.29(2)
(2) In its approval of any project the department shall specify the total number of approved additional beds and the maximum capital expenditure and per diem rates permitted.
150.29(3)
(3) In determining whether expenditures require prior approval under this section, the department shall aggregate separate expenditures and consider them together if any of the following applies:
150.29(3)(a)
(a) The aggregated expenditures were agreed upon at the same time, authorized by one act or devised or designed as parts of one plan.
150.29(3)(b)
(b) The needs for or purposes of the aggregated expenditures reasonably could have been foreseen when the first expenditure was made, and the aggregated expenditures most economically and efficiently would be made at the same time.
150.29 History
History: 1983 a. 27;
1993 a. 290.
150.31
150.31
Statewide bed limit. 150.31(1)(1) In order to enable the state to budget accurately for medical assistance and to allocate fiscal resources most appropriately, the maximum number of licensed nursing home beds statewide is 51,795 and the maximum number of beds statewide in facilities primarily serving the developmentally disabled is 3,704. The department may adjust these limits on licensed beds as provided in
subs. (2) to
(6). The department shall also biennially recommend changes to this limit based on the following criteria:
150.31(1)(c)
(c) The total number of additional nursing home beds approved under
s. 150.29.
150.31(1)(d)
(d) The availability of alternatives less costly than increasing the number of nursing home beds to provide long-term care.
150.31(1)(e)
(e) The amount of medical assistance funds available or to be made available in the following biennial executive budget for additional nursing home beds.
150.31(1)(f)
(f) The cost of providing additional nursing home beds.
150.31(2)
(2) The department may increase the statewide bed limit specified in
sub. (1) to account for the conversion of community-based residential facilities to nursing homes in order to maintain medical assistance certification, as provided in
s. 49.45 (16).
150.31(2m)(a)(a) The department may, on July 1, 1990, increase the statewide bed limit in
sub. (1) by not more than 25 beds to permit the permanent and complete conversion of a hospital to a nursing home if the hospital seeking conversion:
150.31(2m)(a)1.
1. Had, on January 1, 1990, an approved bed capacity of no more than 50 beds; and
150.31(2m)(a)2.
2. Ceases to exist as an acute care hospital by July 1, 1990.
150.31(2m)(b)
(b) The department shall decrease the number of beds authorized for increase under
par. (a) by the amount of any addition in the actual number of available beds within the limit specified in
sub. (1), up to 25 beds, that exists on July 1, 1990.
150.31(2r)(a)(a) The department may, on July 1, 1998, increase the statewide bed limit in
sub. (1) by not more than 6 beds to permit the permanent and complete closure of a hospital and its partial conversion to a nursing home if the hospital seeking partial conversion:
150.31(2r)(a)1.
1. Had, on January 1,
1998, an approved bed capacity of not more than 50 beds.
150.31(2r)(a)3.
3. Ceases to exist as an acute care hospital by July 1, 1998.
150.31(2r)(b)
(b) The department shall decrease the number of beds authorized for increase under
par. (a) by the amount of any addition in the actual number of available beds within the limit specified in
sub. (1), up to 6 beds, that exists on July 1, 1998.
150.31(2r)(c)
(c) The application to the department governing the permanent and complete closure of a hospital and partial conversion to a nursing home under
par. (a) is exempt from the procedural requirements of this chapter.
150.31(3)
(3) The department may decrease the statewide bed limit specified in
sub. (1) to account for nursing home beds that are not set up or not staffed due to life safety code or physical plant requirements under
s. 50.04, but that have not been permanently removed from the nursing home's bed capacity. In addition, the department may decrease the statewide bed limit specified in
sub. (1) to account for beds closed under a medical assistance waiver, as specified in
42 USC 1396n (c) or under other medical assistance waivers specified in
42 USC 1396 to
1396n.
150.31(4)
(4) The department may decrease the statewide bed limit in facilities primarily serving the developmentally disabled in order to account for any decreased use of beds at the state centers for the developmentally disabled due to the community integration program under
s. 46.275.
150.31(5)
(5) The department may decrease the statewide bed limits specified in
sub. (1) to account for any reduction of available beds not included under
sub. (3) or
(4), in accordance with criteria promulgated by rule.
150.31(5m)
(5m) The department shall decrease the statewide bed limit specified in
sub. (1) to account for any reduction in the approved bed capacity of the nursing home operated at the Wisconsin Veterans Home at King or at the nursing care facility operated by the department of veterans affairs under
s. 45.385, as specified in
s. 45.375 (2).
150.31(5r)
(5r) The department shall decrease the statewide bed limit specified in
sub. (1) by the number of any beds that a nursing home shall agree to reduce in order to convert a separate area of its total area to a residential care apartment complex under
s. 50.034 (4).
150.31(5t)
(5t) The department shall decrease the statewide bed limits specified in
sub. (1) to account for any reduction in the licensed bed capacity of a nursing home that has relinquished use of a bed, as specified in
s. 49.45 (6m) (ap) 4.
