Wis. Admin. Code Department of Health Services DHS 105.09 - Medicare bed requirement
(1) DEFINITION. In
this section, "sufficient number of medicare-certified beds" means a supply of
beds that accommodates the demand for medicare beds from both the home county
and contiguous counties so that no dual eligible recipient is denied access to
medicare SNF benefits because of a lack of available beds. In this subsection,
"dual eligible recipient" means a person who qualifies for both medical
assistance and medicare.
(2)
MEDICARE BED OBLIGATION. Each county shall have a sufficient number of skilled
nursing beds certified by the medicare program pursuant to ss.
49.45(6m) (g)
and 50.02(2),
Stats. The number of medicare-certified beds required in each county shall be
at least 3 beds per 1000 persons 65 years of age and older in the
county.
(3) PENALTY.
(a) If a county does not have sufficient
medicare-certified beds as determined under sub. (1), each SNF within that
county which does not have one or more medicare-certified beds shall be subject
to a fine to be determined by the department of not less than $10 nor more than
$100 for each day that the county continues to have an inadequate number of
medicare-certified beds.
(b) The
department may not enforce penalty in par. (a) if the department has not given
the SNF prior notification of criteria specific to its county which shall be
used to determine whether or not the county has a sufficient number of
medicare-certified beds.
(c) If the
number of medicare-certified beds in a county is reduced so that the county no
longer has a sufficient number of medicare-certified beds under sub. (1), the
department shall notify each SNF in the county of the number of additional
medicare-certified beds needed in the county. The department may not enforce
the penalty in par. (a) until 90 days after this notification has been
provided.
(4) EXEMPTIONS.
(a) In this subsection, a "swing-bed
hospital" means a hospital approved by the federal health care financing
administration to furnish skilled nursing facility services in the medicare
program.
(b) A home or portion of a
home certified as an ICF-IID is exempt from this section.
(c) The department may grant an exemption
based on but not limited to:
1. Availability
of a swing-bed hospital operating within a 30 mile radius of the nursing home;
or
2. Availability of an adequate
number of medicare-certified beds in a facility within a 30 mile radius of the
nursing home.
(d) A
skilled nursing facility located within a county determined to have an
inadequate number of medicare-certified beds and which has less than 100 beds
may apply to the department for partial exemption from the requirements of this
section. An SNF which applies for partial exemption shall recommend to the
department the number of medicare-certified beds that the SNF should have to
meet the requirements of this section based on the facility's analysis of the
demand for medicare-certified beds in the community. The department shall
review all recommendations and issue a determination to each SNF requesting a
partial exemption.
Notes
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