DHS 131.14(2)(b)5.5. A listing of those hospice services provided directly by the hospice, and those hospice services provided through a contractual agreement.

DHS 131.14(2)(b)7.7. Evidence to establish that the applicant has sufficient resources to permit operation of the hospice for a period of at least 90 days.

DHS 131.14(2)(b)8.8. Any additional information specified by the department as necessary to determine that the entity detailed in the application is a hospice and that the applicant is and is fit and qualified to operate it.

DHS 131.14(2)(c)(c) The applicant shall submit the application form to the department accompanied by the applicable fee established under s. 50.93 (1) (c), Stats.

DHS 131.14 NoteNote: To obtain an application form for a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, Department of Health Services, P.O. Box 2969, Madison, WI 53701-2969 or telephone (608) 266-2702. The completed application form should be sent to the same office.

DHS 131.14(3)(3) Review of the application.

DHS 131.14(3)(a)(a) Investigation. After receiving a complete application, the department shall investigate and inspect the applicant to determine if the applicant is fit and qualified to be a licensee and to determine if the applicant is able to comply with this chapter. An applicant that is currently certified as meeting conditions for medicare participation under 42 USC 1395 to 1395ccc, need not be investigated or inspected as a condition for issuance of a license.

DHS 131.14(3)(b)(b) Fit and qualified. In making its determination of the applicant’s fitness, the department shall review the information contained in the application and shall review any other documents that appear to be relevant in making that determination, including survey and complaint investigation findings for each health care provider with which the applicant is affiliated or was affiliated during the past 5 years. The department shall consider at least all of the following:

DHS 131.14(3)(b)1.1. Any adverse action against the applicant by the licensing agency of this state or any other state relating to the applicant’s operation of a hospice, home health agency, residential facility or health care facility. In this subdivision, “adverse action” means an action initiated by a state licensing agency which resulted in the denial, suspension or revocation of the license of a hospice, home health agency, residential facility or health care facility operated by the applicant.

DHS 131.14(3)(b)2.2. Any adverse action against the applicant based upon noncompliance with federal statutes or regulations in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state. In this subdivision, “adverse action” means an action by a state or federal agency which resulted in civil money penalties, termination of a provider agreement, and suspension of payments or the appointment of temporary management of a hospice, home health agency, residential facility or health care facility operated by the applicant.

DHS 131.14(3)(b)3.3. The frequency of noncompliance with state licensure and federal certification laws in the applicant’s operation of a hospice, home health agency, residential facility or health care facility in this state or any other state.

DHS 131.14(3)(b)4.4. Any denial, suspension, enjoining or revocation of a license that the applicant had as a health care provider as defined in s. 146.81 (1), Stats., or any conviction of the applicant for providing health care without a license.

DHS 131.14(3)(b)5.5. Any conviction of the applicant for a crime involving neglect or abuse of patients, or involving assaultive behavior, wanton disregard for the health or safety of others or any act of elder abuse under s. 46.90, Stats.

DHS 131.14(3)(b)9.9. Any prior financial failure of the applicant that resulted in bankruptcy or in the closing of a hospice, home health agency or an inpatient health care facility or the relocation of its patients.

DHS 131.14(4)(4) Provisional license. After receiving a complete application for a new license, the department shall investigate the applicant to determine the applicant’s ability to comply with this chapter. Prior to completing its investigation or if the hospice is not in operation at the time that application is made, the department may issue a provisional license. Unless sooner revoked or suspended, a provisional license shall be valid for no more than 24 months from the date of issuance.

DHS 131.14(5)(5) Regular license.

DHS 131.14(5)(a)(a) The department shall inspect a hospice prior to issuing a regular license unless sub. (3) (a) applies and the hospice need not be inspected.

DHS 131.14(5)(b)(b) During the provisional period specified in sub. (4), the hospice shall actively serve at least 5 patients in Wisconsin. At the time of this inspection the hospice shall be actively providing services to at least 3 patients and be able to demonstrate the operational capability of all the facets of the program in order to be issued a regular license.

DHS 131.14(7)(7) Ongoing licensure.

DHS 131.14(7)(b)(b) Every 12 months, on a schedule determined by the department, the hospice submits an annual report to the department in the form and containing the information that the department requires, including payment of the applicable fee specified in s. 50.93 (1) (c), Stats. If a complete annual report is not timely filed, the department shall issue a warning to the licensee. If a hospice that has not filed a timely report fails to submit a complete report to the department within 60 days after the date established under the schedule determined by the department, the department may revoke the license.

DHS 131.14 NoteNote: To obtain an application form for renewal of a license, write the Bureau of Technology, Licensing and Education, Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969 or telephone (608) 266-2702.

DHS 131.14(8)(8) Action by the department. Within 60 days after receiving a complete application for a license the department shall either approve the application and issue a license or deny the application. The department shall deny a license to any applicant who has a history, determined under sub. (3) (b) 1. to 3., of substantial noncompliance with federal or this state’s or any state’s requirements, who fails under sub. (3) (b) 4. to 9. to qualify for a license, or who is found not in substantial compliance with this chapter. If the application for a license is denied, the department shall give the applicant reasons, in writing, for the denial and shall identify the process under sub. (11) for appealing the denial.