50.90(1)
(1) "Hospice" means any of the following:
50.90(1)(a)
(a) An organization that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays and, if necessary to meet the needs of an individual with terminal illness, arranges for or provides short-term inpatient care and treatment or provides respite care.
50.90(1)(b)
(b) A program, within an organization, that primarily provides palliative care and supportive care to an individual with terminal illness where he or she lives or stays, that uses designated staff time and facility services, that is distinct from other programs of care provided, and, if necessary to meet the needs of an individual with terminal illness, that arranges for or provides short-term inpatient care and treatment or respite care.
50.90(1)(c)
(c) A place, including a freestanding structure or a separate part of a structure in which other services are provided, that primarily provides palliative and supportive care and a place of residence to individuals with terminal illness and provides or arranges for short-term inpatient care as needed.
50.90(1m)
(1m) "Managing employee" means a general manager, business manager, administrator, director or other individual who exercises operational or managerial control over, or who directly or indirectly conducts, the operation of the hospice.
50.90(2)
(2) "Organization" means a public agency, as defined in
s. 46.93 (1m) (e), a nonprofit corporation, a for-profit stock corporation, a cooperative, a partnership, a limited liability company or a sole proprietorship.
50.90(3)
(3) "Palliative care" means management and support provided for the reduction or abatement of pain, for other physical symptoms and for psychosocial or spiritual needs of individuals with terminal illness and includes physician services, skilled nursing care, medical social services, services of volunteers and bereavement services. "Palliative care" does not mean treatment provided in order to cure a medical condition or disease or to artificially prolong life.
50.90(3g)
(3g) "Respite care" means care provided to a terminally ill individual in order to provide temporary relief to the primary caregiver.
50.90(3m)
(3m) "Short-term care" means care provided to a terminally ill individual in an inpatient setting for brief periods of time for the purpose of pain control or acute or chronic symptom management.
50.90(4)
(4) "Supportive care" means services provided during the final stages of an individual's terminal illness and dying and after the individual's death to meet the psychosocial, social and spiritual needs of family members of the terminally ill individual and other individuals caring for the terminally ill individual. "Supportive care" includes personal adjustment counseling, financial counseling, respite services, bereavement counseling and follow-up services provided by volunteers or other persons.
50.90(5)
(5) "Terminal illness" means a medical prognosis that an individual's life expectancy is less than 12 months.
50.90 History
History: 1989 a. 199;
1993 a. 112.
50.91
50.91
Departmental powers and duties. The department shall provide uniform, statewide licensing, inspection and regulation of hospices as specified in this subchapter.
50.91 History
History: 1989 a. 199.
50.92
50.92
Licensing requirements. 50.92(1)
(1) No person may conduct, maintain, operate or otherwise participate in conducting, maintaining or operating a hospice unless the hospice is licensed by the department.
50.92(2)
(2) The department shall issue a license if the department finds that the applicant is fit and qualified and that the hospice meets the requirements of this subchapter and the rules promulgated under this subchapter.
50.92(3)
(3) The department or the department's designated representative shall inspect or investigate a hospice prior to issuance of a license for the hospice except as provided in
sub. (4) and may inspect or investigate a hospice as the department deems necessary, including conducting home visits or a review of health care records of any individuals with terminal illness served by the hospice, to determine if any person is in violation of this subchapter.
50.92(4)(a)(a) In lieu of inspecting or investigating a hospice under
sub. (3) prior to issuance of a license, the department may accept evidence that a hospice applying for licensure under
s. 50.93 has been inspected under and is currently certified as meeting the conditions for medicare participation under
42 USC 1395 to
1395ccc. If a hospice fails to meet the conditions for medicare participation under
42 USC 1395 to
1395ccc, the department shall inspect or investigate the hospice under
sub. (3) before initially issuing a license for the hospice.
50.92(4)(b)
(b) In lieu of inspecting or investigating a hospice under
sub. (3) prior to issuance of a license, the department may accept evidence that a hospice applying for licensure under
s. 50.93 has been inspected under and is currently in compliance with the hospice requirements of the joint commission for the accreditation of health organizations. A hospice shall provide the department with a copy of the report by the joint commission for the accreditation of health organizations of each periodic review the association conducts of the hospice.
