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.
To view regulatory resources that are applicable for both skilled nursing and assisted living facilities (i.e. Life Safety Code, OSHA), click HERE.
Please contact WHCA/WiCAL Vice President of Government Relations and Regulatory Affairs Jim Stoa for more information.
“Nursing home” as defined under Wisconsin State Statute, is a place where 5 or more persons who are not related to the operator or administrator reside, receive care or treatment and, because of their mental or physical condition, require access to 24-hour nursing services, including limited nursing care, intermediate level nursing care and skilled nursing services.
“Nursing home” does not include any of the following:
View Waivers and Variances: Long-Term Care for information to submit a request.
If you have questions about the waiver or variance process, email Elizabeth Laubenstein or call 608-266-2966.
In October 2016, the Centers for Medicare and Medicaid Services (CMS) published a final rule making significant changes to the Medicare and Medicaid Requirements of Participation (RoP) for nursing centers. This represents the first comprehensive revision to the regulations since 1991.
Click HERE for additional information about the background of the final rule, frequently asked questions, and other related resources from CMS.
The Electronic Code of Federal Regulations (e-CFR) is a web version of the Code of Federal Regulations (CFR) that we update daily to better reflect its current status. The e-CFR is an editorial compilation of CFR material and amendments published in the daily Federal Register. Nursing home regulations can be found in 42 CFR 483.5, 42 CFR 483.10 through 483.75.
The Centers for Medicare and Medicaid Services (CMS) issued the revised State Operations Manual for Long-Term Care Facilities Appendix PP Guidance to Surveyors dated 11-23-2017. Click HERE to view the manual.
The Department of Health Services, Division of Quality Assurance, Bureau of Nursing Home Resident Care (BNHRC) is responsible for conducting unannounced health care surveys of nursing homes and facilities serving persons with developmental disabilities (FDDs – also known as Intermediate Care Facilities for Individuals with Intellectual Disabilities, ICF/IID).
In addition, BNHRC conducts complaint investigations, and makes care level determinations for persons receiving medical assistance in the community or in nursing homes and FDDs.
Nursing home surveys are conducted in accordance with survey protocols and Federal requirements to determine whether a citation of non-compliance appropriate.
The survey protocols and interpretive guidelines serve to clarify and/or explain the intent of the regulations. All surveyors are required to use them in assessing compliance with Federal requirements. Deficiencies are based on violations of the regulations, which are to be based on observations of the nursing home’s performance or practices.
Click HERE for FAQs related to Long-Term Care Regulations, Survey Process, and Training.
Immediate Jeopardy (IJ) represents a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death. These situations must be accurately identified by surveyors, thoroughly investigated, and resolved by the entity as quickly as possible. In addition, noncompliance cited at IJ is the most serious deficiency type, and carries the most serious sanctions for providers, suppliers, or laboratories (entities). An immediate jeopardy situation is one that is clearly identifiable due to the severity of its harm or likelihood for serious harm and the immediate need for it to be corrected to avoid further or future serious harm.
Click HERE for State Operations Manual Appendix Q: Core Guidelines for Determining Immediate Jeopardy.
Click HERE for F-02544: Nursing Home Immediate Jeopardy (IJ) Removal Plan.
Click HERE for the CMS Immediate Jeopardy Template.
A statement of deficiency document uses a federal tag numbering system that addresses the degree to which a facility meets minimal federal standards.
F-tags correspond to specific stipulations within the Code of Federal Regulations. Facilities that receive F-tags are required to display them in a public location within the facility and reported on federal websites and databases.
Click HERE for a list of revised F-Tags.
A CMP is a monetary penalty the Centers for Medicare & Medicaid Services (CMS) may impose against nursing homes for either the number of days or for each instance a nursing home is not in substantial compliance with one or more Medicare and Medicaid participation requirements for long-term care facilities. A portion of CMPs collected from nursing homes are returned to the states in which CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life.
CMP funds may be used for (but not limited to) the following:
Click HERE for CMP Fund FAQs.
Click HERE for the Wisconsin Nursing Home Grant Program.
