-- Use of the American College of Surgeons publication, Resources for Optimal Care of the Injured Patient: 1999, to evaluate the adequacy of hospitals' trauma care capabilities;
-- Policies guiding the development and use of Regional Trauma Advisory Councils for the purpose of developing, implementing and monitoring the trauma care system; and
-- Policies governing the establishment and operation of a statewide trauma registry; triage and transfer protocols among trauma care providers; and the promotion of improved trauma care provider performance.
Data collected from the state trauma registry on injury incidence, patient care and outcomes, specified in section
HFS 118.09, will help identify problems and evaluate the performance of the existing trauma care system. Through this information, communities will be able to assess the nature of traumatic injuries in Wisconsin and establish appropriate injury prevention programs to reduce the occurrence of injuries, expedite patients' recovery and minimize the lasting effects of injuries.
Effect on Small Business
This chapter will primarily affect Wisconsin hospitals, rural medical centers and ambulance service providers. Based on fiscal year 2002 data, three hospitals had annual revenues under $5 million. There are currently 456 ambulance service providers in Wisconsin. The Department does not have annual revenue data for ambulance service providers. However, the Department presumes that most, if not all, ambulance service providers have annual revenues under $5 million.
Under these proposed HFS 118 rules, the Department would require all ambulance service providers to affiliate and participate with a Regional Trauma Advisory Council (RTAC). The purpose of such affiliation is to participate in their region's trauma care system. The proposed rules require ambulance service providers to state their RTAC affiliation choice in the ambulance service provider's operational plan. Under chapter HFS 110, ambulance service providers already must submit operational plans to the Department. The Department collects operational plans to ensure the appropriate operation of ambulance services. There will be no additional cost to fulfill this obligation.
Fiscal Estimate
Section
146.56 of the statutes mandates a statewide trauma care system and requires the Department to promulgate rules to develop and implement the system. The statutes also require the Department to develop Regional Trauma Advisory Councils (RTACs). The rule requires hospitals to become affiliated with a Regional Trauma Advisory Council by December 31, 2004. There will be no fiscal effect as a result of this requirement.
Under this statute, hospitals are required to certify to the Department the classification level of trauma care services they provide. Trauma facilities are classified as Level I, II, III, or IV, depending on the comprehensiveness of the trauma care provided. Each hospital determines the level of trauma facility care for which it qualifies. If a hospital wishes to become a Level I or Level II trauma care facility, it must receive verification from the American College of Surgeons (ACS). Hospitals not seeking to obtain Level I or II trauma status need only do a self-report survey.
This rule requires hospitals to report the level of their trauma facilities to the Department. The rule does not require that hospitals attain a certain level of facility. Any costs that hospitals incur in becoming Level I or II facilities would be the result of the verification process, not the reporting requirement of the rule. There will, therefore, be no cost to hospitals as the result of this requirement.
The rule requires Emergency Medical Services (EMS) to become affiliated with an RTAC. There will be no cost to EMS providers for this affiliation.
The rule establishes policies governing the operation of a statewide trauma registry and the promotion of improved trauma provider performance. When the registry is operational, hospitals and EMS providers will be required to submit trauma data on a quarterly basis to the registry. The Department will use this data to improve trauma care.
It is likely that most agencies will collect trauma data for their own purposes. Hospitals with Level I and Level II trauma centers, for example, are required to collect trauma data as a condition of their verification. The requirements of this rule are not expected to result in significant additional cost for agencies that are already collecting this data. To the extent that hospitals and EMS providers will be required to gather data that has not previously been collected, this requirement may result in some costs to these agencies. It is not possible to estimate these costs, but they are not expected to be significant.
There are no new local government requirements.
The trauma system is implemented on a regional basis and requires Regional Trauma Advisory Councils for its implementation and evaluation. The RTACs and the trauma system will require long-term funding for its sustainability. Hospitals will need to reclassify themselves every three years, but the costs are the same as summarized above. The trauma system shall also require a state trauma registry in order to collect data for the evaluation of the system's effectiveness.
For More Information
A copy of the full text of the rule and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at
http://adminrules.wisconsin.gov. At this website, you can also register to receive email notification whenever the Department posts new information about this rulemaking. During he public comment period, you can submit comments on the rulemaking order and view comments that others have submitted about the rule.
