To view regulations related to COVID-19, please visit whcawical.org/coronavirus for more information.
WHCA/WiCAL understands that state and federal regulations play an important role in ensuring the highest quality of care for Wisconsin’s frail elderly and persons with disabilities.
We encourage you to use the resources below to stay informed about the latest regulatory issues and quality improvement initiatives in Wisconsin.
For regulations specific to skilled nursing facilities, please click HERE.
For regulations specific to assisted living facilities, please click HERE.
Please contact WHCA/WiCAL CEO Rick Abrams for more information.
Entities must investigate and in some cases report incidents and allegations of caregiver misconduct to the Department of Health Services (DHS), Office of Caregiver Quality (OCQ). See Wisconsin Caregiver Program: Misconduct Reporting Requirements, P-63158 and the Wisconsin Caregiver Program Manual, P-00038, for a comprehensive overview of entity investigation and documentation responsibilities.
Misconduct is defined as abuse or neglect of a client, or misappropriation of a client’s property. Nursing homes participating in Medicare or Medicaid must also investigate injuries of unknown source and exploitation. These terms are defined in Misconduct Definitions, P-00976.
Caregiver means a person who is an employee or contractor of an entity, who is under the control of an entity, and who is expected to have, regular, direct contact with clients of the entity. The term also includes a person who has, or is seeking, a license, certification, registration, or certificate of approval issued or granted by DHS to operate an entity.
“Entity” means a facility, organization or service that is licensed or certified by or registered with DHS to provide direct care or treatment services to clients; or an agency that employs or contracts with an individual to provide personal care services.
Entities include:
Entities do not include:
For a full list of entities covered, please click HERE.
Refer to the following resources to determine when incidents must be reported to DHS.
In addition, the following documents are for nursing homes only:
Nursing homes are required by federal law to submit an Alleged Nursing Home Resident Mistreatment, Neglect, and Abuse Report, F-62617, including reports of injuries of unknown source and misappropriation of resident property, immediately and no later than 24 hours after discovery of the incident.
Nursing homes and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID) that are certified to receive Medicare and Medicaid funds must submit a Misconduct Incident Report, F-62447 of alleged caregiver misconduct to DQA within five working days of the incident or the date the entity knew or should have known about the incident.
All other entities must submit reports of alleged caregiver misconduct to DQA using the Misconduct Incident Report, F-62447 within seven calendar days of the incident or the date the entity knew or should have known of the incident.
The Misconduct Incident Reporting (MIR) system is a secure, web-based system for entities to submit the Alleged Nursing Home Resident Mistreatment, Neglect and Abuse Report, F-62617 and/or the Misconduct Incident Report, F-62447 forms.
How to create and register for an account
Entities must create and register an account to access the MIR system. It may take up to three business days to process a registration. Refer to DQA Misconduct Incident Reporting (MIR) System: How to Sign Up, P-02312 for instructions on completing these steps:
Step 1: Create a Wisconsin Logon Management System (WILMS) account for the regulated-entity/provider by accessing the WILMS website. Each provider may have up to two WILMS accounts for the purpose of submitting reports to the MIR system.
For assistance with WILMS, please contact helpdesk@wisconsin.gov or call 866-335-2180 and specify you are requesting assistance with the MIR system.
Step 2: Register your WILMS account with the MIR system online by completing the DQA MIR WILMS Account Registration, F-02426.
How to use the MIR system
DQA Misconduct Incident Reporting (MIR) System Entity User Instructions, P-02312A provides instructions on how to use the MIR system to submit reports.
If the MIR system cannot be accessed, reports will be accepted via postal mail, fax, or email at:
Department of Health Services
Division of Quality Assurance
Office of Caregiver Quality
PO Box 2969
Madison, WI 53701-2969
Fax: 608-264-6340
Email: DHSCaregiverIntake@wi.gov
Compliance with the detailed requirements of the Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) regulations is a challenging and burdensome task. One of the significant purposes of these federal regulations is to protect the personal health information of patients and residents; and covered employers must comply.
For help in determining whether you are covered, use CMS’ decision tool.
Click HERE to view HIPAA Privacy Tools.
Click HERE to view Risk Assessment and Security Tools.
Helping our members to improve the lives of residents and patients is our number one priority. This includes providing quality care as well as protecting and nourishing each resident. By providing a skilled nursing or assisted living center that focuses on safety, efficiency, fire prevention, and adhering to national and state health codes, our members are treating the whole person, not just their medical needs.
A fire can be an unpredictable and frightening event. But a fire that occurs in a long-term care setting can completely devastate your residents, your facility, and your entire community. The National Fire Protection Association (NFPA) mandates that all long-term care facilities have a considerable number of safety systems in place, such as fire alarms, sprinkler systems, fire doors, and evacuation plans, in order to keep everyone safe should a fire occur.
Updates
Helpful Resources
Click HERE to view Life Safety Code & Health Care Facilities Code Requirements
The Occupational Safety and Health Administration pays particular attention to LTC facilities to ensure that they comply with safety and health standards. Implementation of workplace safety and health programs is an essential factor in reducing the extent and severity of work-related injuries and illnesses. This is the key to providing a safe workplace for you and your employees.
OSHA Recordkeeping, Tools & Guidelines
The OIG (Office of Inspector General) maintains a list of individuals and entities (LEIE) that are excluded from participation in Medicare, Medicaid and other Federal health care programs. An individual or entity listed on the LEIE cannot be employed, in any capacity, by a health care provider that receives reimbursement from any Federal health care program. There are two types of exclusions — mandatory and permissive.
Mandatory exclusions require OIG to exclude individuals and entities convicted of criminal offenses such as Medicare or Medicaid fraud or patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription or dispensing of controlled substances.
Permissive exclusions give OIG discretion to exclude individuals and entities for various reasons including misdemeanor convictions related to health care fraud; fraud in a program (other than a health care program) funded by any Federal, State or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription or dispensing of controlled substances; suspension, revocation or surrender of a license to provide health care for reasons bearing on professional competence, professional performance or financial integrity; provision of unnecessary or substandard services; submission of false or fraudulent claims to a Federal health care program; engaging in unlawful kickback arrangements; defaulting on health education loan or scholarship obligations; and controlling a sanctioned entity as an owner, officer or management employee. Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP).
The General Service Administration’s (GSA) System for Award Management (SAM) contains additional information about individuals and entities that have been debarred or suspended from doing business with the federal government, and is not included in the OIG’s LEIE. Providers have an “affirmative duty” to check both the LEIE and the SAM to ensure that excluded individuals are not in their centers, otherwise they face significant fines. Some state also are now requiring providers to regularly check State exclusion lists.