150.31(6)
(6) The department may adjust the statewide bed limits specified in
sub. (1) to account for the partial or total conversion of nursing homes to facilities primarily serving the developmentally disabled or of facilities primarily serving the developmentally disabled to nursing homes. The department may promulgate rules limiting the number of nursing home beds converted under this subsection, allocating the beds so converted, and establishing standards for the limitation and allocation.
150.31(7)
(7) The department may not approve or license any additional nursing home beds if the addition of those beds would exceed the limits established under
subs. (1) to
(6).
150.31(8)
(8) The department may allocate or distribute nursing home beds in a manner, developed by rule, that is consistent with the criteria specified in
sub. (1) (a) to
(f) and
s. 150.39.
150.32
150.32
Distinct-part facilities primarily serving the developmentally disabled. 150.32(1)
(1) Upon application to the department, the department may approve the operation for a period of time not to exceed 4 years of a distinct part of a nursing home as a facility primarily serving the developmentally disabled. Renewals of approvals initially granted under this subsection may be granted for periods of time not to exceed 4 years and only if all of the following conditions are met by the renewal applicant:
150.32(1)(a)
(a) Continued operation of the facility primarily serving the developmentally disabled meets the review criteria and standards under
ss. 150.31 (6) and
150.39.
150.32(1)(b)
(b) There is continued need, as determined by the department, for the facility primarily serving the developmentally disabled in the health planning area in which the facility is located.
150.32(1)(c)
(c) Community-based services, including services developed under
s. 46.278, are inappropriate for the individuals served in the facility primarily serving the developmentally disabled.
150.32(2)
(2) The department may require that a nursing home seeking approval or a facility primarily serving the developmentally disabled seeking renewal under
sub. (1) agree to reduce the size of the facility primarily serving the developmentally disabled, under a plan submitted by the facility and approved by the department, during the approval or renewal period, in order to reflect reduced service need or increased availability of community-based services providing long-term care.
150.32(3)
(3) Notwithstanding
s. 150.31 (6), the department may waive any minimum size limits established under
s. 150.31 (6) for a facility with an approved plan under
sub. (2).
150.32(4)
(4) Notwithstanding
s. 150.29, if initial approval of a facility primarily serving the developmentally disabled is not renewed under
sub. (1) or if approval or renewal is conditioned upon the requirement of
sub. (2), reconversion to nursing home beds of beds which may not be operated as part of a facility primarily serving the developmentally disabled does not require approval under
s. 150.29.
150.32 History
History: 1987 a. 27.
150.33
150.33
Applications for available beds. 150.33(1)
(1) At least once each year the department shall publish a class 2 notice under
ch. 985 concerning the number of nursing home beds and beds in facilities primarily serving the developmentally disabled, if any, that are available under
s. 150.31 or
150.40 in each of its health planning areas. The department shall promulgate rules defining the boundaries of these areas. The notice shall state the procedures by which any person may apply for approval for those beds.
150.33(2)
(2) An application for approval of beds under
sub. (1) shall state the applicant's per diem operating and capital rates, which are the maximum allowable reimbursement that may be granted by the department for the first 12 months following licensure of the new beds. If the medical assistance facility payment formula under
s. 49.45 (6m) generates per diem operating and capital rates that are less than those stated in the application under review, the department shall use the lower rates.
150.33(3)
(3) The department shall provide forms for submitting applications but may only accept applications submitted within 60 days after it publishes a notice under
sub. (1).
150.33(3m)
(3m) The department shall review each application it receives for completeness. If the department finds that the application is incomplete, it shall notify the applicant of the information required within 10 working days after receiving the application. Each applicant shall provide any required additional information within 30 days following the closing date for accepting applications specified in
sub. (3). The department may not accept for review any incomplete application if it fails to receive the additional information within this 30-day period until it issues another public notice soliciting applications under
sub. (1). The department shall declare the application complete on the date on which the department receives all the required information.
150.33(4)
(4) The department shall issue a class 2 notice under
ch. 985 within 20 days after the date on which it declares all applications complete under
sub. (3m), listing all applicants and describing their applications.
150.34
150.34
Other applications. 150.34(1)(1) Any person intending to engage in activities subject to this subchapter not specified under
s. 150.33 shall notify the department in writing of this intent at least 30 days prior to submitting an application for review. An application expires unless the department declares the application complete under
sub. (2) within 365 days after the date the department receives notice of the applicant's intent to engage in the activity. The department shall provide forms for submitting applications under this section.
150.34(2)
(2) The department shall review each application it receives for completeness. If the department finds that the application is incomplete, it shall notify the applicant of the information required within 10 working days after receiving the application. The department shall declare the application complete on the date on which the department receives all the required information.