A copy of the full text of the rule and the fiscal estimate may also be obtained by contacting the Department's representative listed below:
Marianne Peck RN, MSN
Bureau of Local Health Support and Emergency Medical Services
Division of Public Health
1 W. Wilson St., Room 118
Madison, WI 53702
608-266-0601
Notice of Hearings
Health and Family Services
Notice is hereby given that, pursuant to ss.
49.68 (2) (a) to
(c) and
(3),
49.683,
49.685 (8) (c) and
49.687 (1),
(1m),
(2) and
(2m), Stats., and interpreting ss.
49.68,
49.683,
49.685 and
49.687, Stats., the Department of Health and Family Services will hold public hearings to consider the proposed permanent rules amending ss.
HFS 152.065 (2) and
(6) 153.07 (2) and
(4), and
154.07 (2) and
(4); and creating ss.
HFS 152.02 (2m) and
(26m),
152.03 (1) (e),
152.035,
152.06 (3) (g) and
(h),
152.065 (2) (f) to
(h),
153.02 (1m),
(11g),
(11r) and
(18),
153.03 (5),
153.035,
153.037,
153.06 (3) (g),
153.07 (2) (f) to
(h),
154.02 (1m) and
(17),
154.03 (5),
154.035,
154.037,
154.06 (3) (g) and
154.07 (2) (f) to
(h), relating to the provision and reimbursement of services under the Wisconsin Chronic Disease Program.
Hearing Information
The public hearings will be held:
Date & Time Location
July 19, 2004 Conference Room #1
Monday Portage County Courthouse Annex
10:00 a.m. to Noon 1462 Strongs Ave.
Stevens Point, WI
July 20, 2004 Room 151
Tuesday State Office Building
10:00 AM to Noon 141 NW Barstow
Waukesha, WI
The hearing sites are fully accessible to people with disabilities. If you are hearing or visually impaired, do not speak English, or have circumstances that might make communication at a hearing difficult and if you, therefore, require an interpreter or a non-English, large print or taped version of the hearing document, contact the person at the address or phone number given above at least 10 days before the hearing. With less than 10 days notice, an interpreter may not be available.
Written comments may be submitted at the public hearing or in lieu of attending a public hearing, written comments can be submitted by regular mail or email to the contact person listed below. Written comments may also be submitted to the Department using the Wisconsin Administrative Rules Internet website at the web address listed below.
Deadline for Comment Submission
The deadline for submitting comments is 4:30 p.m., on July 26, 2004.
Analysis Prepared by the Department of Health and Family Services
Using a legislative appropriation, the Wisconsin Chronic Disease Program (WCDP) reimburses health care providers for disease-related services provided to individuals with one of the following three illnesses: chronic renal disease; hemophilia; and cystic fibrosis. Because the benefit program requirements associated with each illness vary, the Department has established three individual chapters of administrative rules to administer the WCDP benefit program: chapters HFS 152 (chronic renal disease); 153 (hemophilia); and 154 (cystic fibrosis.) In the most recent biennial budget,
2003 Wisconsin Act 33, the Wisconsin Legislature and the Governor made a number of changes to the statutes that authorize the WCDP. These statutory changes require the Department to modify the three chapters of administrative rule so that they are once again consistent with and responsive to the statutes under which the WCDP benefit program operates.
Act 33 made several changes to the benefit programs, all of which are designed to allow the Department to contain the programs' costs:
1. It expanded the requirement that program beneficiaries must apply for other benefits provided under other health care coverage programs they may be eligible for before receiving benefits under WCDP, and authorized the Department to specify in rules what those other health care coverage programs are.
2. It instituted a statutorily-required prescription drug co-payment requirement for all 3 programs. The co-payment amount is $7.50 for each generic drug and $15 for each brand name drug. These amounts are currently $5 and $10, respectively, in chs.
HFS 152,
153 and
154.
3. It established the requirement that persons whose family income is at or above 200% of the poverty line must pay a portion of their family income towards their care before the Department pays any benefits. The proportion a person must pay increases with the increase in family income.
4. It authorizes the Department to adopt managed care methods of cost containment for each of the three programs.
5. Under the chronic renal disease program, it requires health care providers to accept the Department's payment to them as payment in full, and prohibited providers from billing patients for charges above the amount paid by the Department.
A separate piece of legislation,
2003 Wisconsin Act 198, authorized the Department to waive the requirement that persons must apply for other health care coverage programs before applying for benefits under the financial assistance program for persons with hemophilia and other related congenital bleeding disorders.
