Section 106.065. Involuntary termination and alternative sanctions for home care providers.

 

(1)   Termination.

(a) The department may terminate a home care provider's certification to participate in the MA program for failure to comply with the requirements of s. DHS 105.19 , 107.11 , 107.113 or 107.12 , as applicable, or for any of the reasons described in s. DHS 106.06 after reasonable notice and opportunity for a hearing under s. DHS 106.12 (4) .

(b) The department shall provide at least 15 working days advance notice of termination to the provider, except at least 5 calendar days advance notice to providers is required in situations where the recipient's health and safety is in immediate jeopardy.

(c) Any provider terminated under this section shall have 30 calendar days from the date of termination of certification to make alternative care arrangements for MA recipients under the provider's care before the effective date of termination. After the 30-day period, MA payment for services provided will cease, except for payments to providers terminated in immediate jeopardy situations. In immediate jeopardy situations, as determined by the department, the department may make alternative care arrangements to preserve continuity of care and for the protection of the recipient.

(2)   Alternative sanctions.

(a) In the event the department finds it more appropriate to take alternative action to termination of certification under sub. (1) to ensure compliance with program requirements, it may impose one or more sanctions under par. (b) for no more than 6 months following the last day of the department's review of the provider. If, at the end of the 6 month period, the provider continues to not comply with the MA program requirement or requirements, the provider shall be terminated from MA program participation under sub. (1) .

(b) The department may apply one or several of the following sanctions:

1. Suspension of payment for new admissions;

2. Suspension of payments for new admissions who require particular types of services;

3. Suspension of payments for any MA recipient requiring a particular type of service;

4. A plan of correction prescribed by the department;

5. Provider monitoring by the department;

6. Appointment of a temporary manager; or

7. Any of the sanctions described in s. DHS 106.07 (4) .

(c) In determining the most effective sanctions to be applied to a non-compliant provider, the department shall consider:

1. The severity and scope of noncompliance;

2. The relationship of several areas of the deficiencies or noncompliance;

3. The provider's previous compliance history, particularly as it relates to the insufficiencies under consideration;

4. Immediate or potential jeopardy to patient health and safety;

5. The direct relationship to patient care; and

6. The provider's financial condition.

(d) The department may revisit the provider during the sanction period. Termination procedures may be initiated as a result of the review conducted during the revisit if substantial noncompliance is found to persist, or if recipient safety is potentially or actually compromised.

History: Cr. Register, February, 1993, No. 446 , eff. 3-1-93; corrections in (1) (a) made under s. 13.92 (4) (b) 7. , Stats., Register December 2008 No. 636 .