50.92(5)
(5) The past record of violations of applicable laws or regulations of the United States or of state statutes or rules of this or any other state, in the operation of any health-related organization, by an operator, managing employee or direct or indirect owner of a hospice or of an interest of a hospice is relevant to the issue of the fitness of an applicant for a license. The department or the department's designated representative shall inspect and investigate as necessary to determine the conditions existing in each case under this subsection and shall prepare and maintain a written report concerning the investigation and inspection.
50.92 History
History: 1989 a. 199;
1997 a. 27.
50.925
50.925
Use of name or advertising prohibited. No entity that is not a hospice licensed under this subchapter or an applicant for a license or a provisional license under this subchapter may designate itself as a "hospice" or use the word "hospice" to represent or tend to represent the entity as a hospice or services provided by the entity as services provided by a hospice.
50.925 History
History: 1989 a. 199.
50.93
50.93
Licensing procedure. 50.93(1)
(1)
Application. The application for a license or for a provisional license shall:
50.93(1)(a)
(a) Be in writing on a form provided by the department.
50.93(1)(b)
(b) Contain such information as the department requires.
50.93(1)(c)
(c) Include licensing fee payment, unless the licensing fee is waived by the department on a case-by-case basis under criteria for determining financial hardship established in rules promulgated by the department. An initial licensing fee is $300, except that, for a hospice that is a nonprofit corporation and that is served entirely by uncompensated volunteers or employs persons in not more than 1.5 positions at 40 hours of employment per week, the initial licensing fee is $25. The annual fee thereafter is an amount equal to 0.15% of the net annual income of the hospice, based on the most recent annual report of the hospice under
sub. (3m), or $200, whichever is greater, and if the amount equal to 0.15% of the net annual income of the hospice is greater than $1,000, the fee is $1,000, except that for a hospice that is a nonprofit corporation and that is served entirely by uncompensated volunteers or employs persons in not more than 1.5 positions at 40 hours of employment per week the annual fee is $10. The amount of the provisional licensing fee shall be established under
s. 50.95 (2). The initial licensing fee for a hospice, including the initial licensing fee for a hospice that is a nonprofit corporation and that is served entirely by uncompensated volunteers or employs persons in not more than 1.5 positions at 40 hours of employment per week, issued after September 1 may be prorated.
50.93(2)(a)(a) A hospice license is valid until suspended or revoked.
50.93(2)(c)
(c) Each license shall be issued only for the applicant named in the application and may not be transferred or assigned.
50.93(2)(d)
(d) Any license granted under special limitations prescribed by the department shall state the limitations.
50.93(3)
(3) Provisional license. If the applicant has not been previously licensed under this subchapter or if the hospice is not in operation at the time that application is made, the department may issue a provisional license. Unless sooner suspended or revoked under
sub. (4), a provisional license shall be valid for 24 months from the date of issuance. Within 30 days prior to the termination of a provisional license, the department shall fully and completely inspect the hospice and, if the hospice meets the applicable requirements for licensure, shall issue a regular license under
sub. (2). If the department finds that the hospice does not meet the requirements for licensure, the department may not issue a regular license under
sub. (2).
50.93(3m)
(3m) Reporting. Every 12 months, on a schedule determined by the department, a licensed hospice shall submit an annual report in the form and containing the information that the department requires, including payment of the fee required under
sub. (1) (c), evidence of current certification as meeting the conditions for medicare participation under
42 USC 1395 to
1395ccc and evidence of current compliance with the hospice requirements of the joint commission for the accreditation of health organizations. If a complete annual report is not timely filed, the department shall issue a warning to the licensee. The department may revoke the license for failure to timely and completely report within 60 days after the report date established under the schedule determined by the department.
50.93(4)(a)(a) The department, after notice to the applicant or licensee, may suspend or revoke a license in any case in which the department finds that there has been a substantial failure to comply with the requirements of this subchapter or the rules promulgated under this subchapter. No state or federal funds passing through the state treasury may be paid to a hospice not having a valid license issued under this section.
50.93(4)(b)
(b) Notice under this subsection shall include a clear and concise statement of the violations on which the revocation is based, the statute or rule violated and notice of the opportunity for an evidentiary hearing under
par. (c).
50.93(4)(c)
(c) If a hospice desires to contest the revocation of a license, the hospice shall, within 10 days after receipt of notice under
par. (b), notify the department in writing of its request for a hearing under
s. 227.44.
