Wisconsin Hospice Application
Process
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Hospices must be licensed
in Wisconsin prior to obtaining Medicare or Medicaid certification.
NOTE
TO APPLICANTS: INITIAL SURVEYS FOR MEDICARE PARTICIPATION:
S&C Memo
08-03: Initial Surveys for New
Medicare Providers (PDF,
103 KB)
IMPORTANT NOTE: THE INITIAL LICENSURE
PROCESS MAY TAKE SIX MONTHS TO COMPLETE Interim
Survey Guidance (PDF 29 KB)
The issuance of a state license to operate a hospice
in Wisconsin is separate from the Medicare provider enrollment and certification
process.
THE FEDERAL MEDICARE CERTIFICATION PROCESS MAY TAKE
AN ADDITIONAL SIX MONTHS TO COMPLETE
State
Licensure
Application
for Provisional License:
As a hospice applicant, you are required to complete
an application, pay fees and submit supporting documentation in the
form of policies & procedures that will demonstrate your compliance
with Wisconsin regulatory requirements, including:
- You
must complete an application which may be obtained from the
Hospice Licensing Specialist who can be reached at 608-266-2702.
- Demonstrate
compliance with Caregiver Background Check Process
- Demonstrate
compliance with WI Stats., Chp 50.09(2) Licensing Requirement for fit
and qualified
- Submit
required application fees
- Demonstrate,
via submission of policy/procedures and patient care documentation,
compliance with WI Administrative Rule
requirements: HFS 131 –
Hospice
- Demonstrate,
via submission of policies/procedures compliance with WI
Administrative Rule HFS 13: Reporting and Investigation of Caregiver
Misconduct
Issuance of
Provisional License:
Wisconsin has a two-tier provisional license application review process.
The first review determines whether an applicant is fit and
qualified, and includes an analysis of a variety of factors; financial
solvency, personnel qualifications; including criminal background checks,
payment of required fees, if applicable, history of operating a hospice in
other states, and documentation that demonstrates the provision of the
following required hospice services:
- Nursing
care by a registered nurse
- Medical
Services – A medical director who is a medical doctor or a
doctor of osteopathy
- Social
Services – Based on qualifications of HFS 131.43(3)(c)
- Bereavement
services by qualified individuals
Following a determination of whether the applicant is
fit and qualified, the second tier review is completed by a Registered
Nurse (RN) who will review the applicant’s copies of policies and
procedures to determine whether they meet administrative rule requirements
of HFS 131 and HFS
13. The RN
will consult with the applicant during this review.
When tier one and tier two reviews are complete and satisfy code
requirements, a 2-year provisional license will be recommended.
NOTE: If
seeking Medicare certification, you must request application materials and
take measures to assure compliance with all Medicare Conditions of
Participation.
Regular
License and Medicare Certification Process:
Before expiration of the 24-month provisional
license, the hospice licensee must receive an on-site survey by the
Division of
Quality Assurance to determine compliance with all WI Administrative rule
requirements. If not, the
provisional license automatically expires and the licensee is required to
discharge all patients from service.
At this survey, the Division of Quality Assurance will
evaluate the licensee’s compliance with the Medicare Conditions of
Participation for Hospice. This
assumes the licensee has made appropriate application for Medicare
certification and has received notice of federal fiscal intermediary
clearance (CMS 855).
Before an unannounced survey is scheduled, the
licensee must provide a written request for the on-site survey and provide
written evidence that demonstrates you meet the following criteria:
- Admitted
at least 5 patients; 3 must be active patients at the time of survey.
- Provide
evidence that licensee will provide services to patients residing in
their homes and not limited to patients residing in nursing homes,
CBRFs, assisted living facilities or inpatient facilities.
- Hired
all required personnel and each has been fully oriented to their job
responsibilities.
- Provide
signed copies of all required contracts.
- Provide
copies of 3 patient care plans; including the patient’s initial plan
of care, and subsequent integrated plans of care.
The written request for the on-site survey; including
submission of the above documents, must be sent to: Hospice Licensing Specialist,
Division of Quality Assurance, Post Office
Box 2969, Madison, WI 53701-2969.
Upon successful completion of the on-site survey, and
a determination made whether the licensee is in substantial compliance
with the administrative rules, a regular, non-expiring license will be
issued. This regular license
will remain in effect unless voluntarily surrendered by the licensee, a
change of owner occurs, or the license is revoked or suspended by the
Department.
The results of the initial Medicare certification
survey will be forwarded to the Centers for Medicare/Medicaid Services
(CMS) with a recommendation regarding certification.
CMS will notify the licensee of their effective date of
participation in the Medicare program.
Residential
Free-Standing Hospice and/or Freestanding Inpatient Facility
Wisconsin Administrative Rule addresses the physical
plant requirements for a hospice facility that will serve three or more
patients not located in a licensed hospital or nursing home.
HFS 131, Subchapter V – Physical Environment outlines the
requirements. These provisions
apply to all new, remodeled and existing construction unless otherwise
noted.
You will be required to submit a plan review to the
Department for approval before
construction is started:
- A
copy of the preliminary or schematic plan
- A
copy of the final plans and specifications
Please visit Plan Review for HealthCare Facilities
Medicare Certification (Optional)
In order to become certified in the Medicare Program, an agency must
first meet State of Wisconsin licensing requirements
and obtain a provisional license. The hospice must also meet the
following:
Hospice
Information Resource for Medicare (exit DHS)
42 CFR 418, Hospice Conditions of Participation, Code
of Federal Regulations (exit DHS)
Medicare Definition of Hospice:
- Hospices limiting their scope of services to treating only patients
in residential facilities do not meet the definition of hospice as
defined by Medicare.