150.34(3)
(3) The department shall issue a class 2 notice under
ch. 985 on or before the 20th day of the month following the month in which it declares an application complete under
sub. (2), listing the applicant and describing the applicant's proposed activity.
150.34 History
History: 1987 a. 27,
399;
1989 a. 56.
150.35
150.35
Review procedures. 150.35(2)(2) The department shall hold a public meeting upon the request of an affected party to review applications under
s. 150.33 or
150.34, at which all affected parties may present testimony. The department shall keep minutes or other record of testimony presented at the public meeting and shall, based on the testimony, consider the record in determining whether the applicant has met the review criteria under
s. 150.39.
150.35(3)
(3) Except as provided under
sub. (3m), the department shall issue an initial finding to approve or reject the application within 75 days after the date it publishes its notice under
s. 150.33 (4) or
150.34 (3), unless all applicants consent to an extension of this period. The department may extend by 60 days the review cycle of all applications being concurrently reviewed if it finds that completing the reviews within 75 days after the date it publishes its notice under
s. 150.33 (4) or
150.34 (3) is not practicable due to the volume of applications received. The department shall base its initial finding on a comparative analysis of applications, relying on the criteria specified in
s. 150.39. The applicant has the burden of proving, by a preponderance of the evidence, that each criterion specified in
s. 150.39 has been met or does not apply to the project. The department may approve fewer additional nursing home beds than allowed by the statewide bed limit if the cost of adding those beds exceeds the medical assistance allocation for new beds projected in
s. 150.31 (1) (e). Unless an adversely affected applicant makes a timely request for a public hearing under
sub. (4), the department's initial finding under this subsection is its final action.
150.35(3m)(a)(a) The department may receive any of the following applications:
150.35(3m)(a)1.
1. An application which was developed under a plan of correction, as defined in
s. 50.01 (4r), previously approved by the department and which does not add beds to the current licensed bed capacity.
150.35(3m)(b)
(b) Subsection (2) does not apply to the applications under
par. (a). Within 60 days after it receives a completed application, the department shall, according to procedures it promulgates by rule, review the application and issue its initial finding. No public meeting need be held on any project submitted under this subsection.
150.35(3m)(c)
(c) Unless an adversely affected applicant makes a timely request for a public hearing under
sub. (4), the department's initial finding under this subsection is its final decision.
150.35(4)(a)(a) Any applicant whose project is rejected may request a public hearing to review the department's initial finding under
sub. (3) or
(3m), if the request is submitted in writing within 10 days after the department's decision. The department shall commence the hearing within 30 days after receiving a timely request, unless all parties consent to an extension of this period.
150.35(4)(b)
(b) Sections 227.42 to
227.50 do not apply to hearings under this subsection. The department shall promulgate rules to establish:
150.35(4)(b)1.
1. Procedures for scheduling hearings under this subsection.
150.35(4)(b)2.
2. Procedures for conducting hearings under this subsection, including methods of presenting arguments, cross-examination of witnesses and submission of exhibits.
150.35(4)(b)3.
3. Procedures following the completion of a hearing under this subsection, including the establishment of time limits for issuance of a decision.
150.35(4)(b)4.
4. Standards relating to ex parte communication in hearings under this subsection.
150.35(4)(c)
(c) The department shall issue all decisions in writing.
150.35(4)(d)
(d) Each applicant at any hearing under this subsection has the burden of proving, by clear and convincing evidence, that the department's initial finding was contrary to the weight of the evidence on the record when considered as a whole, arbitrary and capricious or contrary to law.
150.39
150.39
Review criteria and standards. The department shall use the following criteria in reviewing each application under this subchapter, plus any additional criteria it develops by rule. The department shall consider cost containment as its first priority in applying these criteria, and shall consider the comments of affected parties. The department may not approve any project under this subchapter unless the applicant demonstrates:
150.39(1)
(1) The medical assistance funds appropriated are sufficient to reimburse the applicant for providing the nursing home care.
150.39(2)
(2) The cost of providing an equal number of nursing home beds or of an equal expansion would be consistent with the cost at similar nursing homes, and the applicant's per diem rates would be consistent with those of similar nursing homes.
150.39(3)
(3) The project does not conflict with the statewide bed limit under
s. 150.31.
150.39(4)
(4) A need for additional beds in the health planning area where the project would be located.
150.39(5)
(5) The project is consistent with local plans for developing community-based services to provide long-term care.
150.39(6)
(6) Health care personnel, capital and operating funds and other resources needed to provide the proposed services are available.
150.39(7)
(7) The project can be undertaken within the period of validity of the approval and completed within a reasonable period thereafter.
150.39(8)
(8) Appropriate methods alternative to providing nursing home care in the health planning area are unavailable.
150.39(10)
(10) The quality of care to be provided is satisfactory, as determined by:
150.39(10)(b)
(b) Materials submitted by the applicant, including independent evaluations of performance in nursing homes owned or operated by the applicant and patient satisfaction surveys.
