Section DHS 127.03 - Licensure(1) License requirement. Only an entity that is licensed as a rural medical center by the department may establish, conduct, maintain, operate or permit to be maintained or operated, or represent and advertise by any means that it operates or provides rural medical center health care services.(2) APPLICATION. (a)Initial license. An entity that meets the definition of rural medical center under s. DHS 127.02(21) may apply to the department for a license to operate as a rural medical center. Application shall be made on a form prescribed by the department and shall include all of the following information: 1. The name or names and address or addresses of the applicant who shall be a natural person or persons.2. For all incorporated applicants, the date and state of incorporation, a copy of the articles of incorporation, tax status and, if an out-of-state corporation, evidence of authority to do business in Wisconsin.3. The location of the center's central administrative offices, the location of the center's services and the locations of any branches of those services.4. The names, principal business addresses and percentage of ownership interest of all officers, directors and stockholders owning 10% or more of stock and of all board members, partners and all other persons having authority or responsibility, directly or indirectly, for the operation of the services provided by the center, including owners of any business entity that owns any part of the land or buildings, and whether the interest is in the profits, land or buildings.5. The identities of all creditors and lessors holding a security interest in the premises, whether land or buildings.6. The names and addresses of persons serving on the center's board of directors.7. In the case of a change in ownership, disclosure of any direct or indirect relationship or connection between the applicant and the prior manager, the prior owner and the manager of the rural medical center, and between the new owner and the manager of the rural medical center.8. A detailed description of the geographic area to be served by the rural medical center.9. Descriptions of the number and types of health care services to be provided by the rural medical center, and identification of all contracted health care services and the providers of those services, including the street address and distance of each provider from the rural medical center building.10. Proof of sufficient financial resources to operate the center for at least 90 calendar days.11. Any additional information requested by the department during the department's review of the license application. Note: For a copy of the rural medical center license application form, write to the Division of Quality Assurance, P.O. Box 2969, Madison, Wisconsin 53701-2969.
(b)License modification. A rural medical center proposing to add a new health care service shall apply to the department for a revised license. Application shall be on a form prescribed by the department and shall include all of the following information: 1. The name and address of the applicant.2. Descriptions of the number and types of health care services to be provided by the rural medical center, and identification of all contracted health care services and the providers of those services, including the street address and distance of each provider from the rural medical center building.3. Any additional information requested by the department during the department's review of the license application. Note: For a copy of the form for adding a new health care service, write to the Division of Quality Assurance, P. O. Box 2969, Madison, WI 53701-2969.
(3) LICENSE FEES. (a) An application for a license or for addition of a new health care service shall be accompanied by a license fee. Pursuant to s. 50.51(2) (c), Stats., the fee for a provisional license or for a regular license not preceded by a provisional license shall be the sum of fees for the specific types of health care services provided by the rural medical center as follows: 1. The fee for provision of hospital services shall be the same as the fee assessed under s. 50.135, Stats.2. The fee for provision of nursing home services shall be the same as the fee assessed under s. 50.135, Stats.3. The fee for provision of home health services shall be the same as the fee assessed under s. DHS 133.03(3) to (6).4. The fee for provision of hospice services shall be the same as the fee assessed under s. 50.93(1) (c), Stats.(b) The department shall determine an applicant's rural medical center license fee by adding the separate fees assessed for health care services under par. (a) 1. to 4. The rural medical center license fee shall be assessed biennially, except that for a rural medical center that does not provide any of the health care services for which fees are assessed under par. (a) 1. to 4., the rural medical center license fee shall be $300 and shall be assessed for a two-year period. (c) A rural medical center applying to initiate a new health care service shall pay a fee for the new service prorated for the period of time remaining until the next biennial license fee assessment, as determined by the department.(4) REVIEW OF APPLICATION. (a)General provisions. The department shall perform a full review, an expedited review or a combined review of an application for a rural medical center license, depending on whether the applicant holds current, valid state licenses or approvals or federal certifications for the types of health care services described in the application.(b)Review types.1. `Full review.' a. If the applicant proposes to provide health care services for which the applicant does not hold current, valid state licenses or approvals or federal certifications on the date of application for a rural medical center license, the department shall conduct an inspection under par. (c) and a review under par. (d).b. If a rural medical center proposes to provide a health care service not currently listed on its license, the department shall conduct an inspection under par. (c) and a review under par. (d).c. The department shall make a determination on the application within 90 calendar days after receiving the complete application.2. `Expedited review.' If the applicant proposes to provide health care services for which the applicant holds current, valid state licenses or approvals or federal certifications on the date of application for a rural medical center license, the department shall conduct a review under par. (d) and make a determination on the application within 30 calendar days after receiving a complete application.3. `Combined review.' If the application requires both full review and expedited review under this subsection, the department shall make a determination on the application within 90 calendar days after receiving a complete application.