50.93(4)(d)1.1. Subject to
s. 227.51 (3), revocation shall become effective on the date set by the department in the notice of revocation, or upon final action after hearing under
ch. 227, or after court action if a stay is granted under
ch. 227, whichever is later.
50.93(4)(d)3.
3. The department may extend the effective date of license revocation in any case in order to permit orderly removal and relocation of individuals served by the hospice.
50.94
50.94
Admission to and care in a hospice for certain incapacitated persons. 50.94(1)(a)
(a) "Hospice care" means palliative care, respite care, short-term care or supportive care.
50.94(1)(b)
(b) "Incapacitated" means unable to receive and evaluate information effectively or to communicate decisions to such an extent that a person lacks the capacity to manage his or her health care decisions.
50.94(1)(c)
(c) "Physician" means a person licensed to practice medicine and surgery under
ch. 448.
50.94(1)(d)
(d) "Terminal condition" means an incurable condition caused by injury, disease or illness that according to reasonable medical judgment will produce death within 6 months, even with available life-sustaining treatment provided in accordance with the prevailing standard of medical care.
50.94(2)
(2) A person who is determined to be incapacitated under the requirements of
sub. (8), does not have a valid living will or valid power of attorney for health care and has not been adjudicated incompetent under
ch. 880 may be admitted to a hospice under this section only if all of the following requirements are met:
50.94(2)(a)
(a) An individual who is specified in
sub. (3) signs all of the following:
50.94(2)(a)1.
1. On behalf of the person who is incapacitated, an informed consent for the receipt of hospice care by the person who is incapacitated.
50.94(2)(a)2.
2. A statement certifying that it is his or her belief, to the best of his or her knowledge, that, if able to do so, the person who is incapacitated would have selected hospice care.
50.94(2)(b)
(b) A physician certifies that the person who is incapacitated has a terminal condition and that the physician believes that the individual under
par. (a) is acting in accordance with the views or beliefs of the person who is incapacitated.
50.94(3)
(3) The following individuals, in the following order of priority, may act under
sub. (2) (a):
50.94(3)(a)
(a) The spouse of the person who is incapacitated.
50.94(3)(b)
(b) An adult child of the person who is incapacitated.
50.94(3)(c)
(c) A parent of the person who is incapacitated.
50.94(3)(d)
(d) An adult sibling of the person who is incapacitated.
50.94(3)(e)
(e) A close friend or a relative of the person who is incapacitated, other than as specified in
pars. (a) to
(d), to whom all of the following apply:
50.94(3)(e)1.
1. The close friend or other relative is aged at least 18 and has maintained sufficient regular contact with the person who is incapacitated to be familiar with the person's activities, health and beliefs.
50.94(3)(e)2.
2. The close friend or other relative has exhibited special care and concern for the incapacitated person.
50.94(4)
(4) The individual who acts under
sub. (2) (a) may make all health care decisions related to receipt of hospice care by the person who is incapacitated.
50.94(5)
(5) The person who is incapacitated or the individual under
sub. (4) may object to or revoke the election of hospice care at any time.
50.94(6)
(6) A person who disagrees with a hospice decision made under this section may apply under
ch. 880 for temporary guardianship of the person who is incapacitated. In applying for the temporary guardianship, such a person has the burden of proving that the person who is incapacitated would not have consented to admission to a hospice or hospice care.
50.94(7)
(7) The individual who acts under
sub. (2) (a) shall, if feasible, provide to all other individuals listed under
sub. (3) notice of the proposed admission of the person who is incapacitated to a hospice and of the right to apply for temporary guardianship under
sub. (6). If it is not feasible for the individual to provide this notice before admission of the person who is incapacitated to a hospice, the individual who acts under
sub. (2) (a) shall exercise reasonable diligence in providing the notice within 48 hours after the admission.
50.94(8)
(8) A determination that a person is incapacitated may be made only by 2 physicians or by one physician and one licensed psychologist, as defined in
s. 455.01 (4), who personally examine the person and sign a statement specifying that the person is incapacitated. Mere old age, eccentricity or physical disabilities, singly or together, are insufficient to determine that a person is incapacitated. Whoever determines that the person is incapacitated may not be a relative, as defined in
s. 242.01 (11), of the person or have knowledge that he or she is entitled to or has claim on any portion of the person's estate. A copy of the statement shall be included in the records of the incapacitated person in the hospice to which he or she is admitted.
