1. (1) Eligibility. Except as provided under sub. (2) (a), to be eligible for designation as a critical access hospital, a hospital shall be all of the following:

   1. (a) A hospital approved by the department under this chapter to operate as a hospital.
   2. (b) Located in an area outside of a metropolitan statistical area as defined in 42 USC 1395ww(d), or located in a rural area of an urban county.
   3. (c) Located more than a 35-mile drive from another hospital or certified by the department under sub. (2) as a necessary provider of health care services to residents in the area.
   4. (d) A hospital that has a provider agreement to participate in medicare in accordance with 42 CFR 485.612.
   5. (e) A hospital that has not been designated by the federal centers for medicare and medicaid services as an urban hospital for purposes of medicare reimbursement.

2. (2) Application for certification as a necessary provider for an area.

   1. (a)

      1. 1. A hospital meeting the criteria under sub. (1) (a), (b), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if it cannot meet the criterion under sub. (1) (c) that it be located more than a 35-mile drive from another hospital.
      2. 2. A rural hospital meeting the criteria under sub. (1) (a), (d) and (e) may apply to the department for certification as a necessary provider of health care services to residents in its area if the rural hospital cannot meet the criteria under sub. (1) (b) and (c).

      3. 3. Application under subd. 1. or 2. shall be made in accordance with a format provided by the department.

         Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; (608) 266-7297.

   2. (b) Upon receipt of a completed application from a hospital for certification as a necessary provider of health care services to residents in the area, the department shall review the application and shall approve or disapprove it within 60 days of receipt.

3. (3) Application for critical access hospital status.

   1. (a) A hospital eligible under sub. (1) or (2) (a) for designation as a critical access hospital may apply to the department for designation. Application shall be made in accordance with a format provided by the department.

      Note: To obtain the format for the application, write or phone: Division of Quality Assurance, P.O. Box 2969, Madison, WI 53701-2969; (608) 266-7297.

   2. (b) Upon receipt of a completed application from a hospital for designation as a critical access hospital, the department shall review the application and shall determine if the applicant meets the federal conditions of participation in medicare for critical access hospitals under 42 CFR 485.601 to 485.645, and, if applicable, 42 CFR 412.103(a)(1). If the applicant hospital meets those federal regulations and all requirements under s. DHS 124.41, the department shall, within 90 days after receipt of a completed application, recommend certification of the hospital as a critical access hospital to the federal centers for medicare and medicaid services.

      Note: The federal Centers for Medicare and Medicaid Services will notify the Department and the applicant hospital of the certification decision.

   3. (c) Following notification by the federal centers for medicare and medicaid services that it has accepted the department’s certification recommendation, the department shall issue a certificate of approval that establishes the applicant’s critical access hospital status in the state.

History

History: Emerg. cr. eff. 9-12-98; cr. Register, January, 1999, No. 517, eff. 2-1-99; emerg. am. (1) (intro.) and (e), (2) (a) and (3), eff. 3-21-03; CR 03-042: am. (1) (intro.), (a), (b), (e), (2) (a) and (3) Register September 2003 No. 573, eff. 10-1-03; CR 23-046: am. (3) (b) Register April 2024 No. 820, eff. 5-1-24; correction in (3) (b) made under s. 35.17, Stats., Register January 2025 No. 829.