(c)Inspection. Pursuant to s. 50.52(2) (b) to (c), Stats., the department may conduct an inspection of each of the health care services that the applicant proposes to provide, except that the department in lieu of conducting an inspection may accept evidence that for a specific type of health care service the applicant meets one of the following requirements:1. Has current, valid state licensure or approval and is in good standing as described in par. (d) 6. to operate as a hospital, a nursing home, a hospice or a home health agency applicable to the types of health care services that the applicant proposes to provide as a rural medical center.2. Has a current, valid agreement and is in good standing as described in par. (d) 6. to participate as an eligible provider in medicare for the types of health care services that the applicant proposes to provide as a rural medical center.3. Is a critical access hospital in good standing as described in par. (d) 6.(d)Review criteria. The department shall review an application and make a determination on whether to issue a license based on all of the following criteria: 1. Whether the applicant has supplied all information required or requested by the department under sub. (2).2. Whether the applicant proposes to provide health care services.3. Whether the applicant qualifies as a rural medical center.4. Whether the applicant is operating in compliance with the provisions of this chapter or is able to comply with the provisions of this chapter, as determined by the inspection under par. (c) where applicable.5. For the proposed provision of hospice or nursing home services, whether the applicant is fit and qualified under s. DHS 131.14(3) (b) for hospice services or s. DHS 132.14(4) (b) for nursing home services.6. Whether the applicant is in good standing. In making its determination of good standing, the department may review the information contained in the application and any other relevant documents, including but not limited to survey and complaint investigation findings for each health care services provider with which the applicant is or was affiliated during the past 5 years. The department shall also conduct a background check of the applicant as required by ch. DHS 12. The department shall consider all of the following: a. Any outstanding adverse action or state class "A" or "B" violations as defined by s. 50.04(4) (b) 1 and 2., Stats., against the applicant.b. The frequency of any noncompliance with state licensure or approval or federal certification laws in the applicant's operation of health care services in this or any other state.c. Any conviction of the applicant for a crime related to the delivery of health care services or items, providing health care services without a license, controlled substances violations, neglect or abuse of patients or residents or assaultive behavior or wanton disregard for the health or safety of others. If the applicant is a corporation, the background check consideration applies to the chief executive officer, each officer or director of the corporation and each owner, directly or indirectly, of any equity security or other ownership interest in the corporation. This restriction does not apply if the corporation has terminated its relationship with the convicted administrator, officer, director or owner.d. Any knowing or intentional failure or refusal by the applicant to disclose required ownership information.e. Any prior financial failures of the applicant, including but not limited to those related to bankruptcy or to the closing of a health care services entity or the moving of its patients or residents.(5) LICENSE ISSUANCE. (a)General provisions.1. If the department approves an application following its review under sub. (4), the department shall issue either a provisional license under par. (c) or a regular license within the time period for the applicable type of review under sub. (4) (b), provided that the applicant pays the license fee under sub. (3).2. The license shall bear the name and address of the rural medical center and the name and address of the applicant and identify the types of health care services that the center is licensed to provide.3. The license shall state any applicable conditions and restrictions, including maximum bed capacity and the level of care that may be provided, and any other limitations that the department finds necessary and appropriate.4. A license shall be issued exclusively for the rural medical center applicant named in the application and may not be transferred or assigned. A licensee shall fully comply with all requirements and restrictions of the license. When there is a change in the ownership of the rural medical center, the new operator shall submit a new application to the department.5. Rural medical center licensees shall surrender to the department all single-service licenses or other approvals held for the types of health care services identified in the rural medical center license.(b)Regular license. A regular license is valid until it is suspended or revoked.(c)Provisional license.1. If an approved applicant is not currently licensed by the department or certified by the federal government to provide one or more of the health care services that the applicant seeks to provide as a rural medical center, the department shall issue the applicant a provisional license.2. A provisional license is valid for 6 months from the date of issuance per s. 50.52(4), Stats.3. A rural medical center with a provisional license shall submit an application for a regular license to the department so that it is received by the department at least 45 calendar days before expiration of the provisional license. If an application for a regular license is not received by that date, the provisional license shall lapse as of the date of its expiration. If the department does not make a favorable determination under sub. (4) on the application for a regular license, the department may not issue a regular license. Expiration of a rural medical center's provisional license does not affect other licenses, approvals or certifications maintained by the entity.