Wisconsin Administrative Code › Department of Health Services › DHS 110-199 - Health › Chapter DHS 127 - Rural Medical Centers › Subchapter I - General › Section DHS 127.03 - Licensure

Current through June 24, 2024
(1) License requirement. Only an entity that
				  is licensed as a rural medical center by the department may establish, conduct,
				  maintain, operate or permit to be maintained or operated, or represent and
				  advertise by any means that it operates or provides rural medical center health
				  care services.
(2) APPLICATION.
(a)
Initial license.
An
				  entity that meets the definition of rural medical center under s.
				  DHS
				  127.02(21) may apply to the
				  department for a license to operate as a rural medical center. Application
				  shall be made on a form prescribed by the department and shall include all of
				  the following information:
1. The name or
				  names and address or addresses of the applicant who shall be a natural person
				  or persons.
2. For all incorporated
				  applicants, the date and state of incorporation, a copy of the articles of
				  incorporation, tax status and, if an out-of-state corporation, evidence of
				  authority to do business in Wisconsin.
3. The location of the center's central
				  administrative offices, the location of the center's services and the locations
				  of any branches of those services.
4. The names, principal business addresses
				  and percentage of ownership interest of all officers, directors and
				  stockholders owning 10% or more of stock and of all board members, partners and
				  all other persons having authority or responsibility, directly or indirectly,
				  for the operation of the services provided by the center, including owners of
				  any business entity that owns any part of the land or buildings, and whether
				  the interest is in the profits, land or buildings.
5. The identities of all creditors and
				  lessors holding a security interest in the premises, whether land or
				  buildings.
6. The names and
				  addresses of persons serving on the center's board of directors.
7. In the case of a change in ownership,
				  disclosure of any direct or indirect relationship or connection between the
				  applicant and the prior manager, the prior owner and the manager of the rural
				  medical center, and between the new owner and the manager of the rural medical
				  center.
8. A detailed description
				  of the geographic area to be served by the rural medical center.
9. Descriptions of the number and types of
				  health care services to be provided by the rural medical center, and
				  identification of all contracted health care services and the providers of
				  those services, including the street address and distance of each provider from
				  the rural medical center building.
10. Proof of sufficient financial resources
				  to operate the center for at least 90 calendar days.
11. Any additional information requested by
				  the department during the department's review of the license application.
Note: For a copy of the rural medical center license
					 application form, write to the Division of Quality Assurance, P.O. Box 2969,
					 Madison, Wisconsin 53701-2969.