50.94 History
History: 1999 a. 9.
50.95
50.95
Rule-making authority. The department shall promulgate all of the following rules:
50.95(1)
(1) Standards for the care, treatment, health, safety, rights, welfare and comfort of individuals with terminal illness, their families and other individuals who receive palliative care or supportive care from a hospice and the maintenance, general hygiene and operation of a hospice, which will permit the use of advancing knowledge to promote safe and adequate care and treatment for these individuals. These standards shall permit provision of services directly, as required under
42 CFR 418.56, or by contract under which overall coordination of hospice services is maintained by hospice staff members and the hospice retains the responsibility for planning and coordination of hospice services and care on behalf of a hospice client and his or her family, if any.
50.95(2)
(2) Provisional hospice licensure fees or the methods of computation of those fees.
50.95(3)
(3) Inspection or investigation procedures that the department or the department's designated representative may use to assure the provision of care and treatment that is commensurate with the standards established under
sub. (1).
50.95(4)
(4) Criteria for determining financial hardship for the waiver of licensing fees.
50.95(5)
(5) Criteria for determining that the applicant for licensure is fit and qualified.
50.95(6)
(6) A procedure for waiver of and variance from standards under
sub. (1) or criteria under
sub. (5). The department may limit the duration of the waiver or variance.
50.95 History
History: 1989 a. 199;
1997 a. 27.
50.97
50.97
Right of injunction. The department may, upon the advice of the attorney general, who shall represent the department in all proceedings under this section, institute an action in the name of the state in the circuit court for Dane County for injunctive relief or other process against any licensee, owner, operator, administrator or representative of any owner of a hospice for the violation of any of the provisions of this subchapter or rules promulgated under this subchapter if the violation affects the health, safety or welfare of individuals with terminal illness.
50.97 History
History: 1989 a. 199.
50.98(1)(1) Any person who violates this subchapter or rules promulgated under this subchapter may be required to forfeit not more than $100 for the first violation and may be required to forfeit not more than $200 for the 2nd or any later violation within a year. The period shall be measured using the dates of issuance of citations of the violations. Each day of violation constitutes a separate violation.
50.98(2)
(2) In determining whether a forfeiture is to be imposed and in fixing the amount of the forfeiture to be imposed, if any, for a violation, the following factors shall be considered:
50.98(2)(a)
(a) The gravity of the violation, including the probability that death or serious physical or psychological harm to a resident will result or has resulted; the severity of the actual or potential harm; and the extent to which the provisions of the applicable statutes or rules were violated.
50.98(2)(b)
(b) Good faith exercised by the licensee. Indications of good faith include, but are not limited to, awareness of the applicable statutes and regulation and reasonable diligence in complying with such requirements, prior accomplishments manifesting the licensee's desire to comply with the requirements, efforts to correct and any other mitigating factors in favor of the licensee.
50.98(2)(c)
(c) Any previous violations committed by the licensee.
50.98(2)(d)
(d) The financial benefit to the hospice of committing or continuing the violation.
50.98(3)
(3) The department may directly assess forfeitures provided for under
sub. (1). If the department determines that a forfeiture should be assessed for a particular violation or for failure to correct it, it shall send a notice of assessment to the hospice. The notice shall specify the amount of the forfeiture assessed, the violation, and the statute or rule alleged to have been violated, and shall inform the licensee of the right to a hearing under
sub. (4).
50.98(4)
(4) A hospice may contest an assessment of forfeiture, by sending, within 10 days after receipt of notice under
sub. (3), a written request for hearing under
s. 227.44 to the division of hearings and appeals created under
s. 15.103 (1). The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under
s. 227.46. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days after receipt of the request for hearing and shall issue a final decision within 15 days after the close of the hearing. Proceedings before the division are governed by
ch. 227. In any petition for judicial review of a decision by the division, the party, other than the petitioner, who was in the proceeding before the division shall be the named respondent.
50.98(5)
(5) All forfeitures shall be paid to the department within 10 days after receipt of notice of assessment or, if the forfeiture is contested under
sub. (4), within 10 days after receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order under the same terms and conditions as found in
s. 50.03 (11). The department shall remit all forfeitures paid to the state treasurer for deposit in the school fund.