(6) REPORTING OF CHANGES. (a)Changes requiring notice.1. The licensee shall notify the department in writing of any changes that affect the continuing accuracy and completeness of the information required under sub. (2) (a). If the rural medical center provides nursing home services, any change in ownership shall be reported to the department in writing at least 30 calendar days prior to the change.2. The licensee shall notify the department in writing of any changes in the administrator of the nursing home service within 2 business days of the change.3. The licensee shall notify the department in writing of any changes in the director of nursing of the nursing home service within 2 business days of the change.(b)Changes requiring new application. An application for a new license shall be submitted to the department within 30 calendar days after any of the following: 1. The licensee transfers title of the rural medical center, regardless of whether the transfer includes title to the real estate.2. In a partnership, the removal, addition or substitution of an individual as a partner or the dissolving of an existing partnership and the creation of a new partnership.3. The operator has relinquished management of the rural medical center.(7) DENIAL, SUSPENSION OR REVOCATION. (a)Action.1. `Denial.' The department shall deny an application for an initial rural medical center license or for modification of a license to provide an additional health care service to any applicant not receiving a favorable license application determination under sub. (4) or failing to pay the license fee under sub. (3). The department shall provide written notice to the applicant within 45 calendar days after receipt of the complete application. If the department denies an application for a license or for authorization to provide a specific type of health care service for the sole reason that the applicant has an outstanding adverse action and the cause of the adverse action is subsequently corrected, the department shall issue the license within 30 calendar days after receiving notice from the applicant that the cause of the adverse action has been corrected, provided that the application is otherwise complete and the applicant pays the license fee under sub. (3).2. `Suspension or revocation.' a. Non-emergency. The department, after providing written notice to the licensee, may suspend or revoke a rural medical center license or authorization to provide a specific type of health care service if the department determines that the rural medical center has substantially failed to comply with the requirements of ss. 50.50 to 50.56, Stats., or this chapter. Except as provided in subd. 2. b., the department shall provide written notice to the licensee of the suspension or revocation at least 30 days before the suspension or revocation is to take effect.b. Emergency. The department may, in the event of an emergency condition that imminently threatens the health, safety or welfare of rural medical center patients or residents, order summary suspension of new admissions to all or part of the rural medical center or order summary suspension of the rural medical center's authorization to provide a specific type of health care service until such time as the department decides that the rural medical center has removed or corrected the causes or violations creating the emergency.(b)Contents of notice. In a notice of denial, suspension or revocation under par. (a), the department shall state the reasons for its action and specify the statute or rule and facts that constitute any violation or noncompliance. The notice shall identify the process under par. (g) for an appeal of the denial, suspension or revocation. (c)Return receipt. If the department receives a return receipt for the notice sent under par. (a), the return receipt is conclusive evidence that the addressee received the notice. If the department does not receive a return receipt for the notice sent under par. (a), the addressee shall be presumed to have received the notice on the fifth calendar day after the date the notice was mailed. (d)Effective date.1. Subject to s. 227.51, Stats., a denial, suspension or revocation is effective on the date set by the department in the notice of denial, suspension or revocation, on the date of expiration of an existing license, except that:a. In the event of a contested case hearing pursuant to s. 227.42, Stats., the effective date is the date of final action.b. In the event of judicial review pursuant to s. 227.52, Stats., or a stay granted under s. 227.54, Stats., the effective date is the date of final action.2. The department may delay the effective date of license revocation in order to permit orderly removal and relocation of patients or residents served by the rural medical center.(f)Effect on other licenses, approvals, certifications or health care services. The department's denial, suspension or revocation of an application, license or authorization to provide a specific type of health care service shall have no bearing on any other license, approval or certification of health care services maintained in good standing as specified under sub. (4) (d) 6., unless the applicant ceases to qualify as a rural medical center.(g)Appeal of denial, suspension or revocation. An applicant or licensee may request a hearing under ch. 227, Stats., to appeal the department's decision to deny, suspend or revoke the application or license. The request for hearing shall be in writing and filed in the department of administration's division of hearings and appeals within 10 working days after receipt of the notice of denial under par. (a) 1. or of suspension or revocation under par. (a) 2. A request for a hearing is considered filed on the date of its receipt by the division of hearings and appeals. Review of the department's decision by that office is not available if the request for a hearing is received more than 10 working days after the date that the applicant or licensee receives the notice of denial, suspension or revocation of the license. Wis. Admin. Code Department of Health Services DHS 127.03
Cr. Register, February, 1999, No. 518, eff. 3-1-99; corrections in (2) (a), (3) (a), (4) (d) 5. and 6. made under s. 13.92(4) (b) 7, Stats., Register January 2009 No. 637; correction in (3) (a) 4. made under s. 13.92(4) (b) 7, Stats., Register December 2010 No. 660; correction in (3) (a) 4. made under s. 13.92(4) (b) 7, Stats., Register January 2011 No. 661.A hearing request should be sent or may be delivered to the Department of Administration's Division of Hearings and Appeals, 5005 University Avenue, Suite 201, Madison, Wisconsin, 53705-5400.