Register

Fiscal Estimate

These are updating amendments to the Department's rules for reporting communicable diseases and taking action to control the spread of them.

The rule-making order adds several diseases to the list of reportable communicable diseases in an appendix of the rules, and deletes a few diseases from that list. The Department is authorized by s. 990.01 (5g), Stats., to add diseases to that list by rule. There is no fiscal impact of the rule changes because reporting mechanisms are already in place.

The rule-making order also:

1) Adds a general statement concerning the measures the Department or the local health officer can take to protect the public's health when a person is known to have or is suspected of having a communicable disease which poses a threat to others;

2) Makes updating changes related to reporting procedures, referenced documents and special disease control measures; and

3) Expands the rules relating to public health dispensaries established for the diagnosis and treatment of persons with tuberculosis (TB), by including criteria by which the Department will approve the operation of TB case finding preventive programs, stating that reimburseable dispensary services are the services specified in s. 252.10, Stats., and providing that reimbursement of public health dispensaries for services provided to clients who are not Medical Assistance recipients will be at the Medical Assistance program rate.

The Department is authorized under s. 252.10 (6) (b), Stats., to establish, by rule, reimbursement rates that are greater than the rates specified in that statute. Currently only Milwaukee County operates a public health dispensary for diagnosis and treatment of TB patients, but other counties are likely to establish dispensaries once the reimbursement rate changes to the Medical Assistance program rate.

There will be increased costs to the state associated with the promulgation of s. HFS 145.13, Reimbursement for Dispensary Services. That new section will raise the public health dispensary reimbursement rate for services to persons who are not Medical Assistance recipients from $6 per service ($12 when an X-ray is taken) to the Medical Assistance reimbursement rate. The Department in its 1999-2000 Biennial Budget Request requested an increase in appropriation s. 20.435 (4), Stats., to cover the increased expenditures that the rate increase is expected to generate. The net amount of increased expenditures is expected to be $107,700 GPR (General Purpose Revenue) in FY 00 (Fiscal Year 2000) and $88,800 GPR in FY 01 (Fiscal Year 2001).

Initial Regulatory Flexibility Analysis

These are changes to rules relating to reporting of specified communicable diseases to the Department and local health departments and to general powers of the Department and local health departments to control these diseases and the methods they are to employ in controlling these diseases. The rule changes will affect mainly the Department and local health officers but also physicians, advanced practice nurse prescribers, laboratories, health care facilities and school and day care center authorities, counties operating public health dispensaries for TB patients, and persons with a newly-reportable disease, with TB or persons who have or are suspected of having a contagious medical condition which poses a threat to other persons.

Some of the physicians and laboratories required under the revised rules to report cases and suspected cases of 12 communicable diseases and conditions being added to the list of reportable communicable diseases are small businesses as “small business" is defined in s. 227.114 (10) (a), Stats. They have been reporting cases and suspected cases of communicable diseases that have been on that list for many years, and the reporting system, including forms, is in place, so this additional reporting should not be burdensome and will not require new professional skills.

Notice of Hearing

Physical Therapists Affiliated Credentialing Board

Notice is hereby given that pursuant to authority vested in the Physical Therapists Affiliated Credentialing Board in ss. 15.085 (5) (b), 227.11 (2) and 448.40, Stats., and interpreting ss. 448.52 (2) and (3) and 448.54, Stats., the Physical Therapists Affiliated Credentialing Board will hold a public hearing at the time and place indicated below to consider an order to repeal repeal ss. PT 1.02 (5), 3.01 (5) and 4.01 (1) (d); to amend ss. PT 2.01 (8), ch. PT 5 (title), 5.01 (title) and (4); and to create ss. PT 1.02 (6), 2.01 (8) (a), (b) and (c) and 5.02, relating to the definition of physical therapy aide, the tests of English, written English and spoken English, general supervision of physical therapist assistants, and direct supervision of physical therapist assistants and physical therapy aides.

Hearing Information

May 4, 1999   1400 E. Washington Ave.

Tuesday   Room 180

9:30 a.m.   Madison, WI

Appearances at the Hearing

Interested persons are invited to present information at the hearing. Persons appearing may make an oral presentation but are urged to submit facts, opinions and argument in writing as well. Facts, opinions and argument may also be submitted in writing without a personal appearance by mail addressed to the Department of Regulation and Licensing, Office of Administrative Rules, P.O. Box 8935, Madison, Wisconsin 53708. Written comments must be received by May 18, 1999 to be included in the record of rule-making proceedings.

Analysis prepared by the Department of Regulation and Licensing

Statutes authorizing promulgation: ss. 15.085 (5) (b), 227.11 (2) and 448.40

Statutes interpreted: ss. 448.52 (2) and (3) and 448.54

The Physical Therapists Affiliated Credentialing Board promulgated rules of a housekeeping nature in May of 1998 and inadvertently left out the repeal of s. PT 4.01 (1) (d), which required a photograph to be submitted with applications for a locum tenens license. Photographs are no longer required to be submitted with applications as there are now other means of identification used, such as a driver's license or a picture ID. Also, requiring applicants to submit a photograph creates unnecessary administrative processing for staff.

The Physical Therapists Affiliated Credentialing Board is of the opinion that there needs to be a clarification regarding how many unlicensed persons can be supervised when a physical therapist is directly on-premises and when they are not. The amendment to Chapter PT 5, specifically to the creation of s. PT 5.02, provides what direct supervision by the physical therapist is as it relates to the physical therapist assistant and the physical therapy aide. In newly created s. PT 5.02 (10) it provides that the physical therapist assistants and physical therapy aides practicing under direct supervision may not exceed 5, and the total number of physical therapy aides practicing under direct supervision may not exceed 3.