- Section 1861(dd)(2)(A)(ii) of the Social Security Act defines a
hospice program as a public agency or private organization which
provides for such care and services in individuals' homes, on an
outpatient basis, and on a short-term inpatient basis.
- Entities that only provide hospice services to their residents and
exclude outpatients do not meet this definition and may not
participate in the Medicare program as a hospice.
- This determination may also apply to hospices serving patients only
in residential facilities which are not owned directly by the hospice.
Hospice care is an essential Medicare benefit that focuses on the
patient and family, and special support to the dying.
Medicare is committed to ensuring that all beneficiaries receive
appropriate care tailored to their own needs at the end of life and that
they understand their rights and options.
It was not intended to limit services to a select group of people or to
place any barriers to the provision of care.
Core Services Requirements:
A. You must directly furnish all of the following:
- Nursing care by or under the supervision of a registered nurse
- Medical Social Services by a qualified social worker under the
direction of a physician
- Physician Services
- Counseling, including, but not limited to bereavement, spiritual and
dietary counseling
B. The following services may be provided either directly or
under arrangement by the hospice:
- Physical therapy, occupational therapy, speech-language pathology
and dietary services
- Services of a home-health aide who successfully completed a training
program approved by the Secretary
- Medical supplies and the use of medical appliances
- Short term inpatient care
- Homemaker/Companion services
Federal Forms - Complete and submit:
All forms to be submitted to Division of Quality
Assurance, Hospice Licensing Specialist, PO Box 2969,
Madison, WI 53701-2969.
Survey Process
State Licensure:
A regular state licensure survey will be conducted at the same time as
the initial Medicare survey to ensure the agency is meeting the
requirements in Wisconsin Administrative Code HFS 131.
If it is determined that all requirements have been met, a non-expiring
regular state license will be issued. The license will remain in effect
unless voluntarily surrendered by the licensee, a change of owner occurs,
or the license is revoked or suspended by the Department.
Medicare Certification:
An initial Medicare on-site survey will be performed by a surveyor, who
will inspect the facility, interview you and members of your staff, review
documents, and perform other procedures necessary to evaluate your
agency's compliance with the Conditions of Participation.
Full Operation Letter - Prepare and submit a written
notification once the hospice is in "full operation," i.e., the
agency has provided services to patients and has records to review. Do
this:
- once the agency is operational
- has served at least five (5) patients
- at least three (3) patients remain active
- the CMS 855 enrollment application has been completed
- agency has been approved by the fiscal intermediary
Notice of anticipated date of full operation is not sufficient.
This notification is required in order to signal that your agency is
ready for a state and federal onsite survey to determine if all conditions
of participation and compliance with HFS 131 rules are met.
It is important to remember that a survey will not be
scheduled until the notification is received.
The notification should be sent to Hospice Licensing Specialist,
Division of Quality Assurance, Post Office
Box 2969, Madison, WI 53701-2969.
Following the survey, the Wisconsin Department of Health and Family
Services will recommend to the U.S. Department of Health and Human
Services (DHHS) whether the agency is to be certified in the Medicare
program.
If denied Medicare approval, notification will be sent identifying the
reasons for denial, with information about rights to appeal the decision.
Medicaid Certification with the Wisconsin
Medical Assistance (Medicaid) Program (WMAP) - OPTIONAL
If you are interested in becoming a certified provider with the WMAP,
you are encouraged to apply at the same time that you apply to Medicare.
See Wisconsin
Medicaid provider certification packets - Scroll down to Home Health
Agencies
If the completed application for the WMAP is returned within thirty
(30) days of the date the blank application was mailed to the applicant,
the certification effective date with the WMAP will be the same as the
effective date with the Medicare program.
- Delays in applying to the WMAP may result in assignment of a later
certification effective date.
Application materials can be obtained by writing to EDS, Attention:
Provider Maintenance, 6406 Bridge Road, Madison, WI 53713, or by
calling 1-800-947-9627 (in-state toll free) or (608) 221-9883.
Licensee
Change of Ownership:
If operation of the hospice is later transferred to
another owner, ownership group, or to a lessee, the licensee is required
to notify the Office of Quality Assurance at the time they are planning a
change-of-ownership transfer as the license
is non-
Documentation must be submitted to the Office of
Quality Assurance to officiate the change of owner.
Change of Ownership
If operation of the hospice
is later transferred to another owner, ownership group, or to a
lessee, the Health Insurance Benefits Agreement will be transferred.
See Rules_&_Regulations
for hospices:
-
Wisconsin Statutes, Chapter 50.90
-
Wisconsin Administrative
Code, HFS 131 - Hospice Rules
-
Please review and submit
Policies and Procedures Necessary to
meet HFS 131
-
A nonrefundable fee
of $300.00 must be included with your application as required under
HFS 131.14(1), except that:
- The fee for a hospice that is a nonprofit corporation and
is served entirely by uncompensated volunteers or employs
persons in not more than 1.5 positions at 40 hours of employment
per week shall be $25; and
- The fee for a hospice that is a nonprofit organization,
that is served entirely by uncompensated volunteers and
that charges no fees may be waived by the department upon
request.
Your check should be made payable to the Division
of Disability and Elder Services.
-
Caregiver
Background Check Process - A background check is completed
on all signatories and interested parties having access to clients.
-
Select the appropriate section, "New
Applicant" or "Existing License Holder."
-
Complete and return HFS 64A and HFS 69A.
-
Review Chapters 1 and 2
in the "Caregiver Program Manual" concerning the fees
and process of employees' background checks.
The applications, fees, and forms should be sent to: Hospice Licensing
Specialist, Division of Quality Assurance,
Post Office Box 2969, Madison, WI 53701-2969.
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Last Revised: June 30, 2008 |
