In July of 2016, through 2013 Wisconsin Act 236 (Act 236), many of the regulatory provisions of Wis. Admin. Code DHS 124, Wisconsin’s long-standing hospital regulations, were sunset and replaced with the Medicare Conditions of Participation for hospitals (CoPs) as the minimum standards, enforceable by the Department of Health Services (the Department). However, the administrative provisions detailing the approval and plan review processes, fees, waivers and variances, requirements relating to Critical Access Hospitals (CAHs) were retained. Moreover, the Department retained the ability to promulgate additional rules, if necessary,Th to provide safe and adequate care and treatment of hospital patients and to protect the health and safety of the patients and employees.
Effective July 1, 2020, the Department issued updated requirements under DHS 124 applicable to hospitals, which the Department determined are necessary to ensure a safe and adequate environment for hospital patients and employees and to protect the health and welfare of the patients and employees. We have summarized some of the key changes below.
Waivers and Variances
Hospitals may request waivers and variances of the rules under DHS 124 as necessary to protect the public health, safety, or welfare or to support the efficient and economic operation of the hospital. The revisions seek to clarify the circumstances under which a waiver or variance would be seen to support the efficient and economic operation of the hospital; that is (1) strict enforcement would result in unreasonable hardship on the hospital or on a patient; or (2) an alternative to a rule is in the interest of better care or management.
Statements of Deficiency and Plans of Correction
The new rules provide that the Department may issue a statement of deficiencies for violations of the statutory administration and requirements of hospitals and the process of responding to the Department with a plan to correct these violations. Specifically, hospitals are required to submit a plan of correction within ten calendar days, including holidays and weekends, after receiving the statement.
Patient Rights and Responsibilities in CAHs
While the Department is required to use and enforce the CoPs as minimum standards, the CoPs do not directly address patient rights in the CAH setting. The new rules implement new patient rights and responsibilities applicable to CAHs, which are substantially similar to those previously applicable to hospitals prior to the sunset of those provisions of DHS 124 under Act 236.
Maternity and Neonatal Care
The Department promulgated new rules to address the care and treatment of maternity patients and newborns regarding personnel, admissions, patient placement and transfer, delivery, security, labor inducing medication and nursery.
Freestanding Emergency Departments
The updated rules define what qualifies as a “freestanding emergency department” and provides for requirements relating to the physical environment, personnel, ancillary services, and ambulance delivery requirements in freestanding emergency department settings. A “freestanding emergency department” is defined as a “dedicated location that is physically separate from a hospital campus that offers inpatient overnight care, with services and staff organized primarily for the purpose of delivering emergency medical services without requiring a previously scheduled appointment.” Wis. Admin. Code DHS 124.09.
Changes to the rules relating to the physical environment now incorporate the provisions of the Life Safety Code (LSC) adopted into the CoPs.
Construction Plans and Fees for Plan Review
The rules now establish standards for plan reviews and prescribe a fee schedule for providing plan review services. The Fee Table is located here.