On April 3, 2020 the Wisconsin Department of Health Services (DHS) released DQA Memo 20-001, which establishes the process for hospitals and critical access hospitals (collectively, “hospitals”) to temporarily expand acute care inpatient services in order to maintain the health and safety of hospital patients during the COVID-19 public health emergency. This guidance is provided in conjunction with the blanket waivers recently issued under § 1135 of the Social Security Act by the Center for Medicare and Medicare (CMS). The CMS blanket waivers relieved certain regulatory burdens imposed on healthcare providers, such as the ability to expand inpatient beds to enable healthcare providers to focus on providing care during the current public health emergency.
In its guidance, DHS identified three options for hospitals to increase inpatient beds during the anticipated surge related to COVID-19, and the requirements hospitals must follow to implement such expansions:
Option One: Expansion/Addition Within Licensed Hospital Building
Option one allows hospitals to convert existing space within the hospital facility into a surge space by increasing the number of inpatient beds without requiring additional licensure. However, hospitals must submit notification to DHS regarding the hospital’s intention to increase inpatient beds and the anticipated number of beds.
DHS clarified that no additional Life Safety Code (LSC) inspection or survey will be required for this type of expansion. However, to the extent the expansion will not substantially comply with the applicable provisions of the LSC (NFPA 101, 2012 edition) or Wis. Admin. Code DHS 124, subch. V, hospitals should submit an interim life safety plan to DHS describing how the proposed expansion will safeguard patients, staff and others in accordance with the goals and objectives of the LSC.
Option Two: Expansion on the Campus of a Licensed Hospital, Separate or Detached Structure
This option is designed for hospitals with the intention of expanding the physical space of the facility or a separate and detached facility to accommodate additional inpatient beds. No additional licensure is required so long as the expansion is located on the same campus with the same physical address or otherwise on the contiguous property of the licensed hospital. However, similar to option one, the hospital must submit notification to DHS regarding the intent to increase inpatient beds, the anticipated number of additional beds, and information relating to the type of building or structure.
Under option two, the hospital is required to conduct an evaluation of LSC compliance, and as with option one, to the extent the contemplated expansion is not anticipated to substantially comply with the applicable LSC and related requirements, hospitals must submit an interim life safety plan to DHS detailing how the proposed expansion will safeguard patients, staff and others.
Option Three: Expansion in a Separate and Detached Structure, Not on the Campus of a Licensed Hospital
Finally, the third option provides flexibility to hospitals seeking to expand inpatient services by adding inpatient beds in a separate building that is not located on the campus of the licensed hospital. Under this option, an expedited licensure process has been implemented by DHS, which requires hospitals to submit F-62092 Hospital Certificate of Approval application with several modifications, as detailed in DQA Memo 20-001.
This option also requires hospitals to conduct an evaluation of LSC requirements. Consistent with options one and two, if the expansion will not substantially comply with the LSC and related requirements, the hospital must submit an interim life safety plan to DHS. Moreover, if any construction or alteration is necessary to accommodate a building to be temporarily licensed as a hospital, DHS directs hospitals to consult with DHS’ Office of Plan Review and Inspection and the local municipality.
DHS directs hospitals to submit notices regarding inpatient bed expansions via email to Thomas Rylander at Thomas.Rylander@wi.gov and Angela Mack at Angela.Mack@wi.gov. Further, notices regarding the LSC interim plans should be submitted to Henry Kosarzycki at Henry.Kosarzycki@wi.gov. Additional information regarding the permissibility and related requirements regarding these temporary expansion options is detailed in DQA Memo 20-001.