Through this rulemaking order, the Department is proposing to reflect in chs.
HFS 152,
153 and
154 these changes made by Acts 33 and 198 to the WCDP. Finally, the proposed rulemaking order clarifies that eligibility for benefits terminates under certain circumstances, such as death of the patient, and clarifies the limited circumstances under which retroactive eligibility is available under the chronic renal disease program.
Effect on Small Business (Initial Regulatory Flexibility Analysis)
The three chronic disease programs provide health care benefits to individuals. This rulemaking order does not have any foreseeable impact on small businesses.
Fiscal Estimate
This administrative rule revision implements changes in the biennial budget bill,
2003 Wisconsin Act 33. Provisions in Act 33 increased drug co-payments and the income deductibles which patients are required to pay before becoming eligible for WCDP. Act 33 also required individuals applying for the program to apply first to other health insurance programs for which they might be eligible and required to Department to use managed care methods for cost containment in the WCDP. Act 33 assumed savings in WCDP as the result of these provisions. There should be no additional fiscal effect as the result of this rule.
For More Information
A copy of the full text of the rules and the full text of the fiscal estimate, and other documents associated with this rulemaking may be obtained, at no charge, from the Wisconsin Administrative Rules website at
http://adminrules.wisconsin.gov. At this website you can also register to receive email notification whenever the Department posts new information about this rulemaking and, during the public comment period, you can submit comments on the rulemaking order electronically and view comments that others have submitted about the rule.
A copy of the full text of the rule and the fiscal estimate may also be obtained by contacting the Department's representative listed below:
Alfred Matano
Division of Health Care Financing, Bureau of Fee-for-Service Health Care Benefits
P.O. Box 309, Room 350
Madison, WI 53701-0309
(608) 267-6848 or, if you are hearing impaired, (608) 266-1511 (TTY)
Notice of Hearings
Natural Resources
(Fish, Game, etc., Chs.
NR 1—)
NOTICE IS HEREBY GIVEN that pursuant to ss.
29.014,
29.041 and
29.197, Stats., interpreting ss.
29.014,
29.041 and
29.197, Stats., the Department of Natural Resources will hold public hearings on revisions to ch.
NR 10, Wis. Adm. Code, relating to the 2004 migratory game bird season. Under international treaty and federal law, migratory game bird seasons are closed unless opened annually via the U.S. Fish and Wildlife Service regulations process. Actual season lengths, dates and harvest allocations will change based on the federal framework regulations. The Department anticipates the regulations to include:
Ducks – The state is divided into two zones, each with 60-day seasons. The zones are subject to change based on public feedback and approval by the U.S. Fish and Wildlife Service. Under current U.S. FWS rules, a zone change is not allowed until 2006. The daily bag limit is expected to be 6 ducks including no more than 4 mallards, of which only one may be a hen, one black duck, one pintail, 2 wood ducks, 2 redheads and 3 scaup. The canvasback and pintail seasons may again be shorted than the 60-day season.
Canada geese – The state is apportioned into three goose hunting zones: Horicon, Collins and Exterior. Other special goose management subzones within the Exterior Zone include Brown County, Burnett County, Rock Prairie and the Mississippi River. Season length are expected to be as follows: Collins Zone – 67 days; Horicon Zone – 95 days; Exterior Zone – 95 days; and Mississippi River Subzone – 70 days.
Youth hunt – The Canada goose bag limit is established for the youth waterfowl hunt and two days will be offered.
NOTICE IS HEREBY FURTHER GIVEN that pursuant to s.
227.114, Stats., it is not anticipated that the proposed rule will have an economic impact on small businesses.
NOTICE IS HEREBY FURTHER GIVEN that the Department has made a preliminary determination that this action does not involve significant adverse environmental effects and does not need an environmental analysis under ch.
NR 150, Wis. Adm. Code. However, based on the comments received, the Department may prepare an environmental analysis before proceeding with the proposal. This environmental review document would summarize the Department's consideration of the impacts of the proposal and reasonable alternatives.
NOTICE IS HEREBY FURTHER GIVEN that the hearings will be held on:
August 2, 2004 Basement Auditorium, Admin. Ctr.
Monday at 7:00 p.m. 400 4th Street North
La Crosse
August 3, 2004 University of Wisconsin
Tuesday at 7:00 p.m. Experimental Farm