Applications will be reviewed to verify requests for equipment are within parameters established by CMS. Facilities will receive an approval letter from DQA with instructions on how to submit invoices for payment.
Click HERE for the project proposal application.
Please direct questions to: DHSDQAFiscal@dhs.wisconsin.gov.
On September 8, 2016 CMS published in the Federal Register the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule. The regulation became effective November 16, 2016. Health care providers and suppliers affected by this rule were to be compliant and implement all regulations one year after the effective date, on November 15, 2017.
The Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers regulation outlines four core elements which are applicable to all 17 provider types, with a degree of variation based on inpatient versus outpatient, long-term care versus non long-term care.
Four Core Elements of Emergency Preparedness
Click HERE for CMS emergency preparedness requirements by provider type.
Click HERE for the State Operations Manual Appendix Z: Emergency Preparedness for All Provider and Certified Supplier Types Interpretive Guidance.
When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act and the HHS Secretary declares a public health emergency under Section 319 of the Public Health Service Act, the Secretary is authorized to take certain actions in addition to her regular authorities. For example, under section 1135 of the Social Security Act, she may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods and that providers who provide such services in good faith can be reimbursed and exempted from sanctions (absent any determination of fraud or abuse). Examples of these 1135 waivers or modifications include:
These waivers under section 1135 of the Social Security Act typically end no later than the termination of the emergency period, or 60 days from the date the waiver or modification is first published unless the Secretary of HHS extends the waiver by notice for additional periods of up to 60 days, up to the end of the emergency period.
The Emergency Preparedness Rule requires that some providers have policies and procedures, which address the “role of the facility under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials.” This may include policies and procedures on what a facility would do if they had to provide care at an approved alternate site as well as processes on how would they let the community know they are operating at a different care site and any reporting they may need to do if they were under an approved 1135 Waiver.
Click HERE for 1135 Waivers: At a Glance
Click HERE for information on requesting an 1135 waiver.
Click HERE for information to provide for an 1135 waiver request.
In order to request a waiver of a Federal requirement not covered under the CMS blanket waivers, you must make the request on an individual basis. Those inquiries can be sent to the CMS mailbox at ROCHISC@cms.hhs.gov.
Any additional questions regarding Section 1135 waivers should be sent to the CMS national email box at: 1135waiver@cms.hhs.gov.
The Affordable Care Act requires CMS to collect electronic staffing data from nursing centers. The Act requires this data to be auditable and verifiable. The information is intended to collect direct care staff (employed and contracted), employee turnover and tenure, and must include census data and case mix. CMS developed the Payroll-Based Journal (PBJ) to collect this data. Details on the collection methodology and other policies related to staffing data submission can be found in the latest PBJ Policy Manual and FAQs can be found here.
In April 2018, CMS started to use PBJ data to determine each facility’s staffing rating used in the Nursing Home Five-Star Quality Rating System.
In April 2019, CMS announced changes to the staffing component of Five-Star. CMS will be adjusting the thresholds for overall staffing ratings, which will provide a greater emphasis on RN staffing. Additionally, CMS will give a one-star staffing rating to those facilities that report four or more days without an RN in a quarter. More information on these changes can be found in the Five-Star Technical User Guide.
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) established quality standards for all laboratory testing to ensure the accuracy, reliability and timeliness of patient test results regardless of where the test was performed. A laboratory is defined as any facility that performs laboratory testing on specimens derived from humans for the purpose of providing information for the diagnosis, prevention, treatment of disease, or impairment of, or assessment of health.
The Centers for Medicare & Medicaid Services (CMS) is charged with the implementation of CLIA, including laboratory registration, fee collection, certificate generation, surveys, surveyor guidelines development and training, enforcement, financial management and finally, approvals of proficiency testing providers, accrediting organizations and exempt states. The Food and Drug Administration is responsible for test categorization. The Centers for Disease Control and Prevention is responsible for the CLIA studies, convening the CLIA Committee and providing scientific and technical support to CMS.
Click HERE for the federal CLIA overview.
Click HERE for CLIA waived tests.
Click HERE for the CLIA waiver application.
Click HERE for the USFDA CLIA database.