A recent change in the Physical Therapy National Examination being given on a computerized basis required the board to promulgate rules regarding temporary licenses. In making those amendments in Clearinghouse Rule 96-052, which states that a temporary license cannot be renewed, is necessary as it conflicts with s. PT 3.01 (4), which says that a temporary license can be renewed for hardship reasons. Therefore, s. PT 3.01 (5) is repealed.

Rules are amended to require that applicants who have not graduated from a school of physical therapy whose primary language is not English take and pass three language proficiency examinations, which is the requirement the physical therapy schools now use. Therefore, the board amends its rule to conform to a standard requirement. Those examinations are the test of English as a foreign language (TOEFL), the test of written English (TWE), and the test of spoken English (TSE).

Text of Rule

SECTION 1. PT 1.02 (5) is repealed.

SECTION 2. PT 1.02 (6) is created to read:

PT 1.02 (6) “Physical therapy aide" means a person other than a physical therapist or physical therapist assistant who provides physical therapy services under the direct on-premises supervision of a physical therapist.

SECTION 3. PT 2.01 (8) is amended to read:

PT 2.01 (8) (intro.) Any applicant who is a graduate of a school in a program in physical therapy in which English is not the primary language of communication shall take and pass TOEFL each of the following in order to qualify for a license. :

SECTION 4. PT 2.01 (8) (a), (b) and (c) are created to read:

PT 2.01 (8) (a) The test of English as a foreign language (TOEFL) as administered by the educational testing service.

(b) The test of written English (TWE) as administered by the educational testing service.

(c) The test of spoken English (TSE) as administered by the educational testing service.

SECTION 5. PT 3.01 (5) is repealed.

SECTION 6. PT 4.01 (1) (d) is repealed.

SECTION 7. Chapter PT 5 (title), 5.01 (title) and (4) are amended to read:

Chapter PT 5

PHYSICAL THERAPIST ASSISTANTS

AND PHYSICAL THERAPY AIDES

PT 5.01 (title) General supervision of physical therapist assistants.

PT 5.01 (4) Limit the number of physical therapist assistants supervised practicing under general supervision to a number appropriate to the setting in which physical therapy is administered, to ensure that all patients under the care of the physical therapist receive services that are consistent with accepted standards of care and consistent with all other requirements under this chapter. No physical therapist may at any time supervise more than 2 physical therapist assistants full-time equivalents at any time practicing under general supervision.

SECTION 8. PT 5.02 is created to read:

PT 5.02 Direct supervision of physical therapist assistants and physical therapy aides. Physical therapist assistants and physical therapy aides may practice physical therapy under the direct on-premises supervision of a physical therapist. In providing direct supervision, the physical therapist shall do all of the following:

(1) Have primary responsibility for physical therapy care rendered by the physical therapist assistant or physical therapy aide.

(2) Be available at all times for consultation with the physical therapist assistant or physical therapy aide.

(3) Observe and monitor those under direct supervision on a daily basis.

(4) Evaluate the effectiveness of services provided by those under direct supervision on a daily basis by observing and monitoring persons receiving such services.

(5) Determine the competence of each physical therapist assistant and physical therapy aide based upon his or her education, training and experience.

(6) Provide interpretation of referrals and initial patient evaluation. The initial evaluation may utilize information that a physical therapist assistant or physical therapy aide has recorded, but must include direct observation and examination of the patient by the physical therapist.

(7) Delegate only those portions of an examination which are standardized objective measurements or standardized tests and which the physical therapist assistant or physical therapy aide has demonstrated competence to perform.

(8) Provide interpretation of objective tests, measurements and other data in developing and revising a physical therapy diagnosis, assessment, and treatment plan.

(9) Delegate appropriate portions of the treatment plan and program to the physical therapist assistant or physical therapy aide consistent with the education, training, and experience of the person supervised.

(10) Limit the number of physical therapist assistants and physical therapy aides practicing under direct supervision to a number appropriate to the setting in which physical therapy is administered, to ensure that all patients under the care of the physical therapist receive services that are consistent with accepted standards of care and consistent with all other requirements under this chapter. The total number of physical therapist assistants and physical therapy aides practicing under direct supervision may not exceed 5, and the total number of physical therapy aides practicing under direct supervision may not exceed 3.

Fiscal Estimate

1. The anticipated fiscal effect on the fiscal liability and revenues of any local unit of government of the proposed rule is: $0.00.

2. The projected anticipated state fiscal effect during the current biennium of the proposed rule is: $0.00

3. The projected net annualized fiscal impact on state funds of the proposed rule is: $0.00.

Initial Regulatory Flexibility Analysis

These proposed rules will be reviewed by the department through its Small Business Review Advisory Committee to determine whether there will be an economic impact on a substantial number of small businesses, as defined in s. 227.114 (1) (a), Stats.

Copies of Rule and Contact Person

Copies of this proposed rule are available without cost upon request to: Pamela Haack, Department of Regulation and Licensing, Office of Administrative Rules, 1400 East Washington Avenue, Room 171, P.O. Box 8935, Madison, Wisconsin 53708 [phone].

Notice of Hearings

Transportation

Notice is hereby given that pursuant to ss. 85.16(1), 85.22(3)(h) and 227.11(2), Stats., and interpreting s. 85.22, Stats., the Department of Transportation will hold public hearings at the following locations to consider the amendment of ch. Trans 2, Wisconsin Administrative Code, relating to elderly and disabled transportation capital assistance program.

Hearing Information

May 12, 1999   Hill Farms State

Wednesday   Transportation Bldg.

10:00 a.m.   4802 Sheboygan Ave.

  Room 144-B

  Madison, WI

May 13, 1999   State Patrol District 4

Thursday   2805 Martin Ave.

10:00 a.m.   Junction of Hwys. 51 & NN

  Upper Conference Room

  Wausau, WI