150.11(3)(a)(a) If a project whose cost falls below the minimum threshold specified in
s. 150.21 (3) or
(4) incurs costs exceeding the threshold, the person who operates the project shall submit an application for the department's approval under
s. 150.21.
150.11(3)(b)
(b) If a project that has received the department's approval incurs a cost overrun, the person who operates the project shall submit another application for the department's approval under
s. 150.21.
150.11(3)(c)
(c) Any person required to submit an application under this subsection for the department's approval under
s. 150.21 shall comply with the time limits for submission of applications under
s. 150.33 (3) and
(3m). The department shall afford an applicant under this subsection a reasonable time to obtain its approval but if it rejects the application it may refuse to issue or renew a license or approval, as specified in
sub. (1), and costs associated with the project may not be recovered through charges or rates, as specified in
sub. (2). If the department approves the project it shall impose a forfeiture on the person who operates the project of not less than 10% and not more than 50% of the costs exceeding the threshold under
par. (a) or of the cost overrun under
par. (b). Project approval takes effect only after payment of the forfeiture has been made.
150.11(4)
(4) The department's approval of any project is revoked if the capital expenditures specified in the approval have not been obligated, if financing in an amount sufficient to complete the project has not been obtained or if substantial and continuing progress has not been undertaken within the period specified in the approval. In addition, the department's approval of any project is revoked if the person who operates a project misses any other deadlines specified in the approval and fails to make a good faith effort to meet these deadlines.
150.11(5)
(5) The department may reject the application for approval of a project operated by any person who has repeatedly been subject to the penalties specified in this section or may impose restrictions as part of its approval to ensure compliance with
subchs. I and
II.
150.13
150.13
Fees. Any person applying for approval under
subch. I or
II shall pay an application fee equal to 0.37% of the estimated project cost, but not less than $1,850 and not more than $37,000. No application is complete without payment of the correct fee.
150.13 History
History: 1983 a. 27;
1991 a. 250.
RESOURCE ALLOCATION PROGRAM;
LONG-TERM CARE
150.21
150.21
Applicability. Except as provided in
s. 150.46, this subchapter applies to any person who intends to engage in any of the following activities:
150.21(1)
(1) The construction of a new nursing home.
150.21(2)
(2) An increase in the bed capacity of a nursing home.
150.21(3)
(3) A capital expenditure, other than a renovation or replacement, that exceeds $1,000,000 by or on behalf of a nursing home.
150.21(4)
(4) An expenditure, other than a renovation or replacement, that exceeds $600,000 for clinical equipment by or on behalf of a nursing home.
150.21(5)
(5) The partial or total conversion of a nursing home to a facility primarily serving the developmentally disabled or of a facility primarily serving the developmentally disabled to a nursing home.
150.27
150.27
Per diem capital rates. An application for approval of an activity specified under
s. 150.21 (1),
(3),
(4) or
(5) shall state the applicant's per diem capital rates, which are the maximum allowable reimbursement that may be granted by the department for the first 12 months following completion of the approved project. If the medical assistance facility payment formula under
s. 49.45 (6m) generates per diem capital rates that are less than those stated in the application under review, the department shall use the lower rates.
150.29
150.29
Approval requirement. 150.29(1)
(1) No person may enter into an obligation for a project described in
s. 150.21 or engage in activities described in that section without the department's prior approval.
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 a skilled nursing facility operated by the department of veterans affairs under
s. 45.50, as specified in
s. 45.50 (10).
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.
150.345
150.345
Nursing home bed transfers. 150.345(1)
(1) Notwithstanding
ss. 150.33 and
150.34, a nursing home may transfer a licensed bed to another nursing home, if all of the following apply:
150.345(1)(a)
(a) The receiving nursing home is within the same area for allocation of nursing home beds, as determined by the department, as is the transferring nursing home, or is in a county adjoining that area.
150.345(1)(b)
(b) The transferring nursing home and the receiving nursing home are owned by corporations that are owned by the same person.
150.345(1)(c)
(c) The transferring and receiving nursing homes notify the department of the proposed transfer within 30 days before the transfer occurs.
150.345(1)(d)
(d) The department reviews and approves the transfer.
150.345(2)
(2) Upon receiving the notification specified in
sub. (1) (c), the department shall adjust the allocation of licensed beds under
s. 150.31 for each nursing home in accordance with the transfer that was made.
150.345 History
History: 2001 a. 16.
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.
